BMI Criteria Research Articles

Pancreas transplantation in type 2 diabetes: expanding the criteria.

Pancreas transplantation in type 2 diabetes mellitus (T2DM) candidates remains disproportionately lower than in type 1 diabetes mellitus (T1DM); however, outcomes in carefully selected patients mirrors that of T1DM. Despite the 2014 United Network for Organ Sharing (UNOS) eligibility criteria for simultaneous pancreas/kidney transplant (SPK) transplantation in T2DM patients, an expected increase in the number of transplants was not observed. In an updated International Pancreas and Transplant Registry (IPTR) analysis, 1514 primary deceased donor pancreas transplants were performed in T2DM recipients [1995-2015, SPK 88%, pancreas after kidney (PAK) 9%, pancreas transplant alone (PTA) 3%]. In contrast to the declining number of SPK transplants for T1DM, the number of primary SPK transplants in T2DM patients is increasing over time in the USA. Improvement over time was noted for T2DM SPK patient and graft survival, and the rate of technical failures decreased, paralleling similar overall trends for pancreas transplants in general. Long-term follow-up data of pancreas outcomes in C-peptide positive vs. negative demonstrate noninferior outcomes. BMI does not appear to impact outcomes in carefully selected T2DM candidates. The current UNOS regulations that currently limit access of T2DM to pancreas transplantation based on strict BMI criteria and C-peptide levels need to be liberated.

A study of blood pressure in rural and urban school children

Background: Hypertension is one of the most common diseases worldwide. Early diagnosis of Hypertension is an important strategy in its control. The purpose of this study was to determine the prevalence of hypertension and risk factors among school going children and to find its relationship with regard to age, sex, height, weight and BMI criteria and comparing the values with available standards.Methods: It is a prospective cross-sectional study done in the age group of 10 to 16 years. Children were selected from urban and rural areas in and around Mysore city. Blood pressure measurements were taken by mercury Sphygmomanometer as per recommendation of American Heart Association. Three readings of blood pressure were recorded for each subject and were correlated with age, gender and anthropometry. All the statistical operations were done through SPSS.Results: The present study was conducted amongst children in the age group of 10-16 years in rural and urban schools. A total of 2000 children were included in the study. BP measurements of 1000 subjects in three urban school children and 1000 school children in one rural school children in Mysuru district were done. In rural school children prevalence of systolic hypertension was 2.8% in males and 0.9% in females. In urban school children prevalence of systolic hypertension was 2.1% in males and 1.2% in females.Conclusions: Blood pressure measurement in children is pivotal in clinical examination. Periodic measurement of blood pressure would identify hypertension at an early age. Further studies are needed to know the exact prevalence of hypertension and long term follow up studies are required to know the effect and risk factors associated in children with sustained hypertension.

Identifying Patients with GDM at Risk for GCK-MODY

GCK-MODY is characterized by stable, mild hyperglycemia without typical long-term diabetes complications. The prevalence of GCK-MODY is 0.1% in the general population. However patients are frequently misclassified as type 1, type 2, or gestational diabetes. Since all pregnant women undergo glycemic assessment, there is an opportunity to identify women with GCK-MODY within the Obstetrics (OB) clinic. The purpose of this study is to use retrospective data from the electronic medical record (EMR) to identify a combination of anthropometric and glycemic data that can differentiate women with GCK-MODY from those with gestational diabetes in a multiethnic United States population. A screening cohort of 927 study patients was identified through the University of Chicago Clinical Research Data Warehouse (CRDW) using the parameters of age >=18, outpatient visit to the OB clinic from 2009 to present and ICD-9 or ICD-10 diagnosis code of pregnancy and diabetes. A total of 1patients were identified who fulfilled criteria of BMI < 30 kg/m2 and fasting glucose 99-145 mg/dL or HbA1c 5.6-7.6%. Twelve patients were excluded due to confirmed type 1 diabetes (n= 11) and secondary CF-related diabetes (n= 1). The final cohort are predominantly African-American (66%), followed by Asian/Mideast Indian (13%) and white (11%). Diagnoses based on ICD9/10 codes included gestational diabetes (52%), type 2 diabetes (41%), unconfirmed type 1 diabetes (4%), and secondary diabetes (2%). The average BMI using lowest recorded BMI was 25.6 (range 16-29.96 kg/m2). Average hemoglobin A1c was 6.0% and fasting glucose was 100.6 mg/dL. These patients will be contacted for study enrollment and genetic testing to determine the pickup rate of GCK-MODY using the proposed screening cutoffs in this multiethnic population. The initial data indicate that the EMR can be used to identify patients at higher risk for GCK-MODY to undergo genetic testing. Several challenges were encountered including duplicate ICD codes but these did not preclude successful cohort identification. Disclosure L.T. Dickens: None. L.R. Letourneau: Other Relationship; Self; Novo Nordisk Inc.. M. Sanyoura: None. L.H. Philipson: Research Support; Self; Novo Nordisk Inc.. Speaker's Bureau; Self; Merck & Co., Inc.. Research Support; Self; JAEB Center For Health Research, JDRF, Janssen Pharmaceuticals, Inc., Medtronic MiniMed, Inc. S.W. Greeley: Research Support; Self; Novo Nordisk Inc.. R.N. Naylor: None.

