Impact Of Body Habitus Research Articles

Impact of Body Habitus on the Outcomes of Pediatric Patients With Diabetic Ketoacidosis.

To determine whether obese and overweight pediatric patients with new onset diabetic ketoacidosis (DKA) treated with continuous infusion insulin have increased time to subcutaneous insulin initiation or adverse events as compared with patients with normal body habitus. A retrospective, cohort study was designed that included patients 2 to 18 years of age admitted with new onset DKA who received continuous infusion insulin from January 1, 2011, to December 31, 2017. Patients were stratified according to BMI percentile with the primary outcome of time to initiation of subcutaneous insulin. Secondary endpoints included time to minimum beta-hydroxybutyrate, and incidence of hypoglycemia or other adverse events. A total of 337 patients (46.6% male, 9.6 ± 3.8 years of age) met study criteria. Patients were classified by body habitus as obese (7.7%, n = 26), overweight (7.1%, n = 24), normal body weight (58.8%, n = 198), or underweight (26.4%, n = 89), based on BMI percentile. Most patients were initiated on insulin at 0.1 unit/kg/hr (86.7%) for 16.7 ± 7.0 hours. Time from continuous infusion insulin initiation to subcutaneous insulin was not different between body habitus groups, nor was hypoglycemia or the use of mannitol (p > 0.05). Median time to lowest beta-hydroxybutyrate was greater for obese (26.4, IQR [13.9, 41.9]) and overweight (32.4, IQR [18.3, 47.0]) groups than for normal body habitus patients (16.5, IQR [12.3, 23.8]) (p < 0.05). Time to subcutaneous insulin and adverse events was not associated with body habitus, but obese and overweight patients may have delayed beta-hydroxybutyrate clearance.

IMPACT OF BODY HABITUS ON INCIDENCE OF COMPLICATIONS IN PATIENTS HOSPITALIZED WITH OVARIAN HYPERSTIMULATION SYNDROME

The impact of body habitus on risk of complications resulting from ovarian hyperstimulation syndrome (OHSS) has not been well-elucidated. This study aimed to evaluate the association between body habitus and complications resulting from OHSS in hospitalized patients.

Impact of Body Habitus (Arm Span and Abdominal Girth) on Activities of Daily Living (ADL)

Impact of Body Habitus (Arm Span and Abdominal Girth) on Activities of Daily Living (ADL)

Effectiveness of progestin-based therapy for morbidly obese women with complex atypical hyperplasia.

While progestins can effectively treat women with complex atypical hyperplasia (CAH), the impact of body habitus on treatment outcome is not well studied. We examine the association between body mass index (BMI) and progestin treatment outcomes. We conducted a retrospective cohort study of patients diagnosed with hyperplasia between 2003 and 2011. Demographics, past medical history, BMI, hormonal therapy, and histologic treatment response were abstracted. Patients with CAH who received progestin therapy were examined, and rates of regression were assessed. Of 623 patients identified, 117 had CAH and satisfied the inclusion criteria. Median age was 34, and nearly, two-thirds (64%) were nulliparous. Mean BMI was 40.2, and 81% were obese (BMI 30-39.9: 36%, BMI ≥ 40: 45%). 103 patients (88%) received systemic progestin therapy and 14 patients (12%) received levonorgestrel-releasing intrauterine devices (LNG-IUS). 47 patients (40%) had a complete response to progestin-based therapy. BMI had no effect on the rate of complete response. The proportions of CAH patients with complete regression after hormonal therapy were BMI < 30: 39%, 30-39.9: 40%, and ≥ 40: 36% (P = 0.73). Women treated with LNG-IUS displayed higher rates of complete regression than those receiving systemic therapy (62% versus 38%, P = 0.096), and those with class III obesity were more likely than non-obese patients to receive LNG-IUS although neither reached statistical significance (< 40: 6.7% versus ≥ 40: 17%, P = 0.09). In this morbidly obese population, response to progestin therapy was generally low; body habitus did not impact treatment outcome for CAH, but local therapy may be more effective than systemic therapy.

Impact of Obesity on Fosphenytoin Volume of Distribution in Pediatric Patients.

