Elevated Between Body Mass Index Research Articles

The impact of body mass index on the risk of postoperative complications following myomectomy

This study aimed to assess the relationship between body mass index (BMI) and short-term postoperative complications following myomectomy. Utilizing data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database spanning the period from 2012 to 2020, we conducted an analysis of major and minor 30-days postoperative complications stratified by BMI among patients who underwent abdominal or laparoscopic (conventional or robotic assisted) myomectomy. Vaginal myomectomy cases were excluded. Complications were stratified according to the Clavien-Dindo classification. A total of 27,387 cases were included. Postoperative complications occurred in 11.4% of cases (n=3,131), ranging from 9.4% among underweight patients to 16.1% among patients with obesity class 3 (p<0.001). In multiple regression analysis, patients with obesity class 1 experienced fewer postoperative major complications [aOR 95%CI 0.71 (0.53-0.96)], compared to patients with normal BMI. Conversely, patients with obesity class 2 demonstrated more complications [aOR 95%CI 1.18 (1.03-1.35)] including minor complications [aOR 95%CI 1.17 (1.02-1.34)], and obesity class 3 demonstrated more complications [aOR 95% CI 1.26 (1.08-1.47)] including minor [aOR 95%CI 1.21 (1.03-1.42)] and major [aOR 95%CI 1.41 (1.01-21.99)] complications, compared to patients with normal BMI. Similar outcomes were observed when analyzing abdominal myomectomy exclusively, with disparities much less pronounced when the analysis was confined to laparoscopic myomectomies. Patients with class 2 and class 3 obesity are at increased odds of experiencing complications following myomectomy, while those with a slightly elevated BMI may experience a protective effect. These BMI-related discrepancies in complication rates predominantly manifest following abdominal myomectomy procedures rather than laparoscopic approach.

Body Mass Index and Breast Cancer-Related Lymphedema: A Retrospective Cohort Study.

This study aims to evaluate the association between body mass index (BMI) and the incidence of breast cancer-related lymphedema (BCRL). This retrospective cohort study analyzed data from 1464 breast cancer patients treated at The Third Hospital of Nanchang between 2018 and 2021. Patients were categorized based on BMI (<25, 25 to < 30, ≥ 30 kg/m²). Variables such as axillary lymph node dissection, infections, radiotherapy, and comorbidities were taken into account. The incidence of BCRL was 23.4%. Higher BMI was associated with increased risk of BCRL, with significant incidence rates observed at 1, 2, and 3 years in the higher BMI groups. Multivariate analysis confirmed BMI as an independent risk factor for BCRL. Elevated BMI is associated with increased BCRL risk and decreased BCRL-free survival, underscoring the significance of weight management in breast cancer care.

Impact of body mass index on aortic valve stenosis and its clinical outcomes in early adulthood: a long-term study of young men

Abstract Aims Studies investigating associations between body mass index (BMI), incidence of aortic valve stenosis (AVS), and clinical outcomes in AVS patients are scarce. Purpose To investigate the relationship between BMI in youth and subsequent diagnosis of AVS. A secondary aim was to determine the role of obesity in clinical outcomes in individuals diagnosed with AVS. Methods This was a nationwide, register-based cohort study of 1 701 390 men (mean age, 18.3 ±0.8 years) enrolled in compulsory conscription for military service in Sweden from 1969 through 2005. Anthropometrics, blood pressure, fitness, muscle strength and IQ were recorded at baseline. AVS cases and cardiovascular outcomes were identified according to the International Classification of Diseases (ICD)-10 registered in the National patient register and Cause of Death Register through the Swedish 12-digit personal identification number. BMI (kg/m2) was categorized as &amp;lt;18.5, 18.5–&amp;lt;20, 20–&amp;lt;22.5, 22.5–&amp;lt;25, 25–&amp;lt;27.5, 27.5 &amp;lt;30, 30–&amp;lt;35, and 35–&amp;lt;50 kg/m2. Cox proportional hazard models were used to estimate the association between adolescent BMI and future hospitalization for AVS while adjusting for potential confounders. The BMI reference was set as 20–&amp;lt;22.5. Those who developed AVS formed a subcohort that was followed until a first clinical cardiovascular outcome of death, cardiovascular mortality, Heart failure, Atrial fibrillation, myocardial infarction, or ischaemic stroke. Results During a median follow-up of 32 years (IQR, 24-41 years), 5766 cases (mean age 54.7±9.4 years) of AVS were diagnosed. After adjustment, underweight subjects with a BMI of &amp;lt;18.5 kg/m2, compared to those with a low-normal BMI (20.0–&amp;lt;22.5 kg/m2) showed lower risk (HR 0.70; 95% CI 0.61–0.80) of AVS. The multivariable-adjusted HR for AVS increased from HR 1.28; 95% CI 1.17–1.39 for BMI 22.5–&amp;lt;25 kg/m2 to HR 1.91; 95% CI 1.12–3.25 for those with BMI 35–50 kg/m2. Further on, individuals diagnosed with AVS were followed for a median of ~5.5 years. The multivariable-adjusted HR for all-cause mortality, cardiovascular mortality, and heart failure for obese (BMI 30–50 kg/m2), compared to BMI &amp;lt;20.0 kg/m2 in men diagnosed with AVS, were 4.69 (95% CI 2.61–8.44), 4.09 (95% CI 1.72–9.73), and 2.76 (95% CI, 1.36–5.60), respectively. Conclusions Elevated BMI in youth, even within the normal range, is associated with increased risk of developing AVS, while subnormal BMI was protective. Excess weight in youth diagnosed with AVS is associated with higher risk of subsequent clinical outcomes. These findings are novel, generating new questions as to potential mechanisms and implying more vigilant monitoring of patients with AVS and a history of obesity in youth.Figure 1Figure 2

