Higher Body Mass Index Categories Research Articles

Prevalence of Weight Stigma in Medical Settings Among Reproductive-Aged Women in the All of Us Study.

To analyze health care treatment experiences among a diverse cohort of reproductive-aged women from the All of Us study, focusing on variations due to body mass index (BMI). We conducted a cross-sectional study that used data from the All of Us Research Program. We analyzed weight bias among reproductive-aged women aged 18-44 years. Weight bias was assessed using a proxy 7-item survey that evaluated discrimination in health care experiences, including courtesy, respect, service quality, being treated as competent, displaying fear, being treated as inferior, and being listened to during health care visits. Overall, 16,791 reproductive-aged women (mean [SD] age, 35.8 [6.3]) were included in the study. Of 11,592 patients with data available on BMI, 582 were Asian (5.0%), 1,984 (17.1%) were Hispanic or Latinx, 1,007 (8.7%) were non-Hispanic Black, and 7,370 (63.6%) were non-Hispanic White. Approximately 24.2% of participants (n=2,878) had obesity, and 11.1% of participants (n=1,292) had severe obesity. In general, participants in higher BMI categories had negative experiences in the health care setting. Women with severe obesity were 1.5 to 2 times more likely to report poor experiences with their health care clinicians compared with women with healthy weight. Results show significant disparities in the health care experiences among reproductive-aged women. As participants' BMI category increased, so did their negative experiences in the health care setting. These findings underscore the urgent need for targeted interventions to address these inequities. Health care systems must prioritize strategies to ensure that all individuals, regardless of weight or BMI, receive equitable and respectful care.

Assessing the impact of body mass index on insulin resistance and metabolic risk factors in pre-diabetic individuals: A comprehensive cross-sectional study

Background: Insulin resistance plays a crucial role in the onset of type 2 diabetes, with body mass index (BMI) being a significant determinant. Aims and Objectives: This study examines the link between BMI and insulin resistance in pre-diabetic individuals to inform strategies for early diabetes intervention. Materials and Methods: This cross-sectional study involved 100 pre-diabetic participants. Data on demographic characteristics, BMI, insulin resistance (measured by the Homeostatic Model Assessment for Insulin Resistance, HOMA-IR), lipid profiles, and blood pressure (BP) were collected. Participants were categorized into normal weight, overweight, and obese groups to explore the relationship between BMI and insulin resistance and its impact on metabolic and cardiovascular health. Results: The average participant age was 45.8 years (SD=12.3), with a slight majority being female (52%) and an average BMI of 28.4 kg/m² (SD=4.5). A significant positive correlation (r=0.64, P<0.001) between BMI and the HOMA-IR index highlighted the association between increased BMI and insulin resistance. Obese individuals had a notably higher HOMA-IR index (3.5±1.3) compared to those overweight (2.5±1.0) and of normal weight (1.9±0.8). In addition, the study found worsening lipid profiles and increased BP with higher BMI categories. Gender did not significantly affect insulin resistance, whereas a slight increase in HOMA-IR with age was noted (r=0.23, P=0.02). Conclusion: The findings highlight the strong correlation between higher BMI and increased insulin resistance in pre-diabetics. They emphasize the importance of managing body weight to mitigate the risk of diabetes and cardiovascular diseases.

Trends of HbA1c and BMI in People with Type 2 Diabetes: A Japanese Claims-Based Study.

Obesity prevalence has increased in Japan in recent years. Given the strong association of obesity with poor glycemic control, and increased risk of type 2 diabetes (T2D) with central obesity, this study describes the current trends and relationships between glycated hemoglobin (HbA1c), body mass index (BMI), and waist circumference in the Japanese people with T2D. This was a retrospective, cross-sectional study of people with T2D who had at least one recorded HbA1c and BMI (or waist circumference) value in the Japan Medical Data Center Claims database. Five annual cohorts of the study population were formed between January 2017 and December 2021. Annual trends of HbA1c across BMI categories (obesity class I [≥ 25 ~ < 30kg/m2]-IV [≥ 40kg/m2]) and in people with central obesity (waist circumference: ≥ 85cm in men; ≥ 90cm in women) were described by sex and age groups. Overall, 106,089 people with T2D (HbA1c and BMI data: 106,079; HbA1c and waist circumference data: 105,424) were included, with the majority of people belonging to obesity class I (range: 39.7-40.6%) and obesity class II (range: 16.2-17.7%) categories across all annual cohorts. People in higher BMI categories had higher mean HbA1c, with > 50% of people with T2D in obesity class I-IV (54.8-56.5%) having HbA1c ≥ 7%. Between 2017 and 2021, BMI and waist circumference increased in the age group 18-44years. More than 50% of people with T2D and central obesity in both sexes and people of age group 18-44years across obesity class I-IV or with central obesity had HbA1c ≥ 7%. More than half of the people with T2D belonging to obesity class I-IV or central obesity had poor glycemic control (HbA1c ≥ 7%), especially in the 18-44 age group. This highlights the need for body weight management for better glycemic control in relatively young Japanese people with T2D and obesity.

