Body Weight In Kilograms Research Articles

Essential amino acids to treat sarcopenia in patients with COPD?

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Mind Your Composition: Clinical validation of Samsung's pocket-based bioelectrical impedance analyzers may increase consumer interest in personal health management.

When asked about our weight, most of us can name a figure based on prior knowledge. And while stepping on a scale gives us the ability to know that exact number and track it routinely, it does not provide insights into our body?s composition. This, at the basic level, refers to proportions of fat and lean or fat-free mass (FFM) that comprise the human body. Conventionally, the body mass index (BMI), which is the ratio of body weight in kilograms to the square of its height in meters, and anthropometric parameters like waist circumference, waist-to-hip ratio, and skinfold thickness have been used to estimate the level of fatness. In fact, BMI is the de facto marker for stratifying individuals into underweight (<18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (>30 kg/m2) categories. Nonetheless, these metrics are limited in precisely characterizing individuals by percentages of body fat and muscle mass, particularly in epidemiological studies where these proportions vary across age, sex, and ethnic groups. Of note is also how, solely on the basis of BMI, a physically fit individual may be classified as overweight due to having a higher proportion of lean body mass, which outweighs fat. This highlights the importance of body composition in weight tracking and management.

Reactive Oxygen Species Response to Exercise Training and Weight Loss in Sedentary Overweight and Obese Female Adults.

Reactive oxygen species (ROS) are implicated in cardiovascular disease and in the pathogenesis of type 2 diabetes and its complications, and it has been shown to increase insulin resistance. The purpose of this study was to examine the effect of aerobic exercise training and weight loss on ROS in overweight and obese patients as applied in a community clinical setting. Fifty healthy female clinic patients (M ± SEM: age, 41.0 ± 1.8 years; body mass index, 28.2 ± 0.8 kg/m2), free of cardiovascular events and not on drug therapy were evaluated before and after 3 months of dietary restriction (∼150 to 300 kcal/day deficit) and aerobic training (3 days/week for 1 hour at ∼75% VO2max). Measures included ROS, maximal power (kg/min) on cycle ergometry, postexercise heart rate recovery responses at 1 and 2 minutes, and selected anthropometric and hematologic variables. Significant (P < .01) improvements were observed after aerobic training and weight loss in body weight in kilograms (-7.1%); maximal power in kg/min (+32.6%), ROS in U.CARR (Carratelli units) (-25.7%); and heart rate recovery 1 minute in beats per minute (-37.6%) following the program. Significant improvements were also noted in other anthropometric, cardiovascular, and hematologic measures. A 12-week program of nutritional and exercise intervention in overweight/obese sedentary women improves levels of oxidative stress when accompanied by weight loss and improved fitness. More than restricted caloric intake, physical activity at a relatively high intensity was effective in improving cardiovascular risk markers. The reduction in ROS may be an additional mechanism by which physical activity may contribute to preventing metabolic syndrome and subsequent atherosclerotic disease.

Self-reported anthropometric information cannot vouch for the accurate assessment of obesity prevalence in populations of middle-aged and older Korean individuals

While there are strong correlations between self-reported and directly measured anthropometric data, the discrepancy and systematic errors associated with these, particularly among middle-aged and older persons residing in South Korea, remain a contentious issue.All participants were selected from the Korean Longitudinal Study of Aging (KLoSA), a panel study conducted by the Korea Labor Institute; data from 510 participants (290 females; 56.9%) were analyzed. We considered general characteristics, including sex, age, education, marital status, employment, income, and residential region, and used self-rated health (SRH) as a generic indicator of health status. One-way ANOVA, t-test, and Scheffé’s test (α=0.1) were employed to explore the difference between directly measured and self-reported values. Sensitivity and specificity values were used to assess the validity of obesity diagnoses based on self-reported body mass index (BMI: body weight in kilograms divided by the square of height in meters).The means of BMI differences were 1.3 (±1.2)kg/m2 among men and 1.8 (±1.5)kg/m2 among women. In men, the difference could be attributed to measured BMI and residential region; among women, age and education level influenced the discrepancy in BMI. Scheffé’s test (α=0.1) for multiple comparisons of group means revealed that women over the age of 65 years, with lower than middle-school education, who lived in rural areas, and had a measured BMI of 25kg/m2 or more, were more likely to have significant BMI discrepancies. In contrast, for men, significant predictors were living in rural areas and being obese. Although adequate correlations were seen in self-reported BMI, they indicated low sensitivity, with 46.5% and 60.1% among males and females, respectively. However, specificities were very high, at 97.8% and 98.0% for males and females, respectively. The diagnostic performance of self-reported BMI is insufficient for assessing obesity prevalence among middle-aged or older Koreans.

