Non-obese Group Research Articles

Endometrial Heparin-Binding Epidermal Growth Factor Gene Expression and Hormone Level Changes in Implantation Window of Obese Women with Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS) is a common endocrine disorder amongst reproductive-age women, and 61% to 76% of women with PCOS are obese. Obese women with PCOS are usually burdened with infertility problems due to implantation failure. Thus, progesterone treatment is usually used to improve implantation rates. Although Hb-EGF expression is actively involved in endometrial receptivity and implantation, the data on heparin-binding epidermal growth factor (Hb-EGF) expression following progesterone therapy in obese women with PCOS are still lacking. To investigate the changes in serum follicle-stimulating hormone (FSH), luteinising hormone (LH), dehydroepiandrosterone sulphate (DHEA), progesterone and oestradiol levels and Hb-EGF expression in obese women with PCOS during the implantation window following progesterone therapy. A total of 40 participants aged 18-40 years old were recruited following the provision of written consent. The participants were divided into the obese PCOS, normal-weight PCOS, obese fertile and normal-weight fertile groups. First blood collection was done before ovulation. Then, daily oral micronised progesterone (Utrogestan 200 mg) was given to the PCOS group for 10 days. The treatment was followed by a second blood collection and endometrial tissue sampling by using a Pipelle de Cornier catheter. In the fertile group, ovulation was confirmed by using ultrasound, and a second blood sample was collected on days 7 to 9 postovulation. The serum levels of FSH, LH, DHEA, progesterone and oestradiol were measured in all participants. Wilcoxon signed-rank test was used to compare FSH, LH, DHEA, progesterone and oestradiol levels during pre- and postovulation. Mann-Whitney test was performed to compare FSH, LH, DHEA, progesterone and oestradiol levels between two groups: (1) the PCOS group and the fertile group, (2) the obese PCOS group and the non-obese PCOS group and (3) the obese group and the non-obese fertile group. Serum FSH levels were lower in obese women in their follicular phase than in women with normal weight regardless of their PCOS status, whereas serum LH/FSH ratios and DHEA levels were higher in women with PCOS than in women without PCOS. However, endometrial Hb-EGF expression was lower in the obese PCOS group than in the normal-weight PCOS group. Different patterns of hormonal levels and Hb-EGF expression levels were seen between the studied groups. However, further in vitro and in vivo studies are needed to investigate the mechanism underlying the changes in FSH, LH/FSH ratio, DHEA and Hb-EGF expression in PCOS after progesterone treatment.

Diabetes Mellitus and Obesity as Prognostic Factors in Arthroscopic Repair of Chronic Rotator Cuff Tears.

Metabolic diseases such as obesity and diabetes mellitus seem to have an influence on reoperation and long-term functional outcomes after arthroscopic repair of chronic rotator cuff tears. High prevalence of these pathologies can be found in the Canary Islands. A retrospective cohort study was carried out, in which 80 patients undergoing shoulder arthroscopic surgery for the repair of chronic rotator cuff tears were included, with a minimum follow up of 5 years, to study the occurrence of complications, reoperation, and functional outcomes. Functionality after surgery improved in 75% of patients with diabetes and remained the same or worsened in 25% (OR = 1.444). In the group of non-diabetic patients, 83.9% had improved function after surgery while it remained the same or worsened in 16.1% (OR = 0.830). Functionality after surgery improved in 76.6% of obese patients and remained the same or worsened in 23.4% (OR = 1.324). In the non-obese group, 87.9% had improved function after surgery, while it remained the same or worsened in 12.1% (OR = 0.598). Despite not obtaining statistically significant differences, the analysis of the results obtained suggests that obesity and diabetes could act by decreasing the subjective improvement in functionality after surgery, and, in the case of obesity, also increase the risk of reoperation.

Effects of labor induction in obesity with delayed pregnancy: A retrospective study based on Chinese obese primipara.

