Baseline BMI Research Articles

Long-term Outcomes of Transoral Outlet Reduction (TORe) for Dumping Syndrome and Weight Regain After Roux-en-Y Gastric Bypass

BackgroundBoth weight regain and dumping syndrome (DS) after Roux-en-Y gastric bypass (RYGB) have been related to the dilation of gastro-jejunal anastomosis. The aim of this study is to assess the safety and long-term efficacy of endoscopic transoral outlet reduction (TORe) for DS and/or weight regain after RYBG.Materials and MethodsA retrospective analysis was performed on a prospective database. Sigstad’s score, early and late Arts Dumping Score (ADS) questionnaires, absolute weight loss (AWL), percentage of total body weight loss (%TBWL), and percentage of excess weight loss (%EWL) were assessed at baseline and at 6, 12, and 24 months after TORe.ResultsEighty-seven patients (median age 46 years, 79% female) underwent TORe. The median baseline BMI was 36.2 kg/m2. Out of 87 patients, 58 were classified as “dumpers” due to Sigstad’s score ≥ 7. The resolution rate of DS (Sigstad’s score < 7) was 68.9%, 66.7%, and 57.2% at 6, 12, and 24 months after TORe, respectively. A significant decrease in Sigstad’s score as well as in early and late ADS questionnaires was observed (p < 0.001). The median Sigstad’s score dropped from 15 (11–8.5) pre-operatively to 2 (0–12) at 24 months. The %TBWL was 10.5%, 9.9%, and 8.1% at 6, 12, and 24 months, respectively. Further, “dumpers” with resolution of DS showed better weight loss results compared with those with persistent DS (p < 0.001). The only adverse event observed was a perigastric fluid collection successfully managed conservatively.ConclusionTORe is a minimally invasive treatment for DS and/or weight regain after RYGB, with evidence of long-term efficacy.Graphical

Effects of 12 -week home - based aerobic exercise on insulin resistance and body composition among polycystic ovary syndrome

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder that is characterized by menstrual irregularity and elevated serum androgens, and is often accompanied by insulin resistance. Materials &amp; Methods: In these 12- week prospective study included 86 patients diagnosed with PCOS, aged 24 to 32 years. Excercise are with choice of participants within aerobics. The pre and post assessment were taken to measure the fasting glucose, fasting insulin, HOMA-IR and body composition. Result: The HOMA-IR baseline was 1.24(±0.63) which decreased to 0.86(±0.36) after 12 weeks. The Body composition baseline BMI (kg/m2), Waist circumference, Waist Hip ratio, Neck circumference and Body fat percentage was 28.44 (±2.05), 82.56 (±3.43), 0.87 (±0.06), 32.16 (±2.57), and 37.79 (±3.15) was significantly reduced to 27.49(±2.01), 81.16(±3.56), 0.86 (±0.07), 31.97 (±2.43) and 36.55 (±3.36)after the exercise programme (p&lt;0.00001). In contrast, paired T-test analysis showed no such significant difference for variables Hip circumference when compared with the post test. Conclusion: The home-based aerobic exercise programme reduced HOMA-IR, and body composition. Although more research on the effects of aerobic exercises in PCOS is needed, these findings support aerobic exercise's effectiveness in reducing inflammation and enhancing insulin sensitivity in these patients.

Association between body mass index, weight loss and the chance of pregnancy in women with polycystic ovary syndrome and overweight or obesity: a retrospective cohort study in the UK.

What are the associations between baseline BMI (Study 1) and change in body weight (Study 2) with the likelihood of pregnancy in women with polycystic ovary syndrome (PCOS). In women with PCOS, higher baseline BMI was associated with a lower chance of pregnancy; however, weight loss was associated with an increased chance of pregnancy versus maintaining a stable weight or gaining weight. Two studies in large cohorts of Danish women with the intention to become pregnant showed a decline in fecundability ratios with higher BMI. Furthermore, a meta-analysis found that overweight/obesity significantly worsened metabolic and reproductive outcomes in women with PCOS. Data were extracted from the UK Clinical Practice Research Datalink GOLD database. Patients included women aged 18-45 years with BMI ≥18.5 (Study 1) or ≥25 kg/m2 (Study 2) at time of PCOS diagnosis (index date). The primary outcome was the time to first pregnancy recorded during 36-months' follow-up, analysed with Cox proportional hazard models and presented as hazard ratios (HRs). Study 1 included 9955 women with PCOS. Study 2 included 7593 women with PCOS and median BMI of 34.0 kg/m2. Higher BMI was associated with a lower chance of pregnancy in the 3 years following diagnosis. It was estimated that 41% of women with normal weight (18.5-24.9 kg/m2) would become pregnant compared to 17% of women with obesity class III (BMI ≥40.0 kg/m2) during follow-up. Furthermore, the chance of pregnancy for women with obesity class III was estimated to be 63% lower than for women with normal weight, with the same age and glycaemic status (HR 0.37, 95% CI 0.31-0.44; P < 0.0001). A significant inverse association was found between BMI change and chance of pregnancy: 10% weight loss was estimated to increase the chance of pregnancy by 68% for women with baseline BMI of 40 kg/m2 (HR 1.68, 95% CI 1.49-1.90). Multiple factors influence the chance of pregnancy (the ability and willingness to become pregnant), which was addressed by exclusion criteria employed. The real-world nature of the study means that use of non-prescription contraceptives was not available. Bias may have been introduced by the fact that only around 40% of women with PCOS in the CPRD GOLD database had their BMI recorded during the year prior to PCOS diagnosis. BMI categories used in the analyses may not be applicable to women of all ethnicities. The study population was only representative of women in the UK and results may not be generalizable to other regions. PCOS diagnoses were based on codes entered into the system by primary care providers, and no information was available regarding the criteria used for diagnosis, although symptoms used to diagnose PCOS have not changed over time. Our observations provide further evidence of the benefits of weight loss in women with overweight/obesity and PCOS who are seeking to become pregnant. Novo Nordisk A/S. A.H.B. declares fees for consultancy from Novo Nordisk. P.N.L. and C.L.H. are employees of Novo Nordisk. V.S. and A.V. are employees of, and hold shares in, Novo Nordisk. N/A.

