Basal Body Mass Index Research Articles

Factors associated with different patterns of weight change after bariatric surgery: A longitudinal study.

The mean weight loss (WL) after successful bariatric surgery is approximately one third of the initial body weight, which is mainly achieved between the first 2years of follow-up. However, 15%-35% of patients do not achieve a significant percentage of total WL (%TWL). Information on factors associated with a higher or lower WL after bariatric surgery is limited. This study aimed to assess the change in %TWL and describe the factors associated with greater or lesser WL over time. This prospective longitudinal study included patients treated with laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy. Baseline data were recorded before surgery. Follow-up was performed at 3 (n=141), 6 (n=208), 9 (n=115), 12 (n=216), 24 (n=166), and 36months (n=99). Generalized estimating equation analysis was performed to assess the changes in %TWL over time and factors associated with different patterns of WL. In total, 231 patients were included (women, 82.2%; basal body mass index (BMI) 41.4±5.1kg/m2). The tendencies to increase %TWL (32±6.5) were evident in the first year and stabilized thereafter. Sustained nutritionist follow-up (2.3%, p=0.004), baseline BMI >40kg/m2 (0.4%, p<0.001), and WL≥10kg before surgery (0.3%, p=0.001) were associated with a higher %TWL. Patients who performed physical activity >30min/day after surgery reduced their %TWL by 0.6% (p=0.002). Modifiable factors such as nutritional monitoring and WL before surgery are associated with a significant increase in %TWL over time. Basal BMI was associated with a significant decrease in %TWL.

Abstract P4-07-55: Neoadjuvant trastuzumab and pertuzumab in combination with anthracyclines in HER2-positive early breast cancer: real-world data on effect of body mass index in cardiac safety

Abstract BACKGROUND: Neoadjuvant therapy with trastuzumab and pertuzumab (HP) combined with chemotherapy (ChT) is the standard of care in ≥ cT2cN0 or N+ HER2-positive early breast cancer (EBC). Although cardiotoxicity is a known adverse effect of anti HER2-therapy and anthracyclines, recently BERENICE final analysis showed cardiac safety of HP in combination with standard or dose-dense anthracycline-based ChT. However, real-world data is lacking, specifically in patients (pts) with identified cardiovascular (cv) risk factors. Our study aimed to evaluate cardiac safety of HP and anthracyclines in HER2+ EBC and explore potential impact of body mass index (BMI). METHODS: This retrospective analysis included HER2+ EBC pts receiving neoadjuvant HP and anthracycline- and taxane- based ChT, at our institution, between 2016 and 2021. Baseline clinical, demographic, histopathological and immunohistochemical features were reported. Pts were categorized as underweight (&amp;lt; 18.5kg/m2), normal (≥18.5;&amp;lt; 25kg/m2), overweight (≥25;&amp;lt; 30kg/m2) and obese (≥30kg/m2), according to basal BMI WHO categories. The primary objective was to evaluate cardiac safety, assessed by incidence of left ventricular ejection fraction (LVEF) declines (≥10% from baseline and to a value &amp;lt; 50%) and NYHA class III/IV heart failure. Univariate and multivariate logistic regression analysis were performed using BMI as a categorical variable. Safety data were compared in subgroup analyses for underweight/normal and overweight/obese pts. Statistics were performed with IBM™ SPSS software, version 23. RESULTS: Our analysis enrolled 112 female pts, with a median age of 54 years (30-78), including 22pts (19.6%) with ≥65years and 55 (49.1%) postmenopausal women. Most pts (n=89; 79.5%) had HR-positive disease. 44pts (39.3%) had stage II and 68pts (60.7%) had stage III disease. According to BMI, pts were classified as underweight (n=3; 2.7%), normal (n=40; 35.7%), overweight (n=47; 42%) and obese (n=22; 19.6%). No association was found between BMI and tumor stage (p=0.829), grade (p=0.753) and HR status (p=0.212). Other baseline cv risk factors were identified: former/active smoker (n=34;30.4%), diabetes (n=10;8.9%), hypertension (n=30;26.8%), and dyslipidemia (n=32;28.6%). Most pts had ≥2 cv risk factors (n=66;58.9%). Two diferent regimes were used FEC100-D+HP (2016-2019, n=84) and ddAC-wkPaclitaxel+HP (2020-2021, n=28). Overall, pCR was achieved in 62 pts (55.4%). Regarding cardiac safety evaluation, 4 pts (3.6%) experienced at least one LVEF decline ≥10% from baseline and to a value &amp;lt; 50%, including 3 pts that were overweight/obese. Declines were reversible in all pts, with recovery by next assessment. Two pts (1.8%) experienced one NYHA class III heart failure event. Both pts were overweight/obese and had another concomitant risk factor for cardiovascular disease. Both pts discontinued treatment. No statistically significant association was found between overweight/obesity and cardiac events (OR 1.26, 95%CI 0.22-7.20; p=0.792). Median follow-up duration was 39 months. No new safety signals were identified. CONCLUSION: Cardiac safety of neoadjuvant HP in combination with anthracyclines in HER2-positive EBC in our real-world data is consistent with previous studies. Despite most cardiac events occurred in overweight/obese pts, no statistically significant effect was found. Further studies are needed to evaluate cardiotoxicity in pts with cv risk factors and evaluate impact of therapeutic interventions. Citation Format: Diana Simão, Mariana Sardinha, Lúcia Gil, Alexandra Montenegro, José Mendes, Leonor Fernandes, Patrícia Winckler, Ricardo Luz, Sónia Oliveira. Neoadjuvant trastuzumab and pertuzumab in combination with anthracyclines in HER2-positive early breast cancer: real-world data on effect of body mass index in cardiac safety [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-55.

