Low Body Mass Index Group Research Articles

Impact of Surgeon's Surgical Experience on Outcomes After Laparoscopic Distal Gastrectomy in High Body Mass Index Patients.

The aim of this study was to evaluate the impact of surgical experience on laparoscopic distal gastrectomy in high body mass index (BMI) patients. Retrospective data were collected on patients who underwent laparoscopic distal gastrectomy for early gastric cancer from July 2002 to December 2014. Patients were divided into a high BMI group (BMI≥25 kg/m) and a low BMI group (BMI<25 kg/m) and classified into subgroups by surgeon experience. Patient characteristics and surgical outcomes between groups were analyzed and compared. Mean operation time in the high BMI group was longer than the low BMI group (173.0±52.5 vs. 164.2±48.0 min; P=0.009). Subgroup analysis showed longer operation time in the high BMI group than the low BMI group (200.8±49.3 vs. 187.9±45.2 min; P<0.001) and fewer retrieved lymph nodes (36.3±11.7 vs. 33.0±13.1; P=0.004) in the early surgeon experience period. Patients in the late experience period showed no significant differences in surgical outcomes between the high BMI and low BMI group. High BMI did not influence surgical outcomes of laparoscopic distal gastrectomy after accumulation of surgical experience.

Positive Predictive Value of Noninvasive Stress Testing Is Poor in the Real World.

Abnormal noninvasive stress test (NIST) findings do not always correlate with angiographically significant (luminal obstruction ≥50%) coronary artery disease. Positive predictive value (PPV) of NIST in the real clinical practice is not well known. The goal of this retrospective study was to determine the PPV of NIST and assess the factors affecting PPV in a US community hospital. This study included all consecutive patients (n = 355) who underwent invasive coronary angiography after a positive NIST within ~1-year duration at our institution. Three hundred twenty-four patients were included in the analysis after exclusion of 31 patients. Sixty percent of patients were female and mean age was 63.2 (SD 12.4). Myocardial perfusion imaging, echocardiogram (treadmill or dobutamine), and treadmill electrocardiogram were the tests of choice in 95% (n = 307), 4% (n = 14), and 1% (n = 3) of patients, respectively. Overall PPV of NIST was 36.4% (118/324). When patients were stratified by age (<50 years, 50-65 years, ≥65 years), older age groups had significantly higher PPV (<0.001). When patients were grouped by body mass index (<25, 25-30, ≥30), those in lower body mass index groups had higher PPV (P = 0.01). Stress echocardiogram had significantly higher PPV compared with myocardial perfusion imaging stress test (71% vs. 35%; P < 0.005). Stress test site (in-hospital vs. outpatient office) or specialty of interpreting physician did not significantly impact PPV. Multivariable logistic regression analysis revealed that older age, male sex, and total number of cardiac risk factors were significant determinants of higher PPV. Our single-center study revealed that overall PPV of NIST is poor (36.4%), more notably in young, female, or obese patients.

The Predictive Factors for Diabetic Remission in Chinese Patients with BMI > 30kg/m2 and BMI < 30kg/m2 Are Different.

Roux-en-Y gastric bypass has been proven to be beneficial for patients with obesity and type 2 diabetes mellitus (T2DM). In less-obese patient (BMI 30-35kg/m2), surgical treatment is indicated when medication fails to control the T2DM. Asian develops diabetes at a lower BMI. For lower-BMI patients, the rate of diabetes amelioration varies significantly with patients of higher BMI after surgical treatment. The factors that contribute to the post-operative diabetes response rate in lower-BMI patients have not been elucidated. Between 2010 and 2014, a total of 144 patients who underwent gastric bypass for the treatment of T2DM were included for study. Patients were divided into two groups for subgroup analysis, namely BMI > 30kg/m2 and BMI < 30kg/m2. Factors affecting the remission rate were examined. Of the studied patients, the DM remission rate for the high-BMI group (BMI > 30kg/m2) was 80% (n = 90) whereas for the lower BMI (BMI < 30kg/m2) was 50% (n = 54), p < 0.001. For high-BMI group, low HbA1c and high fasting C-peptide are predictive factors whereas for lower-BMI group, along with elevated C-peptide level, disease duration is the positive predictive factor for DM remission. Patients with BMI > 30kg/m2 and those with BMI < 30kg/m2 have distinct remission predicting factors. Low HbA1c is a predictor of remission in low-high-BMI patients while duration of diabetes is for high-low-BMI patients. C-peptide is a predictor of remission in both groups. Further large-scale studies are required to define the predictors of diabetes remission after gastric bypass in low- and high-BMI patients.

