Body Mass Index Cutoff Research Articles

The effects of obesity on 1-year functional outcomes after arthroscopic rotator cuff tear repair.

BackgroundThe purpose of our study was to examine the impact that an increased body mass index (BMI) has on arthroscopic rotator cuff repair (aRCR) outcomes.MethodsWe identified a sample of 313 patients who underwent aRCR at our institution from 2017 to 2020. Patients were classified into cohorts by BMI: normal BMI (<25), overweight (25-30), and obese (≥30). Patient-Reported Outcomes Measurement Information System (PROMIS) scores (Pain Interference, Pain Intensity, and Upper Extremity) and Clinical Global Impressions scale rating of pain and functional improvement after surgery were obtained at 1 year postoperatively. The significance of the BMI category as a predictor for outcomes was evaluated using multiple linear and multivariable logistic regressions. Receiver operating characteristic curve analysis with Youden’s J-statistic was used to determine optimal BMI cutoff for predicting likelihood of achieving minimum clinically important difference (MCID) and substantial clinical benefit (SCB) on the Clinical Global Impressions scales.ResultsObesity was a significant predictor of reduced preoperative-to-postoperative improvement in the PROMIS Upper Extremity score (P = .04). However, BMI was not predictive of other preoperative-to-postoperative differences in outcome scores or the size and number of cuff tendons torn (P > .05). Optimal BMI cutoffs were determined for pain MCID (40.8), pain SCB (26.8), function MCID (27.4), and function SCB (26.8), but all cutoffs had low correct classification rates (≤13%).Discussion and ConclusionObesity was not found to be an independent risk factor for increased rotator cuff tear size or tendon involvement but was nonetheless associated with worse upper extremity function and pain after aRCR.

PD29-12 IS A BMI CUTOFF FOR GENDER AFFIRMATION SURGERY SCIENTIFICALLY SUPPORTED?

You have accessJournal of UrologyCME1 May 2022PD29-12 IS A BMI CUTOFF FOR GENDER AFFIRMATION SURGERY SCIENTIFICALLY SUPPORTED? Erin Carter, Michael Safir, Ashley DeLeon, Curtis Crane, and Richard Santucci Erin CarterErin Carter More articles by this author , Michael SafirMichael Safir More articles by this author , Ashley DeLeonAshley DeLeon More articles by this author , Curtis CraneCurtis Crane More articles by this author , and Richard SantucciRichard Santucci More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002577.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Gender-affirming surgeries (GAS) are increasingly in demand. Though these procedures are elective, there is a significant morbidity and mortality benefit. Access to GAS is an ongoing discussion and must balance operative risks, individual risk factors, and potential benefit. Many of those offering these procedures list an ideal or inflexible upper limit of body mass index (BMI). The objective of this work is to determine if there is a relationship between BMI and surgical outcomes for GAS, both chest and genital, both masculinizing and feminizing. Additionally, we seek to evaluate whether any such relationship between BMI and outcomes suggests that a cutoff should (or should not) be considered for access to GAS. METHODS: The scientific literature was searched for original articles reporting on any GAS, including chest, genital, masculinizing, and feminizing procedures. Review articles and abstracts were excluded. We extracted BMI cutoff criteria, reported BMI of each cohort, and statistically evaluated outcomes from each article. A similar search was performed for selected analogous soft-tissue surgeries for comparison. RESULTS: The highest and lowest BMI reported were 54 and 14.6, both for masculinizing chest surgery. 6 groups reported using BMI upper limits of 25-33 or morbid obesity to undergo GAS. 3 recommended or required an alternative surgical approach for BMI greater than 27-30. 2 specified that BMI is not considered a contraindication for GAS at their institution(s). Of those that reported BMI, 77% (n=34/44) did not specify using BMI to qualify for GAS. It was common for reported BMI mean, standard deviation, and/or ranges to suggest that GAS may have been discouraged or considered contraindicated in obese patients (e.g. 24.8 ± 1.84), though this is of limited credibility without known ranges. 48% (n=21/44) evaluated surgical outcomes in relation to BMI. 11 individual criteria were found to be statistically significant; most commonly choice of surgical approach (n=7/11, 64%). CONCLUSIONS: In a comprehensive review of the literature, we found limited evidence that suggests high BMI is associated with higher risk of complications. The available data supports using high BMI as a proxy for more dangerous health conditions (i.e. diabetes, hypertension, cardiac disease) which must be optimized preoperatively for safety, as in any patient. A higher risk of uncommon or non-life threatening complications may not justify BMI limits to GAS, as long as patient and surgeon acknowledge the higher risk of common obesity related complications, as in other elective but indicated surgeries. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e509 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Erin Carter More articles by this author Michael Safir More articles by this author Ashley DeLeon More articles by this author Curtis Crane More articles by this author Richard Santucci More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP47-11 DIFFERENTIAL ASSOCIATION OF BODY MASS INDEX ON SURVIVAL OUTCOMES IN RENAL CELL CARCINOMA: IMPACT OF TUMOR HISTOLOGY

