OBESITY AS A RISK FACTOR FOR HIGHER FREQUENCY OF MACROSCOPIC INVASION OF PAPILLARY THYROID CARCINOMA

Association of Body Mass Index With Clinicopathological Features of Papillary Thyroid Carcinoma: A Retrospective Study

To compare obese with normal and overweight type 2 diabetic patients regarding body mass index (BMI) and cardiovascular risk factors, and to analyse changes in weight versus risk factors. A cross-sectional study of 44 042 type 2 patients, and a 6-year prospective study of 4468 type 2 patients. Obese patients (BMI > or = 30 kg m(-2)), 37% of all patients, had high frequencies of hypertension (88%), hyperlipidaemia (81%) and microalbuminuria (29%). Only 11% had blood pressure <130/80 mmHg. Their ratio of triglycerides to HDL cholesterol was considerably elevated, whilst the mean total and LDL cholesterol were similar as in normal weight subjects. Obese patients had elevated odds ratios for hypertension, hyperlipidaemia and microalbuminuria: 2.1, 1.8 and 1.4 in the cross-sectional study, similarly confirmed in the prospective 6-year study. BMI was an independent predictor of these risk factors (P < 0.001), although only slightly associated with HbA1c and not with total or LDL cholesterol. A change in BMI during the prospective study was related to a change in HbA1c in patients treated with diet and oral hypoglycaemic agents (OHAs) but not with insulin. In all patients, an increase in BMI was related to the development of hypertension, and a change in BMI to change in blood pressure, also mostly confirmed when treated with diet, OHAs or insulin. The high frequencies of risk factors in obese type 2 patients implies an increased risk of cardiovascular disease and the need for therapeutic measures. The paradox that hypoglycaemic treatment accompanied by weight gain may increase cardiovascular risk factors seems to be verified here concerning hypertension but not concerning microalbuminuria.

Asthma is a significant public health problem, with approximately 24.6 million Americans reporting current asthma in 2009 (1). Obesity prevalence has continuously increased over the last 30 years, reaching 33.8% among U.S. adults in 2007–2008 (2). A meta-analysis of prospective studies showed a dose-dependent relationship between increasing body mass index (BMI) and the risk of incident asthma (3). Understanding the influence of BMI and obesity on effectiveness of interventions to improve asthma control will help clinicians better care for obese patients with asthma. The Better Outcomes of Asthma Treatment study, a randomized controlled trial in 612 adults with poorly controlled asthma, found that a shared treatment decision-making (SDM) intervention improved controller medication adherence and clinical outcomes (4). Given the increased attention to the links between obesity and asthma, we conducted post hoc analyses to investigate whether baseline BMI modified the SDM intervention effects on asthma medication acquisition outcomes (fill/refill adherence and regimen strength) and clinical outcomes in the follow-up year. We hypothesized that obese patients would have benefitted less from the SDM intervention than did overweight or normal weight patients. Some of the results reported here were previously reported in the form of an abstract (5). Standard BMI categories were defined: normal (18.5–24.9 kg/m2, n = 132) and underweight (< 18.5 kg/m2, n = 7) combined, overweight (25–29.9 kg/m2, n = 185), and obese (≥ 30 kg/m2, n = 286).Using comprehensive pharmacy dispensing records, we computed continuous medication acquisition (CMA) indices (6–8) to measure fill/refill adherence for controller medications (inhaled corticosteroids, leukotriene modifiers, and others) and for long-acting β agonists (LABA) during the 12 months before and after randomization of individual participants. Controller and LABA medication regimen strength was measured by cumulative beclomethasone canister-equivalents (C-E) and salmeterol diskus-equivalents (D-E), respectively, using a standardized weighting methodology (9). Clinical outcome measures included the symptom subscale of the Juniper mini-Asthma Quality of Life Questionnaire (mini-AQLQ) (10), the Asthma Therapy Assessment Questionnaire (ATAQ) (11), asthma-related health care utilization, rescue medication use (via albuterol C-E), and lung function. Multivariable regression models were used to determine whether BMI modified the SDM intervention effect on these outcomes relative to usual care. Compared with the controller regimen strength among normal weight SDM patients (0.036 ± 0.02 C-E), obese (0.05 ± 0.026 C-E, P = 0.027) and overweight SDM patients (0.048 ± 0.03 C-E, P = 0.0007) negotiated a higher daily controller dose. BMI negatively modified the SDM intervention effect on controller fill/refill adherence (P = 0.04; Figure 1). The SDM-related increase in controller CMA index among obese patients, relative to obese usual care patients, was smaller than observed for the other weight groups, although still in a favorable direction (β = 0.086; 95% confidence interval [CI], −0.03 to 0.202; P = 0.15). Obese SDM patients also received a smaller intervention benefit (but still significantly better than UC) in terms of the total number of salmeterol D-E dispensed (β = 1.82; 95% CI, 0.81 to 2.84; P = 0.0005) than SDM patients in other weight groups (interaction term P = 0.04). Figure 1. Increase in controller continuous medication acquisition (CMA) associated with shared decision-making (SDM) intervention, compared with usual care, by body mass index (BMI) category. *Normal weight: n = 139; β-coefficient for SDM versus UC: P ... BMI did not significantly modify the observed beneficial SDM intervention effects on any of the clinical outcomes. Like normal weight and overweight SDM patients, obese SDM patients demonstrated significantly better clinical outcomes compared with obese patients in usual care for asthma-related health care utilization, use of rescue medication (albuterol C-E), the FEV1 and FEV1/FEV6 ratio, and the odds of reporting no asthma control problems (a score of 0) on the ATAQ scale. Although these analyses are exploratory, and thus, further research is needed, these results demonstrate that a shared decision-making approach to treatment choice can clinically benefit adult patients with poorly controlled asthma, regardless of BMI.

