Body Mass Index Distribution Research Articles

Impact of body mass index on in-hospital mortality for six acute cardiovascular diseases in Japan

Body mass index (BMI) distribution and its impact on cardiovascular disease (CVD) vary between Asian and western populations. The study aimed to reveal time-related trends in the prevalence of obesity and underweight and safe ranges of BMI in Japanese patients with CVD. We analyzed 5,020,464 records from the national Japanese Registry of All Cardiac and Vascular Diseases—Diagnosis Procedure Combination dataset over time (2012–2019) and evaluated BMI trends and the impact on in-hospital mortality for six acute CVDs: acute heart failure (AHF), acute myocardial infarction (AMI), acute aortic dissection (AAD), ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Patients were categorized into five groups using the WHO Asian-BMI criteria: underweight (< 18.5 kg/m2), normal (18.5–22.9 kg/m2), overweight at risk (23.0–24.9 kg/m2), obese I (25.0–29.9 kg/m2), and obese II (≥ 30.0 kg/m2). Age was significantly and inversely related to high BMI for all diseases (P < 0.001). The proportion of BMI categories significantly altered over time; annual BMI trends showed a significant and gradual increase, except AAD. In adjusted mixed models, underweight was significantly associated with a high risk of in-hospital mortality in all CVD patients (AHF, OR 1.41, 95% CI 1.35–1.48, P < 0.001; AMI, OR 1.27, 95% CI 1.20–1.35, P < 0.001; AAD, OR 1.23, 95% CI 1.16–1.32, P < 0.001; IS, OR 1.45, 95% CI 1.41–1.50, P < 0.001; ICH, OR 1.18, 95% CI 1.13–1.22, P < 0.001; SAH, OR 1.17, 95% CI 1.10–1.26, P < 0.001). Moreover, obese I and II groups were significantly associated with a higher incidence of in-hospital mortality, except AHF and IS. Age was associated with in-hospital mortality for all BMI categories in six CVD patients. BMI increased annually in patients with six types of CVDs. Although underweight BMI was associated with high mortality rates, the impact of obesity on in-hospital mortality differs among CVD types.

Diet diversity, malnutrition and health: Evidence from Kenya

AbstractWe investigate the effects of diet diversity on health outcomes indicated by the body‐mass index (BMI) of Kenyan women in their reproductive age (15–49 years). We estimate the demand for diet diversity (which is a proxy for diet quality) and analyse its relationship with BMI by allowing the effect of diet diversity to vary along the conditional BMI distribution. Results show that diet diversity is associated with a beneficial effect on the lower and upper tails of the BMI distribution, that is, dietary diversity improves BMI for underweight individuals while, at the same time, it reduces BMI for overweight/obese individuals. Specifically, doubling the diet diversity is associated with a 14.7% increase in BMI for underweight women and a 7.0% reduction in BMI of obese women. These results support the hypothesis that diet diversity is associated with optimal BMI and, thus, better health, contributing to the policy discourse concerning the double burden of malnutrition in developing countries.

RF03 | PMON300 Sex Hormones, Sex Hormone Binding Globulin, and Gonadotropins in Men with Inguinal Hernias

