Mean BMI Levels Research Articles

Is there a difference in testosterone levels and its regulators in men carrying BRCA mutations?

BackgroundMale BRCA mutation carriers are at risk for an early onset aggressive prostate cancer. No data exist on the association of testosterone levels among these patients. We aimed to analyze testosterone and associated hormonal levels among male BRCA carriers and non-carriers.Patients and methodsOverall 87 male carriers and 43 non-carriers aged 40-70 were prospectively enrolled. Clinical data were collected and all patients were tested for total testosterone (TT), prostate specific antigen (PSA), follicle stimulating hormone (FSH), luteinizing hormone (LH), free androgen index (FAI), sex hormone binding globulin (SHBG) and prolactin. Multivariate linear regression analysis was performed to predict TT levels.ResultsThe median age, mean BMI, comorbidities, PSA, FSH, LH and SHBG levels in both groups were similar. However, mean TT and FAI were higher in the carriers (16.7 nmol/l vs 13.5 nmol/l, p=0.03 and 39.5 vs 34.8, p=0.05, respectively), while prolactin was significantly lower. Multivariate analysis demonstrated that while BMI was inversely correlated to TT levels in both groups, LH was a predictor only in non-carriers.ConclusionsCarriers have higher TT and FAI levels and lower prolactin levels; but LH does not predict their TT levels. Further research in a larger cohort of BRCA carriers with and without prostate cancer should be performed.

Effect of national wealth on BMI: An analysis of 206,266 individuals in 70 low-, middle- and high-income countries.

BackgroundThis study explores the relationship between BMI and national-wealth and the cross-level interaction effect of national-wealth and individual household-wealth using multilevel analysis.MethodsData from the World Health Survey conducted in 2002–2004, across 70 low-, middle- and high-income countries was used. Participants aged 18 years and over were selected using multistage, stratified cluster sampling. BMI was used as outcome variable. The potential determinants of individual-level BMI were participants’ sex, age, marital-status, education, occupation, household-wealth and location(rural/urban) at the individual-level. The country-level factors used were average national income (GNI-PPP) and income inequality (Gini-index). A two-level random-intercepts and fixed-slopes model structure with individuals nested within countries was fitted, treating BMI as a continuous outcome.ResultsThe weighted mean BMI and standard-error of the 206,266 people from 70-countries was 23.90 (4.84). All the low-income countries were below the 25.0 mean BMI level and most of the high-income countries were above. All wealthier quintiles of household-wealth had higher scores in BMI than lowest quintile. Each USD10000 increase in GNI-PPP was associated with a 0.4 unit increase in BMI. The Gini-index was not associated with BMI. All these variables explained 28.1% of country-level, 4.9% of individual-level and 7.7% of total variance in BMI. The cross-level interaction effect between GNI-PPP and household-wealth was significant. BMI increased as the GNI-PPP increased in first four quintiles of household-wealth. However, the BMI of the wealthiest people decreased as the GNI-PPP increased.ConclusionBoth individual-level and country-level factors made an independent contribution to the BMI of the people. Household-wealth and national-income had significant interaction effects.

Characteristics of very long responder to maintenance cetuximab after a platinum-cetuximab based chemotherapy for recurrent and/or metastatic head and neck squamous cell carcinomas (RM HNSCC).