Tracking of thinness and overweight in children of Dutch, Turkish, Moroccan and South Asian descent from 3 through 15 years of age: a historical cohort study.

Overweight is shown to track (= to maintain a relative position in a distribution) from childhood to adulthood, but is mostly studied in preobesogenic cohorts and in single ethnic groups. Little is known about tracking of thinness by ethnicity. to determine (differences in) tracking of BMI (class) from 3 through 15 years and the prediction of BMI class at 13-15 years of age in contemporary Dutch, Turkish, Moroccan and South Asian children living in the Netherlands. Historical cohort of 7625 children, born 1994-1997, with 24,376 measurements of BMI. BMI z-score and BMI class was analysed using universal criteria. South Asian children were also assessed using ethnic specific BMI criteria. Diagnostic odds ratios (OR) and test properties were calculated to estimate the ability of BMI class at 3-4 years to predict BMI class at 13-15 years. Tracking of thinness between 3 and 15 years was stronger than that of overweight, as indicated by a generally higher diagnostic OR. BMI trajectories between 3 and 15 years of age of thin, normal weight and overweight adolescents were, although significantly different, quite similarly shaped in children of Dutch, Turkish and Moroccan descent. The South Asian BMI trajectory deviated considerably from the other ethnic groups, but the differences disappeared when South Asian specific BMI criteria were applied. A substantial proportion of overweight developed between 5-10 years, after which less children shifted to other BMI classes. A total of 55-78% of children with overweight at 3-4 years retained their overweight at 13-15 years, and 10-20% of 3-4 year olds with thinness remained thin. In all ethnic groups, overweight and especially thinness highly tracked into adolescence. South Asian children differed from the other ethnic groups when universal BMI criteria were applied, but with South Asian specific BMI criteria tracking patterns became more concordant.

Knowledge, attitude, and practices about obesity among obese homemakers in urban udupi: A Cross-Sectional study

Background:National Family Health Survey (NFHS) reported that percentage of women who were obese at age group 15–49 years increased from 11% to 15% from NFHS-2 to NFHS-3. In rural parts, under nutrition is more predominant, but in urban areas, obesity and overweight are more than three times higher, which may be owing to less physical activity levels in urban. The prevalence of obesity is greater for urban women and it is largely preventable through changes in lifestyle. It is important to assess the individual's knowledge about the link between food, physical work, and obesity in planning any intervention strategies. So it is necessary to explore the knowledge, attitude, and practices on obesity before planning any intervention programs.Objective: To assess Knowledge, Attitude, and Practices (KAP) on obesity among obese homemakers in urban Udupi.Method: A cross-sectional study was carried out among obese homemakers residing in urban Udupi. A total of 180 obese homemakers were recruited from 30 wards in urban Udupi community based on BMI criteria within the age group of 30 to 45 years. An investigator developed KAP questionnaire on obesity was administered to the participants.Results:The mean age of study population was 36.77 years. In knowledge section, 45% respondents had a low level of knowledge regarding obesity. 51.7% had a negative attitude towards obesity and 76% had a poor practice related to obesity.Conclusion:Women who are obese and homemakers by occupation residing in the urban community had a limited knowledge, negative attitude and worst in practices related to obesity.

