Boss mass index and mortality from cardiovascular disease in China: a prospective study in rural men

To assess the relationship between body mass index (BMI) and ischaemic heart disease (IHD) mortality, especially in populations with low mean BMI levels. We examined the data from a population-based, prospective cohort study of 220 000 Chinese men aged 40 - 79, who were enrolled in 1990 - 1991, and followed up ever since to 1/1/2006. Relative risks of the deaths from IHD by the baseline BMI were calculated, after controlling age, smoking, and the other potential confounding factors. The mean baseline BMI was 21.7 kg/m(2), and 2763 IHD deaths were recorded during the 15-year follow-up (6.8% of all deaths) program. Among men without prior vascular diseases at baseline, there was a J-shaped association between BMI and IHD mortality. When baseline BMI was above 20 kg/m(2), there was a strongly positive association of BMI with IHD risk, with each 5 kg/m(2) higher in BMI associated with 21% (95%CI: 9% - 35%, P = 0.0004) higher IHD mortality. Below this BMI range, the association appeared to be reverse, with the risk ratios as 1.00, 1.11, and 1.14, respectively, for men with BMI 20 - 21.9, 18 - 19.9, and < 18 kg/m(2). The excess IHD risk observed at low BMI levels persisted after restricting analysis to never smokers or excluding the first 3 years of follow-up. Lower BMI was associated with lower IHD risk among people in the so-called 'normal range' of BMI values (20 - 25 kg/m(2)). However, below that range, the association might well be reversed.

Purpose: The aim of this study is to investigate the relationship between body mass index (BMI) and plantar pressure in college students and to provide reference indicators for the application of plantar pressure analysis. Methods: For the experiment, 96 young college students were recruited as test subjects, including 44 men and 52 women between the ages of 18 and 21. They were divided into three groups based on their body mass index (BMI) values. The overweight group (BMI > 25 kg/m², n=27), the underweight group (BMI < 18 kg/m², n=40) and the normal weight group (BMI 18-25 kg/m², n=20). Tests on natural gait were carried out in the three groups of test subjects using the Zebris pressure distribution measuring plate. The analysis included the maximum force value, peak pressure, and proportion of time in each support phase during the dynamic walking task. A Pearson correlation analysis was performed to examine the relationship between these parameters and different Body Mass Index values. Results and Discussion: The overweight group had the highest maximum force value and peak pressure in the left foot, midfoot, and hindfoot. The order of maximum force value and peak pressure from high to low was overweight group > normal weight group > underweight group. This suggests that as BMI increases, the maximum force value and peak pressure also increase. Within each BMI group, the maximum force value and peak pressure were highest in the forefoot, followed by the hindfoot and midfoot. The correlation between the maximum force value and the overweight group showed a significant difference, while the peak pressure in the left midfoot of the normal weight group also showed a significant correlation with BMI. In addition, there was a significant correlation between BMI and the phase of arch support in the normal weight group, indicating that there were significant differences in the correlation between different BMI groups and the time proportion of each stage of the support phase. Conclusions:The overweight group, with a higher BMI, experiences increased maximum force value and peak pressure during walking, which can lead to pathological changes in the foot over time. The increased BMI in obese individuals leads to flattening of the arch of the foot, prolonged metatarsal-to-ground contact, and an increased risk of developing flat feet. Arch support time decreases with increasing BMI, resulting in a relatively larger proportion of time in the forefoot propulsion phase. This is because people with a higher BMI require a longer time to push off the ground to generate sufficient momentum.

