Between Body Mass Index Categories Research Articles

Inverse association of mortality and BMI in patients with cardiomyopathy of any etiology

Abstract Background Obesity is a worldwide epidemic that has been associated with poor outcomes. Previous studies have demonstrated an inverse relationship between body mass index (BMI) and patients' outcomes, the “obesity paradox”, in several diseases. Purpose We sought to evaluate whether the obesity paradox applies to cardiomyopathy patients of all etiologies, using all-cause mortality as the primary endpoint. Methods We conducted a retrospective study of cardiomyopathy patients (n=18,003) seen within the UPMC network between January 2011 and December 2017. Patients were divided into 4 BMI categories (underweight, normal weight, overweight, and obese) and stratified by left ventricular ejection fraction (LVEF): <20%, 20–35%, and 36–50%. A Cox proportional hazards model was created to assess the independent predictive value of BMI on mortality. Results Over a median follow-up of 2.28 years, higher BMI was associated with better survival for the overall cohort (Figure) and within LVEF strata (p<0.0001). The most common cause of hospitalization was subendocardial infarction among underweight and normal weight patients and heart failure among overweight and obese patients. Cox proportional hazards model showed that BMI, age, and comorbid conditions of COPD, CKD, and CAD are independent predictors of death. Conclusion Our results support the existence of an obesity paradox impacting all-cause mortality in cardiomyopathy patients of all etiologies even after adjusting for LVEF. Additional research is needed to understand the effect of weight loss on survival once a diagnosis of cardiomyopathy is established. Figure 1. Kaplan-Meier Survival Estimates Funding Acknowledgement Type of funding source: None

The Correlation of Body Mass Index with Sputum Conversion Time in MDR-TB Patients Undergoing Treatment with Short Term Regimen at H. Adam Malik Medan General Hospital

Background: It was estimated about 10.4 million incidence of TB cases worldwide, of which 580,000 were MDR TB cases in 2015, however, only 125,000 were successfully found and treated. The World Health Organization (WHO) issued a recommendation of 9-11 month Short Term Regimen (STR) guideline that could provide satisfactory results in terms of successfull outcome, easier to control and also low-cost. The study aimed to analyze the correlation between Body Mass Index (BMI) and sputum conversion time in MDR TB patients undergoing treatment with STR and to determine the final treatment outcome using STR at H. Adam Malik Medan General Hospital, North Sumatra, Indonesia. Methods: This was a case series study of a total 76 MDR TB patients undergoing treatment using STR. Samples were obtained from medical record of the pulmonary isolation ward and MDR TB clinic at H. Adam Malik Medan General Hospital. Data were analyzed descriptively to identify the trend in sputum conversion from nine months of treatment. Results: The number of patients with normal BMI was 51.3% higher than those of low, very low and high BMI. The time to sputum conversion occured in the second month of treatment. All groups of BMI categories experienced conversions and normal BMI was higher in number. At the end of the treatment evaluation, the cure rate was 44.8%, the drop out was 28.9%, the regimen change was15.8%, died 9.2%, and moved 1.3%. Conclusion: There was a significant correlation between BMI and sputum conversion time in MDR TB patients. Good nutritional status was a predictor of treatment success.

The Effect of Body Mass Index on Long-Term Patient-Reported Outcome Scores after Anterior Cervical Discectomy and Fusion in an Asian Population: A 2-Year Study

