Gender-specific Cutoffs Research Articles

Sarcopenia is a strong predictive factor of clinical and oncological outcomes following curative colorectal cancer resection.

Skeletal muscle depletion and subsequent functional loss is common in gastrointestinal malignancy. Usual markers of nutritional status may not be part of routine workup. The predictive value of sarcopenia was assessed and compared with clinically utilized factors. The aim of this was to assess the association between computed tomography assessed sarcopenia with outcomes in colorectal cancer resection. A total of 228 consecutive patients who underwent curative colorectal cancer resection were included. Skeletal muscle area was measured at L3, with pre-defined gender-specific cut-offs applied to a height standardized index. Albumin, body mass index and Subjective Global Assessment scores were recorded alongside measures of comorbidity. Predictors of complications, mortality, and recurrence were identified through multivariate logistic regression. Computed tomography assessed sarcopenia was significantly associated with longer stays, complications, 30-day mortality, readmissions and recurrence at 1 year. Specific associations with major, respiratory and cardiac complications were seen. It independently predicted overall complications (odds ratio 2.96, confidence interval 1.19-7.35 P=0.019), recurrence at 1 year (odds ratio 8.00, confidence interval 1.45-44.21, P=0.017) and an increase in comprehensive complication index of 14 (P=0.002). Subgroup analysis found sarcopenia predicted overall complications in rectal surgery and major complications in colonic surgery. American Society of Anesthesiologists predicted complications but not major complications while cancer stage also predicted recurrence rates. Sarcopenia presents an objective, available predictive factor that may be superior to current biochemical and clinical measures of nutritional and functional status. This study found it to be predictive of complication rates and recurrence after curative in colorectal cancer resection.

Bedtime Salivary Cortisol as a Screening Test for Cushing Syndrome in Children.

BackgroundDiagnosing Cushing syndrome (CS) can be challenging. The 24-hour urine free cortisol (UFC) measurement is considered gold standard. This is a laborious test, dependent on correct urine collection. Late-night salivary cortisol is easier and is used as a screening test for CS in adults, but has not been validated for use in children.ObjectiveTo define liquid chromatography tandem mass spectrometry (LC-MS/MS)-based cutoff values for bedtime and morning salivary cortisol and cortisone in children, and validate the results in children with and without CS.MethodsBedtime and morning salivary samples were collected from 320 healthy children aged 4 to 16 years. Fifty-four patients from the children’s outpatient obesity clinic and 3 children with pituitary CS were used for validation. Steroid hormones were assayed by LC-MS/MS. Cutoff levels for bedtime salivary cortisol and cortisone were defined by the 97.5% percentile in healthy subjects.ResultsBedtime cutoff levels for cortisol and cortisone were 2.4 and 12.0 nmol/L, respectively. Applying these cutoff levels on the verification cohort, 1 child from the obesity clinic had bedtime salivary cortisol exceeding the defined cutoff level, but normal salivary cortisone. All 3 children with pituitary CS had salivary cortisol and cortisone far above the defined bedtime cutoff levels. Healthy subjects showed a significant decrease in salivary cortisol from early morning to bedtime.ConclusionsWe propose that bedtime salivary cortisol measured by LC-MS/MS with a diagnostic threshold above 2.4 nmol/L can be applied as a screening test for CS in children. Age- and gender-specific cutoff levels are not needed.

Dietary factors associated with being overweight and obese among school-going adolescents in Region One, The Gambia

BackgroundThe purpose of this study was to determine the dietary factors associated with being overweight and obese among school-going adolescents in Region One, The Gambia. MethodThis was a school-based cross-sectional study and 1008 students from eight Senior Secondary Schools in Region one of The Gambia participated in it. Data were collected through questionnaire self-administered method, and weight and height measurements. Using the age and gender-specific cutoff points proposed by World Health Organization, body mass index (BMI) was calculated using the weight and height measures. The data were analyzed using frequencies for underweight, overweight, and obesity, and the association between dietary factors and weight status of participants was determined using the Chi-square test. FindingsOut of the 1008 students recruited in the study, 981 of them completed and returned the questionnaires, resulting in a total response rate of 97%. The mean age of the participants was 17.3 years (SD = 1.9) and 385 of them (39.2%) were from grade 10. There were 627 (63.9%) females. The mean BMI for all the students was 20.0 ± 3.4 kg/m2. Most of the students (n = 672; 68.5 %) had normal body weight, but 226 (23%), 76 (7.7 %) and 7 (0.7%) of them were underweight, overweight and obese respectively. There was a significantly higher number of female students who were overweight (n = 64, 10.2%) than their male counterparts (χ2 = 72.336, p < 0.001). The frequency of drinking sugar added juices and full cream milk, eating fish, shrimps, oysters, lobsters, and snacks such as cakes and biscuits were significantly associated with overweight and obesity among the participants (p < 0.05). In conclusion, the problem of under-nutrition and over-nutrition co-existed among the students which were associated with poor eating habits.

