Overweight OR Research Articles

Obese women less likely to have low serum ferritin, Nicaragua.

To examine the association between overweight and obesity and serum ferritin among women of reproductive age (15-49 years) in Nicaragua, considering the effect of α1-acid glycoprotein (AGP), a marker of inflammation. We analysed data from the 2004-05 Nicaraguan Integrated Surveillance System for Nutrition Interventions. Three logistic regression models were analysed with low serum ferritin (<15 μg/l) as the dependent variable: (i) overweight or obese status and covariates; (ii) model 1 plus AGP; and (iii) model 1 restricted to only women with normal AGP levels (≤1.0 g/l). Nicaragua. Included in this analysis were 832 non-pregnant mother/caregivers (15-49 years) surveyed in 2004-2005. In the sample, prevalence of overweight and obesity was 31.8 % and 19.2 %, respectively, and 27.6 % had low serum ferritin. In model 1, the adjusted OR of low serum ferritin was 0.74 (95 % CI 0.52, 1.05) for overweight women and 0.42 (95 % CI 0.26, 0.65) for obese women. In model 2, AGP was significantly independently associated with low serum ferritin (adjusted OR=0.56, 95 % CI 0.34, 0.92) while the adjusted OR for overweight and obesity were largely unchanged. Excluding women with elevated AGP did not appreciably affect the relationship between overweight or obesity and low serum ferritin (model 3). Overall, in this population of reproductive-age women, obese women were less likely to have low serum ferritin levels, and this was independent of inflammation as measured by AGP.

Body Mass Index and its Association with Lumbar Disc Herniation and Sciatica: A Large-Scale, Population-Based Study

Introduction Elevated body mass index (BMI) or overweight and obesity are pandemics. Lumbar disc herniation and sciatica occur in every population and present severe socioeconomic consequences. However, little is known regarding the role of BMI with lumbar disc herniation and sciatica. As such, the following large-scale study addressed the association of BMI, in particular overweight and obesity, with disc herniation, its global lumbar involvement and its implications with the development of sciatica. Materials and Methods A cross-sectional study of 2,596 Southern Chinese (mean age: 42 years; 60% females) was conducted assessing T2-weighted MRI, environmental and lifestyle factors, as well as clinical profiles of sciatica. On imaging, the presence of disc bulge/extrusion (DBE) and other spinal phenotypes from L1-S1 were assessed. Disc degeneration was assessed and graded based on the Schneiderman et al criteria and summated of all levels to produce a degenerative disc disease (DDD) score (potential score range: 0-15). A total DBE (TDBE) score of L1-S1 was calculated (potential score range: 0-10). Asian-modified BMI values and categories of underweight, normal weight, overweight, and obese were obtained for each subject. Results DBE was noted in 46.3% of the subjects, mainly occurring at L4-S1. The mean DDD and TDBE scores were 0.7 and 2.83, respectively. Historical prevalence of sciatica was 44.6%, with 17.9% reporting sciatica at the time of assessment. The mean BMI was 22.9 kg/m2 (7.2% underweight, 47.9% normal weight, 36.1% overweight, and 8.9% obese). Elevated DDD score was significantly correlated with an elevated TDBE score (r=0.610; p&lt; 0.001). TDBE score significantly increased with elevated BMI categories ( p&lt; 0.001). Multivariate analyses adjusting for covariates noted that elevated BMI was significantly associated with DBE (normal weight [Ref]; underweight OR: 0.71[95% CI: 0.49-1.03]; overweight OR: 1.26[95% CI: 1.04-1.52]; obese OR: 1.78[95% CI: 1.30-2.44]). TDBE score (OR: 1.36; 95% CI: 1.15-1.60) and obesity (OR: 1.68; 95% CI: 1.25-2.24) were significantly related with sciatica. Worse functional and disability scores were associated with sciatica ( p&lt; 0.05). Conclusion Based on the largest population-based study to assess the role of BMI and its association with disc herniation, this study definitely noted that overweight and obesity significantly increased the likelihood of having lumbar disc herniation, its global severity, and the risk of developing sciatica. Disclosure of Interest None declared

Obesity and mental disorders during pregnancy and postpartum: a systematic review and meta-analysis.

