Association between body mass index and survival in individuals on hemodialysis.

Health hazards of obesity have been recognized for centuries, appearing, for example, in writings attributed to Hippocrates. From the later decades of the 20th century through the present, there have been numerous epidemiological studies of the relationship between excess weight and the total, or all-cause, mortality rate,1 a critical cumulative measure of the public health impact of any health condition. Using body mass index (BMI), an indicator of relative weight for height (weight [kg]/height [m]2) and a frequently used surrogate for assessment of excess body fat, these studies have found linear, U-shaped, or J-shaped relationships between total mortality and BMI. That is, in some studies, both the thin and the obese were more likely to die than those in between. There is, however, always a point at which increasing BMI is associated with increasing mortality risk, but the BMI at which this occurs varies across studies and populations.2 Currently,3 overweight in adults is defined as a BMI of 25.0 to <30.0 kg/m2 and obesity as a BMI of ≥30.0 kg/m2 (Table 1). A number of studies have found no significant relationship between BMI in the overweight range and mortality rate4 and have shown the nadir of mortality risk to be in the overweight range. In particular, commentaries in both the lay press5–7 and scientific literature2,8,9 subsequent to recent reports from National Health and Nutrition Examination Surveys (NHANES)10,11 have highlighted the confusion and controversy regarding this issue. Some have interpreted the recent data to mean that overweight is not detrimental to health and is not in itself a public health concern and that drawing attention to the need for weight loss in this range will have negative effects on the health and well-being of the general population.8 Others have argued …

Introduction Obesity has been considered a risk factor for cardiovascular death and for poor outcomes from a variety of surgical procedures, recent studies suggest that overweight (OW) and obese (OB) patients may paradoxically have a better prognosis in cardiac surgery (CS) compared with patients with normal body mass index (BMI). We aimed to investigate the obesity paradox and assess the effect of BMI on early and late clinical outcomes after CS Methods A retrospective cohort study of consecutive patients undergoing CS from January 2007 to January 2019 was carried out. Patients were divided into 4 groups defined by BMI:underweight (UW) (≤18,5 kg/m2):0.5%, n=27; normal weight (NW) (18,5–25 kg/m2): 25.7%, n=1393; OW (25–30 kg/m2): 44.7%, n=2423; OB (≥30 kg/m2): 29.1%, n=1576. Multivariable analyses was used to compare the outcomes among the different BMI groups. Overall 1-year survival of BMI categories were determined by the Kaplan-Meier method. Results We included 5419 patients (72% male, mean age 65,8±12.1). The BMI groups were significantly different regarding pre-surgical variables, UW patients were statistically more comorbid and severe clinical presentation. Categorical mortality was 7% in UW, 5,2% in NW, 3,2% in OW, 4,3% in the OB group, P=0,016. The risk of death according to BMI exhibited a reverse J-shaped curve. Low cardiac output syndrome, medical and surgical bleeding and longer hospital stay was more frequent in the UW group (P&lt;0,05), and mediastinitis, hyperglycemia and prolonged mechanical ventilation in OB group (P&lt;0,05). Univariable regression detected the following significant predictors of in-hospital mortality: Age, female, non-elective surgery, non isolated coronary surgery, vascular peripheral disease, chronic obstructive pulmonary disease, severe left ventricular fraction ejection, chronic renal disease, anemia, stroke, myocardial infarction, heart failure and BMI categories (P&lt;0.05): NW (odds ratio (OR), 1,49; 95% CI: 1,09–1,9, P=0,01), in contrast, OW had a significantly lower risk of death (OR 0,66; 95% CI: 0,5–0,88, P=0,005), with no statistical significance in the UW and OB categories. After adjusting for other risk factors at the multivariate analysis, BMI as a continuous variable was not an independent predictor of in-hospital mortality. One-year follow-up was completed in 95%, during this period 223 (4,12%) died. The analysis of unadjusted long-term mortality did not show a significant difference between BMI categories (P log rank = 0,16). Conclusion In our population OW patients had lower mortality and better outcomes after cardiac surgery. However, when other preoperative variables are taken into account, BMI did not have independent effect on in-hospital and one-year mortality, questioning the existence of an “obesity paradox”. Its effect on mortality could be indirect, being mediated through other comorbidities.