Healthy PNPLA3 Risk Allele Carriers Present with Unexpected Body Fat Composition. A Study of One ousand Subjects

The common PNPLA3 (adiponutrin) variant p.I148M represents a major genetic driver of progression in non-alcoholic fatty liver disease (NAFLD). NAFLD is commonly associated with traits of the metabolic syndrome, therefore it is mostly suspected in obese individuals. Here, we investigate the association between the PNPLA3 variant and anthropometric traits in a cohort of healthy individuals. We recruited 1,000 (500 females; age 18-66 years) healthy blood donors. The PNPLA3 variant was genotyped using TaqMan assays. All individuals were phenotyped with respect to anthropometric characteristics. We also determined the percentage of total fat (F%) and active tissue (TA%) of body weight. Healthy carriers of the PNPLA3 [IM] and [MM] genotypes, although not differing in height from individuals with the genotype [II], displayed significantly lower body weight and lower BMI (both P = 0.005), higher TA% (P = 0.03) but lower F% (P = 0.03) and smaller waist, chest and shin circumferences (all P < 0.05). Separate analysis for males and females demonstrated an association between the [IM] and [MM] genotypes and higher TA% but lower F% (P = 0.04) in females. In males, BMI and total weight were significantly (P = 0.04) lower among carriers of the [M] allele. Healthy individuals carrying the prosteatotic PNPLA3 allele p.I48M may be leaner as compared to the carriers of the common allele. Hence in clinical practice they might be overlooked since they do not necessarily present with the anthropometric characteristics commonly associated with severe hepatic steatosis.

Scores in der Allgemeinen Inneren Medizin

Scores are tools to combine complex information into a numerical value. In General Medicine, there are scores to assist in making diagnoses and prognoses, scores to assist therapeutic decision making and to evaluate therapeutic results and scores to help physicians when informing and advising patients. We review six of the scoring systems that have the greatest utility for the General Physician in hospital-based care and in General Practice. The Nutritional Risk Screening (NRS 2002) tool is designed to identify hospital patients in danger of malnutrition. The aim is to improve the nutritional status of these patients. The CURB-65 score predicts 30-day mortality in patients with community acquired pneumonia. Patients with a low score can be considered for home treatment, patients with an elevated score require hospitalisation and those with a high score should be treated as having severe pneumonia; treatment in the intensive care unit should be considered. The IAS-AGLA score of the Working Group on Lipids and Atherosclerosis of the Swiss Society of Cardiology calculates the 10-year risk of a myocardial infarction for people living in Switzerland. The working group makes recommendations for preventative treatment according to the calculated risk status. The Body Mass Index, which is calculated by dividing the body weight in kilograms by the height in meters squared and then divided into weight categories, is used to classify people as underweight, of normal weight, overweight or obese. The prognostic value of this classification is discussed. The Mini-Mental State Examination allows the physician to assess important cognitive functions in a simple and standardised form. The Glasgow Coma Scale is used to classify the level of consciousness in patients with head injury. It can be used for triage and correlates with prognosis.

„Obesity Paradox“ – Fiction or a Fact?

Background: Many cardiovascular diseases are associated with obesity, but, despite this fact, obese people live longer than their normal-weight counterparts do. This phenomenon is called the „obesity paradox“. Aim: Purpose was to investigate the impact of obesity on the final outcome; determine the connection between obesity and heart rate > 80 beats per minute and other risk factors, and presence of „obesity paradox“. Material and Methods: Research included 140 patients with anterior wall acute STEMI treated in Coronary Unit, Clinical Center Kragujevac form January 2001-June 2006. Heart rate was calculated as the mean value of baseline and heart rate in the first 30 minutes after admission. Body mass index was calculated as the ratio of body weight in kilograms and body height in squared meters, and classified according to the WHO recomendations. Results: More than 75% obese patients were in both groups, survivors and those who died. In the subgroup with heart rate > 80 results were similar. Obesity had no significant effect on mortality despite the fact that the large number of patients with fatal outcome was obese. Conclusion: Correlation with acute myocardial infarction and elevated heart rate is evident, but obesity was not independent predictor for mortality which can only partly confirm presence of „obesity paradox“.