To evaluate the prevalence and risk of antenatal and postpartum mental disorders among obese and overweight women. Seven databases (including MEDLINE and ClinicalTrials.gov) were searched from inception to January 7, 2013, in addition to citation tracking, hand searches, and expert recommendations. Studies were eligible if antenatal or postpartum mental disorders were assessed with diagnostic or screening tools among women who were obese or overweight at the start of pregnancy. Of the 4,687 screened articles, 62 met the inclusion criteria for the review. The selected studies included a total of 540,373 women. Unadjusted odds ratios were pooled using random-effects meta-analysis for antenatal depression (n=29), postpartum depression (n=16), and antenatal anxiety (n=10). Obese and overweight women had significantly higher odds of elevated depression symptoms than normal-weight women and higher median prevalence estimates. This was found both during pregnancy (obese odds ratio [OR] 1.43, 95% confidence interval [CI] 1.27-1.61, overweight OR 1.19, 95% CI 1.09-1.31, median prevalence: obese 33.0%, overweight 28.6%, normal-weight 22.6%) and postpartum (obese OR 1.30, 95% CI 1.20-1.42, overweight OR 1.09, 95% CI 1.05-1.13, median prevalence: obese 13.0%, overweight 11.8%, normal-weight 9.9%). Obese women also had higher odds of antenatal anxiety (OR 1.41, 95% CI 1.10-1.80). The few studies identified for postpartum anxiety (n=3), eating disorders (n=2), or serious mental illness (n=2) also suggested increased risk among obese women. Health care providers should be aware that women who are obese when they become pregnant are more likely to experience elevated antenatal and postpartum depression symptoms than normal-weight women, with intermediate risks for overweight women.

The Impact of Cesarean Section on Offspring Overweight and Obesity

Concerns have arisen regarding the long-term impacts of cesarean section (CS) on the health of offspring. One mechanism linking CS with later diseases is the hygiene hypothesis, based on the concept of different bacteria present in the newborns depending on mode of delivery. This early-life difference in bacteria acquisition could have lasting effects on offspring gut microbiota composition and related disorders. This review and meta-analysis were performed to determine whether an association exists between CS and overweight/obesity in offspring and to evaluate the strength of the possible association. Relevant articles and abstracts were obtained from searches of PubMed, EMBASE, and Web of Science databases through June 2012. Studies were cohort or case-control investigations that examined the association of CS compared with vaginal delivery with overweight/obesity in childhood (3–8 years), adolescence (9–18 years), or adulthood (>19 years). Statistical heterogeneity across estimates was assessed by I2 statistics; values of 25%, 50%, and 75% indicated low, medium, and high heterogeneity, respectively. The primary analysis was to estimate the overall pooled OR for offspring delivered by CS versus vaginal delivery and specific pooled ORs for children, adolescents, and adults. Two-sided P < 0.05 indicated statistical significance. Eight of an initial 2454 studies met the inclusion criteria along with 1 unpublished study, for a total of 7 cohort and 2 case-control studies. Overall, 10 childhood, 2 adolescence, and 3 adulthood estimates were included in the meta-analysis. The pooled OR of overweight/obesity for offspring delivered by CS compared with those born vaginally was 1.33 (95% CI, 1.19–1.48), with moderate to high heterogeneity (I2 = 63%) across the 15 estimates. Pooled ORs of overweight and obesity were 1.22 (95% CI, 0.99–1.50; I2 = 64%) and 1.37 (95% CI, 1.21–2.56; I2 = 45%; P for interaction = 0.33), respectively. The pooled OR for childhood overweight/obesity was 1.32 (95% CI, 1.15–1.51; I2 = 66%) across the 10 estimates. The pooled OR of overweight was 1.22 (95% CI, 0.99–1.50; I2 = 64%), and that for obesity was 1.40 (95% CI, 1.17–1.67; I2 = 50%; P for interaction = 0.31). The pooled ORs for adolescence and adult obesity were 1.24 (95% CI, 1.00–1.54; I2 = 0%) and 1.50 (95% CI, 1.02–2.20; I2 = 74%), respectively. The pooled ORs for male and female offspring did not differ significantly. Compared with vaginal delivery, CS was associated with a 33% increased risk of later overweight and obesity in offspring. The underlying mechanism of this association is unclear, although the hygiene hypothesis is one possible mechanism. Future studies should examine the causal relationship between CS and obesity, particularly in adolescents and adults, and whether these associations have a common pathway with other health outcomes in offspring born by CS.

Association Between Body Mass Index, Sexually Transmitted Infections, and Contraceptive Compliance

Recent studies have examined the relationship between body mass index (BMI) and sexual behaviors, but little information exists on this relationship among racially diverse, low-income women using objectively measured clinical data. The purpose of this study was to examine the association between BMI and sexual behaviors, rates of sexually transmitted infections (STIs) and unintended pregnancy, and contraceptive adherence among adolescent and young adult women. As part of a larger study, 1,015 Hispanic (54.2%), Black (18.6%) and White (24.8%) women aged 16 to 24 years seeking family planning services at publicly funded reproductive health clinics provided data on their baseline sexual behaviors, and contraceptive use and pregnancy history over 12 months. Objective clinical data were available from medical records at baseline (i.e., height, weight, and Papanicolaou [Pap] smear results), and over a 12-month period (i.e., STI results). Multivariable analyses were used to compare sexual behaviors, STI rates, contraceptive compliance, and unintended pregnancy rates between obese, overweight, and normal weight participants after adjusting for age, race/ethnicity, and other confounders. Overall, 423 (36.6%), 304 (26.3%), and 288 (24.9%) participants were classified as normal weight, overweight, and obese, respectively. No statistically significant association was observed between BMI and sexual behaviors, STI rates (overweight odds ratio [OR] 0.67; 95% confidence interval [95% CI] [0.4, 1.08]; obese OR 0.68; 95% CI [0.42, 1.10]); contraceptive compliance (overweight OR 0.89; 95% CI [0.69, 1.16]; obese OR 0.89; 95% CI 0.68, 1.16]), or unintended pregnancy (overweight OR 1.08 95% CI [0.73, 1.60]; obese OR 1.09; 95% CI [0.72, 1.63]). STI history and contraceptive compliance did not vary by BMI. Therefore, all women should receive equal contraceptive counseling (including condoms) to reduce the risk of unplanned pregnancy and STIs.

