Highest Quartile Of Body Mass Index Research Articles

Hemodynamic profile of obesity in cardiogenic shock

Abstract Background There is a growing understanding that cardiogenic shock (CS) is a hemodynamically heterogenous condition. Hemodynamic variants within this entity are not well studied but, if recognize, may help to optimize therapies. Purpose We explored hemodynamics in patients with CS based on their body mass index (BMI). Methods The Cardiogenic Shock Working Group (CSWG) registry includes patients with CS, regardless of etiology, from 17 clinical sites across the USA. We stratified the participants into BMI quartiles (BMI≤24.4 kg/m2, 24.433.1 kg/m2), and studied the hemodynamic variables in CS depending on body mass index (BMI). Results The total cohort consisted of 3,492 patients admitted with CS (mean age 62.1±14 years, 69% male), including 2,024 (58.0%) of CS related to advanced heart failure (HF-CS) and 969 (27.8%) acute myocardial infarction (AMI) related CS. IN HF-CS, more obese patients in higher BMI quartile had larger left ventricle, higher ejection fraction, and greater cardiac output (Table). Their systolic blood pressure was higher, and pulmonary artery pressure was lower than in lower BMI quartiles. Their pulmonary artery pulsatility index decreased from 2.2±1.4 in the second quartile to 1.6±1.3 in the forth (highest) quartile. Mortality in creased with the BMI increase, from 23.3% in the lowest BMI quartile to 30% in the highest BMI quartile, p=0.0128. In AMI-CS, there was no distinct hemodynamic profile related to obesity. Conclusions In cardiogenic shock related to heart failure, unlike in AMI-related cardiogenic shock, there is a distinct hemodynamic pattern of obesity, consistent with larger left ventricle, higher ejection fraction, higher cardiac output and systemic pressure, higher right atrial pressure, and lower pulmonary artery pulsatility index. In this subset, obesity is associated with the highest in-hospital mortality.

A multidimensional functional fitness score has a stronger association with type 2 diabetes than obesity parameters in cross sectional data.

We examine here the association of multidimensional functional fitness with type 2 diabetes mellitus (T2DM) as compared to anthropometric indices of obesity such as body mass index (BMI) and waist to hip ratio (WHR) in a sample of Indian population. We analysed retrospective data of 663 volunteer participants (285 males and 378 females between age 28 and 84), from an exercise clinic in which every participant was required to undergo a health related physical fitness (HRPF) assessment consisting of 15 different tasks examining 8 different aspects of functional fitness. The odds of being diabetic in the highest quartile of BMI were not significantly higher than that in the lowest quartile in either of the sexes. The odds of being a diabetic in the highest WHR quartile were significantly greater than the lowest quartile in females (OR = 4.54 (1.95, 10.61) as well as in males (OR = 3.81 (1.75, 8.3). In both sexes the odds of being a diabetic were significantly greater in the lowest quartile of HRPF score than the highest (males OR = 10.52 (4.21, 26.13); females OR = 10.50 (3.53, 31.35)). After removing confounding, the predictive power of HRPF was significantly greater than that of WHR. HRPF was negatively correlated with WHR, however for individuals that had contradicting HRPF and WHR based predictions, HRPF was the stronger predictor of T2DM. The association of multidimensional functional fitness score with type 2 diabetes was significantly stronger than obesity parameters in a cross sectional self-selected sample from an Indian city.

Impact of body mass index on the clinical outcomes in heart failure patients undergoing cardiac rehabilitation