Abstract Background More than 1 in 4 men will undergo inguinal hernia repair during their lifetime. Age is a significant risk factor for inguinal hernias in men with increased incidence in older age. Sex steroid hormone changes are observed with a higher ratio of serum estradiol (E2) to testosterone (T) as men age. We previously demonstrated that a shift from androgen to estrogen action caused inguinal hernia formation in a transgenic male mouse model with increased estrogen action in lower abdominal muscle tissues. However, age-related changes in serum E2 levels in men are conflicting, as some studies have reported increases but others have noted unchanged or even decreased E2 levels with advancing age. Method: This study was performed on 212 men with inguinal hernias, aged 20 to 90 years, stratified at 10-year intervals of age (20-30, 31-40, 41-50, 51-60, 61-70, 71-80, 81-90 years). We assessed total T (TT), total E2 (TE2), dehydroepiandrosterone (DHEA), sex hormone-binding globulin (SHBG), and gonadotropins (FSH and LH). Body mass index (BMI) was calculated using height and weight. Results The BMI distribution was balanced for men with inguinal hernias among all age groups. TE2 was low in 23.7%, normal in 65.8%, and high in 10.5% of men 50 years or younger. In contrast, the percentage of patients with high TE2 was increased 2.6-fold in men over the age of 50 (20.1% in low, 52.3% in normal, and 27.6% in high). TT was normal in all men 50 years and younger but was low in 3.5% and normal in 96.5% of men over the age of 50. We found that serum TE2 levels and the ratio of TE2/TT positively correlated with age (p=0.001). In addition, serum TE2 levels were significantly higher in the advanced age groups (71-80 and 81-90 years) than in the young age group (20-40 years). Serum TT levels decreased but did not reach significance in the advanced age groups compared to the young age group. Remarkably the ratio of E2/T was higher in the advanced age groups than in the young age group (20-30 years). Serum DHEA levels in men over the age of 50 were significantly higher than in men 50 years or younger. SHBG levels were higher in men over 70 years than men 50 years or younger (p&amp;lt; 0.01). Serum levels of FSH and LH in men over 60 years were 3-fold greater than in men 50 or younger (p&amp;lt;0.01). Conclusions Our findings suggest a correlation of increased estrogen action in the formation of inguinal hernias at an advanced age. This points to a potential utilization of inhibitors of estrogen synthetase or estrogen antagonists in a subset of elderly inguinal hernia patients with increased circulating estrogen as a non-surgical intervention. Presentation: Saturday, June 11, 2022 1:42 p.m. - 1:47 p.m., Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Does Central Fat Distribution Reduction After Bariatric Surgery Induce Ocular Refraction Change Independent of Body Mass Index?

The effect of body mass index (BMI) and central fat distribution (CFD) reduction after bariatric surgery on ocular refraction is not well established. We assessed association between anthropometric parameters and refraction errors with other ocular and metabolic parameters 1year after the surgery. This was a retrospective study with patients underwent bariatric surgery and had at least 1year follow-up. Data were extracted from the bariatric and ophthalmology outpatient clinic records of the participants. Measurements of metabolic, anthropometric, and ocular parameters including BMI, CFD, refraction status, visual acuity, intraocular pressure (IOP), optic coherence tomography (OCT), and biometry test of the eyes were evaluated. Seventy-four eyes of 37 patients had a mean follow-up of 14.4 ± 1.7months after the surgery. Mean BMI and percentage of CFD decreased from 47.5 ± 6.7 to 33.1 ± 5.2kg/m2 (p < 0.01) and 28.5 ± 5.74 to 17.8 ± 4.64 (p < 0.001) after 1year, respectively. Mean refractive errors of the right and left eyes changed from - 0.62 ± 1.23 D to - 0.17 ± 1.36 D and from - 0.79 ± 1.39 to - 0.34 ± 1.56 after 1year of the surgery (p < 0.001). Mean IOP was significantly reduced (p < 0.001). Unlike BMI, reduction in CFD was significantly correlated with refraction change in both eyes (right eyes; r = 0.783, left eyes; r = 0.791, p < 0.001) after 1year. No significant differences were found in the other parameters. Bariatric surgery induced significant refractive change in eyes, which is significantly associated with CFD reduction after 1year. Bariatric surgery should be considered as a risk factor in patients with unexpected refractive error changes.

No association between body composition and walking outcomes in multiple sclerosis