Association of neck circumference and obesity status with elevated blood pressure in children

High blood pressure (BP) and overweight/obesity are increasingly prevalent in children. We examined the associations of excess weight indicators including neck circumference (NC) and body mass index (BMI) with high BP in children. We hypothesized that high NC is associated with elevated BP. We utilized cross-sectional anthropometric and BP data on 1058 children aged 6-18 years. Patients were classified into weight and NC categories according to published guidelines. Prehypertension was defined as systolic or diastolic BP levels between 90th and 95th percentile for gender, age and height. Hypertension signifies systolic and/or diastolic BP levels ≥ 95th percentile for age, gender and height. The prevalence of elevated BP was 29.2% (prehypertension=10.1%, hypertension=19.1%). The prevalence of overweight and obesity was 19.0 and 18.7%, respectively. Rates of wide NC increased progressively with BMI categories by 8.8, 29.4 and 68.7% among normal weight, overweight and obese children, respectively. Within each BMI category, the unadjusted odds ratio for elevated BP was significantly higher in children with wide NC than those with normal NC (normal weight OR=1.78 (1.0-3.1), P=0.04); overweight OR=2.74 (1.5-5.2), P=0.001); obese OR=2.44 (1.3-4.6), P=0.006)). Increasing NC and BMI are associated with elevated BP in children. Joint presence of wide NC and high BMI is associated with significantly high rates of elevated BP. NC measurement may be a helpful tool to detect the presence of elevated BP in children.

Sex and dieting modify the association between emotional eating and weight status

Unlike other psychological correlates of weight status, emotional eating (EmE) has received relatively limited attention in the literature. We aimed to examine the association between the EmE score and weight status and the influence of sex and dieting on this association. A total of 8580 men and 27,061 women aged ≥18 y who participated in the NutriNet-Santé cohort study were selected in this cross-sectional analysis. Self-reported weight and height, EmE scores of the revised 21-item version of the Three-Factor Eating Questionnaire, and dieting status data were collected. The relation between EmE and weight status was estimated by using multiple linear and logistic regression models adjusted for sociodemographic and lifestyle factors. Interactions of EmE with sex and dieting history were assessed. Median EmE scores were greater in women than in men and in former or current dieters than in subjects without a history of dieting. Strong associations appeared between the EmE score and weight status in most categories of sex × dieting status. The strongest associations between EmE and weight status were observed in women, particularly in never dieters [body mass index slope (95% CI): 2.61 (2.43, 2.78); overweight OR (95% CI): 5.06 (4.24, 6.05)]. These observations support the existence of an association between EmE and weight status. The effect modification of sex and dieting on the EmE score and on the association of the EmE score with weight status should be taken into account in obesity prevention.

Parental smoking during pregnancy and risk of overweight and obesity in the daughter

