Current BMI Research Articles

Detrimental Effects of Online Pro-Eating Disorder Communities on Weight Loss and Desired Weight: Longitudinal Observational Study.

BackgroundOnline pro–eating disorder (pro-ED) communities are considered harmful because of their detrimental effects on their users’ body dissatisfaction, dieting, and help seeking. To date, it is unknown to which extent participation in pro-ED communities affects users’ body weight and desired weight loss.ObjectiveThis study aims to investigate the changes in the current and desired body weight of users of a pro-ED community (r/proed) on the social media website Reddit over time.MethodsData on 1170 users and the unsolicited weight information they shared with the pro-ED community were collected over a period of 15 months. Linear growth models were used to model changes in the users’ current and desired BMI over time.ResultsBoth current and desired BMI decreased over time, with a predicted rate of 0.087 and 0.015 BMI points per week, respectively. Weight loss was moderated by the users’ activity level in the community, with more active users losing more weight. Users with a higher baseline BMI experienced greater weight loss, but even users with a very low baseline weight (BMI <17 kg/m2) lost weight during their participation. In addition, users decreased their desired weight over time, with many pursuing extremely low, unrealistic weight goals. Changes in the desired weight were moderated by the baseline current BMI and baseline desired BMI. Users with higher desired weight and lower body weight at baseline decreased their desired weight more over time.ConclusionsThis is the first study to demonstrate the detrimental effects of pro-ED communities in a longitudinal study based on a large data set of user-generated online data. The results extend the literature detailing the harmful effects of online pro-ED communities by showing users’ weight loss, decreases in desired weight, and that higher activity levels lead to greater weight loss. Users could be driven to pursue very low, unrealistic weight loss goals by images of very thin bodies presented in these communities.

Sleep Health Characteristics among Adults Who Attempted Weight Loss in the Past Year: NHANES 2017-2018.

Background: The purpose of this study was to characterize sleep health in adults who attempted weight loss in the prior year. Methods: We analyzed data from the National Health and Nutrition Examination Survey 2017–2018 exam cycle. We included 4837 US adults who did (n = 1919) or did not (n = 2918) attempt weight loss in the past year. Participants self-reported their sleep regularity, satisfaction, sleepiness, timing, and duration, which we defined as “good” based on the prior literature. We characterized sleep health by weight loss attempts status, current BMI and weight change among participants who attempted weight loss. Results: On average, participants reported good sleep health in 3.21 ± 1.14 out of the five sleep domains. A total of 13% of participants had good sleep health in all five domains. The prevalence of sleep regularity (52%) was lowest, and the prevalence of infrequent sleepiness was highest (72%), relative to other sleep domains. In models adjusting for BMI, sleep health was similar in participants who did and did not attempt weight loss. Among adults who attempted weight loss, good sleep health was inversely associated with current BMI and self-reported weight change. Discussion: This study’s findings highlight the importance of considering sleep health when engaging with adults attempting weight loss.

Birth weight was associated positively with gluteofemoral fat mass and inversely with 2-h postglucose insulin concentrations, a marker of insulin resistance, in young normal-weight Japanese women.

We tested whether birth weight might be associated with gluteofemoral fat mass and insulin sensitivity later in life. Body size trajectory since birth, body composition at age 20, and markers of insulin resistance were measured in 316 Japanese women. A subset of 148 women underwent a 75g oral glucose tolerance test. Multiple linear regression analyses were used to identify most important determinants of birth weight. Birth weight was correlated positively with height and weight at age 12, 15, and 20years (all p < 0.001 except for weight at 12years, p = 0.03). Although it showed no correlation with BMI at age 12 and 15, it was correlated positively with current BMI (p = 0.006). It showed positive correlations with lean mass in arms, legs, trunk, and the whole body at age 20 (all p < 0.001). Additionally, it was correlated positively with leg (gluteofemoral) fat mass (p = 0.007), although there was no correlation with total body and trunk fat mass. Furthermore, weight at birth showed inverse correlations with 2-h postglucose insulin concentrations (p = 0.008) whereas it was not correlated with fasting insulin and homeostasis model assessment-insulin resistance. In a multiple regression analysis, which included anthropometric and biochemical variables as independent variables, appendicular muscle mass (standardized β 0.394, p < 0.001) emerged as a single determinant of birth weight (R 2 = 0.15). In a model which included gluteofemoral fat mass and 2-h postglucose insulin, birth weight was associated with gluteofemoral fat mass (standardized β 0.240, p = 0.003) and 2-h postglucose insulin concentrations (standardized β - 0.217, p = 0.007) (R 2 = 0.09). Birth weight was associated positively with gluteofemoral fat mass and inversely with 2-h postglucose insulin concentrations, a marker of insulin resistance.

