Normal Weight Patients Research Articles

Cryoballoon Pulmonary Vein Isolation in Obese Patients with Atrial Fibrillation Compared to Non-Obese Counterparts: A Meta-Analysis

Introduction: Obesity is an important risk factor for atrial fibrillation (AF) development. Data on cryoballoon ablation (CBA) outcomes in obese patients have so far been scarce. We reviewed the existing literature to compare the efficacy and safety of CBA in obese versus non-obese AF patients. Methods: A systematic literature search was conducted for studies comparing clinical outcomes (arrhythmia recurrence and/or procedural data and/or safety outcomes) between obese and non-obese patients undergoing CBA for AF. Statistical pooling was performed according to a random-effects model with generic inverse-variance weighting of relative risks (RRs) and standardised mean differences (SMDs) computing risk estimates with 95% confidence intervals (CIs). Results: Obese and non-obese patients had comparable arrhythmia recurrence rates (normal versus overweight, RR = 0.95, 95% CI: 0.82–1.11, p = 0.55, I2% = 91%; normal versus class I obesity, RR = 0.97, 95% CI: 0.82–1.13, p = 0.68, I2% = 87%; normal versus class II obesity, RR = 0.98, 95% CI: 0.91–1.07, p = 0.29, I2% = 65%). Procedure time was marginally increased in obese patients compared to non-obese counterparts (normal versus overweight, SMD = 0.05, 95% CI: −0.15–0.26, p = 0.62, I2% = 74%; normal versus class I obesity, SMD = 0.10, 95% CI: −0.00–0.19, p = 0.06, I2% = 2%; overweight versus class I obesity, SMD = 0.11, 95% CI: 0.01–0.21, p = 0.048, I2% = 25%). Regarding radiation exposure, fluoroscopy time was increased in patients with class I obesity compared to normal-weight or overweight patients and dose area product was also increased in obese patients compared to non-obese patients. Lastly, the risk of complications did not differ between obese and non-obese patients. Statistical heterogeneity and the small number of patients included are the main limitations of this study. Conclusion: CBA seems to be effective for obese patients suffering from AF, featuring also similar safety outcomes with non-obese individuals. Radiation exposure was increased in obese patients.

P1240 Overweight in patients with inflammatory bowel disease and the associated risk of malnutrition

Abstract Background Although inflammatory bowel disease(IBD) has traditionally been associated with malnutrition,the prevalence of overweight(0W)and obesity is currently increasing.Moreover, both overweight and chronic inflammation can elevate the risk of essential micronutrient deficiencies.The objective of this study is to investigate the prevalence of OW in a cohort of IBD patients and the associated risk of nutritional deficiencies Methods This is a cross-sectional study that consecutively included patients attending the day hospital for intravenous biologic that didn’t fulfill exclusion criteria (e.g. short bowel syndrome or oral nutritional supplements).All patients underwent weight and height measurements,assessment of IBD clinical activity (Harvey-Bradshaw Index[HBI] for Crohn's disease and Walmsley Index[WI] for ulcerative colitis and completion of the MUST(Malnutrition Universal Screening Tool) questionnaire. A blood test was also performed to obtain a comprehensive nutritional profile, and fecal calprotectin(FC)levels were measured Results A total of 93 patients were included. Baseline characteristics are summarized in TABLE 1.Regarding body mass index(BMI), 2 patients(2.5%) had a BMI below 18.5, 45 (57%) were classified as normal weight(BMI 18.5-25), and 32 (40.5%) were OW(BMI over 25). No differences were found in clinical activity ( HBI or WI) between OW and normal-weight patients(p=0.75 and p=0.57, respectively).However, a lower mean FC level was observed in overweight patients(166.2 µg/g vs. 445.1 µg/g),though this difference did not reach statistical significance(p=0.18).Similarly, no significant differences in C-reactive protein levels were observed between the two groups(5.13 mg/L vs. 2.6 mg/L; p=0.09).There were also no differences in the type of IBD, disease location or the line of biologic treatment among patients with or without OW. OW IBD patients showed a statistically significant association with higher levels of prealbumin, hemoglobin, triglycerides, and ferritin.No greater micronutrient deficiencies were identified in overweight patients compared to those with normal weight. The laboratory profiles of both groups are summarized in TABLE 2.Regarding the risk of malnutrition, using the self-completed portion of the MUST questionnaire to minimize potential BMI bias, it was identified that only 20% of patients with intermediate/high risk of malnutrition were OW(p=0.04) ( vs normal-weight patients; p=0.04) Conclusion OW is common in IBD patients,even among those with active inflammation and refractory response to advanced treatments. In our experience,OW IBD patients do not exhibit greater micronutrient deficiencies compared to normal-weight patients,though they do present characteristic laboratory alterations associated with OW

