Body Mass Index Categories Research Articles

Body Weight and Composition Changes in Geriatric Rehabilitation Are Dependent on Sarcopenia and Malnutrition: RESORT

ObjectivesBody weight and muscle mass loss following an acute hospitalization in older patients may be influenced by malnutrition and sarcopenia among other factors. This study aimed to assess the changes in body weight and composition from admission to discharge and the geriatric variables associated with the changes in geriatric rehabilitation inpatients. DesignRESORT is an observational, longitudinal cohort. Setting and ParticipantsGeriatric rehabilitation inpatients admitted to geriatric rehabilitation wards at the Royal Melbourne Hospital, Melbourne, Australia (N = 1006). MethodsChanges in body weight and body composition [fat mass (FM), appendicular lean mass (ALM)] from admission to discharge were analyzed using linear mixed models. Body mass index (BMI) categories, (risk of) malnutrition (Global Leadership Initiative on Malnutrition), sarcopenia (European Working Group on Sarcopenia in Older People), dependence in activities of daily living (ADL), multimorbidity, and cognitive impairment were tested as geriatric variables by which the changes in body weight and composition may differ. ResultsA total of 1006 patients [median age: 83.2 (77.7–88.8) years, 58.5% female] were included. Body weight, FM (kg), and FM% decreased (0.30 kg, 0.43 kg, and 0.46%, respectively) and ALM (kg) and ALM% increased (0.17 kg and 0.33%, respectively) during geriatric rehabilitation. Body weight increased in patients with underweight; decreased in patients with normal/overweight, obesity, ADL dependence and in those without malnutrition and sarcopenia. ALM% and FM% decreased in patients with normal/overweight. ALM increased in patients without multimorbidity and in those with malnutrition and sarcopenia; ALM% increased in patients without multimorbidity and with sarcopenia. Conclusions and ImplicationsIn geriatric rehabilitation, body weight increased in patients with underweight but decreased in patients with normal/overweight and obesity. ALM increased in patients with malnutrition and sarcopenia but not in patients without. This suggests the need for improved standard of care independent of patients’ nutritional risk.

The impact of prepregnancy body mass index on pregnancy and neonatal outcomes.

The obesity epidemic in the United States is continuing to worsen. Obesity is a known risk factor for pregnancy morbidity. However, many studies use the patient's body mass index (BMI) at the time of delivery, do not stratify by class of obesity, or utilize billing codes as the basis of their study, which are noted to be inaccurate. This study aims to investigate the prepregnancy BMI class specific risks for pregnancy and neonatal complications based on a prepregnancy BMI class. We conducted a retrospective cohort study of40,256 pregnant women with 55,202 singleton births between October 16, 2007 and December 3, 2023. We assessed the risk of pregnancy and neonatal morbidity based on the maternal prepregnancy BMI category. The primary outcome was composite maternal morbidity, including hypertensive disorders of pregnancy (i.e.,gestational hypertension [GHTN] and preeclampsia), and gestational diabetes mellitus (GDM), adjusted for pregestational diabetes mellitus and chronic hypertension (cHTN). Secondary maternal outcomes included preterm premature rupture of membranes (PPROM), preterm delivery (PTD<37 and <32weeks), induction of labor (IOL), cesarean delivery (CD), and postpartum hemorrhage (PPH). Neonatal outcomes included a composite adverse outcome (including stillbirth, intraventricular hemorrhage (IVH), hypoglycemia, respiratory distress syndrome [RDS], APGAR [Appearance, Pulse, Grimace, Activity, and Respiration] <7 at 5 min, and neonatal intensive care unit [NICU] admission), birthweight, fetal growth restriction (FGR), and macrosomia. Composite maternal morbidity (odds ratio [OR] 4.40,confidence interval [CI] 3.70-5.22 for class III obesity [BMI≥40.0 kg/m2] compared with normal BMI), hypertensive disorders of pregnancy (HDP), GDM, PTD, IOL, CD, PPH, neonatal composite morbidity, hypoglycemia, RDS, APGAR<7 at 5 min, NICU admission, and macrosomia showed a significant increasing test of trend among BMI classes. Increased BMI was protective for FGR. Our data provides BMI-class specific odds ratios (ORs) for adverse pregnancy outcomes. Increased BMI class significantly increases the risk of HDP, GDM, IOL, CD, composite adverse neonatal outcomes, and macrosomia, and decreases the risk of FGR. Attaining a healthier BMI category prior to conception may lower pregnancy morbidity.

Associations of appendicular lean mass and abdominal adiposity with insulin resistance in older adults: A cross-sectional study.

Loss of lean muscle mass and accumulation of adipose tissue are changes associated with aging. Previous studies have documented various components of body composition as predictors for insulin resistance. The objective of this study was to investigate whether components of body composition-appendicular lean mass (ALM) and/or abdominal fat mass (AFM)-correlate with insulin resistance in older men and women. This was a cross-sectional study of 92 older men and women. Weight was classified according to body mass index (BMI)-normal (BMI <25), overweight (BMI 25-30), and obese (BMI >30). All body composition data was determined by dual energy x-ray absorptiometry (DEXA), and insulin resistance was assessed by the homeostatic model assessment of insulin resistance (HOMA-IR). Multivariable regression models with two-way interaction terms were employed to assess whether the associations between components of body composition and log HOMA varied by BMI categories. Adjusted regression showed that log HOMA was significantly associated with AFM (estimate ± standard error: 0.055 ± 0.026) and ALM (0.057 ± 0.029) for the overweight participants (p-values <0.05). Additionally, the adjusted associations between log HOMA and ALM were significantly greater for participants who were either obese or overweight compared to those with a normal BMI (p<0.002). Less consistent relationships were observed between insulin resistance and abdominal fat mass across BMI categories, whereas more consistent associations were observed between insulin resistance and appendicular lean mass in individuals with greater BMI. Further research is needed to clarify if lipid deposition within muscle tissue promotes muscle dysfunction and thereby increases risk for insulin resistance.