A Randomized, Placebo-Controlled Study of Zonisamide to Prevent Olanzapine-Associated Weight Gain

Weight gain is commonly observed with olanzapine treatment. Zonisamide is an antiepileptic drug associated with weight loss. This study examined the effectiveness of zonisamide in preventing weight gain in 42 patients beginning olanzapine for bipolar disorder or schizophrenia. Each patient had a body mass index of 22 mg/kg or greater and was randomized to taking olanzapine with either zonisamide (n = 20) or placebo (n = 22) for 16 weeks. The primary outcome measure was change in body weight in kilograms from baseline. In the primary analysis using longitudinal regression, patients who received zonisamide had a significantly slower rate of weight gain and increase in body mass index than those who received placebo. The patients treated with zonisamide gained a mean (SD) of 0.9 (3.3) kg, whereas those treated with placebo gained a mean (SD) of 5.0 (5.5) kg; P = 0.01. None of the patients in the zonisamide group, compared with 7 patients (33%) in the placebo group, gained 7% of body weight or greater from baseline (Fisher exact test, P = 0.009). The zonisamide group, however, reported significantly more cognitive impairment as an adverse event than the placebo group (25% vs 0, respectively; P = 0.02). Zonisamide was effective for mitigating weight gain in patients with bipolar disorder or schizophrenia initiating treatment with olanzapine but was associated with cognitive impairment as an adverse event.

290 THE ASSOCIATION BETWEEN NOCTURIA AND HYPERTENSION A LONGITUDINAL STUDY IN JAPANESE MEN AND WOMEN

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness II1 Apr 2012290 THE ASSOCIATION BETWEEN NOCTURIA AND HYPERTENSION A LONGITUDINAL STUDY IN JAPANESE MEN AND WOMEN Yoshitaka Aoki, Yosuke Matsuta, Katsuki Tsuchiyama, Chieko Matsumoto, Yukinori Kusaka, and Osamu Yokoyama Yoshitaka AokiYoshitaka Aoki Fukui, Japan More articles by this author , Yosuke MatsutaYosuke Matsuta Fukui, Japan More articles by this author , Katsuki TsuchiyamaKatsuki Tsuchiyama Fukui, Japan More articles by this author , Chieko MatsumotoChieko Matsumoto Fukui, Japan More articles by this author , Yukinori KusakaYukinori Kusaka Fukui, Japan More articles by this author , and Osamu YokoyamaOsamu Yokoyama Fukui, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.348AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The relation between nocturia and hypertension (HT) is not clear. Some authors reported that HT was an independent risk factor for nocturia (Odds ratio 1.5-2.0), but other studies reported no association between HT and nocturia. We hypothesized that the progression or regression of noctuira may associate changes in blood pressure. To investigate the association between nocturia and hypertension, we performed a longitudinal epidemiological study. METHODS We collected data on 13,536 individuals (4,167 males and 9,369 females) who participated in a multiphasic health screening in Fukui, Japan in 2003 and 2007. We analyzed the relationships between nocturia (defined as two or more voids/night) and other variables including age, gender, body mass index (BMI, body weight in kilograms divided by the square of height in meters), high blood pressure, and impaired glucose tolerance. We defined them as follows; high BMI (≥25.0 kg/m2); high blood pressure (systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥85 mmHg); and impaired glucose tolerance (fasting glucose concentration ≥110 mg/dL). We could not include waist circumference in the definition of obesity, because waist circumference measurement was not available in our study. Chi-square tests and logistic regression models were used for statistical analysis. P-values <0.05 were considered statistically significant. RESULTS The mean age of participant was 66 years (23-95 years) in 2003. The overall prevalence of nocturia (≥2 voids/night) in 2003 and 2007 was 11.0% and 13.2%, and prevalence was higher in older age groups. In the univariate analysis, a significant relationship was found between the progression of nocturia and the following factors: age (OR 1.53), male gender (OR 1.54), and the incidence of high diastolic blood pressure (OR 1.21). A significant relationship was also found between the regression of nocturia and the following factors: age (OR 0.96), male gender (OR 0.66), the improvement of high diastolic blood pressure (OR 1.55), and impaired glucose tolerance (OR 1.21). In the multivariate analysis, a significant relationship was found between the progression of nocturia and age (OR 1.03) and male gender (1.43), and between the regression of nocturia and age (OR 0.96), male gender (0.75), the improvement of high diastolic blood pressure (OR 1.44). CONCLUSIONS The results from our epidemiological study indicate that changes of nocturia can be a marker of progression and regression for diastolic HT. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e118 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yoshitaka Aoki Fukui, Japan More articles by this author Yosuke Matsuta Fukui, Japan More articles by this author Katsuki Tsuchiyama Fukui, Japan More articles by this author Chieko Matsumoto Fukui, Japan More articles by this author Yukinori Kusaka Fukui, Japan More articles by this author Osamu Yokoyama Fukui, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A Simple Dosing Scheme for Intravenous Busulfan Based on Retrospective Population Pharmacokinetic Analysis in Korean Patients