Is this the end of intensified insulin therapy and obesity in light of updates with novel medicines?

Introduction: Modern times witness an increased prevalence of obesity and diabetes mellitus. While patients are offered a plan for blood glucose regulation, possible obesity issues, unfortunately, remain ignored. Blood glucose regulation inevitably deteriorates over time in diabetic patients that gradually gain weight.&#x0D; Material and Method: We recruited 42 diabetic patients who applied to our internal medicine outpatient clinic to investigate the impacts of two new generation therapies, sodium-glucose co-transporter-2 inhibitor (SGLT-2i) and glucagon-like peptide-1 receptor agonist (GLP1-RA), on weight. Six patients were excluded from follow-up for various reasons, and the study was finalized with 36 patients. The patients were followed up regarding body mass index (BMI), HbA1c levels, and insulin cessation or dose reduction.&#x0D; Results: We stopped insulin in 20 of 36 patients who started to receive SGLT-2i and GLP1-RA, while the insulin dose was reduced in the remaining patients. While the mean basal HbA1c level of the first group with insulin cessation was 9.13% (min-max: 6.4-14), it was recorded as 7.63% (min-max: 5, 2-10,8) in the sixth month of treatment modification (p &lt; 0.001). Despite a slight HbA1c increase in two patients, we concluded a significant decrease in HbA1c levels in 18 patients. Altogether, these 20 patients experienced an average of 1.5% HbA1c reduction.&#x0D; The findings also revealed that the mean basal BMI value (38.99 kg/m2; min-max: 33.2-43.4) among these 20 patients significantly decreased to 38.13 kg/m2 (0.86 kg/m2) in the sixth month of treatment modification. Among eight patients with reduced insulin and HbA1c level, the mean BMI value changed from 43.05 kg/m2 (min-max: 38.3-52.5) to 40.91 (min-max: 38.1-50) at the sixth-month follow-up. In this case, we may assert that losing weight has a positive impact on blood glucose regulation. However, it changed from 34.87 kg/m2 (min-max: 30.6-38.2) to 35.77 kg/m2 (min-max: 31. 8-39.1) among the other eight patients with reduced insulin but unreduced HbA1c.&#x0D; Conclusion: Overall, we believe that SGLT-2i and GLP1-RA, with significant benefits in both cardiovascular protection and weight control, would be more advantageous when used more frequently in obese patients without obvious contraindications since they rarely cause hypoglycemia and are easily tolerated

Relationship of serum lipid profiles in preeclampsia and normal pregnancy, Bangladesh.

The purpose of this present study to investigate the lipid profile levels and basal body mass index in preeclampsia and normal pregnancy in Bangladeshi women. This case-control study was conducted at Sheba Hospital Kaligonj Bangladesh with 70 participants among 35 normal pregnancy (control) and 35 preeclampsia women (case) were enrolled from August 2018 to July 2019. Blood samples were obtained for analysis of total cholesterol, triglyceride and high-density lipoprotein by enzymatic assays and low-density lipoprotein by using Fried Ewald's formula in between 22-36 weeks of gestation. This study found the mean age of preeclampsia and normal pregnancy women were 24.71±2.56 and 23.09±2.1 respectively with significant (P= 0.005). Basal body mass index, total cholesterol, triglyceride and low-density lipoprotein significantly higher (P=0.002), (P= 0.000), (P= 0.022) and (P=0.000) in preeclampsia compared to normal pregnancy respectively. While high-density lipoprotein comparatively lower in preeclampsia than normal pregnancy and consider significant as (P=0.037). Abnormal lipid profile and increased body mass index is contributed to the development of preeclampsia. The frequent antenatal monitoring of lipid profiles provides the status which helps to require management and reduces the preeclampsia which enhances maternal and fetal wellbeing and fetal outcome.

Reversal of Diabesity: Normalization of Insulin Release Curve in Association with Reversal of Non-Alcoholic Fatty Liver Disease

Objective: Type 2 diabetes with obesity is regarded as an incurable, progressive disease with many complications. The hypothesis was tested that glycated haemoglobin (HbA1c) and the insulin release curve can be restored by traceable systematic methods. Methods: 122 people with diabesity were investigated before and after three and 6 months of traceable systematic management methods. Basal body mass index (BMI), fatty liver, HbA1c, and insulin release curve were measured. Results: After 3 months of traceable systematic management, BMI decreased from 30.76 ± 0.48 to 21.86 ± 0.09 kg/m2 (p < 0.001) and remained stable during the last 3 months (21.82 ± 0.09 kg/m2 at 6 months). Colour Doppler ultrasound showed non-alcoholic fatty liver disease (NAFLD) in all diabesity participants at baseline. At 3 months, only one participant had low-grade fatty liver, and fatty liver was reversed in other participants (p < 0.001). The number and grade of fatty liver at 6 months were the same as at 3 months. Fasting plasma glucose decreased and continued to decrease thereafter (p < 0.001). Two-hour postprandial plasma glucose decreased and continued to decline until 6 months (p < 0.001). HbA1c also decreased and maintained this level at 6 months. At baseline, the peak value of insulin release was 1,141.09 ± 43.02 pmol/L at 2 h after meals, and the early phase of insulin secretion was lost. After 3 months of management, the insulin concentration was 621.62 ± 19.32 pmol/L at 2 h after meals. After 6 months, the value decreased, and the early phase of insulin secretion recovered. Conclusions: Normalization of the insulin release curve in type 2 diabetes was achieved by traceable systematic methods. This was associated with recovery from NAFLD. Diabesity is reversible by traceable systematic management.

