Moderate Obesity Research Articles

Youths with extreme obesity: A high-risk group for pain and mental health impairments.

Youths with extreme obesity (Body mass index (BMI)>40) are at increased risk for physical and mental health impairments but this patient group has received little attention in research. This study aimed to analyze the pain experience and mental health impairments of youths with extreme obesity compared to those with mild and moderate obesity (BMI=30-39.9) by considering gender differences. Cross-sectional data of 431 youths (M=16.6; SD=2.3; 53.1% female) were analyzed. Of these, 159 (36.8%) youths were characterized by extreme obesity. Self-reported sociodemographic data, pain-related variables, depression, and health-related quality of life (HRQoL) were assessed with standardized questionnaires. Data were analyzed with univariate tests and logistic regression models. Youths with extreme obesity reported more pain in the last 4 weeks (p=.018), increased pain-related impairments in daily life (p=.009), more pain-related days of absence (p=.030), higher depression scores (p = .030), and reduced HRQoL (p=.005) compared to youths with mild and moderate obesity. In regression models, extreme obesity and pain in the last 4 weeks were associated when additionally including sex and age in the model (odds ratio 1.88; 95 % confidence interval 1.16 - 30.40, p=.010). In the subgroup of extreme obesity (n=159), women (n=83) reported more pain in the last 4 weeks (p=.001), higher depression scores (p<.001), and lower HRQoL (p<.001) compared to men (n=76). These findings underpin the need for standardized assessments of pain and mental health, especially in the treatment of female youths with extreme obesity. Upcoming studies may analyze reciprocal interactions since both aspects are important barriers for lifestyle changes and weight loss.

Body Mass Index Improvement Reduces Total Knee Arthroplasty Complications Among Patients Who Have Extreme, but Not Severe, Obesity

BackgroundWhile morbid obesity has been associated with increased complication risk in primary total knee arthroplasty (TKA), limited evidence is available to attribute decreased surgical complication rates with body mass index (BMI) reduction. MethodsWe retrospectively assessed 464 unilateral TKAs performed in morbidly obese patients, including 158 extremely obese (BMI ≥ 45) and 306 severely obese patients (BMI 40 to 44.9). A detailed medical record review identified concurrent modifiable risk factors and successful preoperative BMI reduction, reaching either a contemporary risk target (BMI < 40) or an institutionally accepted threshold (BMI < 45). Postoperative blood glucose levels and 1-year adverse outcomes (periprosthetic joint infection, wound dehiscence, knee manipulation, periprosthetic fracture) were compared to 557 contemporary control subjects with expected slightly lower (moderate obesity, BMI 35 to 39.9) or sufficiently lower complication risk (overweight, BMI 25 to 29.9). ResultsPeriprosthetic joint infection and postoperative hyperglycemia were identified more frequently among morbidly obese patients in comparison with a moderately obese control group. Extremely obese patients (BMI ≥ 45) whose BMI improved below 45 had no measurable difference in infection risk from the control group (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.04 to 16.88), while those with a nonimproved BMI had a significantly higher risk (OR 7.70, 95% CI 1.89 to 31.41). No significant differences in the risk for infection were observed between severely obese patients (BMI 40 to 44.9) with preoperative BMI improvement (1.5% rate, OR 1.70, 95% CI 0.17 to 16.57) or nonimprovement (1.7% rate, OR 1.87, 95% CI 0.41 to 8.43). ConclusionsPreoperative medical optimization may decrease postoperative TKA complications. The findings of this study support BMI improvement for extremely obese patients (BMI ≥ 45). The assignment of 40 BMI as a threshold for otherwise healthy patients may exclude patients from potential surgical benefits without realizing risk reduction.

Maternal prepregnancy weight as an independent risk factor for congenital heart defect: systematic review and meta-analysis stratified by subtype and severity of defect.