Predictors of Prolonged Opioid Use After Lumbar Fusion and the Effects of Opioid Use on Patient-Reported Outcome Measures.

Retrospective case series. To determine risk factors associated with prolonged opioid use after lumbar fusion and to elucidate the effect of opioid use on patient-reported outcome measures (PROMs) after surgery. Patients who underwent 1-3 level lumbar decompression and fusion with at least one-year follow-up were identified. Opioid data were collected through the Pennsylvania Prescription Drug Monitoring Program. Preoperative "chronic use" was defined as consumption of >90days in the one-year before surgery. Postoperative "prolonged use" was defined as a filled prescription 90-days after surgery. PROMs included the following: Short Form-12 Health Survey PCS-12 and MCS-12, ODI, and VAS-Back and Leg scores. Logistic regression was performed to determine independent predictors for prolonged opioid use. The final analysis included 260 patients. BMI >35 (OR: .44 [.20, .90], P = .03) and current smoking status (OR: 2.73 [1.14, 6.96], P = .03) significantly predicted postoperative opioid usage. Chronic opioid use before surgery was associated with greater improvements in MCS-12 (β= 5.26 [1.01, 9.56], P = .02). Patients with prolonged opioid use self-reported worse VAS-Back (3.4 vs 2.1, P = .003) and VAS-Leg (2.6 vs 1.2, P = .03) scores after surgery. Prolonged opioid use was associated with decreased improvement in VAS-Leg over time (β = .14 [.15, 1.85], P = .02). Current smoking status and lower BMI were significantly predictive of prolonged opioid use. Excess opioid use before and after surgery significantly affected PROMs after lumbar fusion.

LAPAROSCOPICALLY-CONFIRMED ENDOMETRIOSIS AND RISK OF INCIDENT STROKE: A PROSPECTIVE COHORT STUDY

Prior research has suggested that women with endometriosis are at greater risk of cardiovascular disease later in life, including myocardial infarction and hypertension. However, there has been limited research on endometriosis and risk of stroke, which may have similar underlying pathophysiologic mechanisms. Therefore, our objective was to prospectively investigate the association between laparoscopically-confirmed endometriosis and risk of incident stroke during 28 years of follow-up. Participants in the Nurses’ Health Study II were followed from 1989 until 2017 for development of incident stroke. Cox proportional hazard models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI), with adjustment for potential confounding variables (alcohol intake, body mass index [BMI] at age 18, current BMI, age at menarche, menstrual cycle pattern in adolescence, current menstrual cycle pattern in adulthood, parity, oral contraceptive use history, smoking history, diet quality, physical activity, race, and income). We estimated the proportion of the total effect mediated by factors that may be on the causal pathway between endometriosis and stroke (history of hypertension, hypercholesterolemia, diabetes, gestational diabetes, hysterectomy/oophorectomy, and hormone therapy). We also investigated heterogeneity in the associations by testing for effect modification by age (<50, ≥ 50 years), infertility history, BMI (<25, ≥25 kg/m2), and menopausal status (updated over follow-up). We observed 893 incident cases of stroke during 2,770,129 person-years of follow-up. Women with laparoscopically-confirmed endometriosis had a 36% greater risk of stroke in multivariable models adjusted for potential confounding factors (RR:1.36, 95% CI: 1.12-1.66). Of the total association of endometriosis with risk of stroke, the largest proportion was attributed to hormone therapy (16% mediated; 95% CI: 5.1-39.9%) and hysterectomy/oophorectomy (39% mediated; 95% CI: 14.6-70.9%). We observed no differences in this relationship endometriosis and stroke by age, infertility history, BMI, or menopausal status. We observed that women with endometriosis were at greater risk of stroke and this association persisted even after taking into account known risk factors for stroke.

High-sensitivity CRP levels in women with gestational hypertension, preeclampsia and in normotensive pregnant women and its correlations.