The impact of body habitus on fosphenytoin pharmacokinetics is poorly understood in pediatric patients. This retrospective, single-center review examined differences in fosphenytoin volume of distribution (VD) between children with normal and obese body habitus. From 2013 to 2015, patients 2 to 18 years of age who received a loading dose of fosphenytoin were identified. Thirty-seven patients met inclusion criteria. Mean total serum phenytoin concentration was 25.3 ± 6.5 μg/mL in the nonobese group and 29.5 ± 7.6 μg/mL in the obese group ( P = .09). VD was not significantly different between obese and nonobese groups, 0.92 ± 0.26 L/kg and 0.97 ± 0.48 L/kg ( P = .76), respectively. In contrast to adult studies, these data suggest that fosphenytoin dose adjustments for obese children may be unnecessary.

The impact of body habitus on outcomes after aneurysmal subarachnoid hemorrhage: a Nationwide Inpatient Sample analysis.

OBJECTIVE Although the prevalence of obesity is increasing rapidly both nationally and internationally, few studies have analyzed outcomes among obese patients undergoing cranial neurosurgery. The goal of this study, which used a nationwide data set, was to evaluate the association of both obesity and morbid obesity with treatment outcomes among patients with aneurysmal subarachnoid hemorrhage (SAH); in addition, the authors sought to analyze how postoperative complications for obese patients with SAH differ by the treatment modality used for aneurysm repair. METHODS Clinical data for adult patients with SAH who underwent microsurgical or endovascular aneurysm repair were extracted from the Nationwide Inpatient Sample (NIS). The body habitus of patients was classified as nonobese (body mass index [BMI] < 30 kg/m2), obese (BMI ≥ 30 kg/m2 and ≤ 40 kg/m2), or morbidly obese (BMI > 40 kg/m2). Multivariable logistic regression analyzed the association of body habitus with in-hospital mortality rate, complications, discharge disposition, and poor outcome as defined by the composite NIS-SAH outcome measure. Covariates included patient demographics, comorbidities (including hypertension and diabetes), health insurance status, the NIS-SAH severity scale, treatment modality used for aneurysm repair, and hospital characteristics. RESULTS In total, data from 18,281 patients were included in this study; the prevalence of morbid obesity increased from 0.8% in 2002 to 3.5% in 2011. Obese and morbidly obese patients were significantly younger and had a greater number of comorbidities than nonobese patients (p < 0.001). Mortality rates for obese (11.5%) and morbidly obese patients (10.5%) did not significantly differ from those for nonobese patients (13.5%); likewise, no differences in neurological complications or poor outcome were observed among these 3 groups. Morbid obesity was associated with significantly increased odds of several medical complications, including venous thromboembolic (OR 1.52, 95% CI 1.01-2.30, p = 0.046) and renal (OR 1.64, 95% CI: 1.11-2.43, p = 0.01) complications and infections (OR 1.34, 95% CI 1.08-1.67, p = 0.009, attributable to greater odds of urinary tract and surgical site infections). Moreover, morbidly obese patients had higher odds of a nonroutine hospital discharge (OR 1.33, 95% CI 1.03-1.71, p = 0.03). Patients with milder obesity had decreased odds of some medical complications, including cardiac, pulmonary, and infectious complications, primarily among patients who had undergone coil embolization. CONCLUSIONS In this study involving a nationwide administrative database, milder obesity was not significantly associated with increased mortality rates, neurological complications, or poor outcomes after SAH. Morbid obesity, however, was associated with increased odds of venous thromboembolic, renal, and infectious complications, as well as of a nonroutine hospital discharge. Notably, milder obesity was associated with decreased odds of some medical complications, primarily in patients treated with coiling.

Impact of Body Habitus on Operative Difficulties during Extraperitoneal Laparoscopic Radical Prostatectomy.

