Decrease In Mean Body Mass Index Research Articles

Characteristics of Patients Undergoing Bariatric Surgery in an Inner-City Minority Population: A Pre and Postoperative Comparison Between Patients With and Without Obstructive Sleep Apnea.

Background Obese patients are at an increased risk of obstructive sleep apnea (OSA). Bariatric surgery or weight loss surgery is an important therapeutic measure in obese patients for the management of weight and comorbidities. Data are scarce in inner-city Hispanic and Black patients who undergo bariatric surgery, which eventually leads to health disparity in this minority population. Differences between patients with and without OSA have not been assessed in this population. This study aims to answer these questions. Methodology The study was conducted in a high-volume hospital in the Bronx, New York. Before bariatric surgery, patients underwent a preoperative evaluation that included a variety of blood tests, a sleep study, esophagogastroduodenoscopy, and echocardiography. They also underwent basic anthropometric measurements, such as weight, height, and body mass index (BMI), before surgery and 6 months and 12 months postoperatively. Additional calculations were made using these anthropometric measures, namely, total weight loss, excess weight loss, and delta BMI. Results Most patients were Hispanic (85.2%), with a mean age of 41.9 ± 10.8 years. We found that of the 108 patients included in the study, 69.4% (70/108) had OSA.Preoperative BMI in the study was 43.9 ± 13 kg/m2. Postoperatively, the mean decrease in BMI was 12.3 ± 14.5 kg/m2. Total weight loss and excess weight loss were 30.2 ± 14.3 and 52.6 ± 16.6, respectively. Conclusions In this study, no significant difference was noted in patients with or without OSA in either the laboratory or anthropometric parameters.

The Association Between Weight Loss and Hepatitis B Surface Antigen Seroclearence in Chronic Hepatitis B Patients

Background: In chronic hepatitis B (CHB) patients, hepatitis B surface antigen (HBsAg) seroclearance is the main target of therapy and is rarely observed. Objectives: This study aimed to investigate the factors affecting HBsAg loss by focusing especially on the relationship between weight loss and HBsAg loss. Methods: This study was designed retrospectively to assess HBsAg status and clinical and laboratory findings in CHB patients, as well as cross-sectionally to evaluate lifestyle factors. A total of 5600 hepatitis B (HB) infection patients who were treated or followed between 2008 and 2020 were evaluated retrospectively. In the HBsAg loss group, 94 CHB patients were examined based on exclusion criteria, and 95 patients without HBsAg loss were matched as controls. Patient data and laboratory findings were retrieved from patient files. All participants were surveyed using a questionnaire developed by the authors, which inquired about the lifestyle characteristics of CHB patients. The questionnaire covered topics such as the use of herbal products, coffee consumption, medication history, antiviral treatment, concurrent diseases, weight changes, and patient demographics. Statistical analysis was performed using SPSS version 25.0. The Student's t-test was used to compare quantitative variables, while the chi-square test was used for categorical variables. A paired samples t-test was used to compare dependent samples. The statistical significance level was set at a p value less than 0.05. Results: The basal mean hepatitis B virus (HBV) DNA level was significantly lower in the HBsAg loss group (P < 0.001). The prevalence of hyperlipidemia comorbidity (P = 0.008) and moderate/severe hepatosteatosis (P < 0.05) was significantly higher in the HBsAg loss group compared to the non-HBsAg loss group. Prior to HBsAg loss, 44 (47%) patients in the HBsAg loss group experienced weight loss, whereas only 22 (23%) patients in the non-HBsAg group had a history of weight loss (P < 0.001). Conversely, the incidence of weight gain was significantly lower in the HBsAg loss group (P = 0.001). A paired samples t-test was conducted to compare the baseline and last period body mass index (BMI) means of the HBsAg loss group, revealing a statistically significant decrease in mean BMI in the last period (P < 0.001). Conclusions: Weight loss was significantly associated with HBsAg seroclearance in patients with CHB infection. Conversely, weight gain was associated with HBsAg persistence.