P0613 Obesity is associated with inferior treatment outcomes in inflammatory bowel disease: a nationwide Dutch registry study

Abstract Background The impact of overweight and obesity on treatment outcomes in inflammatory bowel disease (IBD) remains unclear, as current literature is inconclusive and often restricted to selected patient populations. We examined the effect of Body Mass Index (BMI) on response to treatment in patients with IBD starting various treatments. Methods Patients ≥ 16 years old with IBD, a documented baseline BMI, and starting thiopurines and allopurinol, intravenous (iv) vedolizumab, subcutaneous (sc) vedolizumab, ustekinumab, ozanimod, filgotinib, or tofacitinib were selected from the Dutch Initiative on Crohn and Colitis (ICC) registry. Underweight patients (BMI < 18.5 mg/kg2) were excluded. The primary outcome was steroid-free clinical remission (i.e. Simple Clinical Colitis Activity Index (SCCAI) ≤ 2 for ulcerative colitis (UC) and IBD-unclassified (IBD-U), and Harvey Bradshaw Index (HBI) < 5 for Crohn’s disease (CD)) at week 12 and 24. Outcomes were compared between normal weight (BMI 18.5-25 kg/m2), overweight (BMI 25-30 kg/m2) and obese (BMI ≥ 30 kg/m2) patients using binary logistic regression analyses. Results A total of 1066 IBD patients (616 CD, 432 UC, and 18 IBD-U) were included: 619 had normal weight, 303 were overweight, and 144 were obese. At week 12, overweight patients were more frequently in steroid-free clinical remission (49.8%, OR = 1.452, 95% CI: 1.082-1.947, p = 0.013) compared to normal weight patients. Multivariable regression adjusting for age, smoking, prior vedolizumab use, and baseline corticosteroids confirmed higher odds of steroid-free clinical remission in overweight patients (OR = 1.369, 95% CI: 1.010-1.856, p = 0.043). At week 24, obese patients were less frequently in steroid-free remission (35.3%, OR = 0.578, 95% CI: 0.380-0.879, p = 0.010), with multivariable analysis also indicating lower odds of steroid-free clinical remission in obese patients (OR = 0.537, 95% CI: 0.346-0.832, p = 0.005). A logistic mixed-effects model demonstrated a different course of steroid-free clinical remission rates over time from baseline to week 24 between the BMI groups, which is shown in Figure 1, with a near-significant overall interaction effect (p = 0.061). Conclusion Obesity was associated with lower steroid-free clinical remission at week 24. Surprisingly, at week 12, overweight was associated with a higher rate of steroid-free clinical remission. However, despite this apparent faster treatment response, this advantage disappeared at 24 weeks.

Depression and anxiety in patients with type 2 diabetes in Indonesia and Malaysia: do age, diabetes duration, foot ulcers, and prescribed medication play a role?

ABSTRACT Patients with type 2 diabetes mellitus (T2DM) are susceptible to mental health issues, impacting medication adherence and diabetes control. This study aimed to evaluate factors associated with depression and anxiety among T2DM patients in Indonesia and Malaysia. A cross-sectional study was conducted in Indonesia and Malaysia from October 2022 to April 2023 among T2DM patients. The study utilised an instrument with patient and disease data and three validated tools to assess depression, anxiety, and medication adherence. Statistical analysis, including binary logistic regression, was performed using SPSS® version 28 software. A study of 606 T2DM patients revealed that 56.5% were at risk of depression, while 41.6% were at risk of anxiety. Older patients with T2DM had lower rates of depression (AOR = 0.41, 0.25–0.68) and anxiety than younger patients. Normal-weight patients were less likely to experience depression and anxiety (AOR = 0.44, 0.27–0.72) than overweight patients. Patients without diabetic foot ulcers had a lower risk of depression (AOR = 0.34, 0.21–0.55) and anxiety than those with foot ulcers. Patients with a shorter duration of diabetes had a higher risk of depression (AOR = 3.27, 1.70–6.30) and anxiety than those with a longer duration. Patients on insulin-based regimens had higher rates of depression and anxiety (AOR = 2.28, 1.20–4.30) than those on metformin-based regimens. Nonadherent patients were more likely to experience depression and anxiety (AOR = 4.30, 2.22–8.32) than patients who adhered to their medication. The prevalence of depression and anxiety is concerning and influenced by factors such as age, diabetes duration, the presence of diabetic foot ulcers, and the prescribed medication regimen. Further efforts are necessary to enhance the mental health of T2DM patients and improve management outcomes.

