High Body Mass Index Group Research Articles

Dietary diversity and overweight are associated with high intrinsic capacity among Chinese urban older adults (2020−2021)

Background and objectivesThe associations of intrinsic capacity (IC) with dietary diversity and body mass index (BMI) remain unclear in older adults. This study aimed to examine the associations of dietary diversity and BMI on high IC. MethodsThe cross-sectional study used data from the Fujian Prospective Aging Cohort, which included 1972 individuals aged 60–98 from 2020 to 2021. The dietary diversity score (DDS) was constructed with eight food varieties, and consuming ≥five varieties of food daily was considered a high DDS. BMI was grouped into underweight, normal weight, overweight, and obesity according to the Chinese guidelines. High IC was defined as ≥three unimpaired domains of cognition, locomotion, sensory, vitality, and psychology. ResultsMultivariate logistic regression analysis was used to assess the separate association of high DDS and BMI groups with high IC. Compared with low DDS, high DDS had a positive association with high IC (OR = 1.42, 95 % CI = 1.16–1.74). Compared with normal weight, underweight was inversely related to high IC (OR = 0.18, 95 % CI = 0.09–0.36), overweight was positively related to high IC (OR = 1.65, 95 % CI = 1.33–2.06), while no significant association was observed between obesity and high IC. The restricted cubic spline model exhibited an inverted U-shaped nonlinear curve of BMI and high IC and identified an optimal BMI of 25.7 kg/m2 for high IC. ConclusionsHigh DDS is a protective factor of high IC in older adults. Overweight had the most protective association with high IC among the four BMI subgroups. Individuals with overweight and higher dietary diversity had higher IC.

Comprehensive prognostic effects of systemic inflammation and Insulin resistance in women with breast cancer with different BMI: a prospective multicenter cohort

To investigate the prognostic value of systemic inflammation and insulin resistance in women with breast cancer with different body mass index (BMI). This multicenter, prospective study included 514 women with breast cancer. Multivariate survival analysis showed that patients with high C-reactive protein (CRP), high CRP to albumin ratio (CAR), high lymphocyte to CRP ratio (LCR), high low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (LHR), and high triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-c) were significantly associated with worse prognosis. The mortality rate of patients with both high CAR and high LHR or both low LCR and high LHR were 3.91-fold or 3.89-fold higher than patients with both low CAR and low LHR or both high LCR and low LHR, respectively. Furthermore, the combination of LCR and LHR significantly predicted survival in patients within the high BMI group. The CRP, CAR, LCR, LHR, and TG/HDL-c were associated with poor survival in women with breast cancer. The combination of CAR and LHR or LCR and LHR could better predict the prognostic outcomes of women with breast cancer, while the combination of LCR and LHR could better predict the prognosis of those patients with overweight or obese patients.

Influence of body mass index on early post-operative functional outcomes after total knee arthroplasty: A prospective, clinical and observational study

Background/Purpose: The evidence on the influence of body mass index (BMI) on functional outcomes following total knee arthroplasty (TKA) is conflicting. This study assessed and compared the effect of BMI on early mobility and function after TKA. Methods: Adult patients with osteoarthritis (OA) or rheumatoid arthritis (RA) who received unilateral TKA were recruited and then divided into normal, overweight and obese groups. The pain and functional outcomes of pre/post-TKA were examined using visual analogue scale (VAS) and Lysholm Knee Scale (LKS), respectively. Results: At 3 and 6 weeks post-TKA, LKS score was significantly higher in normal BMI group compared to overweight and obese. Lower BMI gained early improvement in functional outcome than higher BMI groups. However, patients showed considerable functional improvement at 6 months post-TKA, regardless of BMI category. Conclusion: Although BMI levels influence postoperative early functional improvement in TKA patients, the functional benefits after TKA at 6 months were similar regardless of BMI class.

Risk of dementia associated with body mass index, changes in body weight and waist circumference in older people with type 2 diabetes: The Edinburgh Type 2 Diabetes Study.

