The lowest-mortality BMI: What is its relationship with fat-free mass?

Do overweight folks live longer? It is not uncommon to see graphs like the one below, from the Med Journal Watch blog (), suggesting that, at least as far as body mass index (BMI) is concerned (), overweight folks (25 < BMI < 30) seem to live longer. The graph shows BMI measured at a certain age, and risk of death within a certain time period (e.g., 20 years) following the measurement. The lowest-mortality BMI is about 26, which is in the overweight area of the BMI chart.



Note that mortality risk, relative to the mortality risk of people in the same age group, increases less steeply in response to weight variations as one becomes older. An older person increases the risk of dying to a lesser extent by weighing more or less than does a younger person. This seems to be particularly true for gains in weight.

The table below is from a widely cited 2002 article by Allison and colleagues (), where they describe a study of 10,169 males aged 25-75. Almost all of the participants, ninety-eight percent, were followed up for many years after measurement; a total of 3,722 deaths were recorded.



Take a look at the two numbers circled in red. The one on the left is the lowest-mortality BMI not adjusting for fat mass or fat-free mass: a reasonably high 27.4. The one on the right is the lowest-mortality BMI adjusting for fat mass and fat-free mass: a much lower 21.6.

I know this may sound confusing, but due to possible statistical distortions this does not mean that you should try to bring your BMI to 21.6 if you want to reduce your risk of dying. What this means is that fat mass and fat-free mass matter. Moreover, all of the participants in this study were men. The authors concluded that: “…marked leanness (as opposed to thinness) has beneficial effects.”

Then we have an interesting 2003 article by Bigaard and colleagues () reporting on a study of 27,178 men and 29,875 women born in Denmark, 50 to 64 years of age. The table below summarizes deaths in this study, grouping them by BMI and waist circumference.



These are raw numbers; no complex statistics here. Circled in green is the area with samples that appear to be large enough to avoid “funny” results. Circled in red are the lowest-mortality percentages; I left out the 0.8 percentage because it is based on a very small sample.

As you can see, they refer to men and women with BMIs in the 25-29.9 range (overweight), but with waist circumferences in the lower-middle range: 90-96 cm for men and 74-82 cm for women; or approximately 35-38 inches for men and 29-32 inches for women.

Women with BMIs in the 18.5-24.9 range (normal) and the same or lower waists also died in small numbers. Underweight men and women had the highest mortality percdntages.

A relatively small waist (not a wasp waist), together with a normal or high BMI, is an indication of more fat-free mass, which is retained together with some body fat. It is also an indication of less visceral body fat accumulation.

Traumatic Brain Injury Overview

A traumatic brain injury is something we hope will never happen to us or our loved ones. Once injured, your life can be changed forever. Some forms of head injuries are treatable where others will leave you permanently disabled for the rest of your life. This could mean that you or your family member will require around the clock treatment for the rest of their life.

A traumatic brain injury (TBI) can happen a number of different ways. Car crashes, pedestrian accidents, on the job injuries, and sports accidents among others can all cause TBI. No matter how the injury happened these types of catastrophic injury accidents usually involve one of two circumstances. Either the head experiences a high impact collision with another object (or vice versa) or an object passes through the skull and enters the brain tissue. Both of these traumatic injuries can cause serious damage to the brain.

Symptoms of Brain Injuries

According to the National Institute of Neurological Disorders and Stroke, some of the symptoms of traumatic brain injury include the following:

Loss of consciousness for seconds or minutes
Headache
Lightheadedness or dizziness
Confusion
Blurred vision
Ears ringing
Fatigue
Bad taste in mouth
Change in sleep patterns
Change in mood
Difficultly remembering or concentrating

What to Do If You Are Experiencing the Above Symptoms

If you are experiencing any of the previously mentioned symptoms you may need medical attention. It would be a good idea to contact your doctor as soon as possible. After an accident, there is not much that can be done to reverse the initial damage caused to the brain. A medical professional can work with you to help prevent further damage. It may also be necessary for patients to receive physical therapy as well as speech therapy.

Brain Injury Help after an Accident

Dealing with a brain injury can be difficult but you do not have to take that route alone. There are a number of support groups online who may be able to offer help. If the injury was caused by a negligent party you may also want to contact an experienced brain injury lawyer. An attorney can help you determine if you have a claim for compensation. If it is found that you have a right to compensation your lawyer can help you receive what is owed to you for lost wages, lost future wages, pain and suffering and other damages.

How to make white rice nutritious

One of the problems often pointed out about rice, and particularly about white rice, is that its nutrition content is fairly low. It is basically carbohydrates with some trace amounts of protein. A 100-g portion of cooked white rice will typically deliver 28 g of carbohydrates, with zero fiber, and 3 g of protein. The micronutrient content of such a portion leaves a lot to be desired when compared with fruits and vegetables, as you can see below (from Nutritiondata.com). Keep in mind that this is for 100 g of “enriched” white rice; the nutrients you see there, such as manganese, are added.

