Difference In Mean Body Mass Index Research Articles

The Beneficial Effects of Moxibustion on Overweight Adolescent Girls.

Among adolescent girls, overweight or obesity has both physical and psychological involvement. We conducted a randomized controlled trial of moxibustion using a moxa burner. Fifty-four eligible girls aged 15–18 years with a body mass index (BMI) greater than 25.3 were enrolled in the study. The girls were randomly allocated to the treatment (n = 27) and control (n = 27) groups. The girls underwent treatment three times per week for 8 weeks (24 treatments). Moxibustion was applied to the RN12, RN6, ST25, ST36, and SP6 acupoints. Physical assessments were BMI, waist-to-hip ratio (WHR), and body fat ratio (BFR). Psychological outcomes were measured using the Rosenberg Self-Esteem Scale (RSE). Data were collected at the beginning of the study (baseline), week 4, and week 8. Of the 54 participants, 46 completed the trial. The difference in mean BMI from baseline between the two groups was 0.097 (p=0.655) at week 4 and −0.794 (p=0.001) at week 8. The mean WHR of the treatment group was significantly reduced compared with baseline, with a −0.011 (p=0.017) and −0.035 (p < 0.001) mean change at weeks 4 and 8, respectively. The mean BFR was slightly reduced (−0.253;p=0.474 ) at week 4 compared with baseline in the treatment group. At week 8, it was significantly reduced (−2.068; p < 0.001) from baseline in the treatment group. The mean RSE in the treatment group showed no significant increase from baseline at week 4 (0.155 points, p=0.803), but it improved significantly from baseline at week 8 (1.606 points, p=0.021) compared to that in the control group. No obvious adverse effect was reported during this study. Moxibustion using a moxa burner may be an effective and safe intervention for overweight adolescent girls, having both physical and psychological benefits.

Sex differences in the relationship between body composition and biomarkers of bone and fat metabolism in obese boys and girls

Whether a body mass derived from extremes of body weight is beneficial to bone remains controversial. When fat accumulation reaches excessive levels and induces changes in hormonal factors and adipokines, it may affect bone accrual during growth. This study evaluated the relationships between body composition and key biomarkers in relation to bone and fat metabolism in obese Thai boys and girls. Subjects aged 12–14 years were grouped by body mass index (BMI) and percentage of body fat (%Fat). Body composition and heel bone Z-score and speed of sound (SOS) were assessed by bioelectrical impedance analysis and calcaneus bone densitometry, respectively. Serum osteocalcin (OC), adiponectin, leptin, insulin, and 25 hydroxyvitamin D (25(OH)D) were measured by ELISA. Their correlations were analyzed and compared between sexes. The results showed that the obese groups had no differences in mean BMIs and body composition, except that boys had more muscle mass than girls. Boys had lower serum OC and leptin levels than girls. Positive correlations of leptin with %Fat and FM were found in both sexes, while positive associations of %Fat with OC and insulin were found only in boys. Bone Z-score and SOS positively correlated with OC in boys but negatively correlated with 25(OH)D in girls. When classifying the obese group using %Fat ≥25, the positive correlations between %Fat and insulin and the negative associations between %Fat and adiponectin in girls were more pronounced. These results suggest that the associations of body fat and bone parameters with OC, adiponectin, 25(OH)D, and insulin were sex-specific, with greater clarity when %Fat was used instead of BMI to classify obesity.

493 Weight Loss With FT218, a Once-Nightly Sodium Oxybate Formulation for the Treatment of Narcolepsy: Post Hoc Analysis From REST-ON

Abstract Introduction Patients with narcolepsy are more likely to be obese compared with healthy controls. FT218 is an investigational once-nightly sodium oxybate formulation for the treatment of narcolepsy. Here, we report on changes in weight-related clinical values with FT218 treatment in patients with narcolepsy. Methods This was a randomized, double-blind, placebo-controlled multicenter study in patients with narcolepsy ≥16 years old. Patients were not excluded based on baseline weight or body mass index (BMI). Patients were randomized 1:1 to receive FT218 or matching placebo: 4.5 g/night for 1 week, 6.0 g/night for 2 weeks, 7.5 g/night for 5 weeks, and 9.0 g/night for 5 weeks (maximum treatment duration, 13 weeks). Weight and BMI were measured at baseline and study end. LS mean difference in BMI between FT218 and placebo was analyzed using analysis of covariance. Results A total of 107 patients received FT218 and 105 patients received placebo. At baseline, mean (SD) weight was 81.2 (20.8) kg in the FT218 treatment group and 82.1 (22.5) kg in the placebo treatment group. At end of study (week 13), mean (SD) weight was 80.9 (21.9) kg in the FT218 treatment group and 82.25 (21.6) in the placebo treatment group. At week 13, mean (SD) change in weight from baseline was –1.29 (3.6) kg for FT218 and 0.19 (2.6) kg for placebo; 17.5% of patients receiving FT218 vs 3.8% of patients receiving placebo had ≥5% weight loss. At baseline, mean (SD) BMI was 28.1 (7.8) kg/m2 in the FT218 treatment group and 28.2 (6.6) kg/m2 in the placebo treatment group. At study end (week 13), LS mean (SE) change from baseline in BMI was ‒0.51 (0.13) kg/m2 for patients receiving FT218 and 0.08 (0.13) kg/m2 for patients receiving placebo (LS mean difference [95% CI], ‒0.59 [‒0.95 to ‒0.23]; P=0.001). FT218 was generally well tolerated. Conclusion Patients receiving FT218 experienced a significantly greater decrease in weight and BMI vs placebo. These results suggest that treatment with once-nightly FT218 may provide weight-related benefit for patients with narcolepsy and comorbid weight gain. Support (if any) Avadel Pharmaceuticals