Body mass index modified the effectiveness of low dose aspirin treatment on frozen-thawed embryo transfer outcome: a propensity score-matched study.

Low-dose aspirin is one of the widely used adjuvants in assisted reproductive technologies with the hope of improving the live birth rate. However, the studies regarding its effects are conflicting. The study aimed to investigate the association between aspirin administration and live birth following frozen-thawed embryo transfer (FET) in patients with different body mass index (BMI). A retrospective cohort study was performed on 11,993 patients receiving FET treatments. 644 of which received a low-dose aspirin (100 mg/day) during endometrial preparation until 10 weeks after transfer. Propensity score matching was performed to avoid selection biases and potential confounders. The clinical pregnancy rate and live birth rate were similar before matching (54.4% versus 55.4%, RR: 1.02, 95%CI: 0.95-1.09, and 46.3 versus 47.8, RR: 1.03, 95%CI: 0.95-1.12 respectively). A weak association in favor of aspirin administration was found in the matched cohort (49.5% versus 55.4%, RR: 1.12, 95%CI: 1.01-1.24, and 41.9% versus 47.8%, RR: 1.14, 95%CI: 1.01-1.29 respectively). However, when stratified the patients with WHO BMI criteria, a significant increase in live birth rate associated with aspirin treatment was found only in patients with low BMI (<18.5 kg/m2) in either unmatched (46.4% versus 59.8%, RR:1.29, 95%CI:1.07-1.55) or matched cohort (44% versus 59.8%, RR: 1.36, 95%CI: 1.01-1.83) but not in patients with higher BMI categories. With the interaction analysis, less association between aspirin and live birth appeared in patients with normal BMI (Ratio of OR:0.49, 95%CI: 0.29-0.81) and high BMI (Ratio of OR:0.57, 95%CI: 0.27-1.2) compared with patients with low BMI. BMI may be considered when evaluating aspirin's effect in FET cycles.

Association between BMI and Survival in Adolescents and Young Adults (AYA) with Acute Myeloid Leukemia Treated with Intensive Chemotherapy

