Overweight Body Mass Index Categories Research Articles

Long-term weight patterns and physical activity in gallstones

While obesity, rapid weight loss, and sedentary lifestyles contribute to gallstones, the impacts of long-term weight patterns and physical activity on gallstone risk have not been extensively studied at the population level. Using Korea’s population-based health database, we created a cohort of 5,062,154 subjects who received over five consecutive biannual health check-ups from 2002 to 2018. Gallstone risk was calculated using hazard ratios (HRs) based on weight patterns (gain, loss, and cycling) and physical activity. Adjustments were made for covariates, such as body mass index (BMI), waist circumference, diabetes, and life style factors. Subgroup analysis was performed by sex and age groups (< 45 and ≥ 45 years). All groups with weight changes showed increased HRs 1.32 (95% CI 1.07–1.65) for > 20% weight loss, 1.13 (0.96–1.33) for > 20% weight gain, 1.04 (1.02–1.06) for weight cycling, 1.03 (1.01–1.05) for 5–20% weight gain, and 1.02 (1.00–1.04) for 5–20% weight loss. Risk increased with weight loss or gain in underweight or overweight BMI categories, respectively, and in any weight change for normal BMI. Males and older individuals had higher risks with weight loss, while females and younger individuals had higher risks with weight gain. Weight cycling increased risk for both sexes. Regular physical activity reduced gallstone risk in weight changers to levels similar to weight maintainers, with the highest reduction in those with > 20% weight gain (61%) and the lowest in weight cycling (1%). The risks of gallstones associated with weight gain, loss, or cycling can be mitigated by regular physical activity. The risks vary by sex and age.

7833 Gestational Diabetes Mellitus (GDM): A Weighted Spectrum of Clinical Outcomes

Abstract Disclosure: M. Moazzami: None. N. Venkatesan: None. K.S. Rajagopalan: None. A.V. Vella: None. A. Egan: None. Gestational diabetes mellitus (GDM) affects approximately 10% of pregnancies, with rates almost doubling in minority subgroups. Higher body mass index (BMI) is a significant GDM risk factor, and BMI ≥ 25kg/m2 is often used as a criterion in risk factor-based screening programs. However, up to 60% of individuals with GDM have a normal BMI, and it is unclear if this offers protection against associated adverse outcomes. Furthermore, many prior studies fail to address the fact that those of Asian descent require a lower BMI cut-off, given their different distribution of body fat. Our study evaluated GDM pregnancy outcomes using BMI as a risk indicator. We compared individuals with BMIs &amp;lt; 25 kg/m2, 25-30 kg/m2, and &amp;gt; 30 kg/m2. For individuals that self-identified as Asian, we adjusted BMI categories: &amp;lt;23 kg/m2 for normal weight, 23-30 kg/m2 for overweight, and &amp;gt;30 kg/m2 for obese. We identified 2212 subjects diagnosed with GDM via universal screening and Carpenter and Coustan criteria at our institution from 2018 - 22. In total, 508 (23.0%) were normal weight, 611 (27.6%) overweight, and 1093 (49.4%) obese. The average maternal age was 31 years. Higher proportions identified as Hispanic and non-White race in overweight and obese categories. Maternal adverse outcomes were higher in obese compared to overweight or normal BMI categories (cesarian delivery: normal 26.7 v overweight 28.3 v obese 22.7%, p&amp;lt;0.001; hypertensive disorders: normal 13.2 v overweight 12.5 v obese 22.7%, p &amp;lt;0.001). Pharmacological therapy was required in 50% with obesity versus 24.8% in normal, and 28.7% in overweight categories (p&amp;lt;0.001). While there were no differences in live birth rates across categories, infants born to mothers with obesity had a higher birthweight (normal 3.30 v overweight 3.38 v obese 3.45kg, p&amp;lt;0.001) and were more likely to have neonatal hypoglycemia (normal 28.7 v overweight 25.5 v obese 43.8%, p&amp;lt;0.001) and require intensive care unit admission (normal 8.4 v overweight 5.5 v obese 12.7%, p&amp;lt;0.001). Attendance at postpartum glucose testing varied across BMI categories with lower attendance in mothers with obesity followed by normal weight BMI (normal 40.75 v overweight 45.99 v obese 36.2%, p&amp;lt;0.001). Compared to overweight individuals, those with normal weight exhibited higher rates of postpartum glucose intolerance (12.4 v 6.9%, p =0.002). However, those with obesity had the highest rates of glucose intolerance (20.7%, p&amp;lt;0.0002). Individuals with normal weight had the highest rates of breastfeeding (normal 95.9 v overweight 92.8 v obese 91.4% p=0.006). This study highlights the nuanced relationship between BMI and pregnancy outcomes in GDM. While maternal obesity was associated with the poorest outcomes, those with normal BMI were not protected compared to overweight individuals, and experience higher rates of postpartum glucose intolerance. Presentation: 6/2/2024

Association of Body Composition Changes with the Development of Diabetes Mellitus: A Nation-Wide Population Study.

