Body Mass Index Levels Research Articles

Abstract 4115222: Distinct Demographic, Cognitive, and Psychosocial Factors Associated with Different Types of Self-Care in Patients with Type 1 Diabetes and in Patients with Type 2 Diabetes

Background: Poor self-care in patients with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) leads to increased diabetes complications and health costs. While the goal of self-management for patients with T1DM and T2DM is to maintain normal blood glucose levels, the major methods for achieving this differ (exogenous insulin delivery vs. a combination of self-care techniques, respectively). This implies that factors associated with self-care in the two groups may differ. Hypothesis: Distinct demographic, cognitive, and psychosocial factors are associated with overall self-care, diet, exercise, blood glucose testing, foot care, and smoking in patients with T1DM and T2DM, in separate models. Methods: In this cross-sectional, correlational study, data were collected from 148 patients with T1DM (n = 64, mean age: 51.3 years) or T2DM (n = 84, mean age: 62.5) using REDCap during 2023. The participants were recruited from various organizations, institutions, and ResearchMatch in the United States. Several multiple regression analyses were done to test the hypothesis. Results: Patients with T1DM had better self-care, including overall diabetes self-care, exercise, and blood glucose testing than the T2DM group. Older age (p = .003), lower body mass index (BMI) (p = .040), and stronger knowledge (p = .028) in the T1DM group (F[10,53]= 2.290, p = .026, R 2 = .302), while lower BMI (p = .045) and higher levels of self-efficacy (p < .001) in the T2DM group were associated with better overall diabetes self-care (F[10,73] = 3.219, p = .002, R 2 = .306). Older age, lower BMI, stronger knowledge, stronger resilience, and lower self-esteem were associated with better self-care in diet, blood glucose testing, and/or foot care in the T1DM group, while lower BMI, stronger knowledge, higher levels of self-efficacy, and less severe depressive symptoms were associated with better self-care in diet, exercise, and/or blood glucose testing in the T2DM group. None were associated with smoking in both groups. Diabetes distress, self-compassion, and social support were not associated with any types of self-care. Conclusions: Factors associated with self-care differed based on types of self-care and types of diabetes, thus, supporting the hypothesis. When healthcare providers provide interventions to improve diabetes self-care in individual patients with diabetes, they need to consider types of diabetes, types of self-care, and distinct factors associated with each type of self-care.

Investigating the Effects of Gossypetin on Cardiovascular Function in Diet-Induced Pre-Diabetic Male Sprague Dawley Rats

Gossypetin (GTIN) is a naturally occurring flavonoid recognised for its pharmacological properties. This study examined the effects of GTIN on cardiovascular function in a diet-induced pre-diabetic rat model, which has not been previously studied. Pre-diabetes was induced using a high-fat high-carbohydrate (HFHC) diet supplemented with 15% fructose water for 20 weeks. Thereafter, the pre-diabetic animals were sub-divided into five groups (n = 6), where they were either orally treated with GTIN (15 mg/kg) or metformin (MET) (500 mg/kg), both in the presence and absence of dietary intervention for 12 weeks. The results demonstrated that the pre-diabetic (PD) control group exhibited significantly higher plasma triglyceride, total cholesterol, low-density lipoprotein and very low-density lipoprotein levels, along with decreased high-density lipoprotein (HDL) levels in comparison to the non-pre-diabetic (NPD) group. This was accompanied by significantly higher mean arterial pressure (MAP), body mass index (BMI), waist circumference (WC) and plasma endothelial nitric oxide (eNOS) levels in PD control. Additionally, there were increased heart malondialdehyde levels, reduced heart superoxide dismutase and glutathione peroxidase activity as well as increased plasma interleukin-6, tumour necrosis factor alpha and c-reactive protein levels present in the PD control group. Notably, both GTIN-treated groups showed significantly reduced plasma lipid levels and increased HDL, as well as decreases in MAP, BMI, WC and eNOS levels in comparison to PD control. Additionally, GTIN significantly decreased heart lipid peroxidation, enhanced antioxidant activity and decreased plasma inflammation markers. These findings may suggest that GTIN administration in both the presence and absence of dietary intervention may offer therapeutic potential in ameliorating cardiovascular disturbances associated with the PD state. However, future studies are needed to determine the physiological mechanisms by which GTIN improves cardiovascular function in the PD state.

Prediction of Fragility Fractures and Mortality in a Cohort of Geriatric Patients.

