Body Mass Index Groups Research Articles

Abstract 4136804: Effect of Obesity on Arrhythmia Recurrence and Complications following Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation in the REAL-AF Registry

Introduction: Obesity is an important risk factor for atrial fibrillation and its prevalence in the United States is rising. The effect of obesity on outcomes following pulmonary vein isolation in a contemporary setting has not been extensively evaluated. Research Questions: - Is higher body mass index (BMI) associated with increased risk of atrial arrhythmia recurrence following pulmonary vein isolation? - Is higher BMI associated with increased risk of post-procedural complications? Method: - The REAL-AF (Real-world Experience of Catheter Ablation for the Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation; ClinicalTrials.gov Identifier: NCT04088071) Registry is a multicenter, prospective observational registry of patients undergoing radiofrequency catheter ablation of atrial fibrillation. We included 2666 patients with paroxysmal atrial fibrillation undergoing index ablation from January 2018 through April 2023. We excluded patients with missing covariates. - The primary outcome was freedom from atrial arrhythmia following ablation. Rhythm monitoring was standardized using patch monitor at 6 month and 1 year. Time-to-event analysis was performed using a 3-month blanking period. Results: - Baseline characteristics are shown in Table 1. The median follow-up was 382 days (IQR: 363-410). - There was a trend toward higher rate of atrial arrhythmia following ablation for patients in the highest BMI group compared with the reference group (BMI<25) ( BMI≥40: HR = 1.41 (0.94-2.12), p= 0.092). There was no difference in the rate of atrial arrhythmia for other BMI groups ( BMI 25 - <30: HR = 0.90 (0.65-1.23), p = 0.5; BMI 30 - <35: HR = 0.89 (0.64-1.23), p = 0.5; BMI 35 - <40: HR = 0.87 (0.57-1.32), p = 0.5). This trend persisted following adjustment for baseline covariates ( BMI 25 - <30: HR = 1.01 (0.77-1.33), p > 0.9; BMI 30 - <35: HR = 0.97 (0.72-1.32), p = 0.9; BMI 35 - <40: HR = 1.01 (0.66-1.55), p > 0.9; BMI≥40: HR = 1.57 (0.96-2.57), p =0.071). - First-pass isolation rates progressively decreased with higher BMI (Table 2). - Complication rates were low across all BMI groups (Table 2). Conclusions: - Severely obese patients with BMI ≥40 experience higher risk of atrial arrhythmia following radiofrequency catheter ablation of paroxysmal atrial fibrillation compared with normal weight individuals. This corresponds with lower rates of first-pass isolation at higher BMI. - Patients across BMI categories experience similarly low rates of procedural complication.

Abstract 4125493: Is There an Obesity Paradox for Cardiovascular Outcomes in Patients Undergoing Transcatheter Edge-to-Edge Repair? A Pilot Meta-Analysis

Background: The impact of body mass index (BMI) on Transcatheter Edge-to-Edge Repair (TEER) outcomes remains uncertain, with studies showing conflicting results. Some suggest an 'obesity paradox' exists, favoring better outcomes for obese patients and worse outcomes for underweight patients, while others report no significant impact of BMI. Methodology: We conducted a systematic literature search using major databases to identify studies investigating the association between baseline BMI status and post-procedural outcomes in patients undergoing TEER. Patients were categorized into four BMI groups: underweight (BMI < 18.5 kg/m 2 ), normal weight (BMI 18.5-24.9 kg/m 2 ), overweight (BMI 25-29.9 kg/m 2 ), and obese (BMI ≥ 30 kg/m 2 ). The endpoints included were the risk of in-hospital mortality, myocardial infarction, and stroke. Data were pooled using Review Manager with a random-effects model. Risk ratios (RRs) with their 95% confidence intervals (CIs) were used as the effect measure. Statistical significance was set at p<0.05. Results: Our study included a total of six observational studies, encompassing 7,627 obese and 74,820 non-obese patients. The outcome of in-hospital mortality revealed no significant difference between the two groups (RR: 0.85; 95% CI: 0.57, 1.27; p=0.43). Subgroup analysis showed a trend towards higher in-hospital mortality risk for underweight patients compared to overweight (RR: 1.48; 95% CI: 1.11, 1.95; p=0.007) and obese patients (RR: 1.40; 95% CI: 1.02, 1.92; p=0.04). The comparison between underweight and normal-weight patients did not reach statistical significance (RR: 1.18; 95% CI: 0.91, 1.55; p=0.22). Additionally, the risk of myocardial infarction (RR: 1.10; 95% CI: 0.77, 1.58; p=0.59) and stroke (RR: 0.43; 95% CI: 0.13, 1.42; p=0.17) did not differ significantly between obese and non-obese patients. Conclusions: Our study found no significant difference in in-hospital mortality between obese and non-obese patients. However, underweight patients had a higher mortality risk compared to both overweight and obese patients. While myocardial infarction rates were similar across all groups, there was a non-significant trend suggesting a potentially lower risk of stroke in obese patients. These findings warrant further prospective studies to provide robust evidence.

