Obesity Class Research Articles

Elevated fetal growth during the antenatal period is associated with maternal obesity class

Obesity is characterized as a body mass index (BMI) >30.0 kg/m2. Obesity is further classified into Obesity Class 1 (BMI 30-34.9 kg/m2), Obesity Class 2 (BMI 35-39.9 kg/m2), and Obesity Class 3 (BMI ≥ to 40 kg/m2). In Mississippi, over 43% of women of childbearing age (18-44 years old) are obese. Numerous studies support the concept that in-utero exposure to a maternal obesogenic environment promotes fetal macrosomia (fetal growth above average per gestational age) and program offspring to metabolic complications throughout their lifespan. Yet, the association of obesity class on fetal growth and development is not well defined. Thus, we tested the hypothesis that increases in maternal obesity class promote excess fetal growth in offspring from obese mothers during the antenatal period. This study evaluated ultrasounds of pregnant women (n= 568) at the University of Mississippi Medical Center (UMMC) from 2019-2020. Women were evenly divided by BMI class (Normal, Obesity Class 1, Obesity Class 2, and Obesity Class 3). Obesity Class 3 was limited to a BMI of 40-44.9 kg/m2. Women were of reproductive age (18-44 years old). Maternal and fetal measurements were assessed at 1 time point at a routine ultrasound visit between 18-38 weeks gestation. Average maternal age was 28.27±6.15 years. Average gestational age of offspring was 23.91±5.41 weeks. Estimated fetal weight did not differ between Normal, Obesity Class 1, and Obesity Class 2. Estimated fetal weight was significantly increased in Obesity Class 3 (854.50±677.00 g) ( p<0.05) vs. Normal (401.10±159.60 g) ( p<0.05), Obesity Class 1 (445.9±202.3 g) ( p<0.05), and Obesity Class 2 (532.5±348.3 g) ( p<0.05). Estimated fetal weight by offspring gender per BMI Class did not differ. Abdominal circumference, a predictor of fetal growth, was only significantly increased in Obesity Class 2 (47.85±28.58 mm) vs Normal (37.15±24.85 mm) ( p<0.05). We also evaluated abdominal circumference by offspring gender per BMI class. Abdominal circumference was significantly reduced in Normal females (25.90±20.79 mm) vs. Normal males (44.67±24.60 mm) ( p<0.05), Obesity Class 1 females (48.25±27.79 mm) ( p<0.05), Obesity Class 2 males (45.26±27.74 mm) ( p<0.05) and females (48.31±30.03 mm) ( p<0.05), and Obesity Class 3 males (52.18±33.29 mm) ( p<0.05). These data indicate that severe obesity (BMI ≥ to 40 kg/m2) increases risk for fetal macrosomia, placing offspring at risk for metabolic disorders throughout their lifespan. Females exhibit greater increases in abdominal circumference by obesity class which suggests that female offspring are at greater risk of excess gestational growth in obesogenic environments compared to male counterparts. Yet, these data do not represent offspring weight or abdominal circumference at birth. Further studies are warranted to determine the influence of obesity on fetal growth after 38 weeks gestation and the placental mechanisms associated with fetal growth and development in maternal obesity. UMMC Department of Obstetrics and Gynecology This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Assessment of fetal thymus size and BMI in pregnant women with diabetes.

The purpose of this study is to demonstrate whether diabetes during pregnancy affects the development of the fetal immune system. The background: evaluation of potential complications in diabetic pregnancy. The objective is evaluation of the significance of a new ultrasound method of thymus size in pregnancies complicated by diabetes. The analysis was performed with the use of IBM SPSS Statistics 25.0 software. The Mann-Whitney U test was used for comparison of two groups, i.e., diabetic pregnancies and non-diabetic pregnancies, whereas Kruskal-Wallis H test was used to compare multiple groups. A linear regression model was used to determine the correlation between the type of diabetes and fetal thymus size as well as between maternal body mass index (BMI) and fetal thymus size. The significance level α was set at 0.05. A comparison between diabetic and non-diabetic pregnancies was made with the use of Kruskal-Wallis H test. The compared groups included women without gestational diabetes, with pre-gestational diabetes, gestational diabetes managed by diet and gestational diabetes treated with insulin and diet. The analysis revealed significant differences between the compared groups, H (3) = 23.06; p < 0.001; ƞ2 = 0.04. The additional post hoc Dunn's test with Bonferroni correction of the significance level was used to explore specific differences between group means. The results of this detailed analysis indicated that foetuses of diabetic mothers treated with diet had smaller thymus than foetuses of non-diabetic mothers (p = 0.001). Linear regression analysis was used to establish whether maternal BMI (defined as the body mass divided by the square of the body height and expressed in units of kg/m²) affects fetal thymus size. The analysis found no correlation between maternal BMI divided into the following categories: 18.5-24.99 normal weight, 25-29.99 overweight, 30.00-34.99 obese class I, 35.00-39.99 obese class II and ≥ 40.00 very severely obese, and fetal thymus size, b = -1.82; SE = 2.17; t = -0.84; p = 0.405; R2 < 0.01. Thymus size is statistically smaller in foetuses of diabetic mothers when compared to healthy controls. Overweighted and obese pregnancy is not a factor affecting fetal thymus size.