Risk factors associated with glycated hemoglobin A1c trajectories progressing to type 2 diabetes

Background and objective The notion of prediabetes, defined by the ADA as glycated hemoglobin A1c (HbA1c) of 5.7–6.4%, implies increased vascular inflammatory and immunologic processes and higher risk for developing diabetes mellitus and major cardiovascular events. We aimed to determine the risk factors associated with rapid progression of normal and prediabetes patients to type 2 diabetes mellitus (T2DM). Methods Retrospective cohort study in a single 8-hospital health system in southeast Michigan, between 2006 and 2020. All patients with HbA1c <6.5% at baseline and at least 2 other HbA1c measurements were clustered in five trajectories encompassing more than 95% of the study population. Multivariate linear regression analysis was performed to examine the association of demographic and comorbidities with HbA1c trajectories progressing to diabetes. Results A total of 5,347 prediabetic patients were clustered based on their HbA1c progression (C1: 4,853, C2: 253, C66: 102, C12: 85, C68: 54). The largest cluster (C1) had a baseline median HbA1c value of 6.0% and exhibited stable HbA1c levels in prediabetic range across all subsequent years. The smallest cluster (C68) had the lowest median baseline HbA1c value and also remained stable across subsequent years. The proportion of normal HbA1c in each of the pre-diabetic trajectories ranged from 0 to 12.7%, whereas 81.5% of the reference cluster (C68) were normal HbA1c at baseline. The C2 (steady rising) trajectory was significantly associated with BMI (adj OR 1.10, 95%CI 1.03–1.17), and family history of DM (adj OR 2.75, 95%CI 1.32–5.74). With respect to the late rising trajectories, baseline BMI was significantly associated with both C66 and C12 trajectory (adj OR 1.10, 95%CI 1.03–1.18) and (adj OR 1.13, 95%CI 1.05–1.23) respectively, whereas, the C12 trajectory was also significantly associated with age (adj OR 1.62, 95%CI 1.04–2.53) and history of MACE (adj OR 3.20, 95%CI 1.14–8.93). Conclusions We suggest that perhaps a more aggressive preventative approach should be considered in patients with a family history of T2DM who have high BMI and year-to-year increase in HbA1c, whether they have normal hemoglobin A1c or they have prediabetes. KEY MESSAGES Progression to diabetes from normal or prediabetic hemoglobin A1c within four years is associated with baseline BMI. A steady rise in HbA1c during a four-year period is associated with age and family history of T2DM, whereas age and personal history of MACE are associated with a rapid rise in HbA1c. A more aggressive preventative approach should be considered in patients with a family history of T2DM who have high BMI and year-to-year increase in HbA1c.

Sleep quality and predictors of optimal sleep in patients with rheumatoid arthritis: data from a recent-onset cohort.

Sleep disorders are part of the symptomatology of rheumatoid arthritis (RA) patients and are related to disease characteristics and comorbidities. The study describes sleep quality among RA patients and identifies predictors of optimal sleep. Patients whose data were analysed were identified from the recent-onset RA cohort initiated in 2004. In 2010, the Medical Outcome Study Sleep Scale (MOS-SS) was incorporated into the patients' assessments. Up to December 2019, the cohort comprised 187 patients with at least one MOS-SS application (in 78 patients at cohort entry) and six months of outcomes behaviour (cumulative) previous to the MOS-SS application: DAS28-ESR, pain-VAS, fatigue, HAQ-DI, SF-36, treatment (corticosteroids, DMARDs/patient and adherence), Charlson score, and major depressive episodes. A trained data abstractor retrospectively reviewed their charts. Multiple logistic regression analysis estimated odds ratios (95% confidence interval) to define baseline and cumulative variables predictive of optimal sleep (dichotomised variable derived from the quantity of sleep dimension of the MOS-SS). At the first MOS-SS application, patients were primarily middle-aged women with short disease duration and low disease activity. They scored higher on the "snoring" and "sleep non-adequacy" MOS-SS dimensions. There were 96 patients (51.3%) with optimal sleep. Lower baseline BMI, better baseline fatigue score, longer follow-up at the clinic, and better SF-36 physical summary score were predictors of optimal sleep (mental summary score also remained in the model when switched to the physical summary score). Optimal sleep is achieved by half of the RA patients and predicted by BMI, patient-reported outcomes, and follow-up.

