Obesity Outcomes Research Articles

The relationship between obesity and patient-reported outcome measures in people with polymyalgia rheumatica.

To examine the association between obesity and patient-reported outcome measures (PROMs) in a primary care-based cohort of people with PMR. The PMR Cohort Study recruited people with incident PMR from 382 general practices. Self-completed questionnaires (0, 12, 24 months) captured a range of PROMs for pain, stiffness, anxiety, depression, fatigue, function and quality of life, alongside data on BMI. People were categorized as underweight/normal weight (BMI < 25kg/m2), overweight (25-29.99 kg/m2) or obese (≥30 kg/m2). Piecewise, multilevel, linear mixed-effects regression models examined relationships between BMI categories and PROMs over time, adjusting for confounding variables. Chi-squared tests examined the relationship between obesity and glucocorticoid persistence. 644 people with PMR were included. At baseline, 33.9% were normal/underweight, 40.6% overweight and 25.5% obese. Compared with normal/underweight people, those with obesity had significantly worse scores for the following: pain and stiffness at 12 months; fatigue at 12 and 24 months; depression at baseline; physical function at all time points; and quality of life at baseline and 12 months. They also had significantly smaller improvements in stiffness (1.13 units on an 11-point numeric rating scale; P = 0.001) and physical function (0.14 units measured using the modified Health Assessment Questionnaire; P = 0.025) between 0 and 12 months. BMI categories did not relate to persistent glucocorticoid use at 12 months (P = 0.110) or 24 months (P = 0.166). Obesity associates with poorer outcomes for a range of PROMs in people with PMR. Consideration should be given to providing weight management support to people with PMR and obesity.

Understanding the relationship between obesity and in-hospital outcomes in gastric cancer patients : A nationwide analysis.

e16050 Background: Gastric cancer is the fifth most common form of cancer and the third leading cause of cancer-related deaths worldwide. Obesity has been identified as a significant risk factor for gastric cancer, associated with increased incidence and heightened complications in hospitalized patients. Our analysis comprehensively evaluates obesity's impact on hospital-admitted gastric cancer patients. Methods: Using the National Inpatient Sample (NIS) 2020, we identified gastric cancer patients with regional and advanced metastatic disease, and they were stratified into patients with and without obesity. The primary outcome was mortality, and secondary outcomes included length of stay, the total cost of hospitalization, and other in-hospital adverse outcomes. Multivariate logistic regression analysis was used to calculate the outcomes after adjusting for confounding variables. Results: A total of 17560 patients were hospitalized with gastric cancer, among which 1720(9.8%) had the concurrent diagnosis of Obesity. The mean age of patients with and without Obesity was 63 (+/- 13.88) and 66 (+/- 12.93),p&lt;0.001 respectively. The obese category had the greater percentage of male patients as compared to females (58.14% vs 44.85% respectively, p&lt;0.001). After adjusting for confounding variables, Obesity was not considered as an independent predictor of mortality in patients with gastric cancer (OR=1.06(0.59-1.92); p=0.90). However, patients with Obesity had prolonged length of stay (+ 1.52 days(1.49-2.26); p=0.004) and total cost of hospitalization (+ $30977(12320-49633); p=0.001). Similarly, obese patients had an increased likelihood of Acute kidney injury (OR=1.47(1.09-1.96); p=0.01), ICU admission (OR=2.01(1.30-3.09); p=0.002), invasive (OR=2.14(1.29-3.54); p=0.003) Noninvasive mechanical ventilation (OR=5.36(2.17-13.14); p&lt;0.001) and Heart failure (OR=1.68(1.09-2.57); p=0.02). No difference was noted in the risk of cardiac arrest (OR=1.26(0.28-5.68); p=0.76), and sepsis(OR=1.76(0.99-3.13); p=0.05). Conclusions: Obesity in patients with gastric cancer is not an independent predictor of mortality but is associated with increased length of stay, the total cost of hospitalization, increased risk of mechanical ventilation, and ICU admissions. Management of obesity can prove crucial in averting a wide range of potential health complications and significantly enhancing the overall quality of life in gastric cancer patients. [Table: see text]

Determining Extracorporeal Membrane Oxygenation Outcomes in Obese Patients with ARDS