To test the hypothesis that obese primiparous women with an unfavorable cervix in delayed pregnancy may experience a worse induction of labor. In total, 467 primiparas with poor cervical condition and delayed pregnancy (gestational age [GA]: >40weeks) were divided into an obese primiparas group (body mass index [BMI] >30kg/m2; n=166) and a non-obese primiparas group (BMI < 30kg/m2; (n=301). Labor was induced by various methods, double balloon, dinoprostone inserts, and amniotomy combined with oxytocin depending on the Bishop score. Experimental data were analyzed by Statistical Product Service Solutions (SPSS). BMI in the obese primiparas group was higher than in the non-obese group (33.91 ± 2.67 versus 24.09 ± 5.78, p<0.001), and there were significant differences in uterine tone and duration of contractions between the two groups in the second stage of labour (p=0.041, p=0.026, respectively).The rate of cesarean section (CS) was significantly higher in the primiparas group (23.49% versus 12.29%; P=0.002). There was a significant difference between the two groups in terms of the duration of time to vaginal delivery (VD) (18h versus 8h; P <0.001) while the duration until VD in the obese primiparas group within 12 hours and 24 hours was significantly longer (P <0.001). After adjusting for possible confounders, caesarean section rates remained high in the obese primiparas women (OR: 2.564;95%CI1.919,3.864;P<0.001). Similarly, after adjusting for the same confounding factors, obese primiparas women increased the duration until VD within 24h by 3.598 hours. Obese primiparas with an unfavorable cervix in delayed pregnancy have a significantly higher risk of CS and a longer duration until VD than non-obese primiparas during labor induction.

Chronic physical exercise alleviates stress-associated amygdala metabolic activity in obese women: A prospective serial 18F-FDG PET/CT study.

Psychological stress is considered as a major risk factor for cardiovascular disease (CVD). Chronic exercise is known to reduce CVD risk partly through attenuating psychological stress. Obesity has been linked with increased levels of psychological stress. We aimed to prospectively evaluate whether physical exercise could alleviate stress-associated amygdala metabolic activity, assessed by 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in women with obesity. A total of 43 participants were enrolled in this study. Twenty-three obese women were participated in a physical exercise program 5 days per week for 3 months. The exercise program consisted of aerobic exercise and resistance training. Serial 18F-FDG PET/CT was taken before the start of physical exercise program (baseline) and after finishing the program (post-exercise). A total of 20 participants who underwent 18F-FDG PET/CT for general health check-up were enrolled as non-obese control group. Brain amygdala activity (AmygA) was calculated as maximum standardized uptake value (SUVmax) of amygdala normalized to mean SUV of temporal lobe. Chronic physical exercise significantly reduced AmygA and improved body adiposity and systemic inflammation. AmygA was highest in baseline, intermediate in post-exercise, and lowest in non-obese control group (0.76 ± 0.17, 0.61 ± 0.1, 0.52 ± 0.09, p < 0.001). Furthermore, physical exercise also abrogated the association of AmygA with systemic inflammation. Chronic physical exercise reduced stress-associated amygdala metabolic activity and broke its association with systemic inflammation in obese women. This study could explain the putative mechanism underlying the health beneficial effect of exercise on CVD via attenuation of stress neurobiology.

High-normal free thyroxine level is related with decreased bone mineral density in nonobese male patients with type 2 diabetes over 50 years old.

The prevalence of 'low bone mineral density (BMD)' in Type 2 diabetes (T2DM), especially stratified by body mass index, is seldom reported. The relation of the euthyroid range and low BMD in T2DM remains to be further elucidated. We aim to investigate the thyroid hormones' impact on BMD among euthyroid patients with T2DM. A total of 1452 hospitalized T2DM patients with normal thyroid function (43.6% males aged over 50 and 56.4% postmenopausal females) were enrolled in this cross-sectional study. BMD was measured at lumbar spine by GE lunar dual-energy X-ray absorptiometry system, and 'low BMD' was defined as T-score <-1.0 SD. The prevalence of 'low BMD' was compared between obese and nonobese (body mass index < 25 kg/m2) groups for both sexes, and the relation of low BMD and free T4 quartiles was explored by multiple logistic regression. The general prevalence of 'low BMD' was 12.3% for male patients aged over 50 (15.5% in the nonobese group and 8.0% in the obese group) and 49.8% for postmenopausal females (56.7% in the nonobese group and 48.9% in the obese group). After adjustment in multiple linear regression, free T4 level remained significantly related to decreased BMD in nonobese male subgroup. Multiple logistic regression revealed that BMD of the highest free T4 quartile (1.12-1.48 ng/dL) decreased significantly than other three quartiles after adjusting for confounding factors including age, body mass index, serum calcium and creatinine level, fasting glucose, alkaline phosphatase, glycosylated hemoglobin, total cholesterol, and smoking history (OR = 2.724, 95% CI = 1.085-6.840, p = 0.033). No significant relation was found in obese male or postmenopausal female groups. High-normal free T4 is a potential independent risk factor for 'low BMD' in nonobese male T2DM patients aged over 50. Close attention should be paid to thyroid function profile, even within normal range, in nonobese men with underlying higher fracture risks on diabetes status.

