Variation by age, smoking, and menopausal status in the impact of body mass index change on liver cancer risk.

With obesity on the rise among people living with HIV (PLWH), there is growing concern that weight gain may result as an undesired effect of antiretroviral therapy (ART). This analysis sought to assess the association between ART regimens and changes in body mass index (BMI) among ART-experienced, virologically suppressed PLWH. ART-experienced, virologically suppressed PLWH ≥18 years of age in the Observational Pharmacoepidemiology Research and Analysis (OPERA) cohort were included for analysis if prescribed a new regimen containing one of the following core agents: dolutegravir (DTG), elvitegravir/cobicistat (EVG/c), raltegravir (RAL), rilpivirine (RPV), or boosted darunavir (bDRV), for the first time between August 1, 2013 and December 31, 2017. Multivariable linear regression was used to assess the association between regimen and mean changes in BMI at 6, 12, and 24 months after switch. In unadjusted analyses, BMI increases ranged from 0.30 kg/m2 (bDRV) to 0.83 kg/m2 (RPV) at 24 months following switch, but gains were observed with every regimen. In adjusted analyses, compared to DTG, only bDRV was associated with a smaller increase in BMI at all time points, while EVG/c and RAL were associated with smaller increases in BMI at 6 months only. Overall, results were consistent in analyses stratified by baseline BMI category. BMI increases were relatively small but followed an upward trend over time in this cohort of treatment-experienced, suppressed PLWH. Gains were attenuated with a longer period of follow-up. BMI gains did not differ by regimens, except for bDRV regimens, which were consistently associated with smaller BMI increases than DTG.

Change in Body Mass Index After Total Knee Arthroplasty and Its Influence on Functional Outcome

Aim: To assess the trend of the pregravid body mass index (BMI), pregnancy weight gain, and BMI gain in singleton pregnancies delivered at ≥38 completed weeks during the last decade.Materials and methods: We used data from a population-based dataset for the period of 2006–2015. Linear regression was used to assess the relationship between BMI, pregnancy weight gain, and BMI change over time.Results: A total of 70,866 women were included and stratified as primiparous and multiparous. The average BMI in the primiparous women increased 0.52 kg/m2 in the past decade, increasing for 0.05 kg/m2 every year. The average pregnancy weight gain in this group decreased in this period by 0.7 kg, consequently lowering for 0.07 kg per year, the average BMI change during pregnancy decreased overall by 0.26 kg/m2 (0.026 kg/m2/year). However, in multiparous women, the average pregravid BMI did not change over time, but the average pregnancy weight gain decreased by 0.21 kg (0.021 kg/year), and the average BMI change decreased for 0.10 kg/m2.Conclusions: Our study showed that the pregravid BMI is increasing in the pregnant primiparous women, but the BMI gain, as well as the pregnancy weight gain, decreased irrespective of parity. Given that the range of differences is not clinically significant, we conclude that pregravid BMI, pregnancy weight gain, and BMI change during pregnancy did not change in the last decade.

Bariatric surgery is an effective treatment for youth with severe obesity. However, outcomes are variable and there remains sparse understanding of predictors of weight loss following surgery. The current study examines the role of adolescent-reported pre-operative social support around exercise, binge eating, and exercise to predict excess body mass index (EBMI) loss from 3 to 12months post-surgery. Participants were 101 adolescents ages 12-21 (M age=16.6, SD=1.8). Pre-operative body mass index (BMI) ranged from 35 to 87 (M=50.3, SD=8.6). Structural equation modeling (SEM) was used to evaluate a model of the association of adolescent report of perceived social support for exercise with less binge eating (items from the Eating Disorder Diagnostic Scale) and more self-reported exercise (items from the Youth Risk Behavior Surveillance System). The model was used to predict EBMI loss at 3, 6, 9, and 12months post-surgery. Social support significantly predicted exercise and demonstrated a trend for predicting binge eating, such that more social support was associated with more exercise and a trend for less binge eating. Binge eating was associated with less EBMI loss. However, there was no association of exercise with EBMI loss. Pre-operative binge eating should be a target for identification and treatment prior to sleeve gastrectomy in adolescents. Although not directly or indirectly associated with EBMI loss, perceived social support around exercise was associated with increased exercise, which may make it a consideration for a target for intervention as well.

