Body mass index, waist circumference, waist-to-hip ratio, and body fat in relation to health care use in the Canadian Longitudinal Study on Aging.
Journal
International journal of obesity (2005)
ISSN: 1476-5497
Titre abrégé: Int J Obes (Lond)
Pays: England
ID NLM: 101256108
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
06
07
2020
accepted:
09
12
2020
revised:
21
10
2020
pubmed:
13
1
2021
medline:
27
1
2022
entrez:
12
1
2021
Statut:
ppublish
Résumé
Obesity is associated with increased health care use (HCU), but it is unclear whether this is consistent across all measures of adiposity. The objectives were to compare obesity defined by body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and percent body fat (%BF), and to estimate their associations with HCU. Baseline data from 30,092 participants aged 45-85 years from the Canadian Longitudinal Study on Aging were included. Measures of adiposity were recorded by trained staff and obesity was defined as BMI ≥ 30.0 kg/m Obesity prevalence varied by measure: BMI (29%), WC (42%), WHR (62%), and %BF (73%). BMI and WC were highly correlated with %BF (r ≥ 0.70), while WHR demonstrated a weaker relationship with %BF, with differences by sex (r = 0.29 and r = 0.46 in females and males, respectively). There were significantly increased RR and RD for all measures and health care services, for example, WC-defined obesity was associated with an increased risk of hospitalization (RR: 1.40, 95% CI: 1.28-1.54 and RD per 100: 2.6, 95% CI:1.9-3.3). Age-stratified results revealed that older adult groups with obesity demonstrated weak or no associations with HCU. All measures of adiposity were positively associated with increased HCU although obesity may not be a strong predictor of HCU in older adults.
Sections du résumé
BACKGROUND/OBJECTIVES
Obesity is associated with increased health care use (HCU), but it is unclear whether this is consistent across all measures of adiposity. The objectives were to compare obesity defined by body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and percent body fat (%BF), and to estimate their associations with HCU.
SUBJECTS/METHODS
Baseline data from 30,092 participants aged 45-85 years from the Canadian Longitudinal Study on Aging were included. Measures of adiposity were recorded by trained staff and obesity was defined as BMI ≥ 30.0 kg/m
RESULTS
Obesity prevalence varied by measure: BMI (29%), WC (42%), WHR (62%), and %BF (73%). BMI and WC were highly correlated with %BF (r ≥ 0.70), while WHR demonstrated a weaker relationship with %BF, with differences by sex (r = 0.29 and r = 0.46 in females and males, respectively). There were significantly increased RR and RD for all measures and health care services, for example, WC-defined obesity was associated with an increased risk of hospitalization (RR: 1.40, 95% CI: 1.28-1.54 and RD per 100: 2.6, 95% CI:1.9-3.3). Age-stratified results revealed that older adult groups with obesity demonstrated weak or no associations with HCU.
CONCLUSIONS
All measures of adiposity were positively associated with increased HCU although obesity may not be a strong predictor of HCU in older adults.
Identifiants
pubmed: 33432110
doi: 10.1038/s41366-020-00731-z
pii: 10.1038/s41366-020-00731-z
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
666-676Subventions
Organisme : CIHR
ID : LSA 94473
Pays : Canada
Références
Finucane MM, Stevens GA, Cowan M, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377:557–67.
pubmed: 21295846
pmcid: 4472365
doi: 10.1016/S0140-6736(10)62037-5
Dixon JB. The effect of obesity on health outcomes. Mol Cell Endocrinol. 2010;316:104–8.
pubmed: 19628019
doi: 10.1016/j.mce.2009.07.008
WHO. Obesity: preventing and managing the global epidemic: report of a WHO consultation [Internet]. Report No.: 984. WHO; 2000. p. 1–253. http://www.who.int/entity/nutrition/publications/obesity/WHO_TRS_894/en/index.html
Health Canada. Canadian guidelines for body weight classification in adults [Internet]. Ottawa: Health Canada; 2003. Report No.: H49-179/2003E. https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/healthy-weights/canadian-guidelines-body-weight-classification-adults.html
Lau DCW, Douketis JD, Morrison KM, Hramiak IM, Sharma AM, Ur E, et al. 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children. Can Med Assoc J. 2007;176:S1–13.
doi: 10.1503/cmaj.061409
Zamboni M, Mazzali G, Zoico E, Harris TB, Meigs JB, Di Francesco V, et al. Health consequences of obesity in the elderly: a review of four unresolved questions. Int J Obes. 2005;29:1011–29.
doi: 10.1038/sj.ijo.0803005
World Health Organization. Waist circumference and waist-hip ratio: report of a WHO expert consultation. Geneva: World Health Organization; 2011.
