scholarly journals Higher risk of dementia in English older individuals who are overweight or obese

2020 ◽  
Vol 49 (4) ◽  
pp. 1353-1365 ◽  
Author(s):  
Yixuan Ma ◽  
Olesya Ajnakina ◽  
Andrew Steptoe ◽  
Dorina Cadar
Keyword(s):  
Body Weight ◽  
Abdominal Obesity ◽  
Central Obesity ◽  
Proportional Hazards ◽  
Normal Weight ◽  
Cox Proportional Hazards ◽  
Older Individuals ◽  
Obese Women ◽  
Dementia Incidence

Abstract Background Several risk factors contribute to dementia, but the role of obesity remains unclear. This study investigated whether increased body weight or central obesity were associated with a higher risk of developing dementia in a representative sample of older English adults. Methods We studied 6582 participants from the English Longitudinal Study of Ageing (ELSA) who were aged ≥50 years and were dementia-free at baseline, that being either wave 1 (2002–2003) for study members who started at wave 1, or at either wave 2 (2004–2005) or 4 (2008–2009) for those who began the study as refreshment samples. Body mass index (BMI) was measured at baseline and categorized into normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2) and obese (≥30 kg/m2). Central obesity was defined as a waist circumference (WC) >88 cm for women and >102 cm for men. Cumulative incidence of dementia was ascertained based on physician-diagnosed dementia, an overall score >3.38 on the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and Hospital Episodes Statistics (HES) data at every ELSA wave from baseline until wave 8 (2016–2017). Cox proportional hazards models were used to assess the association between baseline BMI levels or abdominal obesity in relation to dementia incidence during the mean follow-up period of 11 years. Results From the overall sample, 6.9% (n = 453) of participants developed dementia during the follow-up period of maximum 15 years (2002–2017). Compared with participants with normal weight, those who were obese at baseline had an elevated risk of dementia incidence [hazard ratio (HR) = 1.34, 95% confidence interval (CI) 1.07–1.61] independent of sex, baseline age, apolipoprotein E-ε4 (APOE-ε4), education, physical activity, smoking and marital status. The relationship was slightly accentuated after additionally controlling for hypertension and diabetes (HR = 1.31, 95% CI 1.03–1.59). Women with central obesity had a 39% greater risk of dementia compared with non-central obese women (HR = 1.39, 95% CI 1.12–1.66). When compared with a normal BMI and WC group, the obese and high WC group had 28% (HR = 1.28, 95% CI 1.03–1.53) higher risk of dementia. Conclusions Our results suggest that having an increased body weight or abdominal obesity are associated with increased dementia incidence. These findings have significant implications for dementia prevention and overall public health.

scholarly journals Combined association of general and central obesity with incidence and mortality of cancers in 22 sites

2020 ◽  
Author(s):  
Solange Parra-Soto ◽  
Fanny Petermann-Rocha ◽  
Jirapitcha Boonpor ◽  
Stuart R Gray ◽  
Jill P Pell ◽  
...  
Keyword(s):  
Central Obesity ◽  
Proportional Hazards ◽  
Normal Weight ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Models ◽  
Incidence And Mortality ◽  
Incidence Risk ◽  
The Mean ◽  
Risk Of Cancer