Baseline CT-derived muscle quality influences post-operative morbidity and five-year survival following pancreatic surgery

Purpose: Concerns regarding rapid disease progression have delayed the translation and evaluation of prehabilitation in patients with pancreatic cancer (PC). This study sought to investigate the association between baseline CT-derived muscle indices and post-operative outcome following pancreatic surgery. Methods: Consecutive patients who underwent surgery for suspected pancreatic malignancy at a tertiary, high-volume centre between 2010 and 2013 were identified, and patient status censored on 31st December 2018 to allow a minimum five-year follow up period for all participants. Major post-operative morbidity was defined as per Clavien-Dindo classification (>3). Individual muscle mass and attenuation were measured at the third lumbar vertebrae (L3) using Slice-O-Matic software, and pre-defined BMI- and gender-specific cut-offs applied. Associations between muscle indices and the occurrence of post-operative complications was assessed using binary logistic regression analysis, with results reported as odds ratios (OR) and corresponding 95% confidence intervals. The log-rank (Mantel- Cox) test was used to assess the influence of muscle indices on overall survival. Results: Sarcopenia and low muscle attenuation (MA) were present in 46% and 52% of patients respectively (n=276). Low MA was associated with increased post-operative morbidity (OR 1.6, 95% CI 1.07 -2.19, p=0.029), while both sarcopenia and low MA were associated with reduced overall survival (41 vs 62 months, p=0.036, 29 vs 61 months, p=0.0001 respectively). When patients with pathologically confirmed PC were evaluated separately (n=107), the influence of muscle indices on survival were sustained (sarcopenia 16 vs 26 months, p=0.017, low MA 12 vs 30 months, p= 0.016). Conclusion: Low MA and sarcopenia were prevalent among patients undergoing surgery for suspected pancreatic malignancy. Both factors were associated with increased mortality risk and shorter overall survival, while low muscle attenuation was associated with increased major post-operative morbidity risk. CT-derived muscle assessment could aid patient selection and risk stratification for pancreatic cancer, both by identifying a vulnerable patient cohort in need of pre-operative optimisation, and providing an objective assessment parameter for the evaluation of targeted interventions.

ENDOCRINE TUMOURS: Calcitonin in thyroid and extra-thyroid neuroendocrine neoplasms: the two-faced Janus.

An increased calcitonin serum level is suggestive of a medullary thyroid cancer (MTC), but is not pathognomonic. The possibility of false positives or other calcitonin-secreting neuroendocrine neoplasms (NENs) should be considered. Serum calcitonin levels are generally assessed by immunoradiometric and chemiluminescent assays with high sensitivity and specificity; however, slightly moderately elevated levels could be attributable to various confounding factors. Calcitonin values >100 pg/mL are strongly suspicious of malignancy, whereas in patients with moderately elevated values (10-100 pg/mL) a stimulation test may be applied to improve diagnostic accuracy. Although the standard protocol and the best gender-specific cut-offs for calcium-stimulated calcitonin are still controversial, the fold of the calcitonin increase after stimulation seems to be more reliable. Patients with MTC show stimulated calcitonin values at least three to four times higher than the basal values, whereas calcitonin-secreting NENs can be distinguished from a C-cell disease by the absence of or <two-fold response to stimulation. The measurement of calcitonin in fine-needle aspirate washout (FNA-CT) and calcitonin immunocytochemical staining from thyroid nodules are ancillary methods that may significantly improve MTC diagnosis. The present review examines the gray areas in the interpretation of calcitonin measurement in order to provide a tool to clarify the origin of calcitonin secretion and differentiate the behavior of the two-faced Janus of neuroendocrinology: intra-thyroid (MTC) and extra-th9yroid NENs.

