Obesity, smoking habits, and serum phosphate levels predicts mortality after life-style intervention

English version

Autoři: Lena Håglin ^aff001; Birgitta Törnkvist ^aff001; Lennart Bäckman ^aff001
Působiště autorů: Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden ^aff001
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0227692

Souhrn

Background

Life-style interventions, including smoking cessation and weight control are of importance for managing future escalating prevalence of obesity. Smoking habits and obesity have jointly great impact on mortality, however mechanisms behind the effect and variables involved in the obesity paradox is still unknown.

Objectives

This study examines risk factors for all-cause, cardiovascular, and cancer mortality in males and females with high cardiovascular risk, mediated by smoking habits, body mass index (BMI, kg/m²), and serum phosphate (S-P) levels.

Methods

Patients were admitted to the Vindeln Patient Education Center in groups of 30 for a four-week residential comprehensive program (114 hours) focusing on smoking cessation, stress reduction, food preferences and selections, and physical exercise. The follow-up, in years from 1984 to 2014 corresponds to 30 years. This study included 2,504 patients (1,408 females and 1,096 males). Cox regression analysis was used to assess mortality risk associated with smoking habits, low and high BMI, and low and high S-P levels.

Results

High BMI (>34,2 kg/m²), current smoking, type 2 diabetes mellitus (T2DM), high serum calcium (S-Ca), mmol/L and high systolic blood pressure (SBP, mmHg) were associated with all-cause mortality irrespective of sex. Former and current smoking females had a high all-cause mortality (adjusted hazard ratio [HR] 1.581; 95% CI 1.108–2.256, adjusted hazard ratio [HR] 1.935; 95% CI 1.461–2.562, respectively) while current smoking and high BMI increased risk for cardiovascular mortality (adjusted hazard ratio [HR] 3.505; 95% CI 2.140–5.740 and [HR] 1.536; 95% CI 1.058–2.231, respectively). Neither low nor high levels of S-P predicted all-cause, cardiovascular disease (CVD) and cancer mortality in males or females while low levels of S-P predicted all-cause mortality in smokers (adjusted hazard ratio [HR] 1.713; 95% CI 1.211–2.424). In non-smokers, low BMI (<27.6 kg/m²) was protecting and high BMI a risk for all-cause mortality. In males, ischemic heart disease (IHD), and low serum albumin (S-Alb) were associated with all-cause mortality. In females, an interaction between high BMI and smoking (HbmiSM) decreased the cardiovascular mortality (adjusted hazard ratio [HR] 0.410; 95% CI 0.179–0.937, respectively).

Conclusions

High BMI and current smoking were associated with all-cause mortality in both males and females in the present high cardiovascular-risk cohort. In current smokers and non-smokers, T2DM and high S-Ca were associated with an increase in all-cause mortality, while low S-P was associated with all-cause mortality in smokers. Interaction between high BMI and smoking contribute to the obesity paradox by being protective for cardiovascular mortality in females.

Klíčová slova:

Body Mass Index – Cardiovascular diseases – Death rates – Medical risk factors – Obesity – Phosphates – Smoking habits – Type 2 diabetes

Zdroje

1. Koster A, Leitzmann MF, Schatzkin A, Adams KF, van Eijk JT, Hollenbeck AR, et al. The combined relations of adiposity and smoking on mortality. Am J Clin Nutr. 2008 Nov;88(5):1206–12. doi: 10.3945/ajcn.2008.26298 18996854

2. Borrell LN. The effects of smoking and physical inactivity on advancing mortality in U.S. adults. Ann Epidemiol. 2014b/ Jun;24(6):484–7. doi: 10.1016/j.annepidem.2014.02.016 Epub 2014 Mar 21. 24842763

3. Cao B. Future healthy life expectancy among older adults in the US: a forecast based on cohort smoking and obesity history. Popul Health Metr. 2016 Jul 12;14:23. doi: 10.1186/s12963-016-0092-2 eCollection 2016. 27408607

4. Ma J, Jemal A, Flanders WD, Ward EM. Joint association of adiposity and smoking with mortality among U.S. adults. Prev Med. 2013 Mar;56(3–4):178–84. doi: 10.1016/j.ypmed.2012.12.012 Epub 2012 dec 28. 23276778

5. Siahpush M, Singh GK, Tibbits M, Pinard CA, Shaikh RA, Yaroch A. It is better to be a fat ex-smoker than a thin smoker: findings from the 1997–2004 National Health Interview Survey-National Death Index linkage study. Tob Control. 2014 Sep;23(5):395–402. doi: 10.1136/tobaccocontrol-2012-050912 Epub 2013 Apr 10. 23574644