e17524 Background: Standard treatment for first line RM HNSCC is the association of platinum-5FU and cetuximab. For non-progressive patients (pts), cetuximab is given weekly as maintenance until progression or unacceptable toxicity. In the EXTREME protocol (Vermorken et al, NEJM 2008), this strategy showed an OS of 10.1 months with a mean duration of maintenance of 3 months. This study aimed at describing pts who have benefited from a cetuximab maintenance for a longer period (i.e. > 6 months). Methods: We did a retrospective study in 7 centers in France. Inclusion criteria were: pts > 18 years with a RM HNSCC treated between November 2009 and January 2017, with platinum based chemotherapy and cetuximab followed by weekly cetuximab maintenance of more than 6 months. Results: 53 pts (45 male), with a median age of 57 [38-76] were recorded. Median follow-up was 63.7 months [14.8-237.6]. 72% [37/53] had an oral cavity or oropharynx tumor location with a well or moderately differentiated carcinoma (74%). 45/53 (85%) were smokers and 4/21 (19%) p16 positive. 46/53 (87%) had a Performans Status of 0-1. Mean BMI and albumin level were respectively 22.5 [SD: 4.19] and 40g/l [SD: 4.9]. EXTREME regimen was used for 44 pts, 2 pts had platinum and cetuximab and 7 received platinum, docetaxel and cetuximab. Mean number of chemotherapy cycles was 5 [3-7]. After chemotherapy, the number of pts with complete response (CR), partial response (PR) or stabilization was respectively 5 (9%), 23 (43%) and 25 (47%). 2 pts in PR finally achieved CR during maintenance. One of them stopped cetuximab and was still in CR 5 months later. Mean duration time of maintenance by cetuximab was 11 months [6-24]. Toxicities were mainly cutaneous: 47/53 pts had toxicities, of which 6 had grade 3. Presence of cutaneous toxicities seemed to be correlated with a longer response (p = 0.01). PFS and OS were respectively 15.5 and 27.4 months. Conclusions: Our study allowed us to identify a cohort of long responder pts to maintenance cetuximab including 2 pts who obtained a complete response. More analysis should be done to identify biomarkers able to predict long responder.

Higher levels of physical activity are independently associated with a lower incidence of diabetic retinopathy in Japanese patients with type 2 diabetes: A prospective cohort study, Diabetes Distress and Care Registry at Tenri (DDCRT15).

We assessed the prospective association between baseline levels of physical activity (PA) and the incidence of newly developed diabetic retinopathy (DR) in patients with type 2 diabetes. Data from 1,814 patients with type 2 diabetes without DR were obtained from a Japanese diabetes registry at Tenri Hospital, Nara, Japan. To assess the independent correlations between baseline PA levels and newly developed DR, the participants were divided into five categories based on their PA levels. A Cox proportional hazards model with time-varying exposure information was used and adjusted for potential confounders to assess the independent correlations. At baseline, the mean age, BMI, and hemoglobin A1c levels of the patients were 65.5 years, 24.5 kg/m2, and 7.2% (54 mmol/mol), respectively. After 2 years, newly developed DR was confirmed in 184 patients (10.1%). Patients with newly developed DR had longer duration of type 2 diabetes (14.7 versus 11.0 years, p < 0.0001), higher systolic blood pressure (139.2 versus 135.1 mmHg, p = 0.0012), lower estimated glomerular filtration rate (74.0 versus 77.1 mL/min/1.73 m2, p = 0.0382), greater urinary albumin–creatinine ratio (4.00 versus 2.45 mg/mmol, p < 0.0039), and higher HbA1c levels (7.5 versus 7.2%, p = 0.0006) than those without newly developed DR. The multivariable-adjusted hazard ratios for DR development were 0.87 (95% CI, 0.53–1.40; p = 0.557), 0.83 (95% CI, 0.52–1.31; p = 0.421), 0.58 (95% CI, 0.35–0.94; p = 0.027), and 0.63 (95% CI, 0.42–0.94; p = 0.025)for the second, third, fourth, and fifth PA categories, respectively, compared with the reference category of patients with a mean PA of 0 metabolic equivalent of task-hours/week). Higher PA levels are independently associated with a lower incidence of DR in Japanese patients with type 2 diabetes.

Are the Recent Secular Increases in Waist Circumference among Children and Adolescents Independent of Changes in BMI?