Obesity Is Associated With Family History of ESRD in Incident Dialysis Patients

Decision Making in Chronic Hypercapnic Respiratory Failure: A Real Challenge!

Background and Aims Obesity is a major issue with an estimated prevalence of 1.9 billion adults worldwide. Obesity is an important risk factor for premature death and the development of non-communicable diseases such as diabetes mellitus (DM), heart diseases, and chronic kidney disease (CKD). However, mounting evidence in the literature describes a reverse association whereby obesity may have a protective effect on mortality; this is sometimes referred to as the “obesity paradox”. Several reports question the concept of obesity paradox claiming methodology flaws such as collider stratification bias. In this study, we aimed to examine the effects of obesity on the combined outcomes of all-cause mortality (ACM) and renal replacement therapy (RRT) incidence in a cohort of patients with non-dialysis dependent CKD (NDD-CKD) by correcting for major risk factors to reduce the risk of bias. Method This retrospective study was undertaken on all patients with a documented body mass index (BMI) in the Salford Kidney Study database from October 2002 until December 2016. Patients were grouped according to their BMI into normal weight [BMI 18.5-24.9 kg/m2], overweight [BMI 25–29.9 kg/m2 and obese [BMI&amp;gt; 30 kg/m2]. Patients were also grouped according to their level of co-morbidity into 4 groups: group 1 had CKD only; group 2 had CKD and heart failure (HF); group 3 had CKD and DM; and group 4 had CKD, DM, and HF. Univariate Cox regression as well as three stepwise models of multivariate analysis were performed to study the strength of association between BMI categories and combined outcomes (incidence of RRT and ACM) across the 4 groups of different clusters of co-morbidity. Results A total of 2416 patients were included in the analysis. The median age of the cohort was 67.3 years [IQR 55.9-75.6], 61.8% were male, and 96.4% were of white ethnicity. The median BMI was 28.1 kg/m2 [IQR 24.7-32.6] and the median estimated glomerular filtration rate (eGFR) was 30.7 ml/min/1.73m2 [IQR 20.4-43.5]. At baseline, patients with increasing level of co-morbidity tended to be older with higher prevalence of hypertension (HTN), angina, myocardial infarction (MI), and stroke with lower baseline eGFR. The risk of combined outcomes followed the same trend in the three BMI groups, risk is higher with higher index of co-morbidity (p &amp;lt;0.001). Further analysis of four subgroups of co-morbidity was undertaken. A univariate Cox regression analysis for group 1 [CKD only, n = 1351], and group 2 [CKD and HF, n = 227] showed that patients with obesity had significant lower rates of combined outcomes compared to patients with normal BMI (HR 0.75; 95%CI = 0.63-0.89; p = 0.001 and HR 0.56; 95%CI = 0.38-0.82; p = 0.003 for group 1 and group 2 respectively). In multivariate models, obesity consistently proved to be a strong protective factor against combined outcomes (HR 0.77; 95%CI = 0.65-0.92; p = 0.005 for group 1 and HR 0.53; 95%CI = 0.34-0.83; p = 0.005 for group 2). This was independent of age, gender, HTN, angina, stroke, MI, and prescription of statins and angiotensin converting enzyme inhibitors. For group 3 [CKD and DM, n = 614], and group 4 [CKD, DM, and HF, n = 190], there was no significant difference in the combined outcomes between the different BMI groups when using univariate Cox regression analysis (for patients with obesity: HR 0.78; 95%CI = 0.61-1.01; p = 0.060 and HR 0.70; 95%CI = 0.43-1.16; p = 0.166 for both groups respectively). There was no significant difference in the incidence of RRT in any of the four groups. Conclusion In our largely white NDD-CKD cohort of patients, there was evidence of increasing risk of RRT or ACM as comorbidity increased irrespective of BMI. This is not surprising as ACM would be expected to increase as the burden of disease increases. However, when comparing the effect of BMI within groups, obesity was protective against combined outcomes in group 1 (CKD only) and group 2 (CKD+HF). This ‘protective’ effect was not seen in patients who had concomitant diabetes. These data suggest that diabetes is a potent predictor of outcomes irrespective of BMI, however, in patients without diabetes, obesity may play a protective role.

