Body Mass Index Groups Research Articles

Associations of hypertension, diabetes and heart disease risk with body mass index in older Chinese adults: a population-based cohort study

ObjectiveObesity is a well-established risk factor for disease. Controversy exists regarding the relative risk of morbidity and mortality in individuals who are overweight or underweight compared with individuals with a...

The association of diabetes with progression of sleep-disordered breathing based on a prospective cohort.

Prospective studies suggest that sleep-disordered breathing enhances the risk of diabetes. However, it remains unclear whether diabetes could worsen sleep-disordered breathing. The participants from Sleep Heart Health Study underwent two polysomnograms at a 5-year interval. The relationship of baseline diabetes to change in the apnoea-hypopnoea index (AHI) was examined based on general linear models, adjusting for demographics, lifestyles, history of hypertension, pulmonary function, length of follow-up and baseline AHI. In total, 161 of the 2603 participants were diagnosed with diabetes at the first polysomnograms. Compared with participants without diabetes, those with diabetes had a higher baseline and larger increases in follow-up AHI and obstructive apnoea index (oAI). Diabetes increased 2.52 events per hour (95% confidence interval 0.45-4.59; p = .017) for AHI change and 1.13 events per hour (95% confidence interval 0.04-2.23; p = .042) for oAI change, respectively. In addition, subgroup analysis suggested that the association was consistent across baseline obstructive sleep apnoea severity and body mass index groups. Baseline diabetes was associated with worsening sleep-disordered breathing over 5 years, which mainly increased the change in AHI and oAI.

Normative Data for Modified Ferriman-Gallwey Score and the Prevalence of Hirsutism in Young South Indians.

The modified Ferriman-Gallwey score (mFGS) cut-offs to define hirsutism vary with ethnicity, whereas no such cut-offs are established for Indian women. Well-conducted studies that report the prevalence of hirsutism in Indian women are limited. Hence, this study was conducted to report the prevalence of hirsutism and population-specific cut-offs for mFGS in South-Indian women. In this cross-sectional, community-based study, adult women in reproductive age (18-40 years) were screened for hirsutism by two trained medical students. Hirsutism was assessed using the mFGS and case record file. A total of 453 women were included in the study [age: 22.15 ± 5.27 years; body mass index (BMI): 22.5 ± 3.58 kg/m2]. The median (IQR) mFGS was 1(0-3); only eight participants (1.8%) had mFGS ≥8, and all these eight women had at least another PCOS-related feature (irregular menstrual cycles and/or topical therapy-resistant acne). The median (IQR) mFGS in the PCOS phenotype group (n = 52), non-PCOS-phenotype group (n = 401), non-obese group (<25 kg/m2), non-PCOS-phenotype group (n = 322), obese group (≥ 25 kg/m2), non-PCOS-phenotype group (n = 79), overweight group (BMI: 23-25 kg/m2), non-PCOS-phenotype group (n = 74), normal BMI group (<23 kg/m2), and non-PCOS-phenotype group (n = 248) were 4 (1-6), 1 (0-2), 1 (0-2), 2 (1-3), 1 (0-2), and 1 (0-2), respectively. The 97.5th centile mFGS in all groups except the PCOS phenotype group and the obese and non-PCOS phenotype groups was 5. We propose a new mFGS cut-off of 5 in the South-Indian population for evaluation of hirsutism, and the prevalence rates of hirsutism in the South-Indian population were 1.8% and 9.9% using mFGS of ≥8 and ≥5 to define hirsutism, respectively.

Optimal Weight-Based Dosing of Vancomycin to Achieve an Area Under the Curve of 400 to 600 Stratified by Body Mass Index