Abstract Su704: Body Mass Index and Outcomes of In-Hospital Cardiac Arrest

Background: Although previous studies have reported an association between a patient’s body mass index (BMI) and outcomes for various cardiovascular conditions, the relationship between BMI and survival for in-hospital cardiac arrest (IHCA), a condition for which emergent response is required, has not been fully described. Aims: Examine the association between BMI and survival outcomes for IHCA. Methods: Within the Get With The Guidelines®-Resuscitation, we identified 56,411 patients with IHCA and available BMI data during 2005-2012 when weight and height data were collected in the registry. BMI was classified as underweight [<18.5 kg/m 2 ], normal [18.5 to 24.9 kg/m 2 ], overweight [25.0 to 29.9 kg/m 2 ], obese [30.0 to 34.9 kg/m 2 ], and very obese [≥35.0 kg/m 2 ]). Using multivariable hierarchical models with hospital as a random effect, we examined the association between BMI and survival to discharge, stratified by cardiac arrest rhythm type (shockable and non-shockable). As secondary outcomes, we examined rates of sustained return of spontaneous circulation for > 20 minutes (ROSC) and favorable neurological survival (i.e., survival to discharge without severe neurological disability). Results: Among 10,219 patients with a shockable arrest rhythm, 3,964 (38.7%) survived to discharge. After multivariable adjustment, compared with overweight patients, those who were underweight, of normal weight, and very obese had lower survival rates, whereas obese patients had similar survival rates ( Table ). Underweight patients also had a lower rate of ROSC and favorable neurologic survival ( Table ). Among 46,192 patients with a non-shockable arrest rhythm, 7,331 (15.8%) survived to discharge. After multivariable adjustment, all BMI groups had similar rates of survival, ROSC, and favorable neurologic survival, except for underweight patients ( Table ). Conclusions: Although the association between BMI and survival outcomes for IHCA varied by initial rhythm, underweight patients consistently had lower survival rates of survival. Very obese patients generally had similar outcomes to other weight groups, underscoring that morbid obesity was not a negative predictor of survival outcomes for IHCA.

Association between body mass index trajectories and type 2 diabetes incidence over an 18-year follow-up in the Tehran Lipid and Glucose Study.

Body mass index (BMI) is a well-known risk factor for type 2 diabetes mellitus (T2DM). We aimed to identify BMI trajectory patterns and evaluate their association with T2DM during 18 years of follow-up. We included 6026 participants aged 20 to 65 from the prospective population-based Tehran Lipid and Glucose Study (TLGS). The BMI trajectory patterns were identified using latent growth mixture modeling (LGMM) during the measurement period. The association between the BMI trajectory patterns and future T2DM was evaluated using the Cox proportional hazard regression models. Three BMI trajectory patterns of low-increasing (38.6%), medium-increasing (47.1%), and high-increasing (14.3%) were detected. The participants in the medium-increasing and high-increasing BMI trajectory groups had HRs of 1.87 (95% CI 1.53-2.28) and 3.41(95% CI 2.71-4.29) for T2DM incidence, respectively. Within the normoglycemic subpopulation, the high-increasing BMI group had an HR of 3.82 (95% CI 2.79-5.24) compared to the low-increasing BMI group, while in the prediabetic subpopulation, the high-increasing BMI group had an HR of 2.93 (95% CI 2.04-4.19) compared to the low-increasing BMI group. Body weight varies in a relatively stable pattern in adulthood over the long-term period. Medium and high-increasing BMI trajectory patterns have a significantly increased risk for future T2DM in both normoglycemic and prediabetic individuals. Identifying BMI trajectory patterns can help healthcare providers in early prediction, risk assessment, and monitoring strategies development for the prevention of T2DM.

Maternal and neonatal risks and outcomes after bariatric surgery: a comparative population based study across BMI categories in Qatar

The impact of Bariatric Surgery (BS) on maternal and neonatal outcomes among pregnant women is not fully understood, especially in comparison to different weight categories. The primary aim of this study is to assess the factors associated to women who have undergone BS. The study also investigates the maternal and neonatal outcomes amongst this group in comparison to the three Body Mass Index (BMI) groups (women with obesity, overweight and normal weight). A 12-month population-based retrospective study was conducted using registry data from the PEARL-Peristat Study at the Women's Wellness and Research Center (WWRC) in Qatar from January 1, 2017, through December 31, 2017. Both univariate and multivariable regression analyses were employed to scrutinize risk factors and maternal and neonatal outcomes. The study included 6212 parturient women, of which 315 had a history of BS, while 5897 with no BS history. Qatari women, aged 35 and higher, with parity > 1, diabetes, and hypertension were more likely to be in the post-BS group. Women in the post-BS group were found to be more likely to have a cesarean delivery (37.5% vs. 24%, Adjusted Odds Ratio (aOR) = 1.59, CI 1.18–2.14), preterm babies (10% vs. 7%, aOR = 1.66, CI 1.06–2.59), and stillbirth (1.6% vs. 0.4%, aOR = 4.53, CI 1.33–15.50) compared to the normal weight women group. Moreover, post-BS women had a higher risk of low-birth-weight neonates than women with obesity (15% vs. 8%, aOR = 1.77, CI 1.153–2.73), overweight (15% vs. 7%, aOR = 1.63, CI 1.09–2.43), and normal weight (15% vs. 8%, aOR = 1.838, CI 1.23–2.75). Finally, women in the post-BS group were more likely to have low-birth-weight neonates amongst term babies than women with obesity and overweight. Pregnancies with post-BS should be considered a high-risk group for certain medical outcomes and should be monitored closely. These findings may guide the future clinical decisions of antenatal and postnatal follow-up for post-BS women.