To assess the association between increased maternal prepregnancy body mass index (BMI) and the risk of congenital heart defect (CHD) in offspring. This systematic review and meta-analysis searched PubMed/MEDLINE, Web of Science and Scopus from inception to 20 April 2023. Risk estimates were abstracted or calculated for increased BMI categories (overweight, obesity, moderate obesity and severe obesity) compared with normal weight (reference). Fixed-effects or random-effects models were used to combine individual study risk estimates based on the degree of heterogeneity. Sensitivity analyses were conducted to weight pooled estimates for relevant moderators, particularly diabetes before and during pregnancy. Subgroup analyses for specific CHD subtypes were conducted if there were at least two studies with available data. Findings were presented for groups of defects, categorized using severity and topographic-functional criteria, and for individual defects. The certainty of the evidence for each effect estimate was evaluated according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines. Overall, 31 studies comprising 4 861 693 patients and 86 136 CHD cases were included. The risk of CHD increased progressively from moderate to severe obesity (pooled odds ratio (OR), 1.15 (95% CI, 1.11-1.20) and 1.39 (95% CI, 1.27-1.53), respectively). Sensitivity analysis indicated that this effect persisted independently of maternal diabetes status before or during pregnancy. In the subgroup analysis, obesity was associated with up to a 1.5-fold increase in the risk of severe CHD (pooled OR, 1.48 (95% CI, 1.03-2.13)). Severe obesity was associated with an even higher risk, with 1.8-times higher odds compared with the reference group for specific CHD subtypes, including tetralogy of Fallot (pooled OR, 1.72 (95% CI, 1.38-2.16)), pulmonary valve stenosis (pooled OR, 1.79 (95% CI, 1.39-2.30)) and atrial septal defect (pooled OR, 1.71 (95% CI, 1.48-1.97)). Maternal weight is a crucial modifiable risk factor for CHD, particularly for severe forms of defect. Further research is needed to investigate whether weight management before pregnancy might serve as a preventive measure against CHD. In pregnant women with obesity, fetal echocardiography should be a routine diagnostic procedure. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Assessment of Chronic Malnutrition and Its Correlation With Oral Health Status in Children Aged Three to Six Years in Jabalpur District, India: An Epidemiological Study.

This study aims to examine the correlation of chronic malnutrition with the oral health status of children aged three to six years. A total of 400 children were selected and divided into four groups based on z-scores. For evaluation of oral health status, teeth were examined for dental caries using the decayed, missing, and filled permanent teeth (DMFT) scores. Salivary samples were collected to measure salivary flow rate (SFR), pH, and salivary buffering capacity (SBC). Teeth were also visualized to detect the presence or absence of enamel hypoplasia. The data obtained was statistically analyzed (p<0.05). A total of 400 children participated and were also categorized into mild, moderate, and severe obesity according to the z-scores. The mean DMFT scores among adequately nourished children were 2.4086; with severely malnourished and severely obese children, the mean values were found to be 1.0652 and 1.4286, respectively. The mean SFR among children with adequate nutrition was 1.0366, and the mean flow rate among children with severe malnutrition and obesity was 0.5348 and 0.4036, respectively. The mean salivary pH among children with adequate nutrition was 7.1295, and the mean values for participants with severe malnutrition and severe obesity were found to be 6.4772 and 7.6521, respectively. The mean SBC among children with adequate nutrition was found to be 4.4861; for severely malnourished children and those with severe obesity, the values were 3.2472 and 2.8332, respectively. There was an absence of enamel hypoplasia in children with adequate nutrition, whereas a total of five participants with severe malnutrition and three children with severe obesity were found to have hypoplastic lesions, respectively. Malnutrition exerts a negative impact on the overall oral health of children. It is critical to diagnose the effects of malnutrition on children's oral environments in order to provide appropriate treatment and enhance their quality of life.

Clinical features of a novel compound heterozygous genotype of the BBS2 gene: a case report.

Bardet-Biedl syndrome is a rare autosomal recessive genetic disorder with heterogenous clinical manifestations. The present study reports the clinical features of a novel compound heterozygous genotype of the BBS2 gene in a 14-year-old girl and her 6-year-old sister who had complaints of early-onset low vision. Fundus images revealed retinitis pigmentosa-like changes, and full-field electroretinograms showed no amplitude for the rod or cone response in both patients. Interestingly, nystagmus was observed in the older sister. On physical examination, the sisters had moderate obesity without polydactyly, hypogonadism, or intellectual disability. Exome sequencing revealed a novel compound heterozygous genotype of BBS2 in the sisters, namely the paternally inherited NM_031885.5:c.534 + 1G > T variant and the maternally inherited NM_031885.5:c.700C > T (p.Arg234Ter) variant. Both variants were classified as pathogenic according to the American College of Medical Genetics and Genomics guidelines. This study provides useful information on the genotype-phenotype relationships of the BBS2 gene for genetic counseling and diagnosis.