BackgroundOne major concern of excess body weight is diminished physical function. The excess body weight associated with obesity can bring about challenges for physical function, particularly walking performance, among persons living with the consequences of a chronic, neurological disease. There is evidence that persons with multiple sclerosis (MS) have significantly reduced walking performance compared with controls; however, the relationship between body composition and walking outcomes has not been well-defined in persons with MS. To that end, the study examined the associations between body composition metrics and a comprehensive battery of walking outcomes in persons with MS recruited across a wide distribution of body mass index. MethodsAmbulatory participants with MS (n=64) underwent an assessment of neurological disability status using the Expanded Disability Status Scale (EDSS) and body composition metrics (i.e., percent body fat, fat mass, lean mass, bone mineral content and density) using dual-energy x-ray absorptiometry. Participants then completed the Timed 25-Foot Walk (T25FW), Timed Up and Go (TUG), 6-Minute Walk (6MW), and 12-Item Multiple Sclerosis Walking Scale (MSWS-12). We examined Spearman rank-order bivariate correlations among percent body fat, fat mass, lean mass, bone mineral content and density, T25FW, TUG, 6MW, MSWS-12, and EDSS. ResultsBody composition metrics were not significantly associated with T25FW (rs=-.11, .12), TUG (rs=-.04, .11), 6MW (rs=-.01, .20), and MSWS-12 (rs=-.16, .03). Of note, body composition metrics were not correlated with disability status based on EDSS (rs=-.11, .03). Body composition metrics were not associated with walking outcomes even after controlling for EDSS. ConclusionOur data indicated that worse body composition profiles are not necessarily associated with worse walking performance, greater perception of MS-related walking impairment, or more severe disability status in MS. Future research may consider examining other health-related or disease outcomes of overweight or obesity in MS. Overall, our findings suggest that optimization of body composition may not be a target of interventions for improving walking outcomes, and future research might explore other factors that influence lower physical function in MS.

Prevalence and risk factors of obesity in children with Diamond-Blackfan anemia

To investigate the distribution of body mass index (BMI) and risk factors for obesity in children with Diamond-Blackfan Anemia (DBA). The children with DBA who attended National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, from January 2003 to December 2020 were enrolled as subjects. The related clinical data and treatment regimens were recorded. The height and weight data measured within 1 week before or after follow-up time points were collected to calculate BMI. The risk factors for obesity were determined by multivariate regression analysis in children with DBA. A total of 129 children with DBA were enrolled, among whom there were 80 boys (62.0%) and 49 girls (38.0%), with a median age of 49 months (range 3-189 months). The prevalence rate of obesity was 14.7% (19/129). The multivariate logistic regression analysis showed that the absence of ribosomal protein gene mutation was closely associated with obesity in children with DBA (adjusted OR=3.63, 95%CI: 1.16-11.38, adjusted P=0.027). In children with glucocorticoid-dependent DBA, obesity was not associated with age of initiation of glucocorticoid therapy, duration of glucocorticoid therapy, and maintenance dose of glucocorticoids (P>0.05). There is a high prevalence rate of obesity in children with DBA, and the absence of ribosomal protein gene mutation is closely associated with obesity in children with DBA.

Reduced Consumption of Sugar-Sweetened Beverages Is Associated with Lower Body Mass Index Z-Score Gain among Chinese Schoolchildren.

To examine whether reducing sugar-sweetened beverage (SSB) consumption is associated with reduced body mass index z-score gain among Chinese schoolchildren in Nanjing, China, a randomized controlled trial (RCT) was conducted in four selected primary schools from September 2019 to September 2020. Students in the third grade in the Intervention Group received school-based and home-based interventions for two consecutive semesters to reduce SSB consumption, while two schools in the Control Group did not receive any interventions. Weight changes were expressed as body mass index (BMI) z-scores as standard deviations of the BMI distribution per age and sex group. Changes in SSB consumption before and after the interventions were categorized into Level-Up if it increased, Level-Same if it was maintained and Level-Down if it decreased. Multivariable linear regression models were used to explore the association of different levels of changes in SSB consumption pre- and post-intervention with the BMI z-score. Among 1633 participants who completed the trial, the mean age at baseline was 9.36 years (±0.48 SD).The median baseline BMI z-score was −0.24 (25th percentile −0.72; 75th percentile 0.58). After the intervention, the median BMI z-score increased by 0.06 (−0.17~0.37) in the Intervention Group and by 0.14 (−0.08~0.41) in the Control Group (p < 0.001). A higher increase in BMI was found in the Control Group than in the Intervention Group (1.20 vs. 0.94) during the 12-month period. Among participants whose parents’ educational attainment was above 9 years, the median BMI z-score increased by 0.07 (−0.17~0.37) in the Intervention Group and by 0.16 (−0.06~0.41) in the Control Group (p < 0.001). In a linear regression analysis adjusted for potential confounders, the BMI z-score decreased by 0.057 more in Level-Down than in Level-Up (95% CI: −0.103 to −0.012, p = 0.014). These results indicate that the decreased consumption of SSBs might have reduced the prevalence of overweight in schoolchildren in China, especially in students whose parents had high educational levels.