Role of Hypertension and Obesity as Risk Factors for IHD

Background: Hypertension and obesity are two major modifiable risk factors for CAD, most of the time there will be more than two risk factors in an IHD. Obesity itself cause insulin resistance to initiate type -2 DM. is the most common and significant RFs for IHD, and proper BP management is the cornerstone of both direct and indirect prevention. Overweight and obesity account for more than 80% of CHD patients. Obesity is sometimes viewed as a "minor" CHD RF; however, it is a widely effective risk-factor approach. A range of "major" risk factors have been proven to be significantly influenced by weight loss, including HTN, hyperlipidemia and insulin resistance/T2DM. Aim: To assess arterial hypertension and obesity as risk factors of IHD. Methods: This cross-sectional study which was done retrospectively by collecting data from database of "Scientific Research Institute of Cardiology and Internal Diseases" Almaty city, Kazakhstan during 2020. IHD confirmed by history, physical exam, angiography and other lab findings. Result: The research involved a total of 649 participants. The mean age of study population was 64.2±9.24 (P = 0,000). Mean of SBP and DBP were 180.73±34.9; 99.48±14.28 mmHg respectively. Number of females with normal BMI 50(21.6%), overweight 93(40.10%), obesity class – 1, 59(25.4%), obesity class – 2, 23(9.90%) and obesity class – 3, 7(3%), (P = 0.486). Number of males with underweight BMI 1(0.20%), normal BMI 96(23%), overweight 190(45.6%), obesity class – 1, 89(21.3%), obesity class – 2, 29(7%) and obesity class – 3, 12(2.9%). (P = 0.486). The Mean BMI in both genders was (28.72±11.79). Conclusion: The burden of CVDs and their related risk factors are significant in Almaty, posing a major public health concern. For accurate management and implementation of preventive measures in this area, effective strategies in management, education, and healthcare centers are needed.

33. Obesity as a Risk Factor in Cosmetic Abdominoplasty: A Systematic Review and Meta-Analysis

PURPOSE: The incidence of obesity is on the rise around the globe. Outside the massive weight loss patient population, knowledge of risk factors associated with abdominoplasty is limited. This systematic review and meta-analysis assesses the impact obesity has on cosmetic abdominoplasty outcomes. METHODS: A systematic review was conducted in accordance with PRISMA. PubMed, MEDLINE, Embase, Scopus, and COCHRANE databases were reviewed using syntax “obesity”, “abdominoplasty”, “panniculectomy”, and “body contouring” for articles. Cosmetic was defined as abdominoplasty or panniculectomy outside the context of massive weight loss. Obesity was defined as BMI ≥ 30 kg/m2. Studies reporting postoperative outcomes with less than 50% of their population involving massive weight loss patients were included. Postoperative outcomes were assessed by pooled analysis and meta-analysis. RESULTS: Of 3,088 initial studies, 16 met inclusion criteria. Of which, 9 studies included patient-reported outcomes that were used for pooled and meta-analysis. Six studies utilized national databases and were excluded from our data analysis. Meta-analysis demonstrated obesity was associated with more seromas (OR 1.45, 1.06-1.98, p=0.02), hematomas (OR 2.21, 1.07-4.57, p=0.03), and total surgical site occurrences (OR 1.99, 1.30-3.04, p=0.0016). There was no significant difference in odds of any other complications. Analysis by obesity class revealed no significant increase in odds in seromas or wound dehiscence. CONCLUSION: This review demonstrates obesity increased the odds of postoperative complications following cosmetic abdominoplasty. However, risk of complications does not continue to increase with higher obesity class. Additional research in cosmetic abdominoplasty is encouraged to further assess the impact of obesity on complications.

PC44. The Link Between Obesity and Migraine: Does This Exist?

PURPOSE: Metabolic syndrome is hypothesized to be linked to an increased prevalence and attack frequency of migraine headaches. The aim of this study was to evaluate the association between obesity and migraine characteristics. METHODS: A retrospective chart review was performed between 2015-2022. Demographic data, body mass index (BMI, classified per CDC obesity categories) and migraine characteristics, including migraine headache index (MHI, calculated by multiplying frequency, intensity and duration of headaches) of patients aged ≥18 years were recorded. Univariate linear regression models were used to evaluate the associations between measures of migraine severity and obesity. RESULTS: A total of 212 patients with migraine headaches were identified. Seventy-eight percent was female and 22% was male, with an average age of 44.6±12.7 years (average±SD). Higher MHI and number of headaches per month were significantly associated with class 3 obesity (BMI >40, p=0.009), but not with other BMI classes (p>0.05). Intensity and duration of headaches were not associated with severity or number of headaches, respectively. Postmenopausal status was associated with a significantly lower number of migraines per month (p=0.02). CONCLUSION: A higher BMI is associated with increased severity (i.e. MHI) and frequency of migraines, but not with the intensity and duration of headaches experienced. Furthermore, number of headaches decreased after menopause. As fat mass increases in obesity, aromatase expression and consequently estrogen levels are also elevated. Moreover, it is believed that a higher BMI increases entrapment neuropathy. These findings provide new insights into the association between obesity and migraine headaches.