(082) Integrated Urology and Primary Care Model Improves Outcomes for Men with Testosterone Deficiency

Abstract Introduction Testosterone deficiency affects approximately 4-5 million men in the United States. The bidirectional association between testosterone deficiency and metabolic syndrome has been well-established. The diagnosis of testosterone deficiency should serve as a trigger for medical evaluation of other comorbidities. Furthermore, male sex is an independent predictor of decreased routine health maintenance; men are 40% less likely to have a primary care provider (PCP) compared to women in the United States. Thus, many patients who present to the urologist for symptomatic testosterone deficiency might have undiagnosed or poorly managed comorbidities coupled with a lack of a PCP. Objective We sought to investigate the impact of offering primary care access within an integrated Men’s Health Center to men presenting for initial evaluation of symptomatic testosterone deficiency. Methods This is a retrospective single institution study. All new patients presenting with testosterone deficiency between October 2019 and October 2022 were offered evaluation by a PCP within a university-based Men’s Health Center. Patients who were seen by the PCP underwent standard health screening and blood work including a lipid profile, liver function testing, and diabetes screening with hemoglobin (Hgb) A1c. All data were collected from the electronic medical record and deidentified. Institutional review board (IRB) exemption was obtained. Variables collected for analysis included age, race, body mass index (BMI), testosterone level on presentation, prior access to a pre-existing PCP, and number of visits attended with our PCP. Outcomes measured include new diagnoses made by the PCP and referral patterns to other specialties. All statistical analysis was conducted utilizing SPSS version 28. Results 81 men were evaluated over the 3-year study period. Median age was 49.0 (range: 21.2-93.7 years). 48 men (59%) established continuity of care and were seen by our PCP for more than 1 visit. 33 men (41%) did not have a pre-existing PCP. Older men were significantly more likely to have a pre-existing PCP (OR 1.06 [95% CI: 1.02-1.10], p<0.001). Hispanic men were significantly less likely to have an existing PCP (OR 0.16 [95% CI: 0.03-0.84], p=0.01). Newly diagnosed comorbidities included hypertension (41%), obesity (37%), hyperlipidemia (27%), obstructive sleep apnea (OSA; 25%), depression (23%), and diabetes (14%). 41 patients (51%) were prescribed a new medication. 21 patients (26%) were referred to nutrition, with mean BMI decrease of 1.75. 26 patients (32%) underwent sleep medicine evaluation for OSA. 27 (33%) and 37 patients (46%) received a flu vaccination and immunization updates. 11 patients (14%) were referred for screening colonoscopy. Patients who established continuity of care were significantly more likely to be treated for a new diagnosis (p<0.001) and receive a flu vaccination (p=0.007; Table 1). Conclusions This is the first report of integrated primary care and urology evaluation for testosterone deficiency. This comprehensive model results in improved outcomes including increased access to subspecialty referrals, objective weight loss, treatment of new diagnoses, updated immunizations, and cancer screening. Further studies are needed to assess reproducibility across other institutions, cost-effectiveness of this model, and patient satisfaction. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Endo Pharmaceuticals.

Integrated Urology and Primary Care Model Improves Outcomes for Men With Testosterone Deficiency.

Many men presenting with testosterone deficiency do not have access to a primary care provider. We sought to integrate primary care into initial urological evaluation to better identify and manage undertreated comorbidities. New patients presenting with testosterone deficiency were offered primary care provider evaluation within a men's health center between October 2019 and 2022. Data collected from the electronic health record included age, race, BMI, access to prior primary care provider, new diagnoses, prescriptions, and referrals. Eighty-one men were evaluated over the 3-year study period. Thirty-three men (41%) did not have a preexisting primary care provider. Older men were significantly more likely to have a preexisting primary care provider (OR 1.06 [95% CI: 1.02-1.10], P < .001). Hispanic men were significantly less likely to have an existing primary care provider (OR 0.16 [95% CI: 0.03-0.84], P = .01). Forty-eight men (59%) established continuity of care. Newly diagnosed comorbidities included hypertension (41%), obesity (37%), hyperlipidemia (27%), obstructive sleep apnea (25%), depression (23%), and diabetes (14%). Forty-one patients (51%) were prescribed a new medication. Twenty-one patients (26%) were referred to nutrition, with mean BMI decrease of 1.75 kg/m2. Twenty-six patients (32%) underwent sleep medicine evaluation for obstructive sleep apnea. Twenty-seven (33%) and 37 patients (46%) received a flu vaccination and immunization updates. Eleven patients (14%) were referred for screening colonoscopy. This is the first report of integrated primary care and urology evaluation for testosterone deficiency. This comprehensive model results in improved outcomes including increased access to subspecialty referrals, objective weight loss, treatment of new diagnoses, updated immunizations, and cancer screening.