The Impact of Preoperative Low Body Mass Index on Postoperative Complications and Long-term Survival Outcomes in Gastric Cancer Patients.

PurposeThe aim of this study was to investigate the impact of preoperative low body mass index (BMI) on both the short- and long-term outcomes in patients with gastric cancer.Materials and MethodsA total of 510 patients with gastric cancer were divided into the following 3 groups: low BMI group (≤18.5 kg/m2, n=51), normal BMI group (18.6–24.9 kg/m2, n=308), and high BMI group (≥25.0 kg/m2, n=151).ResultsThere were significantly more stage III/IV patients in the low BMI group than in the other groups (P=0.001). Severe postoperative complications were more frequent (P=0.010) and the survival was worse (P<0.001) in the low BMI group. The subgroup analysis indicated that survival was worse in the low BMI group of the stage I/II subgroup (P=0.008). The severe postoperative complication rate was higher in the low BMI group of the stage III/IV subgroup (P=0.001), although the recurrence rate and survival did not differ in the stage III/IV subgroup among all the BMI groups. Low BMI was an independent poor prognostic factor in the stage I/II subgroup (disease-free survival: hazard ratio [HR], 13.521; 95% confidence interval [CI], 1.186–154.197; P=0.036 and overall survival: HR, 5.130; 95% CI, 1.644–16.010; P=0.005), whereas low BMI was an independent risk factor for severe postoperative complications in the stage III/IV subgroup (HR, 17.158; 95% CI, 1.383–212.940; P=0.027).ConclusionsPreoperative low BMI in patients with gastric cancer adversely affects survival among those with stage I/II disease and increases the severe postoperative complication rate among those with stage III/IV disease.

Size-Specific Dose Estimation In the Korean Lung Cancer Screening Project: Does a 32-cm Diameter Phantom Represent a Standard-Sized Patient in Korean Population?

ObjectiveThe purposes of this study were to evaluate size-specific dose estimate (SSDE) of low-dose CT (LDCT) in the Korean Lung Cancer Screening (K-LUCAS) project and to determine whether CT protocols from Western countries are appropriate for lung cancer screening in Korea.Materials and MethodsFor participants (n = 256, four institutions) of K-LUCAS pilot study, volume CT dose index (CTDIvol) using a 32-cm diameter reference phantom was compared with SSDE, which was recalculated from CTDIvol using size-dependent conversion factor (f-size) based on the body size, as described in the American Association of Physicists in Medicine Report 204. This comparison was subsequently assessed by body mass index (BMI) levels (underweight/normal vs. overweight/obese), and automatic exposure control (AEC) adaptation (yes/no).ResultsSize-specific dose estimate was higher than CTDIvol (2.22 ± 0.75 mGy vs. 1.67 ± 0.60 mGy, p < 0.001), since the f-size was larger than 1.0 for all participants. The ratio of SSDE to CTDIvol was higher in lower BMI groups; 1.26, 1.37, 1.43, and 1.53 in the obese (n = 103), overweight (n = 70), normal (n = 75), and underweight (n = 4), respectively. The ratio of SSDE to CTDIvol was greater in standard-sized participants than in large-sized participants independent of AEC adaptation; with AEC, SSDE/CTDIvol in large- vs. standard-sized participants: 1.30 ± 0.08 vs. 1.44 ± 0.08 (p < 0.001) and without AEC, 1.32 ± 0.08 vs. 1.42 ± 0.06 (p < 0.001).ConclusionVolume CT dose index based on a reference phantom underestimates radiation exposure of LDCT in standard-sized Korean participants. The optimal radiation dose limit needs to be verified for standard-sized Korean participants.