BackgroundSeveral studies have shown that the waist circumference of children and adolescents has increased over the last 25 years. However, given the strong correlation between waist circumference and BMI, it is uncertain if the secular trends in waist circumference are independent of those in BMI.MethodsWe analyzed data from 6- to 19-year-olds who participated in the 1988–1994 through 2011–2012 cycles of the National Health and Nutrition Examination Survey to assess whether the trends in waist circumference were independent of changes in BMI, race-ethnicity and age.ResultsMean, unadjusted levels of waist circumference increased by 3.7 cm (boys) and 6.0 cm (girls) from 1988–94 through 2011–12, while mean BMI levels increased by 1.1 kg/m2 (boys) and 1.6 kg/m2 (girls). Overall, the proportional changes in mean levels of both waist circumference and BMI were fairly similar among boys (5.3%, waist vs. 5.6%, BMI) and girls (8.7%, waist vs. 7.7%, BMI). As assessed by the area under the curve, adjustment for BMI reduced the secular increases in waist circumference by about 75% (boys) and 50% (girls) beyond that attributable to age and race-ethnicity. There was also a race-ethnicity interaction (p < 0.001). Adjustment for BMI reduced the secular trend in waist circumference among non-Hispanic (NH) black children (boys and girls) to a greater extent (about 90%) than among other children.ConclusionsOur results indicate that among children in the U.S., about 75% (boys) and 50% (girls) of the secular increases in waist circumference since 1988–94 can be accounted for by changes in BMI. The reasons for the larger independent effects among girls and among NH blacks are uncertain.

The Association Between Pre-Diabetes With Body Mass Index and Marital Status in an Iranian Urban Population

Pre-diabetes increased the development of diabetes mellitus (type 2). The aim of study was to determine the association of body weight, education and marital status with pre-diabetes in an Iranian urban population. A sample of 788 subjects (360 men and 428 women) between the ages 30–85 years participated in our study and anthropometric measurements, educational level and fasting blood sugar of participants were recorded. The t and Chi square tests were used for continuous and categorical variables. The association of age, BMI categories, educational level and marital status to pre-diabetes was assessed by estimating the odds ratio. A p-value ≤ 0.05 were considered significant. The analysis was done using SPSS version 11.5. Our study showed that pre-diabetic subjects were older and low educated than normoglycemic subjects. Mean BMI and educational level were associated to pre-diabetes only in women. The odds of being pre-diabetes also were higher in obese women than in normal BMI women. No relationship was found between education and marital status with pre-diabetes in both men and women. Based on our finding, it is possible that advancing age and obesity has increased in pre-diabetes. This highlights the importance of population based survey to monitor blood glucose for effective prevention and control.

The role of adenovirus 36 as a risk factor in obesity: The first clinical study made in the fatty tissues of adults in Turkey

Obesity which developes due to multifactorial reasons, was associated recently with human Adenovirus-36 (Ad-36). The aim of this study was to investigate the prevalence of Ad-36 antibodies in obese adults and also to investigate the DNA of Ad-36 in their adipose tissue. In this cross-sectional and case-control based study, 49 obese adults, with BMI ≥30 kg/m2, and 49 non-obese adults, with BMI ≤25 kg/m2, applied for esthetic purposes and were included in this study as patient and control groups, respectively. Adipose tissue samples, obtained by the lipoaspiration method, were studied by single-step PCR and nested-PCR methods. Simultaneously, the presence of Ad-36 antibodies and serum leptin and adiponectin levels were assessed by serum neutralization assay (SNA) and ELISA, respectively. Serum samples which didn't cause a cytopathic effect at ≥1:8 were accepted as positive. Ad-36 antibody was detected in 6 (12.2%) of 49 patients by SNA and was statistically significant (p < 0.05). Ad-36 DNA was not detected in any of the adipose tissue samples of the patient or control groups. Mean BMI and leptin levels were higher in the Ad-36-positive group, while adiponectin levels were found to be lower in the Ad-36-positive group. Although no statistically significant difference was found in cholesterol and triglyceride levels between the two groups (p > 0.05), lower mean serum cholesterol and triglyceride levels were found in the Ad-36-positive patients. In conclusion, we couldn't detect Ad-36 DNA in adipose tissue; however, we detected significantly higher Ad-36 antibody levels in the obese group compared to the non-obese group, according to the both univariant and multivariant analyses, suggesting that Ad-36 may play a role in obesity. There is a need for new and extended serial, particularly cohort and human-based, studies in order to have a clear understanding of the Ad-36-obesity relationship.

