Adjustment For Baseline Body Mass Index Research Articles

Association between BMI trajectories from childhood to early adulthood and the carotid intima-media thickness in early adulthood: Tehran lipid and glucose study

Background and aimsChildhood and adolescence overweight/obesity is an important predictor of obesity and increased long-term cardiometabolic abnormalities in adulthood. In this study, we aimed to investigate the association of body mass index (BMI) and waist circumference (WC) trajectories among children and adolescents with adulthood carotid intima-media thickness (cIMT) as a determinant of subclinical atherosclerosis.MethodsIn this prospective cohort study, 1265 participants aged 3 to 18 were followed up for 18 years. By using Latent Class Growth Analysis, three groups of BMI and WC trajectory were defined; low stable, moderate-increasing, and high-increasing. Linear and logistic regression analysis were used to investigate the association of each lifetime BMI and WC trajectory group with cIMT.ResultsAlthough the high-increasing BMI trajectory group was significantly associated with higher cIMT (ß=0.0464, P < 0.001), moderate-increase was not (ß=0.0096, P = 0.102); in reference to the low-stable BMI trajectory group. Among WC trajectory groups, both moderate- (ß=0.0177, P = 0.006) and high-increasing (ß=0.0533, P < 0.001), in reference to the low-stable group, were significantly associated with higher cIMT. The results did not change after adjustment for baseline BMI. The ORs of high-increasing BMI, moderate-increasing WC, and high-increasing WC trajectories were 3.24, 1.92, and 3.29, respectively for high cIMT.ConclusionOur study resulted that a high-increasing trajectory of childhood BMI and moderate- and high-increasing trajectories of childhood WC are associated with higher cIMT and higher risk of high-cIMT. Regular monitoring and screening of BMI and WC trajectory from childhood may improve identifying individuals with high risks of cardiovascular disease, more accurately.

U-Shaped Relationship Between Proteinuria and High-Density Lipoprotein Cholesterol: Results of Cross-Sectional and Six Years Cohort Studies (KITCHEN-10).

BackgroundAlthough a very high level of high-density lipoprotein cholesterol (HDL-C) may be a potential cardiovascular disease risk factor, the detail and underlying mechanism remain unclear. Therefore, we examined the associations of serum HDL-C with the incidence of proteinuria, a predictor for cardiovascular disease, in a community-based study.MethodsWe investigated clinical parameters, including serum HDL-C and proteinuria, among 1,191,409 people aged 40 - 74 years who underwent a health checkup in a cross-sectional study. In the cohort study, the incidence of proteinuria after 6 years was investigated in 451,987 participants without proteinuria at baseline, who were simultaneously enrolled in the cross-sectional study.ResultsThe prevalence of proteinuria showed a U-shaped relationship with 10 HDL-C categories, with a minimum of 60 - 89 mg/dL in the cross-sectional study. Logistic regression analysis showed similar U-shaped relationships between odds ratios for proteinuria and HDL-C categories, with a minimum of 70 - 79 mg/dL. The associations between very high HDL-C (≥ 90 mg/dL) and proteinuria were strengthened after adjustment for body mass index (BMI). In the cohort study, a crude L-shaped relationship was observed between the incidence of proteinuria and baseline HDL-C, which turned into U-shaped relationship after adjustment for baseline BMI and HDL-C after 6 years.ConclusionsLow and very high levels of HDL-C may be associated with the incidence of proteinuria, and BMI may be a potent contributing factor to the underlying mechanism.

Association between genetic predisposition to childhood obesity and the risk of adult ischemic heart disease in China