Abstract Background Increased body mass index (BMI) has recently shown to have a favorable effect on the prognosis in heart failure (HF) patients. However, the impact of BMI on clinical events and mortality in HF patients who underwent cardiac rehabilitation (CR) remains unclear. Purpose This study aimed to investigate whether the obesity paradox is present in HF patients who have undergone CR. Methods This study enrolled 238 consecutive HF patients who had undergone CR at our university hospital between November 2015 and October 2017. The clinical characteristics and anthropometric data of these patients, including BMI, were collected at the beginning of the CR. The major adverse cardiovascular event (MACE) was defined as a composite of all-cause mortality and unplanned hospitalization for HF. Follow-up data regarding the primary endpoints were collected until November 2018. Results Patients (mean age 68.7 years, male 61%) were divided into four groups as per BMI quartiles. More patients in the highest BMI group were women, were significantly younger, and had a higher prevalence of hypertension, dyslipidemia, and diabetes mellitus; however, no significant differences were observed in the prevalence of chronic kidney disease, left ventricular ejection fraction, and brain natriuretic peptide levels of the four groups. During a median follow-up duration of 583 days, 28 patients experienced all-cause mortality, and 42 were hospitalized for HF. Kaplan–Meier analysis showed that patients in the highest BMI quartiles had lower rates of MACE (Log-rank P<0.05) (Figure 1). After adjusting for confounding factors, Cox regression multivariate analysis revealed that BMI was negatively and independently associated with the incidence of MACE (hazard ratio: 0.89, 95% confidence interval: 0.83–0.96, P<0.05). Conclusion Increased BMI was associated with better clinical prognosis even in HF patients who have undergone CR Therefore, BMI assessment may be useful for risk stratification in HF patients who have undergone CR. Figure 1. Kaplan-Meier survival curve Funding Acknowledgement Type of funding source: None

Morphologic Factors Associated With Open Conversion During Holmium Laser Enucleation of the Prostate

OBJECTIVETo determine if there is an association between patient body habitus as measured by body mass index (BMI), body surface area (BSA), preoperative prostate volume, postoperative specimen weight, and open conversion with cystotomy or perineal urethrotomy (PU) during holmium laser enucleation of the prostate (HoLEP). We attempt to provide meaningful criteria to assist in preoperative patient counseling. MATERIALS AND METHODSThree hundred consecutive patients underwent HoLEP between August 3, 2018 and February 20, 2020 by a single surgeon. Patient metrics were recorded in a database including age, height, weight, preoperative prostate volume, postoperative specimen weight, catheter dependence, and transfusion requirement. Nine patients were identified who had cystotomy (8) or PU (1) performed during HoLEP secondary to inability to complete the procedure using standard endoscopic technique. Univariate and multivariate statistical analysis was performed. RESULTYounger age, higher BMI, higher BSA, and higher estimated prostate volume were associated with increased risk of open conversion during HoLEP. No patient with a BMI under 30 required open conversion. CONCLUSIONMen with BMI >30 kg/m2 or preoperative prostate volume >125 mL should be counseled on the possibility of open conversion with cystotomy or PU. Although the overall risk of conversion is low (3%), the risk may be as high as 10% for patients in the highest quartile of BMI (>30.5 kg/m2) and BSA (>2.2m2).

Donor Sex, Age, and Body Mass Index on Bone Marrow Harvest Collection Quality Outcomes

Introduction To evaluate factors of sex, age, and body mass index (BMI) on the bone marrow (BM) harvest collection outcomes of total nucleated cell (TNC) yield, anesthesia time, and sterility; a retrospective review of BM harvest donors at our institution from 2008 to 2017 was conducted. Donors were compared by sex and quartiles based on age and BMI. Materials and Methods Fifty-one donors underwent BM harvest. Thirty-three, 64.7%, of donors were male while 18, 35.3%, were female. Ages ranged from 20 to 72 years, median 33. BMI ranged from 18.7 to 43.4 kg/m2, median 27.7. BMI quartiles approximate WHO nutritional categories: first quartile, Normal weight; second and third quartiles, Overweight; fourth quartile, Obese. As TNC number targets are not donor dependent, outcomes were standardized by concentration: TNC/ml for TNC yield, seconds/ml for anesthesia time. Results There were no significant differences in TNC yield between sexes and between age quartiles. There was a significantly higher TNC yield in the fourth quartile of BMI (>32.5 kg/m2) compared to the first quartile of BMI (≤24.3), p = 0.032. There were trends towards longer median anesthesia times in females, highest BMI quartile, and youngest age quartile. Cultures were positive in 5, 9.8%, products; all occurred in the male donor group, 15.2% of male donors. Conclusion Selection biases might explain the greater number of male donors and donors with a greater BMI. There were no significant differences in TNC yields between sexes and between age quartiles. There was a significantly higher TNC yield in the fourth quartile of BMI compared to the first. Median anesthesia times were longest in female, youngest quartile of age, and Obese donors but did not approach statistical significance. BM products collected from male donors were significantly more likely to have positive cultures. Sample size limits the power of these analyses.