Risk factors of refracture after fragility fractures include osteoporosis, female gender and advanced age among others. We hypothesized that the assessment of functionality, muscle health and nutrition status contribute to the risk prediction for further fractures and death. We assessed 334 patients admitted to the department of acute geriatrics for sociodemographic data, bone fragility, selected laboratory tests, body composition and data on functionality using the comprehensive geriatric assessment. Patients had follow-ups until the occurrence of further fractures or death. Dual-energy X-ray absorptiometry and pulse echo measurements were performed to assess bone mineral density. Fracture risk was assessed using the FRAX score and muscle strength according to published guidelines on sarcopenia. The mean age was 81 years (70-95), and 82.3% (275/334) were women. An incidence of 10.4% (35/334) new fragility fractures was observed within 24 months, and the mortality rate was 12.2% (41/334). A significantly higher rate of further fractures was associated with lower BMI (body mass index) (HR 0.925, CI 0.872-0.98; p = 0.009), lower parathyroid hormone levels (HR 0.986, CI 0.973-0.998; p = 0.026) and with the diagnosis of osteoporosis (HR 2.546, CI 1.192-5.438; p = 0.016). No significant associations were present in patients with previous fractures, with higher age, higher FRAX scores, sarcopenia, in women, sarcopenic obesity, frail patients, lower grip strength, lower walking speed, lower Barthel index or lower DI (density index) values. The predictive power for further fractures was 10.7% higher adding osteosarcopenia, BMI and parathyroid hormone levels to standard assessment parameters osteoporosis, age and the status of previous fractures. Mortality was significantly higher with advanced age (HR 1.101, CI 1.052-1.151; p < 0.001), in men (HR 6.464, CI 3.141-13.305; p < 0.001), in smokers (p = 0.002), higher FRAX score (HR 1.039, CI 1.009-1.070; p = 0.010), lower renal function (HR 0.987, CI 0.976-0.997; p = 0.010), lower Tinetti test scores (HR 0.943, CI 0.900-0.987; p = 0.012), lower walking speed (HR 0.084, CI 0.018-0.382; p = 0.001), lower hand grip (HR 0.876, CI 0.836-0.919; p < 0.001) and lower Barthel index scores (HR 0.984, CI 0.971-0.997; p = 0.015). In a cohort of geriatric patients, the addition of BMI, low parathyroid hormone levels and osteosarcopenia increases the predictive power for further fractures by 10.7%. These parameters are a valuable addition to the standard assessment parameters age and history of sustained fractures. Mortality is partly associated with potentially treatable functional parameters.

The Incidence and Predictive Factors of Thromboembolism During Hospitalizations for Inflammatory Bowel Disease Flare-Ups: A Retrospective Cohort Study in Taiwan.

Thromboembolism (TE) notably increase morbidity and mortality among inflammatory bowel disease (IBD) patients. Despite ECCO's 2024 guidelines advocating routine anticoagulant prophylaxis, its application in Asia remains inconsistent due to a lack of regional studies. This research investigates the incidence and predictors of TE during IBD-related hospitalizations in Taiwan, aiming to improve prevention strategies. Our retrospective cohort study included 282 adult IBD patients, accounting for 515 flare-up related hospitalizations at Linkou Chang Gung Memorial Hospital from January 2001 to March 2024. Patients were classified into two groups based on the occurrence of TE. The incidence of TE was 1.55%. The TE group had significantly lower body weight, body mass index (BMI), hemoglobin and albumin levels but higher rate of sepsis and concurrent autoimmune diseases compared to the non-TE group. Multivariate analysis indicated that concurrent autoimmune diseases and hypoalbuminemia were independent predictors of TE. The optimal serum albumin cutoff was established at 3.01 g/dL, with sensitivities and specificities of 87.5% and 77.3%, respectively. This pioneering Asian study identifies concurrent autoimmune diseases and low serum albumin as key predictors of TE in hospitalized IBD patients. We recommend targeted anticoagulant prophylaxis for IBD patients with these risk factors, especially when serum albumin falls below 3.01 g/dL.

Establishing a Female Animal Model of Prediabetes Using a High-Carbohydrate, High-Fat Diet

Prediabetes is a condition that often precedes the onset of type 2 diabetes and is characterized by moderate levels of insulin resistance. This condition is well established in male animal models for diabetes; however, few female models exist. There is accumulating evidence that sex variations affect the pathogenesis, treatment, and consequences of numerous diseases, such as type 2 diabetes. Therefore, we sought to develop a diet-induced prediabetic female animal model to better understand prediabetes development and its effects in females. Female Sprague Dawley rats were randomly allocated to one of two groups: the standard diet (SD) group fed a standard diet with normal drinking water, and the high-carbohydrate, high-fat (HCHF) group fed a high-carbohydrate and high-fat diet with drinking water supplemented with fructose. During induction, we measured food intake, body weight, body mass index (BMI), and oral glucose tolerance response (OGT). After the induction period, biochemical analyses were conducted to assess the levels of plasma leptin, ghrelin, insulin, and glycated hemoglobin (HbA1c). Glycogen concentrations were quantified in the liver and skeletal muscles. The HCHF diet-fed group presented higher body weight gain, food intake, and BMI levels, which were accompanied by elevated plasma insulin, ghrelin, and liver and skeletal muscle glycogen levels compared to the SD-fed group. In the HCHF diet-fed group, the HOMA-IR was above 1.9, suggesting the presence of moderate levels of insulin resistance. The OGT response was significantly higher in the HCHF-fed group versus the SD-fed group, suggesting impaired glucose tolerance, thus displaying the signs and symptoms of prediabetes. The HCHF diet with fructose led to the induction of prediabetes in female Sprague Dawley rats. This model could be used to investigate and outline the pathophysiological complications associated with prediabetes in females as a result of the prolonged ingestion of a high carbohydrate, high-fat diet with fructose. The development of this model could also serve as an effort to further bridge the gap regarding the inclusion of females in biomedical research, thus providing advancements in deriving better, specified treatment strategies for women.