Objective: To examine the associations of childhood obesity, assessed by genetic variations of childhood body mass index (BMI), with the risk of adult ischemic heart disease (IHD) and major coronary event (MCE). Methods: More than 69 000 participants from the China Kadoorie Biobank were genotyped. After excluding those with coronary heart disease, stroke, or cancer at baseline, a total of 64 454 participants were included in this study. Based on genome-wide significant single nucleotide polymorphisms (SNPs), childhood BMI genetic risk score were constructed for every participant and divided into quintiles, with the lowest quintile as the low genetic risk group and the highest quintile as the high genetic risk group. Cox proportional hazards regression models were used to estimate the association between genetic predisposition to childhood obesity and the risk of ischemic heart disease. Results: During a median of 10.7 years of follow-up, 7 073 incident cases of IHD and 1 845 cases of MCE were documented. After adjusting for sex, age, region, and the first ten genetic principal components, the HRs (95%CIs) for IHD and MCE in the high genetic risk group were 1.10 (1.02-1.18) and 1.10 (0.95-1.27), compared with the low genetic risk group. IHD risk increased by 4% (2%-6%) for each one standard deviation increase in genetic risk score (trend P=0.001). After further adjustment for baseline BMI, the differences between genetic risk groups were not statistically significant, but there was still a linear trend between genetic risk score and IHD risk (trend P=0.019). Conclusions: IHD risk increased with genetic predisposition to childhood obesity, suggesting that childhood obesity is an important risk factor for the development of IHD in China. As an easily identifiable feature, changes of childhood BMI should be monitored regularly to realize early intervention of IHD in adults.

Effects of weight change on all causes, digestive system and other causes mortality in Southern Italy: a competing risk approach.

Weight change is associated with all causes of death, cardiovascular, and cancer mortality and a heterogeneous group of other causes of death. We aimed to estimate the effect of weight change on all causes and cause-specific mortality in a cohort with a high prevalence of deaths due to diseases of the digestive system.MethodsIn this prospective cohort study, 2230 subjects aged 30 to 50 years were examined. The study consisted of a 32-year longitudinal study period (January 1985 to December 2017) and mortality follow-up. Outcomes were mortality from all causes and deaths from gastrointestinal disease. Root Mean Squared Error (RMSE) was evaluated to capture individual residual variation in Body Mass Index (BMI) after adjustment for baseline BMI, and the relationship of residual variation with mortality was calculated as cumulative incidence function and cause-specific hazard (CSH) rate.ResultsIn total, 793 participants died during the follow-up, 96 of them due to Digestive system causes. Magnitude of residual variation weight in the last quintile was associated with all-cause mortality (relative risk, 2.00; 95% CI, 1.54-2.59) and Digestive system causes (relative risk, 3.82; 95% CI, 1.86-7.81).ConclusionThe findings suggest an association between weight change and gastrointestinal disease mortality. Epidemiological works studying the correlation between weight change and mortality should consider this aspect.

Healthy eating and lifestyle in pregnancy (HELP): a cluster randomised trial to evaluate the effectiveness of a weight management intervention for pregnant women with obesity on weight at 12 months postpartum

ObjectiveTo assess whether a weight management intervention for pregnant women with obesity was effective in reducing body mass index (BMI) 12 months after giving birth.MethodsPragmatic, cluster randomised controlled trial (RCT) with embedded cost-effectiveness analysis. 598 women with a BMI of ≥30 kg/m2 (between 12 and 20 weeks gestation) were recruited from 20 secondary care maternity units in England and Wales. BMI at 12 months postpartum was the primary outcome. A range of clinical and behavioural secondary outcomes were examined.InterventionsWomen attending maternity units randomised to intervention were invited to a weekly weight management group, which combined expertise from a commercial weight loss programme with clinical advice from midwives. Both intervention and control participants received usual care and leaflets on diet and physical activity in pregnancy.ResultsMean (SD) BMI at 12 months postpartum was 36.0 kg/m2 (5.2) in the control group, and 37.5 kg/m2 (6.7) in the intervention group. After adjustment for baseline BMI, the intervention effect was −0.02 (95% CI −0.04 to 0.01). The intervention group had an improved healthy eating score (3.08, 95% CI 0.16 to 6.00, p < 0.04), improved fibre score (3.22, 1.07 to 5.37, p < 0.01) and lower levels of risky drinking at 12 months postpartum compared to the control group (OR 0.45, 0.27 to 0.74, p < 0.002). The net incremental monetary benefit was not statistically significantly different between arms, although the probability of the intervention being cost-effective was above 60%, at policy-relevant thresholds.ConclusionsThere was no significant difference between groups on the primary outcome of BMI at 12 months. Analyses of secondary outcomes indicated improved healthy eating and lower levels of risky drinking.Trial registration: Current Controlled Trials ISRCTN25260464.

Prior loss of body mass index, low body mass index, and central obesity independently contribute to higher rates of fractures in elderly women and men.