Extracorporeal membrane oxygenation (ECMO) is crucial for managing acute respiratory distress syndrome (ARDS) refractory to conventional therapy, but its impact on obese ARDS patients remains inadequately understood due to relative contraindications per the Extracorporeal Life Support Organization (ELSO) guidelines. This study aimed to analyze the association between obesity and ECMO outcomes in ARDS patients. Using five years of National Inpatient Sample data (2016–2020), we identified ARDS patients through ICD-10 codes, classifying those with a BMI &gt; 30 as obese. Univariate and multivariate analyses were performed to assess mortality, rates of left ventricular assist devices, and tracheostomy differences between obese and non-obese patients, with secondary outcomes examining the impact of obesity on length of stay (LOS) and total hospitalization charges (TOTCHG). Among 3,219 ARDS patients requiring ECMO, 8.2% were obese. While initial univariate analysis showed a non-significant 43% lower mortality odd in obese patients, adjusting for confounders revealed a statistically significant 46% lower odd of mortality compared to non-obese patients (adjusted odds ratio 0.54, 95% confidence interval 0.3-0.94, p 0.032). LOS and TOTCHG did not significantly differ between the two groups, nor did the rates of LVAD or tracheostomy. These findings suggest that obesity may confer a survival advantage in ARDS patients undergoing ECMO, potentially due to factors such as nutritional reserves and the obesity paradox observed in critical illnesses. Therefore, BMI alone should not preclude obese patients from ECMO treatment, emphasizing the need for further research to inform clinical decision-making in this population.

Obesity paradox in atrial fibrillation patients on oral anticoagulation therapy: a Korean nationwide cohort study

Abstract Background The obesity paradox is a phenomenon that has been observed in specific pathological conditions, wherein individuals who are overweight or obese exhibit a survival advantage over those with a normal weight. This phenomenon has also been noted in patients diagnosed with atrial fibrillation (AF), although the impact of body mass index (BMI) on clinical outcomes in AF patients undergoing oral anticoagulant (OAC) therapy remains uncertain. Purpose The aim of this study was to investigate the potential relationship between obesity and cardiovascular outcomes in patients diagnosed with AF who were receiving OAC. Methods We utilized administrative claims data from the Korean National Health Insurance Service and the combined health check-up database of the National Health Insurance Corporation to conduct a retrospective national cohort study spanning from 2013 to 2020. The patients newly prescribed OAC for AF were included, between January 2015 and December 2019. We followed up with patients from their index date until each outcome event or the end of the study period. BMI was categorized into 5 groups based on the World Health Organization's recommended criteria for Asian populations. The predefined clinical outcomes included thromboembolism, major bleeding, all-cause death, and the composite outcome. Results A total of 35,333 patients were included in the study. The mean age was 69 ± 10 years, and 37.1% were female. During a median follow-up of 2.0 years (IQR, 0.4–3.3), there were 11,634 thromboembolic events, 1,521 major bleeding events, and 2,586 deaths. The adjusted hazard ratio (HR) for thromboembolism, major bleeding, all-cause death, and a composite outcome were lower in obese II group (HR 0.79, 95% CI 0.73–0.86; HR 0.99, 95% CI 0.79–1.24; HR 0.75, 95% CI 0.62–0.91; HR 0.81, 95% CI 0.75–0.88) compared to the normal range BMI group. Conclusions In AF patients undergoing OAC therapy, individuals classified as obese exhibited a reduced risk of thromboembolism, major bleeding, all-cause mortality, and composite outcome compared to patients with normal weight.Adjusted hazard ratio of outcomes by BMI

Role of food choice motives in the socio-economic disparities in diet diversity and obesity outcomes in Kenya.

The increased prevalence of overweight and obesity, along with high diet diversity, is observed among higher socio-economic groups in Sub-Saharan Africa. One contributing factor to these observed variations is food choice motives. However, the role of these motives in explaining the observed differences has not been thoroughly explored in this context. This study investigates whether there are significant differences in food choice motives among socio-economic groups and whether these variations can partly explain the socio-economic disparities in diet diversity and overweight and obesity outcomes. This study utilizes cross-sectional data from four counties in Kenya: Kiambu, Murang'a, Uasin Gishu, and Nakuru. The survey employed a three-stage cluster sample design to gather data using structured questionnaires on food choice motives, diet diversity, and anthropometrics from 381 adults in 2022. The mediating effects of 8 food choice motives (health, mood, convenience, sensory appeal, natural content, price, weight control, and familiarity) were analyzed using the Karlson-Holm-Breen method. The results show that individuals with higher household incomes place greater importance on health, mood, sensory, and weight concerns. The probability of an overweight and obesity outcome increases by 19% for a standard deviation change in the asset score, and by 8% for a standard deviation change in the years of schooling. Sensory motives significantly mediated these relationships. Sensory motives explained 29% of the income-BMI association and 30% of the education-BMI relationship. Higher education was also associated with increased diet diversity (β = 0.36, P < 0.001) mediated by higher health and sensory concerns. The findings suggest significant differences in food choice motives among socio-economic groups, which contribute to outcomes such as overweight and obesity. Therefore, educational and other policies aimed at reducing obesity should also address food choice motives, while considering the disparities among socio-economic segments within populations.

First study with positive cardiovascular outcome in obesity: Reflections on SELECT.

First study with positive cardiovascular outcome in obesity: Reflections on SELECT.

