Ideal Body Weight Research Articles

Effect of nutritional guidance on mortality and composite endpoints in patients with acute myocardial infarction: a single center retrospective cohort study

Abstract Background/Introduction Acute myocardial infarction (AMI) stands as a major global cause of mortality. Various intervention strategies, such as pre-hospital care, reperfusion therapies, pharmacological interventions, dietary modifications, and exercise therapies, have been researched to improve patient prognosis (1,2). While reports suggest the efficacy of the Mediterranean diet, there remains a lack of evidence regarding the impact of nutritionist-led dietary guidance on the prognosis of AMI patients. Purpose This study aimed to elucidate whether nutritional guidance by nutritionists who have national qualifications would improve the mortality and the primary composite endpoint (including acute decompensated heart failure, stroke, and acute coronary syndrome) of patients following an acute myocardial infarction. Methods A retrospective cohort study was conducted, enrolling 446 consecutive AMI patients who underwent emergency coronary angiography and percutaneous coronary interventions between September 1, 2015, and October 31, 2023. Patients meeting the universal definition of myocardial infarction were included (3). After excluding 37 in-hospital deaths, evaluations for all-cause mortality, cardiovascular mortality, and composite endpoints were performed during follow-up in 409 patients. Nutritionists guided 223 patients (54.5%) during hospitalization in this study. The nutritional guidance used in our study was also based on the definition of adequate caloric intake of 25–30 kcal per ideal body weight (kg). Under an appropriate total energy intake, a fat energy ratio of 20–25% and a carbohydrate energy ratio of 50–60% are recommended, with protein and lipid restrictions depending on the disease state. Results During a median follow-up of 39 months, 24 cases of all-cause mortality (5.9%) and 6 cases of cardiovascular mortality (1.5%) were recorded. Additionally, 15 cases of nonfatal stroke (3.7%), 17 cases of nonfatal acute coronary syndrome (4.2%), and 20 cases of hospitalizations for acute decompensated heart failure (4.9%) were observed. Kaplan–Meier curves demonstrated significantly higher incidence rates of death and primary composite endpoints among patients without nutritional guidance. The multivariate Cox regression model incorporated all variables exhibiting statistically significant associations with long-term mortality, and the primary composite endpoints. The multivariate Cox regression model revealed nutritional guidance as a significant predictor for long-term mortality but not for primary composite endpoints. Conclusion Nutritional guidance for AMI patients may improve overall mortality. Further research is warranted to explore the physiological impacts of improved diets resulting from such guidance and their effects on enhancing prognosis.

What is the true normal: comparison of different equations for estimating peak oxygen uptake for outcome prediction in heart failure

Abstract Background and Objectives One of the strongest prognostic parameters obtained during Cardiopulmonary exercise testing (CPET) in patients with heart failure (HF) is the peak oxygen uptake (pVO2), as a standalone or as a percentage of the predicted peak oxygen uptake (ppVO2) reached. However, traditional standards by which ppVO2 is calculated have limitations, having been derived from small cohorts, lacking portability and poorly represented by women. Thus, we aim to compare the FRIEND Registry equation to previously used methods of calculating ppVO2 as it relates to prognostic value imparted by the percentage of ppVO2 (%ppVO2) reached during CPET and portability to the Portuguese HF population. Methods Single centre retrospective study of patients with HF with LVEF < 50% who underwent CPET between 2015-2021. Patients who did not reach RER≥ 1.05 were excluded from our analysis. All tests were evaluated and ventilatory thresholds determined by 3 independent, experienced operators. ppVO2 was calculated according to 1) the Wasserman equation; 2) the Wasserman equation using ideal body weight; 3) the Neder equation, 4) the SHIP equation and 5) the FRIEND equation. Our primary endpoint was a composite of CV death, urgent transplant or left ventricular assist device implantation and HF hospitalization. Results We included 238 patients (mean age 59 ± 11 years, 83% males). The HF aetiology was mostly ischemic in nature (68%), with LVEF of 34 ± 9% and median NTproBNP of 776 (2566 – 2342) pg/mL. Most patients (67%) were in class NYHA I-II and with high prevalence of GDMT (93% ACEi/ARB; 97% beta-blockers and 64% on MRA). Mean BMI in this group was 27.3 ± 4.7 kg/min. Patients performed CPET on a treadmill with a protocol adjusted to their predicted exercise capacity. Mean pVO2 was 18.1 ± 6.2mL/kg/min, corresponding to a median %ppVO2 that ranges from 51 ± 16% to 71 ± 22%, depending on the equation that is used. Mean VE/VCO2 Slope was 42 ± 13 and 48 % (n = 98) of patients showed exercise oscillatory ventilation (EOV). Mean ppVO2 as per the FRIEND and Wasserman equations was 18.9 ± 6.6 and 21.2 ± 4.5 mL/kg/min, with no statistically significant difference between both. %ppVO2 as calculated through all equations was an independent predictor of prognosis on multivariate analysis adjusted for LVEF, NTproBNP and VE/VCO2 Slope (p < 0.001 for values derived from all equations). However, the FRIEND and Wasserman equations showed a slight advantage over the remaining 2 equations, with higher AUC on ROC curve analysis (see figure). Conclusions In our population of Portuguese patients with HF, both the FRIEND registry and Wasserman equations for predicting pVO2 yielded strong prognostic power. However, these equations provide different absolute predicted VO2 values for the same patients and thus should not be used interchangeably. Standardisation of the type ppVO2 equation used should be recommended by local scientific societies.