Role of Peripheral and Central Insulin Resistance in Neuropsychiatric Disorders

Insulin acts on different organs, including the brain, which helps it regulate energy metabolism. Insulin signaling plays an important role in the function of different cell types. In this review, we have summarized the key roles of insulin and insulin receptors in healthy brains and in different brain disorders. Insulin signaling, as well as insulin resistance (IR), is a major contributor in the regulation of mood, behavior, and cognition. Recent evidence showed that both peripheral and central insulin resistance play a role in the pathophysiology, clinical presentation, and management of neuropsychiatric disorders like Cognitive Impairment/Dementia, Depression, and Schizophrenia. Many human studies point out Insulin Resistance/Metabolic Syndrome can increase the risk of dementia especially Alzheimer’s dementia (AD). IR has been shown to play a role in AD development but also in its progression. This review article discusses the pathophysiological pathways and mechanisms of insulin resistance in major neuropsychiatric disorders. The extent of insulin resistance can be quantified using IR biomarkers like insulin levels, HOMA-IR index, and Triglyceride glucose–body mass index (TyG–BMI) levels. IR has been shown to precede neurodegeneration. Human trials showed current treatment with certain antidiabetic drugs, as well as life style management, like weight loss and exercise for IR, have shown promise in the management of cognitive/neuropsychiatric disorders. This may pave the pathway to the development of new therapeutic approaches to these challenging disorders of dementia and psychiatric diseases. Recent clinical trials are showing some encouraging evidence for these pharmacological and nonpharmacological approaches for IR in psychiatric and cognitive disorders, even though more research is needed to apply this evidence into clinical practice. Early identification and management of IR may help as a strategy to potentially alter neuropsychiatric disorders onset as well as its progression

Comparison Between Billroth II and Billroth II + Braun Anastomosis in Gastrectomy for Gastric Cancer

IntroductionDistal gastrectomy remains the predominant therapeutic approach for gastric cancer, with digestive tract reconstruction as an integral procedure. The implementation of Braun anastomosis following Billroth II anastomosis is common in distal gastrectomy. This retrospective cohort study evaluated the clinical utility of Braun anastomosis by comparing the outcomes and quality of life between Billroth II (B-II) and Billroth II with Braun (B-IIB) anastomosis in the treatment of gastric cancer. MethodsA retrospective cohort study examined clinical and pathological data from 377 patients who underwent distal gastrectomy for gastric cancer treatment at The Affiliated Lihuili Hospital, Ningbo University, from October 2016 to October 2021.185 patients received B-II anastomosis, while the other 192 received B-IIB anastomosis, forming the B-II and B-IIB groups, respectively. Baseline characteristics, perioperative variables, short-term and long-term complications, and nutritional indicators at 1 mo and 1 y postsurgery were compared across both groups. Additionally, gastric endoscopy results at 6 mo and 1 y postsurgery were evaluated. Quality of life at 1 y postsurgery was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30. ResultsBaseline characteristics between the two groups revealed no statistically significant differences (all P > 0.05), confirming their equivalence. All 377 patients successfully underwent curative distal gastrectomy for gastric cancer without intraoperative procedural modifications. No intraoperative complications or perioperative mortality occurred. Notable differences included extended operative time (222.1 ± 41.0 vs. 199.4 ± 24.9 min, P < 0.001), reduced postoperative nasogastric tube removal time (1.8 ± 0.9 vs. 2.2 ± 1.1 d, P < 0.001), decreased average gastric drainage volume (100.7 ± 35.2 vs. 112.2 ± 32.0 mL, P = 0.001), and increased incidence of internal hernia and ileus (4.7% vs. 1.1% and 8.3% vs. 3.2%, P = 0.038 and P = 0.035) in the B-IIB group compared to the B-II group. No significant differences were observed in estimated blood loss, lymph node dissection, postoperative flatus time, transition to a semiliquid diet, length of hospital stay, or short-term and long-term complications (all P > 0.05). Nutritional assessments conducted 1 mo and 1 y postsurgery indicated no statistically significant differences in body mass index, total protein, and serum albumin levels between the two groups (all P > 0.05). Gastric endoscopy evaluations at 6 mo and 1 y postsurgery, including food residue grade, gastritis severity, extent of gastritis, and bile reflux, demonstrated no significant discrepancies between the groups (all P > 0.05). At the 1-y follow-up, neither group exhibited tumor recurrences, deaths from tumor-related diseases, postoperative complications, or other diseases. Additionally, quality of life assessments using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core revealed no significant differences across various domains or items between the groups (all P > 0.05). ConclusionsA comparative analysis between B-II and B-IIB anastomosis demonstrated no notable variations in intraoperative parameters, postoperative nutritional outcomes, gastric endoscopic results, or postoperative quality of life. Nevertheless, incorporating Braun anastomosis can extend the duration of surgery and may elevate the likelihood of postoperative internal hernia.

The association of vitamin D insufficiency with the prevalence of obesity in children: implications for serum calcium levels, alkaline phosphatase activity, and bone maturation

BackgroundVitamin D deficiency has been identified as a potential risk factor for various adverse health outcomes. However, its specific role in metabolic regulation and skeletal development in school-aged children is not fully understood. This study aimed to explore the correlation between vitamin D deficiency and childhood obesity rates, and its impact on serum calcium, alkaline phosphatase, and bone age in children.MethodsThe study analyzed clinical data from 159 school-aged children who underwent medical examinations. Participants were divided into the 25-hydroxyvitamin D3 (25(OH)D3) deficiency group and the 25(OH)D3 normal group based on their serum levels. We compared body mass index (BMI), total cholesterol (TC), triglycerides (TG), Ca, ALP, bone age, fasting blood glucose (FBG), and hemoglobin A1c (HbA1c) between the two groups. Logistic regression and Spearman correlation analyses were performed to further investigate relationships between 25(OH)D3 levels and metabolic and bone-related markers.ResultsThis study showed that the 25(OH)D3 deficiency cohort exhibited significantly higher BMI, TC, TG, and ALP levels, with lower Ca levels and delayed bone age compared to the normal group. Logistic regression analysis identified Ca, ALP, and bone age as significant predictors of 25(OH)D3 deficiency. Subgroup analysis showed that in the 25(OH)D3 deficient group, children with higher BMI had elevated TC, ALP levels, and delayed bone age, while Ca levels were lower. Correlation analysis confirmed the predictive value of these markers for 25(OH)D3 deficiency.ConclusionOur findings demonstrate that 25(OH)D3 deficiency is strongly associated with obesity in school-aged children and may negatively affect normal skeletal development. Regular monitoring of 25(OH)D3 levels in school-aged children is essential for ensuring proper growth and development, especially in those at risk for obesity.

