Lower Body Mass Index Category Research Articles

Validation of Long-term Recall of Pregnancy-related Weight in the Life-course Experiences And Pregnancy Study.

Prepregnancy body mass index (BMI) and gestational weight gain (GWG) are determinants of maternal and child health. However, many studies of these factors rely on error-prone self-reported measures. Using data from Life-course Experiences And Pregnancy (LEAP), a US-based cohort, we assessed the validity of prepregnancy BMI and GWG recalled on average 8 years postpartum against medical record data treated as alloyed gold standard ("true") values. We calculated probabilities of being classified into a self-reported prepregnancy BMI or GWG category conditional on one's true category (analogous to sensitivities and specificities) and probabilities of truly being in each prepregnancy BMI or GWG category conditional on one's self-reported category (analogous to positive and negative predictive values). There was a tendency toward under-reporting prepregnancy BMI. Self-report misclassified 32% (95% confidence interval [CI] = 19%, 48%) of those in LEAP with truly overweight and 13% (5%, 27%) with obesity into a lower BMI category. Self-report correctly predicted the truth for 72% (55%, 84%) with self-reported overweight to 100% (90%, 100%) with self-reported obesity. For GWG, both under- and over-reporting were common; self-report misclassified 32% (15%, 55%) with truly low GWG as having moderate GWG and 50% (28%, 72%) with truly high GWG as moderate or low GWG. Self-report correctly predicted the truth for 45% (25%, 67%) with self-reported high GWG to 85% (76%, 91%) with self-reported moderate GWG. Misclassification of BMI and GWG varied across maternal characteristics. Findings can be used in quantitative bias analyses to estimate bias-adjusted associations with prepregnancy BMI and GWG.

Frailty modifies the association of body mass index with mortality among older adults: Kyoto-Kameoka study

The differences in the association of body mass index (BMI) with mortality between older adults with and without frailty remain unclear. This study investigated this association in community-dwelling older adults with and without frailty. This prospective study included 10,912 adults aged ≥65 years who provided valid responses to a baseline mail survey questionnaire in the Kyoto-Kameoka Study in Japan. The BMI was calculated based on self-reported height and body weight and classified into four categories: <18.5, 18.5-21.4, 21.5-24.9, and ≥25.0kg/m2. Frailty was evaluated using the validated Kihon Checklist and defined as a score of 7 or higher out of a possible 25 points. Mortality data were collected from 30 July 2011 to 30 November 2016. Hazard ratios (HR) for all-cause mortality were calculated using a multivariable Cox proportional hazards model. During the 5.3 year median follow-up period (54,084 person-years), 1352 deaths were recorded. After adjusting for confounders, including lifestyle and medical history, compared with participants with a BMI of 21.5-24.9kg/m2, those in the lower BMI category had a higher mortality HR, while those with a higher BMI displayed an inverse association with mortality (<18.5kg/m2: HR: 1.85, 95% confidence interval [CI]: 1.58-2.17; 18.5-21.4kg/m2: HR: 1.38, 95% CI: 1.21-1.58; and ≥25.0kg/m2: HR: 0.80, 95% CI: 0.67-0.96). In a model stratified by frailty status, the BMI range with the lowest HR for mortality was 23.0-24.0kg/m2 in non-frail older adults; however, in frail older adults, a higher BMI was inversely associated with mortality. The relationship between BMI and mortality varies between individuals with and without frailty, with those experiencing frailty potentially benefiting from a higher BMI compared to those without frailty. This study suggests that frailty should be assessed when considering the optimal BMI for the lowest mortality risk among older adults.

Factors Influencing the Referral of Patients with Prediabetes to a Diabetes Prevention Program in the Bronx, New York.

Disparate engagement in the Diabetes Prevention Program (DPP) may occur as early as the point of referral for certain subgroups, including Black and Hispanic men. We aimed to determine patient demographic and provider characteristics associated with referrals to a health system DPP in the Bronx, New York. Patient and health system characteristics for DPP-eligible patients seen in primary care between July 1, 2015, and December 31, 2017, were obtained through the electronic health record. Generalized mixed-effects modeling was used to test the association between referral rate and clinical and sociodemographic variables. Of 26,727 eligible patients, 66% were female, 46% were Hispanic, and 39% were non-Hispanic Black. Only 10% (n = 2,785) of eligible patients were referred to DPP. In the adjusted analyses, lower odds of referral were observed for men versus women (OR = 0.60; 95% CI, 0.52-0.66), for non-Hispanic White versus Hispanic patients (OR = 0.53; 95% CI, 0.40-0.71), and for uninsured patients versus Medicaid patients (OR = 0.66; 95% CI, 0.54-0.80). The odds were higher for patients in the highest versus lowest hemoglobin A1c (OR = 2.49; 95% CI, 2.27-2.72) category; for those in the highest versus lowest body mass index categories (OR = 1.61; 95% CI, 1.45-1.79); for middle-aged patients (aged 45-64 y) versus those aged 18-26 y (OR =1.63; 95% CI, 1.33-2.00); and for patients being seen by a family versus an internal medicine physician (OR = 1.65; 95% CI, 1.22-2.22). We identified under-referral for men and highlighted other patient and health system factors associated with referral rates. Interventions to address bias in referrals and increase referrals for men at high risk for diabetes, not typically represented in DPP, are recommended.

