Dietary Reference Intakes for Energy (2023) / Chapter Skim
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8 Risk Characterization and Public Health Implications
8 Risk Characterization and Public Health Implications
Pages 179-204
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From page 179... ...
In this chapter, evidence from published systematic reviews, augmented when appropriate with other relevant scientific publications, are summarized. Because of inaccuracies in reported energy intakes, this approach relies on indicators of energy intake imbalances as exposures for evaluating the risks of adverse health outcomes for studied age and sex groups, primarily from high-income countries.
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From page 180... ...
The committee carried out an umbrella review (described in Chapter 3) of published systematic reviews to evaluate associations of body mass index (BMI)
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The most frequently stated limitation of BMI is that individuals with a high lean body mass (i.e., skeletal muscle) might have a high BMI without having excess body fat.
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From page 182... ...
Numerous studies have shown a strong linear relationship between high BMI and an increased risk for chronic disease. Although risk for some chronic disease states, such as cardiovascular diseases, may be better predicted by waist circumference, waist–hip ratio, or waist–height ratio, the body of evidence based on systematic reviews, meta-analysis, and Mendelian randomization indicate a profound relationship between high BMI and functional disabilities, impaired quality of life, serious disease states, and mortality.
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From page 183... ...
The analyses found that overweight and obesity were associated with a 24 percent increased risk for prediabetes, while overweight was associated with a 2-fold increased risk and obesity a 4.5-fold increased risk for type 2 diabetes. A systematic review to determine whether associations exist between sarcopenic obesity and risk of type 2 diabetes in adults with overweight and obesity found a 38 percent increased risk for type 2 diabetes among those with sarcopenic (compared to nonsarcopenic)
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From page 184... ...
Other systematic reviews for the risk of CVD found that waist circumference or waist–height ratio were better predictors of risk than BMI. Darbandi et al.
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From page 185... ...
(2022) searched previously published systematic reviews and meta-analyses of cohort studies to identify potential risk factors for prostate cancer.
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A systematic review of an overlapping set of epidemiological studies on the association of BMI with early-onset colorectal cancer risk was conducted in males and females aged less than 55 years old with BMI ≥ 25.0 (Li et al., 2021)
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From page 187... ...
BMI < 18.5 was associated with almost a 3-fold increased risk for fragility hip fracture, whereas a BMI > 30 decreased hip fracture risk by, on average, 42 percent. All-Cause Mortality Evidence from systematic reviews In addition to assessing the risk of hip fracture, Jiang et al.
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From page 188... ...
. Given the likelihood that weight gain in middle-aged to older adults is more likely to involve decreases in muscle mass and increases in abdominal adiposity as compared to younger adults, both systematic reviews selected studies with populations of middle-aged or older adults.
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. Weight Gain and Hypertension Weight gain and hypertension were evaluated in two systematic reviews (Jayedi et al., 2018; Sun et al., 2021)
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. In comparing highest weight gain to lowest weight gain categories in women after menopause, there was an increased risk of postmenopausal breast cancer (RR, 1.59; 95% CI, 1.23–2.05)
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The review included four studies with 6,901 participants and showed that weight cycling was associated with a 63 percent increased risk for all-cause mortality. A systematic review by Zou et al.
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(2019) conducted a systematic review to identify reports of intentional weight loss, weight cycling after intentional weight loss, bariatric surgery, and endometrial cancer risk.
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. Intentional Weight Loss and Chronic Disease Outcomes Evidence from Systematic Reviews Ma et al.
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. Medications Evidence from systematic reviews Whereas the effects of many medications on energy expenditure are unknown, a systematic review of 33 studies showed that continuous sedation or analgesia used in intensive care reduces energy expenditure as measured by indirect calorimetry (Dickerson and Roth-Yousey, 2005)
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From page 195... ...
and impaired bone accretion in children, susceptibility to infections, immune system vulnerability, and impaired wound healing. Critical Illness A systematic review of 103 articles that included 4,388 adults, children, and neonates showed that several physiological and clinical factors influencing energy expenditure are not included in predictive equations.
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From page 196... ...
FINDINGS AND CONCLUSIONS BMI and Health Outcomes Findings The committee finds that systematic reviews show that high BMI (in the WHO categories of overweight and obese) is associated with significantly increased risk for gestational diabetes, juvenile onset type 1 diabetes, childhood/adolescent asthma, prediabetes, type 2 diabetes, hypertension, stroke, premature myocardial infarct, coronary heart disease, several types of cancer, nonalcoholic fatty liver disease, age-related disability, and all-cause mortality, but lower risk of hip fracture.
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From page 197... ...
Conclusions he committee concludes that, considered collectively, the systematic reviews T on weight cycling and health outcomes examined by the committee suggest that weight cycling appears to reduce REE in persons with obesity at base line, especially in those who have severe obesity and those who cycle more frequently. However, these data are limited by small sample sizes, lack of standardized definition, and lack of more rigorous study designs such as DLW or metabolic chamber studies.
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From page 198... ...
2021. The association of weight change and all-cause mortality in older adults: A systematic review and meta-analysis.
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2019. The influence of maternal body mass index, maternal diabetes mellitus, and maternal smoking during pregnancy on the risk of childhood-onset type 1 diabetes mellitus in the offspring: Systematic review and meta analysis of observational studies.
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2021. Causal role of high body mass index in multiple chronic diseases: A systematic review and meta-analysis of Mendelian randomization studies.
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2017. Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: Systematic review and meta-analysis.
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2019. Intentional weight loss, weight cycling, and endometrial cancer risk: A systematic review and meta-analysis.
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From page 203... ...
2021. Association between weight cycling and risk of developing diabetes in adults: A systematic review and meta-analysis.
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