BMI Cut-off Values Research Articles

Do obese patients undergoing extracorporeal membrane oxygenation have a higher mortality ? a systematic review and meta-analysis

Abstract Background While ECMO is a life-saving intervention for patients with severe respiratory or cardiac failure, the impact of obesity on its efficacy and associated risks remains unclear. Purpose We aimed to perform a systematic review and meta-analysis comparing whether obese individuals undergoing ECMO face higher mortality and morbidity risks compared to their non-obese counterparts. Methods PubMed, Embase, and Cochrane were searched in December 2023 for studies comparing the outcomes between obese versus non-obese patients undergoing extracorporeal membrane oxygenation. We computed mean differences (MD) for continuous outcomes and odds ratios (OR) for binary outcomes, with 95% confidence intervals (95%CIs). Heterogeneity was assessed using I² statistics. Statistical analyses were performed using R version 4.2.3. Results Twenty-two studies comprising 39,322 participants were included in the meta-analysis. We divided the exposure and the control into 4 pairwise meta-analyses including BMI cut-off values of <25 kg/m², <30 kg/m², <35 kg/m², <40 kg/m². There were no significant differences between groups with a BMI <25, <30, <35 in all-cause mortality (<25: OR 0.96; 95% CI 0.76 - 1.21; p: 0.708 / <30: OR 0.88; 95% CI 0.68 - 1.14; p: 0.340 / <35: 0.97; 95% CI 0.80 - 1.19) p: 0.784) respectively; but with an increasing tendency towards favoring a higher BMI. On the other hand, the higher BMI analysis (<40) demonstrated a significant association between higher BMI and less mortality (OR 0.52; 95% CI 0.29 - 0.95; p: 0.034). Conclusion In patients undergoing ECMO, a higher BMI is associated with decreased all-cause mortality.Figure 1.Cut off <25; Cut off <30Figure 2.Cut off <35; Cut off <40

Body Composition, Nutritional Status, and Socio-Demographic Factors Among University Students and Teachers in Bangladesh: A Pilot Study

BackgroundBody composition, particularly visceral fat content, is regarded as an important determinant of major metabolic disorder. People with similar BMI could have differential body fat and muscle composition with different metabolic outcome. Epidemiological research largely focuses on BMI or relative body weight across the range of height and waist hip ratio (WHR) as a index of central body shape; however, body composition has hitherto given little importance in Bangladesh. Therefore, we designed a small pilot cross sectional study to assess anthropometrics, the body composition by bioelectrical impedance and nutritional status and its differences among students and teacher of Islamic University, Bangladesh. MethodsA total of 133 participants (median age of 22.51±3.86 years), students and teachers, were recruited. In addition to BMI and waist-hip ratio (WHR), a body composition analyzer (based on bioelectrical impedance) was used to determine the body composition parameter. Descriptive statistics, chi-square, T test and Pearson correlations were done. ResultsConsiderable differences were observed among various age groups and genders. Most of the respondents had a higher metabolic age (definition) than the chronological age, and 42.86% had high fat percentage. Male had lower body fat (19.56% vs 26.29%) but more visceral fat (4.96% vs 4.32) than female. Visceral fat was significantly (p<0.001) raised in older age groups than younger ones (10.26% vs 4.33%, P<0.05). The cut-off values of BMI were normal in range for both genders, and WHR for male and female were 0.83 and 0.81 respectively. Body protein, muscle, water, moisture, and abio-salt content were higher at the age of 40 years, and female respondents had the lowest ones compared to males. ConclusionUnhealthy visceral fat was higher in male and older age group. A healthy level of all body composition parameters was observed in young age groups compared to the older ones.

Evaluation of the Postoperative Risk of Deep Tissue Injury to the Lower Extremities Following Surgery in the Lithotomy Position.

