Increasing Body Mass Index Group Research Articles

Concentration of Selected Adipokines and Factors Regulating Carbohydrate Metabolism in Patients with Head and Neck Cancer in Respect to Their Body Mass Index

Head and neck cancers (HNCs) are a group of tumors not common in European populations. So far, not much is known about the role of obesity, adipokines, glucose metabolism, and inflammation in the pathogenesis of HNC. The aim of the study was to determine the concentrations of ghrelin, omentin-1, adipsin, adiponectin, leptin, resistin, visfatin, glucagon, insulin, C-peptide, glucagon-like peptide-1 (GLP-1), plasminogen activator inhibitor-1 (PAI-1), and gastric inhibitory peptide (GIP) in the blood serum of HNC patients depending on their body mass index (BMI). The study included 46 patients divided into two groups according to their BMI values: the normal BMI group (nBMI) included 23 patients with BMI < 25 kg/m2 and the increased BMI group (iBMI) included patients with BMI ≥ 25 kg/m2. A control group (CG) included 23 healthy people (BMI < 25 kg/m2). Statistically significant differences in the levels of adipsin, ghrelin, glucagon, PAI-1, and visfatin were shown between nBMI and CG. In the case of nBMI and iBMI, statistically significant differences were observed in the concentrations of adiponectin, C-peptide, ghrelin, GLP-1, insulin, leptin, omentin-1, PAI-1, resistin, and visfatin. The obtained results indicate a disruption of endocrine function of adipose tissue and impaired glucose metabolism in HNC. Obesity, which is not a typical risk factor for HNC, may aggravate the negative metabolic changes associated with this type of neoplasm. Ghrelin, visfatin, PAI-1, adipsin, and glucagon might be related to head and neck carcinogenesis. They seem to be promising directions for further research.

Higher baseline BMI and lower estimated median income associated with increasing BMI after endometrial cancer diagnosis

IntroductionEndometrial cancer is often directly related to obesity and interventions for weight loss have mixed results. Risk factors for continued weight gain after diagnosis are not clearly defined in the literature. The objective of this study is to describe risk factors associated with increased body mass index (BMI) trajectory among endometrial cancer patients. MethodsPatients who were surgically treated for endometrial cancer at a single institution between 2010 and 2015 were identified. Demographics including age, race/ethnicity and estimated median income at diagnosis were obtained. BMI at five time points after diagnosis were calculated. BMI trajectories were estimated by latent class growth modeling using the PROC TRAJ procedure in SAS. Chi-squared tests and ANOVA were used to assess differences between trajectory groups. Statistical significance was set to a p-value < 0.05. ResultsOf 695 patients included in the study, the average age at diagnosis was 62 years and over 70% of patients were obese at baseline. Patients experienced increasing, stable, or decreasing BMI over 2 years following diagnosis. Patients with younger age and lower estimated median income were most likely to be in the increasing BMI group. Among obese patients, those with Class I obesity (BMI 30 to 34.9 kg/m2) were most likely to experience decreasing BMI and those with Class III obesity (BMI > 40 kg/m2) were most likely to experience increasing BMI, p < 0.0001. ConclusionA third of endometrial cancer survivors experience increasing BMI. Severity of obesity at diagnosis matters, patients with severe obesity (Class III) were most likely to experience weight gain.

WITHDRAWN: Higher baseline BMI and lower estimated median income associated with increasing BMI after endometrial cancer diagnosis

Endometrial cancer is often directly related to obesity and interventions for weight loss have mixed results. Risk factors for continued weight gain after diagnosis are not clearly defined in the literature. The objective of this study is to describe risk factors associated with increased body mass index (BMI) trajectory among endometrial cancer patients. Patients who were surgically treated for endometrial cancer at a single institution between 2010 and 2015 were identified. Demographics including age, race/ethnicity and estimated median income at diagnosis were obtained. BMI at five time points after diagnosis were calculated. BMI trajectories were estimated by latent class growth modeling using the PROC TRAJ procedure in SAS. Chi-squared tests and ANOVA were used to assess differences between trajectory groups. Statistical significance was set to a p-value<0.05. Of 695 patients included in the study, the average age at diagnosis was 62years and over 70% of patients were obese at baseline. Patients experienced increasing, stable, or decreasing BMI over 2years following diagnosis. Patients with younger age and lower estimated median income were most likely to be in the increasing BMI group. Among obese patients, those with Class I obesity (BMI 30 to 34.9kg/m2) were most likely to experience decreasing BMI and those with Class III obesity (BMI>40kg/m2) were most likely to experience increasing BMI, p<0.0001. A third of endometrial cancer survivors experience increasing BMI. Severity of obesity at diagnosis matters, patients with severe obesity (Class III) were most likely to experience weight gain.