Recommendations of Lifestyle Modification According to a Survey of First-Year University Students.

BackgroundWe analyzed what kind of lifestyle modification first-year university students need based on the results of a health-consciousness survey conducted in first-year students immediately after they entered a university.MethodsThis population-based cross-sectional study used a “questionnaire survey on lifestyle and health for promoting health” conducted in Japan in 2015. From among an initial pool of 3,912 students, we excluded 314 due to insufficient data. The remaining 3,598 students (2,206 males and 1,392 females) were divided into four groups according to body mass index (BMI) based on Japan Society for the Study of Obesity “Guidelines for the management of obesity disease 2016”: low (18.5 > BMI), less than standard (22.0 > BMI ≥ 18.5), standard or higher (25.0 > BMI ≥ 22.0) and obesity (BMI ≥ 25.0).ResultsFemales had an ideal body image that was at a lower body weight regardless of their BMI. Males in the low BMI and obesity groups tended to be less aware of health issues. For each level of BMI, and in both males and females, the most frequent report of stress was “sometimes feel”. The most frequent method for relieving stress was spending time with friends. Among males, those in the obesity group spent more time with “personal computers, televisions and games, etc.” in a sitting position. When students were asked to rank which of their lifestyle habits needed the most improvement, “lack of exercise” was the highest, followed by “irregular schedule” and “dietary habits”. In daily living behavior, a significant difference was observed for “exercise” among males, but not females.ConclusionThe attitudes of both males and females regarding the importance of physical activity and the necessity of efforts to improve health are presented. Health education for university students based on the attitudes may be useful for the prevention of lifestyle-related diseases for themselves in the future and before they become parents.

Platelet to lymphocyte ratio in peripheral blood and body mass index: novel independent prognostic factors in patients with melanoma

Objective: To investigate whether platelet to lymphocyte ratio (PLR) in peripheral blood and body mass index (BMI) can be independent prognostic factors in patients with melanoma. Methods: Clinical date of 140 patients with melanoma in the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital from January 1, 2010 to December 31, 2015 were analyzed retrospectively.Receiver operating characteristic (ROC) curve was performed the optimal cut-off value for PLR.The 140 patients were divided into high PLR group and low PLR group.According to "Guidelines for prevention and control of overweight and obesity in Chinese adults" , the patients were divided into high BMI group and low BMI group.The relationship between PLR, BMI with overall survival (OS), progression free survival (PFS) and disease free survival (DFS) were analyzed.The Kaplan-Meier method and Log rank test was used for univariate survival analysis and Cox proportional hazards regression model for multivariate analysis. Results: The optimal cut-off value of PLR determined by ROC curve was PLR=120.15, and BMI threshold was 24.Univariate survival analysis showed that PLR, BMI and clinical stage were the factors affecting the OS in patients (P<0.05). The median survival time (MST) was 21 months in the whole group and 17 months in the high PLR group, 34 months in the low PLR group, respectively; the MST in the high and low BMI group were 29 months and 13 months, respectively.The difference was statistically significant (P<0.05). The effects of PLR and BMI on PFS and DFS were not statistically significant.Cox multivariate analysis showed that PLR, BMI and clinical stage were independent prognostic factors of OS (P<0.05). And BMI was the only independent protective factor for OS, the risk of death decreased by 0.611 times, with each unit increased for BMI.Clinical subgroup analysis showed that PLR also was risk factor to the prognosis of patients with stage Ⅱ, Ⅲ, and Ⅳ (P<0.05). Conclusions: PLR is an independent prognostic risk factor for patients with melanoma, and BMI is an independent protective factor.PLR and BMI are important factors in prognostic evaluation of melanoma.

Quadriceps muscle fat infiltration is associated with cardiometabolic risk in COPD.