Is the extent of left atrial fibrosis associated with body mass index in patients undergoing pulmonary vein isolation for atrial fibrillation?

Left atrial (LA) fibrosis is associated with a higher rate of recurrence of atrial fibrillation (AF) after pulmonary vein isolation (PVI). Body mass index (BMI) is strongly associated with the prevalence of AF, but there is insufficient data about the association between BMI and LA fibrosis. The aim of the study was to examine the association between LA fibrosis and BMI in patients with AF undergoing PVI. In 114 patients an electro-anatomical voltage map was created using the CARTO 3 three-dimensional system before PVI. The total fibrosis area (voltage criteria ≤0.5 mV), percentage, and the number of fibrotic areas were calculated. A general linear model was used to determine the differences in BMI with confounders between groups of patients with differing extents of fibrosis and numbers of focuses. Advanced fibrosis was found in 53 (47%) patients, in up to 9 areas with a median of 2 and an interquartile range (IQR) of 0-3. The median total fibrotic area was 27.3 cm2 with an IQR of 0.1-30.3 cm2. Patients were stratified by percentage of fibrotic area: <5%, 5%-20%, 20%-35%, and above 35%; no significant difference in mean BMI was found between the groups (P = 0.57). When stratified by the number of fibrotic areas (0, 1, 2, and ≥3 fibrotic areas), no difference in BMI was noted between the groups (P = 0.67). Fibrosis of the LA, as the strongest predictor of AF recurrence after PVI, does not correlate with BMI in patients with AF where PVI is indicated.

Weight trends in living kidney donors suggest predonation counselling alone lacks a sustainable effect on weight loss: a single centre cohort study.

Living kidney donors are at risk of long-term end-stage renal disease, and obesity is an independent risk factor. In our centre, predonation counselling of obese donors concentrates on lifestyle modifications, particularly weight loss and exercise. Whether these recommendations have a sustainable effect after donation remains unknown. We conducted a retrospective analysis of all donors who proceeded to donation between 2012 and 2016. Donors' body mass index (BMI) was compared between predefined time points using matched pair analysis. Among 303 donors included, 15% were obese at initial assessment. Obese donors were observed to lose weight by the time of donation (mean BMI difference 1.32kg/m2 , P<0.001), but bounced back to their initial weight at one-year postdonation (mean BMI difference+1.47kg/m2 , P<0.001), which was maintained at two-year postdonation. While 71% of obese donors lost weight by the time of donation, 56% of them gained that weight back at one year. Our findings underline the success of predonation counselling on lifestyle modification in highly motivated obese donors, although additional strategies are required to sustain weight loss. The impact of weight gain on long-term risk needs further evaluation. Living donor programmes should provide continued support with lifestyle modifications after donation.

Effect of obesity and body mass index on coronavirus disease 2019 severity: A systematic review and meta-analysis.

We conducted a systematic review of observational studies to examine the effects of body mass index (BMI) and obesity (BMI ≥ 30 kg/m2 ) on coronavirus disease 2019 (COVID-19). Medline, Embase, and the Cochrane Library were searched. Sixteen articles were finally included in the meta-analysis, and a random effects model was used. BMI was found to be higher in patients with severe disease than in those with mild or moderate disease (MD 1.6, 95% CI, 0.8-2.4; p = .0002) in China; however, the heterogeneity was high (I2 = 75%). Elevated BMI was associated with invasive mechanical ventilation (IMV) use (MD 4.1, 95% CI, 2.1-6.1; p < .0001) in Western countries, and this result was consistent across studies (I2 = 0%). Additionally, there were increased odds ratios of IMV use (OR 2.0, 95% CI, 1.4-2.9; p < .0001) and hospitalization (OR 1.4, 95% CI, 1.3-1.60; p < .00001) in patients with obesity. There was no substantial heterogeneity (I2 = 0%). In conclusion, obesity or high BMI increased the risk of hospitalization, severe disease and invasive mechanical ventilation in COVID-19. Physicians must be alert to these early indicators to identify critical patients.

Gene-obesogenic environment interactions on body mass indices for older black and white men and women from the Health and Retirement Study.

