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 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Since the original description of the obesity-survival paradox in 1999, which suggested a survival advantage for overweight and obese patients undergoing hemodialysis, a large body of evidence supporting the paradox has accumulated. The reason for the paradox has yet to be defined. Better nutrition may be a partial explanation, or it may be that in uremic milieu, excessive fat and surplus calories might confer some survival advantage. The "surplus calorie theory" as a potential mechanism for the paradox is of great interest. If proven to be correct, it might explain why peritoneal dialysis patients who receive excessive calories through dialysis do not exhibit the paradox and, secondly and more importantly, therapy could be directed to enhance a greater caloric intake by renal failure patients to engender a better survival outcome. Finally, other clinical settings, for example, congestive heart failure, have their own obesity-survival paradox. Thus, the paradox appears to be a wider phenomenon and might merely be the external expression of a larger principle yet to be uncovered.
Semin Dial
PMID:Obesity-survival paradox-still a controversy? 1799 Nov 92

In contrast to the associations of high body mass index (BMI) with increased mortality in the general population, high BMI is associated with better survival in dialysis patients. Nonetheless, high BMI/adiposity in chronic kidney disease (CKD)/dialysis patients is associated with insulin resistance, inflammation, dyslipidemia, atherosclerosis and coronary calcification as described in the general population. These apparently perplexing associations might be explained if (1) adiposity has dual competing effects on survival; a protective nutritional effect and a deleterious metabolic effect resulting in insulin resistance, dyslipidemia, hypertension and inflammation and (2) the level of kidney function modifies the relative importance of these effects. In this paradigm, the deleterious metabolic effects of obesity outweigh its protective nutritional effects in the non-CKD population, the deleterious metabolic effects of obesity are neutralized by its protective nutritional effects in the moderate CKD population and the deleterious metabolic effects of obesity are outweighed by its protective nutritional effects in stage V CKD on dialysis. In other words, the over-all effects of obesity on survival vary according to the level of kidney function and there is an interaction of body size and presence or absence of CKD on survival even though the metabolic effects of adiposity are not modified by the level of kidney function. Therefore, we propose that despite an association of adiposity with better survival, there is no reverse epidemiology of the associations traditional and nontraditional cardiovascular risk factors and disease with adiposity in dialysis patients.
Semin Dial
PMID:A story half untold: adiposity, adipokines and outcomes in dialysis population. 1799 Nov 93

"Reverse epidemiology" refers to paradoxical and counterintuitive epidemiologic associations between survival outcomes and traditional cardiovascular risk factors such as obesity, high blood pressure, and high cholesterol. Reverse epidemiology has been well described in end stage renal disease, but also has been observed in chronic disease states, including chronic heart failure, rheumatoid arthritis, chronic obstructive pulmonary disease, and Acquired Immune Deficiency Syndrome, and in elderly populations. This review will highlight the recent medical literature on reverse epidemiology in these populations. Common pathophysiologic underpinnings in these chronic disease states may help explain the reversal of risk factors observed in these diverse populations. Furthermore, guidelines for the general population for optimal goals of weight, cholesterol levels, and blood pressure may not apply to special populations, including patients with chronic diseases or elderly persons.
Semin Dial
PMID:Reverse epidemiology beyond dialysis patients: chronic heart failure, geriatrics, rheumatoid arthritis, COPD, and AIDS. 1799 Dec 3

Until recently, it was not apparent whether apparent paradoxical associations of body mass index (BMI), lipids, and blood pressure with survival observed in hemodialysis (HD) patients, which contradict observations from the general population, also applied to peritoneal dialysis (PD) patients. Studies of survival in PD patients must account for differences in adjusted survival relative to HD patients, namely, early equivalent to superior survival, but after about 1-2 years, inferior survival. Several recent observational studies have analyzed the association between BMI and survival in PD patients from different perspectives and using different patient populations. In general, these studies found that any survival advantage associated with obesity is significantly less likely in PD than HD patients. Among PD patients, those who are obese can be said to have equivalent survival to PD patients with normal BMI. Studies of lipids and blood pressure in PD patients also yield conflicting associations with survival. Obese patients, especially if diabetic, may have increased risk of death after starting on PD compared to HD, although firm conclusions are premature given the limitations of current evidence. At present, the levels of lipids and blood pressure which are best associated with survival in PD patients are not well-defined.
Semin Dial
PMID:Body mass index and peritoneal dialysis: "exceptions to the exception" in reverse epidemiology? 1799 Dec 5

The term "reverse epidemiology" has been proposed to address the apparent different relationship between numerous risk factors and outcomes among dialysis patients: thus, obesity, hypertension, high cholesterol, and elevated creatinine all appear to be associated with decreased risk. Since this is contrary to the general findings in otherwise healthy populations, some kind of "reversal" has been suggested, that would be contrary to classical epidemiology. The authors describe several faults to this conception. The rules of epidemiology have not been reversed in dialysis patients. In fact, the complexity of the population implies a greater need for attention to the distinction between association and causation and the importance of confounding and bias. In particular existing subclinical and clinical disease which is very common among dialysis patients can change associations so drastically that they are dominated by different causal pathways than those seen in the general population. For example, lower cholesterol is a better marker of poor health than of a healthy diet and thus is associated with different outcomes. To the extent the term reverse epidemiology implies either epidemiology or biology is different in dialysis patients it can be misleading and detrimental. The differences between risk factors in end-stage renal disease (ESRD) and other individuals are surely important, but can themselves be the basis of excellent epidemiology, applied with the classic rules developed for this discipline with the goal of uncovering causal association and hypotheses to be tested in clinical trials.
Semin Dial
PMID:Reverse epidemiology: a confusing, confounding, and inaccurate term. 1799 Dec 9

