Higher Average Body Mass Index Research Articles

413 Inpatient Sleep Screens: Effective for Screening but Poor Follow Up

Abstract Introduction Only 20% of adult Americans with Obstructive Sleep Apnea (OSA) are thought to have been diagnosed. Portable monitors (PM) can provide shorter time to diagnosis and treatment in at risk populations including inpatients. Data on inpatient sleep screen testing outcomes and population phenotypes are limited. We hypothesized that inpatients undergoing sleep screens via PM have higher disease severity but are less adherent to follow up. Methods We conducted a retrospective observational study comparing severity of OSA based on apnea-hypopnea index (AHI) and compliance with follow up between patients who received inpatient vs. outpatient sleep screens. There was a total of 347 patients, 18 years and older, who received a sleep screen from August 2017 to August 2018. Exclusion criteria were cancellations/no shows (13.56% inpatients vs. 13.51% outpatients) or loss of data (26.12% inpatients vs. 23.72% outpatients). For analysis, t-test and chi-square were used for continuous and categorical variables respectively. Results The patients diagnosed with severe OSA were more than double in the inpatient group vs. the outpatient group, 46.7% and 21.7% respectively. The inpatient group had a higher average AHI (30/h) compared to the outpatient group (20.3/h). 30.7% of the inpatient group were adherent with their follow up vs. 83.3% of the outpatient group. A chi-square test of independence demonstrated a significant difference between testing location and follow up (p < .001). Those in the inpatient group were significantly older (mean 60.4 years old) than the outpatient group (47.5 years old). There was no significant difference in gender between the groups. The inpatient group had significantly higher average body mass index (39.9 kg/m2) when compared to the outpatient group (34.3 kg/m2). Conclusion Hospitalized patients screened for OSA with portable monitors are significantly more likely to have severe disease when compared to outpatients. Despite this, adherence to follow up is poor. Systematic evaluation of inpatient OSA screening program effectiveness and factors impacting adherence to follow up and treatment are needed. Support (if any):

Comparing tracheostomy techniques: Bjork flap vs. tracheal window

ObjectivesVarious operative techniques are used to perform tracheostomies. The objective of this study was to evaluate patient factors that influence the decision to perform a Bjork flap or a window. MethodsA retrospective review was conducted of all patients who underwent tracheostomies from January 2015 to December 2019 at a tertiary care medical center. All patients underwent tracheostomy with either a Bjork flap or a window. Charts were reviewed for demographics, comorbidities, indication for tracheostomy, operative details, and complications. ResultsA total of 217 tracheostomies were evaluated, of which 104 (47.9%) had a Bjork flap and 113 (52.1%) had a window. Bjork flap was significantly more likely to be performed in patients with a higher average body mass index (p = 0.05), requiring ventilatory support (p = 0.0001), or had a stroke (p = 0.0140). A window was used significantly more in patients with prior neck dissection (p = 0.0110) or neck radiation (p < 0.0001). No significant difference was observed for post-op bleeding, returning to the operating room, or days to decannulation. In all tracheostomies, thrombocytopenia was found to significantly correlate with post-op bleeding (p = 0.0006), while blood thinner use did not. ConclusionBjork flaps were more likely to be performed in those with a history of prolonged mechanical ventilation and elevated body mass index. Windows were performed more frequently in patients with a head and neck cancer history. Future prospective studies are needed to compare the outcomes of these techniques and their impacts on the trachea long term.

Impact of Postoperative Opioid Use on 2-Year Patient-Reported Outcomes in Knee Surgery Patients.