Abstract 13919: Race and Gender Specific High Sensitivity Troponin-t Cutoff Values Improve Detection in Patients’ With Ischemic Heart Disease

Introduction: Death rates from acute coronary syndrome events (ASCE) are 30% higher in African Americans than in Caucasians. A potential reason for this disparity is the underdiagnosis of ACSE due to race-specific differences in blood levels of cardiac troponin-T (cTnT), the biomarker of choice for the exclusion of myocardial injury. Hypothesis: Race- and gender-specific high-sensitivity cTnT (hs-cTnT) cutoff values will improve the detection of myocardial injury. Methods: Emergency Department encounters at the University of Chicago from June 2018 through April 2019 with at least 1 hs-cTnT value were included. Race- and gender-specific 99 th percentiles for hs-cTnT were determined for patients without a history of hypertension, heart failure, coronary artery disease, diabetes, or chronic kidney disease, and used as the threshold for a positive result. These threshold values were compared against manufacturer’s recommended gender-only values (male ≥ 22 ng/dL, female ≥ 14 ng/dL). Confusion matrices were used to calculate test characteristics. The presence of ischemic heart disease was determined by the corresponding International Statistical Classification of Diseases. Results: Among 10,934 included encounters, 89.9% were African American. The 99 th percentile values for African American were lower than for matched white counterparts. Race and gender specific cutoffs had higher specificity (83.1% vs 75.2%), greater positive predictive value (91.9% vs 90.7%), and lower false negative rates (16.9% vs. 24.8%) compared with traditional gender-only cutoff values. During the 10 months of data collection, race- and gender-specific cutoffs would have correctly identified 215 additional encounters as having ischemic heart disease, all of them African Americans. The net reclassification rate was +7.91%. Conclusions: Using race-specific, in addition to traditional gender-specific, hs-cTnT cutoff values resulted in higher specificity, greater positive predictive value, and lower false negative rates. Nearly 8% of patients with eventual diagnosis of ischemic heart disease would have been correctly reclassified using race- and gender-specific cutoffs. These findings suggest that race- and gender-specific cutoffs should be further explored.

Does the Lack of Gender-Specific Apnea-Hypopnea Index Cutoff for Obstructive Sleep Apnea Impact Surgical Selection?

The apnea-hypopnea index (AHI) is the parameter on which the severity of obstructive sleep apnea (OSA) is based and is also the determinant for both clinicians and third-party payers for surgical procedures. The purpose of this retrospective cross-sectional chart review is to examine differences in symptoms and AHI between men and women with OSA and whether this may impact timing and selection of surgical care. Retrospective cross-sectional study of patients aged 18years and older who presented at a single center for surgical evaluation of OSA from January 2017 to 2020. AHI, oxygen desaturation index, respiratory disturbance index, and lowest oxygen saturation were obtained from polysomnography. The predictor variable was gender, and the outcome variable was AHI. Unadjusted and multivariate adjusted linear regression models were used to compare differences in AHI between gender, controlling for age, body mass index (BMI), Epworth sleepiness scale, and fatigue severity scale. Poisson regression analysis with robust error was used to assess the relative risks of antidepressant and anxiolytic medication use between genders. A total of 408 consecutive new patients seen for surgical evaluation to treat OSA (248 men and 160 women) were included. Median patient age was 40years for men and 41years for women. Median AHI for men was 22.1 events per hour and 13.7 for women (P<.001). When adjusted for age and BMI, men have 33.2% higher AHI than women, with age contributing to 2% and BMI contributing to 6% of the difference. When controlling for age, BMI, Epworth sleepiness scale, and fatigue severity scale, women have a 2.2 increased relative risk of taking anxiolytic or antidepressant medications. Women with OSA seeking surgery in a dedicated sleep practice have 33% lower AHI than men when controlling for age, BMI, and symptoms. Based on our findings, non-gender-specific AHI may handicap the surgeon from offering the full range of available procedures to women with OSA.

MRI‐defined sarcopenia predicts mortality in patients with chronic liver disease

Background & AimsTo explore whether sarcopenia, diagnosed by an abbreviated magnetic resonance imaging (MRI) protocol is a risk factor for hepatic decompensation and mortality in patients with chronic liver disease (CLD).MethodsIn this retrospective single‐centre study we included 265 patients (164 men, mean age 54 ± 16 years) with CLD who had undergone MRI of the liver between 2010 and 2015. Transverse psoas muscle thickness (TPMT) was measured on unenhanced and contrast‐enhanced T1‐weighted and T2‐weighted axial images. Sarcopenia was defined by height‐adjusted and gender‐specific cut‐offs in women as TPMT < 8 mm/m and in men as TPMT < 12 mm/m respectively. Patients were further stratified into three prognostic stages according to the absence of advanced fibrosis (FIB‐4 < 1.45, non‐advanced CLD), compensated‐advanced CLD (cACLD) and decompensated‐advanced CLD (dACLD).ResultsThe inter‐observer agreement for the TPMT measurements (κ = 0.98; 95% confidence interval [95% CI]:0.96‐0.98), as well as the intra‐observer agreement between the three image sequences (κ = 0.99; 95% CI: 0.99‐1.00) were excellent. Sarcopenia was not predictive of first or further hepatic decompensation. In patients with cACLD and dACLD, sarcopenia was a risk factor for mortality (cACLD: hazard ratio (HR):3.13, 95% CI: 1.33‐7.41, P = .009; dACLD:HR:2.45, 95% CI: 1.32‐4.57, P = .005) on univariate analysis. After adjusting for the model of end‐stage liver disease (MELD) score, albumin and evidence of clinical significant portal hypertension, sarcopenia (adjusted HR: 2.76, 95% CI: 1.02‐7.42, P = .045) remained an independent risk factor for mortality in patients with cACLD.ConclusionSarcopenia can be easily evaluated by a short MRI exam without the need for contrast injection. Sarcopenia is a risk factor for mortality, especially in patients with cACLD.