The Impact of Body Mass Index on Postpartum Infectious Morbidities and Wound Complications: A Study of Extremes.

As body mass index increases, the risk of postpartum infections has been shown to increase. However, most studies lump women with a body mass index (BMI) of above 40 kg/m2 together, making risk assessment for women in higher BMI categories challenging. The objective of this study was to evaluate the impact of extreme obesity on postpartum infectious morbidity and wound complications during the postpartum period. The present study is a secondary analysis of women who underwent cesarean delivery and had BMI ≥ 40 kg/m2 in the Maternal-Fetal Medicine Units Cesarean Registry. The primary outcome was a composite of postpartum infectious morbidity including endometritis, wound infection, inpatient wound complication prior to discharge, and readmission due to wound complications. Appropriate statistics used to compare baseline demographics, pregnancy complications, and primary outcomes among women by increasing BMI groups (40-49.9, 50-59.9, 60-69.9, and >70 kg/m2). Rates of postpartum infectious morbidity increased with BMI category (11.7% BMI: 50-59.9 kg/m2; 13.7% BMI: 60-69.9 kg/m2; and 21.9% BMI >70+ kg/m2; p = 0.001). Readmission for wound complications also increased with BMI (3.1% for BMI: 50-59.9 kg/m2; 6.2% for BMI: 60-69.9 kg/m2; and 9.4% for BMI >70+ kg/m2; p = 0.001). After adjusting for confounders, increased BMI of 70+ kg/m2 category remained the most significant predictor of postpartum infectious complications compared with women with BMI of 40 to 49.9 kg/m2 (adjusted odds ratio [aOR] = 6.38; 95% confidence interval [CI]: 1.37-29.7). The adjusted odds of readmission also increased with BMI (aOR = 2.33, 95% CI: 1.35-4.02 for BMI 50-59.9 kg/m2; aOR = 4.91, 95% CI: 2.07-11.7 for BMI of 60-69.9 kg/m2; and aOR = 36.2, 95% CI: 7.45-176 for BMI >70 kg/m2). Women with BMI 50 to 70+ kg/m2 are at an increased risk of postpartum wound infections and complications compared with women with BMI 40 to 49.9 kg/m2. These data provide increased guidance for counseling women with an extremely elevated BMI and highlight the importance of postpartum wound prevention bundles. · Women with super obesity have higher rates of wound complications.. · Women at extremes of obesity experience worse postpartum infectious morbidity.. · More research is needed on effective strategies to minimize morbidity in this population..

Increased Risk of Chronic Kidney Disease Associated With Weight Gain in Healthy Adults: Insight From Metabolic Profiles and Body Composition.

Objective: Obesity is an established risk factor for kidney damage. In this study, we explored the long-term association of changes in body mass index (BMI) over time with incident chronic kidney disease (CKD).Methods: For this analysis, 5,393 middle-aged adults without comorbidities in the Korean Genome and Epidemiology Study (KoGES) were included. Group-based trajectory modeling was used to determine the patterns of BMI change (decreasing, stable, and increasing BMI) between baseline and year 4. The primary outcome was the subsequent development of CKD from year 4. A multivariable Cox proportional hazards model was constructed to determine the risk of incident CKD according to BMI trajectories.Results: During 55,327 person-years, incident CKD occurred in 354 (6.5%) participants; 6.0, 6.1, and 7.8 per 1,000 person-years across the trajectories, respectively (P = 0.005). In the multivariable-adjusted Cox proportional hazards model, the increasing BMI trajectory was associated with a 1.4-fold [hazard ratio (HR), 1.41; 95% CI, 1.06–1.87] a higher risk of incident CKD compared with stable BMI trajectory. This association was stronger for overweight and obese individuals. The HRs for CKD development in these two groups were 1.6 (95% CI, 1.06–1.87) and 2.2 (95% CI, 1.40–3.48), respectively. While the increasing BMI group was gaining weight, there were concomitant increases in blood pressure, insulin resistance, serum concentrations of total cholesterol, triglyceride, and high-sensitivity C-reactive protein (hs-CRP), and fat mass, but high-density lipoprotein (HDL)-cholesterol level and muscle-to-fat (MF) ratio decreased.Conclusion: Weight gain is associated with an increased risk of incident CKD in healthy adults. This association is attributed to worsening metabolic profiles and increasing fat mass.

