BMI Units Research Articles

Maternal weight change from prepregnancy to 18 months postpartum and subsequent risk of hypertension and cardiovascular disease in Danish women: A cohort study.

One-fourth of women experience substantially higher weight years after childbirth. We examined weight change from prepregnancy to 18 months postpartum according to subsequent maternal risk of hypertension and cardiovascular disease (CVD). We conducted a cohort study of 47,966 women with a live-born singleton within the Danish National Birth Cohort (DNBC; 1997-2002). Interviews during pregnancy and 6 and 18 months postpartum provided information on height, gestational weight gain (GWG), postpartum weights, and maternal characteristics. Information on pregnancy complications, incident hypertension, and CVD was obtained from the National Patient Register. Using Cox regression, we estimated adjusted hazard ratios (HRs; 95% confidence interval [CI]) for hypertension and CVD through 16 years of follow-up. During this period, 2,011 women were diagnosed at the hospital with hypertension and 1,321 with CVD. The women were on average 32.3 years old (range 18.0-49.2) at start of follow-up, 73% had a prepregnancy BMI <25, and 27% a prepregnancy BMI ≥25. Compared with a stable weight (±1 BMI unit), weight gains from prepregnancy to 18 months postpartum of >1-2 and >2 BMI units were associated with 25% (10%-42%), P = 0.001 and 31% (14%-52%), P < 0.001 higher risks of hypertension, respectively. These risks were similar whether weight gain presented postpartum weight retention or a new gain from 6 months to 18 months postpartum and whether GWG was below, within, or above the recommendations. For CVD, findings differed according to prepregnancy BMI. In women with normal-/underweight, weight gain >2 BMI units and weight loss >1 BMI unit were associated with 48% (17%-87%), P = 0.001 and 28% (6%-55%), P = 0.01 higher risks of CVD, respectively. Further, weight loss >1 BMI unit combined with a GWG below recommended was associated with a 70% (24%-135%), P = 0.001 higher risk of CVD. No such increased risks were observed among women with overweight/obesity (interaction by prepregnancy BMI, P = 0.01, 0.03, and 0.03, respectively). The limitations of this observational study include potential confounding by prepregnancy metabolic health and self-reported maternal weights, which may lead to some misclassification. Postpartum weight retention/new gain in all mothers and postpartum weight loss in mothers with normal-/underweight may be associated with later adverse cardiovascular health.

Does a weight bearing equinus affect plantar pressure differently in older people with and without diabetes? A case control study

BackgroundA weight bearing ankle equinus has adverse effects on forefoot plantar pressure variables in older adults with diabetes, but it is unclear if this is also the case in older adults without diabetes. Methods40 older adults with diabetes (88% type 2, mean diabetes duration 17.6 ± 14.8 years) and 40 older adults without diabetes, matched for age (±3 years), sex and BMI (±2 BMI units) were included (63% female, mean age 72 ± 4 years, BMI 30 ± 4 kg/m2). Primary outcomes were prevalence of a weight bearing equinus and evaluation of barefoot forefoot plantar pressures in older adults with and without diabetes. FindingsA weight bearing equinus was present in 37.5% and 27.5% of the diabetes and non-diabetes group respectively with no significant difference between groups (p = 0.470). People with diabetes and equinus displayed higher peak pressure (808 versus 540 kPa, p = 0.065) and significantly higher pressure-time integral (86 versus 68 kPa/s, p = 0.030) than people with diabetes and no equinus group. The non-diabetes equinus group had significantly higher peak pressure (665 versus 567 kPa, p = 0.035) than those with no diabetes and no equinus, but no difference in pressure-time integral. InterpretationA high prevalence of a weight bearing equinus was detected in older adults with and without diabetes, with associated increases in plantar pressures. As an equinus has been associated with many foot pathologies this study's findings suggest that clinicians should check for the presence of a weight bearing ankle equinus in all older adults.

Seasonal Variability in Weight Gain Among American Indian, Black, White, and Hispanic Children: A 3.5-Year Study

