Between Body Mass Index Quartiles Research Articles

Association between body mass index and sex hormones among men: Evidence from cross-sectional and Mendelian randomization studies

PurposeThis study aims to investigate the association between Body Mass Index (BMI) and sex hormone levels utilizing a cross-sectional study design alongside Mendelian randomization (MR) analysis. Materials and methodsA cross-sectional study was performed based on National Health and Nutrition Examination Survey (NHANES) 2013–2016. Additionally, a two-sample MR analysis was performed, utilizing Single Nucleotide Polymorphisms (SNPs) associated with BMI identified in a genome-wide association study (GWAS) comprising 339224 individuals. Data on outcomes, including total testosterone (TT, 199569 samples), estradiol (E2, 17134 samples), and sex hormone binding globulin (SHBG, 185211 samples), were sourced from the United Kingdom Biobank (UKB). ResultsIn cross-sectional analysis involving 4092 males, multivariable linear regression demonstrated that each unit increase in BMI was positively correlated with an elevated risk of testosterone deficiency (TD), increased E2 levels, and a reduced TT, SHBG, free androgen index and TT/E2. Subsequent quartile division of BMI revealed, through multivariable logistic regression, that higher BMI quartiles were associated with a greater TD risk, elevated E2 levels, and reduced TT, SHBG, and TT/E2 levels compared to quartile 1 (P for trend <0.001). In the MR analysis, a causal effect was established, with each unit increase in BMI being associated with decreased TT (β = −0.17; 95 % CI −0.24 to −0.09) and SHBG (β = −0.13; 95 % CI −0.21 to −0.05) levels. ConclusionsOur findings unveil a causal link between BMI and reduced TT and SHBG levels in males.

Triglycerides Mediate the Influence of Body Mass Index on Non-Alcoholic Fatty Liver Disease in a Non-Obese Chinese Population with Normal Low-Density Lipoprotein Cholesterol Levels.

Over 25% of the world's population has non-obese or lean non-alcoholic fatty liver disease (NAFLD), and the prevalence is higher than average in Asia. The present study focused on the relationship between body mass index (BMI) and non-obese NAFLD in non-overweight people in China, particularly the influence of triglycerides (TG) in the pathogenesis of non-obese NAFLD. The findings suggest new treatments for NAFLD patients with normal BMI, as well as provide an early warning system for the understanding and prevention of NAFLD in non-obese patients. This cross-sectional study enrolled 159,959 Chinese subjects with BMI &lt;24 kg/m2 and normal levels of low-density lipoprotein cholesterol (LDL-c). The average age was 40.21 ± 13.88 years, and males accounted for 45.7%. A total of 15,907 (9.94%) patients with NAFLD were diagnosed by ultrasonography. Biochemical indicators were measured using an automated analyzer (Abbott AxSYM). The BMI (kg/m2) was calculated from the weight (kg)/height in square meters (m2). The BMI quartile was used as the column-stratified variable to determine the baseline distribution, and logistic regression analysis was used to assess the relationship between NAFLD and its risk factors, with multiple logistic regression used to assess the relationships between BMI or TG and NAFLD and multivariate linear regression used to analyze the association between BMI and TG, while mediation analysis was used to assess the mediation effect of TG. After adjustment of all covariates, the odds ratios were 1.788 (95% CI: 1.749-1.829; p &lt; 0.00001) and 1.491 (95% CI: 1.451-1.532; p &lt; 0.00001) for the association between BMI and TG with NAFLD incidence. The multivariate linear regression coefficient of BMI and TG was β = 0.027 (95% CI: 0.023-0.030; p &lt; 0.00001). Mediation analysis showed that BMI contributed to 10.81% of lean NAFLD with a mediation effect of 2.98%. In a Chinese population with BMI &lt;24 kg/m2 and normal LDL-c levels, BMI and TG were found to be independent predictors of NAFLD. The direct effect of BMI on non-obese NAFLD was 10.41%. The TG level was found to partially mediate the association.

