Richard E. Gress

Cigarette Smoking: Risk Factor for Premature Facial Wrinkling

OBJECTIVE To determine if cigarette smoking is a risk factor for the development of premature facial wrinkling. DESIGN Cross-sectional study. SETTING Smoking cessation clinic and community. PATIENTS Convenience sample of 132 adult smokers and non-smokers in 1988. MEASUREMENTS A questionnaire was administered to quantify cigarette smoking and to obtain information about possibly confounding factors such as skin pigmentation, sun exposure, age, and sex. Wrinkling was assessed using photographs of the temple region, and a severity score based on predetermined criteria was assigned. A logistic regression model, which controlled for confounding variables, was developed to assess the risk for premature wrinkling in response to pack-years of smoking. MAIN RESULTS The prevalence of premature wrinkling was independently associated with sun exposure and pack-years of smoking. After controlling for age, sex, and sun exposure, premature wrinkling increased with increased pack-years of smoking. Heavy cigarette smokers (greater than 50 pack-years) were 4.7 times more likely to be wrinkled than nonsmokers (95% CI, 1.0 to 22.6; P value for trend = 0.05). Sun exposure of more than 50,000 lifetime hours also increased the risk of being excessively wrinkled 3.1-fold (CI, 1.2 to 7.1). When excessive sun exposure and cigarette smoking occurred together, the risk for developing excessive wrinkling was multiplicative (prevalence ratio of 12.0; CI, 1.5 to 530). CONCLUSION Cigarette smoking is an independent risk factor for the development of premature wrinkling.

Obesity and Sexual Quality of Life

Objectives: Reduced sexual quality of life is a frequently reported yet rarely studied consequence of obesity. The objectives of this study were to 1) examine the prevalence of sexual quality‐of‐life difficulties in obese individuals and 2) investigate the association between sexual quality of life and BMI class, sex, and obesity treatment—seeking status.

Left Ventricular Hypertrophy in Severe Obesity: Interactions Among Blood Pressure, Nocturnal Hypoxemia, and Body Mass

Obese subjects have a high prevalence of left ventricular (LV) hypertrophy. It is unclear to what extent LV hypertrophy results directly from obesity or from associated conditions, such as hypertension, impaired glucose homeostasis, or obstructive sleep apnea. We tested the hypothesis that LV hypertrophy in severe obesity is associated with additive effects from each of the major comorbidities. Echocardiography and laboratory testing were performed in 455 severely obese subjects with body mass index 35 to 92 kg/m2 and 59 nonobese reference subjects. LV hypertrophy, defined by allometrically corrected (LV mass/height2.7), gender-specific criteria, was present in 78% of the obese subjects. Multivariable regression analyses showed that average nocturnal oxygen saturation <85% was the strongest independent predictor of LV hypertrophy (P<0.001), followed by systolic blood pressure (P<0.015) and then body mass index (P<0.05). With regard to LV mass, there were synergistic effects between hypertension and body mass index (P interaction <0.001) and between hypertension and reduced nocturnal oxygen saturation. Severely obese subjects had normal LV endocardial fractional shortening (35±6% versus 35±6%) but mildly decreased midwall fractional shortening (15±2% versus 17±2%; P<0.001), indicating subtle myocardial dysfunction. In conclusion, more severe nocturnal hypoxemia, increasing systolic blood pressure, and body mass index are all independently associated with increased LV mass. The effects of increased blood pressure seem to amplify those of sleep apnea and more severe obesity.

A major predisposition locus for severe obesity, at 4p15-p14.

Although the predisposition to morbid obesity is heritable, the identities of the disease-causing genes are largely unknown. Therefore, we have conducted a genomewide search with 628 markers, using multigenerational Utah pedigrees to identify genes involved in predisposition to obesity. In the genomewide search, we identified a highly significant linkage to high body-mass index in female patients, at D4S2632, with a multipoint heterogeneity LOD (HLOD) score of 6.1 and a nonparametric linkage (NPL) score of 5.3. To further delineate the linkage, we increased both the marker density around D4S2632 and the size of our pedigree data set. As a result, the linkage evidence increased to a multipoint HLOD score of 9.2 (at D4S3350) and an NPL score of 11.3. Evidence from almost half of the families in this analysis support this linkage, and therefore the gene in this region might account for a significant percentage of the genetic predisposition to severe obesity in females. However, further studies are necessary to clarify the effect that this gene has in males and in the general population.

