Final BMI Research Articles

Variations in echocardiography after bariatric surgery. Biliopancreatic diversion vs vertical gastrectomy

Introduction: obesity has become a worldwide health problem due to its relationship with cardiovascular morbimortality, thus bariatric surgery is considered as one of the main solutions for the correction of excess weight and, consequently, the improvement of its associated heart diseases. Objective: to compare vertical gastrectomy (VG) and biliopancreatic diversion (BPD) by observing echocardiographic characteristics both before and after surgery, as well as to evaluate surgical outcome in terms of the BAROS scale. Methods: results were collected from the echocardiographic testing requested for the preoperative study of patients who underwent surgery over the course of 24 months (from January 2014 to December 2015), as well as their anthropometric data. These were compared with postoperative parameters measured at 3 years after surgery. Results: finally, 26 patients were selected (13 VG and 13 BPD) with a mean age of 42 yrs. VG: initial BMI: 44.6 ± 7.1; final BMI: 31.8 ± 11.3 (p < 0.01); BPD: initial BMI: 48.1 ± 14.2; final BMI: 32.7 ± 10.4 (p < 0.01). Echocardiography: normal systolic function: 100% vs 92%; normal diastolic function: 88.5% vs 69.2%; no valvulopathy: 80% vs 69%; normal left atrium: 76.9% vs 73.1% (p > 0.05); HTA: 38.5% vs 19.2% (p < 0.05), preoperatively and postoperatively, respectively. Conclusions: no significant differences were found between the two groups studied with different techniques, although a slight deterioration in diastolic function was found in both groups. The comorbidities associated with obesity improved in both groups, and the surgery was scored as positive. The scant variation revealed by echocardiography prompts to reconsider its systematic preoperative use in these patients given the low cost-benefit ratio.

Effect of mild obstructive sleep apnea in mountaineers during the climb to Mount Aconcagua.

Objectiveto compare mountaineers with and without asymptomatic sleep apnea (OSA) before the ascent and to study high altitude-related sleep disorders, its interaction with metabolic, neuroendocrine and immunological components.Material and MethodsDuring an expedition to Mount Aconcagua, researchers assessed the respiratory polygraphy (RP), clinical condition and inflammatory parameters, and rhythm of cortisol secretion in mountaineers sleeping at different altitude camps.Results8 athletes (4 women), 36 years old (25-51) participated. Baseline and final BMI were; 23.6 (20.9-28.7) and 22.77 (20.9-27.7), respectively: p<0.01. 40 valid RP recordings were analyzed. At 746 m.a.s.l. (baseline), only 2 mountaineers presented mild asymptomatic OSA. The OSA group presented baseline apnea-hypopnea index (AHI) values between 5-15 events per hour, which evidence a mild respiratory sleep disorder with AHI increased by altitude depending of central apneas and hypopneas (p<0.05) as high altitude periodic breathing pattern but no increase in obstructive apneas (p<0.01). The circadian rhythm of cortisol was maintained in all cases in which they had not received treatment with dexamethasone and their values increased with the altitude reached. Increased systolic blood pressure was observed in the OSA group.ConclusionIn a context of hypobaric hypoxia, individuals with pre-existing asymptomatic OSA are prone to experiencing lower oxygen saturations and clinical deterioration.

Sexual Dysfunctions in Obese Women Before and After Bariatric Surgery.