Study DesignRetrospective cohort study.PurposeThis study aims to analyze the relationship between body mass index (BMI) subjective patient-reported outcomes (PRO) after 1- and 2-level anterior cervical discectomy and fusion (ACDF).Overview of LiteratureThe prevalence of cervical spondylosis and ACDF in expected to continue rising among the aging population of Asia. Moreover, the prevalence of obesity is also increasing. However, limited information is available about the mechanism by which BMI affects PRO after ACDF.MethodsTotal 878 patients underwent ACDF between 2000 and 2015. After excluding patients with previous cervical instrumentation, >2 levels fused, missing BMI measurement, or neoplastic/trauma indication for surgery, 535 patients were included. The PRO measures of the Neck Disability Index, Numerical Pain Rating Scale (NPRS) for Neck Pain, NPRS for Limb Pain, American Academy of Orthopaedic Surgeons–Neurogenic Symptom Score, and Japanese Orthopaedic Association myelopathy score were used. Patients were grouped based on their preoperative BMI, as per the World Health Organization guidelines for Asian populations. PRO scores were collected preoperatively, at 6 months postoperatively, and 2 years postoperatively. A generalized linear model was used to analyze the relationship of BMI category with the individual score, accounting for several factors that are likely to affect the outcomes.ResultsTotal 19 (3.4%) were underweight, 155 (28.0%) were normal weight, 112 (20.3%) were overweight, and 267 (48.3%) were obese. Patients across all BMI categories experienced significant and similar improvements in their postoperative PRO scores. There were no significant differences in the preoperative, 6-month postoperative, and 2-year postoperative PRO scores of the groups. Rate of reoperation was highest in patients with grade II obesity at 8.07%; however, the difference was not statistically significant.Conclusions Irrespective of the BMI, all patients exhibited similar satisfactory outcomes following ACDF. The results support surgery in all subgroups of patients with symptomatic nerve compression in the cervical spine.

Effects of glucagon-like peptide-1 receptor agonists liraglutide and semaglutide on cardiovascular and renal outcomes across body mass index categories in type 2 diabetes: Results of the LEADER and SUSTAIN 6 trials.

Associations between body mass index (BMI) and the cardiovascular (CV) and kidney efficacy of glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) in patients with type 2 diabetes (T2D) are uncertain; therefore, data analysed separately from the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial and the Trial to Evaluate Cardiovascular and Other Long‐term Outcomes with Semaglutide in Subjects with Type 2 Diabetes (SUSTAIN 6) were examined. These international, randomized, placebo‐controlled trials investigated liraglutide and semaglutide (both subcutaneous) in patients with T2D and at high risk of CV events. In post hoc analyses, patients were categorized by baseline BMI (<25, ≥25‐<30, ≥30‐<35 and ≥35 kg/m2), and CV and kidney outcomes with GLP‐1 RA versus placebo were analysed. All baseline BMI data from LEADER (n = 9331) and SUSTAIN 6 (n = 3290) were included (91% and 92% of patients with overweight or obesity, respectively). In SUSTAIN 6, nominally significant heterogeneity of semaglutide efficacy by baseline BMI was observed for CV death/myocardial infarction/stroke (major adverse CV events, primary outcome of both; P interaction = .02); otherwise, there was no statistical heterogeneity for either GLP‐1 RA versus placebo across BMI categories for key CV and kidney outcomes. The lack of statistical heterogeneity from these cardiorenal outcomes implies that liraglutide and semaglutide may be beneficial for many patients and is probable not to depend on their baseline BMI, but further study is needed.

Association Between Body Size Phenotypes and Subclinical Atherosclerosis.

ContextThe underlying relationship between body mass index (BMI), cardiometabolic disorders, and subclinical atherosclerosis is poorly understood.ObjectiveTo evaluate the association between body size phenotypes and subclinical atherosclerosis.DesignCross-sectional.SettingCardiovascular disease-free cohort.ParticipantsMiddle-aged asymptomatic subjects (n = 3909). A total of 6 cardiometabolic body size phenotypes were defined based on the presence of at least 1 cardiometabolic abnormality (blood pressure, fasting blood glucose, triglycerides, low high-density lipoprotein cholesterol, homeostasis model assessment-insulin resistance index, high-sensitivity C-reactive protein) and based on BMI: normal-weight (NW; BMI <25), overweight (OW; BMI = 25.0-29.9) or obese (OB; BMI >30.0).Main Outcome MeasuresSubclinical atherosclerosis was evaluated by 2D vascular ultrasonography and noncontrast cardiac computed tomography.ResultsFor metabolically healthy subjects, the presence of subclinical atherosclerosis increased across BMI categories (49.6%, 58.0%, and 67.7% for NW, OW, and OB, respectively), whereas fewer differences were observed for metabolically unhealthy subjects (61.1%, 69.7%, and 70.5%, respectively). When BMI and cardiometabolic abnormalities were assessed separately, the association of body size phenotypes with the extent of subclinical atherosclerosis was mostly driven by the coexistence of cardiometabolic risk factors: adjusted OR = 1.04 (95% confidence interval [CI], 0.90-1.19) for OW and OR = 1.07 (95% CI, 0.88-1.30) for OB in comparison with NW, whereas there was an increasing association between the extent of subclinical atherosclerosis and the number of cardiometabolic abnormalities: adjusted OR = 1.21 (95% CI, 1.05-1.40), 1.60 (95% CI, 1.33-1.93), 1.92 (95% CI, 1.48-2.50), and 2.27 (95% CI, 1.67-3.09) for 1, 2, 3, and >3, respectively, in comparison with noncardiometabolic abnormalities.ConclusionsThe prevalence of subclinical atherosclerosis varies across body size phenotypes. Pharmacologic and lifestyle interventions might modify their cardiovascular risk by facilitating the transition from one phenotype to another.