Variants for dosing of rocuronium taken into obesity during general anesthesia in gynecological laparoscopic surgery

The objective was to identify the optimal method of dosing the muscle relaxant rocuronium during gynecological laparoscopic surgery in obese patients.Materials and methods. The study included 36 women with obesity II–III degree, which performed elective gynecological laparoscopic surgery. They were divided into 3 groups. In group 1, rocuronium were dosed at the rate of 0.6 mg/kg of ideal body weight calculated by the Lorentz formula. In group 2, rocuronium were dosed at the rate of 0.6 mg/kg of actual body weight. In group 3, rocuronium were dosed at the rate of 22.5 mg/m2 of body surface area. The comparison group (group 0) included 20 patients with body mass index equal to 18.5–25 kg/m2.Results. The shortest time for the onset of deep neuromuscular block was noted in groups 2 and 3, and the longest, comparable to the indicator in group 0, was in group 1 (p < 0.05). The time from rocuronium administration to the onset of restoration of neuromuscular conduction was the shortest in group 1: 22 [20; 25] minutes, and the longest in group 2: 40 [35; 45] min. There was no statistically significant difference in the dosing of rocuronium in obese patients at body surface area in group 3 compared with dosing for actual weight in group 0: 27 [22; 29] and 27 [25; 33] min, respectively. The recovery time of neuromuscular conduction from TOF = 1 to TOF = 25% was the shortest in group 1 (23 [18; 24] min) and was significantly different from the value in groups 2 and 3, as well as in patients of group 0. In groups 0, 2, 3, values of this indicator were identical. The recovery index did not differ significantly in all four groups.Conclusion. Dosing rocuronium in obese patients based on body surface area has an advantage for comparison over dosing based on both actual and ideal body weight, resulting in greater predictability of neuromuscular block dynamics.

Hand dynamometer and clinical tests to evaluate the recovery of neuromuscular conductance in atracurium versus rocuronium in patients undergoing laparoscopic surgery

Background. Postoperative muscle weakness is not unusual and may be related to postoperative complications in patients after general anesthesia. However, the clinical practice of neuromuscular conductance monitoring is uncommon among anesthesiologists.The objective was to evaluate the rate of neuromuscular recovery after atracurium and rocuronium and to determine the numerical value of grip strength using a hand dynamometer, indicating the safety of transferring a patient from the postoperative ward.study design. A prospective, observational, clinical comparison study.Materials and Methods. Upon proper authorization and approval from the local ethics committee, patients referred for laparoscopic surgery, 120 patients of the American Society of Anesthesiology (ASA) physical status I &II between ages 20–49 years were randomly assigned into 2 groups of 60 each. Group I received a single atracurium dose of 0.5mg/kg of ideal body weight and Group II patients received a single rocuronium dose of 0.6mg/kg of ideal body weight. Parameters such as modified Alderete score (MAS), grip strength, and sustained head and leg lift for five seconds were compared in both groups 50 minutes after giving the reversal agent at 10-minute intervals.Results. Postoperative muscle recovery (grip strength) was faster in the atracurium group than the rocuronium group, with a p-value of 0.042 at 20 minutes, and 0.0000 for 30, 40, and 50 minutes after giving the reversal agent. The time to obtain a modified Alderete score (MAS) > 8 scores was statistically insignificant with a p-value of 0.335. Positive clinical test for sustained head lift for 5 seconds was statistically insignificant within a majority of the time, except in the 20 minutes, most of the cases in the atracurium group were able to sustain head elevation for 5 seconds with a p-value of 0.021. In the 10 &20 minutes, most cases in the atracurium group could sustain leg elevation for 5 seconds with a p-value of 0.015 and 0.014 respectively. However, most cases in both groups could sustain head and leg elevation for 5 seconds in the 30 minutes after giving a reversal agent.Conclusion. Compared to rocuronium, atracurium has been associated with faster muscle recovery after a single tracheal intubation dose for a short surgery. This was determined by utilizing an electronic hand dynamometer to measure grip strength. 42% grip strength from baseline might be applicable for safe discharge from the recovery room. A hand dynamometer assessment revealed more post-operative muscle weakening than a clinical evaluation.

