Chewing Over the Issues

Research: Neither weight nor body shape predicts risk of heart disease

From the New York Times.

A major new analysis challenges the long-held idea that obese people who carry their extra weight mainly around the middle — those with an “apple” shape — are at greater risk for heart disease than “pears,” whose fat tends to cluster on their thighs and buttocks.

The new report, published online on Friday in The Lancet, pooled data from 58 studies about more than 220,000 people, with a mean age of 58. During the time they were followed, more than 14,000 suffered a heart attack or stroke.

Conventional risk factors like blood pressure, cholesterol, diabetes and smoking were accurate predictors of a heart attack or stroke, but additional information about weight or body shape (ascertained by measuring waist circumference or waist-to-hip ratio) did not improve the ability to predict risk.

“Whatever your shape is doesn’t really matter,” said Dr. Emanuele Di Angelantonio, a lecturer at the University of Cambridge and a member of the Emerging Risk Factors Collaboration, which carried out the study.

But even with those results, Dr. Di Angelantonio doesn’t seem to be able to let go of the idea that being overweight equals poor health:

He emphasized that being overweight or obese is one of the main modifiable risk factors for cardiovascular disease, and is often an early sign of future risk. But he said, “Whatever form of obesity or overweight you have is all the same.”

So “additional information about weight… did not improve the ability to predict risk” but “being overweight or obese is one of the main modifiable risk factors for cardiovascular disease, and is often an early sign of future risk”.

Got that? It’s an early sign of future risk, but it doesn’t improve the ability to predict risk. Um, what?

(Source: The New York Times)

Who thrives after surgery? Assessing frailty in the elderly

From the New York Times.

We laypeople tend to use the word imprecisely to allude to fragility or vulnerability in old people, but for physicians and researchers, frailty is a specific medical syndrome with measurable criteria.

They look for a series of declines that include weight loss (specifically, an unintentional loss of 10 pounds or more in the past year), a weaker grip, exhaustion and lack of physical activity, and a slower gait. The assessment takes perhaps 15 minutes to conduct in an office. Then the doctors assign a score: 0 to 1 for those who aren’t frail, 2 to 3 for the intermediately frail.

Patients who score 4 to 5 are frail. “They tend to have much less reserve, a decreased ability to bounce back” from physiological stress, said Dr. Fried, who previously taught at Johns Hopkins.

Might frailty scores be better at predicting how patients fare after surgery than the existing methods? For a year, Dr. Makary, Dr. Fried and their colleagues at Johns Hopkins tracked nearly 600 patients over age 65 who had elective surgery in that hospital – from minor gallbladder removal to joint replacement and major abdominal surgery. All lived independently.

The researchers assessed patients’ frailty before their operations: slightly more than 10 percent were adjudged frail (average age 76.3), and more than 58 percent weren’t frail at all (average age 71.3). The remainder were classified as intermediately frail.

“The data are quite persuasive,” Dr. Fried said. “People who are frail before surgery are at higher risk for poor outcomes afterwards.” This is the way careful researchers talk; they say results are “persuasive.”

A layperson like, say, me would say: Yow. The frailty index did a superior job of predicting how seniors will do after surgery, and just look at the extent of the differences.

Those who were intermediately frail faced twice the odds of complications after surgery, compared to patients who were not frail, according to the study; frail patients had more than two and a half times the complication rate. Hospital stays were 44 percent to 53 percent longer for those intermediately frail, and 65 percent to 89 percent longer for the frail.

And after operation, the odds of a patient being discharged to a nursing home or to assisted living, instead of her own home, rose in proportion to her frailty. The intermediately frail were more than three times as likely to have to enter such a facility, compared with those who were not frail. The frail were 20 times (not a typo) as likely to go to a nursing home or assisted living — from which they may or may not have emerged.

(Source: The New York Times)