BMI Cutoff Research Articles

The accuracy of STOP-Bang questionnaire in the screening of patients with obstructive sleep apnea

Objective: To evaluate the accuracy of STOP-Bang (SBQ) questionnaire in the screening of patients with obstructive sleep apnea (OSA). Methods: The data were collected from September, 2011 to May, 2012 at the Sleep Medicine Center of West China Hospital, Sichuan University. A total of 350 consecutive patients (302 males and 48 females, 19-68 years old, average (42.9±11.0) years old) with suspected OSA who underwent an overnight polysomnography (PSG) were recruited into this study. SBQ questionnaire was completed. Based on the severity of OSA which were determined by apnea-hypopnea index (AHI), the patients were classified into four groups of primary snoring (<5 events/h), mild (5-14 events/h), moderate (15-29 events/h) and severe OSA (≥30 events/h). To evaluate the accuracy of SBQ, sensitivity, specificity, positive predictive values, negative predictive values and the area under the receiver operating characteristics curve of SBQ questionnaire were calculated. Results: Of the subjects, 322 (92.0%) were classified as high risk based on the questionnaire. With mild+moderate+severe OSA (AHI≥5 events/h), moderate+severe OSA (AHI≥15 events/h), and severe OSA as cutoffs, the sensitivity of SBQ questionnaire were 94.0%, 94.1%, and 95.3%; the specificity were 25.7%, 15.2%, and 13.2%; the positive predictive values were 91.9%, 79.2%, and 63.4%; the negative predictive values were 32.1%, 42.9%, and 64.3%, respectively. When variable BMI and age cutoffs (BMI≥24 kg/m(2) and age>42 years old), the questionnaire had the highest sensitivity (98.4%, 98.2%, and 99.5%, respectively) and the lowest specificity (8.6%, 3.8%, and 5.2%, respectively). Conclusions: When BMI and/or age cutoff values gradually decline, the sensitivity of SBQ questionnaire are increased, but the specificity and positive predictive values are declined. Lowering BMI and/or age cutoffs possibly does not improve questionnaire accuracy.

Body composition derived Body Mass Index and Waist Circumference cut-offs for Sri Lankan adults

BackgroundObesity associated non-communicable diseases (NCDs) have emerged as major public health problems in Sri Lanka. However, the absence of derived Body Mass Index and Waist Circumference cut-offs for Sri Lankan adults hinder the early identification of NCDs. The aim of this study therefore was to derive BMI and WC cut-offs for Sri Lankan adults according to body composition data derived from the deuterium dilution technique. MethodsDemographic and anthropometric measurements were collected from a representative sample of 300 Sri Lankan adults and the deuterium dilution technique was used to estimate fat-free mass (FFM) and fat mass (FM) and subsequently converted to percent body fat. ROC curve analysis was carried out to determine the appropriate cut-offs of BMI and WC at adiposity levels of 25% for men and 35% for women. ResultsA total of 258 participants completed the study; with a mean age of 43.8 (±12.9) years for men and 45.6 (±12.8) years for women, respectively. The majority of participants were Sinhalese from urban residential areas. Mean BMI values were 23.0 kg m−2 (±4.2) for men and 24.8 kg m−2 (±4.5) for women. According to our findings, BMI of 23 kg m−2 corresponds to a body fat percentage of 25% and 35% for Sri Lankan men and women, respectively and body fat percentages of 30% for men and 40% for women equated to a BMI of 25 kg m−2. Corresponding WC cut-offs for %BF of 25% and 35% were 85 cm for men and 76 cm for women respectively. ConclusionsThe traditional BMI and WC cut-offs for obesity have grossly underestimated the adiposity status of Sri Lankan adults. Findings from the current study suggest that lower BMI cut-offs be used for the identification of overweight and obesity among Sri Lankan adults.

High adherence to a mediterranean diet at age 4 reduces overweight, obesity and abdominal obesity incidence in children at the age of 8.