To determine the relationship of dementia with preceding body mass index (BMI), changes in body weight and waist circumference in older people with type 2 diabetes. In the Edinburgh Type 2 Diabetes Study (1064 men and women with type 2 diabetes, aged 60-75), body weight, waist circumference and BMI were measured at baseline and after 4 years in a subgroup (n= 821). Percentage body weight and waist circumference change over 4 years were calculated. Data on incident dementia was recorded during a median follow-up time of 10.84 years. Survival models considering a range of co-variables and/or death as a competing risk were used to estimate the risks of dementia associated with each weight-related variable. A total of 105 incident dementia events were recorded. When compared with people in the lowest BMI group (<25 kg/m2 ), risk of dementia was lower in intermediate BMI groups (25-29.9kg/m2 , HR 0.44, p= 0.002; 30-34.9kg/m2 , HR 0.41, p= 0.001) and the highest BMI group (≧35 kg/m2 , HR 0.35, p= 0.001). In the weight change subgroup, 78 incident dementia events were recorded between years 4 and 10. Body weight loss over 5% (compared with ≦5%) was associated with higher incidence of dementia (HR 2.06, p= 0.010). The association between waist circumference change and dementia was not significant. Both a lower BMI and weight loss over a period of years are indicative of increased dementia risk for older people with type 2 diabetes, while waist circumference changes may be less informative.

The influence of body weight index on initial stability of uncemented femoral knee protheses: A finite element study

Background and objectiveObesity is one of the risk factors for osteoarthritis. The end-stage treatment for osteoarthritis is total knee arthroplasty (TKA). However, it remains controversial whether a high body mass index (BMI) affects the initial stability of the femoral prosthesis after TKA. Finite element analysis (FEA) was used to investigate this question in this study. MethodsFour femur models that assembled with TKA femoral components were reconstructed and divided into high BMI group and normal BMI group. The three-dimensional femurs were modeled and assigned inhomogeneous materials based on computed tomography (CT) images. Then each FEA model was applied with gait and deep bend loading conditions to evaluate the maximum principal strain on the distal femur and the relative micromotion between the femur and prosthesis. ResultsThe mean strain of the high BMI group increased by 32.7% (936.9 με versus 706.1 με) and 50.9% (2064.5 με versus 1368.2 με) under gait and deep bend loading conditions, respectively, compared to the normal BMI group. Meanwhile, the mean micromotion of the high BMI group increased by 41.6% (2.77 μm versus 1.96 μm) and 58.5% (62.1 μm versus 39.2 μm), respectively. Under gait condition, the maximum micromotion for high BMI group was 33.8 μm and would compromise the initial stability. Under deep bend condition, the maximum strain and micromotion exceeded −7300 με and 28 μm for both groups. ConclusionHigh BMI caused higher strain on the bone and higher micromotion between the prosthesis and the femur. Gait activities could be risky for prosthesis stability in high BMI group while be safe in normal group. Deep bend activities were highly dangerous for both groups with high BMI and normal BMI and should be avoided.

Morbid obesity's impact on COVID-19 patients requiring venovenous extracorporeal membrane oxygenation: The covid-19 critical care consortium database review.

Introduction: Obesity is associated with a worse prognosis in COVID-19 patients with acute respiratory distress syndrome (ARDS). Veno-venous (V-V) Extracorporeal Membrane Oxygenation (ECMO) can be a rescue option, however, the direct impact of morbid obesity in this select group of patients remains unclear.Methods: This is an observational study of critically ill adults with COVID-19 and ARDS supported by V-V ECMO. Data are from 82 institutions participating in the COVID-19 Critical Care Consortium international registry. Patients were admitted between 12 January 2020 to 27 April 2021. They were stratified based on Body Mass Index (BMI) at 40kg/m2. The endpoint was survival to hospital discharge.Results: Complete data available on 354 of 401 patients supported on V-V ECMO. The characteristics of the high BMI (>40kg/m2) and lower BMI (≤40kg/m2) groups were statistically similar. However, the 'high BMI' group were comparatively younger and had a lower APACHE II score. Using survival analysis, older age (Hazard Ratio, HR 1.49 per-10-years, CI 1.25-1.79) and higher BMI (HR 1.15 per-5kg/m2 increase, CI 1.03-1.28) were associated with a decreased patient survival. A safe BMI threshold above which V-V ECMO would be prohibitive was not apparent and instead, the risk of an adverse outcome increased linearly with BMI.Conclusion: In COVID-19 patients with severe ARDS who require V-V ECMO, there is an increased risk of death associated with age and BMI. The risk is linear and there is no BMI threshold beyond which the risk for death greatly increases.