Background The aim of this study was to determine the incidence of deep tissue injury (DTI) and potential risk factors after surgery in the lithotomy position. Methods All patients who underwent surgery in the lithotomy position under general anesthesia at a single center between January 2017 and December 2021 were retrospectively evaluated. The medical records of these patients were reviewed, and patient demographic and clinical characteristics, surgical data, and occurrence of DTI were recorded. Results During the study period, 5146 patients, 2055 (39.9%) males and 3091 (60.1%) females, witha mean age of 57.3 ± 17.4 years, underwent surgery in the lithotomy position. Seven (0.14%) patients developed DTI on their calf following surgery. All presented with severe pain and swelling, requiring prolonged hospital stay. Multivariate analysis showed that male sex (odds ratio (OR): 11.43; 95% confidence interval (CI): 1.15-113.34, p = 0.037), higher BMI (OR: 1.32; 95% CI: 1.17-1.50, p = 0.0001), and longer operation time (OR: 1.01;95% CI: 1.004-1.014, p = 0.0002) were independent risk factors for postoperative DTI. Optimal cut-off values for BMI and operation time were 23.5 kg/m2 (sensitivity = 100%; specificity = 64%) and 285 minutes (sensitivity = 100%; specificity = 90%), respectively. Conclusion Factors significantly associated with DTI include male sex, higher BMI, and prolonged operation time.

Undernutrition in obese older adults by fat percentage

ObjectiveThe prevalence of obesity by fat percentage has seen a steady increase in older adults in recent years, secondary to increases in fat mass in body composition, even in healthy aging. Malnutrition is a common geriatric syndrome with serious clinical outcomes. Increases in fat mass and waist circumference with healthy aging should not prevent the risk of malnutrition from being masked. Malnutrition is often ignored in obese older people due to low BMI cut-off values in many screening tests. The present study seeks to raise awareness of the need to assess the frequency of undernutrition and related factors in obese older adults.MethodsThe data of 2013 community-dwelling patients aged ≥ 60 years who applied to a university geriatrics outpatient clinic between April 2012 and November 2022 were analyzed retrospectively, of which 296 were found to be obese based on fat percentage and were included in the study. Demographic data and the presence of any geriatric syndromes were obtained retrospectively from the patient files, functional status was assessed using the KATZ Activities of Daily Living (ADL) Scale and the LAWTON-BRODY Instrumental Activities of Daily Living Scale (IADL); frailty was screened using FRAIL-scale; and the sample was assessed for malnutrition using the Mini Nutritional Assessment-Short Form (MNA-SF), with undernutrition defined as an MNA-SF score of ≤11.\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\le 11.$$\\end{document} The patients’ fat percentage and weight were measured using a bioimpedance analyzer. Fatty obesity was defined using the Zoico methodology (fat percentage ≥\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\ge$$\\end{document} 27.3% for males, ≥\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\ge$$\\end{document} 40.7% for females),\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$,$$\\end{document} handgrip strength (HGS) was measured using a hand dynamometer, and probable sarcopenia was defined as low HGS based on regional cut-off values (35 kg for males, 20 kg for females).ResultsThe mean age of the 296 fatty obese older adults (102 males/194 females) was 74.4 + 6.5 years, and the median fat was 42.2% (27.4–59.5). Undernutrition was detected in 19.6% of the patients based on MNA-SF screening. A univariate analysis revealed age, sex, educational status, daily physical activity status, depression, difficulty in swallowing, chewing difficulty, probable sarcopenia, number of chronic diseases, and IADL to be associated with undernutrition, while a multivariate logistic regression analysis revealed depression [OR = 3.662, 95% CI (1.448–9.013), p = 0.005] and daily physical activity status [OR:0.601, 95% CI (0.417–0.867), p = 0.006] to be independently associated with malnutrition in obese older adults based on fat percentage.Conclusion The present study clarifies the significance of undernutrition in obese older adults also in our country, and recommends undernutrition screening to be carried out, by fat percentage, on obese older adults, especially with depression and low daily physical activity.

The dynamic nexus: exploring the interplay of BMI before, during, and after pregnancy with Metabolic Syndrome (MetS) risk in Chinese lactating women

Background and aimThe health implications of BMI and MetS in lactating women are significant. This study aims to investigate the relationship between risk of Mets in lactation and BMI in four stages: pre-pregnancy, prenatal period, 42 days postpartum, and current lactation.Methods and resultsA total of 1870 Lactating Women within 2 years after delivery were included from "China Child and Lactating Mother Nutrition Health Surveillance (2016–2017)". Logistic regression model and Restricted cubic spline (RCS) were used to estimate the relationship between BMI and risk of MetS. ROC analysis was used to determine the threshold for the risk of MetS. Chain mediating effect analysis was used to verify the mediating effect. BMI of MetS group in all stages were higher than non-MetS group (P < 0.0001). There were significant positive correlations between BMI in each stage and ORs of MetS during lactation (P < 0.05). The best cut-off values for BMI in the four stages were 23.47, 30.49, 26.04 and 25.47 kg/m2. The non-linear spline test at BMI in 42 days postpartum, current and MetS in lactation was statistically significant (P non-linear = 0.0223, 0.0003). The mediation effect of all chains have to work through lactation BMI. The total indirect effect accounted for 80.95% of the total effect.ConclusionsThe risk of MetS in lactating women is due to a high BMI base before pregnancy and postpartum. High BMI in all stages of pregnancy and postpartum were risk factors for MetS in lactation. BMI during lactation plays a key role in the risk of MetS.