Obesity Indicators and Health-related Quality of Life - Insights from a Cohort of Morbidly Obese, Middle-aged South Indian Women.

The global prevalence of obesity is increasing and has nearly doubled in the last decade, disproportionately impacting less-developed countries. The aim of this cross-sectional study was to analyse health-related quality of life (HRQOL) in morbidly obese women attending a bariatric clinic in India, and assess potential obesity indicators that can be utilised in under-resourced settings, to better understand HRQOL of individual patients. Anthropometric measurements were collected, including waist circumference, hip circumference, waist-hip ratio, waist-height ratio and body mass index (BMI). HRQOL was assessed using an obesity-related quality-of-life questionnaire focused on the impact of obesity on physical distress, self-esteem, sexual life and work life. The average BMI of study participants was 39.6 kg/m2, with an average HRQOL of 40.2%. The strongest correlation was noted between BMI and HRQOL (R2=0.16). Exploratory analyses demonstrated that patients with higher BMI quartiles had lower scores for physical impact and psychosocial impact, and higher scores for sexual health, comfort with food, and experience with dieting compared to patients in lower quartiles. In South Indian, middle-aged, morbidly obese women, HRQOL is lower than average and is highly correlated with BMI, with different BMI levels having higher impacts in different subcategories, supporting the need for an individualised therapeutic focus for each patient.

Does the Healthy Eating Index and Mediterranean Diet Score Identify the Nutritional Adequacy of Dietary Patterns in Chronic Pancreatitis?

Chronic pancreatitis (CP) is a progressive, irreversible disease characterized by maldigestion and frequently accompanied by epigastric pain, exocrine insufficiency, and/or endocrine insufficiency. There is limited information about the dietary patterns in CP from which to guide medical nutrition therapy recommendations. Study design was a cross-sectional, case-control study comparing subjects with CP (n = 52) to healthy controls (n = 48). Vioscreen™ food frequency questionnaire was used to assess the dietary pattern and nutrient intake in both groups. Dietary quality scores (the Healthy Eating Index, Mediterranean Diet score), and daily energy, macronutrient, and micronutrient intake levels were compared between groups. Two sample t tests and Wilcoxon rank sum tests were used to evaluate differences in continuous variables, and Chi-squared tests were used for categorical variables. CP was associated with a lower body mass index (BMI) (24 vs. 31mg/kg2; p < 0.001), lower HEI (57 vs. 65; p = 0.002), and aMED scores (29 vs. 32; p = 0.043) compared to healthy controls. Subjects with CP in the highest BMI quartile had the highest median aMED score compared to those in the lowest BMI quartile. There were no differences in kilocalories, macronutrients, or fat-soluble vitamin intake between groups, with the exception that vitamin K intake was lower in the CP group. The overall quality of dietary intake is lower in subjects with CP compared to controls when assessed by two independent nutritional measurement tools. Further research is needed to examine contributing factors, such as food insecurity and coexisting endocrine or exocrine insufficiency, to dietary patterns in patients with CP from which to guide evidence-based recommendations for medical nutritional therapy.

Physical activity, obesity and sedentary behaviour and the risks of colon and rectal cancers in the 45 and up study

BackgroundObesity and physical activity (PA) are predictors of colon (CC) and rectal (RC) cancers. Prolonged sitting is also emerging as a potential predictor for these cancers. Little knowledge exists about the interactive effects of obesity, PA and prolonged sitting on cancer risk. This analysis assessed independent and interactive effects of PA, body mass index (BMI) and sitting time on CC and RC risks.MethodsThis analysis used data from a prospective study of 226,584 participants aged 45 years and over in New South Wales (NSW), Australia, who joined the 45 and Up study between 2006 and 2009. Baseline data were linked with data relating to mortality, cancer registration, hospital admission and Department of Human Services to December 2010. Multivariable Cox regression was used to estimate adjusted hazard ratios (referred to as relative risks, RRs) and 95% confidence intervals (Cis). Statistical significance was defined as p < 0.05.ResultsThere were 846 and 369 ascertained cases of CC and RC. BMI was positively associated with CC risk (p = 0.003, P-trend = 0.0006) but not with RC. CC risk was increased in participants in the highest BMI quartile (≥29.4-≤50 kg/m2) compared to the lowest (15- < 23.6 kg/m2), (RR = 1.32, 95% CI:1.08–1.63). PA was associated with CC risk (p = 0.02) but not with RC. Specifically, CC risk was lower in individuals partaking in any amount of vigorous activity (time/week) compared to participants with no engagement (RR = 0.78, 95% CI:0.65–0.93). Sitting time was not associated with CC or RC. We found no evidence of interactive effects of PA, BMI and prolonged sitting on cancer risk.ConclusionThis evidence suggests that a healthy weight and vigorous activity are essential to reduce CC risk since these factors may be independent of each other.