You have accessJournal of UrologyCME1 May 2022MP47-11 DIFFERENTIAL ASSOCIATION OF BODY MASS INDEX ON SURVIVAL OUTCOMES IN RENAL CELL CARCINOMA: IMPACT OF TUMOR HISTOLOGY Arman Walia, Yasuhisa Fujii, Viraj Master, Ava Saidian, Rekha Narasimhan, Mimi Nguyen, John Perry, Margaret Meagher, Madison Chakoumakos, Kevin Hakimi, Dattatraya Patil, Yosuke Yasuda, Hajime Tanaka, and Ithaar Derweesh Arman WaliaArman Walia More articles by this author , Yasuhisa FujiiYasuhisa Fujii More articles by this author , Viraj MasterViraj Master More articles by this author , Ava SaidianAva Saidian More articles by this author , Rekha NarasimhanRekha Narasimhan More articles by this author , Mimi NguyenMimi Nguyen More articles by this author , John PerryJohn Perry More articles by this author , Margaret MeagherMargaret Meagher More articles by this author , Madison ChakoumakosMadison Chakoumakos More articles by this author , Kevin HakimiKevin Hakimi More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Yosuke YasudaYosuke Yasuda More articles by this author , Hajime TanakaHajime Tanaka More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002618.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The “obesity paradox” for renal cell carcinoma (RCC) has been described in clear cell histology. We investigated impact of Body Mass Index (BMI) on outcomes in Clear Cell (ccRCC) and Non-Clear Cell RCC (nccRCC). METHODS: The International Marker Consortium for Renal Cancer database was retrospectively analyzed for patients with ccRCC and nccRCC (papillary and chromophobe). Adult BMI (kg/m2) cutoffs were defined as obese >30 and non-obese ≤30. Descriptive analyses were conducted for demographics and disease characteristics. Multivariate analysis (MVA) via Cox regression and Kaplan Meier analyses (KMA) were conducted for survival assessment. Primary outcome was risk of cancer-specific mortality (CSM); secondary outcome was all-cause mortality (ACM). RESULTS: 3,742 patients were included (ccRCC n=2,895/nccRCC n=847; median follow up 107 months). BMI >30 was independently associated with lower risk of CSM in ccRCC patients (HR 0.69, p=0.038). Hypertension (HR 2.29, p <0.001), high grade (HR 3.27, p <0.001), and stage 3/4 (HR 5.29, p <0.001) were associated with increased risk of CSM. For nccRCC, stage 3/4 disease (HR 19.48, p <0.001) was associated with worsened CSM, while BMI >30 was not a risk factor (HR 1.38, p=0.415).BMI >30 was independently associated with decreased ACM in ccRCC patients (HR 0.74, p=0.011). Age (HR 1.03, p <0.001), male gender (HR 1.39, p <0.001), hypertension (HR 1.39, p<0.001), high grade (HR 1.72, p <0.001), and stage 3/4 (HR 2.33, p <0.001) were associated with increased risk of ACM, while increasing preoperative eGFR (HR 0.99, p <0.001) was protective. BMI >30 was not a risk factor for ACM in nccRCC (HR 0.99, p=0.99). Figure 1 provides KMA survival curves for cancer-specific (CSS) and overall survival (OS). For ccRCC stratified by BMI >30 and ≤30, 5-year CSS rates were 88% vs 88% (p=0.686) and OS 77% vs 73% (p=0.022), respectively. For nccRCC, 5-year CSS rates were 91% vs 93% (p=0.620) and OS 78% vs 80% (p=0.180) for BMI >30 and ≤30, respectively. CONCLUSIONS: BMI >30 was independently associated with decreased risk of mortality outcomes in ccRCC but not nccRCC. Mechanisms are unclear but call for further investigation into impact of BMI and metabolic sequelae on different RCC histologic subtypes. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e814 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arman Walia More articles by this author Yasuhisa Fujii More articles by this author Viraj Master More articles by this author Ava Saidian More articles by this author Rekha Narasimhan More articles by this author Mimi Nguyen More articles by this author John Perry More articles by this author Margaret Meagher More articles by this author Madison Chakoumakos More articles by this author Kevin Hakimi More articles by this author Dattatraya Patil More articles by this author Yosuke Yasuda More articles by this author Hajime Tanaka More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement PDF DownloadLoading ...