Gestational hypertension is a less investigated hypertensive disorder of pregnancy than preeclampsia, but evidence exists of an unfavourable cardiovascular profile for women after such a pregnancy. To determine serum high-sensitivity C-reactive protein (hs-CRP) levels in women with preeclampsia, gestational hypertension, and in normotensive pregnancy in order to assess the cardiovascular implications and to examine its correlations with some characteristics of women. Thirty-six women with gestational hypertension, thirty-seven with preeclampsia, and fifty maternal and gestational age-matched controls were included in a single-center prospective clinical-epidemiological study. Serum hs-CRP levels were determined using ELISA method. Significantly higher hs-CRP levels were found in the gestational hypertension group than in the controls (p=0.043), but not in the preeclampsia group (p=0.445). The levels between the two pathological groups did not differ significantly (p=0.247). Odds ratio for hs-CRP levels higher than the provided cut-off was 3.31 (95% CI 1.32-8.29) for the presence of gestational hypertension. In the normotensive pregnant women, the hs-CRP levels had a positive correlation with BSA, pre-pregnancy and current BMI, but such correlations were absent in the hypertensive groups. There were no correlations with the maternal or gestational age, current weight gain in any of the groups or with the highest detected blood pressure in the pathological groups. These levels did not differ according to gravidity, smoking status and smoking during pregnancy. Elevation of hs-CRP was more pronounced in women with gestational hypertension than in women with preeclampsia, which could indicate a different pathophysiological mechanism and a higher cardiovascular risk for those women.

Recommendations for a More Organized and Effective Approach to the Early Detection of Pancreatic Cancer From the PRECEDE (Pancreatic Cancer Early Detection) Consortium

Recommendations for a More Organized and Effective Approach to the Early Detection of Pancreatic Cancer From the PRECEDE (Pancreatic Cancer Early Detection) Consortium

Underreporting of energy intake in weight loss maintainers

Individuals with overweight or obesity commonly underreport energy intake (EI), but it is unknown if the tendency to underreport persists in formerly obese individuals who lose significant weight and maintain their weight loss over long periods of time. Assess the accuracy of self-reported EI in successful weight loss maintainers (WLM) compared with controls of normal body weight (NC) and controls with overweight/obesity (OC). Participants for this case-controlled study were recruited in 3 groups: WLM [n = 26, BMI (in kg/m2) 24.1±2.3; maintaining ≥13.6 kg weight loss for ≥1 y], NC (n = 33, BMI 22.7±1.9; similar to current BMI of WLM), and OC (n = 32, BMI 34.0±4.6; similar to pre-weight loss BMI of WLM). Total daily energy expenditure (TDEE) was measured over 7 d using the doubly labeled water (DLW) method, and self-reported EI was concurrently measured from 3-d diet diaries. DLW TDEE and self-reported EI were compared to determine accuracy of self-reported EI. WLM underreported EI (median, interquartile range) (-605, -915 to -314 kcal/d) to a greater degree than NC (-308, -471 to -68 kcal/d; P < 0.01) but not more than OC (-310, -970 to 18 kcal/d; P = 0.21). WLM also showed a greater degree of relative underreporting (-25.3%, -32.9% to -12.5%) compared with NC (-14.3%, -19.6% to -3.1%; P = 0.02) but not OC (-11.2%, -34.1% to -0.7%; P = 0.16). A greater proportion of WLM was classified as underreporters (30.8%) than NC (9.1%; P = 0.05) but not OC (28.1%; P = 1.00). WLM underreported EI in both absolute and relative terms to a greater extent than NC but not OC. These findings call into question the accuracy of self-reported EI in WLM published in previous studies and align with recent data suggesting that WLM rely less on chronic EI restriction and more on high levels of physical activity to maintain weight loss. This trial was registered at clinicaltrials.gov as NCT03422380.

Temporal patterns of physical activity in successful weight loss maintainers.