The influence of a healthy lifestyle on body mass index in a sample of 12-14 year old individuals in Murcia (Spain)

Excess weight and obesity in childhood is directly related to comorbidities that can have serious conse-quences for health. This study set out to identify the main modifiable lifestyles that influence the development of excess weight and obesity in childhood. A cross-sectional study was carried out at seven secondary schools in Area V, Murcia, Spain. Questionnaires completed by parents were used to gather information about healthy habits in adolescents (ENHASA), The surveys con-sisted of four dimensions made up of modifiable lifestyle factors: nutrition, physical activity, new technologies and schoolmates. The adolescents' somatometric data was measured and classified according to the WHO categories for body mass index (BMI). ANOVA was used to compare the score differences among the BMI groups. The questionnaire was completed by the parents of 421 adolescents with an average age of 12 years. 21.1% pre-sented excess weight and 19.7% obesity. The score obtained by adolescents in the physical activity dimension decreased in the increased BMI group (score in normal weight 6.36 vs. 4.45 in obesity; p<0.001). The other three dimensions showed insignificant differences in scores between normal weight and obesity groups. Excess weight was present in 40.8% of the sample. Physical activity was the modifiable lifestyle to be most markedly linked to BMI. This outcome may help in planning specific strategies for sedentary lifestyles to reduce this dietary epidemic.

573 Effect of increasing body mass index on infectious morbidity at the extremes of obesity

While the risks associated with obesity in pregnancy are well-appreciated, very little data on the effects of extreme obesity on postpartum outcomes exists. The objective of this study was to evaluate the impact of extreme obesity on infectious morbidity and wound complications during the postpartum period. Retrospective cohort analysis included women with a body mass index (BMI) ≥40kg/m2 delivering at a single tertiary care hospital from 2013-2017. The primary outcome was postpartum infectious morbidity including endometritis, wound infection, and wound seroma. Bivariate statistics was used to compare baseline demographics, pregnancy complications, and primary outcomes among women by increasing BMI groups (40-49.9kg/m2, 50-59.9kg/m2, 60-69.9kg/m2, and >70kg/m2). Regression modeling was used to estimate odds of primary infectious composite and components. Of 374 women included, 244(65.2%) had a BMI 40-49.9kg/m2, 113(35.5%) BMI 50-59.9kg/m2, 13(3.4%) BMI 60-69.9kg/m2, and 4(1.0%) BMI>70kg/m2. Rates of chronic hypertension and weight gain increased with BMI category (Table 1). Increased estimated blood loss and lower rates of vaginal delivery were also seen with increasing BMI category (Table 1). The composite was not significantly different among increasing BMI groups, though rates of postpartum wound infection (2.9% vs 5.3% vs 23.1 % vs 0%, p<0.01) did vary (Table 2). After adjusting for confounders, compared to women with BMI40-49.9, adjusted odds of infectious composite and postpartum wound infection for women with BMI 60-69.9 were 1.91 (95% 0.31-11.8) and 11.01 (95% 1.90-64.0) respectively. Women with BMI 50-70 are at an increased risk of infectious morbidity compared to women with BMI 40-49.9. The lower probability of successful vaginal delivery among women with extremes of BMI raises the question regarding the utility of attempted vaginal delivery in this population. Providers should consider the increased infectious risk when counseling women with BMI>50.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Comparison of body composition assessment across body mass index categories by two multifrequency bioelectrical impedance analysis devices and dual-energy X-ray absorptiometry in clinical settings

InBody-770 and SECA mBCA 515 are multifrequency bioelectrical impedance analysis (BIA) devices, which are commonly used in the clinic to assess fat-free mass (FFM) and body fat (BF). However, the accuracy between devices in clinical settings, across different body mass index (BMI) groups remains unclear. Body composition for 226 participants (51% men, aged 18-80 years, BMI 18-56 kg/m²) was assessed by two commercial multifrequency BIA devices requiring standing position and using eight-contact electrodes, InBody 770 and SECA mBCA 515, and compared to results from dual-energy X-ray absorptiometry (DXA). Measurements were performed in a random order, after a 3 h fast and no prior exercise. Lin's-concordance correlation and Bland-Altman analyses were used to compare between devices, and linear regression to assess accuracy in BF% across BMI groups. We found strong correlation between DXA results for study population BF% and those obtained by InBody (ρc = 0.922, 95% confidence interval (CI) 0.902, 0.938) and DXA and SECA (ρc = 0.940, CI 0.923, 0.935), with 95% limits of agreements between 2.6 and -8.9, and 7.1 and -7.6, respectively. BF% assessment by SECA was similar to DXA (-0.3%, p = 0.267), and underestimated by InBody (-3.1%, p < 0.0001). InBody deviations were largest among normal weight people and decreased with increasing BMI group, while SECA measurements remained unaffected. Both BIA devices agreed well with BF% assessment obtained by DXA. Unlike SECA, InBody underestimated BF% in both genders and was influenced by BMI categories. Therefore, in clinical settings, individual assessment of BF% should be taken with caution.

Childhood factors related to diverging body mass index trajectories from childhood into mid-adulthood: A mixed methods study.