Frequency of Obesity, Associated Factors and Fetomaternal Outcome in Women Coming for Antenatal Care at Lady Willingdon Hospital, Lahore

Background: Obesity is now taking the shape of an epidemic worldwide and is on the rise among women of reproductive age especially over the last 40 years. This happening has a major bearing on reproductive outcomes as per latest studies. During pregnancy and childbirth, obese women are more likely to develop fetomaternal complications than women with a normal body mass index (BMI). Objective: To determine the prevalence of normal weight, over weight and obese women among those presenting for antenatal care and to compare the fetomaternal outcome in different BMI categories. Patients and Methods Descriptive cross sectional study conducted from 29 October 2022 to 29 April 2023 at Lady Willingdon Hospital, Lahore. 200 subjects meeting the inclusion criteria were enrolled in the study after informed consent. BMI was recorded and weight category assigned. All relevant details noted on especially designed performa. Data analysis was done using SPSS No. 24. Results: Prevalence of obesity in pregnant females was recorded as 25.5 %( n=51) and overweight women as 40.5 %( 81). A total of 200 females with an overall mean age of 29.9 ± 3.5 years were included in this study. The mean body mass index was 27.5 ± 3.9. The proportion of preeclampsia was significantly (p-value &lt; 0.05) higher in obese women (31.9%) followed by overweight (22.2%) and normal women (15.6%), respectively. Likewise, the rate of eclampsia (22.8%, 13.6% and 8.3%), gestational diabetes (28.6%, 18.5, and 9.7%) and hypertension (27.7%, 16.1% and 11.4%) was also significantly higher in obese women followed by overweight women and normal weight women. In addition, a significant (p-value &lt; 0.05) greater rate of C-section (41.5% vs. 35.8% vs. 14.4%) was reported in obese weight groups as compared to overweight versus normal weight women .The mean birth weight of new born was significantly higher in obese women as compared to overweight and normal weight women. Six (11.8%) babies born to obese women were macrosomic and only (1.3% and 1.5%) babies had macrosomia in overweight and normal weight women. APGAR score at 1 minute and 5 minute was significantly higher in normal weight women followed by overweight and obese women. The requirement of admission to NICU was statistically significantly higher in obese women (55.4%) followed by overweight (45.7%) and normal weight women (28.3%).Conclusion: Fetomaternal morbidity is significantly increased in obese and overweight pregnant females. Keywords: Pregnancy, obese, over-weight, prevalence, fetomaternal, outcome.

Abstract PO5-28-01: Dynamics of Adipocyte Progenitors in the Mammary Gland during Obesity

Abstract Being overweight or obese is associated with a higher risk of breast cancer (BC) and worse disease-free and overall survival compared to normal-weight BC patients. The underlying biological basis for this association is attributed to alterations in the endocrine and inflammatory milieu of adipose tissue. However, existing chemotherapy and endocrine therapy are not effective in obese BC patients. There is a critical need to pin down adipose tissue cell types that may govern increased BC risk and adverse outcome in obesity. Adipocyte progenitors are immature mesenchymal cells in adipose tissue that have adipocyte differentiation potential and reported to be dysfunctional in obesity. In previous research, we first reported mammary adipocyte progenitors (MAPs) expressing Platelet-Derived Growth Factor Receptor alpha (PDGFRα) in the stromal microenvironment that transition into epithelial lineages during expansion of the murine mammary epithelium. The contribution of MAPs to shaping a pro-tumorigenic mammary tissue milieu in obesity is not known. Here, using diet-induced obesity MAP reporter and lineage tracing mouse models combined with single-cell RNA sequencing, we reveal elevated PDGFRα+ MAPs in the local mammary stroma in obesity. MAPs in the obese mammary gland manifest alterations in proliferation, cell state and molecular mechanisms, generating an inflammatory, cancer-prone tissue microenvironment. Our findings uncover the MAP lineage as a key contributor to forging an aberrant mammary gland in obesity, providing insight into the potential utility of targeting this cell population for eradicating BC risk related to augmented adiposity. Citation Format: Sharon Kwende, Prashant Nuthalapati, Dun Ning, Jacqulene Sunder Singh, Purna Joshi. Dynamics of Adipocyte Progenitors in the Mammary Gland during Obesity [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-28-01.

Obesity and Penetrating Trauma: Outcomes from a Level 1 Trauma Center in New York City.