Several studies have reported that children gain more weight during the summer season. Despite high obesity rates, little research has included American Indian/Alaskan Native children, and few studies have been longitudinal. This observational study examines seasonal weight variability over 3.5 years among ethnically diverse children, including 2,184 American Indian/Alaskan Native children. Children's height and weight were measured before and after the summer from 2012-2015 and analyzed in 2019-2020, including children with ≥2 consecutive measurements (N=7,890, mean age=8.4 [SD=2.8] years). Mixed-effects models tested whether the percentage of the 95th BMI percentile and BMI differed by season (summer versus the rest of the year) and ethnicity. American Indian/Alaskan Native (23.7%), Hispanic (19.8%), and Black (17.8%) children had significantly higher baseline obesity rates than White children (7.1%). The percentage of the 95th BMI percentile significantly increased during the summer compared with the percentage during the rest of the year, with the strongest effects for children who were obese (b=2.69, 95% CI=1.35, 4.03, p<0.001) or overweight (b=1.47, 95% CI=0.56, 2.35, p<0.01). In BMI units, summer BMI increase was 0.50 kg/m2 higher (obese model) and 0.27 kg/m2 higher (overweight) than that of the rest of the year. Seasonal effects were significantly less pronounced for American Indian/Alaskan Native children than for White children. Children gained significantly more weight during the summer season, with the strongest effects for children who were obese. American Indian/Alaskan Native children had less seasonal variability than White children, but higher overall obesity rates. These data underscore summer as a critical time for obesity prevention among children who are overweight/obese but suggest that seasonal patterns may vary for American Indian/Alaskan Native children.

The Metabolic Equivalent BMI in Patients with Familial Partial Lipodystrophy (FPLD) Compared with Those with Severe Obesity.

This study aimed to investigate the shortcoming of BMI as a measurement of adiposity in patients with familial partial lipodystrophy (FPLD). Two different matching procedures were used to compare 55 FPLD versus control patients with severe obesity (N = 548 patients) to study the relationship between body weight, fat distribution, and metabolic diseases, such as diabetes mellitus, hypertriglyceridemia, and nonalcoholic steatohepatitis. In MATCH1, the patients with FPLD were matched to controls with obesity (OCs) by truncal mass, and in MATCH2, the patients with FPLD were matched to OCs with respect to glucose control. With MATCH1, the FPLD group had worse glycemic control (hemoglobin A1c 8.2% ± 1.6% vs. 5.9% ± 0.9%), higher triglycerides (884 ± 1,190 mg/dL vs. 139 ± 79 mg/dL), and lower leptin (20.5 ± 15.8 ng/mL vs. 41.9 ± 29.4 ng/mL, P < 0.001 for all comparisons). In MATCH2, metabolic comorbidity-matched FPLD patients had significantly lower BMI compared with OCs (29.5 ± 5.7 kg/m2 vs. 38.6 ± 5.2 kg/m2 , P < 0.001). Patients with FPLD with similar truncal mass have worse metabolic profiles than non-FPLD OCs. The differential BMI between the FPLD and OCs, when matched for their metabolic comorbidities, approximates 8.6 BMI units.

Does moderate weight loss affect subjective health perception in obese individuals? Evidence from field experimental data

This paper analyzes whether moderate weight reduction improves subjective health perception in obese individuals. Besides simple regression models, in a simultaneous equation framework we use randomized monetary weight loss incentives as instrument for weight change, to address possible endogeneity bias. In contrast to related earlier work that also employed instrumental variables estimation, identification does not rely on long-term, between-individuals weight variation, but on short-term, within-individual weight variation. Yet, our result does not suggest that the simple regressions suffer from much endogeneity bias, since instrumental variables estimation yields similar—though far noisily estimated and statistically insignificant—estimates. In qualitative terms, our results do not contradict previous findings pointing to weight loss in obese individuals resulting in improved subjective health. Our results suggest that a reduction of body weight by one BMI unit is associated with an increase in the probability of reporting self-rated health to be ‘satisfactory’ or better by 3 to 4 percentage points. This finding may encourage obese individuals in their weight loss attempts, since they are likely to be immediately rewarded for their efforts by subjective health improvements.

Dedicated business model innovation units: do they work? A case study from Germany

