Lower BMI Levels Research Articles

The prevalence and correlates of haematological abnormalities in adult inpatients with anorexia nervosa

IntroductionThere is only limited literature concerning haematological abnormalities in anorexia nervosa (AN), with little past investigation into these abnormalities in adult AN patients admitted to inpatient eating disorder (ED) units.ObjectivesThis study sought to determine the prevalence and severity of haematological abnormalities in admitted AN patients, and to examine correlates of these abnormalities.MethodsAll adult patients with a clinical diagnosis of AN admitted to the Cotswold House specialist ED inpatient unit between November 2013 and December 2014 were included in the study. Demographic, anthropometric and haematological parameters were systematically recorded for the duration of each admission. The proportions of patients affected by haematological abnormalities (anaemia, leucocytopaenia, neutropaenia, thrombocytopaenia and pancytopaenia) were selected as primary outcomes, and binary logistic regression was performed using SPSS 22.0.ResultsA total of 37 AN patients (91.9% female; mean age: 29.7 years) were included in this study, with a mean admission BMI of 13.7 kg/m2 (SD: 1.8) and a mean admission duration of 128 days; 54.1% of patients were anaemic, 64.9% of patients experienced leucocytopaenia, 56.8% of patients developed neutropaenia, 16.2% of patients suffered thrombocytopaenia, and 8.1% of patients were pancytopaenic. Logistic regression identified low admission BMI (P = 0.009) and low serum albumin level (P = 0.017) as significant correlates of anaemia, and isolated increased age (P = 0.034) as a significant associate of leucocytopaenia.ConclusionsHaematological abnormalities occur frequently in AN inpatients. Given the frequency at which abnormalities occurred in this cohort, further large-scale and prospective studies examining haematological abnormalities in inpatient AN populations are warranted.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Excessive adiposity at low BMI levels among women in rural Bangladesh.

Asian populations have a higher percentage body fat (%BF) and are at higher risk for CVD and related complications at a given BMI compared with those of European descent. We explored whether %BF was disproportionately elevated in rural Bangladeshi women with low BMI. Height, weight, mid-upper arm circumference, triceps and subscapular skinfolds and bioelectrical impedance analysis (BIA) were measured in 1555 women at 3 months postpartum. %BF was assessed by skinfolds and by BIA. BMI was calculated in adults and BMI Z-scores were calculated for females <20 years old. Receiver operating characteristic (ROC) curves found the BMI and BMI Z-score cut-offs that optimally classified women as having moderately excessive adipose tissue (defined as >30 % body fat). Linear regressions estimated the association between BMI and BMI Z-score (among adolescents) and %BF. Mean BMI was 19·2 (sd 2·2) kg/m(2), and mean %BF was calculated as 23·7 (sd 4·8) % by skinfolds and 23·3 (sd 4·9) % by BIA. ROC analyses indicated that a BMI value of approximately 21 kg/m(2) optimised sensitivity (83·6 %) and specificity (84·2 %) for classifying subjects with >30 % body fat according to BIA among adults. This BMI level is substantially lower than the WHO recommended standard cut-off point of BMI ≥ 25 kg/m(2). The equivalent cut-off among adolescents was a BMI Z-score of -0·36, with a sensitivity of 81·3 % and specificity of 80·9 %. These findings suggest that Bangladeshi women exhibit excess adipose tissue at substantially lower BMI compared with non-South Asian populations. This is important for the identification and prevention of obesity-related metabolic diseases.