Unlocking the potential: exploring the impact of dolutegravir treatment on body mass index improvement in underweight adults with HIV in Malawi.

The introduction of dolutegravir (DTG) in treating HIV has shown enhanced efficacy and tolerability. This study examined changes in weight gain and body mass index (BMI) at 6- and 12-months after post-initiating antiretroviral therapy (ART), comparing people living with HIV (PLHIV) on DTG-based regimens with those on non-DTG-based regimens in Malawi. Retrospective cohort data from 40 public health facilities in Malawi were used, including adult ART patients (aged ≥ 15 years) from January 2017 to March 2020. The primary outcomes were BMI changes/transitions, with secondary outcomes focused on estimating the proportion of mean weight gain > 10% post-ART initiation and BMI category transitions. Descriptive statistics and binomial regression were used to estimate the unadjusted and adjusted relative risks (RR) of weight gain of more than ( >) 10%. The study included 3,520 adult ART patients with baseline weight after ART initiation, predominantly female (62.7%) and aged 25-49 (61.1%), with a median age of 33 years (interquartile range (IQR), 23-42 years). These findings highlight the influence of age, ART history, and current regimen on weight gain. After 12months follow up, compared to those aged 15-24 years, individuals aged 25-49 had an Adjusted RR (ARR) of 0.5 (95% Confidence Interval (CI): 0.35-0.70), suggesting a 50% reduced likelihood of > 10% weight gain after post-ART initiation. Similarly, those aged 50 + had an ARR of 0.33 (95% CI: 0.20-0.58), indicating a 67% decreased likelihood compared to the youngest age group 15-24 years. This study highlights the positive impact of DTG-based regimens, revealing significant transitions from underweight to normal BMI categories at 6- and 12-months post-initiation. This study provides insights into weight gain patterns in patients on DTG-based regimens compared with those on non-DTG regimens. Younger individuals (15-24 years) exhibited higher odds of weight gain, suggesting a need for increased surveillance in this age group. These findings contribute to the understanding DTG's potential effects on weight gain, aiding clinical decision making. Further research is required to comprehensively understand the underlying mechanisms and long-term implications of weight gain in patients receiving DTG-based regimens.

Primary omental infarction- a benign cause of acute abdomen.

Omental infarction (OI) is an uncommon cause of acute abdominal pain. A high index of clinical suspicion is required for diagnosis of OI as the incidence is less than 1 %, presenting with abdominal pain. We report primary OI's clinical and radiological profile from a single tertiary care hospital in India. In this retrospective cross-sectional study, the electronic medical and radiology records of patients withabdominal pain were reviewed over seven years (2015-2022). Variables were systematically collected and analyzed. A total of 22 patients diagnosed with primary OI were included in this study. Male preponderance (63.6 %) was noted with a mean age of 47.45 years (SD±13.84; range: 18-72 years). Most patients belonged to class I obesity (according to the Asia-Pacific body mass index classification) with a mean BMI of 26.56 kg/m2 (SD±3.21 kg/m2). All patients had abdominal pain as the primary symptom, with a mean duration of 8.64days (SD±10.15; range: 1-42days). The most common locations of pain were the right hypochondrium (27.3 %) and diffuse (27.3 %), followed by the right iliac fossa (18.1 %). Most (95.45 %, n=21/22) patients were treated conservatively, and only one required surgical intervention. Primary OI is a rare and benign cause of acute abdomen. Obesity is a risk factor but does not correlate with the size or severity of OI. Radiological imaging, like a computed tomography (CT) scan, is essential for diagnosis. Aconservative management line should be the first approach in treating primary OI before considering surgical options.

The dual prevalence of advanced degrees of obesity and heart failure: a study from the National Inpatient Sample database

BackgroundNational prevalence rates for obesity and heart failure (HF) have been steadily increasing, which predisposes patients to higher morbidity and mortality rates. ObjectivesThe purpose of this study was to evaluate the prevalence of HF stages in hospitalized patients according to their body mass index (BMI). SettingAcademic institution. MethodsNational Inpatient Sample data from 2016 to 2018 were examined to identify patients with obesity, HF (presence or absence of advanced HF [AHF]), and cardiogenic shock (CS). The proportion of hospital admissions was determined for each category on the basis of the presence of AHF with/without CS. A comparative analysis was performed between patients with and without AHF, and multivariate logistic regression analysis was performed for the event of AHF. The same analyses were performed for the event of CS. ResultsA total of 3,354,970 hospital admissions were identified. The prevalence of hospital admissions with a diagnosis of AHF and class III obesity and a diagnosis of CS and class III obesity was 21% and .5%, respectively. The prevalence of AHF and other classes of BMI and CS and other classes of BMI was 17% and .5%, respectively. The univariate analysis showed that there were significant variations in 10 factors between hospital admissions with/without the diagnosis of both AHF and CS. Statistical analyses indicated the following findings: Hospitalized patients in higher obesity groups are more likely to have AHF, and they are less likely to have CS compared with those with a BMI of ≤29.9. ConclusionsThis study revealed that the prevalence of AHF was significantly higher in hospitalized patients with class III obesity. These findings have implications for clinical management, and it can be inferred that these patients are less likely to receive advanced cardiac replacement therapies and might benefit from innovative approaches to address severe dual morbidity.

