Extreme BMI Research Articles

Exploring risk factors for endocrine-related immune-related adverse events: Insights from meta-analysis and Mendelian randomization.

This study utilized meta-analysis and Mendelian randomization (MR) to identify risk factors for endocrine-related immune-related adverse events (EirAEs) and to ascertain whether EirAEs confer better prognosis of immunotherapy. The meta-analysis identified several risk factors for EirAEs, including elevated baseline TSH (OR = 1.30, 95% CI 1.10-1.53), positive TgAb (OR = 14.23, p < .001), positive TPOAb (OR = 3.75, p < .001), prior thyroid-related medical history (OR = 4.19), increased BMI (OR = 1.11), combination immune checkpoint inhibitors (ICIs) therapy with targeted treatment (OR = 2.71, 95% CI 2.11-3.47), and dual ICI therapy (OR = 3.26, 95% CI 2.22-4.79). MR analysis further supported causalities between extreme BMI, hypothyroidism, and irAEs from a genetic perspective. In addition, cancer patients who experienced EirAEs exhibited significantly prolonged PFS (HR = 0.84, 95% CI 0.73-0.97) and OS (HR = 0.59, 95% CI 0.45-0.76) compared to those without. These findings provide valuable insights for clinical decision-making among healthcare professionals and offer direction for future research in this field.

Factors to take into account when interpreting 25-hydroxy-vitamin D serum levels

ABSTRACT Background Assessing vitamin D status, typically evaluated using serum or plasma 25-hydroxy vitamin D [25(OH)D] concentration, is complex because of various influencing factors. Methods Seasonality significantly affects intra-individual variability in 25(OH)D levels. This variation can be addressed by employing cosinor functions that are tailored to the geographical location of the patient to correct for seasonal effects. In addition to seasonality, genetic factors, such as DBP polymorphism and body composition, particularly adiposity, play crucial roles. Dialysis patients with DBP 2–2 phenotype exhibit higher vitamin D requirements. Genotyping/phenotyping of DBP allows for better tailored vitamin D supplementation. The lipid-soluble nature of vitamin D also interacts with plasma components such as serum triglycerides, which can influence vitamin D measurements. Adiposity, which is negatively correlated with vitamin D concentration, necessitates body mass-based mathematical adjustments for accurate vitamin D assessment in subjects with extreme BMI values. Conclusions Accordingly, vitamin D replacement therapy must be personalized, taking into account factors such as body size and seasonal variations, to effectively reach the target serum 25(OH)D concentrations.

Reference centiles of bone mineral density, and body composition of lower limbs in children and adolescents for Hologic DXA Discovery model A.

Background: Regional Dual-energy X-ray absorptiometry (DXA) assessments are useful for patients where whole body measurements are not feasible due to positioning difficulties because of anatomic anomalies (e.g. severe scoliosis) and artifacts due to neuroorthopedic hardware. Until now, there is a lack of reference centiles of bone mineral density and body composition of lower limbs for the DXA device Hologic Discovery model A densitometer. The study aimed to generate age-and sex specific reference centiles of bone mineral content (BMC), bone mineral density (BMD), lean body mass (LBM), and fat mass (FM) of the lower limbs of children and adolescents of Hologic DXA system (Discovery model A). Methodology: Data from children and adolescents aged 8-20 years of the National Health and Nutrition Examination Survey (NHANES) of the years 2015-2018 were used to create age-specific and sex-specific reference centiles. Study population was subdivided into three ethnic groups (non-Hispanic Black, non-Hispanic White and Mexican-American). The LMS method was used to calculate the reference centiles. Study population was adjusted concerning the BMI. Results: A total of DXA scans of 769 non-Hispanic Black children (386 females), 937 non-Hispanic White children (447 females) and 692 Mexican-American children (370 females) were used to calculate age-specific and sex-specific reference curves. 881 DXA scans had to be excluded because of extreme BMI values of the study population, leaving 513 non-Hispanic Black (205 females), 346 Mexican-American children (179 females), 658 Non-Hispanic White (282 females) for statistical analysis and creating age-and sex specific reference centiles after BMI adjustment. Conclusions: We presented pediatric reference centiles for regional bone mineral density, bone mineral content, lean body mass and fat mass of the lower limbs which were age-and sex-specific for three ethnic groups (Mexican-American, non-Hispanic Black and non-Hispanic-White). The reference centiles can be used for the Hologic DXA system Discovery model A with the software version 3.2.

Association of BMI with mortality in drug-induced liver injury.