Effect of Paternal Body Mass Index on Cumulative Live Birth Rates: Retrospective Analysis of 3048 Embryo Transfers in Couples Using Autologous Gametes

Obesity is a multifactorial disease present worldwide and correlated with hormonal alterations that may cause a decrease in reproductive outcomes and seminal quality. However, the specific mechanisms involved are unknown. This led us to examine the relationship between paternal body mass index (BMI) and clinical reproductive outcomes by evaluating the cumulative live birth rates (CLBRs) per number of embryo transfers (ETs), embryos replaced (EmbRs), and oocytes used (OUs) in consecutive treatments until achieving the first newborn. A retrospective study was performed, and Kaplan–Meier survival curves were created to observe CLBRs with regard to the paternal BMI, adjusted by relevant confounders through Cox regression models. The participants were couples undergoing intracytoplasmic sperm injection (ICSI) and ET in Spanish IVIRMA clinics using autologous gametes. The cohort was subdivided based on paternal BMI: normal (18.5–24.99 kg/m2) (N), overweight (25–29.99 kg/m2) (OV), or obese (≥30 kg/m2) (OB) patients. A total of 4750 ICSI cycles were included, encompassing 49,485 mature oocytes, 23,963 blastocysts, and 3048 ETs. When calculating CLBRs based on the number of ETs carried out until live birth was achieved, no statistically significant differences were found (p = 0.72). After adjusting for maternal age and BMI, female infertility diagnosis, the use of preimplantation genetic testing, and the number of ETs, Cox regression showed that there were no statistically significant differences between the BMI groups (HR: 0.94 [95% CI: 0.7–1.2]; p = 0.59). When calculating CLBRs considering EmbRs, there was a similarity between the BMI groups (p = 0.57). However, there were no statistically significant differences in the adjusted Cox regression (HR: 0.93 [95% CI: 0.7–1.2]; p = 0.51). Finally, when calculating CLBRs considering OUs, the results were comparable among BMI subgroups (p = 0.75), and there were no statistically significant differences with adjusted Cox regression (HR: 0.95 [95% CI: 0.8–1.2]; p = 0.66). In conclusion, paternal BMI was not associated with clinical reproductive outcomes when considering the ETs, EmbRs, or OUs needed to reach the first liveborn (LB).

Maternal body mass index, maneuvers, and neonatal morbidity associated with shoulder dystocia

BackgroundShoulder dystocia is associated with neonatal morbidity. Higher maternal prepregnancy body mass index is an established risk factor for shoulder dystocia, yet the relationship between maternal prepregnancy body mass index and resulting neonatal morbidity after shoulder dystocia is not well studied. ObjectivesWe assessed the association between body mass index and neonatal adverse outcomes following shoulder dystocia. The frequency and type of maneuvers used to resolve shoulder dystocia by maternal body mass index was compared. Study DesignWe conducted a retrospective cohort study of pregnant individuals who experienced a shoulder dystocia at delivery from June 2012-July 2021 at a tertiary care center. We included singleton non-anomalous livebirths ≥36 weeks’ gestation at a single academic medical center in the Midwestern US. The primary exposure was prepregnancy body mass index categorized as: <30 kg/m2 [referent], 30-34.9 kg/m2, and ≥35 kg/m2. The primary outcome was a composite neonatal morbidity including birth injury (brachial plexus injury or fracture), seizures, hypoxic ischemic encephalopathy, and 5-minute Apgar < 7. Secondary outcomes were neonatal intensive care unit admission and neonatal acidemia (cord arterial pH < 7.10). Shoulder dystocia duration and the number and types of maneuvers were compared by body mass index group. Multivariable logistic regression was used and adjusted for nulliparity, diabetes, operative vaginal delivery, and gestational age. ResultsAmong 872 individuals who experienced a shoulder dystocia at delivery, 602 (69.0%) had a body mass index <30 kg/m2, 160 (18.3%) had a body mass index between 30-34.9 kg/m2, and 110 (12.6%) had a body mass index ≥35 kg/m2. The median duration of shoulder dystocia was 40 seconds (interquartile range 30, 60 seconds) and did not vary by maternal body mass index. Deliveries complicated by body mass index ≥35 kg/m2 required a greater number of maneuvers compared to those with lower maternal body mass index (p<0.01). McRoberts (96.0%), suprapubic pressure (90.2%) and delivery of the posterior arm (41.1%) were the most frequent maneuvers in all body mass index groups. Rubin’s maneuver was more frequently used with body mass index ≥35 kg/m2 compared with body mass index <30 kg/m2 (34.6% versus 22.4%, p = 0.02, adjusted odds ratio 1.63, 95% CI 1.04-2.57). Composite neonatal morbidity did not differ by body mass index. Neonatal injury was more frequent with body mass index ≥35 kg/m2 compared with body mass index <30 kg/m2 (adjusted odds ratio 1.97, 95% CI 1.06-3.68). Interaction between body mass index and number of maneuvers was not statistically significant (p=0.94). ConclusionsAmong pregnant individuals who experienced a shoulder dystocia, increased prepregnancy body mass index was associated with an increased number of maneuvers performed during a shoulder dystocia, but not longer duration. Risk of neonatal injury following shoulder dystocia, but not the composite neonatal adverse outcome, was increased with body mass index ≥35 kg/m2.