Probability of 5% or Greater Weight Loss or BMI Reduction to Healthy Weight Among Adults With Overweight or Obesity

Information on the probability of weight loss among US adults with overweight or obesity is limited. To assess the probability of 5% or greater weight loss, 10% or greater weight loss, body mass index (BMI) reduction to a lower BMI category, and BMI reduction to the healthy weight category among US adults with initial overweight or obesity overall and by sex and race. This cohort study obtained data from the IQVIA ambulatory electronic medical records database. The sample consists of US ambulatory patients 17 years or older with at least 3 years of BMI information from January 1, 2009, to February 28, 2022. Minimum age was set at 17 years to allow for the change in BMI or weight starting at 18 years. Maximum age was censored at 70 years. Initial BMI (calculated as weight in kilograms divided by height in meters squared) category was the independent variable of interest, and the categories were as follows: lower than 18.5 (underweight), 18.5 to 24.9 (healthy weight), 25.0 to 29.9 (overweight), 30.0 to 34.9 (class 1 obesity), 35.0 to 39.9 (class 2 obesity), and 40.0 to 44.9 and 45.0 or higher (class 3 or severe obesity). The 2 main outcomes were 5% or greater weight loss (ie, a ≥5% reduction in initial weight) and BMI reduction to the healthy weight category (ie, BMI of 18.5-24.9). The 18 461 623 individuals in the sample had a median (IQR) age of 54 (40-66) years and included 10 464 598 females (56.7%) as well as 7.7% Black and 72.3% White patients. Overall, 72.5% of patients had overweight or obesity at the initial visit. Among adults with overweight and obesity, the annual probability of 5% or greater weight loss was low (1 in 10) but increased with higher initial BMI (from 1 in 12 individuals with initial overweight to 1 in 6 individuals with initial BMI of 45 or higher). Annual probability of BMI reduction to the healthy weight category ranged from 1 in 19 individuals with initial overweight to 1 in 1667 individuals with initial BMI of 45 or higher. Both outcomes were generally more likely among females than males and were highest among White females. Over the 3 to 14 years of follow-up, 33.4% of persons with overweight and 41.8% of persons with obesity lost 5% or greater of their initial weight. At the same time, 23.2% of persons with overweight and 2.0% of persons with obesity reduced BMI to the healthy weight category. Results of this cohort study indicate that the annual probability of 5% or greater weight loss was low (1 in 10) despite the known benefits of clinically meaningful weight loss, but 5% or greater weight loss was more likely than BMI reduction to the healthy weight category, especially for patients with the highest initial BMIs. Clinicians and public health efforts can focus on messaging and referrals to interventions that are aimed at clinically meaningful weight loss (ie, ≥5%) for adults at any level of excess weight.

Translation and Codons

Background: The trend in the use of fluoroscopic-guided transcatheter aortic valve implantation (TAVI) is increasing because the procedure is less invasive than surgical procedure. However, high radiation doses have been reported with the procedure. Moreover, the amount of radiation received by patients undergoing TAVI has never before been registered in Thailand. Objectives: This study aimed to investigate the radiation dose and the effects of sex and body mass index (BMI) on the radiation dose received by patients undergoing TAVI at Chulabhorn Hospital. Materials and methods: Data were collected on the radiation dose received by patients undergoing the TAVI procedure during the first 26 months after the operation at the Cardiology Center, Chulabhorn Hospital. We recorded patient demographic data including age, sex, and BMI and the following measures of radiation dose from the procedure: the number of exposure images, air kerma-area product (PKA), cumulative air kerma at the patient entrance reference point (Ka,r), and total fluoroscopy time. Results: In total, 68 patients (35 male and 33 female) underwent TAVI, with medi­an exposure images, PKA, Ka,r, and total fluoroscopy time of 1,067 images, 166.14 Gy/cm2, 1,171.50 mGy, and 31.90 minutes, respectively. The patient’s sex did not affect total fluoroscopy time or the radiation dose received. Patients with BMI ≥30.0 kg/m2 had the highest median values of PKA, Ka,r, and total fluoroscopy time. Moreover, patients with BMI ≥18.5-24.9 kg/m2 received higher doses of radiation than patients with BMI ≥25.0-29.9 kg/m2; the result corresponded with longer total fluoroscopy time in the lower BMI category. Conclusion: The amount of radiation that patients received during TAVI was appropriate for diagnosis and treatment. However, to ensure patient safety, operators should consider reducing the duration of radiation during the procedure. Data from this study are a starting point for the recording of radiation doses received by patients undergoing TAVI and can be used as a future dose reference.