Comparison of fat-free mass in super obesity (BMI ≥50 kg/m2) and morbid obesity (BMI <50 kg/m2) in response to different weight loss surgeries

Mid-life body mass index (BMI) has been consistently and positively associated with risk of postmenopausal breast cancer, but BMI at younger ages has been inversely associated with risk. Few studies have looked at the timing of adult BMI change and risk. Our analysis of adult BMI, BMI change, and postmenopausal breast cancer risk is, to our knowledge, the largest study to date. Our study population included 72,007 women, 55-74 years old at baseline, in the PLCO cohort: 3,677 postmenopausal breast cancer cases were ascertained from 1993 to 2007 (median follow-up, 9.9 y; interdecile range, 6.2 -12.9 y). Cox proportional hazards models were used to estimate multivariate relative risks (RRs) and 95% confidence intervals (95% CIs). BMI at age 20 and postmenopausal breast cancer risk were consistently inversely associated across use of menopausal hormone therapy (MHT) (Ptrend = 0.01). As the positive association between BMI at study baseline and breast cancer risk appeared to be limited to women who had never used MHT, we present these results among women who never used MHT. Postmenopausal breast cancer risk increased steadily across categories of increasing BMI at study baseline (Ptrend &amp;lt;0.0001) regardless of BMI at age 20. Furthermore, being overweight or obese (&amp;gt;25 kg/m2) at both study baseline and at age 20 had a protective effect on postmenopausal breast cancer risk, compared to being overweight or obese at study baseline but having a normal BMI (&amp;lt;25 kg/m2) at age 20. The RR of postmenopausal breast cancer for a BMI gain &amp;gt;5 kg/m2 between age 20 and age 50 was 1.82 (95% CI, 1.45-2.30), compared to women with no change in BMI (+/− 1 kg/m2). The RR for the same BMI gain from age 50 to age at baseline was 1.56 (95% CI, 1.29-1.90), compared to women with no change in BMI. In addition, in women who gained &amp;gt;5 kg/m2 between age 20 and age at baseline, postmenopausal breast cancer risk nearly doubled (RR, 1.93; 95% CI, 1.46-2.62), compared to the combined group of women with no change in BMI or with BMI loss (&amp;lt;-1 kg/m2). Among women who had never used MHT, BMI gain before and after age 50 was associated with increased postmenopausal breast cancer risk. Our study suggests that, with respect to postmenopausal breast cancer, healthy weight maintenance throughout adulthood is important and that BMI gain from age 20 to age 50 may play a particularly important role in increasing risk. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 4823.

Obesity is a strong risk factor for breast cancer. The polymorphisms of leptin (LEP) and leptin receptor (LEPR) may be associated with breast cancer by regulator of adipose tissue mass and tumor cell growth. A total of 794 cases and 805 matched controls were sequentially enrolled. Time-of-flight mass spectrometry was used to determine the LEPrs7799039, LEPRrs1137100, and LEPRrs1137101 genotypes for each participant. Associations between polymorphisms of these genes, change in body mass index (BMI), and breast cancer risk were assessed by unconditional multivariable logistic regression models. The unconditional logistic regression model showed that persistent overweight (BMI ≥24 kg/m2) over the preceding 10 years was associated with increased breast cancer risk in premenopausal women (odds ratio [OR] = 1.67, 95% confidence interval [CI]: 1.19-2.35). No associations between LEPrs7799039, LEPRrs1137100, or LEPRrs1137101 polymorphisms alone and breast cancer risk were found. Persistent overweight over the preceding 10 years and carrying the LEPrs7799039 AA genotype together increased breast cancer risk in premenopausal women (ORadj = 2.00, 95% CI: 1.26-3.16). Persistent overweight over the preceding 10 years and carrying the LEPRrs1137100 GG genotype increased breast cancer risk in premenopausal women (ORadj = 1.68, 95% CI: 1.06-2.68). In premenopausal women, persistent overweight (BMI ≥24 kg/m2) over the preceding 10 years increases breast cancer risk. Persistent overweight along with LEPrs7799039 AA or LEPRrs1137100 GG genotypes synergistically increase risk of breast cancer among premenopausal women.