To clarify the associations between BMI and the incidences of all-cause death or liver-related death (LRD)/liver transplantation (LT) in drug-induced liver injury (DILI). DILI patients from three hospitals were retrospectively retrieved and follow-up from 2009 to 2021. They were categorized into underweight (BMI < 18.5 kg/m 2 ), normal weight (BMI of 18.5-23.9 kg/m 2 ), overweight (BMI of 24-27.9 kg/m 2 ) and obese (BMI ≥ 28 kg/m 2 ) groups. Cox regression models were conducted to reveal the effect of BMI on all-cause death or LRD/LT. A total of 1469 eligible DILI patients were included: underweight 73 (4.97%), normal weight 811 (55.21%), overweight 473 (32.20%) and obese 112 (7.62%). Eighty-nine patients (6.06%) had all-cause death, of which 66 patients (4.49%) had LRD/LT. The median age was 52 years old, and females were 1039 (70.73%). The associations between BMI and all-cause mortality ( nonlinear test P < 0.01) or liver-related mortality/LT ( nonlinear test P = 0.01) were J-shaped. Multivariate Cox regression analysis showed that underweight (HR: 3.02, 95% CI: 1.51-6.02) was significantly associated with all-cause mortality after adjusting for age and sex. Furthermore, obese males were significantly associated with liver-related mortality/LT (HR: 3.49, 95% CI: 1.13-10.72) after additional adjustment for serological indices and comorbidities. Association between BMI and mortality is a J-shape. The overall mortality was significantly higher in underweight and obese group. Male obesity is independently associated with LRD/LT. These findings indicate that DILI patients with extreme BMI would have a high risk of dismal outcomes, which warrants extra medical care.

Socio-demographic Characteristics Associated with Tobacco Consumption among Smokers Attended Ministry of Health Smoking Cessation Clinics in Jeddah, Saudi Arabia during 2018

Introduction: The World Health Organization (WHO) has identified tobacco smoking as a global epidemic, causing an estimated three million deaths annually. This study aims to examine the socio-demographic characteristics and smoking-related behaviours among individuals attending smoking cessation clinics in Jeddah during 2018. By identifying these factors, appropriate interventions can be developed to combat the smoking epidemic.&#x0D; Methods: The study enrolled All the clients who visited the Smoking Cessation Clinics in Jeddah from January 2018 to December 2018. Eligible participants were between 18 and 60 years old and agreed to take part in the study. Data on smoking status, medical history, previous attempts at quitting, and medication use were collected. Statistical analysis, including chi-square tests and p-values, were conducted to assess the associations between participants' medical history and smoking cessation attempts.&#x0D; Results: A total of 5869 participants were included in the study. The findings revealed that approximately one-fifth of the participants had previously attempted to quit smoking, while the majority (81.4%) had not made any cessation attempts. Among those who had made quit attempts, most had tried quitting between one to four times (16.5%). The duration of successful cessation reported by participants was generally short, with the majority (81.5%) not experiencing any extended period of quitting. Common reasons for relapse included cravings, social influences, mood changes, stress, and withdrawal symptoms.&#x0D; Conclusion: There was a significant association between male gender, age group over 51years, divorced marital status, intermediate educational levels, higher income levels, retired status, extreme BMI category, and previous attempts at smoking cessation. Healthcare providers and policymakers should consider these findings when developing and implementing smoking cessation programs. The insights gained from this research can contribute to the development of targeted interventions to reduce smoking rates and improve public health outcomes.

Does Operative Time Modify Obesity-related Outcomes in THA?

