BMI Points Research Articles

Telemedical Franconian Obesity Aftercare Therapy (Tele-FANT) Results of a Formative Evaluation

Following rehabilitation, patients are often unable to continue with the behavioral changes they had learned there in the long term. It is therefore important to offer aftercare services to improve self-management. Internet-based and telephone aftercare concepts in particular are low-cost and flexible in application, and offer an opportunity to significantly increase the use of aftercare measures. In, the"Tele-FANT" project, obese patients were supported by an aftercare therapist over a period of 12 months following their inpatient rehabilitation stay by regular telephone or video consultations. A one-group pre-post design was used for the formative evaluation. Participants took part in a written survey at the start of rehabilitation, at the end of rehabilitation and 4, 8 and 12 months after rehabilitation. As a key variable, body weight (external measurement by the family doctor) was also recorded at all measurement times to calculate the percentage weight loss from the start of rehabilitation. Descriptive parameters were calculated at the beginning, as well as mean differences and standardized effect sizes (SES) at the post-measurement time points. A total of 47 obese rehabilitation patients (mean BMI=44.56, SD=7.23) from the Frankenlandklinik Bad Windsheim were recruited to participate in the aftercare program. The complete program up to the 12-month follow-up was completed by 30 participants (drop-out: 36.2%). The remaining participants showed a high level of acceptance for both the structural processes and the content of the aftercare program. A weight loss of at least 10% was achieved by 13 participants (50%) at the 12-month follow-up, a further 4 participants (15.4%) had lost 5 to 10%. The participants were able to reduce their BMI by an average of 4.45 BMI points from 43.69 (SD=7.25) to 39.24 (SD=7.25) since the start of rehabilitation (mean effect size: SES=0.61). In the formative evaluation, the "Tele-FANT" aftercare program shows good feasibility and promising results with regard to the goal of weight reduction/stabilization. However, the high drop-out rate indicates that some of the participants were not satisfied with the program or were unable to achieve the desired outcome. The next step would be to test the effectiveness of the "Tele-FANT" aftercare concept in a randomized control group study.

Long-term volume retention of breast augmentation with fat grafting depends on weight changes: a three-year prospective MRI study.

Fat grafting is increasingly used for breast augmentation. However, long-term volume retention, time to reach steady state, and the effect of postoperative weight changes on these outcomes are not fully understood. In this prospective study, we included patients undergoing breast augmentation with fat grafting and examined them with MRI preoperatively and up to three years postoperatively. We modeled fat graft retention over time and calculated the time to volumetric steady state of the fat graft. Secondly, we used our model to assess the effect of postoperative weight changes on fat graft retention and to determine the association between the graft/recipient volume ratio and the percentage breast augmentation at steady state. Finally, we assessed patient satisfaction using the BREAST-Q questionnaire. The study included 28 patients (46 breasts). The time to steady state was 253 days (95%CI 185-283) postoperatively, with a volume retention of 46% (95%CI 35-58). Patients with a weight loss of one BMI point after surgery had a volume retention of 22% (95%CI 4.7-38) while those increasing one and two BMI points had retention rates of 57% (95%CI 45-69) and 85% (95%CI 72-98), respectively. Increasing graft/recipient volume ratio was associated with higher percentage augmentation with no plateau in this relationship even up to ratios of 2:1. Postoperative satisfaction with breasts and sexual well-being increased substantially. Breast augmentation with fat grafting reached volumetric steady state after 8 months with a volume retention of 46%. Weight loss following fat grafting leads to significantly lower volume retention.

SMART-2D: a novel scoring system to predict non diagnostic exercise stress echocardiography in renal transplant candidates

