Baseline Baseline Body Mass Index Research Articles

Effect of continuous positive airway pressure on maximal exercise capacity in patients with obstructive sleep apnea: a systematic review and meta-analysis.

Exercise capacity is impaired in obstructive sleep apnea (OSA). There are conflicting reports on the effect of continuous positive airway pressure (CPAP) on maximal exercise capacity. The objective of this review was to determine if there is a change in exercise capacity and anaerobic threshold following CPAP treatment in OSA patients. We conducted a systematic review and meta-analyses to summarize the changes in peak rate of oxygen uptake (V̇O₂ peak) or maximum rate of oxygen uptake (V̇O2 max) and anaerobic threshold (AT) during cardiopulmonary exercise testing following CPAP intervention in patients with OSA. A systematic literature review was conducted to identify published literature on markers of V̇O₂ peak, V̇O₂ max, and AT pre- vs post-CPAP using a web-based literature search of PubMed/MEDLINE, Embase, CINAHL, and Cochrane review (CENTRAL) databases. Two independent reviewers screened the articles for data extraction and analysis. The total search of all the databases returned 470 relevant citations. Following application of eligibility criteria, 6 studies were included in the final meta-analysis for V̇O₂ peak, 2 studies for V̇O₂ max, and five studies for AT. The meta-analysis showed a mean net difference in V̇O₂ peak between pre- and post-CPAP of 2.69 mL·kg-1·min-1, P = .02, favoring treatment with CPAP. There was no difference in V̇O₂ max or AT with CPAP treatment (mean net difference 0.66 mL·kg-1·min-1 [P = .78] and -144.98 mL·min-1 [P = .20] respectively). There is a paucity of high-quality studies investigating the effect of CPAP on exercise capacity. Our meta-analysis shows that V̇O₂ peak increases following CPAP treatment in patients with OSA, but we did not observe any change in V̇O₂ max or AT. Our findings should be considered preliminary and we recommend further randomized controlled trials to confirm our findings and to clarify the peak and maximum rates of oxygen uptake adaptations with CPAP therapy.

High bodyweight variability and increased risk of atrial fibrillation in patients with type 2 diabetes mellitus

Abstract Background Bodyweight variability is a risk factor for atrial fibrillation (AF), but this has not been studied with a focus on patients with diabetes mellitus (DM). Methods A nationwide population-based cohort of 670,797 patients with type 2 DM from the Korean National Health Insurance Service database without a history of AF and with ≥3 measurements of body weight over a 5-year period were followed up for AF development. Intra-individual bodyweight variability was calculated using variability independent of mean (VIM), and high bodyweight variability was defined as the quintile with the highest variability with the lower four quintiles as reference. Results During a median of 7.0 years of follow-up, 22,019 patients (3.3%) were newly diagnosed with AF. Risk of incident AF was increased in those in the highest quintile of bodyweight variability, after adjustment for baseline body mass index (BMI), age, sex, lifestyle factors, comorbidities, number of oral anti-diabetic medication, insulin use, duration of DM, and fasting glucose (HR 1.16, 95% CI 1.12–1.20). High bodyweight variability was significantly associated with AF development regardless of baseline BMI group and direction of overall weight change. This association was stronger in subjects with lower BMI, those on insulin, and those with a DM duration of greater than 5 years. Conclusions High bodyweight variability was associated with AF development, independently of traditional cardiovascular risk factors and baseline BMI. This association was stronger in underweight patients and in advanced diabetic stage. Funding Acknowledgement Type of funding source: None

Baseline prognostic nutritional index and changes in pretreatment body mass index associate with immunotherapy response in patients with advanced cancer

BackgroundRecent research suggests that baseline body mass index (BMI) is associated with response to immunotherapy. In this study, we test the hypothesis that worsening nutritional status prior to the start...

ASSOCIATION BETWEEN CLINICAL OUTCOMES AND BASELINE BMI OR ANNUALIZED WEIGHT LOSS IN PATIENTS WITH IDIOPATHIC PULMONARY FIBROSIS ENROLLED IN THE PULMONARY FIBROSIS FOUNDATION PATIENT REGISTRY