BackgroundObesity and associated comorbidities increase the probability of sexual disorders. The present study evaluated sexual satisfaction levels in obese women prior to and following bariatric surgery, utilizing the validated Female Sexual Function Index (FSFI) to also evaluate the sexual satisfaction in obese and non-obese women.Material/Methods60 obese women (mean initial BMI of 43.7±5.9 kg/m2; mean age of 41.7±10.8 years) were administered the questionnaire on sexual function (FSFI) preceding bariatric surgery (laparoscopic adjustable gastric banding, 22 women; gastric plication, 33 women; and biliopancreatic diversion, 5 women), 6 months and 12 months after the procedure, i.e., following substantial weight reduction (final mean BMI of 35.5±5.5 kg/m2). The control group comprised 60 non-obese women (mean BMI of 22.2±1.9kg/m2; mean age of 36.4±10.7 years).ResultsOur findings indicate that baseline sexual function in the preoperative obese females was significantly lower than in non-obese women, with p<0.01 in each domain. Data gathered at the 6- and 12-month points following the procedure indicated no significant difference. Before the procedure, 31 obese subjects (51.6%) exceeded the cutoff for FSD, at the 6-month evaluation point, 17 women (39.5%) exceeded the cutoff, and at 12 months postoperatively, 18 subjects (41.9%) exceeded the cutoff, indicative of FSD. Among the non-obese controls, only 9 subjects (15%) exceeded the cutoff threshold.ConclusionsThese findings show that substantive weight reduction resulting from bariatric surgery results in reduced sexual dysfunction in female subjects.

Effect of Chronic Regular Swimming Exercise on Thyroid Function in Ovariectomized Rats

AbstractBackground: Thyroid dysfunction may occur in women in menopausal period or after ovariectomy. Effect of exercise on thyroid function remains controversial and need more investigations.Aim of Study: This study was done to investigate the effect of chronic regular swimming exercise on thyroid function in ovariectomized rats.Material and Methods: Rats were divided into 6 groups (7 rats per each); Sham-operated sedentary (sham-S) group, (2) Sham-operated with swimming exercise training (sham + Ex) group, (3) Ovariectomized sedentary (OVX-S) group, (4) OVX-group with swimming exercise training (OVX + Ex), (5) OVX-group injected with 17-b estradiol (OVX + E), (6) OVX-group with swimming exercise training and injected with 17-R estradiol (OVX + Ex + E). 3 months after the surgery, rats were exposed to the exercise protocol for another 3 months. BMI was calculated. At the end experimental period, the serum levels of T3, T4, TSH, estradiol and interleukin-6 (IL-6) were determined. The thyroid glands were weighed. The histopathological examination of thyroid tissue was done for determination of epithelial cell height, follicular and colloidal areas.Results: In OVX-S group, final BMI was significantly increased, serum levels of T3 and T4 were significantly decreased with significant increase of serum TSH level as compared with Sham-S group. While, as compared to OVX-S group, final BMI was significantly decreased, T3 and T4 levels were significantly increased with decrease of TSH level in OVX-treated groups. Estradiol level was significantly decreased in OVX-S group compared to sham-S group. While, in comparison with OVX-S group, its level significantly increased in OVX-treated groups. Serum IL-6 was insignificant changed between Sham-S, OVX-S and OVX + E groups. But, it significantly increased in Sham-Ex, OVX + Ex and OVX + Ex + E groups as compared to Sham-S, OVX-S and OVX + E groups. Histopathological examination showed significant decrease of the thyroid gland weight and height of epithelial cells, with significant increase in the follicular and colloidal areas in the OVX-S group as compared to sham-S group. These histopathological changes were improved in OVX-treated groups.Conclusion: We concluded that regular swimming exercise in OVX-rats ameliorated the thyroid hypofunction which may be related to its ability to increase estradiol level in these rats.

Biologic agents are associated with excessive weight gain in children with inflammatory bowel disease

Children with active inflammatory bowel disease (IBD) are frequently underweight. Anti-tumor necrosis factor (anti-TNF) agents may induce remission and restore growth. However, its use in other autoimmune diseases has been associated with excess weight gain. Our aim was to examine whether children with IBD could experience excess weight gain. A centralized diagnostic index identified pediatric IBD patients evaluated at our institution who received anti-TNF therapy for at least 1 year between August 1998 and December 2013. Anthropometric data were collected at time of anti-TNF initiation and annually. Excess weight gain was defined as ΔBMI SDS (standard deviation score) where patients were (1) reclassified from “normal” to “overweight/obese,” (2) “overweight” to “obese,” or (2) a final BMI SDS >0 and ΔSDS >0.5. During the study period, 268 children received anti-TNF therapy. Of these, 69 had sufficient follow-up for a median of 29.3 months. Median age at first anti-TNF dose was 12.8 years. At baseline, mean weight SDS was −0.7 (SD 1.4), while mean BMI SDS was −0.6 (1.3). Using baseline BMI SDS, 11.6% were overweight/obese. At last follow-up (LFU), however, the mean ΔBMI SDS was 0.50 (p 0 and ΔSDS >0.5. Pediatric patients with IBD may experience excess weight gain when treated with anti-TNF agents. Monitoring for this side effect is warranted.