Resting Heart Rate and Incident Atrial Fibrillation in Black Adults in the Jackson Heart Study

Resting heart rate (RHR) is a widely available measure of cardiovascular fitness that has been associated with several cardiovascular outcomes. RHR has previously been associated with the risk of atrial fibrillation (AF) among individuals of European ancestry, but little is known about this association in Black adults. To evaluate the association between RHR and incident AF in a large community-based sample of Black adults, independently of established risk factors. This cohort study uses data from the Jackson Heart Study, a prospective community-based cohort in Jackson, Mississippi. Participants without prevalent AF were included and were monitored for new-onset AF during follow-up, from 2000 through 2016. Data analysis was performed from August 1 to December 11, 2023. RHR was assessed from resting 12-lead electrocardiograms performed at examination 1 (2000-2004) and examination 3 (2009-2013). AF was identified from study electrocardiograms, hospitalization discharge diagnosis codes, and Medicare claims diagnosis codes. Cox regression was used to evaluate the association between baseline (examination 1) RHR and incident AF, adjusting for established AF risk factors. Among 4965 Black adults eligible for analysis, the mean (SD) age was 55 (13) years, 1830 (37%) were male, and the mean (SD) RHR at baseline was 65 (11) beats per minute (bpm). During a median (IQR) 14 (12-15) years of follow-up, there were 458 incident AF events, resulting in an incident rate of 7.5 per 1000 person-years (95% CI, 6.8-8.2 incidents per 1000 person-years). Each 10-bpm higher RHR was associated with a 9% higher risk of incident AF after adjustment for AF risk factors (hazard ratio, 1.09; 95% CI, 1.00-1.19). In a sensitivity analysis that excluded individuals with prior heart failure, prior myocardial infarction, and antiarrhythmic medication use at baseline, the hazard ratio was 1.14 (95% CI, 1.02-1.28). There was little evidence of effect modification of these associations by age, sex, body mass index, hypertension, or physical activity level. In this large prospective cohort study of Black adults, elevated baseline RHR was associated with increased risk of incident AF, consistent with findings from previous studies of European ancestry populations. Future research should focus on determining whether RHR can be used to screen patients at high risk of AF.

Evaluation of Eating Behavior in Children with Psoriasis: Retrospective Cross Sectional Study

Background. Patients with psoriasis have increased thickness of visceral fat, including epicardial adipose tissue (EAT) that has wide spectrum of biological effects. Its thickness can be affected by the presence of obesity and eating behavior (EB) changes. Studying the associations between EB and markers of adipose tissue functional activity in children with psoriasis may help to better understand this variables correlations in the scope of comorbidities. Objective. Aim of the study is to analyze the relationship between Psoriasis Area and Severity Index (PASI), Children’s Dermatology Life Quality Index (CDLQI), EAT thickness, and leptin levels in pediatric patients with psoriasis and EB disorders. Methods. Retrospective cross sectional single-center study was conducted. 72 medical records of children with psoriasis (with varying body mass index level) who were examined and treated in dermatology department in the period from December 2021 to January 2024. All included patients have underwent dietician consultation and survey with DEBQ and CEBQ questionnaires, as a result predominant EB type was determined. EAT thickness (via two-dimensional echocardiography) and leptin levels were also measured. Psoriasis severity was evaluated via PASI and CDLQI indices. Patients were divided into three groups: with external, emotiogenic, and restrictive EB. The medians of the obtained values were calculated with determination of the confidence interval, all results were compared with each other via Kruskall-Wallis test. Results. Group of patients with external EB has shown following results: median EAT thickness was 2.5 mm (Q1–Q3: 2.1–2.8), median leptin level — 17.3 ng/ml (Q1–Q3: 14.4–26.4), median of PASI — 17 points (Q1–Q3: 12.5–20.5), median of CDLQI — 7 points (Q1–Q3: 4–13.5). Group of patients with emotionogenic EB has median EAT thickness of 2.2 mm (Q1–Q3: 1.85–2.55), median leptin level — 20.1 ng/ml (Q1–Q3: 14.5–23.95), median of PASI — 14 points (Q1–Q3: 12–16.5), median of CDLQI — 6 points (Q1–Q3: 3–12). Group of patients with restrictive EB has median EAT thickness of 3.4 mm (Q1–Q3: 3.1–3.9), median leptin level — 28.2 ng/ml (Q1–Q3: 26.1–33.5), median of PASI — 24 points (Q1–Q3: 21–27), median of CDLQI — 13 points (Q1–Q3: 9–21). Statistically significant (p = 0.0014) increase in PASI and CDLQI points was observed at comparison of different groups via Kruskall-Wallis test. Patients from restrictive EB group have shown higher values of EAT thickness, leptin levels, PASI, and CDLQI scores compared to patients with emotionogenic and external EB. No statistically significant differences were observed when comparing leptin levels and EAT thickness in the remaining groups. Conclusion. Patients with restrictive EB had higher PASI and CDLQI scores compared to patients with emotionogenic and external EB. No statistically significant differences were observed when comparing EAT thickness and leptin levels. Small study sample was the only research limitation.