SESSION TITLE: Diffuse Lung Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Low baseline body mass index (BMI) and weight loss have been linked with poor outcomes in patients with idiopathic pulmonary fibrosis (IPF). This analysis investigated the association between clinical outcomes and baseline BMI or annualized change in body weight in patients with IPF enrolled in the Pulmonary Fibrosis Foundation Patient Registry (PFF-PR). METHODS: This analysis examined the relationship between (a) BMI group at enrollment (<25 kg/m2, 25 to <30 kg/m2 or ≥30 kg/m2) or annualized percent change in body weight group (no loss, >0% to <5% or ≥5%) and patient baseline characteristics, (b) BMI group at enrollment and clinical outcomes and (c) annualized percent change in body weight group and clinical outcomes. Outcomes included all-cause mortality at 24 months as well as changes from baseline to 24 months in lung function and exercise capacity, as assessed by percent predicted forced vital capacity (%FVC) and percent predicted diffusing capacity for carbon monoxide (%DLCO). Regression analyses were conducted with adjustment for age, sex, smoking history, oxygen use during exertion, pulmonary function, significant comorbidities and medications (pirfenidone, nintedanib and corticosteroids). RESULTS: As of February 14, 2020, 696 patients with IPF from the PFF-PR were eligible for the analysis. At enrollment, pulmonary arterial hypertension (PAH) was the only comorbidity that varied across weight-change categories (P=0.026), with 34 of 36 patients with PAH in the >0% to <5% annualized weight loss category. Logistic regression models did not indicate any difference in all-cause mortality between baseline BMI groups. Compared with patients with no weight loss, increased all-cause mortality was observed in patients with >0% to <5% and with ≥5% weight loss (odds ratios [95% CI], 5.4 [1.5, 34.4] and 5.4 [1.3, 36.9]). In the longitudinal analysis of %FVC and %DLCO, patients with baseline BMI <25 kg/m2 had a greater estimated annualized decline in %FVC than patients with baseline BMI ≥30 kg/m2 (difference [95% CI], 1.74% [0.47%, 3.0%]). A similar trend was also observed with %DLCO. There was no significant difference in annualized change of %FVC or %DLCO between groups defined by annualized percentage change in weight. CONCLUSIONS: Lower all-cause mortality was observed in patients with IPF with no annualized weight loss. Higher baseline BMI was associated with a lesser decline in lung function but not with lower all-cause mortality. CLINICAL IMPLICATIONS: Baseline BMI and annualized weight loss may be associated with clinical outcomes in patients with IPF. DISCLOSURES: Employee relationship with Genentech Please note: >$100000 Added 04/07/2020 by Cindy Burg, source=Web Response, value=Salary No relevant relationships by Elizabeth Freiheit, source=Web Response Consultant relationship with Boehringer Ingelheim Please note: $1001 - $5000 Added 04/07/2020 by Joyce Lee, source=Web Response, value=Consulting fee Consultant relationship with Genentech Please note: $1001 - $5000 Added 04/07/2020 by Joyce Lee, source=Web Response, value=Consulting fee Consultant relationship with Celgene Please note: $1001 - $5000 Added 04/07/2020 by Joyce Lee, source=Web Response, value=Consulting fee Consultant relationship with Galapagos Please note: $1001 - $5000 Added 04/07/2020 by Joyce Lee, source=Web Response, value=Consulting fee Consultant relationship with Eleven P15 Please note: $1001 - $5000 Added 04/07/2020 by Joyce Lee, source=Web Response, value=Consulting fee No relevant relationships by Adam Martin-Schwarze, source=Web Response Employee relationship with Genentech, Inc. Please note: >$100000 Added 04/07/2020 by Ming Yang, source=Web Response, value=Salary

Baseline BMI and BMI variation during first line pembrolizumab in NSCLC patients with a PD-L1 expression ≥ 50%: a multicenter study with external validation

BackgroundThe association between obesity and outcomes in patients receiving programmed death-1/programmed death ligand-1 (PD-L1) checkpoint inhibitors has already been confirmed in pre-treated non-small cell lung cancer (NSCLC) patients, regardless of...

Risk factors and pattern of weight gain in youths using antipsychotic drugs

Antipsychotic-induced weight gain is a major health concern in children and adolescents. The aim of this study was to identify risk factors for weight gain during short-, middle- and long-term treatment with antipsychotic drugs in this young population. We analysed a combined prospective and a retrospective observational cohort of Dutch children and adolescents, starting with risperidone, aripiprazole or pipamperone treatment. Linear mixed models were used to test whether sex, age, baseline body-mass-index (BMI) z score, type of antipsychotic, dose equivalent/kg, duration of use, previous antipsychotic use, ethnicity, physical exercise, IQ, concomitant medication, and psychiatric classification predicted the BMI z score for a follow-up of < 15 weeks, 15–52 weeks or > 52 weeks. A total of 144 patients were included with a median [interquartile range ([IQR)] age of 9 (4) years and median follow-up of 30 (73) weeks. During the complete follow-up, the median (IQR) weight gain was 0.37 (0.95) BMI z score points. Antipsychotic-induced weight gain was found to be most pronounced during the first 15 weeks of use (BMI z score increase per week β = 0.02, 95% CI 0.01–0.03, p = 0.002). A higher baseline BMI z score and the absence of stimulant use were associated with a higher BMI z score during the entire follow-up and after 15 weeks, respectively. Previous treatment with an antipsychotic drug was associated with less weight gain during the first 15 weeks of treatment. Our findings underscore the importance of close patient monitoring during the first weeks of antipsychotic treatment with a focus on patients with a high baseline BMI z score.