A higher adherence to a Mediterranean diet has been shown to be protective against obesity in adults, but the evidence is still inconclusive in children at early ages. Our objective was to explore the association between adherence to Mediterranean Diet at the age of 4 and the prevalence of overweight, obesity, and abdominal obesity at 4 years of age, and incidence at the age of 8. We analyzed data from children of the INMA cohort study who attended follow-up visits at age 4 and 8 years (n = 1801 and n = 1527, respectively). Diet was assessed at the age of 4 using a validated food frequency questionnaire. The adherence to MD was evaluated by the relative Mediterranean diet (rMED) score, and categorized as low (0-6), medium (7-10), and high (11-16). Overweight and obesity were defined according to the age-sex specific BMI cutoffs proposed by the International Obesity Task Force, and abdominal obesity as waist circumference >90th percentile. We used Poisson regression models to estimate prevalence ratios at 4 years of age, and Cox regression analysis to estimate hazard ratios (HR) from 4-8 years of age. In cross-sectional analyses at the age of 4 no association was observed between adherence to MD and overweight, obesity, or abdominal obesity. In longitudinal analyses, a high adherence to MD at age 4 was associated with lower incidence of overweight (HR = 0.38; 95% CI: 0.21-0.67; p = 0.001), obesity (HR = 0.16; 95% CI: 0.05-0.53; p = 0.002), and abdominal obesity (HR = 0.30; 95% CI: 0.12-0.73; p = 0.008) at the age of 8. This study shows that a high adherence to MD at the age of 4 is associated with a lower risk of developing overweight, obesity, and abdominal obesity at age 8. If these results are confirmed by other studies, MD may be recommended to reduce the incidence of obesity at early ages.

Impact of metabolically healthy obesity on the risk of incident gastric cancer: a population-based cohort study

BackgroundThe risk of colon or breast cancer in metabolically healthy obese (MHO) were lower than that in metabolically abnormal obese (MAO). We hypothesized that the risk of incident gastric cancer in MHO is lower than that in MAO.MethodsThis historical cohort study included 19,685 Japanese individuals who received health-checkup programs from 2003 to 2016. Each subject was classified as metabolically healthy (MH) (no metabolic abnormalities) or metabolically abnormal (MA) (one or more metabolic abnormalities), according to four metabolic factors (hypertension, impaired fasting glucose, hypertriglyceridemia and low HDL-cholesterol). Obese (O) or non-obese (NO) was classified by a BMI cutoff of 25.0 kg/m2. Hazard ratios of metabolic phenotypes for incident gastric cancer were calculated by the Cox proportional hazard model with adjustments for age, sex, alcohol consumption, smoking and exercise.ResultsOver the median follow-up period of 5.5 (2.9–9.4) years, incident rate of gastric cancer was 0.65 per 1000 persons-years. Incident rate of MHNO, MHO, MANO and MAO were 0.33, 0.25, 0.80 and 1.21 per 1000 persons-years, respectively. Compared with MHNO, the adjusted hazard ratios for development of gastric cancer were 0.69 (95% CI 0.04–3.39, p = 0.723) in MHO, 1.16 (95% CI 0.63–2.12, p = 0.636) in MANO and 2.09 (95% CI 1.10–3.97, p = 0.024) in MAO.ConclusionsThis study shows that individuals with MAO, but not those with MHO, had an elevated risk for incident gastric cancer. Thus, we should focus more on the presence of metabolic abnormalities rather than obesity itself for incident gastric cancer.

Association of BMI, Fitness, and Mortality in Patients With Diabetes: Evaluating the Obesity Paradox in the Henry Ford Exercise Testing Project (FIT Project) Cohort

To determine the effect of fitness on the association between BMI and mortality among patients with diabetes. We identified 8,528 patients with diabetes (self-report, medication use, or electronic medical record diagnosis) from the Henry Ford Exercise Testing Project (FIT Project). Patients with a BMI <18.5 kg/m2 or cancer were excluded. Fitness was measured as the METs achieved during a physician-referred treadmill stress test and categorized as low (<6), moderate (6-9.9), or high (≥10). Adjusted hazard ratios for mortality were calculated using standard BMI (kilograms per meter squared) cutoffs of normal (18.5-24.9), overweight (25-29.9), and obese (≥30). Adjusted splines centered at 22.5 kg/m2 were used to examine BMI as a continuous variable. Patients had a mean age of 58 ± 11 years (49% women) with 1,319 deaths over a mean follow-up of 10.0 ± 4.1 years. Overall, obese patients had a 30% lower mortality hazard (P < 0.001) compared with normal-weight patients. In adjusted spline modeling, higher BMI as a continuous variable was predominantly associated with a lower mortality risk in the lowest fitness group and among patients with moderate fitness and BMI ≥30 kg/m2. Compared with the lowest fitness group, patients with higher fitness had an ∼50% (6-9.9 METs) and 70% (≥10 METs) lower mortality hazard regardless of BMI (P < 0.001). Among patients with diabetes, the obesity paradox was less pronounced for patients with the highest fitness level, and these patients also had the lowest risk of mortality.

Body composition-derived BMI cut-offs for overweight and obesity in ethnic Indian and Creole urban children of Mauritius.