Most orthopaedic surgeons refuse to perform arthroplasty on patients with morbid obesity, citing the higher rate of postoperative complications. However, that recommendation does not account for the relationship of operative time (which is often longer in patients with obesity) to obesity-related arthroplasty outcomes, such as readmission, reoperation, and postoperative complications. If operative time is associated with these obesity-related outcomes, it should be accounted for and addressed to properly assess the risk of patients with obesity undergoing THA. We therefore asked: (1) Is the increased risk seen in overweight and obese patients, compared with patients in a normal BMI class, associated with increased operative time? (2) Is increased operative time independent of BMI class a risk factor for readmission, reoperation, and postoperative medical complications? (3) Does operative time modify the direction or strength of obesity-related adverse outcomes? This retrospective, comparative study examined 247,108 patients who underwent THA between January 2014 and December 2020 in the National Surgical Quality Improvement Project (NSQIP). Of those, emergency cases (1% [2404]), bilateral procedures (1% [1605]), missing and/or null data (1% [3280]), extreme BMI and operative time outliers (1% [2032]), and patients with comorbidities that are not typical of an elective procedure, such as disseminated cancer, open wounds, sepsis, and ventilator dependence (1% [2726]), were excluded, leaving 95% (235,061) of elective, unilateral THA cases for analysis. The NSQIP was selected due to its inclusion of operative time, which is not found in any other national database. BMI was subdivided into underweight, normal weight, overweight, Class I obesity, Class II obesity, and Class III obesity. Of the patients with a normal weight, 69% (30,932 of 44,556) were female and 36% (16,032 of 44,556) had at least one comorbidity, with a mean operative time of 86 ± 32 minutes and a mean age of 68 ± 12 years. Patients with obesity tend to be younger, male, more likely to have preoperative comorbidities, with longer operative times. Multivariable logistic regression models examined the effects of obesity on 30-day readmission, reoperation, and medical complications, while adjusting for age, sex, race, smoking status, and number of preoperative comorbidities. After we repeated this analysis after adjusting for operative time, an interaction model was conducted to test whether operative time changes the direction or strength of the association of BMI class and adverse outcomes. Adjusted odds ratios (AOR) and 95% confidence intervals (CIs) were calculated, and the interaction effects were plotted. A comparison of patients with Class III obesity to patients with normal weight showed that the odds of readmission went from 45% (AOR 1.45 [95% CI 1.32 to 1.59]; p < 0.001) to 27% after adjusting for operative time (AOR 1.27 [95% CI 1.01 to 1.62]; p = 0.04), the odds of reoperation went from 93% (AOR 1.93 [95% CI 1.72 to 2.17]; p < 0.001) to 81% after adjusting for operative time (AOR 1.81 [95% CI 1.61 to 2.04]; p < 0.001), and the odds of a postoperative complication went from 96% (AOR 1.96 [95% CI 1.58 to 2.43]; p < 0.001) to 84% after adjusting for operative time (AOR 1.84 [95% CI 1.48 to 2.28]; p < 0.001). Each 15-minute increase in operative time was associated with a 7% increase in the odds of a readmission (AOR 1.07 [95% CI 1.06 to 1.08]; p < 0.001), a 10% increase in the odds of a reoperation (AOR 1.10 [95% CI 1.09 to 1.12]; p < 0.001), and 10% increase in the odds of a postoperative complication (AOR 1.10 [95% CI 1.08 to 1.13]; p < 0.001). There was a positive interaction effect of operative time and BMI for readmission and reoperation, which suggests that longer operations accentuate the risk that patients with obesity have for readmission and reoperation. Operative time is likely a proxy for surgical complexity and contributes modestly to the adverse outcomes previously attributed to obesity alone. Hence, focusing on modulating the accentuated risk associated with lengthened operative times rather than obesity is imperative to increasing the accessibility and safety of THA. Surgeons may do this with specific surgical techniques, training, and practice. Future studies looking at THA outcomes related to obesity should consider the association with operative time to focus on independent associations with obesity to facilitate more equitable access. Level III, therapeutic study.

The combined effect of BMI and age on ART outcomes.

For a woman with infertility and overweight/obesity, can infertility treatment be postponed to first promote weight loss? Advice regarding a delay in IVF treatment to optimize female weight should consider female age, particularly in women over 38 years for whom only substantial weight loss in a short period of time (3 months) seems to provide any benefit. Body weight excess and advanced age are both common findings in infertile patients, creating the dilemma of whether to promote weight loss first or proceed to fertility treatment immediately. Despite their known impact on fertility, studies assessing the combined effect of female age and BMI on cumulative live birth rates (CLBRs) are still scarce and conflicting. We performed a multicentre retrospective cohort study including 14 213 patients undergoing their first IVF/ICSI cycle with autologous oocytes and subsequent embryo transfers, between January 2013 and February 2018 in 18 centres of a multinational private fertility clinic. BMI was subdivided into the following subgroups: underweight (<18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obesity (≥30.0 kg/m2). The primary outcome was CLBR. The secondary outcome was time to pregnancy. To assess the influence of female age and BMI on CLBR, two multivariable regression models were developed with BMI being added in the models as either an ordinal categorical variable (Model 1) or a continuous variable (Model 2) using the best-fitting fractional polynomials. CLBR was estimated over 1-year periods (Model 1) and shorter timeframes of 3 months (Model 2). We then compared the predicted CLBRs according to BMI and age. When compared to normal weight, CLBRs were lower in women who were overweight (adjusted odds ratio (aOR) 0.86, 95% CI 0.77-0.96) and obese (aOR 0.74, 95% CI 0.62-0.87). A reduction of BMI within 1 year, from obesity to overweight or overweight to normal weight would be potentially beneficial up to 35 years old, while only a substantial reduction (i.e. from obesity to normal BMI) would be potentially beneficial in women aged 36-38 years. Above 38 years of age, even considerable weight loss did not compensate for the effect of age over a 1-year span but may be beneficial in shorter time frames. In a timeframe of 3 months, there is a potential benefit in CLBR if there is a loss of 1 kg/m2 in BMI for women up to 33.25 years and 2 kg/m2 in women aged 33.50-35.50 years. Older women would require more challenging weight loss to achieve clinical benefit, specifically 3 kg/m2 in women aged 35.75-37.25 years old, 4 kg/m2 in women aged 37.50-39.00 years old, and 5 kg/m2 or more in women over 39.25 years old. This study is limited by its retrospective design and lower number of women in the extreme BMI categories. The actual effect of individual weight loss on patient outcomes was also not evaluated, as this was a retrospective interpatient comparison to estimate the combined effect of weight loss and ageing in a fixed period on CLBR. Our findings suggest that there is potential benefit in weight loss strategies within 1 year prior to ART, particularly in women under 35 years with BMI ≥25 kg/m2. For those over 35 years of age, weight loss should be considerable or occur in a shorter timeframe to avoid the negative effect of advancing female age on CLBR. A tailored approach for weight loss, according to age, might be the best course of action. No specific funding was obtained for this study. All authors have no conflicts to declare. N/A.