P127 TO INVESTIGATE THE ASSOCIATION BETWEEN BODY MASS INDEX(BMI) AND NECK CIRCUMFERENCE FOR ASSESSING THE RISK OF DEVELOPING HYPERTENSION

Background: This study investigates the association between body mass index (BMI) in combination with neck circumference and the risk of developing hypertension. Methods: Participants (35,000) were selected from the 2021 May Measurement Month participants, comprising normotensive individuals. We categorized participants into four groups based on BMI and neck circumference. Neck circumference was then analyzed for its association with BMI in both females and males. Receiver operating characteristic (ROC) analysis was conducted to determine the best cut-off values for predicting central obesity, and the area under the curve (AUC) was compared between neck circumference and BMI. Results: Following a median observation period of 2.1years, hypertension was diagnosed in 22,400 (64%) participants. Groups 2, 3, and 4 displayed notably elevated hypertension risks compared to Group 1, exhibiting hazard ratios (HRs) of 1.066 (95% CI: 1.025, 1.110), 1.322 (95% CI: 1.235, 1.415), and 1.422 (95% CI: 1.337, 1.512), respectively. Moreover, integrating BMI into a conventional model yielded a more substantial enhancement in hypertension prediction than neck circumference alone. Concurrently assessing BMI and neck circumference further improved hypertension risk estimation accuracy. Neck circumference demonstrated significant correlations with waist circumference in both females and males, with respective b-coefficients of 1.03 (95% CI: 0.85, 1.21) and 0.74 (95% CI: 0.54, 0.70). Receiver operating characteristic (ROC) analysis identified neck circumferences ≥36 cm in females and ≥40 cm in males as optimal thresholds for predicting central obesity. Additionally, the area under the curve (AUC) for neck circumference (0.71; 95% CI: 0.72–0.77) in predicting central obesity surpassed that of BMI (0.77; 95% CI: 0.78–0.82). Conclusion: Individuals with elevated BMI and neck circumference face an increased risk of developing hypertension. While BMI proves to be a predictor of hypertension risk, neck circumference is a superior predictor. Utilizing both measures together enhances hypertension risk prediction accuracy. This underscores the importance of considering both BMI and neck circumference in assessing hypertension risk among individuals.

Nutritional Status in Pediatric Psoriasis: A Case-Control Study in a Tertiary Care Referral Centre.

Psoriasis and obesity are chronic, inflammatory diseases, sharing certain pathophysiological factors. Psoriasis, increasingly viewed as a systemic inflammatory condition, may have various symptoms beyond the skin manifestations. This research aimed to explore the connection between body mass index (BMI) and pediatric psoriasis, through a case-control study on 100 psoriasis cases and 100 controls who were matched in terms of age and sex. The percentiles of the BMI by age and sex determined the nutritional status of each patient and control. The severity of psoriasis was evaluated based on the psoriasis area and severity index (PASI), nail involvement based on the nail psoriasis severity index (NAPSI), and quality of life impairment with the dermatology life quality index (DLQI). While no statistically significant relationship was identified between increased BMI and PASI (p = 0.074), the risk of being overweight and obesity was significantly higher in the psoriasis group (OR 6.93, p = 0.003; OR 12.6, p < 0.001, respectively). The BMI increased with the PASI for psoriasis vulgaris but not for psoriasis inverse. No connections were found between disease duration and BMI (p = 0.56) or between BMI and PASI based on sex (p = 0.26). The NAPSI increased significantly with increased BMI (p = 0.000015). This study highlights the association between elevated BMI, psoriasis diagnosis, and severity of psoriatic onychopathy in pediatric patients, advocating for further large-scale studies to confirm these explorations and increasing awareness for better screening and management of such cases for overweight/obese patients.