The Role of Body Mass Index on Physical Activity, Symptoms, and Related Outcomes Following Pediatric Concussion

To determine the step count and self-reported activity levels for obese and non-obese pediatric patients following concussion and predict self-reported symptoms, quality of life, and psychological health over time. Participants completed the Post-Concussion Symptom Scale (PCSS), Pediatric Quality of Life (PedsQL), and Behavioral Symptom Inventory-18 (BSI-18) at an initial visit (<72 hours), 3-5 days post-injury, 10-18 days post-injury, and 1 and 2 months post-injury. Physical activity data (eg, step count) were collected via a commercial actigraph. Participants were categorized into obese and non-obese body mass index (BMI) groups based on age- and sex-adjusted growth standards. Mann Whitney U tests compared groups while nonparametric series regression models examined the effect of obese BMI and average daily step count on PCSS, PedsQL, and BSI-18 outcomes at 1- and 2-months post-injury. 194 participants were included: 153 (78.9%; M=14.6 ± 2.4 years; 50% female) in the non-obese group and 41 (21.1%; M=14.2 ± 2.0 years; 44% female) in the obese group. The obese group had a 22.8% lower average daily step count in the week post-injury (p=0.02). At 2-months, there was a significant association between obese BMI and worse PCSS total score (p=0.042), PedsQL (p=0.017), and BSI-18 anxiety (p=0.046). Average daily step count in the first week post-injury was associated with a higher PCSS total score at 2 months (p=0.031). Pediatric patients following concussion with an obese BMI had a lower daily average step count in the week after injury and exhibited worse concussion symptoms, quality of life, and anxiety at 2 months compared with those with a non-obese BMI.

Radiographic Outcomes of Flexible and Rigid Fixation Techniques of Syndesmotic Injuries Across Various Body Mass Indices: A Retrospective Analysis

In the setting of ankle trauma, surgical management of syndesmosis injury involves screw fixation and suture button technique. The efficacy of flexible (suture button) versus rigid (screw) fixation in the management of syndesmotic injury has been investigated extensively in current literature. There is sparse data comparing these two techniques across different body mass indices (BMI). In this study, two fellowship-trained foot and ankle surgeons at urban level-1 trauma centers reviewed blinded post-operative ankle radiographs of BMI-stratified patients undergoing syndesmotic fixation. A total of 79 patients were included for analysis based on inclusion and exclusion criteria. There were 42 patients in the screw fixation group and 37 patients in the suture button group. The average follow-up period was 5.5 months. No significant difference was found in the average radiographic measurements when comparing the two fixation types, regardless of BMI parameters. This was consistent when analyzing individual fixation types stratified by BMI, as well as when comparing BMI groups stratified by fixation type. Additionally, the distribution of body mass index was even across both fixation types. Our study demonstrates that both fixation groups achieved comparable anatomic ankle reduction regardless of body mass index. The authors suggest expanding the indication of suture button fixation to include the higher body mass index patients.

Associations Between Body Mass Index, Gait Biomechanics, and In Vivo Cartilage Function After Exercise in Those With Anterior Cruciate Ligament Reconstruction

Background: Both high body mass index (BMI) and anterior cruciate ligament reconstruction (ACLR) independently influence knee osteoarthritis risk. Preliminary evidence shows the combination of these risk factors leads to poorer recovery and altered biomechanical outcomes after ACLR, but few studies have directly evaluated early changes in cartilage health between normal-BMI and high-BMI groups in this population. Purpose: To evaluate ultrasound-based measures of cartilage strain and compositional changes (via echo-intensity [EI]) in response to an incline walking stress test between normal-BMI and high-BMI individuals with ACLR. A secondary evaluation was conducted of associations between habitual walking biomechanics (ie, ground-reaction forces, sagittal knee kinetics and kinematics) and cartilage strain and EI outcomes. Study Design: Controlled laboratory study. Methods: Gait biomechanics and femoral trochlear ultrasound analyses were evaluated in 64 participants with ACLR who had normal BMI (BMI < 27.0; n = 40) and high BMI (BMI ≥ 27.0; n = 24). Ultrasound images were collected bilaterally before and after an incline treadmill walk, and medial and lateral trochlear strain and EI changes pre-post exercise were used to compare BMI groups and limbs. Gait outcomes included ground-reaction forces, peak sagittal plane knee moments, angles, and excursions and were used to determine associations with cartilage outcomes in the entire cohort. Results: High-BMI individuals with ACLR exhibited greater medial trochlear cartilage strain in the ACLR limb compared with normal-BMI individuals (approximately 6%; P < .01). In those with high BMI, the ACLR limb exhibited greater medial trochlear strain relative to non-ACLR limbs (approximately 4%; P < .05), but between-limb differences were not observed in the normal-BMI group (P > .05). Medial trochlear EI changes were greater bilaterally in those with high BMI compared with normal-BMI ACLR counterparts (approximately 10%; P < .01). Last, individuals who walked with greater peak knee flexion angles exhibited less medial cartilage strain (ΔR2 = 0.06; P = .025). Conclusion: The data suggested that high BMI affects cartilage functional properties after ACLR, whereas smaller knee flexion angles were associated with larger medial cartilage strain. Clinical Relevance: High-BMI individuals with ACLR may represent a subset of patients exhibiting earlier declines in cartilage functional integrity in response to loading, necessitating additional or more targeted interventions to mitigate disease development.

Association of BMI with adherence and outcome in heart failure patients treated with wearable cardioverter defibrillator.