Busulfan is an antineoplastic agent with a narrow therapeutic window. A post-hoc population pharmacokinetic analysis of a prospective randomized trial for comparison of four-times daily versus once-daily intravenous busulfan was carried out to search for predictive factors of intravenous busulfan (iBu) pharmacokinetics (PK). In this study the population PK of iBu was characterized to provide suitable dosing recommendations. Patients were randomized to receive iBu, either as 0.8 mg/kg every 6 h or 3.2 mg/kg daily over 4 days prior to hematopoietic stem cell transplantation. In total, 295 busulfan concentrations were analyzed with NONMEM. Actual body weight and sex were significant covariates affecting the PK of iBu. Sixty patients were included in the study (all Korean; 23 women, 37 men; mean [SD] age, 36.5 [10.9] years; weight, 66.5 [11.3] kg). Population estimates for a typical patient weighing 65 kg were: clearance (CL) 7.6 l/h and volume of distribution (Vd) 32.2 l for men and 29.1 L for women. Inter-individual random variabilities of CL and Vd were 16% and 9%. Based on a CL estimate from the final PK model, a simple dosage scheme to achieve the target AUC0-inf (defined as median AUC0-inf with a once-daily dosage) of 26.18 mg/l·hr, was proposed: 24.79·ABW0.5 mg q24h, where ABW represents the actual body weight in kilograms. The dosing scheme reduced the unexplained interindividual variabilities of CL and Vd of iBu with ABW being a significant covariate affecting clearance of iBU. We propose a new simple dosing scheme for iBu based only on ABW.

Assessing Adiposity

The prevalence of obesity in the United States and the world has risen to epidemic/pandemic proportions. This increase has occurred despite great efforts by healthcare providers and consumers alike to improve the health-related behaviors of the population and a tremendous push from the scientific community to better understand the pathophysiology of obesity. This epidemic is all the more concerning given the clear association between excess adiposity and adverse health consequences such as cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). The risks associated with overweight/obesity are primarily related to the deposition of adipose tissue, which leads to excess adiposity or body fatness. Furthermore, weight loss, specifically loss of body fat, is associated with improvement in obesity-related comorbidities. Before weight loss interventions can be recommended, however, patients must be assessed for their adiposity-related risk. Unfortunately, healthcare providers and systems have not done a good job of assessing for excess adiposity even in its simplest form, such as measuring body mass index (BMI). It is for these reasons that we must emphasize the importance of assessing adiposity in clinical practices. Although it can be argued that the entire population should be targeted as an important public health issue with a goal of prevention of weight gain and obesity, there are currently so many “at risk” individuals that simple strategies to identify and treat those individuals are necessary. We must identify those individuals at highest risk of comorbidities in order to identify those who might benefit the most from aggressive weight management. This scientific statement will first briefly review the epidemiology of obesity and its related comorbidities, supporting the need for improved assessment of adiposity in daily clinical practice. This will be followed by a discussion of some of the challenges and issues associated with assessing adiposity and then by a review …