Pediatric Lipid Screening Prevalence Using Nationwide Electronic Medical Records

Universal screening to identify unfavorable lipid levels is recommended for US children aged 9 to 11 years and adolescents aged 17 to 21 years (hereafter, young adults); however, screening benefits in these individuals have been questioned. Current use of lipid screening and prevalence of elevated lipid measurements among US youths is not well understood. To investigate the prevalence of ambulatory pediatric lipid screening and elevated or abnormal lipid measurements among US screened youths by patient characteristic and test type. This cross-sectional study used data from the IQVIA Ambulatory Electronic Medical Record database and included youths aged 9 to 21 years with 1 or more valid measurement of height and weight during the observation period (2018-2021). Body mass index (BMI) was calculated and categorized using standard pediatric BMI percentiles (9-19 years) and adult BMI categories (≥20 years). The data were analyzed from October 6, 2022, to January 18, 2023. Lipid measurements were defined as abnormal if 1 or more of the following test results was identified: total cholesterol (≥200 mg/dL), low-density lipoprotein cholesterol (≥130 mg/dL), very low-density lipoprotein cholesterol (≥31 mg/dL), non-high-density lipoprotein cholesterol (≥145 mg/dL), and triglycerides (≥100 mg/dL for children aged 9 years or ≥130 mg/dL for patients aged 10-21 years). After adjustment for age group, sex, race and ethnicity, and BMI category, adjusted prevalence ratios (aPRs) and 95% CIs were calculated. Among 3 226 002 youths (23.9% aged 9-11 years, 34.8% aged 12-16 years, and 41.3% aged 17-21 years; 1 723 292 females [53.4%]; 60.0% White patients, 9.5% Black patients, and 2.4% Asian patients), 11.3% had 1 or more documented lipid screening tests. The frequency of lipid screening increased by age group (9-11 years, 9.0%; 12-16 years, 11.1%; 17-21 years, 12.9%) and BMI category (range, 9.2% [healthy weight] to 21.9% [severe obesity]). Among those screened, 30.2% had abnormal lipid levels. Compared with youths with a healthy weight, prevalence of an abnormal result was higher among those with overweight (aPR, 1.58; 95% CI, 1.56-1.61), moderate obesity (aPR, 2.16; 95% CI, 2.14-2.19), and severe obesity (aPR, 2.53; 95% CI, 2.50-2.57). In this cross-sectional study of prevalence of lipid screening among US youths aged 9 to 21 years, approximately 1 in 10 were screened. Among them, abnormal lipid levels were identified in 1 in 3 youths overall and 1 in 2 youths with severe obesity. Health care professionals should consider implementing lipid screening among children aged 9 to 11 years, young adults aged 17 to 21 years, and all youths at high cardiovascular risk.

Optimal gestational weight change associated with improved perinatal outcomes in women with gestational diabetes mellitus: a population-based study in the United States

BackgroundOptimal gestational weight change (GWC) is little known among pregnant women with gestational diabetes mellitus (GDM). ObjectivesThis study aimed to explore the optimal GWC ranges for women with GDM and validate these ranges compared with the Institute of Medicine (IOM) guidelines. MethodsA population-based cohort study using natality data from the National Center for Health Statistics in the United States included 1,338,460 mother–infant pairs with GDM from 2014 to 2020. Poisson regression models were performed to identify GWC ranges (GDM targets) associated with acceptable risks (<10% increase) for a severity-weighted composite outcome including preterm birth (PTB) <37 wk, large for gestational age (LGA, birthweight >90th percentile) and small for gestational age (SGA, birthweight <10th percentile). These targets were validated in individual outcomes including PTB, LGA, SGA, hypertensive disorders of pregnancy, neonatal intensive care unit admission, and neonatal respiratory morbidity, and compared with the IOM guidelines using logistic regression models with population-attributable fractions (PAFs) calculated. ResultsThe severity-weighted composite outcome had a U-shaped or a J-shaped relationship with GWC across body mass index categories. The GDM targets were 14.1 to 20.3 kg, 9.0 to 17.0 kg, 4.8 to 13.8 kg, –0.8 to 10.8 kg, –2.4 to 8.2 kg, and –8.3 to 6.0 kg for underweight, normal weight, overweight, class 1 obesity, class 2 obesity, and class 3 obesity, respectively. GWC outside the GDM or the IOM targets was associated with increased adverse perinatal outcomes in validation analyses. PAFs indicated that the IOM guidelines reduced a similar or higher proportion of adverse perinatal outcomes compared with the GDM targets for women with GDM, except for those with class 2 and 3 obesity. ConclusionsThe IOM guidelines are generally applicable for women with GDM, except for women with moderate and severe obesity. The optimal GWC ranges for women with GDM and moderate to severe obesity may be lower than the IOM guidelines.