Obesity is a known risk factor for cardiovascular disease (CVD), yet an 'obesity paradox' has been observed in various CVD contexts. The impact of obesity on heart failure (HF) patients treated with a wearable cardioverter-defibrillator (WCD) remains underexplored. In a multicentre international registry, we retrospectively collected data from a consecutive series of 1003 patients. These patients were divided into three body mass index (BMI) groups: <25kg/m2 (n=348), 25-30kg/m2 (n=383), and >30kg/m2 (n=272), with BMI>30kg/m2 defined as the reference category. Demographics, indications, adherence, WCD shocks, arrhythmic events, rehospitalization due to cardiovascular causes, and mortality were analysed. At 3month follow-up, patients with a BMI>30 showed the greatest improvement in left ventricular ejection fraction (LVEF) at 51.4%, significantly higher than the 41.4% in those with a BMI<25 (P=0.017) and comparable with the 49.4% in the BMI 25-30 group (P=0.635). WCD wearing time and adherence were similar across all BMI groups. The incidence of WCD shock was similar across BMI groups. Rates of ventricular tachycardia (VT), ventricular fibrillation and non-sustained VT (ns-VT) were comparable across BMI groups. The rate of implantable cardioverter-defibrillator (ICD) implantation was 40.3% across all patients, with a slightly lower rate in the BMI>30 group (36.8%) compared with others, although not significantly. Rehospitalization due to cardiovascular causes was significantly lower in the BMI>30 group (55.4%) compared with the BMI 25-30 group (70.9%; P=0.048), but similar to the BMI<25 group (54.9%; P=0.957). At 2year follow-up, mortality was lower in the BMI>30 group (5.9%) compared with the BMI<25 (7.5%; P=0.029) and BMI 25-30 groups (7%; P=0.681). In multivariable analysis, LVEF at long term was significantly associated with a reduction in mortality. Obese patients exhibited significantly greater improvement in LVEF, which was associated with reduced mortality. Adherence to WCD therapy was excellent across all BMI groups. ICD implantation occurred in 40.3% of patients, with similar WCD shock rates and arrhythmic events across BMI groups. An obesity paradox was observed, with obese patients demonstrating significantly lower rehospitalization rates due to cardiovascular causes and reduced mortality at follow-up.

Exploring The Relationship Between Body Mass Index and Body Fat Percentage Across Age and Gender: A Cross – Sectional Study

Background: In today’s fast-paced world, the prevalence of non- communicable diseases (NCDs) is rising due to work, academic and personal pressures. Obesity, a preventable disease, is often underestimated in clinical settings. The ‘obesity paradox’ where NCDs occur in individuals with normal body mass index (BMI), complicates health assessments. This study evaluates the relationship between BMI and body fat percentage (BFP) by age and gender and assesses if BMI alone is a good predictor of body adiposity. Methods: A cross-sectional observational study was conducted on 385 normal healthy subjects aged 18-67 years, attending an annual temple festival in Kerala during 2016. Subjects were selected based on the inclusion and exclusion criteria, after obtaining the ethical clearance. Using an Omron Body fat analyser, we measured BFP. Statistical analysis was done using Independent T test, ANOVA and Chi square test on SPSS version 20. Results: A significant increase in BMI and BFP with age in both genders, with BFP changes starting at a younger age. Females showed higher increases in both BMI and BFP. Among participants, 34% had normal BMI. 29% had normal BFP and only 20% had both normal. We also found many ‘invisible’ obese individuals within the normal BMI group and some ‘muscle obese’ individuals in the overweight BMI group. Conclusions: To conclude, as BMI and BFP increase with age, the quality of fat free mass likely deteriorates. BFP is a better predictor of adiposity compared to BMI. For early NCD detection, both BMI and BFP should be included in routine clinical screenings.

Impact of body weight and body mass index on clinical outcomes of edoxaban therapy in atrial fibrillation patients included in the ETNA-AF-Global registry

Abstract Background In atrial fibrillation (AF) patients (pts) receiving non-vitamin K antagonist oral anticoagulant therapy, extreme body weights, both obesity and low body weight, may impact clinical outcomes. Purpose To determine the impact of body weight and body mass index (BMI) on clinical outcomes in AF pts receiving edoxaban from the Global ETNA program (Europe [NCT02944019], Japan [UMIN000017011], Korea/Taiwan [NCT02951039], Hong Kong [NCT03247582] and Thailand [NCT03247569]). Methods ETNA-AF-Global, a multinational, prospective, observational study collected demographic and clinical outcomes data for AF pts receiving edoxaban. In this subanalysis, pts were categorised into the following body weight groups: ≤60kg, &amp;gt;60 to 80kg (reference body weight), &amp;gt;80 to ≤100kg and &amp;gt;100kg; and BMI groups: &amp;lt;18.5kg/m², ≥18.5 to &amp;lt;25.0kg/m² (reference BMI), ≥25.0 to &amp;lt;30.0kg/m², ≥30.0 to &amp;lt;40.0kg/m² and ≥40.0kg/m². Clinical outcomes at 2-year follow-up were compared across body weight and BMI groups. Results 26,805 pts were included in this analysis. Mean ± standard deviation body weight was 72.2 ± 18.1kg and mean BMI was 26.4 ± 5.0kg/m². 43.7% of pts were categorised into the &amp;gt;60 to 80kg reference body weight group. [other groups: ≤60kg, 28.1%; &amp;gt;80 to ≤100kg, 21.7%; &amp;gt;100kg, 6.5%] and 40.0% of pts into the ≥18.5 to &amp;lt;25.0kg/m² reference BMI group [other groups: &amp;lt;18.5kg/m², 3.0%; ≥25.0 to &amp;lt;30.0kg/m², 37.3%; ≥30.0 to &amp;lt;40.0kg/m², 18.0%; ≥40.0kg/m², 1.7%]. Clinical outcomes are shown in Fig. 1 as unadjusted hazard ratios vs. reference group according to weight and in Fig. 2 according to BMI. Among body weight groups, pts weighing ≤60kg had the highest annualised rates of any stroke or systemic embolic event (SEE; 1.24%), ischemic stroke (0.97%), all-cause death (3.96%), major bleeding events (1.49%), and major bleeding or clinical-relevant non-major (CRNM) bleeding events (3.45%). Pts in the reference body weight group had the lowest annualised rates of all-cause death (2.81%). Annualised rates of major bleeding, major bleeding or CRNM bleeding events and any stroke or SEE were lowest in pts weighing &amp;gt;100kg. Among BMI groups, annualised rates of all effectiveness and safety outcomes were highest in pts with a BMI &amp;lt;18.5kg/m². Pts in the ≥25.0 to &amp;lt;30.0kg/m² BMI group had the lowest annualised rates of all-cause death (2.85%) and pts in the ≥18.5 to &amp;lt;25.0kg/m² BMI group had the lowest annualised rates of CV death (0.73%). Conclusions In the Global ETNA-AF program, clinical outcomes varied between different body weight and BMI subgroups. These findings highlight the need to consider the clinical implications of low body weight and/or low BMI, as AF pts who belong to these categories may be at higher risk of adverse outcomes during long-term anticoagulant treatment.Figure 1.Figure 2.