Bariatric procedures including Roux-en-Y gastric bypass in French adolescents

IntroductionIn France, approximately 100 obese adolescents undergo a bariatric procedure every year. To date, only data from laparoscopic adjustable gastric banding (LAGB) or sleeve gastrectomy (SG) have been published. Our objective was to report the outcomes of a series of French obese adolescents who underwent a Roux-en-Y gastric bypass (RYGB). MethodsWe included all obese adolescents aged 13–19 years who underwent RYGB in our department from 2008 with at least 2 years of follow-up after surgery. We analyzed the course of the anthropometric data, comorbidities, and subsequent adverse events. ResultsStarting in September 2008, out of 93 obese adolescents who requested bariatric surgery, 39 (35%) underwent a bariatric procedure. From these adolescents, 2-year follow-up data were available for 26 patients who had a RYGB. At the time of surgery, the mean patient age was 17.4 years (standard deviation [SD]=1.4) and the body mass index (BMI) was 52.0 kg/m² (SD=7.8). One patient was lost to follow-up. At 2 years after surgery, the mean BMI was 35.7 kg/m² (SD=9.4) with a mean decrease in BMI of 31.9% (SD=11.6). Comorbidities improved for most of the patients: high blood pressure (2/2) and pseudotumor cerebri (1/1) were cured after surgery, and dyslipidemia improved globally. The complications observed were anemia, abdominal pain requiring celioscopy (n = 2), and oxalic nephrolithiasis. ConclusionOnly one third of the obese adolescents requesting bariatric surgery were operated on. Our series including exclusively obese adolescents who underwent an RYGB presents the results of this technique on weight loss and comorbidities; mechanical and nutritional complications remain uncommon. These results are similar to those obtained in studies of adult patients.

A retrospective study of pharmacological treatment in anorexia nervosa: 6-month and 12-month follow-up

BackgroundAnorexia nervosa (AN) is a serious and potentially life-threatening eating disorder characterized by starvation and malnutrition, a high prevalence of coexisting psychiatric conditions, marked treatment resistance, frequent medical complications, and a substantial risk of death. Body mass index (BMI) is a key measure of treatment outcome of AN and it is necessary to evaluate the long-term prognosis of AN. This study aimed to better assess the BMI course trend between different medications and timepoints in order to improve AN treatment in clinical practice.MethodsDuring the period 2010–2021, we retrospectively reviewed historical data of all patients diagnosed with AN. There were two groups in this study, which were based on the duration of follow-up. Group A was a 6-month follow-up group, comprising 93 patients (mean age 19.6 ± 6.8 years), with BMI assessed at three consecutive time points: first outpatient visit (T0), three months follow-up (T3), and six months follow-up (T6). Group B was a 12-month follow-up group comprising 36 patients (mean age 17.0 ± 5.2 years) with BMI assessed at five consecutive time points: first outpatient visit (T0), three months follow-up (T3), six months follow-up (T6), nine months follow-up (T9), and twelve months follow-up (T12). In our study, we retrospectively compared BMI courses based on patients’ usage of medication using the following variables: single medication, switching medications, combined medications, and without medications. The primary outcome measurement was BMI recorded at the 6-month follow-up and the 12-month follow-up respectively. In our study, which was conducted at Taichung Veterans General Hospital, we reviewed outpatient medical records of all patients with AN who were seen at the hospital during the period 2010–2021.ResultsIn Group A (6-month follow-up), patients treated with antidepressants showed a mean BMI increase of 1.3 (p < 0.001); patients treated with antipsychotics showed a mean BMI increase of 1.1 (p = 0.01); patients treated with switching medications showed a mean BMI increase of 0.1 (p = 0.397); patients treated with combined medications showed a mean BMI increase of 0.5 (p = 0.208); and patients treated without medications showed a mean BMI increase of 0.1 (p = 0.821). The results indicated that patients with AN had a significant BMI increase after treatment with antidepressants and antipsychotics in the 6-month follow-up group. In Group B (12-month follow-up), patients treated with antidepressants showed a mean BMI increase of 2.7 (p < 0.001); patients treated with antipsychotics showed a mean BMI increase of 2.8 (p = 0.168); patients treated with switching medications showed a mean BMI decrease of 0.8 (p = 0.595); patients treated with combined medications showed a mean BMI increase of 1.6 (p = 0.368); and patients treated without medications showed a mean BMI increase of 1.0 (p = 0.262). The results indicated that patients with AN had a significant BMI increase after treatment with antidepressants at the 12-month follow-up.ConclusionsAN is a complex disease caused by multiple factors. Evaluating its long-term prognosis is crucial. Our study provides insights and highlights three key findings: 1) medication adherence is crucial in treating AN, 2) frequent switching of medications may not promote weight gain and may also require a re-establishment of rapport with patients with AN, and 3) pharmacotherapy, especially antidepressants, is more effective than no treatment. Further research is needed to confirm these findings.

Green Space Exposure and Obesity in the Mexican Adult Population.