It is increasingly recognised that the use of BMI cut-off points for diagnosing obesity (OB) and proxy measures for body fatness in a given population needs to take into account the potential impact of ethnicity on the BMI-fat % relationship in order to avoid adiposity status misclassification. This relationship was studied here in 377 Mauritian schoolchildren (200 boys and 177 girls, aged 7-13 years) belonging to the two main ethnic groups: Indian (South Asian descent) and Creole (African/Malagasy descent), with body composition assessed using an isotopic 2H dilution technique as reference. The results indicate that for the same BMI, Indians have more body fat (and less lean mass) than Creoles among both boys and girls: linear regression analysis revealed significantly higher body fat % by 4-5 units (P < 0·001) in Indians than in Creoles across a wide range of BMI (11·6-34·2 kg/m2) and body fat % (5-52 %). By applying Deurenberg's Caucasian-based equation to predict body fat % from WHO-defined BMI thresholds for overweight (OW) and OB, and by recalculating the equivalent BMI values using a Mauritian-specific equation, it is shown that the WHO BMI cut-offs for OB and OW would need to be lowered by 4·6-5·9 units in Indian and 2·0-3·7 units in Creole children in the 7-13-year-old age group. These results have major implications for ethnic-based population research towards improving the early diagnosis of excess adiposity in this multi-ethnic population known to be at high risk for later development of type 2 diabetes and CVD.

Association of pre-pregnancy BMI with biochemical profile during pregnancy, delivery mode and size of neonates in the CRIBS birth cohort

AbstractIn the last few decades the prevalence of overweight and obesity has reached epidemic levels worldwide affecting over 2.1 billion people, including a large proportion of women of childbearing age. An adverse intrauterine environment resulting from conditions such as maternal obesity or gestational diabetes, can have long-term negative effect on the child's health later in life. This study focuses on maternal pre-pregnancy BMIs and their association with biochemical profile in pregnancy, delivery mode and size of neonates in the Croatian Islands’ Birth cohort Study (CRIBS). A total of 301 mother-child dyads were included in this study. The classification of the pre-pregnancy nutritional status followed WHO BMI cut-offs. Blood samples of women were taken in the second trimester of pregnancy and analysed for fasting blood glucose level, urates, creatinine, uric acid, total protein, bilirubin, triglycerides, total cholesterol, HDL and LDL cholesterol, potassium, sodium, aspartate transaminase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), homocysteine, fibrinogen and lipoprotein A. The neonates’ length in cm and weight in gm were measured immediately after delivery at the University Hospital Split. Differences in mean values of biochemical parameters and neonates’ size between pre-pregnancy BMI categories were tested using One-way ANOVA (p &lt; 0.05) and differences in prevalence of delivery mode using the Chi-square test. Nutritional status before pregnancy showed that 4% of women were underweight (BMI &lt; 18.5 kg.m2), 75.1 % had normal weight (BMI 18.5–24.9 kg.m2), 14.6% were overweight (BMI 25–29.9 kg.m2) and 6.3% were obese (BMI ≥ 30.0 kg.m2). Pre-pregnancy obesity and overweight were significantly associated with elevated fasting glucose (p = 0.02), triglycerides (p = 0.01), and uric acid (p = 0.001) levels, and with decreased protective HDL cholesterol (p = 0.01) during pregnancy. Also, in comparison with normal weight and underweight women, obese pregnant women more often gave birth to heavier (p = 0.01) and longer babies (p = 0.036) and there was a strong correlation between higher pre-pregnancy BMI and delivery mode (p = 0.004). Obese women had 50% chance of giving birth by caesarean section in comparison with 20.1% in normal weight women. Our study confirmed that high maternal pre-pregnancy BMI could be a significant risk factor for both mother's health during pregnancy and different adverse birth outcomes, such as elevated risk of caesarean section delivery and child macrosomia. Therefore, women should be advised to attain normal weight before starting the pregnancy.

737: Optimal BMI for use of external fetal ECG for fetal heart rate assessment in labor