Differential effects of body mass index on domain-specific cognitive outcomes after stroke

Although the obesity paradox is an important modifiable factor in cardiovascular diseases, little research has been conducted to determine how it affects post-stroke cognitive function. We aimed to investigate the association between body mass index (BMI) and domain-specific cognitive outcomes, focusing on the subdivision of each frontal domain function in post-ischemic stroke survivors. A total of 335 ischemic stroke patients were included in the study after completion of the Korean-Mini Mental Status Examination (K-MMSE) and the vascular cognitive impairment harmonization standards neuropsychological protocol at 3 months after stroke. Frontal lobe functions were analyzed using semantic/phonemic fluency, processing speed, and mental set shifting. Our study participants were categorized into four groups according to BMI quartiles. The z-scores of K-MMSE at 3 months differed significantly between the groups after adjustment for initial stroke severity (p = 0.014). Global cognitive function in stroke survivors in the Q1 (the lowest quartile) BMI group was significantly lower than those in Q2 and Q4 (the highest quartile) BMI groups (K-MMSE z-scores, Q1: − 2.10 ± 3.40 vs. Q2: 0.71 ± 1.95 and Q4: − 1.21 ± 1.65). Controlled oral word association test findings indicated that phonemic and semantic word fluency was lower in Q4 BMI group participants than in Q2 BMI group participants (p = 0.016 and p = 0.023 respectively). BMI might differentially affect cognitive domains after ischemic stroke. Although being underweight may negatively affect global cognition post-stroke, obesity could induce frontal lobe dysfunctions, specifically phonemic and semantic word fluency.

Thromboembolic and bleeding risk in obese patients with atrial fibrillation according to different anticoagulation strategies

BackgroundData on the relationship between body mass index (BMI), thromboembolic events (TEE) and bleeding in patients with atrial fibrillation (AF) are controversial, and further evidence on the risk of such events in obese patients with AF receiving different anticoagulant therapies (OAC) is needed. Methods and resultsWe divided a total of 9330 participants from the prospective PREFER in AF and PREFER in AF PROLONGATION registries into BMI quartiles at baseline. Outcome measures were TEE and major bleeding complications at the 1-year follow-up. Without OAC, there was a ≥6-fold increase of TEE in the 4th vs other BMI quartiles (P = .019). OAC equalized the rates of TEE across different BMI strata. The occurrence of major bleeding was highest in patients with BMI in the 1st as well as in the 4th BMI quartile [OR 1.69, 95% CI 1.03–2.78, P = .039 and OR 1.86, 95% CI 1.13–3.04, P = .014 vs those in the 3rd quartile, respectively]. At propensity score-adjusted analysis, the incidence of TEE and major bleeding in obese patients receiving non-vitamin K antagonist oral anticoagulants (NOACs) or vitamin K-antagonist anticoagulants (VKAs) was similar (P ≥ .34). ConclusionsOur real-world data suggest no obesity paradox for TEE in patients with AF. Obese patients are at higher risk of TEE, and here OAC dramatically reduces the risk of events. We here found a comparable clinical outcome with NOACs and VKAs in obese patients. Low body weight and obesity were also associated with bleeding, and therefore OAC with the best safety profile should be considered in this setting.

Associations between body mass index, waist circumference, waist-to-height ratio, and high blood pressure among adolescents: a cross-sectional study

The purpose of the present study was to examine the associations between body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and high blood pressure (HBP), and to determine which anthropometric parameters can best predict HBP among Lithuanian adolescents aged 12–15 years. Data from the survey of “Prevalence and Risk Factors of HBP in 12–15-Year-Old Lithuanian Children and Adolescents (Study 1, 2010–2012)” were used; a total of 7,457 respondents (3,494 boys and 3,963 girls) were included in this analysis. Adolescents with BP above the 90th percentile were measured on two different occasions. Logistic regression analysis was used to assess the associations and to calculate odds ratios. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive ability of the three anthropometric parameters to predict HBP. The adjusted odds ratios (aOR) in the highest quartiles of BMI, WC, and WHtR were statistically significant for both sexes separately (reference group – the first quartile): in boys, prehypertension – 4.91, 4.09, and 1.59; hypertension – 7.96, 6.44, and 2.81; and prehypertension/hypertension – 6.85, 5.65, and 2.37, respectively; and in girls, prehypertension – 3.42, 2.70, and 1.66; hypertension – 5.71, 3.54, and 2.90; and prehypertension/hypertension – 4.62, 3.17, and 2.31, respectively). According to the analyses of the ROC curve, BMI z-score provided the largest area under the curve (AUC) value, followed by WC z-score, while WHtR z-score showed the lowest AUC value in predicting elevated BP in both sexes separately. Among Lithuanian adolescents aged 12–15 years, both anthropometric indices – BMI and WC (but particularly BMI) – showed stronger associations with HBP and were better for the prediction of HBP, compared to WHtR.