We aimed to comprehensively evaluate the association of body composition with fracture risk using longitudinal data from a Swedish cohort of 44,366 women and men (mean age of 70 years) and a subcohort of 5022 women. We estimated hazard ratios (HRs) of fracture for baseline body mass index (BMI), BMI change during the prior 12 and 18 years, baseline waist-to-height ratio, total and regional distribution of fat and lean mass, with and without areal bone mineral density (BMD) adjustment. During follow-up (median 8.7 years), 7290 individuals sustained a fracture, including 4279 fragility fractures, of which 1813 were hip fractures. Higher baseline BMI and prior gain in BMI were inversely associated with all types of fracture. Lower fracture rate with higher baseline BMI was seen within every category of prior BMI change, whereas higher prior BMI gain conferred a lower rate of fracture within those with normal baseline BMI. Each standard deviation (SD) higher baseline waist-to-height ratio, after adjustment for BMI, was associated with higher rates of hip fracture in both women and men (HR 1.12; 95% CI, 1.05-1.19). In the subcohort (median follow-up 10 years), higher baseline fat mass index (FMI) and appendicular lean mass index (LMI) showed fracture-protective effects. After BMD adjustment, higher baseline BMI, total LMI, FMI, and higher prior BMI gain were associated with higher fracture rate. Baseline fat distribution also was associated with fracture rate; a 1-SD higher android to gynoid fat mass ratio in prior BMI gainers was associated with BMD-adjusted HRs of 1.16 (95% CI, 1.05-1.28) for any fracture and 1.48 (95% CI, 1.16-1.89) for hip fracture. This pattern was not observed among prior BMI losers. These findings indicate that for optimal fracture prevention, low baseline BMI, prior BMI loss and high baseline central obesity should be avoided in both women and men. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Cross-sectional associations between central and general adiposity with albuminuria: observations from 400,000 people in UK Biobank

BackgroundWhether measures of central adiposity are more or less strongly associated with risk of albuminuria than body mass index (BMI), and by how much diabetes/levels of glycosylated haemoglobin (HbA1c) explain or modify these associations, is uncertain.MethodsOrdinal logistic regression was used to estimate associations between values of central adiposity (waist-to-hip ratio) and, separately, general adiposity (BMI) with categories of urinary albumin-to-creatinine ratio (uACR) in 408,527 UK Biobank participants. Separate central and general adiposity-based models were initially adjusted for potential confounders and measurement error, then sequentially, models were mutually adjusted (e.g. waist-to-hip ratio adjusted for BMI, and vice versa), and finally they were adjusted for potential mediators.ResultsLevels of albuminuria were generally low: 20,425 (5%) had a uACR ≥3 mg/mmol. After adjustment for confounders and measurement error, each 0.06 higher waist-to-hip ratio was associated with a 55% (95%CI 53–57%) increase in the odds of being in a higher uACR category. After adjustment for baseline BMI, this association was reduced to 32% (30–34%). Each 5 kg/m2 higher BMI was associated with a 47% (46–49%) increase in the odds of being in a higher uACR category. Adjustment for baseline waist-to-hip ratio reduced this association to 35% (33–37%). Those with higher HbA1c were at progressively higher odds of albuminuria, but positive associations between both waist-to-hip ratio and BMI were apparent irrespective of HbA1c. Altogether, about 40% of central adiposity associations appeared to be mediated by diabetes, vascular disease and blood pressure.ConclusionsConventional epidemiological approaches suggest that higher waist-to-hip ratio and BMI are independently positively associated with albuminuria. Adiposity–albuminuria associations appear strong among people with normal HbA1c, as well as people with pre-diabetes or diabetes.

Abstract P518: Prospective Study of Skipping Meals to Lose Weight as a Predictor of Incident Type 2 Diabetes and Coronary Heart Disease: The Canadian 1995 Nova Scotia Health Survey