Losses of peripheral muscle mass and ectopic fat accumulation have been associated with cardiometabolic morbidity in COPD. We aimed at identifying the relationship between quadriceps muscle fat infiltration and cardiovascular risk. From 2009 to 2014, 78 COPD patients (64±8years; 80% male) were prospectively included after having given written consent (ethical committee approval number: 2006-A00491-50). The cohort was divided into three groups (tertiles) according to body mass index (BMI), low [15<BMI≤23·3], middle [23·3<BMI≤27·6] and high [27·6<BMI≤36] kg/m²). Measurements were respiratory function, plasmatic biomarkers and surrogate markers of cardiovascular risk (arterial stiffness and endothelial function). Mid-thigh quadriceps muscle volume and per cent of muscle fat infiltration, as assessed by 64-slice CT scanning, were compared between the tertiles. ANOVA or Kruskal-Wallis tests were used for statistical analyses with Bonferroni's correction for the 'post hoc' tests. Intramuscular fat volume was 52% [95% CI, 43 to 60%] of total quadriceps volume in high BMI vs. 47% [38 to 55%] and 34% [29 to 38%] in the middle and low-BMI groups, respectively (P<0·0001), without differences between groups in fat-free muscle volumes. Elevated muscle fat infiltration correlated with lower thiol to protein ratios in the whole population reflecting impaired antioxidant capacity (r=0·50; P=0·009). Furthermore, muscle fat infiltration was linked to endothelial dysfunction (r=-0·49, P=0·01) in the low-BMI group. Skeletal muscle fat infiltration may be an indicator of increased cardiometabolic risk in both obese and lean COPD patients.

Body weight–dependent relationships between alcohol consumption and pulse pressure in middle-aged Japanese women

High pulse pressure is a risk factor for cardiovascular disease, and excessive alcohol drinking increases the risk of hypertension. The purpose of this study was to elucidate the relationship between alcohol intake and pulse pressure in women and to determine whether body weight influences their relationship. The subjects were 18,791 Japanese middle-aged women, and they were divided into tertile groups for body weight or three different body mass index (BMI, kg/m2) groups (low BMI <22; middle BMI ≥22 and <25; high BMI ≥25). The subjects in each group were further divided into four groups of nondrinkers, occasional drinkers, regular light drinkers, and regular heavy drinkers by habitual alcohol consumption. Pulse pressure levels were compared between nondrinkers and drinkers in each group for body weight or BMI. Pulse pressure was significantly higher in regular heavy drinkers than in nondrinkers in the first tertile group for body weight and in the low BMI group but not in the second and third tertile groups for body weight and in the middle and high BMI groups. In all tertile groups and all BMI groups, pulse pressure was not significantly different in occasional drinkers and regular light drinkers than in nondrinkers. In women with lower body weight, heavy drinking was positively associated with pulse pressure, while this association was not found in women with middle or higher body weight. Thus, body weight potently confounds the relationship between alcohol consumption and pulse pressure.

The prognostic value of preoperative inflammation-based prognostic scores and nutritional status for overall survival in resected patients with nonmetastatic Siewert type II/III adenocarcinoma of esophagogastric junction.

Background:Immune and nutritional status of patients have been reported to predict postoperative complications, recurrence, and prognosis of patients with cancer. Therefore, this retrospective study aimed to explore the prognostic value of preoperative inflammation-based prognostic scores [neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR)] and nutritional status [prognostic nutritional index (PNI), body mass index (BMI), hemoglobin, albumin, and prealbumin] for overall survival (OS) in adenocarcinoma of esophagogastric junction (AEG) patients.Methods:A total of 355 patients diagnosed with Siewert type II/III AEG and underwent surgery between October 2010 and December 2011 were followed up until October 2016. Receiver operating characteristic (ROC) curve analysis was used to determine the cutoff values of NLR, PLR, and PNI. Kaplan–Meier curves and Cox regression analyses were used to calculate the OS characteristics.Results:The ideal cutoff values for predicting OS were 3.5 for NLR, 171 for PLR, and 51.3 for PNI according to the ROC curve. The patients with hemoglobin <120 g/L (P = .001), prealbumin <180 mg/L (P = .000), PNI <51.3 (P = .010), NLR >3.5 (P = .000), PLR >171 (P = .006), and low BMI group (P = .000) had shorter OS. And multivariate survival analysis using the Cox proportional hazards model showed that the tumor-node-metastasis stage, BMI, NLR, and prealbumin levels were independent risk factors for the OS.Conclusion:Our study demonstrated that preoperative prealbumin, BMI, and NLR were independent prognostic factors of AEG patients.