Perioperative management of obese patients undergoing elective hip and knee arthroplasty

Obesity is aworldwide growing health crisis, affecting younger and younger age groups and posing new challenges for arthroplasty. Due to increased complication rates in this population, many authors are of the opinion that in patients with abody mass index (BMI) of over40, the problems outweigh the benefits of surgery and that surgery should be postponed until significant weight reduction has been achieved. Asystematic review of electronic databases (PubMed, Embase, Web of Science and the Cochrane Library) was performed. 49relevant articles were analyzed. Pre-defined questions were answered based on the literature. The level of evidence for the recommendation was defined in aconsensus meeting. Obese patients with aBMI ≥ 30have an up to threefold increased perioperative risk, particularly for infections and mechanical complications. In addition, surgery in obese patients is technically demanding, which results in ahigher risk of implant malpositioning. Despite these risks, obese patients benefit from surgery in asimilar way compared to normal-weight patients, showing comparable improvements in function and quality of life. Preoperative weight loss can reduce the risk but should be long-term to avoid negative metabolic effects. Bariatric surgery and drug therapies can help, but their effects on perioperative risk are unclear. Besides the BMI, careful diagnosis and treatment of comorbidities is crucial. Obese patients benefit from arthroplasty in asimilar way to normal-weight patients but have ahigher risk of complications, particularly infection. Prior to joint replacement, patients with aBMI of 40or more should undergo dietary counselling and weight reduction; their metabolic status should be checked, as malnutrition can increase the risk. If weight reduction is not achieved despite these measures, the operation can be performed with increased risks, whereby the patient should be fully informed and involved in the decision-making process.

Clinical Pharmacokinetics of Antitubercular Drugs in the Overweight and Obese Population: Implications for Dosage Adjustments.

The rise in global obesity prevalence has increased the need to understand the pharmacokinetics of drugs in overweight and obese individuals. Tuberculosis remains a significant health challenge, and its treatment outcomes can be influenced by the pharmacokinetic profiles of antitubercular agents. This literature review aims to point out the clinical pharmacokinetics of antitubercular drugs in the overweight and obese patient population, highlighting considerations for potential dosage adjustments. We conducted a comprehensive search of the PubMed US National Library of Medicine from inception to January 2024. Articles focusing on the pharmacokinetics of antitubercular agents used for both drug-susceptible and multidrug-resistant tuberculosis in overweight and obese adults were included. In total, 349 scientific articles were identified and examined for human pharmacokinetic parameters. Of these, 19 were included in this article. To highlight potential differences, pharmacokinetic data for normal-weight tuberculosis patients are also presented, albeit selectively. In general, pharmacokinetic studies of antitubercular agents in overweight and obese individuals are lacking. Fixed-dose combinations often used in the treatment of drug-susceptible tuberculosis are not recommended when treating these population groups. Rather, individual dosing based on therapeutic drug monitoring and the known solubility of the substance should be considered. To improve the management of tuberculosis in overweight and obese patients, there is an urgent need for pharmacokinetic studies and, ultimately, adequate dosing in this patient population, especially given the increasing prevalence of obesity.

Dose Escalation of Adalimumab in Patients with Hidradenitis Suppurativa: A Retrospective Case Series.

Adalimumab is a central treatment for moderate-to-severe hidradenitis suppurativa (HS). However, half of patients treated with adalimumab for HS do not achieve a clinically significant response. Data on non-immunological factors correlating clinical response and adalimumab blood concentration are scarce. To determine whether increasing adalimumab dose to 80 mg weekly can improve the clinical outcome of patients unresponsive to adalimumab 40 mg weekly. To identify parameters influencing disease activity and those modifying serum adalimumab concentration. This is a retrospective case series from a tertiary dermatology clinic, comprising 40 patients with moderate-to-severe HS with suboptimal response to the FDA-approved dose of adalimumab. All patients had a measurement of blood adalimumab concentration. Depending on their dosage, some patients had their adalimumab dose increased to 80 mg weekly while others stayed at 40 mg dose weekly. Chi-squared and ANOVA tests were used for data analysis. 43.8% of patients who increased to a weekly dose of 80 mg clinically improved at their follow-up, compared with 33.3% of those who stayed at a weekly dose of 40 mg. The dose increase led to a statistically significant increase in serum concentration of adalimumab (P < .001). Higher serum adalimumab concentration is associated with lower disease activity (P = .043). Normal-weight patients had significantly higher concentrations than overweight patients (P = .011). An increase in the weekly dose of adalimumab led to a nonstatistically significant improvement in clinical response but led to a statistically significant increase in serum concentration.

Analysis of the Relationship Between Body Mass Index (BMI) and Dento-Skeletal Maturation: A Cross-Sectional Case-Control Study.