PurposeBusiness model innovation (BMI) provides enormous opportunities to multinational corporations (MNCs). Consequently, some MNCs have created dedicated BMI units. Yet, research only provides limited guidance and lacks empirical evidence on the implementation of BMI processes in a corporate environment through dedicated units. Accordingly, the main goal of the research is to shed light on understanding the role (s) of a dedicated BMI unit and how it interacts with the existing businesses to help them identify, evaluate or implement new business models.Design/methodology/approachThis work adopts a case study approach as a research design (Yin, 2015). In particular, the study is set up as a single in-depth case study in a holistic design (Yin, 2013). The data consists of a total of nine extensive interviews with employees of Bosch’s BMI unit, as well as project team members the unit has worked with. Of the nine interviewees, six are working within the BMI unit (internal perspective) and three are members of two project teams, i.e. customers of the BMI unit (external perspective). Archival records serve as an additional source of evidence aimed at enhancing internal validity.FindingsThis research is the first work to determine the explicit roles of an MNC’s dedicated BMI unit throughout the BMI process. Through derivation of roles from the tasks and responsibilities of Bosch’s BMI unit in each process phase, six overarching roles have been identified, namely, process owner, executor, enabler, challenger, networker and connector. Simultaneously, this work has suggested the existence of process-independent roles, namely, knowledge intermediary and trainer.Research limitations/implicationsThe case study approach underlying this work allowed an in-depth investigation of the BMI process and the BMI unit of Bosch but the results are still based on a single case study. In this regard, limitations that occur for qualitative case study approaches are also relevant for this study, i.e. although careful analysis to reveal the stage-gate such as the design of BMI processes or the roles of a dedicated BMI unit was performed, a certain degree of subjectivity remains.Practical implicationsThe results underline that a dedicated BMI unit within an MNC constitutes a way to allow for managing the cross-functional and complex tasks of BMI by giving projects the necessary flexibility to develop while remaining aligned and benefitting from the organizational setting. This paper further observes that a dedicated BMI unit expresses an opportunity to define responsibilities for corporate BMI processes that are described in the literature (Geissdoerfer et al., 2017; Tesch, 2019; Wirtz and Daiser, 2018). Thus, the results may be used by practitioners working in MNCs to understand some of the issues related to the implementation of BMI processes in a corporate context, i.e. how to organize and structure BMI (Geissdoerfer et al., 2017; Winterhalter et al., 2017) or where to locate and how to interlink BMI with existing corporate functions (Chesbrough and Rosenbloom, 2002; Cortimiglia et al., 2016).Originality/valueThe outcomes of this work are twofold. First, building on existing literature, a process model for BMI through dedicated BMI units is proposed. Second, based on findings from the in-depth case study, eight overarching roles a BMI unit can hold have been identified. Thereby, this work constitutes a starting point for intensified research on the value and the implications of dedicated BMI units in the context of BMI and BMI processes.

Clinical outcomes and inflammatory marker levels in patients with Covid-19 and obesity at an inner-city safety net hospital.

Patients with Covid-19 and obesity have worse clinical outcomes which may be driven by increased inflammation. This study aimed to characterize the association between clinical outcomes in patients with obesity and inflammatory markers. We analyzed data for patients aged ≥18 years admitted with a positive SARS-CoV-2 PCR test. We used multivariate logistic regression to determine the association between BMI and intensive care unit (ICU) transfer and all-cause mortality. Inflammatory markers (C-reactive protein [CRP], lactate dehydrogenase [LDH], ferritin, and D-dimer) were compared between patients with and without obesity (body mass index [BMI] ≥30 kg/m2). Of 791 patients with Covid-19, 361 (45.6%) had obesity. In multivariate analyses, BMI ≥35 was associated with a higher odds of ICU transfer (adjusted odds ratio [aOR] 2.388 (95% confidence interval [CI]: 1.074-5.310) and hospital mortality (aOR = 4.3, 95% CI: 1.69-10.82). Compared to those with BMI<30, patients with obesity had lower ferritin (444 vs 637 ng/mL; p<0.001) and lower D-dimer (293 vs 350 mcg/mL; p = 0.009), non-significant differences in CRP (72.8 vs 84.1 mg/L, p = 0.099), and higher LDH (375 vs 340, p = 0.009) on the first hospital day. Patients with obesity were more likely to have poor outcomes even without increased inflammation.

Accessibility to Parks and Trails and Physical Health Measures in CATSLife: Evaluating Selection

Associations of obesity and cardiovascular health with neighborhood walkability have been observed in the literature; however, limited research has evaluated self-selection that may underlie associations. We measured accessibility to parks and trails using geospatial measurements as well as self-reported activity-friendliness of neighborhoods (ease of walking, biking, and recreating) in 1140 participants (ages 28-49 years) in the ongoing Colorado Adoption/Twin Study of Lifespan behavioral development and cognitive aging (CATSLife). Physical health indicators included BMI, resting heart rate, and mean arterial blood pressure. The relative similarity of siblings’ accessibility was evaluated to consider self-selection; all models were adjusted for sociodemographics including education. BMI was associated with accessibility to parks, with each increasing log(mile) distance associated with 1.2 BMI unit increase (se=.49, p<0.02). Self-reported neighborhood activity-friendliness was comparable in prediction of BMI (p<0.01). Greater trail accessibility was associated with lower resting heart rate (b=-.30, se=.14, p<0.04) and mean arterial pressure (b=-0.33, se=0.14, p<0.03), whereas self-reported neighborhood activity-friendliness was not associated (p>0.40). Measures of park accessibility tended to be more similar among identical twins (median ICC = 0.30) than fraternal twins or siblings (median ICC = 0.15) or siblings in adoptive families (median ICC = 0.12), excluding siblings who live together. Measures of trail accessibility were consistent across sibling types (median ICCs = 0.25-0.27). Sibling similarity for park accessibility modestly increased with genetic relatedness suggesting potential heritable contributions, whereas comparable similarity was apparent for trail accessibility. Altogether, small associations were observed for park and trail access with physical health, with indications of environmental selection.