Patient radiation dose from fluoroscopic-guided transcatheter cardiac aortic valve implantation procedure: A single-center study in Thailand

Background: The trend in the use of fluoroscopic-guided transcatheter aortic valve implantation (TAVI) is increasing because the procedure is less invasive than surgical procedure. However, high radiation doses have been reported with the procedure. Moreover, the amount of radiation received by patients undergoing TAVI has never before been registered in Thailand. Objectives: This study aimed to investigate the radiation dose and the effects of sex and body mass index (BMI) on the radiation dose received by patients undergoing TAVI at Chulabhorn Hospital. Materials and methods: Data were collected on the radiation dose received by patients undergoing the TAVI procedure during the first 26 months after the operation at the Cardiology Center, Chulabhorn Hospital. We recorded patient demographic data including age, sex, and BMI and the following measures of radiation dose from the procedure: the number of exposure images, air kerma-area product (PKA), cumulative air kerma at the patient entrance reference point (Ka,r), and total fluoroscopy time. Results: In total, 68 patients (35 male and 33 female) underwent TAVI, with medi­an exposure images, PKA, Ka,r, and total fluoroscopy time of 1,067 images, 166.14 Gy/cm2, 1,171.50 mGy, and 31.90 minutes, respectively. The patient’s sex did not affect total fluoroscopy time or the radiation dose received. Patients with BMI ≥30.0 kg/m2 had the highest median values of PKA, Ka,r, and total fluoroscopy time. Moreover, patients with BMI ≥18.5-24.9 kg/m2 received higher doses of radiation than patients with BMI ≥25.0-29.9 kg/m2; the result corresponded with longer total fluoroscopy time in the lower BMI category. Conclusion: The amount of radiation that patients received during TAVI was appropriate for diagnosis and treatment. However, to ensure patient safety, operators should consider reducing the duration of radiation during the procedure. Data from this study are a starting point for the recording of radiation doses received by patients undergoing TAVI and can be used as a future dose reference.

Risk of obesity during a gluten-free diet in pediatric and adult patients with celiac disease: a systematic review with meta-analysis.

Obesity is a significant risk factor for many pathological conditions. Whether a gluten-free diet (GFD) is a risk factor for overweight or obesity remains controversial. The primary aim of this study was to assess the prevalence of body mass index (BMI) categories at disease presentation and the variation in BMI category from underweight/normal to overweight/obese and vice versa during a GFD. PubMed, Scopus, and Web of Science databases were searched through February 2021 for retrospective, cross-sectional, and prospective studies reporting BMI categories at disease diagnosis and during a GFD. Data were extracted by 2 reviewers independently. Disagreements were resolved by consensus; a third reviewer was consulted, if necessary. Risk of bias was assessed with the Cochrane ROBINS-I tool. Subgroup analysis based on age (pediatric/adult patients), study design (prospective, cross-sectional, retrospective), and duration of GFD was performed.. Forty-five studies were selected (7959 patients with celiac disease and 20 524 healthy controls). The mean BMI of celiac patients at presentation was significantly lower than that of controls (P < 0.001). During a GFD, the mean BMI increased significantly (mean difference = 1.14 kg/m2 [95%CI, 0.68-1.60 kg/m2]; I2 = 82.8%; P < 0.001), but only 9% of patients (95%CI, 7%-12%; I2 = 80.0%) changed from the underweight/normal BMI category to the overweight/obese category, while 20% (95%CI, 11%-29%; I2 = 85.8%) moved into a lower BMI category. Most celiac patients had a normal BMI at presentation, although the mean BMI was significantly lower than that of controls. A GFD does not increase the risk of becoming overweight/obese, especially in children. The quality of several studies was suboptimal, with moderate or high overall risk of bias and heterogeneity.

Body Mass Index and the Risk of Poor Outcome in Surgically Treated Patients With Good-Grade Aneurysmal Subarachnoid Hemorrhage.

