Higher Body Mass Index Values Research Articles

The Role of Adipokines and Myokines in the Pathogenesis of Different Obesity Phenotypes-New Perspectives.

Obesity is a characteristic disease of the twenty-first century that is affecting an increasing percentage of society. Obesity expresses itself in different phenotypes: normal-weight obesity (NWO), metabolically obese normal-weight (MONW), metabolically healthy obesity (MHO), and metabolically unhealthy obesity (MUO). A range of pathophysiological mechanisms underlie the occurrence of obesity, including inflammation, oxidative stress, adipokine secretion, and other processes related to the pathophysiology of adipose tissue (AT). Body mass index (BMI) is the key indicator in the diagnosis of obesity; however, in the case of the NWO and MONW phenotypes, the metabolic disturbances are present despite BMI being within the normal range. On the other hand, MHO subjects with elevated BMI values do not present metabolic abnormalities. The MUO phenotype involves both a high BMI value and an abnormal metabolic profile. In this regard, attention has been focused on the variety of molecules produced by AT and their role in the development of obesity. Nesfatin-1, neuregulin 4, myonectin, irisin, and brain-derived neurotrophic factor (BDNF) all seem to have protective effects against obesity. The primary mechanism underlying the action of nesfatin-1 involves an increase in insulin sensitivity and reduced food intake. Neuregulin 4 sup-presses lipogenesis, decreases lipid accumulation, and reduces chronic low-grade inflammation. Myonectin lowers the amount of fatty acids in the bloodstream by increasing their absorption in the liver and AT. Irisin stimulates the browning of white adipose tissue (WAT) and consequently in-creases energy expenditure, additionally regulating glucose metabolism. Another molecule, BDNF, has anorexigenic effects. Decorin protects against the development of hyperglycemia, but may also contribute to proinflammatory processes. Similar effects are shown in the case of visfatin and chemerin, which may predispose to obesity. Visfatin increases adipogenesis, causes cholesterol accumulation in macrophages, and contributes to the development of glucose intolerance. Chemerin induces angiogenesis, which promotes the expansion of AT. This review aims to discuss the role of adipokines and myokines in the pathogenesis of the different obesity phenotypes.

Abstract 15587: Iimpact of Body Mass Index on Bleeding Events Patients Undergoing Percutaneous Coronary Intervention With or Without High Bleeding Risk

Introduction: High body mass index (BMI) values are associated with a lower risk of ischemic complications after percutaneous coronary intervention (PCI). Hypothesis : Higher BMI values may correlate with fewer bleeding after PCI in patients meeting or not the High Bleeding Risk (HBR) criteria of the Academic Research Consortium (ARC). Methods: All patients undergoing PCI between 2012 and 2019 at the Mount Sinai Hospital were included and stratified in 5 BMI categories according to World Health Organization definition. Patients where considered at HBR if they fulfilled ≥1 major or ≥2 minor ARC-HBR criteria. The primary outcome was major bleeding, the secondary outcome was post-discharge major bleeding at 1 year after PCI. Risks for these outcomes were obtained using a multivariable Cox regression model adjusted for the ARC-HBR criteria. Results: Among 16,229 patients, 20.2% had a BMI ≥18.5-25 (normal), 40.7% had a BMI ≥25-30, 24.4% had a BMI ≥30-35, 9.2% had a BMI ≥35-40, and 4.8% had a BMI ≥40 kg/m 2 . The proportion of patients meeting the ARC-HBR criteria progressively decreased from 48% in the normal BMI group to 41% in the highest BMI group. As compared to the normal BMI group (6.0%), the 1-year risk of major bleeding was significantly lower (p<0.05) in the groups with BMI ≥25-30 (4.1%, adj. HR 0.73, 95% CI 0.60-0.88), with BMI ≥30-35 (3.5%, Adj. HR 0.62, 95% CI 0.49-0.77), with BMI ≥35-40 (4.2%; Adj. HR 0.72, 95% CI 0.54-0.9), while it was similar in the group of BMI ≥40 (4.9%, Adj. HR 0.83, 95% CI 0.58-1.18) ( A ). These differences were driven by lower rates of in-hospital bleeding in patients with BMI ≥25-40 kg/m 2 . Among HBR patients, 1-year rates of major bleeding were consistently above 4% in each BMI category, but relatively lower for BMI ≥25-40 kg/m 2 ( B ). Conclusions: BMI values between 25 and 40 kg/m 2 were associated with an attenuated risk of major bleeding at 1-year in patients undergoing PCI and this association was consistent among HBR individuals.