Diabetes treatment-related quality of life is associated with levels of self-care activities in insulin injection among Japanese patients with type 2 diabetes: Diabetes Distress and Care Registry at Tenri (DDCRT 8).

We investigated the association between diabetes treatment-related quality of life (QOL) and levels of self-care activities in insulin injection among Japanese patients with type 2 diabetes. Data from 1394 patients with type 2 diabetes on insulin therapy were obtained from a diabetes registry in Japan. We used the Diabetes Therapy-Related QOL (DTR-QOL) questionnaire and relative risk regression analysis to assess the independent association of high levels of self-care activities in insulin injection and DTR-QOL scores while adjusting for possible confounders. The mean age, BMI and HbA1c level were 65.8 years, 24.8 kg/m(2) and 62 mmol/mol (7.8 %), respectively. The frequency of insulin injection omission was associated with DTR-QOL scores. In the multivariable-adjusted model, the relative risks for high levels of self-care activities in insulin injection was 1.15 (95 % confidence interval, 1.05-1.26) in the highest quintile compared with those in the lowest quintile of DTR-QOL scores. Subgroup analysis confirmed this association in patients <65 years. DTR-QOL was associated with self-reported levels of self-care activities in insulin injection, particularly among Japanese patients <65 years with type 2 diabetes. DTR-QOL might be a useful tool to identify patients who consequently omit insulin. For patients with low DTR-QOL score, healthcare providers should discuss their treatment-related problems to prevent insulin injection omission.

Serum high-sensitivity C-reactive protein levels are associated with high risk of development, not progression, of diabetic nephropathy among Japanese type 2 diabetic patients: a prospective cohort study (Diabetes Distress and Care Registry at Tenri [DDCRT7]).

To assess the prospective association between baseline serum hs-CRP concentration and the subsequent risk of development or progression of diabetic nephropathy. Longitudinal data were obtained from 2,518 patients with type 2 diabetes registered in a Japanese diabetes registry. To assess the independent correlations between serum baseline hs-CRP and either the development or progression of diabetic nephropathy 1 year later, the Cox proportional hazards model was used and adjusted for potential confounders. The mean patient age, BMI, and HbA1c level were 66.1 years, 24.6 kg/m2, and 7.5% (57.6 mmol/mol), respectively. Baseline serum hs-CRP levels were significantly associated with the urinary albumin-to-creatinine ratio at baseline (P < 0.001). Multivariable adjusted hazard ratio for the development from normoalbuminuria to microalbuminuria was 1.31 (95% CI 0.80-2.17; P = 0.286), 1.55 (1.16-2.08; P = 0.003), and 1.57 (1.22-2.03; P = 0.001), respectively, for the second, third, and fourth quartiles of serum hs-CRP levels, showing a statistically significant linear trend across categories (P < 0.001). We did not observe a significant association between hs-CRP levels and the subsequent risk of diabetic nephropathy progression (P for trend = 0.575). Serum hs-CRP levels, independent of possible confounders, were associated with a subsequent risk of developing, not progressing, diabetic nephropathy in type 2 diabetic patients. Serum hs-CRP may be useful for predicting the future risk of developing diabetic nephropathy.