Genetic and environmental associations between insulin resistance and weight-related traits and future weight change

The aims of this study were to investigate the association between initial insulin resistance (IR), weight status, and precedent weight change (PWC) and future weight change and the genetic and environmental contributions affecting these relationships in a prospective cohort of Korean twins and their family members. The PWC (weight change from 20 y of age), baseline body mass index (BMI), baseline homeostasis model assessment of IR (HOMA-IR) score, and future weight change (follow-up interval 3.28 ± 1.32 y) of 1565 adults were assessed. The mixed linear model was applied after adjusting for intrafamilial relationship, age, education, health behaviors, chronic diseases, dietary intake, eating restraint, and menopausal status of women at baseline. A bivariate genetic analysis was performed after adjusting for age and sex. In the model that simultaneously included all predictors and confounding factors, inverse associations were observed between PWC and baseline HOMA-IR score and future weight change in men, and only baseline BMI was inversely associated with future weight change in women. Men and women with BMI ≥25 kg/m2, HOMA-IR score ≥2.5, and PWC greater than or the same as the sex-specific median of PWC were more likely to lose weight than those with the combination of the counterparts. Approximately 63.6% of the correlation between the baseline HOMA-IR score and future weight change was attributed to genetic effects, and 68.4% to 91.3% of the correlations between weight-related traits and future weight change were correlated to environmental effects. An inverse association was observed between the initial IR, weight status, and PWC and future weight change, and genetic or environmental factors contributed to these relationships.

High variability in bodyweight is associated with an increased risk of atrial fibrillation in patients with type 2 diabetes mellitus: a nationwide cohort study

BackgroundBodyweight variability is a risk factor for atrial fibrillation (AF). We aimed to examine the relationship between bodyweight variability and the risk of AF in patients with type 2 diabetes mellitus (DM), and whether this relationship was affected by baseline body mass index (BMI), weight change, or advanced diabetic stage.MethodsA nationwide population-based cohort of 670,797 patients with type 2 DM from the Korean National Health Insurance Service database without a history of AF and with ≥ 3 measurements of bodyweight over a 5-year period were followed up for AF development. Intra-individual bodyweight variability was calculated using variability independent of mean, and high bodyweight variability was defined as the quintile with the highest variability with the lower four quintiles as reference.ResultsDuring a median of 7.0 years of follow-up, 22,019 patients (3.3%) newly developed AF. After multivariate adjustment, those in the highest quintile of bodyweight variability showed a higher risk of incident AF (HR 1.16, 95% CI 1.12–1.20) compared to those in the lower 4 quintiles with reference bodyweight variability, irrespective of baseline BMI group and direction of overall weight change. This association was greater in magnitude in subjects with lower BMI, those on insulin, and those with a DM duration of greater than 5 years. In sensitivity analyses, high bodyweight variability was consistently associated with AF development using other indices of variability and adjusting for glycemic variability.ConclusionsHigh variability in bodyweight was associated with AF development, independently of traditional cardiovascular risk factors and baseline BMI. This association was stronger in underweight patients and with advanced diabetic stage. Weight fluctuation may interfere with the beneficial effects of weight loss and should be avoided when possible in weight control regimens for DM patients.

Adverse events in Chinese human immunodeficiency virus (HIV) patients receiving first line antiretroviral therapy

BackgroundAlthough the global human immunodeficiency virus (HIV) epidemic has improved significantly due to antiretroviral treatment (ART), ART-related adverse events (AEs) remain an issue. Therefore, investigating the factors associated with ART-related AEs may provide vital information for monitoring risks.MethodsA prospective cohort study was conducted among adult patients (aged 18 years or older) with HIV who received Tenofovir (TDF) + Lamivudine (3TC) + Efavirenz (EFV) as first-line ART regimens. All AEs during the first 12 months of therapy were recorded. Logistic regression analysis was used to identify variables associated with AEs.ResultsFour hundred seventy-four patients receiving TDF+ 3TC+ EFV ART regimens between March 2017 and October 2017 were included in the study analysis. Among them, 472 (99.6%) experienced at least one AE, 436 (92.0%) patients experienced at least one AE within 1 month of treatment, 33 (7.0%) between one and 3 months of treatment, and three (0.6%) patients after 3 months of treatment. The most commonly reported AE was nervous system (95.6%) related, followed by dyslipidemia (79.3%), and impaired liver function (48.1%). Patients with baseline body mass index (BMI) greater than 24 kg/m2 (adjusted OR 1.77, 95%CI 1.03–3.02), pre-existing multiple AEs (adjusted OR 2.72, 95%CI 1.59–4.64), and pre-existing severe AEs (adjusted OR 5.58, 95%CI 2.65–11.73) were at increased odds of developing a severe AE. Patients with baseline BMI greater than 24 kg/m2 (adjusted OR 2.72, 95%CI 1.25–5.89) were more likely to develop multiple AEs.ConclusionThe incidence of ART-related adverse events over a 12-month period in China was high. Baseline BMI greater than 24 kg/m2, pre-existing multiple AEs, and pre-existing severe AEs were shown to be independent risk factors for developing a severe AE.