BACKGROUND:Heterogeneity among study populations and treatment procedures has led to conflicting results on outcome predictors for patients with aneurysmal subarachnoid hemorrhage (aSAH). One such conflicting predictor is body mass index (BMI).OBJECTIVE:To clarify whether high BMI values protect patients from poor outcome after aSAH, as previously suggested.METHODS:We surveyed 6 prospective studies conducted in 14 different countries (93 healthcare units) between 1985 and 2016 and pooled the data on surgically treated patients with good-grade (Glasgow Coma Scale 13-15 on admission) aSAH. We calculated BMI for each patient and created 4 balanced categories based on the BMI quartiles of each cohort. We calculated adjusted odds ratios (ORs) with 95% CIs for the 3-month poor outcome (Glasgow Outcome Scale 1-3) by BMI.RESULTS:The pooled study cohort included 1692 patients with good-grade aSAH (mean age 51 years; 64% female). At 3 months, 288 (17%) had poor outcomes. The risk for poor outcomes increased with increasing BMI values (OR = 1.15 [1.02-1.31] per each standard deviation increase of BMI). The risk for poor outcome was over 1.6 times higher (OR = 1.66 [1.13-2.43]) in the highest BMI category (range 27.1-69.2) compared with the lowest BMI category (range 14.4-23.8). These associations were found in each of the 6 study cohorts in both men and women, regardless of age.CONCLUSION:Because higher BMI values seem to associate with poor outcomes in surgically treated patients with good-grade aSAH, it seems unlikely that obesity protects patients with aSAH from poor outcomes.

Association of Generalized and Abdominal Obesity with Diabetic Retinopathy in Chinese Type 2 Diabetic Patients.

Obesity has been proposed to promote the progression of diabetic retinopathy (DR), but previous studies have not shown consistent results. We aimed to explore the association between generalized and abdominal obesity and DR risk, and to assess the joint effect of these two different types of obesity on DR development. A nested case-control study within a large prospective study on type 2 diabetes was conducted in communities in Huai'an City, Jiangsu Province, China. Cases were individuals who had diagnoses of DR during the 6-year follow-up. A total number of 1544 DR cases and 1:1 matched controls were included. Binomial and multinomial logistic regression models were used to investigate the effects of obesity on DR occurrence and DR severity. Compared with individuals in the first tertile of the baseline waist-to-hip ratio (WHR), subjects in the third tertile at baseline had significantly higher risk of DR (OR 1.44, 95% CI 1.17-1.78) during the follow-up period. Conversely, body mass index (BMI) (continuous) had an adjusted OR of 0.97 (95% CI 0.95-0.99) of developing DR. Individuals with low BMI and high WHR levels were identified as a high-risk population with a higher likelihood of developing DR (OR 1.65, 95% CI 1.17-2.33) than those in the lowest BMI category and simultaneously in the first WHR tertile. Type 2 diabetic individuals with low BMI levels and high WHR levels had a significantly increased risk of developing DR which indicated that isolated abdominal obesity might be involved in the pathogenesis of DR.

The association between serum high-sensitivity cardiac troponin T and acute myocardial infarction in patients with suspected chronic coronary syndrome is modified by body mass index

BackgroundHigher systemic concentrations of cardiac troponins and biomarkers of inflammation and endothelial dysfunction as well as obesity are associated with increased risk of cardiovascular disease (CVD) and may share pathophysiological pathways. We sought to explore the association between serum high sensitive cardiac troponin T (hs-cTnT) and future acute myocardial infarction (AMI) according to body mass index (BMI) among patients with suspected chronic coronary syndrome (CCS), as well as interactions with C-reactive protein (CRP) and asymmetric dimethylarginine (ADMA). MethodsA total of 3879 patients with baseline hs-cTnT ≤ 30 ng/L who underwent elective coronary angiography due to chronic coronary syndrome (CCS) were followed to subsequent AMI or end of 2009. Risk associations between hs-cTnT and incident AMI were explored with Cox regression according to BMI categories <25 kg/m 2, 25–30kg/m2 and >30kg/m2 and quartiles of serum CRP and plasma ADMA. ResultsMedian (25 th −75 th percentile) age was 62 (54–69) years and 2773 (77.5%) were men. During median 7.5 (25 th −75 th percentile) (6.9–9.2) years of follow-up, 460 (11.9%) patients experienced an AMI. The risk relationship between hs-cTnT and incident AMI was stronger among patients in the higher vs lower BMI categories, HR 1.087 (1.055–1.119), P for interaction 0.043. A similar interaction was not found in categories of CRP or ADMA. ConclusionThe risk relationship of hs-cTnT with incident AMI was stronger in patients with higher BMI. Our results motivate further studies into potential pathophysiological mechanisms connecting hs-cTnT with increased cardiovascular risk.