Comparative Efficacy and Safety of Super-Bioavailable Itraconazole-130 mg Once Daily in Obese and Non-Obese Patients of Glabrous Tinea

Background: Obesity is considered one of the risk factors for dermatophytosis and warrants systemic therapy. Itraconazole is the most commonly used antifungal, but owing to pharmacokinetic challenges, super-bioavailable itraconazole (SITZ) was approved globally, recently. For the management of dermatophytosis in obese patients, there are mixed opinions regarding the dosing of systemic antifungals. Materials and Methods: This study was conducted to compare the efficacy and safety of SITZ-130 mg once daily in glabrous tinea or dermatophytosis in obese and non-obese patients for a total duration of 10 weeks on 87 eligible patients. Efficacy and safety assessments were done at weeks 3 and 6 with follow-up at week 10 for relapse. The primary objective was to assess the proportion of patients achieving complete cure at week 6 with the assessment of safety, clinical, and mycological cure rates as secondary objectives. Results: Out of 87 patients, 80 were considered for analysis. At week 6, 22/35 (63%) and 33/45 (73%) patients in obese and non-obese groups were completely cured (P = 0.47). Similarly, there was no statistically significant difference for mycological and clinical cure in both the groups (P = 0.17 and P = 0.61, respectively). Four patients in the obese group (18% of completely cured), while one patient in the non-obese group (3% of completely cured), relapsed within 4 weeks of completion of treatment (P = 0.14). The therapy was well tolerated by both groups, with only one patient in the non-obese group experiencing pruritus. Conclusion: SITZ-130 mg once daily achieved desired and similar clinical response in obese patients as of non-obese patients suffering from dermatophytosis, and hence, a higher dose may not require in obesity.

The Relationship Between Breastfeeding and Maternal Obesity: A Clinical Trial

Objective: There are several factors in parental infant feeding decisions including intention to breastfeed which is a strong predictor of initiation and duration of breastfeeding. We aimed to investigate the association between obesity and breastfeeding performance to help further attempts in public health intercession for maternal obesity control. We also compared breastfeeding and non-breastfeeding women regarding other demographic and clinical characteristics. Material and Methods: This prospective cohort study was conducted between December 2019 and February 2020 in the University of Health Sciences, İstanbul Kanuni Sultan Süleyman Health Training and Research Medical Center. All postpartum patients who had delivered in the past 48 hours and were still hospitalized at our center were included. Results: Obese and non-obese groups were similar in terms of age, gravidity, parity, medical history, socioeconomic condition, and education level. Breastfeeding presence, frequency and duration did not show a significant difference between groups. When the breastfeeding and non-breastfeeding patients regarding were compared their clinical and demographic characteristics, there was no significant difference between the groups except for gravidity, parity, and postpartum complication. Among them, 94.4% of patients who were breastfeeding had the wish to breastfeed and 96.1% had a history of breastfeeding in their prior pregnancies. Conclusion: Since obesity is a variable that can affect breastfeeding performance, and can have secondary effects on breastfeeding through postpartum complications, the importance of pre-pregnancy weight and weight gain during pregnancy should be shared with patients in prenatal counseling.