Body mass index (BMI) trajectories that improve over the lifecourse result in better cardiometabolic profiles, but only a small proportion of children of an unhealthy weight show improving BMI trajectories. This study aimed to examine the childhood factors related to diverging BMI trajectories from childhood into adulthood using data from the Childhood Determinants of Adult Health study. A convergent parallel mixed methods design was used. Quantitative data (n=2206) came from the first (2004-06) and second (2009-11) adult follow-ups of 8498 Australian children (7-15 years) assessed in 1985. Using BMI z-scores, group-based trajectory modelling identified five trajectory groups: Persistently Low, Persistently Average, High Decreasing, Average Increasing and High Increasing. Qualitative data (n=50) were collected from a sub-group (2016; 38-46 years). Semi-structured interviews with 6-12 participants from each BMI trajectory group focused on individual, social and environmental influences on weight, diet and physical activity across the lifecourse. Log multinomial regression modelling estimated relative risks of trajectory group membership across childhood demographic, behavioural, health, parental and school factors. Qualitative data were thematically analysed using a constant comparative approach. Childhood factors influenced BMI trajectories. Paternal education, main language spoken, alcohol and self-rated health were significant quantitative childhood predictors of BMI trajectory. A distinct 'legacy effect' of parental lifestyle influences during childhood was apparent among interview participants in the Stable and High Decreasing groups, a strong and mostly positive concept discussed by both men and women in these groups and persisting despite phases of unhealthy behaviours. In contrast, the 'legacy effect' was much weaker in the two Increasing BMI groups. This study is the first to simultaneously identify important quantitative and qualitative childhood factors related to divergent BMI trajectories, and to observe a legacy effect of parents' lifestyle behaviours on divergent BMI trajectories. This work provides direction for further exploration of the factors driving divergent BMI trajectories.

Longitudinal Body Mass Index Trajectories and Incident Chronic Kidney Disease in the General Population: Community-Based Cohort Study

Objectives: Obesity is a risk factors for chronic kidney disease (CKD). However, the weight changes overtime and this was not well reflected in previous studies. Thus, this study performed to investigated the association body mass index (BMI) trajectories and incident CKD using group-based trajectory modeling. Subjects/Methods: 6,497 healthy subjects without medical comorbidities in the Korean Genome and Epidemiology Study were included in the analysis. Changes in BMI determined by trajectory modeling to accurately identify groups with similar trends of changes in BMI over time; decreasing BMI (slope of BMI per year (%)=-0.481, 95% CI, -0.482 to -0.480), stable BMI (slope=0.001, 95% CI, 0.001-0.002), and increasing BMI (slope=0.499, 95% CI, 0.498-0.501). The primary outcome of interest was incident CKD, which was defined as an estimated glomerular filtration rate of <60 mL/min/1.73m2 for two consecutive measurements. Results: During a 61,894.7 person-years, incident CKD occurred in 455 (7.0%) participants; 8.6, 6.5, and 8.2 per 1000 person-years across the trajectories, respectively ( P =0.005). The decreasing BMI group was associated with a 36% (hazard ratio [HR], 0.64; 95% CI, 0.48-0.85) and 29% (HR, 0.71; 95% CI, 0.52-0.98) lower risk of incident CKD in fully adjusted models compared with subjects with increasing BMI group. This association was evident particularly in overweight and obese subjects, while the significance was lost in underweight or normal weight group. Changes in BMI well correlated with changes in various metabolic parameters. Conclusions: Weight loss is associated with decreased risk of developing CKD in healthy individuals without comorbid diseases. Funding Statement: This study was supported by the Ministry for Health and Welfare, Republic of Korea [4845-301 and 4851-302], and also supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (grant number: HC15C1129). Declaration of Interests: No potential conflict interest relevant to this article were reported. Ethics Approval Statement: KOGES was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Yonsei University Health System’s Clinical Trial Center (approval number: 4-2016-0100).

Different Profiles of Body Mass Index Evolutions Among Patients with Multidrug-Resistant Tuberculosis: A Retrospective Cohort Study