Introduction: Obesity is linked to a higher incidence of acute myeloid leukemia (AML) in older adults as well as B-cell acute lymphoblastic leukemia in children and adolescents and young adults (AYA). To date, however, the relationship between weight and clinical outcomes in AYA patients (pts) diagnosed with AML has not been clearly established. We hypothesized that obesity reflected by higher body mass index (BMI) would confer worse prognosis in AYA pts treated with intensive chemotherapy and/or allogeneic stem cell transplant (SCT) for AML. Methods: We conducted a single institute retrospective chart review of AYA patients aged 18 to 39 years diagnosed with AML between Jan 2006 and Oct 2022. All patients received intensive chemotherapy with cytarabine- and anthracycline-based induction and consolidation chemotherapy followed in some cases by SCT. BMI was calculated based on height and weight on the date of AML diagnosis. Additional information including European Leukemia Net (ELN) 2022 risk classification, therapy response (complete remission (CR), CR with incomplete count recovery [CRi]), receipt of SCT, relapsed disease, event-free (EFS), overall survival (OS) and percentage of pts alive at 2- and 5-years after diagnosis were collected. All data was de-identified and procured on an IRB-approved protocol. Results: Seventy-six AYA patients were identified. Median age was 25.2 (range 18-39) years. 39 (51%) were female. The majority (65, 86%) were Caucasian. Per ELN 2022 risk classification, 24 (32%) had favorable, 36 (47%) had intermediate, and 16 (21%) had adverse risk disease. The CR rates based on ELN 2022 risk classification were 86%, 72% and 50%, respectively. Median OS for all pts was 791 days and per risk group was 1379, 569, and 595 days, respectively. Pts were then categorized per initial BMI into 4 categories. The majority of pts (44, 58%) had above average BMI (≥ 25), with 21 (28%) considered overweight with BMI 25-29.9 and 23 (30%) obese defined as BMI &amp;gt;30. Only 3 pts (4%) were underweight with BMI &amp;lt;18.5 (Table 1). Of note, 43% of obese pts had ELN favorable risk vs 33% of overweight pts and 24% of normal weight pts. Overall response rates in each BMI category were similar, ranging from 96-100% except in overweight pts where only 6 of 21 pts (29%) obtained CR. Relapse occurred in approximately one third (29-35%) of pts in the three highest BMI categories. Two thirds of all pts with BMI ≥18.5 underwent SCT. Excluding underweight pts due to small numbers (n=3), there was a trend to decreased survival in pts with BMI ≥18.5. Median overall survival among normal, overweight, and obese pts was 1403, 1295, and 777 days, respectively, with a significant difference between healthy and obese pts (p-value 0.0274 by log rank test). The percentage of pts alive after 5 years was 41%, 29%, and 17%, respectively (Table 2). Conclusion: Our real-world single-institute retrospective analysis suggests that AYA pts aged 18-39 yrs old diagnosed with AML and with higher BMI have decreased overall survival following intensive chemotherapy and/or allogeneic transplant. Obese patients with the highest BMI (&amp;gt;30) had a markedly shorter overall survival (median 777 days) and lower percentage of pts (17%) alive after five years following therapy than AYA AML pts with normal BMI (median 1403 days, 41% 5-year survival). This was despite over 40% of obese pts having favorable ELN risk. Potential reasons for this include biological heterogeneity in BMI cohorts, chemotherapy dosing, weight-related medical co-morbidities (i.e. cardiovascular disease) and/or transplant-related complications leading to shorter survival. Additional analyses to rule out the contribution of these and other factors and to confirm these results in a larger cohort are ongoing.

SAT657 Work Loss Among Privately Insured Employees With Overweight And Obesity In The United States

Abstract Disclosure: S. Shinde: Employee; Self; Eli Lilly &amp; Company. M. Jerry: Employee; Self; Merative. A. Tran: Employee; Self; Merative. C.J. Lee: Employee; Self; Eli Lilly &amp; Company. Background and objectives: Obesity is a significant public health issue affecting approximately 42% of the United States (US) population. However, few studies have evaluated the impact of overweight and obesity on work productivity in recent years. By understanding the burden of overweight and obesity on employee health and function, employers and healthcare providers will be able to develop appropriate programs to improve the wellbeing and work productivity of employees. This study aimed to measure work loss and associated productivity costs among employees with overweight and obesity compared to employees with normal weight in the US. Methods: This retrospective cohort study used the MarketScan databases to identify employees (aged ≥18 years) with ≥1 diagnosis code reporting a body mass index (BMI) between 1/1/2015-12/31/2019. Employees were assigned to the normal weight (BMI 19-24.9), overweight (BMI 25-29.9), obesity class 1 (BMI 30-34.9), obesity class 2 (BMI 35-39.9), and obesity class 3 (BMI ≥40) cohorts based on their earliest BMI (index) with BMI thresholds defined by the Centers for Disease Control and Prevention. Among employees with data for each category of work loss (absenteeism, short-term disability [STD], long-term disability [LTD], or worker’s compensation [WC]) during the 12-month follow-up period, the percentage of employees with work loss, number of hours/days lost from work, and costs associated with productivity loss were reported. Results: 719,482 total employees (normal weight: 106,631, overweight: 230,637, obesity class 1: 185,850, obesity class 2: 101,909, obesity class 3: 94,455) were included in the analysis. Roughly 14%, 83%, 75%, and 60% of all included employees were eligible for analysis of absence, STD, LTD, and WC, respectively. Among employees with ≥1 absence hour, the number of hours absent increased with each higher BMI category (mean hours [in order of BMI category]=262.1, 272.5, 284.9, 289.6, 304.2). The percentage of employees with a STD, LTD, or WC claim also increased with each higher BMI category (STD: 6.8%, 7.6%, 9.7%, 11.7%, 17.0%; LTD: 0.4%, 0.4%, 0.5%, 0.6%, 0.8%; WC: 2.7%, 2.8%, 3.4%, 3.6%, 3.5%, respectively). Attributable estimated costs to the employer due to the loss in productivity associated with absenteeism, STD, LTD, and WC were $1,036, $611, $38, and $91 higher per year (respectively) for individuals in the obesity class 3 cohort relative to the normal weight cohort. Conclusion: This real-world analysis demonstrated that employees with overweight and obesity have higher loss of work productivity as measured by absenteeism, STD, LTD, and WC compared to employees with normal weight. Furthermore, the loss of work productivity was greater with each higher BMI category. Future studies are warranted to better understand factors that can improve employee health and productivity. Presentation: Saturday, June 17, 2023