ABSTRACT Background Body mass index (BMI) and waist circumference (WC) are measures of general and central obesity, respectively, and both have been shown to be associated with cancer. However, there is insufficient evidence of their combined association with the risk of cancer. Objectives This study aimed to investigate the associations of combinations of BMI and WC with cancer at 22 sites. Methods A total of 386,101 (54.5% women) UK Biobank participants aged from 37 to 73 y were included. The outcomes were incidence of and mortality from cancer at 22 sites. Participants were categorized as normal weight (BMI 18.5–24.9) or overweight (including obese, BMI ≥ 25) and as normal WC or centrally obese (WC ≥ 94 cm for men and ≥80 cm for women). Four mutually exclusive groups were derived: 1) normal weight without central obesity, 2) normal weight with central obesity, 3) overweight without central obesity, and 4) overweight with central obesity. We used Cox proportional hazards models to estimate HRs and 95% CIs. Results The mean follow-up period was 8.8 y. Compared with participants with normal weight and WC, men who were overweight and centrally obese had higher cancer incidence risk at 3 sites [stomach (HR: 1.75; 95% CI: 1.33, 2.32; Padj = 0.002), kidney (HR: 1.45; 95% CI: 1.17, 1.81; Padj = 0.016), and colorectal (HR: 1.31; 95% CI: 1.17, 1.47; Padj < 0.001) cancer]. Similar associations were found at 4 sites in women [endometrial (HR: 2.48; 95% CI: 2.06, 2.98; Padj < 0.001), uterine (HR: 2.23; 95% CI: 1.89, 2.64; Padj < 0.001), kidney (HR: 1.84; 95% CI: 1.37, 2.46; Padj = 0.001), and breast (HR: 1.24; 95% CI: 1.16, 1.32; Padj < 0.001) cancer] and for all-cause cancer (HR: 1.07; 95% CI: 1.03, 1.10; Padj = 0.003). Only endometrial cancer mortality (HR: 3.28; 95% CI: 1.77, 6.07; Padj = 0.004) was significantly associated with being overweight and centrally obese. Conclusions The combination of general and central obesity was associated with a higher risk at several cancer sites and some associations were sex-specific.

scholarly journals Association of β-amyloid level, clinical progression and longitudinal cognitive change in normal older individuals

Neurology ◽  
2020 ◽  
pp. 10.1212/WNL.0000000000011222
Author(s):  
Laura M. van der Kall ◽  
Thanh Truong ◽  
Samantha C Burnham ◽  
Vincent Doré ◽  
Rachel S Mulligan ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Cognitive Change ◽  
Cox Proportional Hazards ◽  
Imaging Biomarkers ◽  
Older Individuals ◽  
Mixed Effect ◽  
Preclinical Ad ◽  
Risk Of Progression ◽  
Very High

Objective:To determine the effect of Aβ level on progression risk to MCI or dementia and longitudinal cognitive change in cognitively normal (CN) older individuals.Methods:All CN from the Australian Imaging Biomarkers and Lifestyle study (AIBL) with Aβ PET and ≥3 years follow-up were included (n=534; age 72±6 yrs; 27% Aβ positive; follow-up 5.3±1.7 yrs). Aβ level was divided using the standardised 0-100 Centiloid scale: <15 CL negative, 15-25 CL uncertain, 26-50 CL moderate, 51-100 CL high, >100 CL very high, noting >25 CL approximates a positive scan. Cox proportional hazards analysis and linear mixed effect models were used to assess risk of progression and cognitive decline.Results:Aβ levels in 63% were negative, 10% uncertain, 10% moderate, 14% high and 3% very high. Fifty-seven (11%) progressed to MCI or dementia. Compared to negative Aβ, the hazard ratio for progression for moderate Aβ was 3.2 (95% CI 1.3-7.6; p<0.05), for high was 7.0 (95% CI 3.7-13.3; p<0.001) and for very high was 11.4 (95% CI 5.1-25.8; p<0.001). Decline in cognitive composite score was minimal in the moderate group (-0.02 SD/year, p=0.05) while the high and very high declined substantially (high -0.08 SD/year, p<0.001; very high -0.35 SD/year p<0.001).Conclusion:The risk of MCI or dementia over 5 years in older CN is related to Aβ level on PET, 5% if negative vs 25% if positive but ranging from 12% if 26-50 CL to 28% if 51-100 CL and 50% if >100 CL. This information may be useful for dementia risk counselling and aid design of preclinical AD trials.

scholarly journals Obesity and risk of infections: results from men and women in the Swedish National March Cohort

2019 ◽  
Author(s):  
Francesca Ghilotti ◽  
Rino Bellocco ◽  
Weimin Ye ◽  
Hans-Olov Adami ◽  
Ylva Trolle Lagerros
Keyword(s):  
Proportional Hazards ◽  
Cox Model ◽  
Normal Weight ◽  
Cox Proportional Hazards ◽  
Event Analysis ◽  
Obese Women ◽  
Cox Models ◽  
Increased Risk ◽  
Repeated Events ◽  
Tract Infections