Is Obesity Driving the Increase in Young Stroke? (P6-5.002)

<h3>Objective:</h3> Our aim was to identify the association of obesity with young acute ischemic stroke (AIS), and the burden of lifestyle-related risk factors based on different body-mass-index (BMI) categories in patients with young AIS. <h3>Background:</h3> Obesity is a known risk factor for AIS in both the adult and young (&lt;50 years) population. Prior studies suggest that this association is mediated through risk factors such as diabetes and hypertension; however, the extent of this association has not been reported. <h3>Design/Methods:</h3> All patients with AIS, younger than 50 years, admitted to the University of Maryland hospital system hospitals Jan 2017 and December 2020, were included. Patients were categorized into 3 BMI categories: 1) Normal (18.5–24.9), 2) Overweight (25–29), and 3) Obese (≥30). Lifestyle-related risk factor (HTN, DM, DLD, and sleep apnea) burden and distribution was analyzed across the three groups using Chi-squared tests of association. One-way Welch’s ANOVA was utilized to test mean differences in number of risk factors across BMI categories. <h3>Results:</h3> We identified 1272 patients with young stroke. A total of 797/1272 (63%) of our young stroke patients were obese and 23.1% (n=294) were in the overweight category. In the obese category: mean age was 41.4 years (SD +/−6.75), 49.4% were women and 53.4% were Black. Risk factor burden was significantly higher in the obese vs. the overweight and normal weight categories (p = &lt;0.001). The proportion of patients with HTN, DM, DLD and sleep apnea was significantly higher in the obese category. <h3>Conclusions:</h3> A majority of young stroke patients were obese, and the obese and overweight patients were predominantly African American. Obese patients had the highest proportion of all medical risk factors, as well as a risk factor burden nearly twice as high as those with normal BMI. Efforts to reduce obesity hold promise in mitigating the burden of stroke in young adults. <b>Disclosure:</b> Dr. Solomonow has nothing to disclose. Karen Yarbrough has nothing to disclose. Dr. Chaturvedi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astra Zeneca. Dr. Chaturvedi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Calgary. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Ramar &amp; Paradiso. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Cole, Scott, Kissane. The institution of Dr. Chaturvedi has received research support from NINDS. Dr. Mehndiratta has nothing to disclose.

Access to the Kidney Transplant Waitlist for People With HIV.

The Advisory Committee on Blood and Tissue Safety and Availability recently voted to remove the statutory National Institutes of Health research criteria and institutional review board requirements for performing kidney transplantation using kidneys from donors with HIV. This policy change may subsequently increase utilization of such organs.1 Despite excellent kidney transplant outcomes, single-center studies have demonstrated significantly lower kidney transplant waitlist addition rates for people with HIV (PWH) in the United States as compared with those without HIV, a requisite step for deceased donor kidney transplantation.2-4 Should adoption of transplantation using kidneys from donors with HIV increase following the implementation of this policy, understanding waitlist addition nationally is imperative. Acknowledging the lack of granularity in HIV-specific data, we used the United States Renal Data System and accompanying Medicare claims data to identify a cohort of PWH (January 1, 2007–December 31, 2016) with end-stage kidney disease (ESKD) and compared waitlist addition rates among PWH with ESKD patients without HIV. This study was approved by the Institutional Review Board at the University of Alabama at Birmingham. Among 602 006 incident patients whose primary payer was Medicare,5 HIV status was defined using the Chronic Conditions Data Warehouse algorithm (sensitivity: 93.2%; specificity: 99.4%). PWH with claims for an opportunistic infection within 90 d of dialysis initiation were excluded. Cox proportional hazards and Fine and Gray competing risks regressions were used to examine the likelihood of waitlist addition. The 6250 PWH were younger, more commonly African American, and more commonly reported alcohol dependence, drug dependence, and tobacco use. Cumulative incidence of waitlist addition within 5 y of dialysis initiation was 11.1% among PWH and 15.3% among ESKD patients without HIV. Following adjustment for demographics, comorbid conditions, and geography, HIV was associated with 52% lower likelihood of waitlist addition (adjusted hazard ratio: 0.48; 95% confidence interval, 0.43-0.52; P < 0.001; Table 1). After accounting for competing risks of death and living donor kidney transplantation before waitlist addition, a similar inequity was observed (adjusted subdistribution hazard ratio: 0.45; 95% confidence interval, 0.42-0.49; P < 0.001). TABLE 1. - Unadjusted and adjusted likelihood of waitlist addition among ESKD patients within 5 y and within all observed time following dialysis initiation 5 y, HR (95% CI) a Full follow-up, HR (95% CI) a Unadjusted PWH (ref: HIV–) 0.90 (0.83-0.98) 0.64 (0.54-0.75) PWH (ref: HIV–) b 0.93 (0.86-0.99) 0.62 (0.58-0.68) aHR (95% CI) b aHR (95% CI) b Adjusted PWH (ref: HIV–) 0.48 (0.43-0.52) 0.27 (0.21-0.35) PWH (ref: HIV–) b 0.45 (0.42-0.49) 0.25 (0.20-0.32) Bold values indicate significance at P < 0.05.aAdjusted for age, race, ethnicity, sex, WHO obesity class, alcohol abuse, drug abuse, diabetes, hypertension, cancer, peripheral vascular disease, nonambulatory status, assistance needed for daily activities, atherosclerotic heart disease, cerebrovascular disease, amputation, coronary obstructive pulmonary disease, institutionalized (yes/no), functional status, tobacco use, rurality, ESKD network, and year of dialysis initiation.bCompeting risk model.aHR, adjusted HR; CI, confidence interval; ESKD, end-stage kidney disease; HIV–, HIV negative; HR, hazard ratio; PWH, people with HIV; WHO, World Health Organization. This disparity in waitlist addition experienced by PWH has been described in single-center data,2-4 and commonly attributed to clinical factors, specifically severity of HIV infection as defined by CD4 counts, HIV viral loads, presence of opportunistic infections, substance use, and failure to complete transplant evaluation. Reported substance use was included in our analysis, but, despite attempts to account for HIV-specific characteristics through the exclusion of PWH with opportunistic infections, we were unable to completely account for such, nor could we assess where this disparity manifests, including referral rates or evaluation completions. Reliance upon Medicare claims data also resulted in an older cohort, potentially resulting in lower waitlist addition rates. Thus, the magnitude of the disparity between PWH and ESKD patients with HIV may have been overestimated or developed earlier at referral or evaluation. Despite these limitations, this observed inequity is confirmed by studies that collected HIV-specific characteristics, referral, and evaluation data. Given advances in transplantation for PWH, national data collection should be revised to capture early steps in transplantation and HIV-specific characteristics to ensure equitable access to and outcomes of transplantation.2-4