Objective: To investigate the relationship between body mass index (BMI) and clinicopathological characteristics and prognosis of gastric cancer patients. Methods: The clinical data of 788 patients with advanced gastric cancer were retrospectively analyzed. According to WHO weight standard, BMI<18.5 kg/m(2) was the low weight group, BMI 18.5~< 25.0 kg/m(2) was the normal weight group, BMI ≥ 25.0 kg/m(2) was the overweight group. The low weight group included 127 cases, the normal weight group included 540 cases and the overweight group included 121 cases. The relationship between different BMI groups and clinicopathological characteristics of patients was analyzed. Cox multivariate regression model was used to analyze the independent factor of the prognosis of patients. Results: The average BMI of 788 patients was 21.70 kg/m(2). The patients' BMI was significantly correlated with depth of invasion, maximum diameter of tumors, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) (all P<0.05). BMI was marginally correlated with gender, age, smoking, alcohol consumption, TNM stage, lymph node metastasis and histological type (all P>0.05). Furthermore, BMI was significantly correlated with prealbumin, prognostic nutritional index, total protein, albumin and hemoglobin levels (all P<0.05). BMI was also significantly correlated with intraoperative bleeding volume, operation time, number of lymph node resection, number of lymph node metastasis and lymph node metastatic ratio (all P<0.05). The median survival time of the entire group was 35.3 months. The median survival time of patients in low weight group, normal weight group, and overweight group was 21.0 months, 26.3 months, and 31.2 months, respectively, the differences were statistically significant (P<0.001). Cox multivariate analysis showed that TNM stage, depth of tumor invasion, lymph node metastasis, PLR and BMI were independent risk factors of the prognosis of patients with gastric cancer (all P<0.05). Conclusions: BMI is associated with the nutritional status, intraoperative blood loss, operative time, and lymph node metastatic ratio of patients with gastric cancer. BMI is an independent risk factor of the prognosis of patients with gastric cancer. The overall survival time of patients with low body weight is shorter than those of normal weight and overweight patients.

The relationship between body mass index and the severity of coronary artery disease: A prospective study

ABSTRACTBackground: Understanding the impact of obesity on premature mortality is critical, as obesity has become a global health issue.Objective: To contrast the relationship between body mass index (BMI) and premature death (all-cause; circulatory causes) in New York State (USA) and Northern Sweden.Methods: Baseline data were obtained between 1989 and 1999 via questionnaires (USA) and health exams (Sweden), with mortality data from health departments, public sources (USA) and the Swedish Death Register. Premature death was death before life expectancy based on sex and year of birth. Within country and sex, time to premature death was compared across BMI groups (18.5–24.9 kg/m2 (reference), 25–29.9 kg/m2, 30.0–34.9 kg/m2, ≥35.0 kg/m2) using Proportional Hazards regression. Absolute risk (deaths/100,000 person-years) was compared for the same stratifications among nonsmokers.Results: 60,600 Swedish (47.8% male) and 31,198 US subjects (47.7% male) were included. Swedish males with BMI≥30 had increased hazards (HR) of all-cause premature death relative to BMI 18.5–24.9 (BMI 30–34.9, HR = 1.71 (95% CI: 1.44, 2.02); BMI≥35, HR = 2.89 (2.16, 3.88)). BMI≥25 had increased hazards of premature circulatory death (BMI 25–29.9, HR = 1.66 (1.32, 2.08); BMI 30–34.9, HR = 3.02 (2.26, 4.03); BMI≥35, HR = 4.91 (3.05, 7.90)). Among US males, only BMI≥35 had increased hazards of all-cause death (HR = 1.63 (1.25, 2.14)), while BMI 30–34.9 (HR = 1.83 (1.20, 2.79)) and BMI≥35 (HR = 3.18 (1.96, 5.15)) had increased hazards for circulatory death. Swedish females showed elevated hazards with BMI≥30 for all-cause (BMI 30–34.9, HR = 1.42 (1.18, 1.71) and BMI≥35, HR = 1.61 (1.21, 2.15) and with BMI≥35 (HR = 3.11 (1.72, 5.63)) for circulatory death. For US women, increased hazards were observed among BMI≥35 (HR = 2.10 (1.60, 2.76) for all-cause and circulatory HR = 3.04 (1.75, 5.30)). Swedish males with BMI≥35 had the highest absolute risk of premature death (762/100,000 person-years).Conclusions: This study demonstrates a markedly increased risk of premature death associated with increasing BMI among Swedish males, a pattern not duplicated among females.