6. Badrick E, Sperrin M, Buchan IE, Renehan AG. Obesity paradox and mortality in adults with and without incident type 2 diabetes: a matched population-level cohort study. BMJ Open Diabetes Res Care. 2017 Mar 10;5(1): e000369. doi: 10.1136/bmjdrc-2016-000369 eCollection 2017. 28321314

7. Borrell LN, Samuel L. Body mass index categories and mortality risk in US adults: the effect of overweight and obesity on advancing death. Am J Public Health. 2014a/ Mar;104(3):512–9. doi: 10.2105/AJPH.2013.301597 Epub 2014 Jan 16. 24432921

8. Nikolakaros G, Vahlberg T, Auranen K, Sillanmäki L, Venetoklis T, Sourander A. Obesity, Underweight, and Smoking Are Associated with Worse Cardiorespiratory Fitness in Finnish Healthy Young Men: A Population-Based Study. Front Public Health. 2017 Aug 18;5:206. doi: 10.3389/fpubh.2017.00206 eCollection 2017. 28868273

9. Kim NH, Lee J, Kim TJ, Kim NH, Choi KM, Baik SH, et al. Body Mass Index and Mortality in the General Population and in Subjects with Chronic Disease in Korea: A Nationwide Cohort Study (2002–2010). PLoS One. 2015 Oct 13;10(10):e0139924. doi: 10.1371/journal.pone.0139924 eCollection 2015. 26462235

10. Klatsky AL, Zhang J, Udaltsova N, Li Y, Tran HN. Body Mass Index and Mortality in a Very Large Cohort: Is It Really Healthier to Be Overweight? Perm J. 2017;21. doi: 10.7812/TPP/16-142 28678695

11. Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW Jr. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med. 1999 Oct 7;341(15):1097–105. doi: 10.1056/NEJM199910073411501 10511607

12. Nyholm M, Merlo J, Råstam L, Lindblad U. Overweight and all-cause mortality in a Swedish rural population: Skaraborg Hypertension and Diabetes Project. Scand J Public Health. 2005;33(6):478–86. doi: 10.1080/14034940510006102 16332613

13. Lindgärde F & Trell E (1977): Serum inorganic phosphate in middle-aged men. Inverse relation to body weight. Acta Med. Scand. 202, 307 ± 311. doi: 10.1111/j.0954-6820.1977.tb16833.x 21518

14. Håglin L, Lindblad A, Bygren LO.Hypophosphataemia in the metabolic syndrome. Gender differences in body weight and blood glucose. Eur J Clin Nutr. 2001 Jun;55(6):493–8. doi: 10.1038/sj.ejcn.1601209 11423926

15. Campos-Obando N, Lahousse L, Brusselle G, Stricker BH, Hofman A, Franco OH, et al. Serum phosphate levels are related to all-cause, cardiovascular and COPD mortality in men. Eur J Epidemiol 2018; 33:859–71. doi: 10.1007/s10654-018-0407-7 29766437

16. Håglin LM, Törnkvist B, Bäckman LO. High serum phosphate and triglyceride levels in smoking women and men with CVD risk and type 2 diabetes. Diabetol Metab Syndr. 2014 Mar 17;6(1):39. doi: 10.1186/1758-5996-6-39 24636522

17. Appelman Y, van Rijn BB, Ten Haaf ME, Boersma E, Peters SA. Sex differences in cardiovascular risk factors and disease prevention. Atherosclerosis. 2015 Jul;241(1):211–8. doi: 10.1016/j.atherosclerosis.2015.01.027 Epub 2015 Jan 28 25670232

18. Haider DG, Lindner G, Wolzt M, Ahmad SS, Sauter T, Leichtle AB, et al. Hyperphosphatemia Is an Independent Risk Factor for Mortality in Critically Ill Patients: Results from a Cross-Sectional Study. PLoS One. 2015 Aug 7;10(8):e0133426. doi: 10.1371/journal.pone.0133426 eCollection 2015. 26252874

19. Cheungpasitporn W, Thongprayoon C, Mao MA, Kittanamongkolchai W, Sakhuja A, Erickson SB. Admission serum phosphate levels predict hospital mortality. Hosp Pract (1995). 2018 Aug;46(3):121–127. doi: 10.1080/21548331.2018.1483172 Epub 2018 Jun 18. 29848117

20. Yoo KD, Kang S, Choi Y, Yang SH, Heo NJ, Chin HJ, et al. Sex, Age, and the Association of Serum Phosphorus With All-Cause Mortality in Adults With Normal Kidney Function. Am J Kidney Dis. 2016 Jan;67(1):79–88. doi: 10.1053/j.ajkd.2015.06.027 Epub 2015 Sep 2. 26341926