Risk Factors of Acute Renal Cortical Lesions in Scintigraphy in Children with Urinary Tract Infection

Introduction: Urinary Tract Infection (UTI) is one of the most common pediatric infections. UTI may create cystitis or pyelonephritis by involving bladder or renal parenchyma, respectively. Pyelonephritis, especially in pediatric patients, can lead to scar formation in kidneys and consequent complications such as hypertension, proteinuria, dysfunction and chronic renal insufficiency. The current study aimed to determine risk factors of acute rental cortical lesions in renal scintigraphy in children with UTI.Materials and Methods: Fifty-three patients with significant renal cortical lesions and 53 cases without significant renal cortical lesions were compared based on the intensity of findings of DMSA scintigraphy within the first two weeks of diagnosis. Patients were divided into three groups of 1 month to 2 years, 2 to 4 years and 4 to 10 years.Results: Of 106 patients, 11 males (20.8%) and 42 females (79.2%) had significant acute renal cortical lesions, whereas 15.1% of males and 84.9% of females had no significant acute renal cortical lesions. There was a significant difference in the degree of fever, the average interval between the onset of fever and treatment, mean level of CRP, leukocytosis and ESR in the two studied groups. The presence of Vesicoureteral Reflux (VUR), low initial hemoglobin and low initial BMI as random findings were associated with significant renal cortical lesions. Gender, age, grade of VUR and type of organism in urine culture had no significant association with significant renal cortical lesions.Conclusions: In this study, delaying in treatment, high degree fever, leukocytosis, high initial ESR and CRP, existence of VUR and low initial BMI and hemoglobin levels were associated with an increase in the value of acute renal cortical lesions, so in these cases, DMSA scan is suggested.Keywords: Urinary Tract Infections; DMSA (Dimercaptosuccinic Acid); Renal scars; Pediatrics.

Impact of Lowering BMI Cut Points as Recommended in the Revised American Diabetes Association's Standards of Medical Care in Diabetes-2015 on Diabetes Screening in Asian Americans.

OBJECTIVEThis study estimated the screening prevalence of prediabetes and diabetes using a lower BMI cutoff of 23 kg/m2 in Asians in the U.S. using the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2012.RESEARCH DESIGN AND METHODSA cross-sectional analysis was conducted of non-Hispanic Asians, aged 45 years and older, with available BMI, HbA1c, and fasting glucose data. These overall criteria were met by 341 participants.RESULTSLowering the screening BMI to 23 kg/m2 increased the sensitivity of screening for prediabetes and diabetes from 50.2 to 74.1% (P < 0.0001) but decreased the specificity from 62.9 to 38.7% (P < 0.0001).CONCLUSIONSAlthough this will add additional health care costs resulting from more widespread screening, early identification of these conditions may be beneficial for primary and secondary prevention in this unique population that develops prediabetes and diabetes at lower BMI levels.

Low BMI and low TSH value as risk factors related to lower bone mineral density in postmenospausal women under levothyroxine therapy for differentiated thyroid carcinoma.

ObjectiveTreatment of differentiated thyroid carcinoma (DTC) includes suppression of TSH with levothyroxine therapy, which may negatively influence bone mineral density (BMD), but the effects are controversial. We aimed to evaluate the relationship between TSH-suppressive therapy and BMD in postmenopausal women with DTC.MethodologyCross-sectional study that assessed BMD by densitometry and risk factors for decreased BMD in 109 postmenopausal women under TSH-suppressive therapy for DTC, compared to an age-matched euthyroid women control group. Conditions that might have affected BMD were exclusion criteria.ResultsPatients were 58.4 ± 8.3 years-old, mean serum TSH was 0.21 ± 0.28μIU/ml. In BMD evaluation, T-scores were −1.09 ± 1.43 SD (lumbar spine) and −0.12 ± 1.18 SD (total femur). No significant differences were found between lumbar or femoral T-scores of patients and control group. Multivariate logistic regression analysis evidenced that low BMI and low mean TSH levels (assessed in the year of BMD measurement) were factors significantly related to lower lumbar and spinal BMD.ConclusionAlthough low TSH levels and low BMI were correlated with lower BMD, it was not observed an increased prevalence of osteopenia or osteoporosis in this cohort of post-menopausal women under levothyroxine treatment for DTC, when compared to age-matched control women. Nevertheless, such risk factors should be carefully observed in individual patients at high risk of decrease in BMD.

Optimum BMI cut points to screen asian americans for type 2 diabetes.