BMI and Its Changes As a Predictor of Survival in DLBCL Patients

This study investigates the correlation between body mass index (BMI) and osteoporosis utilizing data from the Taiwan Biobank. Initially, a comprehensive analysis of 119,009 participants enrolled from 2008 to 2019 was conducted to assess the association between BMI and osteoporosis prevalence. Subsequently, a longitudinal cohort of 24,507 participants, initially free from osteoporosis, underwent regular follow-ups every 2–4 years to analyze the risk of osteoporosis development, which was a subset of the main cohort. Participants were categorized into four BMI groups: underweight (BMI < 18.5 kg/m2), normal weight (18.5 kg/m2 ≤ BMI < 24 kg/m2), overweight (24 kg/m2 ≤ BMI < 27 kg/m2), and obese groups (BMI ≥ 27 kg/m2). A T-score ≤ − 2.5 standard deviations below that of a young adult was defined as osteoporosis. Overall, 556 (14.1%), 5332 (9.1%), 2600 (8.1%) and 1620 (6.7%) of the participants in the underweight, normal weight, overweight and obese groups, respectively, had osteoporosis. A higher prevalence of osteoporosis was noted in the underweight group compared with the normal weight group (odds ratio [OR], 2.20; 95% confidence interval [95% CI], 1.99 to 2.43; p value < 0.001) in multivariable binary logistic regression analysis. Furthermore, in the longitudinal cohort during a mean follow-up of 47 months, incident osteoporosis was found in 61 (9%), 881 (7.2%), 401 (5.8%) and 213 (4.6%) participants in the underweight, normal weight, overweight and obese groups, respectively. Multivariable Cox proportional hazards analysis revealed that the risk of incident osteoporosis was higher in the underweight group than in the normal weight group (hazard ratio [HR], 1.63; 95% CI 1.26 to 2.12; p value < 0.001). Our results suggest that BMI is associated with both the prevalence and the incidence of osteoporosis. In addition, underweight is an independent risk factor for developing osteoporosis. These findings highlight the importance of maintaining normal weight for optimal bone health.

BackgroundThe association between body mass index (BMI) and clinical outcomes of gastric cancer were still under debate. The aim of the present study was to investigate the impact of BMI on intraoperative conditions, postoperative complications and prognosis of gastric cancer.MethodsFrom October 2008 to March 2015, 1210 gastric cancer patients treated with D2 gastrectomy were enrolled in the present study. Patients were divided into three groups: low BMI group (BMI < 18.5 Kg/m2), normal BMI group (18.5 Kg/m2 ≤ BMI < 25.0 Kg/m2) and high BMI group (BMI ≥ 25.0 Kg/m2). Clinicopathological characteristics and prognosis of patients were recorded and analyzed. Propensity score matching was used to match patients in the three groups.ResultsThere were 107 patients in low BMI group (8.9%), 862 patients in normal BMI group (71.2%) and 241 patients in high BMI group (19.95%). Before matching, BMI was inversely associated with tumor size, tumor depth, lymph node metastasis (LNM) and tumor stage (all P < 0.05). After matching, the clinicopathological features were all comparable among the three groups (all P > 0.05). High BMI was associated with increased blood loss and operation time, and deceased number of retrieved lymph nodes (all P < 0.05). For postoperative complications, low BMI was associated with decreased rate of postoperative fever (P = 0.025). Age, BMI, tumor size, Borrmann type, pathological type, type of gastrectomy, tumor depth, LNM and tumor stage were risk factors for the prognosis of gastric cancer. Multivariate analysis showed that only BMI, tumor size, tumor depth and LNM were independent prognostic factors. The overall survival of patients with low BMI was significantly worse than patients with normal (P < 0.05) or high BMI (P < 0.05). However, the overall survival was comparable between patients with normal and high BMI (P > 0.05).ConclusionsBMI was inversely associated with tumor size, tumor depth, LNM and tumor stage. High BMI was associated with increased blood loss and operation time, and deceased number of retrieved lymph nodes. Low BMI was associated with decreased rate of postoperative fever and decreased survival.