An obesity paradox in patients with myocardial infarction undergoing percutaneous intervention

Background and aimsData concerning the relationship between body mass index (BMI) and outcome in myocardial infarction (MI) patients are inconclusive. Long-term data on the influence of BMI on survival in patients with MI who have undergone percutaneous intervention (PCI) are lacking. We aimed to assess the effect of different categories of BMI on long-term mortality. Methods and resultsA single-center retrospective study of 6496 patients with MI who underwent PCI was performed. Patients were divided into six categories according to their BMI and these were compared. All-cause mortality was assessed over a median period of 6.0 years. An inverse J-shaped relationship was observed between BMI and long-term mortality. The lowest mortality was observed in patients with class I obesity. The patients with a BMI below 25.0 kg/m2 were more likely to die than patients with class I obesity. A gradual decrease in BMI below 25.0 kg/m2 was associated with a progressively increased risk of dying, with underweight patients showing a 2.18-fold increase in mortality risk. An obesity paradox was present. In addition, the patients with class III obesity had a more than 70% higher long-term mortality risk as compared to the reference group. Both lower and higher degrees of BMI were found to be harmful in patients with MI who underwent PCI. ConclusionThe obesity paradox was present in a very long-term follow-up of patients with MI who underwent PCI. However, both lower and higher BMI values are harmful, and an inverse J-shaped relationship between BMI and outcome was observed.

The relationship between body mass index and poor self-rated health in the South Korean population.

ObjectiveThis study aimed to examine the association between body mass index (BMI) and self-rated health (SRH) in Korean adults.MethodsThe study included 214,997 adults who participated in the 2016 Korean Community Health Survey. Participants were categorized into four groups according to WHO Asian classification based on their BMI: underweight (<18.5 kg/m2), normal-weight (18.5–22.9 kg/m2), overweight (23.0‒24.9 kg/m2), obese (25.0‒29.9 kg/m2), and severely obese (≥30.0 kg/m2). Multivariate Poisson regression analysis with sampling weights and robust variance estimators was performed to evaluate the relationship between BMI categories and poor SRH.ResultsA J-shaped association was observed between BMI and poor SRH in both sexes. Compared to normal-weight subjects, the age, lifestyle, and comorbidities adjusted prevalence rate ratios (PRRs) in men for poor SRH were 1.73 (95% confidence interval [CI], 1.60–1.88) for underweight, 0.87 (95% CI, 0.83–0.92) for overweight, 0.98 (95% CI, 0.93–1.03) for obese, and 1.79 (95% CI, 1.63–1.97) for severely obese. In women, compared to normal-weight subjects, the age, lifestyle, and comorbidities adjusted PRRs for poor SRH were 1.33 (95% CI, 1.26–1.41) for underweight, 1.02 (95% CI, 0.98–1.06) for overweight, 1.15 (95% CI, 1.10–1.19) for obese, and 1.42 (95% CI, 1.31–1.53) for severely obese. Associations between underweight and SRH were stronger at older ages than at younger ages, whereas those between high BMI and SRH were stronger at younger ages than at older ages.ConclusionsThis cross-sectional study using a nationally representative survey observed a J-shaped relationship between BMI and poor SRH. This association differed depending on age and presence or absence of comorbidities.