Association of Frailty With Nutritional Status in Patients With Chronic Kidney Disease

Frailty is commonly observed in patients with chronic kidney disease (CKD) and is associated with adverse outcomes. Protein-energy wasting (PEW), a state of decreased body stores of protein and energy fuels, may be associated with frailty. However, few data are available on the possible association between frailty and PEW in CKD. We examined the association between frailty and nutritional status assessed using anthropometric and body composition measurements, serum albumin, handgrip strength, the Malnutrition Inflammation Score (MIS), and dietary protein and calorie intake in a cross-sectional analysis of nondialysis patients with CKD stages 3-5. Body composition was assessed using multifrequency bioelectrical impedance. Frailty was defined as a Clinical Frailty Scale ≥4. We performed logistic regression with different nutrition assessment tools as the main predictors and age, sex, comorbidity, estimated glomerular filtration rate (eGFR), and hemoglobin as covariates. A total of 157 patients (93 men and 64 women; mean age 64years; diabetes prevalence 38.9%) with CKD (eGFR 24.4±13.4mL/min/1.73m2) were included. Overall, 29.3% of patients were frail. Patients with frailty were older and had a significantly higher fat tissue index and MIS but a significantly lower lean tissue index, eGFR, hemoglobin value, serum albumin value, handgrip strength value, and dietary protein intake. In multivariate logistic regression analyses, a higher body mass index category (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.03-2.31), higher fat tissue index (OR, 1.15; 95% CI, 1.03-1.28), larger waist circumference (OR, 1.05; 95% CI, 1.01-1.09), reduced handgrip strength (OR, 2.70; 95% CI, 1.17-6.21), PEW defined by MIS ≥5 (OR, 3.49; 95% CI, 1.35-9.01), and dietary protein intake ≤0.8g/kg/day (OR, 2.70; 95% CI, 1.18-6.19) were associated with higher odds of frailty. Frailty is associated with nutritional status in patients with CKD. A comprehensive nutrition assessment may allow the implementation of strategies to prevent or reduce frailty.

Raised BMI is associated with fewer Type I endoleaks in patients treated with the Gore Excluder device: data from the Global Registry for Endovascular Aortic Treatment (GREAT).

Obesity is increasing in prevalence globally and within the cohort of vascular surgical patients, leading to poorer outcomes. There are few data on endoleak as a complication of AAA surgery in obese patients. The aim of this study was to use large scale registry data from the Global Registry for Endovascular Aortic Treatment (GREAT) to interrogate any relationship between obesity and endoleak following endovascular aneurysm repair (EVAR) using a Gore Excluder device (W. L. Gore & Associates, Newark, DE, USA), in order to guide treatment recommendations in the future. A retrospective review of the GREAT Registry was carried out and patients who were recorded as having a postoperative endoleak requiring intervention were included. Patient demographics including Body Mass Index (BMI), aneurysm parameters and on- or off-instructions for use (IFU) were recorded. Ruptured AAA were excluded. Data were obtained for 3326 patients with an operation date between August 25, 2010 and September 22, 2019. Obese patients were significantly less likely to have a Type 1 endoleak (Fisher's Exact P value=0.006), and the association was maintained in a multiple logistic regression model which controlled for age, gender, neck angulation and off IFU device use (OR=0.33, P=0.01). Among AAA patients treated with a Gore Excluder device (W. L. Gore & Associates), a higher BMI category was associated with a lower risk of Type 1 endoleak requiring reintervention. Further work needs to be carried out to assess our findings in other patient cohorts.