Tired of not knowing what that fatigue score means? Normative data of the Modified Fatigue Impact Scale (MFIS)

Background: The Modified Fatigue Impact Scale (MFIS) is one of the most common self-report measures used to assess fatigue in multiple sclerosis (MS). Despite its widespread use, there are no existing normative data for the MFIS. ObjectiveThe present investigation aimed to develop normative data for the MFIS in a large community sample, stratified by age, gender, and education and to compare the derived new cutoffs to an existing cutoff. MethodsA total of 675 healthy individuals, stratified by age, gender, and education completed the MFIS. After the removal of 19 outliers, the final sample consisted of 656 individuals. Archival data of 540 individuals with MS who completed the MFIS were also included to analyze the utility of the new cutoffs. ResultsThere were no main effects on the MFIS for gender. However, there were main effects for age and education. Specifically, younger cohorts (25-34 and 35-44) reported less physical fatigue compared to the two oldest cohorts (55-64 and 65-74). Similar effects were found for total MFIS fatigue with individuals aged 55-64 reporting greater overall fatigue than 35-44 year olds. Finally, 18-24 year olds reported significantly higher levels of cognitive fatigue compared to 35-44 and 65-74 aged cohorts. No other effects were observed for age. Individuals with higher education consistently reported less fatigue. Subsequent analyses also revealed an interaction effect for age x gender. When examining the age x gender interaction, women age 18-24 reported significantly greater levels of physical, cognitive, psychosocial, and total fatigue than their male counterparts. In contrast, men aged 65-74 reported greater physical, cognitive, and total fatigue than women their age. Comparisons of the existing cutoff of the MFIS to the new age, gender, and education specific cutoffs found either comparable or slightly higher rates of fatigue with the latter. ConclusionBased on these findings, updated normative data and age, gender, and education specific cutoffs are provided. Utilization of these updated norms will result in a more accurate assessment of fatigue and will be valuable for those conducting research and/or clinical practice with individual with MS.

Predicting Literacy Skills at 8 Years From Preschool Language Trajectories: A Population-Based Cohort Study.

Purpose This article explored the predictive values of three main language delay (LD) trajectories (i.e., persistent, late onset, and transient) across 3-5 years on poor literacy at 8 years. Additionally, the effect of gender was assessed, using both gender-neutral and gender-specific thresholds. Method The data comprised mother-reported questionnaire data for 8,371 children in the Norwegian Mother, Father, and Child Cohort Study. Analyses were conducted using binary logistic regression in SPSS to make predictions about risk. Results LD reported at preschool age was associated with excess risk of poor literacy at 8 years with odds ratios ranging from 3.19 to 9.75 dependent on trajectory, persistent LD being the strongest predictor. The odds ratio of transient LD was similar to that of late-onset LD. Gender was not found to play an important role in the association between oral language and literacy, as the gender difference disappeared when gender-specific deficit criterion was used. Conclusion Our study supports the longitudinal association between preschool oral language and school-aged literacy skills and highlights the importance of different LD trajectories across preschool ages in predicting later literacy. Furthermore, practitioners are recommended to consider gender-specific cutoffs in relation to language and literacy measures.

Sarcopenia: Influence of Regional Skeletal Muscle Cutoff Points and Fat-Free Mass in Older Mexican People-A Pilot Study.