Tourniquets and Adductor Canal Blocks in Total Knee Arthroplasty: Is There a Synergistic Effect on Postoperative Pain and Quadriceps Weakness?

Background and Hypothesis: Adequate pain control and avoidance of falls are crucial for successful early recovery following total knee arthroplasty (TKA). Studies have shown an increase in postoperative quadriceps weakness (QW) and pain associated with tourniquet use during TKA. Additionally, increasing doses of adductor canal block (ACB) anesthetic per unit of BMI are associated with QW after TKA. This retrospective cohort study examined whether tourniquets and ACBs have a synergistic effect on postoperative QW and pain. &#x0D; &#x0D; Experimental Design or Project Methods: 348 TKAs in 319 patients performed by a single surgeon between October 2015 and May 2018 were retrospectively reviewed. Outcomes included QW as documented in the physical therapy evaluation, average pain score during the first 24 hours after PACU discharge, average pain score during the remainder of the hospital stay, and final pain score prior to discharge. &#x0D; &#x0D; Results: Sex, age, and BMI did not differ in patients with ACBs with (n=177) and without (n=168) tourniquet use (p≥0.330). The overall prevalence of QW in the sample was 8.7%. Proportionally more patients with ACBs and tourniquets (11.6%) had QW compared to patients with ACBs without tourniquets (6.1%), but the difference was not statistically significant with the numbers available. Patient-reported pain scores at the three time points did not differ significantly between patients who received ACBs with or without tourniquets. &#x0D; &#x0D; Conclusion and Potential Impact: There appears to be no synergistic effect of ACBs and tourniquet use on postoperative pain. However, due to the effect size and number of cases in each group, the synergistic effect of ACBs and tourniquet use on QW deserves additional study with a larger sample size as these results may impact functional recovery and postoperative complications among patients undergoing primary TKA.

Characteristics of and Risk Factors for Monoclonal Gammopathy of Undetermined Significance (MGUS) in the Multiethnic Cohort Study

Background: There is a 2-3-fold excess of both monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM) among African Americans (AAs) compared to non-Hispanic whites (NHWs) for unknown reasons. It is unclear if risk of progression from MGUS to MM is similar across racial/ethnic groups. We identified MGUS patients and controls from the Multiethnic Cohort (MEC), a population-based cohort study in Los Angeles and Hawaii, described characteristics of and examined risk factors for MGUS among different racial/ethnic groups. Methods: A total of 637 MEC participants with a diagnosis of MGUS by CMS billing codes and 1,065 race/ethnicity-matched MM-free and presumed MGUS-free controls were identified. Screening for monoclonal proteinemia was performed at the USC Clinical Laboratories using serum protein electrophoresis (SPEP) with reflex to immunofixation (IFX) when SPEP was abnormal. For this study, MGUS was defined as IFX positive with M-protein concentration&amp;lt; 3g/dL. Controls were SPEP- and IFX-negative with no history of MGUS or MM. MGUS cases who progressed to MM during a mean 8.11-year follow-up were identified by linkage with the SEER databases of the Hawaii Tumor Registry and the California Cancer Registry. Multivariable logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for the effect of body mass index kg/m2 (BMI), diabetes or aspirin use prior to diagnosis on the risk of MGUS and progression to MM. Results: A total of 452 participants had laboratory validated MGUS. The racial/ethnic distribution was 109 AAs, 107 NHWs, 95 Latinos, 105 Japanese and 36 Hawaiian's. 58.6% were males. From the pool of laboratory-validated controls, an equal number of controls were frequency matched to cases by race/ethnicity, age and sex. Mean age at blood draw was 65 years for Hawaiians, 69 years for NHWs and Latinos, and 70 years for AAs and Japanese. The distribution of immunoglobulin (Ig) isotypes differed significantly by race/ethnicity(p=0.001) (Figure 1), with AAs having the highest proportion of IgG Kappa (48.1%) and the lowest proportion of IgM (2.8%) compared to other racial/ethnic groups (range IgG Kappa 31.8%-40%, range IgM 11.1%-28.0%). There was no difference in isotype distribution by sex (p=0.28). AAs and NHWs had the highest (mean=0.75 mg/dL ±0.6) and lowest (mean=0.53 mg/dL ±0.6) levels of M-protein, respectively, but there was no significant difference when all racial/ethnic groups were compared. Each unit of BMI (kg/m2) was associated with a 16% increase in risk of MGUS among Hawaiians (95% CI= 1.04,1.30); and a borderline increased risk ranging from 2%-7% among the other racial/ethnic groups. Neither history of aspirin use nor diabetes mellitus were significantly associated with MGUS risk. A total of 109/452 MGUS patients progressed to MM between 1 to 10 years after blood draw. Compared to NHWs, AAs (OR=2.09; 95%CI= 1.08-4.05) and Latinos (OR= 2.55, 95% CI=1.29-5.08) were more likely to progress. Progression was not significantly associated with sex (p=0.34) or BMI (p=0.12). Progressors were slightly younger than non-progressors (-1.6 years, p=0.057). A higher risk of progression was associated with IgA compared to IgG Kappa (OR=2.45; 95% CI=1.34-4.48) and an M-spike &amp;gt;1.5 g/dL compared to &amp;lt;1.5g/dL (OR=5.81, 95% CI=2.92-11.57). IgM was associated with a lower risk of progression (OR=0.03, 95% CI= 0.00-0.23). Conclusion: The distribution of MGUS isotypes and risk of progression to MM differed by race/ethnicity, with AA and Latinos more likely to progress, not explained by age at blood draw. Because we detected prevalent MGUS, lead time bias could explain racial/ethnic differences in risk. More studies with diverse populations and large sample sizes are needed to better understand the disparities in MGUS risk and progression, along with the underlying biological explanations. Disclosures No relevant conflicts of interest to declare.