The purposes of this study were to identify the patient characteristics associated with refilling a postoperative opioid prescription after knee surgery and to determine whether refilling opioids is associated with 2-year patient-reported outcomes. We hypothesized that postoperative refill of opioids would be associated with worse 2-year patient-reported outcomes. We studied 192 patients undergoing knee surgery at a single urban academic institution. Patients completed multiple patient-reported outcome measures preoperatively and 2 years postoperatively, including six Patient-Reported Outcomes Measurement Information System (PROMIS) domains, the International Knee Documentation Committee (IKDC) questionnaire, numeric pain scale scores for the operative knee and the rest of the body, Marx Activity Rating Scale, as well as measures of met expectations, improvement, and satisfaction. Total morphine equivalents (TMEs) were calculated from a regional prescription monitoring program. Patients who refilled a postoperative opioid prescription were compared with those who did not, and TMEs were calculated for those who refilled (Refill TMEs). One hundred twenty-nine patients (67%) refilled at least one postoperative opioid prescription. Black race, older age, higher average body mass index (BMI), smoking, greater medical comorbidities, preoperative opioid use, lower income, government insurance, and knee arthroplasty were associated with refilling opioids. Greater Refill TMEs was associated with black or white race, older age, higher average BMI, smoking, greater medical comorbidities, preoperative opioid use, government insurance, and unemployment. Refilling opioids and greater Refill TMEs were associated with worse postoperative scores on most patient-reported outcome measures 2 years after knee surgery. However, refilling opioids and greater Refill TMEs did not have a significant association with improvement after surgery. Multivariable analysis controlling for potential confounding variables confirmed that greater postoperative Refill TMEs independently predicted worse 2-year PROMIS Physical Function, 2-year PROMIS Pain Interference, and 2-year IKDC knee function scores. Postoperative refill of opioids was associated with worse 2-year patient-reported outcomes in a dose-dependent fashion. These findings reinforce the importance of counseling patients regarding opioid use and optimizing opioid-sparing pain management postoperatively.

Revision Discectomy with or without Fusion for the Treatment of Recurrent Lumbar Disc Herniation: A Nationwide Analysis of Risk Profiles and Short-Term Outcomes

We compared the demographics, risk factors, and complications for adult patients with recurrent lumbar disc herniation (RLDH) undergoing revision discectomy with or without concurrent fusion. The American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients who had undergone revision discectomy with or without simultaneous fusion. The demographic variables and various peri- and postoperative complications were compared between these 2 patient groups. A total of 6901 discectomy patients were included in the present study, of whom 2996 (43.4%) had undergone revision discectomy with fusion and 3905 (56.6%) had undergone revision discectomy alone. The revision discectomy with fusion group was significantly more likely to be older, female, and White or Black and to have a higher average body mass index than was the revision discectomy alone group. The discectomy with fusion group had longer hospital lengths of stay and was more likely to have a diagnosis of hypertension, insulin-dependent and non-insulin-dependent diabetes, and chronic obstructive pulmonary disease. In addition, the patients who had undergone discectomy with fusion were significantly more likely to develop pneumonia, require ventilation for >48 hours, require a blood transfusion, and to develop urinary tract infection, myocardial infarction, deep vein thrombosis, or pulmonary embolism compared with the patients who had undergone revision discectomy only. Our findings reveal that older patients with more comorbidities were more likely to undergo revision discectomy with fusion. Also, this surgical group experienced more adverse events after their procedure compared with the revision discectomy only group.

Glycemic parameters in patients with new-onset diabetes during COVID-19 pandemic are more severe than in patients with new-onset diabetes before the pandemic: NOD COVID India Study

Background and aimsIt is not known if new onset diabetes during Coronavirus-19 disease (COVID-19; NOD COVID) is phenotypically or biochemically different than new onset diabetes before COVID-19 (NOD). MethodsAll adults diagnosed with new onset diabetes from during the time of COVID-19 were compared with new onset diabetes prior to COVID-19 from two tertiary care hospitals in Chennai and Delhi. RTPCR test for SARS-CoV-2 virus was done as appropriate, and COVID-19 antibody test was done in all other NOD COVID patients. ResultA total of 555 patients with new onset diabetes were included in the study (282 NOD and 273 NOD COVID patients). Patients with NOD COVID had higher fasting and post prandial blood glucose and glycated hemoglobin levels vs. NOD patients. Both the groups had high average body mass index; ∼28 kg/m2. Interestingly, fasting C-peptide levels were significantly higher in the NOD COVID group vs. NOD group. There was no difference in C-peptide levels or glycemic parameters between the COVID-19 antibody positive and negative NOD COVID cases. ConclusionIndividuals who were diagnosed with diabetes during COVID-19 epidemic (NOD COVID) do not significantly differ from those diagnosed before COVID-19 in symptomatology, phenotype, and C-peptide levels but they had more severe glycemia.