The correlates and reference values for the 6-minute walk distance in Taiwanese adults with schizophrenia

Purpose The study aimed to identify the factors associated with the 6-min walk distance (6MWD) and to provide reference values for the 6MWD in individuals with schizophrenia (SCZ) in Taiwan. Methods A proportional stratified sampling method was utilized based on distribution of gender, age and body mass index (BMI) at the study hospital. The 6-minute walk test was conducted according to the American Thoracic Society protocol. Results A total of 237 patients with SCZ completed the 6-minute walk test. The 6MWD was significantly associated with age, height, weight, and length of the onset of SCZ. Stepwise linear regression revealed that height and age were significant determinants of 6MWD. The reference values for males and females at different age groups were determined. Notably, females over 60 walked substantially shorter than the age younger than 60. Conclusions Height and age were the main predictors for 6MWD among people with SCZ in Taiwan. The established reference values can be used to identify those at risk of poor cardiorespiratory fitness and as a target outcome during exercise programs in psychiatric rehabilitation. Our results highlight that older females with SCZ may be a priority group to target with exercise interventions to mitigate the faster decline in cardiorespiratory fitness. IMPLICATIONS FOR REHABILITATION Height and age were predictors of 6-min walk distance (6MWD) in schizophrenia (SCZ). The established age- and gender reference values for the 6MWD can be used to identify those at risk of poor cardiorespiratory fitness. Females with SCZ over age 60 may be a priority group to target with exercise interventions to mitigate the faster decline in cardiorespiratory fitness.

Trends in the distribution of body mass index, waist circumference and prevalence of obesity among Taiwanese adults, 1993–2016

Differences in the prevalence of general and abdominal obesity by subgroups such as age, sex, and education have been reported worldwide. Most studies in Taiwan regarding obesity prevalence were targeted at school-aged children or without further stratification by subgroups. Our aim was to examine the age-specific secular trend of body mass index (BMI), waist circumference (WC), and obesity prevalence stratified by sex, education and urbanization levels in Taiwanese adults. We used three waves of nationally representative population from the Nutrition and Health Survey in Taiwan (NAHSIT) 1993-1996 (n = 2 989), 2005-2008 (n = 2 495), and 2013-2016 (n = 2 880). The data included standardized measurement of body weight, height, and WC. We conducted a serial cross-sectional analysis among adults aged 20 years or above to examine the age-specific trends of BMI, WC, and the prevalence of underweight, overweight, general obesity, and abdominal obesity with stratification by sex, education, and urbanization levels. The general obesity prevalence was 16%, 21%, and 20% and the abdominal obesity prevalence was 27%, 42%, and 47% in the 1993-1996, 2005-2008, and 2013-2016 surveys, respectively. The age-specific secular trend of BMI differed across subgroups; however, the trend of WC increased rapidly regardless of subgroups, except for women aged ≥60 years. The general obesity prevalence increased noticeably among men, younger- and middle-age adults with high school or higher education, middle- and older-age adults with lower than high school education, people <39 and ≥50 years of age residing in rural areas, and among those between 30 and 59 and ≥70 years of age residing in urban areas. Although the increasing trend of general obesity prevalence was levelling off among several subgroups, the abdominal obesity prevalence increased significantly and rapidly in Taiwan. Future research in developing effective weight and WC control interventions tailored to different subgroups is urgently needed.

Radiological Comparison of Femoral Neck-Shaft Angle in Piriformis Syndrome: A Case-Control Study.