Body composition and mortality from middle to old age: a prospective cohort study from the UK Biobank.

How the association between adiposity and the risk of death changes with age, and which is the optimal level of adiposity to reduce mortality in older ages, is still not completely understood. We aimed to ascertain the age-specific risks of mortality associated with different measures of adiposity. This was a prospective UK Biobank cohort study. Participants were categorized based on five different adiposity and body composition metrics. We explored the age-varying associations between body composition indices and all-cause mortality from 45 to 85 years of age at follow-up using hazard ratios (HR) from flexible parametric survival models with multivariable adjustment and age as timescale. Participants were followed from baseline (2006-2010) through 31 March 2020. We included 369,752 participants (mean baseline age = 56.3 ± 8.1 years; range 38.9-73.7 years; 54.1% women) and 10,660 deaths during a median follow-up of 11.4 years. Associations between body mass index and mortality were similar when using the fat mass index in magnitude and shape. Compared to participants with normal weight, overweight was not associated with the risk of death regardless of age and the adiposity measure used. Participants with obesity class I showed an HR of 1.20 (95% confidence interval [CI]: 1.08, 1.33) and 1.14 (95%CI: 0.98, 1.30) at ages 60 and 80, respectively, and participants with obesity class II an HR about 1.55 across all age. More attenuated associations with higher age were found in individuals with the highest obesity using the fat mass index. Very high lean mass was associated with an increased risk of mortality in those aged 55-75 years (HR about 1.20 across all ages). Obesity should be prevented at any age. Attenuated associations with older age were observed only among the individuals with the highest obesity, but the risk remained higher compared to normal-weight participants. Lean mass did not reduce mortality risk at any age.

СВЯЗЬ КОЛИЧЕСТВА CD163+ ПОЛОЖИТЕЛЬНЫХ МОНОЦИТОВ КРОВИ У ДЕТЕЙ С ОЖИРЕНИЕМ

Children obesity is becoming global and causing dysregulation throughout the immune system, affecting the balance and levels of cytokines and adipokines. The purpose of this research was to study the amount of CD14+CD163+ blood monocytes in obese children compared to practically healthy children of normal body weight (BW). Materials and methods used: 70 children aged 9 to 15 y/o were included in a cross-sectional single-center comparative study in parallel groups from Feb. to Nov., 2022. The main group consisted of 60 obese children aged 11.95 (9.45; 14.45) y/o, 43% boys/57% girls. The control group consisted of 10 children without signs of obesity aged 10.4 (9.3; 13.8) y/o, 40% boys/60% girls. The amount of CD14+CD163+ monocytes in peripheral blood was assessed using CytoFLEX platform flow cytometer. All participants have undergone bioimpedance measurement of adipose tissue parameters using InBody 770 body composition analyzer. Results: a statistically significant increase in the amount of CD14+CD163+ blood monocytes was connected with an increase in the obesity class (p=0.010) in children. Thus, in the 2nd and the 3rd obesity classes, an increase in the amount of blood monocytes was noted by 2.8 and 2.6 times, respectively, compared to the children with normal BW (p&lt;0.05). There was also an increase in the amount of CD14+CD163+ monocytes in children with allergic diseases coupled with obesity - by 2.68 times compared to the children without this pathology (p=0.003). Conclusion: the connection between the amount of CD14+CD163+ peripheral blood monocytes, the obesity in children and the development of concomitant pathology was found. Therefore, reprogramming of blood monocytes would probably cause metabolic changes associated with obesity, which in its turn triggers various pathological processes. The results obtained are of a great practical importance for the purposes of treatment correction and undoubtedly require the continuation of the research in the field.