We investigated the association between body composition changes and new-onset diabetes mellitus (DM) development according to the body mass index (BMI) in a longitudinal setting in the general Korean population. From 2010 to 2011 (1st) and 2012 to 2013 (2nd), we included 1,607,508 stratified random sample participants without DM from the National Health Insurance Service-Health Screening dataset of Korean. The predicted appendicular skeletal muscle mass index (pASMMI), body fat mass index (pBFMI), and lean body mass index (pLBMI) were calculated using pre-validated anthropometric prediction equations. A prediction equation was constructed by combining age, weight, height, waist circumference, serum creatinine levels, alcohol consumption status, physical activity, and smoking history as variables affecting body composition. Decreased pASMMI (men: hazard ratio [HR], 0.866; 95% confidence interval [CI], 0.830 to 0.903; P<0.001; women: HR, 0.748; 95% CI, 0.635 to 0.881; P<0.001), decreased pLBMI (men: HR, 0.931; 95% CI, 0.912 to 0.952; P<0.001; women: HR, 0.906; 95% CI, 0.856 to 0.959; P=0.007), and increased pBFMI (men: HR, 1.073; 95% CI, 1.050 to 1.096; P<0.001; women: HR, 1.114; 95% CI, 1.047 to 1.186; P=0.007) correlated with the development of new-onset DM. Notably, only in the overweight and obese BMI categories, decreases in pASMMI and pLBMI and increases in pBFMI associated with new-onset DM, regardless of gender. Decreased pASMMI and pLBMI, and increased pBFMI with excess fat accumulation may enhance the risk of newonset DM. Therefore, appropriate changes in body composition can help prevent new-onset DM.

Effect of body mass index on exercise capacity following pediatric heart transplantation.

Obesity and impaired exercise tolerance following heart transplantation increase the risk of post-transplant morbidity and mortality. The aim of this study was to evaluate the effect of body mass index on markers of exercise capacity in pediatric heart transplant recipients and compare this effect with a healthy pediatric cohort. A retrospective analysis of cardiopulmonary exercise test data between 2004 and 2022 was performed. All patients exercised on a treadmill using the Bruce protocol. Inclusion criteria included patients aged 6-21 years, history of heart transplantation (transplant cohort) or no cardiac diagnosis (control cohort) at the time of testing, and a maximal effort test. Patients were further stratified within these two cohorts as underweight, normal, overweight, and obese based on body mass index groups. Two-way analyses of variance were performed with diagnosis and body mass index category as the independent variables. A total of 250 exercise tests following heart transplant and 1963 exercise tests of healthy patients were included. Heart transplant patients across all body mass index groups had higher resting heart rate and lower maximal heart rate, heart rate recovery at 1 min, exercise duration, and peak aerobic capacity (VO2peak). Heart transplant patients in the normal and overweight body mass index categories had higher VO2peak and exercise duration when compared to underweight and obese patients. Underweight status and obesity are strongly associated with lower VO2peak and exercise duration in heart transplant patients. Normal and overweight heart transplant patients had the best markers of exercise capacity.

Perinatal outcomes in women with class IV obesity compared to women in the normal or overweight body mass index categories: A population-based cohort study in Qatar.

The prevalence of childhood and adult obesity is rising exponentially worldwide. Class IV obesity (body mass index, BMI ≥50kg/m2) is associated with a higher risk of adverse perinatal outcomes. This study compared these outcomes between women with class IV obesity and women in the normal or overweight categories during pregnancy. A retrospective cohort study was performed in Qatar, including women having singleton live births beyond 24weeks of gestation, classified into two class IV obesity and normal/overweight (BMI between 18.5 and 30.0kg/m2). The outcome measures included the mode of delivery, development of gestational diabetes and hypertension, fetal macrosomia, small for date baby, preterm birth and neonatal morbidity. Adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) were determined using multivariable logistic regression models. A total of 247 women with class IV obesity were compared with 6797 normal/overweight women. Adjusted analysis showed that women with class IV obesity had 3.2 times higher odds of cesarean delivery (aOR: 3.19, CI: 2.26-4.50), 3.4 times higher odds of gestational diabetes (aOR: 3.39, CI: 2.55-4.50), 4.2 times higher odds of gestational hypertension (aOR: 4.18, CI: 2.45-7.13) and neonatal morbidity (aOR: 4.27, CI: 3.01-6.05), and 6.5 times higher odds of macrosomia (aOR 6.48, CI 4.22-9.99). Class IV obesity is associated with more adverse perinatal outcomes compared with the normal or overweight BMI categories. The study results emphasized the need for specialized antenatal obesity clinics to address the associated risks and reduce complications.