30-Day Postoperative Outcomes in Adults with Obstructive Sleep Apnea Undergoing Upper Airway Surgery.

Obstructive sleep apnea (OSA) is a chronic disorder of the upper airway. OSA surgery has oftentimes been researched based on the outcomes of single-institutional facilities. We retrospectively analyzed a multi-institutional national database to investigate the outcomes of OSA surgery and identify risk factors for complications. We reviewed the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2008-2020) to identify patients who underwent OSA surgery. The postoperative outcomes of interest included 30-day surgical and medical complications, reoperation, readmission, and mortality. Additionally, we assessed risk-associated factors for complications, including comorbidities and preoperative blood values. The study population included 4662 patients. Obesity (n = 2909; 63%) and hypertension (n = 1435; 31%) were the most frequent comorbidities. While two (0.04%) deaths were reported within the 30-day postoperative period, the total complication rate was 6.3% (n = 292). Increased BMI (p = 0.01), male sex (p = 0.03), history of diabetes (p = 0.002), hypertension requiring treatment (p = 0.03), inpatient setting (p &lt; 0.0001), and American Society of Anesthesiology (ASA) physical status classification scores ≥ 4 (p &lt; 0.0001) were identified as risk-associated factors for any postoperative complications. Increased alkaline phosphatase (ALP) was identified as a risk-associated factor for the occurrence of any complications (p = 0.02) and medical complications (p = 0.001). OSA surgery outcomes were analyzed at the national level, with complications shown to depend on AP levels, male gender, extreme BMI, and diabetes mellitus. While OSA surgery has demonstrated an overall positive safety profile, the implementation of these novel risk-associated variables into the perioperative workflow may further enhance patient care.

Computational modeling of posteroanterior lumbar traction by an automated massage bed: predicting intervertebral disc stresses and deformation.

Spinal traction is a physical intervention that provides constant or intermittent stretching axial force to the lumbar vertebrae to gradually distract spinal tissues into better alignment, reduce intervertebral disc (IVD) pressure, and manage lower back pain (LBP). However, such axial traction may change the normal lordotic curvature, and result in unwanted side effects and/or inefficient reduction of the IVD pressure. An alternative to axial traction has been recently tested, consisting of posteroanterior (PA) traction in supine posture, which was recently shown effective to increase the intervertebral space and lordotic angle using MRI. PA traction aims to maintain the lumbar lordosis curvature throughout the spinal traction therapy while reducing the intradiscal pressure. In this study, we developed finite element simulations of mechanical therapy produced by a commercial thermo-mechanical massage bed capable of spinal PA traction. The stress relief produced on the lumbar discs by the posteroanterior traction system was investigated on human subject models with different BMI (normal, overweight, moderate obese and extreme obese BMI cases). We predict typical traction levels lead to significant distraction stresses in the lumbar discs, thus producing a stress relief by reducing the compression stresses normally experienced by these tissues. Also, the stress relief experienced by the lumbar discs was effective in all BMI models, and it was found maximal in the normal BMI model. These results are consistent with prior observations of therapeutic benefits derived from spinal AP traction.

Optimized Replacement T4 and T4+T3 Dosing in Male and Female Hypothyroid Patients With Different BMIs Using a Personalized Mechanistic Model of Thyroid Hormone Regulation Dynamics.