A Novel Method for Stratification of Major Complication Risk Using Body Mass Index Thresholds for Patients Undergoing Total Hip Arthroplasty: A National Cohort of 224,413 Patients

IntroductionElevated body mass index (BMI) is associated with complications following Total Hip Arthroplasty (THA). Since obese individuals are almost 10 times more likely to require THA compared to non-obese individuals, we need to understand the risk-benefit continuum while considering THA in obese patients. We aimed to determine data-driven thresholds for BMI at which the risk of major complications following THA increases significantly. MethodsPatients were identified in a national database who underwent primary THA from 2010 to 2020. BMI thresholds were identified using the stratum-specific likelihood ratio (SSLR) methodology, which is an adaptive technique that allows for identification of BMI cut-offs, at which the risk of major complications is increased significantly . BMI cutoffs identified using SSLR were used to create a logistic regression model. ResultsA total of 224,413 patients were identified with a mean age of 66 ± 10, BMI 32 ± 6.7, and 7,186 (3%) sustained a major complication. BMI thresholds were defined as 19-31, 32-37, 38-49 and 50+. Overall, the absolute risk of major complications increased from 2.9% in the lowest BMI strata to 7.5% in the highest BMI strata. Compared to patients with a BMI between 19-31, the odds of sustaining a major complication sequentially increased by 1.2, 1.6, and 2.5-times for patients in each higher BMI strata (all, P < .05). ConclusionsWe have identified BMI cutoffs using SSLR that categorizes patients into four categories of risk for major complications in a nationally representative patient sample. These thresholds can be used in the surgical decision-making process between patients and surgeons.

Epistemic injustice and Body Mass Index: Examining Māori and Pacific women’s access to fertility treatment in Aotearoa New Zealand

ABSTRACT The availability and uptake of assisted reproductive technologies is increasing across the globe yet delays and disparities continue to exist for many Indigenous and minority ethnic groups in terms of outcomes and access to fertility treatment and reproductive services. In this article, we examine the fertility stories of nine Māori (Indigenous people of Aotearoa) and Pacific cisgender women living in Aotearoa who were interviewed as part of a large qualitative study conducted with participants seeking access to assisted reproduction for the purposes of family building. The focus of the article is on the experiences of Māori and Pacific women for whom clinical criteria, which include a Body Mass Index cutoff of 32 kg/m2, present a key barrier blocking access to publicly funded fertility services. We draw on the conceptual tool of epistemic injustice, described by the philosopher Miranda Fricker, as a lens through which to examine the challenges Māori and Pacific women face accessing fertility treatment. The study findings indicate that most participants, at some point throughout the course of their reproductive journeys, encountered epistemic injustice when seeking fertility treatment. To redress this bias, we believe revision of Body Mass Index criteria guidelines, which were implemented as part of a nationwide Clinical Priority Criteria Assessment strategy more than 20 years old, are warranted.

What is the Impact of Body Mass Index Cutoffs on Total Knee Arthroplasty Complications?

Body mass index (BMI) cutoffs are commonly used to decide whether to offer obese patients elective total knee arthroplasty (TKA). However, weight loss goals may be unachievable for many patients who are consequentially denied complication-free surgery. The purpose of this study was to assess the impact of different BMI cutoffs on the rates of complication-free surgery after TKA. Patients undergoing elective, primary TKA from 2015 to 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program database using Common Procedural Terminology code 27447. The BMI and rates of any thirty-day complication were collected. BMI cutoffs of 30, 35, 40, 45, and 50 kg/m2 were applied to model the incidence of complications if TKA would have been allowed or denied based on the BMI. A total of 314,719 patients underwent TKA, and 46,386 (14.7%) had a BMI ≥40 kg/m2. With a BMI cutoff of 40 kg/m2, 268,333 (85.3%) patients would have undergone TKA. A total of 282,552 (94.8%) would experience complication-free surgery, and 17.3% of all complications would be prevented. TKA would proceed for 309,479 (98.3%) patients at a BMI cutoff of 50 kg/m2. A total of 293,108 (94.7%) would not experience a complication, and 2.8% of complications would be prevented. A BMI cutoff of 35 kg/m2 would prevent 36.6% of all complications while allowing 94.8% of complication-free surgeries to proceed. Lower BMI cutoffs can reduce complications, but will limit access to complication-free TKA for many patients. These data do not indicate TKA should be performed without consideration of risks from obesity; however, a holistic assessment and shared decision-making may be more valuable when deciding on appropriate goal weight reduction.