Comparison of bioelectrical body and visceral fat indices and anthropometric measures in relation to type 2 diabetes by sex among Chinese adults, a cross-sectional study.

We aim to compare the efficacies of the bioelectrical indices (percentage of body fat, PBF; visceral fat area, VFA) with the conventional anthropometric measures (body mass index, BMI; waist-hip ratio, WHR) for predicting type 2 diabetes (T2D) risk by sex and to determine the sex-specific optimal adiposity indices to predict the T2D risk. Cross-sectional design. Tianjin First Central Hospital and Tianjin Union Medical Center, Tianjin, China. A total of 9,332 adults (41.35% men) undergoing physical examination. T2D was defined using the WHO's criteria: fasting blood glucose (FBG) ≥7.0 mmol/L and/or previous diagnosis of T2D. Height, weight, waist, hip, PBF, VFA, and fasting plasma glucose were measured. All studied adiposity indices were associated with T2D among both males and females, and the observed associations differed by sex. The standardized aORs of BMI, WHR, PBF and VFA for T2D were 1.60 (95% CI 1.42-1.81), 1.43 (95% CI 1.25-1.64), 1.42 (95% CI 1.23-1.62) and 1.53 (95% CI 1.35-1.75) for females, and 1.47 (95% CI 1.31-1.66), 1.40 (95% CI 1.25-1.58), 1.54 (95% CI 1.36-1.74) and 1.47 (95% CI 1.31-1.65) for males, respectively. The AUCs of VFA, WHR and BMI were 0.743, 0.742 and 0.717 in women, respectively, whereas none of the indices had AUC larger than 0.70 in men. The AUCs were not significantly different between VFA and WHR, while both demonstrate larger AUCs than BMI and PBF in females (all p < 0.05). The optimal cutoff values of VFA, WHR, and BMI for T2D in women were 103.55 cm2, 0.905, and 24.15 kg/m2, respectively. Although BMI, WHR, and PBF and VFA as measured by bioelectrical impedance analysis (BIA) were all positively associated with T2D, their efficacy for predicting the risk of T2D differed by sex. VFA, WHR and BMI could be used as biomarkers to predict T2D risk in women, however none of the study indicators demonstrated favorable efficacy of predicting T2D risk in men.

Associations between parental adherence to healthy lifestyles and risk of obesity in offspring: a prospective cohort study in China

BackgroundMaternal adherence to a healthy lifestyle has been associated with a lower risk of obesity in offspring. However, little is known about the potential effect of an overall healthy parental lifestyle on the development of obesity in children. We aimed to investigate the prospective association of parental adherence to a combination of healthy lifestyle factors with the risk of obesity in offspring. MethodsParticipants in the China Family Panel Studies, without obesity at baseline, were enrolled between April and September, 2010; between July, 2012, and March, 2013; and between July, 2014, and June, 2015; and followed up until the end of 2020. Parental healthy lifestyle score (ranged 0–5) was characterised by five modifiable lifestyle factors: smoking, alcohol consumption, exercise, diet, and BMI. The first occurrence of offspring obesity during the study follow-up period was defined by age-specific and sex-specific cutoff values of BMI. We used multivariable-adjusted Cox proportional hazard models to examine the associations between parental healthy lifestyle scores and risk of obesity in children. FindingsWe included 5881 participants aged 6–15 years; median follow-up was 6 years (IQR 4–8). A total of 597 (10·2%) participants developed obesity during follow-up. Compared with those in the lowest tertile of parental healthy lifestyle scores, participants in the top tertile had a 42% lower risk of obesity (multivariable-adjusted hazard ratio [HR] 0·58 [95% CI 0·45–0·74]). The association persisted in sensitivity analyses and was similar across major subgroups. Both maternal (HR 0·75 [95% CI 0·61–0·92]) and paternal (0·73 [0·60–0·89]) healthy lifestyle scores were independently associated with lower risks of obesity in offspring, with significant contributions observed for paternal diverse diet and healthy BMI. InterpretationAdherence to an overall parental healthier lifestyle was associated with a substantially lower risk of obesity in childhood and adolescence. This finding highlights the potential benefits of promoting a healthy lifestyle among parents for the primary prevention of obesity in offspring. FundingSpecial Foundation for National Science and Technology Basic Research Program of China (grant reference 2019FY101002) and National Natural Science Foundation of China (grant reference 42271433).