One size does NOT fit all – factoring weight into current stem cell transplant guidelines in multiple myeloma patients

Abstract Autologous hematopoietic stem cell (HPSC) transplantation serves as the standard of care treatment for multiple myeloma patients. The standard ASCT procedures for multiple myeloma (MM) patients often includes induction therapy, stem cell collection via apheresis and autologous hematopoietic cell transplantation (HCT) for eligible patients. The current guideline for HPSC collection for multiple myeloma established that 3x106 cells/kg of actual body weight (ABW) by the 1997 study of stem cell transplants in breast cancer. Recent research indicates that ideal body weight (IBW) utilization is a stronger predictor of post-autotransplantation neutrophil recovery than calculations based on ABW. Reducing the cost of HPSC collection and cryopreservation is critical to mitigate the cost incurred by the transplant center and the patient. This study evaluates whether using a patient’s IBW or Adjusted Ideal Body Weight (AIBW) would be satisfactory in determining the amount of stem cells required for transfusion when compared to ABW. After institutional review board approval, a retrospective chart review study analyzed a cohort of 224 deceased MM patients, who received HCT at the UAB Medicine Hospital within the fiscal years of 2017 to 2019. The ABW for each patient was used to calculate their IBW and AIBW using the formulas shown below. The target CD34+ cell amount for patients was calculated using each body weight parameter. The platelet count and absolute neutrophil count (ANC) defined a successful platelet and neutrophil engraftment. The engraftment date was determined as the day the platelet value exceeded 20 and ANC exceeded 0.5 for three consecutive days (without any transfusion within a seven day window) and a statistical analysis was utilized to determine whether the IBW and AIBW parameters were adequate to achieve successful engraftment and HCT. This study finds that the cohort of multiple myeloma patients are significantly more overweight than the prior study that established the current guidelines for autologous hematopoietic cell transplantation. The results for CD34+/kg cell targets for ideal and adjusted ideal body weight suggests that there are minimal differences in platelet and neutrophil engraftment and number of platelet transfusions when compared to CD34+/kg targets using actual body weight. Some methods to reduce excessive stem cell collection include decreasing target cell dosage from previous standards of 6.0 x 106 cells/kg or calculating total cell dosage with IBW or AIBW instead of ABW. Future studies should evaluate the efficacy of cell dosage decrease to lowered targets and total cell calculations using IBW or AIBW instead of ABW. Equation 1. ABW to IBW Conversion (H = height over 5 ft. in inches) IBW(males) = 50 kg + (2.3 kg x H) IBW(females) = 45.5 kg + (2.3 kg x H) Equation 2. ABW to AIBW Conversion AIBW = IBW + 0.5(ABW-IBW)

BALANCED NUTRITION EDUCATION AND NUTRITIONAL STATUS SCREENING OF MALE ADOLESCENTS IN DORMITORY

Introduction: Adolescence is a golden period of reproductive, psychological and intelligence development. During the transition period between childhood and adulthood, biological, emotional, social and cognitive changes occur. Fulfilling nutrition during this period is important. This activity aims to educate teenagers about balanced nutrition and screen their nutritional status. Methods: This community service activity is carried out by providing education about balanced nutrition through lecture and discussion methods. While screening the nutritional status of adolescents is done through anthropometric measurements of body weight and height. The results of anthropometric measurements were then processed using the BMI formula according to age to obtain a z-score that describes the nutritional status of adolescents. This activity was carried out in dormitory of a high school with 36 young male participants. Results: Based on verbal observation and evaluation, students can receive and understand the material about balanced nutrition that is given properly. The results of the nutritional status screening showed that 31 of the adolescents in this activity (86%) had good nutrition but there were still students who had problems with thinness (3%), overweight (8%) and obesity(3%). Conclusion: It is recommended that schools and boarding schools follow up on students who are not in the good nutrition category. Students are directed to consume a balanced diet and physical activity so as to achieve the ideal body weight according to their height and age.

Body mass index and sarcopenia and mortality risk among older hypertensive outpatients; the Nambu Cohort Study.

Maintaining ideal body weight and muscle strength through lifestyle modification is essential for improving activities of daily living (ADL) and life expectancy in hypertensive patients. The effect of weight reduction in older patients with hypertension, however, is controversial. We evaluated the prognostic significance of body mass index (BMI) and handgrip strength (HG) in older patients with hypertension. Patients were stratified by the combination of BMI and HG. COX regression analysis was used to assess the mortality risk. A total of 563 patients (age 77 [71-84] years, 50% male, 40% frailty) were followed for a median duration of 41 (34-43) months. In total, 59 deaths occurred during the follow-up period. Validation of mortality by BMI level revealed that patients with BMI < 22 kg/m2 were likely to have higher mortality risk. Low HG, however, was associated with a 3.7-fold increased mortality risk. The risk of all-cause mortality using BMI combined with HG (adjusted hazard ratio [95% confidence interval]) was as follows: (1) Normal HG + 22 kg/m2 ≤ BMI, reference; (2) Normal HG + BMI < 22 kg/m2, 2.39 (0.12-16.46); (3) Low HG + 22 kg/m2 ≤ BMI, 4.01 (1.42-14.38); and (4) Low HG + BMI < 22 kg/m2, 4.55 (1.33-18.13). These findings demonstrate that weight reduction may deteriorate the mortality risk in older patients with hypertension, and new lifestyle modification strategies for improving ADL, quality of life, and prognosis are warranted for older patients with hypertension. We assessed the association between BMI, handgrip strength, and risk of all-cause mortality to evaluate the validity of weight reduction in older patients with hypertension.

