Lower Mean Body Mass Index Research Articles

Abstract 4120131: Absence of standard modifiable risk factors (SMuRF-less) among 5002 Middle Eastern patients with atherosclerotic cardiovascular disease: (Interim analysis from the Jo-SMuRF Study)

Introduction: A growing number of patients develop atherosclerotic cardiovascular disease (ASCVD) despite the absence of standard modifiable risk factors i.e. hypertension (HTN), type 2 diabetes (T2D), dyslipidemia (DSL), and cigarette smoking (SMuRF-less). There is scarcity of studies on prevalence and clinical profiles of SMuRF-less patients in the Middle Ease (ME). Aim: To study the prevalence and clinical features of ME patients with ASCVD who are SMuRF-less vs. those with ≥ 1 SMuRFs, presence of other risk factors and utilization of secondary preventive medications in the 2 groups, and one year survival. Methods: Clinical details of adult patients with ASCVD who participated in 5 previous registries were analyzed according to the absence or presence of ≥ 1 SMuRFs. Results: Of the 5002 patients included in the analysis, 676 (13.5%) were SMuRF-less and 4326 (86.5%) had ≥ 1 SMuRFs. Prevalence of the 4 SMuRFs in the whole cohort was 53.5% HTN, 47.8% T2D, 40.2% smoking, and 37.5% DSL, and the SMuRF group was 61.9%, 55.2%, 46.5%, and 43.4%, respectively. Compared with the SMuRFs group, patients in the SMuRFless group were younger (mean age 52±11.4 years vs. 56.3±11.5 years, respectively, p<0.001) and more likely to be women than men (38.6% vs. 27.9%, p<0.0001). Furthermore, SMuRF-less patients had lower mean body mass index, and less prevalence of metabolic syndrome, heart failure, and family history of ASCVD. Utilization of secondary cardiovascular prevention medications was significantly less in the SMuRF -less group than those with SMuRFs; dual antiplatelet therapy (36.4% vs. 69.5%), statins (66.3% vs. 87.4%), B blockers (57.5% vs. 70.5%), and renin-angiotensin inhibitors (35.2% vs. 55.3%, respectively, all p<0.001. Of the subgroup with one year follow up after percutaneous coronary intervention (N=2641), mortality rate was not different in the 2 groups; 1.4% vs. 1.8%, p=0.98. Conclusions: In this first study of SMuRFs in ASCVD patients in the Middle East, SMuRF-less patients account for nearly 14% of the studied cohort. These patients were younger, had less comorbid disease, received less guidelines-recommended prevention medication, and had same one year event rate compared with patients who have SMuRFs.

Impact of Sex, Age and Body Habitus on RBD-specific Antibody Response After Two Doses of Sinopharm BBIBP-CorV Vaccine

Background: Mongolia started its nationwide vaccination campaign against COVID-19 on 23 February 2021 after receiving the first batch of the inactivated BBIBP-CorV. Age and body habitus of vaccinees may be associated with the immune effecter functions. Several systematic reviews and meta-analyses suggested lower immunogenicity of vaccines against SARS-CoV-2 infection in the older adult population and obese individuals. We aimed to establish a possible relationship between post-vaccine seroconversion rate and some biometric characteristics in the Mongolian cohort of vaccinees after two shots of the Sinopharm BBIBP-CorV vaccine. Materials and Methods: We collected serum samples from 846 eligible vaccinees before the first dose of the BBIBP-CorV vaccine and 21-28 days after the second dose of the same vaccine. Anti-SARS-CoV-2 Receptor Binding Domain (RBD) Immunoglobulin class G (IgG) and M (IgM) titer were measured in all samples. Results: 686 (81.1%) of 846 vaccinees received the Sinopharm BBIBP-CorV vaccine demonstrated seroconversion. Vaccinees with seroconversion had a younger mean age and lower mean body-mass index (BMI) than non-responders. Seroconversion rate according to age of vaccinees tends to decrease and obese vaccinees demonstrated a greater portion among non-responders. The Optimal Cut-Point (OCP) of age for seroconversion was found to differ significantly in male and female vaccinees. BMI has shown prediction ability for seroconversion only in male vaccinees but not in females. Using Receiver Operating Characteristics (ROC) analysis, we found 39 years for males and 41 years for females as a crucial milestone increasing the probability of seronegativity 2.5 times on average. A BMI higher than 29.1kg/m2 in male vaccinees was considered an acceptable predictor for seroconversion increasing the probability of seronegativity 2.4 times on average. Conclusion: The above findings allow us to summarize the sex-adjusted approach to biometric characteristics has an improved predictiveness for post-vaccine antibody response.