Higher Heart Rate is Independently Associated with Abnormal Body Mass Index in a J Shape Pattern.

High heart rate is independently associated with higher cardiovascular mortality and usually occurs in sedentary persons. Inactivity can also lead to obesity. The purpose of this study was to evaluate the associations between body mass index as an independent marker of high heart rate. Data generated from screening echocardiography, for the prevention of sudden death at the Anthony Bates Foundation, was used. Data from 1,340 subjects, with documented heart rate (HR) and body mass index, between the ages 19-79 years with a mean age of 32 years, was used. We correlated the presence of a high heart rate (HR) > 90 beats per minute (BPM)) with different body mass index (BMI) categories. High heart rate was significantly associated with higher BMI categories and underweight subjects in adults suggesting a J shape association. A total of 22.7% of participants with a HR of more than 90 bpm had BMI > 40 kg/m2, vs 19.0% of patients with BMI of 35-40 kg/m2 vs 13.5% of subjects with BMI of 30-35 kg/m2 vs 12.2% of subjects with BMI of 25-30 kg/m2 - 29.9 kg/m2, vs in 10.3% of subjects with BMI between 18.5-25 kg/m2 , P< 0.01) Furthermore, increased HR was also more prevalent in underweight patient. (17.4% in subjects with BMI < 18.5 kg/m2 }. High heart rate is strongly associated with obesity and underweight suggesting that maintaining a normal weight is associated with most positive effect on the cardiovascular system.

Inflammatory and Oxidative Stress Biomarkers in the Elderly, the Birjand Longitudinal Aging Study.

Cigarette smoking is a significant risk factor for chronic and atherosclerotic vascular disease that causes preventable considerable morbidity and mortality worldwide. This study is aimed at comparing inflammation and the levels of oxidative stress biomarkers in elderly subjects. The authors recruited the participants (1281 older adults) from the Birjand Longitudinal of Aging study. They measured oxidative stress and inflammatory biomarkers serum levels in the 101 cigarettes and 1180 nonsmokers. The mean age of smokers was 69.3 ± 7.95 years, and most were male. The most percentage of male cigarette smokers have lower body mass index (BMI) (≤19 kg/m2). Females have higher BMI categories than males (P ≤ 0.001). The percentage of diseases and defects was different between cigarette and non-cigarette smoker adults (P ≤ 0.01 to P ≤ 0.001). The total white blood cells, neutrophils, and eosinophils were significantly higher in cigarettes compared to non-cigarette smokers (P ≤ 0.001). Besides, cigarette consumers' percentage of hemoglobin and hematocrit compared to other aged people was significantly different (P ≤ 0.001). However, biomarkers of oxidative stress and antioxidant levels were not significant differences between the two senior groups. Cigarette smoking in older adults was associated with increased inflammatory biomarkers and cells, but it did not find a significant difference in oxidative stress markers. Longitudinal prospective studies may help illuminate the mechanisms inducing oxidative stress and inflammation due to cigarette smoking in each gender.

Ultrasonic Measurement of Left Ventricular Mass Index of Hypertensive and Normotensive Adults in a Tertiary Hospital in South-South Nigeria

Background: Hypertension is a known cause of heart disease which may manifest as an increase in left ventricular mass index. Echocardiography is a painless, safe and reliable test using sound waves for measuring Left Ventricular Mass (LVM) from which Left Ventricular Mass Index (LVMI) can be derived.&#x0D; Aims and Objectives: This study was aimed at evaluating and comparing the ultrasonic measurement of the left ventricular mass index of hypertensive patients and normotensive participants and correlating the Left Ventricular Mass Index (LVMI) to the Body Mass Index (BMI) and Gender in the study populations.&#x0D; Methodology: This was a prospective hospital-based case-control study of adult hypertensive participants and normotensive controls. Echocardiography was done with measurements of the Left Ventricular Mass (LVM) obtained. The LVMI of the study groups was correlated to their BMI and gender.&#x0D; Results: The mean BMI was statistically higher in the hypertensive group (25.98 4.40 kg/m2) (p-value=0.001).The mean Left Ventricular Mass Index (LVMI) was significantly higher in the hypertensive group (79.5961.67g/m2.7) than in normotensive group (55.36 34.77g/m2.7) (p-value 0.0001). In this study, the high BMI category (obese/overweight) was the strongest predictors of LVMI above 51g/m2.7 (p-value= 0.0001) and females were almost 1.8 times more likely to have increased LVMI than men&#x0D; Conclusion: This study revealed that the female gender, BMI and hypertension were significant predictors of increased left ventricular mass index. High BMI category (obese/overweight) was the strongest predictors of LVMI above 51g/m2.7. Periodic ultrasonic measurement of the ventricular mass index will help in early detection and reducing this common and potentially modifiable risk that leads to increased morbidity and mortality.