Comparison of Different Methods for Assessing Overall and Abdominal Obesity among Adolescents in Ibadan Northwest Local Government Area, Ibadan, Oyo State

Objectives: The aim of this study was to determine the level of agreement among CDC BMI percentile, WHO BMI Z-scores and IOTF criteria for the assessment of overall obesity and also among the waist circumference, waist to hip ratio, and waist to height ratio criteria for the assessment of abdominal obesity. Methods: The study involved 602 adolescents identified by multistage sampling method from selected communities. Overall obesity was determined using the CDC BMI percentile, IOTF and WHO BMI Z score criteria while abdominal obesity was assessed using the WC, WHR, and WHtR. Weight category was divided into underweight, normal, overweight and obesity while the measurement of abdominal adiposity was classified as normal and abdominal obesity. Agreement among the different methods was determined using Kappa coefficient. Results: The prevalence of overall obesity was 18 (3%), 17 (2.8%) and 6 (1%) using the CDC BMI percentile, WHO Z score, and the IOTF criteria respectively while the prevalence of abdominal obesity was 2.3%, 9.6% and 29.1% using the WC, WHtR and WHR respectively. For the classification of overall obesity, the agreement between the criteria of CDC and WHO BMI Z score was the highest (K=0.76) and the lowest was between IOTF and WHO (K=0.244). For abdominal obesity, the agreement between WC and WHtR K=0.365) while agreement between WC and WHR gave the lowest K=0.088. Conclusion: The highest level of agreement for overall obesity determination obtained was between CDC BMI percentile and WHO BMI Z score while only a moderate agreement was observed between WC and WHtR.

Comparison of Different Methods for Assessing Overall and Abdominal Obesity among Adolescents in Ibadan Northwest Local Government Area, Ibadan, Oyo State

Objectives: The aim of this study was to determine the level of agreement among CDC BMI percentile, WHO BMI Z-scores and IOTF criteria for the assessment of overall obesity and also among the waist circumference, waist to hip ratio, and waist to height ratio criteria for the assessment of abdominal obesity. Methods: The study involved 602 adolescents identified by multistage sampling method from selected communities. Overall obesity was determined using the CDC BMI percentile, IOTF and WHO BMI Z score criteria while abdominal obesity was assessed using the WC, WHR, and WHtR. Weight category was divided into underweight, normal, overweight and obesity while the measurement of abdominal adiposity was classified as normal and abdominal obesity. Agreement among the different methods was determined using Kappa coefficient. Results: The prevalence of overall obesity was 18 (3%), 17 (2.8%) and 6 (1%) using the CDC BMI percentile, WHO Z score, and the IOTF criteria respectively while the prevalence of abdominal obesity was 2.3%, 9.6% and 29.1% using the WC, WHtR and WHR respectively. For the classification of overall obesity, the agreement between the criteria of CDC and WHO BMI Z score was the highest (K=0.76) and the lowest was between IOTF and WHO (K=0.244). For abdominal obesity, the agreement between WC and WHtR K=0.365) while agreement between WC and WHR gave the lowest K=0.088. Conclusion: The highest level of agreement for overall obesity determination obtained was between CDC BMI percentile and WHO BMI Z score while only a moderate agreement was observed between WC and WHtR.

Cardiometabolic Risk Factors among Healthcare Workers: A Cross-Sectional Study at the Sefwi-Wiawso Municipal Hospital, Ghana.

Background There is a dearth of information about the burden of cardiometabolic risk factors among the Ghanaian health workforce in the Western Region. This study sought to determine the prevalence of cardiometabolic risk factors among healthcare workers at the Sefwi-Wiawso Municipal Hospital in the Western Region of Ghana. Materials and Methods A hospital-based cross-sectional study involving 112 employees of the Sefwi-Wiawso Municipal Hospital was conducted. The cardiometabolic risk variables assessed were obesity, hypertension, dyslipidaemia, and diabetes. Sociodemographic parameters were also captured. The prevalence of hypertension and obesity was determined using the JNC VII panel and WHO BMI criteria for obesity classifications. Blood lipids and glucose concentrations were evaluated using standard methods. Results The prevalence of hypertension and prehypertension was 16.07% and 52.68%, respectively. About 38.39% of participants were overweight, and 12.50% were obese. Atherogenic dyslipidaemia was 26.79%, whereas prediabetes glycaemic levels and diabetes incidence were 5.41% and 4.50%, respectively. Fifty percent (50.00%) of participants presented at least one cardiometabolic risk factor. Aging and adiposity were associated with increasing cardiometabolic risk. Conclusion Cardiometabolic risk factors are prevalent among healthcare providers in Sefwi-Wiawso. The cardiometabolic dysregulation observed among this cohort of healthcare professionals may be modulated by age and adiposity.