We have previously shown that in obese women, an external fetal electrocardiogram (fECG) monitoring device generates more interpretable fetal heart rate (FHR) data compared to standard external Doppler monitoring (SEM). We sought to identify the BMI cutoff where a fECG monitoring system would be preferable to SEM to optimize the amount of interpretable FHR data provided in a clinical setting. Secondary analysis of a randomized controlled trial at 4 Utah hospitals. 218 patients with singleton, term pregnancies, were enrolled at labor admission and randomized in blocks based on BMI to fECG or SEM. The proportion of interpretable 10-minute FHR tracing segments was determined following tracing evaluation by two reviewers blinded to study device allocation. A 10-minute FHR segment was deemed interpretable if tracing baseline and periodic changes could be discerned. The proportion of total interpretable minutes of FHR tracing was also evaluated. Mixed effects logistic regression models were fit to predict 10-minute and 1-minute FHR segment interpretability. Akaike information criteria (AIC) were determined to identify the optimal BMI cutoff, indicating when fECG device use consistently provides more interpretable FHR data compared to SEM. Regression model AIC plot identified BMI ≥ 31 as the ideal cut off point for fECG device performance, where fECG generated consistently more interpretable 10-minute FHR tracing segments compared to SEM (Figure 1). For the 1-minute FHR tracing analysis, an even lower BMI cut off point of 25 was identified based on AIC estimates, where fECG generated a higher proportion of interpretable minutes of FHR tracing compared to SEM at BMI 25 (Figure 2). fECG consistently generated more interpretable 10 and 1-minute FHR tracing segments compared to SEM in women with BMI > 31 and > 25, respectively. Obese women with BMI > 31 may benefit from use of the fECG device in labor.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Associations between dietary patterns, eating behaviours, and body composition and adiposity in 3‐year‐old children of mothers with obesity

The relationships between eating habits, behaviours, and the development of obesity in preschool children is not well established. As children of mothers with obesity are themselves at risk of obesity, we examined these relationships in a cohort of 482 three-year-old children of mothers with obesity from the UK Pregnancy Better Eating and Activity Trial (UPBEAT). Dietary patterns were derived using factor analysis of an 85-item food frequency questionnaire (FFQ). Eating behaviours were assessed using the Children's Eating Behaviour Questionnaire (CEBQ). Measures of body composition included age-specific BMI cut-offs, WHO z scores, sum of skinfolds, waist and arm circumferences, and body fat percentage. Using adjusted regression analysis, we examined associations between dietary patterns, eating behaviours, and measures of body composition. Three distinct dietary patterns were defined: "healthy/prudent," "African/Caribbean," and "processed/snacking." The "processed/snacking" pattern was associated with greater odds of obesity; OR 1.53 (95% CI, 1.07-2.19). The "African/Caribbean" and the "healthy/prudent" patterns were associated with a lower arm circumference (β = -0.23 cm [-0.45 to -0.01]) and sum of skinfolds (β = -1.36 cm [-2.88 to -0.37]), respectively. Lower enjoyment of food and food responsiveness, and greater slowness in eating and satiety, were associated with lower arm and waist circumferences, WHO z scores, and obesity (all P < .05). In children of mothers with obesity, those who had higher scores on a "processed/snacking" dietary pattern had greater odds of obesity. In contrast, slowness in eating was associated with lower measures of body composition. These novel findings highlight modifiable behaviours in high-risk preschool children which could contribute to public health strategies for prevention of childhood obesity.

Risk factors for refracture after plate removal for midshaft clavicle fracture after bone union

BackgroundOpen reduction and internal fixation (ORIF) with plates and screws is one of the treatment options for clavicle fractures. However, an additional operation for implant removal after union of the fracture is commonly performed due to a high incidence of hardware irritation. Despite union of the fracture, a subsequent refracture might occur after removal of the implant which requires additional surgeries for fixation. This study aims to determine the risk factors associated with refracture of the clavicle after hardware removal.MethodsWe retrospectively reviewed the medical records of 278 patients that were diagnosed with a midshaft clavicle fracture (male 190; female 88) that had (1) undergone ORIF of the clavicle with plates and (2) received a second operation for removal of hardware after solid union of the fracture between 2010 and 2017. Their mean age was 40.1 ± 15.1 years, and mean interval from fixation to plate removal was 12.5 ± 7.5 months. The patients were then divided into two groups based on the presence of refracture (n = 20) or without refracture (n = 258). We analyzed patient demographics, interval between fixation and implant removal, fracture classification (AO/OTA, Robinson), fixation device, whether wires or interfragmentary screws were used, clavicular length, and bone diameter at the fracture site.ResultsThe overall refracture rate was 7.2%, and the mean interval between plate removal and refracture was 23.9 days. A multivariate analysis showed that female (adjusted odds ratio [aOR] 4.74; 95% CI 1.6–14.1) and body mass index [BMI] (for every 1-unit decrease, aOR 1.25; 95% CI 1.06–1.48) were risk factors for refracture. In women, BMI was the only risk factor. The optimal BMI cutoff value was 22.73. In a female patient with a lower BMI, the refracture rate was 29.8%.ConclusionsThere are no significant radiographic parameters associated with refracture. Routine plate removal in a female patient with a low BMI after bony union of a midshaft clavicle fracture is not recommended because of a high refracture rate.