Predictive analysis of maternal subcutaneous fat thickness for the risk of postpartum haemorrhage

The incidence of postpartum haemorrhage has been increasing in several developed countries over the past two decades. Obese women are at increased risk of postpartum hemorrhage. Till date BMI has been used to define obesity. Maternal abdominal subcutaneous fat thickness (SCFT) can be used as a measure for central obesity and can be measured by ultrasound easily. The present study was done to find association between maternal BMI and SCFT with development of PPH and to find a cut-off value of BMI and SCFT for prediction of risk of PPH. Methods: 200 women with live singleton pregnancy of 16-18 weeks gestation were included in the study after obtaining written informed consent. Maternal abdominal subcutaneous thickness was measured by USG. All women were monitored till delivery and observed for PPH. All data were entered into MS excel sheet and analysed. Results: Mean BMI was significantly more in women who had PPH (25.85 ± 3.24 vs 22.63 ± 2.80 kg/m2, p - &lt;0.001). Mean SCFT was significantly more in women who had PPH than in women without PPH (16.12 ± 2.75 vs 12.22 ± 3.00 mm, p - &lt;0.001). On ROC curve analysis, SCFT above 15.7 mm (AUC=0.840) predicted PPH with a sensitivity of 85% and specificity of 86% and associated with approximately 34 times increased risk of PPH [OR 34.1; 95% CI ((7.1383 – 162.49290, p - &lt;0.0001]. Conclusion: Maternal abdominal subcutaneous fat thickness measured at 16 to 18 weeks of pregnancy by USG is a reliable marker to identify women at risk of PPH.

Risk Factors of Deep Vein Thrombosis in Adults with Acute Compartment Syndrome Following Lower Extremity Fractures.

This study aimed to identify the risk factors of deep vein thrombosis (DVT) in adults with acute compartment syndrome (ACS) following lower extremity fractures. We collected data on adults with ACS following lower extremity fractures in our hospital from November 2013 to January 2021. Patients were divided into the DVT group and the non-DVT group according to whether they had DVT or not. The demographics, comorbidities, and admission laboratory examinations were computed by univariate analysis, logistic regression analysis, and receiver operating characteristic (ROC) curve analysis. In our study, the rate of DVT (26 of 110) was 23.6%. Univariate analysis showed that numerous factors were associated with the formation of DVT. Logistic regression analysis showed that patients with multiple fractures (P = .015, OR = 5.688), patients with a history of hypertension (P = .011, OR = 16.673), and patients with a higher BMI (P = .008, OR = 1.950) and FDP (P = .013, OR = 1.031) were relevant predictors of DVT. ROC curve analysis indicated 24.73 kg/m2 and 28.33 μg/mL were the cutoff values of BMI and FDP to predict the DVT, respectively. Furthermore, the combination of BMI and FDP had the highest diagnostic accuracy. Our findings identified multiple fractures, BMI, and FDP as independent risk factors for DVT in patients with ACS following lower extremity fractures and determined the cutoff values of BMI and FDP, helping us individualize the assessment of the risk of DVT to manage early targeted interventions.

Assessment Of Left and Right Ventricular Functions In Overweight and Obese Females by Different Echo-Doppler Modalities