Background: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.Methods:Utilizing mixed-effects models, we examined the interaction effects of a polygenic risk score (PGS) generated from BMI-associated single nucleotide polymorphisms, and environmental factors, including age, physical activity, alcohol intake and childhood socioeconomic status on measured longitudinal BMI from the Health and Retirement Study (HRS). HRS is a population representative survey of older adults in the United States. This study used a sub-sample of genotyped Black (N=1,796) and White (N=4,925) men and women (50–70 years) with measured BMI.Results:Higher PGS was associated with higher BMI. The association between PGS and BMI weakened as individuals aged among White men (Pinteraction=0.0383) and White women (Pinteraction=0.0514). The mean BMI difference between the 90th and 10th PGS percentile was 4.25 kg/m2 among 50-year old White men, and 3.11 kg/m2 among the 70-year old’s, i.e. a 1.14 kg/m2 (95%CI: −0.27, 2.82) difference. The difference among 50- and 70-year old White women was 1.34 kg/m2 (95%CI: 0.09, 2.60). Additionally, the protection effect of physical activity was stronger among White women with higher PGS (Pinteraction=0.0546). Vigorous physical activity (compared to never) was associated with 1.66 kg/m2 (95%CI: 1.06, 2.29) lower mean BMI among those in the 90th PGS percentile, compared to 0.83 kg/m2 (95%CI: 0.37, 1.29) lower among those in the 10th PGS percentile. Interactions were also observed between both PGS and alcohol intake among White men (Pinteraction=0.0034) and women (Pinteraction=0.0664) and Black women (Pinteraction=0.0108), and PGS and childhood socioeconomic status among White women (Pinteraction=0.0007).Conclusion:Our findings reinforce the importance of physical activity among those with an elevated genetic risk; additionally, other detected interactions may underscore the influence of broader social environments on obesity-promoting genes.

Outcome of revisional bariatric surgery for insufficient weight loss after laparoscopic Roux-en-Y gastric bypass: an observational study.

Insufficient weight loss or secondary weight regain with or without recurrence of comorbidity can occur years after laparoscopic Roux en Y gastric bypass (LRYGB). In selected patients, increasing restriction or adding malabsorption may be a surgical option after conservative measures failed. Evaluation of short and long term results of revisional surgery for insufficient weight loss or weight regain after LRYGB. Tertiary hospital. Retrospective analysis of prospectively collected data from a cohort of 1150 LRYGB patients. Included were patients, who underwent revisional bariatric surgery after LRYGB for insufficient weight loss with a follow-up of minimal 1 year. Fifty-four patients were included in the analysis. After an interdisciplinary evaluation, patients with insufficient weight loss, signs of dumping syndrome, and lacking restriction were offered a nonadjustable band around the pouch (banded group, n = 34) and patients with sufficient restriction, excellent compliance, and adherence were offered a revision to laparoscopic biliopancreatic diversion (BPD group, n = 20). The revisional procedure was performed 3.3 ± 2.3 years after LRYGB in the banded-group and after 6.4 ± 4.3 years in the BPD group (P = .001). Mean body mass index at the time of the primary bariatric procedure was 41.7 ± 6.2 kg/m2 in the banded group and 45.2 ± 8.2 kg/m2 in the BPD group (P = .08); minimal body mass index between both operations was 29.1 ± 4.7 kg/m2 in the banded group and 36.5 ± 9.4 kg/m2 in the BPD group, and, at the time of revisional surgery, 31.4 ± 5.5 kg/m2 in the banded group and 40.8 ± 6.7 kg/m2 in the BPD group (P = .0001). The mean body mass index difference 1 year after revisional surgery was 1.3 ± 3.0 kg/m2 in the banded group and 6.7 ± 4.5 kg/m2 in the BPD group (P = .01). In the banded group, 11 patients (32.4%) needed removal of the band, 4 patients (11.8%) needed an adjustment, and 4 patients (11.8%) were later converted to BPD. In the BPD group, 2 (10.0%) patients needed revision for severe protein malabsorption. Insufficient weight loss or secondary weight regain after LRYGB is a rare indication for revisional surgery. Banded bypass has modest results for additional weight loss but can help patients suffering from dumping. In very carefully selected cases, BPD can achieve additional weight loss with acceptable complication rate but higher risk for reoperation. Future "adjuvant medical treatments," such as glucagon-like peptide 1 analogues and other pharmacologic treatment options could be an alternative for achievingadditional weight loss and better metabolic response.

Demographic Associations of Diabetes Status by Both Fasting Plasma Glucose Concentration and Glycated Hemoglobin in a Community Survey in Galle District, Sri Lanka.