P.093 BMI as a predictor of recurrence in high-grade meningioma: A single center retrospective cohort study

Background: Elevated BMI has been proposed as a risk factor for the development of meningioma. The relationship between body mass index (BMI) and disease control in high-grade meningioma has not yet been examined. A retrospective cohort study was performed to assess the relationship between high-grade meningioma recurrence and BMI. Methods: This is a retrospective cohort study of patients with Grade 2 or Grade 3 meningioma at a single tertiary care center between 2008 and 2017. We collected clinical data including age, sex, BMI, location, Simpson grade, brain invasion, and radiation treatments. Disease control was monitored on followup MRI scans. We stratified patients by BMI greater than or less than 25. Results: A total of 45 patients were included. Recurrence was observed in 15 patients (33.3%). There were 32 (71.1%) patients with BMI &gt; 25, and 13 (28.9%) patients with normal BMI. Patients with elevated BMI had higher risk of recurrence (p=0.04). Multivariate analysis identified BMI as an independent predictor of recurrence. Conclusions: Our results suggest that overweight patients with a Grade 2 or Grade 3 meningioma are at higher risk of recurrence than patients with normal BMI. The explanation for this association unknown. Further research is suggested to confirm and better characterize this association.

Association of body mass index with progression from binge-eating behavior into binge-eating disorder among adolescents in the United States: A prospective analysis of pooled data

The association between body mass index (BMI) and binge-eating disorder (BED) is well-established. However, data on the extent to which BMI is associated with progression from binge-eating behavior into BED among adolescents are limited, which was the aim of this investigation. Participants were 9964 U.S. adolescents from the Adolescent Brain Cognitive Development (ABCD) Study, aged 9–13 at the time of study enrollment. A computerized parent-reported assessment was used to establish adolescents’ binge-eating behaviors and BED. Cox proportional hazards models adjusting for sociodemographic covariates were used to examine prospective associations between BMI and likelihood of BED onset among a) adolescents with binge-eating behavior, and b) adolescents with no binge-eating behavior. Of 975 adolescents who met the study criteria for binge-eating behavior, 89 (9.1%) subsequently met the study criteria for BED. Of 8989 adolescents with no binge-eating behavior, 82 (0.9%) subsequently met the study criteria for BED. BMI percentile was significantly associated with the likelihood of BED onset in participants with (adjusted HR = 1.03, 95% confidence interval [CI] 1.00, 1.06) and participants without (adjusted HR = 1.05, 95% CI 1.03, 1.07) binge-eating behavior. Results were also significant when examining BMI as a dichotomous predictor (above and below 85th percentile) among those with (adjusted HR = 2.60, 95% CI 1.00, 6.68) and those without (adjusted HR = 6.01, 95% CI 3.90, 11.10) binge-eating behavior. Overall, results indicate that elevated BMI is prospectively associated with a greater risk for BED onset among U.S. adolescents with or without binge-eating behavior. Adolescents with a higher BMI may benefit from screening for binge eating, and prevention/early intervention strategies to mitigate the risk for developing BED.

Relationship Between Body Mass Index and Blood Lipids with Kidney Stone Disease: The Fasa Adults Cohort Study

Background: Urinary stones rank as the third most common disease of the genitourinary system, following urinary tract infections and prostate diseases. Their incidence is influenced by various demographic, environmental, and genetic factors. Objectives: This study aimed to explore the association between Body Mass Index (BMI), blood lipids, and kidney stones. Methods: This cross-sectional study utilized the baseline data of 10 133 participants aged 35 - 70 years from the Fasa cohort study. The dataset included demographic information, biochemical laboratory results, anthropometric measurements, behavioral data, and the presence or absence of kidney stones. Data analysis employed t-tests, chi-square tests, and logistic regression models. Results: Among the 10 133 participants, 54.9% were women, with a mean age of 48.63 ± 9.57 years. The prevalence of kidney stones was 17.3%. The findings indicated a correlation between BMI and triglyceride levels (TG) with kidney stones. Elevated BMI and triglyceride levels were associated with increased odds of developing kidney stones, with odds ratios of 1.048 (95% CI: 1.025 - 1.048) and 1.006 (95% CI: 1.001 - 1.006), respectively. Conclusions: The study revealed a significant relationship between BMI, triglyceride levels, and kidney stones. Individuals with kidney stones exhibited higher mean BMI and TG levels compared to those without. These findings from the Fasa PERSIAN (Prospective Epidemiological Research Studies in Iran) cohort suggest that kidney stone disease is linked to elevated triglyceride levels and BMI. Given that a high-fat diet contributes to increased BMI and elevated serum triglyceride levels, measures to reduce weight, combat obesity, and manage triglyceride levels are warranted to mitigate the risk of kidney stone formation.