Severe Hyporesponsiveness to Erythropoiesis-Stimulating Agents in Patients on Chronic Hemodialysis—Reconsidering the Relationship with Thrombo-Inflammation and Oxidative Stress

Background/Objectives: Besides a multitude of consequences patients on chronic renal replacement therapy have, anemia is one of the most prominent factors making a significant number of patients dependent on erythropoiesis-stimulating agent (ESA) therapy. The aim of this study was to examine the relationship between the levels of a broad spectrum of thrombo-inflammatory and oxidative stress-related biomarkers and the presence and level of ESA hyporesponsiveness in patients undergoing regular chronic hemodialysis. Methods: This cross-sectional study included 96 patients treated with chronic hemodialysis. Levels of several thrombo-inflammatory and oxidative stress-related biomarkers, as well as demographic, clinical, and laboratory analyses, were collected and analyzed based on the calculated value of the ESA-hyporesponsiveness index (EHRI). Results: In the analyzed sample, 58 patients received ESAs. Of all the investigated parameters, only body mass index (BMI), level of plasminogen activator inhibitor-1, and level of L-type fatty acid binding protein (L-FABP) were observed as significant predictors of EHRI. A significant diagnostic potential for ESA resistance has been observed in BMI and L-FABP between ESA-resistant and ESA-non-resistant groups of patients (p = 0.004, area under the curve 0.763 and p = 0.014, area under the curve 0.712, respectively) with the cut-off values of 25.46 kg/m2 and 5355.24 ng/mL, respectively. Having a BMI of 25.46 kg/m2 or less and an L-FABP level higher than 5355.24 ng/mL were observed as significant predictors of ESA resistance (odds ratio 9.857 and 6.125, respectively). Conclusions: EHRI was positively predicted by low BMI and high levels of plasminogen activator inhibitor-1 and L-FABP. High levels of L-FABP and low BMI have been observed as strong predictors of ESA resistance.

Blood Pressure Decreases in Overweight Elderly Individuals on Vitamin D: A Randomized Trial

Abstract Context Evidence for a beneficial role of vitamin D on blood pressure (BP) outcomes is inconclusive. Objective This work aimed to investigate the effect of 2 doses of cholecalciferol (vitamin D3) supplementation coadministered with calcium on systolic blood pressure (SBP) and diastolic blood pressure (DBP). Methods Exploratory analyses were conducted from a 1-year, multicenter, double-blind, randomized controlled trial (RCT). Total of 221 ambulatory older overweight individuals received calcium dose and oral vitamin D3, at the equivalent of 600 IU/day or 3750 IU/day. Results SBP and DBP decreased significantly in the overall group, and in the high-dose group at 6 and 12 months. Similar trends were observed in the low-dose group, but did not achieve statistical significance. In participants with a body mass index (BMI) greater than 30, SBP decreased significantly in both treatment groups whereas DBP significantly decreased in the high-dose group only. In the subgroups of hypertensive participants (N = 143), there was a decrease in SBP and DBP at 6 and 12 months, with both vitamin D doses and independently of BMI levels. Using multivariate linear mixed models with random effects in the overall group of participants, SBP at 6 and 12 months was significantly predicted by BMI (β = .29; P = .05) and by baseline SBP (β = .16; P &amp;lt; .001), but not by vitamin D treatment dose. Conclusion Vitamin D and calcium decrease SBP and DBP in overweight older individuals, but more is not necessarily better. This effect is seen in individuals with BMI greater than 30, in hypertensive patients, and seems to be largely independent of dose.

Evidence of association between gender and physical fitness in physically active people in Colombia

Abstract Background Physical Condition (PC) is an important health marker (Colley, 2019), as a predictor of morbidity and mortality from cardiovascular diseases, among other causes (Cruz, 2018). Aim To perform association tests between gender (G) and CP in physically active people in Colombia. This study is observational cross-sectional, 1,503 people participated, 1,019 Women (W) (68.6%) and 485 Men (M) (31.4%) in Colombia, mean age 52±16.2 in W and 42±17.8 in M. Data were analyzed with Rstudio v2022.12.0. The statistical protocol was: 1- Empirical distribution. 2- Normality tests with Kolmogorov-Smirnov. 3- Tests of independence with Chi-square (χ²). The mean (X¯), percentage (%) and standard deviation (±) were taken into account. PC was measured in body composition variables; Body Mass Index (BMI), Body Adiposity Index (BAI) and Abdominal Circumference (AC), Grip Strength (GS) and Maximal Oxygen Consumption (Vo2max). Results In W, 38.3% (27.2±1.37) were overweight (Ow) and 19.1% (33.0±2.83) obese (Ob), 69.6% (90.9±8.14) cardiovascular risk (CVR) for AC and 50.4% (32±4.73) risk for BAI. Regarding GS 43.4% (15.8±6.38) is weak and 54.6% (27.7±4.98) Vo2max is low. In M 35.6% (26.9±1.48) presented Ow and 10.6% (32.7±2.39) in Ob, 39.7% (98.4±6.8) with Rcv by AC and 24.3% (29.7±3.45) at risk by BAI. As for GS 41.5% (27.1±6.39) are weak and 32.3% (33.3±6.33) under Vo2max. According to independence tests with χ² there is association between the G and BMI (χ²=1452.1, df = 1427, p-value=0. 315), G and AC (χ²=394.9, df = 382, p-value=0. 313), G and Vo2max (χ²=155.5, df = 6, p-value&amp;lt;2. 2e-16), G and BAI (χ²=2970.3, df = 1502, p-value&amp;lt;2.2e-16), G and GS (χ²=6015.5, df = 1502, p-value&amp;lt;2.2e-16). This project has been approved by the bioethics committee. Conclusions Test of independence with (χ²), being a non-homogeneous sample, there is a strong association between G and PC with BMI, BAI, AC, GS and Vo2max, each variable depending on the others, evidencing higher Rcv in women with respect to men. Key messages • Several studies consider Physical Condition (PC) is an important health marker (Colley, 2019), as a predictor of morbidity and mortality of cardiovascular disease, among other causes (Cruz, 2018). • There is a strong association between G and the levels of BMI, BAI, AC, SG and Vo2max variables, each variable depending on the others, showing a higher Rcv in women compared to men.