Introduction: Skipping meals is an increasingly common practice to lose weight among North American adults of all bodyweights. However, due to a lack of long-term studies, the long-term effect of skipping meals to lose weight on cardiometabolic health outcomes such as a diagnosis of type 2 diabetes mellitus (T2DM) or incident coronary heart disease (CHD) remains unknown, although previous short-term studies of skipping meals and risk factors for T2DM and CHD have suggested plausible biological pathways for a relationship to exist in either direction, protective or harmful. Hypothesis: We assessed the hypotheses that skipping meals to lose weight was associated with long-term risk of incident T2DM and CHD in the Canadian 1995 Nova Scotia Health Survey (NSHS95), and that these associations were influenced by cardiometabolic risk factors. Methods: Skipping meals to lose weight was assessed via questionnaire in a cohort of 2,898 adults in the NSHS95 and was linked to population-based health care administrative databases to determine incidence of T2DM and/or CHD in the following 23 years. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for T2DM and CHD. Results: During 23 years of follow-up, 430 incident cases of T2DM and 632 incident cases of CHD were diagnosed. Compared to participants who did not skip meals to lose weight, those who did skip meals to lose weight (2.7%) had an 87% higher risk of T2DM (multivariable-adjusted HR=1.87, 95% CI: 1.11-3.17). This association was no longer present after adjustment for baseline body mass index (BMI) (HR=1.42, 0.83-2.42). After stratification by BMI, skipping meals was associated with T2DM among participants who had BMI &lt;25 kg/m 2 (n=1,030; HR=4.42, 1.01-19.30) but not among participants with BMIs of 25-29.9 kg/m 2 (n=1,123; HR=1.07, 0.39-2.96) or 30+ kg/m 2 (n=586; HR=1.21, 0.61-2.39). The multivariable-adjusted (including BMI) association was also present within participants with elevated cholesterol (n=1,450; HR=1.88, 1.00-3.53) and high blood pressure (n=1,363; HR=2.07, 1.11-3.85), but not among those without. No significant association was observed between skipping meals to lose weight and CHD risk before (HR=1.14, 0.67-1.96) or after adjustment for BMI (HR=1.05, 0.61-1.81), or within subgroups. Conclusion: These findings suggest that skipping meals to lose weight may be a predictive modifiable risk factor for developing T2DM over time, especially among people with a BMI &lt;25 kg/m 2 , potentially working in connection or iteration with other T2DM risk factors. With the growing number of popular diets that include skipping meals, future studies are warranted to understand perturbations of potential metabolic consequences.

Disordered Eating Behaviors and 15-year Trajectories in Body Mass Index: Findings From Project Eating and Activity in Teens and Young Adults (EAT).

Disordered eating behaviors are prevalent among adolescents. Understanding how these behaviors link to body mass index (BMI) across different stages of development and over an extended period may provide insight for designing interventions around eating and weight. This study had two objectives: (1) to assess the distribution of disordered eating behaviors and develop a global score of disordered eating behaviors among adolescents and (2) to examine the association between the number of disordered eating behaviors in adolescence and BMI trajectory over 15years. Project Eating and Activity in Teens and Young Adults (EAT), a longitudinal study of weight-related health and behavior comprising four waves (EAT-I to EAT-IV), measured seven disordered eating behaviors (importance of weight and shape, frequent dieting, extreme unhealthy weight control behaviors, overeating, distress about overeating, loss of control while overeating, and frequency of overeating and loss of control) at baseline (N= 1,230, ages 11 to 18years, 1998-1999). These behaviors were summed to create a disordered eating behavior score. BMI was self-reported at all four waves (up to age 27-33years at EAT-IV). Repeated measures with random slope and intercept examined the association between disordered eating behaviors and BMI trajectories over 15years. At baseline, 50.7% and 33.7% of females and males endorsed disordered eating behaviors. Throughout 15years of follow-up, sociodemographic-adjusted BMI was higher among adolescents who engaged in disordered eating behaviors. The association remained significant after further adjustment for baseline BMI (p < .05). Among adolescents, regardless of the type of disordered eating behaviors, engagement in disordered eating behavior predicted higher BMI in a dose-response fashion.

Role of inflammation markers in the prediction of weight gain and development of obesity in adults – A prospective study

Background and aimsThere is a growing body of literature confirming the association between inflammation and obesity. Recent research suggests that inflammation may play a role in weight gain. The aim of the study was to analyse whether serum inflammatory markers predict weight gain or development of obesity in a prospective study design. Methods and resultsThe baseline study (DILGOM 2007) consists of a population-based sample of 5024 Finnish men and women aged 25–75 years, of whom 3735 participated in the follow-up study in 2014. Baseline data collection included a questionnaire on health behaviour, physical examinations and blood samples including serum high-sensitivity C-Reactive Protein (hs-CRP), Interleukin-1 receptor antagonist (IL-1Ra), Interleukin-6 (IL-6), Tumor Necrosis Factor Alpha (TNF-alpha) and high molecular weight adiponectin (HMW adiponectin). Indicators of obesity were weight, body mass index (BMI), waist circumference and body fat percentage (% body fat). At baseline hs-CRP, IL-1Ra, IL-6, TNF-alpha and HMW adiponectin associated strongly (p < 0.0001) with obesity indicators. After adjustment for several potential predictors of obesity, hs-CRP and IL-1Ra associated inversely with changes in obesity indicators during the 7-year follow-up. These associations disappeared, however, after further adjustment for baseline BMI. Only HMW adiponectin retained a modest positive association with the change in weight (p = 0.008), in BMI (p = 0.007) and in waist circumference (p = 0.002). ConclusionThese findings suggest that the inflammatory markers, although highly associated with obesity, do not predict weight gain in an adult population. This could translate into inflammation being a result of obesity rather than a contributing factor to it.