Proprietary alpha-amylase inhibitor formulation from white kidney bean (Phaseolus vulgaris L.) promotes weight and fat loss: a 12-week, double-blind, placebo-controlled, randomized trial

White kidney bean (Phaseolus vulgaris L.) extracts can aid weight management by reducing calorie intake from complex carbohydrates through alpha-amylase inhibition. We examined the impact of a proprietary aqueous extract from whole dried white kidney beans standardized by its alpha-amylase inhibitor activity (Phase 2 white kidney bean extract (WKBE)) on weight management in subjects with overweight and moderate obesity. In a randomized, double-blind, placebo-controlled fashion, 81 participants completed the study and ingested either a high dose of Phase 2 (1000 mg, WKBE HIGH), a low dose (700 mg, WKBE LOW), or a matching placebo (microcrystalline cellulose, PLA) three times a day, 30 min before meals, for 12 weeks during a calorie restricted diet. In a dose-dependent manner, Phase 2 significantly reduced body weight, fat mass, BMI, waist, hip and in the WKBE HIGH group thigh circumference. Phase 2 is an effective and safe supplement aiding weight and fat loss. ClinicalTrials.gov identifier NCT02930668.

Moderate Obesity is Not a Limiting Factor in Cardiac Rehabilitation after Aortic Valve Replacement for Severe Stenosis.

Moderate Obesity is Not a Limiting Factor in Cardiac Rehabilitation after Aortic Valve Replacement for Severe Stenosis.

Abstract MP47: Fetal Life Exposure to GDM and Postnatal Breastfeeding and Beverage Intake in the First Year Are Associated With Severe Child Obesity at 6 to 11 Years: The SWIFT Study in Youth

Objective: To evaluate associations between fetal exposure to GDM and postnatal breastfeeding (BF) and sugary beverages in the first year with risk of child overweight and obesity severity at 6-11 y. Methods: The sample included 850 children exposed to maternal GDM with BF and infant diet assessed by monthly surveys from birth to 1 y and weight and length/height measurements up to ages 6-11 y from electronic health records. Maternal GDM severity was classified by diagnosis time (Early &lt;24 wks or Standard ≥24 wks) and treatment type (Diet or Medication). Child BMI percentiles at 6-11 y were categorized as normal &lt;85 th (referent), overweight 85 th to &lt;95 th , moderate obesity 100 to &lt;120% of 95 th and severe obesity ≥120% of 95 th . Multinomial logistic regression estimated adjusted odds ratios (aOR) and 95%CI of child BMI categories associated with fetal GDM exposure (diagnosis time &amp; treatment) and postnatal diet; BF inadequate &lt;6 months or adequate &gt;6 months and sugary beverages (fruit juice or sugar added) adjusted for race/ethnicity, WIC recipient, pre-pregnancy BMI and gestational weight gain. Results: There were 480 (56.5%) children with normal weight, 150 (17.6%) with overweight, 155 (18.2%) with moderate obesity and 65 (7.6%) with severe obesity. Child average age (SD) at follow-up was 9.6 (1.4) y. Early GDM diagnosis was associated with aORs [95%CI] of severe obesity = 3.06 (1.33-7.04) with medication, and 2.61 (1.08-6.35) with diet and of moderate obesity = 1.93 (1.05-3.55) with diet vs. Standard diagnosis with diet. Inadequate BF with sugary beverage or fruit juice was associated with aOR [95%CI] of severe obesity = 3.06 (1.07-8.72) vs. adequate BF and no beverage. Conclusions: Earlier fetal exposure to maternal GDM and shorter BF combined with sugary beverages in the first postnatal year shows persistent higher risk of severe child obesity about 10 y later. These findings highlight pre-pregnancy screening to avert GDM and the importance of adequate BF and avoidance of sugary beverages and fruit juice among offspring exposed to GDM.

Alanine aminotransferase elevation varies by ethnicity among Asian and Pacific Islander children with overweight or obesity.