Background Variation in the prevalence of sarcopenia is related to the skeletal muscle index cutoff points applied. The objective of this pilot study was to examine the recruitment process for testing different sarcopenia definitions (ASMI cutoffs) in older Mexican adults. It explored whether the prevalence of sarcopenia decreased by applying ethnic- and gender-specific, DXA-derived appendicular skeletal muscle index (ASMI)-cutoff points in the definitions, as well as some associated factors in a sample of community-dwelling older Mexican people. Methods This is a pilot feasibility study that included a convenience sample of 217 community-dwelling older adults. Volunteers underwent DXA measurements and an assessment of functional status based on hand grip strength and physical performance. Six definitions were formed based on the 2010 EWGSOP criteria, but using different cutoff points for each of the three components, including regional cutoff points for ASMI derived from young Mexican adults. Several risk factors for sarcopenia were also assessed. Results The prevalence of sarcopenia varied according to the different definitions applied. The lowest level was found with the definition that applied regional ASMI-cutoff points (p < 0.01). The sarcopenic older adults had significant lower body weight, fat mass, and fat-free mass (FFM) than the nonsarcopenic subjects. The risk of sarcopenia increased with age and low FFM (p < 0.001). Conclusion The present study demonstrates the feasibility of the main study, and our data support the notion that using regional ASMI cutoff points resulted in a low prevalence of sarcopenia. Therefore, it is preferable to estimate the prevalence of this condition using ethnic- and gender-specific cutoff points and to explore associated factors such as low FFM.

Iron Deficiency Is the Strongest Predictor of Anemia in Indian Adolescents Aged 10–19 years: Evidence from the Comprehensive National Nutrition Survey

Abstract Objectives Anemia has been a severe public health problem in India for decades, owing to its multifactorial etiology. Large surveys investigating causal factors of anemia in both male and female adolescents 10–19 years have not been available, thus our understanding of optimal interventions has been limited. Using data from a recent national micronutrient survey, our aims were to 1) describe the prevalence of anemia and micronutrient deficiencies (MNDs) in Indian adolescents and 2) examine risk factors of anemia in this population. Methods Data were from India's Comprehensive National Nutrition Survey (CNNS, 2016–18). Analyses were run separately for females (F; n = 3966) and males (M; n = 3944) aged 10–19 years. CNNS used a multi-stage, stratified, probability proportion to size cluster sampling design. Prevalence of anemia and micronutrient deficiencies were estimated based on age- and gender-specific WHO cutoffs, using weights for biomarker data. We examined predictors covering socio-demography (age, sex, residence, religion, caste, schooling status, parental education), nutrition (diets, anthropometry, micronutrient status), hygiene, sanitation and access to school-based services. Multivariable logistic regression models were used to examine associations between these factors and anemia. Results Forty % of females and 18% of males were anemic. The prevalence of anemia was higher in adolescents aged 15–19 years (F: 48%, M: 18%) than those aged 10–14 years (F: 32%, M: 17%). Deficiencies of iron (F: 31%, M: 12%), vitamin B12 (F: 27%, M: 35%), folate (F: 34%, M: 39%), vitamin A (16% in both), vitamin D (F: 35%, M: 14%) and zinc (F: 28% girls, M: 35%) were also common. Iron deficiency was the strongest predictor of anemia (adjusted OR and 95% CI for F: 4.23, 2.99–5.99; M: 4.12, 2.78–6.12). Among females, other risk factors were being older (1.53, 1.09–2.15) and belonging to a disadvantaged caste (1.86, 1.12–3.09). Among males, other risk factors included being older (1.47, 1.02–2.13), being short for age (1.61, 1.12–2.31) and no mobile or internet access (1.59, 1.16–2.19). Conclusions Anemia and MNDs are highly prevalent in Indian adolescents. Iron deficiency is a major biological risk factor for anemia as are a range of social determinants. Program design and targeting should fully account for the range of risk factors. Funding Sources UNICEF, POSHAN.

Optimal Body Fat Percentage Cut-Off Values in Predicting the Obesity-Related Cardiovascular Risk Factors: A Cross-Sectional Cohort Study.

BackgroundReliable obesity assessment is essential in evaluating the risk of cardiovascular risk factors (CRFs). Non-availability of clearly defined cut-offs for body fat percentage (BF%), as well as a widespread application of surrogate measures for obesity assessment, may result in incorrect prediction of cardio-metabolic risk.PurposeThe study aimed to determine optimal cut-off points for BF%, with a view of predicting the CRFs related to obesity.Patients and MethodsThe study involved 4735 (33.6% of men) individuals, the Polish-Norwegian Study (PONS) participants, aged 45–64. BF% was measured with the aid of bioelectrical impedance analysis (BIA) method. The gender-specific cut-offs of BF% were found with respect to at least one CRF. A P-value approach, and receiver operating characteristic curve analyses were pursued for BF% cut-offs, which optimally differentiated normal from the risk groups. The associations between BF% and CRFs were determined by logistic regression models.ResultsThe cut-offs for BF% were established as 25.8% for men and 37.1% for women. With the exception of dyslipidemia, in men and women whose BF% was above the cut-offs, the odds for developing CRFs ranged 2–4 times higher than those whose BF% was below the cut-offs.ConclusionControlling BF% below the thresholds indicating an increased health hazard may be instrumental in appreciably reducing overall exposure to developing cardio-metabolic risk.