Asian Americans manifest type 2 diabetes at low BMI levels but may not undergo diagnostic testing for diabetes if the currently recommended BMI screening cut point of ≥25 kg/m(2) is followed. We aimed to ascertain an appropriate lower BMI cut point among Asian-American adults without a prior diabetes diagnosis. We consolidated data from 1,663 participants, ages ≥45 years, without a prior diabetes diagnosis, from population- and community-based studies, including the Mediators of Atherosclerosis in South Asians Living in America study, the North Kohala Study, the Seattle Japanese American Community Diabetes Study, and the University of California San Diego Filipino Health Study. Clinical measures included a 2-h 75-g oral glucose tolerance test, BMI, and glycosylated hemoglobin (HbA1c). Mean age was 59.7 years, mean BMI was 25.4 kg/m(2), 58% were women, and type 2 diabetes prevalence (American Diabetes Association 2010 criteria) was 16.9%. At BMI ≥25 kg/m(2), sensitivity (63.7%), specificity (52.8%), and Youden index (0.16) values were low; limiting screening to BMI ≥25 kg/m(2) would miss 36% of Asian Americans with type 2 diabetes. For screening purposes, higher sensitivity is desirable to minimize missing cases, especially if the diagnostic test is relatively simple and inexpensive. At BMI ≥23 kg/m(2), sensitivity (84.7%) was high in the total sample and by sex and Asian-American subgroup and would miss only ∼15% of Asian Americans with diabetes. The BMI cut point for identifying Asian Americans who should be screened for undiagnosed type 2 diabetes should be <25 kg/m(2), and ≥23 kg/m(2) may be the most practical.

Predictors of response to liraglutide in Japanese type 2 diabetes

AimIn Japan, liraglutide is approved for use alone or in combination with sulfonylureas, and the approved maximum dosage is 0.9mg/day. This restriction could limit the glucose-lowering effect of liraglutide in Japanese patients with type 2 diabetes mellitus (T2DM). This study was designed to identify predictors of response to liraglutide therapy at the approved dosage. MethodsThis observational retrospective study included 380 patients with T2DM who were treated with liraglutide alone or in combination with sulfonylureas at Diabetes Centers located in four geographically different areas of Japan. Binary logistic regression analysis was used to identify patient characteristics associated with discontinuation of liraglutide, while multiple regression and decision tree analyses were used to identify predictors of response to liraglutide therapy. ResultsFactors associated with discontinuation of liraglutide included high BMI, long duration of diabetes, and prior insulin therapy. Predictors of response to liraglutide therapy in patients who did not use insulin previously included previous use of few oral glucose-lowering agents and high baseline HbA1c level. ConclusionThe results suggest greater efficacy of liraglutide monotherapy or liraglutide-sulfonylurea combination therapy in patients with short duration of diabetes, non-insulin therapy, and low BMI and high HbA1c level at baseline.

Abstract P249: Urinary Cadmium and Cardiovascular Health: Findings from the Survey of the Health of Wisconsin

Mounting evidence in both human and animal studies suggest cadmium exposure increases the risk for cardiovascular disease morbidity and mortality. Recent evidence have found associations between cadmium exposures and mortality in the general US population, however, studies of incident CVD events have been mixed. Consequently, there is a need to better understand determinants of variations in cadmium exposure and the association of current population exposure levels with cardiovascular risk factors in diverse population-based studies. Data from a sub-sample of 300 participants from the 2008-11 waves of the Survey of the Health of Wisconsin (SHOW) were used to study the association between urinary cadmium levels and cardiovascular health. SHOW is based on a probabilistic statewide sample of adult (21-74 years old) residents of the state of Wisconsin. Good cardiovascular health (CVH) was defined as recommended by the American Heart Association, using a combination of “ideal or intermediate” levels of seven factors and health behaviors (body mass index, cholesterol, glucose, diet, physical activity, blood pressure and smoking). Associations of log-linear estimates of creatinine-adjusted cadmium levels (ug/g creatinine) and CVH were examined using logistic and linear regression models. Covariates included individual-level demographics (race/ethnicity and gender), SES (median family income and education), smoking status (current or former vs. non), and diet (fruits and vegetable consumption). Urinary cadmium levels (ug/g creatine) were statistically higher than comparable national estimates among women (geometric mean = .36;95% CI =.30-.44) and populations living 200% above federal poverty estimates (geometric mean =.32; 95% CI .28-.38). Higher cadmium levels were associated with good CVH (OR 1.4; 1.06-1.90). Using linear regression log-cadmium levels were inversely associated with BMI (ß=-1.04; p-value=.002) after adjustment for sociodemographic, smoking and dietary factors. Stratified analyses found associations held among non-smokers but not current or former. Cadmium was not associated with any other individual CVH factors. Paradoxically, findings suggest that urinary cadmium levels, a marker of chronic cadmium exposure, are associated with high SES, lower levels of BMI and good cardiovascular health in this population based sample, further exploration and long-term follow-up are warranted.