MO217: Proteinuria/BMI Ratio in Primary Membranous Nephropathy as a Possible Predictive Factor of Therapeutic Efficacy

Abstract BACKGROUND AND AIMS The attempt to identify the most suitable therapies and their appropriate dose is at the base of tailored medicine approach. We decided to analyze the renal outcomes of patients affected by primary membranous nephropathy (MN) referring to our unit from January 2005 to December 2020, treated with conservative or immunosuppressive therapy, searching for any predictive factor of therapeutic response. METHOD We performed a retrospective analysis of 31 MN patients (M 20, F 11), checking anti-PLA2R status, kidney biopsy and comorbidities. All patients underwent a quarterly control for 1 year, evaluating blood pressure, body mass index (BMI), biochemistry, urinalysis and 24-h proteinuria. Variable distribution was evaluated with Kolgomorov–Smirnov test and data expressed as median [interquartile range (IQR) range] or mean ± SD. Basal features were analyzed with student's t- test for independent variables, Mann–Whitney test for continuous variables and Pearson's chi-squared analysis for dummy variables. Trend analysis was computed with a linear mixed model for repeated analysis. RESULTS We performed 186 repeated measurements, with median age at diagnosis of 52 years old (43.7–68) and eGFR of 72.8 ± 31.6 mL/min. Median reduction of proteinuria was 3.732 g/24 h (7.63–1.77). We first found a direct association of proteinuria/BMI ratio at diagnosis with proteinuria remission at last follow-up (r −.7506; P &amp;lt; .0001), irrespective of the specific therapy. We divided the patients according to their basal proteinuria/BMI ratio being lower or higher than the whole cohort median value. Significant differences between the two groups were found in serum albumin (3.5 ± 0.68 versus 2.52 ± 0.62 g/dL, P = .001) and LDL (132 ± 17 versus 179 ± 66 mg/dL, P = .034), but the latter was rather an effect of proteinuria, as proved by the adjusted model. Also hypertension prevalence in the higher proteinuria/BMI ratio group lacked any statistical significance. The adjusted model proved an association in longitudinal follow-up between eGFR and both proteinuria/BMI ratio (β: 29.28, P = .037, 95% CI 1.75–56.80) and age [β = −1.27, P = .001, 95% CI −1.75–(−0.79)]. At biopsy time, almost half of the patients were anti-PLA2R positive (15), while the other were screened for secondary causes of MN (16). Irrespective of their anti-PLA2R status or the administration of Ponticelli regimen or Rituximab, complete remission was achieved in 31% of patients, while 34.5% experienced a partial remission and 34.5% did not respond to at least a therapeutic protocol. CONCLUSION As previously reported by Yonekura in a cross-sectional registry study, larger physical constitution defined by both BMI &amp;gt;25 kg/m2 and body surface area (BSA) &amp;gt;1.73 m2 was associated with higher proteinuria in glomerulonephritis such as MN and minimal change disease (MCD) [1], compared with other primary glomerulopathies. Their hypothesis was based mainly in the different distribution of lesions in podocytes, capillary walls and glomerular basement membrane, whose permeability may be worsened by both hyperfiltration associated with obesity and the overfilling of nephrotic syndrome. In our patients, BMI was also a surrogate marker to quantify the edema amount and to attempt a clinical evaluation of therapy efficacy, along with biochemistry. Patients with higher proteinuria/BMI ratio were typically affected by nephrotic syndrome and less responsive to at least a line of RAAS inhibitors and/or immunosuppressants such as Ponticelli regimen or Rituximab treatment as demonstrated by serum albumin variations. Albeit remission is not directly correlated with basal BMI, our results appear to confirm that patients’ body mass and extracellular fluid volume may result in more effective individualized therapies in MN but this recorded association must be confirmed by larger scale clinical trials.

Informative Power Evaluation of Clinical Parameters to Predict Initial Therapeutic Response in Patients with Advanced Pleural Mesothelioma: A Machine Learning Approach.