BackgroundThe aim of this study was to investigate the association between body mass index (BMI) and brachial-ankle pulse wave velocity (baPWV) in hypertensive males.Material/MethodsAltogether, 14 866 male hypertensive participants were included in the analysis. Participants were divided into 3 groups: low BMI group (BMI <24 kg/m2), moderate BMI group (24 kg/m2 ≤BMI <28 kg/m2), and high BMI group (BMI ≥28 kg/m2). According to baPWV values, arteriosclerosis (AS) was set as 3 degrees: mild AS (baPWV ≥1400 cm/s), moderate AS (baPWV ≥1700 cm/s) and severe AS (baPWV ≥2000 cm/s). Multivariate logistic regression analysis was used to explore the effect of different BMI groups on different degrees of AS. The multivariate linear regression analysis was used to explore the relationship between BMI and baPWV.ResultsAmong low BMI, moderate BMI, and high BMI groups, the average baPWV values were 1824±401 cm/s, 1758±363 cm/s, and 1686±341 cm/s, respectively. Prevalence in the mild, moderate and high BMI groups were 91.0%, 87.8%, 81.5%, respectively for mild AS; 55.3%, 48.8%, and 40.0% respectively for moderate AS; and 25.9%, 20.2%, and 14.9% respectively for severe AS. Compared to the low BMI group, multivariate logistic regression analysis showed that odds ratio (OR) and 95% confidence intervals (95%CI) in the moderate BMI group and the high BMI were 0.71 (95%Cl, 0.62–0.80), 0.43 (95%Cl, 0.38–0.50) for mild AS; and similar trends were shown for moderate AS and severe AS. Based on age-stratification, a negative relationship remained for 35–55 years old participants for different degrees of AS among the moderate BMI group and the high BMI group. A negative relationship was detected between BMI and baPWV in total and different age-stages.ConclusionsAmong male hypertension participants in this study, there was a negative relationship between BMI and baPWV. High BMI was found to be a protective factor for AS especially in the age range of 35–55 years.

Effect of BMI on Central Arterial Reflected Wave Augmentation Index, Toe-Brachial Index, Brachial-Ankle Pulse Wave Velocity and Ankle-Brachial Index in Chinese Elderly Hypertensive Patients with Hemorrhagic Stroke

