Elevated BMI Research Articles

284-LB: From Metabolically Healthy Obesity (MHO) to Metabolically Unhealthy Obesity (MUHO)—Decreased Thyroid Hormone Sensitivity

Background: To explore the difference of thyroid hormone sensitivity between metabolically healthy and metabolically unhealthy obesity patients and its influence on obesity phenotype. Methods: 10927 euthyroid adults were enrolled, 4 groups based on the presence/absence of metabolic disorders (MD) and BMI were divided: 1) NC (n=1441): no MD and 22≤BMI < 25Kg/m2. 2) NMu (n=3765): MD and 22≤BMI < 25Kg/m2. 3) MHO (n=148): obese with no MD (BMI≥28Kg/m2). 4) MuHO (n=1981): obese with MD (BMI≥28Kg/m2). MD was defined as meeting none of the following criteria: fasted blood glucose ≤6.1 mmol/L; triglycerides ≥1.7 mmol/L; high density lipoprotein (HDL) <1.0 mmol/L (male) and <1.3 mmol/L (female); elevated SBP (≥130 mmHg) or/and DBP (≥85 mmHg). Thyroid hormone central sensitivity indices were calculated by thyroid feedback quantile-based index (TFQI), TSH index (TSHI), Chinese-referenced parametric TFQI (PTFQI) and thyrotropin thyroxine resistance index (TT4RI). Peripheral thyroid hormone sensitivity was evaluated by FT3/FT4 ratio. Results: Compared with MHO group, TFQI, PTFQI and TT4RI elevated in MuHO group, and the trend still existed after adjusting for confounding factors. High FT3/FT4 ratio was an independent risk factor for MuHO (OR = 1.22, 95%CI: 1.13, 1.37, P<0.001). In euthyroid obese patients, decreased TFQI was a protective factor for MHO (OR=0.71, 95%CI 0.51, 0.83, P=0.036), while TSHI (OR= 1.27, 95%CI: 1.11, 1.38, P =0.027) and TT4RI (OR= 1.08, 95%CI: 1.03, 1.16, P =0.022) were significantly correlated with the occurrence of MuHO. Conclusions: Thyroid hormone sensitivity is impaired with elevated BMI. Impaired thyroid hormone sensitivity associated with the development of metabolically unhealthy obesity in patients with similar BMI. Keywords Metabolically Healthy Obesity, Thyroid Hormone Sensitivity Disclosure N. Zhang: None. G. Wang: None. Funding National Natural Science Foundation of China (81770792)

County incidence and geospatial trends of early-onset hypertensive disorders of pregnancy in Kentucky, 2008-2017

BackgroundEarly-onset hypertensive disorders of pregnancy (eHDP) are associated with more severe maternal and infant outcomes than later-onset disease. However, little has been done to evaluate population-level trends. Therefore, in this paper, we seek to address this understudied area by describing the geospatial and temporal patterns of county-level incidence of eHDP and assessing county-level demographics that may be associated with an increased incidence of eHDP.MethodsEmploying Kentucky certificates of live and stillbirth from 2008–2017, this ecological study detected county-level clusters of early-onset hypertensive disorders of pregnancy using SaTScan, calculated average annual percent change (AAPC) with a join point analysis, and identified county-level covariates (% of births to women ≥ 35 years of age, % with BMI ≥ 30 kg/m2, % currently smoking, % married, and % experienced eHDP) with a fixed-effects negative binomial regression model for longitudinal data with an autoregressive (AR) correlation structure offset with the natural log of the number of births in each county and year.ResultsCounty-level incidence of eHDP had a non-statistically significant increase of almost 3% (AAPC: 2.84, 95% CI: -4.26, 10.46), while maternal smoking decreased by almost 6% over the study period (AAPC:-5.8%, 95%CI: -7.5, -4.1), Risk factors for eHDP such as pre-pregnancy BMI ≥ 30 and proportion of births to women ≥ 35 years of age increased by 2.3% and 3.4% respectively (BMI AAPC:2.3, 95% CI: 0.94, 3.7; ≥ 35 years AAPC:3.4, 95% CI: 0.66, 6.3). After adjusting for race, county-level proportions of college attainment, and maternal smoking throughout pregnancy, counties with the highest proportion of births to women with BMI ≥ 30 kg/m2 reported an eHDP incidence 20% higher than counties with a lower proportion of births to mothers with a BMI ≥ 30 kg/m2 and a 20% increase in eHDP incidence (aRR = 1.20, 95% CI: 1.00, 1.44). We also observed that counties with the highest proportion vs. the lowest of mothers ≥ 35 years old (> 6.1%) had a 26% higher incidence of eHDP (RR = 1.26, 95%CI: 1.04, 1.50) compared to counties with the lowest incidence (< 2.5%). We further identified two county-level clusters of elevated eHDP rates. We also observed that counties with the highest vs. lowest proportion of mothers ≥ 34 years old (> 6.1% vs. < 2.5%) had a 26% increase in the incidence of eHDP (RR = 1.26, 95% CI: 1.04, 1.50). We further identified two county-level clusters of elevated incidence of eHDP.ConclusionsThis study identified two county-level clusters of eHDP, county-level covariates associated with eHDP, and that while increasing, the average rate of increase for eHDP was not statistically significant. This study also identified the reduction in maternal smoking over the study period and the concerning increase in rates of elevated pre-pregnancy BMI among mothers. Further work to explore the population-level trends in this understudied pregnancy complication is needed to identify community factors that may contribute to disease and inform prevention strategies.