Abstract Aim of work Assessment of left and right ventricular functions in overweight and obese females using different echo-Doppler modalities. Methods This study included 32 obese females (group I), 26 overweight females (group II) -both of them have no chronic illnesses- in addition to 25 healthy females (group III) as a control group. All of them had hsCRP level measured. The following parameters were measured using 2D echocardiography: LA, Ao, LA/Ao ratio, LV measures included LV dimensions, 2D LVEF, 2D LV global longitudinal strain (LVGLS), average LV Sm, Em, Am, LV E/Em ratio, LV E, A and LV E/A ratio. RV measures included LV dimensions, RV FAC, RV Tei index, TAPSE, RV Sm, Em, Am, Em/Am ratio, RV E, A, E/A ratio and PASP. Results hsCRP, LA, Ao, LV dimensions, Average LV Am, E/Em, RVD1, RV Tei and PASP were significantly higher in group I compared to group III, but group I had significantly lower LV E/A, LV Sm, Em, LVGLS, RV E/A, Em/Am and RVGLS compared to group III. Group II had significantly higher hsCRP, Ao and RV Tei and significantly lower LV E/A ratio and LV Em compared to group III. On the other hand, group, I had significantly lower average Sm, LVGLS and RVGLS than group II but no significant difference detected between two groups as regard LV and RV diastolic function. Pulse, BMI, BSA, waist circumference, waist to hip ratio, hsCRP were negatively correlated with LVGLS and RVGLS. Cut-off values for BMI showed good sensitivity and specificity to predict impaired LVGLS and RVGLS. Cut-off point 31.9 kg/m2 for impaired LVGLS with sensitivity 80%, specificity 76.81% and p value &amp;lt;0.001, cut-off point &amp;gt;30.73kg/m2 for impaired RVGLS with sensitivity 80%, specificity 69.57% and p value 0.001. Waist circumference was the most sensitive predictor for impaired LVGLS and hsCRP for impaired RVGLS. Conclusion Isolated obesity and overweight are independent predisposing factors for impaired LV and RV systolic and diastolic dysfunctions. TDI and 2D STE are good echo-Doppler modalities to detect subclinical effects on LV and RV functions. Additional Content An author video to accompany this abstract is available on https://academic.oup.com/eurheartjsupp. Please click on the arrow next to ‘More Content’ and then click on ‘Author videos’.

Predictive analysis of maternal subcutaneous fat thickness for the risk of foetal macrosomia

Introduction: Foetal macrosomia is defined as a birth weight above the 90th percentile for gestational age or a birth weight ≥4000 g. Maternal obesity is one of the risk factors for foetal macrosomia. Maternal abdominal subcutaneous fat thickness can be used as a marker for central obesity. This present study was done to find association of maternal BMI and abdominal SCFT with macrosomia and to find a cut-off value of BMI and SCFT for prediction of macrosomia. Methods: 200 women, with live singleton pregnancy of 16-18 weeks of gestation were included after written informed consent. Maternal abdominal subcutaneous thickness was measured by ultrasonography. Women were followed till delivery and birth weight was calculated and babies with birth weight &gt;4000 gm were diagnosed to be macrosomic. Data were analyses. Results: Spearman correlation between SCFT and neonatal weight shows a significant but weak positive linear relation (r= 0.4325, p- 0.000). Mean SCFT was significantly more in women with macrosomia (17.26 ± 2.6 vs. 12.35 ± 3.05 mm, p 0.0005 respectively) ROC curve analysis for ASCFT showed that ASCFT above 14.3 mm (AUC=0.970) predicted macrosomia with a sensitivity of 100% and specificity of 73%. Increased abdominal SCFT was significantly associated with increased risk of developing macrosomia. Using 14.3 mm cut -off value (by ROC curve) for ASCFT, the odd ratio of macrosomia was 30 (95% CI 1.6341-553.2106, p 0.02). Conclusion: Our study found that measurement of SCFT at 16-18 weeks is a significant predictor of macrosomia.

Acute postoperative pain and opioid consumption after laparoscopic cholecystectomy is associated with body mass index: a retrospective observational single-center study

Aim: The aim of this study was to determine the relationship between postoperative pain scores and opioid analgesic consumption according to BMI levels in patients undergoing laparoscopic cholecystectomy.&#x0D; Material and Method: In this retrospective observational study, we scanned the medical data of 154 patients aged from 18-55 years who underwent laparoscopic cholecystectomy. Patients were divided into two groups based on the BMI cut-off value (Group Non-obese, BMI 30 kg/m2, n=35). Postoperative visual analog scale (VAS) pain scores, total tramadol consumption, and intraoperative fentanyl bolus requirements were compared between the groups at five-time points (T0: in the recovery room, T1: 1st hour in the ward, T2: 6th hour, T3: 12th hour, and T4: 24th hour).&#x0D; Results: Postoperative VAS pain scores were significantly higher in the Group Obese at T1-2 time points (p=0.009). The number of patients with a VAS score of &gt;3 at the T-0 time point was significantly higher in the Group Obese (p=0.014). Total tramadol consumption was significantly higher in the Group Obese (40.0±46.6 mg) than in the Group Non-obese (16.10±34.0 mg) (p=0.003). There was a weak positive correlation between BMI and postoperative pain scores (T0, T-1, T-2) of the patients, and a moderate positive correlation (r=0.307) between total tramadol consumption.&#x0D; Conclusions: According to the results of this study, BMI is associated with acute postoperative pain in patients undergoing cholecystectomy, and obese patients require more opioid analgesia postoperatively. However, postoperative analgesia requirements should be determined according to BMI levels in patients undergoing cholecystectomy.