Obesity is associated with increased morbidity and mortality in trauma scenarios; however, there has been conflicting evidence on outcomes of obesity and penetrating injuries, specifically gunshot wounds and stab wounds. We hypothesized that obesity may be protective due to a "cushioning effect" attributed to increased adiposity. This was a retrospective cohort study of patients presenting to a Level 1 Trauma Center with a penetrating trauma (gunshot/stab) injury during 2008-2021. Patients with a BMI ≥ 30 were compared to those with a BMI < 30. The primary outcome was Injury Severity Score (ISS). Secondary outcomes included intensive care unit (ICU) length of stay, days on ventilation, length of hospital stay, service of admission (trauma surgery, general surgery, discharged home, general medical floor), the body region of injury(s), Abbreviated Injury Scale (AIS), OR requirement, type of surgery, and discharge status. Statistical analysis was performed using χ2-test or Fisher's exact tests for categorical data, and Student's t-test or Mann-Whitney U-test for continuous variables with p < 0.05 as statistically significant. Subgroup analysis was performed based on the mechanism of injury. There were 721 patients that met inclusion criteria, of which 540 were classified in the non-obese group and 181 (25.1%) in the obese group. The primary outcome, mean ISS score, in obese patients (9.0, SD = 13.0) and non-obese patients (9.4, SD = 13.8) was similar between groups respectively. Secondary outcomes, which included rates of severe abdominal injury (AIS ≥ 3), rates of intra-abdominal organ injury, and rates of gastro-intestinal resection, were also similar between non-obese and obese patients. This study did not demonstrate the existence of a "cushioning effect" in the setting of penetrating traumatic injury. Patients with increased BMI had similar a ISS score and patterns of injury as their non-obese counterparts.

Obesity, Inflammation, and Clinical Outcomes in COVID-19: A Multicenter Prospective Cohort Study.

Obesity is a risk factor for coronavirus disease 2019 (COVID-19)-related outcomes; however, the mechanism remains unclear. The objective of this analysis was to determine whether inflammation mediates the association between obesity and COVID-19 outcomes. The International Study of Inflammation in Covid-19 (ISIC): A Prospective Multi-Center Observational Study Examining the Role of Biomarkers of Inflammation in Predicting Covid-19 Related Outcomes in Hospitalized Patients. Ten hospitals in the United States and Europe. Adults hospitalized specifically for COVID-19 between February 1, 2020, through October 19, 2022. Inflammatory biomarkers, including soluble urokinase plasminogen activator receptor (suPAR), were measured at admission. Associations were examined between body-mass index (BMI, kg/m2) and a composite of death, need for mechanical ventilation, and renal replacement therapy, stratified by pre- and post-Omicron variants. The contribution of inflammation to the relationship between obesity and outcomes was assessed. Among 4644 participants (mean age 59.3, 45.6% male, 21.8% BMI≥35), those with BMI>40 (n=485) had 55% higher odds of the composite outcome (95% CI[1.21 to 1.98]) compared to non-obese individuals (BMI<30, n=2358) in multivariable analysis. In multiple mediation analysis, only suPAR remained a significant mediator between BMI and composite outcome. Associations were amplified for participants younger than 65 years and with pre-Omicron variants. Obesity is associated with worse outcomes in COVID-19, notably in younger participants and in the pre-Omicron era. Inflammation, as measured by suPAR, is a significant mediator of the association between obesity and COVID-19 outcomes.

Evaluating the potential mediating role of ADAMTS13 activity in the relationship between obesity and the severity of COVID-19: A retrospective cohort study.

Obesity and low enzyme A disintegrin and metalloproteinase with thrombospondin type-1 motif-13 (ADAMTS13) activity have been linked to poor coronavirus disease 2019 (COVID-19). Given that obesity may influence ADAMTS13 activity, it is feasible; however, it remains unclear whether ADAMTS13 activity acts as a mediator between obesity and COVID-19 outcomes. We investigated the link between body mass index (BMI) and COVID-19 outcomes, using ADAMTS13 activity as a mediator. ADAMTS13 activity was measured in 86 hospitalized COVID-19 patients. BMI, ADAMTS13 activity, and COVID-19 outcomes were assessed. Obese patients had a high odds ratio for low ADAMTS13 levels. When different levels of ADAMTS13 activity were considered, the severity of COVID-19 in obese patients was 4.5 times that in the normal BMI group. Furthermore, increased coagulopathy indicators correlated with low ADAMTS13 activity. Patients with elevated ALT and AST levels showed a 3 to 4-fold increase in the chances of low ADAMTS13 activity (OR:3.19, 95% CI:1.22-8.90, P = .021; OR:2.17, 95% CI:0.91-5.27, P = .082, respectively). When ADAMTS13 activity was considered, obese patients had greater COVID-19 severity and slower viral clearance than those with normal BMI. Low ADAMTS13 activity and impaired liver function are associated with poor COVID-19 outcomes. These findings encourage researchers to use molecular component identification to study the effects of obesity on the von Willebrand factor (VWF)/ADAMTS13 axis, COVID-19 pathogenesis, and outcomes.

Pre-pregnancy maternal obesity and infant neurodevelopmental outcomes in Latino infants.