ObjectiveEmerging evidence suggests that prenatal exposures may affect long-term health outcomes. In utero exposure to smoking is associated with an increased risk of overweight and obesity in children and adolescents. However, few studies have examined how prenatal exposure to parental smoking influences risk of obesity in adulthood and whether these associations are independent of childhood and adolescent adiposity. The aim of the current study was to investigate whether prenatal exposure to parental smoking influences body size in adulthood and whether any association may be mediated by childhood and adolescent body size.MethodsWe investigated the association between parental smoking during pregnancy and risk of overweight and obesity in adulthood and at age 18, and adiposity during childhood among 35,370 participants in the Nurses’ Health Study II. Data on smoking during pregnancy and socioeconomic variables were provided by the mothers, and anthropometric data and adult risk factors were reported by participants.ResultsAfter adjustment for socioeconomic and behavioral variables, maternal smoking during pregnancy was associated with adiposity at ages 5–10, age 18, and during adulthood. For age 18 overweight the ORs (95% CIs) for 1–14, 15–24, and 25+cigarettes/day were 1.13 (1.18–1.50), 1.40 (1.20–1.64), and 1.15 (0.79–1.69) and for obesity were 1.41 (1.14–1.75), 1.69 (1.31–2.18), and 2.36 (1.44–3.86). The corresponding ORs (95% CIs) for obesity in adulthood were 1.26 (1.16–1.37), 1.46 (1.30–1.63), and 1.43 (1.10–1.86). Risk of adiposity was not increased among daughters whose mothers stopped smoking during the first trimester (OR [95% CI] for overweight (1.03 [95% CI 0.90–1.17] and obesity (1.12 [95% CI 0.97–1.30]). Women whose fathers smoked during pregnancy were also at increased risk of overweight and obesity in adulthood with covariate-adjusted ORs (95% CIs) for obesity of 1.19 (1.11–1.29) for 1–14 cigarettes/day, 1.27 (1.18–1.37) for 15–24 cigarettes/day, and 1.40 (1.27–1.54) for 25+ cigarettes/day compared to fathers who did not smoke (ptrend<0.0001). Paternal smoking during pregnancy was also associated with an increased risk of obesity at age 18 among those whose fathers smoked 15 or more cigarettes/day but was not associated with childhood body size.ConclusionsMaternal smoking during pregnancy was associated in a dose-response manner with overweight and obesity in the daughter through adolescence and adult life. Smoking cessation during the first trimester appears to mitigate this excess risk.Paternal smoking was also associated with risk of overweight and obesity of the adult daughter and this association persisted after adjustment for maternal smoking.

Dietary calcium intake is associated with adiposity, metabolic profile, inflammatory state and blood pressure, but not with erythrocyte intracellular calcium and endothelial function in healthy pre-menopausal women

Recent studies have suggested that dietary Ca may have beneficial effects on adiposity, insulin resistance, dyslipidaemia and blood pressure (BP). One potential mechanism underlying these benefits involves modifications in intracellular Ca concentration ([Ca2+]i). The present study aimed to evaluate the associations of dietary Ca with adiposity, erythrocyte [Ca2+]i, metabolic profile, BP, inflammatory state and endothelial function in healthy pre-menopausal women. In the present cross-sectional study, seventy-six women aged 18–50 years were submitted to the evaluation of dietary intake, anthropometric parameters, body composition, erythrocyte [Ca2+]i, biochemical variables, endothelial function and BP. A FFQ was used to assess usual dietary intake. Endothelial function was evaluated by serum concentrations of adhesion molecules and by the peripheral arterial tonometry (PAT) method, using Endo-PAT 2000®. Participants were allocated into two groups according to Ca intake: low-Ca group (LCG; n 32; < 600 mg/d) and high-Ca group (HCG; n 44; ≥ 600 mg/d). Women in the LCG compared with those in the HCG exhibited, after adjustments for potential confounders, higher values of BMI, waist circumference, waist:height ratio, percentage of body fat, insulin, homeostasis model assessment of insulin resistance, leptin, diastolic and mean BP; and lower levels of HDL-cholesterol, adiponectin and vascular cell adhesion molecule 1. Endothelial function assessed by PAT and [Ca2+]i was similar in both groups. Subjects in the HCG had lower OR for prevalent overweight, obesity, abdominal obesity, insulin resistance, HDL-cholesterol < 600 mg/l and systolic BP >120 mmHg. The findings of the present study suggest that high Ca intake is inversely associated with some cardiovascular risk factors.

Sports-Related Injuries in Nonathletic Children

Q: ARE KIDS WHO ARE LESS PHYSICALLY ACTIVE OR OVERWEIGHT AT INCREASED RISK FOR SPORTS-RELATED INJURIES? A. Yes. Last month we reviewed how pediatricians can explain to parents the benefits of physical activity for kids, beyond weight control. This month we thought it would be important to follow up with advice on addressing parents’ concerns for when their typically inactive children get involved in sports by dealing with this important question. Early data in support of a relationship between poor physical fitness and activity-related injury came from investigation of army trainees: a history of inactivity, higher body mass index (BMI), and low aerobic fitness were all believed to contribute to physical training-related injuries in this population.1 In fact, there are good data demonstrating that youth with increased BMIs have a significantly higher risk of sustaining a sports-related injury then their normal-weight peers. In a review of the available literature on obesity and injury, McHugh reported that in 11 of the 13 studies included in his analysis, a higher BMI and/or high percentage of body fat were associated with an increased risk of sports-related injury.2 The reported increases in injury risk ranged from 1.4 to 3.9 times the risk identified for the normal-weight control groups. The most common injuries reported in the overweight/poorly conditioned athletes were ankle sprains, tears of the medial collateral ligament of the knee, and dental injuries. Proposed mechanisms for an increased sports-related injury rate in overweight and obese children include: poor postural control (leading to problems with balance and coordination); poor physical fitness (associated with early muscle fatigue and subsequent injury); and low preparticipation physical activity levels (associated with impaired or delayed neuromuscular and motor learning).2 Overweight or poorly conditioned children do seem to have an increased risk for sports-related injuries than their normal-weight peers.