Impact Of Risk Factor Modifications On Coronary Heart Disease Mortality In Turkish Adults For 2025

Background Despite declines over the last years, coronary heart disease (CHD) mortality rates in Turkey can be decreased much more by interfering to the policies. This study uses a modelling approach to compare the potential impact of future risk factor scenarios relating to smoking, physical activity levels, dietary salt, saturated fat intakes, mean BMI levels, diabetes prevalence and fruit-vegetable(F/V) consumption on future CHD mortality in Turkey for year 2025. Methods CHD mortality model previously developed …

Patent Foramen Ovale is Associated with an Increased NAFLD Risk for Health of Young Men

Between March 2012 and July 2013, 1000 asymptomatic young military male underwent hepatic ultrasonography and echocardiography at Medical Check-up Center for general young health screening. Blood biochemistry, arterial blood pressure and anthropometric measurements were studied. All analyses were performed using the statistical package SPSS 15.0, where the statistical significance was assessed at the two-tailed 0.05 threshold. It was found that among 1000 persons, 60 had patent foramen ovale (PFO) and 110 subjects had symptoms of nonalcoholic fatty liver disease (NAFLD). The PFO-group consisted of 20 male with 33.3% of NAFLD symptoms, while the group without PFO consisted of 90 male with 9.6% of NAFLD symptoms only. There were significant differences between two groups: p<0.001. Moreover, such factors as the mean age, BMI, triglycerides, hemoglobin, and aspartate aminotransferase level, the mean HDL cholesterol, alanine aminotransferase, platelet count did not differ between the two groups. The main cause of the pathogenesis of nonalcoholic fatty liver disease (NAFLD) has not been sufficiently elucidated. Serotonin of plasma is removed from circulation in capillary beds, predominantly in the lung. Nevertheless, metabolism of serotonin can be by-passed by patent foramen ovale (PFO) that can lead to NAFLD. Therefore, the aim of this study was to test the hypothesis that echocardiographic diagnosed PFO predicts the subsequent NAFLD, which can be diagnosed by ultrasonography. The statistical analysis of the 1000 young male supports the hypothesis that PFO can be associated with increased NAFLD risk for the health of young men.

A study on prevalence of anemia and growth pattern among HIV infected children and adolescents from rural areas attending VCTC and ART center Govt. General Hospital, Vijayawada, A.P., India

Results Totally 125 subjects of age group 1-20 years were included in the study. Among 125 HIV+ subjects only 45 subjects were in HAARTera, 75 subjects in preHAART era and 5 subjects died during the study period. The study patients in HAART era showed a significant increase (p<0.001) in CD4 counts from 174 to 902 cells/ cmm, significant decrease (p<0.001) in Hb content from 7.3 to 6.5 gm/dL and significant increase (p<0.05) in BMI level from 18.1 to 22.6 from baseline to follow up treatment after 18 months. The study patients in preHAART era showed a significant increase (p<0.05) in mean CD4 counts from 592 to 790 cells/cmm from initial count to count after 18 months. The subjects in preHAART era showed low level of Hb content 6.9 gm/dL in male and 6.3 gm/dL in female subjects; the mean BMI level was 20.43 in male and 18.47 in female subjects.

Trends in the association of parental history of obesity over 60 years

ObjectiveThe association of familial as compared to genetic factors in the current obesogenic environment, compared to earlier, leaner time periods, is uncertain.Design and MethodsParticipants from the Framingham Heart Study were classified according to parental obesity status in the Original, Offspring, and Third Generation cohorts; mean BMI levels were estimated and we compared the association of parental history across generations. Finally, a genetic risk score comprised of 32 well-replicated single nucleotide polymorphisms for BMI was examined in association with BMI levels in 1948, 1971, and 2002.ResultsBMI was 1.49 kg/m2 higher per each affected parent among the Offspring, and increased to 2.09 kg/m2 higher among the Third Generation participants (p-value for the cohort comparison=0.007). Parental history of obesity was associated with increased weight gain (p<0.0001) and incident obesity (p=0.009). Despite a stronger association of parental obesity with offspring BMI in more contemporary time periods, we observed no change in the effect size of a BMI genetic risk score from 1948 to 2002 (p=0.11 for test of trend across the time periods).ConclusionsThe association of parental obesity has become stronger in more contemporary time period, whereas the association of a BMI genetic risk score has not changed.