The hidden impact of neuropathic pain after surgical fixation of wrist, hip, and ankle fractures: A cross-sectional retrospective study evaluating its prevalence and risk factors

BackgroundDysesthesia, electrical and burning sensations, in addition to allodynia are frequent symptoms of neuropathic pain. Despite the high frequency, scientific data on the development of neuropathic pain after surgery for fracture fixation are scarce. The goal of the present study was to determine the prevalence, risk factors, and evaluate potential associations among neuropathic pain, pain intensity, sociodemographic, and clinical variables after wrist, hip, and ankle fracture fixation. MethodsA cross-sectional retrospective study involving a cohort of 166 patients who underwent surgery for distal radius, proximal femur, malleolar fracture fixation was performed. Neuropathic pain was assessed one year after fracture fixation using the Doleur Neuropathique Questionnaire (DN4). ResultsThe incidence of neuropathic pain in our sample was 49 (29.5%). Predictors for the development of neuropathic pain included patients with a high body mass index (BMI), female gender, diabetes mellitus, long-term use of analgesics (especially using pain-modulating medication), patients who presented some fracture-related complication during the course of the treatment, who had limitations for daily activity, and who were away from work due to chronic pain. ConclusionIn our study, neuropathic pain after wrist, hip, and ankle fracture fixation was prevalent and associated with higher BMI values and amount of medication, in addition to higher proportions of female sex, absence from work, DM, limitation for daily activities, postoperative complications, and use of pain modulating medications.

Assessment of Hypertensive Patients' Complex Metabolic Status Using Data Mining Methods.

Cardiovascular diseases are among the leading causes of mortality worldwide. Hypertension is a preventable risk factor leading to major cardiovascular events. We have not found a comprehensive study investigating Central and Eastern European hypertensive patients' complex metabolic status. Therefore, our goal was to calculate the prevalence of hypertension and associated metabolic abnormalities using data-mining methods in our region. We assessed the data of adults who visited the University of Debrecen Clinical Center's hospital (n = 937,249). The study encompassed data from a period of 20 years (2001-2021). We detected 292,561 hypertensive patients. The calculated prevalence of hypertension was altogether 32.2%. Markedly higher body mass index values were found in hypertensive patients as compared to non-hypertensives. Significantly higher triglyceride and lower HDL-C levels were found in adults from 18 to 80 years old. Furthermore, significantly higher serum glucose and uric acid levels were measured in hypertensive subjects. Our study confirms that the calculated prevalence of hypertension is akin to international findings and highlights the extensive association of metabolic alterations. These findings emphasize the role of early recognition and immediate treatment of cardiometabolic abnormalities to improve the quality of life and life expectancy of hypertensive patients.

Classical Prognostic Factors Predict Prognosis Better than Inflammatory Indices in Locally Advanced Cervical Cancer: Results of a Comprehensive Observational Study including Tumor-, Patient-, and Treatment-Related Data (ESTHER Study).

Systemic inflammation indices were found to be correlated with therapeutic outcome in several cancers. This study retrospectively analyzes the predictive role of a broad range of systemic inflammatory markers in patients with locally advanced cervical cancer (LACC) including patient-, tumor-, and treatment-related potential prognostic factors. All patients underwent definitive chemoradiation and pretreatment values of several inflammatory indices (neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio, monocyte/lymphocyte ratio, systemic immune inflammation index (SII), leukocyte/lymphocyte ratio, combination of platelet count and NLR, aspartate aminotransferase/platelet ratio index, aspartate aminotransferase/lymphocyte ratio index, systemic inflammatory response index, and aspartate transaminase/neutrophil ratio index) were calculated. Their correlation with local control (LC), distant metastasis-free (DMFS), disease-free (DFS), and overall survival (OS) was analyzed. One hundred and seventy-three patients were included. At multivariable analysis significant correlations were recorded among clinical outcomes and older age, advanced FIGO stage, lower hemoglobin levels, larger tumor size, and higher body mass index values. The multivariate analysis showed only the significant correlation between higher SII values and lower DMFS rates (p < 0.01). Our analysis showed no significant correlation between indices and DSF or OS. Further studies are needed to clarify the role of inflammation indices as candidates for inclusion in predictive models in this clinical setting.