The Association Between Body Mass Index and Death Following Elective Endovascular and Open Repair of Abdominal Aortic Aneurysms in the Vascular Quality Initiative

The effect of body mass index (BMI) on post-operative outcomes after abdominal aortic aneurysm (AAA) repair remains poorly defined. The association between BMI and death following elective endovascular aneurysm repair (EVAR) and open aneurysm repair (OAR) of AAA in a large national quality registry is investigated. All elective AAA repairs within the Society for Vascular Surgery Vascular Quality Initiative (VQI; 2010 to September 2021) were reviewed (EVAR, n= 53 426; OAR, n= 9 479). All analyses were conducted separately for EVAR and OAR patients. The primary end points were 30 day mortality and five year survival rates. Study cohorts were divided into World Health Organisation BMI categories (C1 < 18.5, C2 18.5 ≤ BMI < 25, C3 25 ≤ BMI < 30, C4, 30 ≤ BMI < 35, C5 35 ≤ BMI < 40, C6 ≥ 40). BMI was examined as both a categorical and continuous variable. Logistic and Cox proportional hazards regression were used for risk adjustment. Among EVAR patients, BMI distribution was C1, 1 216 (2%); C2, 14 687 (28%); C3, 20 516 (38%); C4, 11 352 (21%); C5, 3 947 (7%); C6, 1 708 (3%). Class 1, 2, and 6 BMI patients experienced an increased 30 day mortality rate (C1 2.6%; C2 1.3%; C6 1.4% vs. C3 - 5 0.7%; p < .001) and C1 and C2 had correspondingly inferior long term survival (five years: C1 69 ± 3%; C2 79 ± 1% vs. C3 - 6 86 - 88 ± 2%; log rank p < .001). These survival disparities persisted after risk adjustment for multiple confounders. In the OAR cohort, BMI distribution was C1, 280 (3%); C2, 2 862 (30%); C3, 3 587 (38%); C4, 1 940 (21%); C5, 581 (6%); C6, 229 (2%). Crude 30 day mortality rates were increased for both the lowest and highest BMI patients (C1 12%, C6 7% vs. C2 - 5 3 - 4%; p < .001); these differences also persisted in long term survival (five years: C1 71 ± 6%, C6 82 ± 6% vs. C2 - 6 85 - 88 ± 3%; log rank p < .001). In risk adjusted analysis, both low and high BMI OAR patients had an increased 30 day and long term mortality rate. Within the VQI, both the extreme low (< 18.5) and high (≥ 40) BMI groups experienced an increased 30 day mortality rate after both elective EVAR and OAR. By comparison, while the lowest BMI cohort was significantly associated with decreased long term survival after both procedures, the highest BMI group only experienced reduced long term survival after OAR. Based upon this large real world registry analysis of elective AAA repairs, differential metabolic signatures exist within extreme BMI categories, which may inform peri-operative risk stratification and clinical decision making.

Donor BMI and Post-living Donor Liver Transplantation Outcomes: A Preliminary Report.

We studied 66 living donors and their recipients who underwent living donor liver transplant at our center between 2013 and 2020. BMI was divided into 3 categories (<25, 25-29.9, and ≥30 kg/m2). Magnetic resonance imaging-derived proton density fat fraction was used to quantify steatosis. Donor outcomes included length of stay (LOS), emergency department visits within 90 d, hospital readmissions within 90 d, and complication severity. Recipient outcomes included LOS and in-hospital mortality. The Student t test was used to compare normally distributed variables, and Kruskal-Wallis tests were used for nonparametric data. There was no difference in donor or recipient characteristics based on donor BMI. There was no significant difference in mean magnetic resonance imaging fat percentage among the 3 groups. Additionally, there was no difference in donor LOS (P = 0.058), emergency department visits (P = 0.64), and hospital readmissions (P = 0.66) across BMI category. Donor complications occurred in 30 patients. There was no difference in postdonation complications across BMI category (P = 0.19); however, there was a difference in wound complications, with the highest rate being seen in the highest BMI group (0% versus 16% versus 37%; P = 0.041). Finally, there was no difference in recipient LOS (P = 0.83) and recipient in-hospital mortality (P = 0.29) across BMI category. Selecting donors with BMI ≥30 kg/m2 can result in successful living donor liver transplantation; however, they are at risk for perioperative wound complications. Donor counseling and perioperative strategies to mitigate wound-related issues should be used when considering obese living donors.

PS-C18-4: HIGH BODY MASS INDEX IS A RISK FACTOR FOR TRANSITION TO HEMODIALYSIS OR HYBRID THERAPY AND PERITONEAL DIALYSIS-RELATED INFECTION