Appropriate bmi criteria for Indian population: does it help stratify obstructive sleep apnea (OSA) patients better?

Obstructive sleep apnea (OSA) is a common yet unrecognized medical problem with significant morbidity. It is commonly considered an obesity-related problem, although not uncommon in non-obese patients of Indian origin. Currently, the World Health Organization (WHO) Western BMI criteria are widely used to classify obesity levels. Indian population has a different association between body mass index (BMI), percentage of body fat, and health risks compared to the western population. Due to these ethnic variations, applying the appropriate criteria—the WHO recommendation for appropriate BMI for Asian population—would be more suitable for identifying obesity in Indians, and, hence, to identify those at risk for OSA. We aimed to explore the discrepancy that could arise by applying the WHO Western BMI criteria to the Indian population which might misclassify and exclude those who are at risk for obesity-related OSA. This is a retrospective study of patients who presented to Nithra Institute of sleep sciences, Chennai, India, from May 2015 to May 2017. Patients who underwent polysomnography and diagnosed with OSA were included. Data pertaining to demographics, BMI, and severity of OSA were collected and analyzed. Patients were classified into different weight bands based on both the Western and Asian BMI criteria and compared. Stratification based on severity of OSA and its association with both the BMI classification was also analyzed. During the study period, 904 patients were clinically suspected to have OSA, of whom 787 patients underwent polysomnography. Of these, 754 patients were confirmed to have OSA and were included in the study. [626 males (83%)/128 females (16.9%); mean age—50.7 ± 28.6 years]. 735 (97.5%) patients were classified as overweight/obese as per Asian BMI, whereas only 695 (92.2%) patients were classified as overweight/obese as per Western BMI classification. With respect to the association of the BMI categories with the severity of OSA, there were significant differences between the numbers of severe OSA patients in each weight band of Asian BMI when compared to Western BMI. OSA may be underestimated clinically in Indian population when Western BMI criteria is applied. Asian BMI as recommended by WHO is more suitable in reflecting the correlation between obesity and OSA than the western BMI criteria.

Association between adiposity outcomes and residential density: a full-data, cross-sectional analysis of 419 562 UK Biobank adult participants