Extent and impact of obesity in patients with diabetes and acute myocardial infarction - experience from a national cohort

Abstract Background Elevated body mass index (BMI) has an adverse effect on cardiovascular riskfactors where diabetes and coronary artery disease increases with obesity. However, less in known about the prevalence and the grades of obesity in a diabetes population with acute myocardial infarction (AMI) and the impact on prognosis. Further, for the moment there is a shortage of access to cardioprotective weight loss medications as Glucagon Like Peptide Receptor Agonists (GLP-1 RA). Purpose To explore features and grades of obesity in patients with diabetes and AMI and impact on outcome in a national perspective. Methods All patients with diabetes and AMI admitted for coronary angiography in Sweden the years 2010-2021 were included. Information on BMI was collected at the time of angiography and grouped into obesity categories: low BMI (&amp;lt;18.5 kg/m2), normal BMI (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), obesity grade 1 (30.0-34.9 kg/m2), obesity grade 2 (35.0-39.9 kg/m2) and obesity grade 3 (≥40.0 kg/m2). Information on baseline characteristics and outcome was collected from national registries. Mortality was followed until March 2022. Restricted cubic spline analysis of association between continuous BMI and age-adjusted mortality was performed where normal BMI served as a reference with Hazard Ratio (HR) 1.0. Results Of 19 378 patients with diabetes, 67% were men and 46% suffered a STEMI. Normal BMI was present in 21%, overweight in 41%, obesity grade 1 in 25%, obesity grade 2 in 9% and obesity grade 3 in 3% (Figure 1). Age was decreasing with grade of obesity (72 years in normal BMI vs. 62 years in obesity grade 3, p&amp;lt;0.001). Hypertension and hyperlipidaemia were more common in patients with more severe obesity than in those with normal BMI (67% vs. 80%, p&amp;lt;0.001, and 44% vs. 50%, p&amp;lt;0.001, in normal BMI and obesity grade 3 respectively) while a higher proportion of those with normal BMI had suffered a previous MI (10% vs. 6% in obesity grade 3, p&amp;lt;0.001) and a previous stroke (10% vs. 5% in obesity grade 3, p&amp;lt;0.001). In patients with normal BMI STEMI was more common (51% vs. 39%, p&amp;lt;0.001) than in those with obesity grade 3. In patients with obesity grade 3 GLP-1 RA was used in 14% compared to 4% in those with normal BMI. Figure 2 depicts age-adjusted HR and 95% Confidence Interval for mortality for different BMI levels with a U-shaped pattern illustrating that associated mortality risk is higher when obesity is present especially grade 2 and 3. Conclusion Obesity is common affecting around one third of patients with diabetes and AMI and impacts survival. This strengthens that after AMI use of effective weight loss cardioprotective treatment should be prioritised in patients with diabetes and obesity especially if severe.

Effect of body mass index on mortality for diabetic patients with aortic stenosis

Abstract Background Several studies suggest an "obesity paradox," associating obesity with better cardiovascular outcomes compared to normal or underweight individuals (1-3). Purpose This study explores the impact of body mass index (BMI) on mortality in patients with diabetic mellitus (DM) and aortic stenosis (AS). Methods This is a retrospective cohort study conducted at a tertiary centre. Between 2014 and 2019, patients with DM who underwent echocardiography were screened (4). Patients were enrolled if AS was diagnosed, according to established guidelines (5). Two echocardiography specialists independently reviewed the echocardiography in the cohort. The index date of the DM-AS cohort was the first AS diagnosis by echocardiography, and detailed data collection methods are described in previous studies (6,7). Patients were categorized as underweight, normal weight, or obese based on BMI (&amp;lt;18.5, 18.5 to 27, and &amp;gt;27 kg/m2, respectively). Outcomes included all-cause mortality, cardiovascular, and non-cardiovascular death, which were adjudicated by a central committee. The occurrence times of the outcomes of interest were determined using diagnosis codes from electronic health records, and medical records were reviewed until the last clinical visit or death. Results Among 74,835 DM patients, 734 had AS. Normal weight comprised 65.5% (n=481), underweight 4.1% (N=30), and 30.4% were obese. With a median follow-up time of 34 months, 285 patients (38.8%) experienced outcomes of death, comprising 93 patients (32.7%) with cardiovascular death and 192 patients (67.3%) with non- cardiovascular death. Underweight patients had significantly higher all-cause mortality (HR 1.96, 95% CI 1.22 – 3.14, p = 0.005), while obese patients had significantly lower mortality (HR 0.79, 95% CI 0.68 - 0.91, p=0.001) compared to the normal group. Regarding etiologies, underweight patients had a higher risk of non- cardiovascular death (HR 2.47, 95% CI 1.44-4.25, p = 0.001), while obese patients had a lower risk of cardiovascular death (HR 0.66, 95% CI 0.50-0.86, p=0.003). Subgroup analysis showed a consistent trend without significant interaction. To elucidate the interaction of BMI as a continuous variable with outcomes, restricted cubic spline analysis was applied. Cardiovascular death showed a negative association with BMI across available BMI levels, and non-cardiovascular death exhibited a U curve, with the lowest hazard ratio occurring when BMI was between 25 to 30. Conclusion Our study underscored the significance of both cardiovascular and non-cardiovascular deaths as crucial contributors to overall mortality in DM patients with AS. Being underweight is associated with increased non- cardiovascular death, while obesity is linked to less cardiovascular death. Proposed mechanisms include reduced frailty, enhanced tolerance to guideline-directed medical therapies (GDMTs), and heightened disease awareness in the obese group (8,9).Kaplan–Meier analysis for outcomesAssociation between BMI and outcomes