Abstract Background Exercise stress echocardiography (ESE) is often used for pre-renal transplant risk stratification. Nearly 20% of ESE may be non-diagnostic, resulting in delays to transplant and increased healthcare cost. A simple, reliable tool for predicting non-diagnostic ESE may streamline assessment. Methods Retrospective analysis of 898 kidney transplant candidates between 2013-2020 who underwent exercise stress echocardiography for pre-transplant cardiovascular assessment was performed. The cohort was separated into a derivation and validation set. Multivariable logistic regression identified predictors of non-diagnostic ESE. Covariates associated with non-diagnostic ESE (p<0.10) on univariate analysis were included in the multivariable model. From this model, only variables with p<0.05 were included for score development. Model discrimination was assessed by area under the receiver operating curve (AUROC). Results Non-diagnostic ESE occurred in 17% (151/898). Predictors of non-diagnostic study formed the scoring system: 1 point for female sex, 2 points for BMI >40, 1 point for age >55, Heart Rate<55 4 points, <65 3 points and <75 2 points. LV Hypertrophy was assigned 2 points, Type 1 Diabetes 3 points and Type 2 diabetes 1 point, LV Dysfunction was assigned 2 points. This scoring system had excellent discriminative ability (derivation AUROC 0.80, validation AUROC 0.81). A score of 8 or more had a specificity of 97% and a positive likelihood ratio of 9.4 for non-diagnostic ESE. A score of <8 had a negative predictive value of 86%. Patients with Non-Diagnostic ESE had longer time to transplantation (695 vs 636 days), and more investigations performed (43.05% vs 17.94%, p<0.001) and less likely to receive a renal transplant (OR 0.47, p<0.001). Conclusion Non diagnostic ESE in pre-transplant assessment causes significant delays to patient care. A simple clinical scoring system may identify patients likely to have non-diagnostic ESE and can be utilised to identify patients who may benefit from alternative risk-stratification investigations.

Impact of waitlist weight change on outcomes in heart transplant recipients: a UNOS database analysis.

While the effect of pre-transplant weight on patient outcomes following heart transplantation (HTx) has previously been studied, data regarding the impact of dynamic weight change prior to HTx are extremely limited. We sought to elucidate the interaction between HTx listing weight and weight change while waitlisted, and explore how that interaction impacts post-HTx survival in a continuous manner. Adult patients listed for HTx from 1987 to 2020 were identified from UNOS database. Three-dimensional restricted cubic spline analysis explored post-HTx survival relative to both changes in BMI/weight and BMI at time of HTx listing. Continuous predictor variables were analyzed with Cox proportional hazards method. 9,628 included patients underwent HTx. Median recipient age was 55 [IQR 46-62] years, and 21% were females. 53% of patients lost while 47% gained weight on the waitlist. Median BMI (27.6kg/m2 [24.3-31.3] vs. 27.4kg/m2 [24.2-30.9], paired p < 0.001) and weight (84.8kg [73.0-98.0] kg vs. 84.4kg [72.6-96.6], p < 0.001) were similar at listing and transplant. One-year survival was 89.3%. Weight loss over 3 BMI points or 10kg was associated with higher hazard of death irrespective of listing BMI. In non-obese patients, some weight gain (1-4 BMI points or 5-15kg) was associated with improved survival. In cachectic patients (BMI < 18.5), failure to gain weight was associated with worse survival. Impact of weight change varies depending on listing BMI. While a survival benefit is seen in non-obese patients who gain some weight, significant weight loss is associated with poorer survival.

Ultrasound-guided percutaneous biopsy for focal liver lesions: Adverse events and diagnostic yield in a single-centre analysis.

Ultrasound-guided biopsy of focal liver lesions (FLL) is a well-established procedure with crucial impact on therapeutic decisions. The safety and accuracy depend on needle type, tumour location and comorbidities. Modern oncological concepts often require large tumour specimens which may increase the procedural risk. We retrospectively collected data from consecutively scheduled ultrasound-guided FLL biopsies performed in an interdisciplinary ultrasound unit at a university hospital from 2015-2020. We analysed complication rates, diagnostic accuracy, and patient outcome in a one-year period. Of 426 scheduled interventions, 339 were included: 322 primary biopsies (40% female, median age 65 years, median BMI 25.4 kg/m2) and 17 rebiopsies in cases with undetermined diagnosis. Indications comprised 309 (96%) cases with suspected malignant lesions. Important comorbidities were type 2 diabetes (n = 107, 33%) and cirrhosis (n = 64, 20%). A conclusive histopathological diagnosis was achieved in 270 (84%) cases with a weak association with lesion size (OR 1.12 per cm, 95%CI 0.99-1.27). Greater BMI (OR 0.60 per 10 BMI points, 95%CI 0.34-1.05) showed a trend towards an insufficient diagnosis. Relevant complications occurred in 8 (2.5%) cases (2 major; 1 life-threatening). Multiple passes showed a trend towards adverse events (OR 2.32 for > 1 pass, 95%CI 0.99-5.42). 93 (29%) patients died during a median follow-up of 171 days. Ultrasound-guided FLL biopsy is an efficient and safe diagnostic measure. The limitations of the procedure and its associated risks should be considered in patients with advanced malignancies.