Longitudinal Analysis Between Maternal Feeding Practices and Body Mass Index (BMI): A Study in Asian Singaporean Preschoolers.

Bidirectional studies between maternal feeding practices with subsequent child weight are limited, with no studies in Asian populations. In longitudinal analyses, we assessed the directionality of the associations between maternal feeding practices and body mass index (BMI) in preschoolers. Participants were 428 mother child dyads from the GUSTO (Growing Up in Singapore Toward healthy Outcomes) cohort. Feeding practices were assessed using the Comprehensive Feeding Practices Questionnaire (CFPQ) at age 5 y. Child BMI was measured at ages 4 and 6 y. BMI and maternal feeding practices subscales were transformed to SD scores and both directions of their associations examined with multivariable linear regression and pathway modeling. Higher BMI at age 4 was associated with lower encouragement of balance and variety (β = −0.33; 95%CI: −0.53, −0.13), lower pressure to eat (β = −0.49; −0.68, −0.29) and higher restriction (β = 1.10; 0.67, 1.52) at age 5, adjusting for confounders and baseline feeding practices at 3 years. In the reverse direction, only pressure and restriction at age 5 were associated with lower and higher child BMI at age 6 years, respectively. After the adjustment for baseline BMI at age 5, the association with pressure was attenuated to non-significance (β = 0.01 (−0.01, 0.03), while the association with restriction remained significant (β = 0.02; 0.002, 0.03). Overall, associations from child BMI to maternal restriction for weight control and pressure feeding practices was stronger than the association from these maternal feeding practices to child BMI (Wald's statistics = 24.3 and 19.5, respectively; p < 0.001). The strength and directionality suggests that the mothers in the Asian population were likely to adopt these feeding practices in response to their child's BMI, rather than the converse.Clinical Trial Registry Number and Website This study was registered at clinicaltrials.gov as NCT01174875 (www.clinicaltrials.gov, NCT01174875).

Is incident type 2 diabetes associated with cumulative excess weight and abdominal adiposity? Tehran Lipid and Glucose Study

AimsTo examine the association of the risk of incident type 2 diabetes (T2D) with cumulative excess weight (CEW) and cumulative excess waist circumference (CEWC) scores. MethodsAdults participants without T2D (n = 4635) aged ≥20 years were included in the study. The differences between the body mass index (BMI) and waist circumference (WC) values and their normal references were calculated until the incident T2D. The CEW and CEWC scores represent the accumulation of BMI and WC deviations from normal values over time, i.e. (kg/m2 × years and cm × years, respectively). Time-dependent Cox models, adjusting for confounders were used to examine the association between CEW/CEWC and the risk of T2D. Further multivariate analyses were performed to examine the association of CEW and CEWC with incident diabetes in baseline BMI and WC strata. ResultsThere were 503 incident cases of T2D over a median follow-up 9.38 years. The multivariate sex adjusted hazard ratios (HR) per one standard deviation (SD) increase in CEW and CEWC were 1.23 (95% CI: 1.15–1.32) and 1.41 (1.25–1.59), respectively. After further adjustment for baseline BMI and WC, no significant association was observed for CEW (1.02: 0.84–1.23) and CEWC (1.09: 0.93–1.28) and incident T2D. A strong association was found between CEW and CEWC with incident diabetes among overweight (2.12: 1.20–3.74) and centrally obese individuals (1.29: 1.10–1.51), respectively. ConclusionsGenerally, CEW and CEWC were not associated with risk of T2D, independent of baseline values for BMI and WC, respectively. Moreover, CEW and CEWC highlighted an increased risk among overweight and centrally obese participants for T2D.