Abstract PD3-09: Sulindac reduces breast density and alters collagen alignment in patients on aromatase inhibitors

Abstract Background. Preclinical and observational evidence supports cancer prevention activity of non-steroidal anti-inflammatory drugs (NSAIDs) in the breast via suppression of prostaglandin E2 (PGE2) synthesis by cyclooxygenase-2 (COX2). Evidence includes linking of PGE2 to aromatase activity and estrogen synthesis in breast adipose tissue, as well as effects on collagen and breast density (BD). Methods. In an open-label trial, we evaluated the effect of the non-selective NSAID sulindac at 150 mg bid for 12 months on BD in 52 postmenopausal women taking adjuvant aromatase inhibitors (AIs) for breast cancer. BD was measured using a fat-water decomposition MRI based BD measure (MRD) previously shown to be more quantitative than mammographic density. A non-randomized observation cohort of 46 postmenopausal women on AI without NSAID use was conducted in parallel to assess the effect of AI on MRD over 12 months. Eligible participants were recruited at two study sites and included women with an intact, unaffected contralateral breast and BI-RADS ≥ 2. Each subject’s MRI_BD measures at baseline and at 6 and 12 months were included in linear mixed models for longitudinal data. Log-transformation was applied to the outcome of BD. Covariates included log-transformed baseline BD, time on AI, and baseline body mass index (BMI) and change in BMI. Breast tissue collagen fiber alignment for 30 women with paired breast biopsies, before and after 6 months on sulindac, was examined using Second-Harmonic Generation (SHG) microscopy and analysis of the distribution (histogram) of ‘straight’ fibers in three randomly selected areas of breast tissue. Straightness of individual fibers was calculated as the linear length of a fiber divided by the distance along the fiber. Results. Participants on sulindac intervention had a significant change in BD relative to baseline BD at 6 (p=0.05) and 12 months (p&amp;lt;0.001). After adjusting for time on AI, baseline BMI and BMI change, the relative change in BD at 12 months from baseline BD was 10% lower (95% CI; -14.4, -5.4%) for women on sulindac. For the AI only group, no significant change from baseline BD was observed at 6 (p=0.50) or 12 months (p=0.17). The relative change in BD for the AI only group at 12 months was -3.5% (95% CI; -8.3, +1.6%). For women with baseline MRD_BD of ≥ 25%, the relative decrease in BD from baseline in the sulindac group was greater, at -16.3% (95% CI, -25.4, -6.2%). In contrast, there was no evidence for baseline BD effect on change in BD at 12 months in the AI only group whose baseline BD was ≥25% [-3.3% change at 12 mo (95% CI; -12.7, +7.1%)]. Exploratory analyses of collagen fiber alignment in the sulindac group at 6 months showed a significant decrease in straight collagen fibers (p=0.01). The decrease in collagen straightness correlated with a decrease in BD (rho=0.66, p=0.01). Conclusions. Twice daily 150 mg sulindac for 12 months in postmenopausal women on AIs was associated with a significant decrease in BD using MRD that was slightly higher for women with higher baseline BD. At the tissue level, the decrease in BD was associated with change in collagen straightness. No decrease in BD was observed in a non-randomized population of postmenopausal women on AI only therapy. These results suggest that sulindac decreases BD and may do so through effects on collagen alignment. Further investigation of sulindac for effects on BD, including synergy with AIs, for breast cancer prevention is indicated. Citation Format: Patricia Thompson, Chuan Huang, Betsy Wertheim, Christina Preece, Jie Yang, Jessica Martinez, Denise Roe, Pavani Chalasani, Alison Stopeck. Sulindac reduces breast density and alters collagen alignment in patients on aromatase inhibitors [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr PD3-09.

Effects of metformin in obesity treatment in different populations: a meta-analysis.

Objective:Some studies have shown that metformin can reduce body weight. However, metformin has not been officially approved as a medicine for weight loss because its effect on different populations remains inconsistent. This meta-analysis aimed to summarize the weight loss effect of metformin quantitatively.Method:The randomized controlled and high-quality case-control trials of metformin monotherapy in obesity treatment were eligible. Baseline body mass index (BMI) was chosen as a self-control to compare the changes in BMI of different populations before and after treatment. All changes were calculated as differences between the final and initial BMI values (with negative values indicating a decrease). Results were presented as weighted mean difference (WMD) with a 95% confidence interval (CI 95%). Subgroup analysis was performed based on baseline BMI, age, daily dose, and duration of medication.Results:A total of 21 trials (n = 1004) were included, and the meta-analysis of metformin treatment in different populations showed that metformin has a modest reduction in the BMI of included participants (WMD −0.98; 95% CI, −1.25 to −0.72), and the reduction of BMI was most significant in the simple obesity population (WMD −1.31; 95% CI, −2.07 to −0.54). The subgroup analysis showed that metformin treatment significantly reduced BMI in obesity patients with a BMI >35kg/m2 (WMD −1.12; 95% CI, −1.84 to −0.39) compared with before treatment. BMI in the high dose group decreased by 1.01 units (WMD−1.01; 95% CI, −1.29 to −0.73) and BMI did not continue to decrease significantly after treatment of more than 6 months.Conclusion:Patients treated with metformin experienced about a one-unit reduction in BMI at the end of treatment. But whether this decreased value produced enough weight loss (5% of baseline body weight) to qualify as a “weight loss drug” as current guidelines require, requires larger specific randomized control trials.