What variables should inform needle length choice for deltoid intramuscular injection? A systematic review

Objectives(1) Assess the distribution of skin-to-deltoid-muscle distance (SDMD) at the deltoid intramuscular (IM) injection site; (2) its relationship with demographic and anthropometric variables and (3) Consider the findings in relation...

Postpartum weight retention and its association with socio-demographic and obstetrics correlates: A cross-sectional hospital-based preliminary survey in India

Background and aimsPostpartum weight retention can predispose women to an elevated risk of obesity and associated complications. The study aims to assess the magnitude of postpartum weight retention and its association with socio-demographic and obstetrics correlates. MethodsA cross-sectional survey was carried out in February and March 2022 via telephonic interviews. Convenience sampling technique was used for recruiting postpartum women in first three months, four to six months and beyond six months post-delivery (date of delivery January 2021 to January 2022). Chi2 test and regression analysis were employed to study the association of socio-demographic and obstetrics correlates with postpartum weight retention. ResultsThe final sample comprised 505 postpartum women with a mean age of 29 ± 4 years. The mean postpartum weight retention was 4.96 ± 3.64 kg, 5.38 ± 3.93 kg and 5.80 ± 3.95 kg in the first three months, four to six months and beyond six months post-delivery respectively. In the first three months, socio-economic status and gestational weight gain were associated with weight retention (p < 0.05). In four-six months, type of family, education qualification, and gestational weight gain were associated with weight retention (p < 0.05). Beyond six months post-delivery, gestational weight gain was associated with postpartum weight retention (p < 0.05). ConclusionThe findings provide preliminary data on the magnitude of weight retention in Indian postpartum women. Postpartum women are at an increased risk of weight retention with the overall shift to a higher body mass index category as compared to the pre-pregnancy period. It is crucial to timely screen women at risk and implement weight management strategies.

Impact of the COVID-19 Pandemic on the Overall Health of Patients With Pre-diabetes and Diabetes.

Coronavirus disease 2019 (COVID-19) impacted those with chronic diseases worldwide, especially those with diabetes. Very few studies have explored the effect of COVID-19 on diabetic patients' health markers. The present retrospective study compared various health markers of diabetic patients before and during the COVID-19 pandemic. Patients (N= 511) displayed a significant increase in systolic blood pressure, hemoglobin A1c (HbA1c), diabetic medications, and dose of insulin (p< 0.05) as well as a decrease in low density lipoprotein (LDL) levels (p = 0.04). When patients were stratified by body mass index (BMI), those in higher BMI categories were more negatively impacted during the pandemic than those in lower categories. Results display the impact that COVID-19 had on the general well-being of diabetic patients, and should encourage providers to increase telehealth visits when in-person visits are not possible.

How does body mass index impact self-perceived health? A pan-European analysis of the European Health Interview Survey Wave 2

BackgroundObesity remains a major global public health issue, despite numerous attempts to address it. Health behaviour theories suggest that a misconception of how excess weight affects general health may be...

High Blood Pressure and Changes in the Body Mass Index Category Among Japanese Children: A Follow-Up Study Using the Updated American Academy of Pediatrics Guidelines.