The Relationship Between Squat Strength, Vertical Jump, and Power Score of High School Football Players

PURPOSE: The purpose of this study was to determine if a significant relationship exists between 1RM squat strength, vertical jump performance, and power scores of high school football players. METHODS: Fifty-five male football players from a public high school in Corpus Christi, Texas were used for the study. Height, weight, school classification, 1RM squat strength, vertical jump performance, and power scores were obtained for all participants. The Vertec™ vertical jump apparatus, American College of Sports Medicine 1RM squat protocol, and the Lewis formula, which calculates power score, were all utilized for the study. The Lewis formula utilizes vertical jump in meters and body weight in kilograms to calculate lower body power production. A counter-movement jump with no step was used to determine vertical jump performance. Data was collected over a two-day period. Descriptive data and vertical jump performance were collected on Day One. One-repetition maximum squat values were collected on Day Two. Pearson's r correlations were utilized to determine if significant relationships existed between 1RM squat strength and vertical jump, vertical jump and power score, and 1RM squat strength and power score. RESULTS: Correlations coefficients were calculated for 1RM squat strength and vertical jump (r = 0.09, p = 0.51), vertical jump and power score (r = −0.11, p = 0.42), and 1RM squat strength and power score (r = 0.48, p = 0.0002). Also, correlations coefficients were calculated for body weight and vertical jump (r = −0.43, p = 0.001) and body weight and 1RM squat strength (r = 0.4, p = 0.003). Mean 1RM squat strength was 132.9 ± 29.9 kg, and mean vertical jump was 59.7 ± 8.1 cm. Vertical jump performances by classification were as follows: freshmen (56.2 ± 6.1 cm); sophomores (58 ± 8.5 cm); juniors (64.4 ± 6.3 cm). Mean power score was 2095.5 ± 395.2 Watts. Power scores by classification were: freshmen (2149.6 ± 411.9W); sophomores (2119.7 ± 423.4W); and juniors (2029 ± 346.6W). CONCLUSIONS: RESULTS indicated no significant relationship between 1RM squat strength and vertical jump (r = 0.09, p = 0.51) and vertical jump and power score (r = −0.11, p = 0.42). However, a significant relationship did exist between 1RM squat strength and power score (r = 0.48, p = 0.0002). PRACTICAL APPLICATIONS: The findings from the current study show that calculating power scores could be a valuable assessment tool for coaches or practitioners to evaluate potential weightlifting performance based on the moderate relationship observed.

Obesity and the Risk of Non-Hodgkin's Lymphoma – A Meta-Analysis Involving More Than 40,000 Cases

AbstractAbstract 5089 Background –Obesity is linked with altered immune function and chronic inflammatory response; multiple studies have related autoimmune and chronic inflammatory processes with an increased risk of non-Hodgkin's lymphoma. However, epidemiological studies on the relation between excess body weight and risk of non-Hodgkin's lymphoma have yielded inconsistent results. The objective of this study is to examine the relationship between obesity, as measured by body mass index (BMI), and risk of non-Hodgkin's lymphoma in a meta-analysis of epidemiological studies. Methods –We performed a comprehensive search of MEDLINE, EMBASE and CINAHL databases for studies on BMI and non-Hodgkin's lymphoma that were published from 1966 to June 2010. Search terms included body mass index, BMI, or obesity combined with lymphoma. The reference lists of identified articles were manually reviewed to identify additional papers. Key Inclusion Criteria - cohort or case–control studies reporting NHL incidence or mortality as an outcome, BMI (body weight in kilograms divided by the square of height in meters) as the exposure of interest, and relative risks (RRs) or odds ratios with their 95% confidence intervals (CIs) as the outcome measures. Data Extraction and Statistical analysis - Two reviewers independently extracted study information and data. Where multiple outcome measures were reported, the most adjusted for was used. Before analysis, all studies were tested for publication bias using the Begg's and Egger's test. Pooled RRs with 95% confidence intervals (CI) were calculated using the random-effects meta-analysis model if heterogeneity was present; otherwise, the fixed-effects model was used. All statistical analyses were performed using Stata software, version 9.0 (Stata-Corp, College Station, TX). Results –Twenty-five studies (17 cohort and 8 case-control studies) with 40,279 participants met the inclusion criteria. Compared to individuals with BMI < 25.0 kg/m2, the summary RRs for non-Hodgkin's lymphoma were 1.05 (95% CI, 1.01–1.10) and 1.15 (95% CI, 1.06–1.25) for overweight (BMI between 25 and 30 kg/m2) and obese (BMI > 30.0 kg/m2) individuals respectively. By histological subtypes, obesity was associated with a statistically significant increase risk of diffuse large B-cell lymphoma (RR, 1.23; 95% CI, 1.11–1.37; n = 13 studies) but not with follicular lymphoma (RR, 1.11; 95% CI, 0.97–1.27; n = 13 studies) or small lymphocytic lymphoma/chronic lymphocytic leukemia (RR, 0.95; 95% CI, 0.84–1.07; n = 8 studies). There was no evidence of publication bias. Conclusions –The results of this meta-analysis suggest that compared to normal weight individuals, overweight and obese individuals have a 5% and 15% increased risk of non-Hodgkin's lymphoma respectively. Though statistically significant, these proportions are relatively small and perhaps may be accounted for by residual confounding. Larger, long term prospective studies will be needed to conclusively define the magnitude and strength of the association between body weight and non-Hodgkin lymphoma. Disclosures:Off Label Use: High dose Melphalan is not FDA approved as conditioning regimen for Autologous stem cell transplant.

