Higher Body Mass Index Categories Research Articles

Modifiable lifestyle factors are associated with lower pain levels in adults with knee osteoarthritis.

With no cure or effective treatments for osteoarthritis (OA), the need to identify modifiable factors to decrease pain and increase physical function is well recognized. To examine factors that characterize OA patients at different levels of pain, and to investigate the relationships among these factors and pain. Details of OA characteristics and lifestyle factors were collected from interviews with healthy adults with knee OA (n=197). The Western Ontario and McMaster Universities Osteoarthritis Index was used to assess pain. Factors were summarized across three pain score categories, and χ(2) and Kruskal-Wallis tests were used to examine differences. Multiple linear regression analysis using a stepwise selection procedure was used to examine associations between lifestyle factors and pain. Multiple linear regression analysis indicated that pain was significantly higher with the use of OA medications and higher body mass index category, and significantly lower with the use of supplements and meeting physical activity guidelines (≥ 150 min/week). Stiffness and physical function scores, bilateral knee OA, body mass index category and OA medication use were significantly higher with increasing pain, whereas self-reported health, servings of fruit, supplement use and meeting physical activity guidelines significantly lower. No significant differences across pain categories were found for sex, age, number of diseases, duration of OA, ever smoked, alcoholic drinks/week, over-the-counter pain medication use, OA supplement use, physical therapy use, servings of vegetables or minutes walked/week. Healthy weight maintenance, exercise for at least 150 min/week and appropriate use of medications and supplements represent important modifiable factors related to lower knee OA pain.

Abstract 19852: The Relationship Between Obesity and Heart Failure is Stronger than Those for Other CVD Subtypes and Not Explained by Traditional Risk Factors

Background: Although obesity is a risk factor for various subtypes of cardiovascular disease (CVD), the mechanisms responsible for these relationships likely differ. Limited studies have prospectively compared the associations between obesity and CVD subtypes within the same population. Hypothesis: We hypothesized that the association of obesity with heart failure (HF) is stronger than those with other subtypes of CVD, and not fully explained by traditional risk factors. Methods: We followed 13,730 ARIC participants without CVD at baseline (1987-1989) and with body mass index (BMI) ≥18.5 kg/m2. BMI (kg/m2) was categorized as normal (18.5-24.9), overweight (25-29.9), obese (30-34.9) and severely obese (≥35). Participants were followed prospectively for incident HF, coronary heart disease (CHD), and stroke. Cox regression models with adjustment for demographic and traditional CVD risk factors were constructed to estimate the associations between BMI and CVD subtypes. Seemingly unrelated regression was used to compare coefficients for the different risk associations, to account for correlations in the error terms. Results: The mean age was 54 years (SD +/- 6) and 56% were female. Over a median follow-up of 23 years, there were 2,090 HF events, 1,577 CHD events, and 948 strokes. Incident HF demonstrated the highest hazard ratios in association with higher BMI among CVD subtypes in all models, and was the only CVD subtype demonstrating significant associations with higher BMI categories in the fully adjusted model (Table). Indeed, in the fully adjusted model, the risk coefficient between severe obesity and HF was significantly greater than those for CHD and stroke (both p<0.0001). Conclusions: The relationship between obesity and HF was stronger than those for other CVD subtypes, and was not explained by traditional risk factors. Research efforts should focus on elucidating non-traditional pathways linking obesity to HF and devising novel preventive strategies.

Prevalence, associated factors, and comorbid conditions for Ménière's disease.