СРАВНЕНИЕ ПОКАЗАТЕЛЕЙ ФИЗИЧЕСКОГО РАЗВИТИЯ И ФИЗИЧЕСКОЙ ПОДГОТОВЛЕННОСТИ ПЕРВОКУРСНИКОВ С РАЗНЫМ СОСТОЯНИЕМ ЗДОРОВЬЯ, ПЕРЕНЕСШИХ COVID-19

To study the "post-covid syndrome," as a natural consequence of the pathological course of the new coronavirus infection "covid-19," data from a retrospective analysis of the incidence and testing of motor abilities of freshmen in 2022 are presented. The incidence rate of covid-19 among 2022 freshmen was significantly higher than among 2021 freshmen and had two peaks in October 2021 and February 2022. The ratio of girls who had been ill and did not have covid-19 was significantly higher than in the group of boys. Among young men who had recovered from covid-19, 14.86% belonged to a special medical group, while among those who were not sick, only 4.27% belonged to a special medical group. In the group of girls who had had covid-19, 17.45% belonged to the special medical group, and 11.42% among those who were not sick. Among young men who had been ill and did not have covid-19, 68.92 and 68.29% of freshmen, respectively, had a normal level of body mass index (BMI); 13.51 and 14.63% − reduced BMI values, and 16.22 and 13.42% − high BMI values. Among girls, 64.98 and 69.84% of freshmen were characterized by normal BMI values; 21.52 and 19, 34% − reduced values, and 13.08 and 8.86% − high BMI. Comparison of physical fitness indicators of freshmen who had been ill and did not have covid-19 were performed in subgroups with comparable BMI values. In the group of boys and girls with normal body mass index values, there were no significant differences in physical development and physical fitness among students who had been ill and did not have covid-19. In boys and girls with an insufficient body mass index who had recovered from covid-19, the indicators of active orthostatic test were significantly worse than in those who were not sick. In boys with excessive BMI who have had covid-19, the indicators of the hand dynamometry index and resistance to hypoxia were significantly lower than among non-sick fellow students.

Diagnostic value of anthropometric indicators and body composition as indicators of aging rates and comorbidity in patients with cardiometabolic diseases

Objective — to assess anthropometric indicators and body composition in patients with certain cardiometabolic diseases depending on their aging rates and the number of existing comorbid pathologies.&#x0D; Materials and methods. Examinations involved 92 patients with cardiometabolic diseases, including arterial hypertension (AH), non‑alcoholic fatty liver disease, obesity, dyslipidemia, insulin resistance. Female prevailed among patients (62.0%), the mean age was 49.2 [41.4; 55.4] years. All patients were divided into groups depending on calendar age (CA): young &lt;45 years (n=32), middle age 45—59 years (n=49), elderly &gt;60 years (n=11), and also divided by the rates of aging: with accelerated age delta (Δ) &gt;0 years (n=14), with significantly slowed rates of ageing — Δ ≤–5 years (n=51) and intermediate ones — Δ ∈ (–5; 0] years (n=27). Anthropometric parameters and calculated indices were determined in all patients and included body mass index (BMI), waist circumference (WC), hip circumference (HC), WC/HC ratio, percentage of total fat (TF), percentage of skeletal muscle mass (SM), visceral fat (VF), weight‑adjusted waist index (WWI), a body shape index (ABSI) and abdominal volume index (AVI). As additional indicators of aging, the level of uric acid, the total mortality risk during the next 10 years (MR) and the level of global methylation (GM) of DNA were determined.&#x0D; Results. Significant differences between all groups divided according to CA were in BA and MR (p=0.0001 in all cases). Patients &lt;45 years of age compared to the elderly had significantly higher rates of aging (p=0.019) and significantly lower levels of BMI (p=0.039), WC (p=0.034), WWI (p=0.002) and AVI (p=0.032). WWI was the only marker that significantly increased in the middle‑aged group of patients (p=0.033) compared to young patients. Patients re‑divided into groups according to  did not differ in the levels of anthropometric indicators and body composition. However, patients with significantly slower rates of aging had significantly lower uric acid levels compared to the group with accelerated (p=0.0001) and intermediate rates of aging (p=0.024), and also had higher CA compared to patients in the intermediate group (p=0.026). Various indicators of aging were significantly associated with weight, BMI, VF, WC, WC/HC, WWI and AVI, but only WC and AVI were simultaneously associated with all markers of aging (uric acid, BA, MR, GM). Only WWI was associated with CA, in addition it had the strongest association with BA and MR compared to other indicators. Patients with 4—5 comorbid pathologies had worse weight (p=0.045), BMI (p=0.0001), WC (p=0.002), WC/HC (p=0.002), TF (p=0.004), SM (p=0.010), WWI (p=0.006), AVI (p=0.002), WWI (p=0.040) and aging rates (p=0.008).&#x0D; Conclusions. Among anthropometric and body composition parameters in patients with cardiometabolic pathology, WWI is probably the most effective one for monitoring premature aging, as it is associated with both CA, markers of aging and cardiometabolic parameters. The higher calendar age among patients with cardiometabolic pathologies was accompanied by higher values of BMI, WC, WWI and AVI, so control of these indicators may be useful for prevention of premature aging. Assessment of weight, BMI, WC, WC/HC, TF, SM, WWI and AVI is effective for predicting aging rates among patients with multimorbidity.