This study explores the impact of maternal pre-pregnancy BMI on infant neurodevelopment at 24 months in low-income Latino families. It also investigates whether infant diet mediates this relationship. Latino mother-infant pairs (n = 163) were enrolled at 1 month post partum and were followed for 2 years, with assessments at 6-month intervals. Maternal pre-pregnancy anthropometrics were self-reported at baseline, and child neurodevelopment was assessed at 24 months using the Bayley Scales of Infant Development. Diet quality of infants was measured using the Healthy Eating Index (HEI)-2015 and HEI-Toddlers-2020 scores at multiple time points. Mediation and regression models that adjust for maternal factors were used to examine the associations. Pre-pregnancy BMI showed significant negative associations with child cognitive scores (β = -0.1, 95% CI: -0.2 to -0.06, p < 0.001) and language scores (β = -0.1, 95% CI: -0.2 to -0.03, p = 0.01) at 24 months. Infant HEI-2015 scores at 24 months partly mediated these associations, explaining 23% and 30% of the total effect on cognitive and language subscales, respectively. No specific dietary components in infants mediated the relationship, except for the total HEI-2015 score. Managing maternal obesity pre-pregnancy is crucial for improving infant neurodevelopmental outcomes, especially in low-income Latino families. Promoting healthy weight and enhancing infant diet quality can enhance neurodevelopment in these populations.

Abstract SY38-01: Diverse effects of obesity on cancer immunology and therapy: Both the good and the bad

Abstract Obesity (BMI of 30 or higher) has reached pandemic proportions in the US and continues to rise. Obesity is associated with increased cancer incidence, progression, and mortality. Obesity is also associated with a meta-inflammation as well as general immune suppression. However, we and others have observed in both preclinical models involving diet-induced obese (DIO) mice as well as clinical cancer outcomes, that obesity can be associated with increased efficacy and T cell responses following immune checkpoint inhibition (ICI) targeting PD-1/PDL-1 (Wang Z et al, Nat Med 2019). This protective effect in preclinical models occurred despite marked increased tumor growth and progression in DIO mice. The results indicated that an “obesity paradox” existed regarding some cancer immune therapies. However, this increased efficacy did not apply to all immune therapy responses as we have also observed that following strong systemic immunostimulatory regimens such as with high dose cytokines (IL2) or following an allogeneic hematopoietic stem cell transplant (HSCT), that obesity was correlated with poorer outcomes due to increased cytokine release syndrome (CRS) due to macrophage dysregulation, reduction in gut microbiome diversity, and increased gut permeability, in both preclinical models and clinical outcomes (Khuat LT et al, Sci Trans Med 2020). These results indicated that a balance exists between the positive and negative effects of obesity which could be contingent on the particular type of cancer immunotherapy applied. With ICI, obesity is beneficial, but strong systemic immunostimulatory therapies can result in heightened proinflammatory responses and pathologies. It has also been reported that sex differences regarding the obesity paradox may also occur with high BMI males demonstrating increased anti-tumor efficacy (McQuade JL et al, Lancet Oncol 2018). The physiology of obesity regarding adiposity deposition and metabolic perturbations are also affected by sex hormones and obesity can also have marked effects on both androgen and estrogen production. We therefore assessed the role of sex on different cancer immunotherapy outcomes in obesity. Following systemic cytokine application or after allogeneic HSCT, no differences were observed between male and female DIO mice regarding the increased toxicities due to CRS. In marked contrast, following ICI targeting PD-1, increased anti-tumor effects were only observed in male and not female DIO mice. This was associated with immune differences in which female DIO mice had higher myeloid derived suppressor cells (MDSCs) and decreased T cell responses. However, when female mice were ovariectomized before placed on diet, application of ICI now resulted in increased anti-tumor efficacy comparable to DIO males. Importantly, metabolomics indicated that key metabolite changes could be correlated with the return of responsiveness. Similarly, clinical outcomes stratified on both sex and BMI also demonstrated the increased efficacy following ICI in high BMI males. These results demonstrate that sex-linked differences exist regarding the effects obesity has on cancer immunotherapy outcome following ICI but not other types of immune therapies. Further, these sex-based differences in obesity can be correlated with immunological alterations, and these can be reversed by estrogen inhibition suggesting that hormone modulation may offer immunological benefits in the context of obesity following cancer immunotherapy involving ICI. Citation Format: William J. Murphy, Logan Vick, Robert Canter, Spencer Rosario, Arta Monjazeb. Diverse effects of obesity on cancer immunology and therapy: Both the good and the bad [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr SY38-01.