The aims of this study were to estimate the prevalence of Ménière's disease and investigate its relationship with: demographic factors; symptoms and conditions that are known or hypothesized to be associated with Ménière's disease; other physical diseases; mental health. The authors used cross-sectional data from the UK Biobank to compare 1376 self-reported Ménière's participants with over 500,000 without Ménière's. The data set has comprehensive anthropometric measures, questionnaire data investigating health, well-being, diet, and medical and drug-prescribing history for each participant. The authors used logistic regression models to investigate the relationship of Ménière's disease with: demographic factors; symptoms and conditions that are known or hypothesized to be associated with Ménière's disease; other physical diseases; and mental health. Ménière's disease was more common in participants who were older (adjusted odds ratio per 10-year increase: 1.5 [95% confidence interval:1.4-1.6]), white (odds ratio: 1.7;1.2-2.3), female (1.4;1.3-1.6), and having higher body mass index categories (p < 0.001). The Ménière's group had greater odds of hearing difficulty (10.9;9.6-12.5), current tinnitus (68.3;47.8-97.5), and had fallen more than once in the last year (2.1;1.8-2.5). Ménière's participants had greater odds of reporting at least one disease from each grouping of allergic, immune dysfunction, or autonomic dysfunction (2.2;1.8-2.6), and poor mental health (2.1;1.8-2.5). This study provides an evidence base that improves understanding of Ménière's disease. Associations were noted with a number of diseases, and the authors hypothesize a role for the autonomic nervous system and immune system dysfunction in Ménière's etiology. The study also highlights the physical and mental health correlates of the condition.

Extremes of body mass index and mortality among Asian peritoneal dialysis patients.

Extremes of body mass index and mortality among Asian peritoneal dialysis patients.

BODY WEIGHT AND ITS IMPACT ON ALL-CAUSE AND CARDIOVASCULAR MORTALITY IN RUSSIA

The current status of obesity (O) as a global problem justifies the use of the term “obesity epidemic”, since the prevalence of O has increased substantially, in contrast to the decreasing prevalence of other risk factors (RFs).Aim.This analysis assessed the all-cause (AC) and cardiovascular disease (CVD) mortality levels by body mass index (BMI) in a middleaged Russian population.Material and methods.The present analysis included the data from seven studies performed by the State Research Centre for Preventive Medicine in 1975–2001. The total number of participants was 17821: 12887 men and 4934 women, aged 35–74 years. All participants were examined following the same protocol. The following parameters were analysed: socio-demographic and behavioural characteristics, lipid and carbohydrate metabolism disturbances, and clinical parameters. All participants were divided into seven categories by their BMI values: from BMI &lt;21 kg/m 2 (first category) to BMI ≥36 kg/m 2 (sixth category). Results. There were positive associations between BMI and systolic blood pressure, diastolic blood pressure, triglycerides, and coronary heart disease presence. At the same time, BMI was negatively associated with smoking and excessive alcohol consumption. No associations were observed for BMI and left ventricular hypertrophy, heart blocks, or cholesterol levels. After adjustment for age, there was a U-shaped association between BMI and AC mortality. With the category “BMI &lt;21 kg/m 2” as a reference group, mortality risk levels were decreasing for the second and third BMI categories, with an increased risk for the sixth category. In women, age-adjusted relative risk (RR) of AC mortality was only slightly lower than that in men. After additional adjustment for RFs and clinical parameters, RR of AC mortality was relatively similar across all BMI categories in both genders, without any significant differences compared to the reference group. Among lower BMI categories in men, RR of CVD mortality was close to RR for AC mortality. However, in higher BMI categories, the former was substantially higher than the latter. No similar patterns were registered for women.Conclusion.The observed tendency of elevated CVD risk in people with O suggests that particular attention should be paid to this risk factor. Adverse effects of O have also been demonstrated for people with arterial hypertension and diabetes mellitus. For the latter, its prevalence has substantially increased in Russia over the past years.

Short-term Precision Error in Dual Energy X-Ray Absorptiometry, Bone Mineral Density and Trabecular Bone Score Measurements; and Effects of Obesity on Precision Error

Introduction: Bone mineral density (BMD) measured by dual energy x-ray absorptiometry (DXA) is the primary screening tool for diagnosis of osteopenia and osteoporosis. BMD alone does not provide information regarding the structural characteristics of bone and this limitation has been a driver for the development of techniques, including trabecular bone score (TBS) software, to assess bone microarchitecture. Precision error in DXA is important for accurately monitoring changes in BMD and it has been demonstrated that BMD precision error increases with increasing body mass index (BMI). Information on in vivo precision error for TBS is very limited. This study evaluated short-term precision error (STPE) of lumbar spine BMD & TBS measurement, and investigated the effect of obesity on DXA precision error. Method: DXA lumbar spine scans (L1-L4) were performed using GE Lunar Prodigy. STPE was measured in ninety-one women at a single visit by duplicating scans with repositioning in-between. Precision error was calculated as the percentage coefficient of variation. Participants were sub-divided into four groups based on BMI to assess the effect of obesity on STPE. Results: STPE is poorer for TBS than for BMD. STPE is adversely affected for both BMD and TBS measurements by increasing BMI but this effect is mitigated for TBS in the highest BMI category where use of the thick scanning mode improves signal to noise ratio. Conclusion: Results from serial BMD and TBS measurements should take account of differences in precision error in the two techniques and in different BMI categories.