Limited research on alanine aminotransferase (ALT) screening for metabolic dysfunction-associated steatotic liver disease (MASLD) among US Asian/Pacific Islander (PI) children necessitates investigation in this heterogeneous population. Examine ALT elevation among Asian/PI children with overweight or obesity. Elevated ALT prevalence (clinical threshold) and association with body mass index ≥85th percentile were compared among 18 402 Asian/PI and 25 376 non-Hispanic White (NHW) children aged 9-17 years using logistic regression. ALT elevation was more prevalent among Asian/PI (vs. NHW) males with overweight (4.0% vs. 2.7%), moderate (7.8% vs. 5.3%) and severe obesity (16.6% vs. 11.5%), and females with moderate (5.1% vs. 3.0%) and severe obesity (10.2% vs. 5.2%). Adjusted odds of elevated ALT were 1.6-fold and ~2-fold higher for Asian/PI (vs. NHW) males and females (with obesity), respectively. Filipino, Chinese and Southeast Asian males had 1.7-2.1-fold higher odds, but Native Hawaiian/PI (NHPI) and South Asian males did not significantly differ (vs. NHW). Filipina and Chinese females with obesity had >2-fold higher odds, Southeast and South Asian females did not differ and NHPI findings were mixed (vs. NHW). High elevated ALT prevalence among Asian/PI children with overweight and obesity emphasizes the need for MASLD risk assessment and examination of ethnic subgroups.

Prevalence and Factors Associated with Grade of Obesity in Selected Health Areas in Yaoundé: A Cross-Sectional Study

Background: According to the WHO, obesity is an abnormal or excessive accumulation of body fat that poses a health risk. It is a major public health problem with growing numbers (1,400,000,000 overweight adults and more than 500,000,000 obese). Every year, there are at least 2,800,000 associated deaths. The prevalence of obesity in Africa is above 61% in the adult population. Despite control strategies, obesity is still a real problem in Cameroon. Methodology: This study aimed to determine the relationship between various risk factors and the prevalence of different grades of obesity in selected health areas in Yaounde. This work consisted of a descriptive cross-sectional study carried out in Yaoundé, in Central Cameroon. Data were collected via a questionnaire administered face-to-face to obese patients in the target hospitals and the anthropometric parameters of these were determined. These data were analyzed using CSPRO 7.1 and SPSS 21.0 software. Results: The total number of participants in this study was 267 patients, most of whom were women (82.4%). The predominant type of obesity was moderate obesity; its frequency was 53%, followed by severe obesity, 37%. The factors associated with all grades of obesity were female gender (73% moderate obesity, 89% severe obesity, 100% morbid obesity), and genetic factors (54.6% moderate obesity, 73.5% severe obesity, 54.6% morbid obesity). Age was associated with moderate obesity: the age group most affected by moderate obesity was 55–65 years (37.5%). Conclusion: These results show that it is of paramount importance to reeducate the population on diet and lifestyle to prevent obesity, including among genetically predisposed people and even women, whatever their conditions (Menopause, multipara).

Hemoglobin A1c and Type 2 Diabetes Incidence Among Adolescents With Overweight and Obesity.

With the increase in prediabetes among adolescents with overweight and obesity, identifying those at highest risk for type 2 diabetes (T2D) can support prevention strategies. To assess T2D risk by hemoglobin A1c (HbA1c) levels among adolescents with overweight and obesity. This retrospective cohort study was conducted using data for January 1, 2010, to December 31, 2019, from a large California health care system. The study population comprised adolescents aged 10 to 17 years who had a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) at or above the 85th percentile, had HbA1c measured during 2010 to 2018, and did not have preexisting diabetes. Data abstraction and analyses were conducted from January 1, 2020, to November 16, 2023. Baseline HbA1c, with covariates including BMI category (overweight: 85th to <95th percentile; moderate obesity: 100% to <120% of 95th percentile; or severe obesity: ≥120% of 95th percentile), age, sex, race and ethnicity, and Neighborhood Deprivation Index score. The main outcome was incident T2D during follow-up through 2019, including cumulative incidence and multivariable hazard ratios (HRs) with 95% CIs using Cox proportional hazard regression analyses. This study included 74 552 adolescents with a mean (SD) age of 13.4 (2.3) years. More than half (50.6%) were female; 26.9% of individuals had overweight, 42.3% had moderate obesity, and 30.8% had severe obesity. Individuals identified as Asian or Pacific Islander (17.6%), Black (11.1%), Hispanic (43.6%), White (21.6%), and other or unknown race or ethnicity (6.1%). During follow-up, 698 adolescents (0.9%) developed diabetes, and 626 (89.7%) had T2D; 72 individuals (10.3%) who had type 1, secondary, or other diabetes were censored. The overall T2D incidence was 2.1 (95% CI, 1.9-2.3) per 1000 person-years, with a 5-year cumulative incidence of 1.0% (95% CI, 0.9%-1.1%). Higher baseline HbA1c (from <5.5% to 5.5%-5.6%, 5.7%-5.8%, 5.9%-6.0%, 6.1%-6.2%, and 6.3-6.4%) was associated with higher 5-year cumulative T2D incidence (from 0.3% [95% CI, 0.2%-0.4%] to 0.5% [0.4%-0.7%], 1.1% [0.8%-1.3%], 3.8% [3.2%-4.7%], 11.0% [8.9%-13.7%], and 28.5% [21.9%-36.5%], respectively). In addition, higher baseline HbA1c was associated with greater T2D risk (reference [HbA1c <5.5%]: HR, 1.7 [95% CI, 1.3-2.2], 2.8 [2.1-3.6], 9.3 [7.2-12.1], 23.3 [17.4-31.3], and 71.9 [51.1-101.1], respectively). Higher BMI category, older age, female sex, and Asian or Pacific Islander race (HR, 1.7 [95% CI, 1.3-2.2]), but not Black race or Hispanic ethnicity (compared with White race), were also independent indicators of T2D. In stratified analyses, incremental risk associated with higher HbA1c was greater for Asian or Pacific Islander and White adolescents than for Black and Hispanic adolescents. In this cohort study of adolescents with overweight and obesity, T2D risk increased substantially with baseline HbA1c above 6.0%. Risk varied by BMI, age, sex, and race and ethnicity. These findings suggest that diabetes surveillance in adolescents should be tailored to optimize identification among high-risk subgroups.