Objective: Obesity may negatively impact clinical outcomes of peritoneal dialysis (PD) patients. However, obesity is defined differently in Japan, and its impact on PD-related outcomes remains unclear. In current study, we aimed to examine the association of high body mass index (BMI) with the complete hemodialysis (HD) transfer, transition to HD and PD/HD hybrid therapy, peritonitis, catheter exit-site and tunnel infection (ESI/TI), and heart failure-related hospitalization. Design and method: This retrospective cohort study included 120 patients who underwent PD catheter insertion between January 2008 and June 2018. BMI ≧ 25 kg/m2, which was calculated from the height (m) and body weight (kg) at the time of PD catheter insertion, was defined as high BMI. Patients who develop solute retention or fluid overload with PD alone could choose to transfer first to PD/HD hybrid therapy, wherein patients usually undergo PD 5–6 days a week along with once-weekly HD, instead of directly transferring to HD alone. Association between high BMI and outcomes were analyzed by the log-rank test and the Cox proportional hazards models. Results: The follow-up duration was 46.2 (23.3–75.3) months. Time until transfer to HD and hybrid therapy was significantly shorter in the high BMI group than in the low one, whereas time until transfer to HD was not significantly different between both groups (P &lt; 0.001 and 0.18, respectively). Peritonitis-free and ESI/TI-free survival were significantly shorter in the high BMI group than in the low one (P = 0.006 and 0.03, respectively). After adjusting for age, sex, diabetes mellitus, estimated glomerular filtration rate, BMI ≧ 25 kg/m2 remained as a significant risk factor for transferring to HD and PD/HD hybrid therapy, peritonitis, and ESI/TI (hazard ratio [HR] 2.60, P &lt; 0.001; HR 2.08, P = 0.01; HR 2.64, P = 0.02, respectively). Conclusions: High BMI, defined as BMI ≧ 25 kg/m2, is a risk factor for transition to HD and PD/HD hybrid therapy, peritonitis, and ESI/TI. However, high BMI is not associated with early complete HD transfer in Japan, where PD/HD hybrid therapy is commonly used.

Association of body mass index and recurrence of gestational diabetes mellitus

To assess whether body mass index (BMI) is associated with recurrence of gestational diabetes mellitus (GDM) among pregnant persons with a history of GDM in a prior pregnancy. This was a retrospective cohort study of births in California between 2000-2012 to pregnant persons who had a history of GDM in a prior pregnancy. Births at gestational ages 23-42 weeks were included if they were also singleton and non-anomalous, and we excluded those who developed pre-existing diabetes mellitus between pregnancies or with missing data for BMI. We assessed race/ethnicity, age, educational attainment and insurance type as potential confounders. We performed statistical analyses using chi-squared and multivariable logistic regression with a p-value of 0.05. There were 15,112 births that met our inclusion criteria. Pregnant persons were significantly different for all sociodemographic characteristics by recurrence of GDM. This highest proportion of GDM recurrence occurred among the highest BMI group (63%). We found that the adjusted odds of GDM recurrence was higher among all BMI groups higher than the referent, while the adjusted odds of GDM recurrence was lower for the lowest BMI group. We found that among pregnant persons with a history of GDM, there was a higher adjusted odds of GDM recurrence with higher-than-normal BMI and lower adjusted odds with underweight BMI. Future studies should assess prevention strategies among those with a history of GDM planning another pregnancy to reduce the recurrence of GDM.

The Contemporary Impact of Body Mass Index on Open Aortic Aneurysm Repair

IntroductionThe Centers for Disease Control and Prevention (CDC) has deemed obesity a national epidemic and contributor to other leading causes of death including heart disease, stroke, and diabetes. Accordingly, the role of body mass index (BMI) and its impact on surgical outcomes has been a focus of persistent investigation. The purpose of this study was to quantify the effect of BMI on open abdominal aortic aneurysm repair (oAAA) outcomes in contemporary practice. MethodsAll elective oAAAs in the VQI (2010-2021) were identified. End-points included 30-day death, in-hospital complications and 1-year mortality. Patients were stratified into four BMI cohorts (BMI<18.5, 18.5≤BMI<25, 25≤BMI<30, BMI≥30). Spline interpolation was used to explore a potential non-linear association between BMI and perioperative mortality. Mixed-effects Cox regression was used to assess the association between BMI and 1-year survival. Results9,479 patients underwent oAAA over the study interval (median age-70, 74%-male, BMI 27±6). Lower BMI patients(<18.5) compared to higher BMI(>30) patients were more likely to be women (53% vs. 32%;p<.0001), current smokers(65% vs. 50%;p<.0001), and have COPD(58% vs. 37%;p<.0001). In contrast, an increased BMI was associated with a greater prevalence of diabetes and CAD (DM-26% vs. 6%;p<.0001; CAD-27% vs. 20%;p=.01). There was no difference in cross-clamp position or visceral/renal bypass between groups, though low BMI patients necessitated more frequent infrainguinal bypass(5% vs. 2%;p=.0002). 30-day mortality and in-hospital complications were greater among low BMI patients(30-day mortality:12% vs. 4%;p<.0001;complications-47% vs. 37%;p<.0001). Interestingly, low BMI conferred a nearly 2-fold increase in observed pulmonary complications(18% vs. 11%;p<.0001). Surgical site infections were twice as common among the lowest and highest BMI groups(4% vs. 2%;p<.0001). 1-year mortality was greatest among low BMI patients(23% vs. 9%;p<.0001). Adjusted spline-fit analysis demonstrated increased mortality among patients with BMI<21 or >34(BMI<18.5-HR 2.1, 95%CI 1.6-2.8;p<.0001; BMI>34-HR 1.3, 95%CI 1.1-1.6;p=.009). ConclusionBoth low (<18.5) and high (>34) BMI were associated with increased oAAA mortality in current practice. Despite the perception that obesity confers substantial surgical risk during oAAA, diminished BMI was associated with a 3-fold increase in 30-day and 1-year mortality. It appears that BMI extremes are distinct proxies for differential clinical phenotypes and should inform risk stratification for oAAA repair.