The Prevalence of Elevated Blood Pressure and Its Association With Obesity in Children Aged 6-13 Years in Rural India: A Cross-Sectional Study.

Introduction Globally, hypertension is one of the major risk factors for cardiovascular disease. Childhood hypertension is one of the emerging conditions due to the increase in the prevalence of obesity in children in developing countries. An increase in blood pressure (BP) can be classified as secondary hypertension if it is caused by an underlying disease process or as primary hypertension if there is no identifiable cause. Primary hypertension during childhood often tracks into adulthood. The prevalence of primary hypertension, mostly in older school-aged children and adolescents, has increased in parallel with an obesity epidemic. Materials and methods This cross-sectional descriptive study was taken in different schools in the rural areas of Trichy District, Tamil Nadu, for a period of six months from July 2022 to December 2022; the study was done in children between six and 13 years. Anthropometry was taken, and blood pressure was measured using an appropriate-size BP cuff and standardized sphygmomanometer. Three values were taken at an interval for a minimum of five minutes, and the mean of the three values was calculated. Blood pressure percentiles were adopted from the American Academy of Pediatrics (AAP) 2017 guidelines for childhood hypertension. Results Out of 878 students, 49 (5.58%) students had abnormal BP, of which 28 (3.19%) students were categorized into elevated BP and 21 (2.39%)students had hypertension both in stages 1 and 2. Abnormal blood pressure was equally distributed in both males and females. More students were from the age group between 12 and 13 years (chi-square value: 58.469, P=0.001), which shows that as age increases, the prevalence of hypertension increases. The mean weight was around 31.97 kg, and the mean height was 135.34cm. In this study, we found that 223 (25%) students were overweight and 53 (6.03%) students were obese. The prevalence of hypertension was 15.09% in the obese category and 1.35% in the overweight category (chi-square value: 83.712, P=0.000). Conclusion Due to limited data available on childhood hypertension based on the American Academy of Pediatrics (AAP) 2017guidelines, this study highlights the AAP 2017 guidelines for early diagnosis of elevated BP and various stages of hypertension in children, and also, the need for early detection of obesity is essential for the implementation of a healthy lifestyle. This study helps create awareness among parents regarding the rise of obesity and hypertension in children in rural populations of India.

Impact of obesity on all-cause and cause-specific mortality among critically ill men and women: a cohort study on the eICU database.

The effect of obesity on intensive care unit outcomes among critically ill patients and whether there are sex differences have not been well investigated. We sought to determine the association between obesity and 30-day all-cause and cause-specific mortality among critically ill men and women. Adult participants who had body mass index (BMI) measurements were included from the eICU database. Participants were divided into six groups according to BMI (kg/m2) categories (underweight, <18.5; normal weight, 18.5-24.9; overweight, 25-29.9; class I obesity, 30-34.9; class II obesity, 35-39.9; class III obesity, ≥40). A multivariable adjusted logistic model was conducted with odds ratios (ORs) and 95% confidence intervals (CIs). A cubic spline curve based on the generalized additive model was used to represent the nonlinear association. Stratified analysis and sensitivity analysis were also performed. A total of 160,940 individuals were included in the analysis. Compared with the class I obesity category, the underweight and normal weight categories had higher all-cause mortality, and the multivariable adjusted ORs were 1.62 (95% CI: 1.48-1.77) and 1.20 (95% CI: 1.13-1.27) for the general population, 1.76 (95% CI: 1.54-2.01) and 1.22 (95% CI: 1.13-1.32) for men, and 1.51 (95% CI: 1.33-1.71) and 1.16 (95% CI: 1.06-1.27) for women, respectively. Accordingly, multivariable adjusted ORs for the class III obesity category were 1.14 (95% CI: 1.05-1.24) for the general population, 1.18 (95% CI: 1.05-1.33) for men, and 1.10 (95% CI: 0.98-1.23) for women. With cubic spline curves, the association between BMI and all-cause mortality was U-shaped or reverse J-shaped. Similar findings were observed for cause-specific mortality, with the underweight category associated with a higher risk of mortality. Class III obesity increased the risk of cardiovascular death among men (OR 1.51; 95% CI: 1.23-1.84) and increased the risk of other-cause death among women (OR 1.33; 95% CI: 1.10-1.61). The obesity paradox appears to be suitable for all-cause and cause-specific mortality among critically ill men and women. However, the protective effect of obesity cannot be extended to severely obese individuals. The association between BMI and cardiovascular mortality was sex-specific and was more pronounced among men than among women. Graphical abstract.

Identification and Characteristics of Novel Mutations in Nonsyndromic Monogenic Obesity.

