BMI Cut-off Values Research Articles

State-wise Dynamics of the Double Burden of Malnutrition among 15–49 Year-old Women in India: How Much Does the Scenario Change Considering Asian Population-specific BMI Cut-off Values?

This article assesses the gravity of the “double burden of malnutrition” across 21 states of India, through a comparative analysis of traditional and Asian population-specific BMI categorizations for overweight and obesity. This study analyzes data on ever-married women (15–49 years) from the National Family Health Survey (NFHS-2, 1998–1999; NFHS-3, 2005–2006). Findings depict that Indian women tilt toward high BMI resulting in a co-existence of under- and overweight populations, which portray a regional pattern. With Asian population-specific cut-offs, 11 states can be classified as “double burden states”; however, following traditional categorization, only 4 states face such dual pressure.

Optimal cut-off values of BMI, waist circumference and waist:height ratio for defining obesity in Chinese adults.

It has not been established which specific measures of obesity might be most appropriate for predicting CVD risk in Asians. The objectives of the present study were to determine the associations of BMI, waist circumference (WC) and waist:height ratio (WHtR) with CVD risk factors and to evaluate the optimal cut-off values to define overweight or obesity in Chinese adults. Data collected from seven nationwide health examination centres during 2008 and 2009 were analysed. The BMI, WC and WHtR of 244 266 Chinese adults aged ≥ 20 years included in the study were measured. Logistic regression models were fit to evaluate the OR of each CVD risk factor according to various anthropometric indices. Receiver operating characteristic (ROC) analyses were conducted to assess the optimal cut-off values to predict the risk of diabetes, hypertension, dyslipidaemia and the metabolic syndrome. WHtR had the largest areas under the ROC curve for all CVD risk factors in both sexes, followed by WC and BMI. The optimal cut-off values were approximately 24·0 and 23·0 kg/m2 for BMI, 85·0 and 75·0 cm for WC, and 0·50 and 0·48 for WHtR for men and women, respectively. According to well-established cut-off values, BMI was found to be a more sensitive indicator of hypertension in both men and women, while WC and WHtR were found to be better indicators of diabetes and dyslipidaemia. A combination of BMI and central obesity measures was found to be associated with greater OR of CVD risk factors than either of them alone in both sexes. The present study demonstrated that WHtR and WC may be better indicators of CVD risk factors for Chinese people than BMI.

Stability and changes in metabolically healthy overweight or obesity and risk of future diabetes: Niigata wellness study.

Stability and changes in obesity and metabolic health status from a baseline period and longitudinally investigated their impact on predicting future diabetes were assessed. Studied were 27,478 Japanese individuals without diabetes. Metabolically healthy (MH) was indicated by having ≤1 among impaired fasting glucose, hypertension, hypertriglyceridemia and low HDL cholesterol concentration. Metabolically abnormal (MA) was indicated by having ≥2 of those metabolic abnormalities. A cut-off value of BMI 25.0 defined overweight or obesity (O) or normal weight (NW). Hazard ratio (HR) for diabetes for a 6-year period was investigated after changes in phenotypes were assessed during the previous 2 years. Compared with maintaining MH-NW, transitioning to MH-O from MH-NW resulted in a multivariate-adjusted HR of 1.96 (95% CI: 1.18, 3.25) for diabetes. With a stable MH-O the HR for diabetes was 2.59 (2.00, 3.34) while change from MH-O to MH-NW resulted in an HR of 1.30 (0.61, 2.76). Transitioning to MA-O from MH-O was associated with an HR of 7.09 (5.41, 9.30). With a stable MA-O the risk of diabetes was substantially elevated with an HR of 12.5 (10.5, 14.9). Examining the transitory nature of apparently benign or unhealthy obese phenotypes was effective for differentiating high-risk individuals for future diabetes.