Body mass index trajectories from birth to early adulthood and lung function development.

Limited studies have investigated the influence of body mass index (BMI) trajectories on lung function covering the entire growth period. We conducted a prospective study utilizing data from the Swedish BAMSE birth cohort. Latent class mixture modelling was employed to examine the diversity in BMI z-scores from birth to 24 years of age. Participants with four or more BMI z-scores were included (n=3204, 78·4%). Pre-bronchodilator (BD) spirometry was tested at 8, 16, and 24 years, while post-BD spirometry, multiple-breath nitrogen washout (for lung clearance index, LCI), and urinary metabolomics data were assessed at 24 years. Six distinct BMI development groups were identified. Compared to the stable normal BMI group, the accelerated increasing BMI group exhibited reduced pre- and post-BD FEV1/FVC ratio z scores (β=-0·26, 95% CI=[-0·44, -0·08], and -0·22, [ -0·39, -0·05], respectively), along with elevated LCI (0·30, [0·22, 0·42]) at 24 years. The persistent high BMI group demonstrated lower FEV1, and FVC z scores growth between 16 and 24 years (-0.24, [-0.42, -0.05], and -0.27, [-0.45, -0.01], respectively), and elevated LCI (0·20, [0·03, 0·39]) at 24 years. However, those impairments were not observed in the accelerated resolving BMI group. Conversely, the persistent low BMI group displayed persistently decreased FEV1, and FVC from 8 to 24 years, as well as decreased lung function growth. Additionally, histidine-related metabolites were associated with pre- and post-BD FEV1 (hypergeometric FDR=0.008 and <0.001, respectively). Early interventions aiming for normal BMI during childhood may contribute to improved lung health later in life.

The Influence of Anthropometric Factors on Renal mpMRI: Insights From Regional Analysis.

Multiparametric MRI (mpMRI) provides detailed insights into renal function, but the impact of anthropometric factors on renal imaging is not fully understood. To investigate regional correlations between mpMRI parameters and age, body mass index (BMI), and body surface area (BSA). Prospective, cross-sectional observational study. Twenty-nine healthy volunteers (44.5 ± 18.3 years, 18 females) without a history of renal disease. 3-T, pseudo-continuous arterial spin labeling, multi-echo gradient-recalled echo, diffusion-weighted imaging, T1 and T2 mapping. Bilateral kidneys were segmented into nine concentric layers (outer cortex to inner regions) and nine equiangular sections (lower to upper pole). Key parameters (renal blood flow [RBF], , apparent diffusion coefficient [ADC], T1 and T2 maps) were correlated with age, BMI, and BSA. Differences in parameters between age and BMI groups were also evaluated. Spearman correlation, Mann-Whitney U test, and rank-biserial correlation coefficient for effect size. A P-value <0.05 was considered statistically significant. RBF correlated negatively with age in all regions and BMI in inner layers and lower pole. ADC negatively correlated with BMI (significance was not reached in layers 2, 7, 8; P-value = 0.06-0.12) and BSA in layers 1-7. T1 negatively correlated with age in inner regions and lower medial pole. Significant positive correlations were found between age and (outermost layer, upper pole), age and T2 (inner and cranial-caudal regions), as well as BMI and T2 (except upper pole; P-value = 0.06). Significant differences between age groups were observed for RBF (all regions), (outermost and second innermost layers, central lateral region), T1 (innermost layer), and T2 (upper medial pole). Between BMI groups, ADC (middle layers, upper medial pole) and T2 (outermost and inner layers, lower pole to lateral region) differed significantly. Intrarenal variance of mpMRI parameters correlated with age, BMI, and BSA. 4 TECHNICAL EFFICACY: Stage 1.