Survival Trends in Hepatocellular Carcinoma Patients with Portal Vein Tumor Thrombosis: A 3-Month Outcome Assessment

Objective To assess the survival trends among hepatocellular carcinoma (HCC) patients presenting with portal vein tumor thrombosis (PVTT) over a 3-month period. Methodology: This descriptive case series study was conducted at Gastroenterology and hepatology department of Asian Institute of Medical Sciences, Hyderabad from March 2019 to September 2019. Patients of all age groups, both genders diagnosed with hepatocellular carcinoma based on ultrasonography and CT scan imaging as well as screening alpha fetoprotein levels, with evidence of portal vein tumor thrombosis (PVTT) detected through imaging modalities and patients with available medical records containing relevant clinical, laboratory, and imaging data were included. To monitor the survival status of patients, a three-month follow-up period was initiated, facilitated through regular follow-up and phone contact. Throughout this follow-up period, records were maintained, and all relevant data were entered and analyzed using SPSS version 26. Results: The mean age of the patients was 56.4 years, with a standard deviation of 5.7 years. Average Body mass index (BMI) was 23.4 kg/m². Majority of participants were male 80.0%, while females were 20.0%. Regarding the three-month survival rate, only 17.5% of the patients were found to have survived during and remaining patients did not survive. The three-month survival rate did not show statistically significant differences across various demographic factors such as patients' age, gender, and BMI categories (p ? 0.05). Conclusion: Study revealed poor survival outcomes among patients diagnosed with portal vein tumor thrombosis associated with hepatocellular carcinoma, with only 17.5% of patients surviving rat. The overwhelming majority, died to this aggressive malignancy within the observed timeframe.

Clinical impact of body mass index on outcomes of ischemic and hemorrhagic strokes.

To investigate the prognostic implication of body mass index (BMI) on clinical outcomes after acute ischemic and hemorrhagic stroke. The subjects of the study included adult patients with available baseline body weight and height data who had suffered an acute stroke and were registered in the Japan Stroke Data Bank-a hospital-based, multicenter stroke registration database-between January 2006 and December 2020. The outcome measures included unfavorable outcomes defined as a modified Rankin Scale (mRS) score of 5-6 and favorable outcomes (mRS 0-2) at discharge, and in-hospital mortality. Mixed effects logistic regression analysis was conducted to determine the relationship between BMI categories (underweight, normal weight, overweight, class I obesity, class II obesity; <18.5, 18.5-23.0, 23.0-25.0, 25-30, ⩾30 kg/m2) and the outcomes, after adjustment for covariates. A total of 56,230 patients were assigned to one of the following groups: ischemic stroke (IS, n = 43,668), intracerebral hemorrhage (ICH, n = 9741), and subarachnoid hemorrhage (SAH, n = 2821). In the IS group, being underweight was associated with an increased likelihood of unfavorable outcomes (odds ratio, 1.47 (95% confidence interval (CI):1.31-1.65)) and in-hospital mortality (1.55 (1.31-1.83)) compared to outcomes in those with normal weight. Being overweight was associated with an increased likelihood of favorable outcomes (1.09 (1.01-1.18)). Similar associations were observed between underweight and these outcomes in specific IS subtypes (cardioembolic stroke, large artery stroke, and small-vessel occlusion). Patients with a BMI ⩾30.0 kg/m2 was associated with an increased likelihood of unfavorable outcomes (1.44 (1.01-2.17)) and in-hospital mortality (2.42 (1.26-4.65)) in large artery stroke. In patients with ICH, but not those with SAH, being underweight was associated with an increased likelihood of unfavorable outcomes (1.41 (1.01-1.99)). BMI substantially impacts functional outcomes following IS and ICH. Lower BMI consistently affected post-stroke disability and mortality, while higher BMI values similarly affected these outcomes after large artery stroke.

Prevalence of Obesity with its Associated Modifiable Risk Factors among Adolescents of Aged 17-24 Years: Cross-Sectional Study

Objective: This study aims to point out the association of modifiable risk factors and the prevalence and riskfactors of overweight and obesity among adolescents aged 17-24 years.Study Design: Cross-sectional descriptive study.Place and Duration of Study: The study was conducted at the Department of Community Medicine, CombinedMilitary Hospital (CMH) College Lahore, Pakistan from April 2022 to May 2022.Methods: A cross-sectional study was performed on a sample size of 108 adult males through nonprobabilityconvenient sampling in CMH Lahore Medical College, Lahore, Pakistan. HbA1c tests were conducted to checkblood sugar. A questionnaire was distributed to collect data. SPSS software was used for the analysis of datausing the Chi-square test.Results: A total of 108 male cadets participated in the study. Mean age was 20.20 years ±1.4 SD. The majority ofparticipants were involved in physical activity and had healthy eating habits. Eighty-nine percent ofrespondents fall in the category of normal body mass index &amp; 6.5% in the category of overweight &amp; obese &amp; 3.7% were underweight. Forty-seven percent of subjects were physically active for ≤ 3 days/week &amp; 57.4% wereengaged for &gt; 3 days/week. Fifty-seven percent of respondents had a screen time of 5-7 hours/day &amp; 11.1% has&gt; 7 hours/day. Among 108 respondents, 37% had snacking habits in between meals 1-2 times/week &amp; 20.4%has 3-4 times/week.Conclusion: This study concludes that apart from non-modifiable risk factors, modifiable risk factors also have a major influence on the prevalence of overweight &amp; obesity. Those who exercise &amp; eat healthy have less risk ofdeveloping obesity as compared to those who have poor physical activity &amp; unhealthy eating habits. How to cite this: Zaib S, Raza T, Ahmad A, Anwar S, Tariq SMH, Mubashar T. Prevalence of Obesity with its Associated Modifiable Risk Factors Among Adolescents of Aged 17-24 Years: Cross Sectional Study. Life and Science. 2024; 5(2): 210-215. doi: http://doi.org/10.37185/LnS.1.1.362

Frequency of Obesity, Associated Factors and Fetomaternal Outcome in Women Coming for Antenatal Care at Lady Willingdon Hospital, Lahore