ObjectiveA personalized simulation tool, p-THYROSIM, was developed (1) to better optimize replacement LT4 and LT4+LT3 dosing for hypothyroid patients, based on individual hormone levels, BMIs, and gender; and (2) to better understand how gender and BMI impact thyroid dynamical regulation over time in these patients.Methodsp-THYROSIM was developed by (1) modifying and refining THYROSIM, an established physiologically based mechanistic model of the system regulating serum T3, T4, and TSH level dynamics; (2) incorporating sex and BMI of individual patients into the model; and (3) quantifying it with 3 experimental datasets and validating it with a fourth containing data from distinct male and female patients across a wide range of BMIs. For validation, we compared our optimized predictions with previously published results on optimized LT4 monotherapies. We also optimized combination T3+T4 dosing and computed unmeasured residual thyroid function (RTF) across a wide range of BMIs from male and female patient data.ResultsCompared with 3 other dosing methods, the accuracy of p-THYROSIM optimized dosages for LT4 monotherapy was better overall (53% vs. 44%, 43%, and 38%) and for extreme BMI patients (63% vs. ~51% low BMI, 48% vs. ~36% and 22% for high BMI). Optimal dosing for combination LT4+LT3 therapy and unmeasured RTFs was predictively computed with p-THYROSIM for male and female patients in low, normal, and high BMI ranges, yielding daily T3 doses of 5 to 7.5 μg of LT3 combined with 62.5–100 μg of LT4 for women or 75–125 μg of LT4 for men. Also, graphs of steady-state serum T3, T4, and TSH concentrations vs. RTF (range 0%–50%) for untreated patients showed that neither BMI nor gender had any effect on RTF predictions for our patient cohort data. Notably, the graphs provide a means for estimating unmeasurable RTFs for individual patients from their hormone measurements before treatment.Conclusionsp-THYROSIM can provide accurate monotherapies for male and female hypothyroid patients, personalized with their BMIs. Where combination therapy is warranted, our results predict that not much LT3 is needed in addition to LT4 to restore euthyroid levels, suggesting opportunities for further research exploring combination therapy with lower T3 doses and slow-releasing T3 formulations.

Association of Whole Grain Consumption and Cognitive Function in Biracial Population Sample

ObjectivesWe aim to 1) examine the association of whole grain consumption and rate of decline in global cognition, perceptual speed, episodic memory and 2) test whether these associations differ by race/ethnicity.MethodsWe included 4,719 participants from a biracial population-based sample, the Chicago Health and Aging Project (62% African Americans [AAs], 63% female) who responded to a FFQ and with two or more cognitive assessments and a follow-up up to 10 years. We excluded those with extreme BMI (<14 or >55) and implausible caloric intakes (<500 kcal or > 3800 kcal for women, < 800 kcal or > 4200 kcal for men), or entire page or >50% items unanswered. Global cognition was assessed using a composite score of episodic memory, perceptual speed, and the MMSE. Diet was assessed by FFQ. Mixed models were adjusted for age, sex, education, smoking status, calorie intake, cognitive activities, cardiovascular diseases, time since baseline, and the interaction term of time with each covariate.ResultsOn average, AAs had higher whole grain consumption (1.3 ± 1.03 servings/d) than European Americans (EAs, 0.9 ± 0.8 servings/d, P < 0.05). Higher consumption of whole grains was associated with a slower global cognitive decline (P for trend 0.004). Specifically, the association of whole grain consumption and slower rate of decline in global cognition, perceptual speed, and episodic memory was observed in AAs, but not among EAs. Among AAs, those in the highest quintile had a 38% slower rate of decline in global cognition (β = 0.024, P = 0.004), 54% for perceptual speed (β = 0.023, P = 0.006), and 70% for episodic memory (β = 0.028, P = 0.015) compared to those in the lowest quintile. In terms of the amount consumed, in AAs, participants who consumed >3 servings/d versus those who consumed < 1 serving/d, had a slower rate of decline in global cognition (38% slower, P = 0.0093), perceptual speed (79% slower, P = 0.014) and episodic memory (65% slower, P = 0.014). In EAs with >3 servings/d, we did not find a significant association in global cognitive decline (38% slower, P = 0.08) than those who consumed < 1 serving/d.ConclusionsWhole grain consumption is suboptimal in the study population. Improving the consumption of whole grains can lower rate of decline in global cognition, perceptual speed, and episodic memory, especially among AAs.Funding SourcesR01AG03154, R01AG051635, RF1AG057532, R01AG058679.

Weight Categories among Male Adolescents Linked to Risky Behaviors: High or Low BMI, Which Is Worse?