Study of the Relationship between Body Mass Index, Body Image, and Lifestyle Behaviors: A Community Survey in Fiji.

Introduction: Public health promotion efforts aimed at overweight and obesity prevention often proceed from the premise that the first step should be losing weight. Appropriate perceptions of body image may be important for improving weight loss awareness. Therefore, we aimed to examine the relationship between body mass index and body image perception in Fiji, where increasing obesity is currently the most important health-related issue. Methods: Using the resident register based on the governmental census, one household member, aged between 18 and 69 years, was randomly selected from each household in two areas. There were 1,014 participants in the study. The questionnaire items were related to body image, dietary behaviors, physical activity, smoking habits, and alcohol consumption habits. Moreover, information regarding height, weight, blood pressure, and hemoglobin A1c were measured, and questions about social status (age, ethnicity, education, marital status, and employment), and subjective living status were asked. A multivariate logistic regression analysis was performed to analyze the relationship between body mass index (BMI) and body image perception. Results: Data from 391 men and 537 women were analyzed. Men within higher BMI quartiles smoked less (p = 0.0004) and drank less alcohol (p = 0.042). Women in higher BMI quartiles engaged in less physical activity (p = 0.022). Among the assessed data, both men and women in the higher BMI quartiles underestimated their body image compared with their actual physique (p < 0.0001). The higher BMI was associated with underestimated body image (men: odds ratio [OR] = 3.22, 95% confidence interval [CI], 1.94–5.35; p < 0.0001; women: OR = 18.11, 95% CI, 10.10–32.47; p < 0.0001). Conclusions: Higher BMI is strongly associated with underestimated body image among Fiji residents. Health-related counseling should be included within programs that aim to increase recognition of one’s actual physical size.

Overweight and underweight are risk factors for vertebral fractures in patients with type 2 diabetes mellitus.

The aim of this cross-sectional study was to examine the association between body mass index (BMI) and the prevalence of vertebral fracture (VF) in Japanese patients with type 2 diabetes (T2DM). A total of 798 patients with T2DM were enrolled. VF was determined semi-quantitatively using lateral X-ray films. The association between BMI quartiles (Q1: ≤ 21.2kg/m2, Q2: 21.3-23.4kg/m2, Q3: 23.5-25.8kg/m2, Q4: 25.9≤ kg/m2) and the presence of VF was examined. Multiple logistic regression analyses adjusted for age, sex, diabetes duration, hemoglobin A1c (HbA1c), estimated glomerular filtration rate, and albumin showed that Q1, Q3, and Q4 were significantly associated with an increased VF risk compared to Q2, which served as a reference [Q1; odds ratio (OR) = 1.91, 95% confidence interval (CI) 1.24-2.95, p = 0.004, Q3; OR = 1.65, 95% CI 1.07-2.55, p = 0.023, and Q4; OR = 2.18, 95% CI 1.39-3.41, p < 0.001]. Moreover, these associations remained significant after additional adjustment for femoral neck T-score, a bone resorption marker, urinary N-terminal cross-linked telopeptide of type-I collagen, and use of insulin and thiazolidinedione. Our study shows for the first time that both overweight and underweight were associated with the bone mineral density (BMD)-independent risk of VF in patients with T2DM. Therefore, body weight control should be considered as a protective measure against diabetes-related bone fragility.

Aminotransferase levels, body mass index, and the risk of diabetes: a prospective cohort study

PurposeTo investigate whether the relationship between body mass index (BMI) and incident diabetes is modified by different alanine or aspartate aminotransferases (ALT or AST) levels. MethodsWe carried out an analysis of 6484 participants aged 40 years or older using data from the Korean Genome Epidemiology Study. The serum aminotransferase levels were stratified into low and high groups according to the median values and classified into three groups: both low, either high, and both high. To assess the association between BMI and incident diabetes according to the serum aminotransferase levels, multiple logistic regression models were used. ResultsIn participants with high levels of both ALT and AST, compared with the first BMI quartile, the adjusted odds ratios for incident diabetes of the second, third, and fourth BMI quartiles were 1.72 (95% confidence interval, 0.84–3.55), 2.19 (1.11–4.33), and 3.08 (1.60–5.90), respectively (P trend < .001). In participants with either high ALT or AST, the adjusted odds ratios were 3.58 (1.23–10.41), 2.65 (0.90–7.76), and 5.28 (1.86–15.02), respectively (P trend = .005). However, in participants with both low ALT and AST levels, high BMI was not independently associated with the risk of incident diabetes. ConclusionsThere was a strong association between BMI and incident diabetes among individuals with high aminotransferase levels, whereas no association was observed among those with low aminotransferase levels.