Unintentional dural puncture is a known risk after epidural or combined spinal-epidural procedures, occurring in approximately 1% of labor epidural catheters placed in parturients with normal body habitus but may be as high as 4% in morbidly obese parturients. Anecdotal experience and limited publications suggest that an inverse relationship between body mass index (BMI) and postdural puncture headache (PDPH) may exist. We hypothesized that parturients with increased BMI have a lower incidence of PDPH than those with a lower BMI after unintentional dural puncture. After IRB approval, we performed a retrospective cohort study by medical record review. Case logs from our institution were searched for patients with documented unintentional dural puncture during attempted neuraxial analgesia between January 1, 2004, and December 13, 2013. The primary outcome was the incidence of PDPH. The association between BMI and PDPH was assessed using binary logistic regression, and the Wilcoxon-Mann-Whitney odds and confidence intervals (CIs) for a random pair of BMI values from a PDPH subject compared with a non-PDPH subject were calculated from the area under the receiver operator characteristics curve. Classification tree analysis was used to determine the BMI cutoff value for the risk of developing a PDPH. The presence or absence of second-stage labor pushing and placement of an intrathecal catheter after unintentional dural puncture were compared in parturients with and without PDPH using the Fisher exact test. BMI groups were dichotomized at the cutoff value (low and high BMI groups). We compared the incidence of a PDPH between high and low BMI groups using the Fisher exact test after controlling for pushing during labor and placement of an intrathecal catheter at the time of unintentional dural puncture. Secondary analysis evaluated the highest reported numeric rating of pain scores for headache and the need for an epidural blood patch between BMI groups. Unintentional dural puncture was identified in 518 (0.53%) patients (95% CI, 0.48%-0.58%). The overall incidence of PDPH after unintentional dural puncture was 51% (95% CI, 46%-55%). The Wilcoxon-Mann-Whitney odds for a random pair of BMI values from a PDPH subject compared with a non-PDPH subject was 0.74 (95% CI, 0.60-0.90, P = 0.001). The odds ratio for developing a PDPH in women who pushed during delivery was 2.4 (95% CI, 1.2-3.9, P = 0.001) compared with women who did not push. Classification tree analysis identified a BMI cutoff value of 31.5 kg/m for prediction of a PDPH. The incidence of PDPH in parturients with a BMI ≥31.5 kg/m (39%) was lower than in parturients with a BMI <31.5 kg/m (56%; difference -17%; 95% CI, -7% to -26%, P = 0.0004). The odds ratio for a PDPH in the high BMI compared with the low BMI group was 0.36 (95% CI, 0.14-0.92, P = 0.04) in parturients who pushed during labor and 0.62 (95% CI, 0.41-0.97, P = 0. 04) in parturients who did not push. After the unintentional dural puncture, 112 (22%) parturients had an intrathecal catheter placed. The incidence of PDPH in parturients with an intrathecal catheter was 59% (95% CI, 49%-68%) compared with 48% (95% CI, 43%-54%) in women with an epidural catheter (P = 0.06). Median (interquartile range) headache severity (0-10 verbal rating scale) was 8 (6-9) and did not differ between parturients in the high versus low BMI groups (P = 0.61). The rate of epidural blood patch administration for PDPH treatment was similar in BMI groups (difference -12%; 95% CI, 4 to -27, P = 0.13). The findings are consistent with previous reports of decreased PDPH incidence after unintentional dural puncture in parturients with an increased BMI, even after controlling for pushing during labor. Severity of headache and need for epidural blood patch treatment were similar in low and high BMI groups.

ObjectivesThe lower risk of death in overweight or obese patients, compared with normal-weight individuals, has caused confusion for patients with diabetes and healthcare providers. This study investigated the relationship between...

There are limited data about the relationship between body mass index (BMI) and left ventricular ejection fraction (EF) in patients with heart failure (HF). The study aims to assess the correlation between BMI and left ventricular EF under HF conditions. We derived the data from the Dryad Digital Repository for analysis, and the information of the original patients was obtained from the MIMIC-III database by the data uploader. We performed smooth curve and two piecewise linear regression analyses to evaluate the association between BMI and EF in HF patients. A total of 962 participants were included in this study, with age of 73.7±13.5years, and 475 participants were male (49.4%). The results of the smooth curve supported a U-shaped relationship between BMI and EF, and the inflection point was found to be a BMI of 23.3kg/m2 in these HF patients. After adjusting for potential confounders, we found that EF decreased with increasing BMI up to the inflection point (β=-0.7, 95% CI -1.3 to -0.1, P=0.028), whereas beyond the turning point, the relationship between EF and BMI showed a positive correlation (β=0.2, 95% CI 0.1-0.3 P<0.001). Importantly, ischaemic heart disease (interaction P=0.0499) and hyperlipidaemia (interaction P=0.0162) affected the association between BMI and EF in the lower BMI group (BMI<23.3kg/m2 ), although only diabetes mellitus (interaction P=0.0255) altered the association between BMI and EF in the higher BMI group (BMI≥23.3kg/m2 ). In addition to higher BMI, we also found that lower BMI is related to higher EF in intensive care unit patients with HF, supporting a U-shaped association between BMI and EF.