Unicompartmental knee arthroplasty in obese patients, poorer survivorship at 15 years

IntroductionThe preclusion of obese patients from unicompartmental knee arthroplasty (UKA) has increasingly been challenged. This study aimed to evaluate the impact of Body Mass Index (BMI) on UKA at 15-year follow-up. Materials and methods169 unilateral UKA patients from 2003 to 2007 were followed-up prospectively for at least 15 years. 70 patients were left for analysis after accounting for patient demise, revision surgery and loss to follow-up. 48 of these patients (69%) were in the Control group (BMI <30 kg/m2) and 22 (31%) were in the Obese group (BMI ≥30 kg/m2). Patients were assessed before and after operation using the Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS), Oxford Knee Score (OKS), and Physical (PCS) and Mental (MCS) component of the Short Form 12. Survivorship analysis was also performed. ResultsObese patients went through UKA at an earlier age than the non-obese patients (54.7 ± 4.7 years compared to 59.9 ± 7.8 years, p = 0.005). At 2, 10, and 15-year follow-up, both groups achieved clinically significant improvements in outcomes. There was no significant association found between obesity and outcome using multiple linear regression. While propensity matching found PCS improvement at 2 years to be greater in obese patients, no significant association between obesity and 15-year outcome was found. All 13 patients who required revision, underwent total knee arthroplasty (TKA). The overall 15-year survivorship was 74.2% within the obese group and 92.4% within the control group. ConclusionCompared to non-obese patients, obese patients had poorer 15-year survivorship with greater odds of requiring revision surgery. However, assuming implant survival, obese patients can expect a non-inferior outcome relative to their non-obese counterparts in all patient reported outcome measures 15 years after surgery.

Association between protein intake, diet quality, and obesity in Australian adults: A comparison of measurement units

The role of protein in decreasing the risk of cardiometabolic diseases has been proposed, yet the findings are inconsistent, possibly due to how protein intake was expressed(1). This study aimed to examine how different ways of expressing protein intake may influence its relationships with diet quality and obesity. This study used data from the Australian National Nutrition and Physical Activity Survey (NNPAS) 2011-12, focusing on adults aged ≥19 years, excluding those who were pregnant or lactating, and had both anthropometric and dietary data (n = 7637). Total protein intake was assessed by up to two 24-hour dietary recalls and reported in two measurement units, namely g/day and % of energy intake. Usual protein (g) and energy intakes (kJ) were modelled using the Multiple Source Method(2). Diet quality was assessed using the Dietary Guidelines Index (DGI)(3). Body mass index (BMI) and waist circumference were used as measures of obesity. Multiple linear regressions were performed stratified by sex, and adjusting for age, country of birth, Socio-economic Indexes for Areas, physical activity level, energy misreporting, usual energy intake (for diet quality), and non-protein energy intake (for obesity). Positive associations between protein intake and diet quality were confirmed across measurement units. Protein intake expressed in % of energy intake (β-coefficient: men = 0.97; women = 1.21, p&lt;0.001) had a higher β-coefficient than those reported in g/day (β-coefficient: men = 0.19; women = 0.30, p&lt;0.001). Linear regression models showed a positive association between protein intake and BMI for men and women, either expressed in g/day (β-coefficient: men = 0.02, p&lt;0.001; women = 0.03, p = 0.001) or % of energy intake (β-coefficient: men = 0.14, p&lt;0.001; women = 0.12, p = 0.002). The relationship between protein intake expressed in g/day and waist circumference was also statistically significant (β-coefficient: men = 0.04, p = 0.004; women = 0.05, p = 0.035). However, protein intake expressed as % of energy intake was correlated with waist circumference for men only (β-coefficient: men = 0.26, p = 0.001; women = 0.19, p = 0.075). The consistent findings across measurement units suggested that the unit of g/day and % of energy intake can be used for examining associations between protein intake and diet quality. However, associations between protein intake and measures of obesity varied between protein units and sex. These findings suggest that the selection of protein measurement units in relation to obesity outcomes might need to consider the characteristics of study population (e.g., sex, energy intake). Overall, the outcomes of this study suggest that how protein is expressed may impact the associations between protein intake, diet quality, and obesity, and therefore require further considerations when examining the role of protein in cardiometabolic health.

Effect of Maternal Obesity on Pregnancy Outcomes and Metabolic Consequences

Background: Maternal obesity has emerged as a critical public health issue with profound implications for both maternal and neonatal health. The increasing prevalence of obesity among women of reproductive age underscores the urgency of examining its impact on pregnancy outcomes and the metabolic health of offspring. Previous studies have identified associations between maternal obesity and adverse pregnancy outcomes, including gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), and cesarean delivery, as well as long-term metabolic disturbances in offspring. Objective: This study aimed to investigate the effects of maternal obesity on pregnancy outcomes and to elucidate the potential metabolic consequences for offspring, contributing to the understanding of intergenerational transmission of metabolic risk. Methods: Conducted at the Gyne B Unit of Hayatabad Medical Complex, Peshawar, this retrospective cohort study included 6,910 obstetric admissions from January to December of the previous year. Pregnant women aged 18-45 years with singleton pregnancies were included, excluding those with pre-existing medical conditions. BMI was calculated from self-reported pre-pregnancy weight and height. Outcomes analyzed included GDM, HDP, mode of delivery, macrosomia, neonatal hypoglycemia, stillbirth, and neonatal mortality. Data analysis utilized SPSS version 25, employing descriptive statistics, chi-square tests, t-tests or Mann-Whitney U tests, and multivariable logistic regression models. Results: Among the participants, 55.7% were of normal weight, 20.6% overweight, and 18.4% obese. Obese pregnant women demonstrated significantly higher rates of GDM (8.6% vs. 23.7%, p=0.001), HDP (18.3% vs. 6.4%, p=0.011), and cesarean delivery (55.7% vs. 30.1%, p=0.003) compared to their normal-weight counterparts. Offspring of obese mothers had a higher incidence of fetal macrosomia (10.2% vs. 5.4%, p=0.001) and neonatal hypoglycemia (10.4% vs. 6%, p&lt;0.001). Conclusion: The study confirms the significant association between maternal obesity and adverse pregnancy outcomes, including increased risks of GDM, HDP, and cesarean delivery. Furthermore, offspring of obese mothers are at an elevated risk of metabolic disturbances, indicating the necessity of addressing maternal obesity to improve health outcomes for both mothers and their children.