Morbid obesity increases the failure rate of sentinel lymph node mapping for endometrial carcinoma

<h3>Objectives:</h3> Sentinel Lymph Node (SLN) mapping is recommended for patients with endometrial carcinoma to reduce the rate of full lymphadenectomy and its associated morbidity such as lymphedema. Obesity is a risk factor for endometrial carcinoma, and many patients are morbidly obese at the time of diagnosis. The goal of this study is to examine the impact of body mass index (BMI) on the success rate of SLN mapping using indocyanine green (ICG) and near-infrared imaging. <h3>Methods:</h3> A retrospective cohort study was performed of women with endometrial carcinoma undergoing robotic hysterectomy and SLN mapping with ICG between March 2016 and August 2019. Robotic surgery cases were identified from the hospital financial system that were coded with a primary diagnosis of Endometrial Cancer, a procedure of hysterectomy, and a cost code for indocyanine green. A total of 369 cases were identified. A total of 28 cases were excluded because no dye was used or SLN mapping was not attempted due to extent of disease. Preoperative patient characteristics and surgical outcomes including SLN mapping success rate were compared across World Health Organization BMI groups. <h3>Results:</h3> BMI was categorized as normal weight (BMI 18.5 - 24.9, 41 patients), pre-obesity (BMI 25.0 - 29.9, 48 patients), obesity class I (BMI 30.0 - 34.9, 71 patients), obesity class II (BMI 35.0 - 39.9, 70 patients), and obesity class III (BMI ≥40, 111 patients). Across BMI groups, patient age and ASA category were significantly different, with younger ages and higher ASA scores in the higher BMI groups. BMI groups did not differ in the number of prior abdominal surgeries or FIGO Grade. Uterine weight, diameter and procedure time were all significantly different across BMI groups, with higher weights, diameters and procedure times in the higher BMI groups. Estimated blood loss and depth of myometrial invasion were not significantly different. In the cohort, 85% had FIGO Stage 1 disease. For procedures with successful unilateral or bilateral SLN detection, the mean number of lymph nodes removed per side was not significantly different across BMI groups. The overall bilateral SLN mapping success rate for the cohort was 68.9%. However, the bilateral SLN mapping success rate was significantly lower in patients with obesity class III (54.1%) compared with patients who were less obese (76.1%, p<0.01). There was no difference in success rate between lower BMI categories. <h3>Conclusions:</h3> Patients with class III obesity (BMI > 40) have a significantly lower success rate for SLN mapping when compared with all other BMI categories (54.1% vs 76.1%, respectively, p<0.01).

The failure of glomerular filtration rate estimating equations among obese population.

BackgroundObesity is a major public health with increasing numbers of obese individuals are at risk for kidney disease. However, the validity of serum creatinine-based glomerular filtration rate (GFR) estimating equations in obese population is yet to be determined.MethodsWe evaluated the performance of the reexpressed Modification of Diet in Renal Disease (MDRD), reexpressed MDRD with Thai racial factor, Thai estimated GFR (eGFR) as well as Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations among obese patients, defined as body mass index (BMI) ≥25 kg/m2 with the reference measured GFR (mGFR) determined by 99mTc-diethylene triamine penta-acetic acid (99mTc-DTPA) plasma clearance method. Serum creatinine levels were measured using standardized enzymatic method simultaneously with GFR measurement. The statistical methods in assessing agreement for continuous data including total deviation index (TDI), concordance correlation coefficient (CCC), and coverage probability (CP) for each estimating equation were compared with the reference mGFR. Accuracy within 10% representing the percentage of estimations falling within the range of ±10% of mGFR values for all equations were also tested.ResultsA total of 240 Thai obese patients were finally recruited with mean BMI of 31.5 ± 5.8 kg/m2. In the total population, all eGFR equations underestimated the reference mGFR. The average TDI values were 55% indicating that 90% of the estimates falling within the range of -55 to +55% of the reference mGFR. The CP values averaged 0.23 and CCC scores ranged from 0.75 to 0.81, reflecting the low to moderate levels of agreement between each eGFR equation and the reference mGFR. The proportions of patients achieving accuracy 10% ranged from 23% for the reexpressed MDRD equation to 33% for the Thai eGFR formula. Among participants with BMI more than 35 kg/m2 (n = 48), the mean error of all equations was extremely wide and significantly higher for all equations compared with the lower BMI category. Also, the strength of agreement evaluated by TDI, CCC, and CP were low in the subset of patients with BMI ≥35 kg/m2.ConclusionEstimating equations generally underestimated the reference mGFR in subjects with obesity. The overall performance of GFR estimating equations demonstrated poor concordance with the reference mGFR among individuals with high BMI levels. In certain clinical settings such as decision for dialysis initiation, the direct measurements of GFR are required to establish real renal function among obese population.

Weight change in middle adulthood and risk of cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.