Maternal and infant prediction of the child BMI trajectories; studies across two generations of Northern Finland birth cohorts.

Children BMI is a longitudinal phenotype, developing through interplays between genetic and environmental factors. Whilst childhood obesity is escalating, we require a better understanding of its early origins and variation across generations to prevent it. We designed a cross-cohort study including 12,040 Finnish children from the Northern Finland Birth Cohorts 1966 and 1986 (NFBC1966 and NFBC1986) born before or at the start of the obesity epidemic. We used group-based trajectory modelling to identify BMI trajectories from 2 to 20 years. We subsequently tested their associations with early determinants (mother and child) and the possible difference between generations, adjusted for relevant biological and socioeconomic confounders. We identified four BMI trajectories, 'stable-low' (34.8%), 'normal' (44.0%), 'stable-high' (17.5%) and 'early-increase' (3.7%). The 'early-increase' trajectory represented the highest risk for obesity. We analysed a dose-response association of maternal pre-pregnancy BMI and smoking with BMI trajectories. The directions of effect were consistent across generations and the effect sizes tended to increase from earlier generation to later. Respectively for NFBC1966 and NFBC1986, the adjusted risk ratios of being in the early-increase group were 1.08 (1.06-1.10) and 1.12 (1.09-1.15) per unit of pre-pregnancy BMI and 1.44 (1.05-1.96) and 1.48 (1.17-1.87) in offspring of smoking mothers compared to non-smokers. We observed similar relations with infant factors including birthweight for gestational age and peak weight velocity. In contrast, the age at adiposity peak in infancy was associated with the BMI trajectories in NFBC1966 but did not replicate in NFBC1986. Exposures to adverse maternal predictors were associated with a higher risk obesity trajectory and were consistent across generations. However, we found a discordant association for the timing of adiposity peak over a 20-year period. This suggests the role of residual environmental factors, such as nutrition, and warrants additional research to understand the underlying gene-environment interplay.

Gluteus medius muscle activity during gait in people with and without chronic nonspecific low back pain: A case control study

BackgroundResearch investigating differences in gluteus medius muscle activity in those with and without chronic nonspecific low back pain is both limited and conflicting. Additionally, in these populations the relationship between gluteus medius muscle activity, foot type, and transversus abdominis muscle thickness is unclear. Research questionWe aimed to investigate gluteus medius muscle activity during gait in those with and without chronic nonspecific low back pain. Secondarily, we aimed to explore the association between gluteus medius muscle activity, foot type, and transversus abdominis muscle thickness within groups. MethodsThis case control study recruited 30 people with and 30 people without chronic nonspecific low back pain and matched participants by age (±5 years), sex, and body mass index (±2 BMI units). Gluteus medius muscle activity was measured with surface electromyography during walking gait, with foot type and transversus abdominis muscle thickness measured with the Foot Posture Index and ultrasound respectively. The Mann-Whitney U test was used to investigate differences in gluteus medius muscle activity between groups. Spearman rank order correlation was performed to explore the association between gluteus medius muscle activity, foot type, and transversus abdominis thickness within each group. A linear regression was used to analyse significant correlations (P < 0.05). ResultsWe found no significant differences in gluteus medius muscle activity between groups. However, there was a moderate correlation between the Foot Posture Index score and gluteus medius peak amplitude (P = 0.04) for those with mild to moderate chronic nonspecific low back pain. SignificanceClinicians should be aware that patients with mild to moderate chronic nonspecific low back pain may not demonstrate significant differences in gluteus medius muscle activity compared to those without back pain. Additionally, higher peak gluteus medius muscle activity is likely to occur in people with mild to moderate chronic nonspecific low back pain and planus feet.