Social support for exercise from pregnancy to postpartum and the potential impact of a mobile application: A randomized control pilot trial in Southern United States

This study compared perceived social support among women of all body mass index (BMI) categories with an attempt to assess the efficacy of the BumptUp® mobile application to improve social support for exercise during pregnancy and postpartum. Thirty-five pregnant women living in Southern United States were included in the sample. The intervention group received access to the BumptUp® mobile application that was designed to promote physical activity during pregnancy and postpartum. The control group received an evidence-based educational brochure. Perceived social support for exercise was assessed at four-time points using the social support and exercise survey. Outcomes were evaluated at 23–25, 35–37 gestational weeks, and 6 and 12 weeks postpartum. Based on their pre-pregnancy weight and height, BMI was computed to categorize participants into lean, overweight, and obese groups. Social support across BMI categories and between control and intervention groups were compared using linear mixed-effect models. Women grouped in the overweight and obese BMI categories reported receiving significantly lower levels of social support for exercise than women in the lean category throughout pregnancy and postpartum during mid-pregnancy, late pregnancy, and at 12 weeks postpartum (p < 0.05). Although the intervention group received higher social support than the control group throughout all four assessment points, the difference was not statistically significant (p > 0.05). Women with a pre-pregnancy BMI of overweight and obese received lower social support for exercise during pregnancy and postpartum. The efficacy of BumptUp® to improve perceived social support for exercise in pregnancy and postpartum was not evident in the results.

Added value of waist circumference to body mass index for predicting fracture risk in obesity: a prospective study from the CARTaGENE cohort.

Waist circumference (WC) is a stronger risk factor of metabolic disorders than body mass index (BMI), but whether it holds true for fracture risk prediction remains unclear. We aimed to evaluate relationships between WC and fracture incidence within BMI categories and evaluate whether BMI modifies these relationships. Men and women aged 40-70years from the CARTaGENE cohort were divided by BMI category at baseline: normal weight, overweight, and obesity. Incident fractures were identified over 7years via linkage with healthcare administrative databases. Cox proportional hazard models estimated the relationships between WC and incident fractures at any site and by skeletal site within each BMI category. Results are reported as adjusted hazard ratios (95% confidence intervals) per 10cm increase in WC. Effect modification was evaluated qualitatively by comparing relationships between BMI categories. Of the 18 236 individuals included, 754 sustained a fracture. Significant relationships were found between WC and distal lower limb fractures in the normal (1.25 [1.08, 1.45]) and overweight (1.28 [1.07, 1.52]) BMI categories, but not in the obesity category. In the overweight category, we found an increased risk of distal upper limb fractures with increasing WC (1.49 [1.04, 2.15]). No significant relationship was observed regarding WC and fracture risk at any site or major osteoporotic fractures. An effect modification of BMI on the relationships between WC and distal lower limb fractures was observed. WC provides both independent and additive information to BMI for the identification of individuals at risk of obesity-related fractures.

Impact of tumor necrosis factor antagonist combination and anti-integrin therapies on body mass index in inflammatory bowel disease: A cross-sectional study.