Background: Despite the predictor role of the body weight variation on multidrug-resistant tuberculosis (MDR-TB) treatment outcome, little data are available to corroborate this finding. We aimed to study the course of weight in patients with MDR-TB, to identify subgroups of weight evolutions, and to determine factors that influence these evolutions. Methods: Patients treated with a shorter MDR-TB treatment regimen between June 07, 2016 and June 22, 2018 from three major drug-resistance TB centres in Guinea, who had rifampicin resistance, and who were cured or died were analysed. Patients were seen monthly until the end of treatment. Clinical outcome was the Body Mass Index (BMI). We used a linear mixed model to analyze the course of BMI and a latent class mixed model to identify subgroup of BMI evolutions. Findings: Of 232 patients treated for MDR-TB during the study period, only 165 (71%) patients who were cured or died were analysed. These patients had a total of 1387 visits, with a median of 5 visits (interquartile range, 3 - 8 visits). Monthly BMI increase was 0·24 (SE 0·02) per kg/m2. Factors that associated with faster BMI progression were cured to MDR-TB treatment (0·24 [SE 0·09] per kg/m2; p = 0·0205), and the absence of lung cavities on X-ray (0·18 [0·06] per kg/m2; p = 0·0068). Two subgroups of BMI evolution were identified: Rapid BMI (n = 121; 85%) and Slow BMI evolution (n = 22; 15%). Patients in the slow increasing BMI group were mostly female (68%) without history of TB treatment (41%) with most severe clinical condition at baseline, characterized by a higher frequency of symptoms including HIV infection (59%), depression (18%), dyspnea (68%), nausea (23%), poor adherence to MDR-TB treatment (64%), lower platelets count, and higher liver SGOT count. These patients had also a longer time to-initial culture conversion delay (log-rank test: p = 0·0087). Interpretation: The available data provide quantitative information on BMI progression of patients with MDR-TB treated with a shorter regimen, and allowed the identification of the subgroup of patients with different BMI evolutions. Furthermore, they emphasize the usefulness of BMI as biomarker to monitor MDR-TB treatment outcome, and allow more efficient use of resources and patient management. Funding Statement: The authors stated: None Declaration of Interests: The authors declare no competing interests in relation with this work. Ethics Approval Statement: The study was approved by the National Ethics Committee for Heath Research (NECHR) attached to the Ministry of Health (Conakry, Guinea).

Carotid artery intima-media thickness measurement in children with normal and increased body mass index: a comparison of three techniques

BackgroundCommon carotid artery intima-media thickness is a marker of subclinical atherosclerosis. In children, increased intima-media thickness is associated with obesity and the risk of cardiovascular events in adulthood.ObjectiveTo compare intima-media thickness measurements using B-mode ultrasound, radiofrequency (RF) echo tracking, and RF speckle probability distribution in children with normal and increased body mass index (BMI).Materials and methodsWe prospectively measured intima-media thickness in 120 children randomly selected from two groups of a longitudinal cohort: normal BMI and increased BMI, defined by BMI ≥85th percentile for age and gender. We followed Mannheim recommendations. We used M’Ath-Std for automated B-mode imaging, M-line processing of RF signal amplitude for RF echo tracking, and RF signal segmentation and averaging using probability distributions defining image speckle. Statistical analysis included Wilcoxon and Mann-Whitney tests, and Pearson correlation coefficient and intra-class correlation coefficient (ICC).ResultsChildren were 10–13 years old (mean: 11.7 years); 61% were boys. The mean age was 11.4 years (range: 10.0–13.1 years) for the normal BMI group and 12.0 years (range: 10.1–13.5 years) for the increased BMI group. The normal BMI group included 58% boys and the increased BMI group 63% boys. RF echo tracking method was successful in 79 children as opposed to 114 for the B-mode method and all 120 for the probability distribution method. Techniques were weakly correlated: ICC=0.34 (95% confidence interval [CI]: 0.27–0.39). Intima-media thickness was significantly higher in the increased BMI than normal BMI group using the RF techniques and borderline for the B-mode technique. Mean differences between weight groups were: B-mode, 0.02 mm (95% CI: 0.00 to 0.04), P=0.05; RF echo tracking, 0.03 mm (95% CI: 0.01 to 0.05), P=0.01; and RF speckle probability distribution, 0.03 mm (95% CI: 0.01 to 0.05), P=0.002.ConclusionThough techniques are not interchangeable, all showed increased intima-media thickness in children with increased BMI. RF echo tracking method had the lowest success rate at calculating intima-media thickness. For patient follow-up and cohort comparisons, the same technique should be used throughout.

The association between body mass index and health and economic outcomes in Brazil

BackgroundObesity is associated with significant physical, psychosocial and economic burden globally. In Brazil, almost 50% of the population is either overweight or obese. The prevalence of morbid obesity increased by 255% between 1975 and 2003. The current study sought to quantify the relationship between weight status and health outcomes.MethodsData from three waves (2011, 2012, and 2015) of the Brazil National Health and Wellness Survey, an Internet-based survey administered to a demographically diverse sample of Brazilian adults, were used. Body mass index category was calculated based on self-reported height and weight and respondents were categorized into five groups (normal, overweight, obese class I, obese class II, obese class III; n = 34,254). Multivariable analyses, controlling for sociodemographic variables and health history, tested the association with body mass index group and outcomes including health status (Medical Outcomes Study Short Form 12-Item Health Survey version 2/Medical Outcomes Study Short Form 36-Item Health Survey version 2), work productivity (Work Productivity and Activity Impairment-General Health Questionnaire), and costs associated with work impairment (indirect costs), self-reported healthcare resource use and associated direct costs.ResultsOverall, 53.6% of the surveyed Brazilian population reported being overweight or obese. In virtually all the analyses, increasing body mass index group was associated with significant and progressively worse outcomes. Most notable was the finding that hospitalization costs were over twice as high (R$3141.84 vs. R$1349.60) and indirect costs were nearly double (R$1656.80 vs. R$884.15) for obesity class III than for normal body mass index respondents.ConclusionsObesity rates in Brazil are considerable and, from a patient and societal perspective, increasingly burdensome, thereby highlighting the need for stakeholders to prioritize strategies for weight management interventions.