Evidence of Widespread Mechanical Hyperalgesia but Not Exercise-Induced Analgesia in Athletes With Mild Patellar Tendinopathy Compared With Pain-Free Matched Controls: A Blinded Exploratory Study.

The aim of the study was to assess centrally induced pain processing with pressure pain thresholds bilaterally and remotely in active volleyball and basketball athletes with mild patellar tendinopathy compared with asymptomatic control athletes. Secondary objective was to explore the role of exercise-induced analgesia during a training session in athletes with patellar tendinopathy. In this exploratory study, pressure pain thresholds of 21 patellar tendinopathy athletes and 16 age- and sex-matched asymptomatic team members were measured by a blinded assessor bilaterally on the patellar tendon and unilaterally on the elbow extensor tendon with a pressure algometer before, during, and after a regular training session. Patellar tendinopathy athletes had a significantly higher average body mass index compared with asymptomatic athletes (mean difference 1.75 kg/m2; 95% confidence interval = 0.35-3.15, P = 0.02). At baseline, athletes with patellar tendinopathy showed lowered pressure pain thresholds in the affected knee (P = 0.001), unaffected knee (P < 0.001), and elbow (P = 0.01) compared with controls. No clear patterns were identified to explain between-group differences in pressure pain thresholds before, during, and after exercise. This exploratory study found primary and secondary mechanical hyperalgesia in athletes with patellar tendinopathy compared with asymptomatic athletes. Further research is required on the effects of an acute exercise bout on pain thresholds in this population.

Deprivation or discrimination? Comparing two explanations for the reverse income-obesity gradient in the US and South Korea.

In high-income countries, poverty is often associated with higher average body mass index (BMI). To account for this reverse gradient, deprivation theories posit that declining economic resources make it more difficult to maintain a healthy weight. By contrast, discrimination theories argue that anti-fat discrimination in hiring and marriage sorts heavier individuals into lower-income households. This study assesses competing predictions of these theories by examining how household income in representative samples from South Korea (2007-2014, N=20,823) and the US (1999-2014, N=6395) is related to BMI in two key contrasting groups: (1) currently-married and (2) never-married individuals. As expected by anti-fat discrimination in marriage, the reverse gradient is observed among currently-married women but not among never-married women in both countries. Also consistent with past studies no evidence was found for a reverse gradient among men. These findings are consistent with anti-fat discrimination in marriage as a key cause of the reverse gradient and raise serious challenges to deprivation accounts as well as explanations based on anti-fat discrimination in labour markets.

Dietary Profile and Nutritional Status of the Roma Population Living in Segregated Colonies in Northeast Hungary.

Nutrition studies among Roma are scarce and to date no quantified dietary data are available. This report provides, for the first time, quantified dietary data and comprehensive anthropometric information for the Hungarian Roma (HR) population, with Hungarian general (HG) adults as reference. Data were obtained from a complex comparative health survey, involving 387 and 410 subjects of HR and HG populations, respectively. Using corporal measurements, body composition indicators were constructed, while daily nutrient intakes were evaluated in comparison with internationally accepted guidelines on nutrient requirements and recommended intakes. Associations between Roma ethnicity and nutrient intakes, as well as odds of achieving dietary recommendations were explored using regression models, adjusted for relevant covariates (i.e., age, gender, education, marital status and perceived financial status). Results showed occasional differences for selected nutrient intakes between the groups, with HR’s intake being less favorable. Total fat intake, predominantly animal-sourced, exceeded recommendations among HR (36.1 g, 95% confidence interval (CI): 35.2–37.0) and was not dissimilar to HG group (37.1 g, 95% CI: 36.3–38.0). Sodium intake among HR was significantly lower (5094.4 mg, 95% CI: 4866.0–5322.8) compared to HG (5644.0 mg, 95% CI: 5351.9–5936.0), but significantly greater than recommended intake in both groups. HR had greater estimated body fatness (25.6–35.1%) and higher average body mass index (BMI, 27.7 kg/m2, 95% CI: 26.9–28.4), compared to HG. In addition, HR had lower odds of achieving dietary recommendations (odds ratio (OR) = 0.81, 95% CI: 0.67–0.97, p < 0.05). Findings warrant further research, while highlighting the importance of establishing and integrating Roma nutrition into national surveillance and monitoring systems for key dietary risk factors.