Ahn S, Smith ML, Dickerson JB, Ory MG. Health and health care utilization among obese and diabetic baby boomers and older adults. Am J Health Promot. 2012;27:123–32.
pubmed: 23113783
doi: 10.4278/ajhp.111013-QUAN-366
Andreyeva T, Sturm R, Ringel JS. Moderate and severe obesity have large differences in health care costs. Obes Res. 2004;12:1936–43.
pubmed: 15687394
doi: 10.1038/oby.2004.243
Bertakis KD, Azari R. Obesity and the use of health care services. Obes Res. 2005;13:372–9.
pubmed: 15800296
doi: 10.1038/oby.2005.49
Chen Y, Jiang Y, Mao Y. Hospital admissions associated with body mass index in Canadian adults. International J Obes. 2007;31:962–7.
doi: 10.1038/sj.ijo.0803530
Lengerke T, von, Happich M, Reitmeir P, John J, Kora Study Group. Utilization of out- and inpatient health services by obese adults: a population-based study in the Augsburg Region, Germany. Gesundheitswesen. 2005;67:150–7.
doi: 10.1055/s-2005-858510
León‐Muñoz LM, Guallar‐Castillón P, García EL, Banegas JR, Gutiérrez‐Fisac JL, Rodríguez‐Artalejo F. Relationship of BMI, waist circumference, and weight change with use of health services by older adults. Obes Res. 2005;13:1398–404.
pubmed: 16129722
doi: 10.1038/oby.2005.169
Luchsinger JA, Lee W, Carrasquillo O, Rabinowitz D, Shea S. Body mass index and hospitalization in the elderly. J Am Geriatr Soc. 2003;51:1615–20.
pubmed: 14687392
doi: 10.1046/j.1532-5415.2003.51513.x
Musich S, MacLeod S, Bhattarai GR, Wang SS, Hawkins K, Bottone FG, et al. The impact of obesity on health care utilization and expenditures in a medicare supplement population. Gerontol Geriatr Med. 2016;2:1–9.
Nigatu YT, Bültmann U, Schoevers RA, Penninx BWJH, Reijneveld SA. Does obesity along with major depression or anxiety lead to higher use of health care and costs? A 6-year follow-up study. Eur J Public Health. 2017;27:965–71.
pubmed: 29020407
doi: 10.1093/eurpub/ckx126
Quesenberry CP, Caan B, Jacobson A. Obesity, health services use, and health care costs among members of a health maintenance organization. Arch Intern Med. 1998;158:466–72.
pubmed: 9508224
doi: 10.1001/archinte.158.5.466
Raebel MA, Malone DC, Conner DA, Xu S, Porter JA, Lanty FA. Health services use and health care costs of obese and nonobese individuals. Arch Intern Med. 2004;164:2135–40.
pubmed: 15505127
doi: 10.1001/archinte.164.19.2135
Suehs BT, Kamble P, Huang J, Hammer M, Bouchard J, Costantino ME, et al. Association of obesity with healthcare utilization and costs in a Medicare population. Curr Med Res Opin. 2017;33:2173–80.
pubmed: 28760001
doi: 10.1080/03007995.2017.1361915
Trakas K, Lawrence K, Bs M, Shear NH. Utilization of health care resources by obese Canadians. CMAJ. 1999;160:6.
Twells LK, Knight J, Alaghehbandan R. The relationship among body mass index, subjective reporting of chronic disease, and the use of health care services in Newfoundland and Labrador, Canada. Popul Health Manag. 2010;13:47–53.
pubmed: 20158323
doi: 10.1089/pop.2009.0023
Twells LK, Bridger T, Knight JC, Alaghehbandan R, Barrett B. Obesity predicts primary health care visits: a cohort study. Popul Health Manag. 2012;15:29–36.
pubmed: 22088164
doi: 10.1089/pop.2010.0081
Vals K, Kiivet R-A, Leinsalu M. Alcohol consumption, smoking and overweight as a burden for health care services utilization: a cross-sectional study in Estonia. BMC Public Health. 2013;13:772.
pubmed: 23968192
pmcid: 3765337
doi: 10.1186/1471-2458-13-772
Wildenschild C, Kjøller M, Sabroe S, Erlandsen M, Heitmann BL. Change in the prevalence of obesity and use of health care in Denmark: an observational study. Clin Epidemiol. 2011;3:31–41.
pubmed: 21326657
pmcid: 3035604
doi: 10.2147/CLEP.S15230
Wolfenstetter SB, Menn P, Holle R, Mielck A, Meisinger C, von Lengerke T. Body weight changes and outpatient medical care utilisation: results of the MONICA/KORA cohorts S3/F3 and S4/F4. Psychosoc Med. 2012;9:1–14.