Obesity is a major health issue and an important public health target for urban design. However, the evidence for identifying the optimum residential density in relation to obesity has been far from compelling. We examined the association of obesity with residential density in a large and diverse population sample drawn from the UK Biobank to identify healthy-weight-sustaining density environments. For this full-data, cross-sectional analysis, we used UK Biobank data for adult men and women aged 37-73 years from 22 cities across the UK. Baseline examinations were done between 2006 and 2010. Residential unit density was objectively assessed within a 1 km street catchment of a participant's residence. Other activity-influencing built environment factors were measured in terms of density of retail, public transport, and street-level movement density, which were modelled from network analyses of through movement of street links within the defined catchment. We regressed adiposity indicators of body-mass index (BMI; kg/m2), waist circumference (cm), whole body fat (kg), and obesity (WHO criteria of BMI ≥30 kg/m2) on residential density (units per km2), adjusting for activity-influencing built environment factors and individual covariates. We also investigated effect modification by age, sex, employment status, and physical activity. We used a series of linear continuous and logistic regression models and non-linear restricted cubic spline models as appropriate. Of 502 649 adults in the prospective cohort, 419 562 (83·5%) participants across 22 UK Biobank assessment centres met baseline data requirements and were included in the analytic sample. The fitted restricted cubic spline adiposity-residential density dose-response curve identified a turning point at a residential density of 1800 residential units per km2. Below a residential density of 1800 units per km2, an increment of 1000 units per km2 was positively related with adiposity, being associated with higher BMI (β 0·19 kg/m2, 95% CI 0·14 to 0·24), waist circumference (β 0·41 cm, 0·28 to 0·54), and whole body fat (β 0·40 kg, 0·30 to 0·50), and with increased odds of obesity (odds ratio [OR] 1·10, 1·07 to 1·14). Beyond 1800 units per km2, residential density had a protective effect on adiposity and was associated with lower BMI (β -0·22 kg/m2, -0·25 to -0·20), waist circumference (β -0·54 cm, -0·61 to -0·48), and whole body fat (β -0·38 kg, -0·43 to -0·33), and with decreased odds of obesity (OR 0·91, 0·90 to 0·93). Subgroup analyses identified more pronounced protective effects of residential density among individuals who were younger, female, in employment, and accumulating higher levels of physical activity, except in the case of whole body fat, for which the protective effects were stronger in men. Housing-level policy related to the optimisation of healthy density in cities might be a potential upstream-level public health intervention towards the minimisation and offsetting of obesity; however, further research based on accumulated prospective data is necessary for evidencing specific pathways. The findings might mean that governments, such as the UK Government, who are attempting to prevent suburban densification by, for example, prohibiting the subdivision of single lot housing and the conversion of domestic gardens to housing lots, will potentially have the effect of inhibiting the conversion of suburbs into more healthy places to live. University of Hong Kong, UK Biobank, and UK Economic & Social Research Council.

Biomarkers of cardiovascular and metabolic diseases in otherwise healthy overweight subjects in Bangladesh

Biomarkers of cardiovascular and metabolic diseases were assessed in Bangladeshi overweight subjects categorized by Asian BMI criteria. After screening 300 people, 90 apparently healthy subjects were enrolled and grouped into normal weight, overweight and obese. Compared to normal weight, the overweight and obese groups showed significant elevation of serum triglyceride, insulin, homocysteine, insulin resistance/sensitivity, and atherogenic index of plasma. Cardiometabolic biomarkers did not differ between overweight and obese groups. Some biomarkers showed correlation with BMI in overweight but not in obese group. It was concluded that cardiometabolic biomarkers are elevated in Bangladeshi overweight subjects categorized by Asian BMI criteria.

Quality of Life during Third Trimester of Pregnant Women with Normal Pre-Pregnant Weight and Obese Pre-Pregnant Women by Asia-Specific BMI Criteria

Quality of Life during Third Trimester of Pregnant Women with Normal Pre-Pregnant Weight and Obese Pre-Pregnant Women by Asia-Specific BMI Criteria

Single hospital visit elective day-case laparoscopic cholecystectomy without prior outpatient attendance.

Eighty percent of all UK elective laparoscopic cholecystectomies (LC) are performed as day-case procedures, but the pre-operative patient pathway has received little attention. In response to local patient feedback, we aimed to introduce a single hospital visit pathway for day-case LC. A single hospital visit pathway for elective LC was piloted alongside standard services. Following telephone consultation, a pack containing procedure information, knowledge questionnaire and consent form were sent. Patients were not excluded on age, BMI or co-morbidity criteria, but recent ultrasonography and liver function tests were required. Patients were operated without attending any clinic or pre-operative service. There was no restriction on surgical or anaesthetic technique. Early surgeon-led telephone follow-up was made post-operatively and patient satisfaction assessed at 3months. One hundred and sixty-six patients were referred with 92% transferred to day-case waiting lists following telephone consultation. One hundred and six patients underwent LC without previously visiting the hospital with 85% discharged the same day. Nine percent required post-operative primary care review primarily for wound reviews. Median patient-reported time to normal activities was 4weeks (range 1-12). Ninety-nine percent reported being satisfied with the single-stop pathway. Single hospital visit LC is feasible, safe and acceptable for primary care referral patients with symptomatic gallstone disease without evidence of common bile duct or LFT abnormalities.

Interleukin-18 polymorphism as an inflammatory index in metabolic syndrome: A preliminary study.