Food labels and adult BMI in Italy – An unconditional quantile regression approach

A goal of food nutrition labeling policies is to help consumers make informed choices regarding the healthiness of the food they purchase. Yet, findings regarding the effectiveness of label use to decrease negative health outcomes, such as overweight and obesity, are mixed. As most studies focus on estimating mean effects of labels, little is known on whether labels have any effect at the tails of the body weight distribution, which, given the social gradient of obesity, often includes at-risk groups. Additionally, label use, overweight and obesity vary across population subgroups. Thus, the relationship between using food nutrition labels and body weight may be characterized by marked heterogeneity, which the current literature has failed to address. This study explores the non-linearity of the relationship between reading ingredients on the food label and Body Mass Index (BMI) using an unconditional quantile regression estimator and one year of data on adult Italians from the Multipurpose Household Survey. We study this relationship across the BMI distribution and for different groups of respondents, divided by gender, income above and below the sample average, education level, perceived hardships to access food, and regular practice of sport. The results indicate that reading ingredient labels has a negative association with BMI, mostly at higher BMI quartiles (overweight and obese), although a relationship at the highest quartile is only found in a few subsamples. Females, and individuals with a higher risk of being overweight and obese such as low-income, low educated, or those who do not practice sport seem to garner the highest benefit from reading ingredients in the food label. The paper concludes with policy implications, tapping into the recent debate regarding the revision of food labeling in the European Union.

Abstract P171: Smaller Body Mass Index is Associated With Mild Cognitive Impairment in Elderly Hypertensive Patients

Backgrounds: In elderly hypertensive patients, it might be important to pay attention to cognitive function when achieving aggressive blood pressure goal; therefore we evaluated factors associated with cognitive impairment in elderly hypertensive patients. Methods: We performed Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in 209 elderly hypertensive patients who were evaluated frailty (Aged &gt; 65 years, Male 38.3 %). Dementia was diagnosed as MMSE scores &lt; 23 and/or anti-dementia drug use; mild cognitive impairment (MCI), MoCA&lt;24 points and MMSE &gt; 24 points. Results: Mean age was 78.6±6.2 years. There were 84.2 % of patients who were taking antihypertensive drug. Clinic blood pressure was 133.2±17.6 / 74.3±11.9 mmHg and body mass index (BMI) was 23.7±7.6 kg/m 2 . MMSE score was 27.0±3.8 and MoCA was 21.1±4.9 points. There were 53.0 % of patients with MCI; 12.9 % with dementia. Patients with MCI and dementia had lower BMI than those without (MCI group, BMI=23.2±3.5 kg/m 2 ; dementia group, 23.4±2.7 kg/m 2 ; no MCI or dementia group, 24.8±3.9 kg/m 2 ; P=0.012). The risk of MCI increased by 13.2 % per smaller BMI of 1 kg/m 2 (P=0.006); that of dementia increased by 18.6 % per smaller BMI of 1 kg/m 2 (P=0.055) after adjustment for age, gender, antihypertensive drugs use, diabetes, dyslipidemia, smoking habit, alcohol drinking, history of stroke, and systolic and diastolic blood pressure. Patients with the lowest quartile of BMI (&lt; 21.34 kg/m2) had 3.82 (95%CI 1.42-10.27) times greater risk of MCI and had 7.59 (95%CI 1.22-47.27) times greater risk of dementia than those with highest quartile of BMI (&gt; 25.69 kg/m2). Conclusion: In elderly hypertensive outpatients who were suspected of frailty, smaller BMI was associated with presence of MCI and dementia, suggested that we needed to decide optimal blood pressure level carefully in lean hypertensive patients.