THE IMPACT OF OBESITY ON THE CONTROL OF TREATED HYPERTENSIVE PATIENTS

Objective: Obesity is as a risk factor for hypertension, but there are few studies evaluating its impact on the response to antihypertensive drug and on the control of hypertensive patients. The aim of our study was to determine the effect of obesity on the control of treated hypertension. Design and method: We analyzed recordings of ambulatory blood pressure measurement (ABPM) in 84 treated hypertensive patients aged &gt; 18 years, in the cardiology department of Mohamed Taher Maamouri University hospital in Nabeul. Patients were stratified into two groups: obese (Body Mass Index (BMI) &gt;30 kg/m2) and non-obese. Hypertension control is defined by 24-hour ambulatory blood pressure (BP) = &lt; 130/80 mmHg, daytime = &lt; 135/85 mmHg and nighttime = &lt; 120/70 mmHg. The comparisons of percentages were carried out by the Chi-square test. Results: Our Population was composed of 33 obese and 51 non-obese patients. The mean age of our population was 59.37±13.1 years. BMI in obese was significantly higher than in non-obese (34.47±5.4 versus 25.36±2.5; p&lt;0.001). The prevalence of uncontrolled patients was significantly higher in obese patients detected in 24-hour ABPM (75.8% versus 51%; p = 0.039), in daytime ABPM (69.7% versus 41.2%; p = 0.014) and in night-time ABPM (90.9% versus 68.6%; p = 0.018) than in normal weight patients. Conclusions: Prevalence of uncontrolled hypertension was higher with higher BMI values. The level of blood pressure control in our sample remains relatively insufficient. To achieve a better control of hypertension, we must insist on therapeutic compliance and on the correction of risk factors, particularly obesity, which is significantly associated with an increase in BP.

Overexpression of miR-483-5p predicts venous thrombo-embolism onset in patients with lung cancer especially in high BMI cases.

Venous thromboembolism (VTE) is a common complication in patients with lung cancer. The important roles of microRNAs (miRNAs) in VTE have emerged, however, studies about the roles of miRNAs in VTE remain scarce. This study aimed to measure the expression of miR-483-5p in lung cancer patients with VTE, evaluate whether miR-483-5p could predict VTE onset in patients, and further evaluate its predictive value in patients with different BMI values. A total of 170 patients with lung cancer were recruited in this study, including 70 patients with VTE, and 110 patients with non-VTE. The expression of miR-483-5p was detected by quantitative real time PCR. Receiver operating characteristic analysis was used to screen VTE patients from non-VTE patients. Whether miR-483-5p was independently associated with VTE onset in lung cancer patients was evaluated by univariate and multivariate logistic regression analyses. miR-483-5p was higher in VTE patients than that in non-VTE patients. miR-483-5p was correlated with body mass index (BMI), hypertension, C-reactive protein (CRP), and platelet count in VTE patients. In addition, miR-483-5p had high diagnostic value to differentiate between VTE patients and non-VTE patients and served as an independent biomarker in predicting the VTE onset in lung cancer patients. Moreover, miR-483-5p had the highest diagnostic accuracy to screen VTE patients from non-VTE patients in patients with high BMI values. miR-483-5p, increased in VTE patients, can independently predict VTE onset in lung cancer patients especially in patients with high BMI values.