Background: In 2020, the American Society of Health System Pharmacist (ASHP) and Infectious Diseases Society of America (IDSA) published a consensus guideline for vancomycin management, recommending area under the curve (AUC) as the preferred monitoring strategy. These guidelines recommend doses of 15-20 mg/kg every 8 to 12 hours for most patients with normal renal function. However, in extreme body weights, standard dosing may deviate to provide a therapeutic AUC. The primary objective of this pharmacokinetic study is to evaluate the optimal vancomycin weight-based dosing strategy that achieves a therapeutic AUC of 400-600 stratified by body mass index (BMI). The secondary objective is to evaluate the incidence of acute kidney injury (AKI) based on BMI. Methods: Patients were identified from two sites within the Department of Veterans Affairs who received vancomycin for at least 48 hours and had at least one steady-state level from January 2015 through July 2022. Regimens with a frequency of ≤8 hours or patients with baseline creatine clearance of &lt; 5 0 ml/min were excluded. Patients were categorized based on the Center for Disease Control BMI groups: healthy weight, overweight, or obese. The online vancomycin calculator, VancoPK©, was utilized to calculate AUC. Renal function at baseline and during vancomycin therapy was collected. Descriptive statistics were used for data analysis. Continuous outcomes were summarized using mean and standard deviation. The primary and secondary endpoints were analyzed using the analysis of variance and Fisher’s exact tests, respectively. Statistical significance was established at a p-value of &lt; 0 .05. Results: A total of 347 unique vancomycin regimens were included: 120 in the healthy weight group, 101 in the overweight group, and 126 in the obese group. The average total daily doses that achieved a therapeutic AUC were 1971mg (15.6mg/kg/dose), 2298mg (15mg/kg/dose), and 2524mg (12.6mg/kg/dose) for the healthy weight, overweight, and obese groups, respectively. There was a statistically significant difference among these groups. AKI occurred in 10/254 (3.9%) unique patients: 2/89 (2.2%) in the healthy weight group, 3/71 (4.2%) in the overweight group, and 5/94 (5.3%) in the obese group. This did not reach statistical significance. Conclusions: Vancomycin dosing regimens largely followed guideline recommendations. However, the average vancomycin mg/kg/dose that achieved a therapeutic AUC decreased as BMI increased, which was a statistically significant trend. While further research is needed to draw clinically impactful conclusions, these findings suggest that a lower mg/kg vancomycin dose in obesity may be needed to achieve therapeutic targets.

Effects of overweight and obesity on lower limb walking characteristics from joint kinematics to muscle activations

BackgroundObesity is a crucial factor that increases the risk of initiating and advancing knee osteoarthritis. However, it remains unclear how obesity directly impacts the biomechanical experience of the lower limb joints, potentially triggering or exacerbating joint degeneration. This study investigated the interactive effects of BMI augmentation on lower limb kinematics, kinetics, and muscle activations during walking. MethodologyA group of 60 participants underwent a three-dimensional gait analysis. These individuals were categorized into three groups based on their body mass index (BMI): those with a BMI below 25 were classified as having a healthy weight, those with a BMI between 25 and 30 were categorized as overweight, and those with a BMI exceeding 30 were considered obese. This study analyzed the gait of 60 participants categorized by BMI. During walking trials, they recorded ground reaction forces electromyography of leg muscles like the gastrocnemii, hamstrings, and quadriceps. Lower limb joint angles and net moments were also calculated. Statistical mapping identified variations in kinematic, kinetic, and muscle activation patterns across the stance phase between BMI groups. ResultsThe results displayed distinct biomechanical patterns in obese individuals. Notably, there was a significant increase in flexion observed in the hip and knee joints (P < 0.001) during the initial stance phase and an increase in hip and knee adduction angles and moments throughout the entire stance phase (P < 0.001). Additionally, muscle activations underwent significant changes (P < 0.01), with a positive correlation noted with the BMI factor. This correlation was most pronounced during the early stance phase for the quadriceps and hamstring muscles and the late stance phase for the gastrocnemius. ConclusionThese findings represent a comprehensive picture that contributes to understanding how excess weight and obesity influence joint biomechanics, highlighting the associated risk of joint osteoarthritis.

BMI moderates the relationship between depression and chronic obstructive pulmonary disease: A cross‑sectional survey

BackgroundPrior research has established a connection between depression and chronic obstructive pulmonary disease (COPD). However, the influence of age and BMI on this association remains unclear. ObjectivesWe used the National Health and Nutrition Examination Survey (NHANES) database to explore the relationship between depression and COPD, and to investigate whether age and Body mass index (BMI) act as moderators in this relationship. MethodsWe analyzed data from 10,940 participants in the NHANES database. Depression served as the independent variable. COPD status served as the outcome variable. We employed multivariable logistic regression to examine the relationship between depression and COPD. ResultsOf the 10,940 respondents surveyed, about 3.9 % had COPD and 8.5 % had depression. The prevalence of depression in COPD patients was significantly greater than the prevalence of overall respondents (21.1 % VS.8.5 %). We found that the association between depression and COPD was mediated by BMI status. Controlling for other covariates, the association between depression and COPD increased significantly. For the underweight group, the impact of depression on the risk of COPD was lower compared to the normal BMI group. ConclusionThis study confirms a significant association between depression and COPD, with BMI serving as a moderator. These findings enhance our understanding of the complex interplay between depression and COPD and underscore the importance of considering individual physical health characteristics in clinical assessments. The results have significant implications for clinical practice and public health policymaking.