Individuals successful at weight loss maintenance engage in high amounts of physical activity (PA). Understanding how and when weight loss maintainers accumulate PA within a day and across the week may inform PA promotion strategies and recommendations for weight management. We compared patterns of PA in a cohort of weight loss maintainers (WLM, n = 28, maintaining ≥13.6 kg weight loss for ≥1 year, BMI 23.6 ± 2.3 kg/m2), controls without obesity (NC, n = 30, BMI similar to current BMI of WLM, BMI 22.8 ± 1.9 kg/m2), and controls with overweight/obesity (OC, n = 26, BMI similar to pre-weight loss BMI of WLM, 33.6 ± 5.1 kg/m2). PA was assessed during 7 consecutive days using the activPALTM activity monitor. The following variables were quantified; sleep duration, sedentary time (SED), light-intensity PA (LPA), moderate-to-vigorous intensity PA (MVPA), and steps. Data were examined to determine differences in patterns of PA across the week and across the day using mixed effect models. Across the week, WLM engaged in ≥60 min of MVPA on 73% of days, significantly more than OC (36%, p < 0.001) and similar to NC (59%, p = 0.10). Across the day, WLM accumulated more MVPA in the morning (i.e., within 3 h of waking) compared to both NC and OC (p < 0.01). WLM engaged in significantly more MVPA accumulated in bouts ≥10 min compared to NC and OC (p < 0.05). Specifically, WLM engaged in more MVPA accumulated in bouts of ≥60 min compared to NC and OC (p < 0.05). WLM engage in high amounts of MVPA (≥60 min/d) on more days of the week, accumulate more MVPA in sustained bouts, and accumulate more MVPA in the morning compared to controls. Future research should investigate if these distinct patterns of PA help to promote weight loss maintenance.

Prior undernutrition and insulin production several years later in Tanzanian adults

ABSTRACTBackgroundThe prevalence, pathology, and existence of malnutrition-associated diabetes remain uncertain, especially with respect to adult-acquired undernutrition.ObjectiveThe aim was to investigate the association of prior undernutrition (low BMI, in kg/m2), acquired in adulthood and insulin during an oral glucose tolerance test (OGTT).MethodsWe followed up 630 adults recruited 7–14 y previously for other studies. Plasma insulin was measured fasting and at 30 and 120 min during an OGTT. The main exposure was BMI measured 7–14 y prior. The main outcome of interest was plasma insulin, controlling for time during the OGTT using generalized estimating equations, and exploratory outcomes were early insulin response (relative change in insulin and glucose from 0–30 min) and relative insulin and glucose AUCs from 0 to 120 min. Current confounding factors were age, sex, BMI, HIV, socioeconomic status, and physical activity.ResultsIn unadjusted analyses, increasing severity of prior malnutrition was associated with lower insulin concentration. In multivariate adjusted analyses, only current BMI was a strong predictor of overall insulin concentration. Associations with prior BMI of insulin responses accounting for glucose were also seen in unadjusted but not adjusted analyses. For insulin concentration but not the outcomes accounting for glucose, there was a sex interaction with prior BMI such that only men had lower insulin if previously malnourished: insulin (pmol/L) at 120 min was 311 (95% CI: 272, 351) for prior BMI ≥18.5, 271 (95% CI: 221, 321) for prior BMI 17.0–18.5, and 237 (95% CI: 194, 297) for prior BMI <17.0; P = 0.03. HIV status showed limited and variable associations with insulin.ConclusionsInsulin concentration, fasting and during an OGTT, was normalized in women more than in men several years after adult malnutrition. Chronic malnutrition, as indicated by low prior and current BMI, may contribute to diabetes through low insulin secretion.

Sitting Time, Type, and Context Among Long‐Term Weight‐Loss Maintainers

This study aimed to investigate sitting time, the home sedentary environment, and physical activity among weight-loss maintainers in WW (formerly Weight Watchers). Participants were 4,305 weight-loss maintainers who had maintained≥9.1kg of weight loss (24.7kg on average) for 3.3years and had an average current BMI of 27.6kg/m2 . A control group of weight-stable individuals with obesity (n=619) had an average BMI of 38.9kg/m2 . The Multicontext Sitting Time Questionnaire and Paffenbarger physical activity questionnaire were administered. Weight-loss maintainers versus controls spent 3hours less per day sitting during the week (10.9 vs. 13.9; = 0.039; P=0.0001) and weekends (9.7 vs. 12.6; = 0.038). Weight-loss maintainers versus controls spent 1hour less per day in non-work-related sitting using a computer or video games during the week (1.4 vs. 2.3; = 0.03; P=0.0001) and weekends (1.5 vs. 2.5; = 0.03; P=0.0001). Weight-loss maintainers versus controls had similar numbers of sedentary-promoting devices (15.8 vs. 14.8) and expended significantly more calories per week in physical activity (1,835 vs. 785; = 0.036; P=0.0001). Weight-loss maintainers reported less time sitting than weight-stable individuals with obesity. Future research should test the efficacy of targeting sitting time to help promote long-term weight-loss maintenance.