Association between Body Mass Index and Quality of Life in Elderly People over 60 Years of Age.

BackgroundThe Korean population is aging rapidly and the number of health threats is increasing. The elderly obese population is also increasing and this study aimed to evaluate the association between body mass index (BMI) and health-related quality of life in the elderly Korean population.MethodsThe Korean version Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was administered to elderly subjects (≥60 years) selected from welfare and health centers, and university hospitals. Sociodemographic information and subjects' height and weight were also recorded.ResultsThe study population's mean age was 74.2±7.1 years, and the average BMI was 24.5±3.2 kg/m2. The 542 participants were segregated based on BMI quartiles. The SF-36 scores were compared among the sex-stratified quartile groups after adjusting for age, education level, income, smoking, alcohol, and arthritis diagnosis. The SF-36 scores were compared for four BMI quartiles stratified by sex, after adjusting for age, education level, income, smoking, alcohol consumption, and arthritis diagnosis. Men in the Q3 and Q4 groups had higher mental health scores than men in Q2 group. Additionally, men in the Q3 group had higher social function scores than those in the Q2 and Q4 groups. No differences were observed for the remaining six domains; no significant score differences were observed in any of the survey domains for the female subjects.ConclusionThere was no significant association between a high BMI and a low quality of life in the elderly Korean population selected from hospitals and welfare centers, as assessed using the SF-36 scores.

Relation of Body Mass Index to Bleeding During Percutaneous Coronary Interventions

The relation between body mass index (BMI) and bleeding after percutaneous coronary intervention (PCI) remains incompletely understood. This study aimed to assess the association between BMI and bleeding and mortality after PCI. The study included 14,178 patients with coronary artery disease treated by PCI. Bleeding within 30 days of PCI was defined using the Bleeding Academic Research Consortium criteria. The primary outcome was 1-year all-cause mortality. BMI quartiles were 14.1 to 24.8 kg/m(2) (first quartile [Q1]), >24.8 to 27.1 kg/m(2) (second quartile [Q2]), >27.1 to 29.8 kg/m(2) (third quartile [Q3]), and >29.8 to 56.3 kg/m(2) (fourth quartile [Q4]). In BMI Q1, Q2, Q3, and Q4, the frequency of bleeding was 13.8%, 10.1%, 10.8%, and 7.7%, respectively (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.63 to 2.23, p <0.001, for Q1 vs Q4). Multiple logistic regression showed that BMI was independently associated with bleeding (adjusted OR 1.05, 95% CI 1.04 to 1.07, p <0.001, for any bleeding; adjusted OR 1.07, 95% CI 1.04 to 1.09, p <0.001, for access site bleeding; and adjusted OR 1.03, 95% CI 1.01 to 1.05, p = 0.039, for non-access site bleeding with all 3 risk estimates calculated per 1 kg/m(2) decrease in BMI). Analysis by sex showed an increase in the frequency of bleeding with the decrease in BMI for women and men (p for trend <0.001 for women and men) with no sex-by-BMI interaction (p = 0.90). The Cox proportional hazards model showed that bleeding (adjusted hazard ratio [HR] 2.17, 95% CI 1.67 to 2.82, p <0.001) and BMI (HR 1.03, 95% CI 1.01 to 1.06, p = 0.048, per 1 kg/m(2) decrease in the BMI) were independently associated with increased risk of 1-year mortality with no bleeding-by-BMI interaction (p = 0.81). In conclusion, BMI is inversely associated with the increased risk of bleeding and mortality after PCI.

Lack of Associations between Body Mass Index and Clinical Outcomes in Patients with Papillary Thyroid Carcinoma.