Wong JJ, Hood KK, Breland JY. Correlates of health care use among White and minority men and women with diabetes: an NHANES study. Diabetes Res Clin Pract. 2019;150:122–8.
pubmed: 30844470
doi: 10.1016/j.diabres.2019.03.001
Gorber SC, Tremblay M, Moher D, Gorber B. A comparison of direct vs. self-report measures for assessing height, weight and body mass index: a systematic review. Obes Rev. 2007;8:307–26.
pubmed: 17578381
doi: 10.1111/j.1467-789X.2007.00347.x
Akhtar-Danesh N, Dehghan M, Merchant AT, Rainey JA. Validity of self-reported height and weight for measuring prevalence of obesity. Open Med. 2008;2:e83–8.
pubmed: 21602953
pmcid: 3091607
Elgar FJ, Stewart JM. Validity of self-report screening for overweight and obesity. Can J Public Health. 2008;99:423–7.
pubmed: 19009930
pmcid: 6975656
doi: 10.1007/BF03405254
World Health Organization. Ageing and health. 2020. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
Raina P, Wolfson C, Kirkland S, Griffith LE, Balion C, Cossette B. et al. Cohort profile: The Canadian Longitudinal Study on Aging (CLSA). Int J Epidemiol. 2019;48:1752–3j.
pubmed: 31633757
pmcid: 6929533
doi: 10.1093/ije/dyz173
Canadian longitudinal study on aging. Standard operating procedure (SOP): standing height and weight measurement. 2016. https://www.clsa-elcv.ca/doc/1112
Canadian longitudinal study on aging. Standard operating procedure (SOP): hip and waist circumferences. 2016. https://www.clsa-elcv.ca/doc/1037
Canadian longitudinal study on aging. Standard operating procedure (SOP): bone mineral density by dual-energy X-ray absorption (DXA)—whole body scan. 2014. https://www.clsa-elcv.ca/doc/526
Ho-Pham LT, Campbell LV, Nguyen TV. More on body fat cutoff points. Mayo Clin Proc. 2011;86:584.
pubmed: 21628621
pmcid: 3104919
doi: 10.4065/mcp.2011.0097
World Health Organization. Physical status: the use of and interpretation of anthropometry, Report of a WHO Expert Committee. World Health Organization. 1995. https://apps.who.int/iris/handle/10665/37003
Batsis JA, Mackenzie TA, Bartels SJ, Sahakyan KR, Somers VK, Lopez-Jimenez F. Diagnostic accuracy of body mass index to identify obesity in older adults: NHANES 1999–2004. Int J Obes. 2016;40:761–7.
doi: 10.1038/ijo.2015.243
Elagizi A, Kachur S, Lavie CJ, Carbone S, Pandey A, Ortega FB, et al. An overview and update on obesity and the obesity paradox in cardiovascular diseases. Progr Cardiovasc Dis. 2018;61:142–50.
doi: 10.1016/j.pcad.2018.07.003
Dickey RA, Bartuska D, Bray GW, Callaway CW, Davidson ET, Feld S. AACE/ACE position statement on the prevention, diagnosis, and treatment of obesity (1998 revision). Endocr Pract. 1998;4:297–350.
Canadian longitudinal study on aging. Maintaining contact questionnaire (tracing and comprehensive). 2015. https://clsa-elcv.ca/doc/540
Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36:1–10.
doi: 10.2307/2137284
Canadian longitudinal study on aging. Derived variable—alcohol use (ALC) (tracking and comprehensive assessments). 2017. https://www.clsa-elcv.ca/doc/2267
Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med. 1994;10:77–84.
pubmed: 8037935
doi: 10.1016/S0749-3797(18)30622-6
Tjepkema M. Measured obesity adult obesity in Canada: measured height and weight. 2005. p. 32.