Body Composition Assessment by Bioelectrical Impedance Analysis in Prediction of Cardio-Metabolic Risk Factors: Tehran Lipid and Glucose Study (TLGS)

Background:We aimed at evaluating the best body mass index (BMI) and percent body fat (PBF) cutoffs related to cardio-metabolic risk factors and comparing the discriminative power of PBF and BMI for predicting these risk factors.Methods:In this cross-sectional study in phase V (2012–2015), 1271 participants (age ≥ 20 yr; 54.3% women) were enrolled. Bioelectrical impedance analysis (BIA) was used to estimate PBF. Joint Interim Statement criteria were used for defining metabolic syndrome (MetS). We compared PBF with BMI through logistic regression and area under the curve of the receiver operating characteristic (ROC) curve. Percent body fat cutoff points were > 25 in men and >35 in women.Results:Percent body fat and BMI cutoff points for predicting MetS were 25.6% and 27.2 kg/m2 in men and 36.2% and 27.5 kg/m2 in women, respectively. There were no significant differences between BMI and PBF area under the ROC curves for predicting MetS and its components, except for abdominal obesity in men and low high-density lipoprotein (HDL) in women in favor of BMI. Logistic regression analysis indicated that BMI in women was better for predicting MetS and its components, except for abdominal obesity. Moreover, BMI was equal or superior to PBF in men, except for low HDL and high triglyceride levels.Conclusion:Comparison of PBF with BMI showed that the use of PBF is not significantly better than BMI in predicting cardio-metabolic risks in the general population.

What is the Optimal Body Mass Index Range for Older Adults?

BackgroundObesity is pathophysiologically complex in older adults compared to that in young and middle-aged adults. The aim of the present study was to determine the appropriate body mass index (BMI) range based on geriatric evaluation parameters in which complications can be minimized in older adults. MethodsA total of 1,051 older adult patients who underwent comprehensive geriatric assessment were included. The patients’ demographic characteristics, comorbid diseases, number of drugs, BMI, basic and instrumental activities of daily living (BADL and IADL), Tinetti balance and walking scale, Mini Nutritional Assessment, Geriatric Depression Scale-15, Mini-Mental State Examination, Time Up and Go test, and handgrip strength measurement were extracted from patient records.ResultsOf the patients who took part, 73% were female, and the mean age was 77.22±7.10 years. The most negative results were observed in those with a BMI <25 kg/m2 and in those with a BMI >35 kg/m2. Receiver operating characteristic (ROC) analysis of the optimum BMI cutoff levels to detect the desirable values of geriatric assessment parameters was found to be 31–32 and 27–28 kg/m2 for female and male, respectively.ConclusionOlder adults with BMI <25 and >35 kg/m2 were at a higher risk of a decrease in functional capacity, and experienced gait and balance problems, fall risk, decrease in muscle strength, and malnutrition. Data from this study suggest that the optimum range of BMI levels for older adults is 31–32 and 27–28 kg/m2 for female and male, respectively.

Use of Tri-Ponderal Mass Index in Predicting Late Adolescent Overweight and Obesity in Children Aged 7–18

BackgroundCurrent reference systems using body mass index (BMI) or BMI z-scores to estimate overweight and obesity risk in adolescents are complex to use. An easy and effective measure and cutoffs such as the tri-ponderal mass index (TMI) are in need for parents and grassroots health workers.ObjectiveThe aim of this study was to test whether cohort-derived TMI could be efficient for obesity prediction and to find out whether simplified TMI cutoffs could be used in the prediction.MethodsData were obtained from a 12-year retrospective growth cohort generated in Guangdong, China. A total of 17,815 children (53.9% were boys) with 151,879 follow-ups conducted annually between 2005 and 2016 were involved. Late adolescent overweight and obesity were defined based on the BMI z-score (WHO 2007 growth reference) of the last measurement, which happened at the mean age of 17.2 (SD: 0.7) for both sexes. Analysis of the area under the curve (AUC) of the receiver operating characteristic curves was used to find the most appropriate cutoff.ResultsIn total, 9,604 boys and 8,211 girls were included in the final analysis. TMI cutoffs performed better than WHO BMI cutoffs in the prediction of late adolescent overweight and obesity, with all corresponding AUCs <0.7. The simplified TMI cutoffs used to predict late adolescent overweight and obesity were 13.1 and 14.1 kg/m3 for children aged 7 to 15 years, respectively, with the corresponding AUCs ranging from 0.7315 (standard error, SE: 0.0132) to 0.9367 (SE: 0.0052). The cutoffs for predicting late adolescent overweight and obesity for children aged 16 to 18 years were 14.0 and 15.8 kg/m3, respectively, with the corresponding AUCs ranging from 0.9189 (SE: 0.0048) to 0.9841 (95% CI: 0.0027).ConclusionTri-ponderal mass index with the ease of administration in practice could be a promising alternative screening tool to BMI for the prediction of late adolescent overweight and obesity.