Background: Obesity is now taking the shape of an epidemic worldwide and is on the rise among women of reproductive age especially over the last 40 years. This happening has a major bearing on reproductive outcomes as per latest studies. During pregnancy and childbirth, obese women are more likely to develop fetomaternal complications than women with a normal body mass index (BMI). Objective: To determine the prevalence of normal weight, over weight and obese women among those presenting for antenatal care and to compare the fetomaternal outcome in different BMI categories. Patients and Methods Descriptive cross sectional study conducted from 29 October 2022 to 29 April 2023 at Lady Willingdon Hospital, Lahore. 200 subjects meeting the inclusion criteria were enrolled in the study after informed consent. BMI was recorded and weight category assigned. All relevant details noted on especially designed performa. Data analysis was done using SPSS No. 24. Results: Prevalence of obesity in pregnant females was recorded as 25.5 %( n=51) and overweight women as 40.5 %( 81). A total of 200 females with an overall mean age of 29.9 ± 3.5 years were included in this study. The mean body mass index was 27.5 ± 3.9. The proportion of preeclampsia was significantly (p-value &lt; 0.05) higher in obese women (31.9%) followed by overweight (22.2%) and normal women (15.6%), respectively. Likewise, the rate of eclampsia (22.8%, 13.6% and 8.3%), gestational diabetes (28.6%, 18.5, and 9.7%) and hypertension (27.7%, 16.1% and 11.4%) was also significantly higher in obese women followed by overweight women and normal weight women. In addition, a significant (p-value &lt; 0.05) greater rate of C-section (41.5% vs. 35.8% vs. 14.4%) was reported in obese weight groups as compared to overweight versus normal weight women .The mean birth weight of new born was significantly higher in obese women as compared to overweight and normal weight women. Six (11.8%) babies born to obese women were macrosomic and only (1.3% and 1.5%) babies had macrosomia in overweight and normal weight women. APGAR score at 1 minute and 5 minute was significantly higher in normal weight women followed by overweight and obese women. The requirement of admission to NICU was statistically significantly higher in obese women (55.4%) followed by overweight (45.7%) and normal weight women (28.3%).Conclusion: Fetomaternal morbidity is significantly increased in obese and overweight pregnant females. Keywords: Pregnancy, obese, over-weight, prevalence, fetomaternal, outcome.

Effect of body mass index on exercise capacity following pediatric heart transplantation.

Obesity and impaired exercise tolerance following heart transplantation increase the risk of post-transplant morbidity and mortality. The aim of this study was to evaluate the effect of body mass index on markers of exercise capacity in pediatric heart transplant recipients and compare this effect with a healthy pediatric cohort. A retrospective analysis of cardiopulmonary exercise test data between 2004 and 2022 was performed. All patients exercised on a treadmill using the Bruce protocol. Inclusion criteria included patients aged 6-21 years, history of heart transplantation (transplant cohort) or no cardiac diagnosis (control cohort) at the time of testing, and a maximal effort test. Patients were further stratified within these two cohorts as underweight, normal, overweight, and obese based on body mass index groups. Two-way analyses of variance were performed with diagnosis and body mass index category as the independent variables. A total of 250 exercise tests following heart transplant and 1963 exercise tests of healthy patients were included. Heart transplant patients across all body mass index groups had higher resting heart rate and lower maximal heart rate, heart rate recovery at 1 min, exercise duration, and peak aerobic capacity (VO2peak). Heart transplant patients in the normal and overweight body mass index categories had higher VO2peak and exercise duration when compared to underweight and obese patients. Underweight status and obesity are strongly associated with lower VO2peak and exercise duration in heart transplant patients. Normal and overweight heart transplant patients had the best markers of exercise capacity.

Abstract PO1-11-09: Body composition correlates with BMI and menopausal status in patients with breast cancer

Abstract Background: Obesity is associated with higher risk of breast cancer (BC)-related death, all-cause mortality, and recurrence. While used to estimate body fat, body mass index (BMI) is insensitive to body fat distribution and lean muscle mass. We hypothesized that BMI categories (BMI 18.5-24.9 [healthy], 25-29.9 [overweight], and ≥30 kg/m2 [obesity]) would not correlate with CT-derived body composition. Methods: We retrospectively identified 180 patients diagnosed with new or recurrent Stage I-IV BC who presented to Johns Hopkins from 2015-2018 and were part of an institutional database. We extracted demographics, diagnosis date, cancer characteristics, BMI, and CT abdomen pelvis scans from the medical record. Baseline BMI was defined as the closest measurement to diagnosis between 1 year prior and 1 month after diagnosis. Baseline CT was within 6 months of and closest to the baseline BMI date. Fully automated deep-learning algorithms identified L1 and performed muscle and adipose tissue segmentation and quantification. Body composition data included: cross-sectional areas (CSA) of subcutaneous, visceral, and total adipose tissue; the mean, median, and standard deviation of the average of the muscle attenuation (density); and the body wall musculature CSA. ANOVA tests assessed associations between body composition, BMI, and menopausal status. Results: Among 180 patients, 136 (76%) had early-stage BC, and 44 (24%) had metastatic BC. Most patients were women (98%) and non-Hispanic (94%). Patients identified as White (57%), Black (29%), Asian (6%), and Other Race (8%). Sixty percent were post-menopausal. Hormone receptor-positive, HER2-positive, and triple negative subtypes were 56%, 19% and 22%, respectively. At diagnosis, 24% had a healthy BMI while 36% and 41% had overweight and obesity, respectively. All body composition measures were significantly associated with BMI (Table 1). As BMI increased, the average body wall musculature and subcutaneous, visceral, and total adipose tissue CSAs increased while the average muscle attenuation decreased. Specifically, the average visceral adipose tissue CSAs were 2.7 and 4.0-fold larger for overweight and obesity compared to that of the healthy BMI group, respectively, while their average muscle attenuations were 62.4% and 40.6% of the healthy BMI group. Postmenopausal women had 1.5-fold higher visceral adipose tissue CSA and 44.7% less average muscle attenuation compared to premenopausal women. Conclusion: Body composition correlates with all BMI categories in primarily white, non-Hispanic women with breast cancer. As BMI increases, body composition changes reliably, with increased subcutaneous and visceral adipose tissue, increased muscle area, and decreased muscle density. Muscle density, not size/area, is more associated with muscle performance, which can relate to functional status and outcomes. Despite validity concerns, BMI is an accessible and economical surrogate for body adiposity in patients with breast cancer. Postmenopausal status was also associated with greater visceral and total adiposity and lower muscle density. Further investigation is needed to confirm these findings. Table 1: Correlation between body composition, BMI, and menopausal status in patients with breast cancer All measures of body composition were significantly associated with BMI. Visceral adipose tissue increased and muscle density decreased as BMI increased and with post-menopausal status. Citation Format: Terrence Tsou, Tingchang Wang, Amanda Blackford, Ronald Summers, Vered Stearns, Jennifer Sheng. Body composition correlates with BMI and menopausal status in patients with breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-11-09.