Development and validation of nonalcoholic fatty liver disease test: a simple sensitive and specific marker for early diagnosis of nonalcoholic fatty liver disease.

This study aimed to develop a noninvasive test for identifying patients with nonalcoholic fatty liver disease (NAFLD) based on clinical and routine laboratory data. The developed model 'NAFLD test' was compared to the most commonly used NAFLD scores and then validated in three groups of NAFLD patients from five centers in Egypt, China, and Chile. Patients were divided into the discovery cohort (n = 212) and the validation study (n = 859). The ROC curve and stepwise multivariate discriminant analysis were used to develop and validate the NAFLD test and evaluate its diagnostic performance, which was then compared to other NAFLD scores. Elevated C-reactive protein (CRP), cholesterol, BMI, and alanine aminotransferase (ALT) levels were significantly associated with NAFLD (P < 0.0001). NAFLD test is depicted as (-0.695 + 0.031 × BMI + 0.003 × cholesterol + 0.014 × ALT + 0.025 × CRP) to discriminate patients with NAFLD from healthy individuals. The area under the ROC curve (AUC) of the NAFLD test was 0.92 [95% confidence interval (CI): 0.88-0.96]. The NAFLD test was the most accurate diagnostic indicator of NAFLD when compared to widely used NAFLD indices. Upon validating the NAFLD test, its AUC (95% CI) for distinguishing patients with NAFLD from healthy individuals was 0.95 (0.94-0.97), 0.90 (0.87-0.93), and 0.94 (0.91-0.97) in Egyptian, Chinese, and Chilean patients with NAFLD respectively. The NAFLD test is a new validated diagnostic biomarker that can be utilized for the early diagnosis of NAFLD with high diagnostic performance.

Characterization of lipid signatures in the plasma and insulin-sensitive tissues of the C57BL/6J mice fed on obesogenic diets

Diet-induced obesity mouse models are widely utilized to investigate the underlying mechanisms of dyslipidemia, glucose intolerance, insulin resistance, hepatic steatosis, and type 2 diabetes mellitus (T2DM), as well as for screening potential drug compounds. However, there is limited knowledge regarding specific signature lipids that accurately reflect dietary disorders. In this study, we aimed to identify key lipid signatures using LC/MS-based untargeted lipidomics in the plasma, liver, adipose tissue (AT), and skeletal muscle tissues (SKM) of male C57BL/6J mice that were fed chow, LFD, or obesogenic diets (HFD, HFHF, and HFCD) for a duration of 20 weeks. Furthermore, we conducted a comprehensive lipid analysis to assess similarities and differences with human lipid profiles. The mice fed obesogenic diets exhibited weight gain, glucose intolerance, elevated BMI, glucose and insulin levels, and a fatty liver, resembling characteristics of T2DM and obesity in humans. In total, we identified approximately 368 lipids in plasma, 433 in the liver, 493 in AT, and 624 in SKM. Glycerolipids displayed distinct patterns across the tissues, differing from human findings. However, changes in sphingolipids, phospholipids, and the expression of inflammatory and fibrotic genes showed similarities to reported human findings. Significantly modulated pathways in the obesogenic diet-fed groups included ceramide de novo synthesis, sphingolipid remodeling, and the carboxylesterase pathway, while lipoprotein-mediated pathways were minimally affected. This study provides a tissue-specific comparison of lipid composition, highlighting the usefulness of DIO models in preclinical research. However, caution is warranted when extrapolating findings from these models to dyslipidemia-associated pathologies and their complications in humans.