Determinants associated with uncontrolled asthma in Portugal: A national population-based study

Introduction and objectivesAsthma is a chronic and heterogeneous disease that affects people of all ages and has a high estimated increase in prevalence worldwide. Asthma control represents a main goal in the disease management. International studies revealed low levels of disease control resulting in a significant burden for healthcare systems, not only in terms of quality of life, but also in terms of health costs. Modifiable and non-modifiable factors have been identified as relating to poor asthma control level. In this study we evaluated the distribution of asthma control levels in Portuguese adult population and examine the determinants associated with uncontrolled asthma. Materials and methodsUsing a similar methodology to the one employed in the Asthma Insights and Reality in Europe (AIRE) survey, 327 active asthmatic patients were identified by random phone number and completed a questionnaire during 2011 to 2012. Asthma control was assessed by the evaluation of GINA based symptom control, by Asthma Control Test.äó (ACT) and by self-perception of control. To examine the relationship between uncontrolled asthma and its determinants, univariate logistic regression analysis, sequential multivariable regression and population attributable risk percentage were determinate. Results35.2% active asthmatic patients had uncontrolled asthma, 64.8% partially controlled and none of the individuals had total control of asthma assessed by ACT test. Factors significantly associated with poor asthma control scores were: age (OR 1.02 per year of age; 95% CI: 1.01.Çô1.03), female sex (OR 1.87; 95% CI: 1.15.Çô3.04), educational level (OR 0.5; 95% CI: 0.28.Çô0.89 at high school level or over), occupation (OR 4.92; 95% CI: 2.12.Çô11.42 if looking for a first job or unemployed) (OR 2.51; 95% CI: 1.35.Çô4.65 if being retired), income (OR 0.23; 95% CI: 0.07.Çô0.72 if >619 euros), BMI (OR 1.09 per BMI unit; 95% CI: 1.03.Çô1.14), having rhinitis symptoms (OR 4.40; 95% CI: 2.56.Çô7.58) and using inhaled corticosteroids (OR 0.44; 95%CI: 0.24.Çô0.82 if used in the past or never used).Looking for a first job or being unemployed, BMI and having rhinitis symptoms remained significant after multivariate adjustments. ConclusionsUncontrolled asthma was associated with several determinants. Their identification can contribute to improve asthma care both from clinical and from public health perspectives.

Onset of Workplace Bullying and Risk of Weight Gain: A Multicohort Longitudinal Study.

This study aimed to examine the onset of workplace bullying as a risk factor for BMI increase. Repeated biennial survey data from three Nordic cohort studies were used, totaling 46,148 participants (67,337 participant observations) aged between 18 and 65 who did not have obesity and who were not bullied at the baseline. Multinomial logistic regression was applied for the analysis under the framework of generalized estimating equations. Five percent reported onset of workplace bullying within 2 years from the baseline. In confounder-adjusted models, onset of workplace bullying was associated with a higher risk of weight gain of ≥ 1 BMI unit (odds ratio = 1.09; 95% CI: 1.01-1.19) and of ≥ 2.5 BMI units (odds ratio = 1.24; 95% CI: 1.06-1.45). A dose-response pattern was observed, and those exposed to workplace bullying more frequently showed a higher risk (Ptrend = 0.04). The association was robust to adjustments, restrictions, stratifications, and use of relative/absolute scales for BMI change. Participants with exposure to the onset of workplace bullying were more likely to gain weight, a possible pathway linking workplace bullying to increased long-term risk of type 2 diabetes.

Interpregnancy weight change and recurrence of gestational diabetes mellitus: a population-based cohort study.

To estimate recurrence risk of gestational diabetes mellitus (GDM) by interpregnancy weight change. Population-based cohort study. Data from the Swedish (1992-2010) and the Norwegian (2006-2014) Medical Birth Registries on 2763 women with GDM in first pregnancy, registered with their first two singleton births and available information on height and weight. Interpregnancy weight change (BMI in second pregnancy minus BMI in first pregnancy) was categorised in six groups by BMI units. Relative risks (RRs) of GDM recurrence were obtained by general linear models for the binary family and adjusted for confounders. Analyses were stratified by BMI in first pregnancy (<25 and ≥25kg/m2 ). GDM in second pregnancy. Among overweight/obese women (BMI≥25), recurrence risk of GDM decreased in women who reduced their BMI by 1-2 units (relative risk [RR] 0.80, 95% CI 0.65-0.99) and >2 units (RR 0.72, 95% CI 0.59-0.89) and increased if BMI increased by ≥4 units (RR 1.26, 95% CI 1.05-1.51) compared wth women with stable BMI (-1 to 1 units). In normal weight women (BMI<25), risk of GDM recurrence increased if BMI increased by 2-4 units (RR 1.32, 95% CI 1.08-1.60) and ≥4 units (RR 1.61, 95% CI 1.28-2.02) compared with women with stable BMI. Interpregnancy weight loss reduced risk of GDM recurrence in overweight/obese women. Weight gain between pregnancies increased recurrence risk for GDM in both normal and overweight/obese women. Our findings highlight the importance of weight management in the interconception window in women with a history of GDM. Interpregnancy weight loss reduces recurrence of gestational diabetes mellitus in overweight/obese women.