Treatment outcome of oral appliance in patients with REM-related obstructive sleep apnea

PurposeOral appliances (OA) are used to treat patients with obstructive sleep apnea (OSA). The purpose of this study is to evaluate the efficacy of OA treatment in patients with rapid eye movement (REM)–related OSA.MethodsForty-six patients with REM-related OSA and 107 with non-stage-specific OSA were prescribed OA treatment after diagnosis by polysomnography (PSG) and a follow-up sleep test by PSG was conducted. Efficacy and treatment outcome predictors were evaluated according to the following criteria for treatment success: #1, reduction of the apnea-hypopnea index (AHI) to less than 5 and > 50% compared with baseline; #2, AHI reduction to less than 10 and > 50% compared with baseline; and #3, > 50% AHI reduction compared with baseline.ResultsSuccess rates according to criteria #1, #2, and #3 were 45.7%, 50.0%, and 50.0% in REM-related OSA and 36.4%, 52.3%, and 63.6% in non-stage-specific OSA, respectively. No significant differences in success rate were found between the two groups. In multivariate logistic regression analysis with each criterion as the response variable, only BMI was extracted as a significant predictor. The BMI cutoff values defined based on the maximum Youden index according to the three criteria were 26.2 kg/m2, 25.6 kg/m2, and 26.2 kg/m2, respectively.ConclusionsNo significant differences in success rate of OA treatment were found between REM-related OSA and non-stage-specific OSA. BMI has greater impact on treatment outcome of OA in patients with REM-related OSA.

High Prevalence of Overweight/Obesity in Urban Sri Lanka: Findings from the Colombo Urban Study.

Background South Asian countries face a double burden of malnutrition characterized by high prevalence of underweight, overweight, and obesity. Understanding the distribution of this public health problem is important to tailor targeted interventions for communities. The objective of the current study was to find out the prevalence of obesity in urban Sri Lanka and to identify sociodemographic factors associated with it. Methods Adult males and females residing in an urban government division of the Colombo District in Sri Lanka were included in this study (Colombo Urban Study). Stratified simple random sampling was used to select a sample of 463 from the total population. Sociodemographic data using an interviewer-administered questionnaire, anthropometric measurements, and serum samples were obtained for investigations. Results When the global BMI cutoffs were applied, the community prevalences of underweight, normal weight, overweight, and obesity were 7.7%, 39.6%, 37.0%, and 15.8%, respectively. When the Asian BMI cutoffs were applied, the respective prevalences were 7.7%, 26.8%, 34.3%, and 31.2%. The community prevalence for abdominal obesity was 58.1% when using Asian cutoffs. Females had a higher prevalence of both obesity and abdominal obesity. There was an ethnic difference in obesity rates with Moors having the highest rates (65.5%) followed by Sinhalese (52.3%) and Tamils (40.2%). The highest obesity prevalence was observed in the most educated group. Multiple regression analysis showed that high BMI was associated with female gender and family history of hypertension. Serum LDL negatively associated with BMI while the strength of this relationship was impacted by serum HBA1c levels. Finally, serum triglyceride level showed positive association with BMI, and the effect was more marked in Moors compared to Sinhalese. Conclusion Two-thirds of adults in the studied urban population were overweight or obese. This highlights the urgent need for interventions to curb this epidemic. The gender, ethnic differences in obesity, its associations with educational status, and the interactions with metabolic comorbidities indicate that these interventions may need to be targeted towards different groups in the population.

Trends in physical activity and overweight among adolescents and their parents in Russian population

Abstract Background Unhealthy lifestyle, including physical inactivity and overweight, typically begins in adolescence. Familial aggregation of the factors aggravates the predictive risk. During the 1990s Russian population has been exposed to major political, economic and social changes. Methods Seven cross-sectional surveys of representative samples of school children aged 14-18 in 1989-2019 were carried out in Novosibirsk. Total sample was 4677 (45% males). To define overweight in adolescents the sex- and age-specific BMI cut-offs of the IOTF were used. Information about parents physical activity (&amp;lt;150 min/week), height and weight was obtained by mail questionnaire. Parents overweight registered if BMI≥25. Results Levels of low physical activity in adolescents were stably high during all the period in boys (49-55%) and girls (83-73%) with a rising trend in recent years. In 2009 average amounts of weekly screen time were 18 hours in boys and 15 hours in girls, In 2019 - 35 and 33 hours respectively. Their parents had low levels of physical activity: 2,5 hrs/w in men and 1,5 hrs/w in women without any trends. The prevalence of overweight among adolescents during the 30-year period showed U-curve characteristic with significant decreasing (4,0%) at the end of 90s and rising since 2003 particularly in boys (17.6% in 2019, P &amp;lt; 0,01). Overweight prevalence among parents was high: from 25% in 1989 to 38% in 2019 (P &amp;lt; 0,05) and from 32% in 1989 to 28% in 2019 among fathers and mothers respectively. Familial associations between parents and children were found for overweight but not for levels of physical activity. Conclusions Levels of physical activity in Siberian adolescents and their parents were low during 30-year period. Trends in the prevalence of overweight in this groups were differed. Familial aggregation of overweight indicates necessity of preventive actions at a family level. Supported by grant No. 19-013-00800 of RFBR. Key messages Levels of physical activity in Siberian adolescents and their parents were low during 30-year period. Trends in the prevalence of overweight in adolescents and their parents were differed: the shaped curve in children and linear - in parents. However familial associations of overweight were found.