Mild cognitive impairment in older adults: Analysis of some factors.

ABSTRACTMild cognitive decline is a feared aspect of aging associated with frailty experienced by individuals.Objective:To determine the number of elderly people with mild cognitive impairment (MCI); to determine the relationship of sociodemographic and clinical variables by group of individuals with or without MCI and to determine the relationship between MCI assessed by 6CIT and the cognitive domains assessed by the MoCA.Methods:A correlational study was conducted of 44 elderly individuals attending a day-care center or residing in a care home, with an average age of 88.9 ± 8.8 years who answered a structured interview collecting sociodemographic and clinical data.Results:The elderly living at home had higher average body mass index and number of pathologies than those living in an institution for the elderly (p < 0.01). 63.6% of the elderly did not have MCI, and no differences were found between residential settings. The comparison between 6CIT and MoCA yielded differences in the general domain and in visual, attention, abstraction and, orientation subdomains.Conclusion:Cognitive stimulation interventions should be optimized according to the residential setting at the level of comorbidities and nutrition.

General vs Spinal Anesthesia for Total Joint Arthroplasty: A Single-Institution Observational Review

BackgroundTotal joint arthroplasty (TJA) can be successfully carried out under general (GA) or spinal anesthesia (SA). The existing literature does not adequately illustrate which technique is optimal. The purpose of this study is to prospectively compare the effects of anesthesia technique on TJA outcomes. MethodsThis 2-year, prospective, observational study was conducted at a single institution where patients receiving primary TJA were consecutively enrolled. Patients were contacted postoperatively to assess for any 90-day complications. The primary outcome of the study was the overall complication rate. ResultsA total of 2242 patients underwent total hip arthroplasty (n = 656; 29.26%) or total knee arthroplasty (n = 1586; 70.74%) between 2015 and 2017. Of these procedures, 1325 (59.10%) were carried out under SA and 917 (40.90%) were carried out under GA. Patients in the GA cohort had higher mean Charlson Comorbidity Index scores (0.05 SA vs 0.09 GA; P < .05) and higher average body mass index (29.35 SA vs 30.24 GA; P < .05). On multivariate analysis, patients in the SA cohort had a significantly lower overall complication rate relative to their GA counterparts (7.02% vs 10.14%; odds ratio, 0.66; 95% confidence interval, 0.49-0.90; P < .05). In addition, length of stay in the GA cohort was significantly longer (2.43 [SD, 1.62] vs 2.18 [SD, 0.88] days; P < .01) and a larger percentage of GA patients were discharged to a nursing facility (32.28% vs 25.06%; odds ratio, 0.55; 95% confidence interval, 0.44-0.70; P < .05). ConclusionOur study demonstrates that SA for TJA is associated with a decrease in overall complications and healthcare resource utilization.

Epidemiologic Characteristics and Postoperative Complications following Augmentation Mammaplasty: Comparison of Transgender and Cisgender Females.

Background:Breast augmentation in transgender women can be an important first step in addressing gender incongruence and improving psychosocial functioning. The aim of this study was to compare postoperative outcomes of augmentation mammoplasty in transgender and cisgender females.Methods:We queried the American College of Surgeons National Surgical Quality Improvement Program database from 2006 to 2017 to establish 2 cohorts: (1) transgender females undergoing gender-affirming breast augmentation (“top surgery”) and (2) cisgender females seeking cosmetic breast augmentation (CBA). Demographic characteristics and postoperative outcomes were compared between the 2 cohorts. Multivariable regression analysis was used to control for confounders.Results:A total of 1,360 cases were identified, of which 280 (21%) were feminizing top surgeries and 1,080 (79%) were CBA cases. The transfeminine cohort was significantly older, had a higher average body mass index, and was more racially diverse than the CBA cohort. Transfeminine patients also had higher rates of smoking, diabetes, and hypertension. The rates of all-cause complications were low in both cohorts, and differences were not significant (1.6% transfeminine versus 1.8% CBA, P = 0.890) for the first 30-days after operation. After controlling for confounding variables, transfeminine patients had postoperative complication profiles similar to their cisgender counterparts. Multivariable regression analysis revealed no statistically significant predictors for all-cause complications.Conclusions:Transfeminine breast augmentation is a safe procedure that has a similar 30-day complication profile to its cisgender counterpart. The results of this study should reassure and encourage surgeons who are considering performing this procedure.