A Comparative Study between the Preoperative Diagnostic Tumor Size and the Postoperative Pathologic Tumor Size in Patients with Breast Tumors

Purpose: This comparative study analyzed the relationship between the preoperative diagnostic tumor size and the postoperative pathologic tumor size for breast cancer patients and benign breast tumor patients. Methods: We analyzed the clinicopathological information of 191 breast cancer patients and 187 benign breast tumor patients by conducting a retrospective chart review. The preoperative diagnostic tumor sizes were measured using physical examination, mammography and sonography in the benign breast tumor patients and they were additionally measured by computerized tomography and magnetic resonance imaging in the breast cancer patients. Body mass index (BMI) was defined as the ratio of the body weight in kilograms to the square of height in meters. Results: The tumor sizes measured by mammography (r=0.66) and physical examination (r=0.87) were highly correlated to the pathologic tumor size in the breast cancer patients and benign the breast tumor patients, respectively. Physical examination and magnetic resonance imaging had a tendency to overestimate the tumor size and sonography underestimated the pathologic tumor size in the breast cancer patients. The correlation coefficient for the physical examination was increased when the patient age was less than 50 years and the BMI was less than 25. Multiple regression analysis revealed that assessing the tumor size according to physical examination, mammography and sonography were effective for determining estimation of pathologic tumor size in the benign breast tumor patients, but assessing the tumor size by physical examination and sonography was not effective for determining the tumor size in breast cancer patients. Conclusion: Mammography and physical examination can be useful to estimate the pathologic tumor size in breast cancer patients and benign breast tumor patients, respectively. Physical examination can be useful to estimate the size when a breast tumor is palpable, the age of a patient is less than 50, and the BMI is less than 25.