Comparing unfractionated heparin dose for VTE in obese versus non-obese patients

Background: Venous thromboembolism (VTE) is treated based on body weight to determine unfractionated heparin (UFH) dosage. However, this approach has not been thoroughly studied in obese patients. We aimed to determine the optimal infusion rate of UFH in obese patients using the weight-based dosing nomogram. Methods: A retrospective review was conducted on adult patients treated with heparin per VTE protocol with activated thromboplastin time (aPTT) of 60-80 seconds. We calculated the median heparin infusion rate (units/kg/hour) required to achieve the first therapeutic aPTT in obese and non-obese patients. We also investigated the median time required to achieve the first therapeutic aPTT in both groups, the percentage of aPTT at the target goal within the first 24 hours of treatment, the percentage of sub and supra-therapeutic aPTT at 24 hours after initiation of heparin infusion, and incidence of thrombosis and bleeding during heparin treatment. Results: We included 70 patients with confirmed VTE diagnosis. Obese patients required a lower UFH infusion rate (units/kg/hour) compared to non-obese patients (16.5 vs. 18, p = 0.24). The time to reach the first therapeutic aPTT was longer in obese patients compared to non-obese (17.7 hours vs. 15 hours respectively, p = 0.7). Major bleeding events were higher in the obese patients compared to the non-obese (6.25% vs. 2.6%, p = 0.44). In contrast, minor bleeding events were higher in the non-obese group (28.1% vs. 36.8%, p = 0.46). The overall rate of thrombotic events occurring during heparin treatment was 6.2% in obese patients and 5.3% in non-obese patients (p = 0.86). Conclusion: Dosing of UFH in obese patients using the weight-based nomogram was associated with over-anticoagulation and demonstrated no significant difference in UFH dosing to reach the goal of aPTT in obese or non-obese patients.

25-Hydroxycholecalciferol levels and its equation with lipid parameters and Insulin sensitivity in obese and non-obese young adults: A pilot study

Abstract Introduction: Vitamin D deficiency and Obesity are the two prevailing health issues of the globe, with India being no exception. The sub optimal Vitamin D levels is associated with an elevated risk of a number of chronic disorders including malignancy, inflammation and autoimmune diseases. Obesity breeds metabolic disharmony. Recent data reports Vitamin D deficiency being more prevalent among the obese. Objective: This study is undertaken to see the association of Vitamin D levels with Body Mass Index (BMI), Lipid parameters and Insulin resistance in a sample population representing the urban Indian youth. Materials and Method: Fifty five apparently healthy young adults of 18 to 22 years age were recruited in this study and their serum 25-hydroxycholecalciferol(25OHD), serum insulin, Total Cholesterol, High Density lipoprotein-cholesterol (HDL-c), Low Density lipoprotein- cholesterol (LDL-c) and Triglyceride (TGL) levels were estimated. Insulin resistance(IR) was derived using the Homeostasis Model Assessment equation. Based on BMI, the participants were divided into Obese group with BMI ≥ 25 (n=21) and non-obese group with BMI &lt; 25 (n=34). Result: 25OHD levels were almost same in both Groups (Obese11.1 ± 4.6 ng/ml and non-obese 11.0 ± 5.2 ng/ml). Serum total cholesterol, VLDL and insulin levels were significantly increased in the Obese group(p= 0.005, p= 0.015 and p=0.054 respectively) when compared to the non-obese group. We found statistically significant association between 25-hydroxycholecalciferol (25OHD) and TGL/HDL ratio in the Obese group. Conclusion: In this pilot study we have unravelled the subtle onset of metabolic derangement in Obese individuals with Vitamin D deficiency.

Altered Phenotypic Parameters, Obesity Risk Factors and Co-Morbidities in a Population of Southwestern Nigeria

Background: Obesity is a disease with multifactorial etiology with co-morbidities occurring in epidemic proportions in Nigeria, thereby constituting significant economic and health burdens. This study investigates altered biophysical parameters and likelihood model fits for predicting the risk of co-morbidities in obese and non–obese subjects in Southwest Nigeria. Methods: Three thousand subjects (1500 obese and 1500 non-obese) aged 18 years and above were recruited from Osun and Oyo States, Nigeria communities. Blood samples were collected into appropriate bottles for biochemical analyses using standard procedures. Phenotypic parameters (height, weight, BMI, waist and hip circumferences) were also assessed. Multivariate regression analyses and statistical models were designed to determine the association between obesity risk factors and co-morbidities. Results: Mean ages of obese (60.4± 13.8years) and non-obese (58.6± 15.7years) subjects were significantly different. Obesity showed a male preponderance. Mean BMI, waist-hip ratio, and waist and hip circumferences were higher (p&lt;0.05) among obese subjects but increased with age in both groups (P&lt;0.05). Mean triglyceride, fasting glucose levels, arterial blood pressure, pulse pressure, and mean heart rate increased in the obese group compared to the non-obese group. Adjusted Odds of Obesity (WHO) showed that stress, family history of cardiovascular disease, and diabetes were significantly associated with obesity. Conclusion: Increasing age, male gender, and hypertension were all significantly associated with the development of obesity among Nigerians of Southwestern extraction.