Is There a Correlation Between Preoperative or Postoperative Vitamin D Levels with Pseudarthrosis, Hardware Failure, and Revisions After Lumbar Spine Fusion?

Vitamin D deficiency is a well-known cause of postoperative complications in patients undergoing orthopedic surgery. Orthopedic complications seen in vitamin D deficiency include nonunion, pseudarthrosis, and hardware failure. We seek to investigate the relationship between vitamin D deficiency and outcomes after lumbar spinal fusions. A retrospective patient chart review was conducted at a single center for all patients who underwent lumbar spinal fusions from January 2015 to September 2017 with preoperative or postoperative vitamin D laboratory values. We recorded demographics, social history, medications, pre-existing medical conditions, bone density (dual-energy x-ray absorptiometry) T-scores, procedural details, 1-year postoperative Visual Analog Score (VAS), documented pseudarthrosis, revisions, and hardware failure. A total of 150 patients were initially included in the cohort for analysis. Overall, preoperative and postoperative vitamin D levels were not significantly associated with a vast majority of the patient characteristics studied, including comorbidities, medications, or surgical diagnoses (P > 0.05). Age at surgery was significantly associated with vitamin D levels; older patients had higher serum levels of vitamin D both preoperatively (P= 0.03) and postoperatively (P= 0.01). Those with a higher average body mass index had lower vitamin D in both groups (P= 0.02). Vitamin D levels were not significantly associated with rates of postoperative pseudarthrosis, revision, or hardware complications (P > 0.05). VAS pain score at 1 year and smoking status preoperatively or postoperatively were not associated with vitamin D levels (P > 0.05). Both preoperative and postoperative vitamin D levels were not significantly associated with an increased or decreased risk of pseudarthrosis, revision surgery, hardware failure, or 1-year VAS pain score after lumbar spine fusion surgery.

Abstract 160: Comparison of Baseline Characteristics Among World Health Organization Groups in Pulmonary Hypertension

Background: The epidemiology of pulmonary hypertension (PH) is changing with increasing numbers of patients diagnosed with non-group 1 pulmonary arterial hypertension (PAH). The average age of patients diagnosed with PAH is older, and patients are living longer. As a result, patients with PAH frequently have non-PH related comorbidities that make the diagnosis of group 1 PAH challenging. Many patients evaluated for PAH are ultimately diagnosed with non-group 1 PAH, and comorbidities may impact disease progression and treatment response. Understanding presenting clinical characteristics and comorbidities of patients referred to a Pulmonary Hypertension Comprehensive Care Center has the potential to offer insights into the evolving characteristics of patients with PH. Methods: In order to better understand the clinical differences between the patients presenting in different WHO groups, several functional assessments were analyzed from the period surrounding their baseline clinic visit. Using 280 newly diagnosed patients from the University of Michigan’s pulmonary hypertension databasethat were either group I, II, III, or multifactorial, the groups’ mean body mass index (BMI), WHO functional class (WHO FC), six-minute hall walk distance (6MW), diffusing capacity for carbon monoxide (DL CO ), and B-type natriuretic peptide (BNP) were compared. Additionally, the prevalence of ten comorbidities were collated to evaluate differences by etiology: chronic obstructive pulmonary disease, obstructive sleep apnea, interstitial lung disease, diabetes, arrhythmia, hypothyroidism, chronic kidney disease, hypertension, coronary artery disease, and obesity. Results: Two hundred and eighty newly diagnosed PH patients were analyzed (Group 1 = 67, Group 2 = 51, Group 3 = 35, multifactorial = 127). All of the comorbidities except for diabetes and thyroid disease yielded statistically significant differences among the WHO groups. Newly diagnosed Group I patients have the lowest mean BMI (27.97, p &lt;.001) and number of comorbidities (2.55, p &lt;.001), while the multifactorial patients had the most comorbidities (3.95, p &lt;.001) and highest average BMI (34.26, p &lt;.001). Group III patients had the lowest percent predicted DL CO (38.7, p &lt;.001) and lowest mean 6MW distance (220.2m, p &lt;.05). There were no statistically significant differences among groups for WHO FC, 6MW, and BNP. Conclusion: Patients with Group 1 PAH present with lower BMI and fewer comorbid conditions, whereas multifactorial PH patients present with the most comorbidities and highest BMI. The long-term effect of higher BMI and number of comorbidities in multifactorial PH is unknown. Group II and Group III PH patients did not demonstrate statistically significant differences in any of the baseline parameters. Further study including longitudinal follow up and response to treatment is warranted in each of the WHO Groups.