Abstract Background Previous studies have shown an association between body mass index (BMI) and infections, but the literature on type-specific community acquired infections is still limited. Methods We included 39 163 Swedish adults who completed a questionnaire in September 1997 and were followed through record-linkages until December 2016. Information on BMI was self-reported and infections were identified from the Swedish National Patient Register using International Classification of Diseases (ICD), Tenth Revision (ICD-10) codes. We fitted multivariable Cox proportional hazards models for time-to-first-event analysis, and we used extensions of the standard Cox model when repeated events were included. Results During a 19-year follow-up 32% of the subjects had at least one infection requiring health care contact, leading to a total of 27 675 events. We found an increased incidence of any infection in obese women [hazard ratio (HR) = 1.22; 95% confidence interval (CI) = 1.12; 1.33] and obese men (HR = 1.25; 95% CI = 1.09; 1.43) compared with normal weight subjects. For specific infections, higher incidences were observed for skin infections in both genders (HR = 1.76; 95% CI = 1.47; 2.12 for obese females and HR = 1.74; 95% CI = 1.33; 2.28 for obese males) and gastrointestinal tract infections (HR = 1.44; 95% CI = 1.19; 1.75), urinary tract infections (HR = 1.30; 95% CI = 1.08; 1.55) and sepsis (HR = 2.09; 95% CI = 1.46; 2.99) in obese females. When accounting for repeated events, estimates similar to the aforementioned ones were found. Conclusions Obesity was associated with an increased risk of infections in both genders. Results from multiple-failure survival analysis were consistent with those from classic Cox models.

scholarly journals Impact of Comorbidities On Physical Function And Survival of Middle-Aged As Compared To Older, Individuals With Cancer.

2021 ◽  
Author(s):  
Bogda Koczwara ◽  
Laura Deckx ◽  
Shahid Ullah ◽  
Marjan Van den Akker
Keyword(s):  
Functional Impairment ◽  
Proportional Hazards ◽  
Age Groups ◽  
Cox Proportional Hazards ◽  
Older Individuals ◽  
Middle Aged ◽  
Binary Logit ◽  
Comorbidity Index ◽  
Strength Of Association

Abstract Purpose: To investigate if comorbidity predicts mortality and functional impairment in middle-aged individuals with cancer (50-64 years) as compared to older individuals.Methods: A prospective cohort study. Outcomes were mortality and functional impairment at 5 years follow-up. Comorbidity was assessed using adjusted Charlson comorbidity index and polypharmacy (≥5 drugs) as surrogate for comorbidity. Multivariate Cox-proportional hazards and binary logit models were used to assess the risk of 5-year mortality and functional impairment respectively.Results: We included 477 middle-aged (50-64 years) and 563 older (65+ years) individuals with cancer. The prevalence of comorbidity (at least one disease in addition to cancer) was 29% for middle-aged and 45% for older individuals, with polypharmacy observed in 15% and 31% respectively. Presence of ≥3 comorbidities nearly tripled the mortality risk in middle-aged individuals (HR 2.97, 95% CI: 1.43-6.16). In older individuals the HR was 1.7 (95% CI 1.1-2.8). Polypharmacy also significantly increased the risk for mortality in middle-aged (HR 2.35, 95% CI 1.32- 4.16) but not in older individuals (HR 1.2, 95% CI 0.9-1.8). Polypharmacy quadrupled the risk for functional impairment in middle-aged (OR 4.0, 95% CI 1.59-10.06) and older individuals (OR 4.4, 95% CI 1.6-11.7). Conclusion: Comorbidity and polypharmacy are associated with inferior outcomes in younger and older cancer individuals with the strength of association in younger individuals exceeding that of older individuals. Assessment and management of comorbidity should be a priority for cancer care across all age groups.

scholarly journals Changes in Plant Based Diets and Subsequent Risk of Type 2 Diabetes: Results from 3 Large US Cohorts

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1387-1387
Author(s):  
Zhangling Cheng ◽  
Jean-Philippe Drouin-Chartier ◽  
Yanping Li ◽  
Megu Baden ◽  
JoAnn Manson ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Body Weight ◽  
Proportional Hazards ◽  
Meta Analysis ◽  
Cox Proportional Hazards ◽  
Health Study ◽  
Weight Changes ◽  
Cox Proportional Hazards Models