The Status of Vitamin D in Obese Adults in Southern Morocco: a Cross-Sectional Study.

Vitamin D is a fat-soluble vitamin found in two forms, sourced either from plants (D2) or animals (D3). Numerous epidemiological studies worldwide have highlighted its deficiency across diverse populations in various countries. When coupled with obesity, this deficiency becomes a significant global health concern. Our study aimed to evaluate the vitamin D levels among obese individuals in Southern Morocco. This is a retrospective, cross-sectional descriptive study on the vitamin D status in obese subjects. This study was conducted at the "Health Universe" Diet Center in Agadir, Morocco. The measurement method involved using a Tanita® wall-mounted metal stadiometer to determine height and a Tanita® BC 418 MA segmental body composition analyzer to determine weight. The serum level of 25-hydroxyvitamin D was determined by elec-trochemiluminescence (ECLIA) using the Elecsys® and Cobas e411®. The sample of our study, consisting of 1,210 individuals, is composed of 73.5% (n = 889) females and 26.5% (n = 321) males. The mean age of the entire sample is 42.3 ± 13.1 years (ranging from 18 to 86 years). The mean BMI is 37 ± 5.69 kg/m², with a higher value in females (37.4 ± 5.85 kg/m²) compared to males (35.7 ± 5.03 kg/m²), including 42.8% moderate obesity, 34.2% severe obesity, and 23% morbid obesity. The mean serum vitamin D level in our sample is 15.7 ± 7.67 ng/mL. This level is 14.5 ± 7.42 ng/mL for females and 19.2 ± 7.31 ng/mL for males. However, only 5.3% of the subjects have an adequate serum vitamin D level, while 18% have an insufficiency, 52.5% have a moderate deficiency, and 24.2% have a severe deficiency. An inverse trend was noted for BMI, which shows a very significant inverse correlation with serum vitamin D concentration (r = -0.18 and p < 0.01). Our results support the hypothesis that obesity is inversely associated with low vitamin D levels. Lifestyle improvement should be considered as the primary treatment option, aiming to enhance the dysmetabolic state associated with obesity and vitamin D deficiency.

Changes in Obesity Prevalence Following Spinal Cord Injury: A Retrospective Review of Body Mass Index

Background: The prevalence of obesity is high in individuals with spinal cord injury (SCI) due to the alterations in body composition that occur as a direct result of injury. Body mass index (BMI) is used to classify body habitus. In 2009, an adjusted BMI classification, with lower thresholds for obesity, was recommended for individuals with SCI. Objective: Determine obesity prevalence before and after SCI to examine the trajectory of obesity development. Furthermore, we discuss the challenges of applying a modified BMI classification system in this population. Methods: We conducted a retrospective medical record review. Adults with traumatic SCI were selected. Height and body weight measurements were used to calculate BMI two years before injury through two years after injury. Results: Obesity prevalence is high in SCI participants. However, we report no significant difference in BMI between motor complete and incomplete injuries, or between tetraplegic or paraplegic injuries. We report a decrease in BMI from one year before injury to one- and two-years after injury for all groups. With moderate obesity before injury, the transition to a new BMI classification system creates a challenge in reducing obesity prevalence. Conclusion: Obesity prevalence encompassed nearly all participants by the second year following SCI. The adjusted BMI classification system dictates the high obesity prevalence in this population and is best used as a screening tool to track the risk of developing obesity. Exceptions should be considered when using the SCI-adjusted BMI classification system, and tissue composition analysis is preferred.