BackgroundHigh blood pressure (HBP) has become a public health issue worldwide. The relationship between high BP and changes in the body mass index (BMI) category in Japanese pubertal children has not yet been examined. To resolve this issue, we examined existing data with a focus on the primordial prevention of high BP signs, including elevated BP, among pubertal children aged 12 and 15 years.MethodsHeight, body weight, and BP data were examined from health checkups of 18,247 children conducted between 1993 and 2000 in the Karatsu Study, which was a cohort of pediatric lifestyle-related disease prevention medical health checkups in Japan. BP and BMI were assessed using the updated American Academy of Pediatrics (AAP) guidelines and Endocrine Society’s clinical practice guidelines definitions, respectively.ResultsFollow-up data were obtained from 7,090 subjects (50.5% boys). Stage 2 hypertension (HTN) was detected in 3% and 2.7% of boys and girls aged 12 years, respectively, and in 2.7% and 1% of boys and girls aged 15 years, respectively. Among children aged 15 years, 1.4% were newly classified with stage 2 hypertension, and 15.6% exhibited improvements to a normal BP. A binomial logistic regression analysis of high BP and BMI category changes revealed odds ratios (OR) in the group with a deteriorated BMI category of 1.51 (95% confidence interval (CI), 1.17-1.94), 2.30 (95%CI, 1.66-3.17), and 6.83 (95%CI, 4.14-11.29) for elevated BP, stage 1 hypertension, and stage 2 hypertension, respectively.ConclusionHigh BP in puberty positively correlated with BMI category changes. Considering the presence of the tracking phenomenon in hypertension, BP monitoring is an essential part of the early strategy for the prevention of lifestyle-related diseases in childhood, and improvements in BP control are crucial in early life.

Current methods for developing predictive energy equations in maintenance dialysis are imprecise

Purpose For individuals receiving maintenance dialysis, estimating accurate resting energy expenditure (REE) is essential for achieving energy balance, and preventing protein-energy wasting. Dialysis-specific, predictive energy equations (PEEs) offer a practical way to calculate REE. Three PEEs have been formulated via similar methods in different demographic samples; the Maintenance Haemodialysis Equation (MHDE REE), Vilar et al. Equation (Vilar REE) and the Fernandes et al. Equation (Cuppari REE). We compared them in a US cohort and assessed precision relative to measured REE (mREE) from indirect calorimetry. Because of expected imprecision at the extremes of the weight distribution, we also assessed the PEEs stratified by body mass index (BMI) subgroups. Methods This analysis comprised of 113 individuals from the Rutgers Nutrition and Kidney Database. Estimated REE (eREE) was calculated for each PEE, and agreement with mREE was set at > 50% of values within the limits of ±10%. Reliability and accuracy were determined using intraclass correlation (ICC) and a Bland Altman plot, which analysed the percentage difference of eREE form mREE. Results Participants were 58.4% male and 81.4% African American. Mean age was 55.8 ± 12.2 years, and the median BMI was 28.9 (IQR = 25.3 − 34.4) kg/m2. The MHDE REE achieved 58.4% of values within ±10% from mREE; Cuppari REE achieved 47.8% and Vilar REE achieved 46.0% agreement. Reliability was good for the MHDE REE (ICC = 0.826) and Cuppari REE (ICC = 0.801), and moderate for the Vilar REE (ICC = 0.642) (p < .001 for all). The equations performed poorly at the lowest and highest BMI categories. Conclusion Dialysis-specific energy equations showed variable accuracy. When categorized by BMI, the equations performed poorly at the extremes, where individuals are most vulnerable. Innovation is needed to understand these variances and correct the imprecision in PEEs for clinical practice. KEY MESSAGES Potentially impacting over millions of patients worldwide, our long-term goal is to understand energy expenditure (EE) across the spectrum of CKD (stages 1–5) in adults and children being treated with dialysis or transplantation, with the intent of providing tools for the health professional that will improve the delivery of quality care. Our research has identified and focussed on disease-specific factors which account for 60% of the variance in predicting EE in patients on MHD, but significant gaps remain. Thus, our central hypotheses are that (1) there are unique disease-specific determinants of EE and (2) prediction of EE for individuals diagnosed with CKD can be vastly improved with a model that combines these factors with more sophisticated approaches.

Body Mass Index and the Risk of Poor Outcome in Surgically Treated Patients With Good-Grade Aneurysmal Subarachnoid Hemorrhage.