The Association of Body Mass Index and Early Outcomes Following Orthognathic Surgery

The existing data on the link between body mass index (BMI), operative characteristics, and surgical outcomes across orthognathic surgery are limited. The purpose was to measure the association between BMI and early postoperative outcomes in orthognathic surgery. This is a retrospective cohort study of patients (n=118) aged > 14years undergoing bimaxillary orthognathic surgery between 2015 and 2018 by a single surgeon within the Kaiser Permanente Northern California-integrated healthcare system. Patients undergoing unilateral or additional procedures, history of prior orthognathic surgery, or pre-existing pain conditions were excluded. The predictor variable was BMI measured as a continuous (kg/m2) and categorical variable (underweight/normal, overweight, obese). The primary outcome variables were additional postoperative antibiotics, increased postoperative visits, wound dehiscence, and wound infection. The secondary outcome variables were total operative and anesthesia time. The demographic covariates included age, sex, and race/ethnicity. The clinical covariates included history of obstructive sleep apnea, Mallampati score, tobacco use, American Society of Anesthesia classification, thyromental distance, history of difficult intubation, and Angle's classification. Bivariate and multivariate analyses were performed to measure the associations between BMI and the primary and secondary outcomes. Multivariable logistic regression analyses were used to measure associations between BMI and the postoperative outcomes. Statistical significance was defined as P<.05. The study sample was composed of 118 subjects with a mean age of 26.91years (standard deviation 9.43). Forty-seven percent (n=55) were male, and the mean BMI was 25.13 (standard deviation 5.19). BMI category was significantly associated with age, with increasing age associated with higher BMI category (P=.02). According to the bivariate and multivariable logistic regression analyses, controlling for age, race/ethnicity, BMI, and total operative time, increased total operative time was associated with additional postoperative antibiotics (odds ratio=1.03, 95% confidence interval: 1.01, 1.05), and increased postoperative appointments (odds ratio=1.02, 95% confidence interval: 1.01, 1.04). No significant association between BMI and other clinical or operative characteristics was seen aside from American Society of Anesthesia classification. Elevated BMI was not associated with worsened operative characteristics or postoperative outcomes. This supports the suitability of orthognathic surgery in a BMI-diverse population.

Weighing the outcomes: the role of BMI in complex robotic esophageal and hepatobiliary operations.

The correlation between body mass index (BMI) and surgical outcomes has emerged as a critical consideration in complex abdominal operations. While elevated BMI is often associated with increased perioperative risk, its specific effects on the outcomes of robotic surgeries remain inadequately explored. This study assesses the impact of BMI on perioperative variables of complex esophageal and hepatopancreaticobiliary (HPB) robotic operations. Following IRB approval, we prospectively followed 607 patients undergoing pancreaticoduodenectomy, trans-hiatal esophagectomy (THE), major liver resection or distal pancreatectomy with splenectomy, all performed robotically. Perioperative data retrieved included operative duration, estimated blood loss (EBL), intraoperative and postoperative complications, conversions to an 'open' operation and length of stay (LOS). Z scores were assigned to each variable to standardize operations, and the variables were then regressed against BMI. For illustrative purposes, data are presented as median(mean ± standard deviation). Between 2012 and 2020, surgeries included 71 THE, 122 distal pancreatectomies with splenectomies, 129 major hepatectomies and 285 pancreaticoduodenectomies. Median age was 67(65 ± 12.5) years old, and BMI was 27(28 ± 5.5) kg/m2. Operative duration for all operations was 349(355 ± 124.5) min and had a positive correlation with increasing BMI (p = 0.004), specifically for robotic THE and robotic pancreaticoduodenectomy, with both operative durations having positive correlation with increasing BMI (p = 0.02 and p = 0.05). No significant correlation with BMI was found for EBL, intraoperative or postoperative complications, conversion to 'open' surgery, or LOS. Elevated BMI is associated with longer operative durations in select robotic surgeries, such as trans-hiatal esophagectomy and pancreaticoduodenectomy, and highlights the need for strategic planning in these patients.