Association of metabolically healthy obesity (MHO) with subclinical coronary atherosclerosis in a Korean population

The degree of subclinical coronary atherosclerosis detected by coronary multidetector computed tomography (MDCT) in four groups defined by the state of metabolic health and obesity in an asymptomatic Korean population was compared. The data of 4009 asymptomatic subjects who participated in a routine health screening examination were collected. Significant coronary artery stenosis defined as >50% stenosis, plaque, and coronary artery calcium scores (CACS) were assessed by MDCT. Participants were stratified by BMI (cut-off value, 25 kg/m(2) ) and metabolically healthy state, which was defined by Wildman criteria. Metabolically healthy obese (MHO) subjects had a significantly higher prevalence of significant subclinical coronary atherosclerotic burden compared with metabolically healthy nonobese (MHNO) subjects. The adjusted odds ratios of the MHO group for various coronary MDCT findings (MHNO group as the reference), such as coronary artery stenosis, any plaque, calcified plaque, mixed plaque, CACS > 0, and CACS > 100, were 1.87 (95% CI 1.15-3.03), 1.31 (1.01-1.71), 1.40 (1.05-1.86), 1.57 (1.01-2.48), 1.38 (1.04-1.82), and 1.69 (1.03-2.78), respectively. Our data illustrate that MHO subjects have substantial subclinical coronary atherosclerotic burden. Thus, it is important to consider the metabolic health state and obesity in evaluating cardiovascular risk.

Oropharyngeal Crowding and Obesity as Predictors of Oral Appliance Treatment Response to Moderate Obstructive Sleep Apnea

Oral appliances are increasingly prescribed for patients with moderate obstructive sleep apnea (OSA) instead of nasal CPAP. However, the efficacy of oral appliances varies greatly. We hypothesized that oral appliances were not efficacious in patients with moderate OSA who were obese with oropharyngeal crowding. Japanese patients with moderate OSA were prospectively and consecutively recruited. The Mallampati score (MS) was used as an estimate of oropharyngeal crowding. Follow-up polysomnography was performed with the adjusted oral appliance in place. Responders were defined as subjects who showed a follow-up apnea-hypopnea index (AHI) of < 5 with > 50% reduction in baseline AHI. The mean baseline AHI was reduced with an oral appliance from 21 ± 4 to 9.8 ± 8 in 95 subjects. Thirty-five patients were regarded as responders. Logistic regression analyses revealed that both MS and BMI could individually predict the treatment outcome. When the cutoff value of BMI was determined to be 24 kg/m2 based on a receiver operating characteristic curve, 53 obese patients (ie, BMI > 24 kg/m2) with an MS of class 4 were indicative of treatment failure with a high negative predictive value (92) and a low negative likelihood ratio (0.28). We conclude that patients with moderate OSA who are obese with oropharyngeal crowding are unlikely to respond to oral appliance treatment. This simple prediction can be applied without the need for any cumbersome tools immediately after the diagnosis of OSA.

Mid-upper-arm Circumference and Arm-to-height Ratio in Evaluation of Overweight and Obesity in Han Children

The purposes of this study were: (1) to analyze whether mid-upper-arm circumference (MUAC) could be used to determine overweight and obese children and to propose the optimal cutoffs of MUAC in Han children aged 7-12 years; and (2) to evaluate the feasibility and accuracy of the arm-to-height ratio (AHtR) and propose the optimal cutoffs of AHtR for identifying overweight and obesity. In 2011, anthropometric measurements were assessed in a cross-sectional, population-based study of 2847 Han children aged 7-12 years. Overweight and obesity were defined according to the 2004 Group of China Obesity Task Force definition. The AHtR was calculated as arm circumference/height. Receiver operating characteristic curve analyses were performed to assess the accuracy of MUAC and AHtR as diagnostic tests for elevated body mass index (BMI; defined as BMI≥85(th) percentiles). The accuracy levels of MUAC for identifying elevated BMI [as assessed by area underthe curve (AUC)] were over 0.85 (AUC: approximately 0.934-0.975) in both gendersand across all age groups. The MUAC cutoff values for elevated BMI were calculated to be approximately 18.9-23.4cm in boys and girls. The accuracy levels of AHtR for identifyingelevated BMI (as assessed by AUC) were also over 0.85 (AUC: 0.956 in boys and 0.935 in girls). The AHtR cutoff values for elevated BMI were calculated to be 0.15 in boys and girls. This study demonstrates that MUAC and AHtR are simple, inexpensive, and accurate measurements that may be used to identify overweight and obese Han children. Compared with MUAC, AHtR is a nonage-dependent index with higher applicability to screen for overweight and obese children.