Green space or natural vegetation may reduce obesity risk by increasing opportunities for physical activity or reducing stress and exposure to other pollutants. Obesity prevalence in Mexico is ranked among the highest in the world. However, research on the association between green space and obesity in Mexico is lacking. We used data from the National Nutrition Survey in Mexico (2018-2019), a nationally representative sample of Mexican adults. The analytical sample included participants between 20-59 years of age (n = 12,631). We assessed exposure to green space using a 30 m resolution Landsat satellite Normalized Difference Vegetation Index (NDVI) from 2018. Linear regression models examined associations between NDVI and body mass index (BMI), adjusting for confounders. The mean age of the study sample was 38 (SD 0.19) years. Participants living in areas with the highest green space exposure had the lowest education level (53.51%) and socioeconomic status (28.38%) and were located in central (33.01%), south (30.37%), and rural areas (21.05%). Higher residential exposure to green space was associated with a mean decrease in BMI of -1.1 kg/m2 (95% CI: -1.59, -0.68). This is one of the first studies in Latin America to suggest a protective association between green space and obesity among Mexican adults.

The effects of somatostatin analogues on glycaemia in the treatment of neuroendocrine tumours.

Long-acting somatostatin analogues (SSAs) are the most commonly used drugs in the management of neuroendocrine tumours (NETs) because of their ability to control symptoms and prolong survival. SSA use is associated with changes in glucose metabolism. However, the impacts on glycaemic control and body mass index (BMI) caused by SSAs in NETs are largely unknown. In the present study, we evaluated the effects of SSA treatment on BMI and glycated haemoglobin (HbA1c) in our cohort of patients with NETs. We also assessed changes in glycaemic control and BMI before and after SSA treatment. In addition, we assessed the incidence of new diabetes or whether there was worsening of glycaemic control for patients with pre-existing diabetes. The study comprised a retrospective study of 279 patients with NETs who were treated with SSAs between January 2014 and January 2019. Glycaemic control was assessed by measuring changes in Hba1c. A number needed to harm analysis was used to look at new cases of diabetes within the study population. Treatment with SSAs was associated with a mean increase in HbA1c of 3.35±6.30mmolmol-1 despite a mean decrease in BMI of -1.04±2.79kgm-2 . There were 19 new cases of type 2 diabetes mellitus (T2DM) in the population of 209 with a number needed to harm of 12.5. Of the 34 patients with pre-existing T2DM, five had worsening of their mean HbA1c. Treatment with SSAs for NETs is associated with an increase in HbA1c, despite a reduction in BMI and, importantly, a risk of developing T2DM with a number needed to harm of 12.5. This project was registered with the National Health Service Clinical Audit and Registries. It has a CARMS number - 17666.

Social isolation but not deprivation involved in employment status after bariatric surgery.

An increase in employment rate was observed among individuals who underwent bariatric surgery. This study assessed the relationship between employment rate and weight loss, deprivation, and Bariatric Analysis and Reporting Outcome System (BAROS) scores after bariatric surgery in a deprived area. This retrospective study evaluated the employment rate at a mean period of 2.3±0.1 years after bariatric surgery among 133 individuals. The Evaluation of Deprivation and Inequalities in Health Examination Centers (EPICES score), satisfaction scale, and BAROS (self-esteem, physical activity, social life, work conditions, and sexual activity) questionnaires were used. The mean age of the participants was 45 (range: 19-67) years. Approximately 88% were women. The initial mean body mass index (BMI) was 42.7 kg/m2, and about 88% of the participants underwent sleeve gastrectomy. The mean decrease in BMI was 12 ± 0.5 kg/m2. The mean EPICES score (N<30), BAROS, and satisfaction scale (range: 1-5) scores were 31.9±18, 1.3±1.1, and 4.27±1.19, respectively. After surgery, 19 participants obtained a job. However, three were unemployed. Based on a multivariate analysis, employed and unemployed participants (77 vs 52) before surgery had a lower initial BMI and better BAROS and satisfaction scale scores. After surgery, there was no difference between participants who obtained a new job and those still did not have a job in terms of questionnaire responses. Obtaining a new job was not associated with BMI, sex, or age differences. However, there was a positive correlation between social life score and weight loss. Bariatric surgery increased an individual's chance of finding a job independently of deprivation status. Participants with a pre-operative job had a better perception of satisfaction and BAROS scores. Moreover, social isolation was correlated with unsuccessful weight loss.

Bilateral Reduction Mammaplasty Facilitates Subsequent Weight Loss in Obese Patients (BMI ≥30).