Introduction: Psoriasis and obesity share inflammatory pathways and are thought to have a bidirectional relationship with overlapping comorbid complications that can impact overall patient health. In this analysis, we evaluated baseline data from 17 clinical trials of patients with moderate-to-severe psoriasis to assess baseline comorbidities across the BMI spectrum. Methods: This integrated data set included 17 randomized clinical trials on psoriasis described by Lebwohl et al. (2025). Participants were adults with moderate-to-severe psoriasis. Baseline comorbidities and disease severity were analyzed by the following BMI groups ≥18.5 to &lt;25 (Normal), ≥25 to &lt;30 (Overweight), and ≥30 (Obesity). The non-parametric Mann-Whitney U test was used to statistically compare differences between the Obesity or Overweight groups vs the Normal group, with p-value ≤0.05 signaling statistical differences. Results: Among a total of 7029 trial participants, BMI groups included 1710, 2291, and 3028 participants in the Normal BMI, Overweight and Obesity categories, respectively. Mean BMIs (Kg/m2) were 36.7, 27.5 and 22.5 for Obesity, Overweight and Normal BMI groups respectively. Participants with Obesity and Overweight had statistically significantly higher baseline prevalence of comorbidities: hypertension in Obesity (41.7% [40.0%; 43.5%]) and Overweight (24.5% [22.7%; 26.2%]) groups vs Normal BMI (10.8% [9.3%; 12.3%]) group: hyperlipidemia in Obesity (25.2% [ 23.6%, 26.7%]) and Overweight (16.8% [15.2%; 18.3%]) groups vs Normal (8.3% [7.0%, 9.6%]) BMI group; diabetes in Obesity (16.9%, [15.6%; 18.2%]) and Overweight (8.1%, [7.0%; 9.2%]) groups vs Normal BMI (3.5%, [2.6%; 4.4%]) group; cardiovascular disease in Obesity (3.1% [2.5%; 3.8%]) and Overweight (2.0% [1.4%; 2.5%]) groups vs Normal BMI (0.9%[0.5%; 1.4%]) group; asthma in Obesity (7.3% [6.4%; 8.2%]) and Overweight (4.1% [3.3%; 4.9%]) groups vs Normal BMI (3.6% [2.7%; 4.5%]) group; metabolic dysfunction-associated liver disease in Obesity (3.4%[2.7%; 4.0%]) group vs Normal BMI (0.9% [0.4%; 1.3%]) group.No significant difference was observed between the Overweight and Normal BMI groups for metabolic dysfunction-associated liver disease. Psoriatic Arthritis (PsA) baseline diagnosis was higher in Obesity (23.6% [22.1%;25.2%]) and Overweight (18.2% [16.6%; 19.8%]) groups vs Normal BMI (14.5% [12.8%; 16.2%]) group. CRP levels (C-Reactive Protein (Mean mg/L(SD)) levels were also significantly higher in Obesity (7.6(10.6), p &lt;0.001) and Overweight (4.2(7.0), p &lt;0.001) groups vs Normal BMI (4.1(11.3)) group. Measures of psoriasis severity including Static Physician’s Global Assessment (sPGA) score and Psoriasis Area and Severity Index (PASI) were significantly higher in Obesity vs Normal BMI groups. Conclusion: In patients with moderate-to-severe psoriasis, Overweight or Obesity was associated with higher baseline psoriasis severity, cardiometabolic burden, asthma, metabolic dysfunction-associated liver disease, PsA, and systemic. These burdens underscore the broader unmet healthcare needs in high BMI psoriasis. With new options to manage both moderate-to-severe psoriasis and overweight or obesity BMI, there may be an opportunity for dermatologists to intervene to modify the overall health and disease of patients with both moderate-to-severe psoriasis and obesity or overweight BMI.