Diagnostic tools used in detecting individuals with diabetes mellitus (DM) include fasting plasma glucose (FPG), glycated hemoglobin (HbA1C), and oral glucose tolerance test (OGTT). The present study was aimed to determine the demographic associations of diabetes status by both tests (FPG and HbA1C) in Galle district, Sri Lanka. 147 adults (30–60 years) who are having FPG ≥ 126 mg/dL underwent demographic evaluations and testing for HbA1C. Group 01 (diabetes status diagnosed by both tests) and group 2 (diabetes status diagnosed only by FPG) were compared using independant sample t-test and chi-square test. Logistic regression was used to study the association between the demographic factors and the diabetes status by both tests. Of the 147 study subjects, 38.1% were males, 61.9% were females, and 63.3% had a family history of diabetes among first-degree relatives (FDR). Mean age, body mass index (BMI), waist circumference (WC), FPG, and HbA1C of the participants were 48.4 ± 7.2 years, 25.1 ± 4.0 kg/m2, 88.8 ± 9.0 cm, 139.4 ± 30.1 mg/dL, and 6.4 ± 0.7%, respectively. The prevalence of diabetes based on both tests was 55.1%. There is a significant difference in mean BMI and WC while no significant differences in mean age between groups 01 and 02. No association was seen between gender and diabetes status (X2(1) = 0.086, p=0.770), while a significant difference was observed between DM among FDR and diabetes status (X2(1) = 33.215, p < 0.001). Significance of odds of having diabetes by both tests with rising BMI (OR = 1.97, CI 1.15–3.36, p=0.013) and DM among FDR (OR = 7.95, CI 3.54–17.88, p=0.000) was seen. We conclude rising BMI and having DM among FDR are strongly associated with diabetes status diagnosed by both tests of FPG and HbA1C in community screening.

Blame it on the knee: the association of hand osteoarthritis and obesity

Purpose: Obesity and overweight are recognized risk factors for osteoarthritis (OA). There is a strong and consistently found relationship between high body mass index (BMI) and knee OA, but there is ongoing uncertainty as to whether higher BMI is a risk factor for hand OA. As with most OA research, the studies on hand OA consider this joint in isolation (i.e. without consideration of other joints). Given that hand OA often occurs in conjunction with OA of other joints, a failure to consider other joints could lead to misleading results. The Canadian Longitudinal Study on Aging (CLSA) asked separately about the presence of knee, hip, and hand OA, providing the opportunity to investigate whether there is an independent association between hand OA and BMI, accounting for the association of BMI with other concurrent joints, particularly the knee. Methods: The CLSA began in 2013 and is following a representative sample of respondents aged 45-85 years at baseline to gain insight into the development of disease and disability through the aging process. Respondents in the baseline assessment were asked separately about OA in the knee, in the hip, and in the hand, with the lead-in question, “Has a doctor ever told you that you have⋯” Participant height and weight was measured and BMI (kg/m2) calculated, and sociodemographic information was collected. Participants reporting arthritis other than OA or without information on OA or BMI were excluded from the present study. Descriptive analyses compared BMI distributions between those without OA, and those with OA of the knee, hip and hand, individually and with each possible combination of OA at these joint sites. Visual inspection was used to determine whether the shape of the BMI distributions differed for combinations of hand OA with knee and hip OA. The relationship between BMI and joint site was quantified by linear regression, adjusted for age and sex. The relationship between obesity and joint site was quantified by logistic regression, adjusted for age and sex. Results: The analytic sample included 25,459 individuals. Overall, 24.9% of the sample reported OA at any site. Among these, 56.6% reported knee OA, 31.2% hip OA and 46.9% hand OA. Forty-seven percent of individuals reporting hand OA also reported knee and/or hip OA. There was minimal difference in mean BMI between the OA groups (Table, Column A), but the percent obese, especially for the combinations of individual joint sites, showed greater differences across groups (Table, Column B). The distributions of BMI for the hand OA and hand and hip OA groups were similar, but distinct from the distributions that included knee OA, which were likewise similar but had a higher proportion of individuals in the obese I and II/III categories (Figure). Findings for males and females and different age groups were similar. Regression results for OA overall and for OA at individual joint sites (without consideration of other joints), showed a positive and significant association between each joint group and higher BMI and, in particular, likelihood of being obese (Table, Columns C and D). However, when all combinations of joint sites were simultaneously considered, neither hand OA alone nor hand and hip OA together were significantly associated with higher BMI or obesity, whereas any combinations that included knee OA were significantly associated with higher BMI and, in particular, likelihood of being obese (Table, Column C and D). Conclusions: Hand OA assessed without regard to the involvement of other joints appears to be significantly associated with higher BMI and obesity. However, when considering OA in other joints, and in particular knee OA, an independent association between hand OA and BMI/obesity was not found. This suggests that positive associations seen in previous studies are likely due to the presence, but lack of consideration, of concomitant knee OA. Furthermore, the results suggest that a simple comparison of mean BMI values, even when age and sex adjusted, between OA groups may miss important differences that exist in the upper tails of the BMI distribution (i.e. the obese portion of the distribution) where there is greater risk for OA. The findings also raise questions as to whether obesity is a risk factor for OA in general, or only for knee OA.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The clinical relevance of anterior accessory great saphenous vein reflux