One of the most commonly discussed benefits of macromastia treatment surgery, bilateral reduction mammaplasty, is the potential for subsequent weight loss. There is limited research examining weight change after reduction mammaplasty and a definitive relationship remains to be established. Our study aims to investigate this relationship and to identify potential preoperative and operative factors associated with postoperative changes in weight. A retrospective chart review was performed of all patients who underwent bilateral reduction mammaplasty for symptomatic macromastia at a single academic institution (Stony Brook University Hospital) between January 1, 2000, and January 1, 2016. Patients had 12 months or longer of follow-up to track resultant postoperative weight. Two hundred and fifty-six patients met our eligibility criteria. The patients were stratified into 2 groups based on preoperative body mass index (BMI). Group 1 consisted of 112 patients (44%) with a BMI less than 30 (ie, nonobese); group 2 consisted of 145 patients (56%) with a BMI of 30 or higher (ie, obese). The mean total weight of bilateral breast tissue resected for each group was 982 and 1719 g for groups 1 and 2, respectively. For both groups, the mean patient age was 38 years, and the mean follow-up period was approximately 5 years. Patients in group 1 (the nonobese group) had a mean preoperative BMI of 26.25 and postoperative BMI of 26.78 (P = 0.108). Postoperatively, these patients demonstrated an overall mean BMI increase of 0.90. Patients in group 2 (the obese group) had a mean preoperative BMI of 34.99 and postoperative BMI of 34.13 (P = 0.045). Postoperatively, they demonstrated an overall mean BMI decrease of 0.20. The difference in change of BMI between the 2 groups was determined to be significant (P = 0.047). There is a significantly larger mean decrease in BMI in the obese group, 3.86 than the nonobese group, 2.01 (P = 0.006). We found that weight changes after undergoing bilateral reduction mammaplasty are significantly different between obese and nonobese patients. Obese patients (BMI, ≥30) experience greater weight loss than nonobese patients. As the desire for postoperative weight loss and increased physical activity are common reasons to undergo reduction mammaplasty, this study adds valuable data to the discussion.

Safety and effectiveness of REALIZE adjustable gastric band: 5-year prospective study.

BackgroundThe long-term safety results of the REALIZE (Ethicon Endo-Surgery, Inc., Cincinnati, OH) adjustable gastric band collected in this prospective, multicenter study in patients with morbid obesity are presented.ObjectivesTo determine the reoperation rate, including band revisions, replacements, and explants, resulting from a serious adverse device-related event through years 4 and 5. Various efficacy measures were also assessed as secondary objectives.SettingNine academic and/or private institutions.MethodsThe participating institutions enrolled 303 patients, who were then assessed on an annual basis, with 231 patients completing 5 years of follow-up. The study parameters included reoperation rates, changes in percentage of excess weight loss (%EWL), and changes in body mass index (BMI), as well as parameters of diabetes and dyslipidemia. Quality of life was assessed using the Short Form (SF)-36 and the Impact of Weight on Quality of Life-Lite questionnaires.ResultsThe reoperation rate due to a serious adverse event in this population at 5 years after implantation with the REALIZE gastric band was 8.9%. The most common serious adverse event was band slippage, which affected 6.9% of the study population. The mean %EWL was 35.6% ± 26.84%, and the decrease in mean BMI was −7.01 ± 5.45 kg/m2 at 5 years. Patients experienced improvements in mean glycated hemoglobin and serum lipid levels, in addition to improvements in the quality of life measures.ConclusionNo new safety concerns were identified during the 5 years of follow-up. Although the results of this study did not meet the predefined safety criteria of 8% or less, the safety profile and long-term effectiveness observed in this study are consistent with those in the current literature.

Home-Based Multicomponent Intervention Increases Exercise Activity and Improves Body Mass Index: Results of a 5-Year Randomized Trial Among Individuals with Alpha-1 Antitrypsin Deficiency-Associated Lung Disease.

The Step Forward Study (SFS) was designed to increase exercise activity and improve body mass index (BMI) among individuals with alpha-1 antitrypsin deficiency (AATD)-associated lung disease. The SFS is a randomized trial of an intensive distance intervention that was delivered via a series of mailings and teleconferences versus no additional intervention. All participants (n=500) were also enrolled in a disease management program designed for individuals with AATD-associated lung disease who have been prescribed augmentation therapy. The primary outcome was self-reported number of exercise minutes per week. The secondary outcome was BMI. Linear mixed model analyses were used to assess the difference in average weekly exercise minutes between the intervention arms over time. T-tests, signed rank and Wilcoxon rank-sum tests were used to evaluate changes in BMI between the intervention arms and within each BMI category. The study included 429 individuals with evaluable primary outcome data.There was a significant effect of intervention on exercise minutes over time (p=0.018). Participants in the intervention group reported an average of 167.14 minutes (standard deviation [SD]=10.68) of weekly exercise and those in the standard care group reported 148.31 minutes (SD=10.96). There was a significant difference in BMI change between the intervention (mean BMI decrease 0.74, SD=2.16) and the standard care group (mean BMI decrease 0.27, SD=1.63); p=0.0122. Individuals who were randomly assigned to the intervention group reported more exercise activity and improvements in BMI over the course of this multicomponent intervention compared to individuals assigned to standard care.