Effect of Utilizing a Drain on Shoulder Pain in Laparoscopic Cholecystectomy. A Randomized Clinical Trial

Post-laparoscopic shoulder pain is still one of the most important complications of laparoscopic cholecystectomy. Placing a drain after laparoscopic cholecystectomy is controversial among surgeons. It is believed that shoulder pain after laparoscopic cholecystectomy is associated with insufflation of high-pressure CO2 and accumulation of residual gas in subhepatic area. Here, a randomized clinical trial was designed to evaluate the role of a routine drain on shoulder pain after laparoscopic cholecystectomy. One hundred and twenty candidates for laparoscopic cholecystectomy were enrolled in this randomized clinical trial. Among all, 50 patients were randomized to have drain in subhepatic space (group A) and 50 patients did not have it. An investigation was performed by visual scale according to having shoulder pain, abdominal pain, nausea, and vomiting during 6, 12, 24, and 48 h after operation in both groups. Abdominal pressure and anesthetic recovery medications were the same for both groups. Overall, the tip shoulder pain in (group A) was lower than patients in (group B). The mean range of shoulder pain scores after 6, 12, 24, and 48 h in group A is significantly lower than that in group B (p < 0.001). The scores for post-operation abdominal pain in groups A and B had no significant difference (p = 0.13). Moreover, no significant difference was found between shoulder pain in two groups but increasing one unit of BMI decreased vomiting to 34%. By the way, the correlation between BMI and vomiting was statistically significant. It seems that draining after laparoscopic cholecystectomy leads to less postoperative shoulder pain.

EVALUATION OF PHYSICAL EXERCISE'S EFFECTS ON LOW BACK PAIN AMONG UNIVERSITY STUDENTS WITH SHORT FORM-36 AND OSWESTRY DISABILITY INDEX

Aims: This study aims to investigate the main effects of physical exercise on lower back pain with the Short Form-36 Health Survey and Oswestry Disability Index scores. Methods: University students between 18-25 years old who suffer from low back pain were enrolled in the study. Short Form-36 Health Survey and Oswestry Disability Index were used as the reference scales of lower back pain and quality of life, respectively. There are some questions in the questionnaire to scale the average comfort of the place they sleep and sit during the day, which is the result of the Personal Comfort Score. The Mann-Whitney U test was used for non-normal distributed variables. Correlation and Linear Regression were used to analyze data. SPSS 25.0 was used for all statistical analysis. Results: A total of 139 university students (94 females, 45 males) were included in the study. The median age was 20 years (IQR=2) for female students and 20 years (IQR=1) for male students. Oswestry Disability Index scores of fe- male students were higher, while Short Form-36 scores were lower than the male students. Male students' physical functioning scores were higher than female students. Each one-unit increase in Personal Comfort Score is associated with an increase in the rate between the energy/fatigue (3.34 units). Body Mass Index considerably affected the pain and Oswestry Disability Score, an increase in one unit of baseline BMI upsurged the Short Form-36 pain score to 0.13, and Oswestry disability score to 0.55. Conc- lusion: In our study, Body Mass Index is found to be associated with Oswestry Disability Index and Short Form-36 score, which are used for the severity of low back pain and defining the life quality and of patients. PCS had a positive correlation between energy/fatigue. In addition, There was a positive correlation between physical exercise and general health score.