Obese and overweight individuals have greater knee synovial inflammation and associated structural and cartilage compositional degeneration: data from the osteoarthritis initiative.

This work aims to study (i) the relationship between body mass index (BMI) and knee synovial inflammation using non-contrast-enhanced MRI and (ii) the association of synovial inflammation versus degenerative abnormalities and pain. Subjects with risk for and mild to moderate radiographic osteoarthritis were selected from the Osteoarthritis Initiative. Subjects were grouped into three BMI categories with 87 subjects per group: normal weight (BMI, 20-24.9kg/m2), overweight (BMI, 25-29.9kg/m2), and obese (BMI, ≥ 30kg/m2), frequency matched for age, sex, race, Kellgren-Lawrence grade, and history of knee surgery and injury. Semi-quantitative synovial inflammation imaging biomarkers were obtained including effusion-synovitis, size and intensity of infrapatellar fat pad signal abnormality, and synovial proliferation score. Cartilage composition was measured using T2 relaxation time and structural abnormalities using the whole-organ magnetic resonance imaging score (WORMS). The Western Ontario and McMasters (WOMAC) Osteoarthritis Index was used for pain assessment. Intra- and inter-reader reproducibility was assessed by kappa values. Overweight and obese groups had higher prevalence and severity of all synovial inflammatory markers (p ≤ 0.03). Positive associations were found between synovial inflammation imaging biomarkers and average T2 values, WORMS maximum scores and total WOMAC pain scores (p < 0.05). Intra- and inter-reader kappa values for imaging biomarkers were high (0.76-1.00 and 0.60-0.94, respectively). Being overweight or obese was significantly associated with a greater prevalence and severity of synovial inflammation imaging biomarkers. Substantial reproducibility and high correlation with knee structural, cartilage compositional degeneration, and WOMAC pain scores validate the synovial inflammation biomarkers used in this study.

Low body mass index is associated with ectopic pregnancy following assisted reproductive techniques: a retrospective study

To investigate the association between body mass index (BMI) and ectopic pregnancy (EP) following embryo transfer (ET). Retrospective cohort study. University-affiliated hospital. A total of 16378 pregnancies derived from either fresh ET or frozen-thawed ET between January 2008 and December 2017. We used the generalised estimating equation (GEE) to analyse the association between BMI categories and EP, as one woman may contribute to more than one pregnancy. Generalised additive models were also used to demonstrate the non-linear association. Models were adjusted for age, parity, gravidity, previous history of ectopic pregnancy, duration of infertility, polycystic ovary syndrome, endometriosis, diagnosis of tubal problems, ovarian reserve markers, ovarian stimulation parameters, insemination protocol, endometrial thickness and embryo transfer policies. Ectopic pregnancy. According to the WHO criteria, the number of cycles with low (<18.5kg/m2 ), normal (18.5-24.9kg/m2 ) and high (≥25kg/m2 ) BMI were 2155, 13447 and 776, respectively. In comparison with the normal BMI group, the rate of EP was significantly increased in the low BMI group (2.92% versus 2.02%, relative risk 1.45, 95% CI 1.11-1.90), but not in the high BMI group (2.84%, relative risk 1.41, 95% CI 0.92-2.20). Adjusted for confounding factors, the odds ratio for EP comparing low BMI versus normal BMI was 1.61 (95% CI 1.19-2.16) and that comparing high BMI versus normal BMI was 1.12 (95% CI 0.72-1.76). Low BMI is associated with an increased risk of EP. The ectopic pregnancy rate after embryo transfer for lean women is higher than that for women of normal weight.