Obsessive-compulsive disorder with compulsive exercise leading to intensive care treatment in an adolescent male: a case report.

Obsessive-compulsive disorder (OCD) and eating disorders (ED) are compulsive disorders with overlapping symptoms. However, weight loss and over-exercise causing secondary medical complications are rarely seen in OCD. We report the case of a 15-year-old male who presented with atypical symptoms of OCD leading to severe medical compromise. Covid-19 related team sport restrictions led to compulsive exercise associated with intrusive thoughts. The onset of stress fractures limited exercise ability,prompting compensatory food restriction. Bradycardia, hypothermia and hypoglycaemia resulted from severe malnourishment and weight loss in the context of OCD. His weight was 85.8% of ideal body weight on admission, reflective of a weight 10-15 kg lower than his premorbid weight. During admission, he developed exercise-induced rhabdomyolysis with significantly elevated creatinine kinase and required intensive care unit treatment. Psychotropic medication included lamotrigine, olanzapine and high dose fluoxetine alongside cognitive-behavioural therapy. Medical stabilisation and weight restoration allowed discharge to an outpatient Child and Adolescent Mental Health Service. This atypical case of OCD highlights the potentially life-threatening risks associated with excessive exercise and malnutrition. This paper highlights the complexities of treatment in a patient who cannot adhere to bed rest and the differential diagnoses of anorexia nervosa, orthorexia nervosa and exercise addiction.

DETEKSI TEKANAN DARAH DAN STATUS GIZI, SERTA SOSIALISASI APLIKASI KALKULATOR IMT UNTUK PENCEGAHAN PTM

Non-Communicable Diseases (NCDs) have a very high prevalence and most do not know they are affected by NCDs. Early detection efforts are needed to identify NCDs that may occur in adolescents. Teenagers are the next generation towards a Golden Indonesia, therefore health education efforts are needed to prevent PTM. The activity aims to detect the presence of PTM and socialize the BMI calculator application. Community service partners are students who attended Edufair at Gor Ken Arok. The methods used are measuring blood pressure, weight and height, and personal health education through leaflets and a BMI calculator application. The results of blood pressure measurements show that the majority of teenagers have normal blood pressure, but there are still teenagers who are hypotensive or hypertensive. The nutritional status of adolescents measured was mostly normal, but they were still found to be undernourished, overweight and obese. Obesity is still quite high at around 12.5%, so education is needed to maintain ideal body weight. Education is carried out by socializing the use of the BMI calculator application, so that teenagers are motivated to maintain an ideal body weight. In conclusion, detecting blood pressure and nutritional status provides knowledge to teenagers, so they are more aware of their health conditions. The hope is that teenagers will always carry out healthy living behavior to prevent PTM.

Management of immune-checkpoint inhibitor (ICI)-related thyroid dysfunction: An avenue for quality improvement.

309 Background: Hypothyroidism is a common immune-related adverse effect (irAE) with ICI therapy, occurring in 4-9% of patients treated with PD-1 ICI, and 10-15% of patients treated with dual PD-1/CTLA-4 ICI therapy. Prolonged thyroid dysfunction increases risk for cardiovascular and cerebrovascular events. Consensus guidelines recommend weight-based dosing for thyroid repletion in younger patients and/or without cardiovascular comorbidities. We observed that patients on thyroid repletion are often underdosed compared to guideline recommendations. To formally evaluate this, we performed a retrospective study to determine the percentage of ICI-treated cancer patients who are receiving guideline-recommended thyroid repletion at an urban comprehensive cancer center. Methods: We identified patients who received PD-1 ICI, either singly or in combination with chemotherapy, TKI, or other ICI to identify patients who met the consensus guideline criteria for weight-based dosing of thyroid repletion. Analysis was restricted to ICI-treated patients who had a thyroid stimulating hormone (TSH) level above 10 mU/L following initiation of therapy. For each patient, we collected the patient’s age, weight, and initial prescribed dose of levothyroxine. We also obtained the date of abnormality and normalization for TSH and free thyroxine (T4). Results: 402 patients received ICI, either singly or in combination. 55 patients had TSH &gt; 10 mU/L. 15 patients who did not have documentation of hypothyroidism or developed it prior to immunotherapy were excluded. The proportion of patients who were eligible for, and who received weight-based repletion is summarized in the table. The proportion of patients who received guideline-recommended thyroid repletion was: 6/17 (35%) SITC-guideline recommended dose, 18/27 (67%) NCCN-guideline recommended dose and 6/22 (28%) ASCO-guideline recommended dose. The median time to free T4 normalization was 9 weeks (IQR 6-15 weeks) and TSH normalization was 13 weeks (IQR 9-30 weeks). Conclusions: At an urban comprehensive cancer center, the incidence of hypothyroidism in ICI-treated cancer patients is 10%. The compliance with guideline recommended weight-based dosing is low, with 33-72% of patients not receiving appropriate therapy, translating into prolonged time to thyroid function normalization. We aim to develop a quality improvement intervention to improve thyroid dosing in this patient population. Proportion of patients receiving guideline-recommended thyroid repletion. Criteria Per SITC Guidelines Per NCCN Guidelines (if lower end of dosing range) Per ASCO Guidelines Patients eligible for weight-based dosing 17 27 22 # of patients who received appropriate initial dosing 6 (35%) 18 (67%) 6 (28%) Average initial dose prescribed 81 mcg 78 mcg 76 mcg Average initial dose per guidelines (based on ideal body weight) 107 mcg 71 mcg 109 mcg