Birth weight and childhood obesity: effect modification by residence and household wealth

BackgroundThere are both genetic and environmental factors which contribute to a child’s chances of being obese. When low birth weight (LBW) has been specifically evaluated relative to its association with childhood obesity, the results have produced conflicting findings. This study aims to describe the relationship between birth weight and childhood obesity and investigate the influence that residence and household wealth has on this relationship.MethodsI performed a secondary analysis on the 2013 Riskesdas (or Basic Health Research), a cross-sectional, nationally representative survey of the Indonesian population. Height, weight, information regarding child’s birth weight, and basic characteristics of the study population were collected from parents with children aged 0 to 5 years (n = 63,237) in 2013. The exposure was child’s birth weight and the outcomes were child’s current weight, BMI z-score, and obesity. Data were analyzed by using multiple linear regression and multiple logistic regression.ResultsI found a significant increase in the weight, BMI z-score, and risk of childhood obesity to be associated with LBW. LBW children in rural area were associated with higher BMI z-score (mean ± standard error: 1.44 ± 0.02) and higher odds (odds ratio (95% confidence interval): 7.46 (6.77–8.23)) of obesity than those in urban area. LBW children from low class families were associated with higher BMI z-score (1.79 ± 0.04) and had higher odds (14.79 (12.47–17.54)) of obesity than those from middle class and wealthy families.ConclusionsEffective prevention and intervention to childhood obesity as early as possible are imperative. As far as this study was concerned, efforts, policies, and targets are required to reduce the prevalence of LBW. Children born of LBW, who live in a rural area and from low income families, should be emphatically intervened as early as possible.

TV viewing during childhood and adult type 2 diabetes mellitus

We examined whether regular television (TV) viewing at ages 3–5 and 5–10 years is related to the incidence of type 2 diabetes mellitus (T2D) in adult women. We used data from 34,512 mother-nurse daughter dyads in the Nurses’ Health Study (NHS) II and the Nurses’ Mothers’ Cohort Study. Mothers of NHS II participants completed a questionnaire on their pregnancy with the nurse and her early life experience. During 391,442 person-years of follow-up from 2001 to 2013, 1515 nurses developed T2D. Increasing levels of TV viewing at 3–5 years of age retrospectively reported by the mothers were related to a greater risk of T2D in adulthood: multivariable-adjusted hazard ratios (HRs) for ≤ 1, 2, and ≥ 3 h/day vs. no TV viewing were 1.11 [95% confidence interval (CI) 0.96–1.28], 1.20 (95% CI 1.02–1.41), and 1.35 (95% CI 1.11–1.65), p trend = 0.002, respectively, after adjustment for early life variables, including childhood physical activity and adiposity. Retrospectively reported TV viewing for ≥ 3 h/day at 5–10 years of age was associated with a 34% greater risk of adult T2D (HR 1.34, 95% CI 1.05–1.70, p trend < 0.001). Additional adjustments for adult variables, including adult TV viewing and current BMI attenuated the effect estimates (≥ 3 h/day TV viewing at 3–5 years: HR 1.22, 95% CI 0.99–1.49, p trend = 0.07; TV viewing at 5–10 years: 1.16, 95% CI 0.91–1.49, p trend = 0.09). The present study suggests that TV viewing during early childhood increases risk of T2D in adult women; adult BMI explains part of this association. Further research is required to confirm this observation and understand the mediating pathways.

The evaluation of the role of BMI and insulin resistance on inflammatory markers, PAI-1 levels and arterial stiffness in newly diagnosed type 2 diabetes mellitus patients.