IMPROVEMENT IN ELEMENTARY STUDENTS PREFERENCE FOR PHYSICAL ACTIVITY ENGAGEMENT FOLLOWING PHYSICAL LITERACY PROGRAMMING

How children perceive their physical ability and body image can impact their involvement in physical activities. Teaching children basic mechanics and exposing them to new activities may increase the likelihood of selecting a physically active option versus a passive option. PURPOSE: The purpose of this research was to examine the relationship between body mass index (BMI) and self-perception of adequacy in and enjoyment of physical activity following implementation of a six-week physical literacy (PL) intervention. METHODS: Students (n=82) in grades 2-5 completed the Children’s Self-Perceptions of Adequacy and Predilection for Physical Activity (CSAPPA) scale pre- and post- PL intervention. The PL intervention program consisted of a once weekly, 30-minute program conducted by trained individuals during the school day. This program was designed to focus on the mechanics of running, jumping, and throwing. Height and weight were measured pre- intervention to calculate BMI using the Center for Disease Control’s Youth and Teen calculator. RESULTS: A significant interaction between CSAPPA score and BMI category was found, (F (1,82) = 4.948, p < 0.05). Further evaluation of the interaction indicated that students in the unhealthy BMI category were more likely to choose an active over a passive physical activity option following the PL intervention. CONCLUSION: Based on the aforementioned results, PL programming seems favorable in improving self-perception of physical activity selection in children with abnormal BMIs. Previous research has shown that students who do not feel confident performing a task are less likely to participate. Following the trend of decreased exposure to physical activity during school, students with unhealthy BMIs are not getting proper exposure to the mechanics of movement. This may lead to less physical activity participation and increases in unhealthy BMI ranges. By teaching children that they can move proficiently, children are making more active choices possibly leading to improvements in self-perception.

Association of Body Mass Index With Coronary Artery Calcium and Subsequent Cardiovascular Mortality: The Coronary Artery Calcium Consortium.

Obesity is associated with higher risk for coronary artery calcium (CAC), but the relationship between body mass index (BMI) and mortality is complex and frequently paradoxical. We analyzed BMI, CAC, and subsequent mortality using data from the CAC Consortium, a multi-centered cohort of individuals free of established cardiovascular disease (CVD) who underwent CAC testing. Mortality was assessed through linkage to the Social Security Death Index and cause of death from the National Death Index. Multivariable logistic regression was used to determine odds ratios for the association of clinically relevant BMI categories and prevalent CAC. Cox proportional hazards regression modeling was used to determine hazard ratios for coronary heart disease, CVD, and all-cause mortality according to categories of BMI and CAC. Our sample included 36 509 individuals, mean age 54.1 (10.3) years, 34.4% female, median BMI 26.6 (interquartile range, 24.1-30.1), 46.6% had zero CAC, and 10.5% had CAC ≥400. Compared with individuals with normal BMI, the multivariable adjusted odds of CAC >0 were increased in those overweight (odds ratio, 1.13 [95% CI, 1.1-1.2]) and obese (odds ratio, 1.5 [95% CI, 1.4-1.6]). Over a median follow-up of 11.4 years, there were 1550 deaths (4.3%). Compared with normal BMI, obese individuals had a higher risk of coronary heart disease, CVD, and all-cause mortality while overweight individuals, despite a higher odds of CAC, showed no significant increase in mortality. In a sex-stratified analysis, the increase in coronary heart disease, CVD, and all-cause mortality in obese individuals appeared largely limited to men, and there was a lower risk of all-cause mortality in overweight women (hazard ratio, 0.79 [95% CI, 0.63-0.98]). In a large sample undergoing CAC scoring, obesity was associated with a higher risk of CAC and subsequent coronary heart disease, CVD, and all-cause mortality. However, overweight individuals did not have a higher risk of mortality despite a higher risk for CAC.