Parental Warmth Moderates the Association Between BMI Trajectories and Academic Achievement

Using data from the Early Childhood Longitudinal Study–Kindergarten cohort (ECLS-K), this study aimed to identify body mass index (BMI) trajectories from kindergarten to eighth grade using group-based trajectory modeling (GBTM), examine the relationships between BMI trajectories and adolescents’ school achievement (reading and math), determine whether parental warmth had a protective effect on adolescents in the higher BMI groups, and assess whether similar patterns were observed for boys and girls. Three distinct BMI trajectories were identified. Adolescents in the gradually increasing BMI group and consistently higher BMI group were shown to have worse academic achievement compared with adolescents in the consistently low-to-normal BMI group. Parental warmth in eighth grade played a protective role for girls but not for boys, suggesting important gender differences in the role of parental warmth in overweight and obese adolescents’ school achievement. Our results highlighted the importance of intervention programs tailored for specific subgroups of overweight and obese adolescents.

Perioperative Outcomes of Robotic-Assisted Hysterectomy Compared With Open Hysterectomy

Increasing numbers of robotic hysterectomies (RH) are being performed. To provide ventilation (with pneumoperitoneum and steep Trendelenburg position) for these procedures, utilization of lung protective strategies with limiting airway pressures and tidal volumes is difficult. Little is known about the effects of intraoperative mechanical ventilation and high peak airway pressures on perioperative complications. We performed a retrospective review to determine whether patients undergoing RH had increased pulmonary complications compared to total abdominal hysterectomy (TAH). We performed a single center retrospective review comparing the intraoperative, anesthetic, and immediate and 30-day postoperative course of patients undergoing RH to TAH, including intraoperative ventilatory parameters and respiratory complications. Patients undergoing TAH (201) from 2004 to 2006 were compared to RH (251) from 2009 to 2012. It was our hypothesis that patients undergoing RH would have increased incidence of postoperative pulmonary complications. A secondary hypothesis was that morbid obesity predicts pulmonary complications in patients undergoing RH. Complications were compared between groups using Fisher's exact test. To account for potential confounders, the primary analysis was performed for a subgroup of patients matched on the propensity for RH. A total of 351 RH and 201 TAH procedures are included. Higher inspiratory pressures were required in ventilation of the RH group (median [25th, 75th] 31 [26, 36] cm H2O) than the TAH group (23 [19, 27] cm H2O) (P < .001) at 30 minutes after incision. Peak inspiratory pressures at 30 minutes after incision for RH increased according to increasing body mass index group (P < .001). There were 163 RH and 163 TAH procedures included in the propensity matched analysis. From this analysis, there were no significant differences in cardiopulmonary complications between RH and TAH (0.6% vs 1.2%; odds ratio = 2.0, 95% confidence interval = 0.2-2.4; P = 1.00). Surgical site infection was significantly lower in the RH compared to TAH group (0.6% vs 8.6%; P < .001). Hospital length of stay was longer for those who underwent TAH versus RH (median [25th, 75th] 2 [2, 3] vs 1 [0, 2] days; P < .001). There was no significant difference in perioperative complications in obese and morbidly obese women compared to nonobese undergoing RH. Patients undergoing RH had shorter hospital stays, fewer infectious complications, and no increase in overall complications compared to TAH. Higher ventilatory airway pressures (RH versus TAH and obese versus nonobese) did not result in an increase in cardiopulmonary or overall complications. We believe that peritoneal insufflation attenuates the effect of high airway pressures by raising intrapleural pressure and reducing the gradient across terminal bronchioles and alveoli. Thus, we propose that lung protective strategies for patients undergoing RH account for the markedly elevated intraperitoneal and intrapleural pressures, whereas transpulmonary airway pressures remain static. This reduced transpulmonary gradient attenuates the strain on lung tissue that would otherwise be imposed by ventilation at high pressures.

Association among Maternal Obesity, Cervical Length, and Preterm Birth.