Time-use Profiles, Chronic Role Overload, and Women's Body Weight Trajectories from Middle to Later Life in the Philippines.

Although chronic life strain is often found to be associated with adverse health outcomes, empirical research is lacking on the health implications of persistent role overload that many women around the world are subject to, the so-called double burden of work and family responsibilities. Using data from the Cebu Longitudinal Health and Nutrition Survey (1994-2012), we examined the linkage between time-use profiles and body mass index (BMI) trajectories for Filipino women over an 18-year span. Out of the four classes of women with differential levels of a combination of work and family duties, the group with the heaviest double burden has the highest average BMI. In addition, those who have remained in this class for three or more waves of data not only have higher BMI on average but also have experienced the steepest rate of increase in BMI upon transition from midlife to old age.

Inequality in body mass indices across countries: Evidence from convergence tests

This study examines the long-term inequality in body mass index (BMI) based on convergence tests applied to a database of 172 countries recently published by the NCD Risk Factor Collaboration. First, we find that countries converge in clubs, which indicates that country disparities in BMIs will persist over time. Second, there are three and six convergence clubs in BMIs for female and male individuals, respectively. That is, we would not observe a single convergence pattern in body weights as the nutrition transition theory and the dietary convergence hypothesis seem to suggest. Females have only one healthy club (18.5 ≤ BMI < 25) and two overweight clubs (BMI ≥ 25). Males have three healthy clubs and three overweight clubs. Third, the analysis of club convergence indicates that BMI inequality has increased due to the BMI growth observed in club 1 (the one with the highest average BMI and led by the US) in each gender group. Finally, potential determinants of BMI such as globalization, human capital, income, and urbanization are relevant to understand differences across clubs. We interpret the club convergence as the result of a heterogeneous integration of countries into the global economy, which is probably related to strong domestic preferences, policies designed to manage the impacts of globalization, and shifts in productive structures.

Impact of Increased Maternal Body Mass Index on Pregnancy Outcomes

Background: in the last decade, the prevalence of obesity has significantly increased in populations worldwide and becomes epidemic. Obesity has been documented by World Health Organization (WHO) as a pandemic nutritional disorder. Egypt had the highest average Body Mass Index (BMI) and obesity in the world. Aim of the Work: evaluation of the possible effects of increased body mass index on pregnancy and measure its maternal, fetal and neonatal outcomes. Patients and Methods: the present study was approved from alazhar research ethical committee. The present study was carried out in Obstetrics and gynecology out-patient, Nasr city police hospital and El-hussien university hospital. Three hundred (300) pregnant women were included in the study; they were divided into3 groups: Group I 150 pregnant women with normal weight (BMI = 18.5 – 24.9 kg/m2). Group II: 75 pregnant women who are overweight (BMI = 25 – 29.9 kg/m2). Group III: 75 pregnant women who are obese (BMI >= 30 kg/m2). Groups were subjected to full history taking, clinical examination, obstetric palpation, ultrasound, investigations, antenatal care, post natal care and neonatal assessment. Results: statistical significant relationship between increased BMI and incidence of gestational hypertension, diabetes, postpartum hemorrhage and macrosomia. No Statistical significant relationship was found between increased BMI and incidence of cesarean rate, wound infection and intra uterine fetal retardation (IUGR). Conclusion: maternal obesity carries significant risks for the mother and fetus, including maternal outcomes as increased incidence of hypertension, gestational diabetes, cesarean rates, and postpartum hemorrhage. Fetal outcomes as macrosomia.