Clinical Faceoff: Should Orthopaedic Surgeons Have Strict BMI Cutoffs for Performing Primary TKA and THA?

Clinical Faceoff: Should Orthopaedic Surgeons Have Strict BMI Cutoffs for Performing Primary TKA and THA?

Performance of newly developed body mass index cut-off for diagnosing obesity among Ethiopian adults

BackgroundObesity is defined as unhealthy excess body fat, which increases the risk of premature mortality from noncommunicable diseases. Early screening and prevention of obesity is critical for averting associated morbidity, disability, and mortality. Ethiopia has been using the international (WHO’s) BMI cut-off for diagnosing obesity even though its validity among Ethiopian population was questioned. To address this problem, a new body mass index cut-off was developed for Ethiopian adults using population-specific data. However, its performance in diagnosing obesity has not been validated. Therefore, this study determined the performance of the newly developed Ethiopian and World Health Organization (WHO) BMI cut-offs in detecting obesity among Ethiopian adults.MethodsA cross-sectional study was carried out among 704 employees of Jimma University from February to April 2015. The study participants were selected using simple random sampling technique based on their payroll. Data on sociodemographic variables were collected using an interviewer-administered structured questionnaire. Anthropometric parameters including body weight and height were measured according to WHO recommendation. Body fat percentage (BF%) was measured using the air displacement plethysmography (ADP) after calibration of the machine. The diagnostic accuracy of the WHO BMI cut-off (≥ 30 kg/m2) for obesity in both sexes and Ethiopian BMI cut-off (> 22.2 kg/m2 for males and > 24.5 kg/m2 for females) were compared to obesity diagnosed using ADP measured body fat percentage (> 35% for females and > 25% for males). Sensitivity, specificity, predictive values, and kappa agreements were determined to validate the performance of the BMI cut-offs.ResultsIn males, WHO BMI cut-off has a sensitivity of 5.3% and specificity of 99.4% (Kappa = 0.047) indicating a slight agreement. However, the Ethiopian cut-off showed a sensitivity of 87.5% and specificity of 87.7% (Kappa = 0.752) indicating a substantial agreement.Similarly, in females, the WHO BMI cut-off showed a sensitivity of 46.9%, while its specificity was 100% (Kappa = 0.219) showing a fair agreement. The Ethiopian BMI cut-off demonstrated a sensitivity 80.0% and a specificity 95.6% (Kappa = 0.701) showing a substantial agreement. The WHO BMI cut-off underestimated the prevalence of obesity by a maximum of 73.7% and by a minimum of 28.3% among males, while the values for underestimation ranged from 31.4–54.1% in females. The misclassification was minimal using the newly developed Ethiopian BMI cut-off. The prevalence of obesity was underestimated by a maximum of 9.2% and overestimated by a maximum of 6.2%. The WHO BMI cut-off failed to identify nearly half (46.6%) of Ethiopian adults who met the criteria for obesity using BF% in the overall sample.ConclusionsThe findings suggest that WHO BMI cut-off (≥ 30 kg/m2) is not appropriate for screening obesity among Ethiopian adults. The newly developed Ethiopian BMI cut-off showed a better performance with excellent sensitivity, specificity, predictive values, and agreement indicating the diagnostic significance of it use as a simple, cost-effective, and valid indicator in clinical and community setups.

Untreated adult GH deficiency is not associated with the development of metabolic risk factors: a long-term observational study.