Glycemic control of newly-diagnosed type 2 diabetes with different baseline body mass index under the standardized metabolic disease management model

Objective To explore the glycemic control of newly-diagnosed type 2 diabetes with different levels of baseline body mass index (BMI) after 6 months treatment under the standardized metabolic disease management model. Methods (1) 163 patients of newly-diagnosed type 2 diabetes were divided into normal weight (BMI 18.5-23.9 kg/m2), overweight (BMI 24.0-27.9 kg/m2), and obese (BMI≥28 kg/m2) groups according to baseline BMI, the blood glucose and lipids levels were compared among 3 groups. (2) The blood glucose levels were compared among 3 groups after 6 months of standardized management. (3) The overweight and obese patients were divided into group weight loss≥5% and group weight loss<5% or weight gain in 6 months. The blood glucose levels were compared. Results (1) At baseline, overweight and obese groups had higher homeostasis model assessment for insulin resistance and lower high density lipoprotein-cholesterol compared with normal weight group. (2) After 6 months of treatment, HbA1C and HbA1C reduction showed no difference among 3 groups (normal, overweight and obese) after adjusted by baseline HbA1C. The rate of HbA1C 0.05). (3) After 6 months of treatment, 32.28% overweight and obese patients lost weight by ≥ 5%, while HbA1Cand HbA1Creduction showed no difference between 2 groups (weight loss≥5% and weight gain or weight loss 0.05). Group weight loss≥5% had better glucose control (92.68% vs 77.91%, P<0.05). Conclusions As BMI increased, insulin resistance and lipid disorders were more serious in newly-diagnosed type 2 diabetes. After 6 months of standardized metabolic management, newly-diagnosed type 2 diabetes with different baseline BMI and weight changes both achieved good glycemic control. In addition, patients losing weight equal to or more than 5% achieved higher attainment of HbA1C targets. Key words: Newly-diagnosed type 2 diabetes; Body mass index; HbA1C; Weight changes

Body Mass Index and Clinical Response to Tocilizumab in Patients With Rheumatoid Arthritis.

This study aims to determine whether baseline body mass index (BMI) affects clinical response to tocilizumab (TCZ) after six months of treatment in rheumatoid arthritis (RA) patients. In this prospective study, a total of 52 RA patients (10 males, 42 females; mean age 50.6±12.2 years; range, 23 to 73 years) receiving intravenous TCZ were consecutively recruited and followed-up for six months. BMI was calculated before initiation of TCZ treatment. The primary clinical response criterion was clinical disease activity index (CDAI) low disease activity (LDA) and the secondary clinical response criteria included CDAI remission, disease activity score based on 28 joints (DAS28)-erythrocyte sedimentation rate (ESR) LDA, DAS28-ESR remission, European League Against Rheumatism (EULAR) good response, and decreased DAS28-ESR (ΔDAS28-ESR)≥1.2. The number of RA patients classified as normal weight, overweight, and obese according to baseline BMI was 38 (73.1%), eight (15.4%), and six (11.5%), respectively. Similar baseline BMI median levels were found between RA patients reaching CDAI LDA and non-LDA: 21.11 (18.94-23.72) versus 20.78 (20.03-22.29) (p=0.98), and non-significant difference in the proportion of responders between normal weight and overweight/obese RA patients was found (p=0.47). No significant difference was found when the secondary clinical response criteria were applied. Our study demonstrates that BMI is not associated with clinical response to TCZ among RA patients and TCZ may be used to treat RA patients regardless of BMI levels.

A maternal "mixed, high sugar" dietary pattern is associated with fetal growth.

