Body mass index and peripheral arterial disease, a “U-shaped” relationship in elderly African population – the EPIDEMCA study
Abstract
Summary:Background: There is no study available concerning specifically the role of underweight in PAD prevalence. Patients and methods: Individuals ≥ 65 years living in urban and rural areas of two countries in Central Africa (Central African Republic and the Republic of Congo) were invited. Demographic, clinical and biological data were collected, and ankle-brachial index measured. BMI was calculated as weight/height2 and participants were categorized according to the World Health Organization as with underweight (< 18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2), and obese (≥ 30 kg/m2). Results: Among the 1815 participants (age 73.0 years, 61.8 % females), the prevalence of underweight was 34.1 %, higher in subjects with PAD than in PAD free subjects (37.1 % vs. 33.5 %, p = 0.0333). The overall prevalence of PAD was 14.3 %. Underweight and obesity were still significantly associated with PAD after adjustment to all potential confounding factors (OR: 2.09, p = 0.0009 respectively OR: 1.90, p = 0.0336) while overweight was no more significantly associated with PAD after multivariate analysis. Conclusions: While obesity is a well-known PAD associated marker, low BMI provides novel independent and incremental information on African subject’s susceptibility to present PAD, suggesting a “U-shaped” relationship between BMI and PAD in this population.
References
1 . Epidemiology of peripheral artery disease. Circ Res. 2015;116(9):1509–26.
2 Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;382(9901):1329–40.
3 . National health care costs of peripheral arterial disease in the Medicare population. Vasc Med. 2008;13(3):209–15.
4 Peripheral artery disease is a coronary heart disease risk equivalent among both men and women: results from a nationwide study. Eur J Prev Cardiol. 2015;22(3):317–25.
5 . Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013;309(1):71–82.
6 . The relationship between obesity and peripheral arterial disease in adult Nigerian diabetics. Niger Postgrad Medical J. 2014;21(1):57–60.
7 . Ethnic differences in peripheral arterial disease in the NHLBI Genetic Epidemiology Network of Arteriopathy (GENOA) study. Vasc Med. 2003;8(4):237–42.
8 Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study. Cardiovascular Heart Study (CHS) Collaborative Research Group. Circulation. 1993;88(3):837–45.
9 Epidemiology of peripheral artery disease in elder general population of two cities of Central Africa: Bangui and Brazzaville. Eur J Vasc Endovasc Surg. 2012;44(2):164–9.
10 The effect of novel cardiovascular risk factors on the ethnic-specific odds for peripheral arterial disease in the Multi-Ethnic Study of Atherosclerosis (MESA). J Am Coll Cardiol. 2006;48(6):1190–7.
11 Epidemiology of dementia in Central Africa (EPIDEMCA): protocol for a multicentre population-based study in rural and urban areas of the Central African Republic and the Republic of Congo. SpringerPlus. 2014;3:338.
12 Validation of the use of historical events to estimate the age of subjects aged 65 years and over in Cotonou (Benin). Neuroepidemiology. 2010;35(1):12–6.
13 Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. WHO Tech Report Ser. 1995;854:1–452.
14 Executive summary: Guidelines (2013) for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity Society published by the Obesity Society and American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Based on a systematic review from the The Obesity Expert Panel, 2013. Obesity. 2014;22(Suppl 2):S5–39.
15 Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640–5.
16 Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation. 2012;126(24):2890–909.
17 An obesity paradox: an inverse correlation between body mass index and atherosclerosis of the aorta. Cardiovasc Pathol. 2016;25(6):515–20.
18 Association between Body Mass Index and All-Cause Mortality in Hypertensive Adults: Results from the China Stroke Primary Prevention Trial (CSPPT). Nutrients. 2016;8(6).
19 Update on some epidemiologic features of intermittent claudication: the Framingham Study. J Am Geriatr Soc. 1985;33(1):13–8.
20 . The metabolic syndrome: role of skeletal muscle metabolism. Ann Med. 2006;38(6):389–02.
21 . Weight loss-induced rise in plasma pollutant is associated with reduced skeletal muscle oxidative capacity. Am J Physiol Endocrinol Metab. 2002;282(3):E574–9.
22 . Glucocorticoid action networks and complex psychiatric and/or somatic disorders. Stress. 2007;10(2):213–9.
23 . Urinary cortisol and six-year risk of all-cause and cardiovascular mortality. J Clin Endocrinol Metab. 2010;95(11):4959–64.
24 . Exercise and oxidative stress: potential effects of antioxidant dietary strategies in sports. Nutrition. 2015;31(7–8):916–22.
25 Prevalence of low ankle brachial index and its association with pulse pressure in an elderly Chinese population: a cross-sectional study. J Epidemiol. 2012;22(5):454–61.
26 Ankle-arm blood pressure index and cardiovascular risk factors in elderly Japanese men. Hypertens Res. 2003;26(5):377–82.
27 . Determinants of peripheral arterial disease in the elderly: the Rotterdam study. Arch Int Med. 2000;160(19):2934–8.