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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diet is a component in the etiology of the two major causes of death in the United States, namely, cardiovascular disease and cancer. During the last decade, various organizations have suggested that we alter the "typical" American diet in order to decrease the incidence of these diseases even though both diseases are indisputably of multiple etiology. An implication behind these recommendations is that individuals will increase their longevity by changing their diets. The burden of proof falls on those proposing changes to the diet that such alterations will be safe and effective. In spite of our often indicted diet, mortality from heart disease and stroke continue to fall and deaths from diet-related cancers are static or dropping. Longevity in the U.S. is exceeded by only five countries, whose populations consume a diet similar to ours in four, and that in the fifth is approaching ours. While low-fat high-fiber diets probably have some beneficial effect vis-a-vis chronic diseases, it is likely that other risk factors contribute more to the total risk of disease. Therefore, it is illogical to expect dietary manipulation to offset significantly other concurrent risks such as heredity, tobacco use, hypertension, and obesity. Individuals who are at high risk for specific diseases should modify their diets to minimize this particular risk factor. Most Americans can safely reduce their intake of total calories, fat, sugar, and salt. Although this can be achieved most readily on a population basis by following a form of "prudent" diet, it is premature to promise medical benefits to individuals.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The Western diet: an examination of its relationship with chronic disease. 302 70

To assess the meaning of hospital-associated death rates, we studied whether mortality within 30 days of hospital admission (30-day mortality) is more informative than inpatient mortality and whether detailed assessment of additional discharge diagnoses helps in understanding death rates. We examined hospitalizations for elderly Medicare patients with principal diagnoses of stroke, bacterial pneumonia, myocardial infarction, and congestive heart failure; these conditions account for 30.8% of Medicare 30-day mortality. Average hospital stays for these conditions were 99.0% longer, and inpatient mortality was 25.0% higher in New York than in California, but 30-day mortality was 1.6% higher in California. We conclude that inpatient death rates depend on length-of-stay patterns and give a biased picture of mortality. Additional diagnoses such as shock and pneumonia were strongly associated with increased mortality, but Medicare data do not reveal which patients had these conditions at the time of admission. Recorded diagnoses of chronic diseases such as hypertension, diabetes mellitus, obesity, benign prostatic hypertrophy, and osteoarthritis were commonly associated with reduced risk of death; such reduced risk is not clinically plausible. Several lines of evidence suggest that chronic disorders are underreported for patients with life-threatening disorders. We recommend great caution in using discharge diagnoses of comorbid conditions to adjust hospital death rates for clinical differences in the patient populations.
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PMID:Assessing hospital-associated deaths from discharge data. The role of length of stay and comorbidities. 270 88

Hypertension is a cardinal risk factor in the genesis of cardiovascular morbidity and mortality. The presence of concomitant risk factors greatly increases the incidence of vascular events, and associations of age, hypertension, obesity and smoking are particularly lethal combinations. Accelerated atherosclerotic change characterizes sustained hypertension, and ischaemic heart disease, aortic dissection, stroke and multi-infarct dementia are major sequelae. Major studies in the United States, Australia and the United Kingdom have shown that treatment of hypertension significantly reduces the occurrence of strokes. Obesity and excess alcohol consumption closely correlate with hypertension. The relative importance to hypertension of type II diabetes and obesity is difficult to evaluate.
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PMID:Hypertension and associated diseases in elderly patients. 306 91

Obesity--defined by a body mass index above 30 kg per m2--is a major problem for affluent nations. Its prevalence is higher in North America than in Europe--between 9% and 12% of the population. Reduced energy expenditure from exercise or metabolism or both may be an important contributory factor in the development of obesity because of a failure to reduce food intake sufficiently to maintain energy balance. A high ratio of abdominal circumference relative to gluteal circumference carries a twofold or greater risk of heart attack, stroke, hypertension, diabetes mellitus, gallbladder disease, and death. The effect of increased quantities of abdominal fat is greater than that of a similar increase in total body fat on the risks of ill health associated with obesity. Genetic factors appear to contribute about 25% to its etiology.
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PMID:Obesity. Part I--Pathogenesis. 306 47