No effect of age, gender and total intracranial volume on brainstem MR planimetric measurements

ObjectivesMR planimetry of brainstem structures can be helpful for the discrimination of Parkinsonian syndromes. It has been suggested that ageing might influence brainstem MR measurements assessed by MR planimetry, while effects of gender and total intracranial volume (TIV) have not been assessed so far. The aim of this study was to evaluate age, gender and TIV effects on brainstem MR planimetric measures.MethodsBrainstem MR planimetric measures of diameters (midbrain, pons, middle and superior cerebellar peduncle) and areas (pons and midbrain), the derived ratios, and the magnetic resonance Parkinsonism index (MRPI) were assessed on 1.5-T MR images in a large cohort of 97 healthy controls and analysed for the influence of age, gender and TIV with univariate and multivariate linear models.ResultsNeither gender nor age effects on planimetric measurements were observed in the population relevant for the differential diagnosis of neurodegenerative Parkinsonism, aged 50 to 80 years, except for single area-derived measurements, with gender effects on pontine area (p = 0.013) and age effects on midbrain area (p = 0.037). Results were similar upon inclusion of the TIV in the analyses.ConclusionsThere is no need to correct for age, gender or TIV when using brainstem-derived MR planimetric measurements in the differential diagnosis of neurodegenerative Parkinsonism.Key Points• There were no gender effects on single or combined imaging measurements of the brainstem in the population aged 50 to 80 years, the age range relevant for the differential diagnosis of neurodegenerative Parkinsonism (except for pontine area).• There were no age effects on single or combined imaging measurements of the brainstem in the population aged 50 to 80 years, the age range relevant for the differential diagnosis of neurodegenerative Parkinsonism (except for midbrain area).• There is no need for age- or gender-specific cut-offs for the relevant age group.

Preoperative skeletal muscle index predicts postoperative supplemental nutrition needs in patients undergoing pancreatoduodenectomy

Presenter: Andrew DeAtkine | University of Alabama - Birmingham Background: Significant loss of skeletal muscle mass, or sarcopenia, is a common sequela of pancreatic cancer. Sarcopenic patients often exhibit decreased overall survival and major postoperative complications following pancreatoduodenectomy (PD). Few studies have investigated postoperative nutritional requirements for sarcopenic patients compared to non-sarcopenic patients following PD. We hypothesized that preoperative skeletal muscle index (SMI) may predict postoperative supplemental nutrition needs in patients undergoing PD. Methods: A retrospective review of all patients with preoperative CT imaging within 3 weeks of an elective PD from 2013 to March 2019 were identified by billing codes. The skeletal muscle area was measured at the third lumbar vertebra (L3) on CT imaging and indexed to patient height to calculate SMI. Sarcopenia was based on gender-specific cutoffs of SMI (≤52.4 cm2 /m2 in men and ≤38.5 cm2 /m2 in women). Results: We identified 159 patients in the study period undergoing PD with appropriate imaging for analysis. Median SMI of males (n=71) was 49.6 cm2 /m2 and females (n=88) was 37.2 cm2 /m2. The median SMI of female patients who required tube feeds at discharge (dTF) compared to females who did not was lower (32.0 [IQR 28.4-36.8] vs. 38.2 [IQR 34.7-45.7] cm2 /m2; p= 0.019). The median SMI of male patients who required dTF compared to patients who did not was also lower (42.9 [IQR 38.5-50.0] vs. 51.0 [IQR 45.3-56.4] cm2 /m2; p= 0.023). Receiver operating characteristic (ROC) curve analysis suggested SMI may be used to predict dTF for both females (AUC = 0.748) and males (AUC = 0.702). Youden’s index analysis of these curves suggested a SMI cut-off of ≤32.5 cm2/m2 for females and ≤42.9 cm2/m2 for males as prognostic of dTF. Standard cutoffs for sarcopenia did not show a significant association with dTF by univariate logistic regression; however, the above proposed SMI cutoffs did correlate with dTF for both female (OR: 6.76, 95%CI 1.08-42.88) and male (OR: 4.54, 95%CI 1.01-20.45) patient populations. Conclusion: A significant association exists between very low SMI and postoperative enteral nutrition requirements, suggesting that the patients with severe sarcopenia undergoing PD may benefit from the placement of a feeding tube at the time of resection.