Objective The objective of this study was to determine if mid-trimester cervical length is associated with the inverse relationship between maternal body mass index (BMI) at delivery and spontaneous preterm birth (SPTB). Materials and Methods This was a retrospective cohort of women with a singleton pregnancy without prior SPTB who underwent routine transvaginal cervical length assessment between 18 and 24 weeks. Women were categorized into four BMI groups: (1) 18.5 to 24.9, (2) 25 to 29.9, (3) 30 to 34.9, and (4) ≥ 35 kg/m2. Univariable and multivariable analyses were conducted to determine whether BMI group was associated with SPTB at < 37, 34, or 32 weeks independent of the cervical length. Results Of the 18,100 women in this analysis, 43.5% had a BMI ≥ 30. In univariable analysis, increasing BMI group was associated with longer cervical length but not with cervical length < 10th percentile. SPTB at < 37, 35, and 32 weeks was less common among women with higher BMI. In multivariable regression, a higher BMI group was associated with a lower frequency of SPTB at 37 weeks (adjusted odds ratios [aORs] of 0.64, 0.68, and 0.51), at 34 weeks (aORs of 0.53, 0.54, and 0.31) and at 32 weeks (aORs of 0.47, 0.60, and 0.27) for BMI groups 2 to 4, respectively. This association persisted even when cervical length was entered into the model as a covariate. Conclusion Women with a higher BMI group had longer mid-trimester cervical length, and correspondingly reduced SPTB. However, the decreased risk of SPTB was not associated with cervical length. The reason for the potential protective effect from prematurity is unknown and its mechanisms require further investigation.

Survival outcomes of obese patients in type II endometrial cancer: Defining the prognostic impact of increasing BMI

ObjectiveTo investigate the role of obesity as a risk factor for type II endometrial cancer (EC), as well as the prognostic significance of increasing body mass index (BMI) on survival. MethodsA single institution retrospective analysis of 154 type II EC cases from 1987 to 2010 was conducted. Patients were categorized into cohorts by BMI (normal (<25), overweight (25–29.9), obese class I (30–34.9), and obese class IIIII (≥35)). Descriptive, regression and ANOVA analyses were performed. Kaplan-Meier curves were compared with log rank tests. ResultsThe BMI distribution was 22.8% normal BMI; 24% overweight; 17.5% class I; and 35.7% class IIIII. The median follow up was 41months. The median progression-free survival (PFS) was 45.4, 36.0, 35.3 and 42.0months and overall survival (OS) was 54.7, 44.7, 44.8 and 49.7months, among the respective groups. There was no association between BMI and PFS (p=0.71), OS (p=0.72), or time to recurrence (p=0.71). There were no differences among the increasing BMI groups compared to normal weight women for the risk of death. ConclusionsOur analysis did not reveal any differences in outcomes by BMI group. Our data reveals that obesity is highly prevalent in type II ECs, though obesity has not historically been described as a risk factor. While BMI as a single variable may not be prognostic for survival outcomes, the role of obesity as a risk factor for type II EC should be further investigated, given the increasing prevalence of obesity in type II ECs.

The Relationship between Body Mass Index and Risk of Failure following Meniscus Repair

It is unknown whether body mass index (BMI) influences outcomes of meniscus repair. We hypothesized that increased BMI would be associated with increased risk of failure. A retrospective study was performed involving patients who had undergone meniscus repair between 2008 and 2012. Chart review and phone interviews were conducted to determine which patients required additional surgery. Patients were categorized as normal BMI (<25) or increased BMI (≥25). Of the 305 patients who met study criteria, 216 (70.8%) were available for follow-up at a mean of 19 months postoperatively. A total of 100 patients (46.3%) had a BMI <25 and 116 (53.7%) patients had a BMI ≥25. BMI was less than 35 in 90% of patients. Thirty-four patients (15.7%) required further surgery for a repair failure. Failure occurred in 20 patients (20%) in the normal BMI group and 14 patients (12%) in the increased BMI group (p = 0.14). Logistic regression revealed a trend toward decreased odds of repair failure in the increased BMI group (odds ratio: 0.46; 95% confidence interval: 0.20-1.05; p = 0.065). Patients with a BMI ≥25 did not have a higher risk of meniscus repair failure relative to those with a BMI <25. Given these findings, surgeons should not consider moderately increased BMI as a contraindication to meniscal repair. The effect of BMI greater than 35 on outcomes of meniscal repair remains unclear and warrants further study.

Does comorbid obesity impact quality of life outcomes in patients undergoing endoscopic sinus surgery?