Abstract PO2-17-02: Can body mass index be a complete pathological response predictor in breast cancer patients submitted to neoadjuvant chemotherapy? A real-world data trial

Abstract Background: Breast cancer is a prevalent disease, and Its incidence has increased annually worldwide. The prognosis depends on several factors, such as patient characteristics, tumor characteristics and treatment efficacy. In this scenario, neoadjuvant chemotherapy (NAC), previously used only to make surgical approach possible in advanced cases, has been increasingly used in more aggressive initial tumors such as HER 2 positive and triple negative and, in these tumors, the presence of pathological complete response is directly correlated with survival and the disease-free interval. Obesity is very common in Brazil and in the world, and its incidence grows annually. There is a direct relationship between the risk of breast cancer and obesity, especially in postmenopausal women. Justification: Many authors suggest that obese patients are less likely to achieve this pathological complete response (pCR). Real-world data is important to evaluate how patients behave in the real world, only 5% of the patients are enrolled in clinical trials. Most of the clinical trials have strict inclusion and exclusion criteria that ends up selecting a patient that almost doesn't exist in the real world. Objective: To correlate complete pathological response with Body Mass Index (BMI) and, secondarily, to evaluate the relationship between overall and disease-free survival with BMI. Methods: This was a retrospective observational study that has evaluated patients with invasive breast cancer in two Brazilian hospitals. Clinical and pathological characteristics were extracted from the database, being eligible the patients diagnosed with invasive breast cancer, stages I to III, and who underwent neoadjuvant chemotherapy (NAC). Patients were categorized using the World Health Organization (WHO) definition: BMI 18.5 to &amp;lt; 25 kg/m2: normal weight; BMI 25 to &amp;lt; 30 kg/m2: overweight; BMI ≥30kg/m2: obesity. pCR was defined as the absence of breast and axillary invasive tumor. The t test or chi-square test were used to individually analyze the association of each variable between the groups with and without RPc. Univariate and multivariate analyzes to calculate odds ratios (OR) and 95% confidence intervals (CI) of the independent variables BMI, age, clinical stage, histological type, and subtype of cancer, correlated with pCR. where p value &amp;lt; 0.05 was considered statistically significant. Results: 1,779 records were included in the analyses, with a mean age of 50 years at diagnosis and a mean BMI of 28.08 kg/m2. Most patients had stage III cancer (68.1%) at diagnosis and the invasive carcinoma nonspecial type was predominant (95.2%). Immunohistochemistry allowed us to divide the groups into Luminal A like (12.4%), Luminal B like (31.1%), HER2+ like (25.3%) and triple negative like (31.2%). After NAC, 1461 had residual disease and 390 (22.3%) had a pCR. Regarding stages, 2% of the patients were in stage I, 30% in stage II and 68% in stage III. No correlation was found between BMI categories and pCR (p=0.7607). In the multivariate analysis, the results were also not significant for the correlation between the BMI categories after adjusting for age, clinical stage, tumor histology and subtype of breast cancer. We observed, however, that the most aggressive types of cancer were predictors of pathologic complete response. The estimated average overall survival (OS) was 102 months for those of normal weight, 99 months for the overweight ones and 101 months for the obese ones. As for recurrence-free survival, the data were immature. Conclusion: This study with Brazilian real-world data found no correlation between BMI and pCR after NAC and BMI and OS in patients with breast cancer. As an additional finding, most patients were obese or overweight at diagnosis (69%) and public policies should be encouraged to act in this scenario. Trials considering stratification of patients between different regions of the country or specific subtype of cancer can elucidate this finding. Citation Format: Fernanda Grace Bauk Richter, Andre Mattar, Marcelo Antonini, Juliana Real, Luis Henrique Gebrim, Reginaldo Coelho Lopes. Can body mass index be a complete pathological response predictor in breast cancer patients submitted to neoadjuvant chemotherapy? A real-world data trial [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-17-02.