COMPARATIVE FEATURES OF CARBOHYDRATE METABOLISM STATE, BODY WEIGHT AND ASSOCIATED HORMONAL FACTORS IN VARIOUS MOLECULAR-BIOLOGICAL TYPES OF ENDOMETRIAL CANCER

Aims: The tradition of dividing endometrial cancer (EC) into two types - which existed for many decades - has undergone significant changes over the past few years. The aim of this work was to collect data on important aspect of hormonal-metabolic status in patients having one of the four EC types which compose a modern molecular-biological classification of this tumor. Materials and methods: The division of EC into types (234 tumors from patients predominantly of postmenopausal age) was based on the classification of this carcinoma, which includes cases with mutations in tumor tissue of DNA polymerase epsilon (POLE), signs of mismatch repair deficiency - microsatellite instability (MMR-D), expression of the multifunctional protein p53 and, finally, with the absence of these three features. In the studies of hormone-metabolic status, depending on the methodology, materials from a varying number of patients were involved. Results and conclusions: It has been established that EC patients, carriers of the POLE mutations, are characterized by a lower body mass index (BMI), a decreased incidence of overt diabetes and a lower ratio of leptin/adiponectin in the serum. For patients with EC having signs of MMR-D, an increase in BMI and the most pronounced tendency to disturbances in carbohydrate metabolism were found, while for patients with increased expression of oncoprotein p53 were characteristic frequent detection of patients with low body weight (BMI &lt;25.0) and a trend towards a decrease in the insulin resistance index. In conditionally “triply negative” type (not having three listed markers: POLE mutations, MMR-D signs and p53 hyperexpression), uterine body cancer patients revealed highest average BMI value and positive correlation of BMI with the level of leptinemia. The data obtained indicate the need for a selective approach to the prevention of different types of EC and for the study on the association of revealed type-specific features with the further course of the disease.

Does the Medical Comorbidity Profile of Obstructive Sleep Apnea Patients Treated With Maxillomandibular Advancement Differ From That of Obstructive Sleep Apnea Patients Managed Nonsurgically?

Obstructive sleep apnea (OSA) patients with retrognathia and measurable anatomic airway determinants may represent a subset of OSA patients and have distinct comorbidity profiles. Our aim was to compare the medical comorbidities of OSA patients managed surgically with maxillomandibular advancement with those of nonsurgical patients. In this cross-sectional retrospective study, patients for both cohorts were identified through the Massachusetts General Hospital oral and maxillofacial surgery data registry and the Massachusetts General Hospital Research Patient Data Registry. The inclusion criteria consisted of clinical records documenting body mass index (BMI), apnea-hypopnea index, respiratory disturbance index, and/or oxygen nadir.The primary predictor variable was the treatment modality chosen: surgical (maxillomandibular advancement) or nonsurgical. Demographic information and OSA parameters were evaluated. The primary outcome variable was the number of documented comorbidities in each group. Two-sample t tests were used for continuous variables, whereas χ2 or Fisher exact tests were used for categorical variables. The nonsurgical cohort consisted of 71 patients (67.6% men), and the surgical cohort consisted of 51 patients (84.3% men). Comparison of descriptive characteristics showed that the nonsurgical cohort had a higher average age (49±9.4years) than the surgical cohort (41±10.7years, P<.001). In addition, a higher average BMI was present in the nonsurgical group (42.3±11.9 in nonsurgical group vs 29.7±5.5 in surgical group, P<.001). Polysomnogram parameters were comparable with the exception of a higher Epworth Sleepiness Scale score in the surgical cohort (15.5±5.30 in surgical group vs 9.90±6.80 in nonsurgical group, P=.005). The nonsurgical cohort had a higher total number of comorbidities (7±4 in nonsurgical group vs 4±3 in surgical group, P<.001). Hypertension, cardiovascular disease, hyperlipidemia, pulmonary hypertension, obstructive pulmonary disease, and type 2 diabetes mellitus had higher prevalences within the nonsurgical group. The results of this study suggest that nonsurgically managed OSA patients tend to have more complex medical comorbidity profiles than those managed surgically. Obesity (BMI >30) was more prevalent in the nonsurgical cohort, which may be contributory. The additive contribution of OSA needs to be further elucidated.