PS-C03-11: FACTORS ASSOCIATED WITH BLOOD PRESSURE CHANGES IN RESPONSE TO DIGITAL THERAPEUTICS SYSTEM: A RETROSPECTIVE ANALYSIS OF THE HERB-DH1 TRIAL

Digital therapeutics are evidence-based therapeutic interventions driven by software. Recently, the HERB Digital Hypertension 1 (HERB-DH1) pivotal trial was conducted to investigate the efficacy of the digital therapeutics in patients with hypertension. It has demonstrated that the difference between digital therapeutics group and control group in mean change in 24 h ambulatory SBP from baseline to 12 weeks was -2.4 (95% confidence interval [CI]: -4.5 to -0.3). However, The mechanism that led to the decrease in blood pressure has not been elucidated. We retrospectively analyzed the digital therapeutics group (HERB system + standard lifestyle modification) of the HERB-DH1 trial. Spearman's correlation test between the blood pressure change from baseline to 12 weeks and clinical variables in patients with hypertension was performed. Of the 199 patients, 148 patients with available data for initial and final blood pressures were included. In the univariate analysis, age (r = -0.1761; 95% CI: -0.3324 to -0.01033; P = 0.0323), baseline blood pressure (r = -0.3697; 95% CI: -0.5048 to -0.2170; P &lt; 0.0001), body weight change (r = 0.1704; 95% CI: 0.004451 to 0.3271; P = 0.0385), baseline BMI (r = -0.1738; 95% CI: -0.3303 to -0.008007; P = 0.0346) and BMI change (r = 0.1653; 95% CI: -0.0007627 to 0.3225; P = 0.0447) were related to blood pressure change. In conclusion, it is indicated that intervention in the digital therapeutics group of HERB-DH1 trial leads to lifestyle modification and body weight change, which impact on effective blood pressure control.

PS-C10-9: EFFECTIVENESS OF AMLODIPINE ON 24-HOUR AMBULATORY BLOOD PRESSURE IN ADULT PATIENTS WITH MILD-MODERATE ESSENTIAL HYPERTENSION: A MULTICENTRE OBSERVATIONAL, REAL-WORLD STUDY

Objective: Inadequate 24-hour blood pressure control could cause complications, especially in high-risk hypertensive individuals. Hence, it is recommended that the targeted blood pressure levels be maintained round the clock. This prospective, observational study assessed the 24-hour ambulatory blood pressure (ABP) control with 8-week amlodipine therapy 5/10 mg/day in patients with hypertension. Methods: Adult patients (62 m, 42 f) with mild-to-moderate essential hypertension received oral amlodipine 5 mg/day (n = 68) or 10 mg/day (n = 36) for 8 weeks. The study was approved by the independent ethics committee and informed consent was obtained from all participants. Primary outcome was change at 8 weeks from baseline in mean 24-hr ABP (systolic and diastolic), and secondary outcomes were change from baseline in mean morning, daytime, night-time, and last 6-hr dosing interval ABP. A repeat measures analysis of covariance (ANCOVA) was done for changes in ABP over 8 weeks, with age, gender, BMI and associated comorbidities as covariates. Nocturnal dippers were assessed as those greater than or equal to 10% reduction in ABP at 8 weeks. Sub-groups were created based on age, duration of hypertension, occupation, baseline BMI and amlodipine dose. Safety was evaluated based on clinical adverse events and 12-lead electrocardiogram. Results: Of the 104 patients from 2 study centers, 49 completed 8-weeks therapy and were included for per-protocol analysis. Significant reductions in the mean 24-hr blood pressure were seen for both SBP and DBP (figure 1). The mean 24-hr. reduction was -10.82 and -6.25 mmHg with 5 mg amlodipine and -19.81 and -11.19 mmHg with 10 mg amlodipine for SBP and DBP respectively (p &lt; 0.0001). The mean morning, daytime, night-time, and last 6-hr reductions in SBP were -14.06, -18.63, -20.42, and -13.51 respectively (p &lt; 0.0001), and DBP reductions were -7.78, -10.27, -11.07, and -6.44 respectively (p &lt; 0.0001). Significant reduction in ABP was seen in all sub-groups (p &lt; 0.0001). Greater reduction in SBP and DBP were observed in patients with stage-2 hypertension. At baseline, there were 30 (61.2%) non-dippers which decreased to 18 (36.7%) at 8 weeks. At the end of the study, 40% of non-dippers were converted to dippers by Amlodipine, whereas none of the dippers were converted to non-dippers. No adverse effects were reported. Conclusion: Amlodipine significantly reduces the 24-hr. mean morning, daytime, night-time, and last 6-hr. ABP and converted non dippers to dippers in adult patients with mild to moderate essential hypertension. The Study highlights the consistent effects of amlodipine on both quantity and quality of 24 hours BP control which is important for associated CV risk reduction.