Impact of serum leptin and adiponectin levels on breast cancer in postmenopausal Iraqi women: an observational Study

Background: Breast cancer is the most common malignant tumor and the second most significant cause of death for women in Iraq, behind cardiovascular diseases. Obesity has been linked to a substantial increase in the risk of breast cancer. Adipose tissue functions as an endocrine gland, controlling the body's metabolism by secreting adipokines, which play a significant role in metabolism and inflammatory reactions. Methods: Overall, 90 postmenopausal women participated in this research. Of these, 60 patients with breast cancer were recruited at Baghdad's Oncology Teaching Hospital between October 2021 and February 2022: 30 were obese with a body mass index (BMI) of &gt; 30 kg/m2 (group 1), and 30 were not obese (group 2). The third group consisted of 30 participants without breast cancer or obesity (group 3). Each person donated five milliliters of venous blood. The blood levels of adiponectin and leptin are determined using enzyme-linked immunosorbent assay (ELISA) kits. Results: Control individuals who were not obese (group 3) had greater blood adiponectin levels than patients with cancer who were both obese and non-obese (groups 1 and 2), with no significant difference in serum adiponectin levels seen between groups 1 and 2. The findings also showed that group 1 (patients with breast cancer and obesity) had greater serum leptin levels than both group 2 (patients with breast cancer without obesity) and the control group (group 3), with no significant difference in serum leptin levels between groups 2 and 3. Conclusions: Adiponectin levels in the blood of women with breast cancer and obesity were low which may be due to high BMI, which reduces adiponectin's protective effects. Conversely, Leptin levels were more significant in the blood of women with breast cancer and obesity than in the control group, which may be due to its pro-inflammatory effects in obesity, among other variables.

Clinical and radiologic outcomes of biportal endoscopic lumbar discectomy in obese patients: a retrospective case-control study

BackgroundObese patients have a higher risk of complications during spinal surgery than non-obese patients. To the best of our knowledge, no studies have examined the differences in clinical and radiological outcomes after biportal endoscopic lumbar discectomy (BELD) between obese and non-obese patients. The study evaluated the association between obesity and outcomes after BELD in patients with lumbar disc herniation.MethodsThis was a retrospective case-control study conducted from March 2017 to March 2021 at two hospitals with 360 patients who underwent BELD after showing no improvement with conservative treatment. Clinical and radiologic outcomes were retrospectively analyzed after BELD in the non-obese (body mass index [BMI] < 30 kg/m2) and obese (BMI ≥ 30 kg/m2) groups. Demographic data and surgery-related factors were compared between the two groups. Clinical outcomes were followed up for 12 months after surgery and analyzed for differences.ResultsA total of 211 patients were enrolled in this study, and through case-control matching, the data of 115 patients (29, obese group; 86, non-obese group) were analyzed. The two groups showed no significant differences in Oswestry Disability Index, European Quality of Life-5 Dimensions (EQ-5D), and visual analog scale scores measured immediately after BELD and 12 months after surgery. After surgery, back pain, radiating leg pain, and EQ-5D scores improved. However, there was no significant difference in improvement, residual herniated disc, hematoma, or recurrence between the groups.ConclusionsObese patients who underwent BELD for lumbar disc herniation showed no significant difference in clinical and radiologic outcomes compared with non-obese patients.