The correlation between Body Mass Index and histological features of Nonalcoholic Fatty Liver Disease.

Introduction: NAFLD is strongly associated with metabolic syndrome, and for many years, fatty liver was an exclusive feature of obese patients. The study tries to assess whether the body mass index (BMI) and body circumference is correlated to steatosis, fibrosis, or inflammatory activity of the liver. Methods: 81 patients with recent hepatic biopsy were included in the study and were weighed and measured. The biopsy results were compared to the measurements. Results: The average BMI overall for the whole lot was 30.16. There was a significant difference in BMI across the inflammatory activity categories (p=0.009): groups with higher necro inflammatory activity tended to have higher BMI values (average values per grade: 0 - 28, 1 - 29, 2 - 33, 3 - 32, 4 - 29). There was no significant difference for grades of steatosis (p=0.871). With regards to waist circumference, the overall average was 90.70cm/35.70in. There was a significant difference across the steatosis categories (p<0.001): groups with higher steatosis scores had higher waist circumferences (average values per grade: 1 - 77cm / 30 in, 2 - 95 cm / 37 in, 3 - 94 cm / 37 in). There was no significant difference for grades of activity (p=0.058). Conclusion: BMI and waist circumference are easy to measure, non-invasive parameters, which could be useful in screening patients at higher risk for necro inflammatory activity or severe steatosis.

TO STUDY CORRELATION OF INSULIN RESISTANCE WITH PHYSICAL ACTIVITY IN CHILDREN / ADOLESCENTS

Objective: IR is a pathological condition strongly associated with obesity and involved in the pathogenesis of T2D. The treatment of insulin resistant children is firstly targeted to lifestyle interventions. Homeostasis model assessment of insulin resistance (HOMA-IR) may be useful for early evaluation of insulin resistance in children and teenagers and could have a long-term benefit of preventive and diagnostic therapeutic intervention. Method: A cross-sectional study was performed on 80 children and adolescents age 5 to 14 years, 40 of them were apparently healthy with Body mass index (BMI) &lt; 85th percentile 16 were overweight with BMI&gt;85th percentile and below 95th percentile 24 were obese with &gt; 95th percentile. Physical activity was classified on basis of WHO guidelines. Out of 80 children 33 were active and 47 were less active. After overnight fasting for 8 hr, blood samples were taken serum insulin and fasting blood glucose were analysed. Insulin resistance was assessed by homeostasis model of assessment. Result and Conclusion: Our results revealed altered values of HOMA-IR in children with high BMI and mean values were high in children with decrease physical activity. We concluded that more studies should be conducted to focus on preventing and identifying risk factors in children.

Association of rheumatoid arthritis with bronchial asthma and asthma-related comorbidities: A population-based national surveillance study.

The aim of this study was to investigate the impact of rheumatoid arthritis (RA) on the prevalence of bronchial asthma and asthma-related comorbidities. We also aimed to identify the influence of RA on interrelationship between asthma and asthma-related comorbidities. From the Korean National Health and Nutrition Examination Survey, participants >40 years of age who completed questionnaires and spirometry tests were enrolled. Patient data on RA, asthma, allergic rhinitis, atopic dermatitis, chronic obstructive pulmonary disease (COPD), sinusitis, otitis media, and body mass index (BMI) were collected. Logistic regression and network analyses were performed. A total of 14,272 subjects were enrolled, among which, 334 (2.4%) had RA. RA was significantly associated with asthma (OR 2.32; 95% CI 1.51-3.57), allergic rhinitis (OR 1.51; 95% CI 1.08-2.10), and sinusitis (OR 1.64; 95% CI 1.08-2.50). The network analysis of total patients revealed a positive interrelationship between asthma and allergic rhinitis, sinusitis, otitis media, atopic dermatitis, BMI, and RA. The interrelationship between asthma and sinusitis was stronger in the RA group. Of note, the relationship between asthma and BMI was distinctively found only in the RA group (r = 0.214, P < 0.05). In patients with asthma, the prevalence of obesity was 64% in the presence of RA, and 40% in the absence of RA (P = 0.034). This study supports the positive association of RA with asthma, allergic rhinitis, and sinusitis. Our analysis suggests a notable interrelationship between the presence of asthma and higher BMI values in patients with RA, indicating that asthma is more obesity-related in patients with RA.