Correlación entre medidas antropométricas, hipertensión arterial y glucosa en ayunas, en una población rural de Paraguay

Antecedentes: el sobrepeso y la obesidad son importantes factores de riesgo de hipertensión y diabetes tipo 2. Además, imponen una carga significativa sobre el sistema nacional de salud. Objetivo: evaluar la correlación entre el índice de masa corporal (IMC) y la circunferencia de la cintura (CC) con la glucemia de glucosa en ayunas por presión arterial en residentes de la fracción Norma Luisa del municipio de Minga Guazú, Paraguay en 2013. Métodos: Estudio transversal que incluyó a 280 participantes entre 18 y 64 años, de la comunidad Norma Luisa del municipio de Minga Guazú, Paraguay, entre septiembre de 2012 y mayo de 2013. Resultados: en las cuatro categorías de IMC y WC, las diferencias entre los valores medios para la presión arterial sistólica y diastólica y la glucosa en ayunas fueron estadísticamente significativas (p &lt;0.01). Hubo una correlación estadísticamente significativa entre los indicadores de IMC y WC con la presión arterial sistólica, diastólica y glucosa en ayunas. Además, hubo una correlación significativa entre el IMC y el WC. Conclusiones: Los resultados obtenidos mostraron que el IMC y el WC son predictores de hipertensión y aumento de la glucosa en ayunas. Estos estimadores pueden ayudar a establecer predicciones de morbilidad y mortalidad, tanto con fines clínicos como en el diseño de programas de intervención comunitaria para cambiar los hábitos de estilo de vida en la población local.

Body mass index and treatment survival in patients with RA starting treatment with TNFα-inhibitors: long-term follow-up in the real-life METEOR registry

ObjectivesTo study whether there is an association between body mass index (BMI) category and survival of various tumour necrosis factor inhibitors (TNFi) in rheumatoid arthritis (RA) patients in a real-life...

Obesity, cardiovascular risk and healthcare resource utilization in the UK.

Obesity and cardiovascular diseases (CVDs) often co-occur, likely increasing the intensity of healthcare resource utilization (HCRU). This retrospective, observational database study examined the joint effect of obesity and cardiovascular risk status on HCRU and compared HCRU between body mass index (BMI) categories and CVD-risk categories in the UK. Patient demographics and data on CVD and BMI were obtained from the UK Clinical Practice Research Datalink. Cardiovascular risk status, calculated using the Framingham Risk Equation, was used to categorize people into high-risk and low-risk groups, while a CVD diagnosis was used to define the established CVD group. Patients were split into BMI categories using the standard World Health Organization classifications. For each CVD and BMI category, mean number and costs of general practitioner contacts, hospital admissions and prescriptions were estimated. The final study population included 1,600,709 patients. Data on CVD status were available on just over one-quarter of the sample (28.6%) and BMI data for just less than half (43.2%). The number of general practitioner contacts and prescriptions increased with increasing BMI category for each of the three CVD-risk groups. The group with established CVD had the greatest utilization of all components of healthcare resource, followed by high CVD risk then low CVD-risk groups. Increasing BMI category and CVD-risk status both affected several HCRU components. These findings highlight the importance of timely obesity management and treatment of CVD-risk factors as a means of preventing increasing HCRU.

Influence of BMI and geographical region on prescription of oral anticoagulants in newly diagnosed atrial fibrillation: The GLORIA-AF Registry Program

ObjectiveTo investigate the association between body mass index (BMI) and oral anticoagulant (OAC) prescription in atrial fibrillation (AF). MethodsPatients with newly diagnosed non-valvular AF (<3 months) with ≥1 stroke risk factors enrolled in the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) in Asia, Europe and North America were evaluated. ResultsThe cohort (n = 13,793) comprised patients from all BMI categories (kg/m2): 1.4% were underweight (<18.5), 27.3% had a normal BMI (18.5 to <25), 37.9% were overweight (25 to <30), 19.3% were moderately obese (30 to <35), and 12.7% were morbidly obese (≥35). The highest proportion of Asians had a BMI of 18.5 to <25 kg/m2, while the highest proportion of patients from Europe and North America were overweight and a substantial proportion of North Americans morbidly obese. In the multivariable analysis, the probability ratio of non-prescription of OAC, as compared to normal BMI, decreased for overweight (RR = 0.907), moderately obese (RR = 0.802) and severe very severe obese patients (RR = 0.659). Moreover, the probability ratio of non-prescription of OACs was increased in the Asia or North America regions, as compared with Europe, in patients aged <65 years or female patients, as well as in patients with prior bleeding or vascular disease. ConclusionsThe distribution of BMI differed among the continents. An increased BMI was associated with a lower probability of non-prescription of OACs, as compared with a normal BMI. The probability of non-prescription of OACs was increased in the Asia or North America regions, as compared with Europe.