Clinical Correlates of PCOS in A Tertiary Health Care Centre

Aims: To study, analyze and find the correlation between different signs and symptoms of polycystic ovarian syndrome in a tertiary health care center. Settings and Design: (1) Type of study: Observational Study (2) Sample size: 150 (3) Study participants: All patients attending gynecology OPD diagnosed with PCOS. Study design: It was a Questionnaire based observational study. Methods and Material: This study was conducted on 150 patients with Polycystic Ovarian Syndrome. Diagnosis of Polycystic Ovarian Syndrome was done on the basis of 2003 Rotterdam diagnostic criteria. Ferriman Gallwey score was used for assessment of hirsutism and WHO cut-offs of Body Mass Index modified for Asian population was used for assessment of Body mass index, Statistical analysis used: Statistical Analysis: Data were compiled and analyzed using the site. Results: Percentages of Chief complaints: Irregular menses (89%), Obesity (41%), Hirsutism (37%), Acne (32% ), Infertility (10%). A Family History of Diabetes (45%), Hypertension(33%), Obesity (29%), Thyroid disorder (27%), PCOD (14%), and Cardiac Disorder (13%) were also analyzed. Polycystic changes in ultrasonographic findings were Present in 89% of the population and absent in 11% of the population. Only 33% of participants were regular with the exercise routine rest. Hirsutism was graded according to mild (22%), moderate (62%), and severe (16%).50 % had Acne on examination. Body Mass Index was measured and graded into Underweight (11.3%), Normal (28.60%), Overweight (9.30%), Pre-obese (31.30%), Obese type 1 (19.30 %). Acanthosis nigricans (AN) was present in 32% And absent in 68%. There was a significant Correlation between : ( p-value &lt;0.05) Irregular menses and infertility- 7%, Hirsutism and infertility- 3%, Ultrasonographic Findings, and Acne- 48%, Obesity, and Hirsutism- 45%, Irregular menses, and acne - 48% Irregular menses and hirsutism- 33%, Ultrasonographic findings, and acanthosis nigricans- 29.3%. Conclusions: There is a diversity in the presentation of chief complaints of PCOS patients. PCOS patients show a variety in the presentation of the history of metabolic syndromes and of PCOS in their families. They show cutaneous manifestations in the form of Acne, Hirsutism, and Acanthosis nigricans. PCOS patients mostly have moderate grades of hirsutism. Acne is present in almost half of PCOS patients even though most of them don't consider it as their chief complaint. Most of the participants who had increased BMI had Polycystic Ovarian Syndrome. Acanthosis is related to an increase in BMI. Very few patients include exercise in their daily routine. There is a significant correlation in PCOS patients between Irregular menses and infertility, Hirsutism and infertility, Ultrasonographic findings, and Acne as the chief complaint. Chief Complaints of Obesity and Chief Complaints of Hirsutism. Chief Complaints of irregular menses and Acne. Chief Complaints of Irregular menses and Hirsutism. Ultrasonographic findings and Acanthosis nigricans.

What Is the Impact of Body Mass Index Cutoffs on Total Hip Arthroplasty Complications?

BackgroundBody mass index (BMI) cutoffs are commonly utilized to decide whether to offer obese patients elective total hip arthroplasty (THA). However, weight loss goals may be unachievable for many, and some patients are thereby denied complication-free surgery. The purpose of this study was to assess the impact of varying BMI cutoffs on the rates of complication-free surgery after THA. MethodsPatients undergoing THA between 2015 and 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program database using Common Procedural Terminology code 27130. BMI and rates of 30-day complications were collected. BMI cutoffs of 30, 35, 40, 45, and 50 kg/m2 were applied to model the incidence of complications if THA would have been allowed to proceed based on BMI. ResultsA total of 192,394 patients underwent THA, and 13,970 (7%) of them had a BMI ≥40 kg/m2. With a BMI cutoff of 40 kg/m2, 178,424 (92.7%) patients would have proceeded with THA. From this set, 170,296 (95.4%) would experience complication-free surgery, and 11.8% of complications would be prevented. THA would proceed for 191,217 (99.3%) patients at a BMI cutoff of 50 kg/m2, of which 182,123 (95.2%) would not experience a complication, and 1.3% of complications would be prevented. Using 35 kg/m2 as the BMI cutoff would prevent 28.6% of complications and permit 75.9% of complication-free surgeries to proceed. ConclusionLower BMI cutoffs for THA can result in fewer complications although they will consequentially limit access to complication-free THA. Consideration of risks of obesity in THA may be best considered as part of a holistic assessment and shared decision-making when deciding on goals for weight reduction.

Risk factors of unplanned intraoperative conversion to hand-assisted laparoscopic surgery or open surgery in laparoscopic liver resection.