Impact of baseline body mass index on antidepressant response: A study in newly diagnosed patients at a tertiary care center in Kolkata

Background: Depression, affecting 350 million globally, poses significant morbidity and mortality. The correlation between major depressive disorder (MDD) and obesity is noted, with studies indicating poorer treatment outcomes among obese individuals. Measuring weight and body mass index (BMI) could aid in predicting depression treatment outcomes, influencing drug efficacy due to their ease of measurement, amid the shared public health burden of MDD and obesity. Aims and Objectives: The aims and objectives of the study are to evaluate baseline BMI’s impact on antidepressant response in newly diagnosed outpatient department (OPD) patients at a tertiary care center. Materials and Methods: This longitudinal observational study was conducted with OPD patients at a tertiary care center, aged 18–65 years with newly diagnosed MDD. Assessment tools included the Diagnostic Criteria for Research accompanying the ICD-10, the Hamilton Rating Scale for Depression, and physical measurement devices. Sample size determination considered BMI groups: Normal to underweight (N1=120), overweight (N2=120), and obese (N3=70). The methodology involved patient history, examination, and follow-up assessments after 6 weeks, analyzing antidepressant response statistically. Results: Obese patients exhibited reduced treatment response rates compared to normal and overweight counterparts. Responders had lower mean BMI. Gender disparities in obesity prevalence were noted. Limitations: The study’s limitations include a small sample size of 310 cases, single-center design, and potential selection bias in a tertiary care setting. Conclusion: The findings underscore the complex relationship between BMI, depression severity, and treatment response. Obese individuals demonstrated higher initial depression scores and poorer treatment response, echoing previous research. The study highlights the need for personalized treatment approaches that consider individual BMI levels to optimize depression management strategies effectively.

Body mass index changes and their association with SARS-CoV-2 infection: a real-world analysis.

To study body mass index (BMI) changes among individuals aged 18-99 years with and without SARS-CoV-2 infection. Using real-world data from the OneFlorida+ Clinical Research Network of the National Patient-Centered Clinical Research Network, we compared changes over time in BMI in an Exposed cohort (positive SARS-CoV-2 test between March 2020-January 2022), to a contemporary Unexposed cohort (negative SARS-CoV-2 tests), and an age/sex-matched Historical control cohort (March 2018-January 2020). BMI (kg/m2) was retrieved from objective measures of height and weight in electronic health records. We used target trial approaches to estimate BMI at start of follow-up and change per 100 days of follow-up for Unexposed and Historical cohorts relative to the Exposed cohort by categories of sex, race & ethnicity, age, and hospitalization status. The study sample consisted of 249,743 participants (19.2% Exposed, 61.5% Unexposed, 19.3% Historical cohort) of whom 62% were women, 21.5% Non-Hispanic Black, 21.4% Hispanic and 5.6% Non-Hispanic other and had an average age of 51.9 years (SD: 18.9). At start of follow-up, relative to the Unexposed cohort (mean BMI: 29.3 kg/m2 [95% CI: 29.1, 29.4]), the Exposed (0.07 kg/m2 [95% CI; 0.01, 0.12]) had higher mean BMI and Historical controls (-0.20 kg/m2 [95% CI; -0.25, -0.15]) had lower mean BMI. Over 100 days, BMI did not change (0 kg/m2 [95% CI: -0.03, 0.03]) for the Exposed cohort, decreased (-0.04 kg/m2 [95% CI; -0.05, -0.02]) for the Unexposed cohort and increased (0.03 kg/m2 [95% CI; 0.01, 0.04]) for the Historical cohort. Observed differences in BMI at start of follow-up and over 100 days were consistent between Unexposed and Exposed cohorts for most subgroups, except at start of follow-up period among Males and those 65 years or older who had lower BMI among Exposed. In a diverse real-world cohort of adults, mean BMI of those with and without SARS-CoV2 infection varied in their trajectories. The mechanisms and implications of weight retention following SARS-CoV-2 infection remain unclear.

Assessment of cardiac function in farmers occupationally exposed to pesticides in gboko local government area, benue state

Any compound or combination of substances meant to prevent, eradicate, repel, or mitigate any pest is known as a pesticide. Despite the benefits of using pesticides for pests, weeds, and disease control, there have been concerns about adverse effects of these compounds on the human health. This cross-sectional study was designed to assess the cardiac function of farmers occupationally exposed to pesticides, in Gboko Local Government Area, Benue State, Nigeria.One hundred ten (110) participants comprising 70 farmers and 40 controls were recruited for the study using a multi-stage random sampling technique. They were aged between 20-60 years and were age-matched. Five (5) ml of fasting blood samples were collected from each participant for the determination of Apolipoprotein A1 (ApoA1), Apolipoprotein B-100 (ApoB100) and Troponin I level using standard laboratory methods. Also, the body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the participants were also determined. The results showed significantly lower mean BMI (23.02±3.94 Vs 24.94±3.12; p= 0.031) and serum ApoA1 (150.73±13.52 Vs 167.27±15.65; p=0.024) while the mean SBP (140.49±19.34 Vs 119.75±10.30; p=0.000), DBP (82.86±12.16 Vs 77.53±7.76; p=0.014) and mean serum Troponin-I (3.11±5.46 Vs 1.38±0.15; p=0.049) levels were significantly higher in the farmers compared to control respectively. However, there was no significant difference in the mean serum ApoB-100 level in the farmers when compared to the control group (p=0.104). : This study showed that the farmers had lower body mass index and higher serum levels of apoA-I, apoB-100, and Troponin I, as well as systolic and diastolic blood pressure, as compared to the control group. Nonetheless, in both the test and control groups, these results fell within the typical reference ranges. Further longitudinal research is required to gain a deeper understanding of the effects of pesticide exposure on cardiac function in farmers.