Increased cardiovascular risk, represented by endothelial inflammation, probably starts with the very first course of type-2 diabetes (T2DM). Almost 85.2% of all T2DM patients are overweight or obese. Thrombosis accounts 80% of all deaths in patients with diabetes. The thrombotic-fibrinolytic equilibrium shifts in favor of thrombosis by plasminogen activator inhibitor-1 (PAI-1). PAI-1 secretion is induced primarily by CRP. PAI-1 overexpression predisposes unstable plaque development. The contribution of obesity and diabetes to this process is not clearly understood. In this study, we aimed to investigate comparison of inflammatory markers, PAI-1 levels and arterial stiffness according to BMI and impaired glucose metabolism in patient with newly diagnosed T2DM. Newly diagnosed 60 T2DM patients were enrolled. Demographics and measurements were noted. Liver (AST, ALT), kidney (urea, creatinine, albumin/creatinine ratio), metabolic (fasting blood glucose, post-prandial blood glucose, insulin, c-peptide, HbA1c, total cholesterol, low-density lipoprotein [LDL], high-density lipoprotein [HDL], triglyceride) parameters, inflammatory markers [hsCRP, fibrinogen]), PAI-1 levels and pulse wave velocity was measured from all participants. The results were compared. Inflammatory markers and PAI-1 levels were significantly elevated in obese group compared to overweight participants. The correlation analysis showed that waist and hip circumferences, high-sensitive CRP, fibrinogen and PAI-1 levels were positively correlated with BMI but not with HbA1c levels. The results of our study showed that lipid levels, glycemic and blood pressure values of the obese and overweight patients were similar. BMI affects inflammatory markers and PAI-1 levels independent of glucose regulation and insulin resistance in newly diagnosed T2DM. According to the current study BMI is found to be more prominent in terms of inflammatory markers and PAI-1 levels compared to insulin resistance and impaired glucose metabolism in newly diagnosed T2DM.

Revision of a Previous Capella Bypass due to dysphagia, GERD and Candy Cane Syndrome.

Capella ringed gastric bypass is a technical variant of gastric bypass which seeks to improve long-term outcomes with a greater restriction. Frequent complications are due to the band, due to its inclusion or slippage, without being able to reject others. Our purpose is to present the video of a revisional bariatric surgery made by laparoscopic approach in a patient with a previous open retrogastric retrocolic Capella gastric bypass. The patient presents dysphagia, gastroesophagic reflux disease (GERD), and pain, with a BMI of 36 kg/m2. Her supplementary tests show a hiatal hernia, GERD, and a Candy Cane Syndrome. The surgery was difficult due to multiple adhesions. Hiatal hernia was repaired and pillars were closed. The band was visualized intraoperatively close to the gastrojejunal anastomosis, although the high endoscopy did not detect neither stenosis nor difficulty of passage to the gastric pouch. It showed the retrogastric gastrojejunal anastomosis with a normal food loop and a 15-cm widened blind loop (Candy Cane Syndrome), which was resected. She had a left pneumonia and damage in left hepatic lobe (LHL). She was discharged after antibiotic treatment for 7 days. The patient has improved clinically, without dysphagia nor GERD. Her current BMI is 29.8 kg/m2. In conclusion, bariatric revisional surgery can lead to serious complications, but it is justified in patients withpoor quality of life. A ringed retrocolic retrogastric bypass poses more difficulties in revisional procedures. It is mandatory to know which technique was performed before. The duration of the procedure can result in more complications like liver damage.

Body size preferences for women and adolescent girls living in Africa: a mixed-methods systematic review.

To synthesise evidence on body size preferences for females living in Africa and the factors influencing these. Mixed-methods systematic review including searches on Medline, CINHAL, ASSIA, Web of Science and PsycINFO (PROSPERO CRD42015020509). A sequential-explanatory approach was used to integrate quantitative and qualitative findings. Urban and rural Africa. Studies of both sexes providing data on body size preferences for adolescent girls and women aged ≥10 years. Seventy-three articles from twenty-one countries were included: fifty quantitative, fifteen qualitative and eight mixed methods. Most studies reported a preference for normal or overweight body sizes. Some studies of adolescent girls/young women indicated a preference for underweight. Factors influencing preferences for large(r) body sizes included: socio-demographic (e.g. education, rural residency), health-related (e.g. current BMI, pubertal status), psycho-social (e.g. avoiding HIV stigma) and socio-cultural factors (e.g. spouse's preference, social standing, cultural norms). Factors influencing preferences for slim(mer) body sizes included: socio-demographic (e.g. higher socioeconomic status, urban residency, younger age), health-related (e.g. health knowledge, being nulliparous), psycho-social (e.g. appearance, body size perception as overweight/obese) and socio-cultural factors (e.g. peer pressure, media). Preference for overweight (not obese) body sizes among some African females means that interventions need to account for the array of factors that maintain these preferences. The widespread preference for normal weight is positive in public health terms, but the valorisation of underweight in adolescent girls/young women may lead to an increase in body dissatisfaction. Emphasis needs to be placed on education to prevent all forms of malnutrition.