Malignant pleural mesothelioma (MPM) is a rare neoplasm whose early diagnosis is challenging and systemic treatments are generally administered as first line in the advanced disease stage. The initial clinical response may represent a useful parameter in terms of identifying patients with a better long-term outcome. In this report, the initial therapeutical response in 46 patients affected with advanced/unresectable pleural mesothelioma was investigated. The initial therapeutic response was assessed by CT scan and clinical examination after 2–3 treatment cycles. Our preliminary evaluation shows that the group of patients treated with regimens including antiangiogenetics and/or immunotherapy had a significantly better initial response as compared to patients only treated with standard chemotherapy, exhibiting a disease control rate (DCR) of 100% (95% IC, 79.40–100%) and 80.0% (95% IC, 61.40–92.30%), respectively. Furthermore, the therapeutic response was correlated with the disease stage, blood leukocytes and neutrophils, high albumin serum levels, and basal body mass index (BMI). Specifically, the patients with disease stage III showed a DCR of 95.7% (95% IC, 78.1–99.9%), whereas for disease stage IV the DCR decreased to 66.7% (95% IC, 34.9–9.1%). Moreover, a better initial response was observed in patients with a higher BMI, who reached a DCR of 96.10% (95% IC, 80.36–99.90%). Furthermore, in order to evaluate in the predictive power of the collected features a multivariate way, we report the preliminary results of a machine learning model for predicting the initial therapeutic response. We trained a state-of-the-art algorithm combined to a sequential forward feature selection procedure. The model reached a median AUC value, accuracy, sensitivity, and specificity of 77.0%, 75%, 74.8%, and 83.3%, respectively. The features with greater informational power were gender, histotype, BMI, smoking habits, packs/year, and disease stage. Our preliminary data support the possible favorable correlation between innovative treatments and therapeutic response in patients with unresectable/advanced pleural mesothelioma. The small sample size does not allow concrete conclusions to be drawn; nevertheless, this work is the basis of an ongoing study that will also involve radiomics in a larger dataset.

The Effect of Alendronate on Bone Mineral Disorder in Renal Transplant Patients

In this study, we aimed to investigate the effect of long-term administration of alendronate to treat bone loss in renal transplant patients. Eighty-two renal transplant recipients were divided into 3 groups. Group 1 included patients who were treated with calcium, vitamin D3, and alendronate; group 2 included patients who were treated with calcium and vitamin D3; and group 3 included patients who did not receive these medications. All patients' sociodemographic data, biochemical parameters, and bone mineral density (BMD) measurements were recorded. There were no significant differences between sociodemographic and laboratory findings at the beginning of study in all groups. The BMD of lumbar spine and femoral neck was significantly less in group 1 at the beginning, 12 and 24 months of the study when compared with other group. At 12 and 24 months of the study, the BMD levels were decreased both group 2 and group 3, whereas in group 1, it was stable at 12 months and increased thereafter. In group 1, the initial femoral neck BMD was negatively correlated with parathormone, sex, and body mass index, and positively correlated with creatinine level. While there was a positive correlation between basal body mass index and femur neck BMD in group 2, there was no correlation between baseline parameters, demographic data, and bone mineral density in group 3 patients. In conclusion, bone loss is inevitable despite calcium and vitamin D replacement. However, bone loss can be stopped and even reversed with alendronate therapy.

Skeletal muscle loss and body composition in progressive supranuclear palsy: A retrospective cross-sectional study.

Skeletal muscle mass loss has been associated with decreased physical performance; however, the body composition characteristics in progressive supranuclear palsy (PSP) are not well understood. We investigated body composition parameters, focusing on skeletal muscle mass, in patients with PSP and compared them with those of healthy older adults. This retrospective cross-sectional study included 39 patients with PSP and 30 healthy older adults (control group). Using a multi-frequency bioelectrical impedance analysis, we measured the skeletal mass index (SMI), basal metabolism, extracellular water/total body water ratio (ECW/TBW), and body fat percentage and examined the relationship between SMI and age, body mass index (BMI) and other body composition parameters. The PSP group had a higher rate of low muscle mass (56.4%) than the control group (10.0%), although the ages and BMIs were similar. The leg SMI was lower for the PSP group, while the ECW/TBW was higher for the PSP group. The basal metabolism was lower for the PSP group than for the controls but only in the women. The basal metabolism and BMI showed a significant correlation with SMI in the PSP group. There was a significant correlation between SMI and age, ECW/TBW, and body fat percentage in the PSP group but only in the women. This study is the first to show that a high proportion of patients with PSP have low muscle mass. We showed differences in terms of sex in muscle mass loss in women with PSP, which was associated with inactivity and aging.

Eating behavior phenotypes and emotions as predictors of weight gain during COVID-19 confinement

Introduction: situations characterized by a high emotional load might favor weight gain. Objectives: the aim of the present study was to evaluate the association between eating behavior phenotype, emotions and feelings perception and weight gaining in the context of COVID-19 pandemia. Materials and methods: a transversal, descriptive study was carried out by means of an online survey on adults participants, residents in Argentina. The evaluation consisted of demographic and anthropometric data, physical activity level, sleep habits and eating behavior phenotype. The increase in the perception of different emotions and feeling during the confinement was evaluated. Results: 2,619 participants (84.9 females, mean age 39.27±15.21 year old). 40.3% of the subjects reported having gained weight during the confinement. 77.3% of the subjects showed some sort of sleep disturbance. The main feelings and emotions that were reported to have increased were anxiety (50.7%), demotivation (45.1%) and sadness (38.9%). Logistic regression model evidenced that the diminishment in physical activity during the confinement, as well as basal body mass index were associated to weight gain. The hedonic eater eating behavior phenotype predicted weight gain (B=0,408).The increase in the perception of boring (B=0,255), demotivation (B=0,244) and anxiety (B=0,409) during the confinement was also associated to weigh gain during this period, meanwhile those who experienced an increase in the feeling of strength presented a lower risk (B=-0,536). Introduction: situations characterized by a high emotional load might favor weight gain. Objectives: the aim of the present study was to evaluate the association between eating behavior phenotype, emotions and feelings perception and weight gaining in the context of COVID-19 pandemia. Materials and methods: a transversal, descriptive study was carried out by means of an online survey on adults participants, residents in Argentina. The evaluation consisted of demographic and anthropometric data, physical activity level, sleep habits and eating behavior phenotype. The increase in the perception of different emotions and feeling during the confinement was evaluated. Results: 2,619 participants (84.9 females, mean age 39.27±15.21 year old). 40.3% of the subjects reported having gained weight during the confinement. 77.3% of the subjects showed some sort of sleep disturbance. The main feelings and emotions that were reported to have increased were anxiety (50.7%), demotivation (45.1%) and sadness (38.9%). Logistic regression model evidenced that the diminishment in physical activity during the confinement, as well as basal body mass index were associated to weight gain. The hedonic eater eating behavior phenotype predicted weight gain (B=0,408).The increase in the perception of boring (B=0,255), demotivation (B=0,244) and anxiety (B=0,409) during the confinement was also associated to weigh gain during this period, meanwhile those who experienced an increase in the feeling of strength presented a lower risk (B=-0,536). Conclusions: the hedonic eater eating behavior phenotype and the perception of negative emotions were associated to weight gaining in the context of the confinement. This remarks the importance of the addressing emotional aspects and identifying individual eating behavior phenotypes in order to promote adequate preventive strategies. Key words: COVID-19; obesity; hedonic eater, eating behavior phenotypes.