Association between obesity and new-onset heart failure among patients with hypertension in Thailand

BackgroundIn Thailand, the epidemiological data on the relationship between obesity and heart failure (HF) among high-risk populations was limited. We assessed the association between body mass index (BMI) and the new-onset HF among people with hypertension (HTN), and also assessed the effect modifier of uncontrolled HTN on this association.MethodsWe analyzed the data obtained from the 2018 Thailand DM/HT study database. Thai people with HTN aged 20 years and older receiving continuous care at outpatient clinics in hospitals nationwide were included. The new-onset HF was defined regarding the ICD-10 as I50 in the medical records within 12 months. Obesity was defined as BMI ≥\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\ge$$\\end{document} 25 kg/m2. Multivariable log-binomial regression analysis was used to determine the association between BMI and new-onset HF and presented as the adjusted risk ratio (aRR) and 95% confidence interval (CI).ResultsA total of 35,756 participants were included in the analysis. In all, 50.0% of the participants had BP control for the last two consecutive visits. The mean BMI was 25.1 ±\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\pm$$\\end{document} 4.7 kg/m2. New-onset HF occurred in 75 participants (0.21%; 95% CI 0.17–0.26). After adjusting for potential confounders, an elevated BMI was associated with new-onset HF (p value for quadratic trend < 0.001). In comparison with participants with normal BMI (18.5–22.9 kg/m2), the aRR for new-onset HF was 1.57 (95% CI 0.80–3.07) and 3.97 (95% CI 1.95–8.10) in those with BMI 25.0–29.9, and ≥ 30.0 kg/m2. For participants with obesity, aRR for new-onset HF was 2.05 (95% CI 1.24–3.39) compared to non-obese participants. The study found that among patients with control BP, obesity was associated with a higher risk of new-onset HF with an adjusted RR of 2.33 (95% CI 1.12–4.83). For those with uncontrolled BP, the adjusted RR was 1.83 (95% CI 0.93–3.58), but there was no heterogeneity with p value = 0.642.ConclusionAn increased BMI had a higher risk for new-onset HF among Thai people with HTN. Obesity was independently associated with new-onset HF among people with HTN, regardless of uncontrolled HTN. Our findings highlight that weight reduction is crucial for mitigating the risk of HF development in HTN patients, regardless of their BP control status.

Asthma exacerbations and body mass index in children and adolescents: experience from a tertiary care center.

The prevalence and incidence of asthma continue to rise globally. Obesity has been identified as a potential risk factor for asthma exacerbations. The association between body mass index (BMI) and asthma is not well studied in some regions. This study aims to investigate the impact of BMI on pediatric asthmatic patients. This retrospective study was conducted at the Aga Khan University Hospital from 2019 to 2022. Children and adolescents with asthma exacerbations were included. The patients were classified into four groups based on their BMI: underweight, healthy weight, overweight, and obese. The demographic characteristics, medications used, predicted forced expiratory volume in 1 second (FEV1) measurements, asthma exacerbations per year, length of stay per admission, and the number of patients requiring high dependency unit (HDU) care were recorded and analyzed. Our results demonstrated that patients in the healthy weight category had the highest percentage of FEV1 (91.46±8.58) and FEV1/forced vital capacity (FVC) (85.75±9.23) (p<0.001). The study found a significant difference in the average number of asthma exacerbations per year between the four groups. Obese patients had the highest number of episodes (3.22±0.94), followed by the underweight group (2.42±0.59) (p<0.01). The length of stay per admission was significantly shorter for patients with a healthy weight (2.0±0.81), and there was a statistically significant difference observed in the number of patients requiring HDU care among the four groups, as well as in the average length of stay at the HDU (p<0.001). Elevated BMI is related to an increased number of annual asthma exacerbations, a low FEV1 and FEV1/FVC, an increased length of stay at admission, and an increased stay in the HDU.

Hypertension and Ovarian Cancer: A Case-Control Study in Saudi Arabia.

Background There is limited evidence that evaluates the association between hypertension and ovarian cancer. The study aimstoinvestigate the association between ovarian cancer and hypertension, thedifference in lipid profile, and the association between body mass index (BMI) and ovarian cancer. Methods We conducted a case-control study at King Abdelaziz Medical City (KAMC), oncology department. All Saudi female patients who were diagnosed with primary ovarian cancer admitted to the oncology department at KAMC from 2016 to 2019 were selected. The data were collected from medical records of patients of the KAMC by chart review using The Ministry of National Guard Health Affairs BESTCare database. Results A total of 137 Saudi female patients diagnosed with ovarian cancer attending to gynecology and oncology center in KAMC from 2016 to 2019 were included in this study. The mean age of participants was 57 in cases and 56 in controls with a mean BMI of 29.64 in cases and 31 in controls. There were 63 obese cases, therefore, the proportion of obesity was 46%. Approximately one-third of cases were overweight (28%) while one-fourth (26%) of them were underweight or normal weight. Roughly two-thirds of cases were hypertensive with an overall proportion of 66 % (95% confidence interval (CI) 58-74) while one-third of controls were hypertensive with an overall proportion of 32%.Cases were having significantly higher triglycerides (p=0.03) and lower high-density lipoprotein (HDL) (p=0.001) than controls.The significant variables were analyzed using logistic regression. It was found that hypertensive subjects were 10.06 times more likely (95% CI: 4.88-20.71) to be associated with the cases as compared to controls (p<0.001). Also, an increase in BMI was significantly associated with being a case with OR = 1.07 (95% CI: 1.02-1.12; p=0.004). Conclusion In conclusion, hypertension, elevated BMI, higher triglycerides, and lower HDL were significantly associated with ovarian cancer.