Obesity is a risk factor for several major cancers. Associations of weight change in middle adulthood with cancer risk, however, are less clear. We examined the association of change in weight and body mass index (BMI) category during middle adulthood with 42 cancers, using multivariable Cox proportional hazards models in the European Prospective Investigation into Cancer and Nutrition cohort. Of 241 323 participants (31% men), 20% lost and 32% gained weight (>0.4 to 5.0 kg/year) during 6.9 years (average). During 8.0 years of follow-up after the second weight assessment, 20 960 incident cancers were ascertained. Independent of baseline BMI, weight gain (per one kg/year increment) was positively associated with cancer of the corpus uteri (hazard ratio [HR] = 1.14; 95% confidence interval: 1.05-1.23). Compared to stable weight (±0.4 kg/year), weight gain (>0.4 to 5.0 kg/year) was positively associated with cancers of the gallbladder and bile ducts (HR = 1.41; 1.01-1.96), postmenopausal breast (HR = 1.08; 1.00-1.16) and thyroid (HR = 1.40; 1.04-1.90). Compared to maintaining normal weight, maintaining overweight or obese BMI (World Health Organisation categories) was positively associated with most obesity-related cancers. Compared to maintaining the baseline BMI category, weight gain to a higher BMI category was positively associated with cancers of the postmenopausal breast (HR = 1.19; 1.06-1.33), ovary (HR = 1.40; 1.04-1.91), corpus uteri (HR = 1.42; 1.06-1.91), kidney (HR = 1.80; 1.20-2.68) and pancreas in men (HR = 1.81; 1.11-2.95). Losing weight to a lower BMI category, however, was inversely associated with cancers of the corpus uteri (HR = 0.40; 0.23-0.69) and colon (HR = 0.69; 0.52-0.92). Our findings support avoiding weight gain and encouraging weight loss in middle adulthood.

Combined Association of Body Mass Index and Alcohol Consumption With Biomarkers for Liver Injury and Incidence of Liver Disease

Individually, higher body mass index (BMI) and alcohol consumption increase the risk of liver disease. Evidence of a joint association is mixed; however, previous studies have not used causal inference methods robust to confounding and reverse causation. Understanding any true effect is key to developing effective interventions to reduce liver disease. To investigate the joint association of BMI and alcohol consumption with liver injury biomarkers and incident liver disease using factorial mendelian randomization (MR). A population-based cohort study (Copenhagen General Population Study) recruited a random sample of Copenhagen, Denmark, residents aged 20 years or older of white, Danish descent (N = 98 643) between November 25, 2003, and July 1, 2014. Data were also obtained from ongoing links to national registers, and then analyzed from September 30, 2016, to April 23, 2018. High and low BMI and alcohol consumption categories from baseline-measured or self-reported observational data and genetic variants predicting BMI and alcohol consumption. Plasma biomarkers of liver injury (alanine aminotransferase [ALT] and γ-glutamyltransferase [GGT]) and incident cases of liver disease from hospital records were the outcomes. Of the 98 643 individuals recruited, 91 552 (54 299 [45.2%] women; mean [SD] age, 58 [13.05] years) with no baseline liver disease were included in main analyses. Individuals had a mean (SD) BMI of 26.2 (4.3) and consumed a mean (SD) of 10.6 (10.2) U/wk of alcohol. In factorial MR analyses, considering the high BMI/high alcohol group as the reference, mean circulating ALT and GGT levels were lowest in the low BMI/low alcohol group (ALT: -2.32%; 95% CI, -4.29% to -0.35%, and GGT: -3.56%; 95% CI, -5.88% to -1.24%). Individuals with low BMI/high alcohol use and high BMI/low alcohol use also had lower mean circulating ALT levels (low BMI/high alcohol use: -1.31%; 95% CI, -1.88% to -0.73%, and high BMI/low alcohol use: -0.81%; 95% CI, -2.86% to 1.22%) and GGT levels (low BMI/high alcohol use: -0.91%; 95% CI, -1.60% to -0.22%, and high BMI/low alcohol use: -1.13%; 95% CI, -3.55% to 1.30%) compared with the high BMI/high alcohol use reference group. These patterns were similar in multivariable factorial analyses. For incident liver disease (N = 580), factorial MR results were less conclusive (odds ratio of liver disease vs high BMI/high alcohol group: 1.01; 95% CI, 0.84 to 1.18, for the low BMI/high alcohol group, 1.22; 95% CI, 0.56 to 1.88 for the high BMI/low alcohol group, and 0.99 (95% CI, 0.41 to 1.56 for the low BMI/low alcohol group). Interventions to reduce both BMI and alcohol consumption might reduce population levels of biomarkers of liver injury more than interventions aimed at either BMI or alcohol use alone. However, it is not clear whether this intervention will directly translate to a reduced risk of liver disease.

