Impact of body mass index on the outcomes of endoscopic retrograde cholangiopancreatography: a systematic review and network meta-analysis.

Complications of ERCP

Prophylactic pancreatic duct stenting: a panacea?

BackgroundSubstituting sugar-free for sugar-sweetened beverages reduces weight gain. This effect may be more pronounced in children with a high body mass index (BMI) because their sensing of kilocalories might be compromised. We investigated the impact of sugar-free versus sugary drinks separately in children with a higher and a lower initial BMI z score, and predicted caloric intakes and degree of compensation in the two groups.Methods and FindingsThis is a secondary, explorative analysis of our double-blind randomized controlled trial (RCT) which showed that replacement of one 250-mL sugary drink per day by a sugar—free drink for 18 months significantly reduced weight gain. In the 477 children who completed the trial, mean initial weights were close to the Dutch average. Only 16% were overweight and 3% obese. Weight changes were expressed as BMI z-score, i.e. as standard deviations of the BMI distribution per age and sex group. We designated the 239 children with an initial BMI z-score below the median as ‘lower BMI’ and the 238 children above the median as ‘higher BMI’. The difference in caloric intake from experimental beverages between treatments was 86 kcal/day both in the lower and in the higher BMI group. We used a multiple linear regression and the coefficient of the interaction term (initial BMI group times treatment), indicated whether children with a lower BMI responded differently from children with a higher BMI. Statistical significance was defined as p ≤ 0.05. Relative to the sugar sweetened beverage, consumption of the sugar—free beverage for 18 months reduced the BMI z-score by 0.05 SD units within the lower BMI group and by 0.21 SD within the higher BMI group. Body weight gain was reduced by 0.62 kg in the lower BMI group and by 1.53 kg in the higher BMI group. Thus the treatment reduced the BMI z-score by 0.16 SD units more in the higher BMI group than in the lower BMI group (p = 0.04; 95% CI -0.31 to -0.01). The impact of the intervention on body weight gain differed by 0.90 kg between BMI groups (p = 0.09; 95% CI -1.95 to 0.14). In addition, we used a physiologically-based model of growth and energy balance to estimate the degree to which children had compensated for the covertly removed sugar kilocalories by increasing their intake of other foods. The model predicts that children with a lower BMI had compensated 65% (95% CI 28 to 102) of the covertly removed sugar kilocalories, whereas children with a higher BMI compensated only 13% (95% CI -37 to 63).ConclusionsThe children with a BMI above the median might have a reduced tendency to compensate for changes in caloric intake. Differences in these subconscious compensatory mechanisms may be an important cause of differences in the tendency to gain weight. If further research bears this out, cutting down on the intake of sugar-sweetened drinks may benefit a large proportion of children, especially those who show a tendency to become overweight.Trial RegistrationClinicalTrials.gov NCT00893529

ASGE Technology Status Evaluation Report: radiographic contrast media used in ERCP

Obesity and age affect male fertility potential

The term motor fitness is most often used synonymously with physical fitness by the coaches but it is very important for the physical education

ObjectiveObesity and periodontitis are recognized as a major public health problem. The aim of this study was to investigate the response of different body mass index(BMI) groups to non-surgical periodontal treatment(NSPT).MethodsWe retrospectively reviewed the medical records, including baseline medical information and BMI, of patients with periodontal disease. We also analyzed periodontal indices, including periodontal pocket depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), before and after NSPT to assess the correlation between BMI and the effectiveness of NSPT.ResultsA total of 147 patients participated in this study, including 88 individuals in the normal BMI group with an average age of 49.02 ± 10.05 years and 59 individuals in the high BMI group with an average age of 48.15 ± 8.78 years. The results showed that the periodontal index of the abnormal BMI group was higher than that of the normal BMI group both before and after NSPT. NSPT had significant effects on patients with periodontitis in both the normal and abnormal BMI groups. The abnormal BMI group exhibited a significantly higher change in the percentage of PD ≧ 4 mm compared to the normal BMI group (p = 0.019).ConclusionDespite the fact that Taiwan individuals have lower BMI groupings, those with abnormal BMI exhibit less favorable periodontal indices compared to those with normal BMI. However, NSPT has shown promising results in improving periodontal disease among individuals with abnormal BMI. Encouragement should be given to individuals with generalized severe periodontitis and a high BMI to actively consider receiving periodontal treatment.Clinical relevanceDespite generally lower BMI in Taiwan, individuals with abnormal BMI exhibit less favorable periodontal health. NSPT shows promise in improving their periodontal condition. Tailored interventions may enhance periodontal outcomes.