Obesity, Fat Distribution and Risk of Cancer in Women and Men: A Mendelian Randomisation Study.

Obesity and upper-body fat distribution are independent, cardiometabolic risk factors but whether they also display comparable associations with cancer risk is unknown. We investigated the causal relationships between body mass index (BMI) and BMI-adjusted waist-to-hip ratio (WHRadjBMI) and cancer risk and searched for potential drivers linking these traits to carcinogenesis using two-sample and multivariable Mendelian randomisation. In women, genetically instrumented higher BMI was associated with lower breast (OR = 0.87, 95% CI 0.81-0.93) and higher endometrial (OR = 1.75, 95% CI 1.55-1.96) cancer risk whilst WHRadjBMI was associated with higher colon cancer risk (OR = 1.22, 95% CI 1.07-1.42). In men, elevated BMI was associated with lower prostate cancer risk (OR = 0.91, 95% CI 0.85-0.98). Mechanistically, testosterone and insulin mediated 21% and 35%, respectively of the total, genetically determined association of BMI with endometrial cancer risk whilst HDL cholesterol and IGF-1 mediated 40% and 22%, respectively of the association between BMI and breast cancer risk. In men, testosterone mediated 21% of the association between BMI and prostate cancer risk. Colon cancer aside, the total amount of body fat might be more important than its location in modulating cancer susceptibility due to differential effects of obesity and fat distribution on adiposity-associated cancer drivers.

Associations between early-life growth pattern and body size and follicular lymphoma risk and survival: a family-based case-control study

BackgroundThe influence of early-life growth pattern and body size on follicular lymphoma (FL) risk and survival is unclear. In this study, we aimed to investigate the association between gestational age, growth during childhood, body size, changes in body shape over time, and FL risk and survival. MethodsWe conducted a population-based family case-control study and included 706 cases and 490 controls. We ascertained gestational age, growth during childhood, body size and body shape using questionnaires and followed-up cases (median=83 months) using record linkage with national death records. We used a group-based trajectory modeling approach to identify body shape trajectories from ages 5–70. We examined associations with FL risk using unconditional logistic regression and used Cox regression to assess the association between body mass index (BMI) and all-cause and FL-specific mortality among cases. ResultsWe found no association between gestational age, childhood height and FL risk. We observed a modest increase in FL risk with being obese 5 years prior to enrolment (OR=1.43, 95 %CI=0.99–2.06; BMI ≥30 kg/m2) and per 5-kg/m2 increase in BMI 5 years prior to enrolment (OR=1.14, 95 %CI=0.99–1.31). The excess risk for obesity 5 years prior to enrolment was higher for ever-smokers (OR=2.00, 95 %CI=1.08–3.69) than never-smokers (OR=1.14, 95 %CI=0.71–1.84). We found no association between FL risk and BMI at enrolment, BMI for heaviest lifetime weight, the highest categories of adult weight or height, trouser size, body shape at different ages or body shape trajectory. We also observed no association between all-cause or FL-specific mortality and excess adiposity at or prior to enrolment. ConclusionWe observed a weak association between elevated BMI and FL risk, and no association with all-cause or FL-specific mortality, consistent with previous studies. Future studies incorporating biomarkers are needed to elucidate possible mechanisms underlying the role of body composition in FL etiology.

1754P Association between body mass index (BMI) and anti-PD1/L1 immune checkpoint inhibitor (ICI) outcomes in patients with metastatic urothelial carcinoma (mUC)