Validity of BMI, hip and waist circumferences as surrogate measures of obesity in a cohort of Sri Lankan premenopausal women

BMI, hip and waist circumferences (HC and WC) are being used as clinical surrogates of obesity. Unceratinities exist regarding the cut-off values, which are recommonded for Western countries. We conducted a study to determine cut-off values for Sri Lankan women. Healthy premenopausal women (n=128) aged 25 to 50 years were selected randomly, from local MOH area and stratified into four groups (32 in each) according to their BMI. Those who were pregnant, breast feeding, or on long-term medications were excluded. Body weight and height, hip circumference (HC) and waist circumference (WC) were measured, using standard protocols. Lean and fat mass, were measured by DXA and percentage FM (%FM) was calculated (FM/body weight x100). Women with %FM> 30% were considered obese. BMI moderately correlated (r = 0.41) with %FM and BMI accounted for only 16% (r2 = 0.16) of %FM variation. Regression equations were used to estimate the cut-off values that corresponded to %FM of 30. Those cut-off values for BMI, WC, and HC were 24.4 Kg/m2, 92 cm, and 78 cm, respectively. BMI, WC and HC values of 24 kg/m2, 92 cm and 78 cm can be considered appropriate cut-off values when detecting central obesity in premenopausal women.

Validity of newly-developed BMI and waist cut-off values for Sri Lankan children

Background: Excess body fat leads to obesity-related morbidity and population/ethnicity-specific cut-off values of anthropometric measures are useful for better diagnosis. This study assesses the suitability of newly-developed Sri Lankan anthropometric cut-off values in the diagnosis of obesity in Sri Lankan children.Methods: A cross-sectional study was conducted at University of Colombo, Sri Lanka involving 5–15 year old children. Height, weight, waist (WC), and hip (HC) circumferences were measured. Total body fat (FM) was measured using whole body BIA. WHR and WHtR were calculated. Validity of anthropometric measures in detecting childhood obesity (Sri Lankan BMI/WC; IOTF, WHO, British and CDC BMI and British WC cut-off values) were evaluated.Results: Nine hundred and twenty children were assessed. FM showed significant associations with BMI (r = 0.92, p < 0.001), WC (r = 0.90, p < 0.001) and HC (r = 0.85, p < 0.001), but poor association with WHR (r = 0.17, p < 0.001). However, WHtR had a high association with FM (r = 0.75, p < 0.001) and %FM (r = 0.78, p < 0.001). Based on %FM cut-offs, 85 (22.8%) girls and 101 (18.5%) boys were obese. All international anthropometric cut-off values under-estimated obesity. Sri Lankan WC and BMI cut-off values over-estimated obesity. International BMI based cut-off values had high specificity (>99%) but a low sensitivity (∼12–33%), while Sri Lankan BMI cut-off values had high sensitivity (>93.1) but low specificity (>79.7).Conclusions: Internationally available BMI cut-off values are poor in diagnosing obesity in Sri Lankan children. Newly developed Sri Lankan BMI cut-off values for children improved the diagnosis. WC can be used successfully as an alternative diagnostic tool of obesity.