Lorcaserin for Weight Loss: Insights Into US Food and Drug Administration Approval

THE PREVALENCE OF OBESITY OR OVERWEIGHT IS 69% in the United States. 1 Flegal K.M. Carroll M.D. Kit B.K. Ogden C.L. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 2012; 307: 491-497 Crossref PubMed Scopus (4072) Google Scholar Excess weight is associated with a higher risk of mortality and development of lifestyle diseases, including diabetes mellitus, 2 Gautier A. Roussel R. Ducluzeau P.H. et al. Increases in waist circumference and weight as predictors of type 2 diabetes in individuals with impaired fasting glucose: Influence of baseline BMI: Data from the DESIR study. Diabetes Care. 2010; 33: 1850-1852 Crossref PubMed Scopus (39) Google Scholar coronary artery disease, 3 Flint A.J. Hu F.B. Glynn R.J. et al. Excess weight and the risk of incident coronary heart disease among men and women. Obesity (Silver Spring). 2010; 18: 377-383 Crossref PubMed Scopus (83) Google Scholar dyslipidemia, 4 Joshi A.V. Day D. Lubowski T.J. Ambegaonkar A. Relationship between obesity and cardiovascular risk factors: Findings from a multi-state screening project in the United States. Curr Med Res Opin. 2005; 21: 1755-1761 Crossref PubMed Scopus (33) Google Scholar and hypertension. 4 Joshi A.V. Day D. Lubowski T.J. Ambegaonkar A. Relationship between obesity and cardiovascular risk factors: Findings from a multi-state screening project in the United States. Curr Med Res Opin. 2005; 21: 1755-1761 Crossref PubMed Scopus (33) Google Scholar The economic consequences of obesity are staggering, as adults with a body mass index (BMI) >30 pay 42% more in health care costs compared with their normal-weight counterparts, accounting for $147 billion annually attributed to obesity alone. 5 Finkelstein E.A. Trogdon J.G. Cohen J.W. Dietz W. Annual medical spending attributable to obesity: Payer-and service-specific estimates. Health Aff (Millwood). 2009; 28: w822-w831 Crossref PubMed Scopus (1943) Google Scholar Anti-obesity drugs have been developed to fill the therapeutic gap between lifestyle modification and bariatric surgery. However, the regulatory history of anti-obesity drugs is tainted by US Food and Drug Administration (FDA) rejections of new drug applications and market withdrawals of approved drugs due to serious adverse events. In fact, no obesity drug had been approved by the FDA since orlistat in 1999, until the recent clearance of lorcaserin hydrochloride (Belviq; Arena Pharmaceuticals). L. E. Miller is president, Miller Scientific Consulting, Inc, Arden, NC.

Infant antibiotic exposures and early-life body mass

To examine the associations of antibiotic exposures during the first 2 years of life and the development of body mass over the first 7 years of life. Longitudinal birth cohort study. A total of 11 532 children born at 2500 g in the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based study of children born in Avon, UK in 1991-1992. Exposures to antibiotics during three different early-life time windows (<6 months, 6-14 months, 15-23 months), and indices of body mass at five time points (6 weeks, 10 months, 20 months, 38 months and 7 years). Antibiotic exposure during the earliest time window (<6 months) was consistently associated with increased body mass (+0.105 and +0.083 s.d. unit, increase in weight-for-length Z-scores at 10 and 20 months, P<0.001 and P=0.001, respectively; body mass index (BMI) Z-score at 38 months +0.067 s.d. units, P=0.009; overweight OR 1.22 at 38 months, P=0.029) in multivariable, mixed-effect models controlling for known social and behavioral obesity risk factors. Exposure from 6 to 14 months showed no association with body mass, while exposure from 15 to 23 months was significantly associated with increased BMI Z-score at 7 years (+0.049 s.d. units, P=0.050). Exposures to non-antibiotic medications were not associated with body mass. Exposure to antibiotics during the first 6 months of life is associated with consistent increases in body mass from 10 to 38 months. Exposures later in infancy (6-14 months, 15-23 months) are not consistently associated with increased body mass. Although effects of early exposures are modest at the individual level, they could have substantial consequences for population health. Given the prevalence of antibiotic exposures in infants, and in light of the growing concerns about childhood obesity, further studies are needed to isolate effects and define life-course implications for body mass and cardiovascular risks.