Depression, Anxiety, Emotional Eating, and Body Mass Index among Self-Reported Vegetarians and Non-Vegetarians: A Cross-Sectional Study in Peruvian Adults.

Background: Vegetarianism is commonly associated with various health benefits. However, the association between this dietary regimen and aspects of mental health remains ambiguous. This study compared the symptoms of depression and anxiety, emotional eating (EmE), and body mass index (BMI) in Peruvian vegetarian and non-vegetarian adults. Methods: A cross-sectional study was conducted on 768 Peruvian adults, of whom 284 (37%) were vegetarians and 484 (63%) were non-vegetarians. The Depression Patient Health Questionnaire-2 (PHQ-2), Generalized Anxiety Disorder Scale-2 (GAD-2), and an EmE questionnaire were applied; additionally, the BMI was calculated. Simple and multiple linear regression and Poisson regression models with robust variance were used to evaluate the association between depression, anxiety, EmE, and BMI with dietary patterns. Results: The vegetarians (Adjusted Prevalence Ratio [PR] = 0.24, 95% CI 0.16-0.31; p < 0.001) reported more depressive symptoms than the non-vegetarians. This trend persisted for anxiety, with an adjusted PR of 0.17 (95% CI: 0.01-0.29; p = 0.012). However, the vegetarians (adjusted PR = -0.38, 95% CI: -0.61--0.14; p < 0.001) reported lower EmE scores compared to the non-vegetarians. Likewise, the vegetarians had a lower mean BMI than the non-vegetarians (B = -0.16, 95% CI: -0.21--0.08; p < 0.001). Conclusions: Vegetarian diets are associated with increased symptoms of depression and anxiety, as well as lower EmE and BMI scores. Further longitudinal studies are needed to elucidate these associations and determine causality and the underlying mechanisms involved.

Comparison of body mass index and fat mass index to classify body composition in adolescents—The EVA4YOU study

The objectives of this study were to develop age- and sex-specific reference percentiles for fat mass index (FMI) and fat-free mass index (FFMI) in adolescents aged 14 to 19 years and to determine differences in overweight/obesity classification by FMI and body mass index (BMI). The EVA4YOU study is a single-center cross-sectional study conducted in western Austria. Cardiovascular risks including anthropometric measurements and bioelectrical impedance analysis were assessed in adolescents (mean age 17 years). FMI and FFMI were calculated as the ratio of fat mass (FM) and fat-free mass (FFM) to the square of height and compared to study population–specific BMI percentiles. One thousand four hundred twenty-two adolescents were included in the analysis. Girls had a significantly higher mean FM and FMI and a significantly lower mean FFM, FFMI (p < 0.001, each), and mean BMI (p = 0.020) than boys. Body composition classification by FMI and BMI percentiles shows a concordance for the < 75th and > 97th percentile, but a significant difference in percentile rank classifications between these two cut-off values (all p < 0.05). Based on FMI, 15.5% (221/1422) of the whole population and 29.4% (92/313) of those between the 75th and 97th percentiles are classified one category higher or lower than those assigned by BMI. Conclusion: Classification of normal or pathologic body composition based on BMI and FMI shows good accordance in the clearly normal or pathologic range. In an intermediate range, FMI reclassifies categories based on BMI in more than a quarter of adolescents. Cut-off values to differentiate normal from pathologic FMI values on a biological basis are needed.Trial registration: The study is registered at www.clinicaltrials.gov (Identifier: NCT04598685; Date of registration: October 22, 2020).What is Known:• Chronic non-communicable diseases (NCDs) are the leading cause of morbidity and mortality globally, with major risk factors including unhealthy diets, harmful behaviors, and obesity. Obesity in children and adolescents is a key risk factor for later NCDs, which is commonly measured by Body Mass Index (BMI).• BMI can be misleading as it doesn't distinguish between fat mass (FM) and fat-free mass (FFM), leading to potential misclassification of obesity in children. Previous studies have already suggested the use of the Fat Mass Index (FMI) and Fat-Free Mass Index (FFMI) as a more accurate measures of body composition.What is New:• This study adds the first age- and sex-specific reference values for FMI and FFMI in Austrian adolescents using bioelectrical impedance analysis (BIA) as a safe and secure measurement method of a large representative cohort.• We found percentile misclassification between BMI and FMI when categorizing for obesity, especially in intermediate categories of body composition. Furthermore, when comparing the new reference values for FMI and FFMI to existing ones from the US, UK, and Germany we could show a good alignment within the European cohorts and major differences with American values, indicating and confirming the difference of FMI and FFMI for different populations of different ethnical background, living on different continents.

The Impact of Smoking on Hospital Course and Postoperative Outcomes in Patients With Fracture-Related Infections.