A budget impact analysis of cost to implement a whole child health focused, family-based intervention in primary care for children with elevated BMI

BackgroundAlthough the cost of implementing evidence-based interventions (EBIs) is a key determinant of adoption, lack of cost information is widespread. We previously evaluated the cost of preparing to implement Family Check-Up 4 Health (FCU4Health), an individually tailored, evidence-based parenting program that takes a whole child approach, with effects on both behavioral health and health behavior outcomes, in primary care settings. This study estimates the cost of implementation, including preparation.MethodsWe assessed the cost of FCU4Health across the preparation and implementation phases spanning 32 months and 1 week (October 1, 2016–June 13, 2019) in a type 2 hybrid effectiveness-implementation study. This family-level randomized controlled trial took place in Arizona with n = 113 predominantly low-income, Latino families with children ages > 5.5 to < 13 years. Using electronic cost capture and time-based activity-driven methods, budget impact analysis from the perspective of a future FCU4Health adopting entity—namely, ambulatory pediatric care clinicians—was used to estimate the cost of implementation. Labor costs were based on 2021 Bureau of Labor Statistics Occupational Employment Statistics, NIH-directed salary cap levels or known salaries, plus fringe benefits at a standard rate of 30%. Non-labor costs were based on actual amounts spent from receipts and invoices.ResultsThe cost of FCU4Health implementation to 113 families was $268,886 ($2380 per family). Actual per family cost varied widely, as individual tailoring resulted in families receiving a range of 1–15 sessions. The estimated cost of replicating implementation for future sites ranged from $37,636-$72,372 ($333–$641 per family). Using our previously reported preparation costs (i.e., $174,489; $1544 per family), with estimated replication costs of $18,524–$21,836 ($164–$193 per family), the total cost of delivering FCU4Health was $443,375 ($3924 per family), with total estimated replication costs of $56,160–$94,208 ($497-$834 per family).ConclusionsThis study provides a baseline for costs associated with implementation of an individually tailored parenting program. Results provide critical information for decision makers and a model for future economic analysis and can be used to inform optimization thresholds for implementation and, when necessary, benchmarks for program adaptation to promote scale-up.Trial registrationThis trial was prospectively registered on January 6, 2017, at ClinicalTrials.gov (NCT03013309).

Procedural-Related Bleeding in Hospitalized Patients With Liver Disease (PROC-BLeeD): An International, Prospective, Multicenter Observational Study

Hospitalized patients with cirrhosis frequently undergo multiple procedures. The risk of procedural-related bleeding remains unclear, and management is not standardized. We conducted an international, prospective, multicenter study of hospitalized patients with cirrhosis undergoing nonsurgical procedures to establish the incidence of procedural-related bleeding and to identify bleeding risk factors. Hospitalized patients were prospectively enrolled and monitored until surgery, transplantation, death, or 28 days from admission. The study enrolled 1187 patients undergoing 3006 nonsurgical procedures from 20 centers. A total of 93 procedural-related bleeding events were identified. Bleeding was reported in 6.9% of patient admissions and in 3.0% of the procedures. Major bleeding was reported in 2.3% of patient admissions and in 0.9% of the procedures. Patients with bleeding were more likely to have nonalcoholic steatohepatitis (43.9% vs 30%) and higher body mass index (BMI; 31.2 vs 29.5). Patients with bleeding had a higher Model for End-Stage Liver Disease score at admission (24.5 vs 18.5). A multivariable analysis controlling for center variation found that high-risk procedures (odds ratio [OR], 4.64; 95% confidence interval [CI], 2.44-8.84), Model for End-Stage Liver Disease score (OR, 2.37; 95% CI, 1.46-3.86), and higher BMI (OR, 1.40; 95% CI, 1.10-1.80) independently predicted bleeding. Preprocedure international normalized ratio, platelet level, and antithrombotic use were not predictive of bleeding. Bleeding prophylaxis was used more routinely in patients with bleeding (19.4% vs 7.4%). Patients with bleeding had a significantly higher 28-day risk of death (hazard ratio, 6.91; 95% CI, 4.22-11.31). Procedural-related bleeding occurs rarely in hospitalized patients with cirrhosis. Patients with elevated BMI and decompensated liver disease who undergo high-risk procedures may be at risk to bleed. Bleeding is not associated with conventional hemostasis tests, preprocedure prophylaxis, or recent antithrombotic therapy.

ASSOCIATION BETWEEN BMI AND AMBULATORY BLOOD PRESSURE CHARACTERISTICS: EVIDENCE FROM POPULATION-BASED AMBULATORY BLOOD PRESSURE MONITORING COHORT