Laparoscopic liver resection (LLR) is possible in many patients, but pure LLR is sometimes difficult to complete, and unplanned intraoperative hand-assisted laparoscopic surgery (HALS) or open conversion is sometimes necessary. However, appropriate indications and timing for conversion are unclear. This study aimed to clarify the indications for HALS and open conversion from pure LLR. We collected data from 208 patients who underwent LLR from January 2010 to February 2021 in our department. We retrospectively examined these data between cases of unplanned intraoperative HALS conversion, open conversion, and pure LLR, and clarified risk factors and indications for HALS or open conversion. There were 191 pure LLRs, nine HALS conversions, and eight open conversions. In the HALS conversion group versus pure LLR group, body mass index (BMI) (27.0 vs. 23.7kg/m2, p = 0.047), proportions of patients with history of upper abdominal surgery (78% vs. 33%; p = 0.006), repeat hepatectomy (56% vs. 15%; p = 0.002), S7 or S8 tumor location (67% vs. 35%; p = 0.049), and difficulty score (DS) ≥ 7 (56% vs. 19%; p = 0.008) were significantly higher, and surgical time (339 vs. 239min; p = 0.031) was significantly longer. However, postoperative states were not significantly different between the two groups. The BMI cutoff value for risk of unplanned intraoperative conversion determined by receiver operating characteristic curve analysis was 25kg/m2, and the proportion of patients with BMI ≥ 25kg/m2 (89% vs. 31%, p < 0.001) was significantly higher in the HALS conversion versus pure LLR group. In the open conversion group, although there were no significant differences compared to the HALS group in clinicopathological factors except for sex, blood loss was greater (1425 vs. 367mL; p < 0.001). Risk factors for considering HALS during LLR were patients with a history of upper abdominal surgery including repeat hepatectomy, BMI ≥ 25kg/m2, S7 or S8 tumor location, DS ≥ 7, and prolonged surgical time. Furthermore, uncontrollable intraoperative bleeding was an indication for open conversion.

Prevalence of Obesity and Associated Risk Factors among Children and Adolescents in the Eastern Cape Province.

Obesity is a global public health concern that begins in childhood and is on the rise among people aged 18 and up, with substantial health consequences that offer socioeconomic challenges at all levels, from households to governments. Obesity and associated risk factors were investigated in children and adolescents in the Eastern Cape Province of South Africa. A cross-sectional study was conducted at Mt Frere among 209 conveniently selected participants using anthropometric measurements and a structured questionnaire. Chi-squared statistics or Fisher’s exact test were used to evaluate the risk factors predicting different outcomes such as hypertension or diabetes mellitus. A 5% level of significance was used for statistical significance (p-value 0.05). The prevalence of overweight or obesity among females when using waist circumference (2.7%), triceps skinfold (6.9%), and body mass index cut-offs (16.4%) were respectively higher when compared to those of males. About 89% engaged in physical activities. After school, 53% watched television. About 24.9% of participants did not eat breakfast. Most of overweight or obese participants (92.9%) brought pocket money to school. Use of single anthropometric measurements for assessing nutritional status indicated inconclusive results. Strengthening parental care, motivation for consumption of breakfast and limiting pocket money for children going to school are important steps to improve child health.

Anatomical and Neuromuscular Factors Associated to Non-Contact Anterior Cruciate Ligament Injury.

The majority of anterior cruciate ligament (ACL) injuries occur during non-contact mechanisms. Knowledge of the risk factors would be relevant to help prevent athletes’ injuries. We aimed to study risk factors associated with non-contact ACL injuries in a population of athletes after ACL reconstruction. From a cohort of 307 athletes, two populations were compared according to the non-contact or contact mechanism of ACL injury. Gender, age and body mass index (BMI) were reported. Passive knee alignment (valgus and extension), knee laxity (KT-1000 test), and isokinetic knee strength were measured on the non-injured limb. The relationship between these factors and the non-contact sport mechanism was established with models using logistic regression analysis for the population and after selection of gender and cut-offs of age, BMI and knee laxity calculated from Receiver Operating Characteristics curve area and Youden index. Age, BMI, antero-posterior laxity, isokinetic knee strength, passive knee valgus and passive knee extension were associated with non-contact ACL injury. According to the multivariate model, a non-contact ACL injury was associated with non-modifiable factors, age (OR: 1.05; p = 0.001), passive knee extension (OR: 1.14; p = 0.001), and with one modifiable factor (Hamstring strength: OR: 0.27; p = 0.01). For women, only passive knee valgus was reported (OR: 1.27; p = 0.01). Age, passive knee extension and weak Hamstring strength were associated with a non-contact ACL injury. Hamstring strengthening could be proposed to prevent ACL injury in young male athletes or in case of knee laxity.