Obesity is associated with a lower probability of achieving sustained minimal disease activity state among patients with psoriatic arthritis

AimTo assess whether overweight and obese patients with psoriatic arthritis (PsA) are less likely to achieve sustained minimal disease activity (MDA) state compared to patients with normal weight.MethodsA cohort of...

Mortality Risk of Obesity and Underweight Is Overestimated with Self-Reported Body Mass Index

Obese persons (those with a body mass index [BMI] ≥30 kg/m2) tend to underestimate their weight, leading to an underestimation of their true (measured) BMI and obesity prevalence.1,2 In contrast, underweight people (BMI <18.5 kg/m2) tend to report themselves heavier, resulting in a higher BMI compared with measured BMI and an underestimation of underweight prevalence.1 Less is known about biases in the estimate of mortality risk associated with these body weight categories using self-reported data. It has been shown that the mortality risk of obesity based on self-report can be overestimated, ie, biased away from the null.3,4 Underweight is associated with an increased mortality risk5 and, because underweight persons tend to overestimate BMI, one might intuitively expect that the mortality risk of underweight based on self-reported BMI would be underestimated, ie, biased toward the null (the opposite of the effect in obese persons). Is that a misleading intuition? Consider a cohort of 1000 men, of whom 10% were underweight at baseline, 70% had normal weight or were overweight, and 20% were obese, based on measured BMI. After 5 years, 36 men died (Table). The relative risk (RR) of death was higher in underweight (RR = 2.0) and obese men (RR = 1.5) compared with that in normal weight and overweight men combined. We assumed that the mortality risk was higher in the lowest (<17.5 kg/m2) category among underweight persons and in the highest BMI category (≥31 kg/m2) among obese persons.TABLE: Hypothetical Cohort with 1000 Men Providing Measured and Self-Reported Weight and Height to Compute Body Mass Index (BMI)Participants also reported their weight and height at baseline to compute self-reported BMI. We assume that underweight men (measured BMI <18.5 kg/m2) overestimated their BMI by 1 unit, on average. Consequently, men with measured BMI 17.5–18.4 kg/m2 were classified as “normal weight” based on self-reported BMI, while in truth they were underweight (eAppendix, eFigure, https://links.lww.com/EDE/A735). Thus, using self-reported data, the prevalence of underweight was underestimated. Men with self-reported BMI <18.5 kg/m2 had a measured BMI <17.5 kg/m2. Therefore, these men had a higher mortality compared with men with true BMI <18.5 kg/m2 (8% vs. 6%). We assume that obese men underestimated their BMI by 1 unit, on average. Therefore, men with true BMI 30.0–31.0 kg/m2 were classified as normal weight/overweight based on self-reported BMI although they were in truth obese. Using self-reported data, the prevalence of obesity was underestimated. Men with self-reported BMI ≥30.0 kg/m2 had a measured BMI ≥31.0 kg/m2. Accordingly, they had a higher mortality compared with men with true BMI ≥30.0 kg/m2 (6% vs. 4.5%). Using self-reported BMI to define body weight categories, the risk of underweight relative to normal/overweight was (4/50)/[(2 + 21 + 3)/(50 + 700 + 100)] = 2.6, which was higher than the RR (2.0) obtained with measured BMI. The RR of obesity was (6/100)/[(2 + 21 + 3)/(50 + 700 + 100)] = 2.0, which was also higher than the RR (1.5) obtained with measured BMI. Although self-reports lead to an overestimation of BMI by underweight persons and an underestimation by obese persons,1 the mortality (or disease) risk in both obese and underweight persons is likely overestimated when self-reported data are used to categorize people. Our assumptions are simplistic. The errors in weight estimations depend on sex, age, and other characteristics,2,6 and the direction of the bias will depend on how people in the various categories estimate their weight. The possible effects of exposure misclassification on the estimation of RR are complex and barely generalizable.7 Still, as shown, the effects of such misclassification can be counterintuitive. Direction and magnitude of bias should be evaluated carefully for each situation.7 The overestimation of obesity risk based on self-reports has been demonstrated3,4 and recently corroborated in a meta-analysis.8 Research is needed to confirm the bias entailed by defining underweight with self-reported data. David Faeh Lucienne Roh Institute of Social and Preventive Medicine (ISPM), University of Zurich, Zurich, Switzerland, [email protected] Fred Paccaud Arnaud Chiolero Institute of Social and Preventive Medicine (IUMSP), University Hospital Center of Lausanne, Lausanne, Switzerland