Pharmacovigilance on olanzapine

Pharmacovigilance on olanzapine

Obesity and Hypertension

The link between obesity and hypertension is well known, but there are still many questions to be answered: Is abdominal adiposity rather than overall obesity more closely associated with high blood pressure? Is obesity an independent cardiovascular risk factor even if not combined with hypertension? Can obesity be metabolically benign? To what extent weight reduction is expected to contribute to the management or the primary prevention of hypertension? Are there compelling indications and/or contraindications to the use of specific classes of antihypertensive drugs for the pharmacological treatment of obesity hypertension? Consequently, the present editorial seeks to answer these questions by briefly reviewing the current state of knowledge of the association of obesity with hypertension. Several tools are used to estimate obesity. The body mass index (BMI), or Quetelet index, is a statistical measurement which compares a person’s weight and height. BMI is body weight in kilograms divided by the height in meters squared, expressed as weight (in kg)/height (m). Overweight is defined as a BMI >25, obesity as a BMI >30, and morbid obesity is a BMI >35. Abdominal obesity is the accumulation of visceral fat resulting in an increase in waist size. It is often referred to as central, visceral, male-type or android obesity vs. female-type or gynoid obesity with a preferential gluteofemoral distribution. Abdominal obesity is diagnosed by a waist circumference >102 cm in men, and >88 cm in women or by a waist-to-hip ratio >0.95 in men and >0.85 in women. As early as in 1980, in the second National Health and Nutrition Examination Survey (NHANES II), it was noted that the prevalence of hypertension was 2.9 times higher in obese than in non-obese adult Americans. The Third National Health and Nutrition Examination Survey (NHANES III) conducted from 1988 to 1994 revealed a similar linear relationship despite a lower prevalence of hypertension. BMI was recently found to be positively associated with blood pressure even in active, American veteran football players. In a cross-sectional analysis of adults enrolled in NHANES 1999-2004, the odds ratio for hypertension for every 5-unit increase in BMI was 1.45 (95% CI 1.39-1.52). Although obesity was associated with hypertension in all age groups and both sexes, the odds for hypertension associated with obesity were relatively higher in younger people. With regard to hypertension subtypes, increasing BMI was a significant predictor of isolated diastolic hypertension or systodiastolic hypertension as opposed to isolated systolic hypertension. Isolated systolic hypertension represented a minority of hypertension cases in obese men, but remained the most prevalent type in obese women. There is substantial evidence that in addition to BMI, both waist circumference and waist-to-hip ratio are correlated with blood pressure, even after adjustment for BMI. The associations of BMI and waist circumference with systolic and diastolic blood pressure and their possible interactions with gender and age were assessed in a cohort of 10,928 non-smoking and never treated for hypertension adults, recruited from all regions of Greece during 1994–1999, within the context of the European From the Center for the Prevention of Cardiovascular Disease, “Hygieias Melathron,” Athens, Greece

Staged Surgical Approach in Neonates with a Functionally Single Ventricle and Arch Obstruction: Pulmonary Artery Banding and Aortic Arch Reconstruction Before Placement of a Bidirectional Cavopulmonary Shunt in Infants

The success rate of right-heart bypass surgery in patients with a functionally single ventricle (f-SV) and systemic obstruction is low. In patients with a high risk of subaortic stenosis, we performed an initial step of pulmonary artery banding (PAB) and arch reconstruction before placing a bidirectional cavopulmonary shunt (BCPS) in infants with or without Damus-Kaye-Stansel (DKS) anastomosis. We assessed the success of right-heart bypass surgery. Between October 2003 and August 2008, we performed surgery in 19 neonates (median age 5 days) with f-SV and arch obstruction. Extended aortic arch anastomosis, with or without distal arch augmentation, was performed in 10 patients, and subclavian flap aortoplasty was performed in 9 patients. The circumference of the PAB was determined as the individual patient's body weight in kilograms plus 16.2 +/- 3.7 mm. Eighteen of 19 infants (95%) underwent successful BCPS placement at a median age of 7.8 months. DKS anastomosis was performed concomitantly during BCPS placement in 11 infants in whom subaortic stenosis was morphologically suspected but not demonstrated physiologically. As our first-stage operation, arch reconstruction plus PAB provided high success rates for right-heart bypass operations. This strategy is not leading, but it is a reliable approach for progression along a Fontan pathway.

A prospective study to evaluate the depictability of the hepatic veins on abdominal contrast-enhanced CT in small children

The optimal conditions for abdominal contrast-enhanced (CE) CT, especially with respect to depiction of the hepatic veins (HVs), have not been well studied in small children. We compared the depiction of the HVs in small children using scan delay times of 50 s and 60 s and a power injector. The degree of contrast enhancement of the HVs according to body weight was also evaluated. A total of 50 CT studies in 31 children ages 2 days to 3 years 4 months (median 12 months) with a body weight less than 15 kg were prospectively evaluated. Nonionic contrast medium (300 mgI/ml) at a dose of 2 ml/kg and an injection rate calculated as (body weight in kilograms x 0.1) ml/s was injected through a 24-gauge intravenous catheter. Scan delay time was randomly chosen at 50 s or 60 s (25 times each). Subjective assessment of HV depiction was performed and the difference in CT number between the HV and hepatic parenchyma (HV-HP value) was calculated. In all cases, subjective assessment of HV depiction was good and the HV-HP value was greater than 20 HU. The mean+/-SD HV-HP value was 47.7+/-13.2 HU. There were no differences in the mean HV-HP values between scan delay times of 50 s and 60 s (P=0.58). For small children, this protocol for pediatric abdominal CECT resulted in good depiction of the HVs with no difference between scan delay times of 50 s and 60 s.