There are 2 striking differences in the practice of medicine in the US and in the UK: 1) in the former, there is a great emphasis on private medicine, and 2) in the US there is a much higher incidence of litigation, whereas in the UK, family planning services are free, and litigation in this area is almost unknown. British medical opinion agrees with the US on the following oral contraceptive contraindications: 1) cancer of the breast, ovary, uterus, vagina, or cervix; 2) coronary thrombosis, pulmonary embolism, deep vein thrombosis, angina pectoris, or stroke; and 3) unusual or unexplained vaginal bleeding. Both countries agree that it is inadvisable to give the combined pill over the age of 45, and over the age of 35 in smokers. The UK agrees with 75% of the routines adopted by US doctors on a patient's 1st visit for oral contraceptives. However, a patient who becomes amenorrheic while taking the pill is not regarded as lightly in the UK as she would be in the US; she is closely monitored. If 1 of 4 risk factors (age 35 or over, hypertension, obesity, or smoking) is evident, a patient in the UK is closely supervised while taking the pill. If more than 2 risk factors are present, a UK doctor may advise against the pill. Since the 1960s the media have both praisd and condemned the pill. There is no doubt that, in the field of contraceptive advice, the US and the UK lead the way, and a closer liaison between the 2 medical professions is essential to reassure patients.
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PMID:Contraceptive advice: how the English differ from the Americans. 309 Feb 54

Coexistent diabetes and hypertension affect an estimated 2.5 million persons in the United States. Hypertension occurs approximately twice as frequently in persons with diabetes as without and contributes to most of the chronic complications of diabetes, including coronary artery disease, stroke, lower extremity amputations, renal failure and, perhaps, to diabetic retinopathy and blindness. The proportions of complications in the diabetic population attributable to hypertension range from 35 to 75 percent. Hypertension in the diabetic population increases with age and is particularly associated with obesity and nephropathy. Limited data suggest the control of hypertension in the diabetic population may be better than in the general population, perhaps due to greater contact that persons with diabetes have with the health care system. Yet, in approximately half, hypertension is not controlled. Control strategies for hypertension in the diabetic population must take into account the higher frequency of hypertension, increased risks for adverse sequelae from the coexistent conditions, more complicated clinical management, and the greater contact with the health care system experienced by persons with diabetes. Community programs to improve hypertension control in the diabetic population may target a subset of the diabetic population and should tailor strategies to meet the needs of the target population. Hypertension control in the diabetic population must be addressed at multiple levels in the health care system, including improved detection, evaluation, and treatment of hypertension; improved adherence to antihypertensive therapy and long-term followup; provision of quality professional education and patient education and support; and systematic health care monitoring and program evaluation. Hypertension control should be emphasized in all comprehensive diabetes control programs.The treatment and control of hypertension may significantly reduce morbidity and mortality in the diabetic population.
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PMID:The control of hypertension in persons with diabetes: a public health approach. 311 83

The results presented in this paper concerning regional obesity as a health hazard in women refer to a 12-year longitudinal population study of 1,462 women, aged 38-60, which was carried out in Gothenburg, Sweden, in 1968-69. In univariate analysis the ratio of waist-to-hip circumference showed a significant positive association with the 12-year incidence of myocardial infarction, angina pectoris, stroke, diabetes mellitus and death. The association with incidence of myocardial infarction and diabetes mellitus remained in multivariate analysis. The relation between the ratio of waist-to-hip circumference and the end points studied was stronger than for any other anthropometric variable studied.
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PMID:Regional obesity as a health hazard in women--a prospective study. 326 Jul 14