Activity, Energy Intake, Obesity, and the Risk of Incident Kidney Stones in Postmenopausal Women

Obesity is a strong risk factor for nephrolithiasis, but the role of physical activity and caloric intake remains poorly understood. We evaluated this relationship in 84,225 women with no history of stones as part of the Women's Health Initiative Observational Study, a longitudinal, prospective cohort of postmenopausal women enrolled from 1993 to 1998 with 8 years' median follow-up. The independent association of physical activity (metabolic equivalents [METs]/wk), calibrated dietary energy intake, and body mass index (BMI) with incident kidney stone development was evaluated after adjustment for nephrolithiasis risk factors. Activity intensity was evaluated in stratified analyses. Compared with the risk in inactive women, the risk of incident stones decreased by 16% in women with the lowest physical activity level (adjusted hazard ratio [aHR], 0.84; 95% confidence interval [95% CI], 0.74 to 0.97). As activity increased, the risk of incident stones continued to decline until plateauing at a decrease of approximately 31% for activity levels ≥10 METs/wk (aHR, 0.69; 95% CI, 0.60 to 0.79). Intensity of activity was not associated with stone formation. As dietary energy intake increased, the risk of incident stones increased by up to 42% (aHR, 1.42; 95% CI, 1.02 to 1.98). However, intake <1800 kcal/d did not protect against stone formation. Higher BMI category was associated with increased risk of incident stones. In summary, physical activity may reduce the risk of incident kidney stones in postmenopausal women independent of caloric intake and BMI, primarily because of the amount of activity rather than exercise intensity. Higher caloric intake further increases the risk of incident stones.

Body Mass Index and Early Kidney Function Decline in Young Adults: A Longitudinal Analysis of the CARDIA (Coronary Artery Risk Development in Young Adults) Study

Identifying potentially modifiable risk factors is critically important for reducing the burden of chronic kidney disease. We sought to examine the association of body mass index (BMI) with kidney function decline in a cohort of young adults with preserved glomerular filtration at baseline. Longitudinal cohort. 2,839 black and white young adults with cystatin C-based estimated glomerular filtration rate (eGFRcys)>90mL/min/1.73m(2) taking part in the year-10 examination (in 1995-1996) of the Coronary Artery Risk Development in Young Adults (CARDIA) Study. BMI, categorized as 18.5-24.9 (reference), 25.0-29.9, 30.0-39.9, and≥40.0kg/m(2). Trajectory of kidney function decline, rapid decline (>3% per year), and incident eGFRcys<60mL/min/1.73m(2) over 10 years of follow-up. GFRcys estimated from the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation for calibrated cystatin C at CARDIA years 10, 15, and20. At year 10, participants had a mean age of 35.1 years, median eGFRcys of 114mL/min/1.73m(2), and 24.5% had BMI≥30.0kg/m(2). After age 30 years, average eGFRcys was progressively lower with each increment in BMI after adjustment for baseline age, race, sex, hyperlipidemia, smoking status, and physical activity. Higher BMI category was associated with successively higher odds of rapid decline (for 25.0-29.9, 30.0-39.9, and≥40.0kg/m(2), adjusted ORs were 1.50 [95% CI, 1.21-1.87], 2.01 [95% CI, 1.57-2.87], and 2.57[95% CI, 1.67-3.94], respectively). 18 participants (0.6%) had incident eGFRcys<60mL/min/1.73m(2). Inunadjusted analysis, higher BMI category was associated with incident eGFRcys<60mL/min/1.73m(2) (for25.0-29.9, 30.0-39.9, and≥40.0kg/m(2), ORs were 5.17 [95% CI, 1.10-25.38], 7.44 [95% CI, 1.54-35.95], and 5.55 [95% CI, 0.50-61.81], respectively); adjusted associations were no longer significant. Inability to describe kidney function before differences by BMI category were already evident. Absence of data for measured GFR or GFR estimated from serum creatinine level. Higher BMI categories are associated with greater declines in kidney function in a cohort ofyoung adults with preserved GFR at baseline. Clinicians should vigilantly monitor overweight and obese patients for evidence of early kidney function decline.