BACKGROUND:Heterogeneity among study populations and treatment procedures has led to conflicting results on outcome predictors for patients with aneurysmal subarachnoid hemorrhage (aSAH). One such conflicting predictor is body mass index (BMI).OBJECTIVE:To clarify whether high BMI values protect patients from poor outcome after aSAH, as previously suggested.METHODS:We surveyed 6 prospective studies conducted in 14 different countries (93 healthcare units) between 1985 and 2016 and pooled the data on surgically treated patients with good-grade (Glasgow Coma Scale 13-15 on admission) aSAH. We calculated BMI for each patient and created 4 balanced categories based on the BMI quartiles of each cohort. We calculated adjusted odds ratios (ORs) with 95% CIs for the 3-month poor outcome (Glasgow Outcome Scale 1-3) by BMI.RESULTS:The pooled study cohort included 1692 patients with good-grade aSAH (mean age 51 years; 64% female). At 3 months, 288 (17%) had poor outcomes. The risk for poor outcomes increased with increasing BMI values (OR = 1.15 [1.02-1.31] per each standard deviation increase of BMI). The risk for poor outcome was over 1.6 times higher (OR = 1.66 [1.13-2.43]) in the highest BMI category (range 27.1-69.2) compared with the lowest BMI category (range 14.4-23.8). These associations were found in each of the 6 study cohorts in both men and women, regardless of age.CONCLUSION:Because higher BMI values seem to associate with poor outcomes in surgically treated patients with good-grade aSAH, it seems unlikely that obesity protects patients with aSAH from poor outcomes.

Differences in Body Mass Index Trajectories and Their Classification, Sociodemographic Characteristics, and Health Behaviors between People with and without Disabilities Using Korea Health Panel Survey Data.

A high body mass index (BMI) is an important factor that negatively affects the health of people with disabilities. In particular, since the high BMI has a cumulative effect on the occurrence of complications such as cardiovascular disease, it is required to investigate the data through longitudinal studies rather than cross-sectional studies. Therefore, we conducted a longitudinal follow-up study to examine the differences in the BMI trajectories of people in South Korea with disabilities, as well as the sociodemographic characteristics and health behaviors that classify individual trajectories into clusters. Participants aged 40 to 79 years who responded to the Korea Health Panel Survey (KHPS) from 2009 to 2018, 283 people with physical disabilities or brain lesion disorders, and 849 people without disabilities, were extracted. We found that the differences in the initial BMI between clusters were larger in 60–79-year-old people with disabilities (men 22.5 kg/m2, 26.9 kg/m2; women 23.8 kg/m2, 28.1 kg/m2) than in those without disabilities (men 22.1 kg/m2, 23.3 kg/m2; women 24.8 kg/m2, 25.6 kg/m2). Also, logistic regression analysis showed that, among the people with disabilities, women (OR = 1.94), those who lived alone (OR = 2.36), and those who were economically inactive (OR = 1.78) were more likely to be classified into the higher BMI category than those who were not. To effectively manage the BMI, it would be better to focus on women with disabilities, people with disabilities living alone, and people who are economically inactive.

Impact of Obesity on Heart Transplantation Outcomes.

BackgroundPatients with obesity and advanced heart failure face unique challenges on the path to heart transplantation. There are limited data on waitlist and transplantation outcomes in this population. We aimed to evaluate the impact of obesity on heart transplantation outcomes, and to investigate the effects of the new organ procurement and transplantation network allocation system in this population.Methods and ResultsThis cohort study of adult patients listed for heart transplant used the United Network for Organ Sharing database from January 2006 to June 2020. Patients were stratified by body mass index (BMI) (18.5–24.9, 25–29.9, 30–34.9, 35–39.9, and 40–55 kg/m2). Recipient characteristics and donor characteristics were analyzed. Outcomes analyzed included transplantation, waitlist death, and posttransplant death. BMI 18.5 to 24.9 kg/m2 was used as the reference compared with progressive BMI categories. There were 46 645 patients listed for transplantation. Patients in higher BMI categories were less likely to be transplanted. The lowest likelihood of transplantation was in the highest BMI category, 40 to 55 kg/m2 (hazard ratio [HR], 0.19 [0.05–0.76]; P=0.02). Patients within the 2 highest BMI categories had higher risk of posttransplantation death (HR, 1.29; P<0.001 and HR, 1.65; P<0.001, respectively). Left ventricular assist devices among patients in obese BMI categories decreased after the allocation system change (P<0.001, all). After the change, patients with obesity were more likely to undergo transplantation (BMI 30–35 kg/m2: HR, 1.31 [1.18–1.46], P<0.001; BMI 35–55 kg/m2: HR, 1.29 [1.06–1.58]; P=0.01).ConclusionsThere was an inverse relationship between BMI and likelihood of heart transplantation. Higher BMI was associated with increased risk of posttransplant mortality. Patients with obesity were more likely to undergo transplantation under the revised allocation system.