AIMTo assess circulatory levels of interleukin-18 (IL-18) and determine whether the presence of IL-18 promoter polymorphism influences metabolic syndrome phenotypes.METHODSThis study recruited one hundred and eighty individuals divided into three groups with sixty subjects each as: Normal weight (18.0-22.9 kg/m2), overweight (23.0-25.9 kg/m2) and obese (> 26.0 kg/m2) according to South Asian criteria of BMI. Fasting blood glucose (FBG), Lipid profile, insulin, IL-18 and tumor necrosis factor (TNF)α were measured using ELISA kits, whereas low density lipoprotein (LDL)-cholesterol, insulin resistance (HOMA-IR) and insulin sensitivity (QUICKI) were calculated. The body fat percentage (BF) was measured through bioelectrical impedance analysis; waist and hip circumference were measured. Genotyping of IL-18 -607 C/A polymorphism was performed by using tetra-primer amplification refractory mutation system. Student t test, One-way analysis of variance, Hardy-Weinberg equilibrium, Pearson’s χ2 test and Pearson’s correlation were used, where a P value < 0.05 was considered significant.RESULTSIn an aged matched study, obese subjects showed higher levels of FBG, cholesterol, triglycerides and LDL levels as compared to normal weight (P < 0.001). Highest levels of IL-18 and TNF levels were also seen in obese subjects (IL-18: 58.87 ± 8.59 ng/L) (TNF: 4581.93 ± 2132.05 pg/mL). The percentage of IL-18 -607 A/A polymorphism was higher in overweight and obese subjects vs normal weight subjects (P < 0.001). Moreover, subjects with AA genotype had a higher BF, insulin resistance, TNFα and IL-18 levels when compared with subjects with AC (heterozygous) or CC (wild type) genotypes. However, we did not find any difference in the lipid profile between three subgroups.CONCLUSIONThis preliminary data suggests that IL-18 polymorphism affects IL-18 levels that might cause low grade inflammation, further exacerbated by increased TNFα. All these increase the susceptibility to develop MetS. Further studies are required to validate our findings.

Missed Opportunities for Primary Prevention of Cardiovascular Disease in an HIV Clinic

Background Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of death among people living with HIV (PLWH). PLWH have a high prevalence of ASCVD risk factors, including hypertension (HTN), dyslipidemia, diabetes mellitus (DM), elevated BMI, smoking, physical inactivity, and poor diet.Methods Setting—Urban Ryan White funded clinic in Columbia, SC providing care to about 2200 PLWH. A retrospective chart review was performed on a sample of patients ≥40 years old. Patients were eligible if they did not have a known diagnosis of ASCVD, had ≥ 3 visits in the last 3 years, and at least 1 visit in the past 12 months. Data regarding demographics, comorbidities, lab values, medications, and recent blood pressures were abstracted. Data were collected on assessment and intervention for smoking, weight loss, diet, and exercise. Objectives of this study were to: (1) determine the prevalence of ASCVD risk factors among patients without known ASCVD; (2) estimate the proportion of patients who received appropriate pharmacologic and lifestyle interventions. ResultsCharts were reviewed in random order until 100 charts had the required variables to calculate the 10-year ASCVD risk (Figure 1). These complete charts were similar in demographic characteristics to the clinic population. Of the complete charts, 66% met BMI criteria for being obese or overweight; but < 30% of these patients had documentation of the diagnosis, or received appropriate intervention for diet, exercise, or weight loss. HTN was diagnosed in 42% of patients, and 52% of these were adequately controlled. An additional 9% met criteria for HTN but did not carry the diagnosis. Documented diagnosis of DM was surprisingly low at <5%. Nurses assessed smoking in 100% of patients, and the majority of smokers received an intervention. Based on current guidelines, less than 25% of eligible patients were prescribed a statin (Figure 2). To our concern, none of the patients with LDL ≥190 mg/dL or DM had evidence of statin therapy.Conclusion Although > 85% of clinic patients have an undetectable HIV viral load, there were multiple missed opportunities for primary prevention of cardiovascular disease, including interventions for smoking cessation, diet and exercise, and guideline based anti-HTN and statin therapy.Figure 1:Disclosures A. Jones, Proctor & Gamble: Stock, Dividend. CVS Health Corp: Stock, Dividend. Johnson & Johnson: Stock, Dividend. Baxter Inc.: Stock, Dividend. Becton-Dickinson: Stock, Dividend. United Health Group: Stock, Dividend