Association of high body mass index, waist circumference, and body fat percentage with sarcopenia in older women

BackgroundAge-related obesity and body composition changes include loss of muscle mass and increased body fat. This study aimed to investigate sex differences in the impact of sarcopenia, defined by the Asian Working Group for Sarcopenia (AWGS), on obesity in Korean older adults.MethodsIn this 2-year longitudinal study, 3014 participants were excluded based on AWGS sarcopenia parameters (if any one of the sarcopenic parameter criteria was satisfied), including low handgrip strength (HGS), low appendicular skeletal muscle mass index (ASMI), and low short physical performance battery (SPPB). A total of 926 non-sarcopenic participants were recruited for the study. The obese and non-obese groups were compared according to the sarcopenia parameters. The following variables were selected for obesity analysis: body mass index (BMI), waist circumference (WC), and body fat percentage. Unadjusted and fully adjusted logistic regression analyses were performed for each variable to predict sarcopenia and sarcopenic obesity according to sex.ResultsAmong the sarcopenia parameters, reduction in ASMI was significantly lower in the obese group with high WC and percentage of body fat (PBF) in both men and women (P < 0.01). Multivariable analysis revealed that different obesity parameters were associated with AWGS criteria: women in the high BMI group presented significantly lower ASMI and sarcopenia (ASMI, OR = 0.289, 95% CI = 0.174-0.480; sarcopenia, OR = 0.152, 95% CI = 0.048-0.483). Women in the high WC group had significantly lower ASMI and sarcopenia (ASMI, OR = 0.307, 95% CI = 0.189-0.500; sarcopenia, OR = 0.262, 95% CI = 0.106-0.649). Women in the high PBF group had a lower incidence of sarcopenia (OR = 0.214, 95% CI = 0.068-0.278).ConclusionsOur study identified that high BMI had a protective effect on the reduction of muscle mass in men and women. However, obesity parameters including BMI, WC, and PBF were positively correlated with a lower incidence of sarcopenia only in women. Obesity in older women may have a protective effect in reducing ASMI and the incidence of sarcopenia.

Effect of Body Mass Index on the Prognosis of Mantle Cell Lymphoma

To explore the correlation between different body mass index (BMI) and prognosis of mantle cell lymphoma (MCL). The clinical characteristics and biological indices of 108 patients with MCL treated in Fujian Medical University Union Hospital were retrospectively analyzed, and the effects of different BMI on overall survival (OS) and progression-free survival (PFS) were analyzed. The correlation between BMI and B symptoms, LDH and Ki-67 was further observed. Furthermore，the differences of BMI between Autologous peripheral blood stem cell transplantation(Auto-PBSCT) and conventional chemotherapy groups were explored. Among 108 patients, the median age at diagnosis was 59（25-79） years old, and the male to female ratio was 4.4∶1. 88.89% of patients with Ann Arbor staging III-IV, 63.89% with bone marrow involvement, and 49.07% with splenic infiltration. Patients with BMI ≥ 24 kg/m2 were divided into two groups: the high BMI group and the low BMI group. The 5-year PFS and OS of patients in the low BMI group were 31.9% and 47.0%, respectively, while those in the high BMI group were 64.6% and 68.7%, respectively. The incidence of death in the high BMI group was lower than that of the low BMI group (P＜0.01). In multivariate analysis, BMI was an independent predictor of PFS (HR=0.282; 95% CI: 0.122-0.651; P=0.003) and an independent predictor of OS (HR=0.299; 95% CI: 0.129-0.693; P=0.005). Also, patients with B symptoms had a lower BMI than those without B symptoms (P=0.01), but BMI had no effect on patients' LDH and Ki-67. The prognosis of 16 patients treated with Auto-PBSCT was significantly better than that of the conventional chemotherapy group. There was no significant difference in BMI between Auto-PBSCT group and conventional chemotherapy group. BMI is an independent prognostic factor for PFS and OS in MCL, and may be influenced by the effect of B symptoms on BMI.