Mammographic density changes in surgical weight loss-an indication for personalized screening

BackgroundObesity and high radiologic breast density independently increase breast cancer risk. We evaluated the effect of surgical weight loss on mammographic density (MD).MethodsPatients undergoing bariatric surgery and screening mammography (MG) were identified, data regarding demographics, comorbidities, calculated and genetic breast cancer risk was collected. Patients had a MG before and after surgery. Fellowship-trained breast radiologists assigned Breast Imaging Reporting and Data System density categories.ResultsPatients underwent sleeve gastrectomy (n = 56) or gastric bypass (n = 7), 78% had hypertension, 48% had diabetes. Four had deleterious BRCA mutations, four were calculated high risk. Mean weight loss = 28.7 kg. Mean initial BMI = 44.3 kg/m2 (range:33–77), final BMI = 33.6 kg/m2 (range:20–62;p < 0.01). Density was unchanged in 53, decreased in 1, increased in 9. Of these 9(14%), 5 changed from almost entirely fatty to scattered MD, and 4 changed from scattered MD to heterogeneously dense. Mean weight loss of the 9 with increased MD was greater than the cohort (37.7vs.28.7 kg;p < 0.01).ConclusionsSurgical weight loss increased MD in 14%. Increased MD masks malignancies, patients may benefit from additional screening based on calculated risk assessments that include MD.

Exponential decay modeling can define parameters of weight loss trajectory after laparoscopic Roux-en-Y gastric bypass

BackgroundLaparoscopic Roux-en-Y gastric bypass (LRYGB) produces durable and clinically significant weight loss. We aim to characterize the trajectory of weight loss, and demonstrate the predictive ability of three-month performance on final weight loss. MethodsRetrospective analysis of 1097 consecutive LRYGB patients allowed for assessment of conformity of various weight loss trajectory models. Establishing exponential decay as the optimal fit, initial, three-month and final BMI values were used to determine empiric rate constants (λ3). Empirically derived weight loss curves and associated rate constants (λ) were generated. ResultsExponential decay optimally characterizes post-LRYGB weight loss trajectory. Final weight loss can be characterized by λ3, as well as by the demographics black race (P = 0.008) and initial BMI (P < 0.001). Stratification by three-month weight loss allowed derivation of weight loss trajectory curves to predict weight at any point until and including plateau. ConclusionsWeight loss after LRYGB conforms well to exponential decay, and postoperative trajectory can thus be predicted early. This allows the clinician early identification and intervention upon patients at risk of poor performance.

Biologic Agents Are Associated with Excessive Weight Gain in Children with Inflammatory Bowel Disease.

Children with active inflammatory bowel disease (IBD) are frequently underweight. Anti-tumor necrosis factor (anti-TNF) agents may induce remission and restore growth. However, its use in other autoimmune diseases has been associated with excess weight gain. Our aim was to examine whether children with IBD could experience excess weight gain. A centralized diagnostic index identified pediatric IBD patients evaluated at our institution who received anti-TNF therapy for at least 1year between August 1998 and December 2013. Anthropometric data were collected at time of anti-TNF initiation and annually. Excess weight gain was defined as ΔBMI SDS (standard deviation score) where patients were (1) reclassified from "normal" to "overweight/obese," (2) "overweight" to "obese," or (2) a final BMI SDS >0 and ΔSDS >0.5. During the study period, 268 children received anti-TNF therapy. Of these, 69 had sufficient follow-up for a median of 29.3months. Median age at first anti-TNF dose was 12.8years. At baseline, mean weight SDS was -0.7 (SD 1.4), while mean BMI SDS was -0.6 (1.3). Using baseline BMI SDS, 11.6% were overweight/obese. At last follow-up (LFU), however, the mean ΔBMI SDS was 0.50 (p<0.0001). However, 10 (17%) patients had excess weight gain at LFU; 3 patients were reclassified from "normal" to "obese," and 7 had a final BMI SDS >0 and ΔSDS >0.5. Pediatric patients with IBD may experience excess weight gain when treated with anti-TNF agents. Monitoring for this side effect is warranted.