Overweight, Mortality and Survival

Overweight, Mortality and Survival

TNFRSF11B polymorphisms are associated with metabolic traits in Uyghur and Han ethnic groups

Introduction: To test whether genetic variants of osteoprotegerin gene (TNFRSF11B) affect metabolic traits (body mass index [BMI], glucose, triglyceride, total cholesterol) and bone mass traits. Methods: We conducted a population based association study to investigate associations of eight tagging single nucleotide polymorphisms (tSNPs) of the TNFRSF11B gene with the aforementioned traits in a Chinese Han population and an ethnic group admixed with Caucasians and Asians – Uyghur. The associations between the tSNPs and bone mass density (BMD) were also tested in Han population. Results: We found that SNP rs3102727, located in the first intron of the TNFRSF11B gene, was significantly associated with triglyceride levels in Uyghur population and Han population simultaneously. T allele of the rs3102727 variant was associated with a 0.10 mmol/L and 0.09 mmol/L lower level of triglyceride than C allele in Uyghur (p = 0.019) and Han subjects (p = 0.037), respectively. In addition, the T allele is also associated with a lower level of hip BMD (p = 0.025) and total BMD (p = 0.048). Further, we found significant associations between SNP rs11573869 and BMI in Uyghur subjects and SNP rs3134062 with hip BMD in Han sbujects. Rs11573869-T allele was associated with a 0.81 kg/m2 lower level of BMI than C allele (p = 0.002) and the hip BMD decreases with the copy of rs3134062-T allele increases (p = 0.002). Conclusion: We detected novel associations between TNFRSF11B polymorphisms and metabolic traits in Uyghur and Han populations. In addition, we found associations between TNFRSF11B polymorphisms and bone mass traits in Han population.

SAT0186 Trends and correlates of erythropoiesis-stimulating agent use among patients with lupus nephritis reaching end-stage renal disease

BackgroundApproximately 20% of lupus nephritis (LN) patients develop end-stage renal disease (ESRD) within 10 years. As LN progresses, anemia is common. Little is known, however, about utilization patterns of erythropoiesis-stimulating...