To assess the relationship between patient smoking status and fracture-related infection (FRI) characteristics including patient symptoms at FRI presentation, bacterial species of FRI, and rates of fracture union. Retrospective cohort study. Urban level 1 trauma center. All patients undergoing reoperation for FRI from January 2013 to April 2021 were identified through manual review of an institutional database. Data including patient demographics, fracture characteristics, infection presentation, and hospital course were collected through review of the electronic medical record. Patients were grouped based on current smoker versus nonsmoker status. Hospital course and postoperative outcomes of these groups were then compared. Risk factors of methicillin-resistant Staphylococcus aureus (MRSA) infection, Staphylococcus epidermidis infection, and sinus tract development were evaluated using multivariable logistic regression. A total of 301 patients, comprising 155 smokers (51%) and 146 nonsmokers (49%), undergoing FRI reoperation were included. Compared with nonsmokers, smokers were more likely male (69% vs. 56%, P = 0.024), were younger at the time of FRI reoperation (41.7 vs. 49.5 years, P < 0.001), and had lower mean body mass index (27.2 vs. 32.0, P < 0.001). Smokers also had lower prevalence of diabetes mellitus (13% vs. 25%, P = 0.008) and had higher Charlson Comorbidity Index 10-year estimated survival (93% vs. 81%, P < 0.001). Smokers had a lower proportion of S. epidermidis infections (11% vs. 20%, P = 0.037), higher risk of nonunion after index fracture surgery (74% vs. 61%, P = 0.018), and higher risk of sinus tracts at FRI presentation (38% vs. 23%, P = 0.004). On multivariable analysis, smoking was not found to be associated with increased odds of MRSA infection. Among patients who develop a FRI, smokers seemed to have better baseline health regarding age, body mass index, diabetes mellitus, and Charlson Comorbidity Index 10-year estimated survival compared with nonsmokers. Smoking status was not significantly associated with odds of MRSA infection. However, smoking status was associated with increased risk of sinus tract development and nonunion and lower rates of S. epidermidis infection at the time of FRI reoperation. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Clinical Characteristics and Frequency of Chronic Obstructive Pulmonary Disease Exacerbations in Korean Patients: Findings From the KOCOSS Cohort 2012-2021.

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) exert a substantial burden on patients and healthcare systems; however, data related to the frequency of AECOPD in the Korean population are limited. Therefore, this study aimed to describe the frequency of severe, and moderate or severe AECOPD, as well as clinical and demographic characteristics of patients with chronic obstructive pulmonary disease (COPD) in South Korea. Data from patients aged > 40 years with post-bronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity ≤ 70% of the normal predicted value from the Korea COPD Subgroup Study database were analyzed (April 2012 to 2021). The protocol was based on the EXAcerbations of COPD and their OutcomeS International study. Data were collected retrospectively for year 0 (0-12 months before study enrollment) based on patient recall, and prospectively during years 1, 2, and 3 (0-12, 13-24, and 25-36 months after study enrollment, respectively). The data were summarized using descriptive statistics. Data from 3,477 Korean patients (mean age, 68.5 years) with COPD were analyzed. Overall, most patients were male (92.3%), former or current smokers (90.8%), had a modified Medical Research Council dyspnea scale score ≥ 1 (83.3%), and had moderate airflow limitation (54.4%). The mean body mass index (BMI) of the study population was 23.1 kg/m², and 27.6% were obese or overweight. Hypertension was the most common comorbidity (37.6%). The mean blood eosinophil count was 226.8 cells/μL, with 21.9% of patients having ≥ 300 cells/μL. A clinically insignificant change in FEV1 (+1.4%) was observed a year after enrollment. Overall, patients experienced a mean of 0.2 severe annual AECOPD and approximately 1.1 mean moderate or severe AECOPD. Notably, the rates of severe AECOPD remained generally consistent over time. Compared with patients with no exacerbations, patients who experienced severe exacerbations had a lower mean BMI (21.7 vs. 23.1 kg/m²; P < 0.001) and lower lung function parameters (all P values < 0.001), but reported high rates of depression (25.5% vs. 15.1%; P = 0.044) and anxiety (37.3% vs. 16.7%; P < 0.001) as a comorbidity. Findings from this Korean cohort of patients with COPD indicated a high exacerbation burden, which may be attributable to the unique characteristics of the study population and suboptimal disease management. This highlights the need to align clinical practices with the latest treatment recommendations to alleviate AECOPD burden in Korea. ClinicalTrials.gov Identifier: NCT05750810.

Assessment of Metformin Intolerance: A Retrospective Chart Review.