Obesity paradox in heart failure patients - Female gender characteristics-KAMC-single center experience.

Background/IntroductionThe correlation between low body mass index (BMI) and congestive heart failure (obesity paradox) has been described in the literature; However, the association between BMI and clinical outcome measures is not well characterized. Little is known about CHF in the Middle Eastern female population; most of the gender-specific information on heart failure comes from higher income “Western” countries.ObjectivesWe aimed to identify the correlation between heart failure patients especially those with low BMI and clinical/safety outcome measures with focusing on female patients subgroup characteristics.MethodsWe performed group comparisons of statistically relevant variables using prospectively collected data of HFrEF patients hospitalized over a 12 month period.ResultsThe 167 patients (Group I) enrolled by this study with mean age of 59.64 ± 12.9 years, an EF score of 23.96 ± 10.14, 62.9% had ischemic etiology, 12.5% were smoker, 18% had AF, 31.1% had received ICD/CRT-D and an estimated 8.85 ± 9.5 days length of stay (LOS). The low BMI group of patients (Group II) had means age of 58.7 ± 14.5 years, a significant lower EF score of 20.32 ± 8.58, significantly higher 30, 90 days readmission rates and in-house mortality (22%, 36.6% and 17.1% vs 10.2%, 20.4% and 6.6% respectively) and higher rates of CVA, TIA and unexplained syncope (19.5% vs 7.2%). Similarly, female patients with low BMI (Group IV) had lower EF score of 22.0 ± 53, higher 30,90 days readmission rates and in-house mortality (34.4%,43.8% and 25% vs 13.5%,21.6% and 5.4% respectively) and higher rates of CVA, TIA and unexplained syncope(10% vs 0%).ConclusionOur findings showed that heart failure patients with low BMI had poor adverse clinical outcome measures (poor EF, recurrent readmission, mortality and composite rates of CVA, TIA and unexplained syncope) which reflect the effect of obesity paradox in those patients with HFrEF. Female patient subgroup showed similar characteristic findings which also might reflect the value of gender-specific BMI related clinical outcomes.

Effect of Changes in Body Mass Index on Cardiovascular Outcomes in Kidney Transplant Recipients

BackgroundA higher body mass index (BMI) before kidney transplantation (KT) is associated with increased mortality and allograft loss in kidney transplant recipients (KTRs). However, the effect of changes in BMI after KT on these outcomes remains uncertain. The aim of this study was to investigate the effect of baseline BMI and changes in BMI on clinical outcomes in KTRs. MethodsA total of 869 KTRs were enrolled from a multicenter observational cohort study from 2012 to 2015. Patients were divided into low and high BMI groups before KT based on a BMI cutoff point of 23 kg/m2. Differences in acute rejection and cardiovascular disease (CVD) between the 2 groups were analyzed. In addition, clinical outcomes across the 4 BMI groups divided by BMI change 1 year after KT were compared. Associations between BMI change and laboratory findings were also evaluated. ResultsPatients with a higher BMI before KT showed significantly increased CVD after KT (P = .027) compared with patients with a lower BMI. However, among the KTRs with a higher baseline BMI, only persistently higher BMI was associated with increased CVD during the follow-up period (P = .003). Patients with persistently higher BMI had significantly decreased high-density lipoprotein cholesterol and increased hemoglobin, triglyceride, and hemoglobin A1c levels. Baseline BMI and post-transplantation change in BMI were not related to acute rejection in KTRs. ConclusionsBMI in the 1st year after KT as well as baseline BMI were associated with CVD in KTRs. More careful monitoring of obese KTRs who do not undergo a reduction in BMI after KT is required.