Health outcomes of gastric bypass patients compared to nonsurgical, nonintervened severely obese

Favorable health outcomes at 2 years postbariatric surgery have been reported. With exception of the Swedish Obesity Subjects (SOS) study, these studies have been surgical case series, comparison of surgery types, or surgery patients compared to subjects enrolled in planned nonsurgical intervention. This study measured gastric bypass effectiveness when compared to two separate severely obese groups not participating in designed weight‐loss intervention. Three groups of severely obese subjects (N = 1,156, BMI ≥ 35 kg/m2) were studied: gastric bypass subjects (n = 420), subjects seeking gastric bypass but did not have surgery (n = 415), and population‐based subjects not seeking surgery (n = 321). Participants were studied at baseline and 2 years. Quantitative outcome measures as well as prevalence, incidence, and resolution rates of categorical health outcome variables were determined. All quantitative variables (BMI, blood pressure, lipids, diabetes‐related variables, resting metabolic rate (RMR), sleep apnea, and health‐related quality of life) improved significantly in the gastric bypass group compared with each comparative group (all P < 0.0001, except for diastolic blood pressure and the short form (SF‐36) health survey mental component score at P < 0.01). Diabetes, dyslipidemia, and hypertension resolved much more frequently in the gastric bypass group than in the comparative groups (all P < 0.001). In the surgical group, beneficial changes of almost all quantitative variables correlated significantly with the decrease in BMI. We conclude that Roux‐en‐Y gastric bypass surgery when compared to severely obese groups not enrolled in planned weight‐loss intervention was highly effective for weight loss, improved health‐related quality of life, and resolution of major obesity‐associated complications measured at 2 years.

Health-related Quality of life in patients seeking gastric bypass surgery vs non-treatment-seeking controls

Background: Previous research has found that health-related quality of life (HRQOL) differs among obese individuals depending on treatment-seeking status, with greater impairments found in obese individuals seeking treatments of greatest intensity. The goals of this study were to determine: 1) if there are differences in obesity-specific HRQOL between seekers of gastric bypass surgery and non-treatment-seeking controls; and, 2) if the presence and number of co-morbid conditions impacts on HRQOL. Methods: Participants were 339 surgical cases (mean age 42.9, mean BMI 47.7, 85.5% women) and 87 controls (mean age 48.8, mean BMI 43.5, 71.3% women). Obesity-specific HRQOL was assessed using the Impact of Weight on Quality of Life-Lite (IWQOL-Lite). Subjects were given a detailed medical history to determine the presence of co-morbid conditions. Results: After controlling for BMI, age, and gender, obesity-specific HRQOL was significantly more impaired (P<.001) in the surgery-seeking group than in the control group on all 5 scales and total score of the IWQOL-Lite. For total score, physical function and sexual life, there was increasing impairment with increasing number of co-morbid conditions. Treatment-seeking status, BMI, gender, and the presence of depression accounted for most of the variance in IWQOL-Lite total score. Conclusions: Persons seeking gastric bypass expe rience poorer HRQOL than non-treatment-seeking individuals after controlling for BMI, age, and gender. The presence of co-morbid conditions contributes to some aspects of HRQOL impairment.

Health and health-related quality of life: differences between men and women who seek gastric bypass surgery.