Objective: The aim of our study was to investigate the association between BMI and Chinese hypertensive patients’ ambulatory blood pressure characteristics. Design and method: According to the inclusion criteria and exclusion criteria, recruiting participants for analysis. Overweight was defined as BMI = &gt; 18.5 kg/m2, and obesity as BMI = &gt; 25 kg/m2. ABPM characteristics were defined according to European guidelines. Hypertension was defined as elevated mean ambulatory BP (&gt;135/85 mmHg in day-time, &gt;120/70 mmHg in the night-time, &gt;130/80 mmHg over 24-h). There are four kinds of blood pressure circadian rhythm, dippers, non-dippers, reverse dippers, and extreme dippers. The effects of BMI on ambulatory blood pressure characteristics were analyzed using between-group analysis of variance and logistic regression analysis. Results: In our cohort, 35367 hypertensive patients who were eligible for this study were analyzed finally, including 19380 men (54.8%) and 15987 women (45.2%) aged from 19 to 99 (mean age 58.86 years). The mean 24hBP of the study subjects was 126.41±16.00/78.79±11.62 mmHg. The different BMI groups showed that ambulatory BP increased with BMI, and the obese group had the highest increase in BP, HR, and systolic BP (P &lt; 0.05). Blood pressure variability and systolic load tended to increase with BMI, while the nocturnal blood pressure drop rate tended to decrease. When analyzing the type of hypertension among the participants, the prevalence of MBPS and morning hypertension increased significantly with the elevated BMI (P &lt; 0.05), and the highest prevalence of MBPS was found in the obese group. Logistic regression analysis revealed that the increased risks of MBPS and morning hypertension were the highest in the obese group, corresponding to a 2.1-fold (P &lt; 0.05) and 1.6-fold (P &lt; 0.05) increase in risk, respectively, with no change in trend after adjustment. Conclusions: BMI may affect the characteristics of hypertensive patients’ ambulatory blood pressure. The blood pressure variability and 24h SBP tended to increase with BMI, and the incidence of MBPS was highest in the obese group.

Diet Quality and Fecal Bile Acid Composition

Background: Bile acids (BAs) are steroid metabolites generated by the liver from cholesterol. Their function is to support digestion of dietary fat, cholesterol, and fat-soluble vitamins. The gut microbiota metabolizes BAs that escape intestinal reabsorption to secondary BAs and other metabolites that are linked to increased risk of diseases including colorectal cancer (CRC). Diet plays a major role in BA metabolism and may be an important target for optimizing host-microbial BA metabolism for cancer prevention. Purpose: To examine fecal BA metabolites in relation to diet quality (Healthy Eating Index-2015, HEI-2015) among urban middle to older age adults. Methods: 135 participants were recruited from two academic medical centers. Stool, two 24-hour diet recalls, anthropometrics, and survey data were collected. Fecal BA profiling was completed using LC/MS. Diet quality was calculated using USDA's HEI-2015. Descriptive and inferential statistics were conducted. Results: Participants were 57% female, 51% African/American Black, mean age of 59.6 (±6.2) years and mean BMI of 31.4 (±6.9) kg/m2. Using USDA's cut-point for poor diet quality (HEI-2015 &amp;lt; 51 points), participants with poor diet quality were significantly more likely to be classified with obesity, self-report as African American/Black, report lower educational attainment, have increased secondary BAs, deoxycholic acid (DCA) and lithocholic acid (LCA), and lower 3-oxo-lithocholic acid and iso-allo-deoxycholic acid derivatives. In linear models, HEI-2015 (continuous) was a significant inverse predictor of DCA and LCA when controlling for BMI, race, and education. BMI was a significant positive predictor of DCA and LCA when controlling for HEI-2015, race, education. African American/Black was a significant inverse predictor of 3-oxo-lithocholic acid and iso-allo-deoxycholic acid when controlling for HEI-2015, BMI, and education. Conclusion. Poor diet quality and elevated BMI is associated with increased secondary BAs that have been linked to increased risk of CRC. Improving diet quality and reducing BMI may optimize host-microbial BA metabolism to prevent disease. African American/Black was an independent predicator of lower anti-inflammatory BA derivatives which warrants further investigation.

The Man Van: Mobile targeted case finding for prostate cancer.

6522 Background: Early intervention is potentially lifesaving in prostate cancer. The debate for screening continues with recent developments suggesting the arguments in favour are becoming stronger however, barriers to access remain. The Man Van project is designed to address these with a highly novel community-based targeting of high-risk groups on a mobile unit. Methods: A bespoke mobile health vehicle was moved to 8 community-based locations in areas of high deprivation indices in London, UK, inviting men for a health check consisting of: general health questionnaires, blood pressure, height/weight, HbA1c for diabetes and a PSA test. Telemedicine was used to inform patients of outcomes. Direct referrals to secondary care was performed. Community engagement was utilised to increase uptake using: primary healthcare centres, religious organisations and community centres. Results: Between December 2021 and December 2022, 618 men were seen at our Man Van clinics at a range of community settings (non-attendance rate 24%). The highest uptake was in locations where there was collaboration with primary care to recruit patients. The median age of attendees was 56 years, range 25-87. 43% of attendees were non-white (20% black). The median BMI was 27.7, range 16.2-50.5. 422 PSA tests were performed with 14 prostate cancers (3.3%) found till date. 9 (64%) of these cancers were grade group 2 (all &gt; 5% pattern 4) or 3. Of patients diagnosed with prostate cancer the median age was 59 years, range 48-73, 10 were black (71%), median PSA 6.85 g/L, range 0.81-45, median IPSS score was 9.5, range 2-31, median IIEF-5 was 16, range 1-25. The IPSS score was significantly higher (P &lt; 0.05) in men diagnosed with prostate cancer. 1 bladder (G3pT1) and 1 oesophageal cancer (T3N2M1) were also found. 3 patients had either HGPIN or ASAP, 3 patients had renal stones, 2 urethral strictures were found. 334 HbA1c tests were performed with 18 diabetics diagnosed (5.4%). 46 patients (7.4%) required input for benign urinary symptoms and 20 for erectile dysfunction (3.2%). Primary care referrals were as follows: 171 for hypertension (27.6%), 43 for an elevated BMI (7.0%), 37 for mental health issues (6.0%), 43 for excess alcohol intake (7.0%), 51 for smoking cessation assistance (8.3%). Significantly more patients 45 years were referred for primary care follow-up versus &lt; 45 years (P &lt; 0.01). Service evaluation questionnaires showed overwhelmingly positive support for the service. Conclusions: The Man Van initiative is a novel method of linking primary and secondary care for a range of health checks, including PSA. By improving community awareness and access in high-risk groups we demonstrate high uptakes for health checks including for prostate cancer and a willingness to engage with health improvement measures. As well as comparatively high levels of prostate cancers diagnosed at early stages, high levels of other health conditions were found; improving the economic value of the service.