Effects of prognostic nutritional index and obesity on 1-year mortality in patients with acute heart failure

Abstract Background Increased body mass index (BMI) has paradoxically been linked to improved survival rates among patients with acute heart failure (AHF). However, the impact of different nutritional statuses on this obesity paradox on 1-year mortality remains unclear. The prognostic nutritional index (PNI) is a simple tool to assess nutrition status. Recently, landmark findings such as the STEP-HFpEF (Semaglutide Treatment Effect in People With Obesity and HFpEF) trial showed at 1-year, semaglutide not only reduced weight considerably, but also significantly improved health-related quality of life, functional status, and CRP levels. Also, the semaglutide effects on heart disease and stroke in patients with overweight or obesity (SELECT) trial demonstrated a 20% reduction in cardiovascular outcomes. Purpose To investigate the association between obesity and AHF on all-cause mortality according to nutritional status. Methods The cohort study comprised 7258 patients with a cardiopulmonary condition, all of whom were admitted and included on-site at the Emergency Department (ED) in a large University Hospital in Denmark, between March 2020 and March 2022. The follow-up time was at least 365 days. 408 patients with AHF were identified by chart review by trained cardiologists for analysis. PNI was calculated according to the formula: 10×serum albumin (g/ dL) + 5×total lymphocyte count×109/L. A value ≥ 38 is considered well-nourished, and a value &amp;lt; 38 is considered malnourished. Patients were divided into High-PNI (≥38) and Low-PNI (&amp;lt;38) according to cut-off value of PNI. The Kaplan-Meier (KM) curves were used to analyze cumulative survival in each subgroup, and the log-rank test was used to compare differences between groups. Cox regression models were used to analyze associa­tions between BMI, nutritional status and outcomes, expressed as hazard ratios (HR) and relative 95% confi­dence intervals (CI). Results Amongst 408 hospitalized AHF patients, 384 (mean age 75.6 ±11.7) with available PNI scores were enrolled into this study. 55.7% (n=214) were male, 56.4% (n=93) died in the Low-PNI group and 34.2% (n=75) died in the High-PNI group within 1 year. After adjusting for potential confounders in the High-PNI population, compared with the under/normal and overweight BMI group, obesity was negatively associated with 1-year mortality, with adjusted HR of 0.47, 95% CI (0.24–0.94), P = 0.033. However, this correlation disappeared in the Low-PNI group (obese BMI: HR 1.2, 95% CI 0.71–2.1, P = 0.457). In addition, those who were overweight in the Low-PNI group had an 80% increase in 1-year risk of death. Conclusion Obesity (BMI&amp;gt;30) was associated with reduced 1-year mortality only in AHF-patients with good nutritional status. However, this association disappeared in malnourished patients. Consequently, additional research is essential to formulate weight loss recommendations for malnourished obese patients with AHF.

The obesity paradox in patients with hypertrophic cardiomyopathy: A Korean nationwide cohort study

Abstract Background In cardiomyopathies, obesity is known to affect the cardiac remodeling and is associated with a poor prognosis. However, in hypertrophic cardiomyopathy, which is included in the category of heart failure with preserved ejection fraction, the risk of underweight has been suggested, and its impact in practice is controversial. Purpose The aim of this study was to investigate the potential relationship between obesity and cardiovascular outcomes in patients diagnosed with hypertrophic cardiomyopathy. Methods We conducted a retrospective national cohort study from 2013 to 2020 utilizing administrative claims data and health check-up database from the Korean National Health Insurance Service. Patients newly diagnosed with hypertrophic cardiomyopathy from January 2015 to December 2019 were included. Body mass index was stratified into five groups based on the World Health Organization's recommended criteria for Asian populations, and patients were followed until the date of each outcome or the end of the study period. Predefined clinical outcomes included heart failure hospitalization events, fatal arrest events, all-cause death, and composite clinical outcomes. Results A total of 6,361 patients were included in the study, with a mean age was 60 ± 13 years and 32.6% female. During a median follow-up of 3.0 years (interquartile range, 1.8 to 4.3), 921 heart failure hospitalization, 185 fatal arrest, and 340 deaths occurred. The underweight group had higher adjusted hazard ratios for heart failure hospitalization, fatal arrest, all-cause death, and the composite outcome compared to the normal range body mass index group (HR 1.69, 95% CI 1.16-2.47; HR 2.29, 95% CI 1.06-4.93; HR 2.74, 95% CI 1.77-4.24; HR 1.77, 95% CI 1.28-2.45). In addition, the adjusted hazard ratios for the composite outcome were lower in the overweight and obese I group compared to the normal range (HR 0.80, 95% CI 0.68-0.95; HR 0.84, 95% CI 0.72-0.98). Conclusions Among patients with hypertrophic cardiomyopathy, those classified as underweight had an increased risk of heart failure hospitalization, fatal arrest, all-cause death, and composite outcomes compared with normal weight patients, while those classified as overweight and obese had a decreased risk of composite outcomes.