BackgroundObesity is associated with aggressive pathological features and poor clinical outcomes in breast and prostate cancers. In papillary thyroid carcinoma (PTC), these relationships remain still controversial. This study aimed to evaluate the associations between body mass index (BMI) and the clinical outcomes of patients with PTC.MethodsThis retrospective study included 1,189 patients who underwent total thyroidectomy for PTCs equal to or larger than 1 cm in size. Clinical outcomes were evaluated and compared based on the BMI quartiles.ResultsThere were no significant associations between BMI quartiles and primary tumor size, extrathyroidal invasion, cervical lymph node metastasis, or distant metastasis. However, an increase in mean age was associated with an increased BMI (P for trend <0.001). Multifocality and advanced tumor-node-metastasis (TNM) stage (stage III or IV) were significantly associated with increases of BMI (P for trend 0.02 and <0.001, respectively). However, these associations of multifocality and advanced TNM stage with BMI were not significant in multivariate analyses adjusted for age and gender. Moreover, there were no differences in recurrence-free survivals according to BMI quartiles (P=0.26).ConclusionIn the present study, BMI was not associated with the aggressive clinicopathological features or recurrence-free survivals in patients with PTC.

116 The Obesity Paradox in Type II Diabetes Mellitus. Impact of Body Mass Index on Prognosis

BackgroundObese patients with type two diabetes mellitus (T2DM) may have a better prognosis than patients of normal weight, but reports are limited by study size, duration and confounders.MethodsWe investigated the...

Abstract P390: Relationship between BMI and Risk of Hypertension in an urban Japanese cohort study: the Suita study

Objective: The positive relation between body mass index (BMI) and risk of incident hypertension (HT) has been reported mainly in the Western subjects with high BMI. However, there are a few reports in the Asian with relatively lower BMI. This study investigated the relation of BMI with risk of incident HT in the population-based prospective cohort study of Japan, the Suita study. Methods: Participants who had no HT at baseline (1,591 men and 1,973 women) aged 30-84 years were included in this study. BMI categories were defined as following: underweight (BMI&lt;18.5), normal (18.5≤BMI&lt;25.0), and overweight (BMI ≥ 25.0). The Cox proportional hazards model was used to estimate hazard ratios (HRs) of BMI categories for incident HT by sex. HRs were adjusted for age, cigarette smoking and alcohol drinking. The HRs according to quartiles of BMI were also estimated, using the lowest quartile of BMI as a reference. Results: During median follow-up of 7.2 years, 1,325 participants (640 men and 685 women) developed HT. The HR (95% CI) of 1kg/m2 increment of BMI for HT in men and women was 1.08 (1.05-1.11) and 1.10 (1.07-1.12), respectively. When we set a normal BMI as a reference, HR of overweight BMI in men and women was 1.37 (1.13-1.67) and 1.45 (1.18-1.77), whereas HR of underweight BMI in men and women was 0.63 (0.45-0.90) and 0.60 (0.45-0.80), respectively. In addition, compared to the lowest quartile, HR of the highest quartile of BMI in men and women was 1.67 (1.33-2.10, trend p&lt;0.001) and 2.10 (1.67-2.64, trend p&lt;0.001), respectively. Conclusion: In this study, we showed that higher BMI was associated with increased risk of hypertension in both Japanese men and women.

Body Mass Index and Disability in Chinese Nonagenarians and Centenarians

ObjectivesTo examine the potential association between body mass index (BMI) and activities of daily living (ADLs) and instrumental activities of daily living (IADLs) disabilities in a population-based sample of Chinese nonagenarians and centenarians. MethodsThis study analyzed data obtained from a survey conducted in 870 elderly Chinese adults aged 90 years or older in Dujiangyan. The participants were divided into 4 groups according to the World Health Organization (WHO) Asia criteria of underweight, normal weight, overweight, and obesity in BMI (<18.5, 18.5–23.0, 23.0–25.0, ≥25.0 kg/m2, respectively) and to BMI quartile (<16.8, 16.8–18.9, 18.9–21.1, ≥21.1 kg/m2, respectively). The ADL and IADL disabilities were measured using the physical self-maintenance scale (PSMS) and IADL scale developed by Lawton and Brody, respectively. ResultsThe participants included in the current statistical analyses were 233 men and 505 women. The mean age was 93.5 ± 3.2 years (ranging from 90 to 108 years). Using the WHO Asia criteria, the prevalence of underweight and obesity were 43.9% and 6.6%, respectively. In long-lived women, the prevalence of ADL and IADL disabilities was significantly higher in either the underweight group (39.4% and 72.9%, respectively) or the obesity group (38.1% and 77.7%, respectively) compared with the normal weight group (31.4% and 60.8%, respectively). After adjusting for relevant covariates, the underweight group and obesity group showed significantly increased odds ratios (ORs) for either ADL (1.5 and 1.8, respectively) or IADL disability (1.9 and 1.4, respectively). Similar results were found when using the BMI quartile. However, in long-lived men, no significant difference was found with respect to the prevalence of ADL or IADL disability and adjusted ORs among the different BMI groups. ConclusionsAmong Chinese long-lived adults, the risk of ADL and IADL disability was higher for women with both extremely low and high BMIs, but this pattern was not found in men.