Impact of obesity on outcomes of extracorporeal membrane oxygenation support: a systematic review and meta-analysis

BackgroundExtracorporeal membrane oxygenation (ECMO) is used when standard methods of standard treatment methods are not successful. Obese patients present unique challenges during ECMO due to large body size hindering sufficient flows, difficulties with patient positioning and anatomical landmark identification, and restricted radiology scans. This meta-analysis aims to investigate the impact of obesity on the outcomes of patients undergoing ECMO.MethodsDatabases (PubMed, Embase, and Scopus databases) were searched to identify relevant studies published until July 2023. Data were reported as odds ratios (OR) with 95% confidence interval (CI), and the descriptive data were reported as standard difference of means (SDM) by a random effects model.ResultsA literature search identified 345 studies. Of them, 18 studies met the inclusion criteria. The findings from the meta-analysis revealed no significant association between obesity and survival outcomes after ECMO (odds ratio (OR): 0.91, 95% confidence interval (CI): 0.70–1.17, p: 0.46). Moreover, no comparative significant differences were found between obese and non-obese individuals on the duration of ECMO procedure (standardized mean difference (SMD): 0.07, -0.03–0.17), length of hospital stay (-0.03, -0.19 to 0.12), and duration of ventilation support (-0.10, -0.44 to 0.24).ConclusionThe meta-analysis findings suggest no significant impact of obesity on the survival outcomes after the ECMO procedure. There was no significant impact of obesity on the duration of ECMO procedures, length of hospital stay, and duration of ventilation support.

Obesity and Extracorporeal Membrane Oxygenation.

Obesity is increasing in prevalence worldwide and carries a theoretical increased risk of morbidity and mortality in critical illness, including hypercoagulability, thrombosis, and renal dysfunction. Obesity has historically been considered a relative contraindication to candidacy for extracorporeal membrane oxygenation (ECMO); however, recent research has suggested that obesity may be associated with improved outcomes in ECMO. This review was conducted to assess and synthesize the existing literature on ECMO outcomes in the obese population. We searched PubMed, Scopus, and CENTRAL databases for obesity and ECMO outcomes, and articles were screened independently by 2 authors. The selection process yielded 29 articles, with one ambispective and 28 retrospective cohort studies. Analyses of these studies show no evidence of globally increased mortality or complications in obesity. Prospective evaluation is needed to further investigate this relationship, but there is currently no evidence to support using body mass index as exclusionary criteria for ECMO.

Effects of Bariatric Surgery on Sarcopenic Obesity Outcomes: A One-Year Prospective Study in Middle-Aged Women.

Sarcopenic obesity (SO) is characterised by the confluence of muscle deterioration and high adiposity. When non-surgical interventions prove insufficient, bariatric surgery (BS) becomes the primary approach. This study aimed to address BS effects on SO outcomes 1 year post-surgery among middle-aged women, also considering physical exercise's impact. Prospective single-centre study of 140 patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy between November 2019 and December 2022. Participants were categorised into tertiles according to SO's diagnosis and severity (group 1-patients with the most severe SO; group 2-intermediate; group 3-the least severe or without SO), calculated considering the consensus issued by ESPEN and EASO in 2022. Evaluations of clinical and biochemical parameters were conducted before and 12 months after BS, and the variation was used for comparative purposes. Body composition was assessed using bone density scans. Linear regression analysis accounted for both surgery type and baseline body mass index (BMI). Before BS, SO prevalence in the overall sample was 89.3%, decreasing to 2.9% after BS. Group 1 had more body fat mass (56.9 vs 54.8 vs 50.7 kg, p < 0.001), total, trunk and leg fat at baseline and a significantly lower total skeletal muscle mass (47.2 vs 49.4 vs 51.8 kg, p < 0.001). One year post-BS, group 1 presented more weight loss (- 39.8 ± 11.4 kg, p = 0.031), BMI reduction (- 15.9 ± 4.6 kg/m2, p = 0.005) and lost more fat mass (- 32.6 vs - 30.5 vs - 27.9 kg, p = 0.005), but not total skeletal muscle mass (- 5.8 vs - 5.9 vs - 6.8 kg, p = 0.130). Remission rates for comorbidities were substantial among all groups, but more marked among patients within group 1 (type 2 diabetes mellitus 75%, hypertension 47.1% and dyslipidemia 52.8%). Engagement in physical exercise of any kind has increased post-BS (33.1% vs 79.1%). Despite concerns about malabsorptive mechanisms potentially worsening muscle loss, patients with the most severe SO undergoing BS lost more fat mass while experiencing the smallest reduction in total skeletal muscle mass. Remission rates for comorbidities following BS were notable among all groups.