Gestational weight gain below recommendations and adverse maternal and child health outcomes for pregnancies with overweight or obesity: a United States cohort study

BackgroundThe current Institute of Medicine (IOM) pregnancy weight gain guidelines were developed using the best available evidence but were limited by substantial knowledge gaps. Some have raised concern that the guidelines for individuals affected by overweight or obesity are too high and contribute to short- and long-term complications for the mother and child. ObjectivesTo determine the association between pregnancy weight gain below the lower limit of the current IOM recommendations and risk of 10 adverse maternal and child health outcomes among individuals with overweight and obesity. MethodsWe used data from a prospective cohort study of United States nulliparae with prepregnancy overweight (n = 955) or obesity (n = 897) followed from the first trimester to 2–7 y postpartum. We used multivariable Poisson regression to relate pregnancy weight gain z-scores with a severity-weighted composite outcome consisting of ≥1 of 10 adverse outcomes (gestational diabetes, preeclampsia, unplanned cesarean delivery, maternal postpartum weight increase >10 kg, maternal postpartum metabolic syndrome, infant death, stillbirth, preterm birth, small-for-gestational age birth, and childhood obesity). ResultsPregnancy weight gain z-scores below, within, and above the IOM-recommended ranges occurred in 5%, 13%, and 80% of pregnancies with overweight and 17%, 13%, and 70% of pregnancies with obesity. There was a positive association between pregnancy weight gain z-scores and all adverse maternal outcomes, childhood obesity, and the composite outcome. Pregnancy weight gain z-scores below the lower limit of the recommended ranges (<6.8 kg for overweight, <5 kg for obesity) were not associated with the severity-weighted composite outcome. For example, compared with the lower limit, adjusted rate ratios (95% confidence interval) for z-scores of −2 standard deviations in pregnancies with overweight (equivalent to 3.6 kg at 40 wk) and obesity (−2.8 kg at 40 wk) were 0.99 (95% confidence interval [CI]: 0.91, 1.06) and 0.97 (95% CI: 0.87, 1.07). ConclusionsThese findings support arguments to decrease the lower limit of recommended weight gain ranges in these prepregnancy body mass index groups.

Association of Umbilical Cord Perilipin 2 Levels with Neonatal Anthropometric Measurements in Infants of Diabetic Mothers.

Perilipin 2 (PLIN2) is a protein that contributes to the formation and stability of lipid droplets. It has been associated with the development of several diseases, particularly related to glucose and lipid metabolism. In infants of diabetic mother (IDM), fetal hyperinsulinaemia leads to increased adipose tissue and macrosomia. The aim of this study was to investigate the relationship between PLIN2 levels and anthropometric measurements in the IDM and to investigate the relationship between PLIN2 levels and IGF-1, IGF-2 and leptin levels. The study group consisted of IDMs, while the control group consisted of infants born to non-diabetic mother, matched for gestational week and gender. Cord blood samples were collected from all patients to determine PLIN2, IGF-1, IGF-2 and leptin levels. Anthropometric measurements were taken for all patients at birth. There were no differences between the groups in birth weight, birth length, head circumference and body mass index (BMI), but middle arm circumference, triceps, biceps, subscapular and suprailiac skinfold thickness were significantly higher in the IDM. While PLIN2, IGF-1, IGF-2 and leptin levels were similar between groups, there was a strong correlation between PLIN2 levels and IGF-2 and leptin levels. Even if IDMs were not macrosomic, the presence of high subcutaneous adipose tissue was not associated with PLIN2.

Serum Metabolomic and Lipidomic Profiling Reveals the Signature for Postoperative Obesity among Adult-Onset Craniopharyngioma.