White rice is rice that has had its husk, bran, and germ removed. This prevents spoilage and thus significantly increases its shelf life. As it happens, it also significantly reduces both its nutrition and toxin content. White rice is one of the refined foods with the lowest toxin content.

Another interesting property of white rice is that it absorbs moisture to the tune of about 2.5 times its weight. That is, a 100-g portion of dry white rice will lead to a 250-g portion of edible white rice after cooking. This does not only dramatically decrease white rice’s glycemic load () compared with wheat-based products in general (with some exceptions, such as pasta), but also allows for white rice to be made into a highly nutritious dish.

If you slow cook almost anything in water, many of its nutrients will seep into the water. All you have to do is to then use that water (often called broth) to cook white rice in it, and you will end up with highly nutritious rice. Typically you will need twice as much broth as rice, cooked for about 15 minutes – e.g., 2 cups of broth for 1 cup of rice.

You can add meats to the white rice, such as pulled chicken or shrimp; add some tomato sauce to that and you’ll make it a chicken or shrimp risotto. You can also add vegetables to the rice. If you want your rice to have something like an al dente consistency, I recommend doing these after the rice is ready; i.e., after you cooked it in the broth.

For the white rice-based dish below I used a broth from about two hours of slow cooking of diced vegetables; namely red bell peppers, carrots, celery, onions, and cabbage. After cooking the rice for 15 minutes, and letting it "sit" for a while (another 15 minutes with the pan covered), I also added the vegetables to it.

As a side note, the cabbage and onion tend to completely dissolve after 1 h or so of slow cooking. The added vegetables give the dish quite a nutritional punch. For example, the cabbage alone seems to be a great source of vitamin C (which is not completely destroyed by the slow cooking), the anti-inflammatory amino acid glutamine, and the DNA repair-promoting substance known as indole-3-carbinol ().

The good folks over at the Highbrow Paleo group on Facebook () had a few other great ideas posted in response to my previous post on the low glycemic load of white rice (), such as cooking white rice in bone broth (thanks Derrick!).

The Beginnings of Emergency Medicine in the United Kingdom

The specialty of Emergency Medicine developed in the United Kingdom out of a recognition of the need for injured people to receive better care. Over the years its scope has broadened to include serious illnesses, disease, infections and other more medically related problems.

The First World War provided the catalyst needed to kick-start the process of specialism within overstretched hospitals. A pioneering surgeon named Robert Jones was appalled by the lack of provision for those suffering gunshot wounds in the First World War. This led him to establish the British Orthopedic Association in 1918 with Robert Osgood, which became one of the most important developments in the care of the injured, and led to increased cooperation among orthopedic surgeons.

An early example of specialism for fracture patients was the establishment of separate fracture clinics in Manchester by Harry Platt in 1913-14. It was he who, many years later, as the chairman of the Accident and Emergency Services Sub-Committee of the Standing Medical Advisory Committee, produced the famous Platt report in 1962. This report highlighted major concerns over the level of care provided for the seriously ill and injured patients.

Though many of the report's recommendations were taken on board, there was no provision for the creation of senior career posts for the newly named accident and emergency departments. An exception was Maurice Ellis, who had been appointed 10 years before the report in 1952, as the first consultant in Emergency Medicine in the United Kingdom at Leeds General Infirmary. He, among others, noted that a different skill set was required of doctors running accident and emergency departments to those responsible for orthopedic surgery. This was one of the main driving forces behind the formation of the Casualty Surgeons Association in 1967, of which Maurice Ellis was its first president. The main aim of the association was to form a professional body to further the standard of accident and emergency care in the United Kingdom, but accident and emergency departments remained understaffed and poorly led.

In 1971, therefore, the Joint Consultants Committee investigated the problem. The main recommendation of this report was the appointment of 32 consultants in "Accident and Emergency" to work full-time in major departments. This led to immediate improvements in the quality of critical care, and by 1976 there were 105 consultants in post. By the middle of the 1970s it was evident that there was a need to formalise training of consultants, and the Specialist Advisory Committee in accident and emergency medicine was established and a training programme designed. The first senior registrar appointment was in 1977. The number of consultants continued to increase until, by 1997, there were almost 400 consultants in post.

The Casualty Surgeons Association was changed in 2004, to the British Association for Emergency Medicine, reflecting a more holistic approach to the specialism. Then in 2005, this was merged with the Faculty of Accident and Emergency Medicine (formed in 1993) to form the College of Emergency Medicine, which today stands as the authoritative body for emergency medicine in the UK. The College publishes guidelines and standards for the practise of emergency medicine, and its fellowship and membership exams, are the standard by which emergency medicine doctors are measured.