Comparison of Body Mass Index with Modified Subjective Global Assessment for Detection of Malnutrition Among Patients Under Maintenance Hemodialysis: A Multi-Center Cross-Sectional Study

Background: Patients under maintenance hemodialysis are at increased risk of malnutrition, causing from multitude of factors. Present study aims to assess the prevalence of malnutrition among maintenance hemodialysis patients using both modified subjective global assessment score and body mass index, compare them and assess the sensitivity and specificity of body mass index for detecting malnutrition, along with determining a new cutoff value for BMI that better represent the maintenance hemodialysis patient’s nutritional status. Methods: This was a cross-sectional study conducted in the hemodialysis unit of Bangabandhu Sheikh Mujib Medical University, Sir Salimullah Medical College Mitford Hospital, BIRDEM General Hospital and National Institute of Kidney Diseases &amp; Urology; among 80 adult CKD patients who were on regular (≥2 sessions per week) maintenance hemodialysis for more than 3 months without any acute infection, during the period of July 2016 to June 2017. Nutritional assessment was done for each patient using modified SGA score along with BMI. Sensitivity analysis of WHO recommended cutoff value for BMI was done among the study population using modified SGA score as gold standard test for detection of malnutrition among the respondents. ROC curve was used to estimate the best fitting cutoff value of BMI that showed highest sensitivity, specificity and accuracy for detracting malnutrition among maintenance hemodialysis patients. Results: The study participants were predominantly male (66.3%) and from age group 45 to 59 years (36.3%). Modified SGA score detected 90.0% of the study population as malnourished. WHO recommended 18.5 kg/m2 cutoff value was also used to detect malnutrition among study population and 13.8% were found to be malnourished, with a sensitivity and specificity of 12.5% and 75.0% respectively. Accuracy was found to be 18.8%. Using ROC curve, 23.1 kg/m2 was found to be the best fitting cutoff value of BMI for the study population to detect malnutrition. With a sensitivity of 47.2%, specificity of 37.5% and accuracy of 46.3%. Conclusion: BMI showed low sensitivity for detecting malnutrition among patients under maintenance hemodialysis, compared to modified SGA score and should be avoided as a screening tool, but 23.1 kg/m2 cutoff value for BMI showed potential to be used as an easy to use and quick tool for detecting malnutrition among such patients. Further study with larger sample size could shed more light on this. JOPSOM 2021; 40(1): 14-21

Body composition assessment in overweight obese Srilankans-single tertiary care center study

Rationale: Bioelectrical analysis method is a recognized tool for body composition analysis used for obese patients. It allows correct estimation of visceral fat, resting metabolism and skeletal muscle mass in obese patients. Objective of this study is to describe the body composition characteristics in relation to BMI groups of overweight and obese patients referred to obesity clinic of National Hospital-Kandy during August 2020. BMI groups were chosen according to the indian BMI cut-off values(1).

Metabolic Syndrome and Body Composition Among People Aged 50 Years and Over: Results from The Neyshabur Longitudinal Study on Ageing (NeLSA).

There are few studies regarding body composition and metabolic syndrome (MetS) association in older adults. To evaluate the association between MetS and body composition indices in a large-scale population of subjects with an age of 50 and up. This study was based on the data from Neyshabur Longitudinal Study on Ageing (NeLSA) in a total of 7462 people of Neyshabur city in IRAN. The best cut-off scores and AUC value of body composition variables for having association with likelihood of MetS were determined by using a receiver operating curve analysis. Each unit increase in the Waist/Hip ratio, the odds of having MetS increase 3-6 times (OR: 4.937, 95%CI: 3.930, 6.203 in men; OR: 3.322, 95%CI: 2.259, 4.884 in women). In addition, in the case of BMI (OR: 1.256, 95% Cl: 1.226, 1.286 in men; OR: 1.104, 95% Cl: 1.086, 1.121 in women) and BFM (OR: 1.119, 95% Cl: 1.105, 1.133 in men; OR: 1.050, 95% Cl: 1.041, 1.060 in women), the chance of having MetS increases with increasing these variables. Totally, BMI and BFM showed the best AUC values. The optimal cut-off values for BMI in men was 26.45 and in women was 27.35 and for BFM in men was 23.35 and in women was 26.85. These results suggest that adiposity measures such as BMI and BFM are associated with likelihood of having MetS in subjects with an age of 50 and up, and that avoiding high adiposity is important to prevent MetS incidence.