Craniopharyngioma patients often suffer from a diminished quality of life after surgery, which is usually associated with metabolic disorders and hypothalamic obesity. However, the precise etiology of these conditions remains elusive. To identify the metabolic changes after surgery, we conducted a cross-sectional study using metabolomic and lipidomic analysis to profile metabolic alterations in adult-onset craniopharyngioma patients with postoperative obesity. A cohort of 120 craniopharyngioma patients who had undergone surgery were examined. Differential analyses, including clinical characteristics, serum metabolome, and lipidome, were conducted across distinct body mass index (BMI) groups. Our findings indicated no statistically significant differences in age, sex, and fasting blood glucose among postoperative craniopharyngioma patients when stratified by BMI. However, a noteworthy difference was observed in uric acid and blood lipid levels. Further investigation revealed that alterations in metabolites and lipids were evidently correlated with increased BMI, indicating that postoperative obesity of craniopharyngioma patients affected their whole-body metabolism. Additionally, the multi-omics analysis identified specific metabolites and lipids, including uric acid and DG(18:2/20:4), as contributors to the metabolic disorders associated with postoperative obesity of craniopharyngioma patients. This work provides valuable insight into the involvement of metabolites and lipids in metabolic disorders subsequent to craniopharyngioma surgery.

Comprehensive assessment of body mass index effects on short-term and long-term outcomes in laparoscopic gastrectomy for gastric cancer: a retrospective study

To examine the influence of Body Mass Index (BMI) on laparoscopic gastrectomy (LG) short-term and long-term outcomes for gastric cancer. A retrospective analysis was conducted on gastric cancer patients undergoing LG at the Third Hospital of Nanchang City from January 2013 to January 2022. Based on WHO BMI standards, patients were categorized into normal weight, overweight, and obese groups. Factors such as operative time, intraoperative blood loss, postoperative complications, and overall survival were assessed. Across different BMI groups, it was found that an increase in BMI was associated with longer operative times (average times: 206.22 min for normal weight, 231.32 min for overweight, and 246.78 min for obese), with no significant differences noted in intraoperative blood loss, postoperative complications, or long-term survival among the groups. The impact of BMI on long-term survival following LG for gastric cancer was found to be insignificant, with no notable differences in survival outcome between different BMI groups. Although higher BMI is associated with increased operative time in LG for gastric cancer, it does not significantly affect intraoperative blood loss, postoperative complications, recovery, or long-term survival. LG is a feasible treatment choice for obese patients with gastric cancer.

Gender Disparities and Ultrasonographic Evaluation of Anatomic Features of Anterolateral Thigh Flap (ALT) in Individuals with Diverse BMI: A Retrospective Clinical Study

BackgroundThe anterolateral thigh (ALT) flap plays a crucial role in reconstructive surgeries, providing versatile and reliable soft-tissue coverage. Flap thickness is a critical determinant of tissue volume and quality. Vascular factors, including the vascular diameter of the perforators and the length of the vascular pedicle, significantly influence flap viability and postrepair outcomes. To enhance preoperative assessment, this study integrated gender and body mass index (BMI) to analyze the anatomical characteristics of ALT flaps. MethodsThis study used somatic penetrating ultrasonography to examine bilateral ALT flaps in patients. This study analyzed the relationship between gender and ALT flap thickness, vascular diameter of the perforators, and vascular pedicle length. Chi-square test was used to assess variations in age and gender. Multiple t-tests compared flap thickness, vascular diameter, and pedicle length between men and women in different BMI groups. ResultsA total of 158 patients were included in this study from January 2018 to December 2022. In BMI < 24 and BMI ≥ 24.0 groups, males had lower ALT flap thickness than females (p < 0.0001 in each subgroup). Similarly, the vascular diameter of the perforators followed the same trend, with females having larger vascular diameters than males in BMI < 24 and BMI ≥ 24.0 groups. In terms of vascular pedicle length, males had longer pedicle length than females in both BMI < 24 and BMI ≥ 24.0 groups (p < 0.05 in each subgroup). ConclusionsFemales demonstrate greater ALT flap thickness and larger vascular diameter of the perforators than males, whereas males have a longer length of the vascular pedicle.

Evaluation of Sarcopenia in Patients with Monoclonal Gammopathy of Undetermined Significance.