Single-center retrospective evaluation of short and long-term efficacy of intragastric balloon placement in obesity treatment

Obesity is a serious chronic disease caused by genetic and environmental factors. One of the treatment options is intragastric balloon application. This study aimed to evaluate the results of patients who underwent intragastric balloon placement on the short- and long-term treatment of obesity. The data and long-term follow-up results of 34 patients who underwent intragastric balloon placement due to obesity between December 2011 and August 2013 were retrospectively evaluated. Age, sex, body mass index (BMI), presence of additional diseases, duration of intragastric balloon remaining in the stomach, patients’ weight, and BMI at intragastric balloon removal, weight measured in December 2019, bariatric surgery performed during the study period if any, and general health status during this period were obtained. The mean weight loss of the patients after intragastric balloon removal was 15.6 ± 9.6 kg (range, 0–45 kg). The mean decrease in BMI after intragastric balloon removal was 11.4 ± 6.4% (range, 0%–26.5%). No patients developed any complications. The procedure was ineffective in the long-term in 76.4% of the patients. The most important disadvantage of intragastric balloon placement application in the treatment of obesity is that the weight lost in the early period is regained in the long-term after balloon removal. In patients scheduled to undergo bariatric surgery, intragastric balloon placement can be applied as a bridge therapy to facilitate preoperative weight loss to reduce complications.

GENE-OBESOGENIC ENVIRONMENT INTERACTIONS ON BODY MASS INDICES ACROSS RACE AND SEX AMONG OLDER ADULTS

Gene-obesogenic environment interactions influence body mass index (BMI) across the life-course; however, limited research examines how these interactions may differ by race and sex. Utilizing mixed-effects models, we examined interaction effects of polygenic risk score (PGS) generated from 97 single nucleotide polymorphisms, and environmental factors, including age and physical activity, on measured longitudinal BMI from the Health and Retirement Study (HRS). HRS is a population representative survey study of older adults aged 50-years or older in the U.S. This study used a sub-sample of genotyped Black (N=1,796) and White (N=4,925) males and females. The association between PGS and mean BMI weakened as individuals aged among White males (Pinteraction=0.038) and White females (Pinteraction=0.054). The mean BMI difference between the highest and lowest PGS quintiles was 4.25 kg/m2 among 50-year old White males but 3.11 kg/m2 among the 70-year old’s, i.e. a decrease of 1.14 kg/m2 (95%CI: -0.06,2.65) over 20 years. Similarly, the decrease among 50- and 70-year old White females was 1.33 kg/m2 (95%CI: 0.07,3.45). Additionally, the association between physical activity and BMI was stronger among White females with higher PGS (Pinteraction=0.038). Vigorous physical activity (compared to never) was associated with a 1.71 kg/m2 (95%CI: 1.08,2.35) decrease in mean BMI among those in the highest PGS quintile, compared to a 0.80 kg/m2 (95%CI: 0.32,1.27) decrease among those in the lowest. Overall, we found unique interaction effects across race and sex within an older population; findings reinforce the importance of physical activity among those with an elevated genetic risk.

Weight Loss After Bariatric Surgery Predicts an Improvement in the Non-alcoholic Fatty Liver Disease (NAFLD) Fibrosis Score.

Non-alcoholic fatty liver disease (NAFLD) is present in up to 90% of bariatric surgery patients. Previous literature has demonstrated an improvement in liver steatosis and fibrosis in post-bariatric surgery patients. Our study aims to investigate if bariatric surgery results in an improvement in NAFLD fibrosis scores, and if this correlates with weight loss. A retrospective study was conducted on all patients who underwent bariatric surgery from 2010 to 2016 in our institution. Patients who had a redo bariatric surgery or concomitant gastric pathologies were excluded. Indications for bariatric surgery followed the Asia-Pacific Metabolic and Bariatric Surgery Society guidelines. There were 192 patients in this study, with the majority being females (n = 120, 63%). Mean age was 42.7 ± 10.2years old. Pre-operative mean weight and body mass index (BMI) were 113 ± 27.9kg and 41.6 ± 7.98kg/m2 respectively. The mean pre-operative NAFLD fibrosis score was - 1.27. Six-month and 1-year follow-up post-surgery demonstrated a decrease in mean weight to 90.6 and 85.9kg and a decrease in mean BMI to 33.8 and 31.6kg/m2. Mean NAFLD scores improved from - 1.27 to - 1.56 to - 2.00. The correlation between weight loss and NAFLD fibrosis score improvement was statistically significant at the first post-operative year (r-coefficient = 0.36, p value ≤ 0.001). Bariatric surgery results in weight reduction as well as an improvement in the NAFLD fibrosis score. The degree of weight loss predicts the extent of improvement in NAFLD fibrosis scores. More long-term studies need to be conducted to assess if this effect is permanent.