Nonsyndromic monogenic obesity (NSMO) is a class of individual obesity that is independent of the environment and caused by a single gene mutation. It is mostly caused by mutations in LEP, LEPR, PCSK1, as well as some rare mutations in UCP3, NR0B2, and PPARG. Among 30 obesity patients, five patients are identified with positive gene detection. For the first time, the c.624C>T mutation associated with PCSK1, and the c.50G>A and c.293_301delinsAC mutations associated with NR0B2, as well as the obesity phenotype mutation (c.284A>G) associated with PPARG is confirmed. Following this, the genotype-clinical phenotype, mutation hotspots, and mutation distributions of each gene are summarized, and the genetic characteristics of NSMO are analyzed. The locations of mutation c.50G>A, and c.284A>G are highly conserved according to the sequencing alignment. According to the findings, the c.624C>T mutation in PCSK1 is a newly discovered synonymous mutation, but it can result in significant early-onset obesity. Additionally, the mutation of c.284A>G(PPARG) can lead to a variety of clinical phenotypes and the mutation of UCP3 and NR0B2 may increase the risk of type 2 diabetes mellitus. This study enriches the human NSMO gene mutation database and provides a scientific basis for clinically accurate diagnosis and treatment.

Association of body mass index with 30-day outcomes following groin hernia repair.

Although groin hernia repairs are relativelysafe, efforts to identify factors associated with greater morbidity and resource utilization following these operationsare warranted. An emphasis on obesity has limited studies from a comprehensive evaluation of the associationbetween body mass index (BMI) and outcomes following groin hernia repair. Thus, we aimed to ascertain theassociation between BMI class with 30-day outcomes following these operations. The 2014-2020 National Surgical Quality Improvement Program database was queried to identify adults undergoingnon-recurrent groin hernia repair. Patient BMI was used to stratify patients into six groups: underweight, normal,overweight, and obesity classes I-III. Association of BMI with major adverse events (MAE), wound complication,and prolonged length of stay (pLOS) as well as 30-day readmission and reoperation were evaluated usingmultivariable regressions. Of the 163,373 adults who underwent groin hernia repair, themajority of patients were considered overweight (44.4%). Underweight patients more commonly underwentemergent operations and femoral hernia repair compared to others. After adjustment of intergoup differences,obesity class III was associated with greater odds of an MAE (AOR 1.50), wound complication (AOR 4.30), pLOS(AOR 1.40), and 30-day readmission (AOR 1.50) and reoperation (AOR 1.75, all p < 0.05). Underweight BMIportended greater odds of pLOS and unplanned readmission. Consideration of BMI inpatients requiring groin hernia repair could help inform perioperative expectations. Preoperative optimization anddeployment of a minimally invasive approach when feasible may further reduce morbidity in patients at theextremes of the BMI spectrum.

Loss of Health State Utilities Attributable to Obesity

ObjectivesThis study aimed to quantify the association between the loss of health state utilities (LHSU) and obesity, considering different obesity categories. This is relevant to interventions economic evaluations and for public policy decision planning. MethodsUsing data from the Chilean National Health Survey, this study uses linear regression models and counterfactual scenarios to calculate the prevalent burden, population averages, and total sum of LHSU attributable to obesity for the Chilean national level on people older than 15 years, year 2017. Adjustments for socioeconomic status and associated noncommunicable diseases (NCDs) are considered. Calculating the LHSU using these methods enables the approximation of loss of prevalent quality-adjusted life-years (QALYs). ResultsThe raw obesity LHSU burden was 9.1% (95% uncertainty interval [UI] 5.1-13). When adjustment is considered, the LHSU attributable to obesity reaches 4.6% (95% UI 0.6-8.5) being responsible for 121 045 prevalent QALYs. Socioeconomic status adjusted analysis of higher body mass index (BMI, in kg/m2) categories of obesity shows a dose-response effect for LHSU, being the BMI ≥ 40 category with the highest population average of attributable LHSU (10.1; 95% UI 5.5-14.5, scale 0 [full health] to 100 [dead]). Burden for BMI ≥ 35 categories showed the biggest change after NCD adjustment. ConclusionsObesity carries a significant burden of QALY loss. Policy decision-making addressing obesity should focus specially on the BMI ≥ 40 group. NCD comorbidity should be considered for policies addressing the BMI ≥ 35 group.

THE BURDEN OF END-STAGE OSTEOARTHRITIS IN AUSTRALIA: A POPULATION-BASED STUDY ON THE INCIDENCE OF TOTAL KNEE ARTHROPLASTY ATTRIBUTABLE TO OVERWEIGHT/OBESITY

To determine the risk of total knee replacement (TKR) for primary osteoarthritis (OA) associated with overweight/obesity in the Australian population.This population-based study analyzed 191,723 cases of TKR collected by the Australian Orthopaedic Association National Joint Registry and population data from the Australian Bureau of Statistics. The time-trend change in incidence of TKR relating to BMI was assessed between 2015-2018. The influence of obesity on the incidence of TKR in different age and gender groups was determined. The population attributable fraction (PAF) was then calculated to estimate the effect of obesity reduction on TKR incidence.The greatest increase in incidence of TKR was seen in patients from obese class III. The incidence rate ratio for having a TKR for obesity class III was 28.683 at those aged 18-54 years but was 2.029 at those aged &gt;75 years. Females in obesity class III were 1.7 times more likely to undergo TKR compared to similarly classified males. The PAFs of TKR associated with overweight or obesity was 35%, estimating 12,156 cases of TKR attributable to obesity in 2018. The proportion of TKRs could be reduced by 20% if overweight and obese population move down one category.Obesity has resulted in a significant increase in the incidence of TKR in the youngest population in Australia. The impact of obesity is greatest in the young and the female population. Effective strategies to reduce the national obese population could potentially reduce 35% of the TKR, with over 10,000 cases being avoided.