Papillary Thyroid Carcinoma (PTC), a well-differentiated malignant neoplasm originating from thyroid follicular cells, has been increasingly studied for its association with obesity. In Ukraine, PTC accounts for approximately [1.7–1.8]% of all malignant tumors. Accumulated evidence suggests that obesity, characterized by a Body Mass Index (BMI) over 30 kg/m2, promotes carcinogenesis through hormonal changes, chronic inflammation, oxidative stress, and insulin resistance. The aim of the study was to investigate the relationship of obesity or overweight with PTC size. This retrospective study examined 91 patients with histologically confirmed PTC, categorizing them based on BMI into normal weight, overweight, and obese groups. Patients were divided into groups in relation to their weight. The study group comprised patients with overweight and obesity based on their BMI. Informed consent was obtained from all participants. Statistica 12 (TIBCO Software Inc., USA) and GraphPad Prism 10 (GraphPad Software, LLC, USA) statistical software were used for data analyses. Statistical significance was set at p&lt;0.05. The study showed that in our cohort, 71% of PTC patients were overweight or obese. Notably, larger tumors (≥1 cm) were more common in obese and overweight groups, whereas PTC microcarcinomas (&lt;1 cm) were more frequent in patients with normal weight, suggesting a potential correlation between obesity and larger tumor size (p&lt;0.05). This size differential suggests that metabolic factors associated with higher BMI may influence tumor growth in PTC. The results of the study indicate that PTC with a tumor diameter of ≥1 cm is more likely in obese and overweight patients. Thyroid microcarcinomas are more common in patients of normal weight. Obesity can be considered as a risk factor for faster growth of neoplasms in PTC. Keywords: papillary thyroid microcarcinoma, cancer risk, body mass index, neoplasm staging, prognostic factors, morphometric parameters.

The purpose of this study was to determine the impact of obesity on clinicopathological features and biochemical recurrence (BCR) following radical prostatectomy (RP) in Korean prostate cancer (PCa) patients. A single-institutional retrospective analysis was performed on 880 PCa patients treated by RP without neoadjuvant therapy between July 2005 and December 2011. Patients were stratified according to body mass index (BMI) standards for Asian populations: obese (BMI ≥25 kg/m(2)), overweight (BMI 23-24.9 kg/m(2)), or normal weight (BMI <23 kg/m(2)). For analysis, overweight and obese patients were combined (n = 592, BMI ≥23 kg/m(2)) and compared with normal weight patients (n = 288, BMI <23 kg/m(2)). BCR was defined as prostate-specific antigen (PSA) ≥0.2 ng/ml following RP. Normal weight patients tended to be classified into the higher D'Amico risk category with smaller prostate volumes compared with obese and overweight patients. Normal weight patients had higher pathological Gleason scores and were at higher risk of BCR during the mean follow-up of 58.2 months. This translated to a higher 5-year BCR-free survival rate for obese and overweight patients compared with normal weight patients (77.8 vs. 70.3 %; p = 0.017). On multiple Cox-proportional hazards regression analysis incorporating variables of BMI category, PSA, positive surgical margins, pathological T stage, and Gleason score, higher BMI category remained a significant predictor of a lower risk of BCR (HR = 0.634, p = 0.028). Obese and overweight Korean PCa patients have lower Gleason scores and a reduced risk of BCR compared with normal weight patients. These findings suggest that body fat influences pathological features and oncologic outcomes of PCa.