The impact of biologic therapies on body mass index (BMI) in patients with inflammatory bowel disease (IBD) is unclear. This study investigates any associations between BMI, type of IBD, and the type of medications taken among patients with IBD with varying weight categories. A cross sectional study was performed in an IBD tertiary care center. Data was obtained from patients with IBD attending outpatient clinics from January 1st, 2021 until November 1st, 2021. Adult patients, older than 18 years, with a diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) were recruited. The primary outcome was the association between BMI and medication used in IBD. The secondary outcome was the association between BMI and disease type and location in patients with IBD. The study included a total of 528 patients of which, 66.5% have CD. Patients with normal weight comprises 55.9% of the participants, while those who are underweight, overweight or obese are 3.4, 28.2, and 12.5%, respectively. None of the underweight patients had UC. Among the normal weight, overweight and obese BMI categories, 34.6% vs. 36.2% vs. 31.8% had UC, respectively. Patients who are on tumor necrosis factor inhibitors (anti-TNF) with an immunomodulator (anti-TNF combination), are more likely to be overweight or obese than patients who are not on anti-TNF combination (OR 2.86, 95% CI 1.739-4.711, p < 0.001). Patients on vedolizumab are twice as likely to be overweight or obese than patients not on vedolizumab (OR 2.23, 95% CI 1.086-4.584, p < 0.05). Patients with ileocolonic CD are more likely to be overweight or obese compared to other subtypes of CD (OR 1.78, 95% CI 1.14-2.77, p = 0.01). Many patients with IBD are either obese or overweight. Patients with IBD who are on anti-TNF combination therapy or vedolizumab monotherapy are more likely to be obese and overweight. In addition, patients will ileocolonic CD are more likely to be obese or overweight.

Relationship between BMI and risk of impaired glucose tolerance and impaired fasting glucose in Chinese adults: a prospective study

BackgroundCurrent studies in most Western countries have largely focused on body mass index (BMI) as an important risk factor for impaired glucose tolerance (IGT) and impaired fasting glucose (IFG), which have different pathophysiological bases. In people with obesity, the prevalence of IGT is higher and the prevalence of IFG is lower. The prevalence of IGT in the Asian population is higher than that in the white population, and the obesity rate in China is still increasing. However, few cohort studies explore the relationship between BMI and the incidence of IGT and IFG in China. We aimed to explore the relationship between BMI and the risk of IGT and IFG in Chinese adults and analyze the differences between them.MethodsThe baseline data were obtained from the 2010 China Chronic Disease and Risk Factor Surveillance, of which 20 surveillance sites were followed up from 2016 to 2017. Finally, in this study, a total of 5,578 studies were grouped into BMI categories of underweight (BMI < 18.5 kg/m2), normal weight (18.5–23.9 kg/m2), overweight (24.0–27.9 kg/m2), and obesity (≥ 28.0 kg/m2). We used the unconditional logistic regression model to analyze the relationship between BMI and the risk of IGT and IFG.ResultsDuring an average follow-up of 6.4 years, 562 developed IGT and 257 developed IFG. After age, gender, urban and rural areas, physical activity, family history of diabetes, hypertension, abdominal obesity, dyslipidemia, and other factors were adjusted, overweight increased the risk of IGT by 35% [odds ratio (OR) 1.35, 95% confidence interval (CI) 1.08–1.70], and obesity increased the risk of IGT by 77% (OR 1.77, 95% CI 1.27–1.47). After the factors consistent with the above were adjusted, only obesity increased the risk of IFG by 122% (OR 2.22, 95% CI 1.39–3.54).ConclusionsIn China, obesity is an important risk factor for IGT and IFG, and the risk of IGT increases during the overweight stage.

Alcohol use, physical activity, and muscle strength moderate the relationship between body composition and frailty risk among people living with HIV.

Antiretroviral therapy has improved life expectancy among people living with HIV (PLWH). Despite increased longevity, PLWH are at increased risk of age-related comorbidities, including frailty. We examined the relationship between body composition and frailty among PLWH, and moderation of this relationship by substance use, physical activity (PA), and physical function. Participants (n= 341; 71% male, 48 ± 10 years, body mass index (BMI)=27.3 ± 7.0 kg/m2 ) enrolled in the New Orleans Alcohol Use in HIV (NOAH) study underwent measures of body composition, muscle strength, and gait speed. Whole blood phosphatidylethanol (PEth) was measured, and substance use and PA were self-reported. Frailty risk measures included the 58-Item Deficit Index (DI58) and the Veterans Aging Cohort Study (VACS) Index 1.0, where higher scores indicate greater frailty risk. Multivariable linear regression adjusted for age, sex, and race showed that higher fat-free mass index (FFMI), body fat (%), waist-to-hip ratio, and body mass index (BMI) ≥ 25.0 kg/m2 vs. < 25.0 kg/m2 were significantly (p< 0.05) associated with decreased frailty risk measured by the VACS Index, whereas adjusted analyses showed no association between body composition variables and the DI58 score. Recent alcohol use, muscle strength, and PA, but not lifetime alcohol use or gait speed, significantly moderated associations between body composition variables and frailty risk with medium-to-large effect sizes. Subgroup analyses revealed a negative relationship between DI58 and FFMI among people with PEth>8 ng/ml and negative relationships of VACS Index with FFMI and WHR in people with lower muscle strength. Overweight or obese BMI categories were positively associated with DI58 in people with lower muscle strength or higher PA level but negatively associated in those with higher muscle strength. Our findings indicate that body composition has significant modulatory effects on frailty risk in PLWH, where obesity increases the risk of frailty and greater muscle mass may be protective, even in individuals who use alcohol. These results highlight the importance of considering body composition, physical activity, and physical function in assessing frailty risk in PLWH, particularly among individuals who use alcohol. Moreover, they support the implementation of physical activity interventions to ameliorate the risk of frailty in aging PLWH.