Longitudinal associations of active commuting with body mass index

ObjectiveTo investigate the longitudinal associations between active commuting (walking and cycling to work) and body mass index (BMI). MethodWe used self-reported data on height, weight and active commuting from the Commuting and Health in Cambridge study (2009 to 2012; n=809). We used linear regression to test the associations between: a) maintenance of active commuting over one year and BMI at the end of that year; and b) change in weekly time spent in active commuting and change in BMI over one year. ResultsAfter adjusting for sociodemographic variables, other physical activity, physical wellbeing and maintenance of walking, those who maintained cycle commuting reported a lower BMI on average at one year follow-up (1.14kg/m2, 95% CI: 0.30 to 1.98, n=579) than those who never cycled to work. No significant association remained after adjustment for baseline BMI. No significant associations were observed for maintenance of walking. An increase in walking was associated with a reduction in BMI (0.32kg/m2, 95% CI: 0.03 to 0.62, n=651, after adjustment for co-variates and baseline BMI) only when restricting the analysis to those who did not move. No other significant associations between changes in weekly time spent walking or cycling on the commute and changes in BMI were observed. ConclusionsThis work provides further evidence of the contribution of active commuting, particularly cycling, to preventing weight gain or facilitating weight loss. The findings may be valuable for employees choosing how to commute and engaging employers in the promotion of active travel.

Prospective cohort study of general and central obesity, weight change trajectory and risk of major cancers among Chinese women.

General obesity, typically measured using body mass index (BMI), has been associated with an increased risk of several cancers. However, few prospective studies have been conducted in Asian populations. Although central obesity, often measured using waist-hip ratio (WHR), is more predictive for type 2 diabetes and cardiovascular diseases (CVD) risk than BMI, knowledge of its association with cancer incidence is limited. In a cohort of 68,253 eligible Chinese women, we prospectively investigated the association of BMI, WHR and weight change during adulthood with risk of overall cancer and major site-specific cancers using multivariate Cox proportional hazard models. Compared to the BMI group of 18.5-22.9 kg/m(2) , obese (BMI ≥ 30 kg/m(2) ) women were at an increased risk of developing overall cancer (hazard ratio = 1.36, 95% confidence interval = 1.21-1.52), postmenopausal breast cancer (HR: 2.43, 95% CI: 1.73-3.40), endometrial cancer (HR: 5.34, 95% CI: 3.48-8.18), liver cancer (HR: 1.93, 95% CI: 1.14-3.27) and epithelial ovarian cancer (HR: 2.44, 95% CI: 1.37-4.35). Weight gain during adulthood (per 5 kg gain) was associated with increased risk of all cancers combined (HR: 1.05, 95% CI: 1.03-1.08), postmenopausal breast cancer (HR: 1.17, 95% CI: 1.10-1.24) and endometrial cancer (HR: 1.37, 95% CI: 1.27-1.48). On the other hand, WHR was not associated with cancer risk after adjustment for baseline BMI. These findings suggest that obesity may be associated with cancer risk through different mechanisms from those for type 2 diabetes and CVD and support measures of maintaining health body weight to reduce cancer risk in Chinese women.

FTO genotype and weight loss in diet and lifestyle interventions: a systematic review and meta-analysis

Studies have suggested that the fat mass and obesity-associated (FTO) genotype is associated with individual variability in weight loss in response to diet/lifestyle interventions, but results are inconsistent. We aimed to provide a summary of the literature evaluating the relation between the FTO genotype and weight loss in response to diet/lifestyle interventions. A search of English-language articles in the PubMed and Embase databases (through 30 April 2015) was performed. Eligible studies were diet/lifestyle weight-loss intervention studies conducted in adults that reported changes in body weight or body mass index (BMI) by the FTO variant rs9939609 (or its proxy). Differences in weight loss between FTO genotypes across studies were pooled with the use of fixed-effect models. A meta-analysis of 10 studies (comprising 6951 participants) that reported the results of additive genetic models showed that individuals with the FTO TA genotype and AA genotype (those with the obesity-predisposing A allele) had 0.18-kg (95% CI: -0.09-, 0.45-kg;P= 0.19; NS) and 0.44-kg (95% CI: 0.09-, 0.79-kg;P= 0.015) greater weight loss, respectively, than those with the TT genotype. A meta-analysis of 14 studies (comprising 7700 participants) that reported the results of dominant genetic models indicated a 0.20-kg (-0.43-, 0.04-kg) greater weight loss in the TA/AA genotype than in the TT genotype (P= 0.10). In addition, differences in weight loss between the AA genotype and TT genotype were significant in studies with a diet intervention only, adjustment for baseline BMI or body weight, and several other subgroups. However, the relatively small number of studies limited these stratified analyses, and there was no statistically significant difference between subgroups. This meta-analysis suggests that individuals carrying the homozygous FTO obesity-predisposing allele may lose more weight through diet/lifestyle interventions than noncarriers. Our data provide evidence for genetic variability in response to diet/lifestyle interventions on weight loss, although clinical applications of these findings need further investigations.