Body mass index – from the position of assessment of the condition of patients with ischemic heart disease

Purpose: comparative analysis of clinical, laboratory and angiographic parameters in patients with coronary artery disease, depending on the level of body mass index (BMI).Material and Methods: 71 patients with coronary artery disease were examined. All underwent general clinical laboratory functional studies and coronary angiography with stenting of the coronary arteries. Depending on the level of BMI, 2 groups of patients were identified: 1 gr. – 36 patients with BMI &lt; 30 kg/m2 and 2 gr. – 35 patients with BMI ³ 30 kg/m2.Results: an increase in BMI was associated with young age and female sex, but fewer acute forms of coronary artery disease. The level of BMI ³ 30 kg/m2 was characterized by greater comorbidity, with AH being more frequent among comorbidities; diabetes; diseases of the gastroduodenal zone GDZ (p &lt; 0,05); COPD and past history of Covid-19. In addition, among patients with a BMI ³ 30 kg/m2, the incidence of complex ventricular cardiac arrhythmias was 4 times higher than in patients with a BMI &lt; 30 kg/m2. In patients with BMI ³ 30 kg/m2, the average amount of medications taken per day was 0,8 less than in the comparison group. The most frequently taken groups of drugs (in addition to BAB and ASA drugs) among patients in group 2 were: calcium antagonists AK; sartans and hypoglycemic drugs, and among patients of group 1 – ACE inhibitors; statins; thienopyridines and antiarrhythmics. 8,5% of the surveyed were NOT adherent to drug treatment, while among patients in group 1 – 13,9% and in group 2 – 2,8% of respondents. An increase in BMI according to ECG data was characterized by an increase in heart rate and a greater predisposition to ventricular arrhythmia, and according to echocardiography, by a thickening of the LV walls and a decrease in its systolic function. Angiographically, higher BMI values were not a criterion for the complexity of vascular lesions. Nevertheless, the length of the atherosclerotic lesion in the respondents in group 2 was greater than in group 1 (p &gt; 0,05). In patients with BMI ³ 30 kg/m2, lesions of the distal segments of the main coronary arteries were recorded comparatively more often, with type B stenosis prevailing in the PNA basin (60,0%); in the RCA basin – type A (31,6%) and type B (47,4%) stenoses.Conclusion: there are still many controversial points in the assessment of the relationship between excess weight and cardiovascular pathology. Nevertheless, the significance of the BMI indicator has its prerogatives in this direction, especially in primary health care at the first contact with a patient.

Incidence of Arterial Hypertension is Associated with Adiposity in Children and Adolescents.

The increase of hypertension in children and adolescents has attracted the attention of the scientific community largely due to its association with the obesity epidemic. To describe the incidence of hypertension and its relationship with the cardiometabolic and genetic profile in children and adolescents from a city in southern Brazil in a three-year period. This longitudinal study followed 469 children and adolescents, aged 7-17 years old (43.1% boys), assessed at two-time points. We evaluated systolic and diastolic blood pressures (SBP and DBP), waist circumference (WC), body mass index (BMI), body fat percentage (%BF), lipid profile, glucose, cardiorespiratory fitness (CRF), and rs9939609 Polymorphism ( FTO ). Cumulative incidence of hypertension was calculated, and multinomial logistic regression was conducted. The statistical significance was established as p < 0.05. After three years, the incidence of hypertension was 11.5%. Overweight or obese individuals were more likely to become borderline hypertensive (overweight OR: 3.22, 95% CI: 1.08-9.55; obesity OR: 4.05, 95% CI: 1.68-9.75), and obese individuals were more likely to become hypertensive (obesity OR: 4.84, 95% CI: 1.57-14.95). High-risk WC and %BF values were associated with hypertension development (OR: 3.41, 95% CI: 1.26-9.19; OR: 2.49, 95% CI: 1.08-5.75, respectively). We found a higher incidence of hypertension in children and adolescents as compared with previous studies. Individuals with higher values of BMI, WC and %BF at baseline were more likely to develop hypertension, suggesting the importance of adiposity in the development of hypertension even in such a young population.