Overweight and obese boys reduce food intake in response to a glucose drink but fail to increase intake in response to exercise of short duration

The effect of short duration exercise (EXR) on food intake (FI) and energy balance (EB) is not well understood in either normal weight (NW) or overweight (OW) and obese (OB) 9-14 years old children. Our purpose was to describe the effects of activity and a glucose drink on short term FI, appetite, and EB in NW, OW, and OB boys. Each boy received in random order either a noncaloric Sucralose sweetened control or glucose (1.0 g·kg(-1) body weight) drink 5 min after either exercise (EXR) or sedentary (SED) activity. Boys exercised for 15 min at their ventilation threshold (V(T)) in experiment 1 or at 25% above their V(T) in experiment 2. FI was measured at an ad libitum pizza meal 30 min after drink consumption. FI was lower after the glucose drink (p < 0.001) but not affected by activity, even though EXR increased appetite (p < 0.001). OW/OB boys ate more total food than NW boys (p = 0.020). EB over the duration of the experiments was reduced by EXR in OW/OB boys (p = 0.013) but not in NW boys in either experiment (p > 0.05). We conclude that intake regulation in OW/OB boys in response to a glucose drink is similar to NW boys, but it may be less responsive to activity.

Periodontitis associated with obesity although the magnitude of association unclear

Data sourcesThe search strategy included both electronic and hand searches up to December 2009. The electronic search included Ovid, MEDLINE, EMBASE, LILACS and SIGLE and looked for grey literature.Study selectionAll study designs that included measures of periodontitis and body composition were eligible for inclusion, with the exception of case studies and case series.Data extraction and synthesisData were extracted independently by two reviewers. Three meta-analyses were performed comparing obese and non-obese, overweight and non-overweight and overweight/obese combined compared with non-overweight/obese in relation to the associated odds of periodontitis.ResultsThirty-three studies were included in the systematic review. Nineteen studies provided sufficient information for inclusion in meta-analyses. Meta-analyses indicated statistically significant associations between periodontitis and body mass index (BMI) category obese OR 1.81 (1.42, 2.30), overweight OR 1.27 (1.06, 1.51) and obese and overweight combined OR 2.31 (1.40, 3.26).ConclusionsThese results support an association between BMI overweight and obesity and periodontitis, although the magnitude is unclear. There is insufficient evidence to provide clinicians with guidelines on the clinical management of periodontitis in overweight and obese patients.

Association Between Obesity/Overweight and Leukemia: A Meta-Analysis of Prospective Cohort Studies,

Abstract 3588 Introduction:Leukemia is a common hematologic malignancy for which the etiology remains largely unclear. The epidemiological data regarding the link between overweight and obesity, as defined by body mass index (BMI), and the risk of developing leukemia has revealed conflicting results. The main objective of this meta-analysis is to evaluate the potential relationship that overweight and obesity may have in the development of leukemia in adults. A secondary objective was to evaluate the risk of separate leukemia subtypes such as acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML) and chronic lymphocytic leukemia (CLL). Methods:A MEDLINE search from January 1950 to December 2010 was undertaken using: (obesity OR “body mass index” OR BMI OR overweight) AND (leukemia OR lymphoma OR myeloma). Only prospective cohort studies reporting on the incidence of leukemia were included. Retrospective case-control and cross-sectional studies were excluded. Meta-analyses were performed for leukemia in general and leukemia subtypes. The outcome was calculated as relative risk (RR). Overweight was defined as BMI 25–29.9 kg/m2 and obesity as BMI ≥30 kg/m2, according to the WHO criteria. The quality of the studies was determined by the Newcastle-Ottawa scale (NOS). The random effects model (REM) was used to calculate the combined outcome. Heterogeneity was assessed by the I2 statistic. Publication bias was assessed by the trim-and-fill analysis. Meta-regression analyses were performed to evaluate the association between BMI, as a continuous variable, and the incidence of leukemia in general as well as BMI and leukemia subtypes. Literature search, data gathering and quality assessment were performed independently by at least 2 of the investigators. All graphs and calculations were obtained using Comprehensive Meta-Analysis version 2 (Biostat, Englewood, NJ). Results:From 758 returns, 19 prospective cohort studies evaluating the association between incidence of leukemia and BMI were identified. All the studies were of high quality (NOS >7 points). When pooling all studies, the RR was 1.14 (95% CI 1.07–1.22; p<0.001). Overweight patients had a RR of 1.11 (95% CI 1.06–1.17; p<0.001), and obese patients had a RR of 1.19 (95% CI 1.09–1.31; p<0.001). Meta-regression showed linear association between BMI and leukemia (p<0.001). For AML, the overall RR was 1.24 (95% 1.10–1.41; p=0.001). Overweight patients had RR of 1.08 (95% CI 0.97–1.20; p=0.18). Obese patients had RR of 1.38 (95% CI 1.15–1.67; p=0.001; Figure). Meta-regression showed a statistically significant linear association between BMI and incidence of AML (p<0.001). For ALL, the overall RR was 1.48 (95% CI 1.20–1.80; p<0.001). Overweight patients had RR of 1.36 (95% CI 1.06–1.76; p=0.02). Obese patients had RR of 1.62 (95% CI 1.13–2.32; p=0.009). Meta-regression showed no association between BMI and incidence of ALL (p=0.25). For CML, the RR was 1.20 (95% CI 1.02–1.41; p=0.03). Overweight and obese patients had RR of 1.05 (95% CI 0.74–1.49; p=0.79) and 1.27 (95% CI 1.10–1.46; p=0.001), respectively. Meta-regression showed no association between BMI and CML (p=0.15). For CLL, the overall RR was 1.13 (95% CI 1.07–1.19; p<0.001). Overweight and obese patients had RR of 1.09 (95% CI 1.03–1.16; p=0.003) and 1.17 (95% CI 1.09–1.25; p<0.001). Meta-regression showed a trend towards a linear association between BMI and incidence of CLL (p=0.06). [Display omitted] Conclusions:Obesity, but not overweight, is associated with a mild-to-moderate increased risk of leukemia in general (19%) and for all leukemia subtypes (AML 38%, ALL 62%, CML 27% and CLL 17%). Additionally, meta-regression analyses showed a statistically significant linear association between increasing BMI and general incidence of leukemia in addition to incidence of AML. Disclosures:No relevant conflicts of interest to declare.