Prevalence of Overweight in Dutch Children With Down Syndrome

Prevalence of overweight in children is increasing, causing various health problems. This study aims to establish growth references for weight and to assess the prevalence rates of overweight and obesity in a nationwide sample of Dutch children with Down syndrome (DS), taking into account the influence of comorbidity. In 2009, longitudinal growth data from Dutch children with trisomy 21 who were born after 1982 were retrospectively collected from medical records of 25 Dutch regional specialized DS centers. "Healthy" was defined as not having concomitant disorders or having only a mild congenital heart defect. Weight and BMI references were calculated by using the LMS method, and prevalence rates of overweight and obesity by using cutoff values for BMI as defined by the International Obesity Task Force. Differences in prevalence rates were tested by multilevel logistic regression analyses to adjust for gender and age. Growth data of 1596 children with DS were analyzed. Compared with the general Dutch population, healthy children with DS were more often overweight (25.5% vs 13.3% in boys, and 32.0% vs 14.9% in girls) and obese (4.2% vs 1.8%, and 5.1% vs 2.2%, respectively). Prevalence rates of overweight between DS children with or without concomitant disorders did not vary significantly. Dutch children with DS have alarmingly high prevalence rates of overweight and obesity during childhood and adolescence. Health care professionals should be aware of the risk of overweight and obesity in children with DS to prevent complications.

Re-evaluation of WHO-defined BMI cutoff value for defining overweight and obesity in the Bengalee (Indian) population

Re-evaluation of WHO-defined BMI cutoff value for defining overweight and obesity in the Bengalee (Indian) population

Double burden of malnutrition among urban Bengalee adolescent boys in Midnapore, West Bengal, India

AbstractMalnutrition is an important public health problem worldwide. Therefore a study was undertaken to assess the prevalence of adolescent thinness, overweight and obesity in Midnapore town, West Bengal, India. A total of 974 adolescent boys aged 10-18 years were selected following multistage cluster sampling method from three higher secondary schools. Data was collected using pretested questionnaire following standard technique. Presence of thinness was evaluated using the cut-off values of international survey as suggested by Cole et al (2007). While overweight and obesity was determine by using international cut-off values develop by Cole et al (2000) based on international surveys as recommended by IOTF. Overall the prevalence of thinness, overweight and obesity were 20.8%, 14.9% and 3.8%, respectively. This study developed age specific smooth BMI percentile values using LMS method. Moreover, the study also developed BMI cut-off values to define thinness, overweight and obesity. In conclusion, the present analyses indicated that the prevalence of adolescent undernutrition is still a major problem. In addition, there was also an emerging trend for overweight/obesity, thereby indicating a double burden of malnutrition as observed in other developing countries.

Double burden of malnutrition among urban Bengalee adolescent boys in Midnapore, West Bengal, India

Malnutrition is an important public health problem worldwide. Therefore a study was undertaken to assess the prevalence of adolescent thinness, overweight and obesity in Midnapore town, West Bengal, India. A total of 974 adolescent boys aged 10-18 years were selected following multistage cluster sampling method from three higher secondary schools. Data was collected using pretested questionnaire following standard technique. Presence of thinness was evaluated using the cut-off values of international survey as suggested by Cole et al (2007). While overweight and obesity was determine by using international cut-off values develop by Cole et al (2000) based on international surveys as recommended by IOTF. Overall the prevalence of thinness, overweight and obesity were 20.8%, 14.9% and 3.8%, respectively. This study developed age specific smooth BMI percentile values using LMS method. Moreover, the study also developed BMI cut-off values to define thinness, overweight and obesity. In conclusion, the present analyses indicated that the prevalence of adolescent undernutrition is still a major problem. In addition, there was also an emerging trend for overweight/obesity, thereby indicating a double burden of malnutrition as observed in other developing countries.