The aim of the present study was to investigate whether patients' body habitus affects the operative difficulties associated with extraperitoneal laparoscopic radical prostatectomy (LRP). Therefore, the associations between body habitus and perioperative outcomes of surgery, including bleeding, operative time, and resection margins, were evaluated. Between August 2010 and July 2012, 40 consecutive patients with preoperative magnetic resonance imaging and abdominal X-ray examinations underwent extraperitoneal LRP for localized prostate cancer at our institution. The associations between anthropometric measurements and demographics of patients, operation duration, estimated blood loss (EBL), and resection margins were analyzed retrospectively. Multivariate analyses were performed, and P < .05 was considered significant. On multiple regression analysis, the view of the prostatic apex (VPA) was significantly associated with EBL (P = .02), and body mass index (BMI) was significantly associated with operative time (P = .02). On multiple logistic regression analysis, protrusion of the prostate into the bladder was significantly associated with positive resection margins (P = .04). The findings of the present study suggest that poor VPA, protrusion of the prostate into the bladder, and high BMI were related to operative difficulties in extraperitoneal LRP. If operative difficulty is predicted preoperatively, it would be better to prepare blood for transfusion and/or special instruments (e.g. flexible scope), or switch to other therapeutic procedures.

Letter to the Editor: Impact of body habitus on fluoroscopic radiation to the surgeon.

Letter to the Editor: Impact of body habitus on fluoroscopic radiation to the surgeon.

Impact of Body Habitus on Phenytoin Levels Following Fosphenytoin Loading Dose in Pediatric Patients.

Obesity has been shown to affect the disposition of water-soluble medications in pediatric patients. There are no published data describing serum phenytoin concentrations in obese pediatric patients. A retrospective descriptive study was designed that included patients from 2011 to 2013 between 2 and 19 years of age who received a dose of fosphenytoin with a subsequent serum phenytoin concentration, drawn 2-4 hours postloading dose. Body mass index (BMI) was calculated and patients were categorized by BMI percentiles into underweight (<5th percentile), normal weight (5th-84th percentile), overweight (85th-94th percentile), and obese (≥95th percentile). Descriptive statistical analysis and comparisons between groups occurred to determine differences in serum phenytoin concentrations. Multivariable linear regression analysis was performed to determine the effect of body habitus on serum phenytoin concentrations. One hundred ten patients met study criteria (male 51.8%, mean age: 8.3 ± 4.9 years). Patients were normal weight (47.3%), underweight (20.9%), overweight (14.6%), and obese (17.3%). No significant differences were identified between groups in regard to patient demographics, with the exception of weight (P < 0.05). The mean fosphenytoin dose was 23.4 ± 5.7 mg Phenytoin Equivalents (PE)/kg and the serum phenytoin concentration was 22.4 ± 6.8 mg/L measured at 2.9 ± 0.6 hours after dose, and this did not vary significantly across groups (P > 0.05). Multivariable linear regression identified body habitus as a nonsignificant predictor of serum phenytoin concentrations (P > 0.05). Patients of higher BMI did not require further antiepileptic therapy as compared with patients with lower BMI (P > 0.05). Contrary to the adult population, loading dose adjustments do not seem to be required in pediatric patients. Obesity does not affect serum phenytoin concentrations in pediatric patients after intravenous bolus fosphenytoin administration.

The impact of body habitus on the surgical outcomes of transaxillary single-incision robotic thyroidectomy in papillary thyroid carcinoma patients

Robotic applications have achieved safe and precise thyroidectomy with notable cosmetic and functional benefits. This study was designed to document the influence of body habitus on robotic thyroidectomy in papillary thyroid carcinoma (PTC) patients. From July 2009 to February 2010, 352 patients underwent robotic thyroidectomy using a gasless, transaxillary single-incision approach at Yonsei University Health System. Body habitus was described using body mass index category (normal weight, overweight, obese), neck length, shoulder width, and shoulder width to neck length ratios. The impact of body habitus on surgical outcomes was analyzed with respect to operation time, number of retrieved central nodes, bleeding amount, and postoperative complications. Of the 352 patients, 217 underwent less than total thyroidectomy and 135 underwent total thyroidectomy. Operative variables (i.e. operation times, bleeding amounts, and numbers of retrieved central nodes) showed no significant differences between three BMI groups for less than total thyroidectomy. However, total operation and working space times were longer for obese patients during total thyroidectomy. In particular, shoulder width was positively correlated with total operation time, working space time, console time, and number of retrieved central nodes. On the other hand, postoperative complications were not significantly different in the three BMI groups and showed no significant correlation with the other indices of body habitus. Standardized robotic thyroidectomy can be performed safely and feasibly in patients with a large body habitus despite longer operation times.