The Association of Inflammatory Markers with Maternal-Neonatal Outcome After Cervical Cerclage

Cervical cerclage is effective in prolonging the number of weeks gestation in patients with cervical insufficiency(CI). However, valuable predictors with successful cervical cerclage remain limited. It aimed to evaluate the value of the systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) to predict the outcomes of cervical cerclage. This study analyzed 374 participants. Inflammatory markers were calculated using maternal peripheral blood. The association of inflammatory markers and the outcome of cervical cerclage were analyzed. And the optimal cut-off values of inflammatory markers were calculated. Also, the Chi-square test and logistic and linear regression analyses were performed to evaluate inflammatory markers with the maternal outcome and neonatal outcomes. 374 pregnancies were included in this study. Finally, 268 (71.7%) participants suffered successful cervical cerclage. This study demonstrated that the baseline BMI (cm2/kg), the bulging membrane, cervical dilation (≥2cm), the amniotic sac herniation, the neutrophils counts, the systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were significant difference between the successful and unsuccessful groups (all P<0.05). Additionally, maternal blood inflammatory markers, such as WBC, lymphocyte, neutrophils, monocyte, platelet counts, SII, and SIRI, were significantly associated with maternal-neonatal outcomes. Furthermore, the results demonstrated that the SII level had the highest OR (OR=4.626; 95% CI (2.500-8.560)), as well as the following: SIRI level (OR = 3.795; 95% CI (1.989-7.242)), cervical dilation (≥2cm) (OR =3.477; 95% CI (1.458-10.844)), and amniotic sac herniation (OR = 1.796; 95% (0.473-4.975)). This study demonstrated that the baseline SII level and SIRI level are important biochemical markers for predicting the outcome of cervical cerclage and maternal-neonatal outcomes with non-invasive procedures. They can help to provide personalized treatment before surgery and enhance postoperative surveillance.

Impact of Health Education Intervention and Intrinsic Factors on Microbiota in Overweight Individuals; A Randomized Clinical Trial

Objective The first objective was to assess the influence of a health education program that placed emphasis on improving physical activity level and diet quality on the microbiota. The second objective was to investigate the effect of extrinsic and intrinsic factors on the responses of individual microbiota taxa to the health education intervention. Design A secondary analysis of the Full Plate Diet (FPD) trial, a randomized controlled, clinical trial which included a 10-week health education program at Loma Linda, CA. Setting Drayson Center, Loma Linda University, CA. Method Fecal samples were collected at baseline (Pre) and after the termination of the health education intervention (Post). Bacterial DNA were extracted and 16S rRNA amplicon were then sequenced. Results No significant differences were observed, for any of the groups, in the α or ß diversities between baseline and post-intervention. Baseline microbiome significantly determined the shift of the individual microbial taxa; however, treatment type, gender, and baseline BMI, did not predict this shift. Conclusion A health education intervention emphasizing stress management and improvement in diet quality and physical activity did not have much influence on abundance and diversity of microbiota in a group of obese middle-aged adults. The shift in the microbiome, however, and the responsiveness to health education intervention could be predicted by the baseline microbiome level. Trial Registration Registration number is NCT03232970; July 28, 2017

PS-C17-10: ORAL SEMAGLUTIDE REDUCES ALBUMINURIA IN PATIENTS WITH TYPE 2 DIABETES, OBESITY AND HYPERTENSION, WITH PARTIAL DEPENDENCE ON BLOOD PRESSURE CONTROL