Vitamin D levels of obesity and non-obesity health workers: a cross-sectional study in Dr. Sardjito General Hospital/Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada, Yogyakarta

Obesity is one of the causes of chronic diseases, such as diabetes, hypertension, stroke, cancer, dyslipidemia, and heart disease. It is considered a financial burden on national health insurance since it drains the largest health fund. The study aimed to determine the difference in vitamin D levels in obese and non-obese health workers and analyze the factors that influence it. This was a cross-sectional study of the obese and non-obese health workers at Dr. Sardjito General Hospital, Yogyakarta. A total of 50 subjects, including 25 obese and 25 non-obese subjects were involved. Serum vitamin D levels was determined by ELISA. There was no significant difference between the obese and non-obese groups on vitamin D status (p&lt;0.365). Vitamin D deficiency was found in 10% of subjects, whereas insufficient vitamin D levels were found in 46 and 44% of subjects, respectively. Vitamin D deficiency was more common in the obese (12%) than non-obese (8%) group. Contrarily, vitamin D insufficiency was more common in the non-obese (56%) than obese (36%) group. The serum vitamin D levels in the obese [30.08 (14.67-101.71) ng/mL] was not significantly different compare to those non-obese [28.54 (14.38-54.41) ng/mL] (p = 0.691). The multivariate analysis significantly showed that outdoor activities &lt;30 min had a 7.061 times greater risk of having vitamin D deficiency/insufficiency compared to outdoor activities &gt;30 min (OR 7.061; 95% CI: 1.064-46.872; p=0.043). In conclusion, there is no significant difference in vitamin D levels between the obese and non-obese groups. Vitamin D deficiency/insufficiency is more common in non-obese subjects than in obese subjects. Outdoor activity &lt;30 min is a risk factor for vitamin D insufficiency/deficiency despite living in a tropical country with abundant sunlight throughout the year.

Antibody responses to COVID‐19 vaccination in people with obesity: A systematic review and meta‐analysis

COVID-19 vaccine is critical in preventing SARS-CoV-2 infection and transmission. However, obesity's effect on immune responses to COVID-19 vaccines is still unknown. We performed a meta-analysis of the literature and compared antibody responses with COVID-19 vaccines among persons with and without obesity. We used Pubmed, Embase, Web of Science, and Cochrane Library to identify all related studies up to April 2022. The Stata.14 software was used to analyze the selected data. Eleven studies were included in the present meta-analysis. Five of them provided absolute values of antibody titers in the obese group and non-obese group. Overall, we found that the obese population was significantly associated with lower antibody titers (standardized mean difference [SMD]= -0.228, 95% CI [-0.437, -0.019], P < 0.001) after COVID-19 vaccination. Significant heterogeneity was present in most pooled analyses but was reduced after subgroup analyses. No publication bias was observed in the present analysis. The Trim and Fill method did not change the results in the primary analysis. The present meta-analysis suggested that obesity was significantly associated with decreased antibody responses to SARS-CoV-2 vaccines. Future studies should be performed to unravel the mechanism of response to the COVID-19 vaccine in obese individuals.

Characteristics of Rheoencephalography and some Associated Factors on Menopausal Women.

The significant drop in estrogen levels during menopause increases the cardiovascular risks, one of which is cerebrovascular atherosclerosis. Research on rheoencephalography (REG) parameters for the early diagnosis of cerebrovascular atherosclerotic lesions is of great interest to scientists because of its ease of implementation, low cost, and non-invasiveness. The objectives of study are to evaluate the vascular tone, cerebral circulation flow in each hemisphere of the brain of menopausal women, and some associated factors through waveform characteristics and parameters in REG. A controlled cross-sectional descriptive study was conducted on a group of patients including 80 menopausal women and a control group of 46 menstruating women. All patients were measured REG in the frontal-occipital leads by VasoScreen 5000 impedance REG meter. In menopausal women, the percentage of sharp waves, the percentage of clear side waves, and the average REG were all lower than in the control group (p<0.01). The mean conduction time and mean slope ratio was lower than the control group (p<0.001). The mean peak time was higher than the control group (p<0.01). The mean elasticity index (alpha/T) was higher than the control group (p<0.001). Menopausal women have increased vascular tone, the highest in the group of women 50-60 years old, menopause <5 years, having a habit of eating red meat; and decreased blood flow intensity, the highest in the group of women <50 years old. However, the difference was statistically significant only in the left hemisphere (p<0.05). Vascular hypertonia in menopausal women with central obesity was higher than in the non-obese group in both hemispheres (p<0.05). In conclusion, menopausal women had atherosclerosis in both hemispheres of the brain, which was clearly shown in the rate of increased vascular tone. Central obesity may increase the risk of vascular hypertonia 3.75 times in the right and 5.44 times in the left hemisphere.