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2163: Ultrasound Image Guidance for Abdominal Malignancies: Impact of Body Habitus on Positional Shifts

2163: Ultrasound Image Guidance for Abdominal Malignancies: Impact of Body Habitus on Positional Shifts

Relationship between the thickness of the renal cortex and age: study with CT measurement

目的 研究肾脏皮质厚度与年龄的关系,确定不同年龄段正常肾脏皮质厚度CT测量的参考范围,筛选出与年龄相关性最好、易于临床应用的测量方法.方法(1)确定CT测量肾皮质厚度的准确性:选取因肾脏肿瘤而做全肾切除的18例病人的肾脏标本,测量肾脏正常部分的皮质厚度,将测量结果与术前CT影像肾皮质厚度测量的结果行统计学分析,确定差异有无显著性意义;(2)连续选取120例无肾病,无服用肾脏损害药物史,无高血压史病人的腹部CT资料,分为20～40岁、41～60岁、61～80岁3个年龄组,测量每侧肾脏3个层面皮质、实质的厚度和肾脏径线长,统计学分析3个年龄组间差异有无显著性意义及其与年龄的相关性.结果增强螺旋CT图像测量的肾脏皮质厚度与肾标本测量的皮质厚度差异无显著性意义(t=0.08,P=0.43).3个年龄组肾脏皮质厚度均数分别为0.73 cm、0.65 cm、0.53 cm,组间差异有极显著性意义(F=93.403,P＜0.01).肾脏皮质、实质厚度与年龄呈负相关,其中相关性最好的指标是皮质厚度(r=-0.78～-0.79);60岁以前肾皮质与肾实质厚度比与年龄无相关性.体型对肾脏皮质厚度的影响不明显.男女性别间皮质厚度的差异无显著性意义(P＞0.05).结论增强螺旋CT能够准确地测量肾脏皮质的厚度,是研究肾脏形态变化的一种敏感的手段.肾皮质厚度随年龄减小,但肾皮质与肾实质厚度之比随年龄的增加变化不明显。

Impact of body habitus on accuracy of standardized attenuation correction reconstruction

Impact of body habitus on accuracy of standardized attenuation correction reconstruction

ECG identification of left ventricular hypertrophy: Relationship of test performance to body habitus

Obesity is associated with the presence of left ventricular hypertrophy (LVH) and, conversely, with decreased sensitivity of the electrocardiogram (ECG) for LVH due to attenuating effects on QRS amplitudes. Although the Framingham-adjusted Cornell voltage, incorporating age, sex, and body mass index (BMI), was developed to correct for the effects of obesity on the accuracy of the ECG, the impact of body habitus on ECG detection of LVH for newer, more accurate ECG criteria based on the time-voltage area under the QRS complex has not been determined. The authors examined the test accuracy of the Sokolow-Lyon voltage, Cornell voltage, Cornell product (product of QRS duration and Cornell voltage), Framingham-adjusted Cornell voltage, and time-voltage area of the horizontal plane vector QRS for the detection of echocardiographic LVH in relation to body habitus in 250 patients. Normal-weight or overweight status was based on sex-specific population-based BMI partitions. Using partitions with a matched specificity of 98% in the overall population without LVH, the sensitivity of standard ECG criteria varied according to body habitus. Sensitivity of the Framingham-adjusted Cornell voltage was less in normal-weight than in overweight patients (49 vs 59%, P = .0004); there were also trends toward lower sensitivity in normal-weight patients for the Cornell voltage (40 vs 65%, P = .10) and the Cornell product (43 vs 65%, P = NS), but sensitivity of the Sokolow-Lyon voltage was lower in obese than in nonobese patients (18 vs 50%, P = .025). In contrast, the horizontal plane vector area had similar sensitivity in obese and normal-weight patients (76 vs 74%, P = NS). Specificity varied with body habitus only for the Framingham-adjusted Cornell voltage: 100% in normal-weight vs 95% in overweight patients ( P < .05). Thus, accuracy of the Framingham-adjusted Cornell voltage and Sokolow-Lyon voltage varies significantly with body habitus. In contrast, accuracy of the Cornell voltage and the Cornell product appears less dependent on BMI, and the time-voltage area of the QRS minimizes the effects of obesity on the accuracy of the ECG for LVH.