Background: Low body mass index (BMI) patients (pts) undergoing percutaneous coronary intervention (PCI) are at the highest risk for in-hospital complications and cardiac death when compared to overweight or obese pts (“obesity paradox”). Likewise, chronic kidney disease (CKD) (eGFR &lt;60 mL/min/1.73m 2 ) pts are at a higher risk of adverse events following PCI. Aim: To assess the impact of BMI on bleeding complications in pts with and without CKD undergoing PCI. Methods: Between 12/2010 and 03/2018 a total of 4,400 CKD pts (eGFR &lt;60 mL/min) and 13,197 pts without CKD underwent PCI. Pts were divided into three groups: BMI &lt;24.9 (normal), BMI 25 to 29.9 (overweight), and BMI &gt;30 (obese). Bleeding complications were classified by the Bleeding Academic Research Consortium (BARC). BARC Type 4 (CABG-related) and Type 5 (fatal) bleeding events were excluded. Multiple logistic regression was utilized with p&lt;0.05 significance level. Results: Pts were 72% male, mean age 67 and 43% were diabetic. Both BMI category and CKD status were significantly associated with BARC score ≥3 in a multiple logistic regression model (p=0.004, and p&lt;0.0001, respectively). There was no evidence of an interaction between CKD status and BMI and the effect on BARC score (p= 0.08). Among those with CKD, BMI category failed to associate with BARC≥3 status (p=0.1), but among those without CKD, BMI category was significantly associated with BARC ≥3 status (p= 0.003), as shown in Figure. Multivariate logistic regression analysis will be presented. Conclusion: In pts undergoing PCI: 1) BMI and CKD status are associated with severe bleeding (BARC≥3) complications; 2) normal BMI, non-CKD patients had a significantly higher rate of severe bleeding complications when compared to overweight or obese patients; and 3) obese CKD patients had a lower rate of severe bleeding complications compared to normal BMI or overweight patients but did not achieve statistical significance.

Association between inflammation, body mass index, and long-term outcomes in patients after percutaneous coronary intervention: A large cohort study.

ObjectiveThis study aims to determine the prevalence of metabolic syndrome and its individual components across different BMI categories among patients seen at Wellness Center and Obesity and Weight Management Center, St. Luke’s Medical Center Quezon City.MethodologyThis was a 3-year retrospective study of patients seen at the institution from 2013 to 2016. The patients were divided according to Asia-Pacific BMI categories and presence of metabolic syndrome was determined as defined by NCEP/ATP III-AHA/NHLBI (2005).ResultsThis study included a total of 1367 adult patients with the mean age of 53 (SD=12.4). The overall prevalence of metabolic syndrome is 51.0%. Its prevalence across the different BMI categories are as follows: 29.6 % with Normal BMI (BMI 18.5-22.9 kg/m2), 38.9% in overweight (BMI 23-24.9 kg/m2), 56.9% in Pre-Obese (BMI 25-29.9 kg/m2) and 62.4% in Obese (BMI ≥30 kg/m2) subgroup. Presence of central obesity using the Asian cut-off has the highest prevalence among patients with metabolic syndrome across all categories. In the group with normal BMI, hypertension and elevated blood glucose were highest with central obesity being the least common but still with 7.3% of individuals meeting the criteria for central obesity.ConclusionThere is high prevalence of metabolic syndrome even in patients with normal BMI. Diagnosis and screening for its individual components should not only be confined to individuals with higher BMI.