Objective: GLP-1 receptor agonists reduce blood pressure (BP) and proteinuria in people living with type 2 diabetes (T2D) and obesity, but data on patients with uncontrolled hypertension are very scarce. Oral semaglutide showed interesting results in patients with moderate renal impairment in PIONEER 5, but their BP was well controlled, with SBP &lt; 140 mmHg. We sought to assess the antiproteinuric effect of oral semaglutide in a group of patients with T2D, obesity and uncontrolled hypertension, and whether this effect is dependent on BP reduction. Design and Methods: Retrospective analysis of the data on SBP and albuminuria were performed in consecutive patients with T2D, obesity and uncontrolled hypertension (office sitting SBP &lt; 140 mmHg) who started therapy with oral semaglutide. Data were obtained from a baseline visit in which oral semaglutide was initiated, and a second visit after 3–4 months. Mediation analyses with SBP reduction as mediator were performed post-hoc to quantify its relative contribution to albuminuria reduction. Patients who initiated or changed antihypertensive medication simultaneously with oral semaglutide were excluded. Consent was obtained from all included subjects. Results: Data were obtained from 33 patients, 21 (64%) were female, age 54.2 ± 11.9 years, diabetes duration 6.8 ± 2.7 years, baseline BMI 36.7 ± 5.2 kg/m2, baseline SBP 166 ± 12.2 mmHg, baseline eFGR (CKD-EPI) 58 ± 11.6 ml/min/1.73m2 and baseline albuminuria (geometric mean) 134 ± 125 mg/g Cr, with 16 patients (48.5%) having &lt; 30 mg/g, 12 (36.4%) 30–300 mg/g and 5 (15.1%) &gt; 300 mg/g. SBP reduction was 4.8 ± 2.1 mmHg (p = 0.012, paired t-test), albuminuria reduction was 36 ± 27 mg/g (-27%; p = 0.026, paired t-test), and eGFR change + 1.3 ± 1.6 mL/min/1.73m2 (not significant). There was a significant correlation between SBP and albuminuria reductions (Pearson's r: 0.26, p = 0.002). The mediation analyses showed that albuminuria reduction of 11 ± 10 mg/g (8.3%) was mediated by SBP reduction while 25 ± 14 mg/g (18.7%) was SBP-independent. 4 patients (12.1%) reduced their albuminuria to &lt; 30 mg/g (Figure). Conclusions: In patients with T2D, obesity and uncontrolled hypertension, oral semaglutide significantly reduced SBP and albuminuria, without change in eGFR, and a relevant fraction of them (about 1/8) reduced albuminuria below the conventional normality threshold (&lt; 30 mg/g). The decrease in albuminuria was only partially mediated by SBP reduction, suggesting additional mechanisms, possibly direct glomerular and/or tubular effects.

PS-BPC07-1: PREEXISTING DIURETIC THERAPY DOES NOT ATTENUATE THE ANTIHYPERTENSIVE EFFECT OF EMPAGLIFLOZIN IN TYPE 2 DIABETIC PATIENTS WITH UNCONTROLLED HYPERTENSION

Objective: The antihypertensive effect of SGLT2 inhibitors has been mostly overlooked, but in patients with type 2 diabetes mellitus (T2DM) and uncontrolled hypertension empagliflozin elicits a powerful systolic blood pressure (SBP) lowering effect, often attributed to diuretic/natriuretic effect and/or weight loss (WL), but other mechanisms are possible. We sought to retrospectively study the impact of the initiation of empagliflozin therapy on SBP in patients living with T2DM and uncontrolled hypertension in a real-world setting, and to assess its relationship with previous diuretic and other classes of antihypertensive therapy, and with weight loss during treatment. Design and Methods: Retrospective analysis of the SBP, weight and antihypertensive medication data in patients with T2DM who initiated empagliflozin therapy while having sitting office SBP &gt; 140 mmHg. Mediation analyses with WL as mediator were performed post-hoc to quantify the relative contribution of WL to SBP reduction. Consent was obtained from all included subjects. Patients who changed their antihypertensive medication simultaneously with empagliflozin initiation were excluded. Results: Data were obtained from 198 patients (59.6% female, age 63.2 ± 8.9 years) from the visit in which empagliflozin (largely 10 mg/day) was started and the following one (3–4 months afterwards). Baseline BMI was 31.7 ± 8.5 Kg/m2. Baseline SBP was 166 ± 17 mmHg. 112 patients had ACEI/ARB, 76 diuretic, 69 calcium antagonist, 32 alpha-blocker and 29 beta-blocker therapy. The SBP reduction was 7.2 ± 5.7 mmHg (p = 0.012, paired t-test). The Figure shows comparisons by number and classes of antihypertensive drugs, with no significant differences for SBP reduction. The WL was 3.2 ± 1.7 kg, and it correlated significantly with the SBP reduction (Pearson's r: 0.22, p = 0.0012). The mediation analyses showed that a SBP reduction of 1.5 ± 0.9 mmHg was mediated by WL while 5.7 ± 4.9 mmHg was WL-independent. Conclusions: Empagliflozin initiation elicited a clinically relevant SBP decrease in patients with T2DM and uncontrolled hypertension. The number and classes of previous antihypertensive effects did not modify the SBP reduction. In particular, previous diuretic treatment does not attenuate it, suggesting that the diuretic effect is not the main driver of SBP reduction with empagliflozin. Also, the contribution of WL seems modest, implying alternative mechanisms for SBP reductions with empagliflozin; improvement of endothelial function and/or arterial stiffness and many others have been suggested.

The association of sodium intake with the development of hypertensive disorders of pregnancy

