Years of Life Lost and Healthy Life-Years Lost From Diabetes and Cardiovascular Disease in Overweight and Obese People: A Modelling Study | Journal Scan

Dec 18, 2014
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Authors:
Grover SA, Kaouache M, Rempel P, et al.
Citation:
Lancet Diabetes Endocrinol 2014;Dec 4:[Epub ahead of print].
Summary By:
Prashant Vaishnava, MD, FACC

Study Questions:

What is the impact of excess bodyweight on years of life lost and healthy life-years lost?

Methods:

This was a Markov state-transition model that was used to estimate the life expectancy and healthy life expectancy associated with excess bodyweight. The annual risk of diabetes, cardiovascular disease, and mortality was projected for men and women with body mass index (BMI) of 25-<30 kg/m2 (overweight), 30-<35 kg/m2 (obese), or 35 kg/m2 and higher (very obese), compared to those with an ideal BMI of 18.5-<25 kg/m2. The model was based on data from the National Nutrition and Examination Survey (2003-2010). Healthy life-years were those free of diabetes or cardiovascular disease.

Results:

Compared to those men ages 20-39 years with an ideal bodyweight, overweight men lost 2.7 years (95% confidence interval [CI], 1.6-3.8), obese men lost 5.9 years (95% CI, 4.4-7.4), and very obese men lost 8.4 years (95% CI, 7.0-9.8). Compared to those women ages 20-39 years with an ideal bodyweight, the years lost were 6.1 years (95% CI, 4.7-7.6) for very obese women. The effect of excess weight decreased with increasing age; the effect of excess bodyweight was small in older women, especially for those who were only overweight. Healthy life-years lost were greater than years of life lost for all groups of overweight and obese individuals. For example, compared to men and women ages 20-39 years with ideal bodyweight, very obese men and very obese women in this age group lost 18.8 years and 19.1 healthy-years, respectively.

Conclusions:

The authors concluded that in a Markov state-transition model, excess bodyweight was associated with a significant burden of both years of life and healthy life-years lost, especially among younger individuals.

Perspective:

This is a creative study in which the authors utilize a Markov model to characterize the impact of excess bodyweight on the annual probability of specific fatal and nonfatal cardiovascular outcomes. The results from this analysis may help frame shared decision making in overweight and obese individuals, potentially engaging them to reach weight and treatment targets. The authors also draw attention to the need to focus not only on absolute years of life lost, but also healthy life-years lost.

Keywords: Body Mass Index, Cardiovascular Diseases, Cost of Illness, Decision Making, Diabetes Mellitus, Ideal Body Weight, Life Expectancy, Obesity, Overweight


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