Variations in osseous, neural and muscular anatomical structures in the gluteal region have been investigated for their role in causing deep gluteal pain syndromes including piriformis syndrome. This study aimed to radiologically determine whether the femoral neck-shaft angle (NSA) in piriformis syndrome differs from that in a healthy population. Two groups of participants comprising 23 piriformis syndrome patients and 22 healthy controls were included in the present study. Piriformis syndrome was diagnosed based on clinical findings and the diagnosis was confirmed by intramuscular local anaesthetic injection. Femoral NSAs were measured from the anteroposterior pelvic radiographs and compared between the control and piriformis syndrome-affected groups. The age, height, body weight, body mass index and gender distribution differences between the two groups (control and piriformis) were not statistically significant. The femur NSA was significantly lower in the piriformis group than in the control group. The receiver operating characteristic analysis revealed that the area under the curve, sensitivity and specificity for predicting the risk of piriformis syndrome (PS) were 0.946%, 100% and 86.36%, respectively, at an NSA cut-off of 127°. Reduced femoral NSA is related to PS. However, studies with a larger study sample are needed to further substantiate this finding. The online version contains supplementary material available at 10.1007/s43465-022-00736-y.

The Influence of Elexacaftor-Tezacaftor-Ivacaftor on Body Mass Index Distribution in Pediatric and Adult Patients with Cystic Fibrosis

The Influence of Elexacaftor-Tezacaftor-Ivacaftor on Body Mass Index Distribution in Pediatric and Adult Patients with Cystic Fibrosis

Association between regional fat mass and risk of nonalcoholic fatty liver disease in overweight/obese adults

To explore the relationship between fat distribution and non-alcoholic fatty liver(NAFLD) in overweight/obese adults. This cross-sectional study included 736(190 men and 546 women) 19-56 years old overweight/obese people in Beijing were selected by convenient sampling. Their age and body mass index(BMI) distribution were 36(31-46) years old and 28.0(26.2-30.7), respectively. The body fat mass and regional fat mass were measured by dual energy X-ray absorptiometry(DXA), and Logistic regression model was used to analyze the association between regional fat mass and the risk of NAFLD. The prevalence of NAFLD was 70.0%(515/736) in overweight/obese population. In the multivariate Logistic model, after adjusting for age, gender, BMI, hypertension and body fat mass, waist circumference(WC), thigh fat mass and android fat mass were significantly association with NAFLD risk(P&lt;0.05), but no association was found between arms, trunk and gynoid fat mass and NAFLD risk. There were interactions between thigh fat mass and age(P_(interaction)&lt;0.001) and BMI group(P_(interaction)=0.001). Subgroup analysis showed that thigh fat mass and NAFLD risk were significantly associated in ≤36-year-old(OR=0.62, 95%CI 0.48-0.81), male(OR=0.32, 95%CI 0.16-0.64) and overweight(OR=0.48, 95%CI 0.36-0.64) groups, but in the &gt;36-year-old, female and the obesity group this association was not statistically significant. There was an interaction between trunk fat mass and age group(P_(interaction)=0.009). There was a positive correlation between trunk fat mass and NAFLD risk in &gt;36-year-old group(OR=1.63, 95%CI 1.35-1.97), but no association was found in ≤36-year-old group. In addition, we also found that a significant interaction between gynoid fat mass and BMI group on NAFLD(P_(interaction)&lt;0.001). In overweight, gynoid fat mass was negatively correlated with the risk of NAFLD(OR=0.12, 95% CI 0.06-0.25), but in the obesity group, the association was not statistically significant. There were no statistically significant interactions between WC, arms fat mass and android mass and age, sex and BMI groups. WC, android fat mass and thigh fat mass are associated with the risk of NAFLD. Thigh fat mass has a significant interaction with age and BMI group on the risk of NAFLD(only in ≤36-year-old group, male and overweight group a significant protective effect of thigh fat on NAFLD was found, but not in &gt;36-year-old group, female and obesity group). Trunk fat mass had an interaction with age(the association between trunk fat mass and NAFLD was significant in &gt;36-year-old group). Gynoid fat mass and BMI group also have a significant interaction on NAFLD(the detrimental effect of gynoid fat on NAFLD is much more profound in the obesity group).