To assess the association between daily sodium intake and risk of hypertensive disorders of pregnancy. This was a secondary analysis of the prospective Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be study. In this analysis, we included those with non-anomalous, singleton pregnancies who completed food frequency questionnaires in which they recorded their sodium intake in the 3 months prior to pregnancy. Individuals who did not progress beyond 20 weeks’ gestation were excluded. Sodium intake was categorized as low (< 2g per day), medium (2g to < 3g per day), or high (≥ 3g per day). The primary outcome was development of a new-onset hypertensive disorder of pregnancy (HDP), including antenatal gestational hypertension, preeclampsia, HELLP, and superimposed preeclampsia. Other maternal and neonatal outcomes also were assessed. Kruskal-Wallis and Chi square tests were used to compare baseline characteristics. Adjusted incidence risk ratios (aIRR) with 95% confidence intervals (CIs) were estimated using Poisson regression to control for confounders. Among 7927 individuals eligible for this analysis, 2,482 (31%) reported low sodium intake, 2,978 (38%) medium sodium intake, and 2,467 (31%) high sodium intake. Baseline characteristics, including age, BMI, self-reported race and ethnicity, and tobacco use differed significantly between groups (all p< 0.01, Table 1). The risk of developing HDP was similar among groups (medium vs. low aIRR 1.03, 95% CI 0.88-1.22; high vs. low aIRR 1.13, CI 0.96-1.34). There were no differences in other adverse maternal or neonatal outcomes by sodium intake (Table 2). There was no association between sodium intake and risk of HDP. This may reflect a difference in the pathophysiology underlying pregnancy and non-pregnancy related hypertensive disorders.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Subclinical hypothyroidism in children and adolescents as mild dysfunction ofthe thyroid gland: asingle-center study.

Subclinical hypothyroidism (SH) is a biochemical diagnosis made when a serum thyroid-stimulating hormone (TSH) is ele-vated with circulating thyroid hormone levels within their reference ranges. Aim of our prospective non-randomized study was to evaluate the course of SH. All patients with suspicion of SH referred to the Endocrinology Outpatient Clinic between 2014 and 2018 were recruited to prospective study. A total of 130 patients with SH were recruited for this study. Thirty-five (26.9%) patients were followed up without levothy-roxine (L-T4) (SH-T0 group) and therapy with L-T4 was randomly introduced in 95/130 (73.1%) SH children (SH-T1 group). We did not find statistical differences in hSDS and BMI Z-score between the SH-T0 and SH-T1 groups (p = 0.761 and p = 0.843, respectively). Introducing L-T4 in patients with short stature did not affect the linear growth at the end of FU ex-pressed as hSDS. OH developed in six children (6.3%) in the SH-T1 group. After conducting a multivariate logistic regres-sion, we found that the baseline TSH concentration and BMI Z-score are possible predictors of OH. Our study confirmed a low risk of progression of SH to overt hypothyroidism. The majority of patients remains SH or resolved for nor-mal thyroid function. The L-T4 therapy did not effect on linear growth and body weight. The main predictor of worsening to hypothyroidism were a higher TSH level and Z-score BMI.

Efficacy of Intragastric Balloon versus Liraglutide as Bridge to Surgery in Super-Obese Patients

Introduction: Bariatric surgery is a safe and effective treatment for obesity, although in super-obese patients (BMI ≥50 kg/m²) it can become challenging for anatomical and anesthesiologic issues. Several bridging therapies have been proposed to increase preoperative weight loss and decrease perioperative morbidity and mortality. The aim of this study was to compare the efficacy and safety of different two-stage approaches in super-obese patients: laparoscopic sleeve gastrectomy (LSG) following preoperative liraglutide therapy versus LSG with preoperative intragastric balloon (IGB) during a 1-year follow-up. Methods: Clinical records of 86 patients affected by super-obesity who underwent two-stage approach between January 2019 and January 2022 were retrospectively reviewed using a prospectively maintained database. Patients were separated into two groups: those managed with preoperative IGB and those with liraglutide 3.0 mg prior to LSG. Weight (kg), BMI (kg/m²), %EWL, and %EBWL were reported and compared between the two groups at the end of bridging therapy, at 6th month and 12th month postoperatively. Postoperative complications were recorded. Results: Forty-four patients underwent IGB insertion prior to LSG, while 42 were treated with liraglutide. There were no statistical differences in baseline weight and BMI. At the end of preoperative treatment, the group treated with IGB reported a significant reduction in BMI (47.24 kg/m² vs. 53.6 kg/m²; p < 0.391) compared to liraglutide group. There were no differences recorded between the two groups concerning postoperative complications. At 6 months, the liraglutide group had lower %EWL (15.8 vs. 29.84; p < 0.05) and %EBWL (27.8 vs. 55.6; p < 0.05) when compared to IGB group. At 12 months, the IGB preserved with higher %EWL (39.9 vs. 25; p < 0.05) and %EBWL (71.2 vs. 42; p < 0.05). Conclusion: A two-stage therapeutic approach with IGB prior to LSG in super-obese patients could be considered an attractive alternative to liraglutide as bridging therapy before bariatric surgery.

Brazilian national bariatric registry - pilot study.