The literature about the relationship between extreme BMI and at-risk behaviors is quite inconsistent, and few articles focus on the underweight male population. This study aimed to analyze BMI level and its association with risky behavior, such as psychoactive substances use, gaming, and gambling, in a representative sample of the male adolescent population. Psychosocial variables were considered to better describe the possible at-risk profiles. This study used data from the 2018 ESPAD®Italia cross-sectional study, a survey using a self-administered anonymous questionnaire. For the purpose of the paper, males only were included in the analysis, with a total sample of 6938 students aged 15–19 years. Multinomial logistic regression showed that being overweight is positively associated with the gambler profile, the perception of a low financial family situation, and dissatisfaction with health conditions. Furthermore, being underweight was positively associated with gaming. Both extremes of BMI were associated with a frequent alcohol consumption and a sedentary lifestyle. This study provides important information regarding both extremes of BMI conditions, underling the presence of at-risk behavior and self-related perceptions with shared factors between underweight and overweight.

Genome-wide association study of pain sensitivity assessed by questionnaire and the cold pressor test.

We deployed an online pain sensitivity questionnaire (PSQ) and an at-home version of the cold pressor test (CPT) in a large genotyped cohort. We performed genome-wide association studies on the PSQ score (25,321 participants) and CPT duration (6853). We identified one new genome-wide significant locus associated with the PSQ score, which was located in the TSSC1 (also known as EIPR1 ) gene (rs58194899, OR = 0.950 [0.933-0.967], P -value = 1.9 × 10 -8 ). Although high pain sensitivity measured by both PSQ and CPT was associated with individual history of chronic and acute pains, genetic correlation analyses surprisingly suggested an opposite direction: PSQ score was inversely genetically correlated with neck and shoulder pain ( rg = -0.71), rheumatoid arthritis (-0.68), and osteoarthritis (-0.38), and with known risk factors, such as the length of working week (-0.65), smoking (-0.36), or extreme BMI (-0.23). Gene-based analysis followed by pathway analysis showed that genome-wide association studies results were enriched for genes expressed in the brain and involved in neuronal development and glutamatergic synapse signaling pathways. Finally, we confirmed that females with red hair were more sensitive to pain and found that genetic variation in the MC1R gene was associated with an increase in self-perceived pain sensitivity as assessed by the PSQ.

Plant‐based dietary patterns and cognitive function in U.S. adults: A prospective evaluation

AbstractBackgroundA plant‐based dietary patterns focus on foods primarily from plant sources. However, not all plant‐based foods are necessarily beneficial for health. We aim to examine the relationship between plant‐based diet quality and cognitive function.MethodAnalyses were conducted among 701 participants from the Memory and Aging Project. Food Frequency Questionnaires (FFQ) were incorporated into the studies in 2004 and collected annually thereafter. Individuals with mild cognitive impairment, missing food‐frequency questionnaire (FFQ) at baseline, extreme BMI, and less than two cognitive assessments during 10 years of follow‐up were excluded for these analyses. Plant‐based diet quality were assessed by 3 plant‐based diet indices (score range, 18‐90) including 1) an overall plant‐based diet index (PDI) by assigning positive scores to all plant foods and reverse scores to animal foods; 2) a healthful PDI (hPDI) where positive scores were given to only healthy plant foods, less‐healthy plant foods and animal foods received reverse scores; 3) an unhealthful PDI (uPDI), where less‐healthy plant foods received positive scores and animal and healthy plant foods received reverse scores. Our primary outcome was composite global cognition z score. We used liner mixed model examining the association between PDI (as a continuous and categorical) and cognitive decline.ResultHigher hPDI was associated with a better cognitive functioning during follow‐up. Compared to individuals in the first tertile of hPDI, individuals in the third tertile had slower cognitive decline by 0.03 units per year (β = 0.03, p=0.017). Similarly, when we evaluated the hPDI as continuous variable, each10‐points increase in hPDI was associated with 0.01 units/year slower cognitive decline. In contrast, higher adherence to uPDI was associated with faster cognitive decline. Individuals in the third tertile of uPDI had a faster decline by 0.04 unites per year (β = 0.04 , p=0.017). Every 10‐point increase in uPDI was associated with a 0.01 unit per year faster cognitive decline.ConclusionHigher intake of a plant‐based diet index rich in healthier plant foods was associated with slower cognitive decline. This supports current recommendations to shift to diets rich in healthy plant foods, with lower intake of less healthy plant and animal foods.

Caregiver Characteristics Associated With Quality of Cardiac Compressions on an Adult Mannequin With Real-Time Visual Feedback: A Simulation-Based Multicenter Study.