Body mass index modulates postural proteinuria

Dear Sir, In contrast to constant proteinuria, postural proteinuria has been generally regarded as a benign condition [1–4]. However, anecdotal observations suggest that postural proteinuria might sometimes reflect incipient kidney disease [5, 6]. To further address this controversy we recently reassessed 15 subjects with fixed and reproducible postural proteinuria two or more years after the initial diagnosis. After breakfast and after starting an appropriate water load, the subjects came to the clinic. They had been advised to bring along a portion of the first morning urine (‘‘recumbent’’) for determination of the total protein-to-creatinine ratio (reference value: B30 mg/mmol) [7]. The second morning urine sample was collected for urinary sediment analysis and blood was taken for determination of creatinine. Urinary total protein-to-creatinine ratio was also determined with the subjects in a nonrecumbent position for C3 h. Finally height, body weight, and sitting blood pressure (reference: systolic and diastolic blood pressure \90th centile for gender, age, and height in subjects less than 18 years of age and \140/90 mmHg in the remaining subjects) were recorded and a complete physical examination performed. Body mass index was calculated as the body weight in kilograms divided by squared height in meters [8, 9] and the glomerular filtration rate (reference value: C90 ml/[min. 1.73 m]) estimated from height and circulating creatinine using the ‘‘height to creatinine equations’’ [10]. Since body mass index (in kg/m) varies with age, this parameter was also plotted on the body mass index for age and gender charts and expressed as centile adjusted for age and gender [8]. Descriptive statistics are presented as numbers for qualitative data, and as median and interquartile range (which extends from the value at the 25th to that at the 75th centile and includes half of the data points) for quantitative data. v-test (qualitative data) and Mann-Whitney-Wilcoxon test for independent samples (quantitative data) were used for analysis. Statistical significance was set at the 0.05 level. In the recently reevaluated subjects, whose age ranged from 10 to 24 years, the diagnosis of postural proteinuria had been made 2.3–15 years earlier. Physical examination, blood pressure, glomerular filtration rate, urinalysis, and recumbent urinary total proteinto-creatinine ratio were normal in the subjects. Nonrecumbent urinary total protein-to-creatinine ratio G. Milani E. F. Fossali (&) Clinica Pediatrica De Marchi, Foundation IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Via Commenda 9, 20122 Milan, Italy e-mail: mimmofox2000@yahoo.it

Factors Associated with Peripheral Blood Stem Cell Yield in Volunteer Donors Mobilized with Granulocyte Colony-Stimulating Factors: The Impact of Donor Characteristics and Procedural Settings

Peripheral blood stem cells (PBSCs) are increasingly used as the source of hematopoietic stem cells, but there are large variations in harvest outcome between individuals mobilized by granulocyte colony-stimulating factor (G-CSF). We examined the effects of donor characteristics and procedure factors on the day 1 CD34+ cell yield in 373 unrelated healthy donors. G-CSF was administered subcutaneously at a planned dose of 8.3 to 11 microg/kg daily for 5 days, followed by harvest started on day 5 of G-CSF treatment. Of the 373 donors, 159 (42.6%) had the radial artery as the inlet access for harvest. Poor day 1 cell yield was defined as <10x10(6) CD34+ cells/L of processed blood for the first apheresis; 62 donors (16.6%) did not attain this threshold. The male donors had significantly higher yields at harvest compared with the female donors. The female donors had higher CD34+ cell yields if the circulation access was through an artery than if is was through a vein. In a multiple regression analysis, donor age, sex, body mass index (BMI), preharvest white blood cell and circulating immature cell counts, access type, and flow rate correlated with day 1 yield. Female sex, older age, venous access, and a higher flow rate were significantly associated with greater risk for a day 1 poor yield of CD34+ cells (odds ratio=3.0074, 1.045, 4.3362, and 1.1131, respectively). A higher BMI may decrease the risk (odds ratio=0.8472). In donors at higher risk for poor CD34+ cell yield, strategies for increasing CD34+ cells must be considered.