The term "reverse epidemiology" is used to indicate that such surrogates of cardiovascular risk and metabolic syndrome as obesity, hypercholesterolemia and hypertension are paradoxically associated with greater survival in individuals with chronic disease states and wasting, including dialysis patients, in whom the short-term survival is the issue at hand. It is being debated whether the crossing curves of the obesity-mortality association in dialysis patients vs. the general population reflect the residual confounding that needs to be controlled away statistically, or whether they have biological plausibility in sharp contradistinction to the currently dominating Framingham paradigm. In the rush to define the crossing curves as statistical artifact and to dismiss the term "reverse epidemiology" as a misnomer, we may miss the opportunity to gain information housed in those crossing lines and may miss the bigger picture, i.e., how to improve longevity in dialysis patients. Even though some of the survival paradoxes in dialysis patients appear to fulfill the Hill's criteria of causation, there are still two major drawbacks: (1) convincing pathophysiologic pathways to link dialysis patient survival to obesity, fat accumulation, higher serum lipoprotein levels or slightly higher than normal blood pressure values are yet to be verified in animal and other scientifically sound models; and (2) randomized controlled trials need to show that nutritional interventions resulting in weight gain can lead to greater survival in dialysis patients. Studying the survival paradoxes may lead to a paradigm shift by establishing targets beyond the Framingham guidelines for populations with chronic disease states.
Semin Dial
PMID:What is so bad about reverse epidemiology anyway? 1799 Dec 10

Few studies have addressed Sociocultural factors underlying healthy lifestyles. The Sociocultural component of the Obesity Prevention in Communities (OPIC) project explores social and cultural factors that may promote or protect against obesity via adolescents' values, attitudes, beliefs and explanations for their patterns of eating and physical activity, as well as preferred body size. This paper reports on semi-structured interviews conducted with a sub-sample of indigenous Fijian females in terms of their descriptions of and explanations for their at-school eating patterns. While participants understood which foods and drinks were healthy, many skipped breakfast, and ate junk at recess and after school. The main reasons for these unhealthy eating patterns were poor time management in the mornings, and access to discretionary spending money for junk food. Participants cited family members and friends as key influences on their eating patterns. Findings were used to develop intervention strategies to encourage the regular consumption of healthy food at home and at school.
Pac Health Dialog 2006 Sep
PMID:Sociocultural factors influencing the food choices of 16-18 year-old indigenous Fijian females at school. 1818 91

This paper unravels the physical and psychological health problems of garment workers in Fiji. It is based on research work done between 1997-2007. Majority of the garment workers are women. The main physical health problems faced by workers are: 'Occupational fatigue syndrome', body pains, obesity, and bladder and kidney problems. The major psychological problems work stress and depression. Work stress and depression are caused by 'intensification of work' to meet daily targets, strict factory rules and regulations, poor pay, poor working conditions, in-human abuse, and fear of job loss. Since garment workers do not have much education and skills they have no other option but to work for the garment industry and suffer in silence.
Pac Health Dialog 2006 Sep
PMID:Physical and psychological health problems of garment workers in the Fiji. 1818 92

This pilot study aimed to gather information about knowledge of and attitudes towards a range of health and dietary issues, with a focus on obesity and NCDs. It involved 967 children equally distributed between Form 3 (age range 13-14) and form 5 (age range 16-17) from three schools, one from each of the health divisions in Fiji. It was found that almost half of the sample group were of "normal" weight, whilst 18% were classified as "overweight" and 16% as "obese". Half the children took an inactive mode of transport (bus/car) to school and a higher percentage of those who went by bus/car were overweight. The average daily consumption of fruit and vegetables was very low and the consumption of fried foods was high, particularly in urban-based schools. The majority of students did not know the full and correct definition of "balanced meals". Despite the majority of children (83.7%) recognizing the importance of PA and 75% of children reporting that they exercised "for health", only 14% of boys and 10% of girls said they looked forward to PE classes as it was good for their health. Ninety percent of children indicated that being overweight is not healthy and that 75% of children think that being underweight is not healthy. Overall, the children recognized the importance of good diet and exercise for health. However, gaps existed in the curriculum--particularly regarding the importance of engaging in PE for health, the role of obesity in increasing the risks of NCDs and the specific meanings of terms such as "health" and "balanced meals". Modification of the curriculum to enforce knowledge of the importance of PE/PA and the way they impact upon health, may improve the dietary and PA trends seen in schools in Fiji.
Pac Health Dialog 2006 Sep
PMID:Evidence for a curriculum review for secondary schools in Fiji. 1818 96

Cook Island women (CIW) in New Zealand are disproportionately represented among almost all of the negative health statistics. They predominately occupy the lowest socio-economic level, present with high rates of heart disease risk, cervical cancer and smoking. Furthermore, they delay seeking treatment until their diseases are at an advanced stage. The primary aim of this study was to identify the health challenges that some CIW in New Zealand regarded as salient. We were also interested in the cognitive representations generated by health challenges, such as the cause, the consequences, the timeline, and the degree of control they felt they had. The types of coping strategies employed in response to health challenges were also explored, as was the participant's appraisal of the effectiveness of their efforts. Answers to semi-structured interviews were categorised using QSR NUD*IST Release Version 4.0. The results indicate that women are most concerned about their diet, exercise, obesity and diabetes. Their answers demonstrated that they: often feel overwhelmed by health challenges; believe that they have little control over the cause of these challenges; and that they have a tendency to minimise their consequences. Furthermore, the women were more likely to engage in emotion-focused coping, and appraise their problem-focused coping strategies negatively.
Pac Health Dialog 2003 Sep
PMID:Health challenges of some urban Cook Island women in New Zealand. 1818 11


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