BackgroundInsurance approval for saphenous vein ablation is generally limited to junctional reflux involving the great saphenous vein (GSV) or small saphenous vein. This study was designed to investigate prevalence and disease severity of anterior accessory GSV (AAGSV) compared with GSV disease in patients presenting to dedicated outpatient vein centers. MethodsDeidentified data were pulled from the American Vein & Lymphatic Society PRO Venous Registry for first and second patient encounters. Variables included age, sex, and body mass index (BMI); clinical class of Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification; revised Venous Clinical Severity Score (rVCSS); and duplex ultrasound values for each limb. Data were further scrutinized according to duplex ultrasound findings. Patients with normal findings on duplex ultrasound examination or evidence of acute or chronic thrombosis were excluded. Patients were further characterized into two groups. The primary group had no prior vein treatment vs the progressive group, in which patients have had a superficial venous intervention at some point in the past. ResultsThere were 6836 unique patients with duplex ultrasound patterns of either AAGSV or GSV above the knee or both AAGSV and GSV in either group. This pool contained 2604 patients with recorded CEAP class and rVCSS, representing 2664 patient limbs in the final data set. In comparison to limbs in the progressive group, AAGSV reflux was more common in the primary group (78/563 vs 209/2101; P < .01). Demographic features of the groups demonstrated no significant difference. The primary group demonstrated a significantly higher rVCSS (6.95 vs 6.10; P < .01) than the progressive group. Patients in the primary group also demonstrated a significantly higher incidence of more advanced disease (CEAP class C4 and above; 43.1% vs 24.8%; P < .0001) than those in the progressive group. The primary group demonstrated no significant differences in age, sex proportions, or mean BMI. The mean rVCSS for GSV of these patients (7.22) was significantly higher than that of AAGSV patients (5.63; P < .01). The incidence of superficial vein thrombosis for the AAGSV patients (6.41%) was significantly higher than that of the GSV patients (2.17%; P < .05) in the progressive group. Patients in the progressive group demonstrated no significant difference in age, sex proportions, mean BMI, or average rVCSS. The proportion of AAGSV limbs with superficial thrombosis events (37/287 [12.9%]) was significantly higher than that for GSV (59/2214 [2.7%]; P < .01). ConclusionsAAGSV reflux is common and carries similar morbidity to GSV reflux. It is manifested with an alarming presence of superficial vein thrombosis.

Meta-analysis of the Risk Factors of Thrombosis in the Perioperative Period of the Orthopedics Spinal Surgery

To explore the specific risk factors of thrombosis in the perioperative period of orthopedics spinal surgery, a search was conducted with specific keywords in PubMed, EMbase, the Cochrane Library, China National Knowledge Infrastructure, WanFang Data, very important paper and Web of Science databases between January 2015 and December 2019. Two researchers independently screened the literature, extracted the data and cross-checked. RevMan 5.3 software was used for meta-analysis. A total of 6 articles were included in this study, with a total of 23 106 patients. The results of meta-analysis showed that the age standard mean difference (=0.39, 95 % confidence intervals 0.18, 0.59, p=0.0002), blood loss (mean difference =35.26, 95 % confidence intervals 30.18, 40.34, p=0.00001), and operation time (mean difference =13.49, 95 % confidence intervals 5.34, 21.64, p=0.001) of the experimental group were significantly higher than those of the control group, and the body mass index mean difference was -1.82, 95 % confidence intervals (-2.79, -0.85, p=0.0002) of the experimental group was significantly lower than that of the control group. There was no significant difference in the number of female (odds ration=2.23, 95 % confidence intervals 0.65, 7.69, p=0.2) and male (odds ration=0.65, 95 % confidence intervals CI 0.32, 1.32, p=0.23) patients between the experimental group and the control group. Age, operation time, blood loss, and body mass index were the risk factors of thrombosis in the perioperative period of orthopedics spinal surgery.

Preeclampsia exposed offspring have greater body mass index than non-exposed offspring during peripubertal life: A meta-analysis.

This study evaluates the effect of preeclampsia on body mass index (BMI) of offspring who were exposed to preeclampsia in utero. Data were obtained from studies identified by a literature search in electronic databases. Random-effects metanalyses were conducted to achieve mean difference in BMI, waist circumference, gestation length, and birthweight between preeclampsia exposed (PE) and non-exposed (non-PE) offspring older than 5 years. Metaregression analyses were performed to identify factors affecting offspring BMI. Sixteen studies (11639 PE offspring; age 15.5 years [14.2, 16.8]; 33.3% [32.6, 33.9] males vs 526,576 non-PE offspring; age 15.7 years [15.0, 16.4]; 42.6% [40.6, 44.5] male) were used. Gestation duration and birthweight of PE fetuses were significantly lesser than those of non-PE fetuses (mean difference (MD) -0.66 weeks [-1.25, -0.07]; p = 0.03 and MD -207.9 [-344.0, -71.8]; p = 0.003) respectively. BMI of PE offspring was significantly higher than non-PE offspring (MD 0.54 kg/m2 [0.27, 0.82]; p = 0.0001). Odds of being obese was significantly higher in PE than non-PE offspring (odds ratio 2.12 [1.70, 2.66]; P < 0.00001). Waist circumference was also significantly higher in PE than in non-PE offspring (MD 1.37 cm [0.67, 2.06]; p = 0.0001). Offspring BMI was significantly inversely associated with maternal age in both PE and non-PE groups. Preeclampsia poses risk of higher BMI and waist circumference especially to the offspring of older mothers.