Background: We aimed to determine the prevalence of sarcopenia in patients with monoclonal gammopathy of undetermined significance (MGUS) and to evaluate the links between MGUS and sarcopenia. Methods: Eighty-two patients with a diagnosis of MGUS were enrolled in the study. Muscle strength was measured using the handgrip dynamometer. Physical performance was assessed by assessing gait speed over a 6-minute walking test. Muscle mass was determined using a bioelectrical impedance analyzer. Results: Sarcopenia was confirmed in 34.15% of patients. Male predominance was demonstrated in MGUS subjects with sarcopenia, particularly patients with low hand grip strength, low appendicular skeletal muscle mass (ASMM), or low ASMM index (p < 0.001, 0.013, and 0.001, respectively). Higher age and lower serum free light-chain Lambda levels were shown in MGUS patients with low muscle function scores compared to normal scores (p < 0.001, and 0.014, respectively). In addition, having a low ASMM score was related to low body mass index and high-risk group (p = 0.020, 0.033, respectively). Conclusions: We demonstrated that the frequency of sarcopenia is high in patients with MGUS. Whether sarcopenia has a possible role as a factor contributing to the pathogenesis of MGUS should be supported by further studies containing longitudinal data.

Association between body mass index and short-term outcomes of laparoscopic right hemicolectomy for colon cancer

BackgroundLaparoscopic right hemicolectomy can be technically challenging in patients with increased body mass index, reportedly associated with higher surgical site infection (SSI) and incisional hernia rates. We aimed to assess the association between increased body mass index and short-term outcomes of laparoscopic right hemicolectomy. MethodsThis retrospective cohort study included patients with colon cancer who underwent laparoscopic right hemicolectomy between 2011 and 2021. Patients were managed with a standardized care protocol that comprised preoperative, intraoperative, and postoperative measures and were divided according to body mass index—normal body mass index (18–24.9 kg/m2), overweight (25–29.9 kg/m2), and obesity (≥30 kg/m2). Body mass index groups were compared for baseline characteristics and outcomes. The main outcome measures were operative time, hospital stay, 30-day complications, reoperation, number of harvested lymph nodes, and resection status. ResultsA total of 270 patients (50% male sex; mean age: 68.7 ± 13.5 years) were included—28.5% had normal body mass index, 47% were overweight, and 24.5% had obesity. Mean operative times in obese and overweight patients were significantly longer than patients with normal body mass index (172.1 and 168.8 versus 143.3 minutes, P = .01). Compared to normal body mass index, obesity was associated with significantly higher odds of incisional SSI (odds ratio: 9.29, P = .039). Body mass index had a significant positive correlation with operation time (r = 0.205, P = .004) and incisional SSI (r = 0.126, P = .04). Body mass index groups had similar hospital stays, 30-day complications and mortality, anastomotic leak, ileus, and reoperation. ConclusionPatients with increased body mass index had longer operative times and higher SSI rates, yet similar hospital stays and comparable 30-day complication rates, mortality, and reoperation to patients with normal body mass index.

Interactive effects of Composite Dietary Antioxidant Index with Body Mass Index for the risk of stroke among U.S. adults: insight from NHANES 2001-2018.

This cross-sectional study aims to explore the interactive effects of the Composite Dietary Antioxidant Index (CDAI) and Body Mass Index (BMI) on stroke risk among U.S. adults, utilizing data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2001 and 2018. The analysis involved 42,042 participants from a representative sample of non-institutionalized U.S. civilians, selected through a stratified, multistage probability sampling method. Dietary intake data were collected over two 24-h periods using the Automated Multiple-Pass Method. The study calculated a modified CDAI to assess dietary antioxidant intake, excluding supplements and water sources. Statistical methods included multivariable logistic regression and Generalized Additive Models (GAM) to evaluate the interaction between CDAI scores and BMI in relation to stroke risk, adjusting for a wide range of demographic, lifestyle, and health covariates. The research identified a significant interaction between CDAI scores and BMI categories in stroke risk assessment. While a negative correlation was observed between CDAI scores and stroke risk across the total population (OR 0.97, 95% CI 0.96-0.99), this relationship varied notably across different BMI groups. In participants with a BMI ≥25, a statistically significant negative association persisted, displaying a non-linear pattern. The study also revealed an inflection point in the CDAI score, indicating a shift in the relationship between dietary antioxidants and stroke risk. This study underscores the complex interaction between dietary antioxidant intake and BMI in determining stroke risk among U.S. adults. The findings suggest that individuals with higher BMI may experience more pronounced benefits from dietary antioxidants in stroke prevention. These insights could inform targeted dietary recommendations and public health strategies aimed at reducing stroke risk, particularly in populations with higher BMI. Further research is needed to fully understand these interactions and their implications for stroke prevention guidelines.