Background/Objectives: The aim of this cross-sectional study was to establish if there is a relationship between body mass index (BMI) and skeletodental development in young obese patients in comparison with normal-weight patients. Methods: The sample consisted of 178 individuals (115 normal weight, 37 overweight and 26 obese), aged 6 to 16 years, with a mean biological age of 11.96 ± 2.44 years. Dental maturation (dental age) was determined by using Demerjian's method; craniofacial growth pattern, skeletal and dental class were determined by using cephalometric measurements; skeletal maturation was determined by using Baccetti's method. Data were statistically analyzed. Results: According to Demirjian's method, the mean dental age of the overweight and obese subjects was significantly higher than that of the normal-weight subjects (p = 0.001 and p = 0.02, respectively). A higher rate of dental class III was detected in the overweight group (p = 0.002). Concerning cephalometric records, statistically significant differences (p = 0.018) were observed in the distribution of SNA and SNB values, higher values being found in obese subjects. No difference was detected in the distribution of the ANB angle between the groups. As regards craniofacial growth pattern, no significant differences were found between the groups. Children with obesity presented more advanced skeletal maturation, reaching statistically significant differences (p = 0.02), in comparison with the normal-weight subjects. Conclusions: In conclusion, obese children showed increased tooth and skeletal development in comparison to the normal-weight subjects. These findings may be of interest for orthodontists, who should consider weight status when performing orthodontic treatment in children and adolescents.

RISK FACTORS FOR THE NEGATIVE COURSE OF GASTRODUODENAL GASTROINTESTINAL BLEEDING IN OBESE PATIENTS

Obesity affects 18% of adults in Ukraine, which is one of the highest rates on the European continent. Treating gastrointestinal ulcer bleeding in obese patients is challenging due to 75% of them are taking at list one ulcerogenic or blood-thinning medications, and 25% use three or more because comorbidities. The problem of treating and predicting the outcomes of ulcerative bleeding in such patients is insufficiently studied. This study aimed to assess treatment outcomes for acute ulcerative bleeding in sever obese patients, evaluate the effects of age and medication use, and compare these with outcomes in normal-weight patients. To achieve this goal, a retrospective analysis included 82 sever obese and 282 normal- weight patients, focusing on early recurrences and mortality. The study found that in obese patients under the age of 40, the mortality rate was more than three times higher (7.3%) compared to patients of normal weight (2.1%) (p – 0.0296). However, after the age of 40, no statistically significant difference in mortality was confirmed between the study groups (8.5% and 4.9%, respectively, p- 0.2864). Additionally, no increased risk of early rebleeding was observed in patients using non steroid anti inflammatory drugs or and/or drugs, affecting the rheological or coagulation properties of the blood (12.2% vs. 5%, p = 0.2527). Thus, based on the obtained data, in Ukraine young age and obesity are risk factors for poor prognosis in treating gastrointestinal bleeding due to limited use of medications for comorbidities and resulting homeostasis issues. Despite this, they do not increase early rebleeding. The study suggests revising treatment strategies for young obese patients.

Body composition of metabolically unhealthy normal-weight patients with aortic stenosis: a prospective cohort study

BackgroundThe aim of this study was to evaluate the prognostic impact of computed tomography (CT)-based body composition parameters in metabolically unhealthy normal-weight patients (MUHNW) with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).MethodsThis prospective cohort study involved adults with normal weight scheduled for TAVR. Patients were divided into two groups: metabolically healthy normal-weight (MHNW) and MUHNW. The primary outcome was major adverse cardiovascular events (MACEs), and the secondary outcomes were all-cause mortality and prolonged hospital stay. Logistic regression was used to explore the relationships between variables and outcomes, and Cox regression models were applied to examine the effects of different parameters on patient prognosis. Incremental discriminative improvement (IDI) and the C-index were used to determine the influence of hybrid parameters on the predictive efficiency of the model.ResultsThe cohort study included 182 patients divided into two groups: MHNW metabolically healthy normal-weight (n = 97) and MUHNW (n = 85). Over a median follow-up of 0.8 years, multivariable logistic regression analysis revealed significant associations of the skeletal muscle index (SMind) (HR: 0.50, 95% CI: 0.29 – 0.84, p = 0.01), subcutaneous adipose tissue index (SATind) (HR: 0.63, 95% CI: 0.45 – 0.88, p = 0.01), and visceral adipose tissue index (VATind) (HR: 1.34, 95% CI: 1.10 – 1.63, p < 0.01) with the risk of experiencing MACEs, whereas epicardial adipose tissue (EAT) was not significantly associated with the risk of experiencing MACEs in the multivariable model (HR: 1.10, 95% CI: 0.97 – 1.24, p = 0.14). For the primary outcome, adjusted for significant covariates, the model had an IDI of 0.25 and a C-index of 0.8, with significant associations of SMind (HR: 0.73, 95% CI: 0.62 – 0.87, p < 0.01), SATind (HR: 0.87, 95% CI: 0.78 – 0.97, p = 0.01), and VATind (HR: 1.25, 95% CI: 1.12–1.40, p < 0.01) with the risk of experiencing MACEs. For the secondary outcome, the model had an IDI of 0.36 and a C-index of 0.93, with EAT showing a significant protective effect against all-cause mortality and prolonged hospital stay (HR: 0.97, 95% CI: 0.93 – 0.99; p = 0.04).ConclusionsBody composition parameters, including, VATind, SMind, and SATind, are significant predictors of MACEs in patients undergoing TAVR. Additionally, EAT shows a significant protective effect against all-cause mortality and prolonged hospital stay. These findings highlight the potential importance of comprehensive body composition assessments in the risk stratification and management of AS patients.Graphical