Anti-PD1/L1 ICIs are indicated for mUC, however, only a minority of patients (pts) will derive therapeutic benefit. Strong predictive and prognostic factors are lacking. Obesity causes a low grade chronic inflammatory state and has been associated with increased ICI responsiveness in some cancer types. We investigated whether elevated BMI was associated with ICI outcomes in mUC. We performed a multi-center retrospective cohort study including 121 pts with mUC who received anti-PD1/L1 ICI for metastatic disease between 2016-2021 at 3 Canadian cancer centres. Clinical characteristics, including demographics, BMI, neutrophil to lymphocyte ratio (NLR), objective response, and survival were abstracted from chart review. ICI treatment response was determined by investigator assessment of clinical and radiologic parameters. Fisher’s exact test was used to assess differences in response rates between groups. Log rank and Cox regression models were used to assess overall survival (OS). Ninety (74%) were male, and 74 (61%) received ICI as a 2nd or later line therapy for metastatic disease. Twenty-three pts had a BMI ≥ 30, 43 had a 25 ≤ BMI < 30 and 55 had a BMI < 25. A BMI ≥ 25 was significantly correlated to a higher response rate to ICI (45.4% vs 16.3%, p=0.02). After a median follow-up of 14.5 months, pts with BMI ≥ 30 experienced significant longer median OS 24.8 months vs 14.4 months for 25 ≤ BMI < 30 and 8.5 months for BMI < 25 (p=0.012). In multivariate analysis, BMI ≥ 30 was an independent prognosis factor for OS as detailed in the table.Table: 1754POSUnivariableMultivariableHR95%CIp-valueHR95%CIp-valueBMI ≥ 30 vs < 300.630.45-0.880.0020.400.17-0.960.040Male vs Female0.950.58-1.570.867ECOG ≥ 2 vs 0-11.680.86-3.290.1252.211.02-4.780.042ICI Line ≥ 2 vs 12.391.43-3.970.0011.801.31-2.480.000NLR ≥ 4 vs < 42.461.53-3.940.0002.661.58-4.490.000Bone metastasis Yes vs No2.381.52-3.730.0001.981.17-3.350.010Lung metastasis Yes vs No1.881.21-2.930.005Liver metastasis Yes vs No1.921.20-3.090.006Age ≥ 60 vs < 601.880.65-5.450.235 Open table in a new tab Our data identified BMI, as a novel potential biomarker that is strongly and independently associated with ICI response and survival in mUC. External validation of these data in a larger study and investigations into the mechanisms behind these findings are warranted.

The Effects of Body Mass Index &amp; Spine Flexibility on Surgical Outcomes for Patients with Adolescent Idiopathic Scoliosis

Retrospective cohort study. To investigate the relationship between body mass index (BMI), spine flexibility index (FI), and their combined effects on adolescent idiopathic scoliosis (AIS) surgical outcomes. BMI and FI are two factors considered during presurgical planning for AIS correction, but there is sparse research about their relationship. We hypothesize that AIS patients with increased BMI may be associated with decreased FI-a combination which could lead to worsened surgical outcomes. AIS patients ages 11 to 19 at surgery, who underwent posterior fusion at a single center from 2011 to 2017, were reviewed. Patients without proper radiographs to assess FI, or a previous spine surgical history, were excluded. FI was categorized as stiff (FI<50) or flexible (FI≥50), and patients were separated by major curve region. BMI was categorized as underweight (less than fifth percentile), healthy weight (fifth-85th percentile), overweight (85th-95th percentile), or obese (>95th percentile). Regression analysis was conducted to test BMI and FI's effects on intraoperative, immediate postoperative, and two-year postoperative outcomes. A total of 543 patients (82% female), with an average age of 14.9 years, were included. In all, 346 patients had available two-year data. A 10% increase in BMI was associated with a 1.3% decrease in FI for patients with major thoracolumbar/lumbar curves ( P =0.01). Obese patients were most likely to have a postoperative complication ( P =0.003) or a two-year complication ( P =0.04). Revision surgery occurred after 58% of postoperative complications (15/26) and 80% of two-year complications (4/5). FI was negatively associated with initial curve magnitude ( P <0.001), operative time ( P =0.02), and blood loss ( P =0.02). Overweight patients with flexible curves were 10.0 times more likely to sustain a postoperative complication than healthy weight patients with stiff curves ( P =0.001). Elevated BMI was associated with decreased FI in patients with major thoracolumbar/lumbar curves. Patients with a high BMI and high FI were associated with the greatest risk of postoperative complication.

The Relationship Between Body Mass Index and In-hospital Survival in Patients Admitted With Acute Heart Failure.