Comparison of Bioelectrical Impedance Analyser (BIA) with Dual-Energy X-ray Absorptiometry (DXA) Scan in Assessing the Body Composition of Adult Individuals with Type 2 Diabetes Mellitus

Abstract Introduction: Assessing the body composition is important in adult patients with type 2 diabetes mellitus to prevent and achieve optimum control during treatment. Bioelectrical impedance analysis (BIA), being a more affordable method of assessing the body composition, should therefore be compared with the gold standard dual-energy X-ray absorptiometry (DXA) to look for a correlation between the two and the potential of BIA to be used widely in this population. A cross-sectional observational study was conducted on 60 patients attending the endocrinology outpatient department (OPD) of a tertiary care centre in Kolkata, India. Methods: Body composition was measured by both BIA and DXA. Intra-class correlation (ICC) values were calculated between the two methods for fat mass and fat-free mass for three body mass index (BMI) groups and overall. Results: DXA and BIA correlated well for both fat mass and fat-free mass in the entire study population and in the non-overweight non-obese group (BMI &lt;23) and the obese group (BMI ≥25). However, the overweight group (23 ≥BMI &lt;25) did not correlate well with the above-mentioned parameters. Conclusion: We suggest interchangeable use of the two methods in the non-overweight non-obese (BM I &lt;23) and obese (BMI ≥25) BMI groups of adult subjects with type 2 diabetes mellitus. However, the low correlation for all parameters in the overweight group points towards exercising caution when taking such measurements by BIA and planning a further study with a larger cohort of such individuals to better evaluate the said correlation.

Body Mass Index as a Factor Influencing Oocyte Competence and Implantation Potential – Distribution and Results in 4,882 Women Undergoing Fertility Treatment

Abstract Introduction The large amount of excess adipose tissue affects negatively every single step of the assisted reproductive treatment process – from the controlled ovarian hyperstimulation (COH) to obstetric complications and health consequences for the fetus. A number of scientific data show correlation between impaired clinical pregnancy rates (CPR) and obese patients maintaining high body mass index (BMI). The debate whether high proportion of body fat negatively affects oocyte quality or only impacts endometrial receptivity remains open. Aim The aim of this study is to investigate the specific effect of the different BMI range in patients undergoing assisted reproductive technology (ART) treatment with reference to oocyte quality, fertilization capacity and Implantation potential. Materials and methods We analyzed a total of 4,882 women from partner couples who underwent ART treatment. Height and weight data were entered at the start of the in vitro fertilization (IVF) procedure. According to their BMI the female patients were divided in four distinct groups: in group 1 (underweight and BMI below 18.5 kg/m2) – 498 women, group 2 (normal range from 18.5 to 24.9 kg/m2) – 3021 women, group 3 (overweight with BMI between 25 – 29.9 kg/m2) – 789 women and group 4 (obese with BMI over 30 kg/m2) - 484 women. Results Distribution of the women in different BMI groups indicates that most of the Bulgarian patients undergoing fertility treatment are in the normal range. No association between BMI and ovarian response was found. A total of 33,205 oocytes were obtained after the COH. The mean numbers of the retrieved oocytes were similar (6,85 in group 1; 6,83 in group 2, 6,77 in group 3 and 6,67 in group 4) per woman and the fertilization rate was comparable in the four groups as it varies between 74-75%. Proportional categories of good, fair and bad embryos at cleavage stage were found. On the contrary according to CPR, Statistical difference between normal weight group (34,38%) versus overweight (29,6%) and obese groups (28,80%) (p &lt; 0,05) was found. Conclusion No correlation was found between the number of the retrieved oocytes and BMI values. Statistically lower pregnancy rates were reported in overweight women with BMI ≥ 25 kg/m2 group and further onwards in the obesity group (BMI ≥ 30 kg/m2), which may be associated with impaired endometrial receptivity as a result of abnormally high levels of adipose tissue.

Impact of body mass index (BMI) on survival outcomes in patients with cancer treated with immune checkpoint inhibitors (ICPI): A systematic review and meta analysis.