Impact of low and high body mass index on predicting therapeutic efficacy and prognosis in patients with metastatic renal cell carcinoma treated with first-line tyrosine kinase inhibitors.

To evaluate the significance of both low and high body mass index (BMI) as a biomarker in first-line tyrosine kinase inhibitors (TKIs) for metastatic renal cell carcinoma (mRCC). The oncological outcome of 235 patients with mRCC treated with TKI from 2007 to 2018 was reviewed retrospectively. All patients received first-line TKI as therapy. We analyzed the relationship between BMI (low and high) and disease control rate. The primary outcome was progression free survival and overall survival, and the association between BMI and survival prognosis was evaluated. The median BMI was 22.5 kg/m2 , and 25 patients (10.7%) had a low BMI (<18.5 kg/m2 ), 158 patients (67.2%) had a normal BMI (18.5-25 kg/m2 ), and 52 patients (22.1%) had a high BMI (≥ 25 kg/m2 ). Patients in the low BMI group had a significantly lower disease control rate, whereas patients in the high BMI group had a significantly higher disease control rate (p=0.002 and p=0.030, respectively). A log-rank test showed prognosis to be significantly poorer in the low BMI group and to be significantly better in the high BMI group than that in the normal BMI group. Multivariable Cox regression analysis showed that low BMI was an independent indicator of poor prognosis, whereas high BMI was an independent indicator of favorable prognosis. We showed the impact of both low and high BMI on predicting therapeutic efficacy and prognosis in mRCC patients treated with TKI.

Weakened humoral and cellular immune response to the inactivated COVID-19 vaccines in Chinese individuals with obesity/overweight

Inactivated COVID-19 vaccines have been widely used to vaccinate the Chinese population. However, limited literature exists to explore the effect of obesity on the humoral and cellular immune response to these vaccines. In this study, 132 high BMI (Body mass index) (obesity and overweight, BMI ≥ 24 kg/m2) and 82 normal BMI (BMI < 24 kg/m2) participants were enrolled. Adverse events (AEs), Spike receptor-binding domain IgG antibody (anti-RBD-IgG), neutralizing antibodies (NAbs), and specific B-cell and T-cell responses were evaluated 21–105 days after full-course inactivated COVID-19 vaccination. The overall incidence of AEs was similar in individuals with and without obesity/overweight. No serious vaccine-related AEs occurred. Individuals with obesity/overweight had a reduced seropositivity rate of NAbs compared to those with normal BMI. Anti-RBD-IgG and NAbs titers in the high BMI group were significantly lower than those in the normal BMI group. The frequencies of RBD-specific memory B cells (MBCs) and the numbers of spike-specific TNF-α+ spot-forming cells (SFCs) in individuals with obesity/overweight were reduced compared with those noted in individuals without obesity/overweight. A similar trend of weakened humoral responses was also observed in individuals with central obesity. Our study results suggested that inactivated COVID-19 vaccines were safe and well tolerated but induced poor humoral and cellular immune responses in Chinese individuals with obesity/overweight.

The Clinical and Translational Exploration of the Role of S1P/SPHK1 Pathway in Non-Hodgkin Lymphoma with Obesity