The role of obesity duration on the association between obesity and risk of physical disability.

To relate measured obesity duration in mid-life with subsequent incidence of physical disability over and above body mass index (BMI) attained. Framingham Offspring Study is a longitudinal study that began in 1971. Examination 5 (1991-1995; "baseline") and disability onset ascertained from examinations 6-8 (2008) were used. About 2,095 disability-free participants aged 45-65 years at baseline were included. Obesity (BMI ≥ 30 kg/m(2) ) duration was calculated between examination 1 and examination 5. Cox regression was used to analyze time to disability. 204 participants developed disability (incidence rate=7.9 per 1,000 person-years). Obesity duration ranged from 0 to 22 years (mean of 2.0 years overall, 8.3 years for those with baseline obesity). Obesity duration increased risk of new disability (hazard ratio [HR] 1.07 per year of obesity; 95% confidence interval [CI] 1.05-1.09). This association was attenuated on further adjustment for baseline BMI (HR 1.03; 95% CI 1.00-1.06). Being obese for longer during mid-life increases the risk of later-life disability over and above attained BMI. These results support the need for prevention of weight gain in young adults to avoid an increasing burden of physical disability in later life.

Abstract 13246: The Impact of Body-Mass Index Trajectories During Early Adulthood on Cardiac Mechanics in Middle Age: The CARDIA Study

Introduction: Obesity is a risk factor for left ventricular dysfunction and incident heart failure. We hypothesized that baseline body mass index (BMI) and trajectories in weight change through young adulthood are associated with abnormal cardiac mechanics in middle age. Methods: We examined 2,735 participants from the Coronary Artery Risk Development in Young Adults (CARDIA) study. BMI was calculated at exam years 0, 2, 5, 7, 10, 15, 20, 25. 2D echo was performed with speckle-tracking analysis. Left ventricular ejection fraction (LVEF) and global longitudinal, circumferential, and radial strain (GLS, GCS, GRS, respectively) were measured at y25. Group-based modeling with latent class analysis (PROC TRAJ) was used to identify trajectories in relative changes in BMI (% change in BMI from baseline at each exam). Linear regression examined associations between baseline BMI and trajectory of BMI change and absolute GLS, GCS, and GRS at y25 adjusting for demographics, risk factors, and echo parameters. Results: Mean age at baseline was 25±4 years. Baseline BMI at y0 was significantly associated with mean GLS at y25 (p=0.01), but not GRS or GCS. We identified 4 distinct trajectories of relative BMI change: stable weight (36% of sample), mild increase (40%), moderate increase (18%), and major increase (6%) in weight (Figure). At y25, there was no difference in LVEF across the 4 BMI trajectory groups (P=NS). After adjustment for clinical variables and baseline BMI, absolute GLS was lower in groups with BMI increases (overall P&lt;0.001). GRS and GCS were not significantly different between the groups. Conclusion: In conclusion, baseline BMI and increases in BMI during young adulthood are significantly associated with the presence of subclinical cardiac dysfunction in middle age despite normal EF. This novel characterization of BMI trajectories across young adulthood may assist in improving understanding of the impact of weight gain and obesity on cardiac dysfunction.

Associations of body size and body composition with functional ability and quality of life in hemodialysis patients.