Predictive models for conversion of prediabetes to diabetes

AimTo clarify the natural course of prediabetes and develop predictive models for conversion to diabetes. MethodsA retrospective longitudinal study of 2105 adults with prediabetes was carried out with a mean observation period of 4.7years. Models were developed using multivariate logistic regression analysis and verified by 10-fold cross-validation. The relationship between [final BMI minus baseline BMI] (δBMI) and incident diabetes was analyzed post hoc by comparing the diabetes conversion rate for low (< −0.31kg/m2) and high δBMI (≥ −0.31kg/m2) subjects after matching the two groups for the covariates. ResultsDiabetes developed in 252 (2.5%/year), and positive family history, male sex, higher systolic blood pressure, plasma glucose (fasting and 1h- and 2h-values during 75g OGTT), hemoglobin A1c (HbA1c) and alanine aminotransferase were significant, independent predictors for the conversion. By using a risk score (RS) that took account of all these variables, incident diabetes was predicted with an area under the ROC curve (95% CI) of 0.80 (0.70–0.87) and a specificity of prediction of 61.8% at 80% sensitivity. On division of the participants into high- (n=248), intermediate- (n=336) and low-risk (n=1521) populations, the conversion rates were 40.1%, 18.5% and 5.9%, respectively. The conversion rate was lower in subjects with low than high δBMI (9.2% vs 14.4%, p=0.003). ConclusionsPrediabetes conversion to diabetes could be predicted with accuracy, and weight reduction during the observation was associated with lowered conversion rate.

Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass is Effective for Gastro-Oesophageal Reflux Disease but not for Further Weight Loss

Inadequate weight loss (IWL)/weight regain (WR) and gastro-esophageal reflux disease (GERD), unresponsive to medical management, are two most common indications for conversion of sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB). This study reports detailed outcomes of conversion of SG to RYGB for these two indications separately. We interrogated our prospectively maintained database to identify patients who underwent a conversion of their SG to RYGB in our unit. Outcomes in patients converted for IWL/WR and those converted for GERD were evaluated separately. We carried out 22 SG to RYGB in our unit between Aug 2012 and April 2015 with a mean follow-up of 16months. Indication for conversion was GERD in 10/22 (45.5%) patients and IWL/WR in 11/22 (50.0%) patients. Patients undergoing conversion for GERD were significantly lighter (BMI 30.5) than those converted for IWL/WR (BMI 43.3) at the time of conversion. The conversion was very effective for GERD with 100% patients reporting improvement in symptoms, and 80% patients were able to stop their antacid medications. IWL/WR group achieved a further BMI drop of 2.5 points 2years after surgery (final BMI 40.8) in comparison with 2.0 points BMI drop achieved by the GERD group (final BMI 28.5). This study demonstrates that conversion of SG to RYGB is effective for GERD symptoms but not for further weight loss, which was modest in both groups. Future studies need to examine the best revisional procedure for IWL/WR after SG.