Systemic factors and mortality in elderly patients with pressure ulcers

The aim of this article was to identify specific systemic factors associated with existence of pressure ulcers (PUs) and the effect on survival from the time of admission. Patients admitted to the Skilled Nursing Department of the Herzog Hospital, Jerusalem, between 1 July 2008 and 31 December 2011. Of the 174 admitted patients (mean age: 77·4 ± 13·2 years), 107 (61·5%) had pre-existing PUs and 67 (38·5%) did not have PUs. Major systemic factors were assessed for each patient at the time of admission: sociodemographic characteristics, comorbidities, use of urinary catheter, tube feeding and tracheostomy; nutritional state; Global Deterioration Scale, Glasgow Coma Scale and Norton Scale. Complications such as the number of provided antibiotic courses, and length and outcomes of hospitalisation were identified at the end of the study. In the univariate analysis, patients in the PU group had significantly prevalent characteristics including advanced age, low cognitive and consciousness function, low Norton scale, Parkinson's disease and anaemia due to chronic diseases, low nutritional parameters and higher number of antibiotics provided. Conditions that were associated with PUs in multiple regression analyses included advanced dementia (OR = 3·0, 95% CI: 1·4-6·3; P = 0·002), urinary catheter usage (OR = 2·25, 95% CI: 1·06-4·7; P = 0·03), low body mass index, BMI (OR = 0·92, 95% CI: 0·86-0·99; P = 0·02) and anaemia level (OR = 0·7, 95% CI: 0·58-0·9; P = 0·004). The median survival time of patients with PUs was significantly lower than the non PUs group (94 versus 414 days, respectively) (P = 0·005, log rank test). Length of stay was also significantly lower in the PU group (166 versus 270 days, P = 0·02). The existence of PUs may indicate a final common pathway of various systemic factors (geriatric conditions, diseases and frailty dysfunction).

English

Active living is imperative to maintaining good health, and becoming involved in regular exercise at a young age is fundamental. The purpose of this study was to examine motivation for exercise among university students in relation to metamotivational dominance and body esteem. Participants in this study were 106 undergraduate students who were recruited from their psychology departmental participant pool and from the campus exercise facility at a mediumsized Canadian university. Participants completed an inventory that included the Motivational Style Profile, Big Five Inventory-10, Behavioral Regulation in Exercise Questionnaire, and the Body Weight and Image Self-Esteem Evaluation Questionnaire to assess personality, exercise motivation, and body esteem. High-frequency exercisers were found to be more paratelic dominant than low-frequency exercisers, and scored significantly higher on intrinsic, identified, and introjected regulation, indicating that they exercised for enjoyment, valued exercise outcomes, and wanted to avoid negative emotions associated with not exercising. Among highfrequency exercisers, positive body esteem was associated with high intrinsic and low extrinsic motivation for exercise, paratelic dominance, negativism dominance, and low neuroticism. For low-frequency exercisers, significant correlates of positive body esteem were autic mastery dominance, low BMI, low neuroticism, and lower levels of extrinsic and introjected motivation. Findings are discussed in terms of healthy and unhealthy motivations for exercise, and recommendations are made for tailoring health promotion strategies to metamotivational dominance.

Body Composition and Non-Communicable Diseases: A study on Diabetic Subjects.

Non-communicable disease (NCD), is a medical condition or disease which by definition is noninfectious and non-transmissible between persons. It may be chronic diseases of long duration and slow progression, or they may result in more rapid death such as some types of sudden stroke. They include autoimmune diseases, heart disease, stroke, many cancers, asthma, diabetes, chronic kidney disease, osteoporosis, Alzheimer's disease, cataracts and more. Out of these, India is facing an epidemic of diet-related non-communicable disease namely diabetes along with widely prevalent under-nutrition resulting in substantial socio-economic burden over the country. According to data released by International Diabetes Federations, in India the number of persons suffering from diabetes have increased from 19 million in 1995 to 51 million in 2010 and it is projected to be increased to 87 million by 2030 (Ramachandran, 2010). Diabetes mellitus is a chronic metabolic disorders characterized by high blood glucose levels resulting from defects in insulin secretion, insulin action or both, which prevents the body to utilize glucose completely or partially (zimmet, 1983). The prevalence of diabetes in developing countries is due to adoption of western life-style, sedentary life, smoking, high fat diet and lack of physical exercise. Indians are at special risk because of fat accumulating phenotype/ genotype, high percentage of body fat at lower level of BMI as well as central and truncal distribution of fat. All these factors have led to substantial increase in the prevalence of obesity. People who eat too much food and lead a sedentary life become overweight and obese. Obesity reduces the sensitivity of tissues to the action of insulin in the utilization of glucose. Lack of physical activity and obesity increases the risk for development of diabetes in the later stage of a person’s life (Raghuram et al, 1998). Extensive research published over the past two decades has demonstrated a positive association between increased levels of body fatness, obesity and type-2 diabetes (Pi-Sunyer, 1991). In particular abdominal obesity has been identified as a significant risk factor for the development of insulin resistance, glucose intolerance and type-2 diabetes (Despres, 1993). Although not all Individuals with increased body fatness and abdominal obesity manifest the metabolic complications of diabetes, approximately 85% of patients with type-2 diabetes display increased levels of body fatness (Tsui Eyl et al, 1998). In order to make the most valid assessment of body composition, it is necessary to understand the underlying theoretical models and reference methods used to develop body composition prediction equations. The two-component model of body composition divides the body into a fat component and fat free body (FFB) component (Brozek et al, 1963; siri, 1961). The FFB consists of all residual chemicals and tissues including water, muscles (protein) and bone (minerals). This model assumes that (a) the density of the FFB is 1.1 g/cc and (b) the densities of the fat and the FFB components are same for all individuals (c) the individual being measured differs from the reference body only in the amount of fat, and (4) the FFB of the reference body is 73.8% water, 19.4% protein and 6.8% mineral. So, the present study was planned to know the relationship between body composition and diabetes.