2624 Background: With the increased adoption of ICPI in treating various cancers, there is active exploration of individual-level factors that could predict treatment responses. A high-body mass index (BMI) induces a chronic inflammatory state and could drive T-cell dysfunction through high leptin levels, which may confer better outcomes with ICPI usage. However, there are conflicting outcomes in different studies. We performed this systematic review and meta-analysis to evaluate survival outcomes with ICPI in patients with BMI ≥25 vs &lt;25 Kg/m2. Methods: A comprehensive search was conducted across PubMed, Embase, Scopus, and web of science databases. The original studies evaluating response [overall survival (OS) and progression free survival (PFS)], to ICPI-based therapies among adult cancer patients, stratified by BMI groups (high, BMI ≥25Kg/m2 or low, BMI &lt;25Kg/m2), were included. RevMan version 5.4.1 was used for statistical analysis. A random effect model with inverse variance as the statistical method was used for hazard ratio (HR) and 95% confidence interval (CI). Results: Of 1215 identified studies, 22 observational studies, comprising 5859 patients (60.3% males) met the inclusion criteria. ECOG performance score was reported as 0-1 for 40.3% patients, and ≥2 for 7.1% patients. In 12-studies only PD-1 and/or PD-L1 inhibitors were administered, but no CTLA-4 inhibitor. Most frequently reported cancers were non-small cell cancer of lung (40.9%), melanoma (36.6%), and renal cell cancer (31.8%) in advanced/metastatic stages. Higher BMI, compared to low BMI, favored significant improvement in PFS [HR 0.86; 95% CI (0.76, 0.99), P= 0.03, I2 47%], and OS [ HR 0.73; 95% CI (0.62, 0.85), P&lt; 0.0001, I2 53%] with any ICPI-based regimens. Similar findings were noted for patients treated with PD-1/PDL1 inhibitors [Table]. Conclusions: This study contributes to the evidence that BMI of 25 kg/m2 or higher exerts a beneficial impact on PFS and OS among cancer patients treated with ICPI. The favorable impact underscores the significance of considering BMI as a potential prognostic factor in ICPI therapy. However, the precise underlying mechanisms responsible for this observation warrant further investigation to deepen our understanding and potentially optimize therapeutic strategies in this patient population. [Table: see text]

Preoperative BMI and long-term survival in NAFLD-associated hepatocellular carcinoma: A multicenter study revealing a paradox.

e16262 Background: As non-alcoholic fatty liver disease (NAFLD) emerges as a key factor in hepatocellular carcinoma (HCC) development, exacerbated by the global obesity epidemic, the prognostic role of body mass index (BMI) in NAFLD-HCC patients undergoing surgical resection remains unclear. This study aims to elucidate the impact of preoperative BMI on long-term outcomes after hepatectomy in patients with NAFLD-HCC, offering insights for more personalized treatment strategies. Methods: In this multicenter retrospective study, patients with early-stage (BCLC stage 0/A) NAFLD-HCC who underwent curative hepatectomy between 2009 and 2022 were analyzed. Based on preoperative BMI, patients were classified into lean ( &lt; 23.0 kg/m2), overweight (23.0-27.4 kg/m2), and obese (≥ 27.5 kg/m2) categories. The primary endpoints, overall survival (OS) and recurrence-free survival (RFS), were compared across these BMI groups. Results: This large multicenter cohort comprised 309 early-stage NAFLD-HCC patients: 66 lean, 176 overweight, and 67 obese. Liver-, tumor-, and surgery-related characteristics were similar across groups. Lean patients exhibited significantly lower 5-year OS and RFS (55.4% and 35.1%, respectively) compared to overweight patients (71.3% and 55.6%, P = 0.017 and P = 0.002), with outcomes comparable to obese patients (48.5% and 38.2%, P = 0.939 and P = 0.442). Multivariable Cox-regression analysis revealed lean BMI, but not obese BMI, as an independent predictor of decreased OS (HR: 1.69; 95%CI: 1.06-2.71; P = 0.029) and RFS (HR: 1.72; 95% CI: 1.17-2.52; P = 0.006). Conclusions: This study challenges conventional perceptions of BMI in cancer prognosis, revealing that lean NAFLD-HCC patients have poorer long-term surgical outcomes compared to their overweight and obese counterparts. These findings underscore the need for a nuanced understanding of BMI’s role in NAFLD-HCC management and prompt further investigation into the underlying biological mechanisms of this paradox.