Abstract PO4-03-06: Body mass index and response to neoadjuvant chemo-immunotherapy among women with primary triple negative breast cancer

Abstract Background: Elevated body mass index (BMI) is associated with lower rates of pathologic complete response (pCR) after neoadjuvant chemotherapy in patients with breast cancer. The addition of PD-1 receptor inhibition with pembrolizumab to neoadjuvant chemotherapy is now considered the standard of care for patients with stage II or III triple negative breast cancer (TNBC) based on results from the KEYNOTE-522 (KN-522) trial. In other cancer types such as melanoma and lung cancer, patients with overweight/obesity have better survival outcomes following treatment with immunotherapy compared to patients with normal weight, despite a higher incidence of any-grade immune-related adverse events (irAEs). Whether BMI is associated with differential response and toxicity in patients with TNBC treated with neoadjuvant chemo-immunotherapy is unknown. Methods: Patients with stage II-III TNBC treated with neoadjuvant chemotherapy plus pembrolizumab per the KN-522 regimen from 8/2021 – 9/2022 at Memorial Sloan Kettering Cancer Center were included in this retrospective study. Patient characteristics, tumor characteristics, treatments, surgical pathology information, and irAEs were abstracted from medical records. pCR was defined as absence of invasive or in situ carcinoma in breast and axillary node tissue surgical specimens. BMI was categorized per standard definitions: underweight/normal weight &amp;lt; 25 kg/m2, overweight 25-29.9 kg/m2, and obese &amp;gt;=30 kg/m2. Wilcoxon rank sum tests, Pearson’s chi-squared tests, and Kendall rank correlation tests were used to test associations between variables. Results: 143 patients were included in this study. 57 patients (39.8%) were underweight/normal weight, 46 (32.2%) were overweight, and 40 (28.0%) were obese. Overall, 79/143 patients (55.2%) experienced a pCR. Among patients with a pCR, median BMI was 26.3 kg/m2 (interquartile range [IQR] 23.1-30.5 kg/m2); among patients without a pCR, median BMI was 26.1 kg/m2 (IQR 23.6-30.0 kg/m2; p &amp;gt;0.9). There was no significant association between BMI category and pCR (p=0.9). Overall, 63/143 (44%) of patients experienced an irAE; 42 (29.4%) required treatment for an irAE. There were no associations between BMI and the incidence (p=0.5) or frequency (p=0.7) of irAEs. Conclusions: In this TNBC cohort treated with neoadjuvant chemo-immunotherapy, BMI was not associated with rates of pCR or irAEs. These findings highlight the divergent impact of BMI on immunotherapy response across cancer types. Confirmatory studies in independent cohorts are needed. Citation Format: Sherry Shen, Sara Myers, Yuan Chen, Stephanie Downs-Canner, Nour Abuhadra, Tiffany Traina, Mark Robson, Neil Iyengar. Body mass index and response to neoadjuvant chemo-immunotherapy among women with primary triple negative breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-03-06.

Investigating the causal association of generalized and abdominal obesity with microvascular complications in patients with type 2 diabetes: A community-based prospective study.

The paradoxical protective association between overweight/obesity and diabetic microvascular complications (DMC), a phenomenon well-known as the obesity paradox, has been considered a non-causal association based on methodological influences. We aimed to investigate the association of generalized and abdominal obesity, as measured by body mass index (BMI) and waist circumference (WC), respectively, with DMC in patients with type 2 diabetes (T2D), using a causal inference approach. We enrolled 1436 patients with clinically diagnosed T2D but not DMC at baseline in a community-based prospective cohort in China between 2017 and 2019 and followed them annually until 2022 with new-onset DMC recorded. Marginal structural Cox models with inverse probability weighting were constructed to determine the causal association. Subgroup analyses were performed to identify potential effect modifiers. We observed 360 incident DMC cases, including 109 cases of diabetic nephropathy (DN) and 277 cases of diabetic retinopathy (DR) during four follow-up visits. Multivariable-adjusted hazard ratios (95% confidence intervals) for overall DMC, DN and DR were 1.037 (1.005-1.071), 1.117 (1.062-1.175) and 1.018 (0.980-1.059) for 1 kg/m2 increase in BMI, and 1.005 (0.994-1.017), 1.034 (1.018-1.051) and 1.000 (0.987-1.014) for 1 cm increase in WC, respectively. Similar patterns were observed across the BMI and WC categories, while the positive association appeared to be more pronounced in women. Generalized but not abdominal obesity was associated with an increased risk for the overall DMC, whereas both obesities were causally related to DN, albeit not DR, in T2D. Routine weight management should not be neglected in diabetes care, particularly in women.

Abstract PO5-09-01: Relative low body mass index (BMI) and fat quantity predicts prognosis better than absolute BMI in hormone receptor-positive, HER2-negative breast cancer

