class: RWH_bg_title # .black[Body weight and vasculitis] <!-- ### And how to keep healthy --> .RWH_footnote_title[ .RWH_footer_bold[ Rob Hunter | @renalrob ] ] .RWH_footnote_right_title[ .RWH_footer_bold[ LCTF | 17th Aug 2024 ] ] ??? Slides created with [xaringan](https://github.com/yihui/xaringan). --- # Overview - why it may be worth paying extra attention to body weight if you have vasculitis <br> - what can I do to keep a healthy body weight? <br> - what can I do to stay healthy in general? .RWH_footnote_right[.RWH_footer_style[slides at: www.kidneyfish.net/talks/]] --- class: inverse, center, middle # .white[Why it may be worth paying extra attention to body weight in vasculitis] --- # Other medical problems  .RWH_footnote_right[.RWH_footer_style[[Sarica et al,. A&R (2021)](https://doi.org/10.1002/art.41557)]] ??? Risk of chronic diseases after a diagnosis of AAV. These are relative risks but remember absolute risks important (so CVS disease prominent). Linkage study relies on coding - so what are we missing? Obesity? We decided to find out... <br> <br> ## Notes 500 Scottish patients (with 5x matched general population controls) in National data linkage study. Absolute rates of CVS disease and HTN higher than for osteoporosis. See also: - [Sanchez-Alamo et al. (2023)](https://academic.oup.com/ndt/article/38/7/1655/6973211) - [Robson et al. (2015)](https://pubmed.ncbi.nlm.nih.gov/24243925/) - [Flossman et al. (2011)](https://pubmed.ncbi.nlm.nih.gov/21109517/) <br> Main causes of death in AAV are: - infection - CVS disease - malignancy <br> Morbidity: - HTN - T2DM - osteoporosis - maliganacy --- # Weight changes in vasculitis  .RWH_footnote_right[.RWH_footer_style[Salehi al,. (in revision)]] ??? 215 patients with AAV. --- # BMI categories  ??? 55% overweight or obese at baseline; 65% at 6 months. General population is 67%. So actually, perhaps not too bad. Or are there good reasons to pay particular attention to body weight / lifestyle in AAV? (Yes there are - because CVS risk is elevated and other facets of healthy lifestyle may be hard to achieve.) <br> <br> ### Notes [Risks of obesity](https://www.nhs.uk/conditions/obesity/): - CVS disease - T2DM - HTN - OA - pregnancy morbidity - liver and kidney disease - bowel cancer, breast cancer - sleep apnoea... - reduced life-expectancy by 3 -- 10 yrs --- class: inverse, center, middle # .white[What can I do to keep a healthy body weight?] --- # Losing weight Keep it simple: diet and exercise. (Which is more important?) Calculate your [BMI](https://www.bhf.org.uk/informationsupport/support/healthy-living/managing-your-weight). Know where to get help: - [NHS inform](https://www.nhsinform.scot/healthy-living/): including 12 week program - [BHF advice](https://www.bhf.org.uk/informationsupport/support/healthy-living/managing-your-weight#Heading5) - [NHS Lothian Weight Management & T2DM Prevention Programs](https://services.nhslothian.scot/awmt2d/#): can self-refer More medical options coming (e.g. avacopan, semaglutide = "ozempic"). ??? Simple things: - regular meals; don't skip breakfast - 5 portions of fruit and veg - plan meals ahead - increase exercise you might be doing anyway (walking dog, stairs instead of lift...) - build moderate exercise into a routine rather than going for high-intensity <br> <br> ### Notes Diet probably more important than exercise. Why does exercise not necessarily help with weight loss? See [Pontzer (Curr Biol 2016)](https://doi.org/10.1016/j.cub.2015.12.046). Total energy expenditure rises with lower levels of physical activity but then plateaus at higher levels. Not clear why but perhaps induces metabolic adaptations. Nevertheless exercise does confer many health benefits and so is recommended by [UK Chief Medical Officers](https://www.gov.uk/government/publications/physical-activity-guidelines-uk-chief-medical-officers-report) for its effect on all-cause mortality, CVS disease, HTN, T2DM, cancers, depression, cognitive function, falls etc. ---  .RWH_footnote_right[.RWH_footer_style[[UK Chief Medical Officers Guidance](https://www.gov.uk/government/publications/physical-activity-guidelines-uk-chief-medical-officers-report)]] ---  --- class: inverse, center, middle # .white[What can I do to stay healthy in general?] ---  ??? Main factors are: - healthy diet (i.e. lots of fruit and veg; not processed) - physical activity - good sleep - no smoking - minimal EtOH - maintain healthy BMI Each factor adds 2 - 3 yrs to life-expectancy: additive. <br> To these six, add home ABP montoring if have vasculitis (or CKD). See: - [BHF blog post](https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/tests/blood-pressure-measuring-at-home) - [BHISOC PIL](https://bihsoc.org/resources/bp-measurement/hbpm/) <br> <br> ### Notes [WHO](https://www.who.int/europe/news-room/fact-sheets/item/a-healthy-lifestyle---who-recommendations): - recommendations for healthy living <br> [Li (Circulation, 2018)](https://pubmed.ncbi.nlm.nih.gov/29712712/): - life expectancy from 50 yrs in USA population - lifestyle factors = smoking, >30 mins per day of moderate activity (inc. brisk walking), moderate EtOH, BMI 19-25, diet - 80% of CVD explained by lifestyle factors (see Abramson, BMJ 2013) - therefore GAIN 2.5 – 2.8 yrs PER lifestyle factor! <br> [Khera (NEJM, 2016)](https://pubmed.ncbi.nlm.nih.gov/27959714/): - computed polygenic risk score and adherence to healthy lifestyle in 3 prospective and 1 cross-sectional cohorts (n = 55,000) - healthy lifestyle = smoking, BMI < 30, weekly physical activity, healthy diet (fruits, nuts, veg, fish and NOT refined / processed food) - high vs. low genetic risk score = increase RR for coronary events by 91% - healthy life-style reduced 10 yr event rate across all strata of genetic risk - if high genetic risk, healthy lifestyle (vs. unhealthy) = RRR 46% <br> [Nguyen (AJCN, 2024)](https://doi.org/10.1016/j.ajcnut.2023.10.032): - observational study in 700,000 US veterans, examining 8 lifestyle factors (never smoking, exercise, diet, restorative sleep, stress management, social connections, no XS EtOH, no opiod abuse) - each lifestyle factor associated with c. 2.5 -- 3.0 yrs extra life expectancy <br> [Bian (BMJEMB, 2023)](https:// doi.org/10.1136/bmjebm- 2023-112583): - UK Biobank study in 350,000 adults - polygenic risk score for lifespan plus lifestyle score (smoking, EtOH, exercise, body shape, sleep duration, diet) - HR for death with high- vs. low-risk genes = 1.2 - HR for death with high- vs. low-risk lifestyle = 1.8 - genetic and lifestyle factors associate independently with lifespan - a healthy lifestyle can attenuate genetic risk - optimal lifestyle combination = never smoking, regular exercise, healthy diet, adequate sleep duration ---  ??? Exercise, sleep and BMI (and HTN see below) may be harder if AAV. --- # Take-home messages - weight gain is common after a diagnosis of vasculitis <br> - overall rates of obesity are no higher than the general population <br> - ...but maintaining a healthy body weight all the more important in vasculitis <br> - diet, exercise, ask for help!