Double burden of malnutrition among urban Bengalee adolescent boys in Midnapore, West Bengal, India

AbstractMalnutrition is an important public health problem worldwide. Therefore a study was undertaken to assess the prevalence of adolescent thinness, overweight and obesity in Midnapore town, West Bengal, India. A total of 974 adolescent boys aged 10-18 years were selected following multistage cluster sampling method from three higher secondary schools. Data was collected using pretested questionnaire following standard technique. Presence of thinness was evaluated using the cut-off values of international survey as suggested by Cole et al (2007). While overweight and obesity was determine by using international cut-off values develop by Cole et al (2000) based on international surveys as recommended by IOTF. Overall the prevalence of thinness, overweight and obesity were 20.8%, 14.9% and 3.8%, respectively. This study developed age specific smooth BMI percentile values using LMS method. Moreover, the study also developed BMI cut-off values to define thinness, overweight and obesity. In conclusion, the present analyses indicated that the prevalence of adolescent undernutrition is still a major problem. In addition, there was also an emerging trend for overweight/obesity, thereby indicating a double burden of malnutrition as observed in other developing countries.

Association between variants of the leptin receptor gene (LEPR) and overweight: a systematic review and an analysis of the CoLaus study.

BackgroundThree non-synonymous single nucleotide polymorphisms (Q223R, K109R and K656N) of the leptin receptor gene (LEPR) have been tested for association with obesity-related outcomes in multiple studies, showing inconclusive results. We performed a systematic review and meta-analysis on the association of the three LEPR variants with BMI. In addition, we analysed 15 SNPs within the LEPR gene in the CoLaus study, assessing the interaction of the variants with sex.Methodology/Principal FindingsWe searched electronic databases, including population-based studies that investigated the association between LEPR variants Q223R, K109R and K656N and obesity- related phenotypes in healthy, unrelated subjects. We furthermore performed meta-analyses of the genotype and allele frequencies in case-control studies. Results were stratified by SNP and by potential effect modifiers. CoLaus data were analysed by logistic and linear regressions and tested for interaction with sex. The meta-analysis of published data did not show an overall association between any of the tested LEPR variants and overweight. However, the choice of a BMI cut-off value to distinguish cases from controls was crucial to explain heterogeneity in Q223R. Differences in allele frequencies across ethnic groups are compatible with natural selection of derived alleles in Q223R and K109R and of the ancient allele in K656N in Asians. In CoLaus, the rs10128072, rs3790438 and rs3790437 variants showed interaction with sex for their association with overweight, waist circumference and fat mass in linear regressions.ConclusionsOur systematic review and analysis of primary data from the CoLaus study did not show an overall association between LEPR SNPs and overweight. Most studies were underpowered to detect small effect sizes. A potential effect modification by sex, population stratification, as well as the role of natural selection should be addressed in future genetic association studies.

Deriving Ethnic-Specific BMI Cutoff Points for Assessing Diabetes Risk

OBJECTIVEThe definition of obesity (BMI ≥30 kg/m2), a key risk factor of diabetes, is widely used in white populations; however, its appropriateness in nonwhite populations has been questioned. We compared the incidence rates of diabetes across white, South Asian, Chinese, and black populations and identified equivalent ethnic-specific BMI cutoff values for assessing diabetes risk.RESEARCH DESIGN AND METHODSWe conducted a multiethnic cohort study of 59,824 nondiabetic adults aged ≥30 years living in Ontario, Canada. Subjects were identified from Statistics Canada’s population health surveys and followed for up to 12.8 years for diabetes incidence using record linkages to multiple health administrative databases.RESULTSThe median duration of follow-up was 6 years. After adjusting for age, sex, sociodemographic characteristics, and BMI, the risk of diabetes was significantly higher among South Asian (hazard ratio 3.40, P < 0.001), black (1.99, P < 0.001), and Chinese (1.87, P = 0.002) subjects than among white subjects. The median age at diagnosis was lowest among South Asian (aged 49 years) subjects, followed by Chinese (aged 55 years), black (aged 57 years), and white (aged 58 years) subjects. For the equivalent incidence rate of diabetes at a BMI of 30 kg/m2 in white subjects, the BMI cutoff value was 24 kg/m2 in South Asian, 25 kg/m2 in Chinese, and 26 kg/m2 in black subjects.CONCLUSIONSSouth Asian, Chinese, and black subjects developed diabetes at a higher rate, at an earlier age, and at lower ranges of BMI than their white counterparts. Our findings highlight the need for designing ethnically tailored prevention strategies and for lowering current targets for ideal body weight for nonwhite populations.