Patients with body mass index ≥25 kg/m2 as a target population for improvement of rate of follow-up duplex venous ultrasound examinations following initial incomplete examinations

P963Recurrence of atrial fibrillation after cryoballoon pulmonary vein isolation in overweight and obese patients - does weight matter?

Obstructive Sleep Apnea in Normal Weight Patients: Characteristics and Comparison With Overweight and Obese Patients

Background. Papillary Thyroid Carcinoma (PTC) is the malignant neoplasm of thyroid gland constituting up to 80% of all thyroid cancer types. The relationship between PTC and obesity is not well investigated in Ukraine. Aim. To investigate and evaluate the features of the microscopic invasive features of PTC in the obese and overweight patients and compare it with patients with PTC and normal weight. Materials and Methods. This study enrolled 91 patients who were diagnosed with PTC. The patients were divided into a groups depending on their Body Mass Index (BMI): 20 patients with PTC and obesity (BMI &gt;30 kg/m2), the 45 patients with overweight and PTC (BMI [24.0–29.0] kg/m2) and 26 patients with PTC and normal weight (BMI [18.0–23.9] kg/m2). A clinical data and histopathological parameters were retrieved from archived medical records. Written informed consent was to participated was obtained from all patient. Statistica 12 (TIBCO Software Inc., USA) and GraphPad Prism 10 (GraphPad Software, LLC, USA) statistical software were used for data analyses. Statistical significance was set at p&lt;0.05. Ethical approval for the study was obtained the local ethical committee at Verum Expert Clinic. The study was conducted according to Helsinki Declaration and Ukrainian ethical standards. Results. A statistically significant difference in the higher frequency of microscopic damage to the thyroid gland structures by PTC was detected in 6 (30.0%) patients with PTC with obesity, in 3 (6.0%) patients with PTC with overweight, and in 5 (19.0%) patients with PTC with normal weight (p=0.046). Further data analysis revealed a significantly higher frequency of the PTC perineural invasion in 3 (15%) obese patients with PTC, in 3 (2.2%) overweight patients with PTC, and in none of the patients with PTC and normal weight (p=0.031). Conclusions. Patients with PTC and obesity have 1.57 higher frequency of microscopic invasion predominately due to perineural invasion of the carcinoma, which is aggressive biological characteristics of malignant neoplasm. The risk of PTC in the population with obesity should be taken into consideration by medical professional, and aggressive biological characteristics should be considered at follow up and management of the patients. Keywords: neoplasm invasiveness, perineural invasion, body mass index, cancer risk factors.