Relationship Between C-Reactive Protein and Obesity in Adults

body fatness (3). Raised body mass index (BMI) is a major risk factor for non-communicable diseases such as: CVD (mainly heart disease and stroke), which were the lead- ing cause of death in 2012. In 2014, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 600 million were obese. Overall, about 13% of the world's adult populations (11% of men and 15% of women) were obese. In 2014, 39% of adults aged 18 years and over (38% of men and 40% of women) were overweight. The world- wide prevalence of obesity more than doubled between 1980 and 2014. In this cross-sectional study, A total of 260 adult healthy men and women that being agreed by the chan- cellor and research deputy of Islamic Azad University of Hamadan. BMI (weight/height 2 in kg/m 2 ) was calculated for each participant. Obesity is defined as BMI 30 kg/m 2 . Blood samples were collected into the tube. CRP mea- surements were performed in the laboratory. The serum was transferred into plastic tube. Plasma CRP levels were measured by means of a colorimetric competitive enzyme- linked immunosorbent assay (ELISA). The results showed that prevalence of overweigh was 42.4% and the relation- ship between overweigh and CRP was P = 0.006. Waist cir- cumference in excess of 89 cm in men was 12.7% and in women waist circumference in excess of 89 cm was 21%. The overall prevalence of general obesity was 16.9% and was closely linked to CRP. Subjects with elevated CRP had higher BMI, WC (Waist circumference). For elevated CRP, subjects in the highest BMI quartile had compared with subjects in the lowest BMI quartile. The result shows the re- lationship of CRP with BMI throughout the BMI spectrum (P = 0.0002). CRP levels were strongly correlated with BMI (P = 0.0002). Levels of CRP also increased steadily across WC quartiles (P = 0.0001). Waist circumference quartiles were also strongly associated with odds of elevated CRP. Men in the highest WC (91 cm) and women in the highest WC (89 cm) had an odd of elevated CRP of 5.24 (95% CI, 3.15 - 14.0). Consequently, WHO has the unique authority and the clear mandate to lead the development and implemen- tation of the global strategy for the prevention and control of non-communicable diseases and thereby to create a bet- ter environment for world health in 2020 and beyond.

The association of total sialic acid and malondialdehyde levels with metabolic and anthropometric variables in obesity

Serum sialic acid levels are abnormally high in pathological states that exhibit tissue destruction, tissue proliferation or inflammation. We measured total serum sialic acid levels in 139 women and 125 men. Subjects were divided into quartiles according to their body mass index (BMI): Q1 (18–24.9 kg/m2), Q2 (25–29.9 kg/m2), Q3 (30–39.9 kg/m2) and Q4 (> 40 kg/m2). The patients in Q1 constituted the control group. Serum sialic acid levels of subjects in Q2, Q3 and Q4 were significantly higher than those in Q1. Higher BMI quartiles also were associated with higher levels of serum glucose, insulin, total cholesterol, LDL-cholesterol, triglycerides, high-sensitivity C-reactive protein, malondialdehyde levels, waist circumference, blood pressure and homeostasis model assessment of insulin resistance in both women and men. Lower BMI quartiles were associated with higher levels of serum HDL-cholesterol levels in both women and men. We found positive associations among serum sialic acid levels, BMI and oxidative stress. Serum sialic acid also is related to some conventional cardiovascular risk factors including elevated lipid profile, increased blood pressure, increased serum glucose and insulin levels, and insulin resistance in obese people.

Association between inflammatory biomarkers and adiposity in obese patients with heart failure and metabolic syndrome.