TL 18206 - Foot and ankle insufficiency fractures among postmenopausal sedentary women

Introduction: Insufficiency fractures occur in bones with decreased elastic strength. In contrast to fatigue or stress fractures, which affect normal bones and have been extensively studied in the literature, foot and ankle insufficiency fractures have been poorly researched to date. The objective of this study was to identify behavioral, biomechanical and metabolic factors associated with the development of foot and ankle insufficiency fractures. Methods: In total, 53 sedentary postmenopausal female patients who had foot and ankle insufficiency fractures and who were treated at the São Paulo State Civil Servant Hospital (Hospital do Servidor Público do Estado de São Paulo) were included in the treatment group, and 53 individuals were included in the control group. Data were collected on fracture site, body mass index (BMI), corticoid use, femoral and lumbar T-score measured by bone densitometry, and serum 25-hydroxyvitamin D level. The calcaneal angle, the angle between the first metatarsal and the talus and the metatarsus adductus angle were measured in radiographs. Results: The fractures affected the metatarsal bones in 47 patients. Other fracture sites included the lateral malleolus, lateral cuneiform bone, cuboid bone, tibia and calcaneus. All metatarsal bones were affected, most frequently the 5th. The most common fracture was a 5th metatarsal base fracture in zone II. There was no significant difference in mean BMI, serum 25-hydroxyvitamin D levels, alcohol consumption or smoking between the groups. The development of fractures was significantly associated with corticoid use (p&lt;0.0001), low femur (p=0.028) and lumbar spine (p=0.002) bone mineral density and metatarsus adductus angle (p=0.02). When analyzed separately, 4th and 5th metatarsal fractures were associated with smaller angles between the talus and the first metatarsal (p=0.01). Conclusion: Foot and ankle insufficiency fractures among sedentary postmenopausal women are associated with corticoid use, low bone mineral density and biomechanical characteristics, such as pes cavus and metatarsus adductus. The presence of such fractures may be the first sign of bone fragility and should be used as criteria for initiating adequate treatment to prevent other fractures.

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.

Fluoxetine for adults who are overweight or obese.

Fluoxetine is a serotonin reuptake inhibitor indicated for major depression. It is also thought to affect weight control: this seems to happen through appetite changes resulting in decreased food intake and normalisation of unusual eating behaviours. However, the benefit-risk ratio of this off-label medication is unclear. To assess the effects of fluoxetine for overweight or obese adults. We searched the Cochrane Library, MEDLINE, Embase, LILACS, the ICTRP Search Portal and ClinicalTrials.gov and World Health Organization (WHO) ICTRP Search Portal. The last date of the search was December 2018 for all databases, to which we applied no language restrictions . We included randomised controlled trials (RCTs) comparing the administration of fluoxetine versus placebo, other anti-obesity agents, non-pharmacological therapy or no treatment in overweight or obese adults without depression, mental illness or abnormal eating patterns. Two review authors independently screened abstracts and titles for relevance. Screening for inclusion, data extraction and risk of bias assessment was performed by one author and checked by the second. We assessed trials for the overall certainty of the evidence using the GRADE instrument. For additional information we contacted trial authors by email. We performed random-effects meta-analyses and calculated the risk ratio (RR) with 95% confidence intervals (95% CI) for dichotomous outcomes and the mean difference (MD) with 95% CI for continuous outcomes. We identified 1036 records, scrutinized 52 full-text articles and included 19 completed RCTs (one trial is awaiting assessment). A total of 2216 participants entered the trials, 1280 participants were randomly assigned to fluoxetine (60 mg/d, 40 mg/d, 20 mg/d and 10 mg/d) and 936 participants were randomly assigned to various comparison groups (placebo; the anti-obesity agents diethylpropion, fenproporex, mazindol, sibutramine, metformin, fenfluramine, dexfenfluramine, fluvoxamine, 5-hydroxy-tryptophan; no treatment; and omega-3 gel). Within the 19 RCTs there were 56 trial arms. Fifteen trials were parallel RCTs and four were cross-over RCTs. The participants in the included trials were followed up for periods between three weeks and one year. The certainty of the evidence was low or very low: the majority of trials had a high risk of bias in one or more of the risk of bias domains.For our main comparison group - fluoxetine versus placebo - and across all fluoxetine dosages and durations of treatment, the MD was -2.7 kg (95% CI -4 to -1.4; P < 0.001; 10 trials, 956 participants; low-certainty evidence). The 95% prediction interval ranged between -7.1 kg and 1.7 kg. The MD in body mass index (BMI) reduction across all fluoxetine dosages compared with placebo was -1.1 kg/m² (95% CI -3.7 to 1.4; 3 trials, 97 participants; very low certainty evidence). Only nine placebo-controlled trials reported adverse events. A total of 399 out of 627 participants (63.6%) receiving fluoxetine compared with 352 out of 626 participants (56.2%) receiving placebo experienced an adverse event. Random-effects meta-analysis showed an increase in the risk of having at least one adverse event of any type in the fluoxetine groups compared with placebo (RR 1.18, 95% CI 0.99 to 1.42; P = 0.07; 9 trials, 1253 participants; low-certainty evidence). The 95% prediction interval ranged between 0.74 and 1.88. Following fluoxetine treatment the adverse events of dizziness, drowsiness, fatigue, insomnia and nausea were observed approximately twice as often compared to placebo. A total of 15 out of 197 participants (7.6%) receiving fluoxetine compared with 12 out of 196 participants (6.1%) receiving placebo experienced depression. The RR across all fluoxetine doses compared with placebo was 1.20 (95% CI 0.57 to 2.52; P = 0.62; 3 trials, 393 participants; very low certainty evidence). All-cause mortality, health-related quality of life and socioeconomic effects were not reported.The comparisons of fluoxetine with other anti-obesity agents (3 trials, 234 participants), omega-3 gel (1 trial, 48 participants) and no treatment (1 trial, 60 participants) showed inconclusive results (very low certainty evidence). Low-certainty evidence suggests that off-label fluoxetine may decrease weight compared with placebo. However, low-certainty evidence suggests an increase in the risk for dizziness, drowsiness, fatigue, insomnia and nausea following fluoxetine treatment.