The primary aim was to evaluate the impact of body mass index (BMI) category on objective and subjective cure following single incision sling (SIS) surgery for stress urinary incontinence (SUI). The secondary aim was to compare outcomes among different SIS types within and across BMI categories. This retrospective study included 636 women (mean age 57.4 ± 10.4years) with urodynamic SUI who underwent SIS using the Ophira, Solyx, or I-stop mini between 2015 and 2023. Patients were stratified into BMI categories: normal (< 25kg/m2), overweight (25-29.9kg/m2), and obese (≥ 30kg/m2). Objective cure was defined as no leak on urodynamic testing and the 1-h pad test < 2g, while subjective cure was based on patient-reported outcomes using the UDI-6. Objective and subjective cure rates differed across BMI categories, with the highest rates observed in patients with normal BMI (93.1% and 90.5%) and the lowest in obese patients (77.8% and 75%). Within each BMI category, cure rates did not differ significantly by sling type. However, when outcomes were examined across BMI categories for individual sling types, fixed-length SIS (Ophira and Solyx) showed a significant decline in cure rates with increasing BMI, whereas the adjustable length I-stop mini maintained more consistent outcomes. Independent risk factors for failure included age ≥ 66, menopause, intrinsic sphincter deficiency (ISD), and maximal urethral closure pressure (MUCP) < 40cm H2O. BMI category is associated with SIS outcomes, with obese patients demonstrating lower cure rates compared with normal BMI patients. While sling type does not influence outcomes within BMI groups, preoperative counseling is essential for high-risk patients.

Perioperative outcomes in obese women with uterine cancer

Obesity is common among patients with pediatric Crohn's disease (PCD). Some adult studies suggest obese patients respond less well to anti-tumor necrosis factor (TNF) treatment. This study sought compares anti-TNF response and anti-TNF levels between pediatric patients with normal and high body mass index (BMI). The COMBINE trial compared anti-TNF monotherapy with combination therapy with methotrexate in patients with PCD. In this secondary analysis, a comparison of time-to-treatment failure among patients with normal BMI vs BMI Z -score >1, adjusting for prescribed anti-TNF (infliximab [IFX] or adalimumab [ADA]), trial treatment assignment (combination vs monotherapy), and relevant covariates. Median anti-TNF levels across BMI category was also examined. Of 224 participants (162 IFX initiators and 62 ADA initiators), 111 (81%) had a normal BMI and 43 (19%) had a high BMI. High BMI was associated with treatment failure among ADA initiators (7/10 [70%] vs 12/52 [23%], hazard ratio 0.29, P = 0.007) but not IFX initiators. In addition, ADA-treated patients with a high BMI had lower ADA levels compared with those with normal BMI (median 5.8 vs 12.8 μg/mL, P = 0.02). IFX trough levels did not differ between BMI groups. Overweight and obese patients with PCD are more likely to experience ADA treatment failure than those with normal BMI. Higher BMI was associated with lower drug trough levels. Standard ADA dosing may be insufficient for overweight children with PCD. Among IFX initiators, there was no observed difference in clinical outcomes or drug levels, perhaps due to weight-based dosing and/or greater use of proactive drug monitoring.

Hypothermia has been shown to be associated with a high mortality rate among patients with sepsis. However, the relationship between hypothermia and body mass index (BMI) with respect to mortality remains to be elucidated. We conducted this study to assess the association between hypothermia and survival outcomes of patients with sepsis according to BMI categories. This secondary analysis of a prospective cohort study enrolled 1184 patients (aged ≥ 16 years) with sepsis hospitalized in 59 intensive care units in Japan. Patients were divided into 3 BMI categories (<18.5 [low], 18.5-24.9 [normal], >24.9 [high] kg/m2) and 2 body temperature (36 °C and ≥ 36 °C) groups. The primary outcome was in-hospital mortality rate. Associations between hypothermia and BMI categories with respect to in-hospital mortality were evaluated using multivariate logistic regression analysis. Of the 1089 patients, 223, 612, and 254 had low, normal, and high BMI values, respectively. Patients with body temperature < 36 °C (hypothermia) had a higher in-hospital mortality rate than that had by those without hypothermia in the normal BMI group (25/63, 39.7% vs. 107/549, 19.5%); however, this was not true for patients in the low or high BMI groups. A significant interaction was observed between hypothermia and normal BMI for in-hospital mortality (odds ratio, 1.56; 95% confidence interval, 1.00-3.41; P value for interaction = .04); however, such an interaction was not found between hypothermia and low or high BMIs. Patients with sepsis and hypothermia in the normal BMI subgroup may have a higher mortality risk than that of those in the low or high BMI subgroups and, therefore, require more attention.