Obesity, type 2 diabetes mellitus (DM) and metabolic syndrome (MS) are common in patients with heart failure (HF). Studies investigating the association between known biomarkers and adiposity in patient populations are limited. The aim of the present study was to investigate the association between C-reactive protein (CRP) and leptin with adiposity in a sub-group of overweight/obese patients with HF, DM and/or MS. A total of 36 patients (mean age, 56.72±9.78 years; ranging between 27 and 76 years of age; 80.6% male; 52.8% Caucasian) were enrolled and their height, weight, waist circumference and body composition (e.g. percentage body fat and lean mass), as well as the levels of CRP and leptin, were assessed. The results demonstrated that there was a significant association between CRP and leptin, CRP and body mass index (BMI) and gender and percentage body fat (P<0.05, for all associations). Analysis of leptin and CRP levels revealed that patients in the highest BMI quartile (BMI, 40.3–61.2) had higher CRP levels (4.83 μg/ml vs. 3.03 μg/ml; P=0.033) and higher leptin levels (44.97 ng/ml vs. 24.64 ng/ml; P=0.042) compared with patients in the lower BMI quartile (BMI, 28.6–32.4). In conclusion, among obese patients with HF, DM and/or MS, an association between CRP and leptin was identified, providing further evidence that metabolic and inflammatory mechanisms are involved in these diseases. Future investigation to assess the potential impact of inflammation and adiposity, and the role of dietary interventions and weight loss on clinical outcomes in this population of chronically ill patients is warranted.

The impact of central obesity on accelerated progression of noncalcified coronary plaque assessed by coronary CT angiography: a 4-year-follow-up study

Purpose: Although excess visceral adipose tissue (VAT) is more strongly associated with risk factors of coronary artery disease (CAD) than body mass index (BMI) or waist circumference, an association between VAT and CAD progression has not been fully evaluated. The aim of this study was to investigate whether adding VAT measurements to CAD risk factors provides better risk assessment for progression of calcified and noncalcified coronary plaque on coronary CT angiography. Methods: This prospective cohort study comprised 553 CAD patients with calcified and noncalcified coronary plaque with ≤ 50% coronary stenosis as assessed by coronary CT angiography. Quantification of VAT area was performed using abdominal CT scanning. Results: After a mean 55±8 month follow-up, 332 patients underwent repeated CT scans for worsening angina symptoms without findings of positive ischemia. Increased segments of noncalcified plaque were seen in 161 (48%) and increases above the median calcium score were seen in 168 (51%) patients. The risk for progression of noncalcified plaque increased steadily with higher VAT quartiles, independent of CAD risk factors. Patients in the higher VAT quartiles were at increased risk of progression of noncalcified plaque (quartiles IV OR 5.5; 95% CI 2.8-11.0, p-value < 0.001). In contrast, increases above the median calcium score showed no independent correlation to VAT. Progression of noncalcified plaque showed no phased increase with either higher waist circumference or BMI quartiles. Conclusions: Excess VAT was positively associated with progression of noncalcified coronary plaque, but not of calcified plaque. This suggests that risk assessment of progression of noncalcified plaque can be improved by combining VAT measurements and CAD risk factors.

Frequency and Microbiology of Peritonitis and Exit-Site Infection among Obese Peritoneal Dialysis Patients

Data on obesity as a risk factor for peritonitis and catheter infections among peritoneal dialysis (PD) patients are limited. Furthermore, little is known about the microbiology of PD-related infections among patients with a high body mass index (BMI). Using a cohort that included all adult patients residing in the province of Manitoba who received PD during the period 1997 - 2007, we studied the relationship between BMI and PD-related infections. After categorizing patients into quartiles of BMI, a multivariate Cox regression model was used to determine the independent relationship between BMI and peritonitis or exit-site infection (ESI). We also studied whether increasing BMI was associated with a propensity to infections with particular organisms. Among 990 PD patients, 938 (95%) had accurate BMI data available. Those 938 patients experienced 1338 peritonitis episodes and 1194 exit-site infections. In unadjusted analyses, patients in the highest BMI quartile (median: 33.5; interquartile range: 31.9 - 36.4) had an increased risk of peritonitis overall, and also an increased risk of peritonitis with gram-positive organisms and coagulase-negative Staphylococcus (CNS). After multivariate adjustment for age, sex, diabetes, cause of renal disease, Aboriginal race, PD modality, and S. aureus nasal carriage, the relationship between overall peritonitis risk and BMI disappeared, but the increased risk of CNS peritonitis among patients in the highest BMI quartile persisted (hazard ratio: 1.80; 95% confidence interval: 1.06 to 3.06; p = 0.03). There was no increased risk of ESI among patients in the highest BMI quartile on univariate analysis or after multivariate adjustment. Among Canadian PD patients, obesity was not associated with an increased risk of peritonitis overall, but may be associated with a higher risk of CNS peritonitis.