The Relationship Between Obesity and Lymphoma: A Meta-Analysis of Prospective Cohort Studies

Abstract 5198 Introduction:Lymphoma is a common hematologic malignancy, etiology of which remains largely unclear. Obesity and overweight have been associated with an increased risk of developing lymphoma; however, with conflicting results. The main objective of this meta-analysis is to evaluate the potential relationship that overweight and obesity may have in the development of lymphoma in adults. A secondary objective was to evaluate the risk of separate lymphoma subtypes, such as Hodgkin lymphoma (HL), and non-Hodgkin lymphoma (NHL) and the most common NHL subtypes – diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) – in overweight and obese individuals. Methods:A MEDLINE search from January 1950 to December 2010 was undertaken using: (obesity OR “body mass index” OR BMI OR overweight) AND (leukemia OR lymphoma OR myeloma). Only prospective cohort studies reporting on the incidence of lymphoma were included. Retrospective case-control and cross-sectional studies were excluded. Meta-analyses were performed for HL, NHL and NHL subtypes. The outcome was calculated as relative risk (RR). Overweight was defined as body mass index (BMI) 25–29.9 kg/m2 and obesity as BMI ≥30 kg/m2, according to the WHO criteria. The quality of the studies was determined by the Newcastle-Ottawa scale (NOS). The random effects model was used to calculate the combined outcome. Heterogeneity was assessed by the I2 statistic. Publication bias was assessed by the trim-and-fill analysis. Meta-regression analyses were performed to evaluate the association between BMI, as a continuous variable, and the incidence of HL and NHL in general and NHL subtypes. Literature search, data gathering and study quality assessment were performed independently by at least two of the investigators. All graphs and calculations were obtained using Comprehensive Meta-Analysis version 2 (Biostat, Englewood, NJ). Results:From 758 returns, 22 prospective cohort studies evaluating the association between obesity and lymphoma were identified. All the studies were of high quality (NOS >7 points). For NHL, the overall RR was 1.06 (95% CI 1.02–1.10; p=0.001). For overweight and obese patients, the RR were 1.04 (95% CI 1.01–1.07; p=0.02) and 1.11 (95% CI 1.06–1.16; p<0.001), respectively. Meta-regression showed a linear association between BMI and incidence of NHL (p<0.001). For DLBCL, the overall RR was 1.14 (95% CI 1.01–1.29; p=0.03). Overweight and obese patients had a RR of 1.08 (95% CI 0.96–1.22; p=0.22) and 1.24 (95% CI 1.08–1.44; p=0.003), respectively. Meta-regression showed a trend towards a significant association between BMI and incidence of DLBCL (p=0.1). For FL, the overall RR was 1.11 (95% CI 0.99–1.25; p=0.08). Overweight and obese patients had a RR of 1.10 (95% CI 0.94–1.28; p=0.25) and 1.15 (95% CI 0.97–1.36; p=0.11), respectively. Meta-regression showed no association between BMI and incidence of FL (p=0.78). For HL, the overall RR was 1.10 (95% CI 0.97–1.26; p=0.15). Overweight and obese patients had a RR of 0.91 (95% CI 0.80–1.03; p=0.13) and 1.23 (95% CI 1.05–1.44; p=0.009), respectively. Meta-regression showed a statistically significant linear relationship between BMI and incidence of HL (p=0.009). Conclusions:Obesity was associated with a mild increased risk of developing HL (23%), NHL in general (11%) and DLBCL (24%), but there was no association with FL. There was a statistically significant linear association between BMI and HL as well as for NHL in general, but only a trend towards an association with DLBCL. Disclosures:Castillo:GlaxoSmithKline: Research Funding; Millennium Pharmaceuticals: Research Funding.