Abstract Objectives Plant-based diets may lower type 2 diabetes (T2D) risk. Whether changes in adherence to plant-based diets are associated with subsequent T2D risk remains unknown. We aimed to evaluate the associations between 4 year changes in plant based diets and subsequent 4 year risk of T2D. Methods We prospectively followed 76,530 women in the Nurses’ Health Study (NHS, 1986–2012), 81,586 women in NHS II (1991–2017), and 34,468 men in the Health Professionals’ Follow-up Study (1986–2016). Diet was assessed every 4 years using validated food-frequency questionnaires. Adherence to plant-based diets was assessed using previously developed indices – the overall plant-based diet index (PDI), the healthful PDI (hPDI), and the unhealthful PDI (uPDI). Self reported T2D cases were validated by supplementary questionnaires. We used multivariable time dependent Cox proportional hazards models to estimate hazard ratios (HR) and 95% CIs for T2D associated with 4 year changes in adherence to plant based diets. Results of the three cohorts were pooled using an inverse variance-weighted meta-analysis. Results We documented 12,016 cases of T2D during 2818,485 person-years of follow-up. After adjustment for initial BMI, initial and 4-year changes in lifestyle and other factors, compared with participants whose indices remained relatively stable (±3%), participants with the largest 4-year decrease (&gt;10%) in PDI and hPDI had a 12%-23% higher T2D risk in the subsequent 4 years (HR for PDI, 1.12 (95% CI 1.05, 1.20), HR for hPDI, 1.23 (1.16, 1.31)). Conversely, each 10% incremental increase in PDI and hPDI over 4 years was associated with a 7%–9% lower T2D risk in subsequent 4 years (HR for PDI, 0.93 (0.90, 0.95), HR for hPDI, 0.91 (0.87, 0.95)). Changes in uPDI were not associated with T2D risk. Further adjustment for concurrent changes in body weight, a potential mediator, modestly attenuated the associations but results remained significant. We estimated that body weight changes explained 6.0%–36% of the associations between 4 year changes in PDI and hPDI and subsequent T2D risk. Conclusions Improving adherence to overall and healthful plant based diets over a 4 year period was associated with a lower T2D risk, whereas decreased adherence to overall and healthful plant based diets was associated with a higher T2D risk. Funding Sources Nutricia Research Foundation/NIH.

scholarly journals Markers of cognitive reserve and dementia incidence in the English Longitudinal Study of Ageing

2020 ◽  
pp. 1-9 ◽  
Author(s):  
Pamela Almeida-Meza ◽  
Andrew Steptoe ◽  
Dorina Cadar
Keyword(s):  
Longitudinal Study ◽  
Cognitive Reserve ◽  
Proportional Hazards ◽  
Leisure Activities ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Ageing Population ◽  
Dementia Incidence ◽  
English Longitudinal Study

Background In the current climate of an ageing population, it is imperative to identify preventive measures for dementia. Aims We implemented a multifaceted index of cognitive reserve markers and investigated dementia incidence over 15 years of follow-up in a representative sample of the English population. Method Data were 12 280 participants aged ≥50 years from the English Longitudinal Study of Ageing, free from dementia at their baseline assessments during wave 1 (2002–2003), 3 (2006–2007) or 4 (2008–2009), and followed up until wave 8 (2016–2017). The Cognitive Reserve Index was constructed as a composite measure of education, occupation and leisure activities, using a standardised questionnaire. Cox proportional hazards regression models were used to estimate the hazard ratios of dementia in relation to cognitive reserve levels (low, medium and high) and its components (education, occupation and leisure activities). Results During the follow-up period, 602 participants aged 56–99 years developed dementia. Higher levels of cognitive reserve (hazard ratio 0.65, 95% CI 0.48–0.89, P = 0.008) were associated with a lower risk of dementia. An individual analysis of its components showed that higher levels of education (hazard ratio 0.56, 95% CI 0.36–0.88, P = 0.012), occupation (hazard ratio 0.72, 95% CI 0.56–0.91, P = 0.008) and leisure activities (hazard ratio 0.74, 95% CI 0.56–0.99, P = 0.047) were predictive of a reduced dementia risk, with the first two components particularly protective in younger participants (<85 years). Conclusions This study showed a reduced risk of dementia for individuals with a higher level of cognitive reserve, represented by higher education, complex occupations and multifaceted level of leisure activities.