Evaluation of Ultrasound Guided Measurement of Anterior Neck Soft Tissue Thickness in Predicting Difficult Laryngoscopy in Obese Patients

Background: The incidence of unanticipated difficult airway is 14.3-17.5% in obese. Preoperative difficult airway prediction is important to avoid postoperative morbidity and mortality. USG guided measurement of anterior neck soft tissue thickness can be used to predict difficult laryngoscopy in obese patients and we thus undertook this study to determine the role of USG guided measurement of anterior neck thickness at the level of vocal cords in difficult laryngoscopy prediction. Methods: Sixty obese patients (BMI≥30kg/m2), 18-70 years of age of either sex, were included. Anterior neck soft tissue thickness was measured by ultrasound as the distance from the skin to the anterior commissure of vocal cord. Neck circumference was measured at mid neck just below the laryngeal prominence with the subjects standing upright and facing forward with shoulders relaxed. Thyromental distance, sternomental distance, Mallampatti score and neck circumference were also recorded. Results: The cut off values of BMI (46.94 kg/m2), neck circumference (41.5 cm) and anterior neck soft tissue thickness (22.1mm). Four patients in the morbidly obese and 80% of the superobese patients had a difficult laryngoscopy. Sixteen (26.67%) patients had an anterior neck soft tissue thickness of &gt;22.1mm. Of these, 11 (91.67%) patients had difficult laryngoscopy while one (8.33%) patient with anterior neck soft tissue thickness ≤ 22.1mm had difficult laryngoscopy (P&lt;0.05). There was also significant association between neck circumference and BMI. Conclusion: The USG guided measurement of anterior neck soft tissue thickness, BMI and neck circumference can reliably predict difficult laryngoscopy in obese patients.

Predicational ability of phase angle on protein energy wasting in kidney disease patients with renal replacement therapy: A cross-sectional study.

ObjectiveTo investigate the ability of phase angle (PA) and body composition for predicting protein energy wasting (PEW) in renal replacement therapy (RRT) patients.MethodsRenal replacement therapy (RRT) patients were enrolled in this study. Body composition was measured by direct segmental multi‐frequency biolectrical impedance analysis method (DSM‐BIA); phase angle (PA), fat‐free mass (FFM), fat mass (FM), mid‐arm circumference (MAC), WC (waist circumference), and ECW/TBW (extracellular water/total body water) were obtained. Biochemicals (serum albumin, triglyceride, and cholesterol) were tested. PEW patients were classified according to ISRNM (The International Society of Renal Nutrition and Metabolism) criteria. Cutoff value of PA and related variables was calculated by ROC analysis. The ability of body composition variables as indicators to predict PEW was evaluated.ResultsSixty‐four patients were enrolled in this study. Thirty‐three patients (52.6%) were males, and forty (62.5%) patients were diagnosed with PEW. The ROC curve showed that the optimal cutoff values of PA, FFMI (fat‐free mass index), MAC, WC, and BMI for PEW risk were 4.45°, 16.71, 29.7 cm, 86.4 cm, and 21.1 kg/m2, respectively. These indicators showed significant association with PEW; meanwhile, the PA and MAC can be used as the predictors for PEW with OR 6.333 (95% CI, 1.956–20.505) and 3.267 (95% CI, 1.136–9.394), respectively. Both groups have a lower BUN/Cr ratio (<20).ConclusionIn the RRT patients, over than 60% patients were diagnosed with PEW. PA, MAC, and other body composition can be used as the independent indicators for predicting PEW in renal replacement therapy kidney disease patients.