Application of Institute of Medicine's Gestational Weight Gain Recommendations in Asian Population: A Scoping Review

Background. Gestational weight gain (GWG) is an important factor of the well-being of both mother and fetus. Latest recommendation by Institute of Medicine (IOM) was issued in 2009 based on women population in United States, and is classified based on World Health Organization (WHO) body mass index (BMI) cutoffs. Recommendation for Asian population is not currently available. This review aims to review the evidence of the application of said guidelines in Asian population. Method. Articles were searched using Google Scholar and PubMed. Articles published in 2016 or above, with single pregnancies and unlimited to pre-pregnancy BMI categories were selected. Of 1,239 potential articles, 29 were chosen for full-text screening and 9 were included in this review. Result. Mixed trends were found when assessing adequacy of GWG in relation to pre-pregnancy BMI. Article analyzing optimal GWG showed a higher and wider range compared to IOM. Inadequate GWG is associated with a higher risk of small for gestational age (SGA) while excessive GWG is associated with large for gestational age (LGA). Significant differences were found when different categorizations of BMI are used with IOM guidelines. Conclusion. Asian women rarely gain adequate weight by IOM standard. This might lead to increased risk of adverse pregnancy outcomes, such as SGA and LGA. Further researches are needed to study appropriate optimal GWG for Asian population, and/or to modify IOM guidelines to be applied better in Asian population.

Establishing a new body mass index cutoff value for malnutrition diagnosis using the Global Leadership Initiative on Malnutrition (GLIM) tool in Chinese older adults.

The body weight of the Chinese population rose rapidly over the past two decades. The old 2001 body mass index (BMI) cutoff value for malnutrition may underestimate malnutrition diagnosis. We explored the BMI cutoff value for malnutrition diagnosis based on national BMI data from the past 30 years and applied it to the Global Leadership Initiative on Malnutrition (GLIM) criteria when investigating malnutrition in hospitalized older patients. To explore the BMI cutoff value for malnutrition, we established a linear stepwise model to predict the annual increasing BMI trend based on data from the national BMI data set. The new cutoff value was applied to a large-scale data set from a cross-sectional study pertaining to older hospitalized patients recruited from 30 large hospitals in China. The BMI increased from 21.8 to 23 kg/m2 in two decades. We calculated that the net BMI increase will be 1.49 kg/m2 from 1999 to 2019. We subsequently proposed that the BMI cutoff value for malnutrition should rise to 20kg/m2 . This cutoff value was applied to the validation data set, containing 8725 patients, and the GLIM-determined malnutrition rate was 24.58% (using the Nutrition Risk Screening 2002 [NRS-2002]) and 23.32% (using the Mini Nutritional Assessment-Short Form [MNA-SF]). The results significantly differed from those obtained using the 2001 Chinese BMI criteria. The GLIM tool has good applicability in Asian populations, especially in Chinese older patients. The BMI cutoff value for malnutrition should be adjusted to 20 kg/m2 for Chinese adults.

Effect of obesity and metabolic health on urolithiasis: A nationwide population-based study.

PurposeTo investigate the risk of symptomatic urolithiasis requiring surgical treatment according to obesity and metabolic health status using a nationwide dataset of the Korean population.Materials and MethodsOf the 5,300,646 persons who underwent health examinations between the year 2009 and 2016, within one year after the health examination, 35,137 patients who underwent surgical treatment for urolithiasis were enrolled. Participants were classified as “obese” or “non-obese” using a body mass index (BMI) cutoff of 25 kg/m2. People who developed ≥1 metabolic disease component in the index year were considered “metabolically unhealthy”, while those with none were considered “metabolically healthy”.ResultsOut of 34,330 participants excluding 843 missing, 16,509 (48.1%), 4,320 (12.6%), 6,456 (18.8%), and 7,045 (20.5%) subjects were classified into the metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO) group, respectively. Mean BMI was 22.1±1.9 kg/m2, 22.9±1.6 kg/m2, 26.9±1.8 kg/m2, and 27.9±2.4 kg/m2 respectively. After adjusting the age and sex, the subjects in the MUNO group had an HR (95% CI) of 1.192 (1.120–1.268), those in the MHO group, 1.242 (1.183–1.305), and those in the MUO group, 1.341 (1.278–1.407) for either extracorporeal shockwave lithotripsy or surgery, compared to those in the MHNO group.ConclusionsMetabolically healthy, obese individuals have a higher risk of developing symptomatic urolithiasis than non-obese, unhealthy, but have a lower risk than obese, unhealthy. It suggests that metabolic health and obesity have collaborative effects, independently affecting the development of symptomatic urinary stone diseases.

Longitudinal study of body mass index and percentage of overweight in Japanese children grouped by maturity.