Obesity Paradox and 12 Month Outcome in Patients with Atrial Fibrillation

Obesity increases the risk of atrial fibrillation (AF) while it may impact the outcome of patients with AF. The clinical implications of this relationship are not completely clear. We aimed to analyze the association of traditional anthropometric measures of excessive adiposity with 12month case fatality rate (CFR) in patients with AF. This was a multicenter, longitudinal, observational study on adults with documented AF, excluding records of AF secondary to reversible causes. Anthropometric variables were registered at baseline, and a central committee validated the 12month outcomes. We studied 1193 patients (median age: 69.14years, 55.2% women). At baseline, rhythm control was established for 476 (39.9%) subjects, while frequency control was offered to 717 (60.1%) participants. The 12month all-cause CFR was 8.9%. A high basal body mass index (BMI), waist-to-height ratio (WHtR) and waist circumference (WC) were associated with lower CFR in bivariate analyses. In a Cox-proportional hazards model, variables associated with 12month all-cause CFR were BMI categories (HR: 0.736, 95% CI: 0.584-0.928), chronic heart failure (HR: 1.738, 95% CI: 1.127-2.680), chronic kidney disease (HR: 2.269, 95% CI: 1.162-4.429) and carotid stenosis >50% (HR: 5.342, 95% CI: 1.661-17.181). The risk of death at one year in patients with AF is inversely associated with a high BMI and directly associated with the presence of chronic kidney disease, carotid stenosis, and chronic heart failure in this cohort of patients with AF. The causes and implications of this apparent obesity paradox should be addressed in the future.

Effect of body mass index on response to neo-adjuvant therapy in HER2-positive breast cancer: an exploratory analysis of the NeoALTTO trial

BackgroundObesity is a risk factor for breast cancer (BC) development, recurrence, and death. In view of this, we aimed to investigate the clinical value of obesity in BC patients treated with anti-HER2 therapies in the NeoALTTO trial, which randomized 455 patients to neo-adjuvant lapatinib, trastuzumab, or their combination plus paclitaxel.MethodsPatients were classified according to their basal body mass index (BMI) into underweight (< 18.5 kg/m2), normal (≥ 18.5; < 25 kg/m2), overweight (≥ 25; < 30 kg/m2), and obese (≥ 30 kg/m2) WHO categories. Univariate and multivariate logistic regression analyses were performed using BMI as a categorical variable. Pathological complete response (pCR) and event-free survival (EFS) were the NeoALTTO primary and secondary outcomes, respectively.ResultsAmong 454 patients analyzed, 14 (3%), 220 (48%), 137 (30%), and 83 (18%) were classified as underweight, normal weight, overweight, and obese, respectively; 231 (51%) and 223 (49%) had hormone receptor (HR)-positive and HR-negative primary tumors; 160 (35%) achieved pCR. In the overall patient population, no association was found between BMI groups and pCR, as we reported pCR rates of 57.1%, 35%, 30.7%, and 39.8% in underweight, normal weight, overweight, and obese cases, respectively. In contrast, in HR-positive tumors, overweight or obesity was generally associated with decreased likelihood of achieving a pCR independently of other clinical variables, including planned surgery, nodal status, and tumor size (odds ratio [OR] = 0.55, 95%CI 0.30–1.01, as compared to normal or underweight; p = 0.053); notably, no differential effect of BMI with respect to pCR was observed in HR-negative cases (odds ratio [OR] = 1.30, 95%CI 0.76–2.23, as compared to normal or underweight; p = 0.331), resulting in a statistically significant interaction between BMI and HR status (p = 0.036). There was no association between BMI and EFS neither in the overall nor in the HR-positive population, but this analysis was under-powered.ConclusionsNeoALTTO patients overweight or obese at baseline and with HR-positive primary BC appeared less likely to achieve pCR after neo-adjuvant anti-HER2 therapies. This finding paves the way to future research in targeting the interplay between HER2/HR signaling and metabolism.