Electronic Monitoring Of Mom’s Schedule (eMOMSTM): Recruitment of pregnant populations with elevated BMI in a feasibility randomized controlled trial

Underrepresentation of pregnant populations in randomized controlled trials of lifestyle change interventions is concerning due to high attrition and providers’ limited clinical time. The purpose of this evaluative study was to assess intervention uptake of pregnant individuals enrolled in a three-arm feasibility randomized controlled trial, electronic Monitoring Of Mom’s Schedule (eMOMSTM), examining lifestyle changes and lactation support alone, and in combination. Measures included: (1) participation and completion rates, and characteristics of intervention completers versus other eligible participants; and (2) provider experiences with screening and enrolling pregnant participants. Pregnant people with a pre-pregnancy body mass index ≥ 25 and < 35 kg/m2 were enrolled into the eMOMSTM trial between September 2019 - December 2020. Of the 44 consented participants, 35 were randomized, at a participation rate of 35%, and 26 completed the intervention, resulting in a completion rate of 74%. Intervention completers were slightly older and entered the study earlier in pregnancy compared to non-completers. Completers were more likely to be first-time mothers, resided in urban areas, had higher educational attainment, and were slightly more racially and ethnically diverse. A majority of providers reported willingness to participate, believed the study aligned with their organization’s mission, and were satisfied with using iPads for screening. Lessons learned to guide recruitment success include use of: (1) designated research staff in combination with physician support; and (2) user-friendly technology to help mitigate time burden on physicians and their staff. Future work should focus on successful strategies to recruit/retain pregnant populations in clinical trials.

Analysis of 90-day complications in outpatient total shoulder arthroplasty

BackgroundThere are limited data documenting the safety and clinical outcomes following outpatient total shoulder arthroplasty (TSA) and reverse TSA (RTSA) compared to inpatient shoulder arthroplasty. It was hypothesized that there would be no significant differences in complication and emergency room (ER) visit rate between outpatient TSA and RTSA. MethodsA prospectively maintained institutional registry was retrospectively queried for all patients undergoing primary TSA or RTSA between September 2016 and April 2019 and confirmed as having undergone outpatient surgery, defined as surgery performed at an ambulatory surgery center. Ninety-day complications, readmissions, and ER visits were analyzed for outpatient TSA and RTSA. The 90-day complications included infection, thromboembolic disease (pulmonary embolism, deep venous thrombosis), neurovascular injury, revision surgery, and inflammatory processes. ResultsA total of 140 patients were identified who underwent outpatient TSA or RTSA from 2016 to 2019. Four complications (3.7%) were reported in the TSA cohort, compared to 4 complications (12.9%) reported in the RTSA cohort (P = .060). Three ER visits occurred in the RTSA group compared to 0 in the TSA group (P = .001). Patients who experienced a complication had significantly higher body mass index (TSA: P = .049, RTSA: P = .035). In addition, there were no readmissions or reoperations in either TSA or RTSA patients. ConclusionOverall, the rate of complications, ER visits, and readmission rates in outpatient TSA and RTSA was found to be relatively low given the sample size of this study and minor complications reported. In addition, there were no readmissions or reoperations in either TSA or RTSA patients. Elevated body mass index may significantly increase the risk of complications after both a TSA and RTSA. This study suggests that outpatient TSA and RTSA are safe in selected patients.

Viral infection in chronic otitis media with effusion in children.