Estimating the Risk of Endometrial Cancer in Symptomatic Postmenopausal Women: A Novel Clinical Prediction Model Based on Patients' Characteristics

The aim of this study was to develop a multivariable model to predict the risk of endometrial carcinoma in postmenopausal women with vaginal bleeding using individuals' clinical characteristics. This prospective study of consecutive postmenopausal women presenting with vaginal bleeding was conducted at a gynecological oncology center in the United Kingdom for a 46-month period. All women underwent transvaginal ultrasound scanning as the initial investigation tool to evaluate the endometrium. Women found to have an endometrial thickness 5 mm or more had endometrial sampling performed. Of a total of 3548 women presenting with vaginal bleeding during the study period, 201 (6%) women had a diagnosis of endometrial carcinoma. An investigator-led best model selection approach used to select the best predictors of cancer in the multiple logistic regression model showed that patient's age (odds ratio [OR], 1.06), body mass index (OR, 1.07), recurrent episodes of bleeding (OR, 3.64), and a history of diabetes (OR, 1.48) increased the risk of endometrial malignancy when corrected for other characteristics. The mentioned clinical variables satisfied the criteria for inclusion in our predictive model called FAD 31 (F for the frequency of bleeding episodes, A for the age of the patient, D for diabetes, and the number 31 represents the BMI cut-off value). The total score for the model varies from 0 to 8. The area under the receiver operating characteristics curve for the developed model was 0.73 (95% confidence interval, 0.70-0.77). We have developed a simple model based on patients' clinical characteristics in estimating the risk of endometrial cancer for postmenopausal women presenting with vaginal bleeding. The model shows reasonable discriminatory ability for women with cancer and without, with an area under the receiver operating characteristics curve of 0.73. This will allow clinicians to individualize the diagnostic pathway for women with postmenopausal vaginal bleeding.

Obesity Indices amongst Diabetics in an Urban Population of Western Nepal

Background: It is estimated that 20% of global burden of Diabetes mellitus resides in South East Asia Region and is likely to triple by 2025. There is a strong correlation between changing lifestyle factors and increase in diabetes. Objectives: To find out the prevalence of diabetes and to determine the cut-off values of anthropometric indices (Body mass index and waist circumference) that best predict diabetes status among adult population of Pokhara, District Kaski, Nepal. Methods: The cross sectional field study involved 425 respondents, aged 20 years and above using simple random sampling technique. A study instrument which included socio-demographic information and physical measurements of height, weight, waist circumference was used to collect data. Chi- square test and odds ratio were used to analyze data. Results: Prevalence of diabetes was significantly higher among individuals, aged 40 years and above, male gender and among those with high body mass index and increased waist circumference (P<0.5). The BMI cut-off values that predicted diabetes status best for males and females were observed to be 20 kg/m2 and 24 kg/m2 respectively. The cut-off value for WC that predicted best diabetes status was considered to be 80 cm for both males and females. Conclusions: There is an increase in cases of diabetes amongst adult population of District Kaski. Guidelines should be set for detection of obesity in Nepalese population to enable adequate preventive and curative measures.

Measuring obesity: results are poles apart obtained by BMI and bio-electrical impedance analysis

