In the Journals

Cardiometabolic staging system evaluates mortality risk better than obesity system

When evaluating mortality risk among adults aged 40 to 75 years, researchers may achieve more accurate and discriminate predictions by using the cardiometabolic disease staging system instead of the Edmonton obesity staging system, according to findings published in Obesity.

“Stratifying populations by obesity-related disease risk is fundamental for providing appropriate medical care and for optimally distributing limited resources,” Tapan Mehta, PhD, associate professor in the department of health services administration at the University of Alabama at Birmingham, and colleagues wrote.

Mehta and colleagues evaluated how well the cardiometabolic disease staging (CMDS) system and the Edmonton obesity staging system (EOSS) worked in terms of prediction and discrimination of mortality based on data from 28,419 participants aged 40 to 75 years in the National Health and Nutrition Examination Survey.

According to the researchers, there are five risk stages in the CMDS: stage 0 (metabolically healthy), stage 1 (low risk), stage 2 (medium risk), stage 3 (high risk) and stage 4 (end-stage disease). The EOSS includes four risk stages based on “functional health,” as well as fasting glucose, blood pressure, LDL cholesterol, HDL cholesterol, total cholesterol, triglycerides, liver disease, estimated glomerular filtration rate and osteoarthritis.

Doctor reviewing medical chart_Shutterstock 
When evaluating mortality risk among adults aged 40 to 75 years, researchers may achieve more accurate and discriminate predictions by using the cardiometabolic disease staging system instead of the Edmonton obesity staging system.
Source: Shutterstock

“Although CMDS was suggested to have better predictive and discriminative ability than EOSS, we have to note their conceptual difference,” the researchers wrote. “The EOSS is focused on ranking individuals with obesity on the basis of severity of obesity, which includes functional and mental health status. ... Meanwhile, CMDS was developed to rank individuals on the basis of severity of cardiometabolic condition, which was identified to be associated with obesity. This conceptual difference may explain the greater predictive and discriminative ability of CMDS.”

Using the EOSS, there was a 6.76-year reduction in life expectancy as measured by median years of life lost among participants who were considered stage 3 and a 1.19-year reduction in life expectancy for those considered stage 2 vs. those of stages 0 to 1. Using the CMDS, there was a 8.51-year reduction in life expectancy as measured by median years of life lost among participants who were considered stage 4, a 3.91-year reduction in those considered to be stage 3, a 2.9-year reduction for those considered to be stage 2 and a 1.53-year reduction for those considered to be stage 1 vs. those considered to be stage 0.

How well each system predicted mortality was evaluated by Kent and O’Quigley pseudo-R2 and Royston and Sauerbrei pseudo-R2, whereas how well they discriminated was evaluated by C-statistics. CMDS scored 0.02 points higher on the Kent and O’Quigley pseudo-R2 assessment (95% CI, 0.01-0.04), 0.03 points higher on the Royston and Sauerbrei pseudo-R2 assessment (95% CI, 0.01-0.04) and 0.02 points higher in C-statistics (9% CI, 0.01-0.02), “suggesting that the ability of CMDS to predict and discriminate mortality risk is greater than that of EOSS.”

“Our study demonstrates a higher predictive and discriminative ability of the CMDS score for mortality compared with the EOSS score. CMDS also uses simple point values that can be calculated in clinical settings using basic information available to health care professionals that may make its integration into a busy clinic more feasible,” the researchers wrote. “Enhanced use of CMDS in a clinical setting, because of its higher discriminative ability and potentially easier integration into practices with fewer measurements, may provide for more timely interventions in targeted populations.” – by Phil Neuffer

Disclosures: Mehta reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

When evaluating mortality risk among adults aged 40 to 75 years, researchers may achieve more accurate and discriminate predictions by using the cardiometabolic disease staging system instead of the Edmonton obesity staging system, according to findings published in Obesity.

“Stratifying populations by obesity-related disease risk is fundamental for providing appropriate medical care and for optimally distributing limited resources,” Tapan Mehta, PhD, associate professor in the department of health services administration at the University of Alabama at Birmingham, and colleagues wrote.

Mehta and colleagues evaluated how well the cardiometabolic disease staging (CMDS) system and the Edmonton obesity staging system (EOSS) worked in terms of prediction and discrimination of mortality based on data from 28,419 participants aged 40 to 75 years in the National Health and Nutrition Examination Survey.

According to the researchers, there are five risk stages in the CMDS: stage 0 (metabolically healthy), stage 1 (low risk), stage 2 (medium risk), stage 3 (high risk) and stage 4 (end-stage disease). The EOSS includes four risk stages based on “functional health,” as well as fasting glucose, blood pressure, LDL cholesterol, HDL cholesterol, total cholesterol, triglycerides, liver disease, estimated glomerular filtration rate and osteoarthritis.

Doctor reviewing medical chart_Shutterstock 
When evaluating mortality risk among adults aged 40 to 75 years, researchers may achieve more accurate and discriminate predictions by using the cardiometabolic disease staging system instead of the Edmonton obesity staging system.
Source: Shutterstock

“Although CMDS was suggested to have better predictive and discriminative ability than EOSS, we have to note their conceptual difference,” the researchers wrote. “The EOSS is focused on ranking individuals with obesity on the basis of severity of obesity, which includes functional and mental health status. ... Meanwhile, CMDS was developed to rank individuals on the basis of severity of cardiometabolic condition, which was identified to be associated with obesity. This conceptual difference may explain the greater predictive and discriminative ability of CMDS.”

Using the EOSS, there was a 6.76-year reduction in life expectancy as measured by median years of life lost among participants who were considered stage 3 and a 1.19-year reduction in life expectancy for those considered stage 2 vs. those of stages 0 to 1. Using the CMDS, there was a 8.51-year reduction in life expectancy as measured by median years of life lost among participants who were considered stage 4, a 3.91-year reduction in those considered to be stage 3, a 2.9-year reduction for those considered to be stage 2 and a 1.53-year reduction for those considered to be stage 1 vs. those considered to be stage 0.

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How well each system predicted mortality was evaluated by Kent and O’Quigley pseudo-R2 and Royston and Sauerbrei pseudo-R2, whereas how well they discriminated was evaluated by C-statistics. CMDS scored 0.02 points higher on the Kent and O’Quigley pseudo-R2 assessment (95% CI, 0.01-0.04), 0.03 points higher on the Royston and Sauerbrei pseudo-R2 assessment (95% CI, 0.01-0.04) and 0.02 points higher in C-statistics (9% CI, 0.01-0.02), “suggesting that the ability of CMDS to predict and discriminate mortality risk is greater than that of EOSS.”

“Our study demonstrates a higher predictive and discriminative ability of the CMDS score for mortality compared with the EOSS score. CMDS also uses simple point values that can be calculated in clinical settings using basic information available to health care professionals that may make its integration into a busy clinic more feasible,” the researchers wrote. “Enhanced use of CMDS in a clinical setting, because of its higher discriminative ability and potentially easier integration into practices with fewer measurements, may provide for more timely interventions in targeted populations.” – by Phil Neuffer

Disclosures: Mehta reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.