The outcomes of mechanical thrombectomy in patients with acute stroke with and without intravenous injection of tissue plasminogen activator

Background: Stroke is a major health problem and leading cause of mortality worldwide. This study aimed to evaluate the consequences of intravascular interventions in patients with acute ischemic stroke with and without intravenous tissue plasminogen activator (tPA) injection. Methods: This prospective cohort study was conducted on 120 patients with acute ischemic stroke. Patients were divided into three groups based on the type of disease treatment: angiography, tPA, and combined therapy (angiography + tPA). Patients in the tPA group were treated with a standard dose of intravenous alteplase (0.9 mg/kg). The severity of acute ischemic stroke was calculated on days 0, 14, and 90 after the interventions using the National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) questionnaires. Results: All three groups were homogeneous regarding age, gender, location, job status, education, and body mass index (BMI) distribution. Coronary disease was the most common risk factor for stroke in 38.33% of patients. There was no significant difference in mean NIHSS and mRS scores between the groups on days 0, 14, and 90 after intervention (p &gt; 0.05). Mean NIHSS and mRS scores significantly decreased from the first time point (day 0), 10 days until 90 days after treatment in all three groups (p &lt; 0.001); however, there was no significant difference in treatment effect between the three groups at these time points (p &gt; 0.05). Conclusion: Treatment with angiography and tPA alone or with combined therapy significantly decreased the severity of acute ischemic stroke. A significant decrease was observed in the mean NIHSS and mRS scores in all therapy groups, indicating that these treatments were effective in mitigating acute ischemic stroke and improving functional independence in these patients. The eligibility criteria by which patients with acute ischemic stroke are selected for each specific therapy are essential to achieving better clinical outcomes.

Evaluation of Abdominal Fat Ratio in Patients with Breast Cancer-Related Lymphedema: A Controlled Study.

Background: This study aimed to investigate the possible relationship between breast cancer-related lymphedema and central obesity, which is known to be effective in metabolic syndrome and chronic inflammation. Methods and Results: Thirty-six patients (18 lymphedemas, 18 control) enrolled in the study. There was no statistically significant difference in demographic data between the two groups except body mass index (BMI) distribution (p = 0.008). Although 50% of the patients in the study group were obese, this rate was 5.6% in the control group. Although there was a significant difference between the study and control groups in terms of abdominal circumference measurement, there was no significant difference between total and abdominal fat amount and ratios. When BMI and abdominal circumference measurements were evaluated together to predict lymphedema, the area under the curve in abdominal circumference measurement was higher than BMI (0.715 vs. 0.659). In receiver operating characteristic curve analysis, 107 cm of abdominal circumference measurement was determined as cutoff value for lymphedema, with 55% sensitivity and 89% specificity (Youden index: 0.44). Conclusion: Abdominal circumference measurement can be evaluated together with BMI in determining the risk of lymphedema.

Metabolic Factors Predict Changes in Endothelial Function During the Early Course of Type 1 and Type 2 Diabetes.

ContextEndothelial dysfunction may occur early in the development of cardiovascular and metabolic diseases; however, it remains often underestimated and studies rarely discriminate between diabetes types. We have examined endothelial function and its determinants during the early course of type 1 and type 2 diabetes.MethodsCaucasian participants of the prospective German Diabetes Study (GDS) with known diabetes duration <1 year (n = 398) or without diabetes, but of similar age, body mass index (BMI) and sex distribution (n = 109), underwent measurements of flow-mediated dilation (FMD) and nitroglycerin-mediated dilatation (NMD). Whole-body insulin sensitivity (M-value) was assessed by hyperinsulinemic–euglycemic clamps and physical fitness (VO2max) by spiroergometry. A subset of individuals with type 1 or type 2 diabetes (n = 108) was re-evaluated after 5 years.ResultsAt baseline, neither FMD nor NMD differed between people with diabetes and the matched glucose-tolerant groups. At the 5-year follow-up, decline in FMD (–13.9%, P = .013) of persons with type 2 diabetes was independent of age, sex, and BMI, but associated with baseline adipose tissue insulin resistance and indices of liver fibrosis. The M-value decreased in both type 1 and type 2 diabetes groups by 24% and 15% (both P < .001, respectively) over 5 years. Higher HbA1c, lower M-value, and lower VO2max at baseline was associated with lower FMD in both type 1 and type 2 diabetes.ConclusionEndothelial function decreases during the early course of type 2 diabetes. In addition to age and BMI, insulin sensitivity at diagnosis was the best predictor of progressive impairment in endothelial function in type 2 diabetes.