Uncertainties exist about the predictors of the severity of the clinical picture of GH deficiency (GHD) syndrome. Aim of the study was to evaluate, in adult patients with GHD, the predictors of the development of hypercholesterolemia, hypertension, diabetes mellitus, and osteoporosis. We retrospectively studied 327 adult patients (age 47.1 ± 17.1years) with untreated severe GHD (mean follow-up 110.9 ± 56.8months). GHD was defined by GHRH + arginine test using BMI cut-offs. The possible development of hypercholesterolemia, hypertension, diabetes mellitus, and osteoporosis was investigated by Kaplan-Meier survival analysis. For each clinical outcome, either a univariate or multivariate analysis according to the Cox proportional-hazards model was performed to identify those factors that were associated with the development of the event. GH secretion parameters were not associated with the outcomes. Hypercholesterolemia was positively and negatively predicted by a BMI ≥ 30kg/m2 (HR 2.50, p 0.00) and the dose of l-thyroxine possibly in place (HR 0.98, p 0.02), respectively. Hypertension was positively predicted by a BMI ≥ 30kg/m2 (HR 2.64, p 0.00) and IGF-I SDS values (HR 2.26, p 0.00). Diabetes mellitus was positively predicted by hypertension (HR 11.76, p 0.01). Osteoporosis was positively and negatively predicted by hypercholesterolemia (HR 3.25, p 0.01) and hypertension (HR 0.21, p 0.00), respectively. The severity of the impairment of GH secretion does not predict the development of the clinical picture of GHD syndrome: untreated adult GHD does not increase the development of metabolic risk factors in hypopituitaric patients.

A Bridge to the Fridge? Changes in BMI Post Left Ventricular Assist Device Implant

Background Weight gain after left ventricular assist device (LVAD) implant may result in transplant listing loss in obese patients. We studied weight changes post LVAD amid BMI categories based on the hypothesis that changes in BMI impact transplant candidacy. Methods We retrospectively reviewed patients of LVAD implant at an academic medical center between 1/1/2012 and 12/31/2018. We collected demographic and clinical data, then stratified them into 4 groups based on BMI at implantation: 40. BMI data was collected at 12 and 6 months prior to implant, time of implant, and post implant at 3 and 6 months. A BMI cutoff >35 provided contraindication for transplant listing candidacy. Descriptive summary of variables was given with median and range or group frequency and percentages or mean and standard deviation. Scatter plot visualized correlation between weight difference changes over time. Additional lines overlaid on the plots indicate correlation trend. Mixed effects model was performed to estimating associations between weight difference and variables (time, BMI Implant). Bar plots were performed displaying move from 35 BMI after 6 months post LVAD and the move from >35 BMI at the time of implant to Results A total of 108 patients underwent LVAD implant at our center with complete data available for 59 patients. Baseline characteristics included mean age: 56 ±11.9 years, gender (male 70%), mean implant BMI: 30.1 ±6.9 kg/m2. Number of patients in each implant BMI group ( 40) was 30, 16, 9, and 4 respectively. There was no consistent pattern with weight change across differing implant BMIs as illustrated in Figure 1. Among patients with implant BMI's of 40, the percentage that lost transplant candidacy due to high BMI were 0, 31, 55, and 100 percent respectively in Figure 2. Conclusion Patients with a BMI within 5 points of the typical threshold of 35 for transplant candidacy demonstrate significant variability in response to LVAD therapy. However, all patients with implant BMIs >40 failed to regain transplant candidacy due to high BMI. These data support the concept of implementing aggressive weight loss protocols as a standard of post LVAD treatment in obese patients.

1335-P: Weight Status and Cardiometabolic Risk Factors among Adolescents in Japan

Pediatric obesity is associated with clustered cardiometabolic risk and the future incidence of diabetes. However, few studies have determined the effect of pediatric obesity in Asia, where obesity is less common than in Western countries. Thus, we clarified whether metabolic risk factors are associated with weight status including slight overweight and underweight among Japanese adolescents. We performed a cross-sectional analysis of 2241 Japanese adolescents (1180 boys) aged 13-14 years whose height, weight, HbA1c, blood pressure (BP), and serum lipids were measured. Participants were classified as underweight, normal weight, slightly overweight, overweight, or obese according to both the universal and Asian cutoffs of the International Obesity Task Force, which correspond to adult BMI cutoffs. The clustered cardiometabolic risk (Z-CMR) was estimated by summing standardized sex-specific Z scores of HbA1c, mean arterial pressure (MAP), and non-high-density lipoprotein cholesterol (non-HDL-C). Linear regression analysis showed that MAP (sex-specific Z score), non-HDL-C (sex-specific Z score), and Z-CMR were higher in the slightly overweight, overweight, and obese groups than in the normal weight group after adjusting for confounders. Compared with the normal weight group, the slightly overweight, overweight, and obese groups had significantly higher odds ratios (ORs) for high BP [OR = 1.38 (95% CI, 1.03-1.85); OR = 2.63 (1.77-3.91); and OR = 2.39 (1.57-3.64), respectively]. Compared with the normal weight group, underweight boys, but not girls, had a significantly lower OR for high Z-CMR [OR = 0.20 (0.05-0.84)]. Our results indicated that adolescents classified as slightly overweight had higher levels of BP, serum lipids (but not HbA1c), and clustered cardiometabolic risk than those classified as normal weight. This observation demonstrated that significant associations between weight status and cardiometabolic risk factors could be seen during adolescence even in East Asia. Disclosure S.Y. Morikawa: None. K. Fujihara: None. D. Ishii: None. R. Nedachi: None. M. Ishizawa: None. H. Ishiguro: None. Y. Matsubayashi: None. T. Yamada: None. S. Kodama: None. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited.