Renal function in a cohort of HIV-infected patients initiating antiretroviral therapy in an outpatient setting in Ethiopia.

To evaluate the prevalence and associated factors of abnormal renal function among Ethiopian HIV-infected patients at baseline prior to initiation of antiretroviral therapy (ART) and during follow-up. We conducted a retrospective observational cohort study of HIV infected patients who initiated ART at the outpatient ART clinic of Mehal Meda Hospital of North Shewa, Ethiopia from January 2012 to August 2018. Demographic and clinical data were abstracted from the medical records of patients. Renal function was assessed by estimated glomerular filtration rate (eGFR) calculated using the Modification of Diet in Renal Disease (MDRD) equation. Univariate and multivariate analysis were conducted to determine the factors associated with abnormal renal function at baseline and during follow-up. Among 353 patients, 70 (19.8%) had baseline eGFR <60 ml/min/1.73m2 and 102 (28.9%) had eGFR = 60-89.9 ml/min/1.73m2. Factors associated with baseline renal impairment (eGFR <60 ml/min/1.73m2) included female sex (AOR = 3.52, CI 1.75-7.09), CD4 count < 200 cells/mm3 (AOR = 2.75, CI 1.40-5.42), BMI < 25 Kg/m2 (AOR = 3.04, CI 1.15-8.92), low hemoglobin (AOR = 2.19, CI 1.16-4.09) and high total cholesterol (AOR = 3.15, CI 1.68-5.92). After a median of 3.0 years of ART, the mean eGFR declined from 112.9 ± 81.2 ml/min/1.73m2 at baseline to 93.9 ± 60.6 ml/min/1.73m2 (P < 0.001). The prevalence of renal impairment increased from 19.8% at baseline to 22.1% during follow-up. Of 181 patients with baseline normal renal function, 49.7% experienced some degree of renal impairment. Older age (AOR = 3.85, 95% CI 2.03-7.31), female sex (AOR = 4.18, 95% CI 2.08-8.40), low baseline CD4 (AOR = 2.41, 95% CI 1.24-4.69), low current CD4 count (AOR = 2.32, 95% CI 1.15-4.68), high BMI (AOR = 2.91, 95% CI 1.49-5.71), and low hemoglobin (AOR = 3.38, 95% CI 2.00-7.46) were the factors associated with renal impairment during follow-up. Impaired renal function was common in HIV-infected patients initiating ART in an outpatient setting in Ethiopia, and there appears to be a high prevalence of renal impairment after a median ART follow-up of 3 years. There is a need for assessment of renal function at baseline before ART initiation and regular monitoring of renal function for patients with HIV during follow-up.

DNA methylation signatures of aggression and closely related constructs: A meta-analysis of epigenome-wide studies across the lifespan

DNA methylation profiles of aggressive behavior may capture lifetime cumulative effects of genetic, stochastic, and environmental influences associated with aggression. Here, we report the first large meta-analysis of epigenome-wide association studies (EWAS) of aggressive behavior (N = 15,324 participants). In peripheral blood samples of 14,434 participants from 18 cohorts with mean ages ranging from 7 to 68 years, 13 methylation sites were significantly associated with aggression (alpha = 1.2 × 10−7; Bonferroni correction). In cord blood samples of 2425 children from five cohorts with aggression assessed at mean ages ranging from 4 to 7 years, 83% of these sites showed the same direction of association with childhood aggression (r = 0.74, p = 0.006) but no epigenome-wide significant sites were found. Top-sites (48 at a false discovery rate of 5% in the peripheral blood meta-analysis or in a combined meta-analysis of peripheral blood and cord blood) have been associated with chemical exposures, smoking, cognition, metabolic traits, and genetic variation (mQTLs). Three genes whose expression levels were associated with top-sites were previously linked to schizophrenia and general risk tolerance. At six CpGs, DNA methylation variation in blood mirrors variation in the brain. On average 44% (range = 3–82%) of the aggression–methylation association was explained by current and former smoking and BMI. These findings point at loci that are sensitive to chemical exposures with potential implications for neuronal functions. We hope these results to be a starting point for studies leading to applications as peripheral biomarkers and to reveal causal relationships with aggression and related traits.