Abstract 15904: Hypertension Risk in Adolescent Females With Polycystic Ovary Syndrome

Background: Polycystic ovary syndrome (PCOS) is associated with increased risk of hypertension (HTN) in adult women, but fewer studies have examined PCOS and HTN among adolescents. Characterizing blood pressure (BP) by PCOS status prior to adulthood may inform early cardiovascular risk surveillance efforts. Aim: To examine the prevalence of hypertension-range BP (HTN-BP) in adolescent females with and without PCOS and to characterize the association of PCOS and HTN-BP. Methods: We used data from an existing cohort of 171,855 females aged 13-17y in a US healthcare system with well-child visit (2012-2018) and measured systolic/diastolic BP. The 2017 American Academy of Pediatrics Practice Guideline was used to classify normal BP [&lt;120/&lt;80], elevated BP [120/&lt;80-129/&lt;80], stage 1 HTN [130/80-139/89] and stage 2 HTN [≥140/90 mmHg]. PCOS was based on clinical diagnosis (ICD-9 265.4, ICD-10 E28.2) within 1 year of the visit. Body mass index (BMI) was classified as healthy, overweight, moderate and severe obesity using BMI percentile data; 3062 underweight females were excluded from analyses. Differences by PCOS (N=1142) and no PCOS (N=167,651) status were compared. Multivariable logistic regression examined the association of PCOS and HTN-BP, with adjusted odds ratios (aOR) and 95% confidence intervals (CI). Results: The cohort included 168,793 females (33.6% non-Hispanic White, 9.7% Black, 30.5% Hispanic, 19.9% Asian/Pacific Islander, and 6.3% other/unknown race ethnicity), of whom 65.9% had healthy weight, 18.7% overweight, and 15.4% obesity. Based on visit BP data, 75.6% were normotensive, 17.5% had elevated BP, and 7.0% had HTN-BP (6.1% Stage 1, 0.9% Stage 2). HTN-BP prevalence was much higher for PCOS vs no PCOS (18.6% vs 6.9%, p&lt;0.001). After accounting for age, race/ethnicity, and BMI level, PCOS was associated with 1.3-fold greater odds of HTN-BP (aOR 1.3, CI 1.1-1.5). Similar findings were seen among females with obesity (aOR 1.3, CI 1.1-1.6). Conclusions: Prevalence of HTN-BP was 30% higher for those with PCOS after adjusting for BMI, race/ethnicity, and age. Similar findings were evident among those with obesity. Future studies should examine persistent HTN and the independent association of PCOS and HTN severity in this high-risk population.

Endoscopic sleeve gastroplasty as an early tool against obesity: a multicenter international study on an overweight population

Background and aimsEndoscopic sleeve gastroplasty (ESG) is an effective, minimally invasive gastric remodeling procedure to treat mild and moderate obesity. Early adoption of ESG may be desirable to try to halt progression of obesity, but there are few data on efficacy and safety for overweight patients. MethodsThis was a multicenter, international, analytical case series. Six American, one Brazilian, one Mexican, and one Indian center were included. Overweight patients according to local practice undergoing ESG were considered eligible for the study. The endpoints were %total weight loss (%TWL), BMI reduction, rate of BMI normalization, and adverse events rate (AEs). ResultsOne hundred eighty-nine patients with a mean age of 42.6±14.1 years old and a mean BMI of 27.79±1.17kg/m2 were included. All procedures were successfully accomplished and there were 3 intraprocedural AEs (1.5%). The mean %TWL was 12.28±3.21%, 15.03±5.30%, 15.27±5.28%, and 14.91±5.62% at 6, 12, 24, and 36 months, respectively. At 12 and 24 months, 76% and 86% of patients achieved normal BMI with a mean BMI reduction of 4.13±1.46kg/m2 and 4.25±1.58kg/m2. There was no difference in mean %TWL of the first quartile versus the fourth quartile of BMI in any of the time points. However, the BMI normalization rate was statistically higher in the first group at 6 and 12 months (6m: 100% vs. 48.5%, p<0.01; 12m: 86.2% vs. 50%, p<0.01; 24m: 84.6% vs. 76.1%, p=0.47; 36m: 86.3% vs. 66.6%, p=0.26). ConclusionESG is safe and effective in treating overweight patients with high BMI normalization rates. It could help halt or delay the progression to obesity.