P0825ASSOCIATION OF BODY MASS INDEX CHANGES WITH CHRONIC KIDNEY DISEASE IN A JAPANESE GENERAL POPULATION

Abstract Background and Aims Obesity is a risk factor for chronic kidney disease (CKD), but the effect of reducing body mass index (BMI) on the prevention of CKD is controversial. One of reasons for this disagreement is that part of patients with a BMI decrease may have an unfavourable health status. In such cases, the BMI decrease could be a risk factor for the development of CKD. Therefore, by analysing the data of annual health check-ups, we examined an association between BMI change and CKD development to determine whether BMI reduction helps prevent CKD development. Method We analysed the data of 6,959 subjects who underwent annual health check-ups in both 2013 and 2018. By a multivariate logistic regression analysis, we investigated a relationship between BMI change and CKD development within the 5 years between 2013 and 2018. The percent change in the BMI (ΔBMI) was calculated using the following equation: {(BMI in 2018 − BMI in 2013)/BMI in 2013} ×100. For analyses, we classified the subjects into five groups based on their ΔBMI value: (i) severe BMI decrease (ΔBMI &amp;lt;−2.5%); (ii) moderate BMI decrease (ΔBMI ≥−2.5% but &amp;lt;0%); (iii) maintained BMI (ΔBMI ≥0% but &amp;lt;2.5%); (iv) moderate BMI increase (ΔBMI ≥2.5% but &amp;lt;5%); (v) severe BMI increase (ΔBMI ≥5%). For further analysis, we divided the subjects into non-obesity category (basal BMI &amp;lt;25 Kg/m2) and obesity category (basal BMI ≥25 Kg/m2). Subjects with an estimated glomerular filtration rate &amp;lt;60 mL/min./1.73 m2 were defined as having a CKD. Results After adjusting several covariates, compared with the maintained BMI group, the severe BMI decrease group showed a significantly low risk of CKD development (odds ratio (OR) 0.70, 95% confidence intervals (CI) 0.54-0.91, p &amp;lt;0.01) and the severe BMI increase group had a significantly high risk (OR 1.40, CI 1.08-1.81, p = 0.01). A farther analysis revealed that the OR of CKD development for the severe BMI increase group in the obesity category was higher than that in the non-obesity category (OR 1.75 vs. 1.29). Conclusion In subjects who underwent annual health check-ups, BMI reduction had a significant effect on the prevention of CKD development, whereas an increase in the BMI was a risk factor for CKD development. Moreover, by severe increase in the BMI, obesity subjects showed higher risk of CKD development than non-obesity subjects.

P0491THE ROUTE TO INDIVIDUALIZED THERAPIES IN PRIMARY MEMBRANOUS NEPHROPATHY: BMI AND KIDNEY OUTCOMES

Abstract Background and Aims A real progress in treating patients more than diseases, would rest on tailored medicine and go beyond the hypothesis that “one size fits all”. Glomerular diseases are not an exception to this consideration, and deserve case-by-case evaluation for choosing both the most suitable therapeutic agent and its appropriate dose, because a standardized treatment may result in worse prognosis. We analyzed the role of body mass index (BMI) in modifying renal outcomes of patients with nephrotic syndrome due to membranous nephropathy (MN) treated with immunosuppressive drugs. Method We performed a retrospective analysis of 29 MN patients related to our center (M 19, F 10), checking their anti PLA2R status at kidney biopsy time and any change in proteinuria, serum creatinine (SCr) and body mass index (BMI) between diagnosis and at last follow-up visit, in search of a correlation with their response to immunosuppressive treatment. Data with non normal distribution are expressed as median and interquartile range [IQR]. Results The median follow-up of our patients lasted 49 months [IQR 14-80]. At biopsy time, almost half of them was anti-PLA2R positive (n=14 subjects) while the other resulted to be negative and were thus screened for secondary causes of MN (n=15). Irrespective either of anti-PLA2R status or the administration of Ponticelli regimen or Rituximab, complete remission was achieved in 31% of patients, while 34.5% experienced a partial remission and 34.5% resulted non responder to at least a therapeutic protocol. Median proteinuria reduction was of 3.732g/24h [IQR 7.636-1.77 g/24h]. Median rise in SCr was 0.140 mg/dl [IQR -0.11 – 0.4 mg/dl]. Direct association between the proteinuria/BMI ratio at diagnosis and remission of proteinuria at last follow up was statistically significant (r=-0.7506; P&amp;lt;0.0001) (Fig.1). Conclusion Albeit remission is not directly correlated with basal BMI, our results appear to confirm that an appropriate drug posology, not only according to patients’ renal or hepatic function but also to their body mass, may result in more effective individualized therapies in MN; nevertheless, this recorded association must be confirmed by large scale randomized clinical trials.

Cost-effectiveness of Bariatric Surgery for People with Morbid Obesity in South Korea.

This study aimed to evaluate the cost-effectiveness of bariatric surgery (BS) compared to non-surgical treatment (NST) in Korean people with morbid obesity according to comorbidities and body mass index (BMI) severity. The target cohort was people with morbid obesity, defined as BMI of ≥ 35kg/m2, or obese people with BMI of 30-34.9kg/m2 having obesity-related comorbidities. A decision-tree model for 1-year obesity treatment and Markov model for the rest of life were used. In the decision-tree model, the comorbidity remission rate and BMI change after 1-year treatment were decided based on a prospective clinical trial. In the Markov model, the transition probabilities were calculated considering the BMI level and age. The starting age of 20years, a cycle length of 1year, a time horizon of 80years, and a 5% discount rate were applied for the base case from the healthcare system perspective. In the base case, BS improved quality-adjusted life years (QALYs) and was the cost-effective option in total cohort (incremental cost-effectiveness ratio of BS vs. NST was 674 USD/QALY). It was shown to be cost-effective in all subgroup analyses based on BMI level. In particular, BS was a dominant alternative for the subgroup with basal BMI of 35.0-37.4kg/m2. Various sensitivity analyses showed the robustness of results indicating the cost-effectiveness of BS. BS at BMI of > 30kg/m2 was more effective than NST for a reduction in BMI and remission of obesity-related comorbidities and was cost-effective in Korea.