Coffee Consumption and Risk of Liver Cancer: A Meta-Analysis

Nonoptimal growth during fetal life and infancy is associated with an increased risk of coronary heart disease and type 2 diabetes later in life. This early pattern of growth is associated with an increased disease risk especially when followed by a relative gain in body size later in childhood. Genetic factors are closely involved in growth and disease pathogenesis and gene-early life environmental interactions will be described affecting adult health outcomes. This overview will primarily focus upon findings from the Helsinki Birth Cohort Study consisting of 15846 subjects born 1924-1944 on whom growth data and information on adult health are available.

Background: Weight management is considered a key therapeutic strategy in type 2 diabetes mellitus. However, little is known about the impact of weight loss or body mass index (BMI) reduction on type 2 diabetes-related healthcare costs. Objective: The aim of this study was to estimate the economic impact of change in BMI among patients with type 2 diabetes mellitus from the Spanish healthcare system perspective. Methods: The ECOBIM study is an observational, non-interventional study in which data on BMI change and costs incurred by patients with type 2 diabetes were collected cross-sectionally and retrospectively for a 12-month period. Generalized linear mixed models were applied to estimate the effects of (i) BMI change in general (one-slope model); (ii) BMI gain and no BMI gain (two-slope model); and (iii) BMI gain and no BMI gain among obese and non-obese patients (four-slope model). Results: We studied 738 patients with a mean (SD) age of 66 (11) years and BMI of 30.6 (5.2) kg/m2. During the 12-month study period, 41.2% of patients gained BMI (BMI gainers) and 58.8% experienced either loss (52.2%) or no change (6.6%) in BMI (non-BMI gainers). One-unit gain (or loss) in BMI was significantly (p<0.001) associated with a 2.4% cost increase (or decrease) [one-slope model]. Every unit gain in BMI was associated with a 20.0% increase in costs among BMI gainers while losing one unit was associated with an 8.0% decrease in costs among non-BMI gainers (two-slope model, p<0.01). The economic benefit associated with reducing one BMI unit was 9.4% cost decrease in obese and 2.7% in non-obese patients (4-slope model). Conclusion: An increase in BMI among patients with type 2 diabetes was associated with increased 1-year direct healthcare costs. A reduction in BMI was associated with appreciable short-term economic benefits, especially in obese patients.

Background: Weight management is considered a key therapeutic strategy in type 2 diabetes mellitus. However, little is known about the impact of weight loss or body mass index (BMI) reduction on type 2 diabetes-related healthcare costs.Objective: The aim of this study was to estimate the economic impact of change in BMI among patients with type 2 diabetes mellitus from the Spanish healthcare system perspective.Methods: The ECOBIM study is an observational, non-interventional study in which data on BMI change and costs incurred by patients with type 2 diabetes were collected cross-sectionally and retrospectively for a 12-month period. Generalized linear mixed models were applied to estimate the effects of (i) BMI change in general (one-slope model); (ii) BMI gain and no BMI gain (two-slope model); and (iii) BMI gain and no BMI gain among obese and non-obese patients (four-slope model).Results: We studied 738 patients with a mean (SD) age of 66 (11) years and BMI of 30.6 (5.2) kg/m2. During the 12-month study period, 41.2% of patients gained BMI (BMI gainers) and 58.8% experienced either loss (52.2%) or no change (6.6%) in BMI (non-BMI gainers). One-unit gain (or loss) in BMI was significantly (p<0.001) associated with a 2.4% cost increase (or decrease) [one-slope model]. Every unit gain in BMI was associated with a 20.0% increase in costs among BMI gainers while losing one unit was associated with an 8.0% decrease in costs among non-BMI gainers (two-slope model, p<0.01). The economic benefit associated with reducing one BMI unit was 9.4% cost decrease in obese and 2.7% in non-obese patients (4-slope model).Conclusion: An increase in BMI among patients with type 2 diabetes was associated with increased 1-year direct healthcare costs. A reduction in BMI was associated with appreciable short-term economic benefits, especially in obese patients.