The Clinical Impact of Thoracic Endovascular Aortic Repair in the Management of Thoracic Aortic Diseases

Purpose: Thoracic endovascular aortic repair (TEVAR) has been described to be superior to an open surgical approach, and previous studies have found superiority in TEVAR by reducing overall morbidity and mortality rates. This study aimed to describe the outcomes of TEVAR for patients with thoracic aortic disease at a high complexity. Materials and Methods: Descriptive study, developed by a retrospective review of a prospectively collected database. Patients aged above 18 years who underwent TEVAR between 2012 and 2022 were included. Patient demographics, perioperative data, surgical outcomes, morbidity, and mortality were described. Statistical and multivariate analyses were made. Statistical significance was reached when p values were <0.05. Results: A total of 66 patients were included. Male patients were 60.61% and the mean age was 69.24 years. Associated aortic diseases were aneurysms (68.18%), ulcer-related (4.55%), intramural-related hematoma (7.58%), trauma-related pathology (1.52%), and aortic dissection (30.30%). The mean hospital stay was 18.10 days, and intensive care unit was required for 98.48%. At 30 days, the mortality rate was 10.61% and the reintervention rate was 21.21%. Increased intraoperative blood loss (p=0.001) and male sex (p=0.04) showed statistical relationship with mortality. Underweight patients have 6.7 and 11.4 times more risk of complications and endoleak compared with higher body mass index values (p=0.04, 95% confidence interval [CI]=0.82–7.21) and (p=0.02, 95% CI=1.31–12.57), respectively. Conclusion: Thoracic endovascular aortic repair seems to be a feasible option for patients with thoracic aortic pathologies, with adequate rates of mortality and morbidity. Underweight patients seem to have an increased risk of overall morbidity and increased risk for endoleak. Further prospective studies are needed to prove our results. Clinical Impact Obesity and BMI are widely studied in the surgical literature. According to our study, there is a paradox regarding the outcomes of patients treated with TEVAR in terms of postoperative complications and mortality related to the body mass index. And shouldn’t be considered as a high-risk feature in terms of postoperative morbidity and mortality inthis procedure.

Adipocyte signaling affects thyroid-specific gene expression via down-regulation of TTF-2/FOXE1.

Obesity affects thyroid gland function. Hypothyroidism, thyroid nodules, goiter, and thyroid cancer are more frequent in patients with higher body mass index values. Although these data are supported by many clinical and epidemiological studies, very scarce is our knowledge at the molecular level. In this study, we present the first experimental evidence that adipocyte signaling down-regulates the expression of thyroid-specific transcription factor 2 (TTF-2/FOXE1). It plays a crucial role in thyroid development and thyroid homeostasis and it is strictly connected to thyroid cancer as well. We provide in vivo and in vitro evidence that inhibition of TTF-2/FOXE1 gene expression is mediated by adipocyte signaling.

Fatores associados à percepção da silhueta atual e à insatisfação da imagem corporal em adultos com obesidade

ABSTRACT Objective To verify the factors associated with the perception of current silhouette and body image dissatisfaction in adults with obesity. Methods Cross-sectional study derived from the baseline of a randomized clinical trial. The perception of current silhouette and dissatisfaction with body image, defined by the difference between the perception of current and ideal silhouette, were obtained from a scale that ranged from one (smallest silhouette) to nine (largest silhouette). The independent variables investigated as associated factors (crude and adjusted linear regression) were: sex, age, skin color, body mass index (kg/m2), percentage of body fat, level of physical activity, and food intake. Results Sixty-nine obese individuals (body mass index ≥30kg/m2) were studied, 42 of whom were female and with the following mean values: 34.7 (±7.2) years; 33.5 (±2.8) kg/m2, and current silhouette of 6.6 (±0.9). All were dissatisfied with their excess body weight. The categories associated with a perception that matched the current silhouettes were male sex, white skin color, and higher body mass index values when compared to female sex, non-white, and lower body mass index values, respectively. Regarding body image dissatisfaction, white people had lower scores than those with other skin colors. Conclusion Being male, having white skin color, and having a higher body mass index were risk factors for the perception of larger body silhouettes, while only non-white skin color was associated with dissatisfaction with body image.