The Relationship of Body Size and Adiposity to Source of Self-Esteem in College Women

Background Studies looking at self-esteem and body size or adiposity generally demonstrate a negative relationship. However, the relationship between the source of self-esteem and body size has not been examined in college women. Purpose The purpose of this study was to evaluate the relationship of body size and adiposity to source of self-esteem (achievement or self-acceptance) in young adult women. Methods Participants were healthy women between the ages of 18 and 25 years. Participants completed the Worth Index to determine source of self-esteem. Body height and weight were measured and body composition was assessed by the BOD POD. Results One hundred fifty-eight college women completed the study. Source of self-esteem was primarily self-acceptance. Achievement self-esteem in appearance was positively correlated to percentage body fat (P < 0.05). Body mass index (BMI) was negatively related to self-acceptance self-esteem in appearance and performance (P < 0.05). Global self-esteem was significantly lower for individuals in the highest BMI category. Discussion Women with higher BMI and body fat tend to see their worth as more contingent upon appearance than women with lower body weights. Thus, these women tend to have a source of self-esteem that is less stable and more psychologically vulnerable. Translation to Health Education Practice Self-acceptance self-esteem contributes to a healthier sense of self than achievement self-esteem. These results help to inform health educators on how to effectively plan health programs for young women.

Physical activity matters: associations among body mass index, physical activity, and health-related quality of life trajectories over 10 years.

The objective of this study was to assess the associations among body mass index (BMI), leisure time physical activity (LTPA) and health-related quality of life (HRQL) trajectories among adults. Self-reported data were drawn from the Canadian National Population Health Survey, with respondents being interviewed every 2 years between 1996-97 and 2006-07. Using growth curve modeling, HRQL trajectories for individuals aged 18 and over were associated with measures of BMI and LTPA. Growth models were constructed separately for males and females. Findings suggested that, for males, BMI categories had little impact on baseline HRQL, and no impact on the rate of change in HRQL. Among women, higher BMI categories were associated with significantly lower baseline HRQL. However, BMI had no impact on the rate of change of HRQL. Conversely, for both men and women and regardless of BMI category, LTPA had significant impacts on baseline HRQL, as well as the rate of change in HRQL. Individuals who were inactive or sedentary had much steeper declines in HRQL as they aged, as compared with individuals who were active in their leisure time. The results underscore the importance of LTPA in shaping trajectories of HRQL.

Severe Obesity is Associated With 3-Fold Higher Radiation Dose Rate During Ureteroscopy