SERUM ADIPONECTIN AND IRISIN LEVELS IN OVARIECTOMIZED OSTEOPOROTIC RAT MODEL

Background: Post-menopausal osteoporosis (PMOP) is the most common bone disease in females characterized by decreased bone mineral density (BMD). However, the exact pathogenesis remains unclear. Objective: Investigating the relationship between serum levels of adiponectin and irisin, and their relation to BMD in ovariectomy induced osteoporosis rat model. Material and Methods: Three equal groups of adult female albino rats (n=15) were used; i.e. control, sham operated and ovariectomized (OVX) groups. Nine weeks after ovariectomy, serum analysis of adiponectin, irisin, FSH, estradiol, Ca++, phosphorus (P), alkaline phosphatase (ALP), glucose, and insulin were estimated. Final BMI and HOMA-IR were calculated. Bone BMD measurements (dry and ash femur weight, bone Ca++ and P together with femur histopathological examination) were done. Results: In OVX osteoporotic rat model, while serum levels of adiponectin significantly elevated and negatively correlated with BMD, serum irisin levels significantly reduced, and showed significant positive correlation with BMD. Changes in OVX adiponectin and irisin levels were significantly associated with the elevated insulin resistance. However, they were not association with FSH or estradiol levels. Conclusion: OVX induced osteoporosis was associated with a significant increase in adiponectin levels, and decrease in irisin levels which are associated with changes in insulin resistance rather than sex hormones. It can be hypothesized that the exact causative of PMOP extends beyond pituitary; ovarian axis to be metabolic, muscle and adiposity cross talks which needs more detailed investigations.

The Importance of Mid-to-Late-Life Body Mass Index Trajectories on Late-Life Gait Speed.

Prior studies suggest being overweight may be protective against poor functional outcomes in older adults. Body mass index (BMI, kg/m2) was measured over 25 years across five visits (1987-2011) among Atherosclerosis Risk in Communities Study participants (baseline Visit 1 n = 15,720, aged 45-64 years). Gait speed was measured at Visit 5 ("late-life", aged ≥65 years, n = 6,229). BMI trajectories were examined using clinical cutpoints and continuous mixed models to estimate effects of patterns of BMI change on gait speed, adjusting for demographics and comorbidities. Mid-life BMI (baseline visit; 55% women; 27% black) was associated with late-life gait speed 25 years later; gait speeds were 94.3, 89.6, and 82.1 cm/s for participants with baseline normal BMI (<25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30) (p < .001). In longitudinal analyses, late-life gait speeds were 96.9, 88.8, and 81.3 cm/s for participants who maintained normal, overweight, and obese weight status, respectively, across 25 years (p < .01). Increasing BMI over 25 years was associated with poorer late-life gait speeds; a 1%/year BMI increase for a participant with a baseline BMI of 22.5 (final BMI 28.5) was associated with a 4.6-cm/s (95% confidence interval: -7.0, -1.8) slower late-life gait speed than a participant who maintained a baseline BMI of 22.5. Being overweight in older age was not protective of mobility function. Maintaining a normal BMI in mid- and late-life may help preserve late-life mobility.

Increasing prevalence of overweight and obesity among children in Vilnius, Lithuania: comparison of two longitudinal data sets of children born in 1990 and 1996.

The aim of this study was to assess changes in prevalence of overweight and obesity among children born in 1996 and 1990 in Vilnius city. The results were based on comparison of two longitudinal data sets (N = 624 and N = 389) collected from the personal health records of children born in 1996 and 1990 respectively. No statistically significant differences in final height and BMI were established between children born in 1990 and 1996; however, both boys and girls born in 1996 appeared to be higher and heavier at different ages compared to their peers born in 1990. After controlling for tempo, the differences in height between the two cohorts have become insignificant for girls, with exceptions at the age of 3 and 10 years; for boys, the differences between the cohorts have remained significant, however at a slightly lower level. More children born in 1996 tended to be overweight and obese. In six years, the prevalence of overweight in Vilnius children has more than doubled; the prevalence of obesity has increased up to five times in some age groups.