Both obesity and chronic rhinosinusitis (CRS) are characterized by inflammation. Furthermore, both disease processes are independently associated with decreases in quality-of-life (QOL). We sought to investigate the role of comorbid obesity in QOL outcomes in CRS patients undergoing endoscopic sinus surgery (ESS). Adult patients with medically refractory CRS (n = 241) were prospectively enrolled into a multi-institutional treatment outcomes investigation. Body mass index (BMI) calculations were used to differentiate patient weight groups (normal weight: 18.5 to 24.9, overweight: 25.0 to 29.9; and obese: ≥30.0). Preoperative and postoperative QOL (Rhinosinusitis Disability Index [RSDI] and the 22-item Sino-Nasal Outcome Test [SNOT-22]) were evaluated compared across BMI groups and obesity subclasses. The prevalence of comorbid obesity was 41% (n = 99). Higher prevalence of comorbid disease was found across increasing BMI groups including diabetes mellitus, asthma, and depression. No significant differences were found in mean preoperative QOL measures between any BMI groups. Significant improvement between preoperative and postoperative QOL mean scores (p ≤ 0.050) was found for all BMI groups. Despite no significant difference in mean QOL improvement between BMI groups (p ≥ 0.142), overweight and obese patients reported reduced relative mean percentage (%) improvement compared to normal weight participants on the RSDI total score (33% and 37% vs 55%, respectively) and SNOT-22 total score (29% and 40% vs 48%, respectively). Patients with comorbid obesity experience significant improvement in average QOL gains following ESS though the percentage of relative improvement in QOL may be decreased in patients with comorbid obesity and CRS as compared to those without.

Prevalence of Obesity in Sickle Cell Patients

Traditionally sickle cell disease has been a disease of the young, and most sickle cell disease patients have previously been thin and undernourished. However with recent advances in sickle cell with the improvement in overall management due to groundbreaking medications such as hydroxyurea, sickle cell disease prognostics have improved along with a much increased life span compared to only a few decades ago. In the general population, the prevalence of being overweight and of obesity has exponentially increased causing an increasingly worse morbidity and mortality, and predisposing patients to increased heart disease, hypertension, stroke, and kidney disease. It is estimated that more than one-third of the US adults are obese. Sickle cell patients are prone to similar complications which are observed at an earlier age when compared to the general population due to constant hemolysis and increased stress on the various organ systems. The goal of this study was to examine the prevalence of obesity in sickle cell patients since there is very limited data on weight status and sickle cell disease. Also the nature of sickle cell complications in overweight and obese patients were compared to those of sickle cell patients with normal weight.Adult patients (>18yrs) with sickle cell disease were selected for a retrospective chart review to study their weight status. All the patients admitted over a three year period with the diagnosis of sickle cell disease at Franciscan St James, a 398 bed community hospital and health system were selected for this study. All patients were reviewed carefully to determine the sickle type and body mass index (BMI) and a total of 100 patients were reviewed for this particular study. Patients with sickle cell trait were eliminated from the study group. BMI weight status was defined as follows: <18.5: underweight, 18.5-24.9: normal weight, 25-29.9: overweight, >30: obese. Factors such as number of admissions over a three year period and comorbidities such as stroke, pulmonary disease, heart disease, Type 2 Diabetes Mellitus, renal dysfunction and liver disease were also included for analysis of weight related complications. Regression analysis along with the two tailed Fisher’s exact test was used for statistical analysis.Upon data analysis the weight distribution among the 100 patients showed that 4 patients were underweight, 42 were normal weight, 26 were overweight, and 28 were obese. The overall average age of the patients was 34.3 and the average BMI was 26.3 with a standard deviation of 6.1. There were 34 males in the study and 64 females. Majority of the patients had the HbSS type sickle cell anemia. Comparisons of BMI, age, number of admissions was made based on weight status (Table 1). There is an overall inverse relationship (R² = 0.0343) between BMI and number of admissions (Figure 1). Obesity related variables were compared to evaluate if there was any significant difference between the normal and increased BMI group. The only significant result was that hypertension is more prevalent in sickle patients with increased BMI as compared to sickle patients with a normal BMI (p value=0.01). A larger sample would be useful to compare other variables such as cardiac, neurological, and diabetic complications. Based on this sample, there was no significant correlation found between increased BMI and the other comorbidities of obesity.From this retrospective chart review, it can be deduced that the incidence of obesity and overweight status is increasing among sickle cell patients similar to the general population. It can also be noted that patients who fall within the normal BMI range have fewer admissions overall. There is limited data on adult obese sickle cell patients and the complications associated with it. Further studies are needed to analyze how the trend in increased BMI has affected sickle cell outcomes. Our goal is to make clinicians aware of the rise in BMI in sickle cell patients and to improve patient care by addressing weight status in these patients.Table 1:comparison of weight weight status with variables such as age, BMI, and # of admissionsVariablesUnderweight BMI<18.5Normal weight BMI 18.5-24.9Overweight BMI 25-29.9Obese BMI >30Average age (yrs)40.7528.438.739.2Average BMI16.721.926.333.2Median # of admissions5143.53 [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.