1386-P: Long-Term Weight Change after Pregnancy and Type 2 Diabetes Risk in Women with a History of Gestational Diabetes

Women with a history of gestational diabetes (GDM) are at high risk for developing type 2 diabetes, which may be further increased with weight gain after pregnancy. Our objective was to determine associations of long-term weight changes after a GDM pregnancy and type 2 diabetes risk. We used data on a cohort of 139 women with a GDM pregnancy identified though the Kaiser Permanente Northern California (KPNC) GDM registry (1986-2009) who completed a follow-up study visit an average of 16 years later (2011-2013). Type 2 diabetes was identified through the KPNC diabetes registry, self-report during follow-up visit recruitment, or at least one abnormal value on a 75-gram, 2-hour oral glucose tolerance test (2015 ADA criteria) conducted at the follow-up visit. Clinically measured weights extracted from the electronic health record were used to calculate average BMI change per year between delivery and either type 2 diabetes identification date or follow-up visit date. We used modified Poisson regression to estimate relative risks of type 2 diabetes associated with BMI change categories. Twenty-six percent of women lost weight [mean -0.3 BMI units/year, equivalent to -0.8 kg/year for a woman of the average height in our cohort (1.6 m)], 24% maintained their weight (&amp;lt;0.17 BMI units/year, mean 0.10 BMI units/year [0.3 kg/year]), and 50% gained weight (≥0.17 BMI units/year, mean 0.5 BMI units/year [1.3 kg/year]). Overall, 50% of women developed type 2 diabetes. Each additional BMI unit gained was associated with 28% greater risk of type 2 diabetes (95% CI: 0.98, 1.67) adjusting for age at delivery, race/ethnicity, pre-pregnancy BMI, and years since delivery. Women who lost weight had 39% lower risk of developing type 2 diabetes (95% CI: 0.33, 1.12) compared to women who maintained their weight, though estimates were imprecise. Our findings suggest that long-term weight gain after a GDM pregnancy may increase risk of type 2 diabetes, supporting postpartum weight loss intervention efforts. Disclosure S.E. Badon: None. F. Xu: None. C. Quesenberry: None. A. Ferrara: None. M.M. Hedderson: None. Funding National Institutes of Health (R01HD065904)

Evaluation of weight retention four weeks after delivery as a risk factor for gestational diabetes mellitus in a subsequent pregnancy.

We aimed to assess the association between postpartum weight retention (PPWR) in the fourth week after delivery and the risk of gestational diabetes mellitus (GDM) in a subsequent pregnancy. We performed a retrospective cohort study of the obstetric records of women who gave birth to their second singleton between 32 and 41 weeks of gestation at the National Hospital Organization Kofu National Hospital between January 2013 and September 2019. The exclusion criteria were missing data, twin pregnancy, diabetes in pregnancy, and delivery before 22 weeks in the first pregnancy. We calculated PPWR as the BMI 4 weeks after the first birth minus the BMI before the first pregnancy and grouped the subjects into the stable PPWR (gain of <1 BMI unit) and non-stable PPWR groups (gain of ≥1 BMI units). We used the χ2 test and multivariable logistic regression analysis to investigate the association between weight retention at the postpartum checkup and GDM. We included 566 women in this study (mean age, 31.7±4.8 years; mean maternal pre-pregnancy BMI, 21.3±3.5 kg/m2; term delivery, n = 544 [96.1%]). The overall prevalence of GDM during the second pregnancy was 7.4% (42/566), and 33.9% (192/566) of women had stable PPWR. Non-stable PPWR was not significantly associated with GDM in the second pregnancy (adjusted odds ratio, 1.93; 95% confidence interval, 0.84-4.46) after controlling for each variable. PPWR measured in the fourth week after delivery was not associated with an increased risk of GDM in the second pregnancy.

First trimester HtrA1 maternal plasma level and spontaneous preterm birth

Objectives High temperature requirement A1 (HtrA1) is a serine protease detected in maternal plasma and in placental tissues during normal gestation and in various pathological conditions. The purpose of this study was to determine whether the maternal plasma concentration of HtrA1 in first trimester, alone or combined with other maternal factors, can be used to identify women at risk for spontaneous preterm birth (SPTB). Study design This is a cohort study on pregnant women at 12 weeks of gestation recruited between 2014 and 2016 and prospectively followed until delivery. One hundred and fifty-nine women were included in the study: 140 women delivered at term and 19 (11.9%) delivered spontaneously preterm. Plasma samples were assessed for HtrA1 by ELISA and data were compared between women which delivered at term with women which delivered preterm. A multiple logistic regression analysis was used to estimate the independent effect of women’s characteristics on the probability of a SPTB. Results SPTB was significantly associated with log HtrA1 values at 12 weeks of gestation, BMI before pregnancy and physical activity. In particular, the probability of a SPTB increases of 79% for every added unit of log HtrA1, while decreases of 18% for every added unit of BMI. In addition, physical activity was found as an important protective factor. The ROC curve showed that the model had a good accuracy in predicting SPTB, with an AUC equal to 0.83 (95%CI: 0.73–0.91). Conclusions Maternal plasma HtrA1 may be considered a marker of SPTB. In addition, our model indicates two factors that could be modified to reduce the risk of SPTB, i.e. BMI before pregnancy and maternal physical activity.