Non-Hodgkin lymphoma (NHL) is among the top 10 malignant tumors in incidence and mortality. Accumulating evidence indicates that obesity may influence the prognosis of several types of lymphoma, but the underlying mechanism is largely unknown for contributing to the poor prognosis or the aggressiveness of NHL. Obesity can result in abnormal lipid metabolism, especially abnormal sphingolipid metabolism. Existing data indicate the carcinogenetic role of Sphingosine-1-phosphate (S1P)/ sphingosine kinases (SPHK) signaling, we hypothesized that SIP/SPHK signaling played an important role in lymphomagenesis. To test the hypothesis that obesity deteriorate the prognosis of NHL, we retrospectively investigated a cohort of 2094 patients who were diagnosed with lymphoma in the First Hospital of Jilin University from Jun 1st, 2011 to Jun 1st 2021. These patients were categorized into high Body Mass Index (BMI, defined as BMI≥25) group and low BMI (defined as BMI<25) group. The demographic information and imaging evidence of disease progression were extracted and analyzed. Survival data were follow-up till Jun 1st 2021. Progression-free survival (PFS) and overall survival (OS) of three main subtypes of lymphomas (namely Diffuse large B-cell lymphoma [DLBCL], follicular lymphoma [FL], peripheral T-cell lymphoma-not otherwise specified [PTCL-NOS]) in this cohort were compared with the time-to-event analysis. High BMI group had a negative impact on PFS and OS in all three groups (DLBCL [P < 0.05], FL [P < 0.05], and PTCL-NOS [P < 0.05]).（A） To investigate S1P signaling, we performed an IHC study to determine the levels of S1P in the tissue array-samples from various human lymphomas. By computer-imaging analysis, significantly increased S1P levels were detected in the tissues from DLBCL, follicular lymphoma (FL), and peripheral T-cell lymphoma (PTCL). Using a web-based database, Gene Expression Omnibus (GEO), the high throughput gene expression was profiled for SPHK1 and SPHK2 in the lymphomas (DLBCL, FL, and PTCL) and the respective normal controls. Significantly up-regulated expression of SPHK1 was found in DLBCL (n = 55) versus centroblast B-cells (n = 7), in FL (n = 14) versus normal B-cells (n = 5), and in PTCL (n = 80) versus normal T cells (n =10). Significantly up-regulated expression of SPHK2 were also detected in DLBCL but not in FL and PTCL in comparison with their respective normal controls.（B-C） To further investigate the potential mechanism of S1P-S1P receptors mediated lymphogenisis, we employed two human lymphoma cell lines (HH for T cell lymphoma and SU-DHL-4 for B cell lymphoma) for verification. The S1P mediated down-regulation of YAP phosphorylation was found in both HH cells and SU-DHL-4 cells. WB showed up-regulated S1PR1 and S1PR3, and down-regulated S1PR2, consistent with the qPCR results. Three S1PR inhibitors (W146 for S1PR1, CAY10444 for S1PR3, and FTY720 for S1PR1-5) were selected to confirm the hypothesis that S1P signaling could mediate the HIPPO pathway in lymphoma cells. XTT cell viability assay and a trans-well assay as well as WB were further performed to investigate cell proliferation, migration, and EMT. Consistently, blockage of S1PR1 and/or S1PR3 significantly inhibited the S1P induced cell proliferation and migration, down regulated the Cyclin D1 expression, and attenuated the alterations of E-cadherin/Vimentin in both HH cells and SU-DHL-4 cells. These results indicated that blockage of S1PR1 and/or S1PR3 significantly attenuated the S1P-induced decreases of YAP phosphorylation in both HH cells and SU-DHL-4 cells.（D） In conclusion, the NHL patients with obesity have a poor PFS and OS, which is associated with the elevated S1P-SPHK1 signaling. S1P-S1PR1/S1PR3-YAP signaling mediates lymphomagenesis contributing to tumor aggressive growth. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Abstract 14368: Growth Differentiation Factor-15 in Heart Failure Across Body Mass Index Categories: The PREHOSP-CHF Study

Introduction: Growth differentiation factor-15 (GDF-15), a stress-responsive member of the transforming growth factor ꞵ cytokine superfamily is an independent prognostic predictor in patients with heart failure (HF). GDF-15 has been also reported to be associated with cardiac cachexia and malnutrition. However the association of GDF-15 and prognosis in patients with HF according to body mass index (BMI) is unclear. Methods: The PREHOSP-CHF study is a multicenter prospective cohort study among patients with HF. A total of 1,024 patients (mean age, 75.5 years, 58.7% male) were included in the analyses. Serum levels of GDF-15, as well as N-terminal pro brain natriuretic peptide (NT-proBNP), high sensitivity troponin I (hs-cTnI), and high sensitivity C-reactive protein (hs-CRP), were measured. We divided the patients into 3 groups based on the tertile of BMI: low (≤19.9), middle (19.9&lt;, ≤23.4), and high (&gt;23.4). Results: The low BMI group were older, and had more female, HF with preserved ejection fraction (≥50%), and NYHA 3/4. NT-proBNP levels were higher in the low group, but hs-cTnI and hs-CRP were comparable between the 3 subgroups. Median GDF-15 levels in the low, middle and high groups were 2271, 2264, and 1888 pg/ml, respectively. During 2 years follow-up, all-cause death and major adverse cardiovascular events (MACE: cardiovascular death and HF hospitalization) occurred in 111 and 130 in the low group, 66 and 132 in the middle group, and 34 and 88 in the high group. After adjustment for clinical confounders and cardiac biomarkers, higher GDF-15 was significantly associated with the incidence of all-caused death and MACE in the entire cohort. BMI subgroup analysis revealed that higher GDF-15 was significantly associated with the incidence of all-caused death and MACE in the middle and high groups, but not in the low group (Figure). Conclusions: Among HF, higher GDF-15 was significantly associated with all-cause death and MACE especially in the middle and high BMI groups.