Chest compression (CC) quality directly impacts cardiac arrest outcomes. Provider body type can influence the quality of cardiopulmonary resuscitation (CPR); however, the magnitude of this impact while using visual feedback is not well described. The aim of the study was to determine the association between provider anthropometric variables on fatigue and CC adherence to 2015 American Heart Association CPR while receiving visual feedback. This was a planned secondary analysis of healthcare professionals from multiple hospitals performing continuous CC for 2 minutes on an adult CPR mannequin with dynamic visual feedback. Main outcome measures include compression data (depth, rate, and lean) evaluated in 30-second epochs to explore performance fatigue. Multivariable models examined the relationship of provider anthropometrics to CC quality. Binomial mixed effects models were used to characterize fatigue by examining performance for 4 epochs. Three hundred seventy-seven 2-minute CC episodes were analyzed. Extreme (low and high) BMI and weight are associated with poorer CC. Larger size (height, weight, and BMI) is associated with better depth but worse lean compliance. Performance fatigued for all providers for 2 minutes, but shorter, lighter weight, female participants had the greatest decline. On multivariable analysis, rate compliance did not deteriorate regardless of provider anthropometrics. Anthropometrics impact provider CC quality. Despite visual feedback, variable effects are seen on compression depth, rate, recoil, and fatigue depending on the provider sex, weight, and BMI. The 2-minute interval for changing chest compressors should be reconsidered based on individual provider characteristics and risk of fatigue's impact on high-quality CPR.

Physical activity values in two- to seven-year-old children measured by accelerometer over five consecutive 24-hour days.

interpretation of accelerometer-derived physical activity in preschool children is confounded by differences in cut-off points. the purpose of this study was to analyze physical activity in 2-to-7-year-old children to establish reference values for daily activity. observational study in children aged 2-7 years, without chronic diseases and whose parents provided informed consent. The main variable was physical activity, measured continuously over 120 hours (three workdays and two weekend days) by accelerometer. Secondary variables were weight status (body mass index [BMI] Z-score) and gender. The relationship between the main variable and secondary variables was determined through the t-test, ANOVA and the Pearson correlation coefficient. A multivariate model was used to obtain the standard deviation (SD) of all possible combinations of values, constructing percentiles of normality (x ± SD and x ± 2·SD). one hundred and thirty-six children (35% of municipality children) were included in the study (54.4% of them were girls). Their weight status distribution was: 25 underweight (18.4%), 54 normal weight (39.7%), 12 risk of overweight (8.8%), 22 overweight (16.2%) and 23 obese (16.8%). The median age was 5.7 years and the mean physical activity was 592 counts/minute. The boys undertook more physical activity (p = 0.031) and the underweight and normal-weight children undertook more physical activity than the overweight and obese children (p = 0.012). There were no significant differences according to age. The multivariate analysis showed significant differences (p < 0.001) according to gender and weight status. In boys, physical activity decreased as weight status increased. In contrast, the girls in the extreme BMI groups obtained higher levels of physical activity. overweight and obese preschool children had lower levels of physical activity than normal weight children. Physical activity levels were higher in boys.

P08.08: Pitfalls in interpretation of fetal growth curves in pregnancies complicated with maternal obesity and gestational diabetes

The difficulties of interpretation of the fetal growing curves mostly in the third trimester and the necessity to correlate with the clinical exams, pre-pregnancy weight and gestational weight gain. The study group included 43 obese pregnant women, 27 with GDM and 16 without and 34 pregnancies was defined with normal or overweight as pre-pregnancy BMI, but got over 90 kg at the end of pregnancy with a BMI over 30, from which 12 had also a diagnostic of GDM at the 24-30 weeks of gestation The definition of obesity was based on the pre-pregnancy BMI. The extreme BMI (over 45) and gestational diabetes cases with insulin treatment were excluded. In the pre-pregnancy obesity and with gestational diabetes the growing curves were evaluated at 16 wks GA and respectively at the time of the gestational diabetes diagnosis every 2-3 weeks. It was observed that the fetal abdominal circumference over 80 percentile and polyhydramnios were independent predicting factors for a delivery before 38 wks, Caesarean delivery, LGA, admission in NICU and late pre-eclampsia. Accelerate maternal weight growth in the firsts trimester and till 24 weeks of GA give the same pattern of fetal growth curves as the pre-pregnancy obesity. Growth curves, Doppler ultrasound and neonatal follow up and the fetal weight estimation has a good correlation with the gestational percentiles of neonate weight but not with the neonatal wellbeing. More than 40% of neonates delivered at term and early term were admitted in NICU, despite neonatal weight the behaviour was as child with restriction. The studies should be focussed on the more accurate interpretation of the fetal growth in maternal obesity and accelerate maternal weight growth. In obese women and in women with gestational diabetes – even in the well-controlled cases, interpretation of the fetal growth curves should be interpreted with caution in estimated fetal well-being. The present study is still ongoing, and hope to find an algorithm to asses more accurate the risks.