Background: Obesity is a key trigger for insulin resistance leading to type-2 diabetes mellitus (T2DM). However, recent evidence suggests that obese patients with T2DM may have lower morbidity and mortality compared to patients of normal weight. These reports are limited by statistical power and confounders. We investigated the relationship between Body Mass Index (BMI), mortality and cardiovascular (CV) morbidity in a long-term large cohort of patients with T2DM. Methods: Between 1995 and 2011, weight (BMI), blood pressure, dyslipidemia, smoking and comorbidities was collected in patients with T2DM without known CV disease. Patients were followed prospectively. Total mortality and hospital admissions for acute coronary syndrome (ACS), cerebrovascular accidents (CVA) and heart failure (HF) were gathered. Subjects were divided according to BMI quartiles and in age tertiles. ANOVA was used to compare covariates amongst the BMI groups, Chi square and multivariate Cox-Regression analysis were used to assess the prognostic impact of BMI and confounders on the above-defined events. Sensitivity analysis was performed accounting for cancer, BMI<18.5 and gender. Results: Of 12025 patients (54% men, mean age 60+15 years), followed for a mean of 10+4 years), 4125 (34%)died. In the first age tertile (42+10 years), there was a U-shaped relationship between BMI and outcome; those with BMI 25-28 had the lowest mortality (X2 15.2 P<0.01). In the second age tertile (62+6 years), there was a similar mortality across BMI quartiles (X2 5.1 P=0.14). In the oldest age tertile (75+5 years), mortality was inversely related to BMI; those with BMI 27-30 had the lowest mortality X2 33.0 P<0.0001. Excluding patients with cancer, BMI <18.5 or adjusting for sex did not significantly affect these results. In a multi-variable Cox Regression model, including age, sex, smoking, blood pressure, cancer and diabetes duration, higher BMI was still associated with a lower mortality. However, patients in higher BMI quartiles had a higher incidence of ACS and HF in all age tertiles (all X2 P<0.05) and CVA showed a similar trend. In multi-variable Cox regression models, the association between higher BMI and CV morbidity remained after adjusting for other variables. Conclusion: In this analysis, although being overweight was associated with an increased risk of CV events in patients with T2DM, higher BMIs were associated with a survival benefit in older patients. Slim patients with T2DM may have a more severe metabolic disorder than patients in whom insulin resistance is primarily due to obesity.

Numerous studies have investigated links between body mass index (BMI) trajectories and cardiovascular risk, yet discrepancies in BMI measurement duration and timing of the cardiovascular-related outcome evaluation have led to inconsistent findings. We included participants from the Swedish birth cohort (BAMSE) and applied latent class mixture modeling to identify BMI trajectories using data of multiple BMI measures (≥ 4 times) from birth until 24-year follow-up (n = 3204). Subsequently, we analyzed the associations of BMI trajectories with lipids (n = 1974), blood pressure (n = 2022), HbA1c (n = 941), and blood leukocytes (n = 1973) using linear regression. We also investigated the circulating levels of 92 inflammation-related proteins (n = 1866) across BMI trajectories. Six distinct BMI groups were identified, denoted as increasing-persistent high (n = 74; 2.3%), high-accelerated increasing (n = 209; 6.5%), increasing-accelerated resolving (n = 142; 4.4%), normal-above normal (n = 721; 22.5%), stable normal (n = 1608; 50.2%), and decreasing-persistent low (n = 450; 14.1%) BMI groups. The increasing-persistent high and high-accelerated increasing BMI groups had higher levels of total cholesterol [mean difference (95% confidence intervals): 0.30 (0.04-0.56) and 0.16 (0.02-0.31) mmol/L], triglyceride, low-density lipoprotein, hemoglobin A1C [3.61 (2.17-5.54) and 1.18 (0.40-1.98) mmol/mol], and low-density lipoprotein/high-density lipoprotein ratios, but a lower level of high-density lipoprotein than the stable normal BMI group. These two groups also had higher leukocyte cell counts and higher circulating levels of 28 inflammation-related proteins. No increased cardiometabolic markers were observed in the increasing-accelerated resolving BMI group. Participants with persistently high or accelerated increasing BMI trajectories from birth to young adulthood have elevated levels of cardiometabolic risk markers at young adulthood than those with stable normal BMI. However, a raised BMI in childhood may not be inherently harmful to cardiometabolic health, provided it does not persist into adulthood.