A STUDY ON PREVALENCE OF ANEMIA AND GROWTH PATTERN AMONG HIV-INFECTED CHILDREN FROM RURAL AREAS ATTENDING GOVT. GENERAL HOSPITAL, VIJAYAWADA, ANDHRA PRADESH, INDIA

The present communication deals with the profile of HIV infected children belonging to pre-HAART (pre-Highly Active Anti Retroviral Therapy) era and HAART era to know the status of anemia and growth pattern who attended the ART centre, Govt. General Hospital, Vijayawada, Andhra Pradesh, India. A cross-sectional record based study was carried out in 125 HIV infected children in ART centre from 2009 to 2011. Hemoglobin, height, weight, BMI, waist and hip ratio were calculated according to the standard protocols. The CD4 count was estimated using BD FACS caliber flow cytometer and results were statistically analyzed. According to the present study 125 subjects of age group 1-20 years were chosen. The subjects in pre-HAART era (75 subjects) showed low level of Hb content 6.9 gm/dL in male and 6.3 gm/dL in female subjects; the mean BMI level was 20.43 in male and 18.47 in female subjects and showed a significant increase (p<0.05) in mean CD4 counts from 592 to 790 cells/cmm from baseline count to follow up count after 18 months. The study patients in HAART era (45 subjects) significant decrease (p<0.001) in Hb content from 7.3 to 6.5 gm/dL and significant increase (p<0.05) in BMI level from 18.1 to 22.6 and showed a significant increase (p<0.001) in CD4 counts from 174 to 902 cells/cmm from baseline to follow up treatments. Our study reinforces the finding that anemia, growth pattern of HIV infection in Indian children with prognostic significance.

Serum Leptin and Adiponectin Levels in Obese and Nonobese Asthmatic School Children in relation to Asthma Control

There is growing evidence of a positive correlation between asthma and obesity in children and adults. Leptin and adiponectin regulate several metabolic and inflammatory functions. This study aims to evaluate serum leptin and adiponectin concentrations in asthmatic school children to investigate their association with obesity and the degree of asthma control. Obese asthmatic (OA) and nonobese asthmatic (NOA) children, aged 7 to 14, were randomly enrolled in this prospective study. Data on demographic, anthropometric, serum lipids, and spirometric measures and allergy status were collected and analyzed. Serum leptin was significantly higher (25.8 ± 11.1 versus 8.7 ± 11.1; P < 0.0001) and adiponectin levels were lower (2.5 ± 1.2 versus 5.4 ± 2.9; P < 0.0001) in OA compared to NOA children. The uncontrolled group had higher leptin and lower adiponectin levels compared to well and partially controlled asthma. BMI was positively correlated with leptin (r = 0.79; P < 0.001) and negatively with adiponectin (r = −0.73; P < 0.001). Mean BMI and leptin levels were observed to be higher in girls compared to boys. Stepwise multiple linear regression analysis showed that higher BMI and female gender had significant effect on serum leptin levels. Among asthmatic children higher serum leptin and lower adiponectin levels were significantly associated with obesity and showed no significant association with degree of asthma controls.