Insulin Resistance Modifies the Effects of Omega-3 Acid Ethyl Esters on Left Ventricular Remodeling After Acute Myocardial Infarction (from the OMEGA-REMODEL Randomized Clinical Trial)

Insulin resistance early after acute myocardial infarction is associated with increased heart failure and mortality. OMEGA-REMODEL was a prospective double-blind 1:1 randomized control trial of patients with AMI. We reported that 6-month treatment with omega-3 fatty acid (O-3FA) 4 g/day attenuated cardiac remodeling accompanied by reduction in inflammation. We hypothesized that insulin resistance modifies the therapeutic effect of O-3FA on post-MI cardiac remodeling. The OMEGA-REMODEL study group was dichotomized according to cohort- and gender-specific median cutoff value of leptin-to-adiponectin ratio (LAR) at baseline (LAR-Hi vs LAR-Lo). Mixed model regression analyses were used to evaluate effect modification of O-3FA on reduction of left ventricular end-systolic volume index (LVESVI) by LAR status. Baseline LAR was evaluated on 325 patients (59 ± 11 years, 81% male). A total of 168 patients were categorized in LAR-Lo, and 157 in LAR-Hi. O-3FA treatment resulted in significant LVESVI reduction in patients with LAR-Lo but not with LAR-Hi (p = 0.0002 vs 0.66, respectively). Mixed model regression analysis showed significant modification of LAR on O-3FA's treatment effect in attenuating LVESVI (p = 0.021). In conclusion, this post-hoc efficacy analysis suggests that LAR status significantly modified O-3FA's treatment effect in attenuating cardiac remodeling. During the convalescent phase of acute infarct healing, patients with lower insulin resistance estimated by LAR appear to derive more therapeutic response from O-3FA toward improvement of LVESVI.

D-dimer testing, with gender-specific cutoff levels, is of value to assess the individual risk of venous thromboembolic recurrence in non-elderly patients of both genders: a post hoc analysis of the DULCIS study

Male patients, especially the young, are at a higher risk of recurrent venous thromboembolism (RVTE) than females. Recent scientific reports show the use of D-dimer does not help predict RVTE risk in males. In the present report, we reviewed the data obtained in the DULCIS study (main report published in Blood 2014), focusing on D-dimer results recorded in non-elderly patients of both genders included in the study, and their relationship with RVTE events occurring during follow-up. Using specifically designed cutoff values for positive/negative interpretation, serial D-dimer measurements (performed during warfarin treatment and up to 3 months after discontinuation of anticoagulation) in 475 patients (males 57.3%) aged ≤ 65 years were obtained. D-dimer resulted positive in 46.3% and 30.5% of males and females, respectively (p = 0.001). Following management procedure, anticoagulation was stopped in 53.7% of males and 69.5% of females, who had persistently negative D-dimer results. The rate of subsequent recurrent events was 1.7% (95% CI 0.5–4.5%) and 0.4% (95% CI 0–2.5%) patient-years in males and females, respectively, with upper limits of confidence intervals always below the level of risk considered acceptable by international scientific societies for stopping anticoagulation (< 5%). In conclusion, using sensitive quantitative assays with specifically designed cutoff values and serial measurements during and after discontinuation of anticoagulation, D-dimer testing is useful to predict the risk of RVTE and is of help in deciding the duration of anticoagulation in both male and female adult patients aged up to 65 years.

Neck circumference as a predictor of metabolic syndrome: A cross-sectional study

BackgroundData relating to the association between neck circumference (NC) and metabolic syndrome (MetS) in Southeast Asian population are scarce. AimsWe aimed to investigate association between NC and MetS in Thai adults, and to determine gender-specific NC cutoff values for predicting MetS. MethodsThis cross-sectional study enrolled patients aged ≥18years that attended the health examination center at Siriraj Hospital (Bangkok, Thailand) during February 2016 to January 2017. Demographic, clinical, anthropometric data, and biochemical investigations for diagnosing MetS were collected. Results390 patients (age 35.5±9.7years with range 20–73years; 81.3% women) were included. Mean NC was significantly higher in MetS than in non-MetS (p<0.001). Receiver operating characteristic curve analysis revealed NC ≥38cm and ≥33cm to be the optimal cutoff points for MetS in men and women, respectively. Body mass index and anthropometric indices were positively correlated with NC in both men and women. Among women, all components of MetS were significantly associated with NC. ConclusionsUsing the identified gender-specific cutoff values, NC is a useful tool for predicting MetS in Thais. NC was found to be well-correlated with almost all of the metabolic risk factors, anthropometric indices, and MetS components evaluated in this study.