Objective: The aim of the present study is to determine similarities between patients with type 2 diabetes not on metformin therapy compared to patients on metformin therapy at a resident-led primary care clinic. Methods: An exploratory, single-center retrospective chart review was performed on patients 18 years and older with a documented diagnosis of type 2 diabetes seen at the University of Arkansas for Medical Sciences Family Medicine Clinic in Little Rock, Arkansas. Of the 2452 patients who met criteria for the study, 1085 patients did not have a documented metformin allergy. A subset of 216 patients who were not currently prescribed metformin and had no documented metformin allergy were further examined and compared to the 869 patients who were prescribed metformin. We sought to determine reasons for nonuse by evaluating their EPIC electronic health record. Information on these patients such as race, gender, hemoglobin A1c (A1c), kidney function, stated metformin intolerance, and comorbid disease states such as neuropathy, chronic kidney disease (CKD), ulcerative colitis, and irritable bowel syndrome were collected. Further examination was performed to determine why patients were not on metformin therapy and potential similarities between metformin intolerant patients. Results: The results of the study indicated a significant difference between metformin users and non-users in relation to body mass index (BMI) and diagnosis of CKD. Metformin non-users were found to have significantly lower mean BMI (30.87 vs. 35.43; p-value <0.0001), and significantly higher rates of CKD (25.93% vs 14.73%; p-value <0.0001) as compared to metformin users. BMI value of patients (coefficient: 0.2033, p value: <0.0001) was found to be significantly and positively correlated with metformin use, and CKD (coefficient: - 0.1191, p-value: <0.0001) was found to be significantly and negatively correlated with metformin use. A1c levels for patients not on metformin therapy were evaluated. Most non-metformin patients fell in prediabetic A1c levels ranging from 5-6.4% (84 patients; 38.89%), and 31 patients (14.35%) should be on insulin therapy according to guidelines. Conclusion: The results demonstrated that patients with lower BMI, CKD, or A1c in the prediabetic range were less likely to be prescribed metformin.

Abstract B065: Percent mammographic density and breast cancer risk among U.S. Black women

Abstract Background: High mammographic density is a well-established risk factor for breast cancer. A few studies have suggested a difference in mammographic density by race wherein Black women – who have a high risk of aggressive breast cancer subtypes – are more likely to have dense breasts compared to women of other racial/ethnic groups. It is unknown whether mammographic density may contribute to differences in breast cancer risk by tumor hormone subtype across race and ethnicity. Methods: We used a case-cohort study design to examine the association between percent mammographic density (PMD) and breast cancer risk among Black women in the United States using data from the Black Women’s Health Study (BWHS). Our study consisted of 5,904 women with digital screening (i.e., pre-diagnostic) mammograms of which 363 (6.15%) were women with breast cancer (cases) and 5,541 (93.85%) were women without breast cancer (non-cases). We used Cumulus to assess PMD. Quartiles for PMD were determined based on the distribution in the non-cases. We used logistic regression, adjusted for age and body mass index (BMI) at mammography, to estimate relative risks (RRs) and 95% confidence intervals (CIs) for the association of PMD with breast cancer overall and by estrogen receptor (ER) status. Fully adjusted models additionally included other established breast cancer risk factors. We also stratified analyses by age at mammography (&amp;lt;55 vs. ≥ 55 years). Results: The mean age at mammography was 56 years for both cases and non-cases and approximately 70% of participants were postmenopausal. Cases had a lower mean BMI at age 18 years (20.9 kg/m2) compared to non-cases (21.4 kg/m2), while there was no difference in mean BMI at mammography between cases and non-cases. As expected, cases were more likely than non-cases to have a family history of breast cancer (25% vs. 19%). Additionally, cases had a higher mean PMD than did non-cases (26.3% vs. 24.5%). Overall, women in the highest quartile of PMD had a 58% higher risk of breast cancer compared to those in the lowest quartile (RRQ4vsQ1 1.58; 95% CI: 1.14, 2.18). Corresponding RRs were 1.46 (95% CI: 0.99, 2.14) for ER+ cancer and 1.57 (95% CI: 0.79, 3.14) for ER– cancer. Among women under 55 years of age, the RR for the highest quartile of PMD relative to the lowest quartile was 1.35, 95% CI: 0.83, 2.19). Among the older women, the comparable RR was 1.75, 95% CI: 1.13, 2.69). Associations were largely unchanged in multivariable models. Conclusion: In the largest study of mammographic density in U.S. Black women to date, we confirmed that higher PMD is associated with both ER+ and ER– breast cancer risk in this population. Associations were statistically significant among women ≥55 years of age. Findings from this study reinforce the importance of breast density as a risk factor for breast cancer across racial/ethnic groups. Citation Format: Etienne X. Holder, Zahna Bigham, Kerrie P. Nelson, Julie R. Palmer, Kimberly A. Bertrand. Percent mammographic density and breast cancer risk among U.S. Black women [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B065.

1579. Incidence and Predicting Factors of Opportunistic Infections after Initiation of Antiretroviral Therapy: A Retrospective Cohort Study