Diagnostic thresholds for pregnancy hyperglycemia, maternal weight status and the risk of childhood obesity in a diverse Northern California cohort using health care delivery system data.

ObjectiveTo estimate the risk of childhood obesity associated with the various criteria proposed for diagnosis of gestational diabetes (GDM), and the joint effects with maternal BMI.MethodsCohort study of 46,396 women delivering at the Kaiser Permanente Northern California health care delivery system in 1995–2004 and their offspring, followed through 5–7 years of age. Pregnancy hyperglycemia was categorized according to the screening and oral glucose tolerance test values proposed for the diagnosis of GDM by the International Association of the Diabetes and Pregnancy Study Group (IADPSG), Carpenter Coustan (CC), and the National Diabetes Data Group (NDDG). Childhood obesity was defined by the International Obesity Task Force’s age and sex-specific BMI cut-offs. Poisson regression models estimated the risks of childhood obesity associated with each category of pregnancy glycemia compared to normal screening, and the joint effects of maternal BMI category and GDM by the CC and the IADPSG criteria.ResultsCompared with normal screening, increased risks of childhood obesity were observed for abnormal screening [RR (95% CI): 1.30 (1.22, 1.38)], 1+ abnormal values by the IADPSG or CC [1.47 (1.36, 1.59) and 1.48 (1.37, 1.59), respectively], and 2+ values by CC or NDDG [1.52 (1.39, 1.67) and 1.60 (1.43, 1.78), respectively]. Compared to obese women without GDM, obese women with GDM defined by the CC criteria had significantly increased risk of childhood obesity [1.20 (1.07, 1.34)], which was also observed for GDM by the IADSPG [1.18 (1.07, 1.30)], though GDM did not significantly increase the risk of childhood obesity among normal weight or overweight women.ConclusionsThe risk of childhood obesity starts to increase at levels of pregnancy glycemia below those used to diagnose GDM and the effect of GDM on childhood obesity risk appears more pronounced in women with obesity. Interventions to reduce obesity and pregnancy hyperglycemia are warranted.

How Big is Too Big? An Analysis of Morbidly Obese Heart Donors in the UNOS Database

Purpose As the population becomes increasingly obese, so does the pool of potential organ donors. However, many centers are hesitant to accept hearts from morbidly obese donors, limiting the donor pool. We hypothesized that utilization of hearts from obese donors would not impact recipient outcomes. . Methods Single-organ first-time adult heart transplants from 2003 to 2017 were evaluated from the UNOS database and stratified by donor BMI ≥ 40 (morbid obesity). Univariate analysis compared characteristics and short-term outcomes between groups. Kaplan-Meier analysis evaluated long-term survival. Cox regression assessed the risk-adjusted impact of donor obesity on mortality. Sensitivity analyses evaluated donor BMI cutoffs of 30, 35, and 45. Results A total of 26,532 transplants were evaluated, of which 939 (3.5%) had donors with BMI ≥ 40. Transplants from morbidly obese donors increased over time (2.2% in 2003, 5.3% in 2017). Obese donors were more likely to have diabetes (10.4% vs. 3.1%) and hypertension (33.3% vs. 14.8%, p 130% of recipient). Short-term outcomes were similar, including primary graft dysfunction (1.7% vs. 2.7%, p=0.06), pacemaker need (3.8% vs. 3.3%, p=0.34), dialysis requirement (9.4% vs. 10.0%, p=0.34) and one year survival (10.6% vs. 10.7%, p=0.93). Unadjusted survival was equivalent for those with morbidly obese donors (Log-rank p=0.67), and obesity did not impact survival in risk adjusted analysis (Table). Sensitivity analyses for donor BMI ≥ 30, 35, or 45 and analysis of BMI as a continuous variable demonstrated similar results. Conclusion We demonstrate donor obesity did not impact post-transplant outcomes. Evaluation of hearts from morbidly obese donors has the potential to expand the critically low donor pool.