Age- and Gender-Specific Prognostic Cutoff Values of Coronary Flow Velocity Reserve in Vasodilator Stress Echocardiography

Coronary flow velocity reserve (CFVR) of the left anterior descending artery is useful for risk stratification during stress echocardiography (SE) as an add-on to regional wall motion abnormalities (RWMA). We sought to provide sex- and age-specific prognostic cutoff values for CFVR. A total of 5,577 patients (2,284 women; 110 age≥85years) who underwent dipyridamole SE with evaluation of RWMA and CFVR were enrolled in a multicenter prospective SE registry. Death and myocardial infarction were the clinical end points. During 20months' median follow-up, 649 events (236 deaths, 413 infarctions) occurred: 288 in women and 38 in patients ≥85years. At receiver operating characteristics analysis, the best prognostic cutoff value for CFVR was similar for men (2.03) and women (2.02) and consistent across all age strata (<45years: 2.03; 45-54years: 2.04; 45-64years: 2.03; 65-74 and 75-84years: 2.0) except for patients >85years, who showed 1.90 as the optimal value. Independent predictors of mortality or myocardial infarction were RWMA (hazard ratio [HR]=5.42), reduced CFVR (HR=3.26), resting ejection fraction (HR=0.98), smoking habit (HR=1.41), age (HR=1.02), and prior percutaneous coronary intervention (HR=1.20) in patients age <85years; and RWMA (HR=5.42), smoking habit (HR=3.24), and resting ejection fraction (HR=0.97) in those age ≥85years. CFVR added a prognostic contribution over clinical parameters, resting ejection fraction, and stress-induced RWMA in all age and sex groups except men >85years. A sex-independent value of CFVR ≤2.0 provides the optimal prognostication across all age groups, except for those ≥85years in whom a cutoff ≤1.90 is needed. Risk stratification is more effective for all age groups when CFVR is combined with RWMA.

MON-119 APPLICATION OF GENDER SPECIFIC ULTRASONOGRAPHY CUT-OFFS TO DETERMINE RISK OF PROTEIN ENERGY WASTING IN HEMODIALYSIS PATIENTS

Muscle depletion in hemodialysis (HD) patients associates with protein energy wasting (PEW) but quantification of muscle mass is challenging in the outpatient HD setting. Quadriceps muscle thickness assessment by ultrasound imaging (UI) offers a potential surrogate measure for muscle mass, and we aimed to determine the applicability of gender specific UI cut-off values for identifying risk of PEW in HD patients. PEW risk assessment used the criteria set by International Society of Renal Nutrition and Metabolism (ISRNM), namely body mass index (BMI) <23 kg/m2, reduction >10% in mid-arm muscle circumference (MAMC) in relation to the 50th percentile of reference population, serum albumin <38 g/dL and dietary energy intake (DEI) <25 kcal/kg ideal body weight (IBW). Using a portable UI device, we measured the cross-sectional area of the quadriceps muscle namely rectus femoris (RFCSA) in 351 Malaysian HD patients participated in the on going multi-centered Palm Tocotrienol in Chronic Hemodialysis (PaTCH) screening study. Using receiving operating characteristic analysis, derived RFCSA cut-off values to identify patients at risk of PEW were <6.00 cm2 for men and <4.47 cm2 for women. Differences for PEW criteria and various nutritional parameters were examined based on gender specific categorization (men: <6.00cm2 vs >6.00cm2 and women: <4.47cm2 vs >4.47cm2). Mann-Whitney’s U tested continuous data while Chi-square tested categorical data. Both men (62%, p<0.001) and women (77%, p=0.003) with smaller RFCSA had a higher prevalence of PEW. As per PEW criteria, both men and women with smaller RFCSA had significantly poorer BMI (men: 21.08, IQR: 19.11-23.74kg/m2 vs 25.10, IQR: 22.96-27.50kg/m2, p<0.001; women: 20.54, IQR: 18.29-22.85 kg/m2 vs 25.49, IQR: 22.83-28.85 kg/m2, p<0.001) and MAMC (men: 22.74, IQR: 20.41-24.75cm vs 24.76, IQR: 23.58-26.36cm, p<0.001; women: 19.38 IQR: 17.73-22.45cm vs 23.57, IQR: 21.34-25.39cm, p<0.001). DEI was significantly lower only in men with RFCSA<6.00cm2 (22.53, IQR: 19.09-27.66kcal/kg IBW vs 25.67, IQR: 22.46-30.43kcal/kg IBW, p<0.001) but not in women (23.64, IQR: 20.16-29.34kcal/kg IBW vs 24.35, IQR: 20.90-28.18kcal/kg IBW, p>0.05). Irrespective of gender, significantly lower muscle and fat mass, handgrip strength, and higher Malnutrition-Inflammation Score (all p<0.05) were observed in patients with smaller RFCSA. Using gender-specific RFCSA cut-offs, the UI method enabled differential PEW identification based on ISRNM criteria, yet factoring heterogeneous body compositional differences mediated by gender.