Effect of Low Dose Oral Contraceptive Pill on Coagulation Status in Women with Normal and Low Body Mass Index

Background: Oral contraceptive pill (OCP) is widely used by millions of women of various socioeconomic conditions.Use of low dose oestrogen and newer progesterone in OCP now associated with less thromboembolic and cardiovascular risk. The safety aspects of these pills had not been investigated in details in malnourished women of developing countries. In the present study the effects of the pillson coagulation status have been studied.Objective: To explore the effect of the most widely used low dose OCP (Shukhi) on coagulation status of Bangladeshi women with normal and low BMI(Body Mass Index). Materials and Methods: The study population group (n=29) comprised of women with normal BMI and the underweight group (n=11,BMI&lt;18.5). Both groups use low dose OCP(30?g ethinyl estradiol and 150?g levonorgestrel) for 6-60 months. The coagulation status were assessed as follows: Plasma Fibrinogen, Prothrombin time and Platlete aggregation and Anticoagulation statuseg: AntithrombinIII (ATIII).Result:Coagulation status showed no significant difference in platelet aggregation between the groups. Plasma fibrinogen median value (450mg/dl) just exceeded the upper limit of reference range (normal range: 200-400mg/dl) in normal BMI. In contrast, the corresponding value in the low BMI (318mg/ dl) group was almost at the middle of the reference range. A significantly prolonged prothrombin time (13.80 seconds) was found in the low BMI group (p=0.058); values were still within the reference range (10-14 seconds). No significant correlation existed between plasma fibrinogen, prothrombin time and platelet aggregation in normal BMI or low BMI groups. Antithrombin IIIactivity in normal BMI group was 108% and in low BMI group it was 105%. Atendency of positive correlation existed between antithrombin III activity and BMI in low BMI pill users (r=0.591,p=0.072).Conclusion:The study suggested that a) Reported risk of procoagulant or thromboembolic changes in pill users is lower in low BMI &amp;normal BMI and b) Low BMI users showed significantly longer prothrombin time due to the effect of malnutrition itself or due to the effect of pills in this nutritional background.J Bangladesh Coll Phys Surg 2017; 35(1): 3-8

Predictors of postoperative eGFR change and resolution of hyperfiltration in obese patients following bariatric surgery

BackgroundBariatric surgery (BS) can improve glomerular hyperfiltration (GHPF). Very few studies identified associative factors with glomerular filtration rate and resolution from GHPF after BS. ObjectivesTo investigate the predictors of estimated GFR (eGFR) changes and resolution from GHPF after BS. SettingUniversity hospital, Republic of Korea. MethodsWe enrolled patients who underwent BS for obesity from January 2008 to December 2014 and had more than a year of follow-up. GHPF was defined as an eGFR above 95th percentile values for age- and sex-matched cohorts extracted from the Korea National Health and Nutrition Examination Survey Database. Patients with baseline eGFR less than 60 mL/min/1.73 m2 were excluded. ResultsA total of 138 patients (age interquartile range [IQR] 28–43; 21 men, 117 women) were analyzed. The median follow-up period was 36 months (IQR 25–45 mo). One hundred twenty patients (87%) were defined as having GHPF and 75 (54%) resolved after surgery. Multivariate analysis found that sex, preoperative body mass index (BMI), and age were predictive of postoperative eGFR. In patients with preoperative GHPF, female and lower BMI groups had significantly higher resolution rates (P = .012 for sex, P = .016 for BMI). Younger age was related with early resolution after BS. ConclusionsYounger patients had a faster eGFR decline after BS. Predictive factors for resolution of GHPF after BS include female sex and lower BMI.

Abstract 194: Lipid and Apolipoprotein Size Profile Differences Between Low and High Body Mass Index Individuals in Response to Fat Challenge