Association between dietary diversity, health and nutritional status of older persons in rural Zambia

Objective: The purpose of the study was to assess the association between dietary diversity, health and nutritional status of older persons aged 50 years and above in Milenge district of Luapula province, Zambia. Design: A cross-sectional, descriptive study was conducted. Subjects and setting: The study was conducted among 135 older persons (≥ 50 years) comprising 67 men and 68 women who were randomly selected from three communities in Milenge district, Luapula province. Outcome measures: Anthropometric measurements (weight and height) were used to determine the prevalence of malnutrition among the respondents by calculating the body mass index (BMI). Food consumption was assessed using a non-quantified food frequency questionnaire and dietary diversity scores were used to determine the adequacy of food intake, while a health questionnaire was used to determine self-perceived health status of the respondents. Results: Based on the WHO BMI classification, 30.4% of older persons were underweight, whilst 8.1% were overweight. There was a significant difference in mean BMI between male and female older persons (p < 0.01). More men had severe underweight, whilst more women were found to be overweight and obese. The mean dietary diversity score (DDS) was 3.6 ± 1.1. Dietary assessment showed that 64.4% of the respondents had dietary diversity scores that were below the mean value, while 35.6% had scores above the mean value. The Spearman rho correlation test revealed a positive correlation (r = 0.184, p = 0.028) between BMI categories and dietary diversity scores. The majority (74%) of respondents reported having at least one health condition including high blood pressure (42.6%), coronary heart disease (8.9%), malaria (24.4%), tuberculosis (35.6%) and pneumonia (24.4%), while only 26% perceived themselves to be healthy. Conclusion: The study revealed a high prevalence of undernutrition and low dietary diversity among older persons. A positive association was found between nutritional status and dietary diversity. Although the majority of the respondents reported having health conditions, there was no relationship between nutrition-related health conditions and dietary diversity.

Long-term effects of participation in a prenatal exercise intervention on body weight, body mass index, and physical activity level: a 6-year follow-up study of a randomized controlled trial

Background Growing evidence supports that physical activity and exercise during pregnancy is favorable for the mother, with persisting benefits in the postpartum period. However, there is scant knowledge of the effect of a prenatal exercise program on long-term health and lifestyle habits. Objectives This 6-year follow-up study of a randomized controlled trial had two aims: (1) compare body weight, weight retention and body mass index (BMI) in the intervention group and control group, and (2) evaluate effects on physical activity level and recreational exercise. Materials and methods Out of 105 participants initially randomized to either an intervention group, n = 52 (twice weekly group-exercises and physical activity counselling) or control group, n = 53 (standard prenatal care), 80 women (76.2%) participated in the present long-term follow-up study, performed in a general community in Oslo, Norway. Data were collected through a standardized telephone interview based on the baseline protocol and a modified Physical Activity and Pregnancy Questionnaire (PAPQ). Body weight at 6 years follow-up was self-reported (kg), and calculation of current BMI (kg/m2) was based on self-reported weight and measured height at study inclusion. Investigators were unaware of the original randomization at the time of the interviews. Analyses of covariance were used to examine the difference in change in body weight and BMI between the groups. Even though the MET-values were not normally distributed, differences were examined using a two-sided independent sample t-test due to large sample size (n ≥ 30). Results At 6 years follow-up there were no differences in mean BMI (kg/m2) (24.0 ± 3.8 versus 24.8 ± 4.0, p = .37), physical activity level (4167 ± 2638 versus 3925 ± 3075 MET-min/week, p = .67) or recreational exercise (630 ± 1290 versus 720 ± 1005 MET-min/week, p = .88) between the intervention and control group, respectively. Subgroup analysis of participants with high adherence during the intervention 6 years ago (≥24 prenatal exercise classes), showed a positive intervention effect at long-term follow up in body weight (kg) (62.8 ± 7.9 versus 70.8 ± 11.8, p = .03) and BMI (kg/m2) (22.5 ± 3.1 versus 24.8 ± 4.0, p = .05), and none (versus 11 in the control group) had gained ≥5 kg compared to prepregnancy weight (p = .02). Conclusions Women who adhered to the original prenatal exercise intervention demonstrated significantly lower body weight and BMI at 6-year follow-up. Otherwise, no long-term intervention effect was observed.