Abstract Background Antiretroviral therapy (ART)-associated opportunistic infections (OIs) is the term proposed to encompass all OIs diagnosed after ART initiation, and it is not uncommon. We aimed to determine the incidence of OIs and the predicting factors for OIs developing after ART initiation among Thai people living with HIV (PLHIV). Methods In the university hospital setting, a retrospective cohort study was conducted among naïve PLHIV who initiated ART between January 2016 and December 2019. Results A total of 401 PLHIV were included in the analysis. Of these, the mean (SD) age was 37.1 (11.9) years, 74.3% were male, and 57.6% had heterosexual risk. There were 247 (61.6%) diagnosed with AIDS and a median (IQR) CD4 count at ART initiation was 166 (49-314) cells/µL. The most common prior OIs were tuberculosis (26.4%) and Pneumocystis jirovecii pneumonia (11.5%). Of all, 38 (9.5%) PLHIV developed OIs after initiating ART with an incidence rate of 25.6/1000 person-years. The median time (IQR) from ART initiation to the OIs occurrence was 26.5 (14-73) days. PLHIV who develop OI after ART initiation were more likely to have lower mean body mass index (BMI) (20.1 vs 22.3 kg/m2), lower median CD4 counts (36 vs 188 cells/µL), lower mean hemoglobin levels (10.8 vs 12.4 mg/dL), a higher proportion of AIDS diagnosis (86.5% vs 57.9%), having prior OIs (78.9% vs 35.5%), and a higher proportion of initiation with dolutegravir (DTG)-based regimen (10.5% vs 3%) (p &amp;lt; 0.05, all). By multivariate Cox proportional hazard regression, having BMI ≤18.5 kg/m2 (aHR 2.28; 95% CI 1.18-4.42, p=0.015), symptomatic at presentation (aHR 13.59; 95% CI 3.24-56.9, p &amp;lt; 0.001), SGPT &amp;gt;55 U/L (aHR 2.09; 95% CI 1.06-4.15, p=0.035), and initiation with DTG-based regimen (aHR 4.39, 95% CI 1.54-12.48, p=0.006) were statistically significant associated OIs after ART initiation. The OI-associated mortality was 5.3%. Conclusion The OIs after ART initiation are not uncommon. Malnutrition, symptomatic at presentation, abnormal liver enzyme, and initiation with DTG-based regimens is predicting factors of OI occurrences. It is crucial for physicians to monitor and appropriate treatment of OIs after ART initiation. Disclosures All Authors: No reported disclosures

Compliance with U.S. Government Nutrition Advice and Concurrent Obesity Trends Using Nurses' Health Study Data, 1980–2011

BackgroundBeginning in 1977, the U.S. Government began formally issuing dietary advice, a main objective of which was to reduce and prevent the prevalence of obesity in the American population. Concurrently, the Harvard School of Public Health began conducting dietary intake surveys and collecting body mass index (BMI) (kg/m2) data on female nurses in the Nurses’ Health Study I (NHSI) and II (NHSII). ObjectivesWe aimed to assess whether compliance with the nutrition guidance from the U.S. Government to restrict dietary intake regarding total fat, saturated fat, and cholesterol was meaningfully associated with the prevalence of obesity. MethodsWe analyzed nutrition survey data from 1980 to 2011, grouping the sample into “compliers,” those who complied with guidance on the intake of total fat, saturated fat, and cholesterol, and “noncompliers,” those who did not. We then compared the means, medians, and distributions of BMI for compliers and noncompliers over the period for both the full survey population and an age-controlled sample. Finally, we plotted raw NHS data to examine respondents’ Fat Proportion intake of energy and concurrent BMI. ResultsThe mean and median BMI for both compliers and noncompliers increased throughout the sample period, and the BMI distributions shifted toward obese and severely obese overall and for an age-controlled subset compared with the 1980 NHSI and 1990 NHSII baselines. Compliers had slightly lower mean BMI increases than noncompliers but saw a relatively higher increase in the growth of the prevalence of those with BMI >30. We also found no linear relationship between Fat Proportion of energy intake and concurrent BMI. ConclusionsGuidance from the U.S. Government to limit fat, saturated fat, and cholesterol consumption was widely adopted by American female nurses during the study period. Our results show that compliance with this guidance had little if any effect in mitigating population-wide BMI increases during our study period.

The real-world data of lipid-lowering treatment in patients with peripheral artery disease and its association with severity of disease

BackgroundThe risk of coronary artery disease in peripheral arterial disease (PAD) is high, life prognosis is poor, and lipid-lowering treatment with statins has been reported to improve prognosis. In clinical practice, however, hypolipidemia is more common in patients with severe PAD and statin prescription rates appear to be low, but specific data are scarce in Japan. Therefore, we conducted this cross-sectional study in collaboration with other centers of vascular surgery to determine the rate of statin prescriptions for PAD patients in real-world practice, the rate of achievement of low-density lipoprotein (LDL) cholesterol control targets, and whether statin non-use is a determinant factor of critical limb ischemia (CLI). MethodsA total of 246 PAD patients (97 with CLI) from 5 sites were included in this study. Medical history and blood test data were obtained from medical records and interviews with patients, and were compared between CLI and non-CLI patients. ResultsStatin prescription rate was only 34 %. The overall LDL cholesterol control target rate was 46 % of CLI cases and 51 % of non-CLI cases, according to the lipid management criteria of the Japanese Society for Atherosclerosis 2022 guidelines. Patients in the CLI group had a lower mean body mass index and lower LDL cholesterol levels than those in the non-CLI group, suggesting that these factors were responsible for the lower statin prescription rate. However, multivariate analysis revealed that statin non-use was one of the determinants of CLI. ConclusionsStatin prescription rates for PAD patients were low in real-world practice settings in the field of vascular surgery. Since statin non-use is a determinant of CLI, there is a need to educate physicians engaged in treatment regarding lipid-lowering treatment with statins.