Intravenous Lidocaine Compared with Quadratus Lumborum Block on Postoperative Analgesia Following Laparoscopic Renal Surgery: Protocol for a Randomized Noninferiority Trial.

Patients undergoing laparoscopic renal surgery often experience significant postoperative pain. Quadratus lumborum block (QLB) provides effective postoperative pain control after laparoscopic procedures, while lidocaine administered intravenously also exerts analgesic effects for surgical patients. We design this trial to compare the effects of i.v. lidocaine infusion with QLB on postoperative analgesia in patients undergoing laparoscopic renal surgery. In this randomized noninferiority trial, a total of 120 adult patients undergoing laparoscopic renal surgery will be randomized to receive either i.v. lidocaine or unilateral QLB for postoperative pain management. Lidocaine will be i.v. administered at 1.5 mg/kg (ideal body weight) over 10min during anesthesia induction, followed by an infusion of 1.5 mg/kg/h intraoperatively and in a post-anesthesia care unit. Ultrasound-guided anterior QLB with 0.375% ropivacaine 30 mL will be conducted before the start of surgery. Patient-controlled i.v. sufentanil will be used for pain relief during the first 48h after surgery. The primary outcome is the cumulative sufentanil consumption during 0-24h postoperatively, with a noninferiority margin of 5μg. Secondary outcomes include pain intensity at rest and on coughing at 1, 6, 24, and 48h postoperatively; sufentanil consumption within 24-48h after surgery; rescue analgesic use within 0-48h after surgery; nausea and vomiting within 0-48h postoperatively; and quality of recovery at 24 and 48h after surgery. The results of this trial will add to the clinical evidence for improving postoperative pain management in patients who undergo laparoscopic renal surgery. Chinese Clinical Trial Registry (ChiCTR2400082974).

Gut Microbiome and Body Composition with Sorbitol Intake During Early Lifespan

ObjectiveThe association of sorbitol intake with maintaining healthy body weight through microbiome in the gut during early lifespan was investigated. Research Methods & ProceduresSorbitol intake, body mass index (BMI) and fecal samples were collected in the total of 369 pregnant women with their infants (aged 4 months - 5 years) from the Taipei Mother–Infant Nutrition Cohort (TMINC) and 1946 children and adolescents (aged 6 - 18 years) from the Taiwan Puberty Longitudinal Study (TPLS). The BMI-z score (zBMI) in sorbitol users was compared to that in sorbitol nonusers using generalized linear mixed model (GLMM). The beta diversity of microbiome was investigated in both cohorts. The association between the richness of microbes and body composition was analyzed. ResultsThe children and adolescents with high sorbitol intake had lower zBMI at the age of 6-10 and 11 to 18 years (p < .01) compared with those without sorbitol intake. The beta diversity of microbiome significantly differed between the sorbitol users and nonusers. Bifidobacterium was higher in the gut of infants and children whose mothers were sorbitol users than that of infants and children whose mothers were sorbitol nonusers during pregnancy. Several microbes were involved in the regulation of obesity, such as Staphylococcus, Faecalibacterium, and Oscillospiraceae_UCG-005 negatively associated with anthropometric measures. ConclusionsSorbitol intake was associated with lower children and adolescents’ BMI. Sorbitol consumption could shape the composition and richness of beneficial microbiota, contributing to the maintenance of ideal body weight and metabolic homeostasis in early life.