MON-191 Body Composition and Mineral Density in Transgender Patients in Brazil: A Retrospective Cohort

BACKGROUND: Gender identity disorder is defined as a nonconforming biological gender expression, strong and persistent cross-gender identification that is associated with a remarkable uneasiness of living in an incongruent gender. Long term impact on cross-sex hormone therapy (CSHT) in transgender patients is not clear, and many providers are uncomfortable prescribing transgender hormones due to fears over safety. It is expected that drastic hormonal reversal therapy might be associated with a variety of changes , including in lean/fat mass and patients bone health. PATIENTS AND DESIGN METHODS: In a retrospective observational cohort study we evaluated 76 patients using bioimpedance (BI) and dual-energy X-ray absorptiometry (DXA) to assess their body composition and bone densitometry before and during their first 2 years of CSHT. A total of 45 female to male (FtM) group, mean age 25 years (IC 95% 24.26-30.01), transition age 23.27 years ± 5.99, and 31 Male to Female (MtF) group, mean age 40 years (IC 95% 25,42-59.24, transition age 31.30 anos ± 11.17 were evaluated. MEASUREMENTS: Body mass index (BMI), BI and DXA (biological gender comparison). RESULTS: In FtM, basal BMI was 24.05 ± 4.99 and in MtF was 22.67 ± 2.84. Body composition bioimpedance showed in FtM (n 21) 44.09% ± 4.68% of lean mass (LM), 25.95% ± 7.88% of fat mass (FM). In MtF (n 5) we observed 46.82% ± 5% of LM and 21.27% ± 10.87% of FM. Baseline DXA showed in FtM patients spinal BMD (n 16) 1.148 ± 0.148, (Z score -0.06 ± 0.97), femoral neck (FN) 0.977 ± 0.930, (Z score -0.21 ± -0.60), total femur (TF) 0.996 ± 0.113, (Z score 0.12 ± 0.94). MtF patients (n 7) spinal BMD was 1.130 (IC 95% 1.088-1.196), Z score -0,1, FN BMD was 0.924 (IC 95% 0.819-1.059), Z score -0,7 (CI 95% -3.89-4.02) and TF 0.937 (CI 95% 0.729-1.260), Z score -0,6 (CI 95% -3.46-3.73).After 2 years of CSHT treatment, the following changes were found in the FtM population: Weight: -1.04% (CI 95%: -3.59 to 1.52), p 0.41; BMI: -0.25% (CI 95%: -1.23 a 0.73), p 0.61, LM: +0.17% (CI 95%: -0.41 to 0.74), p 0.55 , FM: +0.68% (CI 95%: -1.50 to 2.86), p 0.52 . In MtF population: Weight: -1.98% (CI 95%: -3.7 to -0.25), p 0.02; BMI: -0.51% (CI 95%: -0.99 to -0.18), p 0.04, LM: +0.47% (CI 95%: -0.34 a 1.29), p 0,16, FM: -1.92% (CI 95%: -4.74 to 0.89), p 0.12. CONCLUSIONS: Both groups had similar BMI before starting CSHT. After 2 years of feminizing hormone therapy, it is possible to verify some changes in BMI, mainly by raising the LM in the MtF group. At baseline, trans men had better bone composition, worse LM and elevated FM compared to trans women, as expected. But short term masculinising hormone therapy was not associated with significant changes in these parameters. The impact of these results on patient-important outcomes such as the fracture risk is still uncertain, but in our practice, the hormone therapy experience was safe. We keep following up both groups in a prospective study to evaluated DXA data after 2 and 5 years of CSHT.

Identifying the limits to socioeconomic influences on human growth

Contemporary humans occupy the widest range of socioeconomic environments in their evolutionary history, and this has revealed unprecedented environmentally-induced plasticity in physical growth. This plasticity also has limits, and identifying those limits can help researchers: (1) parse when population differences arise from environmental inputs or not and (2) determine when it is possible to infer socioeconomic disparities from disparities in body form. To illustrate potential limits to environmental plasticity, we analyze body mass index (BMI) and height data from 1,768,962 women and 207,341 men (20–49 y) living in households exhibiting 1000-fold variation in household wealth (51 countries, 1985–2017, 164 surveys) across four world regions—sub-Saharan Africa, South Asia, Latin America, and North Africa and the Middle East. We find that relationships of environmental inputs with both mean height and BMI bottom out at roughly 100–700 USD per capita household wealth (2011 international units, PPP), but at different basal BMIs and basal heights for different regions. The relationship with resources tops out for BMI at around 20 K–35 K USD for women, with growth potential due to environmental inputs in the range of 6.2–8.4 kg/m2. By contrast, mean BMI for men and mean height for both sexes remains sensitive to environmental inputs even at levels far above the low- and middle-income samples studied here. This suggest that further work integrating comparable data from low- and high-income samples should provide a better picture of the full range of environmental inputs on human height and BMI. We conclude by discussing how neglecting such population-specific limits to human growth can lead to erroneous inferences about population differences.