Distribution of normal body mass index (BMI) according to clinical familial hypercholesterolaemia (FH) diagnosis in Lithuania

Distribution of normal body mass index (BMI) according to clinical familial hypercholesterolaemia (FH) diagnosis in Lithuania

Disease heterogeneity of adult diabetes based on routine clinical variables at diagnosis: Results from the German/Austrian Diabetes Follow-up Registry.

To cluster adults with diabetes using variables from real-world clinical care at manifestation. We applied hierarchical clustering using Ward's method to 56 869 adults documented in the prospective Diabetes Follow-up Registry (DPV). Clustering variables included age, sex, body mass index (BMI), HbA1c, diabetic ketoacidosis (DKA), components of the metabolic syndrome (hypertension/dyslipidaemia/hyperuricaemia) and beta-cell antibody status. Time until use of oral antidiabetic drugs (OADs), use of insulin, chronic kidney disease (CKD), cardiovascular disease (CVD), retinopathy or neuropathy were assessed using Kaplan-Meier analysis and Cox regression models. We identified eight clusters: four clusters comprised early diabetes onset (median age 40-50 years) but differed with regard to BMI, HbA1c, DKA and antibody positivity. Two clusters included adults with diabetes onset aged in their early 60s who met target HbA1c, but differed in BMI and sex distribution. Two clusters were characterized by late diabetes onset (median age 69 and 77 years) and comparatively low BMI, but differences in HbA1c. Earlier insulin use was observed in adults with high HbA1c, and earlier OAD use was observed in those with high BMI. Time until CKD or CVD was shorter in those with late onset, whereas retinopathy occurred earlier in adults with late onset and high HbA1c, and in adults with early onset, but high HbA1c and high percentage of antibody positivity. Adult diabetes is heterogeneous beyond classical type 1/type 2 diabetes, based on easily available variables in clinical practice using an automated clustering algorithm that allows both continuous and binary variables.

Relationship Between Body Mass Index and Osteoarthritis for Single and Multisite Osteoarthritis of the Hand, Hip, or Knee: Findings From a Canadian Longitudinal Study on Aging.

To determine whether an apparent association between hand osteoarthritis (OA) and adiposity is explained by the presence of OA at other joint sites. Data from the Canadian Longitudinal Study on Aging, first cycle, comprehensive cohort, were used. Respondents age 45-85 years (n=18,279) were asked separate questions about doctor-diagnosed OA in the hand, hip, or knee. Multinomial logistic regression was used to investigate the relationship between all combinations of hand, hip, and knee OA and body mass index (BMI) and waist-to-height ratio (WHtR). OA was reported by 34.6% of respondents, 28.0% with OA at >1 joint site. Hand OA was not significantly associated with BMI after accounting for OA at other joint sites, with similar findings for WHtR. All joint site combinations containing the knee were strongly associated with BMI, with odds ratios (ORs) ranging from OR 2.92 (95% confidence interval [95% CI] 2.53-3.37) for knee OA only with obesity class I to OR 9.98 (95% CI 7.12-13.88) for multi-joint knee, hip, hand OA with obesity class II/III. BMI distributions including knee OA were broader and shifted to higher BMI levels than those for hand or hip OA. Apparent associations between hand OA and BMI may be explained by concurrent OA at other joint sites. Recognizing that OA is a multi-joint disease is crucial for studies of the associations of adiposity with OA in a particular joint, especially the hand. The association between knee OA and BMI appears to be distinct from those for OA at other joint sites.

Urinary Sodium Excretion and Obesity Markers among Bangladeshi Adult Population: Pooled Data from Three Cohort Studies.