Modifiable factors, such as body size and body composition, could influence physical function and quality of life in patients undergoing maintenance hemodialysis (MHD). From January 2008 to June 2012, in body mass index (BMI), waist circumference (WC), and magnetic resonance imaging measurements of midthigh muscle area (MTMA) and intra-abdominal fat area (IAFA) were obtained at baseline in 105 MHD patients. Six-minute walk distances and physical and mental component scores (PCS and MCS) from the Short Form-12 questionnaire were obtained at baseline and 6 and 12 months. Separate mixed-effects regression models were used to relate baseline BMI, WC, and IAFA with baseline and the average of follow-up 6-minute walk distances and PCS and MCS after adjustment for baseline covariates and MTMA. for baseline covariates and baseline MTMA, each SD increase in baseline BMI was inversely associated with baseline (-31.5 m; 95% confidence interval [95% CI], -53.0 to -10.0 m) and follow-up (-36.9 m; 95% CI, -54.6 to -19.2 m) 6-minute walk distances. Results were similar for WC and IAFA. In each of these models, each SD increase in MTMA had a strong positive association with 6-minute walk distance. Adiposity measures were not associated with baseline or follow-up PCS and MCS. After adjustment for baseline BMI, each SD increase in baseline MTMA was associated with higher baseline PCS score (3.78; 95% CI, 0.73 to 6.82) and MCS (3.75; 95% CI, 0.44 to 7.05) but had weaker associations with follow-up PCS and MCS. Body size and composition are significantly associated with physical functioning and quality of life. Interventions that improve muscle mass and decrease obesity might improve these measures in patients undergoing MHD.

Steeper increases in body mass index during childhood correlate with blood pressure elevation in adolescence: a long-term follow-up study in a Japanese community

The aim of this study was to clarify the relationship between long-term changes in body mass index (BMI) during childhood and adolescent blood-pressure levels in a general Japanese population. We used health report data from 900 Japanese children between 1983 and 2007. After adjusting for baseline BMI and other confounding factors multivariate linear regression analyses were performed to examine the relationship between changes in BMI (ΔBMI) over a 6-year period (6-12 years) and blood pressure once children reached ages 14 or 15. Sub-group analyses were also performed to ascertain the relationship between ΔBMI and blood pressure at 9th grade for children who had been in the bottom BMI tertile at 1st grade. Endpoint blood-pressure levels in boys (systolic and diastolic) and girls (systolic) from the group whose BMIs increased the most were significantly higher than those from the group whose BMIs increased the least (P<0.05, analysis of variance). After adjustment for baseline BMI and school-entrance year, the former group showed higher blood pressure at the endpoint than the latter (P<0.05, multiple regression analysis). Further adjustment for baseline blood pressure also showed similar results in a combined-sex analysis (n=592). Higher ΔBMI was associated with higher SBP9 even in children whose BMI was in the lowest tertile at baseline after adjustment for sex and school-entrance year (P=0.02, multiple regression analysis). Steeper BMI increases during primary school lead to adolescent increases in blood pressure even if baseline BMI is low. Growth during childhood should be carefully managed.

Anthropometric Measures and Physical Activity and the Risk of Lung Cancer in Never-Smokers: A Prospective Cohort Study

Worldwide, lung cancer in never-smokers is ranked the seventh most common cause of cancer death; however, the etiology of lung cancer in never-smokers is unclear. We investigated associations for body mass index (BMI) at various ages, waist circumference, hip circumference, and physical activity with lung cancer in 158,415 never-smokers of the NIH-AARP Diet and Health Study. Multivariable hazard ratios (HR) and 95% confidence intervals (CI) were estimated from Cox proportional hazards models. Over 11 years of follow-up, 532 lung cancer cases occurred. The risk estimate for obese (BMI≥30 kg/m2) participants at baseline was 1.21 (95%CI = 0.95–1.53) relative to those with a normal BMI between 18.5≤BMI<25.0. Overweight (25.0≤BMI<30.0) at age 18 (HRoverweight-vs-normal = 1.51;95%CI = 1.01–2.26) and time spent sitting (HR≥3 hrs-vs-<3 hrs = 1.32;95%CI = 1.00–1.73) was each associated with lung cancer after adjustment for baseline BMI, as was waist (HRQ4-vs-Q1 = 1.75;95%CI = 1.09–2.79) and hip circumference (HRQ4-vs-Q1 = 0.62;95%CI = 0.39–0.99), after mutual adjustment for each other and baseline BMI. No associations were observed for vigorous activity or television watching. In summary, using a large prospective cohort study, we found no evidence that BMI at baseline or middle age was associated with decreased lung cancer risk in never smokers. If anything, we observed some evidence for positive associations with a larger BMI or waist circumference.