Clearance of elevated triglycerides (TG) level in response to fat challenge is a clinically significant indicator of CVD risk. HDL can play a key role in facilitating TG metabolism explaining the reverse correlation of HDL levels with CVD risk. In this study 6 individuals, low BMI (21-25) and 3 high BMI (30-49) were challenged with a meal containing ~90 g of total fat. Blood samples were drawn in fasting state before meal and 3 times after meal in 2, 4 and 6 hours. Serum was analyzed by a quantitative, multiplexed analytical workflow which included analysis of whole serum and the separation of lipoproteins by asymmetric flow field-flow fractionation where fractions were collected with 1 nm increments of 7-15 nm (HDL), 20-30 nm (LDL) and &gt;30 nm lipoprotein classes. Dynamic light scattering was used to determine hydrodynamic size in each size fraction. Whole serum and individual fractions were analyzed to determine concentrations of apolipoproteins (apo A-I, A-II, A-IV, B, C-I, C-II, C-III and E), and non-polar lipids (FC, CE and TG), using two parallel liquid chromatography tandem mass spectrometry methods developed in our laboratory. In whole serum, the total TG levels for low and high BMI donors, relative to pre-meal levels (57-137 mg/dL and 111-183 md/dL), peaked at between the 2 and 4 hours post meal (103-214 mg/dL and 210-309 mg/dL). LCAT were lower (20%) and CETP levels were higher (30%), in low vs high BMI groups, but did not show change in repose to the fat challenge. In both low and high BMI groups, the most significant change between pre-meal and post-meal after 2 hours occurred in HDL-ApoC-I, HDL-ApoC-II, and HDL-ApoC-III levels mainly in the HDL size range of 9-12 nm (medium HDL) and at 13-16 nm (large HDL), with concurrent TG increase observed in LDL and remnant fractions (Prob-

Influence of body mass index on survival in indolent and mantle cell lymphomas: analysis of the StiL NHL1 trial

Obesity is a well-known risk factor for the development of cancer, but its influence on the course of disease is still controversial. We investigated the influence of body mass index (BMI) on overall survival (OS) in 502 patients with indolent non-Hodgkin’s lymphoma or mantle cell lymphoma in a subgroup analysis of the StiL (Study Group Indolent Lymphomas) NHL1 trial. We defined a cut-off of 22.55 kg/m2 by ROC calculation and Youden Index analysis and stratified patients into “low BMI” and “high BMI”. Five-year OS was significantly longer in the high BMI group (82.2%) when compared to that of the low BMI group (66.2%) (HR 0.597; 95%CI 0.370–0.963; p = 0.034). BMI was also an independent prognostic factor for OS in multivariate analysis (HR 0.541; 95%CI 0.332–0.883; p = 0.014). Of note, patients had a significantly lower BMI in the presence than patients in the absence of B-symptoms (p = 0.025). BMI significantly impacts on OS in indolent non-Hodgkin’s lymphoma and mantle cell lymphoma, which may be influenced by the effect of B-symptoms on BMI.

Gender differences in the correlation between prognosis and postoperative weight loss in patients with non-small cell lung cancer.

The aim of this study was to investigate gender differences in the relationship between preoperative body mass index (BMI), postoperative body weight change and prognosis in patients with non-small cell lung cancer (NSCLC). Two hundred and sixty-three patients with NSCLC were enrolled in this study. Preoperative BMI was categorized based on WHO definition as follows: underweight (BMI <18.5): 21 patients (8.0%), normal (18.5 ≦ BMI <25): 179 patients (68%), overweight and obese (BMI ≧25): 63 patients (24%). Several factors such as age, sex, cancer stage, body weight change and BMI were recorded and correlated to the postoperative overall survival (OS). For male patients, those in the low-BMI group had the worst prognosis (P < 0.05) whereas female patients with low BMI did not. Male patients with low BMI had statistically significant poorer prognosis compared to corresponding female patients (P < 0.05). Male patients with more than 5% body weight loss within 1 year after operation when compared to preoperative body weight had poorer prognosis than those with less than 5% body weight loss (P < 0.001). Furthermore, these male patients had statistically significant worse prognosis than the corresponding female patients (P < 0.05). In multivariable analysis, gender, more than 5% of body weight loss compared to preoperative body weight, and pathological stage were independent prognostic factors in NSCLC. This study illustrates significant gender differences in the relationship between prognosis and BMI or body weight change in patients with postoperative NSCLC.

Heterogeneous impact of body mass index on in-hospital mortality in acute heart failure syndromes: An analysis from the ATTEND Registry.