Objective: To analyse the use of BMI and bioelectrical impedance analysis (BIA) in assessment of adiposity among young and elderly population. Materials and methods: Age, height, weight and percent body fat (PBF) of 101 young and 276 elder subjects were recorded. PBF was measured directly by BIA instrument (PBFb) and also calculated from BMI (PBFf). The classification of subjects into underweight, normal, overweight and obese was based on the age- and sex-specific BMI cutoff values and PBFb following standard guidelines. Results: The calculated mean BMI values of young and old age groups were statistically same. PBF was significantly high in elder subjects. There was no statistical difference in mean PBFb and PBFf in young subjects but the difference was significant in elder subjects. The PBFf values were highly correlated (r: 0.92 to 0.96) with PBFb values in young age groups unlike elder groups of both males and females. PBFb based categorization of subjects’ presented totally different scenario compared to results obtained by BMI analysis to assess adiposity. Conclusion: The cases such as increasing fatness with aging even when BMI remains constant, the causes of country or ethnic differences in BMI analysis, poor correlation in PBFb and PBFf values in elder age group emphasize on the limitations of BMI based analysis. PBFb within limitations seems to be an improved phenotypic characteristic over BMI.

Derivation of anthropometric cut-off levels to define CVD risk in Sri Lankan adults

Obesity is associated with increased cardiovascular risk. Anthropometric cut-off values derived for Caucasians may not be applicable to other populations. The main objective of the present study was to derive population-specific anthropometric cut-off values to define high CVD risk for Sri Lankan adults. A nationally representative sample of 4474 non-institutionalised adults aged ≥18 years was analysed. Cut-off values to provide optimum sensitivity and specificity were derived using receiver-operating characteristic curve analysis. BMI, waist circumference (WC), waist-to-hip ratio (WHR), blood pressure and overnight fasting venous blood samples were collected to measure glucose, HDL-cholesterol and TAG. An oral glucose tolerance test was also performed. The results suggested that the age-adjusted BMI, WC and WHR were significantly associated with all cardiovascular risk factors (P<0·001). Cut-off values for BMI, WC and WHR for males were 20·7kg/m2, 76·5cm and 0·89, respectively. The respective values for females were 22·0kg/m2, 76·3cm and 0·85. The common cut-off value for BMI for males and females was 21·5kg/m2. Similarly, WC and WHR cut-off values for both males and females were 76·3cm and 0·87, respectively. The Asian and Caucasian anthropometric cut-off levels showed lower sensitivity and higher false negative percentage compared with newly derived cut-off levels. In conclusion, BMI, WC and WHR were all associated with increased CVD risk. We propose the following anthropometric cut-off points to determine high CVD risk level for Sri Lankan adults: BMI≥21·5kg/m2, WC≥76cm and WHR≥0·85 (women) and 0·90 (men).

Bariatric surgery: Rhabdomyolysis after open Roux-en-Y gastric bypass: A prospective study

Background Rhabdomyolysis (RML) is a recently recognized complication of bariatric surgery (BS). The aim of this prospective study was to determine frequency, risk factors, and clinical relevance of RML in morbidly obese patients treated with open Roux-en-Y gastric bypass (RYGBP). Methods A total of 23 consecutive patients with morbid obesity undergoing primary open RYGBP were included prospectively in the present study. The following parameters were recorded: age, gender, BMI (kg/m 2), comorbidities (presence of known hypertension and diabetes), duration of surgery, levels of serum creatine phosphokinase (CPK) measured before surgery and daily after until the values were clearly tending towards normal, and the presence of neuromuscular symptoms in the early post-operative period. RML was defined as post-operative CPK >1000 IU/l (5 times the normal value). Patients were divided into two groups according to the presence or absence of RML. Results The study sample consists of 16 females (69.6%) and 7 males (29.4%). RML was diagnosed in 7 (30.4%) patients with CPK levels greater than 5000 IU/l in 3 patients (42.9%). BMI was identified as an independent risk factor for RML ( P = 0.031). The best cut-off value of BMI as a predictor of RML was 55.88 kg/m 2 giving sensitivity of 100% and specificity of 80.7%. Other variables (age, sex, comorbidities, and duration of surgery) did not have a significant predictive effect on the rate of RML. Conclusion After open bariatric surgery with RYGBP, the risk of RML increases in obese patients specially when BMI >56 kg/m 2. In such patients, CPK, which is an inexpensive easily done test, should be performed routinely to guarantee early diagnosis and consequently preventive treatment of RML complications.