Effect of Betahistine and Metformin on Antipsychotic-Induced Weight Gain: An Analysis of Two Clinical Trials.

Antipsychotic-induced weight gain is one of the most common adverse effects of antipsychotic treatment. However, there are no well-established interventions for the weight gain yet. In this study, we pooled the data from two clinical trials, which were originally examining the efficacy of betahistine and the efficacy of metformin in treating antipsychotic-induced weight gain and insulin resistance. A total of 67 people with schizophrenia or bipolar disorder treated with antipsychotics were assigned to 36 mg day−1 betahistine (n = 13) or 1,000 mg day−1 metformin (n = 25) or placebo (n = 29) treatment for 12 weeks, with evaluation at baseline and week 12. The primary outcome was the body mass index (BMI). After treatment, metformin group had a mean decrease in BMI of 1.46 ± 0.14 (p < 0.001) and insulin resistance index (IRI) of 4.30 ± 2.02 (p < 0.001). The betahistine group had no significant alteration in BMI or IRI. However, placebo group had a mean increase in BMI of 1.27 ± 0.77 (p < 0.001) and IRI of 0.45 ± 0.86 (p < 0.001). Between the two treatment groups, metformin significantly decreased weight, BMI, fasting glucose, insulin level, and IRI but not waist circumference when compared with betahistine. Moreover, metformin significantly decreased weight, BMI, waist circumference, fasting glucose, insulin level, and IRI when compared with placebo, whereas betahistine significantly decreased body weight, waist circumference, BMI, insulin level, and IRI but not fasting glucose when compared with placebo. In this study, we found that both metformin treatment and betahistine treatment were efficacious in improving antipsychotic-induced weight gain and insulin resistance, and metformin was more efficacious in preventing and revising the weight gain induced by antipsychotics.Clinical Trial Registration: www.ClinicalTrials.gov, NCT00451399(Study 1), NCT00709202(Study 2)

Decreased body mass index during treatment with sodium oxybate in narcolepsy type 1.

SummaryNarcolepsy type 1 is characterised by an increase in body weight after disease onset, frequently leading to obesity. It was suggested that this weight gain may be counteracted by treatment with sodium oxybate. We here provide longitudinal body mass index data of patients with narcolepsy type 1 after starting treatment with sodium oxybate, compared with patients in whom treatment with modafinil was initiated. Eighty‐one individuals with narcolepsy type 1 fulfilled the entry criteria for this retrospective study: 59 had newly started treatment with sodium oxybate and 22 had newly started modafinil. Gender‐specific differences between both treatment groups were compared using Student's t tests and mixed effect modeling. Patients using sodium oxybate lost weight, with a mean body mass index decrease of 2.56 kg/m2 between the first and last measurement (women; p = .001) and 0.84 kg/m2 (men; p = .006). Patients using modafinil, however, gained weight, with a mean body mass index increase of 0.57 kg/m2 (women; p = .033) and 0.67 kg/m2 (men; p = .122). Medication (p = .006) and baseline body mass index (p = .032) were predictors for body mass index decrease. In conclusion, treatment with sodium oxybate is associated with a body mass index reduction in narcolepsy type 1, whereas modafinil treatment is not. This effect is most pronounced in those who already have a higher baseline body mass index.

OUTCOMES AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY FOR MORBIDLY OBESE PATIENTS