Navigating the obesity paradox in bladder cancer prognosis-insights from the Taiwan National Health Insurance System Database.

This study investigates the complex relationship between body mass index (BMI) and bladder cancer outcomes, utilizing Taiwan's national database. Bladder cancer remains a significant health concern, especially in Taiwan, prompting a comprehensive retrospective analysis to explore the impact of obesity on survival outcomes. A meticulous exclusion process, based on Taiwan National Health Insurance System Database, refined the initial dataset of 15,086 bladder cancer patients to 10,352. Categorizing patients into BMI groups (underweight, normal weight, and obesity), the study examined baseline characteristics, comorbidities, and survival outcomes. The analysis involved Cox regression and subgroup assessments stratified by clinical stage. Among our patients, 71.5% are male, 78.5% are over 60 years of age, and 18.8% are between 45 and 60 years old. Despite a higher prevalence of comorbidities, obesity patients exhibited a more favorable prognosis, supporting the obesity paradox. The overall and specific mortality ratio of obesity patients were 0.76 fold and 0.82-fold compared with normal-weight patients (overall: 95% confidence interval [CI], 0.71-0.82, p < 0.0001; specific: 95% CI, 0.75-0.90, p < 0.0001). Conversely, underweight patients displayed an increased risk of both overall and cancer-specific mortality compared to normal-weight patients (p < 0.0001). This study highlights the potential protective role of higher BMI in bladder cancer survival, revealing a more favorable prognosis among obesity patients, highlighting the need for cautious interpretation and suggesting avenues for future research. These insights could guide BMI-targeted intervention strategies, allowing clinicians to consider BMI as a factor in personalized treatment planning for bladder cancer patients.

Clinical features and adherence to a gluten-free diet in patients with celiac sprue in the north-west of Algeria

This study aims to identify the predominant form of celiac sprue and the adherence to a gluten-free diet in northwest Algeria. A retrospective analysis was performed on 128 celiac patients at the Department of Gastroenterology and the association of celiac patients. The results show a female predominance with a sex ratio of 0.4. The most affected age group is the young adults (15-29 years). Lean patients represent 42.2%, normal-weight patients represent 51.6% of the study sample, and 6.3% are overweight. 47.7% of cases have a familial form of the disease. 93% underwent a biopsy for diagnosis. 60.9% of patients were not diagnosed in childhood. The main classic gastrointestinal symptoms such as Diarrhea (89.1%) and bloating (56.3%) were detected. Extraintestinal symptoms included weight loss (64.1%), weakness and fatigue (58.6%). Other biological disorders like anemia (71.1%), thyroiditis (15.6%), and type 1 diabetes (14.8%) were observed. Most celiac patients (84.4%) follow the gluten-free diet but find its application difficult. The adherence of GFD does not depend on any parameter of the study (p&gt;0.05). The classic form predominates through a variety of gastrointestinal symptoms and extra-digestive disorders. The unavailability and high cost of imported gluten-free products are the major barriers to gluten-free diet adherence.

Obesity is a risk factor for prolonged mechanical ventilation after tracheotomy.

To compare patient outcomes across body mass index (BMI) subgroups in the setting of recent tracheotomy. This retrospective chart review included patients over 18 years old who underwent tracheotomy placement between February 2017 and March 2020. Patients were divided into five groups based on BMI: underweight, normal weight, overweight, obese, and morbidly obese. Data were collected from the electronic medical record (EMR). Statistical analyses were completed via Kruskal-Wallis, Chi-square, log-rank tests, and Cox proportional hazards regression. If significant differences were found between groups, then subsequent pairwise comparisons of BMI were completed. There were 391 patients included in the study. There were significant differences in length of stay (p = .015) and duration of mechanical ventilation (p < .001) among the groups. This was mainly driven by comparisons between the normal weight and obese groups, with patients of normal weight having shorter hospital stays and shorter ventilation durations. With each increasing BMI category from normal weight, a greater proportion of patients were ventilator-dependent at the time of discharge (p < .001). Interestingly, after adjustment for comorbidities, the rate of tracheotomy change was 0.86 times lower for every increase in BMI category (95% CI 0.77-0.96). There was a significant difference among the BMI groups with respect to time to tracheotomy collar placement according to both the log-rank test (p < .001) and the Cox model with adjustment for the presence of heart failure (p = .011). Among patients undergoing tracheotomy, obese and morbidly obese patients have increased lengths of hospital stays. Additionally, they are dependent on ventilators for longer and are more likely to be ventilator-dependent at the time of discharge. It is important to understand how BMI impacts the hospital course for patients undergoing tracheotomy so that patients and their families can be better informed. Level 3.