We evaluated the relationship of urinary sodium excretion with a conditional mean, 10th and 90th percentiles of body mass index (BMI), and waist circumference among 10,034 person-visits of Bangladeshi population. We fitted linear mixed models with participant-level random intercept and restricted maximum likelihood estimation for conditional mean models; and quantile mixed-effect models with participant-level random intercept and Laplace estimation for 10th and 90th percentiles models. For each 100 mmol/24 h increase in urinary sodium excretion, participants had a 0.10 kg/m2 (95% CI: 0.00, 0.10) increase in the mean; a 0.39 kg/m2 (95% CI: 0.23, 0.54) increase in the 10th percentile; and a 0.59 kg/m2 (95% CI: 0.39, 0.78) increase in the 90th percentile of BMI. For each 100 mmol/24 h increase in urinary sodium excretion, participants had a 0.20 cm (95% CI: 0.10, 0.30) increase in mean; a 0.18 cm (95% CI: −0.03, 0.40) change in the 10th percentile; and a 0.23 cm (95% CI: 0.03, 0.43) increase in the 90th percentile of waist circumference. We found a modest association between urine sodium and conditional mean of BMI and waist circumference. The magnitude of associations between urine sodium and the 10th and 90th percentile BMI distributions were higher compared to the conditional mean models, suggesting high sodium intake could be more detrimental to underweight and obese participants.

Epidemiological and clinical characteristics analysis of 681 cases of thoracolumbar osteoporotic vertebral compression fractures

To investigate the epidemiological and clinical characteristics of patients with thoracolumbar osteoporotic vertebral compression fracture (OVCF) treated by percutaneous vertebroplasty (PVP). The clinical and imaging data of 681 patients with thoracolumbar OVCF treated with PVP between January 2017 and December 2021 were collected. The epidemiological and clinical characteristics of the patients with thoracolumbar OVCF in single center were summarized from the aspects of demographic distribution (mainly including gender, age), fracture characteristic analysis [including pathological segments, bone mineral density, and body mass index (BMI)], and operation related results (including the distribution of unilateral and bilateral puncture and bone cement injection, postoperative effectiveness analysis and refracture). Of the 681 patients, 134 (19.68%) were male and 547 (80.32%) were female, with a male-to-female ratio of 1∶4.08. The age ranged from 53 to 105 years, with an average of 75.3 years. The age group of 60-90 years old had the largest number of patients (91.04%); the high incidence age group of men was 70-90 years old (13.95%), and that of women was 60-80 years old (72.98%). A total of 836 vertebrae were involved, and the morbidity of thoracolumbar vertebrae (T 11-L 1) was the highest (56.34%, 471/836). The main type of fracture was compression fracture (92.58%, 774/836) and Kümmell disease (7.42%, 62/836). There were 489 cases (71.81%) of osteoporosis, including 66 males and 423 females, with a male-to-female ratio of 1∶6.42. There was significant difference in distribution of bone mineral density between male and female groups ( Z=-5.810, P<0.001). BMI showed 206 cases (30.25%) of underweight, 347 (50.95%) cases of normal, 58 cases (8.52%) of overweight, 42 cases (6.17%) of obese, and 28 cases (4.11%) of extremely obese. The difference in BMI distribution between male and female groups was significant ( Z=-2.220, P=0.026). Of 836 vertebral bodies, 472 (56.46%) were punctured unilaterally and 364 (43.54%) bilaterally. Most of the vertebral bodies (49.88%, 417/836) were injected with 5.0-6.9 mL bone cement, and most of them were distributed in thoracolumbar and lumbar vertebral bodies (T 11-L 3). The visual analogue scale (VAS) score and Oswestry disability index (ODI) of patients with unilateral puncture and bilateral puncture significantly improved at 6 months after operation ( P<0.001), and also the difference was significant between the two groups in the difference of pre- and post-operation ( P<0.001). There were 628 cases (92.22%) with the first occurrence of OVCF, and 53 cases (7.78%) with two or more times of OVCF, all of which were female patients, and 26 cases (49.06%) occurred in the adjacent segment of the previous PVP operation. Female were more than male in OVCF patients. Thoracolumbar vertebral body has the highest morbidity. Patients with low BMI are more likely to have osteoporosis, and patients with high BMI have a higher risk of compression fracture. The amount of bone cement injected through bilateral puncture was greater than that through unilateral puncture.