This study examined associations between a maternal “mixed, high sugar” dietary pattern during pregnancy and ultrasound‐determined fetal growth in 495 urban African women and explored whether these associations were independent of maternal baseline body mass index (BMI) and gestational weight gain (GWG). Linear mixed effects modelling (LMM) was used to test the associations between maternal mixed, high sugar dietary pattern score, baseline BMI (kg/m2), and GWG (kg/week) and the following fetal growth outcomes: (a) biparietal diameter (cm), (b) head circumference (cm), (c) abdominal circumference (cm), and (d) femur length (cm). In the pooled LMM, a +1 standard deviation (SD) increase in the mixed, high sugar dietary pattern score was associated with higher biparietal diameter (0.03 cm/+1 SD; p = .007), head circumference (0.07 cm/+1 SD; p = .026), abdominal circumference (0.08 cm/+1 SD; p = .038), and femur length (0.02 cm/+1 SD; p = .015). Although these associations were independent of maternal BMI and GWG, higher baseline BMI was independently and positively associated with abdominal circumference (0.03 cm/+1 kg/m2; p = .011) and femur length (0.01 cm/+1 kg/m2; p = .007) and 1 kg/week greater GWG was associated with a 0.82 cm increase in abdominal circumference (p = .007). In urban African settings, where preconception maternal obesity prevalence is high and processed, high sugar diets are common, improving maternal dietary intake and BMI prior to conception should be prioritised for optimising pregnancy and birth outcomes as well as longer‐term offspring health. In addition, dietary management strategies during pregnancy may be beneficial in facilitating healthy fetal growth.

1619P - Impact of cognitive-behavioral-therapy (CBT) on levels of anxiety, depression and distress in cancer patients (pts)

BackgroundOncological pts usually experience symptoms that include anxiety, depression and distress. The aim of this preliminary study was to explore the effect of Cognitive-Behavioral-Therapy (CBT) in cancer pts. MethodsAn open trial evaluated the treatment effects of CBT in breast and lung pts referring to a clinical psychology health service specialized in psycho-oncology. Levels of anxiety and depression were assessed using the validated self-report questionnaires Hospital Anxiety and Depression Scale (HADS), while the distress was evaluated with the Distress Thermometer (DT). The statistical analysis includes the Wilcoxon-Mann-Whitney and the Spearman rank tests. ResultsAt a median follow-up of 6 months, data from 43 pts (88% breast and 12% lung cancer) were prospectively collected (median age: 49 years). At baseline, 62.8% and 44.2% of pts were borderline abnormal for anxiety and depression, while 34.9% and 30.2% reported abnormal levels. All pts presented high levels of distress. A significant correlation between anxiety and depression was observed (rs=0.55; p<0.01), as well as distress (rs=0.78; p<0.01) and baseline body mass index (BMI) (rs=0.41; p<0.01). Moreover, depression was associated with distress (rs=0.70; p<0.01), age (rs=0.30; p=0.05) and time from diagnosis (rs=0.30; p=0.04). Six months after the CTB, only 7% and 5% of pts had abnormal levels of anxiety and depression, while borderline abnormal values were observed in 58% and 40% of pts, respectively. Furthermore, after CTB the levels of anxiety (p<0.001), depression (p<0.001) and distress (p<0.001) were significantly lower than baseline. Of interest, a sub-analysis among breast cancer pts showed that baseline BMI was related to anxiety (rs=0.49; p=0.002) and distress (rs=0.37, p=0.02). Physical activity level was inversely associated with anxiety (rs=-0.41; p=0.01), depression (rs=-0.49; p=0.002) and distress (rs=-0.40; p=0.01). ConclusionsThese results highlight the importance of the introduction in clinical routine of validated psychological screening for anxiety, depression and distress as well as psychological intervention, carried out by trained psycho-oncology. Legal entity responsible for the studyUniversity of Verona. FundingHas not received any funding. DisclosureE. Bria: Honoraria (self): MSD, AstraZeneca, Celgene, Pfizer, Helsinn, Eli Lilly, BMS, Novartis, and Roche. ; Research grant / Funding (self): AIRC-IG 20583. M. Milella: Honoraria (self): Pfizer, EUSA Pharma, AstraZeneca. S. Pilotto: Honoraria (self): AstraZeneca, Eli Lilly, BMS, Boehringer Ingelheim, Roche, MSD and Istituto Gentili. ; Research grant / Funding (self): AIRC-IG 20583. All other authors have declared no conflicts of interest.

Perfluoroalkyl substances and changes in bone mineral density: A prospective analysis in the POUNDS-LOST study

