start-ver=1.4
cd-journal=joma
no-vol=7
cd-vols=
no-issue=
article-no=
start-page=e8146
end-page=
dt-received=
dt-revised=
dt-accepted=
dt-pub-year=2019
dt-pub=20191129
dt-online=
en-article=
kn-article=
en-subject=
kn-subject=
en-title=
kn-title=Combined effects of body mass index and unhealthy behaviors on disability in older Japanese adults: the Okayama study
en-subtitle=
kn-subtitle=
en-abstract=
kn-abstract=Background: Body mass index (BMI) is a significant predictor of functional disability in older adults. However, when evaluated, the association between BMI and incident functional disability, considering behaviors only as covariates or not, may not be appropriate. The primary purpose of the study was to investigate the combined effects of BMI and unhealthy behaviors on the risk of incident functional disability. <br/>
Methods: This was a retrospective cohort study that took place in Okayama City, Japan. Data on BMI and unhealthy behaviors were obtained using the health check-up questionnaire. The certification of Long-Term Care Insurance was used to measure functional disability. Cox proportional hazard models were used; adjusted hazard ratios (HRs) with 95% confidence interval (CI) were calculated for incidence of functional disability across categories of BMI and number of unhealthy behaviors. <br/>
Results: The relationship between BMI and incident functional disability was U-shaped (HR = 1.18, 95% CI [1.11-1.25], among the underweight range; and 1.26 [1.19-1.34] among the obesity range), and its risk was significantly higher within the normal-to-overweight range of BMI values with co-occurring unhealthy behaviors (with normal weight range and one, 1.17 [1.01-1.21]; two, 1.29 [1.18-1.41]; and three or four unhealthy behaviors 1.38 [1.24-1.54]; as well as among overweight range and one, 1.16 [1.05-1.27]; two, 1.26 [1.15-1.38]; and three or four unhealthy behaviors, 1.47 [1.31-1.64]). In each BMI category, the risk of incident functional disability increased with increasing number of unhealthy behaviors (p < 0.05 for linear tread), with the highest risk (1.87 [1.58-2.20]) occurring in combination with at least three unhealthy behaviors with BMI >= 27.5, for both sexes (2.20 [1.64-2.92] in men and 1.66 [1.35-2.04] in women). <br/>
Conclusion: It is necessary to consider the combined effects of BMI and behaviors on incident functional disability. Furthermore, interventions targeting multiple behaviors should be considered as such interventions may offer greater benefits than simple interventions.
en-copyright=
kn-copyright=

en-aut-name=LiuYangyang
en-aut-sei=Liu
en-aut-mei=Yangyang
kn-aut-name=
kn-aut-sei=
kn-aut-mei=
aut-affil-num=1
ORCID=

en-aut-name=MitsuhashiToshiharu
en-aut-sei=Mitsuhashi
en-aut-mei=Toshiharu
kn-aut-name=
kn-aut-sei=
kn-aut-mei=
aut-affil-num=2
ORCID=

en-aut-name=YamakawaMichiyo
en-aut-sei=Yamakawa
en-aut-mei=Michiyo
kn-aut-name=
kn-aut-sei=
kn-aut-mei=
aut-affil-num=3
ORCID=

en-aut-name=SasaiMegumi
en-aut-sei=Sasai
en-aut-mei=Megumi
kn-aut-name=
kn-aut-sei=
kn-aut-mei=
aut-affil-num=4
ORCID=

en-aut-name=TsudaToshihide
en-aut-sei=Tsuda
en-aut-mei=Toshihide
kn-aut-name=
kn-aut-sei=
kn-aut-mei=
aut-affil-num=5
ORCID=

en-aut-name=DoiHiroyuki
en-aut-sei=Doi
en-aut-mei=Hiroyuki
kn-aut-name=
kn-aut-sei=
kn-aut-mei=
aut-affil-num=6
ORCID=

en-aut-name=HamadaJun
en-aut-sei=Hamada
en-aut-mei=Jun
kn-aut-name=
kn-aut-sei=
kn-aut-mei=
aut-affil-num=7
ORCID=

affil-num=1
en-affil=Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
kn-affil=

affil-num=2
en-affil=Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama University
kn-affil=

affil-num=3
en-affil=Department of Epidemiology and Preventive Medicine, Graduate School of Medicine,Gifu University
kn-affil=

affil-num=4
en-affil=Sri Lanka Office, Japan International Cooperation Agency
kn-affil=

affil-num=5
en-affil=Department of Human Ecology, Graduate School of Environmental and Life Science, Okayama University
kn-affil=

affil-num=6
en-affil=Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
kn-affil=

affil-num=7
en-affil=Department of Health Economics and Policy, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
kn-affil=
en-keyword=Elderly
kn-keyword=Elderly
en-keyword=Disability
kn-keyword=Disability
en-keyword=Body mass index
kn-keyword=Body mass index
en-keyword=Long-term care insurance
kn-keyword=Long-term care insurance
en-keyword=Unhealthy behaviors
kn-keyword=Unhealthy behaviors
END