The Curvilinear Effect of BMI on Functional Health - Evidence of the Long-Running German Ageing Survey

Aims: We aimed at determining the effect of BMI on functional health among older Germans longitudinally. Methods: Data from four waves (2002-2014) of the German Ageing Survey (‘Deutscher Alterssurvey'; DEAS), a representative sample of community-dwelling individuals aged 40 years and above, were used. Functional health was quantified by the subscale ‘physical functioning' of the 36-Item Short Form Health Survey (SF-36). Fixed effects regressions were used to estimate the predictors of functional health. Linear, quadratic, and cubic terms were included for BMI (self-reported). Results: Fixed effects regressions showed significant linear, quadratic, and cubic effects of BMI on functional health in the total sample and in both sexes. Furthermore, regressions revealed that functional health decreased with increasing age in the total sample and in both sexes. In addition, changes in marital and employment status were significantly associated with changes in functional health in men, but not in women. Conclusion: Our data indicate that the greater the extreme of BMI (either higher or lower), the greater the risk for functional decline. Nutrition programs aimed at preventing changes to extreme BMI might be productive.

The Decay of Disease Association with Declining Linkage Disequilibrium: A Fine Mapping Theorem.

Several important and fundamental aspects of disease genetics models have yet to be described. One such property is the relationship of disease association statistics at a marker site closely linked to a disease causing site. A complete description of this two-locus system is of particular importance to experimental efforts to fine map association signals for complex diseases. Here, we present a simple relationship between disease association statistics and the decline of linkage disequilibrium from a causal site. Specifically, the ratio of Chi-square disease association statistics at a marker site and causal site is equivalent to the standard measure of pairwise linkage disequilibrium, r2. A complete derivation of this relationship from a general disease model is shown. Quite interestingly, this relationship holds across all modes of inheritance. Extensive Monte Carlo simulations using a disease genetics model applied to chromosomes subjected to a standard model of recombination are employed to better understand the variation around this fine mapping theorem due to sampling effects. We also use this relationship to provide a framework for estimating properties of a non-interrogated causal site using data at closely linked markers. Lastly, we apply this way of examining association data from high-density genotyping in a large, publicly-available data set investigating extreme BMI. We anticipate that understanding the patterns of disease association decay with declining linkage disequilibrium from a causal site will enable more powerful fine mapping methods and provide new avenues for identifying causal sites/genes from fine-mapping studies.

Correlation between blood rheological properties and red blood cell indices(MCH, MCV, MCHC) in healthy women.

Structure and mechanical properties of red blood cells are markedly influenced by pathophysiology of many diseases which in turn potentially impair microcirculatory blood flow. The physiological association between blood rheological parameters and red blood cell indices was investigated in otherwise healthy unselected mid-age women prior to elective gynaecological surgery. Red Blood Cell-deformability (RBC 1.2, 3.0; 6.0, 12.0; 30.0, 60.0) during exposure to low (RBC 1.2, 3.0), moderate (RBC 16.0, 12.0) and high shear forces (RBC 30.0, 60.0; Rheodyn; Myrenne), -aggregation (MA1; Myrenne) during low shear (E1; 4-1 S) and in stasis (E0) and plasma viscosity (Pv; KSV 1; Fresenius) were correlated with red blood cell indices (RBC-I: MCV, MCH and MCHC) and subjects' characteristics in 286 healthy women the day before undergoing gynaecologic standard surgery. Women with known pregnancy, malign-, infective-, chronic-disease or extreme BMI (<16; >40 Kg/m2) were excluded from this trial. From June 2014 to December 2014 a total of 286 healthy women (age: 46.5±17.6 y; BMI: 25.5±5.2 kg/m2) were eligible for inclusion into this prospective evaluation. Pv (mean±SD: 1.17±0.12 mPa s) and RBC aggregation (E0:12.6±6.3; E1:17.9±7.3) were not significantly correlated with RBC-I but with age and BMI. In contrast, RBC-deformability correlated significantly with MCV and MCH but significantly inversely correlated with MCHC. Deformability significantly increased with age but was unaffected by BMI of women. The correlation between RBC-I and RBC deformability was most remarkable during moderate shear force exposure. Neither haemoglobin nor haematocrit were correlated with RBC deformability or RBC-I. Cell volume and haemoglobin content had a strong impact on deformability in apparently healthy mid age women, whereas low MCHC and large MCV were associated with an increase in deformability while high MCHC and small MCV correlated with increased rigidity of RBC. BMI had no impact on deformability while age was associated with an increase in all determinants of blood viscosity. RBC aggregability was not affected by MCV, MCHC or MCH in mid-age women.