Abstract Purpose: Most existing research about obesity and prognosis in breast cancer patients primarily compares obese and non-obese individuals according to standard body mass index (BMI) categories. With a notably high percentage of Asian patients presenting with young age onset and normal weight, the prevalence of overweight and obesity based on absolute BMI values is lower in Asia (according to WHO guideline, BMI under 18.5 means underweight, and BMI over 25 means overweight). Understanding the impact of relatively low and high weight on prognosis can provide more insightful data than assessments based on absolute BMI thresholds. This study aimed to investigate the impact of relative low/high BMI on the prognosis of breast cancer and to explore the influence of body fat quantity (FQ), which is closely related to BMI. Methods: The study population consisted of 3,663 patients who received surgery for primary breast cancer at Seoul National University Hospital from 2006 to 2015. Pre-treatment BMI was divided into quartiles, defining low-BMI (Q1) as ≤ 21.33, high-BMI (Q4) as &amp;gt; 25.53, and mid-BMI as values between the two. Fat quantity (FQ) was derived from chest CT using the deep learning-based FDA-approved DeepCatch software. It measures the fat volume at the L1 level then divides this value by the square of the patient's height. It was then also divided into quartiles, establishing the definitions of low-, mid-, and high-FQ. The associations of BMI and FQ with distant metastasis-free survival (DMFS) and overall survival (OS) were examined. Results: The high-BMI group demonstrated older median age and higher T and N stages (p&amp;lt; 0.001). The high- and low-BMI groups also showed a higher prevalence of estrogen receptor positive cancer compared to the mid-BMI group. A strong correlation (Pearson correlation coefficient 0.83) was observed between BMI and FQ. In HR-positive, HER2-negative breast cancer, high-BMI patients had a 1.55 times higher risk of distant metastasis (95% CI: 1.15-2.11, p = 0.005), and a 1.78 times higher risk of mortality (95% CI: 1.22-2.58, p = 0.003) compared to mid-BMI patients, while low-BMI patients demonstrated better outcomes regarding DMFS (HR 0.67, p=0.035) and OS (HR 0.59, p=0.04). Comparison of FQ with prognosis revealed that the low-FQ patients exhibited better DMFS (HR 0.59, p=0.005) and OS (HR = 0.44, p=0.002) compared to mid-FQ patients in HR-positive, HER2-negative breast cancer. However, when adjusted for T and N stages, low-BMI patients in the HR-positive, HER2-negative group showed no difference in prognosis from mid-BMI patients but better prognosis compared to high-BMI patients. In contrast, when defined using absolute BMI, underweight patients did not show a difference in DMFS (HR 0.72 vs. normal BMI, p = 0.515) and OS (HR 0.91 vs. normal BMI, p = 0.87) compared to those with normal weight and overweight. The low-FQ group had the best prognosis regarding DMFS (HR 0.66 vs. mid-FQ, p=0.032) and OS (HR 0.50 vs. mid-FQ, p=0.008). Conclusions: Low-BMI is a favorable prognostic factor compared to high-BMI for DMFS and OS in HR-positive, HER2-negative breast cancer. The relative BMI defined according to BMI quartiles was a better prognostic factor than to absolute BMI standards. Investigations with FQ showed similar tendencies, suggesting that low BMI's favorable prognostic influence may be associated with fat. Future investigations should aim to validate these results and delve deeper into the underlying mechanisms. Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Soon Ho Yoon work as chief medical officer in MEDICALIP. This author did not involve data/statistical analysis. Other authors have no competing interest to declare. Citation Format: Eunhye Kang, Ji-Jung Jung, Ik Beom Shin, Hawjeong Lee, Jin Young Byeon, Changjin Lim, Hong-Kyu Kim, Hyeong-Gon Moon, Wonshik Han, Jong-Ho Cheun, Soon Ho Yoon, Han-Byoel Lee. Relative low body mass index (BMI) and fat quantity predicts prognosis better than absolute BMI in hormone receptor-positive, HER2-negative breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-09-01.

Abstract PO1-04-10: Body Mass Index and Treatment Efficacy in advanced Luminal Breast Cancer: Insights from the GEICAM/2013-02 (PEARL) trial

Abstract Background: Endocrine therapy (ET) and treatment directed against molecular targets (CDK 4/6, PI3K, mTOR) constitute the basis of initial treatments for patients with advanced luminal breast cancer. Most of these treatments are oral and have been developed at a fixed dose, without weight adjusted dosing. There is little evidence on the influence that patients’ weight might have on clinical outcomes of these oral drugs in the context of a randomized clinical trial. The present study analyzes the potential impact of the weight of patients treated in the two cohorts of the PEARL trial (NCT02028507) on Progression-Free Survival (PFS), Overall Survival (OS) and the incidence of side effects in each treatment arm. Methods: GEICAM/2013-02 (PEARL) is a multicenter, phase III randomized clinical trial that enrolled patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative metastatic breast cancer (MBC) who progressed to a prior aromatase inhibitor. Patients were randomized 1:1 to receive ET + palbociclib or capecitabine. Patient weight was assessed based on baseline body mass index (BMI) categories: normal (BMI ≤25 Kg/m2), overweight (BMI 25-29.9 Kg/m2) and obesity (BMI ≥30 Kg/m2). Cox's stratified proportional hazard model was used for survival analysis. Adverse events were assessed and graded according to National Cancer Institute common terminology criteria for adverse events (NCI-CTCAE) version 4.0. Results: A total of 600 patients were included in the study and all were evaluable for the weight-based analysis, including 301 in the ET +palbociclib arm and 299 in the capecitabine arm. The distribution of patient’s weights is shown in Table 1. For the Intention-to-treat (ITT) population, no significant difference in the median OS was found between the different weight categories (Normal: 32.8 months vs overweight: 31.9 months, [p=0.467]; obese: 32 months [p=0.407]). Specifically, for patients with normal weight, the median PFS was 9.3 months in the ET + palbociclib group compared to 9.0 months in the capecitabine group (hazard ratio (HR) 0.83, 95% confidence interval [CI]: 0.61-1.13; p=0.23). In the overweight group, the PFS was 7.5 months in the ET+palbociclib group and 11.1 months in the capecitabine group (HR 1.17, 95% CI: 0.87-1.58; p=0.30) while for the obese group, the PFS was 5.7 months vs 11.7 months (HR 1.14, 95% CI: 0.82-1.59; p=0.43), respectively. No substantial differences in the incidence of grade ≥ 3 events were observed when considering weight categories in the different treatment groups (capecitabine arm (Normal: 60%, Overweight: 70.4%, Obese: 61.6%) and ET+palbociclib arm (Normal: 74.5%, Overweight: 76.1%, Obese: 51.6%). Conclusions: Our findings, despite not finding statistically significant differences, suggest a potentially clinically relevant trend towards improved PFS with capecitabine in overweight and obese patients compared to those receiving palbociclib plus ET. The impact of weight on the outcomes with fixed-dose oral drugs warrants further investigation in future studies. Table 1. Citation Format: Manuel Alva, Sara López-Tarruella, Christoph Zielinski, Manuel Ruíz - Borrego, Nicholas Turner, Eva Ciruelos, Montserrat Muñoz, Begoña Bermejo, Mireia Margelí, Antonio Antón, Zsuzsanna Kahan, Tibor Csöszi, Maribel Casas, Laura Murillo, Serafin Morales Murillo, Emilio Alba, Einav Nili-Gal Yam, Angel Guerrero, Lourdes Calvo, Juan de la Haba-Rodríguez, Manuel Ramos, Isabel Álvarez, Andrés García-Palomo, María Koehler, José Ángel García-Sáenz, J. Ignacio Chacón, Claire Swift, Christiane Thallinger, Miguel Gil-Gil, Miguel Martín. Body Mass Index and Treatment Efficacy in advanced Luminal Breast Cancer: Insights from the GEICAM/2013-02 (PEARL) trial [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-04-10.