Cigarette smoking, body mass index associated with the risks of age-related cataract in male patients in northeast China.

To determine the association between cigarettes smoking, body mass index (BMI) and the risk of age-related cataract (ARC) in middle-aged and elderly men in Northeast China. A hospital-based case control study was conducted. Cases (n =362) were men who had surgically treated ARC, 45-85 years old; controls frequency-matched (n =362) were men who had been admitted to the same hospital as cases for other diseases not related with eye diseases. Cases and controls were matched with 1:1. The cases and controls were interviewed during their hospital stay, using a structured interviewer-administrated questionnaire that included information on sociodemographic characteristics, socioeconomic, lifestyle habits (tobacco smoking and alcohol consumption, etc.), anthropometric measures, personal medical history, and family history of ARC in first-degree relatives, and simultaneously BMI was calculated. The odds ratios (OR) and 95% confidence intervals (CI) of ARC were estimated using multiple logistic regression models. After adjusting for age and multiple potential confounders, higher BMI was associated with an increased risk of ARC. Cigarette smoking, years smoking or moderate cigarette smoking (1-29 cigarettes per day) had no relation with the risk of ARC (P>0.05), although patients smoking ≥30 cigarettes per day had an elevated risk of ARC as compared with the non-smokers (OR=1.55, 95% CI; 1.16-2.85, P=0.026). Higher BMI was associated with an increased risk of ARC. Both overweight and obesity was associated with an obviously increased risk for surgically ARC (OR=1.55, 95% CI: 1.02-1.98, P=0.015 and OR=1.71, 95% CI: 1.32-2.39, P=0.013 respectively) compared to normal BMI. Then participants were grouped into quartiles of BMI (Q1 to Q4), compared to controls in the lowest quartile, the OR for cases in the highest quartile of BMI was 1.54 (OR=1.54, 95% CI: 1.08-2.46, P=0.022). The results of univariate analysis showed cigarette smoking was not associated with ARC formation for men with lower or normal BMI (P>0.05). Compared to the non-smokers, for men of overweight or obesity, cigarette smoking was associated with a significantly increased risk for surgically ARC (OR=2.00, 95% CI: 1.49-6.65, P=0.003 and OR=1.66, 95% CI: 1.63-13.21, P=0.002 respectively). Similarly, smokers in the highest quartile of BMI had approximately 1.5 times the risk of ARC as non-smokers in the lowest quartile (OR=1.46, 95% CI: 1.06-5.29, P<0.001). Followed multivariate models revealed that the association had never changed. Current cigarette smoking is positively related to ARC only among those who smoking 30 or more cigarettes per day. For men who are both overweight and obesity, cigarette smoking is associated with a significantly increased risk for ARC.

Visceral abdominal fat accumulation predicts the progression of noncalcified coronary plaque

BackgroundExcess visceral abdominal tissue (VAT) is more strongly associated with risk factors of coronary artery disease (CAD) than body mass index (BMI) or waist circumference. However, whether adding VAT measurements to CAD risk factors provides better risk assessment for CAD progression has not been fully evaluated. Methods and resultsThis prospective cohort study comprised 553 CAD patients with coronary plaque with ≤50% coronary stenosis as assessed by computed tomography (CT) angiography. Quantification of VAT area was performed together with CT angiography using abdominal CT scanning. After a mean 38±8months follow-up, 320 patients underwent repeated CT scans for worsening angina symptoms without findings of positive ischemia. Increased segments of noncalcified plaque were seen in 152 (48%) and an increased calcium score was seen in 261 (82%) patients. The risk for progression of noncalcified plaque increased steadily with higher VAT quartiles, independent of CAD risk factors. Patients in the higher quartiles were at increased risk of progression of noncalcified plaque (quartiles IV OR 4.7; 95% CI 2.3–9.4, p-value<0.001). In contrast, increases above the median calcium score showed no independent correlation to VAT. Compared to VAT, progression of noncalcified plaque showed no phased increase with higher waist circumference and weaker increase with higher BMI quartiles. ConclusionVAT accumulation was positively associated with progression of coronary noncalcified plaque, but not of calcified plaque. This suggests that risk assessment of progression of noncalcified plaque can be improved by combining VAT measurements and CAD risk factors.