Body mass index and mortality among middle-aged Japanese individuals with diagnosed diabetes: The Japan Public Health Center-based prospective study (JPHC study)

AimTo examine the association between body mass index (BMI) and mortality among middle-aged people with diabetes in Japan. MethodsA total of 3032 men and 1615 women, aged 40–69 years, with diabetes were analyzed. Cox proportional hazards models, adjusted for potential confounding factors, were used to estimate mortality hazard ratios (HRs) across BMI categories at the baseline. ResultsThere were 1761 deaths during a mean follow-up period of 18.5 years. Increased all-cause mortality was observed at both ends of the BMI distribution; compared with the reference BMI category (23.0–24.9 kg/m2), the HRs were 1.25 (95% confidence interval [CI], 0.9997–1.56) in the lowest (14.0–18.9 kg/m2) and 1.36 (95% CI, 1.06–1.74) in the highest (30.0–39.9 kg/m2) categories (P = 0.001). Similar all-cause mortality trends were observed after excluding deaths within 3 years of follow-up, as well as for men and men who had ever smoked. While a similar non-linear pattern was observed for cancer-specific mortality, heart disease-specific mortality was only increased in the highest BMI category (HR, 1.86; 95% CI, 1.06–3.25). ConclusionThis population-based prospective study demonstrated increased all-cause mortality at both ends of the BMI distribution among Japanese people with diabetes.

A U-Shaped Relationship Between the Prevalence of Frailty and Body Mass Index in Community-Dwelling Japanese Older Adults: The Kyoto-Kameoka Study.

The relationship between body mass index (BMI) and frailty remains unclear. Using two validated frailty assessment tools, this study aimed to investigate the relationship between the prevalence of frailty and BMI in Japanese older adults. This cross-sectional study used baseline data of 7191 individuals aged ≥65 years, living in Kameoka City, Kyoto, Japan. The BMI was calculated based on self-reported height and body weight, and classified into six categories. Frailty was defined using two validated assessment tools, the Fried phenotype (FP) model and Kihon Checklist (KCL). We evaluated the relationship between frailty and BMI using a multivariate restricted cubic spline logistic regression. The prevalence of frailty defined using the FP model was 25.3%, 19.6%, 14.3%, 12.4%, 12.6%, and 19.4% for each BMI category of <18.5, 18.5–19.9, 20.0–22.4, 22.5–24.9, 25.0–27.4, and ≥27.5 kg/m2, respectively. The spline model showed a significant U-shaped relationship between BMI and the prevalence of frailty defined using both, KCL and FP models. This study found that the BMI range corresponding to lowest prevalence of frailty defined using both tools was 21.4–25.7 kg/m2. Thus, a healthy BMI may reduce the prevalence of frailty, and the risk of frailty needs to be evaluated in individuals who are underweight or overweight.

Central adiposity at diagnosis may reduce prostate cancer-specific mortality in African-Caribbean men with prostate cancer: 10-year follow-up of participants in a case-control study.