Introduction: laparoscopic Sleeve gastrectomy has become reportedly one of the most effective standalone bariatric procedures during the past decade. The intermediate and long-term outcomes are being studied by many researchers. Aim: To study the short and intermediate term results of LSG in a group of Egyptian morbidly obese patients as regards mean decrease in body mass index (BMI), % of excessive weight loss (% EWL), and resolution of comorbidities. Results: One hundred and forty patients, 92 females (66%) and 48 males (34%), with a mean BMI of 49 ± 7.4 kg/m2 contributed in our study. Obesity related comorbidities were reported in some of our patients in the form of Type II diabetes mellitus (n=43), hypertension (n=36), hyperlipidemia (n=24), and osteoarthritis (n=30). All patients underwent laparoscopic sleeve gastrectomy. All patients completed a follow up period of two years. At two years period the mean BMI decreased to 30 ± 5.9 kg/m2 (p-value < 0.0001). While the mean % of EWL was 73 ± 10.3 %. We reported complete resolution of disease in 90.6%, 94.4%, and 83.3% of Type II diabetes mellitus, hypertension, and hyperlipidemia patients respectively. Conclusion: laparoscopic sleeve gastrectomy is associated with significant decrease in mean BMI, and % of EWL in morbidly obese patients during the short and intermediate terms. In addition, it is associated with resolution of obesity related comorbidities in high percentage of patients. Key Words: Morbid obesity, Bariatric surgery, Laparoscopic sleeve gastrectomy, Body mass index (BMI), Type II diabetes mellitus, Hypertension

School restrictions on outdoor activities and weight status in adolescent children after Japan’s 2011 Fukushima Nuclear Power Plant disaster: a mid-term to long-term retrospective analysis

ObjectiveRadiation fears following Japan's 2011 Fukushima nuclear disaster affected levels of physical activity in local children. We assessed the postdisaster versus predisaster weight status in school children and evaluated to...

POSTPRANDIAL EXERCISE IS SUPERIOR TO REGULAR CONTINUOUS EXERCISE IN HBA1C REDUCTION FOR TYPE 2 DIABETICS IN SAUDI ARABIA

ABSTRACT BACKGROUND AND OBJECTIVES: Exercise helps people on diet to lose weight, also helps having better Blood Pressure. The aim of the study is to compare the response of glycosylated hemoglobin (HbA1c), body mass index (BMI) and incidence of hypoglycemia to continue running exercise (group A) and intermittent postprandial exercise (group B) for individuals with type 2 diabetes in Jeddah – Saudi Arabia DESIGN AND SETTINGS: Out of 44 enrolled patients from Jeddah region, 24 patients were group A, who were asked to run daily for 45 minutes at any time of the day, continuous running without stopping -as much as they can, and 20 other patients were group B, who were asked to run 60-90 minutes after main meals for 15 minutes three times daily. The study involves mandatory baseline visit then follow up, once after 12 weeks. Results: The mean age was 42.1 (2.8) [Mean (SD)] years for group A, whereas it was 43.8 (1.7) years for group B. 17% were males and 83% were females for group A whereas all patients were females for group B. The main BMI was 26.2 (1.2) kg/m 2 (group A), while it was 26.9 (1.0) kg/m 2 (group B). The mean Postprandial Blood Glucose (PPG) was 150.4 (7.5) mg/dl (group A), while it was 144.5 (11.2) mg/dl (group B). There was no statistically significant difference in the mean PPG between group A and group B ( P > 0.05) . 50 % were house wives (group A), whereas 100% were house wives (group B). There was statistically significant difference in patients’ jobs for group A compared to group B ( P 0.01) All patients on metformin and statin for both groups, and There was no statistically significant difference in Current Medication between group A and group B ( P > 0.05), but There was statistically significant difference in the mean dose between group A and group B ( P 0.01).The mean time of exercise was 33.6 (14.1) min/day (group A), while it was 33.5 (8.3) min/day (group B). There was no statistically significant difference in time of exercise groups between group A and group B ( P > 0.05) . Both groups resulted in a decline in HbA1c. However, the mean of HbA1c was dropped from 8 % (at baseline visit) to 7% (at the end of the study. There was a very high statistically significant decrease of 1% ( P 0.001). Group A resulted in a decline in mean of BMI which was the percentage decrease in BMI was 1.7% with group A. There was statistically significant decrease in mean BMI from baseline visit to the end of the study for group A of 0.4 kg/m² ( p 0.01), while there was no statistically significant difference for group B ( P > 0.05). There was high statistically significant difference in BMI reduction from baseline visit to the end of the study between group A and group B ( P 0.001) . The mean number of episodes of hypoglycemia was 1.8 (3.7) times (group A), while it was 3.9 (3.8) times (group B). There was no statistically significant difference in number of episodes of hypoglycemia in group A compared to group B ( P > 0.05) . Conclusion: The reduction of HbA1c levels with continuous running exercise is less than its levels with intermittent postprandial exercise during both exercises in individuals with type 2diabetes, while the reduction of BMI levels with intermittent postprandial exercise is less than its levels with continuous running exercise However, No significant change in incidences of hypoglycemia was found in both groups. Key Words: Exercise, Type 2 Diabetes, HbA1c, BMI and Hypoglycemia.