Recent research has shown the marked differences in association with disease between obesity localized to the abdominal respectively to the gluteal-femoral regions. In this review systematic analyses were performed of the associations between obesity (body mass index, BMI) or abdominal obesity (increased waist-over-hip circumference ratio, WHR) on the one hand, and a number of disease end points, and their risk factors, as well as other factors on the other, WHR was associated with cardiovascular disease, premature death, stroke, non-insulin-dependent diabetes mellitus and female carcinomas. In contrast, BMI tended to be negatively correlated to cardiovascular disease, premature death, and stroke, but positively to diabetes. The established risk factors for these end points were found to correlate to WHR, while this was often not the case with BMI. BMI was positively correlated only to insulin, triglycerides and blood pressure. Together with diabetes mellitus, this seems to constitute a metabolic group of conditions which are thus associated with BMI. Androgens (in women), and perhaps cortisol, seem to be positively, and progesterone negatively correlated to WHR. The WHR was also positively associated with sick leave, several psychological maladjustments, psychosomatic and psychiatric disease. Attempts were made to interpret these findings. In a first alternative an elevation of FFA concentration, produced from abdominal adipose tissue, was considered to be the trigger factor for the pathologic aberrations associated with abdominal distribution of body fat. When obesity is added, the metabolic aberrations may be exaggerated. In a second alternative adrenal cortex hyperactivity was tested as the cause. When combined with the FFA hypothesis, this might explain many but not all of the findings. It seems possible to produce an almost identical syndrome in primates by defined experimental stress. Women with high WHR were found to have a number of symptoms of poor coping to stress. It was therefore suggested that part of the background to this syndrome might be a hypothalamic arousal syndrome developing with stress. It was concluded that obesity and abdominal distribution of adipose tissue constitute two separate entities with different pathogenesis, clinical consequences and probably treatment.
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PMID:The associations between obesity, adipose tissue distribution and disease. 329 56

Hypertension is a major risk factor for cardiovascular morbidity and mortality. Antihypertensive therapy consistently reduces complications from stroke and congestive heart failure, whereas benefits from the treatment of ischemic heart disease events are variable. Several plausible explanations, including hemodynamic hypotheses, have been put forth to account for the failure of treatment to more favorably influence mortality from ischemic heart disease. The effect of hypertension on coronary heart disease is probably much more complex than a simple elevation of arterial pressure. Some of these complexities include the potential separate risks of high total peripheral resistance, high cardiac output, increased myocardial power that reflects pressure times flow, and several structural and functional vascular changes. These factors may act in concert to unfavorably alter the balance between myocardial oxygen supply and demand. Several of these factors will be highlighted in an attempt to offer alternative or adjunctive pathophysiologic examinations for the high-risk subgroups of obesity and the failure of antihypertensive therapy to normalize the rate of coronary heart disease events.
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PMID:The importance of hemodynamic considerations in essential hypertension. 329 3

Obesity and hypertension are two major risk factors for the cardiovascular system. Whereas arterial hypertension increases afterload to the left ventricle, obesity produces an increase in stroke volume and increases preload. As a result of this double burden, the heart adapts with eccentric left ventricular hypertrophy. Contractility becomes impaired early in the course of obesity hypertension, and ventricular ectopy is observed. As a consequence, the obese hypertensive patient is at a high risk for congestive heart failure and sudden death. Despite the synergistic effects of obesity and hypertension on the heart, patients appear to be relatively protected from nephrosclerosis and coronary artery disease. These epidemiologic observations are supported by the pathophysiologic changes that take place in obesity hypertension. At any given level of arterial pressure, cardiac output and renal blood flow are elevated in obese hypertensive patients, whereas systemic and renal vascular resistance are decreased when compared to lean hypertensive patients. Because total peripheral resistance is considered the hemodynamic hallmark of arterial hypertension, systemic vascular complications may be less pronounced in obesity hypertension. Weight loss decreases preload, afterload to the left ventricle, and the sympathetic drive to the heart. Protecting the heart from these hypertrophic stimuli should be a major goal of preventive cardiology.
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PMID:Obesity hypertension. 330 13


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