Body Mass Index, Waist-circumference and Cardiovascular Disease Risk Factors in Iranian Adults: Isfahan Healthy Heart Program

Considering the main effect of obesity on chronic non-communicable diseases, this study was performed to assess the association between body mass index (BMI), waist-circumference (WC), cardio-metabolic risk factors and to corroborate whether either or both BMI and WC are independently associated with the risk factors in a sample of Iranian adults. This cross-sectional study was performed on data from baseline survey of Isfahan Healthy Heart Program (IHHP). The study was done on 12,514 randomly-selected adults in Isfahan, Najafabad and Arak counties in 2000-2001. Ages of the subjects were recorded. Fasting blood glucose (FBG), 2-hour post-load glucose (2hpp), serum lipids, systolic and diastolic blood pressure (SBP and DBP), BMI, WC, smoking status, and total daily physical activity were determined. Increase in BMI and WC had a significant positive relation with the mean of FBG, 2hpp, SBP, DBP, serum lipids, except for HDL-C (p<0.001 for all). After adjustment for age, smoking, physical activity, socioeconomic status (SES), and BMI, the highest odds ratio (OR) (95% CI) for diabetes mellitus (DM) according to WC was 3.13 (1.93-5.08) and 1.99 (1.15-3.44) in women and men respectively. Moreover, the highest ORs based on BMI with adjustment for age, smoking, physical activity, SES, and WC were for dyslipidaemia (DLP) [1.97 (1.58-2.45) in women and 2.96 (2.41-3.63) in men]. The use of BMI or WC alone in the models caused to enhance all ORs. When both BMI and WC were entered in the model, the ORs for all risk factors, in men, according to BMI, were more compared to WC. However, in women, ORs for DM and hypertension (HTN) in WC quartiles were more than in BMI quartiles. BMI is the better predictor of DM, HTN, and DLP in men compared to WC. Conversely, in women, WC is a superior predictor than BMI, particularly for DM and HTN. Furthermore, the measurement of both WC and BMI in Iranian adults may be a better predictor of traditional risk factors of CVDs compared to BMI or WC alone.

Older patients with diabetes mellitus who are obese have a better long-term prognosis: an analysis of outcome in 12,025 diabetic patients

Background: Obesity is a key trigger for insulin resistance leading to type-2 diabetes mellitus (T2DM). However, recent evidence suggests that obese patients with T2DM may have lower morbidity and mortality compared to patients of normal weight. These reports are limited by statistical power and confounders. We investigated the relationship between Body Mass Index (BMI), mortality and cardiovascular (CV) morbidity in a long-term large cohort of patients with T2DM. Methods: Between 1995 and 2011, weight (BMI), blood pressure, dyslipidemia, smoking and comorbidities was collected in patients with T2DM without known CV disease. Patients were followed prospectively. Total mortality and hospital admissions for acute coronary syndrome (ACS), cerebrovascular accidents (CVA) and heart failure (HF) were gathered. Subjects were divided according to BMI quartiles and in age tertiles. ANOVA was used to compare covariates amongst the BMI groups, Chi square and multivariate Cox-Regression analysis were used to assess the prognostic impact of BMI and confounders on the above-defined events. Sensitivity analysis was performed accounting for cancer, BMI<18.5 and gender. Results: Of 12025 patients (54% men, mean age 60+15 years), followed for a mean of 10+4 years), 4125 (34%)died. In the first age tertile (42+10 years), there was a U-shaped relationship between BMI and outcome; those with BMI 25-28 had the lowest mortality (X2 15.2 P<0.01). In the second age tertile (62+6 years), there was a similar mortality across BMI quartiles (X2 5.1 P=0.14). In the oldest age tertile (75+5 years), mortality was inversely related to BMI; those with BMI 27-30 had the lowest mortality X2 33.0 P<0.0001. Excluding patients with cancer, BMI <18.5 or adjusting for sex did not significantly affect these results. In a multi-variable Cox Regression model, including age, sex, smoking, blood pressure, cancer and diabetes duration, higher BMI was still associated with a lower mortality. However, patients in higher BMI quartiles had a higher incidence of ACS and HF in all age tertiles (all X2 P<0.05) and CVA showed a similar trend. In multi-variable Cox regression models, the association between higher BMI and CV morbidity remained after adjusting for other variables. Conclusion: In this analysis, although being overweight was associated with an increased risk of CV events in patients with T2DM, higher BMIs were associated with a survival benefit in older patients. Slim patients with T2DM may have a more severe metabolic disorder than patients in whom insulin resistance is primarily due to obesity.