The Association between Anti-Nuclear Antibodies and Obesity is Likely Mediated by Abdominal Adiposity and Systemic Inflammation

Background: Obesity and abdominal adiposity have been associated with inflammation as have the presence of anti-nuclear antibodies (ANAs). It was recently reported that there is a decreased likelihood of ANAs in the obese general population. To examine this relationship we used data from adult participants in the National Health and Nutrition and Examination Survey 1999-2004. Methods: Participants were excluded if they reported a history of arthritis other than osteoarthritis, thyroid or liver disease, or steroid use so as to rule out a history of possible prior autoimmune disease. We strictly defined a positive ANA as a titer ≥ 1:160. Overweight and obesity were classified using traditional BMI criteria. High and low C-reactive protein (CRP) were defined using the 75th percentile cutpoint as ≥0.42 and <0.42 mg/dL, respectively. Dual-energy X-ray absorptiometry (DEXA) was used to determine body composition. Logistic regression models were created to examine associations with ANA status. Results: 2552 participants were included in our analyses. Obese participants were older (p<0.001), more likely to be men (p=0.004) and to have comorbidities, and had higher levels of CRP (<0.001). After multivariable adjustment, obesity was associated with a decreased odds of having ANAs (OR 0.78, 95%CI 0.62-0.99). However when adding log-transformed CRP into our model, this association was no longer significant (OR 0.85, 95%CI 0.62-1.15), and there was evidence of effect modification by CRP (p=0.12). Among participants with low CRP, obesity was again associated with a reduced likelihood of ANA positivity (OR 0.69, 95%CI 0.48-0.99), but a trend was seen in the opposite direction in those with high CRP (OR 1.77, 95%CI 0.81-3.88). When looking at the 1143 obese and overweight participants with low CRP, ANA positivity was associated with a higher prevalence of cardiovascular disease (p=0.02) and higher % total body fat (p=0.007), trunk fat (p=0.02), and non-trunk fat (p=0.004). This association, however, was not found in the high CRP group. Conclusion: In the general population the association of obesity with ANA is modified by the presence of systemic inflammation as measured by CRP, where the inverse association previously found is eliminated when controlling for CRP. This inverse relationship remains among obese participants with low CRP, when these obese and overweight participants are ANA positive; it is associated with greater total body and trunk fat. It is possible that body composition is driving autoimmunity in the general population even in the absence of systemic inflammation.

Quality of Life during Third Trimester of Pregnant Women with Normal Pre-pregnant Weight and Obese Pre-pregnant Women by Asia-specific BMI Criteria

Objective : To compare quality of life between pre-pregnant normal weight and obese women during third trimester of pregnancy in Phramongkutklao Hospital. Method : This is a cross-sectional study. Pregnant women during third trimester who seek for antenatal care (ANC) at Phramongkutklao Hospital from August 2014 to March 2015 were enrolled to this research by convenience selection. The participants were classified into 2 groups, normal pre-pregnant weight (105 persons) and obese pregnant women (105 persons). All participants was reviewed demographic data, obstetrical and gynecologic history from and ANC record form and a self-administered SF-12 questionnaire was done. Higher score means better quality of life and each group were compared in both physiological and mental component, including 8 dimensions. Results : Median pre-pregnant BMI of normal pregnant women is 20.4 kg/m 2 while obese pregnant women is 26 kg/m 2 Weight gaining between normal weight and obese pregnant women group were 13.8 and 10.7 kg, respectively. Only underlying hypertension and diabetes mellitus showed significant difference (p=0.008). Meanwhile, familial hypertension and diabetic mellitus history were found significant higher in obese pregnant than normal weight group. In physiological and mental components of both groups were not different significantly (p=0.181) but bodily pain dimension was higher in the obese women than the normal weight group significantly (p=0.044) Conclusion : In conclusion, the quality of life during third trimester of the obese pregnant women were not different from the normal weight pregnant women in both physical and mental component. But the obese pregnant women had statistically significant less quality of life only in bodily pain dimension than the normal weight women.

Metabolically Healthy Obesity and Development of Chronic Kidney Disease.