Neighborhood socioeconomic disadvantage and body mass index among residentially stable mid-older aged adults: Findings from the HABITAT multilevel longitudinal study

Despite a body of evidence on the relationship between neighborhood socioeconomic disadvantage and body mass index (BMI), few studies have examined this relationship over time among ageing populations. This study examined associations between level of neighborhood socioeconomic disadvantage and the rate of change in BMI over time. The sample included 11,035 participants aged between 40 and 65years at baseline from the HABITAT study, residing in 200 neighborhoods in Brisbane, Australia. Data were collected biennially over four waves from 2007 to 2013. Self-reported height and weight were used to calculate BMI, while neighborhood disadvantage was measured using a census-based composite index. All models were adjusted for age, education, occupation, and household income. Analyses were conducted using multilevel linear regression models. BMI increased over time at a rate of 0.08kg/m2 (95% CI 0.02, 0.13) and 0.17kg/m2 (95% CI 0.11, 0.29) per wave for men and women respectively. Both men and women residing in the most disadvantaged neighborhoods had a higher average BMI than their counterparts living in the least disadvantaged neighborhoods. There were no evident differences in the rate of BMI change over time by level of neighborhood disadvantage. The findings suggest that by mid-older age, the influence of neighborhood socioeconomic conditions over time on BMI may have already played out. Future research should endeavor to identify the genesis of neighborhood socioeconomic inequalities in BMI, the determinants of these inequalities, and then suitable approaches to intervening.

Prevalence of obesity and diabetes in patients with schizophrenia.

AIMTo compare the prevalence of diabetes in patients with schizophrenia treated at a community mental health center with controls in the same metropolitan area and to examine the effect of antipsychotic exposure on diabetes prevalence in schizophrenia patients.METHODSThe study was a comprehensive chart review of psychiatric notes of patients with schizophrenia and schizoaffective disorder treated at a psychosis program in a community mental health center. Data collected included psychiatric diagnoses, diabetes mellitus diagnosis, medications, allergies, primary care status, height, weight, body mass index (BMI), substance use and mental status exam. Local population data was downloaded from the Centers for Disease Control Behavioral Risk Factor Surveillance System. Statistical methods used were χ2 test, Student’s t test, general linear model procedure and binary logistic regression analysis.RESULTSThe study sample included 326 patients with schizophrenia and 1899 subjects in the population control group. Demographic data showed control group was on average 7.6 years older (P = 0.000), more Caucasians (78.7% vs 38.3%, P = 0.000), and lower percentage of males (40.7% vs 58.3%, P = 0.000). Patients with schizophrenia had a higher average BMI than the subjects in the population control (32.11, SD = 7.72 vs 27.62, SD = 5.93, P = 0.000). Patients with schizophrenia had a significantly higher percentage of obesity (58.5% vs 27%, P = 0.000) than the population group. The patients with schizophrenia also had a much higher rate of diabetes compared to population control (23.9% vs 12.2%, P = 0.000). After controlling for age sex, and race, having schizophrenia was still associated with increased risk for both obesity (OR = 3.25, P = 0.000) and diabetes (OR = 2.42, P = 0.000). The increased risk for diabetes remained even after controlling for obesity (OR = 1.82, P = 0.001). There was no difference in the distribution of antipsychotic dosage, second generation antipsychotic use or multiple antipsychotic use within different BMI categories or with diabetes status in the schizophrenia group.CONCLUSIONThis study demonstrates the high prevalence of obesity and diabetes in schizophrenia patients and indicates that antipsychotics may not be the only contributor to this risk.