Brazil is a world leader in bariatric surgery. However, the actual number of surgeries performed in the country is still unknown. It is necessary to implement an instrument to monitor the quality of care provided. This study evaluated the implementation of a Bariatric Surgery Data Registry in Brazil. the registry was developed with Dendrite Clinical Systems Ltd., with data collected prospectively on an internet-based software. Seven centers were selected based on surgical volume and data entry commitment. The project covered three years after system implementation. 1,363 procedures performed by 17 surgeons were included. Most patients were female (67.2%), with average age of 39 years old and average baseline BMI of 41.5kg/m2. Diabetes mellitus was present in 34.5%, and hypertension in 40.1%. Roux-en-Y gastric bypass was performed in 79.3%, 95.5% by laparoscopy. There was one in-hospital death of cardiovascular cause. The average hospital stay was 2.03 days. The surgery-related complication rate was 0.97% in the first month, with three reoperations. Short-term follow-up was recorded in 75.6% and one-year follow-up in 21.64%. Total body weight loss was 10% in 30 days, rising to 33.3% after one year, with no difference between surgical techniques. the population profile was in accordance with the global registry of the International Federation for the Surgery of Obesity and Metabolic Disorders. The main difficulty encountered was low postoperative data entry. The experience acquired in this project will help advance data collection and knowledge of the safety and effectiveness of bariatric surgery in Brazil.

High baseline body mass index predicts recovery of CD4+ T lymphocytes for HIV/AIDS patients receiving long-term antiviral therapy.

The relationship between baseline BMI and CD4+ T cells during follow-up in HIV patients in China requires further evaluation. We conducted a retrospective cohort study based on adult AIDS patients who underwent or received antiretroviral therapy from 2003 to 2019 in Guangxi, China. BMI was divided into categories and compared, and after adjusting for BMI being related to the change in CD4 lymphocyte count, with normal weight as the reference group, the BMI before treatment was positively correlated with the changes in CD4+ T cells at different time periods. Among them, obese patients had significant CD4+ cell gain. In patients with pretreatment CD4+ T lymphocyte counts <200 cells/μL, a higher BMI was associated with an increased likelihood of achieving immunologic reconstitution [≥350 cells/μL: AHR: 1.02(1.01, 1.04), P = 0.004; ≥500 cells/μL: AHR: 1.03 (1.01, 1.05), P = 0.004]. Underweight in HIV patients was a risk factor for poor viral suppression [AHR: 1.24 (1.04, 1.48), P = 0.016]. Our study demonstrated that HIV/AIDS patients receiving ART with higher baseline BMI had better immune reconstitution and that baseline BMI could be an important predictor of immune reconstitution in patients receiving ART. Baseline BMI was not associated with virological failure, but a lower baseline BMI indicated poor viral suppression during follow-up.

Association between surrogate indicators of insulin resistance and risk of type 2 diabetes combined with hypertension among Chinese adults: two independent cohort studies

BackgroundType 2 diabetes (T2D) combined with hypertension has a higher risk of developing cardiovascular diseases. This study aimed to investigate the relationships between the surrogate indicators of insulin resistance (TyG, TG/HDL, and Mets-IR) with the risk of T2D combined with hypertension.MethodsThis study is based on a functional community cohort from Beijing and the China Health and Retirement Longitudinal Study, comprising 4234 and 4658 participants respectively. Cox proportional hazards models and restricted cubic spline regression were performed to assess the link between TyG, TG/HDL, and Mets-IR with T2D combined with hypertension. The cross-lagged panel analysis and the mediation analysis were used to examine the temporal relationship between insulin resistance and obesity and their temporal relationship with follow-up T2D combined with hypertension.ResultsIn multivariable-adjusted models, higher TyG was associated with a higher risk of developing T2D combined with hypertension, the hazard ratios (95% confidence interval) were 3.46 (2.43–4.93) and 2.02 (1.67–2.44), in two cohorts respectively. A similar positive association was shown for Mets-IR, the hazard ratios (95% confidence interval) were 1.04 (1.03–1.06) and 1.05 (1.03–1.07), in two cohorts respectively. However, the association between TG/HDL with T2D combined with hypertension was different in two cohorts. The restricted cubic spline regression showed a linear association between TyG and T2D combined with hypertension (P-nonlinear > 0.05). The cross-lagged path coefficient from baseline BMI to follow-up TyG index was significantly greater than the path coefficient from baseline TyG to follow-up BMI. TyG partially mediated the effect of BMI on the risk of T2D combined with hypertension and the percentage of mediated association was estimated at 41.58% and 48.41% in two cohorts, respectively.ConclusionThese findings indicated positive associations between TyG and Mets-IR with the risk of T2D combined with hypertension in two cohorts. In addition, BMI change may precede TyG index change, and the TyG index plays a mediating role in BMI induced T2D combined with hypertension.