Length of inter-pregnancy interval and subsequent preconception adiposity: Findings from a population-based cohort in the South of England

Introduction Maternal obesity is a key predictor of adverse short- and long-term health outcomes for both mother and child. The aim was to investigate the association between duration of the inter-pregnancy interval between successive pregnancies and change in maternal body mass index (BMI) during that period to assess the optimal interval associated with the least likelihood of starting the following pregnancy with a higher body weight. Methods A regional population-based cohort of prospectively collected routine healthcare data for antenatal care between January 2003 and September 2017 at University Hospital Southampton was utilised. Records of women with two or more consecutive singleton pregnancies (up to five) were analysed. Information on previous births was used to categorise pregnancies as first to second, second to third, third to fourth and fourth to fifth. Inter-pregnancy interval was defined as timing between a live birth and the next conception calculated by subtracting gestational age according to dating ultrasound scan of the latter birth from the interval between births. BMI was treated as a continuous and categorical variable, which was defined as underweight (BMI Findings In total, 20,571 women of which 12,636 had first two, 2654 had first three, 530 had first four and 120 had first five pregnancies were included. Two-thirds of women had gained weight when first presenting to antenatal care for their subsequent pregnancy with 21–24% moving into a higher compared to 4–6% moving into a lower BMI category. A significant positive linear association was found between change in maternal BMI with each year of inter-pregnancy interval with the coefficient remaining similar across pregnancies (adjusted increase in maternal BMI per year of inter-pregnancy interval 0.25 kg/m2, 95% CI: 0.22 to 0.28) and increasing for the fourth to fifth pregnancy (adjusted increase in maternal BMI per year of inter-pregnancy interval 0.36 kg/m2, 95% CI: 0.25 to 0.47). Compared to an interval of 24–35 months, there is a significantly increased risk of starting the next pregnancy with a higher weight than the previous one with an interval of 36 months or more for the second, third and fourth pregnancies (adjusted OR: 1.43, 95% CI: 1.29 to 1.59, P Conclusions Birth spacing of 12–23 months appears most protective against starting the next pregnancy with a higher body weight, even when adjusting for maternal age. In high-income country settings, getting pregnant within 1–2 years of the previous birth and advising those anticipating longer intervals to limit weight gain could be simple preconception preventive measures in tackling maternal obesity and hence achieving better subsequent maternal and offspring health outcomes.

The association of body mass index with endometriosis and disease severity in women with pain

Introduction: There is a well-established inverse relationship between body mass index and frequency of endometriosis. However, these population-based studies have relied mostly on self-reported cases of endometriosis, rather than surgically confirmed endometriosis where disease severity has been objectively assessed. The aim of the current retrospective study was to establish whether the established relationship between endometriosis and low body mass index was independent of disease severity. Methods: Women with menstrual and/or pelvic pain undergoing laparoscopy for suspected endometriosis were recruited for this retrospective study (n = 509). Women were grouped by body mass index (kg/m2) according to World Health Organization criteria: underweight (&lt;18.5), normal (18.5–24.99), pre-obese (25–29.99) or obese (≥30). Endometriosis was scored according to the revised American Fertility Society system. Data were analysed based on body mass index and endometriosis status to identify any relationship between body mass index and disease. Results: The average body mass index of women with endometriosis was 25.0 kg/m2. The body mass index distribution of women with endometriosis differed relative to women in the general population. As expected, fewer obese women had endometriosis than in the lower body mass index categories. However, the obese women who did have endometriosis had significantly higher revised American Fertility Society scores compared to women with normal and pre-obese body mass indices. Discussion: Our results are consistent with the established finding of an inverse relationship between body mass index and endometriosis. The novel finding from this study is that obesity is associated with increased disease severity and reduced frequency of stage I endometriosis. It remains unclear what role body mass index has in the cause or effect of endometriosis; we speculate that body mass index may be useful for sub-classifying the disease.