Correlation of Adolescent Caffeine Intake with Blood Pressure in Adolescence and Adulthood

ObjectiveHigh blood pressure (HBP) is one of the leading causes of premature death worldwide. Currently, 1 in 3 adults has HBP. Recent studies have shown that caffeine leads to an acute increase in blood pressure after exposure, but the long–term effects of caffeine on blood pressure are unclear. Our study aimed to assess the longer‐term relationships between dietary caffeine intake and blood pressure using data collected in two longitudinal epidemiologic studies: the Princeton Lipid Research Study and the NHLBI Growth Health Study (NGHS).MethodsThe Princeton cohort included 623 subjects who were seen as children/adolescents and again in adulthood. The NGHS cohort included 870 black and white females ages 9 or 10 at enrollment who were followed yearly for up to ten years. Caffeine intake was assessed using a 24‐hour recall for Princeton (childhood only) and 3‐day diet records for NGHS (at 8 of 10 visits). Blood pressure in both studies was assessed using standard mercury sphygmomanometer, and systolic and diastolic z‐scores were calculated for childhood measurements. The relationship between caffeine intake and blood pressure was analyzed for individuals in each visit.ResultsIn the NGHS cohort, caffeine intake increased from a median of 15 mg to 40 mg/day between ages 10 and 19 years, and was significantly higher in white vs. black participants at all ages (p&lt;0.0001). Similar patterns were noted in Princeton. In NGHS, SBP z‐score and DBP z‐scores were higher in black vs. white participants from age 17–19 (p&lt;0.01); in Princeton, BP z‐scores did not differ by race at any childhood age. Cross‐sectionally, neither cohort demonstrated significant correlations between caffeine intake and blood pressure z‐scores during childhood/adolescence, except for a negative correlation seen in NGHS with DBP z‐score at age 16.0 (Spearman correlation=−0.085, p=0.04). Longitudinally, in Princeton, caffeine intake in childhood/adolescence was not associated with systolic or diastolic blood pressure in adult follow up (both p&gt;0.4), adjusting for sex, race, and age and BMI at adult follow up. In NGHS, neither caffeine intake at age 12, nor the change in caffeine intake between ages 12 and 19, were associated with blood pressure z‐scores at participants’ final visits, adjusting for age at final visit and BMI z‐score.DiscussionThe results of these two long‐term studies suggest that caffeine consumption during childhood/adolescence is not associated with blood pressure in either later adolescence or adulthood.Support or Funding InformationEE supported by a grant from the American Heart Association and the CCHMC Schmidlapp Young Women's Scholarship.

Weight-related and analytical maternal factors in gestational diabetes to predict birth weight and cord markers of diabetic fetopathy

Objective: The objective was to determine the value of clinical and analytical maternal factors to predict birth weight and umbilical cord biochemical markers of diabetic fetopathy.Methods: Prospective evaluation of gestational diabetes pregnancies (n = 50). Maternal weight-related clinical and analytical factors were collected during pregnancy. After birth, an umbilical cord sample was taken.Results: Univariate linear regression analysis showed relationship between maternal weight, glycated hemoglobin (HbA1c) and insulin-like growth factor 1 (IGF1) with birth weight percentile. A significant association was found between maternal weight and cord insulin and C-peptide. Maternal HbA1c, leptin and insulin during pregnancy showed a positive linear association to cord leptin, insulin and C-peptide. In multivariate analysis models, final maternal BMI showed an independent positive association with cord C-peptide.Conclusions: Maternal weight-related and analytical parameters show diagnostic value to birth weight and cord markers.

Effect of Prolonged Consumption of Sweeteners in CD1 Mice in Lymphocyte Populations from Different Lymphoid Organs.

Intake of sweeteners from many products to reduce the energy is high, but the consumption for a long time and their effect on lymphocytes percentage has been scarcely studied. The aim of this study was to evaluate the effect of prolonged use of sweeteners in CD1 mice on lymphocyte populations from different lymphoid organs. We used 32 21-day old CD1 mice, divided into 4 groups: Control (CL), Sucrose (SAC), Sucralose (SUC), Stevia (ST). Ten grams of each sweetener were diluted in 240mL of water, mice drank and fed ad libitum. Peripheral blood glucose, BMI and caloric index was quantified. Weight increased significantly (F=2.587, p<0.029), feed intake (F=16.40, p<0.001) and water consumption (F=21.65, p<0.001) caused mainly by SUC. No differences in final BMI (F=2.02, p<0.134) were found. The caloric index showed differences between groups (F=16.40, p<0.001), it was significantly elevated between CL and SAC group (p<0.001). The blood glucose concentration decreased significantly (F=5.155, p<0.006) in the EST group and increased in the SAC and SUC groups. Lymphocyte percentages decreased in whole blood (F=31.75, p<0.001), increased in spleen (F=7.93, p<0.001) and decreased in Peyer's patches, in all cases at the expense of SUC and EST (F=3.5, p<0.028). The percentage of lymphocytes decreased in Peyer´s patches in SUC and EST groups, indicating a local effect of these sweeteners in the intestinal mucosa.