The clinical assessment of amyotrophic lateral sclerosis patients\u2019 prognosis by ZNF512B gene, neck flexor muscle power score and body mass index (BMI)

BackgroundAssessment on the prognosis of amyotrophic lateral sclerosis (ALS) is becoming a focus of research in recent years since there is no effective treatment. The aim of the research is to explore the major factors involving in prognosis of ALS patients through long-term follow-up.MethodsALS patients’ DNA extracted from peripheral blood white cells were detected for the risk allele by single nucleotide polymorphism (SNP) analysis. Neck flexor muscle score and body mass index (BMI) were recorded during Medical Research Council follow-up using manual muscle testing method.ResultsALS patients with risk alleles (C) deteriorated rapidly with poor clinical outcome. It seemed that the higher neck flexor muscle strength score in ALS patients with the longer survival time but without significant correlation (p > 0.05). The lower the basal body mass index, the shorter the survival time and the faster deterioration (p < 0.05). The patients with body mass index less than 22.04 seemed to have short survival time than those with BMI more than 22.04 (p < 0.05), however, the speed of deterioration in two groups of patients had no significant difference (p > 0.05).ConclusionThe risk (C) allele of the SNP (rs2275294) in the ZNF512B gene, cervical flexor muscle power and body weight index might have clinical potential for ALS prognostication, since these indicators is so simple to perform that they might be very suitable for primary clinics and even community medical institutions to carry out.

Carbohydrate status in patients with phenylketonuria

BackgroundIn patients with phenylketonuria (PKU), a low-phenylalanine (Phe) diet supplemented with low-protein foods and a Phe-free amino acid mixture favors a dietary intake rich in carbohydrates, but little is known about how these molecules are metabolized in this setting. The objective of the present study was to analyze carbohydrate metabolism in patients with hyperphenylalaninemia.MethodsWe conducted a multicenter cross-sectional study to investigate biochemical markers of basal and postprandial carbohydrate metabolism in PKU patients according to age, Phe tolerance, waist circumference and body mass index (BMI), diet, tetrahydrobiopterin (BH4) supplementation, and adherence to treatment. Basal biomarkers and anthropometric parameters were also evaluated in patients with mild hyperphenylalaninemia (MHPA) and in healthy controls.ResultsA total of 83 patients aged 4–52 years were studied; 68.7% had PKU and 31.3% had MHPA. 68 healthy controls of similar sex and age were also evaluated Metabolic control was adequate in 71.9% of PKU patients. Fasting glucose levels (mean 80.77 ± 8.06 mg/dL) were high in just one patient, but fasting insulin levels, with a mean of 12.74 ± 8.4 mIU/L, were altered in 15 PKU patients (26.3%) and markedly higher than in patients with MPHA (p = 0.035). Fasting insulin levels and Homeostasis Model Assessment Insulin Resistance (HOMA-IR) were significantly higher than in healthy controls and correlated with body mass index, waist circumference, age, and also showed statistically significant differences according to diagnosis and Phe tolerance (p < 0.05). Patients under BH4 therapy had lower insulin levels and HOMA-IR. A higher mean carbohydrate intake from AA mixtures was observed in classic PKU patients. The caloric intake in the form of carbohydrates was also higher in PKU than MHPA patients (p = 0.038) and it was correlated with basal insulin (rho = 0.468, p = 0.006), HOMA-IR (rho = 0.423, p = 0.02), BMI (rho 0.533, p = 0.002), and waist circumference (rho 0.584, p = 0.0007).ConclusionsThis study shows that PKU patients are at risk of carbohydrate intolerance and insulin resistance, more evident in adults and overweight patients, probably related to their higher caloric intake in form carbohydrate content. A higher dependency of AA mixtures was demonstrated in PKU patients.

Association of body mass index and weight gain patterns with albumin excretion in pregnancy.

We examined body mass index (BMI) and gestational weight gain (GWG) patterns of pregnant women and investigated the impact of these factors on the urinary albumin-creatinine ratio (ACR) during pregnancy. The data of 163 women whose basal BMI and ACR were measured during the first trimester were used in this study. Body weight alone between 12-16 weeks and body weight together with ACR after 37 weeks of gestation were measured. Overall, 46% of women were overweight or obese, 60.7% had excessive weight gain and 16.6% had inadequate weight gain. Only 22.7% of women gained weight within the recommended range. There was no difference in weight gain patterns with respect to BMI. ACR during the third trimester was significantly higher than during the first trimester (7.08 [0.00-1180.90] mg/g vs 4.73 [0.00-275.00] mg/g, respectively; P = 0.001). The ACR of obese women was higher than in normal weight subjects during the third trimester (16.79 mg/g [0.01-1180.90] vs 8.07 mg/g [0.10-402.14] respectively; adjusted P = 0.015). Both ACR change and third trimester ACR were weakly but significantly correlated with basal BMI (r: 0.228 P: 0.003 and r: 0.301 P < 0.001, respectively) but not with GWG or GWG rate. Basal BMI was not associated with first-trimester ACR. Obesity is associated with an increase in urinary albumin excretion during the course of pregnancy. Distinction of this relationship during pregnancy offers an opportunity for further research on pathophysiological mechanisms. The alarmingly high rate of non-compliance with IOM guidelines in pregnant women is a concern. Prompt measures for counseling of women before and during pregnancy in order to maintain healthy weight are needed.