Abstract P262: Association of Weight History With Risk of Diabetes

Introduction: Weight gain during early adulthood may contribute to diabetes risk above and beyond a single measure in midlife. Nonetheless, most epidemiologic studies have focused on the risks associated with a one body mass index (BMI) value in midlife. Hypothesis: Accounting for change in BMI from early to mid-adulthood would add prognostic value for estimating risk of diabetes compared to using a single value. Methods: We included 9,857 participants from the Atherosclerosis Risk in Communities (ARIC) Study without diabetes and with BMI ≥18.5 kg/m 2 in 1996-1998 (visit 4). Participants were followed through 2015 for incident diagnosed diabetes. Current BMI was defined as calculated BMI using measured height and weight at visit 4. Early adulthood BMI was calculated from current height and self-reported weight at age 25. We classified current and early adulthood BMI into three categories (18.5-&lt;25, 25-&lt;30, and ≥30 kg/m 2 ) and we examined the associations of changes in BMI category with diabetes risk using Cox proportional hazards models. Results: Overall, 64% (6,205 of 9,857) of the participants moved from a lower to higher BMI category between age 25 and visit 4 (mean age, 63), 35% (3,446 of 9,857) remained stable, and 2% (206 of 9,857) moved from a higher to lower BMI category. Adding BMI at age 25 to a model with current BMI significantly improved model fit. In analyses using BMI change categories between age 25 and visit 4, relative to persons with normal BMI at age 25 and visit 4, persons who moved from a lower to higher BMI category and those who maintained a high BMI had a higher risk for diabetes ( Table ). Conclusions: Current weight is associated with diabetes risk. Past weight gain from early adulthood did not appear to add information above and beyond current weight. Our findings highlight the importance of weight management at all ages for optimal diabetes prevention.

Prevalence and recognition of obesity and its associated comorbidities: cross-sectional analysis of electronic health record data from a large US integrated health system

ObjectiveTo determine the prevalence of obesity and its related comorbidities among patients being actively managed at a US academic medical centre, and to examine the frequency of a formal diagnosis...

Effect of BMI and body weight on pregnancy rates with LNG as emergency contraception: analysis of four WHO HRP studies

ObjectiveTo estimate the effect of increased body weight and body mass index (BMI) on pregnancy rates with levonorgestrel (LNG) 1.5mg used as emergency contraception (EC). MethodsThe study reviewed data from 6873 women in four WHO-HRP randomized trials on EC conducted between 1993 and 2010. Participants took either 1.5mg of LNG as a single dose or in two doses 12h apart, up to 120h of unprotected intercourse. Contraceptive efficacy (pregnancy rates) at different weight and BMI categories was evaluated. ResultsOverall pregnancy rate was low at 1.2%. Pregnancy rates were also low in women weighing over 80kg (0.7%) and who were obese (BMI over 30kg/m2) (2.0%). The pooled analyses for pregnancy demonstrated that BMI over 30kg/m2 decreased efficacy significantly (odds ratio 8.27, 95% confidence interval = 2.70–25.37) when compared to women in lower BMI categories, mainly influenced by pregnancies in obese women from one study site. Sensitivity analyses excluding that site showed that obesity was no longer a risk factor; however, the other studies included too few obese women in the sample to exclude a substantial decrease in efficacy. ConclusionsPregnancy rates with use of LNG 1.5mg for EC were low at less than 3% across different weight and BMI categories. Pooled analyses showed an increase in pregnancy rates among obese women (BMI more than 30kg/m2) compared to women with normal BMI levels, influenced by pregnancies all coming from one study site. ImplicationsAccess to LNG as EC should still be promoted to women who need them, and not be restricted in any weight or BMI category, with additional attention for counselling and advice for obese women.

Accuracy of self-reported height, weight, and waist circumference in a general adult Chinese population.

BackgroundSelf-reported height, weight, and waist circumference (WC) are widely used to estimate the prevalence of obesity, which has been increasing rapidly in China, but there is limited evidence for the accuracy of self-reported data and the determinants of self-report bias among the general adult Chinese population.MethodsUsing a multi-stage cluster sampling method, 8399 residents aged 18 or above were interviewed in the Jiangsu Province of China. Information on self-reported height, weight, and WC, together with information on demographic factors and lifestyle behaviors, were collected through structured face-to-face interviews. Anthropometrics were measured by trained staff according to a standard protocol.ResultsSelf-reported height was overreported by a mean of 1.1 cm (95 % confidence interval [CI]: 1.0 to 1.2). Self-reported weight, body mass index (BMI), and WC were underreported by −0.1 kg (95 % CI: −0.2 to 0.0), −0.4 kg/m2 (95 % CI: −0.5 to −0.3) and −1.5 cm (95 % CI: −1.7 to −1.3) respectively. Sex, age group, location, education, weight status, fruit/vegetable intake, and smoking significantly affected the extent of self-report bias. According to the self-reported data, 25.5 % of obese people were misclassified into lower BMI categories and 8.7 % of people with elevated WC were misclassified as normal. Besides the accuracy, the distribution of BMI and WC and their cut-off point standards for obesity of a population affected the proportion of obesity misclassification.ConclusionAmongst a general population of Chinese adults, there was rather high proportion of obesity misclassification using self-reported weight, height, and WC data. Self-reported anthropometrics are biased and misleading. Objective measurements are recommended.