21. Kagansky N, Levy S, Koren-Morag N, Berger D, Knobler H. Hypophosphataemia in old patients is associated with the refeeding syndrome and reduced survival. J Intern Med. 2005 May;257(5):461–8. doi: 10.1111/j.1365-2796.2005.01457.x 15836663

22. Hoffmann M, Zemlin AE, Meyer WP, Erasmus RT. Hypophosphataemia at a large academic hospital in South Africa. J Clin Pathol. 2008 Oct;61(10):1104–7. doi: 10.1136/jcp.2007.054940 18820097

23. Appelman Y, van Rijn BB, Ten Haaf ME, Boersma E, Peters SA. Sex differences in cardiovascular risk factors and disease prevention. Atherosclerosis. 2015 Jul;241(1):211–8. doi: 10.1016/j.atherosclerosis.2015.01.027 Epub 2015 Jan 28. 25670232

24. Broman M, Wilsson AMJ, Hansson F, Klarin B. Analysis of Hypo- and Hyperphosphatemia in an Intensive Care Unit Cohort. Anesth Analg. 2017 Jun;124(6):1897–1905. doi: 10.1213/ANE.0000000000002077 28525508

25. Håglin L, Lundström S, Kaati G, Bäckman L, Bygren LO. All-cause mortality of patients with dyslipidemia up to 19 years after a multidisciplinary lifestyle modification programme: a randomized trial. Eur J Cardiovasc Prev Rehabil. 2011 Feb;18(1):79–85. doi: 10.1097/HJR.0b013e32833a65cc 20700054

26. Soley-Bori M. Dealing with missing data In: Key assumptions and methods for Applied analysis, Technical report no 4, May 6 2013.

27. Stokes A, Preston SH. How smoking affects the proportion of deaths attributable to obesity: assessing the role of relative risks and weight distributions. BMJ Open. 2016 Feb 25;6(2):e009232. doi: 10.1136/bmjopen-2015-009232 26916688

28. Freedman DM, Sigurdson AJ, Rajaraman P, Doody MM, Linet MS, Ron E. The mortality risk of smoking and obesity combined. Am J Prev Med. 2006 Nov;31(5):355–62. doi: 10.1016/j.amepre.2006.07.022 17046405

29. Nikolakaros G, Vahlberg T, Auranen K, Sillanmäki L, Venetoklis T, Sourander A. Obesity, Underweight, and Smoking Are Associated with Worse Cardiorespiratory Fitness in Finnish Healthy Young Men: A Population-Based Study. Front Public Health. 2017 Aug 18;5:206. doi: 10.3389/fpubh.2017.00206 eCollection 2017. 28868273

30. Narumi T, Watanabe T, Kadowaki S, Otaki Y, Honda Y, Nishiyama S, et al. The obesity paradox is not observed in chronic heart failure patients with metabolic syndrome. EXCLI J. 2014 May 12;13:516–25. eCollection 2014. 26417279

31. Håglin L, Törnkvist B, Bäckman L. Prediction of all-cause mortality in a patient population with hypertension and type 2 DM by using traditional risk factors and serum-phosphate, -calcium and-magnesium. Acta Diabetol. 2007 Sep;44(3):138–43. Epub 2007 Aug 26. doi: 10.1007/s00592-007-0254-6 17721752

32. Tonelli M, Sacks F, Pfeffer M, Gao Z, Curhan G; Cholesterol And Recurrent Events Trial Investigators. Relation between serum phosphate level and cardiovascular event rate in people with coronary disease. Circulation. 2005 Oct 25;112(17):2627–33. doi: 10.1161/CIRCULATIONAHA.105.553198 16246962

33. Fisher J, Magid N, Kallman C, Fanucchi M, Klein L, McCarthy D, et al. Respiratory illness and hypophosphatemia. Chest. 1983 Mar;83(3):504–8. doi: 10.1378/chest.83.3.504 6825484

34. Vaidyanathan D, Venkatesan S, Ramadesikan VK. Serum phosphate in acute myocardial infarction. Indian J Physiol Pharmacol. 2000 Apr;44(2):225–8. 10846641

35. Janghorbani M, Hedley AJ, Jones RB, Zhianpour M, Gilmour WH. Gender differential in all-cause and cardiovascular disease mortality. Int J Epidemiol. 1993 Dec;22(6):1056–63 doi: 10.1093/ije/22.6.1056 8144286

Obesity, smoking habits, and serum phosphate levels predicts mortality after life-style intervention

Souhrn

Background

Objectives

Methods

Results

Conclusions

Klíčová slova:

Zdroje

PLOS One

Svět praktické medicíny 3/2024 (znalostní test z časopisu)

Kardiologické projevy hypereozinofilií

Střevní příprava před kolonoskopií

Aktuální možnosti diagnostiky a léčby litiáz

Závislosti moderní doby – digitální závislosti a hypnotika