Association between Visceral Fat Content and Obesity-Related Indicators with Cognitive Impairment after Intracerebral Hemorrhage.

Intracerebral hemorrhage (ICH) is a major cause of morbidity and mortality, often leading to long-term cognitive impairment that significantly diminishes the quality of life. This study investigated the relationship between visceral fat content, obesity-related indicators, and cognitive dysfunction following ICH. A total of 388 subjects with ICH who were admitted to the Neurosurgery Department of the Hospital and met the inclusion and exclusion criteria were included in this study. Obesity-related indicators, including body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), were measured. L3 level images were obtained by abdominal computerized tomography (CT). The visceral fat content was estimated using IMAGE J software, and adiponectin levels were assessed via enzyme-linked immunosorbent assay (ELISA). The Mini-Mental State Examination (MMSE) was used to evaluate the cognitive level of patients within 2 weeks of onset, and the shortened version of the Montreal Cognitive Assessment (miniMoCA) was used to evaluate the cognitive level of patients 6 months after ICH. Univariate and multivariate analyses were used to analyze the correlations of BMI, WC, WHtR, abdominal fat, and adiponectin with cognitive impairment after ICH. BMI, WC, and WHtR were lower in the cognitive impairment group (p < 0.01). Overweight patients exhibited higher MMSE scores than normal-weight patients (p < 0.05) and higher miniMoCA scores than obese patients (p = 0.014). Abdominal obesity, assessed by WC and WHtR, was associated with higher MMSE scores (p = 0.022 and 0.003, respectively). Multivariate analysis indicated that WHtR was associated with cognitive impairment risk post-ICH (odds ratio (OR) = 0.233, 95% confidence interval (CI) (0.071, 0.762); p = 0.016). Although no overall association was found between adiponectin levels and cognitive impairment, subgroup analysis revealed lower adiponectin levels in overweight patients with cognitive impairment (p = 0.040). WHtR is independently and inversely associated with cognitive impairment after ICH. There is no significant correlation between adiponectin with cognitive impairment after ICH, while subgroup analysis indicates that adiponectin levels are lower in overweight patients with cognitive impairment.

Aberrant Dynamic Network Connectivity Changes in Comorbid Depression and Overweight/Obesity: Insights From the Triple Network Model.

The interaction between major depressive disorder (MDD) and overweight/obesity has received considerable attention owing to its widespread occurrence and the intricate biopsychological implications involved. Despite extensive research, the neural mechanisms underlying these comorbid conditions, particularly in terms of functional network connectivity (FNC), are still not well understood. This study aimed to clarify these mechanisms by utilizing resting-state functional magnetic resonance imaging (rs-fMRI) to examine both static and dynamic FNC. We analyzed data from 57 patients with both MDD and overweight/obesity (MDD-OW), 57 MDD patients of normal weight (MDD-NW), and 44 healthy controls, using techniques such as independent component analysis, sliding window analysis, K-means clustering, and graph theory. In contrast to static FNC, which showed no significant differences, dynamic FNC analysis identified four consistent states across all participants. Both MDD groups demonstrated reduced flexibility in functional coordination among these states and decreased nodal characteristics within the salience network. Notably, the MDD-OW group displayed enhanced dynamic FNC between the default mode network (DMN) and the executive control network (ECN) during certain states, which was inversely associated with the severity of depressive symptoms. These results highlight the importance of altered dynamic connectivity patterns in individuals with MDD and concurrent overweight/obesity, especially between the DMN and ECN, suggesting their potential utility as biomarkers for depressive states. This research contributes to our understanding of how comorbid overweight/obesity affects brain network dynamics in depressive disorders and provides a basis for targeted therapeutic strategies.

Association of Complication Rates and Severe Obesity in Patients Undergoing Ankle Arthrodesis.