Although the obesity paradox may vary depending upon clinical background factors such as age, gender, aetiology of heart failure and comorbidities, the reasons underlying the heterogeneous impact of body mass index (BMI) on in-hospital cardiac mortality under various conditions in patients with acute heart failure syndromes (AHFSs) remain unclear. Among 4617 hospitalised patients with AHFSs enrolled in the Acute Decompensated Heart Failure Syndromes (ATTEND) registry, the patient characteristics and in-hospital cardiac mortality rates in those with low BMI (BMI <25 kg/m2, n = 3263) were compared to those with high BMI (BMI ⩾25 kg/m2, n = 1354). Compared to the high-BMI group, the low-BMI group was significantly older, less likely to be male and to have hypertensive or idiopathic dilated aetiologies and more likely to have valvular aetiologies and a history of prior hospitalisation for AHFS. The low-BMI group also had lower prevalence rates of diabetes, dyslipidaemia, hypertension and atrial fibrillation and higher prevalence rates of anaemia and chronic obstructive pulmonary disease. In addition, cardiac mortality was significantly higher in the low-BMI group than in the high-BMI group (5.5 vs. 1.5%, p < 0.001). Logistic regression analysis demonstrated that low BMI was a predictor of cardiac mortality (odds ratio: 3.89, 95% confidence interval: 2.44-6.21). In subgroup analyses, the impact of BMI on cardiac mortality differed depending on the presence of hypertensive aetiology, hypertension, chronic obstructive pulmonary disease and hyponatremia (all p < 0.05), although there were no interactions between the impacts of BMI and age, gender, other aetiologies, prior hospitalisation, diabetes, anaemia, cardio-renal function and in-hospital management. It is necessary to appreciate the obesity paradox in AHFS patients, and a patient's heterogeneous background should also be considered.

Validity of thoracic respiratory inductive plethysmography in high body mass index subjects

We aim to evaluate thoracic respiratory inductive plethysmography (RIP) in high body mass index (BMI) subjects with a pneumotachometer (PT) as a reference. We simultaneously evaluated spontaneous breathing by RIP and PT in 10 low and 10 high BMI subjects at rest and in moderate exercise. We then recorded RIP amplitude with different excursions mimicking respiratory thoracic deformation, with different sizes of RIP belts surrounding cylinders of different perimeters with or without deformable foam simulating adipose tissue. RIP responses correlated with PT values in low and high BMI groups for inspiratory time (r=0.86 and r=0.91, respectively), expiratory time (r=0.96 and r=0.91, respectively) and amplitude (r=0.82 for both) but with a bias (−0.23±0.25L) for high BMI subjects. ANOVA revealed the effects of perimeter and simulated adiposity (p<0.001 for both). We concluded that thoracic perimeter and deformity of adipose tissue are responsible for biases in RIP response in high BMI subjects.

Body Composition and Mortality in Coronary Artery Disease With Mild Renal Insufficiency in Chinese Patients

Obesity is a risk factor for both coronary artery disease (CAD) and chronic renal insufficiency (RI); patients with CAD are prone to obesity and RI. In this study, we try to analyze the effect of body composition on death in CAD patients with mild RI. Retrospective cohort study. A total of 1,591 consecutive CAD patients confirmed by coronary angiography were enrolled and met the mild RI criteria by estimated glomerular filtration rate: 60-90mL/min. The influence of body composition on mortality of CAD was detected in different body compositions, including body mass index (BMI), body fat (BF), and lean mass index (LMI). The end points were all-cause mortality. Cox models were used to evaluate the relationship of quintiles of body compositions with all-cause mortality. A survival curve showed that the risk of death was higher in the low BMI group than in the high BMI group (log-rank for overall P=.002); LMI was inversely correlated with risk of death, such that a lower LMI was associated with a higher risk of death (log-rank for overall P<.001). No significant correlation was observed between BF and risk of death. Multifactorial correction show that LMI was still inversely correlated with risk of death (quintile 1: reference; quintile 2: hazard ratio [HR]: 0.49, 95% confidence interval [CI]: 0.26-0.92; quintile 3: HR: 0.35, 95% CI: 0.17-0.70; quintile 4: HR: 0.41, 95% CI: 0.20-0.85; quintile 5: HR: 0.28, 95% CI: 0.12-0.67). For CAD patients with mild RI, BMI or BF was unrelated to risk of death, while LMI was inversely correlated with risk of death. A weak "obesity paradox" was observed in this study.