Association Between Prenatal Exposure to Organochlorine Pesticides and Telomere Length in Neonatal Cord Blood

Objectives: Environmental exposure may affect the telomere length (TL) of newborns, which is considered as an early biomarker indicating susceptibility for later life diseases. However, the effects of prenatal organochlorine pesticide (OCP) exposure on newborn TL remain unclear. This study aimed to investigate the association between prenatal exposure levels of OCPs during pregnancy and TL in neonatal cord blood. Methods: A total of 168 mother–infant pairs from a birth cohort in Wuhan, China, were included this study. The concentrations of hexachlorocyclohexanes (HCHs, including β-HCH, α-HCH, and γ-HCH), p,p’-dichlorodiphenyltrichloroethane (p,p’-DDT) and its metabolites (p,p’-dichlorodiphenyldichloroethane, p,p’-DDD; p,p’-dichlorodiphenyldichloroethylene, p,p’-DDE) were measured in cord blood. The associations between the OCPs and the TL in newborns were analyzed by a generalized linear regression model. Stratified analyses by newborn sex, maternal gestational weight gain, and pregnancy body mass index (BMI) were performed to evaluate if the associations were modified by these factors. Results: The detection rates of various OCPs ranged from 50.9% to 100.0%. The median concentration of p,p’-DDE was the highest (33.90 ng/g lipid), followed by β-HCH (8.67 ng/g lipid), and the median concentrations of the other OCPs were between 0.12 and 0.33 ng/g lipid. Among the all newborns, a two-fold increase in the γ-HCH concentration in the cord blood was significantly associated with a 0.024 (95% CI: −0.041, −0.007) decrease in the TL. After stratification by newborn sex, the inverse association between γ-HCH and the TL was only statistically significant in boys, but not in girls (P for interaction &lt;0.05). In addition, after stratification by pre-pregnancy BMI, β-HCH and p,p’-DDT concentrations were significantly associated with a decreased TL in the overweight pre-pregnancy BMI group [−0.111 (95% CI: −0.203, −0.018) and −0.036 (95% CI: −0.049, −0.023), respectively]. Conclusions: Prenatal exposure to OCPs during pregnancy was associated with a decreased neonatal telomere length, which may be affected by the newborn sex and pre-pregnancy BMI. These findings may provide new insights into the mechanisms underlying OCP-induced adverse health effects.

Association between nutritional status assessed by body mass index and Crohn's disease phenotype: A Nation-wide analysis

Background & aimsIncidence of obesity and Crohn's disease (CD) is increasing globally. Therefore, understanding any associations between adiposity and disease phenotype is crucial. We aimed explore the relationship between nutritional status measured by body mass index (BMI) and phenotypes of CD using a large national recallable data set. MethodsUsing National Institute for Health and Care Research-IBD Bioresource data base, we retrospectively assessed the relationship between BMI and stenosing CD by logistic regression. BMI was the primary variable of interest; CD behaviour was the dependent variable; stenosing CD was the primary outcome. Confounders were adjusted for in a multivariate model. Results8797 patients diagnosed between 1942 and 2020 were included. Mean overall BMI was 26.3 kg/m2 (SD5.5). 52.7 % had a BMI ≥25 kg/m2 (mean 30.2 kg/m2, SD 4.5). Majority had inflammatory CD (62.9 %) followed by stenosing (25.1 %) and penetrating CD (12 %). Stenosing and penetrating phenotypes were more common in the <25 kg/m2 BMI group (50.7 %, 50.3 % respectively) p < 0.001. Colonic disease location was more common (27.8 % vs 24.3 %, p = 0.001) in patients with high BMI. On univariate analysis, stenosing disease was positively associated with ileal disease location, disease duration, previous surgery, use of infliximab, ustekinumab, vedolizumab, adalimumab and azathioprine but negatively associated with BMI (OR 0.98, 95%CI [0.968–0.99]). On multivariate analyses, BMI remained negatively associated with stenosing CD (OR 0.98, 95%CI [0.97–0.99]); ileal disease location (OR 3.69, 95%CI [3.22–4.24]), adalimumab (OR 1.47, 95%CI [1.30–1.66]), ustekinumab usage (OR 1.51, 95%CI [1.14–2.01] and azathioprine (OR 1.35, 95%CI [1.19–1.53]). ConclusionsAfter multivariate analyses, BMI, ileal disease location and biologic use was negatively associated with a stenosing disease phenotype. This might reflect a change in eating behaviour due to persistent postprandial symptoms related to stenosing disease. Large longitudinal studies are needed to investigate any possible temporal relationship between the obesogenic state and intestinal fibrosis.

Sex-specific associations between body mass index trajectories and risk of hypertension

BackgroundAlthough it is well established that obesity is a risk factor for hypertension, the effect of distinct long-term patterns of body mass index (BMI) on blood pressure (BP) in later life is poorly understood.MethodsBased on the China Health and Nutrition Survey, we analyzed 2920 participants aged 3–17 years with initial normal BP at baseline (1991–2011), who were followed up for the development of hypertension (1993–2015). The group-based trajectory model was applied to identify BMI trajectories, and Cox regression was used to assess their associations with hypertension risk. Stratified analyses were conducted to explore differences across subgroups.ResultsDuring an average follow-up time of 11.20 (7.69) years for males and 7.20 (5.21) years for females, 339 males and 212 females were identified with hypertension, respectively. Three BMI trajectories were identified: low-increasing (60.58% of males and 73.03% of females), moderate-increasing (33.08% of males and 24.22% of females), and high-increasing (6.34% of males and 2.76% of females). Our study found a significant positive association between a higher BMI trajectory and hypertension risk in males (all P for trend < 0.05). Specifically, males in the high-increasing BMI group had a higher risk of hypertension compared with those in the low-increasing group (HR = 1.76, 95% CI: 1.04–2.97). Stratified analyses revealed stronger associations among smokers, drinkers, and inactive individuals.ConclusionOur findings suggest that maintaining a normal BMI and healthy lifestyle from childhood may lower subsequent risk of hypertension.