Introduction: Excessive gain in body mass index (BMI) is associated with a poor pouch outcome. The aim of this study was to evaluate whether increase in BMI is associated with recurrences of chronic pouch sinus. Methods: All consecutive patients with a pouch sinus successfully treated with either endoscopic sinusotomy or redo surgery from 2006 to 2016 were identified from our IRB approved, prospectively maintained Pouch Registry and Colorectal Surgery Pouch Database. The excessive gain in BMI was defined as an increase in BMI≥10%. The primary outcomes were sinus recurrence. Sinus recurrence was defined as the diagnosis of sinus recurring after 6 months from the inception time. Results: This retrospective study included a total of 171 patients. Sinus recurrence was seen in 48 (28.1%) patients. A higher rate of BMI increase≥10% was found in patients with recurrence (22.9% vs. 8.9%, P=0.01). Consequently, patients with an excessive increase in BMI had a lover recurrence-free survival in Kaplan Meier analysis (P=0.10). In multivariate analysis, excessive BMI increase (odd ratio [OR]: 3.0, 95% confidence interval [CI]: 1.0-9.0) and Crohn's disease of pouch (OR: 2.9, 95% CI: 1.0-8.1) was independently related to sinus recurrence. In patients with a recurrent sinus, a similar healing rate was shared between those who had an excessive increase BMI and those who maintained a relatively stable weight (63.6% vs. 70.3%, P=0.81). However, the recurrent-sinus-related pouch failure rate was higher in patients with excessive weight gain (36.4% vs. 16.2%, P=0.31). Conclusion: Excessive gain in BMI after initial successful pouch sinus treatment is associated with an increased risk for sinus recurrence. Appropriate attention towards weight control may help decrease pouch sinus recurrence.802_A Figure 1. Patient and pouch sinus characteristics.802_B Figure 2. Multivariate analysis for risk factors associated with pouch sinus recurrence.802_C Figure 3. Kaplan Meier curve- recurrence-free survival for patients with and without an increase in body mass index≥10%.

Obesity in childhood has been shown to promote adult obesity and the development of cardiovascular disease (CVD) risk. However, little longitudinal information exists on the rate of progression of adiposity during childhood as a predictor of adult insulin resistance and markers of CVD risk. We hypothesize that excessive adiposity in childhood and adolescence predicts adult individual CV risk factors, insulin resistance and vascular changes. Children (n=383 mean age 7 yrs), were measured periodically for height, weight and blood pressure through adolescence. As adults (n=383, mean age 39 y, 50% female), height, weight, lipids, insulin resistance and carotid intima-media thickness (cIMT) were measured. Body mass index (BMI) categories (normal, overweight, and obese) were created by standard criteria. According to the CDC BMI growth charts, the normal mean change in BMI from age 7-16 at the 50th percentile is 5 kg/m 2 . Linear regression evaluated the influence of excessive weight gain in childhood on the development of adverse CVD risk factors in adulthood stratifying by 50 percentile change in BMI (≤5kg/m 2 vs &gt;5kg/m 2 ) between childhood and adolescence, adjusting for confounding factors. Of 313 normal weight children, 32% stayed normal weight, 68% became overweight and obese in adulthood. Of 45 overweight children 90% stayed overweight or became obese in adulthood. Of 25 obese children 100% became overweight and stayed obese in adulthood. Compared to ≤5kg/m 2 , a BMI gain of &gt;5 kg/m 2 between childhood and adolescence was more common in blacks than in whites and was associated with greater CV risk in adulthood: greater % obesity; higher blood pressure, lipids, insulin resistance (M/lbm=insulin sensitivity) and cIMT (Table). These findings show that: 1) childhood adiposity is a strong predictor of adult overweight and obesity, and 2) excessive BMI gain between childhood and adolescence is a major determinant of obesity and CVD risk in adulthood.

To examine the impact of change in body mass index (BMI) during pregnancy on the incidence of macrosomia. This is a retrospective cohort study using 2007 linked birth certificate and discharge diagnosis data from the state of California. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated for the outcome of macrosomia, as a function of a categorical change in pregnancy BMI: BMI loss (<-0.5), no change (-0.5 to 0.5), minimal (0.6 to 5), moderate (5.1 to 10), and excessive (>10). The impact of pregnancy change in BMI was determined for the entire cohort and then stratified by prepregnancy BMI category. Minimal BMI change served as the reference group. The study population consisted of 436,414 women. Overall, women with moderate and excessive BMI changes had aORs of 1.66 and 3.21, respectively, for macrosomia, when compared with women with minimal BMI change. When stratified by prepregnancy BMI, normal (aOR 3.85) and overweight women (aOR 2.96) with antenatal BMI change greater than 10 had the highest odds of macrosomia. Excessive change in pregnancy BMI results in an increased odds of macrosomia. This finding was most pronounced in the normal and overweight women.

Adolescent body mass index and changes in pre-pregnancy body mass index in relation to risk of gestational diabetes.