Correlations Between Serum Bilirubin Levels and Diabetic Nephropathy Progression Among Japanese Type 2 Diabetic Patients: A Prospective Cohort Study (Diabetes Distress and Care Registry at Tenri [DDCRT 5

OBJECTIVE To assess the correlations between serum bilirubin levels and diabetic nephropathy development and progression in type 2 diabetic patients. RESEARCH DESIGN AND METHODS Longitudinal data were obtained from 2,511 type 2 diabetic patients registered in a Japanese diabetes registry. To assess the independent correlations between serum bilirubin levels and either the development or progression of diabetic nephropathy, we used logistic regression analysis adjusted for potential confounders. RESULTS The median follow-up period was 503.4 days (range 238-777). The mean patient age, BMI, and HbA1c level was 65.2 years, 24.7 kg/m(2), and 7.5% (58.5 mmol/mol), respectively. Baseline serum bilirubin levels were significantly associated with the urinary albumin-creatinine ratio at baseline (P < 0.001) and 1 year after registration (P < 0.001). Multivariable adjusted odds ratios for progression from microalbuminuria to macroalbuminuria for the second, third, and fourth quartile of serum bilirubin levels were 0.89 (95% CI 0.49-1.58), 0.93 (0.47-1.83), and 0.33 (0.13-0.84), respectively, showing a statistically significant linear trend across categories (P = 0.032). However, this trend disappeared after adjustment for hemoglobin levels. CONCLUSIONS Serum bilirubin levels were associated with diabetic nephropathy progression in type 2 diabetic patients independent of possible confounders. Serum bilirubin levels might be the link in the correlation between hemoglobin levels and nephropathy progression.

RBBB is associated with an increased risk of NAFLD in young healthy individuals

The pathogenesis of nonalcoholic fatty liver disease has not been fully elucidated. The most widely supported theory implicates insulin resistance as the key mechanism leading to hepatic steatosis, and perhaps also to steatohepatitis. Also one of causes of NAFLD is central congestion and hepatic injury. RBBB can associated with right ventricular dissynchrony that lead to minimal congestion in liver. So the aim of this study was to test the hypothesis that RBBB as diagnosed by ECG predicts subsequent NAFLD as diagnosed by ultrasonography (the most widely used imaging test for diagnosing hepatic steatosis). Between March 2012 and March 2013, 2200 male subjects underwent electrocardiography (ECG) at our Medical Check-up Center for general young health screening. Of them, 220 subjects had RBBB. All analyses were performed using statistical package SPSS 15.0 and statistical significance was assessed at the two-tailed 0.05 threshold. Among the 2200 subjects evaluated, 220 had RBBB. The mean age, BMI, triglycerides, hemoglobin, and aspartate aminotransferase level, the mean HDL cholesterol, alanine aminotransferase, platelet count, %VC, and FEV1/FVC were not different between two groups. The group with RBBB had 66 subjects with NAFLD (30%). The group without RBBB had 44 subjects with NAFLD (2.2%). There were significant differences between the two groups(p < 0.001). RBBB is associated with an increased risk of NAFLD in young healthy individuals.

Low BMI at age 20 years predicts gestational diabetes independent of BMI in early pregnancy in Japan: Tanaka Women’s Clinic Study

Maternal obesity and weight gain since early adulthood are known predictors of gestational diabetes in Western countries. However, their impact has not been evaluated well in Asia, where mean BMI levels are generally lower than in Western countries. We therefore examined the associations of BMI at age 20 years and BMI change since age 20 years with the risk of gestational diabetes in Japanese pregnant women. Six hundred and twenty-four consecutive pregnant women without recognized diabetes before pregnancy, whose initial obstetric clinic visit was before 13 weeks' gestation, were prospectively observed. Weight at age 20 years was self-reported. Baseline height and weight measurements were obtained at the initial obstetric visit. Multivariate logistic regression analysis estimated the risk of incident gestational diabetes for BMI change since 20 years and BMI at age 20 years. Twenty-eight women developed incident gestational diabetes. By multivariate logistic regression analysis that adjusted for maternal age, parity and baseline BMI, we observed a statistically significant inverse association between BMI at age 20 years and incidence of gestational diabetes (odds ratio 0.68, 95% CI 0.51-0.92). Similarly, when we assessed the association of BMI change since age 20 years, adjusted for maternal age and parity, BMI change was associated with an increased risk of gestational diabetes (odds ratio 1.26, 95% CI 1.03-1.53). When we focused on the threshold of risk of gestational diabetes, women with BMI at 20 years of less than 18 kg/m(2) had a 6.30-fold (2.26-17.59) greater risk than women with both BMI at age 20 years of 18 kg/m(2) or more and BMI change since age 20 years of less than 1.85. Both low BMI at age 20 years and BMI change since age 20 years were significantly associated with increased risk of incident gestational diabetes.