BMI disparities in coronary artery bypass grafting outcomes: A single center Society of Thoracic Surgeons (STS) database analysis

Disparities in Body Mass Index (BMI) has been a potential risk factor for intraoperative outcomes, postoperative morbidity and mortality after coronary artery bypass graft (CABG). This study aims to quantify the effect of BMI on early clinical outcomes following CABG. The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database was queried for adult patients who underwent first-time Coronary Artery Bypass Graft (CABG) patients in our center from 2014 to 2020. BMI and gender were investigated as primary risk factors for intraoperative outcomes, in-hospital postoperative outcomes, and hospital readmission using multiple logistic regression models. Propensity score weighting was used due to imbalances in the observational groups. Locally weighted smoothing (LOESS) plots of BMI were inspected for each outcome with a predicted probability plot of the interaction between BMI and gender. Among 591 patients meeting inclusion criteria, 79% were male (n=468) and 21% were female (n=124). Healthy(H), overweight/obese (O), and morbidly obese (MO) BMI was defined as <25, 25–35 and >35 respectively. There were significantly higher proportions of females in the healthy and obese categories, and males in the overweight BMI category (F vs M: H:33.9 vs 66.1% O: 15 vs 85%, MO:35 vs 65%, p < 0.001). Patient demographics and comorbidities are all well-balanced with no significant differences after propensity weighting. There was no significant difference in intraoperative outcomes including operating room time, cross clamp time, by-pass time and intraoperative blood loss requiring blood transfusion (p >0.05). Approximately half (49.16%) of patients had one or more in-hospital postoperative events, and 62 (10.56%) had hospital readmission follow discharge. After propensity weighting, the incidence of surgical site infection (SSI) was significantly higher in the morbidly obese group (H: 1.5%, O: 0.6%, MO: 4.5%, p = 0.016) and pneumothorax requiring intervention appears to be significantly higher also for those in the morbidly obese group (H: 0.3%, O: 1%, MO: 2%, p = 0.028). Death at discharge was found to be significantly higher in the healthy group (H: 2.5%, O: 0.3%, MO: 0.3%, p = 0.028, p = 0.008). Loess plots for in-hospital postoperative events and hospital readmission by BMI and gender showed a slight downward trend in postoperative events as BMI increases. Healthy and morbidly obese patient appear to have slightly higher values of hospital readmission for both genders. There was no difference in perioperative outcomes among the cohort. Morbidly obese patients undergoing CABG have a higher risk of SSI. Mortality was higher in the underweight patients. In general, BMI disparities did not affect the risk of perioperative death and other adverse outcomes.

Body image concerns in patients with persecutory delusions.

Persecutory fears build on feelings of vulnerability that arise from negative views of the self. Body image concerns have the potential to be a powerful driver of feelings of vulnerability. Body image concerns are likely raised in patients with psychosis given the frequent weight gain. We examined for the first-time body esteem - the self-evaluation of appearance - in relation to symptom and psychological correlates in patients with current persecutory delusions. One-hundred and fifteen patients with persecutory delusions in the context of non-affective psychosis completed assessments of body image, self-esteem, body mass index (BMI), psychiatric symptoms and well-being. Body esteem was also assessed in 200 individuals from the general population. Levels of body esteem were much lower in patients with psychosis than non-clinical controls (d = 1.2, p < 0.001). In patients, body esteem was lower in women than men, and in the overweight or obese BMI categories than the normal weight range. Body image concerns were associated with higher levels of depression (r = -0.55, p < 0.001), negative self-beliefs (r = -0.52, p < 0.001), paranoia (r = -0.25, p = 0.006) and hallucinations (r = -0.21, p = 0.025). Body image concerns were associated with lower levels of psychological wellbeing (r = 0.41, p < 0.001), positive self-beliefs (r = 0.40, p < 0.001), quality of life (r = 0.23, p = 0.015) and overall health (r = 0.31, p = 0.001). Patients with current persecutory delusions have low body esteem. Body image concerns are associated with poorer physical and mental health, including more severe psychotic experiences. Improving body image for patients with psychosis is a plausible target of intervention, with the potential to result in a wide range of benefits.