Weighing the Impact: The Influence of Body Mass Index on Facility Costs in Total Joint Arthroplasty

BackgroundUsing time-driven activity-based costing (TDABC), a novel cost calculation method that more accurately reflects true resource utilization in health care, we sought to compare the total facility costs across different body mass index (BMI) groups following total joint arthroplasty (TJA). MethodsThe study consisted of 13,806 TJAs (7,340 total knee arthroplasties [TKAs] and 6,466 total hip arthroplasties [THAs]) performed between 2019 and 2023. The TDABC data from an analytics platform was employed to depict total facility costs, comprising personnel and supply costs. For the analysis, patients were stratified into four BMI categories: <30, 30 to <35, 35 to <40, and ≥40. Multivariable regression was used to determine the independent effect of BMI on facility costs. ResultsWhen indexed to patients who had BMI <30, elevated BMI categories (30 to <35, 35 to <40, and ≥40) were associated with higher total personnel costs (TKA 1.03x versus 1.07x versus 1.13x, P < .001; THA 1.00x versus 1.08x versus 1.08x, P < .001), and total supply costs (TKA 1.01x versus 1.04x versus 1.04x, P < .001; THA 1.01x versus 1.02x versus 1.03x, P = .007). Total facility costs in TJAs were significantly greater in higher BMI categories (TKA 1.02x versus 1.05x versus 1.08x, P < .001; THA 1.01x versus 1.05x versus 1.05x, P < .001). Notably, when incorporating adjustments for demographics and comorbidities, BMI values of 35, 40, and 45 relative to BMI of 25, exhibit a significant association with a 2, 3, and 5% increase in total facility cost for TKAs and a 3, 5, and 7% increase for THAs. ConclusionsUsing TDABC methodology, this study found that overall facility costs of TJAs increase with BMI. The present study provides patient-level cost insights, indicating the potential need for reassessment of physician compensation models in this population. Further studies may facilitate the development of risk-adjusted procedural codes and compensation models for public and private payors. Level of EvidenceLevel IV, economic and decision analyses.

The role of obesity in the clinicopathologic variables and treatment of early stage breast cancer.

e12555 Background: Breast cancer (BC) is the second most common cancer among women in the United States. Studies have found obesity to be a key risk factor for BC, in which obese patients have higher recurrence and mortality. With 40% of the United State population being obese, we studied the differences in clinicopathological variables and treatment of normal-weight (NW) and obese patients with BC in a community-based cancer center within Florida. Methods: In this retrospective study, 535 patients with non-metastatic breast cancer (NMBC) diagnosed between January 1st, 2015 and December 31st, 2021 were identified. A Two Proportion Z test was done to evaluate the association between body mass index (BMI) groups of NW (BMI &lt;25) and obese (BMI &gt;30) patients amongst several independent variables. Variables included are histology, grade, estrogen and progesterone receptor status (ER/PR), human epidermal growth factor receptor 2 (HER2) status, chemotherapy, and surgical modality. Results: Results demonstrated that only Grade 2 histology was statistically more prevalent in NW vs obese patients (p &lt; 0.01). 218 patients underwent mastectomy with 54% in the obese BMI. 317 patients were treated with lumpectomy with 65% in the obese BMI. Of the 211 NW patients, 97% were HER2 negative or low compared to 96% in the obese group. Only 3% and 4% of patients were HER2 positive in NW and obese groups, respectively. Of the obese patients, 40% were treated with neoadjuvant/adjuvant chemotherapy compared to 33% of NW patients (p=0.05). Factors such as mean age, smoking status and other demographic information were not statistically different between the groups. Conclusions: This study demonstrates that obese NMBC patients required chemotherapy more often than NW patients and that histologic characteristics cannot explain this difference in treatment. Factors such as stage at diagnosis or BC prognostic scores may contribute to the increased use of chemotherapy in obese patients. A limitation of this study is that the stage of disease at diagnosis was not abstracted, as a new staging system for BC was implemented in 2018. Furthermore, studies have suggested that, in obese patients, difficulty in identification of a mass in clinical or self -breast exam and poor compliance with screening guidelines may delay diagnosis of BC at an earlier stage. Obesity has many negative health effects, and with the increased use of novel weight loss medications, it will be important in the future to study the impact this may have on breast cancer development, histopathologic features, and treatment of patients with breast cancer. [Table: see text]