To investigate and characterize the association between fluoroscopy radiation dose rate and various patient size metrics during ureteroscopy. Fluoroscopy data were collected from 100 patients undergoing ureteroscopy for stone disease. Radiation dose rates were determined from fluoroscopy dose and time. Estimated entrance skin dose was calculated from air kerma (AK) by applying correction factors. Effective dose (ED) was estimated with Monte Carlo-based simulation software. Patient size metrics included body mass index (BMI), anterior-posterior (AP) midline distance, AP transrenal thickness, and region of interest (ROI) pixel value magnitude on computed tomography scout. Univariate and multivariate regression analyses were performed to determine the association between AK dose rate andpatient size metrics, adjusting for laterality and stone location. Obese patients (>30 kg/m(2)) comprised 46% of the cohort. Mean fluoroscopy time, displayed AK, entrance skin dose, and ED were 4.2 ± 6.0 second, 1.2 ± 2.1 mGy, 1.2 ± 2.2 mGy, and 0.08 ± 0.15 mSv, respectively. Mean AK dose rate and ED dose rates were 0.30 ± 0.23 mGy/second and 0.021 ± 0.016 mSv/second, respectively. Compared with the nonobese category, the highest BMI category (≥35 kg/m(2)) had over a 3-fold higher mean AK rate (0.50 vs 0.16 mGy/second). On univariate and multivariate analysis, BMI, AP midline distance, AP transrenal thickness, and computed tomography scout region of interest pixel value magnitude were each significantly associated with dose rate. Larger patients experience higher radiation dose rates under fluoroscopy. Severely obese patients receive 3-fold higher dose rates compared with nonobese patients. Given the higher incidence of stone disease in obese patients, all attempts should be made to minimize radiation exposure during ureteroscopy.

Association between Health-Related Quality of Life and Body Mass After Adjustable Gastric Banding: A Nonlinear Approach

ObjectiveTo estimate the relationship between health utilities and body mass index (BMI) among a cohort of obese patients who underwent laparoscopic adjustable gastric banding (LAGB). MethodsWe used a cross-sectional survey to ascertain demographic, clinical, and health utility data from patients who had undergone LAGB in Washington State from 2004 to 2010. The EuroQol five-dimensional (EQ-5D) questionnaire was used for health utility estimation. We calculated adjusted EQ-5D questionnaire indices across BMI categories by using a two-part model. We also used logistic regression to examine the relationship between BMI and the likelihood of reporting problems on each of the EQ-5D questionnaire dimension. ResultsData were obtained from 790 subjects. The mean adjusted EQ-5D questionnaire indices for all obese BMI categories were significantly lower than those in the normal weight category. The relationship between BMI and EQ-5D questionnaire indices was nonlinear. Respondents classified as morbidly obese II (BMI > 50 kg/m2) had the greatest decrement (−0.15, 95% confidence interval −0.28 to −0.01) in EQ-5D questionnaire indices. The association between EQ-5D questionnaire indices and BMI at the time of the survey was weaker after adjusting for weight loss after LAGB. Respondents with higher BMI were more likely to report having problems in the mobility, usual/activity, pain/discomfort, and anxiety/depression dimensions (trend test, P < 0.05), but not for the self-care dimension (trend test, P = 0.08). ConclusionsThe EQ-5D questionnaire has a negative and nonlinear relationship with BMI for obese patients who had LAGB. The relationship is confounded by weight loss. Within the EQ-5D questionnaire dimensions, patients are more likely to report having problems in the mobility, usual/activity, pain/discomfort, and anxiety/depression dimensions in higher BMI categories, but not in the self-care dimension.

SAT0266 Obesity is Associated with Lower Probability of Achieving Sustained Minimal Disease Activity State Among Patients with Psoriatic Arthritis

BackgroundThe prevalence of obesity among patients with psoriatic arthritis (PsA) is increased compared to the general population. Obese patients with PsA tend to respond less favorably to TNF alpha blockers...

LDL-cholesterol and body mass index among Japanese schoolchildren: a population-based cross-sectional study

BackgroundSerum low-density lipoprotein cholesterol (LDL-C) is one of the most important risk factors for coronary heart disease. The aim of the present study was to investigate the relationship between LDL-C and body mass index (BMI) in population-based Japanese schoolchildren.MethodsThe subjects comprised all fourth graders and seventh graders in Ina Town, Saitama Prefecture, Japan, during 2002-2009. Information about each subject’s age, sex, and family history of hypercholesterolemia was collected using a self-administered questionnaire. The body height, weight, and LDL-C were measured for each child. LDL-C was measured using the direct method. According to the LDL-C criteria of the Japan Atherosclerosis Society, LDL-C level was categorized into three subgroups: acceptable, < 110 mg/dL; borderline, 110-139 mg/dL; and high, ≥ 140 mg/dL. Children with either borderline or high LDL-C level were considered to have high-normal LDL-C (HLDL-C).ResultsData from a total of 5869 subjects were analyzed. A higher BMI category was associated with a higher prevalence of HLDL-C regardless of sex or grade level (P < 0.05). When compared with the <50th percentile BMI category, the odds ratio (OR) for HLDL-C was statistically significant in the 75th to 84th percentile category of fourth-grade boys (OR: 1.95, 95% confidence interval (95% CI): 1.28-2.97), the 85th to 94th percentile of fourth-grade girls (2.52, 1.74-3.64), and the 85th to 94th percentile of seventh-grade boys (2.04, 1.31-3.20) and girls (1.90, 1.24-2.91).ConclusionA statistically significant association between LDL-C levels and BMI was observed in Japanese school children.