Hypertension and Associated Factors among Patients on HIV Antiretroviral Therapy at Korle-Bu Teaching Hospital

Background: The chronic nature of HIV infection requires lifelong Antiretroviral Therapy (ART) to continuously suppress HIV viral replication, reducing morbidity and mortality. Management of co-morbidities is one of the major challenges associated with the multi-drug regimens used for HIV therapy. Hypertension as a co-morbidity in Persons Living with HIV (PLHIV) has become an important public health challenge and importantly influence patient management and service delivery at HIV clinics. This study determined the prevalence of hypertension among patients attending HIV clinic at the Korle-bu Teaching Hospital (KBTH) and also explored the nature of the relationship between HIV/ART and hypertension in order to help identify individuals who could benefit from interventions to prevent or delay the onset of complications of hypertension and thereby improve the overall quality of life of PLHIV Methods: A simple random sampling technique was used to recruit study participants based on the routine clinic attendance sample frame. A questionnaire adapted from WHO STEPwise approach to chronic disease risk-factor surveillance was modified and used for the collection of study participants' data. The prevalence of hypertension was estimated among study participants. Socio-demographic, lifestyle, anthropometric, metabolic and HIV/ART-related factors associated with hypertension were determined by logistic regression modelling using the purposeful selection of covariates method. Results: A total of 311 PLHIV were recruited as study participants. The present study revealed that the prevalence of hypertension in patients attending HIV clinic at KBTH was 36.7% and the factors associated with hypertension were increasing age, positive family history of hypertension, minimal exercising, current BMI ≥25.0 kg/m2, total cholesterol level ≥5.17 mmol/L, exposure to ART and increasing duration of ART exposure. Conclusion: This study shows a high prevalence of hypertension among patients attending HIV clinic at KBTH which is associated with exposure to Antiretroviral Therapy and increasing duration of this exposure. Blood pressure monitoring should move from being routine at the HIV clinic to more purposeful screening of patients for hypertension. Patients should be encouraged to have regular blood pressure measurements at home and not only when they visit HIV clinic.

Сравнение анамнестических характеристик, особенностей образа жизни и сопутствующих заболеваний у пациентов с ожирением при наличии и отсутствии сахарного диабета 2 типа

Background : Obesity is one of the most significant risk factors for type 2 diabetes (T2D), but a large number of patients with morbid obesity maintain normal glycemia for a long time. There are no definite easy-to-measure clinical features that distinguish severely obese people who will or will not develop T2D. These features may be useful in clinical practice to predict T2D development in obese patients. Aims: We aimed to identify clinical features (lifestyle factors, obesity history, concomitant diseases) that may be associated with T2D in obese patients. Materials and methods : The study was conducted at single center during 2002 and 2017 and recruited patients with BMI≥30 kg/m2 who attended bariatric surgeon. Patients weight and height were assessed by the doctor, other features were obtained from the questionnaire: overweight and obesity history (age of onset, duration, family history of obesity), lifestyle factors, T2D and concomitant diseases medical history. Patients were divided into 2 groups with regard to the presence of T2D. Data analysis was performed with Statistica 13.3. Results : The study included 170 patients with known T2D and 528 patients without history of T2D and prediabetes. Both groups had similar gender structure, as well as current and peak BMI. There were no significant differences in overweight/obesity duration, obesity family history, lifestyle factors and smoking status of patients. Obese patients without T2D were younger than T2D patients at the time of T2D onset (median age 40 and 45 years respectively). Patients without T2D started to gain weight earlier than those with T2D (median age 17 and 25 years respectively) and reached their peak BMI during 1 year before study entry, while patients with T2D went through maximum weight previously. The frequencies of concomitant diseases didn’t differ between the groups with the exception of hypertension that started later in patients with T2D (median age 51 and 47 years in patients with and without T2D respectively); also patients with T2D had gastroesophageal reflux disease (GERD) and chronic back pain less often than patients without T2D with regard to age. Conclusions : Clinical features that distinguished obese patients with and without T2D were age at the start of overweight/ obesity and concomitant disease profile (hypertension, GERD, chronic back pain) at corresponding age.