The aim of this study was to evaluate hemostatic variables in women according to different body mass index (BMI) values ,and then correlate them with some metabolic parameters - fasting insulin and glucose,total cholesterol ,high-density lipoprotein (HDL)-cholesterol ,low-density lipoprotein (LDL)-cholesterol and triglycerides. Eighty-four female patients aged 18-39 years were recruited ,and agreed to participatein the study. The study group was divided into three subgroups according to BMI: low BMI (BMI < 18.5 kg/m2; n = 43) ,normal-weight (control) (BMI 18.5-24.99 kg/m2; n = 21) and overweight/obese(BMI > 25 kg/m2; n = 20). BMI was calculated ,and the following measurements were taken: International Normalized Ratio ,antithrombin III ,tissue plasminogen activator (t-PA) activity ,t-PA-antigen,plasma fibrinogen level ,factor VII ,Plasminogen activator inhibitor (PAI)-1 activity and antigen and metabolic parameters: fasting insulin and glucose ,total cholesterol ,HDL-cholesterol ,LDL-cholesteroland triglycerides. The results were statistically analyzed. In the low BMI group ,a negative correlation between fasting insulin and PAI-1 activity ,and a positive correlation between fasting glucose andPAI-1 antigen were observed. Also ,a strong negative correlation between PAI-1 activity and insulin/glucose index was found. Plasma insulin levels were significantly lower in the low-BMI women than in theoverweight/obese group (p < 0.001) and with no difference compared to the control group. We did not find any difference in fasting glucose level between all groups. HDL-cholesterol showed the highestlevels in the normal BMI group and was significantly higher than in the low BMI and obese groups (p < 0.05 and p < 0.01 ,respectively). PAI-1 activity in the low BMI women revealed increased activityin comparison to control and overweight/obese women (p < 0.001 and p < 0.05 ,respectively). Lower antigen levels were also shown as compared to both these groups (p < 0.001 and p < 0.001 ,respectively).Similar results were obtained with t-PA antigen levels (p < 0.001 and p < 0.001 ,respectively). There were no differences in activity of t-PA in all groups. Obese women showed significantly higherfibrinogen levels than other BMI groups (p < 0.001 and p < 0.001 respectively). Analysis of hemostatic variables in women with a low BMI testify to the impaired fibrinolysis in this group ,also showinga strong correlation with carbohydrate metabolism.

Background and aimsIn some studies, high endoscopic retrograde cholangiopancreatography (ERCP) case-volume has been shown to correlate to high success rate in terms of successful cannulation and fewer adverse events. The aim of this study was to analyze the association between ERCP success and complications, and endoscopist and centre case-volumes.MethodsData were obtained from the Swedish National Register for Gallstone Surgery and ERCP (GallRiks) on all ERCPs performed for Common Bile Duct Stone (CBDS) (n = 17,873) and suspected or confirmed malignancy (n = 6152) between 2009 and 2018. Successful cannulation rate, procedure time, intra- and postoperative complication rates and post-ERCP pancreatitis (PEP) rate, were compared with endoscopist and centre ERCP case-volumes during the year preceding the procedure as predictor.ResultsIn multivariable analyses of the CBDS group adjusting for age, gender and year, a high endoscopist case-volume was associated with higher successful cannulation rate, lower complication and PEP rates, and shorter procedure time (p < 0.05). Centres with a high annual case-volume were associated with high successful cannulation rate and shorter procedure time (p < 0.05), but not lower complication and PEP rates.When indication for ERCP was malignancy, a high endoscopist case-volume was associated with high successful cannulation rate and low PEP rates (p < 0.05), but not shorter procedure time or low complication rate. Centres with high case-volume were associated with high successful cannulation rate and low complication and PEP rates (p < 0.05), but not shorter procedure time.ConclusionsThe results suggest that higher endoscopist and centre case-volumes are associated with safer ERCP and successful outcome.

Obesity is known to be associated with postoperative morbidity in gastric cancer surgery, but its impact on laparoscopy assisted gastrectomy (LAG) for gastric cancer has rarely been evaluated. The clinical data for 1,485 LAG procedures for gastric cancer in 10 institutions were reviewed. The patients were divided into high body mass index (BMI) (BMI > or = 25 kg/m(2); n = 432) and low BMI (BMI <25 kg/m(2); n = 1,053) groups, and their clinical outcomes were compared. The mean age and proportion of comorbid patients were higher in the high BMI group than in the low BMI group. Postoperative morbidity and mortality did not differ between the high BMI (15.7% and 0.9%) and low BMI (14% and 0.5%) groups (p = 0.37 and p = 0.29). Only the operation time and the number of retrieved lymph nodes were significantly different between the high BMI (242.5 min and 30.4) and low BMI (223.7 min and 32.6) groups (p < 0.001 and p = 0.005), especially for male patients undergoing surgery by surgeons who have performed 40 or fewer LAGs. High BMI itself may not increase operative morbidity after LAG for gastric cancer. However, when a surgeon is relatively inexperienced with LAG, a careful approach is required for male patients with a high BMI.