Successful Medical Weight Loss in a Community Setting.

BackgroundResearch has shown that meal replacement calorie reduction combined with lifestyle change can more than double the weight loss seen with other diets. However, its widespread acceptance by physicians has been limited, perhaps waiting on evidence that patients are successful in keeping lost weight off.MethodsObese patients (108.4 ± 25.7 kg, BMI 38.1 ± 7.9 kg/m2) used a diet of meal replacements combined with weekly classes. While learning about nutrition, exercise, and accountability, patients tracked calorie intake and physical activity. Weight loss and retention rates for rapid weight loss and maintenance phases were measured. Weights then obtained years after treatment ended showed that patients were keeping lost weight off without any ongoing clinic intervention.ResultsRecords of 714 patients treated in a medical weight loss practice from 2004 through 2012 were reviewed. For all patients, weight loss was 13.6 ± 8.3 kg, and 12.5% of initial weight. The 469 patients who completed 16 weeks of weight loss classes lost 16.7 ± 7.2 kg and 15.1%. 433 patients then enrolled in maintenance classes, and after 12 months had regained only 0.1 ± 9.1 kg and 0.4%. Follow up weights obtained from 173 patients more than 2 years after treatment ended showed persisting weight loss of 14.3 ± 13.7 kg and 12.9%. Final BMI was 32.7 ± 7.7 kg/m2.ConclusionIn a medical weight loss program that used meal replacements to reduce calorie intake combined with weekly behavior change classes, weight loss was 16.2 kg and 14.4% for the 61% of all enrollees who completed 16 months of treatment. More importantly, over 2 years later, weight loss of 14.3 kg and 12.9% of initial weight persisted, and patients were not regaining their lost weight.

Abstract 17321: Race Differences in Hemodynamic Responses to Acute Mental Stress and the Role of Depressive Symptoms

Introduction: Increased hemodynamic responses to psychological stress have been associated with adverse CAD events. African Americans (AA) have worse CAD outcomes than other groups. Heightened hemodynamic responses to stress may play a role. Our hypothesis was that AA would have higher hemodynamic reactivity to a standardized mental stress compared to Non-African Americans (NAA). Methods: We evaluated 574 patients (163 AA) with CAD, who underwent a standardized mental stress challenge. Hemodynamics were obtained at rest, during stress (speaking task), and during recovery. The rate-pressure product (RPP) was calculated as systolic blood pressure (SBP) x heart rate (HR). Hemodynamic reactivity was evaluated as the difference in RPP at rest and during stress. Depressive symptoms were measured with the Beck Depression Inventory-II (BDI). Results: As compared to NAA, AA patients were younger, had lower education and income, and higher prevalence of diabetes, obesity, hypertension, smoking, and depressive symptoms (BDI mean scores 9.8 vs. 7.6, p= 0.003). AA patients had higher blood pressure during all three periods (Table). However, hemodynamic reactivity with stress was significantly lower in AA than NAA (RPP reactivity 3114 vs 3620, p= 0.02). Adjusting for baseline RPP, age, gender and smoking did not substantially alter the association. However, after adjusting for depressive symptoms, the association was attenuated by 23% (p=0.16). BMI, diabetes and beta-blocker use had minimal additional explanatory role. In the final model, baseline RPP, depressive symptoms and BMI were significantly associated with a lower RPP reactivity (p&lt;0.01). Conclusion: AA patients with CAD, compared with NAA, have elevated blood pressure throughout mental stress, but tend to have blunted hemodynamic reactivity to stress. Depressive symptoms, which are more elevated among AA, play a role in this different response to stress and may be implicated in the higher CAD risk of this group.