Elevated CSF serotonin and dopamine metabolite levels in overweight subjects

Neurotransmitter systems participate in the regulation of food intake, and their activities are expected to influence eating behavior. We investigated possible associations between body mass index (BMI) and central noradrenaline, serotonin, and dopamine activities, as reflected by the cerebrospinal fluid levels of their main metabolites methoxyhydroxyphenylglycol (MHPG), 5-hydroxyindoleacetic acid (5-HIAA), and homovanillic acid (HVA), respectively. We studied 192 subjects (111 males, 81 females) admitted to neurologic clinic for diagnostic investigations that included CSF analysis, and were found not to suffer from any major neurological disease. Subjects were categorized in three groups, namely in lower, in the two middle, and in upper BMI quartiles, the limits calculated separately for males and females. No differences were found in MHPG levels between groups, while subjects in the upper BMI quartile showed significantly elevated levels of 5-HIAA and HVA compared to the levels of subjects in lower and middle quartiles. The results provide evidence that in overweight subjects there are enhanced demands in serotoninergic and dopaminergic signaling for their reward system that may lead to increased motivation for food consumption. The implication of reward centers in eating behavior supports the hypothesis of common mechanisms in obesity and drug addiction.

Menstrual disorders in adolescence: a marker for hyperandrogenaemia and increased metabolic risks in later life? Finnish general population-based birth cohort study

Are self-reported menstrual disorders associated with hyperandrogenaemia and metabolic disturbances as early as in adolescence? Menstrual disorders at the age 16 are a good marker of hyperandrogenaemia, and an adverse lipid profile was associated with higher androgen levels. Hyperandrogenism per se has been suggested to be a significant metabolic risk factor in women and a cause of physical and psychological morbidity in adolescent girls. A weak positive correlation has been described between hyperandrogenaemia and obesity in adolescent girls, but the clinical consequences are still poorly understood. Hyperandrogenism and insulin resistance are also key features of polycystic ovary syndrome (PCOS), and women with PCOS are consequently at an increased risk of developing type 2 diabetes mellitus and/or metabolic syndrome, and may have increased cardiovascular morbidity. Our findings confirm that the association between menstrual disorders, hyperandrogenism, obesity and metabolic risks is already evident in adolescence. This population-based, cross-sectional study used postal questionnaires to targeting 15-16-year-old girls in the Northern Finland Birth Cohort 1986 (n= 4567). There were 3669 girls who answered the postal questionnaire and out of 3373 girls who also underwent clinical examinations and blood tests, 2448 were included in the analyses. The questionnaire included one question about the regularity and length of the menstrual cycle: 'Is your menstrual cycle (the interval from the beginning of one menstrual period to the beginning of the next period) often (more than twice a year) longer than 35 days?' The girls who answered 'yes' to this question were considered to be suffering from menstrual disorders and were classified as 'symptomatic'. The girls who answered 'no' were defined as 'non-symptomatic'. There were 709 (29%) girls who reported menstrual disorders (symptomatic girls) and 1739 who had regular periods (non-symptomatic girls). In the whole population and in both study groups, there were significant correlations between body mass index (BMI) (and waist-to-hip ratio), hyperandrogenaemia and metabolic parameters. Symptomatic girls exhibited significantly higher serum concentrations of testosterone (P= 0.010), lower levels of sex hormone-binding globulin (P =0.042) and higher free androgen indices [FAIs; geometric mean 3.38 (interquartile range (IQR): 2.27, 5.18) versus 3.08 (IQR: 2.15, 4.74), P= 0.002]. The two groups had comparable BMI and insulin sensitivity, and serum levels of glucose, insulin and lipids. There was a significant linear trend towards higher FAI values in the higher BMI quartiles in both symptomatic and non-symptomatic girls. In the whole population, there was a statistically significant linear decrease in high-density lipoprotein concentrations (P < 0.001) and higher triglyceride concentrations (P =0.004) in the upper FAI quartile. Information regarding menstrual disorders in adolescence is a good marker of hyperandrogenaemia and may be an early risk factor for the development of PCOS in adulthood. The association between obesity, hyperandrogenism and metabolic risks is already evident in adolescence, which strengthens the importance of noting menstrual disorders at an early stage. BIAS, LIMITATIONS, GENERALIZABILITY: The cross-sectional nature of the study does not allow us to draw conclusions concerning the metabolic risks of this population in later life. The diagnosis of menstrual disorders was based on a questionnaire, suggesting a risk of information bias in reporting the symptoms. This study was not designed to diagnose PCOS, as ultrasonography was not available and there was no clinical evaluation of hyperandrogenism (i.e. hirsutism). However, we were able to take into account potential confounding factors in the analyses. This work was supported by grants from the Finnish Medical Society Duodecim, the North Ostrobothnia Regional Fund, the Academy of Finland (project grants 104781, 120315, 129269, 1114194, SALVE), University Hospital Oulu, Biocenter, University of Oulu, Finland (75617), the European Commission (EURO-BLCS, Framework 5 award QLG1-CT-2000-01643) and the Medical Research Council, UK (PrevMetSyn/SALVE). None of the authors have any conflict of interest to declare.