139 Background: Obesity is considered as a major perioperative risk factor in various cancer surgeries. We aimed to elucidate the effect of two different obesity index, such as VFA (visceral fat area) and BMI (body mass index), on gastrectomy. Methods: From Mar 2009 to July 2010, 632 patients with diagnosed gastric carcinoma underwent curative gastrecomy at Seoul St. Mary’s hospital. We reviewed patients’ clinicopatholic data and collected 187 patients who had data including BMI, VFA and SFA. Patients with body mass index (BMI) ≥ 25 kg/m 2 were defined as obese and visceral fat area (VFA) ≥ 100 were defined as centrally obese. Results: Out of a total 187 patients, eighty patients were in the high BMI group and 107 patients were in the low BMI group. We selected patients with high VFA and low BMI (group A) and compared to the patients with low VFA and low BMI (group B). Out of a total 107 patients in low BMI, seventy three patients were censored as high VFA, and age older than 60 and male patients were prevalent in this group (p=0.045 and 0.046). The operation time (OT) and estimated blood loss (EBL) were significantly higher in group A than group B (p=0.043 and p=0.05). Conclusions: VFA and BMI are correlated each other and successfully represent patients’ obesity. However in selected patients, such as male patients with age older than sixty, VFA more practically represent their obesity.

Endoscopic retrograde cholangiopancreatography in children. Subcommittee on Endoscopy and Procedures of the Patient Care Committee of the North American Society for Pediatric Gastroenterology and Nutrition.

Perioperative outcomes in obese women with uterine cancer

To evaluate the significance of both low and high body mass index (BMI) as a biomarker in first-line tyrosine kinase inhibitors (TKIs) for metastatic renal cell carcinoma (mRCC). The oncological outcome of 235 patients with mRCC treated with TKI from 2007 to 2018 was reviewed retrospectively. All patients received first-line TKI as therapy. We analyzed the relationship between BMI (low and high) and disease control rate. The primary outcome was progression free survival and overall survival, and the association between BMI and survival prognosis was evaluated. The median BMI was 22.5 kg/m2 , and 25 patients (10.7%) had a low BMI (<18.5 kg/m2 ), 158 patients (67.2%) had a normal BMI (18.5-25 kg/m2 ), and 52 patients (22.1%) had a high BMI (≥ 25 kg/m2 ). Patients in the low BMI group had a significantly lower disease control rate, whereas patients in the high BMI group had a significantly higher disease control rate (p=0.002 and p=0.030, respectively). A log-rank test showed prognosis to be significantly poorer in the low BMI group and to be significantly better in the high BMI group than that in the normal BMI group. Multivariable Cox regression analysis showed that low BMI was an independent indicator of poor prognosis, whereas high BMI was an independent indicator of favorable prognosis. We showed the impact of both low and high BMI on predicting therapeutic efficacy and prognosis in mRCC patients treated with TKI.

BackgroundMany people with radiographic knee osteoarthritis (RKOA) do not present with pain. It is suspected that such persons tend toward lower body mass index (BMI). The purpose of the study was to explore the relationship between BMI and knee pain among persons with RKOA.MethodsSubjects in the Clearwater Osteoarthritis Study with RKOA (N = 576) were classified as reporting knee pain (Pain) or no knee pain (No Pain). WHO-classified BMI categories were compared by pain status. Odds ratios were calculated for the four elevated BMI groups, with the normal BMI group as the reference group. Elevated BMI was the risk factor, and knee pain status was the outcome factor.ResultsPain subjects presented with a higher mean BMI (30.4 kg/m2) compared with No Pain subjects (27.5 kg/m2) (p < 0.0001). Unadjusted and adjusted odds ratios demonstrated a positive association between BMI group and pain for each successive elevated BMI category. Adjusted odds ratios ranged from 1.6 for the Pre-obese group (p < 0.05) to 7.5 for the Obese III group (p < 0.0001).ConclusionAmong subjects with RKOA, those presenting with an elevated BMI had a greater likelihood of knee pain compared to subjects with a normal BMI, and this chance rose with each successive elevated BMI category. As BMI is a modifiable risk factor, longitudinal research is needed to confirm these findings and elucidate the mechanisms underlying this relationship.