Elevated Body Mass Index in Donor Oocyte Recipients Does Not Affect Implantation of Euploid Embryos.

Background: Obesity is a worldwide epidemic that has been shown to have serious implications on health outcomes. Regarding reproductive health, increased body mass index (BMI) reduces fertility and increases the time to conceive. It is unclear how excess weight in females affects the development of oocytes and embryos or the impact of implantation. Materials and Methods: This retrospective single-center study aimed to determine if overweight and obese oocyte recipients had similar pregnancy outcomes compared with healthy weight controls after the transfer of a single euploid frozen-thawed embryo transfer (FET). Five hundred twenty-eight patients who underwent a transfer from 2016 to 2021 were included. The primary outcome studied was the clinical pregnancy (CP) rate. Secondary outcomes included live birth (LB) rate, biochemical pregnancy loss (BPL) rate, and clinical pregnancy loss (CPL) rate. Results: The overall CP rate was 54.9% and did not differ significantly among normal weight (n = 318), overweight (n = 129), and obese (n = 81) BMI categories (0.56 vs. 0.56 vs. 0.49, p = 0.56). There were no significant differences in LB rate (0.47 vs. 0.43 vs. 0.38, p = 0.33), BPL rate (0.14 vs. 0.09 vs. 0.11, p = 0.59), and CPL rate (0.15 vs. 0.21 vs. 0.18, p = 0.38) among BMI groups. Conclusions: Our findings provide support that BMI alone does not adversely alter endometrial receptivity and is not the cause of poor in vitro fertilization (IVF) outcomes in patients with increased BMI. These deleterious IVF outcomes might be to the result of diminished oocyte and/or embryo quality or other factors that have not yet been elucidated.

Association of BMI with pulmonary function, functional capacity, symptoms, and quality of life in ILD

Obesity is a health epidemic associated with greater morbidity and mortality in the general population. Mass loading of the thorax from obesity leads to a restrictive pulmonary defect that reduces lung capacity in obese individuals without pulmonary disease, and may exacerbate the restrictive pulmonary physiology that is characteristic of interstitial lung disease (ILD). The purpose of this study was to test the association of body mass index (BMI) with pulmonary function, functional capacity, and patient-reported outcomes (dyspnea and quality of life) in patients with ILD. We analyzed 3169 patients with fibrotic ILD from the Canadian Registry for Pulmonary Fibrosis. Patients were subcategorized as underweight (BMI<18.5 kg/m2), normal weight (18.5≤BMI<25), overweight (25≤BMI<30), obese I (30≤BMI<35), obese II (35≤BMI<40), and obese III (BMI>40). Analysis was performed using a linear regression with adjustment for common prognostic variables. Overweight and obese BMI categories were associated with worse pulmonary function, functional capacity, dyspnea, and quality of life compared to normal weight. This is likely a result of mass loading on the thorax, and we speculate that intentional weight-loss may improve lung function and functional capacity in obese patients with fibrotic ILD. The underweight BMI category was also associated with worse functional capacity compared to normal weight, which may reflect greater disease severity or the presence of other comorbidities. Future work should explore the clinical utility of BMI to improve patient outcomes.

Weight-Normative versus Weight-Inclusive Narratives in Weight-Related Public Health Campaigns: Effects on Anti-Fat Attitudes, Stigma, Motivation, and Self-Efficacy

Research has shown that weight-related public health campaigns can inadvertently stigmatise individuals with obesity. We compared the effects of weight-normative (personal responsibility and public health crisis) versus weight-inclusive (Health at Every Size [HAES] and fat acceptance) campaign narratives on anti-fat attitudes and reactions to campaigns in two studies. In study 1, participants (n = 283) from a range of Body Mass Index (BMI) categories viewed one of four mock campaigns before rating their anti-fat-attitudes (dislike, fear of fat, willpower, social distance), and reactions to the campaign (motivation, stigma). In study 2, participants (n = 175) in overweight or obese BMI categories viewed one of four mock campaigns before rating their reactions to the campaign (motivation, stigma, self-efficacy). Study 1 results showed that weight-normative campaigns were perceived as significantly more stigmatising than weight-inclusive ones. However, weight-inclusive campaigns did not decrease anti-fat attitudes or increase motivation for health behaviour change in this sample. Similarly, study 2 results showed that the personal responsibility campaign was rated as significantly more stigmatising than other campaigns among women with overweight or obesity. Fat acceptance was rated as the least stigmatising campaign in this sample, but weight-inclusive narratives did not increase motivation or self-efficacy for health behaviour change. Future research should focus on developing campaign narratives that are non-stigmatising, motivating, and efficacious by addressing health behavior benefits irrespective of sex or weight.