General and central adiposity are associated with the risk of developing prostate cancer (PCa), but the role of these exposures on PCa survival among men of African ancestry are less studied. This study aimed to investigate the association of anthropometry at diagnosis with all-cause and PCa-specific mortality and evaluate whether androgen deprivation therapy (ADT) modulated this risk. Associations between body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) at diagnosis and mortality were examined in 242 men with newly diagnosed PCa enrolled between 2005 and 2007 and re-evaluated 10.9years later. Multi-variable Cox proportional hazard models were used to examine associations of body size variables (using standard WHO cut-points and as continuous variables) with mortality, adjusted for sociodemographic characteristics, Gleason score, smoking, diabetes, primary treatment, and ADT therapy. A total of 139 deaths (all-cause mortality 6.98/100 person-years) occurred (PCa-specific deaths, 56; other causes, 66; causes unknown, 17). In multi-variable analysis BMI, WC and WHR categories at diagnosis were not associated with all-cause mortality even after adjusting for ADT. While WHR (but not BMI or WC) when included as a continuous variable predicted lower PCa-specific mortality (multi-variable adjusted WHR per 0.1 difference: HR, 0.50; 95%CI 0.28, 0.93), the effect disappeared with ADT covariance and excluding deaths within the first 2years. Our study suggests that central adiposity as measured by WHR may improve long-term survival among men of African ancestry. Metabolic studies to understand the mechanism for this association are needed.

Incidence of Fetal Anomalies by Maternal Body Composition and Diabetes Status [19D

INTRODUCTION: We sought to examine the association between body mass index (BMI) and fetal anomalies (FA) in women with pre-existing diabetes, gestational diabetes, and without diabetes. METHODS: This is a retrospective cohort study of women with singleton, term pregnancies between 2007 and 2011 using linked vital statistics and discharge data. Chi-square tests were used to compare rates of FA in diabetic and non-diabetic women categorized by BMI. Pre-pregnancy BMI was categorized into underweight, normal weight, overweight, obesity, and morbid obesity. Multivariable logistic regression was used to examine the association of BMI with FA by diabetes classification, controlling for maternal race/ethnicity, age, parity, education, and insurance status. RESULTS: The cohort of 1,993,905 consisted of 392,008 (19.7%) obese pregnant women. Higher BMI was found to be associated with increased odds of FA, independent of diabetes status. Underweight pre-pregnancy BMI was associated with decreased odds of FA compared to normal-weight. Women with gestational and pre-existing diabetes have significantly increased odds of FA (aOR 1.17, 95% CI 1.14–1.19; aOR 1.82 95% CI 1.74–1.90, respectively). A significant association was demonstrated between BMI category and FA for women with pre-existing diabetes and no diabetes but this relationship was not found with gestational diabetes. CONCLUSION: Diabetes status and higher BMI were found to be individually associated with increased odds of FA. This study also demonstrated the compounding effect of diabetes status and obesity on the incidence of FA. Obstetrical education for these women should emphasize the increased potential of this pregnancy complication and the role of prenatal screening for FA.

Incidence of Jaundice by Maternal Body Mass Index and Diabetes Status [19O

INTRODUCTION: To examine the association between body mass index (BMI) and neonatal jaundice in women with pre-existing diabetes, gestational diabetes, and without diabetes. METHODS: This is a retrospective cohort study of women with singleton, non-anomalous, term pregnancies between 2007 and 2011 using linked vital statistics and discharge data. Chi-square tests were used to compare rates of neonatal jaundice in diabetic and non-diabetic women categorized by BMI class. Pre-pregnancy BMI was categorized into underweight, normal weight, overweight, obesity, and morbid obesity. Multivariable logistic regression was used to examine the association of BMI with jaundice by diabetes classification, controlling for maternal race/ethnicity, age, parity, education, and insurance status. RESULTS: The cohort of 1,859,198 consisted of 364,392 (19.6%) obese pregnant women. Overall, a higher BMI class was found to be associated with increased odds of neonatal jaundice, independent of diabetes status. Underweight pre-pregnancy BMI was associated with decreased odds of jaundice when compared to normal-weight women. When compared to women without diabetes, those with gestational and pre-existing diabetes have significantly increased odds of neonatal jaundice (aOR 1.15, 95% CI 1.14–1.17 and aOR 1.63, 95% CI 1.57–1.69, respectively). A significant association was demonstrated between BMI category and jaundice for women with gestational diabetes and no diabetes. In contrast, we did not find a statistically significant relationship between BMI class and neonatal jaundice among women with pre-existing diabetes. CONCLUSION: Diabetes status and higher BMI category are associated with increasing incidence of neonatal jaundice. Obstetrical education for women in these categories should emphasize the increased potential of this neonatal complication.