Body Mass Index and Hypertension Among Chinese Governmental and Institutional Employees in Beijing

Body mass index (BMI) and hypertension have been found to be associated in most studies of diverse populations; however, little information is available on whether the positive relationship is consistent among individuals at work sites. A work site-based screening was performed in 30 682 employees with a mean age of 40.3 years. In crude models, higher BMI quartiles above the lowest quartiles (BMI < 20.6 kg/m2) were associated with progressively higher odds ratio (OR) of hypertension with an OR of 2.80 (95% confidence interval [CI]: 2.67-2.93) for the top quartile (BMI ≥ 24.6 kg/m2). Similar trends were found in fully adjusted models. Moreover, a 1-standard deviation (SD) increase in BMI was associated with a 42% significantly higher (95% CI 38-46) risk of hypertension after adjusting for other factors. Concordant relationships were revealed in all evaluated subgroups, even among those without traditional cardiovascular risk factors.

Childhood Obesity, Other Cardiovascular Risk Factors, and Premature Death

The effect of childhood risk factors for cardiovascular disease on adult mortality is poorly understood.In a cohort of 4857 American Indian children without diabetes (mean age, 11.3 years; 12,659 examinations) who were born between 1945 and 1984, we assessed whether body-mass index (BMI), glucose tolerance, and blood pressure and cholesterol levels predicted premature death. Risk factors were standardized according to sex and age. Proportional-hazards models were used to assess whether each risk factor was associated with time to death occurring before 55 years of age. Models were adjusted for baseline age, sex, birth cohort, and Pima or Tohono O'odham Indian heritage.There were 166 deaths from endogenous causes (3.4% of the cohort) during a median follow-up period of 23.9 years. Rates of death from endogenous causes among children in the highest quartile of BMI were more than double those among children in the lowest BMI quartile (incidence-rate ratio, 2.30; 95% confidence interval [CI], 1.46 to 3.62). Rates of death from endogenous causes among children in the highest quartile of glucose intolerance were 73% higher than those among children in the lowest quartile (incidence-rate ratio, 1.73; 95% CI, 1.09 to 2.74). No significant associations were seen between rates of death from endogenous or external causes and childhood cholesterol levels or systolic or diastolic blood-pressure levels on a continuous scale, although childhood hypertension was significantly associated with premature death from endogenous causes (incidence-rate ratio, 1.57; 95% CI, 1.10 to 2.24).Obesity, glucose intolerance, and hypertension in childhood were strongly associated with increased rates of premature death from endogenous causes in this population. In contrast, childhood hypercholesterolemia was not a major predictor of premature death from endogenous causes.

Increased risk of macrosomia among overweight women with high gestational rise in fasting glucose

Objectives. Maternal overweight is a risk factor for gestational diabetes (GDM) and for newborn macrosomia. Among women without GDM, it is not well understood why some women with high body mass index (BMI) give birth to macrosomic newborns while others do not. We wanted to explore the effect of BMI and fasting plasma glucose (FPG), fasting plasma insulin (FPI) and insulin resistance (HOMA-IR) on the risk of newborn macrosomia.Methods. A cohort of 553 Caucasian women was followed throughout pregnancy. The dependent variable was high birth weight (≥4200 g). Independent variables included gestational age, intake of macronutrients and energy, maternal BMI, weight gain, FPG, FPI and HOMA-IR.Results. FPG in late pregnancy (30–32 weeks) remained a significant determinant of newborn macrosomia in multiple regression analysis (OR: 1.9, 95% CI: [1.1, 3.4]), whereas FPI and HOMA-IR did not. The women in the highest BMI quartile (≥27 kg/m2) who gave birth to macrosomic newborns had higher increase in FPG and HOMA-IR from early to late pregnancy. Among women in this BMI category, the risk for delivering a macrosomic infant was higher among those with an increase in FPG above 0.60 mmol/l (upper quartile) (OR = 4.5, 95% CI: [1.7, 12.5]).Conclusion. Fasting plasma glucose at week 30–32, but not fasting plasma insulin or insulin resistance, is a determinant of newborn macrosomia. Overweight women with high increase in fasting plasma glucose from early to late pregnancy had a 4.5-fold increase in risk of newborn macrosomia compared to the remaining group with high BMI.