Diabetes: Have We Got It All Wrong?

Diabetes is prevalent and chronic (1). A meta-analysis of studies published between 1990 and 2006 showed that in adults, obesity prevalence increased from 13 to 32% between the 1960s and 2004. Currently, 66% of U.S. adults are overweight or obese. The incidence of diabetes is increasing and afflicting new populations including children and developing societies. Changes in obesity prevalence among children and teens tripled, from nearly 5% to approximately 15% since the 1960s (2). Type 2 diabetes mellitus (T2DM) is a global health problem. In particular, Asia is at the epicenter of the epidemic as these populations develop diabetes at younger ages and at lower BMI levels than people of European origin (3). Diabetes does not usually diminish over time despite standard treatment. It is a lifelong illness that generally worsens with time and often leads to debilitating complications including cardiovascular disease, neuropathy, retinopathy, and nephropathy (4). These realities indicate that both our understanding of the disease and our treatment of the disease are inadequate. Current approaches are not working. It is widely believed that overeating calorie-dense food, particularly a high-fat diet, together with an inactive lifestyle causes obesity. A consequence of obesity is increased circulating lipids and cytokines, indicators of inflammation and inducers of insulin resistance. Obesity and insulin resistance are believed to be the precursors of diabetes in about 20% of subjects. The current standard treatment for diabetes includes diet, exercise, and a biguanide together with agents that increase circulating insulin in an effort to overcome insulin resistance (5). The term Insulin Resistance Syndrome is used to describe the combination of insulin resistance and compensatory hyperinsulinemia (HI). It is assumed, without evidence, that insulin resistance precedes and causes HI. Insulin resistance purportedly stimulates increased insulin secretion, interpreted as the body’s attempt to overcome the resistance, …

The clinical efficacy of metformin combined with clomiphene citrate in the treatment of polycystic ovary syndrome

Objective To observe the clinical efficacy of metformin combined with clomiphene citrate in the treatment of polycystic ovary syndrome ( POS ).Methods 104 women with POS and who received routine therapies for induction of ovulation were randomly assigned to receive combination therapy with metformin combined with clomiphene ( 52 women,study group ),or metformin alone ( 52 women,control group ).Bilateral ovarian volume,changes in blood glucose,and levels of fasting insulin,follicle-stimulating hormone,luteinizing hormone,and testosterone levels were compared between the two groups before and after treatment.Results Ovarian volume was lessened at certain degree in both groups after treatment.Levels of BMI,fasting insulin,LH,and testosterone were reduced.Conclusions Metformin combined with clomiphene for polycystic ovary syndrome can effectively lower levels of BMI and hormone,improve endocrine status,and induce ovulation.It is an effective choice for treating this disorder. Key words: Metformin; Clomiphene; Polycystic ovary syndrome; Infertility

Abstract P077: Differences and Similarities in Dietary Pattern and Nutrient Profiles between the Sexes and Blacks and Whites. The Adventist Health Study 2