scholarly journals Body Weight Fluctuation as a Risk Factor for Type 2 Diabetes: Results from a Nationwide Cohort Study

2019 ◽  
Vol 8 (7) ◽  
pp. 950 ◽  
Author(s):  
Kye-Yeung Park ◽  
Hwan-Sik Hwang ◽  
Kyung-Hwan Cho ◽  
Kyungdo Han ◽  
Ga Eun Nam ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Body Weight ◽  
Risk Factor ◽  
Cohort Study ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
National Health Insurance System ◽  
Weight Fluctuation

We aimed to investigate how body weight fluctuation affects the risk of developing type 2 diabetes by conducting a nationwide cohort study. A total of 3,855,884 participants from the National Health Insurance System health check-up data from 2012 were included in this study, and follow-up continued until 2016. Body weight was measured at least thrice between 2009 and 2012. Body weight variability (BWV) was estimated using average successive variability (ASV) indices. Cox proportional hazards regression models were used to evaluate the association of BWV with the risk of type 2 diabetes using hazard ratios (HRs) and 95% confidence intervals (CIs). Body weight fluctuation was associated with a higher risk of incident diabetes after adjustment for confounders (HR 1.10, 95% CI 1.07, 1.12 in the highest BWV quartile compared to the lowest). Regardless of the weight change status, the highest ASV quartile of BWV increased the risk for diabetes. Even subjects with a normal glucose tolerance status and those aged under 65 years had a higher risk of diabetes if their body weight highly fluctuated during the follow-up years. Our results suggest that body weight variability is an independent risk factor for diabetes. It is important to pay attention to frequent body weight fluctuations.

scholarly journals Association between dynamic obesity and mortality in patients with first-ever ischemic stroke: a hospital-based prospective study

2019 ◽  
Author(s):  
Ju Wang ◽  
Jijie Li ◽  
Mier Li ◽  
Lisha Hou ◽  
Ping Zhu ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Abdominal Obesity ◽  
Proportional Hazards ◽  
Personal Characteristics ◽  
Normal Weight ◽  
Cox Proportional Hazards ◽  
Stroke Survivors ◽  
Risk Of Mortality ◽  
Obesity Status ◽  
All Cause Mortality

Abstract Background and Purpose: Although obesity is an established risk factor for the occurrence of a primary stroke, the association between obesity with post-stroke mortality remains unclear. We evaluated the association of dynamic obesity status with mortality among first-ever stroke survivors in China. Methods: Data from 775 patients with first-ever ischaemic stroke from a longitudinal study, 754 patients were categorized 4 categories of BMI (underweight, normal weight, overweight and obese) and 2 categories of WC (normal WC and abdominal obesity) according to Chinese-specific criteria. Mortality information and obesity status were obtained through every 3 months via telephone follow-up, beginning in 2010 and continuing through 2016. Chi-square tests were used to compare different obesity status at admission and personal characteristics. Time-dependent Cox proportional hazards models were used to estimate the unadjusted and adjusted hazard ratios (HRs) for relationship between all-cause mortality and dynamic obesity status. Results: Of 754 analyzed patients, 60.87% were males, with a mean age of 61.45 years. After adjusting for possible confounders, there were significant inverse associations between BMI and WC with all-cause mortality: compared with normal BMI or WC counterparts, overweight and abdominal obesity patients significantly decrease risk of all-cause mortality (HR and 95% confidence interval (CI):0.521(0.303,0.897),0.545(0.352,0.845),respectively), whereas under-weight patients have the highest risk and obese have decreased risk of mortality, though significance was not obtained (1.241(0.691,2.226),0.486(0.192,1.231), respectively). Conclusions: Overweight and abdominal obesity was paradoxically associated with reduced risk of mortality among first-ever ischaemic stroke survivors in China. Body weight management recommendations ought to not be based on mere projection from primary prevention of stroke.