The role of respiratory viruses in chronic otitis media with effusion (COME) in children is not clearly defined. In our study we aimed to investigate the detection of respiratory viruses in middle ear effusions (MEE) as well as the association with local bacteria, respiratory viruses in the nasopharynx and cellular immune response of children with COME. This 2017-2019 cross-sectional study included 69 children aged 2-6 undergoing myringotomy for COME. MEE and nasopharyngeal swabs were analyzed via PCR and CT-values for the genome and loads of typical respiratory viruses. Immune cell populations and exhaustion markers in MEE related to respiratory virus detection were studied via FACS. Clinical data including the BMI was correlated. Respiratory viruses were detected in MEE of 44 children (64%). Rhinovirus (43%), Parainfluenzavirus (26%) and Bocavirus (10%) were detected most frequently. Average Ct values were 33.6 and 33.5 in MEE and nasopharynx, respectively. Higher detection rates correlated with elevated BMI. Monocytes were elevated in MEE (9.5 ± 7.3%/blood leucocytes). Exhaustion markers were elevated on CD4+ and CD8+ T cells and monocytes in MEE. Respiratory viruses are associated with pediatric COME. Elevated BMI was associated with increased rates of virus associated COME. Changes in cell proportions of innate immunity and expression of exhaustion markers may be related to chronic viral infection.

Recipient race modifies the association between obesity and long-term graft outcomes after kidney transplantation

Donor and recipient obesity (defined using body mass index [BMI]) are associated with worse outcomes after kidney transplant (KT). In adult KT recipients identified using the Scientific Registry of Transplant Recipients (2000-2017), we examined the modifying effect of recipient race on recipient obesity (BMI > 30 kg/m2) and combined donor and recipient (DR) obesity pairing, with death-censored graft loss (DCGL), all-cause graft loss (ACGL), and short-term graft outcomes using multivariable Cox proportional hazards models and logistic regression. Obesity was associated with a higher risk of DCGL in White (adjusted hazard ratio [aHR], 1.29; 95% CI, 1.25-1.35) than Black (aHR, 1.13; 95% CI, 1.08-1.19) recipients. White, but not Black, recipients with obesity were at higher risk for ACGL (aHR, 1.08; 95% CI, 1.05-1.11, for White recipients; aHR, 0.99; 95% CI, 0.95-1.02, for Black recipients). Relative to nonobese DR, White recipients with combined DR obesity experienced more DCGL (aHR, 1.38; 95% CI, 1.29-1.47 for White; aHR, 1.19; 95% CI, 1.10-1.29 for Black) and ACGL (aHR, 1.12; 95% CI, 1.07-1.17 for White; aHR, 1.00; 95% CI, 0.94-1.07 for Black) than Black recipients. Short-term obesity risk was similar irrespective of race. An elevated BMI differentially affects long-term outcomes in Black and White KT recipients; uniform BMI thresholds to define transplant eligibility are likely inappropriate.

Natural history of phenotype markers in patients with bronchial asthma (a decade’s observation)

Volatility of certain bronchial asthma (BA) phenotype markers is not enough investigated during maturation of pediatric patients. Material and methods. One hundred thirty-one patients with non-severe BA were included; by the age on inclusion date subgroups of “Children” (62 patients aged 6 to 11 years) and “Adolescents” (69 patients aged 12–17 years) were allocated. Every 6 months patients were examined, fulfi d asthma control questionnaires, performed spirometry with salbutamol test, provided hematology results with absolute eosinophil count and height and weight data. Exacerbation and hospitalization numbers, BA severity and controller treatment step were considered. Acquired data were archived; patients’ management was driven by real clinical practice algorithms.Results. Ninety-three patients included (71%) completed at least decade observation. Adolescents and young adults had body mass index higher than 90th percentile by age more often than younger children; some patients had normalized their body mass during observation. BMI and ACT results had moderate reverse correlation (r=–0.64). Eosinophil counts more than 300 cells per microliter conserved longer in older patients: duration median and [Q1; Q3] for “Adolescents” were 11,7 [9,6; 15,3] months and 9.3 [4.8; 11.1] months for “Children” subgroup, difference was significant (р=0.043). Most lung functional parameters were in age normal range. Rare cases of functional obstruction were not stable and did not differ in duration between “Children” 7.3 [6.2; 8.8] months and “Adolescents” 8.4 [6.5; 10.4] months.Conclusion. Phenotype markers of future BA exacerbation risk are quite volatile in pediatric patients and young adults. We recommend repeated evaluation of such markers every 12–18 month of observation to decide on asthma controller change. Simultaneous detection of several markers was quite often but did not lead to more severe asthma course in most patients. Longer duration of elevated BMI or peripheral blood eosinophils were typical for patients with more often BA exacerbations.