Effects of SGLT-2i and GLP-1RA in vascular function parameters: the impact of the weight loss

Abstract Background Arterial stiffness and endothelial function markers flag increased cardiovascular disease risk in patients with type 2 Diabetes Mellitus (T2DM), while weight management plays a crucial role for the management of glycemic control and prevention of complications in these patients. Purpose To investigate the effects of novel antidiabetic agents on arterial stiffness and endothelial function as well as the metabolic parameters of HbA1c and Weight in T2DM patients. Patients and Methods: We enrolled 99 consecutive patients under stable antidiabetic therapy who did not reach therapeutic targets. Subjects were assessed to receive an additional antidiabetic agent to optimize glucose control; glucagon like peptide-1 receptor agonist (GLP-1RA, n=50) or sodium/glucose cotransporter-2 inhibitor (SGLT-2i, n=49). Glycosylated hemoglobin (Hba1c) and weight expressed through Body Mass Index (BMI) along with carotid-femoral pulse wave velocity (PWV) and flow-mediated dilatation (FMD), as biomarkers of arterial stiffness and endothelial function accordingly, were measured at baseline and 3 months after treatment intensification. Results There were no differences between the study groups in traditional risk factors of age and sex or baseline HbA1c, BMI, PWV, and FMD levels (ps=NS for all). In both groups PWV values displayed a statistically significant improvement from 11.2±2.5 to 9.3±2.2 m/sec (p&amp;lt;0.001) in the GLP-1RA group and from 10.7±2.4 to 8.9±2.0 m/sec (p=0.001) in the SGLT-2i group, as presented in Figure 1 through the differences in the values of PWV. FMD values were also significantly improve in both groups from baseline to follow-up; from 6.04±1.22 to 6.50±1.26% (p&amp;lt;0,001) for the GLP-1RA group and from 6.38±1.21 to 6.81±1.29% (p&amp;lt;0.001) for the SGLT-2i group. Moreover, both groups achieved better weight management goals in terms of BMI values between baseline and follow-up; from 33.6±4.9 to 31.5±4.6 kg/m2 for the GLP-1RA group (p&amp;lt;0.001) and from 31.8±5.5 to 30.5±5.6 kg/m2 for the SGLT-2i group (p&amp;lt;0.001), in addition to achieving better glycemic control in terms of HbA1c values, as seen in their paired differences: for GLP-1RA: 1.3±0.7% and for SGLT-2i: 0.8±0.5%. Interestingly, in the SGLT-2i group the magnitude of the PWV improvement was correlated with the weight loss (r=0.368, p=0.007). Conclusion These data provide evidence that the newer antidiabetic drugs, both GLP1-RA and SGLT-2i, have actions that benefit both vascular function, endothelium as well as metabolic parameters. Interestingly, in the patients receiving SGLT-2i the magnitude of the PWV improvement was correlated with the weight loss.delta PWV for SGLT-2i &amp; GLP-1RA groupsCorrelation of deltaWeight &amp; deltaPWV

Assessing the Impact of Wheat Flour and Baker's Yeast Restricted Diet vs. Calorie Restriction in NAFLD Patients

IntroductionNon-alcoholic fatty liver disease (NAFLD) is a prevalent and nonalcoholic progressive liver disorder associated with metabolic disturbance. This study aimed to compare the efficacy of wheat flour or baker's yeast-restricted diet with traditional calorie restriction in NAFLD patients.Material and methodsAnalyzed data was obtained from 243 individuals with NAFLD who completed the study. Of these patients, 54 belonged to Group (1) (Standard Diet, SD); 104 belonged to Group (2) (Wheat Flour-Free Diet, WFFD); and 85 belonged to Group (3) (Yeast-Free Diet, YFD). The intervention period lasted 6 months, during which participants' dietary compliance was closely monitored.ResultsAt the end of the six-month trial, both the WFFD and HFD groups exhibited a noteworthy reduction in body mass index (BMI) and triglyceride (TG) levels when compared to a standard diet that only involved calorie restriction. Furthermore, a notable reduction in the severity of liver steatosis was seen in these groups (p&lt;0.05). The SD group did not exhibit any significant changes in these metrics. The WFFD group experienced a notable reduction in HSI values (p&lt;0.05). Cluster analysis revealed that the obese group had higher HSI, weight, and BMI values throughout the study period, indicating a more advanced stage of NAFLD.ConclusionsTo summarize, this study highlights the significance of food constituents and dietary strategies in the treatment of NAFLD. It suggests that limiting the intake of wheat flour and baker's yeast specifically could have positive effects on liver well-being.