Tibiotalar arthrodesis (TTA) is a common operation for end-stage ankle arthritis. Elevated body mass index (BMI) is believed to contribute to complications following TTA. Previous studies involved national registries or small, underpowered cohorts. This study aimed to determine the effects of elevated BMI on nonunion and complication rates following TTA with a large cohort from a single academic institution. A retrospective study identified 514 patients (527 ankles) who underwent primary TTA from 2005-2017. Mean age was 60 years. Patients were stratified by BMI according to the World Health Organization classification. A reference group of 203 patients (208 ankles) included normal weight or mildly overweight patients (BMI 18.5 to <30). Ankle radiographs were evaluated to determine union or nonunion. Other outcomes included revision TTA, reoperations, subsequent adjacent joint arthrodesis, infection, and readmission. Data were analyzed using Pearson χ2 and odds ratios for categorical variables. Analysis of variance and Kaplan-Meier estimation assessed continuous variables and time-to-event outcomes, respectively. Mean follow-up was 34.3 months. Obesity class III patients had elevated risk of complications compared with normal weight patients including nonunion (odds ratio [OR] 3.96, P = .002), revision (OR 3.69, P = .03), superficial infection (OR 9.36, P = .002), and readmission (OR 10.90, P = .01). Superficial infection rates were elevated in class I (OR 6.36, P = .007) and readmissions in class II (OR 9.98, P = .01). No differences were found in reoperation (P = .448), symptomatic implant removal (P = .805), adjacent joint arthrodesis (P = .353), or deep infection (P = .507) rates. In this retrospective review after TTA, increased rates of nonunion, revision, superficial infection, and readmission were found in obesity class III patients, compared with the reference group of normal weight or mildly overweight patients. Superficial infection rates were likewise relatively elevated in class I and readmission rates in class II patients.

An Analysis of the Digestive and Reproductive Tract Microbiota in Infertile Women with Obesity.

Previous studies have linked the microbiome of distinct body habitats to obesity and infertility; however, the often-divergent results observed have left the role of the so-called "second genome" in obese infertile patients incompletely explored. Here, we present a prospective observational multicenter study of oral, gut, endometrial, and vaginal microbiota of infertile patients classified according to BMI. Patients collected saliva/fecal samples, while vaginal/endometrial fluid samples were collected in the clinic. Total bacterial DNA was extracted, and microbiota profiles were analyzed by 16S rRNA gene sequencing. Our results showed no differences in the Bacteroidetes/Firmicutes ratio (proposed obesity hallmark) in the gut microbiota between patients with obesity and normal weight; however, a tendency for higher levels of genera such as Escherichia-Shigella in normal-weight patients was observed; in comparison, patients with obesity possessed increased numbers of Parasutterella and Roseburia. In the reproductive tract, vaginal samples possessed a similar microbiota to endometrial fluid, both largely colonised by Lactobacillus, Gardnerella, and Streptococcus, supporting the hypothesis that uterine colonisation proceeds from vaginal bacteria ascension. Additionally, higher prevalence of a Streptococcus-dominated (>50%) endometrial microbiota was observed among patients with obesity. This first description of the human digestive and reproductive tract microbiota in infertile women with obesity may explain their poor reproductive outcomes.

Impact of Body Mass Index on the Outcomes of Cryoballoon Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation.

Atrial fibrillation (AF) is prevalent among obese patients, and cryoballoon ablation (CBA) is an effective strategy for the rhythm control of AF. The impact of body mass index (BMI) on the clinical outcomes of CBA for AF is not fully explored. 85 consecutive patients with paroxysmal AF were enrolled and were categorized into three groups as per their BMI: normal weight (BMI 18.5-25 kg/m2), overweight (BMI 25-30 kg/m2), and obese patients (BMI > 30 kg/m2). The primary study endpoint was a late (12 month) recurrence of AF. Early recurrence of AF, symptom improvement, and procedural outcomes were some key secondary outcomes. 20 patients had normal weight, 35 were overweight, and 30 were obese. Obese patients featured a higher prevalence of diabetes mellitus, heavier exposure to smoking, and worse baseline symptoms (as assessed through EHRA class at admission and 12 months before CBA) compared to overweight and normal weight patients. Both late and early (<3 months) AF recurrence rates were comparable across the three groups. Of note, obese patients showed greater improvement in their symptoms post-CBA, defined as improvement by at least one EHRA class, compared to normal weight patients; this might be explained by improved diastolic function. Total procedure time and dose area product were significantly increased in obese patients. The multivariate logistic regression analysis indicated that early AF recurrence and the duration of hypertension are independent predictors of late AF recurrence. CBA is effective in overweight and obese patients with paroxysmal AF. Procedure time and radiation exposure are increased in obese patients undergoing CBA.