Don't hold PAT: watch for and correct oximetry artifact.

Plante DT, Rumble ME. Don't hold PAT: watch for and correct oximetry artifact. J Clin Sleep Med. 2023;19(12):2113-2116.

Association between maternal hyperglycemia in pregnancy and offspring anthropometry in early childhood: the pandora wave 1 study.

In-utero hyperglycemia exposure influences later cardiometabolic risk, although few studies include women with pre-existing type 2 diabetes (T2D) or assess maternal body mass index (BMI) as a potential confounder. To explore the association of maternal T2D and gestational diabetes mellitus (GDM) with childhood anthropometry, and the influence of maternal BMI on these associations. The PANDORA cohort comprises women (n = 1138) and children (n = 1163). Women with GDM and T2D were recruited from a hyperglycemia in pregnancy register, and women with normoglycemia from the community. Wave 1 follow-up included 423 children, aged 1.5-5 years (median follow-up age 2.5 years). Multivariable linear regression assessed associations between maternal antenatal variables, including BMI and glycemic status, with offspring anthropometry (weight, height, BMI, skinfold thicknesses, waist, arm and head circumferences). Greater maternal antenatal BMI was associated with increased anthropometric measures in offspring independent of maternal glycemic status. After adjustment, including for maternal BMI, children exposed to maternal GDM had lower mean weight (-0.54 kg, 95% CI: -0.99, -0.11), BMI (-0.55 kg/m2, 95% CI: -0.91, -0.20), head (-0.52 cm, 95% CI: -0.88, -0.16) and mid-upper arm (-0.32 cm, 95% CI: -0.63, -0.01) circumferences, and greater mean suprailiac skinfold (0.78 mm, 95% CI: 0.13, 1.43), compared to children exposed to normoglycemia. Adjustment for maternal BMI strengthened the negative association between GDM and child weight, BMI and circumferences. Children exposed to maternal T2D had smaller mean head circumference (-0.82 cm, 95% CI: -1.33, -0.31) than children exposed to normoglycemia. Maternal T2D was no longer associated with greater child mean skinfolds (p = 0.14) or waist circumference (p = 0.18) after adjustment for maternal BMI. Children exposed to GDM had greater suprailiac skinfold thickness than unexposed children, despite having lower mean weight, BMI and mid-upper arm circumference, and both GDM and T2D were associated with smaller mean head circumference. Future research should assess whether childhood anthropometric differences influence lifetime cardiometabolic and neurodevelopmental risk.

Comparison of survival outcomes between de novo and recurrent stage IV gastric cancers: A retrospective cohort study

Purpose: This study analyzes the characteristics and prognosis of patients with &lt;i&gt;de novo&lt;/i&gt; and recurrent metastatic gastric cancers.Methods: This retrospective study included 301 advanced, pathologically confirmed gastric cancer patients who received palliative chemotherapy between 2012 and 2022. The &lt;i&gt;de novo&lt;/i&gt; cohort included patients who presented with distant metastasis at diagnosis, and the recurrent metastatic cohort was composed of patients with metastasis after curative gastrectomy. We analyzed prognostic association by Cox regression and compared survival time of both cohorts using the Kaplan-Meier survival analysis.Results: The study included 167 &lt;i&gt;de novo&lt;/i&gt; and 112 recurrent patients. No differences were noted among the patients with &lt;i&gt;de novo&lt;/i&gt; disease and recurrent metastatic disease concerning age, sex, Eastern Cooperative Oncology Group scores, primary cancer location, and pathologic features. Patients in the recurrent group versus the &lt;i&gt;de novo&lt;/i&gt; group had a longer duration of chemotherapy (1.16±1.18 years vs. 0.85±0.84 years, P= 0.01) and lower mean body mass index (20.22±2.78 kg/m&lt;sup&gt;2&lt;/sup&gt; vs. 21.93±3.38 kg/m&lt;sup&gt;2&lt;/sup&gt;, P&lt; 0.001). The median overall survival in the &lt;i&gt;de novo&lt;/i&gt; group was 11.6 versus 14.4 months in the recurrent group (P= 0.02).Conclusion: &lt;i&gt;De novo&lt;/i&gt; and recurrent metastatic gastric cancer are characterized by distinct subpopulations. Advanced gastric cancer patients with recurrence have significantly better survival versus those in the de novo cohort. The differences between de novo and recurrent gastric cancer patient outcomes could facilitate discussions about the selection of the clinical trial of each patient and help with their personalized treatment.