BACKGROUND The aim of this study was to examine the differences between male and female bariatric surgery candidates with respect to health-related quality of life (HRQOL), health, sociodemographic variables, and interactions among these variables in a bariatric surgery practice in the United States. Women seek bariatric surgery 5 times more often than men. Research on gender differences in HRQOL is limited, and the results are conflicting. METHODS A total of 794 surgery candidates (mean age 42.2 y; body mass index 46.9 kg/m2; 84.8% women) completed both a weight-related (Impact of Weight on Quality of Life-Lite questionnaire) and a generic (Medical Outcomes Study Short-Form-36) measure of HRQOL. Health was evaluated by questionnaire and clinical interviews. RESULTS Compared to men, women reported reduced HRQOL on 3 of the 5 scales assessing obesity-specific HRQOL and also the physical aspects of general HRQOL. Women also had double the rate of depression (48.5% versus 22.5%), and men had double the rate of sleep apnea (80.3% versus 40.2%). Women were younger, less obese, and were less likely to be married. No gender differences were found in the association between HRQOL and co-morbidities. However, an increasing number of co-morbidities was associated with decreasing physical and mental HRQOL. Additionally, depression was associated with decreased mental HRQOL, and coronary heart disease was associated with decreased physical HRQOL. CONCLUSION Womens reduced HRQOL, particularly in self-esteem, sexual life, and physical functioning, and their greater rates of depression, might play a role in their decision to seek bariatric surgery. Although we could not determine causality, this study is a first step toward understanding why women seek surgery 5 times more often than men.

Cancer incidence among Mormons and non-Mormons in Utah (United States) 1971–85

We calculated age-adjusted incidence rates per 100,000 by religion (Mormon, non-Mormon) for Utah (United States) using the 49,182 cancer cases occurring between 1971–85. For all causes of cancer, the rate in Utah for male members of the Church of Jesus Christ of Latter-day Saints (LDS or Mormons) was about 24 percent less than the comparable US rate. There was a 50-percent lower rate of cancers associated with cigarette smoking among LDS men. Non-LDS (NLDS) men in Utah experienced an incidence of smoking-associated cancers slightly higher than other US men. LDS men had an incidence of those cancers not associated with smoking slightly lower than US men, and NLDS men had a 40-percent higher rate than US men because of higher rates of melanoma and cancers of the lip and prostate gland. LDS women had an all-sites cancer rate 24 percent below the comparable US rate, and a 60-percent lower rate of smoking-associated cancers. The incidence of cancer not associated with smoking was 20 percent lower for LDS women compared with US women and was the result of lower rates of cancers of the colon, breast, and uterine cervix. NLDS women had a 13-percent higher incidence of cancers not associated with smoking because of higher rates of cancers of the lip and breast.

Serum bilirubin levels, UGT1A1 polymorphisms and risk for coronary artery disease

Low levels of the antioxidative serum bilirubin are associated with vascular aging and an increased risk for coronary artery disease (CAD). UGT1A1 is the major gene influencing bilirubin concentrations. Therefore, we investigated an association of bilirubin levels and two polymorphisms in the promoter of UGT1A1 (-53(TA-repeat) polymorphism and T-3279G) in 477 patients with premature, familial CAD and 619 age- and sex-matched controls. Bilirubin concentrations were significantly lower in cases than in controls (0.62+/-0.36 vs. 0.76+/-0.41 mg/dl for men, p=1.2 x 10(-10); and 0.42+/-0.29 vs. 0.55+/-0.23 mg/dl, p=1.9 x 10(-9) for women). Both polymorphisms showed a strong association with bilirubin levels with higher levels for homozygote carriers of the minor allele. These associations were most pronounced in male controls and patients (p=5.9 x 10(-26) and p=3.4 x 10(-16), respectively, for the -53(TA-repeat) polymorphism). Logistic regression analysis revealed low bilirubin levels but not the UGT1A1 polymorphisms to be significantly associated with CAD: OR (95% CI) 0.90 (0.86-0.94), p=2.6 x 10(-6) for men and 0.77 (0.68-0.87), p=3.2 x 10(-5) for women, respectively for each 0.1mg/dl increase of bilirubin. These results indicate that it is rather decreased bilirubin levels in general than the changes in the genetic variation of this gene that increase the risk for CAD.

The relationship between body mass index and per cent body fat in the severely obese

Background:  International standards define clinical obesity according to body mass index (BMI) without reference to age and gender. Recent studies among adults in the normal to mildly obese BMI ranges have shown that the relationship between BMI and per cent body fat (% fat) differs by age and gender. The extent to which age and gender affect the relationship between BMI and % fat among more severely obese individuals is less known.