Abstract 4125493: Is There an Obesity Paradox for Cardiovascular Outcomes in Patients Undergoing Transcatheter Edge-to-Edge Repair? A Pilot Meta-Analysis

Background: The impact of body mass index (BMI) on Transcatheter Edge-to-Edge Repair (TEER) outcomes remains uncertain, with studies showing conflicting results. Some suggest an 'obesity paradox' exists, favoring better outcomes for obese patients and worse outcomes for underweight patients, while others report no significant impact of BMI. Methodology: We conducted a systematic literature search using major databases to identify studies investigating the association between baseline BMI status and post-procedural outcomes in patients undergoing TEER. Patients were categorized into four BMI groups: underweight (BMI &lt; 18.5 kg/m 2 ), normal weight (BMI 18.5-24.9 kg/m 2 ), overweight (BMI 25-29.9 kg/m 2 ), and obese (BMI ≥ 30 kg/m 2 ). The endpoints included were the risk of in-hospital mortality, myocardial infarction, and stroke. Data were pooled using Review Manager with a random-effects model. Risk ratios (RRs) with their 95% confidence intervals (CIs) were used as the effect measure. Statistical significance was set at p&lt;0.05. Results: Our study included a total of six observational studies, encompassing 7,627 obese and 74,820 non-obese patients. The outcome of in-hospital mortality revealed no significant difference between the two groups (RR: 0.85; 95% CI: 0.57, 1.27; p=0.43). Subgroup analysis showed a trend towards higher in-hospital mortality risk for underweight patients compared to overweight (RR: 1.48; 95% CI: 1.11, 1.95; p=0.007) and obese patients (RR: 1.40; 95% CI: 1.02, 1.92; p=0.04). The comparison between underweight and normal-weight patients did not reach statistical significance (RR: 1.18; 95% CI: 0.91, 1.55; p=0.22). Additionally, the risk of myocardial infarction (RR: 1.10; 95% CI: 0.77, 1.58; p=0.59) and stroke (RR: 0.43; 95% CI: 0.13, 1.42; p=0.17) did not differ significantly between obese and non-obese patients. Conclusions: Our study found no significant difference in in-hospital mortality between obese and non-obese patients. However, underweight patients had a higher mortality risk compared to both overweight and obese patients. While myocardial infarction rates were similar across all groups, there was a non-significant trend suggesting a potentially lower risk of stroke in obese patients. These findings warrant further prospective studies to provide robust evidence.

Hight return-to-sport rate following traumatic spine injury in amateur athletes

IntroductionData on the resumption of sporting activity (return-to-sport, RTS) after traumatic spine injuries are mainly available for elite athletes. This study aimed to determine the RTS rate in amateurs after spine injury and to identify factors possibly influencing RTS.MethodsFirst, a retrospective analysis of clinical data of patients with traumatic spine injuries receiving inpatient treatment at a national trauma center from 2016 to 2020 was performed. Patients up to the age of 60 who were active in sports before the injury were included. Patients with the following relevant concomitant injuries were excluded: spinal cord injury, pelvic injury, extremity injuries, as well as craniocerebral trauma grade 2 or higher. A telephone interview on participants’ RTS within the first year after the injury was conducted. Participants with early and those with late or no RTS were compared in univariate analysis regarding potential influencing factors. The level of significance was set to p < .05.ResultsThirty-seven women (39%) and 57 men (61%) were included. The mean age was 44 years (16–60). The numbers of patients per injured segment of the spine were: cervical 15 (16%), thoracic 28 (30%), lumbar 33 (35%), multiple spine segments 18 (19%). Thirty patients (32%) were treated conservatively and 64 (68%) surgically. The RTS rate after six months was 62%, corresponding to 57 patients. Compared to patients with late or no RTS, patients with RTS within six months had a significantly lower BMI (24.6 vs. 27.4 kg/qm, p = .004), had isolated cervical spine injuries significantly more often (24% vs. 6%, p = .020), and had undergone outpatient or inpatient rehabilitation significantly less often (35% vs. 72%, p < .001). There were non-significant trends regarding mean age (42 vs. 46 years, p = .175), surgical therapy (66% vs. 75%, p = .333), and the proportion of patients who, before the injury, had been physically active for at least five hours per week (50% vs. 33%, p = .113). Patients with RTS within six months had sustained their spinal injury in a sports accident twice as often (28% vs. 14%, p = .121). Gender, preexisting medical or spinal conditions, severe injuries (types A4, B or C according to AO Spine), and surgical therapy were not significantly associated with RTS. The RTS rate within twelve months was 81% (76 patients).ConclusionThe RTS rate in amateur athletes after an isolated spinal injury without spinal cord injury was high, with 62% after six and 81% after twelve months. This reflects the effectiveness of the existing treatment and posttreatment concepts. Normal-weight patients and isolated cervical injury are favorable factors for RTS. The use of inpatient rehabilitation as a marker of protracted healing is associated with delayed or no RTS.