Abstract 3846: The obesity paradox in immune checkpoint blockade: A pan-tumor analysis

Abstract Background: Chronic systemic inflammation mediated by pro-inflammatory cytokines serves as a major mechanism by which obesity contributes to cancer development. Paradoxically, elevated body mass (BMI) has been associated with improved outcomes after treatment with immune checkpoint inhibitors (ICIs) in many tumor types. The interplay between cytokine response and obesity after ICIs is poorly understood. To characterize underlying mechanisms, we investigated cytokine profiles in relation to obesity and clinical outcomes in patients treated with ICIs. Methods: From June 2021 to October 2022, we enrolled and collected blood samples from patients with advanced or metastatic solid tumors who received ICIs as standard of care at Johns Hopkins. We calculated BMI using height and weight at treatment initiation, with BMI ≥30 obese and BMI &amp;lt;30 non-obese. Underweight patients (BMI &amp;lt;18.5) were excluded. The Bioplex 200 platform (Biorad, Hercules CA) was used to determine the plasma concentration of 37 cytokines at baseline and on-treatment, with the median cytokine value used to differentiate between high and low concentration. Results: Among 94 patients, 29 (31%) were obese and 65 (69%) were non-obese, with a significant difference in sex (Fisher’s exact test, p = 0.02), but no observed difference in age, race, cancer type, autoimmune disease, or presence of immune-related adverse events (irAE) based on BMI category; all the following hazard ratios (HR) are therefore adjusted for sex. Obese patients had improved progression free survival (PFS) (HR 0.41 [95% CI: 0.21-0.80], p=0.01) and overall survival (OS) (HR 0.16 [95% CI: 0.04-0.69], p=0.01). Eighty-six patients had cytokine data at baseline (range: eight days prior to day of initiation). Baseline IL-15 was significantly lower in obese patients (1.71 vs. 2.08, p=0.04), however, there was no difference in PFS (HR 1.49 [95% CI: 0.87-2.56], p=0.15) or OS (HR 1.22 [95% CI: 0.51-2.97], p=0.65) comparing low vs. high baseline IL-15. Eighty-two patients had cytokine data on-treatment (range: 21-349 days after initiation), with significantly lower levels of IL-6 (2.49 vs. 3.45, p=0.04), IL-8 (2.01 vs. 2.92, p=0.01), and IL-15 (1.70 vs. 1.81, p=0.01) in obese vs. non-obese patients, respectively. Low on-treatment IL-8 was associated with improved PFS (HR 0.52 [95% CI: 0.29-0.92], p=0.02) and OS (HR 0.17 [95% CI: 0.05-0.58], p&amp;lt;0.01), and low on-treatment IL-6 was associated with improved OS (0.25 [95% CI: 0.08-0.76], p=0.01). Conclusions: In a diverse, pan-tumor ICI cohort, we observed a positive relationship between obesity and clinical outcomes with ICIs, with no correlation between obesity and irAEs. We also observed lower on-treatment levels of IL-6 and IL-8 in patients with obesity and that low on-treatment levels of IL-6 and IL-8 correlated with improved survival, suggesting that IL-6 and IL-8 may serve as mediating factors for improved outcomes in obese patients treated with ICIs. Citation Format: Stephanie Leigh Alden, Soren Charmsaz, Madelena Brancati, Howard L. Li, Aanika Warner, Kabeer Munjal, Kathryn Howe, Sarah Mitchell, Ervin Griffin, Mari Nakazawa, Hua-Ling Tsai, Ludmila Danilova, Chris Thoburn, Jennifer Gizzi, Alexei Hernandez, Nicole E. Gross, Erin M. Coyne, Sarah M. Shin, Jennifer Durham, Maximilian F. Konig, Brian J. Christmas, Evan J. Lipson, Jarushka Naidoo, Laura C. Cappelli, Aliyah Pabani, Yasser Ged, Marina Baretti, Julie R. Brahmer, Jean Hoffman-Censits, Tanguy Y. Seiwert, Sanjay Bansal, Laura Tang, Elizabeth Jaffee, G Scott Chandler, Rajat Mohindra, Won Jin Ho, Mark Yarchoan, Chester Kao. The obesity paradox in immune checkpoint blockade: A pan-tumor analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3846.