Indicators of functional state of liver, blood lipid spectrum in patients with steatotic liver disease associated with metabolic dysfunction: modern approaches to complex treatment. Review

Objective — to study the dynamics of indicators of the functional state of the liver, the lipid spectrum of the blood, to evaluate the cardiovascular risk according to SCORE‑2 (Systematic Coronary Risk Estimation 2) scale under the influence of complex pathogenetic treatment of the detected disorders in patients with steatotic liver disease associated with metabolic dysfunction (SLDMD) in combination with obesity. Materials and methods. 46 outpatients with a diagnosis SLDMD were examined: 29 (63.1%) men and 17 (36.9%) women aged 32—55 years. The patients were divided into two groups. The main group included 19 (41.3%) persons who received atorvastatin: 20 mg/day for 90 days. The comparison group consisted of 27 (58.7%) patients who were prescribed ursodeoxycholic acid preparations in combination with atorvastatin: 250 mg (15 mg/kg of body weight) for 90 days. The control group consisted of 12 healthy persons of the appropriate age. The anthropometric criterion of obesity was the Quetelet index. Phenotypic variant of obesity was determined by the ratio of waist circumference/hip circumference (WC/HC). Among the patients of the main group, there were 9 (47.4%) persons with I degree of obesity ((32.6±2.2) kg/m2), 6 (31.5%) persons with II degree ( 35.8±3.6 kg/m2), and 4 (21.1%) persons with III degree (40.0±2.1kg/m2), in the comparison group there were 17 (62.9%), 6 (22.3%) and 4 (14.8%) patients, respectively. All patients received a differentiated diet with the calculation of the energy value, the quota of protein (1.4—1.6 g), fat (1.2—1.4 g), carbohydrates (2—3 g) per 1 kg of ideal body weight and dosed physical activity. For assessing the indicators of the functional state of the disease we determined: the level of general bilirubin and its fractions (direct and indirect), activity of serum aminotransferases, alkaline phosphatase, total cholesterol content in the blood serum, high‑density lipoprotein cholesterol, low‑density lipoprotein cholesterol, very‑low‑density lipoprotein cholesterol, triglycerides. Results. In the majority of patients with SLDMD, a statistically significant (p &lt;0.05) increase in the level of direct bilirubin in the blood, the activity of hepatic transaminases, alkaline phosphatase, and changes in the lipid spectrum of the blood were detected. According to the body mass index (BMI) most of the examined patients had visceral obesity. After the course of the combined therapy positive dynamics was marked in biochemical indices of the blood (p &lt;0.05): decrease of the direct bilirubin level, hepatic transaminases, blood phosphatase. The lipid spectrum of the blood was close to normal (p &lt;0.05). The addition of ursodeoxycholic acid to statin therapy contributes to a statistically significant reduction in total cardiovascular risk according to the SCORE 2 scale compared with atorvastatin monotherapy. All patients were recommended to continue the course of treatment (combination of atorvastatin and ursodeoxycholic acid) for 2 to 3 months. Conclusions. The use of a combination of statin and ursodeoxycholic acid in the treatment of patients with SLDMD and obesity helps to normalise the functional state of the liver and blood lipid parameters, reduce the degree of overall cardiovascular risk, and achieve clinical and biochemical remission of the pathological process in the liver.

The Relationship Between Weight Indices and Blood Levels of Immunosuppressive Drugs in Renal Transplant Recipients

Background: Calcineurin inhibitors and mammalian target of rapamycin (mTOR) inhibitors are essential for maintaining transplanted organs. However, determining the appropriate dosage and predicting blood concentrations of these drugs based solely on net body weight may be inadequate. Previous studies have presented contradictory results regarding the impact of obesity on drug concentrations and transplant success. Objectives: This study aims to evaluate various weight indices to identify the most reliable indicator of weight that correlates with the blood levels of drugs used in organ transplantation. Methods: This retrospective descriptive study included patients from nephrology clinics affiliated with Isfahan University of Medical Sciences who were taking calcineurin and/or mTOR inhibitor drugs. Data extracted from medical records included demographic and clinical information, such as height, weight, and various weight indices (total/ideal/adjusted body weight, lean body mass (LBM), Body Mass Index, and predicted normal weight), as well as blood levels of immunosuppressive drugs at each patient's visit. The dosages of each drug (mg/kg) were analyzed to determine which weight indices best correlated with the obtained blood concentrations, using the Generalized Estimating Equation (GEE) model with logistic regression, an independent correlation matrix, and a binary distribution for data analysis. Results: The study analyzed the medical records of 71 patients. Trough (C0) concentrations of drugs were evaluated in relation to each weight index, and odds ratios (OR) were calculated for statistical comparison. All weight indices increased the likelihood of achieving appropriate concentrations for cyclosporine, tacrolimus, and sirolimus. Drug dosing based on LBM (OR: 1.028), ideal body weight (OR: 1.075), and total body weight (OR: 1.041) showed the strongest correlations with achieving proper blood levels for cyclosporine, tacrolimus, and sirolimus, respectively. Conclusions: Integrating various weight indices for calculating individualized doses (mg/kg) of each immunosuppressive drug increases the likelihood of achieving appropriate blood concentrations. However, the optimal weight index varies for each drug. Further studies, particularly those incorporating therapeutic drug monitoring (TDM) plans in transplant centers, are warranted to validate and generalize these findings, providing a potential avenue for improving immunosuppressive therapy and enhancing transplant outcomes.