Hypertension and Socioeconomic Status in South Central Uganda: A Population-Based Cohort Study.

Background:Limited studies exploring the impact of socioeconomic status (SES) on hypertension in Africa suggest a positive association between higher SES and hypertension. The economic development in sub-Saharan African countries has led to changes in SES and associated changes in lifestyle, diet, and physical activity, which may affect the relationship between hypertension and SES differently compared with higher income countries. This cross-sectional study from a large population-based cohort, the Rakai Community Cohort Study (RCCS), examines SES, hypertension prevalence, and associated risk factors in the rural Rakai Region in south-central Uganda.Methods:Adults aged 30–49 years residing in 41 RCCS fishing, trading, and agrarian communities, were surveyed with biometric data obtained between 2016 and 2018. The primary outcome was hypertension (systolic blood pressure (BP) ≥ 130 mmHg or diastolic BP ≥ 80 mmHg). Modified Poisson regression assessed the adjusted prevalence ratios (PR) of hypertension associated with SES; body mass index (BMI) was explored as a potential mediator.Results:Among 9,654 adults, 20.8% had hypertension (males 21.2%; females 20.4 %). Participants with hypertension were older (39.0 ± 6.0 vs. 37.8 ± 5.0; p < 0.001). Higher SES was associated with overweight or obese BMI categories (p < 0.001). In the multivariable model, hypertension was associated with the highest SES category (aPR 1.23; confidence interval 1.09–1.38; p = 0.001), older age, male sex, alcohol use, and living in fishing communities and inversely associated with smoking and positive HIV serostatus. When BMI was included in the model, there was no association between SES and hypertension (aPR 1.02; CI 0.90–1.15, p = 0.76).Conclusion:Hypertension is common in rural Uganda among individuals with higher SES and appears to be mediated by BMI. Targeted interventions could focus on lifestyle modification among highest-risk groups to optimize public health impact.Key Messages What is already known about this subject? Hypertension is an important modifiable risk factor for cardiovascular disease.There are few large epidemiological studies that investigate the relationship between hypertension and socioeconomic status in low-income countries. What are the new findings? Hypertension is common among adults in rural South–Central Uganda, particularly among those with higher socioeconomic status.BMI is a mediator of the relationship between hypertension and socioeconomic status. How might it impact on clinical practice in the foreseeable future? These findings suggest that public health interventions and community efforts to prevent chronic cardiovascular disease and hypertension should focus on lifestyle modification by elucidating obesity risk perception and health risk awareness, particularly among those of higher socioeconomic status.

Body mass index is not associated with survival outcomes and immune-related adverse events in patients with Hodgkin lymphoma treated with the immune checkpoint inhibitor nivolumab

BackgroundOverweight and obese patients with solid tumors receiving anti-programmed cell death-1 (PD-1)/PD-ligand-1(PD-L1) immune checkpoint inhibitors exhibit improved survival and higher risk of immune-related adverse events (irAEs) than those with a normal body mass index (BMI). In classic Hodgkin lymphoma (cHL), the impact of BMI on survival and immune-related toxicity is unknown. We evaluated for the first time associations of BMI with survival and irAEs in patients with relapsed/refractory (RR)-cHL undergoing PD-1 blockade.MethodsData from a multicenter study on 133 patients treated with the anti-PD1 antibody nivolumab (July 2015–December 2016) were retrieved from a prospective database. Progression-free (PFS), overall survival (OS), incidence and severity of irAEs according to BMI categories were estimated by Kaplan–Meier method, landmark-analyses and Cox regressions.ResultsPatients, mostly males (63%, n = 84) with a median age of 35 years (range, 15–82), advanced stage (75%), B symptoms (63%), bulky disease (24%), a median of 4 previous treatments (range, 1–9), received a median of 18 nivolumab doses (range, 1–57). No statistically significant differences across BMI subgroups emerged as to PFS, with 1-year rates of 67.1% for both normal weight (n = 66; 49.6%) and overweight (n = 31; 23.3%) patients. Underweight (n = 12; 9%) and obese (n = 24; 18%) patients had a 1-year PFS of 54.5% and 49%, respectively. In survival analyses, BMI either as a continuous (P = 0.5) or categorical (P for trend = 0.63) variable failed to associate with PFS. Response rates and time-to-response did not cluster in any BMI subset. No BMI-related differences in OS emerged across normal, overweight and obese patients but underweight patients had the worst survival. Occurrence of irAEs of whatever severity did not statistically associate with BMI.ConclusionsIn patients with RR-cHL receiving nivolumab, no statistically significant differences emerged in response rates, PFS and OS across BMI categories of normal weight, overweight and obese. Overweight/obese patients did not display an increased risk of irAEs. The exquisite sensitivity to anti-PD-1 antibodies, the unique cytokine milieu and effector pathways triggered by nivolumab in cHL, may represent biologic ‘equalizers’ counteracting the immunoregulatory effects of adiposity. Differently from solid tumors, BMI is not associated with treatment efficacy and immune-related toxicity and does not represent a predictive tool for PD-1-targeted immunotherapies in cHL.