This study examined the relationship between the impact of weight on quality of life (QoL), emotional appetite, and psychological well-being. The study included 124 individuals with obesity with a body mass index (BMI) of more than 30 kg/m2, 129 individuals with overweight with a BMI between 25 and 29.9 kg/m2, and 123 normal-weight individuals with a BMI less than 25 kg/m2 who applied to certain nutrition and dietetics clinics in Istanbul. We administered the Impact of Weight on Quality of Life Scale (IWQOL), Emotional Appetite Questionnaire (EAQ), and Psychological Well-Being Scale (PWS) to the individuals. The QoL and psychological well-being scores in the group with a normal BMI showed a strong positive association. Positive emotional appetite ratings, psychological well-being, and QoL showed a noteworthy positive link in the BMI group with overweight. The study revealed a negative relationship between a bad emotional appetite and psychological well-being. The QoL and psychological well-being scores in the BMI group with obesity showed a strong positive association. In addition, the psychological well-being scores of those in the normal and overweight BMI groups were significantly higher than those in the BMI group with obesity. The negative emotional appetite scores in the BMI groups with obesity and overweight were significantly higher than those in the normal BMI group. Those in the normal BMI group had significantly higher positive emotional appetite scores than those in the BMI group with overweight did. Findings indicate significant associations between BMI, QoL, and psychological well-being, with potential interventions identified to enhance patient care and support. These results underscore the critical role of social work in addressing weight-related psychological and emotional challenges within health care settings.

Introduction: The proportion of US adults with hypertension who had controlled blood pressure (BP) decreased from 2013-2018. The rising prevalence of obesity has been implicated as a reason for this decline. We investigated trends in BP control from 2013-2018 among US adults with hypertension, overall and among those taking antihypertensive medication, by body mass index (BMI) category. Methods: We used National Health and Nutrition Examination Survey data from 2013-2014, 2015-2016, and 2017-2018 for US adults aged ≥18 with hypertension (N=5,580). We examined the BMI distribution [normal (BMI &lt;25 kg/m 2 ), overweight (BMI 25-&lt;30 kg/m 2 ), class 1 obesity (BMI 30-&lt;35 kg/m 2 ), class 2 or 3 obesity (BMI ≥35 kg/m 2 )] in each survey cycle. We calculated the age-adjusted prevalence of BP control (&lt;140/90 mmHg) overall and among those taking antihypertensive medication in each survey cycle by BMI category. We examined trends in BP control within BMI category adjusted for age and other sociodemographic and clinical characteristics; we tested differences in trends by BMI category using interaction terms. Results: The prevalence of overweight and obesity among US adults with hypertension did not change from 2013-2018 ( Table ). The overall proportion of adults with hypertension who had controlled BP was higher among those with overweight or obesity than those with normal BMI. BP control among those taking antihypertensive medication was similar among those with overweight or obesity and those with normal BMI. BP control overall decreased over time with no evidence of a difference by BMI category. Among those taking antihypertensive medication, BP control decreased in those who were overweight or had class 1 obesity but not in those with normal BMI or class 2 or 3 obesity. Conclusions: Among US adults with hypertension, there was no increase in the prevalence of overweight and obesity from 2013-2018 and BP control decreased in all subgroups. These findings suggest the obesity epidemic is not driving the decrease in BP control in the US population.