Impact of elevated body mass index on cumulative live birth rate and obstetric safety in women undergoing assisted reproductive technology

This study evaluated the impact of elevated body mass index (BMI) on short- and long-term outcomes of in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatments. A total of 7229 patients undergoing IVF/ICSI fresh cycles and subsequent frozen embryo transfer cycles from 2014 to 2020 were divided into normal (18.5–24.9 kg/m2) and high BMI (≥ 25 kg/m2) groups. Ovarian response, pregnancy outcomes, and safety of both mother and fetus were the main outcome measures. Furthermore, multivariate analysis was used to determine whether BMI was associated with cumulative live birth rate (CLBR). Results showed that for younger women (< 38 year), CLBR was significantly reduced in the high BMI group compared with the normal BMI control and was accompanied by fewer retrieved oocytes and available embryos. Additionally, the incidence of hypertensive disorders of pregnancy, fetal macrosomia, and cleft lip and palate birth defects resulting from cumulative live births was significantly higher compared with the normal BMI group. No differences were observed among older women (≥ 38 year). Multivariate analysis revealed that high BMI was a risk factor for CLBR. Our study suggested that elevated BMI has a greater adverse impact on younger women.

Association between low body temperature on admission and in-hospital mortality according to body mass index categories of patients with sepsis.

Hypothermia has been shown to be associated with a high mortality rate among patients with sepsis. However, the relationship between hypothermia and body mass index (BMI) with respect to mortality remains to be elucidated. We conducted this study to assess the association between hypothermia and survival outcomes of patients with sepsis according to BMI categories. This secondary analysis of a prospective cohort study enrolled 1184 patients (aged ≥ 16 years) with sepsis hospitalized in 59 intensive care units in Japan. Patients were divided into 3 BMI categories (<18.5 [low], 18.5-24.9 [normal], >24.9 [high] kg/m2) and 2 body temperature (36 °C and ≥ 36 °C) groups. The primary outcome was in-hospital mortality rate. Associations between hypothermia and BMI categories with respect to in-hospital mortality were evaluated using multivariate logistic regression analysis. Of the 1089 patients, 223, 612, and 254 had low, normal, and high BMI values, respectively. Patients with body temperature < 36 °C (hypothermia) had a higher in-hospital mortality rate than that had by those without hypothermia in the normal BMI group (25/63, 39.7% vs. 107/549, 19.5%); however, this was not true for patients in the low or high BMI groups. A significant interaction was observed between hypothermia and normal BMI for in-hospital mortality (odds ratio, 1.56; 95% confidence interval, 1.00-3.41; P value for interaction = .04); however, such an interaction was not found between hypothermia and low or high BMIs. Patients with sepsis and hypothermia in the normal BMI subgroup may have a higher mortality risk than that of those in the low or high BMI subgroups and, therefore, require more attention.

Effect of body mass index on efficacy of the repositioning procedure for horizontal canal benign paroxysmal positional vertigo

Objective:To evaluate the effect of body mass index （BMI） on efficacy of the repositioning procedure for horizontal canal benign paroxysmal positional vertigo （HC-BPPV）. Methods:A total of 172 patients diagnosed with HC-BPPV in the First Affiliated Hospital of Xi'an Jiaotong University School of Medicine from Jan 2021 to Oct 2021 were enrolled. The patients were divided into low BMI group（BMI<24 kg/m² ） and high BMI group（BMI≥24 kg/m²）. The two groups underwent manual repositioning procedure and vertigo treatment system procedure by Barbecue method according to their orders of visits. After two circles of repositioning, the influencing factors of repositioning were analyzed according to efficiency. Results:The effective rate of manual repositioning in HC-BPPV patients was 33.64%, and the effective rate of vertigo treatment system was 63.08%,the effective rate of vertigo treatment system repositioning was higher than that of manual repositioning （P<0.05）. The effective rate of manual repositioning in the low BMI group （58.70%） was higher than that in the high BMI group （14.75%）, P<0.05. The effective rate of vertigo treatment system repositioning was higher in the low BMI group （75.00%） than that in the high BMI group （54.05%）, but there was no statistically significant difference between the two BMI groups （P>0.05）. Logistic regression analysis suggested that BMI was the influencing factor of HC-BPPV repositioning efficacy （P<0.05）. Conclusion:BMI can affect the efficacy of HC-BPPV manual repositioning. Vertigo treatment system for HC-BPPV reduction is better than manual reduction, and the efficacy is not affected by BMI.