Childhood obesity is a known risk factor for adult diseases, making its evaluation highly important. However, the evaluation is complex because there is no gold standard method. Body mass index (BMI) and percentage of overweight (POW) are widely used in Japan. However, they have the following limitations: it is difficult to set cutoffs for BMI because it dynamically varies in childhood, and POW has not been studied extensively, especially regarding its difference during maturity. Therefore, our study analyzed BMI/POW in Japanese children grouped by maturity. We used longitudinal school check-up data collected from elementary and junior high schools in 20 municipalities. We made percentile curves of BMI/POW and calculated the percentage of participants considered overweight/obese by sex, age, and maturity. Maximum increment age (MIA) was calculated using the graphical fitting method. We included 35,461 subjects aged 15 in 2018. Early-maturing children had higher BMI. The difference among maturity groups decreased by shifting the percentile curves by differences in MIA. Therefore, the use of BMI might lead to the overestimation of overweight/obesity in early-maturing children and underestimation in late-maturing children. The POW percentile curves were "N"-shaped around the MIA, indicating the inappropriate evaluation during this period. The percentile curves of children categorized as overweight/obese were also "N"-shaped, confirming that MIA affects the evaluation of childhood obesity. The possibility of overestimation/underestimation needs verification with the data of accurate age, pubertal changes, and adult diseases. In conclusion, it is difficult to evaluate childhood obesity only with height and weight.

Body Mass Index and Diabetes Mellitus May Predict Poorer Overall Survival of Oral Squamous Cell Carcinoma Patients: A Retrospective Cohort From a Tertiary-Care Centre of a Resource-Limited Country.

Introduction:Oral squamous cell carcinoma (OSCC) is one of the highest-ranking cancers among both genders in Pakistan. Obesity is linked to a much higher risk for developing multiple cancer types. Individuals with Diabetes mellitus (DM) face an increased risk for developing oral cancer. Hence, the objective of this study was to identify the effect of obesity and DM on the prognosis of OSCC patients.Methods:This retrospective cohort analysis was conducted on 386 patients diagnosed and treated for OSCC at The Aga Khan University Hospital, Karachi, Pakistan. Patient information was obtained from hospital medical records. Obesity was defined as having a body mass index (BMI) of ⩾25 kg/m2 according to the WHO Asian cut-offs for BMI. Patient BMI was correlated with diabetes status, clinicopathological features and overall survival. Kaplan-Meier survival analysis was performed, along with univariate and multivariate cox regression analysis to test the effect of obesity and diabetes on overall survival.Results:In a set of 386 patients, there were 296 males (76.7%) and 90 females (23.3%). The mean BMI was 24.4 (SD ± 5.25) and 42.7% of patients were found to be obese (⩾25 BMI). 64 patients (16.6%) were diabetic. The risk of death was significantly higher in underweight patients (P = .035) compared with normal weight individuals. Diabetics had a higher mean BMI compared with non-diabetics. However, DM was not a statistically valid predictor of survival.Conclusion:Underweight OSCC patients were at a higher risk of death compared with normal weight OSCC patients.

Risk factors for cancer-specific survival in elderly gastric cancer patients after curative gastrectomy.

BACKGROUND/OBJECTIVESThis study aimed to investigate cancer-specific survival (CSS) and associated risk factors in elderly gastric cancer (EGC) patients.SUBJECTS/METHODSEGC patients (≥ 70 yrs) who underwent curative gastrectomy between January 2013 and December 2017 at our hospital were included. Clinicopathologic characteristics and survival data were collected. Receiver operating characteristic (ROC) analysis was used to extract the best cutoff point for body mass index (BMI). A Cox proportional hazards model was used to determine the risk factors for CSS.RESULTSIn total, 290 EGC patients were included, with a median age of 74.7 yrs. The median follow-up time was 31 (1–77) mon. The postoperative 1-yr, 3-yr and 5-yr CSS rates were 93.7%, 75.9% and 65.1%, respectively. Univariate analysis revealed risk factors for CSS, including age (hazard ratio [HR] = 1.08; 95% confidence interval [CI], 1.01–1.15), intensive care unit (ICU) admission (HR = 1.73; 95% CI, 1.08–2.79), nutritional risk screening (NRS 2002) score ≥ 5 (HR = 2.33; 95% CI, 1.49–3.75), and preoperative prognostic nutrition index score < 45 (HR = 2.06; 95% CI, 1.27–3.33). The ROC curve showed that the best BMI cutoff value was 20.6 kg/m2. Multivariate analysis indicated that a BMI ≤ 20.6 kg/m2 (HR = 2.30; 95% CI, 1.36–3.87), ICU admission (HR = 1.97; 95% CI, 1.17–3.30) and TNM stage (stage II: HR = 5.56; 95% CI, 1.59–19.43; stage III: HR = 16.20; 95% CI, 4.99–52.59) were significantly associated with CSS.CONCLUSIONSLow BMI (≤ 20.6 kg/m2), ICU admission and advanced pathological TNM stages (II and III) are independent risk factors for CSS in EGC patients after curative gastrectomy. Nutrition support, better perioperative management and early diagnosis would be helpful for better survival.