D137. Effect of Elevated Body Mass on Surgical Complications in Patients Undergoing Body Contouring after Massive Weight Loss

PURPOSE: Massive weight loss can result in whole-body deformities that often are addressed with body contouring. However, even after weight loss, many patients have residual obesity. In this study, we aim to determine the effect of BMI on post-bariatric reconstructive surgery complications. METHODS: Patients undergoing body contouring from 2002-2018 after massive weight loss (≥50 pounds) were retrospectively reviewed. Variables of interest include pre and post weight loss BMI, post-operative complications, and procedures per case. RESULTS: In this cohort, 942 massive weight loss patients underwent 1,063 cases involving 1,814 procedures. 884 patients were female while 58 were male. Mean pre-weight loss BMI, or max BMI, was 51.9 ±9.8 while mean post weight loss BMI was 30.5 ±6.0. For all cases, an increased maximum BMI (p=0.006), but not current BMI, was associated with a higher rate of post-operative complications. Increased current BMI significantly amplified the risk of post-operative fat necrosis (p<0.01) while elevated maximum BMI increased the risk of seroma (p<0.01) and wound infection (p<0.05). In patients with multiple procedures (n= 502), increased maximum and current BMI were associated with higher risk of seroma formation (p<0.05), but neither was associated with risk of seroma for single procedures cases (n=561). CONCLUSION: Both pre and post weight loss BMIs play a role in complication rate and type, while only max BMI plays a role in multiple procedure cases. These findings indicate that pre and post weight loss BMI should be assessed, in addition to number of procedures, to optimize outcomes after body contouring.

PC14. The Impact of Elevated BMI on Outcomes in Patients Undergoing Free Flap Reconstruction of the Head and Neck Region

PC14. The Impact of Elevated BMI on Outcomes in Patients Undergoing Free Flap Reconstruction of the Head and Neck Region

Short-term outcome of diverting loop ileostomy reversals performed by residents: a retrospective cohort prognostic factor study

AimThe reversal of diverting loop ileostomy (DLI) is one of surgical trainees’ first procedures. Complications of DLI reversal can cause life-threatening complications and increase patient morbidity. This study compared DLI reversals performed by surgical trainees with those by attending surgeons.MethodThis retrospective cohort study was performed at a single primary care center on 300 patients undergoing DLI reversal. The primary outcome was morbidity, according to the Clavien-Dindo classification (CDC), with special attention paid to the surgeon’s level of training. The secondary endpoint was postoperative intestinal motility dysfunction.ResultsSurgical trainees had significantly longer operation times (p < 0.001) than attending surgeons. Univariate analyses revealed no influence on the level of training for postoperative morbidity. First bowel movement later than 3 days after surgery was a significant risk factor for CDC ≥\\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} 3 (OR, 4.348; 96% CI, 1670–11.321; p = 0.003). Independent risk factors for surgical site infections (SSIs) were an elevated BMI (OR, 1.162; 95% CI, 1.043–1.1294; p = 0.007) and a delayed bowel movement (OR, 3.973; 95% CI, 1.300–12.138; p = 0.015). For postoperative intestinal motility dysfunction, an independent risk factor was a primary malignant disease (OR, 1.980; 95% CI, 1.120–3.500; p = 0.019), and side-to-side stapled anastomosis was a protective factor (OR, 0.337; 95% CI 0.155–0.733; p = 0.006).ConclusionEven though surgical trainees needed significantly more time to perform the surgery, the level of surgical training was not a risk factor for increased postoperative morbidity. Instead, delayed first bowel movement was predictive of SSI.

MP12-09 THE MAN VAN: COMMUNITY BASED TARGETED CASE FINDING FOR PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP12-09 THE MAN VAN: COMMUNITY BASED TARGETED CASE FINDING FOR PROSTATE CANCER Masood Moghul, Fionnuala Croft, Kaljit Kaur, Netty Kinsella, Declan Cahill, and Nicholas James Masood MoghulMasood Moghul More articles by this author , Fionnuala CroftFionnuala Croft More articles by this author , Kaljit KaurKaljit Kaur More articles by this author , Netty KinsellaNetty Kinsella More articles by this author , Declan CahillDeclan Cahill More articles by this author , and Nicholas JamesNicholas James More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003227.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Early intervention is potentially lifesaving in prostate cancer however barriers to early access remain. The Man Van project is designed to address these with a highly novel community-based targeting of high-risk groups on a mobile unit. METHODS: A bespoke mobile health vehicle was moved to 7 different community-based locations in areas of high deprivation indices in London, inviting men for a health check consisting of: health questionnaires, blood pressure, height/weight, HbA1c for diabetes and a PSA test where relevant. Telemedicine techniques were used to inform patients of outcomes. Direct referrals to secondary care were used if needed. Community engagement to increase uptake was performed using various methods including: primary care centres, religious organisations and community centres. RESULTS: Between December 2021 and September 2022, 444 men were seen at Man Van clinics (non-attendance rate 26%). The highest uptake was in the primary care centre. The median age of attendees was 55 years, range 25-87. 42% of attendees were non-white (30% black). The median BMI was 27.7, range 16.2-50.5. 298 PSA tests were performed with 10 prostate cancers (3.4%) found till date. 6 (60%) of these cancers were grade group 2 (all >5% pattern 4). Of patients diagnosed with prostate cancer the median age was 54 years, range 48-73, 70% were black, median PSA 5.2 μg/L, range 0.81-9.4, median IPSS score was 9.5, range 2-31, median IIEF-5 was 16, range 1-25. 1 bladder and 1 oesophageal cancer were also found. 239 HbA1c tests were performed with 14 diabetics diagnosed (5.9%). 26 patients (5.9%) required input for benign urinary symptoms and 12 for erectile dysfunction (2.7%). Primary care referrals: 98 for hypertension (22.1%), 41 for elevated BMI (9.2%), 36 for mental health issues (8.1%). Of 138 patients at risk for excess alcohol intake, 40 were referred (29%), of 62 smokers 45 were referred for smoking cessation (72.6%). Significantly more patients ≥45 years were referred for primary care follow-up versus <45 years (P<0.05). Service evaluation questionnaires showed overwhelmingly positive support for the service. CONCLUSIONS: The Man Van initiative is a novel method of linking primary and secondary care for a range of men’s health checks, including PSA. By improving community awareness and access in high-risk groups we demonstrate high uptakes for health checks including for prostate cancer and a willingness to engage with health improvement measures. Source of Funding: NHS England grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e136 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Masood Moghul More articles by this author Fionnuala Croft More articles by this author Kaljit Kaur More articles by this author Netty Kinsella More articles by this author Declan Cahill More articles by this author Nicholas James More articles by this author Expand All Advertisement PDF downloadLoading ...