BackgroundRecent studies suggested an inverse association between exposures to perfluoroalkyl substances (PFASs) and bone mineral density (BMD). Whether exposures to PFASs are also associated with changes in BMD has not been examined. MethodsFive major PFASs (perfluorooctanesulfonic acid, PFOS; perfluorooctanoic acid, PFOA; perfluorohexanesulfonic acid, PFHxS; perfluorononanoic acid, PFNA; perfluorodecanoic acid, PFDA) and BMD (g/cm2) at six bone sites (spine, total hip, femoral neck, hip intertrochanteric area, hip trochanter, and hip Ward's triangle area) were measured at baseline among 294 participants in the POUNDS-LOST study, a weight-loss trial, of whom a total of 175 participants had BMD measured at both baseline and year 2. Linear regression was used to model the differences or changes in BMD for each SD increment of PFAS concentrations. In a secondary analysis, interactions between PFASs and baseline body mass index (BMI), as well as a BMI-related genetic risk score (GRS) derived from 97 BMI-predicting SNPs were examined in relation to changes in BMD. ResultsAt baseline, both PFOS and PFOA were significantly associated with lower BMD at several sites. For each SD increase of PFOS, the βs (95% CIs) for BMD were −0.020(-0.037, −0.003) for spine, −0.013(-0.026, 0.001) for total hip, −0.014(-0.028, 0.000) for femoral neck, and −0.013(-0.026, 0.000) for hip trochanter. For PFOA, the corresponding figures were −0.021(-0.038, −0.004) for spine, −0.015(-0.029, −0.001) for total hip, and −0.015(-0.029, −0.002) for femoral neck. After adjusting for baseline covariates and 2-year weight change, higher baseline plasma concentrations of PFOS, PFNA, and PFDA were associated with greater reduction in BMD in the hip; the βs (95% CIs) were −0.005(-0.009, −0.001), −0.006(-0.010, −0.001), and −0.005(-0.009, −0.001), respectively. Similar associations were found in hip intertrochanteric area for all PFASs except PFHxS, with βs ranging from −0.006 for PFOA to −0.008 for PFOS and PFNA. Participants with a higher GRS tended to have less PFAS-related BMD decline in total hip (Pinteraction = 0.005) and the hip intertrochanteric area (Pinteraction = 0.021). There were similar PFAS-related BMD changes by baseline BMI levels, although the interactions did not achieve statistical significance. ConclusionsThis study demonstrated that higher plasma PFAS concentrations were not only associated with a lower BMD at baseline, but also a faster BMD loss in a weight-loss trial setting. Genetic predisposition to larger body size may somewhat attenuate the deleterious effects of PFASs on BMD. Further exploration of the possible impact of PFAS exposures on bone density is warranted.

Abstract 116: BMI is Not a Risk Factor for All-Cause Mortality and Cardiovascular Disease Among African American Women

Background: Across the age spectrum, obesity rates are higher among African Americans (AA) than Whites, particularly women. Previous findings from a large cohort study indicated that risk of all-cause mortality is only moderately elevated with increased weight among AA, but this relationship is a much stronger finding in Whites. In this study, we examined the relationship of baseline body mass index (BMI) to incident all-cause mortality and fatal and non-fatal cardiovascular and renal disease (CVRD) events. Methods: Between 1994 - 2006, 1723 AA (52% women, age: 44±7 yrs., BMI: 29 ± 6 kg/m 2 , 51% hypertensive) were recruited for genetic studies of hypertension. Height and weight were obtained at baseline in a standardized manner. Mortality data were obtained from the National Death Index in 2018 on all subjects. Incidence of fatal/non-fatal CVRD events was obtained and confirmed by review of paper and electronic medical records between 2015-2019 in a sub-sample. Subjects who had either a CVRD event or at least 10 years of follow-up data available with no event were included (n=788). Logistic regression (LR) was performed to determine if BMI predicted mortality or a CVRD event. Results: There were 325 deaths (19%, time-to-death: 12±3 yrs.) from all causes. During a follow-up of 14±4 yrs., 154 subjects had a CVRD (20%) event/death. There was no difference in age between sexes, but women had a higher BMI compared to men (30±7 vs. 27±5 kg/m 2 , p&lt;0.0001). Men had a higher mortality (23% vs. 15%, p&lt;0.0001) and more CVRD events (24% vs. 16%, p = 0.008). The odds ratio (OR) for death was 1.62 (CI: 1.3-2.1, p=0.0002) in men compared to women. Baseline BMI was not predictive of all-cause mortality in the total sample or in men or women separately. BMI predicted CVRD events in men with an OR of 1.08 (CI: 1.03-1.13), i.e. one-unit increase in BMI in men led to 8% increase in odds for CVRD events. However, BMI was not predictive of CVDR events in women (OR: 1.01 [0.98-1.05]). Conclusion: This is the first study to evaluate the effect of BMI longitudinally on incident CVRD events among AA. Although BMI is the most common metric to define obesity, it is not predictive of CVRD and/or mortality risk among AA women. This factor should be considered while determining cardiovascular disease risk status among AA.

Dulaglutide is an effective treatment for lowering HbA1c in patients with type 2 diabetes regardless of body mass index.

To assess the relationship between baseline body mass index (BMI) and glycaemic control in dulaglutide-treated patients, a post hoc analysis was conducted on HbA1c and baseline BMI data from eight AWARD studies, with a total of 5770 patients. Changes from baseline in HbA1c data from patients treated with 1.5 mg or 0.75 mg dulaglutide, active comparator or placebo, were analyzed in each study (AWARD-1 to -6, -8 and - 9) at approximately 6 months (26, 24 and 28 weeks, respectively). Within each study, data were analyzed by the following baseline BMI categories: <30, ≥30 to <35, and ≥ 35 kg/m2 . In this post hoc analysis, 1.5 mg or 0.75 mg dulaglutide treatment achieved statistically significant HbA1c reductions from baseline in all BMI categories (least-squares mean change from -0.62 to -1.75%) across the AWARD studies. No statistically significant treatment-by-BMI category interactions were found for reductions in HbA1c. This post hoc analysis of eight AWARD studies indicates that baseline BMI does not affect the relative treatment efficacy of dulaglutide as measured by HbA1c change from baseline in any study. Dulaglutide is an effective treatment option for adult patients with type 2 diabetes regardless of their baseline BMI category.