Association of Body Mass Index with Glomerular Filtration Rate in Japanese: A Cross-Sectional Study in Work-Site Population

It has been shown that aging and hypertension are important risk factors to promote renal damage. However, little data are available on the effect of obesity on the progression of renal damage, especially in young and middle-aged individuals. The aim of this study was to determine the association between body mass index (BMI) and renal function evaluated by estimated glomerular filtration rate (eGFR) in Japanese men. We studied the cross-sectional association of BMI with eGFR in 3872 Japanese men in a work-site population (18–64 y; mean age 42.1 ± 0.2 y). Estimated glomerular filtration rate was calculated by a novel equation for Japanese men. Estimated glomerular filtration rate was negatively correlated with age, systolic blood pressure (SBP), hemoglobin A1c (HbA1c), and BMI. We performed multiple regression analysis, controlling for factors, such as SBP, low-density lipoprotein-cholesterol, gamma-glutamyl transpeptidase, age, HbA1c, and uric acid. The association between age and eGFR was highly statistically significant. In addition, BMI was still significantly associated with eGFR independently of SBP. Moreover, mean eGFR, which was adjusted for age, SBP, HbA1c, serum uric acid, and gamma-glutamyl transpeptidase, decreased from 88.9 mL/min/1.73 m2 in the first quartile of BMI to 87.5 mL/min/1.73 m2 in the second, 86.9 mL/min/1.73 m2 in the third, and 85.9 mL/min/1.73 m2 in the fourth quartile (test for trend, P < .0001). These results show that a close relationship is present between obesity and decreased eGFR in Japanese men. Keeping appropriate body weight, in addition to appropriate blood pressure, in young and middle age may be important to prevent renal damage in older age.

Association between sleep quality and body mass index among Chinese nonagenarians/centenarians

We examined the individual association between body mass index (BMI) and sleep quality among the very elderly. The present study analyzed data from survey that was conducted on all residents aged 90 years or more in a district, there were 2,311,709 inhabitants in 2005. Subjects were divided into four groups according to quartile of BMI (<16.6, 16.6-18.9, 18.9-21.1, >21.1 kg/m(2)) and according to classification criteria of underweight, normal weight, overweight, and obesity in BMI (<18.5, 18.5-23.0, 23.0-27.5, >27.5 kg/m(2)), respectively. Sleep quality was measured using The Pittsburgh Sleep Quality Index (PSQI). Sleep quality included quality classification and scores, sleep duration, sleep latency, and sleep efficiency. The subjects included in the statistical analysis were 216 men and 444 women. According to quartile of BMI or classification criteria of underweight, normal weight, overweight, and obesity in BMI, none of the differences in sleep quality scores, sleep latency, sleep duration, sleep efficiency percentage, and prevalence of poor sleep quality was significant among different BMI groups. The difference in BMI between subjects with good and poor sleep quality was non-significant. Unadjusted and adjusted multiple logistic regression showed that none of the BMI groups had a function of decreasing the risk for poor quality. Among longevity Chinese, there is no association between BMI and sleep quality.