Elevated body mass index in modified natural cycle frozen euploidembryo transfers is not associated with live birth rate.

To assess the impact of elevated BMI on the success of modified natural cycle frozen embryo transfers (mNC-FET) of euploid embryos. This retrospective cohort study at a single academic institution reviewed mNC-FET involving single euploid blastocysts from 2016 to 2020. Comparison groups were divided by pre-pregnancy BMI (kg/m2) category: normal weight (18.5-24.9), overweight (25-29.9) or obese (≥ 30). Underweight BMI (< 18.5) was excluded from the analysis. The primary outcome was live birth rate (LBR) and secondary outcome was clinical pregnancy rate (CPR), defined as presence of fetal cardiac activity on ultrasound. Absolute standardized differences (ASD) were calculated to compare descriptive variables and p-values and multivariable logistic regressions with generalized estimating equations (GEE) were used to compare pregnancy outcomes. 562 mNC-FET cycles were completed in 425 patients over the study period. Overall, there were 316 transfers performed in normal weight patients, 165 in overweight patients, and 81 in obese weight patients. There was no statistically significant difference in LBR across all BMI categories (55.4% normal weight, 61.2% overweight, and 64.2% obese). There was also no difference for the secondary outcome, CPR, across all categories (58.5%, 65.5%, and 66.7%, respectively). This was confirmed in GEE analysis when adjusting for confounders. While increased weight has commonly been implicated in poor pregnancy outcomes, the effect of BMI on the success of mNC-FET remains debated. Across five years of data from a single institution using euploid embryos in mNC-FET cycles, elevated BMI was not associated with reduced LBR or CPR.

Long-COVID fatigue is not predicted by pre-pandemic plasma IL-6 levels in mild COVID-19

Objective and designFatigue is a prominent symptom in the general population and may follow viral infection, including SARS-CoV2 infection which causes COVID-19. Chronic fatigue lasting more than three months is the major symptom of the post-COVID syndrome (known colloquially as long-COVID). The mechanisms underlying long-COVID fatigue are unknown. We hypothesized that the development of long-COVID chronic fatigue is driven by the pro-inflammatory immune status of an individual prior to COVID-19.Subjects and methodsWe analyzed pre-pandemic plasma levels of IL-6, which plays a key role in persistent fatigue, in N = 1274 community dwelling adults from TwinsUK. Subsequent COVID-19-positive and -negative participants were categorized based on SARS-CoV-2 antigen and antibody testing. Chronic fatigue was assessed using the Chalder Fatigue Scale.ResultsCOVID-19-positive participants exhibited mild disease. Chronic fatigue was a prevalent symptom among this population and significantly higher in positive vs. negative participants (17% vs 11%, respectively; p = 0.001). The qualitative nature of chronic fatigue as determined by individual questionnaire responses was similar in positive and negative participants. Pre-pandemic plasma IL-6 levels were positively associated with chronic fatigue in negative, but not positive individuals. Raised BMI was associated with chronic fatigue in positive participants.ConclusionsPre-existing increased IL-6 levels may contribute to chronic fatigue symptoms, but there was no increased risk in individuals with mild COVID-19 compared with uninfected individuals. Elevated BMI also increased the risk of chronic fatigue in mild COVID-19, consistent with previous reports.