Letters15 November 2016Metabolically Healthy Obesity and Development of Chronic Kidney DiseaseYoosoo Chang, MD, PhD, Seungho Ryu, MD, PhD, Juhee Cho, PhD, Roberto Pastor-Barriuso, PhD, and Eliseo Guallar, MD, DrPHYoosoo Chang, MD, PhDFrom Kangbuk Samsung Hospital and Sungkyunkwan University, Seoul, South Korea; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; and Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.Search for more papers by this author, Seungho Ryu, MD, PhDFrom Kangbuk Samsung Hospital and Sungkyunkwan University, Seoul, South Korea; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; and Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.Search for more papers by this author, Juhee Cho, PhDFrom Kangbuk Samsung Hospital and Sungkyunkwan University, Seoul, South Korea; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; and Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.Search for more papers by this author, Roberto Pastor-Barriuso, PhDFrom Kangbuk Samsung Hospital and Sungkyunkwan University, Seoul, South Korea; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; and Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.Search for more papers by this author, and Eliseo Guallar, MD, DrPHFrom Kangbuk Samsung Hospital and Sungkyunkwan University, Seoul, South Korea; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; and Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L16-0405 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We thank Drs. Stanford and Butsch, Drs. Kahn and Pavkov, and Dr. Little and colleagues for their interest in our study and for raising important points about the interpretation of our results. Several of the arguments address the use of Asian-specific cutoffs for BMI and the obesity paradox. For a given BMI, Asians have a higher percentage of total body fat (1) and a higher risk for cardiometabolic disease (2) than white persons. As a consequence, Asian Pacific–specific BMI criteria have gained widespread acceptance. As for more detailed analyses by degree of obesity, only 211 (0.3%) participants in ...

Natural Course of Metabolically Healthy Overweight/Obese Subjects and the Impact of Weight Change

Few studies have described the characteristics of metabolically healthy individuals with excess fat in the Chinese population. This study aimed to prospectively investigate the natural course of metabolically healthy overweight/obese (MH-OW/OB) adults, and to assess the impact of weight change on developing metabolic abnormalities. During 2009–2010, 525 subjects without any metabolic abnormalities or other obesity-related diseases were evaluated and reevaluated after 5 years. The subjects were categorized into two groups of overweight/obese and normal weight based on the criteria of BMI by 24.0 at baseline. At follow-up, the MH-OW/OB subjects had a significantly increased risk of developing metabolically abnormalities compared with metabolically healthy normal-weight (MH-NW) individuals (risk ratio: 1.35, 95% confidence interval: 1.17–1.49, p value < 0.001). In the groups of weight gain and weight maintenance, the MH-OW/OB subjects was associated with a larger increase in fasting glucose, triglycerides, systolic blood pressure, diastolic blood pressure and decrease in high-density lipoprotein cholesterol comparing with MH-NW subjects. In the weight loss group, no significant difference of changes of metabolic parameters was observed between MH-OW/OB and MH-NW adults. This study verifies that MH-OW/OB are different from MH-NW subjects. Weight management is needed for all individuals since weight change has a significant effect on metabolic health without considering the impact of weight change according to weight status.

Prospective clinical study of the skin markers in childhood obesity-an emerging pandemic

Introduction: Obesity poses an alarming threat to the children in recent days due to poor lifestyle and improper dietary habits. These children are at higher risk of developing Coronary artery diseases, Hypertension, Diabetes mellitus in their early thirties and emerge as an important public health problem. Childhood obesity manifests with a wide array of dermatological changes. In this study we analyzed the dermatological manifestations in the obese and overweight children in the age range of 5-14 years. Methods: All the children taken into the study were either obese or overweight as per WHO criteria of BMI according to the height and weight. Triceps skin fold thickness and waist circumference of these children were also taken for confirmation of obesity. Skin manifestations in these children were diagnosed by the dermatologists and plotted in graph. Results: Total 76 children were taken into the study out of which Acanthosis nigricans is the most common manifestation in the age group of 10-14 years and infections are most common in the age group of 5-9 years. Conclusion: The skin manifestations are the markers of chronic obesity in childhood having negative impact on the quality of life and imparting low self esteem among the peer group.