The effect of maternal obesity and lipid profile on first-trimester serum progesterone levels

Prepregnancy overweight increases the risk of adverse perinatal outcomes. Maternal lipid profile plays a key role in the production of pregnancy hormones. The influence that obesity has on the specific mechanisms that may be involved and the potential associations with abnormal conditions in pregnancy are still poorly understood. This study aimed to evaluate the effect of maternal body mass index and lipid profile on first-trimester serum progesterone levels. This was a prospective cohort study including 734 pregnant people. First-trimester maternal serum progesterone, cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides were measured between 9 and 11 weeks' gestation. Free β-hCG, PAPP-A, age, body mass index, smoking status, gestational age at delivery, fetal sex, and birthweight were also recorded. Pregnant people were classified according to their body mass index into underweight (n=21), normal weight (n=395), overweight (n=221), obesity class I (n=64), and obesity class II/III (n=33) groups. Gestational age at sampling was 10.0 4±1.12 weeks. Serum progesterone levels decreased as maternal body mass index increased (35.84±12.00 ng/mL, 33.08±11.27 ng/mL, 28.04±8.91 ng/mL, 24.37±8.56 ng/mL, and 19.87±11.00 mL for underweight, normal weight, overweight, obesity class I, and obesity class II/III groups, respectively; P<.000001). There were statistically significant negative correlations between maternal progesterone and body mass index, triglycerides, and cholesterol/high-density lipoprotein cholesterol ratio, and positive correlations with gestational age at sampling, maternal age, cholesterol, high-density lipoprotein cholesterol, crown-rump length, free β-hCG, and PAPP-A. Linear regression showed that the only independent predictor variables for progesterone levels were body mass index (P<.0001), PAPP-A (P<.0001), high-density lipoprotein cholesterol (P<.0001), and free β-hCG (P<.0001) (R2=0.33; P<.0000001). First-trimester serum progesterone levels were lower in overweight pregnant people and markedly decreased in those with obesity, especially obesity class II/III. Maternal high-density lipoprotein cholesterol was independently related to progesterone levels as a protective factor. Benefits of progesterone supplementation in pregnant people with obesity need further evaluation.

Prevalence of metabolic syndrome in female patients with rheumatoid arthritis in Erbil city

Background: Rheumatoid arthritis and metabolic syndrome are closely linked, which considerably raises the risk of cardiovascular complications, and consequently, morbidity and mortality. Treatment of the metabolic syndrome reduces mortality and morbidity of cardiovascular disease.&#x0D; Objective: To assess the prevalence of metabolic syndrome in a population of female patients with Rheumatoid arthritis, and association with comorbidities and Disease-modifying anti-rheumatic drugs (DMARDs).&#x0D; Patients and Methods: This cross-sectional analytic study was conducted in Erbil City. A total of 110 female patients with the diagnosis of rheumatoid arthritis were included during the period of July 2021-March 2022. Anthropometric indices, blood pressure, fasting blood sugar, lipid profile, and proteinuria were investigated. The metabolic syndrome defining criteria from the international diabetes federation (IDF-2005) were applied.&#x0D; Results: Out of 110 patients with rheumatoid arthritis, 63 (57.3%) were found to have metabolic syndrome, in whom the majority of them 52 (71.2%) were obese class 1. A significant association of metabolic syndrome was found with comorbidities (hypertension, diabetes, and hypothyroidism), p-value 0.019, and TNF-alpha inhibitor drugs were shown to be associated with a reduced risk for metabolic syndrome.&#x0D; Conclusion: Metabolic syndrome is common in rheumatoid arthritis patients, and it increases the risk of other comorbidities (hypertension, diabetes, and hypothyroidism) as well as cardiovascular diseases. Patients on biologic disease modifying anti-rheumatic drugs are at a lower risk of metabolic syndrome.

Estimating the health impacts of sugar-sweetened beverage tax for informing policy decisions about the obesity burden in Vietnam.

Taxation on sugar-sweetened beverages (SSBs) has been adopted in more than 40 countries but remained under discussion in Vietnam. This study aimed to estimate the health impacts of different SSBs tax plans currently under discussion to provide an evidence base to inform decision-making about a SSBs tax policy in Vietnam. Five tax scenarios were modelled, representing three levels of price increase: 5%, 11% and 19-20%. Scenarios of the highest price increase were assessed across three different tax designs: ad valorem, volume-based specific tax & sugar-based specific tax. We modelled SSBs consumption in each tax scenario; how this reduction in consumption translates to a reduction in total energy intake and how this relationship in turn translates to an average change in body weight and obesity status among adults by applying the calorie-to weight conversion factor. Changes in type 2 diabetes burden were then calculated based on the change in average BMI of the modelled cohort. A Monte Carlo simulation approach was applied on the conversion factor of weight change and diabetes risk reduction for the sensitivity analysis. We found that the taxation that involved a 5% price increase gave relatively small impacts while increasing SSBs' price up to 20% appeared to impact substantially on overweight and obesity rates (reduction of 12.7% and 12.4% respectively) saving 27 million USD for direct medical cost. The greatest reduction was observed for overweight and obesity class I. The decline in overweight and obesity rates was slightly higher for women than men. This study supports the SSB tax policy in pursuit of public health benefits, especially where the tax increase involves around a 20% price increase. The health benefit and revenue gains were evident across all three tax designs with the specific tax based on sugar density achieving greatest effects.