Background. Papillary Thyroid Carcinoma (PTC) is the malignant neoplasm of thyroid gland constituting up to 80% of all thyroid cancer types. The relationship between PTC and obesity is not well investigated in Ukraine. Aim. To investigate and evaluate the features of the microscopic invasive features of PTC in the obese and overweight patients and compare it with patients with PTC and normal weight. Materials and Methods. This study enrolled 91 patients who were diagnosed with PTC. The patients were divided into a groups depending on their Body Mass Index (BMI): 20 patients with PTC and obesity (BMI &gt;30 kg/m2), the 45 patients with overweight and PTC (BMI [24.0–29.0] kg/m2) and 26 patients with PTC and normal weight (BMI [18.0–23.9] kg/m2). A clinical data and histopathological parameters were retrieved from archived medical records. Written informed consent was to participated was obtained from all patient. Statistica 12 (TIBCO Software Inc., USA) and GraphPad Prism 10 (GraphPad Software, LLC, USA) statistical software were used for data analyses. Statistical significance was set at p&lt;0.05. Ethical approval for the study was obtained the local ethical committee at Verum Expert Clinic. The study was conducted according to Helsinki Declaration and Ukrainian ethical standards. Results. A statistically significant difference in the higher frequency of microscopic damage to the thyroid gland structures by PTC was detected in 6 (30.0%) patients with PTC with obesity, in 3 (6.0%) patients with PTC with overweight, and in 5 (19.0%) patients with PTC with normal weight (p=0.046). Further data analysis revealed a significantly higher frequency of the PTC perineural invasion in 3 (15%) obese patients with PTC, in 3 (2.2%) overweight patients with PTC, and in none of the patients with PTC and normal weight (p=0.031). Conclusions. Patients with PTC and obesity have 1.57 higher frequency of microscopic invasion predominately due to perineural invasion of the carcinoma, which is aggressive biological characteristics of malignant neoplasm. The risk of PTC in the population with obesity should be taken into consideration by medical professional, and aggressive biological characteristics should be considered at follow up and management of the patients. Keywords: neoplasm invasiveness, perineural invasion, body mass index, cancer risk factors.

IntroductionObesity levels in the UK have risen over the years. Studies from the US and elsewhere have reported variable outcomes in terms of post liver transplant morbidity, mortality and graft...

Background:Higher prevalence of obesity has been observed in psoriatic arthritis (PsA) and rheumatoid arthritis (RA) versus the general population, and abnormal body mass index has been associated with worse rheumatic markers.Objectives:To describe PsA and RA patients in Switzerland, stratified by body mass index (BMI) category.Methods:We performed a descriptive cohort study in PsA and RA patients registered in the Swiss Clinical Quality Management in Rheumatic Diseases (SCQM) database. Two distinct cohorts were generated based on patient diagnosis (PsA or RA) and analysed separately but using similar approaches. In both cohorts, we included patients treated for the first time with biologics or targeted synthetic disease-modifying anti-rheumatic drugs (tsDMARDs), and considered the treatment start as index date. Patients without baseline BMI were excluded. Patients were stratified by BMI category at the start of biologic/tsDMARD treatment, defined as underweight (BMI&lt;18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9), and obese (BMI≥30). In the PsA cohort, underweight and normal weight groups were merged due to low numbers. The proportion of patients categorized as overweight or underweight were compared to national statistics from the Swiss Federal Statistical Office. Information on patient demographics (e.g., age, sex, BMI, life-habits), disease-specific characteristics (e.g., disease activity scores, health questionnaires, biomarkers), co-medications and comorbidities were summarized at the start of the first biologic/tsDMARD treatment. Patient characteristics across BMI categories were compared, using the normal weight category as reference group. Additionally, we summarized the frequency and reasons for recorded treatment stop/switch at ≤6 months, 6 to 12 months, and &gt;12months from treatment start, and illustrated the prescription patterns for first and second biologic/tsDMARD treatment, stratifying by BMI.Results:We identified 819 PsA [39.7% normal weight, 36.5% overweight, 23.8% obese] and 3217 RA patients [4.4% underweight, 46.8% normal weight, 31.8% overweight, 17.0% obese]. Figure 1 illustrates the prevalence of overweight and obesity in each cohort stratified by sex, compared to the national average. When comparing obese patients to those with normal weight, both PsA and RA obese patients had significantly higher C-reactive protein, worse disease activity score, lower quality of life (QoL) measures, and more frequent cardiovascular disease and diabetes. Among PsA patients, the overweight and obese had worse physician-assessed skin manifestation and patient-reported pain compared to the normal weight group. While in RA, the obese patients had higher erythrocyte sedimentation rate, smaller prevalence of seropositive patients, lower frequency of fractures/surgeries, and higher tender joint counts, but similar swollen joint counts, when compared to the normal weight group.Adalimumab and etanercept, were the most commonly prescribed drugs as first biologic/tsDMARD treatment in both PsA and RA cohorts and among every BMI category. Overall, 55% PsA and 56% RA patients had recorded treatment stop/switch. Among RA patients, significantly fewer obese patients reported treatment stop/switch at &gt;12 months from treatment start, compared to the normal weight group. Adalimumab and etanercept were also the most commonly prescribed second biologic/tsDMARD treatment, but for the obese group among PsA patients (adalimumab, golimumab) and the obese group in the RA cohort (adalimumab, rituximab).Conclusion:In this national wide study, we observed that the prevalence of obesity in RA and PsA was higher than that of the general Swiss population. Obese PsA/RA patients starting first biologic/tsDMARD treatment presented worse disease activity and poorer QoL than normal weight patients. Results suggest to take BMI into consideration when treating PsA and RA patients.Acknowledgements:We would like to thank all patients and rheumatologists contributing to the SCQM registry, as well as the entire SCQM staff. A list of rheumatology offices and hospitals which contribute to the SCQM registry can be found at http://www.scqm.ch/institutions. The SCQM is financially supported by pharmaceutical industries and donors. A list of financial supporters can be found at http://www.scqm.ch/sponsors.Disclosure of Interests:Enriqueta Vallejo-Yagüe: None declared, Theresa Burkard: None declared, Burkhard Moeller Speakers bureau: AbbVie, Bristol Myers, Eli Lilly, Janssen, Pfizer, Roche, Novartis, Merck, Axel Finckh Speakers bureau: Pfizer, Eli-Lilly, Paid instructor for: Pfizer, Eli-Lilly, Consultant of: AbbVie, AB2Bio, BMS, Gilead, Pfizer, Viatris, Grant/research support from: Pfizer, BMS, Novartis, Andrea Michelle Burden: None declared