Evaluation of sleep apnea prevalance among driving license applicants

Aim: This study aimed at evaluating the PSG results of the applicants of driving license by reference to the BMI, and investigating the accuracy of this cutoff value of BMI (33) on detecting the patients with OSAS among the applicants of driving licenseMaterials and Methods: Driving license applicants with a BMI 36 constituted the group B. The AHI levels of the groups were compared, and ROC analyzes were performed to detect accurate BMI values. Results: Median AHI values did significantly differ among three groups (p0.001). median AHI was statistically significantly higher in group A (median AHI: 12.5) and in group B (median AHI: 12.9) compared to the control group (median AHI: 2.4) (p0.001). However, there was no significant difference between the median AHI of the group A and B (median AHI: 12.5 vs. 12.9) (p= 0.336). Additionally, 34 was found to be the cut-off value for BMI suggesting that AHI could be 15 and/or above; and 34.8 was found to be the cut-off value for BMI suggesting that AHI could be 30 and/or above. Conclusion: Patients with a BMI over 33 had a greater AHI compared to the patients. Additionally, 34.8 value was found to be the cut-off value for BMI suggesting that AHI could be 30 and/or above.

Obesity may be associated with adjacent-segment degeneration after single-level transforaminal lumbar interbody fusion in spinopelvic-mismatched patients with a minimum 2-year follow-up.

In this study, the authors' aim was to investigate whether obesity affects surgery rates for adjacent-segment degeneration (ASD) after transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis. Patients who underwent single-level TLIF for spondylolisthesis at the University of California, San Francisco, from 2006 to 2016 were retrospectively analyzed. Inclusion criteria were a minimum 2-year follow-up, single-level TLIF, and degenerative lumbar spondylolisthesis. Exclusion criteria were trauma, tumor, infection, multilevel fusions, non-TLIF fusions, or less than a 2-year follow-up. Patient demographic data were collected, and an analysis of spinopelvic parameters was performed. The patients were divided into two groups: mismatched, or pelvic incidence (PI) minus lumbar lordosis (LL) ≥ 10°; and balanced, or PI-LL < 10°. Within the two groups, the patients were further classified by BMI (< 30 and ≥ 30 kg/m2). Patients were then evaluated for surgery for ASD, matched by BMI and PI-LL parameters. A total of 190 patients met inclusion criteria (72 males and 118 females, mean age 59.57 ± 12.39 years). The average follow-up was 40.21 ± 20.42 months (range 24-135 months). In total, 24 patients (12.63% of 190) underwent surgery for ASD. Within the entire cohort, 82 patients were in the mismatched group, and 108 patients were in the balanced group. Within the mismatched group, adjacent-segment surgeries occurred at the following rates: BMI < 30 kg/m2, 2.1% (1/48); and BMI ≥ 30 kg/m2, 17.6% (6/34). Significant differences were seen between patients with BMI ≥ 30 and BMI < 30 (p = 0.018). A receiver operating characteristic curve for BMI as a predictor for ASD was established, with an AUC of 0.69 (95% CI 0.49-0.90). The optimal BMI cutoff value determined by the Youden index is 29.95 (sensitivity 0.857; specificity 0.627). However, in the balanced PI-LL group (108/190 patients), there was no difference in surgery rates for ASD among the patients with different BMIs (p > 0.05). In patients who have a PI-LL mismatch, obesity may be associated with an increased risk of surgery for ASD after TLIF, but in obese patients without PI-LL mismatch, this association was not observed.

Obesity: An independent protective factor for localized renal cell carcinoma in a systemic inflammation state.

ABSTRACTObjectivesTo explore the prognostic value of obesity (measured by BMI) on RCC in a systemic inflammation state.Patients and MethodsClinicopathological and hematological data of 540 surgically treated Chinese localized RCC patients between 2005 and 2010 were retrospectively collected. Found by receiver operating characteristic (ROC) curve for cancer-specific survival (CSS), the optimal cutoff values of neutrophil-lymphocyte ratio (NLR, an indicator of systemic inflammation state) and BMI were 2.12 and 23.32, respectively. Survival curves were drawn using Kaplan-Meier method. Univariate and multivariate Cox regression analyses were used to evaluate the prognostic value of BMI in localized RCC patients with different NLR.ResultsOverall, 36 patients died with a median follow-up of 70 months. Median overall survival (OS) was 66 months and the 5-year OS rate was 92.7%. In the multivariate analysis of total patients, higher BMI was an independent protective factor for CSS in total patients (p=0.048). While in systemic inflammation subgroup (high NLR subgroup) patients, higher BMI (obesity) turned out to be an independent protective factor for both CSS (p=0.025) and RFS (p=0.048).ConclusionIn localized RCC patients, obesity was an independent protective factor for CSS and RFS in a systemic inflammation state.