Couldnt you say this for lots of diseases, eg. Fasting glucose > 7 mmol/L or BP > 120/80 mmHg or smoking 20/d might be ay okay for some, but on average this is bad for health...? Also i thought BMI was designed by insurance companies exactly for health demarcation reasons?
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Replying to @angryhacademic @MichaelMindrum
Yes to smoking
. The rest is speculation.
Weight-height tables were used by insurance companies to predict mortality. This is an associative, not causal relationship.
BMI has a long & twisted history, with an origin in stats, not biology. See Hite & Carter 2019.
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Replying to @ahhite @angryhacademic
Adele - there is strong data to show that there is increased health risk with rising blood pressure or increased fasting plasma glucose - hence the definition of the diseases hypertension and diabetes which may not cause a person a problem until the end organ complication occurs.
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Replying to @MichaelMindrum @angryhacademic
This is what I get for tweeting in the grocery store check-out line. It's the cut-points that are speculative, not the overall natural history of the disease that ultimately results in organ damage. Those goalposts have been moved several times and 1/2
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it is not clear whether lowering these cut-points (the goalposts move ever closer to what was formerly "normal," not in the other direction, that I am aware of) improves "prevention" or just increasingly medicalizes us so that everyone is "pre-" something.
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Replying to @ahhite @angryhacademic
thanks Adele - agree. As far as the recent hypertension story I think the pharmaceutical forces overstepped in trying to capture a larger population and glad that there was loud pushback.
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As far as diabetes goes, spoke recently to some of the people responsible for identifying the HbA1c guidelines. "Diabetes" cutoff was based primarily on appearance of retinopathy and peripheral neuropathy, "pre-diabetes" on macrovascular complications
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neat. I know for for A1c, FPG, 2 hr GGT all were created at the increased inflection point for retinopathy. I thought pre-DM was based on increased risk of T2D over the next 5 yrs - I know they're at
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From my understanding it was a combination of the two. I've heard some calls to abolish pre-diabetes completely and just make 6 diagnostic for diabetes
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I can see the rational for that (but could also understand the pushback that would occur). If I were a co. making GLP1a I'd focus on the pre-DM pts. By the time T2D has occurred we've already lost 50% of beta-cell function -- things have already gotten out of hand by that point.
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The challenge is that intervening for established T2DM has a much better short term ROI than prevention!
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