Abstract 3018: Demographic and social patterns of average values of inflammatorymarkers in US adults: A 2009-2016 NHANES analysis

Abstract Several studies report the negative impact of elevated Neutrophil-to-Lymphocyte ratio (NLR) and elevated Platelet-to-Lymphocyte ratio (PLR) on outcomes in many surgical and medical conditions, including cancer. In order to use these inflammatory biomarkers as prognostic factors in disease, a normal value in disease-free individuals must be identified first. This study aims to (1) establish average values of various inflammatory markers using a healthy and nationally representative U.S. adult population and (2) explore heterogeneity in average values by sociodemographic and behavioral risk factors to better specify cut-off points accordingly. The National Health and Nutrition Examination Survey (NHANES) of aggregated cross-sectional data collected from 2009 to 2016 was analyzed; data extracted included markers of systemic inflammation and demographic variables. We excluded participants who were under 20 or had a history of inflammatory diseases such as arthritis and gout. Adjusted linear regression models were used to examine the association between demographic and behavioral characteristics and neutrophil counts, platelet counts, lymphocyte counts, NLR, and PLR. The average NLR is 2.16 and the average PLR is 121.31. Non-Hispanic Black participants have significantly lower mean NLR values (1.78, 95% CI 1.74–1.83 and 2.10, 95% CI 2.04–2.16 respectively) when compared to non-Hispanic Whites (2.27, 95% CI 2.22–2.30–p&amp;lt;0.0001). Participants who reported any no smoking history had significantly lower NLR than subjects who reported any smoking history and higher PLR than current smokers. The average PLR for non-Hispanic blacks is significantly lower compared to non-Hispanic whites. Participants ages 20-29 have significantly lower mean PLR vs. participants in the age groups 30-59, 60-79, and 80 and older. Additionally, current smokers have significantly higher mean PLR compared to those who never smoke. Participants in the obese category also had higher mean PLR compared to normal weight participants. This study provides nationally representative estimates for demographic and behavioral effects on NLR, and PLR, which have been associated with several chronic disease outcomes, suggesting that different cut-off points for inflammatory markers should be set according to social factors. Citation Format: Marlene Camacho-Rivera, Zachary Ye, Raisa Haq, Rose Calixte. Demographic and social patterns of average values of inflammatorymarkers in US adults: A 2009-2016 NHANES analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3018.

Prevalence of obesity related hypertension among overweight or obese adults in River Nile State in Northern Sudan: a community based cross-sectional study.

Reducing excess body weight is important for control and management of high blood pressure (BP) in adults. Previous studies showed high prevalence of hypertension in River Nile State-north of Sudan, hence this study to establish whether obesity can be among the main risk factors and to study the prevalence of obesity related hypertension among Sudanese adults in River Nile State. This was a cross sectional community-based study conducted in River Nile State, Northern Sudan from January to June 2021. Obese and overweight, aged 18 years and above and accepted to participate in the study were included in the study. Convenience sampling method was used to select the participants. Data was collected through structured questionnaire filled by the patients after taking informed consent. Anthropometric measurements were taken. Two measurements of BP were obtained. Data was analyzed using SPSS version 23.0 (IBM, Chicago, USA). Chi-square test was used to determine the associations between categorical variables while logistic regression test was used to predict the presence of hypertension among studied population. A total of 1,295 participants were enrolled in this study. Obesity was reported in 1,118 (86.3%) of the participants. The prevalence of hypertension among the participants was 1,027 (79.3%). Central obesity was reported in 951 (92.6%) among hypertensive patients (P<0.001). Moreover, among hypertensive patients 470 (45.8%) were obese class I, 334 (32.5%) overweight, 139 (13.5%) obese class II and 84 (8.2%) obese class III (P<0.001). Obesity, BMI are risk factor of hypertension (P<0.001). Other risk factors were age above 40 years (P<0.001), unemployment (P<0.001), low education level (P<0.001) and being married (P<0.001). Logistic regression analysis showed that increasing age [P<0.001; odds ratio (OR) =1.055; 95% confidence interval (CI): 1.041-1.068], central obesity (P<0.001; OR =5.16; 95% CI: 3.4-7.8) and high body mass index (BMI) (P<0.001; OR =3.7; 95% CI: 1.7-7.9) were associated with uncontrolled hypertension. The study showed that the prevalence of obesity related hypertension was high. Common risk factors were age above 40 years, unemployment, and marriage. Importantly, central obesity, gross obesity and increasing age can be associated with uncontrolled BP management.