Screening for Cushing’s syndrome in obese type 2 diabetic patients and the predictive factors on the degree of serum cortisol suppression

The aim of this study was to examine the frequency of Cushing’s syndrome (CS) in obese type 2 diabetic patients devoid of specific clinical symptoms of Cushing’s syndrome. A total of 148 obese (BMI ≥30 kg/m2 ) type 2 diabetic patients (113 female, 35 male) were included in the study. An overnight 1-mg dexamethasone suppression test (DST) was performed on all patients. Suppression of serum cortisol to <1.8 μg/dL after administration of 1 mg dexamethasone was considered normal suppression. Low dose dexamethasone suppression test was performed on the patients who had serum cortisol level over 1.8 μg/dL after overnight 1 mg DST. Regression analysis was applied to determine the effective factors on suppression of serum cortisol. Mean age, BMI and HbA1c levels respectively were 50,82 ± 8,50 year, 31,78 ± 4,66 kg/m2, %8,96 ± 2,42 in males and 54,15 ± 10,348 year, 34,32 ± 5.71 kg/m2, % 8,18 ± 2,06 in females. Serum cortisol level was found 1.64 ± 5.62 μg/dl after overnight DST. A total of 9 (6.2 %) patients had non-suppressible overnight DST. Only four (2.6 %) of these patients were diagnosed with Cushing Syndrome after low-dose DST. Diagnosis was confirmed pathologically. Etiologic reasons for Cushing’s syndrome were pituitary microadenoma (2 patients) and adrenocortical adenoma (2 patients). Age and duration of diabetes was found to be related to the degree of suppression. Cushing’s syndrome should be investigated in high-risk groups like uncontrolled diabetes, obesity. All the related factors on the degree of suppression must be considered for the final diagnosis.

Bariatric surgery: a systematic review and network meta-analysis of randomized trials

The clinical efficacy and safety of bariatric surgery trials were systematically reviewed. MEDLINE, EMBASE, CENTRAL were searched to February 2009. A basic PubCrawler alert was run until March 2010. Trial registries, HTA websites and systematic reviews were searched. Manufacturers were contacted. Randomized trials comparing bariatric surgeries and/or standard care were selected. Evidence-based items potentially indicating risk of bias were assessed. Network meta-analysis was performed using Bayesian techniques. Of 1838 citations, 31 RCTs involving 2619 patients (mean age 30-48 y; mean BMI levels 42-58 kg/m(2) ) met eligibility criteria. As compared with standard care, differences in BMI levels from baseline at year 1 (15 trials; 1103 participants) were as follows: jejunoileal bypass [MD: -11.4 kg/m(2) ], mini-gastric bypass [-11.3 kg/m(2) ], biliopancreatic diversion [-11.2 kg/m(2) ], sleeve gastrectomy [-10.1 kg/m(2) ], Roux-en-Y gastric bypass [-9.0 kg/m(2) ], horizontal gastroplasty [-5.0 kg/m(2) ], vertical banded gastroplasty [-6.4 kg/m(2) ], and adjustable gastric banding [-2.4 kg/m(2) ]. Bariatric surgery appears efficacious compared to standard care in reducing BMI. Weight losses are greatest with diversionary procedures, intermediate with diversionary/restrictive procedures, and lowest with those that are purely restrictive. Compared with Roux-en-Y gastric bypass, adjustable gastric banding has lower weight loss efficacy, but also leads to fewer serious adverse effects.