Barotrauma in COVID-19 acute respiratory distress syndrome: retrospective analysis of the COVADIS prospective multicenter observational database

BackgroundDespite evidence suggesting a higher risk of barotrauma during COVID-19-related acute respiratory distress syndrome (ARDS) compared to ARDS due to other causes, data are limited about possible associations with patient characteristics, ventilation strategy, and survival.MethodsThis prospective observational multicenter study included consecutive patients with moderate-to-severe COVID-19 ARDS requiring invasive mechanical ventilation and managed at any of 12 centers in France and Belgium between March and December 2020. The primary objective was to determine whether barotrauma was associated with ICU mortality (censored on day 90), and the secondary objective was to identify factors associated with barotrauma.ResultsOf 586 patients, 48 (8.2%) experienced barotrauma, including 35 with pneumothorax, 23 with pneumomediastinum, 1 with pneumoperitoneum, and 6 with subcutaneous emphysema. Median time from mechanical ventilation initiation to barotrauma detection was 3 [0–17] days. All patients received protective ventilation and nearly half (23/48) were in volume-controlled mode. Barotrauma was associated with higher hospital mortality (P < 0.001) even after adjustment on age, sex, comorbidities, PaO2/FiO2 at intubation, plateau pressure at intubation, and center (P < 0.05). The group with barotrauma had a lower mean body mass index (28.6 ± 5.8 vs. 30.3 ± 5.9, P = 0.03) and a higher proportion of patients given corticosteroids (87.5% vs. 63.4%, P = 0.001).ConclusionBarotrauma during mechanical ventilation for COVID-19 ARDS was associated with higher hospital mortality.

Twelve-month effectiveness of telephone and SMS support to mothers with children aged 2 years in reducing children’s BMI: a randomized controlled trial

Background/objectivesFew quality intervention studies have assessed whether a combined telephone and short message service (SMS) intervention to mothers is effective in reducing BMI and obesity risk behaviors of children at 3 years of age. This study aimed to assess effectiveness of telephone and SMS support in reducing children’s body mass index (BMI) and obesity risk behaviors.Subjects/MethodsA randomized controlled trial (RCT) with 662 women of 2-year-old children (with the proportion of overweight and obesity being similar to the general population) was conducted in Sydney, Australia, March 2019–October 2020. The mothers in the intervention group received three telephone support sessions plus SMS messages and mailed-intervention-booklets over a 12 months period i.e., 24–26, 28–30, and 32–34 months of the child’s age. Mothers in the control group received usual care and two mailed booklets on information not related to the intervention. The primary outcome was child’s BMI at 3 years of age. Secondary outcomes were children’s dietary and activity behaviors. All outcome measures were based on mothers’ self-report using standardized tools due to COVID-19 pandemic restrictions.Results537 (81%) mothers completed the post-intervention assessment at 3 years with only 470 (71%) children having weight and height measures. Multiple imputation analysis showed no statistically significant difference in mean BMI between the groups. Children in the intervention group were more likely not to eat in front of the TV [AOR 1.79 (95% CI 1.17–2.73), P = 0.008], more likely to meet the dietary recommendations [AOR 1.73 (95% CI 0.99–3.02), P = 0.054] and meet the activity recommendations [AOR 1.72 (95% CI 1.11–2.67), P = 0.015] than those in the control group respectively. Among those with an annual household income (<AUD$80,000), the intervention was significantly associated with a lower mean BMI [16.26 (SD 2.22) kg.m−2] in the intervention group than [16.84 (SD 2.37)] in the control, a difference of −0.59 kg/m2 (95% CI: −1.15 to −0.03, P = 0.040).ConclusionsA staged telephone and SMS support intervention to mothers with children aged 2 years was associated with improved dietary and activity behaviors. The intervention was also associated with reduced children’s BMI at age 3 years only for those from lower income households.Trial registrationThe trial is registered with the Australian Clinical Trial Registry (ACTRN12618001571268)

IGlarLixi (insulin glargine 100U/ml plus lixisenatide) is effective and well tolerated in people with uncontrolled type 2 diabetes regardless of age: A REALI pooled analysis of prospective real-world data.

To evaluate the effectiveness and safety in routine clinical practice of insulin glargine/lixisenatide (iGlarLixi) in people with type 2 diabetes (T2D) according to age. Patient-level data were pooled from 1316 adults with T2D inadequately controlled on oral antidiabetic drugs with or without basal insulin who initiated iGlarLixi for 24 weeks. Participants were classified into age subgroups of younger than 65 years (N=806) and 65 years or older (N=510). Compared with participants aged younger than 65 years, those aged 65 years or older had a numerically lower mean body mass index (31.6 vs. 32.6 kg/m2 ), a longer median diabetes duration (11.0 vs. 8.0 years), were more likely to receive prior basal insulin (48.4% vs. 43.5%) and had a lower mean HbA1c (8.93% [74.10 mmol/mol] vs. 9.22% [77.28 mmol/mol]). Similar and clinically relevant reductions in HbA1c and fasting plasma glucose from baseline to week 24 of iGlarLixi therapy were observed regardless of age. At 24 weeks, least-squares adjusted mean (95% confidence interval [CI]) change in HbA1c from baseline was -1.55% (-1.65% to -1.44%) in those aged 65 years or older and -1.42% (-1.50% to -1.33%) in those aged younger than 65 years (95% CI: -0.26% to 0.00%; P=.058 between subgroups). Low incidences of gastrointestinal adverse events and hypoglycaemic episodes were reported in both age subgroups. iGlarLixi decreased mean body weight from baseline to week 24 in both subgroups (-1.6 kg in those aged ≥ 65 years and -2.0 kg in those aged < 65 years). iGlarLixi is effective and well tolerated in both younger and older people with uncontrolled T2D.