Determinants of quality of life and emotional well-being in a prospective bariatric cohort of 1501 multi-ethnic Asian patients

Abstract

Objective:The relationship between ethnicity, obesity and health-related quality of life (HR-QoL) outcomes in a multi-ethnic population remain poorly understood. We aim to investigate the relationship between ethnicity, body mass index (BMI), comorbidities, as well as determinants of quality of life (QoL) in Southeast Asian patients with obesity. We aim to develop and validate a simple objective score to identify bariatric patients at high risk for major depression. Methods:Associations between ethnicity, comorbidities, BMI and determinants of QoL (PHQ-9 and SF-36) were analysed using multivariate logistic regression in a prospective cohort of 1501 bariatric patients. Multivariate regression and Receiver Operating Characteristics curves were used to develop and validate a novel scoring system to identify patients at risk of major depression. Results:Patients of Chinese, Malay and Indian ethnicity had increased risk of hypertension (OR: 1.51 [95% CI: 1.19–1.92, p<0.001]), BMI Class 4 (OR: 17.89 [95% CI: 9.53-33.60, p<0.001]) and major depression (OR: 1.71 [95% CI: 1.23–2.39, p=0.002]) respectively. Females (OR: 1.46 [95% CI: 1.16 – 1.84, p=0.001] & OR: 1.43 [95% CI: 1.11 – 1.83, p=0.005]) and Indian ethnicity (OR: 1.47 [95% CI: 1.09 – 1.98, p=0.011] & OR: 1.42 [95% CI: 1.04 – 1.94, p=0.028]) are at increased risk for poor physical & mental quality of life. Factors associated with major depression (gender, ethnicity, age, OSA, PCS and MCS scores) were used to create and validate a novel scoring system with an AUC of 0.812 (95% CI: 0.787-0.837). A cut-off of 4 of 7 points was identified on ROC curves and Youden’s index with a sensitivity of 70%, specificity 81%, PPV 53% and NPV 90%. Conclusion:The prevalence of metabolic complications from obesity significantly varies with ethnicity. We developed a novel and simple scoring tool combining objective demographic and patient-reported outcomes to screen and triage patients at risk of major depression.