586 BODY WEIGHT AND MICROVASCULAR DYSFUNCTION IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY AT LOW CARDIOVASCULAR RISK REFERRED TO POSITRON EMISSION TOMOGRAPHY

Abstract Introduction Whether obesity, a modifiable risk factor in patients with hypertrophic cardiomyopathy (HCM), can influence coronary microvascular dysfunction (CMD) is unknown. Objective To assess the relationship between body weight and CMD measured with myocardial blood flow (MBF) at positron emission tomography (PET) in patients with HCM. Methods All consecutive patients with HCM referred to PET scan from 2010 to 2020 were reviewed. Only patients with PET and cardiac magnetic resonance (CMR) analysis, &amp;lt;60 years old at diagnosis, with no history of diabetes, dyslipidemia, and hypertension were included. Patients were classified into three groups according to baseline BMI: BMI&amp;lt;25 kg/m2, BMI 25-30 kg/m2, and BMI&amp;gt;30 kg/m2. Results Of 1512 patients with HCM, 134 (8.9%) had been referred to a PET scan and 79 (5.2%) met the inclusion criteria (29% were women, median age was 44 [28-53] years). Overall, 52% had a BMI&amp;lt;25 kg/m2, 37% had a BMI 25-30 kg/m2, and 11% had a BMI &amp;gt;30 kg/m2. At PET, average MBF was 2.08 [1.52-2.40] ml/min/g and was similar among BMI groups (p=0.288) irrespective of fibrosis at CMR. Prevalence of severe microvascular dysfunction was similar (MBF &amp;lt;1.53 ml/min/g: (9 [22%] vs 8 [28%] vs 2 [22%], among study groups, p=0.833). Age at PET and atrial fibrillation were associated with MBF. Conclusions Obesity is not associated with worsening of CMD in HCM patients. These findings support the hypothesis that the worse symptomatic profile in obese HCM patients is due to increased prevalence of obstruction rather than accentuation of structural phenotype. Thus, the symptomatic handicap associated with obesity may be reversible following appropriate weight-reduction strategies

Predictive capacity of COVID-19-related risk beliefs on weight management behaviors on a commercial weight loss program and speed of COVID-19 vaccination uptake: prospective cohort study

BackgroundRecent work has shown that obesity may be a risk factor for severe COVID-19. However, it is unclear to what extent individuals have heard or believe this risk factor information, and how these beliefs may predict their preventive behaviors (e.g., weight management behaviors or COVID-19 preventive behaviors). Previous work has primarily looked at overall risk likelihood perceptions (i.e., not about obesity as a risk factor) within general populations of varying weight and concentrated on COVID-19-related preventive behaviors. Therefore, this prospective cohort study explored whether beliefs about obesity as a risk factor and overall risk likelihood perceptions predicted weight management and COVID-19 preventive behaviors over the next 16 weeks in individuals with obesity or overweight.MethodsParticipants were 393 individuals in the US who joined a commercial weight management program in January, 2021. We leveraged the mobile program’s automatic measurement of real-time engagement in weight management behaviors (e.g., steps taken), while surveys measured risk beliefs at baseline as well as when individuals received COVID-19 vaccination doses (asked monthly) over the next 16 weeks. Mixed effects models predicted engagement and weight loss each week for 16 weeks, while ordinal logistic regression models predicted the month that individuals got vaccinated against COVID-19.ResultsWe found that belief in obesity as a risk factor at baseline significantly predicted greater engagement (e.g., steps taken, foods logged) in program-measured weight management behaviors over the next 16 weeks in models adjusted for baseline BMI, age, gender, and local vaccination rates (minimally adjusted) and in models additionally adjusted for demographic factors. Belief in obesity as a risk factor at baseline also significantly predicted speed of COVID-19 vaccination uptake in minimally adjusted models but not when demographic factors were taken into account. Exposure to obesity risk factor information at baseline predicted greater engagement over 16 weeks in minimally adjusted models.ConclusionsThe results highlight the potential utility of effective education to increase individuals’ belief in obesity risk factor information and ultimately promote engagement or faster vaccination. Future research should investigate to what extent the results generalize to other populations.

Vegetable, but Not Potato, Intake Is Associated With a Lower Risk of Type 2 Diabetes in the Danish Diet, Cancer and Health Cohort.

To examine the relationship between intake of vegetables/potatoes and incident type 2 diabetes (T2D) and explore whether the relationship between vegetable intake and incident T2D is mediated by baseline BMI. Cross-sectional associations between exposure (baseline intake of total vegetables, vegetable subgroups, and potatoes) and baseline BMI were assessed by multivariable-adjusted linear regression models. Associations between exposure and incident T2D were examined by multivariable-adjusted Cox proportional hazards models. Mediation by BMI was quantified through exploration of natural direct and indirect effects. Among 54,793 participants in the Danish Diet, Cancer and Health cohort, 7,695 cases of T2D were recorded during a median follow-up of 16.3 years. Participants in the highest total vegetable intake quintile (median 319 g/day) had a 0.35 kg/m2 (95% CI -0.46, -0.24) lower BMI and a 21% (95% CI 16, 26%) lower risk of incident T2D after multivariable adjustment compared with those in the lowest quintile (median 67 g/day). Baseline BMI mediated ∼21% of the association between vegetable intake and incident T2D. Participants in the highest compared with the lowest (median 256 vs. 52 g/day) potato intake quintile had a 9% (95% CI 2, 16%) higher risk of T2D after multivariable adjustment, with no association found after accounting for underlying dietary pattern. Of the vegetable subclasses, higher intake of green leafy and cruciferous vegetables was associated with a statistically significantly lower risk of T2D. The findings provide evidence that a higher vegetable, but not potato, intake might help mitigate T2D risk, partly by reducing BMI.