P5743Overweight and obesity in adolescent men in Sweden and risk of early stroke

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Rosengren ◽  
J Robertson ◽  
M Schaufelberger ◽  
D Aberg ◽  
L Schioler ◽  
...  
Keyword(s):  
Body Weight ◽  
Parental Education ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Overweight And Obesity ◽  
Weight Category ◽  
Adjusted Risk ◽  
Early Stroke

Abstract Background Increasing numbers of stroke cases in the young are reported in many countries, potentially at least partly due to rising rates of overweight and obesity. Most data on the effect of obesity on stroke is derived from middle aged populations; there is a comparative lack of information on the effect of excessive body weight in young people. Purpose We aimed to determine whether body mass index (BMI) at age 18 predicted early stroke events among men in Sweden. Methods Population-based Swedish cohort study of conscripts (n=1,668,921; mean age at baseline, 18.3 years) who enlisted during 1968–2005. Follow-up was done through linkage to the nationwide Swedish patient and death registries. Risk of a first hospitalization for stroke (any type) during follow-up (5–46 years) was calculated with Cox proportional hazards models. Objective baseline measures of fitness and cognition were included in the models in a second set of analyses. Results During follow-up there were 12,512 first hospitalizations for stroke (mean age at diagnosis, 48.5 (SD 9.4) years, maximum 64 years). Compared with men with BMI of 18.5 to 20.0 kg/m2, men with BMI 20 to <22.5 and 22.5 to <25.0 kg/m2 had hazard ratios (HR) of 1.06 (1.00–1.12) and 1.23 (1.14–1.31), respectively, for hospitalization for stroke, after adjustment for age, year of conscription, comorbidities at baseline, parental education, blood pressure, IQ, muscle strength, and fitness. Those with a BMI of ≥35 kg/m2 had an HR of 3.33 (2.46–4.51) for an event before the age of 65, compared to slim men. The multiple-adjusted risk per 1-unit increase in BMI was 1.07 (95% CI, 1.06–1.08). Conclusion We found a rise in risk of early hospitalisation for stroke detectable already at normal levels of body weight at age 18, and rising to more than 3-fold in the highest weight category. Given increasing levels of body weight, and prevalence of overweight, obesity, and severe obesity in young adults, the increased incidence of stroke in the young may potentially partly be explained by rising body weight, with an obvious potential for prevention.

scholarly journals General thoughts of death and mortality: findings from the Komo-Ise cohort, Japan

2018 ◽  
Vol 28 (6) ◽  
pp. 662-669 ◽  
Author(s):  
A. Stickley ◽  
C. F. S. Ng ◽  
C. Watanabe ◽  
Y. Inoue ◽  
A. Koyanagi ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Older Individuals ◽  
Community Based ◽  
Wish To Die ◽  
Married Individuals ◽  
Older Subjects ◽  
Older Citizens

AbstractAimsDeath ideation (thinking about/wishing for one's own death, thinking that one would be better off dead) is linked to an increased mortality risk. However, comparatively little is known about more general thoughts of death (GTOD) where no wish to die or life value is expressed. This study examined whether GTOD predicted mortality in a community-based cohort of older adults.MethodsData came from the Komo-Ise cohort study in Gunma prefecture, Japan. The analytic sample comprised 8208 individuals (average age 61.3 (range 47–77)) who were asked in wave 2 of the study in 2000 if they had ‘Thought about death more than usual, either your own, someone else's or death in general?’ in the past 2 weeks. Death data were obtained from the municipal resident registration file. Cox proportional hazards regression analysis was used to examine associations.ResultsDuring the follow-up period (2000–2008), there were 672 deaths. In a model adjusted for baseline covariates, GTOD were significantly associated with all-cause mortality (hazards ratio 1.66, 95% confidence interval 1.20–2.29). Stratified analyses showed an association between GTOD and mortality in men, older subjects (⩾70 years), married individuals and those with higher social support.ConclusionsGTOD are associated with an increased mortality risk among older citizens in Japan. Research is now needed to determine the factors underlying this association and assess the clinical relevance of screening for GTOD in older individuals.

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