BackgroundThe association between Body Mass Index (BMI) and clinical outcomes following acute heart failure (AHF) hospitalization is debated in the literature. Our objective was to study the real-world relationship between BMI and in-hospital mortality in patients who were admitted with AHF.MethodsIn this retrospective, multi-center study, we utilized the National Inpatient Sample (NIS) database to identify a sampled cohort of patients who were hospitalized with AHF between October 2015 and December 2016. Outcomes of interest included in-hospital mortality and length of stay (LOS). Patients were divided into 6 BMI (kg/m2) subgroups according to the World Health Organization (WHO) classification: (1) underweight ≤ 19, (2) normal weight 20–25, (3) overweight 26–30, (4) obese I 31–35, (5) obese II 36–39, and (6) extremely obese ≥40. A multivariable logistic regression model was used to identify predictors of in-hospital mortality and to identify predictors of LOS.ResultsA weighted total of 219,950 hospitalizations for AHF across the US were analyzed. The mean age was 66.3 ± 31.5 years and most patients (51.8%) were male. The crude data showed a non-linear complex relationship between BMI and AHF population outcomes. Patients with elevated BMI exhibited significantly lower in-hospital mortality compared to the underweight and normal weight study participants (5.5, 5,5, 2,8, 1.6, 1.4, 1.6% in groups by BMI ≤ 19, 20–25, 26–30, 31–35, 36–39, and, ≥40 respectively, p < 0.001) and shorter LOS. In the multivariable regression model, BMI subgroups of ≤ 25kg/m2 were found to be independent predictors of in-hospital mortality. Age and several comorbidities, and also the Deyo Comorbidity Index, were found to be independent predictors of increased mortality in the study population.ConclusionA reverse J-shaped relationship between BMI and mortality was documented in patients hospitalized for AHF in the recent years confirming the “obesity paradox” in the real-world setting.

Comparing body mass index and obesity-related comorbidities as predictors in hospitalized COVID-19 patients.

SummaryThe association between body mass index (BMI) and poor COVID‐19 outcomes in patients has been demonstrated across numerous studies. However, obesity‐related comorbidities have also been shown to be associated with poor outcomes. The purpose of this study was to determine whether BMI or obesity‐associated comorbidities contribute to elevated COVID‐19 severity in non‐elderly, hospitalized patients with elevated BMI (≥25 kg/m2). This was a single‐center, retrospective cohort study of 526 hospitalized, non‐elderly adult (aged 18–64) COVID‐19 patients with BMI ≥25 kg/m2 in suburban New York from March 6 to May 11, 2020. The Edmonton Obesity Staging System (EOSS) was used to quantify the severity of obesity‐related comorbidities. EOSS was compared with BMI in multivariable regression analyses to predict COVID‐19 outcomes. We found that higher EOSS scores were associated with poor outcomes after demographic adjustment, unlike BMI. Specifically, patients with increased EOSS scores had increased odds of acute kidney injury (adjusted odds ratio [aOR] = 6.40; 95% CI 3.71–11.05), intensive care unit admission (aOR = 10.71; 95% CI 3.23–35.51), mechanical ventilation (aOR = 3.10; 95% CI 2.01–4.78) and mortality (aOR = 5.05; 95% CI 1.83–13.90). Obesity‐related comorbidity burden as determined by EOSS was a better predictor of poor COVID‐19 outcomes relative to BMI, suggesting that comorbidity burden may be driving risk in those hospitalized with elevated BMI.

Clinical Value of Body Mass Index and Waist-Hip Ratio in Clinicopathological Characteristics and Prognosis of Uterine Leiomyomata.

Objective To explore the relationship between body mass index (BMI) and waist-to-hip ratio (WHR) and clinicopathological characteristics and prognosis of uterine leiomyomata (UL). Methods A retrospective analysis of the clinical data of 133 patients with UL admitted to our hospital from September 2018 to August 2019. According to the BMI standard, the patients were divided into the normal group (n = 32), the super-recombination group (n = 45), and the obesity group (n = 56). According to WHR, the patients were divided into the normal body group (n = 32) and the obesity body group (n = 101). The prognosis of all patients with UL at 3 months postoperatively was evaluated. The relationship between BMI patients and clinical characteristics in different groups was compared, and univariate analysis and multivariate logistic regression model were used to analyze the factors affecting the prognosis of UL patients. Results The proportion of UL patients in the overweight/obese group was higher than that of the normal group, the proportion of the obese body group was higher than that of the normal body group, and the proportion of the good prognosis group was higher than that of the poor prognosis group (P < 0.05). The difference between the overweight/obese group and the normal group and the obese body group and the normal body group was irregular vaginal bleeding, the number of tumors, and the diameter of the lesion (P < 0.05), and the differences between the degenerations in the obese body group and the normal body group were statistically significant (P < 0.05). Multivariate analysis showed that BMI, WHR, surgical method, and tumor location were all independent risk factors that affected the prognosis of the surgery (P < 0.05). Conclusion Elevated BMI and WHR can be accompanied by an increased risk of UL. Obesity is a risk factor for UL. Overweight/obese women are more clinically pathological than normal patients, and overweight/obese patients have worse surgical prognosis than normal patients. In order to reduce the prevalence of UL and improve the clinicopathological characteristics and prognosis of patients, clinically obese women should be instructed to use reasonable diet and exercise to control weight.