Síndrome de apnea-hipopnea del sueño en pacientes normopeso: características y comparación con pacientes con sobrepeso y obesidad

Introduction: Obesity is an independent risk factor for the development of breast cancer and has been associated with poor breast cancer outcomes. But, this association usually depend on hormone-receptor positivity and ovarian activity. Obesity was confirmed as an adverse prognostic factor in patients treated with aromatase inhibitors, but the adverse effects in patients treated with tamoxifen was not known exactly. Thus, we aimed to examine the efficacy of adjuvant tamoxifen in hormone receptor-positive premenopausal breast cancer patients according to the body mass index (BMI). Material-Methods: Newly diagnosed hormone receptor-positive breast cancer patients who were premenopausal and non-metastatic were enrolled to the study. Patients with BMI ranging between 18.5 and 24.9 kg/m2 as normal weight patients (Arm A, n = 408), and patients with a BMI ranging ≥ 25 kg/m2 were overweight and obese patients (Arm B, n = 418). Results: The median follow-up time for this analysis was 36 (6-327) months. The median age was 39.5 (22-57) and 43 (20-56) in Arm A and Arm B, respectively (P&amp;lt;0.0001). The mean BMI was 22.1 ± 1.8 kg/m2 and 29.2 ± 3.3 kg/m2 of Arm A and Arm B, respectively ( P = &amp;lt;0.001). In both normal weight and overweight patients, the other baseline clinico-pathologic properties and the treatment history with radiotherapy and chemotherapy were similar and not statistically significant. In overweight and obese patients the history of diabetes mellitus and hypertension was significantly higher compared to normal weight patients. In patients with normal weight patients DFS rate was 88.5% and 78.2% whereas in overweight and obese patients DFS rate was 87.2% and 70.9% in the third and fifth years respectively (Figure 1) ( P = 0.43). In patients with normal weight patients OS rate was 98.5% and 93.2% whereas in overweight and obese patients OS rate was 94.6% and 87.4% in the third and fifth years respectively (Figure 2) ( P = 0.02). Conclusion: Our study showed that BMI have no worse effect on recurrence risk in patients treated with tamoxifen in hormone-receptor positive premenopausal breast cancer. Poor survival outcome was observed in overweight and obese patients can be due to dose limitations of chemotherapeutic agents and higher rate of comorbid diseases. Citation Format: Kadri Altundag, Mehmet AN Sendur, Sercan Aksoy, Taner Babacan, Yavuz Ozisik. Efficacy of adjuvant tamoxifen in hormone receptor-positive premenopausal breast cancer patients according to the body mass index [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-12-16.

Meta-Analysis of Effect of Body Mass Index on Outcomes After Transcatheter Aortic Valve Implantation