Assessing the Impact of Body Mass Index (BMI) on the Efficacy of Proton Pump Inhibitors (PPIs) in GERD: A Review of the Literature

Purpose: To systematically examine the relationship of body mass index (BMI) and the efficacy/effectiveness of proton pump inhibitors (PPIs) in patients with gastroesophageal reflux disease (GERD). Methods: A computerized literature search conducted in the MEDLINE database (1966-present) identified English-language studies based on the following search strategy: (“Body mass index” OR BMI OR overweight OR obese OR weight) AND (“proton pump inhibitors” OR “heartburn” OR “erosive esophagitis” OR “gastroesophageal reflux disease”). Additional targeted searches (e.g., review of FDA documents, package inserts, meeting abstracts, and bibliographies) were conducted to increase search sensitivity and to identify the pivotal trials for each approved PPI in the U.S. Studies were retrieved if the abstract indicated possible information on BMI and PPIs efficacy for GERD. Results: Of 2,196 abstracts screened, 138 met the criteria for retrieval and were reviewed in full, and 15 publications/abstracts were included in this review. The studies included patients with both erosive esophagitis and non-erosive reflux disease, covered all major PPIs [ESO (n=7), RAB (5), OME (3), LAN (3), PAN (1), and DEX (2)], a range of treatment periods (48 hours - 6 months), as well as a variety of response outcomes. Eleven studies evaluated whether BMI was predictive of PPI treatment response, of which 10 were regression analyses of clinical data or observational studies and 1 did not report methodology. Of the 11 studies assessing PPI treatment response across BMI groups, 4 studies indicated increasing BMI was related to negative treatment outcomes (increased heartburn relapse rate or failure of on-demand treatment, or decreased response rate, sustained symptomatic response, and complete healing rates), 2 studies noted increased BMI was associated with positive outcomes (higher healing rates and PPI response rate) and 5 studies indicated no impact of BMI on PPI response/efficacy. Four additional studies conducted analyses comparing treatments by BMI groups. While outcomes across BMI categories were not statistically assessed in the four studies evaluating differences between treatments, data trend presented in these analyses suggest increasing BMI related to positive treatment outcomes. Conclusion: While there is a large body of evidence on the epidemiological relationship between obesity and GERD, very few studies have evaluated how treatment outcomes with PPIs may be mediated by BMI. The diversity in the study population, design, endpoints, analysis and PPI used may have contributed to the mixed nature of results. Further analyses will be conducted to evaluate this association by different PPIs. Disclosure: Dr. Mody - Employee: Takeda Pharmaceuticals International, Inc. Dr. Perez - Employee: Takeda Globa Research and Development, Inc. Drs. Stephen, Gao, and Ms Carpiuc: Contract Research Vendors for this study for Takeda Pharmaceuticals International, Inc. This research was supported by an industry grant from Takeda Pharmaceuticals International, Inc. funded this project.

P2-223 The combined effect of chewing thoroughly and eating until full on childhood overweight: results of 1999–2009 school-based survey in Japan

IntroductionThe aim of the present study was to investigate the relationship of overweight to chewing thoroughly and eating until full and to examine the combined effect of chewing thoroughly and...

P2-153 Prenatal stress following maternal bereavement during pregnancy and overweight in the offspring: a cohort study in 109 919 Danish conscripts

IntroductionIt has been suggested that prenatal stress contributes to the risk of obesity later in life. In a population-based cohort study, we examined whether prenatal stress related to maternal bereavement...

Trimester of Maternal Gestational Weight Gain and Offspring Body Weight at Birth and Age Five

To investigate associations of trimester-specific GWG with fetal birth size and BMI at age 5 years. We examined 3,015 singleton births to women without pregnancy complications from the Child Health and Development Studies prospective cohort with measured weights during pregnancy. We used multivariable regression to examine the associations between total and trimester gestational weight gain (GWG) and birth weight for gestational age and child BMI outcomes, adjusting for maternal age, race/ethnicity, education, marital status, parity, pre-pregnancy body mass index (BMI), and smoking; paternal overweight, gestational age, and infant sex. We explored differences in associations by maternal BMI and infant sex. GWG in all trimesters was significantly and independently associated with birth weight with associations stronger, though not significantly, in the second trimester. First trimester GWG was associated with child BMI outcomes (OR for child overweight = 1.05; 95% CI = 1.02, 1.09). Each kg of first trimester GWG was significantly associated with increased child BMI z-score in women of low (β = 0.099; 95% CI = 0.034, 0.163) and normal (β = 0.028; 95% CI = 0.012, 0.044), but not high pre-pregnancy BMI. GWG in all trimesters was associated with birth weight; only first trimester GWG was associated with child BMI. If replicated, this information could help specify recommendations for maternal GWG and elucidate mechanisms connecting GWG to child BMI.