1445-P: Physical Activity and Insulin Resistance in Midlife Women: 17-Year Longitudinal Associations in SWAN

Insulin resistance increases starting in midlife due to decreasing estrogen production and other aging-related factors. Higher intensity physical activity (PA) has the potential to attenuate rising insulin resistance; however, longitudinal associations of PA and insulin resistance have not been studied in midlife women. We used data from the Study of Women’s Health Across the Nation (SWAN, N=3,230), a cohort study with up to 17 years of follow-up, to estimate longitudinal associations of higher intensity PA with insulin resistance. Women reported PA using the Kaiser Physical Activity Survey at 7 study visits (V0, V3, V5, V6, V9, V12, V13). We used the sports and exercise physical activity index score (range: 1-5) to assess leisure-time moderate to vigorous intensity PA (MVPA). SWAN measured glucose and insulin in blood collected at 8 study visits (V0, V1, V3-V7, V12, V13). We used generalized estimating equations to estimate the adjusted longitudinal associations of MVPA with homeostatic model assessment of insulin resistance (HOMA-IR) overall, by baseline body mass index (BMI) category, and by race/ethnicity. Women were 46 (SD=3) years old at baseline. Forty-seven percent were non-Hispanic white; 28% black; 9% Japanese; 8% Chinese, and 8% Hispanic. Each additional one-unit increase in reported MVPA was associated with an average 0.2 unit lower HOMA-IR (95% CI: -0.3, -0.1) over time. Associations differed by baseline BMI (interaction P&amp;lt;0.001). Reported MVPA was associated with a 0.1 lower HOMA-IR (95% CI: -0.1, -0.02) in normal weight women, a 0.2 lower HOMA-IR (95% CI: -0.3, -0.1) in overweight women, and a 0.4 lower HOMA-IR (95% CI: -0.6, -0.1) in obese women. MVPA was not associated with HOMA-IR in underweight women (mean difference=0.0; 95% CI: -0.1, 0.1). Associations did not differ by race/ethnicity (interaction P=0.39). Our findings support longitudinal associations of MVPA with lower insulin resistance in midlife women, with the strongest associations in obese women. Disclosure S.E. Badon: None. K. Pettee Gabriel: None. C.A. Karvonen-Gutierrez: None. B. Sternfeld: None. J. Lee: None. E. Gold: None. E. Waetjen: None. M. Hedderson: None. Funding National Institutes of Health; U.S. Department of Health and Human Services; National Institute on Aging; National Institute of Nursing Research; Office of Research on Women’s Health (U01NR004061, U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495); National Center for Research Resources; National Center for Advancing Translational Sciences (UCSF-CTSI UL1RR024131)

834-P: Weight Change and Dementia Risk in Patients with New-Onset Type 2 Diabetes: A Nationwide Cohort Study

Objective: This study examined the association between baseline body mass index (BMI), percent weight change, and the risk of dementia in patients newly diagnosed with type 2 diabetes. Research Design and Methods: Using the South Korean National Health Insurance Service-National Health Screening Cohort database, we identified 167,876 subjects aged ≥40 years diagnosed with new-onset type 2 diabetes between 2007 and 2012. Their weight changes were monitored for about 2 years after diagnosis, with follow-ups occurring for an average for 3.5 years. The hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause dementia, Alzheimer’s disease (AD), and vascular dementia (VD) were estimated using multivariable Cox proportional hazards regression models. Results: We identified 2563 incident dementia cases during follow-up. Baseline BMI among patients with new-onset type 2 diabetes was inversely associated with the risk of all-cause dementia and AD, independent of confounding variables (P for trend &amp;lt;0.001). Percent weight change during the two years after a diagnosis of type 2 diabetes, showed significant U-shape associations with the risk of all-cause dementia (P &amp;lt;0.001) and AD (P = 0.018) development; the HRs of both diseases increased significantly when weight loss or gain was greater than 10%. Additionally, weight gain greater than 10% was associated with increased risk of VD. Conclusions: A lower baseline BMI was associated with increased risks of all-cause dementia and AD in patients with new-onset type 2 diabetes. Weight loss or weight gain after diagnosis of diabetes was associated with increased risk of all-cause dementia and AD. Weight gain was associated with increased risk of VD. Disclosure H. Kwon: None. S. Yoo: None. M. Lee: None. G. Nam: None.