Evaluation of the Effect of Early-Onset Steroid Treatment in the COVID-19-Positive Pregnant Women on Pregnancy Outcomes.

Coronavirus disease 2019 (COVID-19) is the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Acute respiratory distress and preterm delivery are the two major complications induced by SARS-CoV-2 infection during pregnancy. In the presence of dyspnea, the use of systemic corticosteroids was recommended in pregnant and non-pregnant groups. Our primary aim was to investigate the effect of early-onset steroid treatment on mortality and adverse effects in pregnant women with COVID-19. Our secondary aim was to investigate the effect of steroid treatment on the length of hospital stay and intensive care unit (ICU) stay, and duration of treatment. The study also investigated infection, preterm birth, and ideal body weight (lbw) in newborns. In this retrospective study, 253 patients were divided into three groups according to steroid administration. In Group 1 patients (n:112), treatment was started at the time of hospitalization. In Group 2 patients (n:90), treatment was started at least 24 h after hospitalization. Group 3 consisted of patients (n:51) who did not receive steroid treatment. Methylprednisolone (32 mg/day) was given to pregnant patients with a gestational age below 24 weeks or above 34 weeks, and dexametazone (6 mg/day) was given in four doses followed by 32 mg/day methylprednisolone for the others (whose baby was at a gestational age of 24 weeks and above but less than 34 weeks). The hospital stay, ICU stay, and steroid administration time were significantly lower in the Group 1 when compared to the others (p < 0.05). The steroid treatment requirement was 4.4 days in Group 1 and 5.7 days in Group 2 (p < 0.05). While no death was observed in Group 1, one patient died in Group 2 and three patients died in Group 3. There was no difference between the groups in terms of complications, including preterm labor. No death was also observed with early-onset treatment. Early-onset treatment may be beneficial for fewer hospitalizations, fewer ICU stays, and less mechanical ventilation requirement in pregnant women with COVID-19. In addition, with early treatment, the total number of steroid administration days was reduced, which is important in terms of reducing the risk of side effects.

Association between geriatric nutritional risk index and cognitive function in older adults with/without chronic kidney disease.

Cognitive impairment is highly prevalent among patients with chronic kidney disease, who face an increased risk of cognitive decline. The aim of this study was to investigate the relationship between the Geriatric Nutritional Risk Index (GNRI) and cognitive function in older individuals, both with and without chronic kidney disease (CKD). In this study, we analyzed data from 2728 participants in the 2011-2014 National Health and Nutrition Examination Survey (NHANES). Cognitive function was measured using the Consortium to Establish a Registry for the Alzheimer's Disease Word Learning subtest (CERAD W-L), the animal fluency test (AFT), the digit symbol substitution test (DSST), and the global cognitive z-score. The GNRI, representing whole-body nutritional status, was calculated based on serum albumin, body weight, and ideal body weight. We employed weighted multiple linear regression analyses and subgroup analyses to assess the independent association of GNRI with cognitive function in CKD and non-CKD populations. Smoothing techniques were used to fit curves, and interaction tests were used to assess the robustness and specificity of the findings. Our analyses revealed a significant positive association between higher GNRI levels and cognitive function in the older US population (for global z-score: β=0.01; 95% confidence interval [CI]=0.00, 0.01). This association remained consistent across various subgroup analyses, including those for different gender groups, age groups, smoking statuses, diabetes statuses, hypertension statuses, individuals with a BMI below 25, individuals who consumed alcohol, and non-Hispanic white individuals. Smoothed curve-fitting analyses indicated that the GNRI was linearly related to cognitive function. No statistically significant interactions were detected among these variables. Our findings emphasize the positive association between GNRI and cognitive health in individuals with or without CKD, especially when combined with other risk factors. Consequently, enhancing the nutritional status of the elderly may serve as a viable strategy to thwart the onset of cognitive decline.

302.2: Comparison of actual versus ideal body weight based dosing of anti-thymocyte globulin in kidney transplant recipients.

302.2: Comparison of actual versus ideal body weight based dosing of anti-thymocyte globulin in kidney transplant recipients.

Comparison of sleep quality, diet quality, and weight change between COVID-19-recovered patients and healthy controls: A matched case-control study.