Body Mass Index and Achilles Tendonitis

High body mass index (BMI) has been implicated as an etiologic agent in Achilles tendonitis (AT) and may contribute to poorer treatment outcomes. The purpose of this study was to better elucidate the role of BMI in both the development and treatment of AT. A matched case-control (1:1) study design was used. Matching criteria were age, gender, and year of presentation. Consecutive patients who presented with a diagnosis of AT between 2002 and 2011 at a single foot and ankle specialty clinic were identified. Patients who presented with other foot pain at the same clinic served as controls (CG). The AT group was further stratified into treatment responders and nonresponders. The main effect measure for both analyses was an adjusted odds ratio. A total of 944 patients (472 AT; 472 CG) were included. AT patients had higher BMI than those in the CG (30.2 ± 6.5 vs 25.9 ± 5.3, P < .001). Overweight and obese patients were 2.6 to 6.6 times more likely than those with a normal BMI to present with Achilles tendonitis (P < .001). There was also elevated risk of presenting with AT at higher BMI categories (Mantel-Haenszel χ (2) = 8.074, P = .004). However, only age, not BMI, correlated with having failed conservative treatment among the AT group, with patients older than 65 years at the greatest risk (odds ratio = 2.4, 95% confidence interval = 1.5 to 4.1, P < .001). BMI plays a role in the development of AT but does not appear to influence patient response to conservative treatment. Prognostic, Level II.

Obesity Is Associated With a Lower Resting Oxygen Saturation in the Ambulatory Elderly: Results From the Cardiovascular Health Study

The contribution of obesity to hypoxemia has not been reported in a community-based study. Our hypothesis was that increasing obesity would be independently associated with lower SpO2 in an ambulatory elderly population. The Cardiovascular Health Study ascertained resting SpO2 in 2,252 subjects over age 64. We used multiple linear regression to estimate the association of body mass index (BMI) with SpO2 and to adjust for potentially confounding factors. Covariates including age, sex, race, smoking, airway obstruction (based on spirometry), self reported diagnosis of emphysema, asthma, heart failure, and left ventricular function (by echocardiography) were evaluated. Among 2,252 subjects the mean and median SpO2 were 97.6% and 98.0% respectively; 5% of subjects had SpO2 values below 95%. BMI was negatively correlated with SpO2 (Spearman R = -0.27, P < .001). The mean difference in SpO2 between the lowest and highest BMI categories (< 25 kg/m(2) and ≥ 35 kg/m(2)) was 1.33% (95% CI 0.89-1.78%). In multivariable linear regression analysis, SpO2 was significantly inversely associated with BMI (1.4% per 10 units of BMI, 95% CI 1.2-1.6, for whites/others, and 0.87% per 10 units of BMI, 95% CI 0.47-1.27, for African Americans). We found a narrow distribution of SpO2 values in a community-based sample of ambulatory elderly. Obesity was a strong independent contributor to a low SpO2, with effects comparable to or greater than other factors clinically associated with lower SpO2.

PP.25 Interpregnancy Changes in Maternal Weight and Body Mass Index

ObjectiveThis longitudinal study examined changes in maternal weight and Body Mass Index (BMI) in the early pregnancy between a woman’s first and second baby.MethodsWe studied women more than 18 years...

Driver obesity and the risk of fatal injury during traffic collisions

BackgroundFew studies have looked at how obesity affects injury outcomes among vehicle occupants involved in traffic collisions.ObjectiveTo estimate the association of obesity with death risk among drivers of passenger vehicles...