Naimi AI, Whitcomb BW. Estimating risk ratios and risk differences using regression. Am J Epidemiol. 2020;189:508–10.
pubmed: 32219364
doi: 10.1093/aje/kwaa044
Banack HR, Wactawski-Wende J, Hovey KM, Stokes A. Is BMI a valid measure of obesity in post-menopausal women?. Menopause.2018;25:307–13.
pubmed: 29135897
pmcid: 5821529
doi: 10.1097/GME.0000000000000989
Padwal R, Leslie WD, Lix LM, Majumdar SR. Relationship among body fat percentage, body mass index, and all-cause mortality: a cohort study. Ann Intern Med. 2016;164:532.
pubmed: 26954388
doi: 10.7326/M15-1181
Blew RM, Sardinha LB, Milliken LA, Teixeira PJ, Going SB, Ferreira DL, et al. Assessing the validity of body mass index standards in early postmenopausal women. Obes Res. 2002;10:799–808.
pubmed: 12181389
doi: 10.1038/oby.2002.108
Silva BR, Mialich MS, Hoffman DJ, Jordão AA. BMI, BMIfat, BAI or BAIFels—which is the best adiposity index for the detection of excess weight?. Nutr Hosp. 2017;34:389–95.
pubmed: 28421795
doi: 10.20960/nh.366
Chen Y-M, Ho SC, Lam SSH, Chan SSG. Validity of body mass index and waist circumference in the classification of obesity as compared to percent body fat in Chinese middle-aged women. Int J Obes. 2006;30:918–25.
doi: 10.1038/sj.ijo.0803220
Flegal KM, Shepherd JA, Looker AC, Graubard BI, Borrud LG, Ogden CL, et al. Comparisons of percentage body fat, body mass index, waist circumference, and waist-stature ratio in adults123. Am J Clin Nutr. 2009;89:500–8.
pubmed: 19116329
doi: 10.3945/ajcn.2008.26847
Ehrampoush E, Arasteh P, Homayounfar R, Cheraghpour M, Alipour M, Naghizadeh MM, et al. New anthropometric indices or old ones: which is the better predictor of body fat? Diabetes Metab Syndr: Clin Res Rev. 2017;11:257–63.
doi: 10.1016/j.dsx.2016.08.027
Ospina PA, Nydam DV, DiCiccio TJ. Technical note: the risk ratio, an alternative to the odds ratio for estimating the association between multiple risk factors and a dichotomous outcome. J Dairy Sci. 2012;95:2576–84.
pubmed: 22541486
doi: 10.3168/jds.2011-4515
Newbold B. Health status and health care of immigrants in Canada: a longitudinal analysis. J Health Serv Res Policy. 2005;10:77–83A.
pubmed: 15831190
doi: 10.1258/1355819053559074
Zarychanski R, Chen Y, Bernstein CN, Hébert PC. Frequency of colorectal cancer screening and the impact of family physicians on screening behaviour. CMAJ. 2007;177:593–7.
pubmed: 17846441
pmcid: 1963385
doi: 10.1503/cmaj.070558
Short ME, Goetzel RZ, Pei X, Tabrizi MJ, Ozminkowski RJ, Gibson TB, et al. How accurate are self-reports? An analysis of self-reported healthcare utilization and absence when compared to administrative data. J Occup Environ Med. 2009;51:786–96.
pubmed: 19528832
pmcid: 2745402
doi: 10.1097/JOM.0b013e3181a86671
Raina P, Torrance-Rynard V, Wong M, Woodward C. Agreement between self-reported and routinely collected health-care utilization data among seniors. Health Serv Res. 2002;37:751–74.
pubmed: 12132604
pmcid: 1434660
doi: 10.1111/1475-6773.00047
Bhandari A, Wagner T. Self-reported utilization of health care services: improving measurement and accuracy. Med Care Res Rev. 2006;63:217–35.
pubmed: 16595412
doi: 10.1177/1077558705285298
Stranges S, Dorn JM, Muti P, Freudenheim JL, Farinaro E, Russell M, et al. Body fat distribution, relative weight, and liver enzyme levels: a population-based study. Hepatology. 2004;39:754–63.
pubmed: 14999694
doi: 10.1002/hep.20149
Woolcott OO, Bergman RN. Defining cutoffs to diagnose obesity using the relative fat mass (RFM): association with mortality in NHANES 1999–2014. Int J Obes. 2020;44:1301–10.
doi: 10.1038/s41366-019-0516-8