BS P03 Safety of Laparoscopic Cholecystectomy in patients with BMI &amp;gt; 35 kg/m2 without preoperative screening for Obstructive Sleep Apnoea

Abstract Background Preoperative Obstructive Sleep Apnoea (OSA) screening, followed by sleep studies as indicated, is commonly performed for patients undergoing bariatric surgery in our hospital but not for patients with similar weight undergoing other surgeries such as laparoscopic cholecystectomy. The purpose of this audit was to understand if laparoscopic cholecystectomy can be performed safely in patients with a Body Mass Index (BMI) ≥35 kg/m2 without such screening. Methods Patients with a BMI ≥ 35 kg/m2 undergoing elective laparoscopic cholecystectomy between 2nd May 2014 and 4th April 2022 were included. Patients with known OSA were excluded and no patients were referred for sleep studies. Data on patient demographics, co-morbidities, and any intraoperative or postoperative surgical complications were extracted and analysed. Univariate associations between different preoperative and operative variables and 30-day morbidity were studied using the Fisher's exact test. Results A total of 434 patients were included in the audit (64 male, 370 female). The mean age was 49 +/- 15 years. The mean weight and BMI were 110 +/- 20 kg (range 70–79kg) and 37 +/- 6 kg/m2 respectively. The mean operating time was 70 +/- 31 minutes (median=62). Approximately, 92% (398/434) had a day case procedure. The readmission rate at 30-day was 1% (5/434). There were no intraoperative complications. 17 patients had post-operative complications including deep vein thrombosis (n=2), leak in transverse colon secondary to cholecysto-colic fistula (n=1), wound infection (n=9), bile leak and post-op ERCP (n=3), common bile duct stone requiring ERCP (n=1) and pneumonia (n=1). No patients required ITU or HDU admission for further organ support. The 30-day mortality rate was 0% (0/434) while the 30-day morbidity rate was 3.9% (17/434). ASA grade, previous abdominal surgery, hypertension, diabetes, dyslipidemia, smoking history, chronic obstructive pulmonary disease, ischemic heart disease, fatty liver disease, preoperative liver reducing diet, number of ports, and conversion to laparotomy were not associated with increased 30-day morbidity rate (p&amp;lt;0.05) on univariate analysis. Higher BMI values (≥40 and ≥50 kg/m2) were also not associated with increased 30-day morbidity rate (p&amp;lt;0.05). Conclusions This audit demonstrated that laparoscopic cholecystectomy can be performed safely without the need for preoperative sleep studies in patients with BMI ≥35 kg/m2.

Abstract 12547: Obesity as Risk Factor for Malignant Ventricular Arrhythmias in Phospholamban Cardiomyopathy

Introduction: The pathogenic phospholamban (PLN) p.Arg14del mutation can cause severe arrhythmogenic cardiomyopathy. However, disease penetrance and clinical course are heterogenous and can differ largely between affected individuals. The impact of external factors - such as lifestyle - on the clinical course has not been studied yet. Hypothesis: We hypothesized that obese PLN mutation carriers have worse clinical outcomes, characterized by a higher burden of malignant ventricular arrhythmias (MVA). Methods: PLN p.Arg14del mutation carriers from the Dutch PLN registry with available follow-up (FU) data were included. MVA was defined as either sustained ventricular tachycardia, ventricular fibrillation, appropriate implantable cardioverter defibrillator intervention or (aborted) cardiac arrest. Patients were categorized into three groups based on their body mass index (BMI): normal weight (BMI 18.5 - 24.9 kg/m 2 ), overweight (25.0 - 29.9 kg/m 2 ) and obese (BMI &gt; 30.0 kg/m 2 ). Mutation carriers with a BMI &lt; 18.5 kg/m 2 or MVA at baseline were excluded. Results: A total of 179 PLN mutation carriers were included in this analysis: 105 (58.7%) normal weight, 59 (33.0%) overweight, 15 (8.4%) obese. The obese group had the highest percentage of MVA (26.7%), followed by the overweight (13.6%) and normal weight (4.8%) groups, as shown in the Kaplan-Meier curve (log-rank 0.016). Continuous BMI was significantly correlated with the incidence of MVA during FU: hazard ratio 1.15 [1.04 - 1.27; p=0.006] per 1-unit increase of BMI, adjusted for age, sex and comorbidities (hypertension, type 2 diabetes mellitus, dyslipidemia, coronary heart disease). Additionally, BMI value predicted MVA with an area under the curve of 0.73 [0.63 - 0.84; p=0.002]. Conclusions: In PLN p.Arg14del mutation carriers, high BMI values and obesity are associated with higher incidence of MVA. This suggests a potential role for lifestyle intervention in the management of this genetic cardiomyopathy.

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.