Impact of Obesity on Midurethral Sling Failure in a Highly Hispanic Population.

Mixed data exist in the literature regarding the impact of obesity on midurethral sling (MUS) failure rates. The aim of this study was to evaluate the impact of obesity and Hispanic ethnicity on MUS failure. This was a retrospective cohort study of females who underwent MUS surgery, alone or with concomitant prolapse repair, with at least 1 year of follow-up. Body mass index (BMI) classes were categorized as normal (<25 kg/m2), overweight (25-29.9 kg/m2), obese (30-39.9 kg/m2), and severe obesity (≥40 kg/m2). The primary outcome was MUS failure, defined as a composite of subjectively unchanged or worsened symptoms or need for additional procedures. Secondary outcomes included risk factors related to MUS failure and the effect of ethnicity on MUS failure rates. A total of 322 women were included for analysis. The mean age was 52.3 years. Increasing BMI was associated with higher MUS failure, with multivariate logistic regression showing a 5% increased risk for each 1 kg/m2 BMI increase. Failure rates were significantly different between normal BMI and severe obesity (16.7% vs 36.4%, P = 0.04). After adjusting for other variables, transobturator slings had a higher risk of failure compared with retropubic slings, whereas surgeon training and patient ethnicity did not affect failure rates. We found that increasing BMI was associated with higher MUS failures, with significantly higher failure rates in the severely obese population. Although MUS remains the standard of care for treatment of SUI, based on our findings, counseling should be individualized to the patient, taking into account each patient's unique characteristics.

Abstract PO2-13-01: Weight change in early breast cancer-based baseline body mass index and treatment

Abstract Background: Early-stage breast cancer is a common condition with significant effects on health, both as a result of treatment and underlying conditions. Breast cancer has been associated with obesity, weight gain, and diabetes. Little is known about changes in weight after breast cancer diagnoses based on baseline weight. Additionally, weight change may differ due to treatments, such as chemotherapy or hormone therapy. Methods: A retrospective study was conducted using deidentified electronic medical records data from a national health informatics provider and insurer database to identify the cohort. The cohort inclusion criteria included women with a diagnosis of breast cancer, a breast biopsy procedure, and a breast cancer surgery within a 1-year period of time from 2010-2018. Body-mass index (BMI) within 1 month of initial biopsy was collected, and weight at 6 months and 1 year after initial biopsy was used to calculate the percentage change in weight. Treatment with chemotherapy within 1 year of diagnosis and hormone therapy within 6 months was also collected. Patients were divided into standard BMI categories as well as BMI &amp;gt;25 vs. ≤25. ANOVA was used to compare outcomes of weight change based on BMI, chemotherapy, and hormone therapy. Linear regression was used to analyze the effects of age, BMI, chemotherapy, and hormone therapy with weight change at 1 year. Results: In 4,541 patients diagnosed with breast cancer, 3,896 patients had weight available at 6 months and 3,406 had weight available at 1 year. Mean age at diagnosis was 61.5 years (standard deviation (SD) 12.4) with mean BMI of 29.9 at baseline (SD 7.3) and weight of 79.5 kg (SD 20.2). Chemotherapy was administered in 1206 patients (26.6%) and hormone therapy in 1,644 (36.2%) with 210 (4.6%) receiving both therapies. Overall, patients lost a mean of 0.6 kg (0.5% change, SD 5.1) at 6 months and 0.6 kg at 1 year (0.4% change, SD 5.7). At one year, patients with BMI &amp;lt; 25 gained 0.74% of body weight vs. lost 1.1% of weight in BMI &amp;gt;25 (p&amp;lt; 0.001). Patients treated with chemotherapy lost 1.4% body weight vs. lost 0.23% in patients without chemotherapy (p&amp;lt; 0.001) and patients treated with hormone therapy lost 0.12% of body weight vs. lost 1.3% without hormone therapy. A linear regression model including age, BMI, chemotherapy, and hormone therapy to explain weight change at one year was statistically significantly better than a baseline model at explaining the weight change at one year [F(4,2474)=61.05]. Increasing age (b=-0.125; t=-10.546; p&amp;lt; .001; 95% CI for beta :0.14 -0.10), BMI (b=-0.178; t=-9.428; p&amp;lt; .001; 95%CI :0.22 -0.14), and chemotherapy (b=-1.643; t=-4.645; p&amp;lt; .001; 95% CI: 2.4 -0.95) were all significant predictors associated with weight loss at one year while hormone therapy was also a significant predictor but was associated with weight gain (b=0.846; t=2.428; p=.015; 95% CI: 0.16-1.5). Conclusions: Women with early breast cancer experienced significant changes in weight in the year after diagnosis. Women with lower BMI gained weight while those with BMI &amp;gt;25 lost weight. Increasing age, BMI, and treatment with chemotherapy was associated with weight loss while use of hormone therapy was associated with weight gain. Further study of weight changes after breast cancer diagnosis are appropriate to understand outcomes and mitigate effects of treatments. Table 1: Percentage weight change across BMI groups by chemotherapy use Citation Format: Martin Schoen, Deepika Gopukumar, Abhilash Akula, Kaitlin Farrell, Aimee Schad, Leslie Hinyard. Weight change in early breast cancer-based baseline body mass index and treatment [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-13-01.

Utilisation of the health belief model to study the behavioural intentions relating to obesity management among university students: a cross-sectional study

BackgroundOverweight and obesity are excessive fat accumulations linked with many health problems, including heart diseases, type 2 diabetes and cancer. Multiple studies have demonstrated that beliefs about overweight, obesity and...