Effect of lifestyle focused text messaging on risk factor modification in patients with diabetes and coronary heart disease: A sub-analysis of the TEXT ME study

AimsThere is potential to provide public health interventions through text messaging for patients with Type 2 diabetes mellitus (T2DM). Our objective was to ascertain if lifestyle focused text messaging addressing cardiovascular risk factors in patients with coronary heart disease (CHD) and T2DM, was more effective than usual care. MethodsThis is a secondary analysis of the TEXT ME study, a randomised clinical trial of a 6-month text messaging intervention in patients with coronary heart disease. The measured outcomes include cholesterol, blood pressure (BP), body mass index (BMI), HbA1c, waist/hip circumference and smoking status. Our objective was to ascertain if lifestyle focused text messaging in patients with T2DM was more effective than usual care, and to determine if the intervention was more effective in patients with T2DM compared to those without. Results229 participants in the TEXT ME study had T2DM (32%), 111 participants in the intervention group and 118 in the control group. At 6 months, the mean difference in systolic BP was −7.6 mmHg (95%CI −11.8, −3.37, p = 0.0003) and diastolic BP −3.7 mmHg (95%CI −6.12, −1.24, p = 0.0032). The mean difference in low density lipoprotein in the intervention arm, compared to the control arm, was −0.05 mmol/L (95%CI −0.27, 0.18, p = 0.813), and in triglycerides was −0.29 mmol/L (95%CI −0.59, 0.01, p = 0.035) respectively. The mean difference in BMI was −0.89 kg/m2 (95%CI −2.74, 0.95, p < 0.0001) in the intervention group, waist circumference −3.98 cm (95%CI −8.57, 0.61, p < 0.0001) and hip circumference −3.26 cm (95%CI −7.67, 1.16, p = 0.0006). Intervention subjects with diabetes were less likely to be smokers at 6 months. The mean difference in HbA1c between the control and intervention group was not significant (p = 0.126). The intervention was as effective in patients with diabetes, compared to those without. ConclusionAmong patients with coronary heart disease with T2DM, lifestyle-focused text messaging resulted in significant risk factor reduction.

Effects of hormone therapy in patients who underwent male-to-female gender confirmation surgery

An estimated 1.4 million transgender individuals currently reside in the USA and this patient population is increasing on an annual basis (Am J Public Health 107: 1–8, 2017). Along with this census increase, there has also been an increasing number of gender confirmation surgeries being performed in the USA (American Society of Plastic Surgeons, 2016). Our primary objective was to study the effects of hormonal therapy on testicular volumetrics on transgender patients who underwent male-to-female (MtF) bottom gender confirmation surgery. Retrospective review of patients who underwent MtF bottom gender confirmation surgery. Based on World Professional Association for Transgender Health (WPATH) guidelines a minimum of 1 year of hormonal therapy was required in order to be included. Two groups were analyzed based on their hormone therapy regimen (estrogen and estrogen/progesterone). Demographics, comorbidities, body mass index (BMI), medications (and length of use), testicular volumetrics (weight, length of spermatic cord, volume), and post-operative complications (dehiscence, seroma, hematoma, infection, return to the OR) were analyzed. A total of 54 patients were analyzed. The mean age of the sample population was 37.7 (± 13.3) years old. The mean difference in BMI before and after hormonal treatment was − 0.14 (± 1.7) in the estrogen only group and + 0.3 (± 1.7) in the estrogen/progesterone (combined) group (p = 0.396). The mean weight of surgical specimens in the estrogen only and in the combined group was 30.2 (± 14.9) and 24.1 (± 8.7), respectively (p = 0.033). The spermatic chord length for patients in the estrogen group was 5.4 cm (± 1.7), and 4.5 cm (± 1.6) for patients in the combined group (p = 0.009). Of all the patients, 18 presented with minor wound dehiscence of labia majora. Analysis of complications regarding to the type of hormonal therapy they received showed no difference among patients in the estrogen only and the combined group (p = 0.859). Hormone therapy is an integral aspect of a multidisciplinary approach to transgender medicine and surgery. Further studies are required to elucidate systemic effects in detail and evaluate outcomes in a post-operative setting. Level of Evidence: Level III, risk /prognostic study.