Pretransplant BMI Should Be

The aim of this study was to determine the appropriate body mass index (BMI) in Japanese kidney transplant (KTx) recipients. We analyzed the effects of pre- and post-transplant (Tx) obesity on graft and patient survival, perioperative complications, post-transplant diabetes mellitus (PTDM), and cardiovascular disease (CVD) in Japanese KTx recipients. This retrospective study included 269 recipients who underwent KTx from 2008 through 2020 at Niigata University Hospital. Obesity was defined as a body mass index (BMI) ≥25 kg/m2. We examined the association between pre- and post-Tx obesity and graft survival, patient survival, the incidence of PTDM and CVD, and perioperative surgical complications. The graft survival rate was lower in the pre-Tx BMI ≥25 kg/m2 group, although there was no significant difference in patient survival. There was no difference in graft and patient survival between the post-Tx BMI ≥25 kg/m2 group and the <25 kg/m2 group. A pre-Tx BMI ≥25 kg/m2 was an independent risk factor for biopsy-proven allograft rejection. New-onset DM after transplantation was significantly more common in the BMI ≥25 kg/m2 group than in the BMI <25 kg/m2 group (36% vs 13%; P=.002). The incidence of CVD was significantly higher in the post-Tx BMI ≥30 kg/m2 group than in the BMI <30 kg/m2 group (50% vs 11%; P=.023). There were no differences in surgical operating time, intraoperative blood loss, or perioperative complications between the obese and non-obese groups. Pre-Tx BMI ≥25 kg/m2 may be a risk factor for allograft rejection and graft loss. Post-Tx BMI should be <25 kg/m2 to reduce the risk for PTDM.

1023: IMPACT OF OBESITY ON HEMODYNAMICS IN CRITICALLY ILL PATIENTS RECEIVING PROPOFOL

Introduction: Propofol is a commonly used sedative in the ICU, but data on optimal dosing in obese patients is lacking. As propofol is a lipophilic medication, a relatively higher dose based on actual body weight (ABW) may lead to accumulation and increase risk of adverse events. The purpose of this research project is to evaluate the rate of hypotension and bradycardia in critically ill patients receiving propofol for sedation. Methods: This single center, retrospective cohort study examined mechanically ventilated, adult patients receiving continuous sedation with propofol in the ICU from 8/1/16-8/1/21. Patients were excluded if they met the any of the following criteria: propofol dosing not based on ABW, on concomitant vasopressors at time of initiation of propofol, received a bolus dose of propofol, on propofol for < 4 hours, and history of heart block or permanent pacemaker. The primary outcome was the percent of hemodynamic instability during the first 72 hours of propofol administration as defined as hypotension (MAP < 65 mmHg or SBP < 90 mmHg) and bradycardia (heart rate < 60 bpm). Secondary outcomes evaluated include the total dose of propofol (mg) and the degree of hemodynamic instability, defined by the need for intervention (administration of atropine, fluid bolus, vasopressor). All continuous data was expressed as an interquartile range or mean (+/-) standard deviation and analyzed using the independent T-test. Categorical data was expressed as a percent and analyzed using the Chi-Squared test. Results: 331 patients met inclusion criteria (n=171 obese patients, n=160 nonobese patients). Baseline characteristics were similar between the groups, apart from age (61.1±13.9 vs 66.7±13.7, p=< 0.001) and SOFA score (4.3 ± 2.8 vs 2.4 ± 2.5, p< 0.001) More patients in the obese patient group required administrations of a fluid bolus than the non-obese patient group (43.3% vs 28.8%, p< 0.006). Conclusions: The use of ABW in the obese population did not result in a significant association between the occurrence of bradycardia and hypotension, though more obese patients required fluids. Additional studies are needed to confirm this relationship and further explore whether clinical significance exists.