Objective: To describe the associations between dietary patterns with nutrient intakes differentiated by sex and race. Methods: Cross-sectional study of 71751 subjects (mean age 59 years, 65% female, 76% white) from the Adventist Health Study 2. Participants completed a 204-item validated semi-quantitative food frequency questionnaire. Five dietary patterns were established: non vegetarian, semi vegetarians, pesco vegetarians, lacto ovo vegetarians and strict vegetarians. ANCOVA and linear regression analysis were used to determine differences of nutrient intakes by dietary patterns. Non-dietary variables, such as age, smoking and physical activity were taken into account and associations between dietary pattern and BMI were compared. Analysis was repeated by stratifying for sex and race. Results: Strict vegetarians had the lowest BMI, with graded higher BMI levels for dietary patterns with greater fractions of animal plant protein, total fat and saturated fatty acids but similar total caloric intakes. Mean nutrient intake was more dissimilar across dietary pattern than between the sexes or blacks and whites. In general nutrient intakes were more similar between males and females than between blacks and whites with blacks revealing a strikingly higher percentage of non vegetarians than whites. Supplement intakes were often markedly higher in females than in males and higher in whites than in blacks with mean micronutrient intakes for all dietary patterns being well above the estimated average requirements for American adults in both sexes and blacks and whites. Conclusions: All groups met current American nutrient requirements. Nutrient intakes varied more markedly between dietary pattern than between sex or race. Lower BMI levels were associated with dietary patterns characterized by higher plant food intake despite generally similar caloric intake across dietary patterns warranting further investigation.

Bodymass index and scoliosis among the population of the United Arab Emirates

These results suggest that the incidence of AIS in the UAE (when determined) will not be expected to be greater than in other parts of the world due to low levels of BMI. Hoewever, normal standards for height and weight in the UAE might need to be adjusted for this specific population in ways similar to some of the Asian countries.

The Growing Role of Bariatric Surgery in the Management of Type 2 Diabetes: Evidences and Open Questions

The use of bariatric surgery in the clinical management of type 2 diabetes has been recently endorsed in the clinical practice recommendations released by the most influential diabetologic associations. However, authoritative critic voices about the application of metabolic surgery in type 2 diabetes continue to appear in diabetologic literature. In this review, we will try therefore to understand what the reasons for this apparent dichotomy. In this paper, we revised what we believe are now clear evidences about the role of bariatric surgery in the treatment of type 2 diabetes in patients with morbid obesity: the efficacy of bariatric surgery in metabolic control, the existence of plausible weight-independent metabolic mechanisms at least in some bariatric procedure, and the importance of the early referral to surgery in patients with firm indications. However, we stressed also the lack of clear high-quality long-term data about the effects of bariatric surgery in the prevention of both macro- and micro-vascular hard endpoints in patients with type 2 diabetes. The accrual of these results will be critical to completely clarify the risk/benefit ratio of bariatric surgery in diabetes, as compared to current pharmacologic therapies. This may be particularly important in patients in which data on long-term efficacy are still not completed, such as in patients with lower BMI levels.

General parenting, childhood overweight and obesity-inducing behaviors: a review

Despite emerging efforts to investigate the influence parents have on their children's weight status and related dietary and activity behaviors, reviews regarding the role of general parenting are lacking. We performed a systematic review regarding the relationship between general parenting and these weight-related outcomes to guide observational research. In total, 36 studies were included. Discrepancies across studies were found, which may be explained by differences in conceptualization of parenting constructs. Overall, however, results suggest that children raised in authoritative homes ate more healthy, were more physically active and had lower BMI levels, compared to children who were raised with other styles (authoritarian, permissive/indulgent, uninvolved/neglectful). Findings of some moderation studies indicate that general parenting has a differential impact on children's weight-related outcomes, depending on child and parental characteristics. These findings underline the importance of acknowledging interactions between general parenting and both child and parent characteristics, as well as behavior-specific parenting practices.