Sleep duration and sleep efficiency in UK long-distance heavy goods vehicle drivers

ObjectivesTo profile sleep duration and sleep efficiency in UK long-distance heavy goods vehicle (HGV) drivers and explore demographic, occupational and lifestyle predictors of sleep.MethodsCross-sectional analyses were carried out on 329...

Differences in total and regional body fat and their association with BMI in UK-born White and South Asian children: findings from the Born in Bradford birth cohort

Background: Body mass index (BMI) is commonly used as a proxy to determine excess adiposity, though this may underestimate fat mass (FM) in individuals of South Asian (SA) heritage. SA tend to have greater central adiposity than white people, which is associated with a higher risk of cardiometabolic disease. In this cross-sectional study, we aimed to determine the differences in total and regional FM using Dual-energy X-ray absorptiometry (DXA), and to see if any differences in FM varied by BMI category in UK-born white and SA children aged ~9 years. Methods: Anthropometric measurements and DXA scans were undertaken from 225 white and 269 SA children from the Born in Bradford cohort study. Linear regression was used to assess ethnic differences in total body fat percent and total and regional FM. Results: Although the mean BMI was similar, compared to white children, the proportion of SA children who were overweight or obese was ~20% higher, they had a median of 2kg more total FM, and the proportion with &gt; 35% total body fat (TBF) was 22% and 16% higher in boys and girls respectively. Mean TBF% was greater in each BMI category, as was truncal, android and gynoid FM, with the greatest differences between ethnic groups observed in the healthy and overweight categories. Conclusions: Greater TBF% and total and regional FM in the healthy- and overweight BMI categories observed in SA children suggests they may be at greater risk of future cardiometabolic disease at a BMI level below obesity threshold. However, our sample size was small, and results may be influenced by selection bias and confounding; our findings need to be replicated in a larger study.

Novel risk factors and outcomes in inflammatory bowel disease patients with Clostridioides difficile infection.

Background:Patients with inflammatory bowel disease (IBD) are at significantly increased risk for Clostridioides difficile infection (CDI) with an increased risk of adverse outcomes including increased in-hospital mortality, IBD treatment failure, re-hospitalization, and high CDI recurrence rates. The existing literature on predictors of these adverse outcomes is limited. We evaluated four potentially modifiable novel risk factors [body mass index (BMI), statin use, opioid use, and antidepressant use] on CDI risk and adverse outcomes in these patients.Methods:Using a retrospective design, variables were abstracted from records for patients with IBD and CDI from 2008 to 2013. Statistical analysis comprised descriptive statistics and univariate and multivariate logistic regression analyses.Results:There were 137 patients with IBD and CDI included in this study. On multivariate analysis controlling for age, 43% of patients in the overweight BMI category had severe or severe, complicated CDI, compared with 22% of patients in the underweight/normal BMI [odds ratio (OR) 2.85, p = 0.02] and 19% in the obese category (OR 3.95, p = 0.04). Statin use was associated with severe or severe, complicated CDI when controlling for age and BMI (OR 5.66, p = 0.01). There was no association between statin use and IBD exacerbations following CDI. Opioid and antidepressant use were not associated with disease severity or frequency of IBD exacerbations following CDI.Conclusions:An overweight BMI and statin use were associated with severe or severe, complicated CDI in IBD patients. Further studies are needed to better understand how these factors impact management of patients with IBD to improve clinical outcomes and potentially reduce the risk of complications from CDI.