Клініко-лабораторні кореляції помірного ожиріння та дисбалансу вітаміну D з предикторами прееклампсії

There is a lot of evidence regarding the validity of various biomarkers as predictors of preeclampsia. However, despite the obviousness and necessity of such studies for women with obesity, such works are not numerous and their data are contradictory. Purpose - to investigate different predictors of preeclampsia in patients with moderate obesity, depending on vitamin D status. Materials and methods. A prospective controlled clinical study was conducted in which 101 pregnant women were included: the main group, consisting of women with moderate obesity (n=75), and the control group, consisting of almost non-obese pregnant women (n=26). The level of 25(OH)D in blood serum, markers of gestational endotheliopathy, blood flow in the uterine arteries of pregnant women, and markers of prenatal screening in the first trimester were studied. STATISTICA 10 software was used for statistical data processing. Results. Among the women in the main group, 85.3% had vitamin D insufficiency or deficiency in their serum. In such women in the first trimester of pregnancy, a significant increase in cases of microalbuminuria with a level of &gt;5.0 mg albumin/mmol creatinine and a decrease in cases of endothelium-dependent vasodilatation with an index of &lt;15.0%, a significantly higher resistance index in the uterine arteries, cases of early lateral and bilateral diastolic notch, as well as a statistically significantly lower level of β-hCG were observed. Conclusions. Moderate obesity and low vitamin D status were statistically significantly associated with predictors of preeclampsia. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author.

Associations of socioeconomic status and obesity with hypertension in tibetan adults in a Chinese plateau area

BackgroundPrevious studies have identified that socioeconomic status (SES) and obesity are associated with hypertension. However, their interaction on hypertension risk has not yet been assessed.MethodsThe study used data from 6,069 Tibetan residents in Chengguan District in Lhasa, the Chinese Tibetan autonomous region’s capital, based on a cohort study conducted from May 2018 to September 2019 in five provinces in southwest China. We used logistic regression models to assess the complex relations of SES and obesity with hypertension.ResultsCompared with individuals of high SES, low and moderate SES were positively associated with high risk of hypertension. SES and obesity have significant additive interaction on hypertension (general obesity by BMI: RERI = 1.33, P < 0.001; abdominal obesity by WC: RERI = 0.76, P < 0.001; abdominal obesity by WHtR: RERI = 0.96, P < 0.001). In people from the low and moderate SES segments, obesity was linked to an increased risk of hypertension, but the correlations were stronger in people from the moderate SES category. Compared with people of high SES and non obese, those with moderate SES and obesity had a higher risk of hypertension, and ORs were 4.38 (2.80, 6.84) for general obesity by BMI, 3.38 (2.05, 5.57) for abdominal obesity by WC, and 3.18 (1.57, 6.42) for abdominal obesity by WHtR.ConclusionThere is an independent and additive interaction effect of obesity and SES on the risk of hypertension. People with obesity, especially those of moderate and low SES, should reduce weight and waist circumference, and pay more attention to blood pressure. Moreover, the government, health administration departments, and society should prioritize improving the socioeconomic status of the Tibetan population and addressing risk factors like obesity.

Association of Maternal Body Mass Index During Early Pregnancy With Offspring Lower Respiratory Infections: A Nationwide Cohort Study.

To assess whether or to what extent maternal obesity during early pregnancy could increase the risk of offspring lower respiratory infections (LRI). This population-based cohort included 688,457 live singleton births born in Denmark between 2004 and 2016. The exposure was maternal body mass index (BMI) during early pregnancy, and the outcome was LRI in offspring. Cox regression models were used to estimate hazard ratios with their 95% confidence intervals (CI) for the association. We also performed subanalysis stratified by the LRI onset age, number of infection episodes before the age of 3, infection pathogens, infection sites, duration of hospital stay due to LRI and allergic constitution of children. A total of 64,725 LRIs in offspring were identified during follow-up. Maternal overweight (BMI 25.0-29.9 kg/m2), moderate or severe obesity (BMI 30.0-39.9 kg/m2) and very severe obesity (BMI ≥40 kg/m2) were associated with a 7% (95% CI: 5%-9%), 16% (95% CI: 14%-19%) and 21% (95% CI: 13%-28%) increased risk of LRI in offspring, respectively. Higher maternal BMI was positively associated with earlier onset age, more episodes before the age of 3, and longer hospital stay of LRI in offspring. In addition, allergic constitution of offspring significantly enhanced the effect of maternal BMI on offspring LRI (44% increased risk, 95% CI: 5%-97% for very severe obesity). Maternal BMI during early pregnancy might be a risk factor for offspring LRI, especially in children with allergic constitution.