Body mass index and immune checkpoint inhibitor efficacy in metastatic cancer patients: A Brazilian retrospective study

Previous studies suggested that obesity pro-inflammatory state could improve immune checkpoint inhibitors (ICI) clinical efficacy. This is a retrospective, multicenter, and observational study that included patients treated in a private Brazilian Oncology Group. Primary outcomes were the association of body mass index (BMI) category with overall survival (OS) and progression free survival (PFS). Secondary outcomes were association between BMI and objective response rate (ORR). In the total cohort, 448 patients were classified as a normal weight (43%), overweight (36%), obese (17%) and underweight (4%). The patients were predominantly male gender (62%), with stage IV lung cancer (57%) and melanoma (19%). The obese group (BMI ≥ 30 kg/m2) had a not statistically significant longer median OS than the non-obese group (BMI &amp;lt; 30 kg/m2) - 21.8 months (95% CI NR - NR) versus 14.9 months (95% CI 8.3 - 21.5); HR = 0.82, (95% CI 0.57 - 1.18, P = 0.28). Obese patients treated with anti-CTLA4 did not reach the mOS, while the non-obese group had a mOS of 23.1 months (P = 0.04). PFS did not differ between subgroups. Obese patients had also lower ORR, but without reaching statistical significance. In conclusion, this study did not report an improved OS among high BMI patients treated with ICI.

Effect of obesity on the time to a successful medical abortion with misoprostol in first-trimester missed abortion.

To evaluate the efficacy of misoprostol used in first-trimester abortion in obese women and to determine whether obesity is associated with time to a successful medical abortion. The records of patients diagnosed with missed abortion at our clinic between 2018 and 2021 were retrospectively reviewed. All women aged 18 to 45years who were diagnosed with missed abortion in the first trimester and treated with misoprostol were included in the study. The cases were divided into two groups: obese (body mass index [BMI] ≥ 30kg/m2) and non-obese (BMI < 30kg/m2). First, they were simultaneously administered 200μg misoprostol orally and 400μg vaginally. After the first misoprostol administration, the dose was repeated vaginally at 400μg every three hours if necessary. The effect of obesity on the time taken to achieve a medical abortion was evaluated. A successful medical abortion occurred in 45.2% of the women in the obese group and 69.0% of those in the non-obese group. The time to uterine evacuation was 8.24 ± 4.03h in the obese group and 6.35 ± 3.54h in the non-obese group. The relationship between obesity and time to a successful medical abortion was evaluated using the Kaplan-Meier curve, which showed a significant difference between the two groups (p = 0.028). Our findings show that obesity affects time to a successful medical abortion. In addition, the rate of successful medical abortion after misoprostol administration was lower in the obese women.

Is Habitual Dietary Intake of Fats Associated with Apelin Gene Expression in Visceral and Subcutaneous Adipose Tissues and Its Serum Levels in Obese Adults?

Introduction: Apelin could be one of the last protective defenses before developing obesity-related disorders, including insulin resistance, type 2 diabetes, and hypertension, which can be modified by dietary intake. The present study investigated the association of habitual intake of total fatty acids (TFAs), saturated-, monounsaturated-, polyunsaturated FAs, n-3, and n-6 FAs with Apelin expression in visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). Methods: We obtained VAT and SAT from 168 participants (64 nonobese and 104 obese) who had undergone open abdominal surgery. Dietary intake information was gathered with a valid and reliable food frequency questionnaire. The mRNA expression of the Apelin gene was analyzed by real-time PCR. Results: Apelin serum levels were increased in the obese subjects compared to the nonobese group (p = 0.016). The SAT and VAT Apelin mRNA levels were significantly elevated in the obese participants compared to the nonobese ones (p < 0.05). Based on BMI status, only obese subjects indicated a positive association between SAT and VAT Apelin expression and TFA intake (p < 0.001). However, this association was observed between SAT and VAT Apelin gene expression and polyunsaturated fatty acid (PUFA) and n-3 FA intakes in both obese and nonobese groups (p < 0.05). Conclusion: High Apelin gene expression was associated with TFA intake in obese subjects in both fat tissues. However, habitual intake of PUFA and n-3 FA was associated with Apelin gene expression in obese and nonobese individuals. Our results indicate a determinative role of the quality and quantity of FA intake on adipose tissue.