Impact of malnutrition on postoperative outcomes in total knee arthroplasty: a comprehensive analysis

Introduction: Malnutrition has been shown to cause perioperative complications, which can be particularly detrimental following total knee arthroplasty (TKA). These complications can lead to increased morbidity, extended hospital stays, and significant financial burdens on both patients and healthcare systems. To evaluate the nutritional status and body mass index (BMI) of patients undergoing TKA and monitor them for complications immediately postoperatively, at one week, and three months after surgery. Methods: This prospective study included 88 patients who underwent TKA at government medical college Kozhikode, Kerala, India. Nutritional status was assessed using serum albumin, ferritin, haemoglobin, and BMI (body mass index) levels. Patients were followed up for three months postoperatively to identify any complications. Data analysis was conducted to determine the relationship between malnutrition and postoperative complications. Results: Of the 88 patients, 5 developed major wound complications, with 4 of these patients exhibiting hypoalbuminemia. Hypoalbuminemia was found to have a statistically significant association with major wound complications (p&lt;0.001). Malnutrition was associated with higher rates of major wound complications, increased need for postoperative blood transfusions, and longer hospital stays. Conclusion: Identifying modifiable risk factors such as malnutrition in patients undergoing TKA is crucial for reducing the risk of postoperative complications, which can otherwise lead to disastrous outcomes. Preoperative optimization of nutritional status can significantly improve surgical outcomes and reduce complications.

The Association between Vitamin D3 Deficiency and Cataract Formation in Baghdad Al-Karkh

Background: Visual impairment is a global issue that is particularly problematic for poor nations. It is linked to diminished physical activity, social isolation, reliance on everyday tasks, and even death. The clouding of the lens inside the eye is called a cataract. It is one of the main causes of blindness and visual impairment in the world. Because of its anti-inflammatory and antioxidant properties, vitamin D, a prohormone in the blood, is crucial to the pathophysiology of many ocular illnesses. Given that oxidative stress and inflammation are significant contributors to the development of cataracts, a number of research have evaluated the relationship between vitamin D3 deficiency and cataract formation. Objective: Determine whether a vitamin D3 deficiency and cataracts are related. Patients and Methods: A cross-sectional study that was carried out included a total of 100 cataract patients who are 60 years of age or younger from September 2023 to March 2024 in the Ophthalmology Department of Imamein Kadhimein Medical City, Baghdad, Iraq. Questionnaire form was used which consist of sociodemographic information, socioeconomic status, dietary sources of vitamin D3, sun exposure, anthropometric measures and ophthalmic examination. Vitamin D3 level had been investigated in laboratory of the hospital. Results: Thirty percent of patients had cortical cataracts, 57% had nuclear cataracts, and 13% had posterior subcapsular cataracts. Sixty-nine percent of patients had a vitamin D3 level that is less than 20 ng/ml. Of the patients, 13% had a vitamin D3 level between 20 and 30 ng/ml, while 18% had a level greater than 30 ng/ml. There is a significant association between the level of vitamin D3 and the type of cataract (p-value = 0.013). Sixty-nine percent of patients with deficient vitamin D3 levels had 9% posterior subcapsular cataracts, 36% cortical cataracts, and 55% nuclear cataracts. Patients with insufficient vitamin D3 levels had 8% posterior subcapsular cataracts, 8% cortical cataracts, and 84% nuclear cataracts. While patients with sufficient vitamin D3 levels had 33% posterior subcapsular cataracts, 22% cortical cataracts, and 45% nuclear cataracts. The body mass index and vitamin D3 level were significantly associated (p-value = 0.003). Patients with a vitamin D3 level less than 20 ng/ml comprised 31% overweight patients, 26% class I obese patients, 26% class II obese patients, and 4% class III obese patients. Thirteen percent of these patients had normal weights. Patients with a vitamin D3 level 20-30 ng/ml comprised 46% overweight patients, 23% class II obese patients, and 31% with normal weight. While patients with a vitamin D3 level more than 30 ng/ml comprised 33% normal weight patients and 67% overweight. Conclusion: Vitamin D3 deficiency has a significant association with cataract formation, especially nuclear and cortical types, sun exposure, educational level, socioeconomic status, and obesity.

Development and validation of a novel nomogram to predict worsening of gastroesophageal reflux symptoms after laparoscopic sleeve gastrectomy using Lasso-logistic regression

Background Gastroesophageal reflux disease (GERD) is among the most common complications of bariatric surgery. This study aimed to analyse the risk factors affecting the worsening of GERD symptoms after laparoscopic sleeve gastrectomy (LSG), and to establish and validate a related nomogram model. Methods The study recruited 236 participants and randomly divided them into training and validation sets in a ratio of 7:3. LASSO regression technique was used to select the optimal predictive features, and multivariate logistic regression was used to construct the column line graphs. The performance of the nomogram was evaluated and validated by analyzing the area under the receiver operating characteristic (ROC) curve, calibration curve, and decision curve. Results In this study, Lasso-logistic regression was applied to select 5 predictors from the relevant variables, which were body mass index (BMI), diabetes, hiatal hernia, GERD, and triglyceride levels. These 5 predictor variables constructed a model with moderate predictive power, with an area under the ROC curve of 0.779 for the training set and 0.796 for the validation set. Decision curve analysis showed that in external validation, if the risk thresholds were between 4 and 98% and 14–95%, then the nomogram can be applied to the clinic. Conclusions We have developed and validated a nomogram that effectively predicts the risk of worsening gastroesophageal reflux symptoms following LSG.