Weight change associated with corticosteroid therapy in adolescents with systemic lupus erythematosus

Physical appearance is very important to adolescents and weight gain secondary to corticosteroid (CS) treatment may have a direct impact on adolescent development. Understanding weight gain in adolescents with SLE who are being treated with CS will help clinicians develop strategies for prevention of nonadherence, obesity and eating disorders in this population. Patients aged 11-18 years old with newly diagnosed SLE between January,1995 and December, 2006 were identified through the Rheumatology database at the Sickkids hospital, Canada. All charts were reviewed. Patients were categorized based on final BMI status as normal, overweight and obese. Risk factors for being obese were examined by logistic regression model analysis. Of 236 patients, 78% fulfilled the criteria. 85% were female with mean age at onset of diagnosis was 14 ± 1.7 years. Mean duration of CS treatment was 50 ± 31 months and mean cumulative CS dosage was 34.11 ± 32.7 g of prednisone. At baseline, 10% had BMI >25 kg/m(2) while at the end of the study, 20% were overweight and 10.4% were obese. In addition, 61% gained <10 kg while 15% gained ≥20 kg. Initial BMI was a significant predictors for final BMI (OR = 27.59, 95%CI = 6.04-126.09, p < .001) while male (OR = 8.50, 95%CI = 2.95-24.5, p < 0.000) and cumulative CS dosage (OR = 1.53, 95%CI = 1.05-2.23, p < .05) were the significant predictors for weight gain >10 kg. Duration of CS treatment did not correlate with obesity. Although a significant number of patients became overweight or obese after being treated with CS, most gained <10 kg. Obesity secondary to CS treatment in SLE patients was significantly correlated with baseline BMI, gender and cumulative CS dosage.

An Analysis of Modifiable Factors Predictive of Delayed Graft Function in Deceased Donor Renal Transplants

Introduction: Delayed graft function (DGF) has demonstrable effects on both the incidence of rejection and long-term survival. Modifiable risk factors for delayed graft function after renal transplant and the implications for graft survival remain poorly defined. Methods: Following IRB approval, records for 713 renal transplants performed between 2005 and 2008 at a large single transplant center were reviewed. DGF was defined as a need for dialysis in the first week after transplant. Paired analysis was conducted using paired donor kidneys where possible. The impact of induction therapy was performed. DGF impact on patient and graft outcomes were also studied. Mean length of follow-up from transplant is 3 years. Results: 300 (42%) of the total 713 recipients developed DGF. In univariate analysis, development of DGF was predicted by days on dialysis (1502 DGF vs. 1173 non-DGF, p=.0003), days on the waitlist (792 DGF vs. 650 non-DGF, p=.0024), creatinine at transplant (8.51 DGF vs. 7.23 non-DGF p< .0001), cold ischemic time (28.71h DGF vs. 23.72h non-DGF p < .0001), donor final creatinine (1.18 DGF vs. 1.03 non-DGF p = 0.0004), recipient and donor BMI were also predictive. Risk of DGF was shown to be independent of left vs. right donor kidneys (OR 1.02). Kidneys from Caucasian donors were nearly twice as likely to develop DGF (OR 1.89) than kidneys from African American donors. Neither D+/R- CMV status, donor CMV status nor number of HLA mismatches were shown to be predictive of DGF.Figure: [DGF Risk Factors]Among induction therapies, 39% of patients who received Simulect developed DGF compared with 42% who received Thymoglobulin and 47% who received Campath. Development of DGF was shown to be predictive of reduced renal function (at 1 year, DGF Cr was 2.08 vs. 1.60 in the non-DGF population, p < .0001). DGF was not a predictor of all-cause mortality, but it was a predictor of retransplant. Conclusions: This is a large single center retrospective study which evaluates modifiable risk factors for the development of renal transplant DGF in a population where the incidence is high. Efforts in decreasing DGF should focus, in part, to factors which have been demonstrated to be highly predictive.