Literature suggests that individuals who have recovered from COVID-19 may experience post-COVID conditions, including sleep problems and alterations in smell or taste. Thus, this study aims to compare the sleep quality, diet quality, and weight change between COVID-19-recovered patients and healthy controls. A matched case-control study involving young adults aged 18-30 years was conducted in the Klang Valley of Malaysia. The young adults were matched in a 1:1 ratio based on their sociodemographic characteristics, including gender, age, marital status, ethnicity, educational attainment, employment status, and monthly earned income. The Pittsburgh Sleep Quality Index was utilized to evaluate sleep quality, and the Diet Quality for Malaysia was used to determine the diet quality of all young adults. The young adults retrospectively recalled their prepandemic body weight in February 2020, while their current body weight in February 2023 was measured using a TANITA HD-314 digital weighing scale. Emerging findings suggest that sleep quality and weight change were comparable between COVID-19-recovered patients and healthy controls. However, healthy controls were reported to have a more diversified diet than COVID-19-recovered patients. Nevertheless, no significant main effects or interaction effects of sleep and diet quality on weight change were observed in COVID-19-recovered patients or healthy controls. In this study, young adults also reported suffering from sleep deprivation and deficiency due to the pandemic. Intervention programs that emphasize avoiding stimulants before bedtime for healthy controls, promoting the importance of having a diversified and balanced diet among the COVID-19-recovered patients, and achieving an ideal body weight for all young adults should be conducted after the COVID-19 pandemic.

Bodily growth and the intervertebral disc: a longitudinal MRI study in healthy adolescents

BACKGROUND CONTEXTLow back pain (LBP) among children and adolescents is a growing global concern. Disc degeneration (DD) is considered a significant factor in the clinical symptom of LBP. Both LBP and DD become more prevalent as adolescents transition into emerging adulthood. However, the relationship between growth during the pubertal growth spurt and the morphology of lumbar discs has yet to be elucidated. PURPOSEThis study aimed to assess the relationship between bodily growth during the pubertal growth spurt and the morphology of lumbar discs at age 18. STUDY DESIGNThis study was a prospective longitudinal cohort study. PATIENT SAMPLEA randomly selected cohort of healthy children was examined at ages 8, 11, and 18. Participants with complete data sets (semi-structured interview, anthropometric measurements and lumbar spine MRI) at age 11 and 18 were included in this analysis (n=59). OUTCOME MEASURESThe morphological characteristics of lumbar discs were evaluated on MRI. Anthropometric measures including height, sitting height and weight were obtained to calculate the Body Surface Area (BSA) and the Body Mass Index (BMI). METHODSThe morphology of the lumbar discs was evaluated on T2-weighted mid-sagittal MRI using the Pfirrmann classification. A disc with a Pfirrmann grade of 3 or higher was considered degenerated at age 18. The relationship between relative growth between ages 11 and 18 (adjusted to sex and baseline values) and DD at age 18 was assessed. To analyze the relationship between the relative increase in BSA and DD, the participants were categorized into three equal-sized categories (tertiles). For all other anthropometric measures, the analysis was based on the relative increase in each measure between ages 11 and 18. RESULTSIn the highest tertile of relative increase in BSA (≥43%), 76% of participants had at least 1 disc with a Pfirrmann grade 3 or higher at age 18 while only 10% and 21% of participants in the lowest and medium tertiles had DD, respectively. The sex- and baseline-adjusted odds ratio (OR) for DD at age 18 for every additional 10% increase in BSA was 1.08 (1.02–1.15). The sex- and baseline-adjusted OR (95% CI) for DD at age 18 was 10.5 (1.60–68.7) and 7.92 (1.19–52.72) with every additional 10% increase in height and sitting height, respectively. For every additional 10% increase in weight, the adjusted OR for DD at age 18 was 1.51 (1.12–2.04) and for BMI 1.05 (1.01–1.09). CONCLUSIONSMore relative growth between ages 11 and 18 is significantly associated with the occurrence of DD in emerging adulthood. Among the measures investigated, height and sitting height are nonmodifiable. Maintaining an ideal body weight during the pubertal growth spurt may be beneficial for the health of the lumbar discs.

The quest for optimal ketamine dosing formula in treatment-resistant major depressive disorder.

Emerging evidence indicates that intravenous ketamine is effective in managing treatment-resistant unipolar and bipolar depression. Clinical studies highlight its favorable efficacy, safety, and tolerability profile within a dosage range of 0.5-1.0mg/kg based on actual body weight. However, data on alternative dosage calculation methods, particularly in relation to body mass index (BMI) and therapeutic outcomes, remain limited. This retrospective analysis of an open-label study aims to evaluate dose calculation strategies and their impact on treatment response among inpatients with treatment-resistant major depressive disorder (MDD) (n = 28). The study employed the Boer and Devine formulas to determine lean body mass (LBM) and ideal body weight (IBW), and the Mosteller formula to estimate body surface area (BSA). The calculated doses were then compared with the actual doses administered or converted to a dosage per square meter for both responders and non-responders. Regardless of treatment response, defined as a reduction of 50% in the Montgomery-Åsberg Depression Rating Scale, the use of alternative ketamine dosing formulas resulted in underdosing compared to the standardized dose of 0.5mg/kg. Only two participants received higher doses (102.7% and 113.0%) when the Devine formula was applied. This study suggests that ketamine dosing formulas, alternative to the standardized 0.5mg/kg based on body weight, may lead to underdosing and potentially impact outcome interpretation. To enhance dosing accuracy, future studies should consider incorporating body impedance analysis and waist-to-hip ratio measurements, as this study did not account for body composition.