Weight Changes after Ankle Fracture Surgery: A Retrospective Cohort Study

Background: Recovery from open reduction internal fixation of the ankle frequently involves a decrease in activity level and some limitations in weightbearing. The purpose of this study was to evaluate weight changes during the postoperative period following ankle fracture surgery. Methods: Hospital billing records were retrospectively reviewed to identify all patients who underwent open reduction internal fixation of bimalleolar and trimalleolar ankle fractures at our hospital system between January 1, 2018 and June 30, 2021. Weight data from outpatient encounters coinciding with the 3-month, 6-month, and 1-year postoperative time points were recorded and analyzed. Results: 56 patients had complete weight data. The mean age at surgery was 44.6±16.2 years. There were 27 women and 29 men. At time of surgery, the mean weight was 197.2.3±53.9 lbs and BMI was 30.3±7.1 kg/m2. At 1 year postoperative, the mean weight was 219.2±51.6 lbs and BMI was 33.8±7.0 kg/m2, representing statistically significant increases of 22.0 lbs and 3.4 BMI points compared to preoperative (p=0.0491 and 0.0330, respectively). On subgroup analysis of different preoperative BMI groups (&lt;25, 25-29, 30-34, and ≥35), only those patients with a pre-operative BMI of &lt;25 experienced statistically significant increases in weight and BMI, 27.9 lbs and 4.8 kg/m2 respectively (p=0.029 and p=0.001). Conclusion: This is the first study to evaluate weight changes following ankle fracture. This study showed that at 1 year patients recovering from ankle open reduction internal fixation gain an average of 22 lbs and 3.4 BMI points. Patients with a pre-operative BMI of &lt;25 are subject to statistically significant increases in weight. We recommend monitoring patients’ weight and counseling them on the risks of weight gain. Further research is necessary to better characterize the risk of weight gain following orthopedic surgery. Level of Evidence: 4 (retrospective cohort)

Impact of bariatric surgery on ovarian reserve markers and its correlation with nutritional parameters and adipokines.

A reduction in anti-müllerian hormone (AMH) levels at short-term after bariatric surgery (BS) has been previously described. However, an assessment of ovarian reserve at longer-follow up, and a comprehensive evaluation of the potentially implicated factors has not been reported. Prospective cohort study. Twenty women aged 18-40 years with BMI 43.95 kg/m2 undergoing BS were studied at baseline (BS0), and at 1 month (BS1), 4 months (BS2), 12 months (BS3), and 24-36 months (BS4) after the surgery. Anthropometrics, reproductive hormones (AMH, FSH, LH, estradiol, testosterone, SHBG, androstenedione), metabolic parameters (adiponectin, leptin, ghrelin, insulin), and nutritional blood parameters (markers of nutritional status, vitamins, and minerals) were obtained at each study time point. Antral follicular count (AFC) was assessed by ultrasonography at BS0, BS3, and BS4. Mixed models were used for analysis of longitudinal data. The mean AMH level was 3.88 ng/mL at BS0, decreased at BS3 (mean= 2.59 ng/mL; p=0.009), and remained stable between BS3 and BS4 (mean= 2.96 ng/mL; p=0.409). We also observed a non-significant decrease in AFC at BS3 (mean=26.14 at BS0, mean 16.81 at BS3; p=0.088) that remained stable at BS4 (mean= 17.86; p=0.731). Mixed models analysis showed: (a) a decrease in 10kg of body weight was associated with an average decrease of 0.357 ng/mL in AMH (p=0.014); (b) a decrease in 1 BMI point was associated with an average decrease of 0.109 ng/mL in AMH (p=0.005); (c) an increase in 1 µg/mL of adiponectin was associated with an average decrease of 0.091 ng/ml in AMH (p=0.041) Significant positive correlations were found between the AMH levels after BS and plasma concentrations of testosterone, free androgen index, insulin and HOMA index. No significant correlations were detected between AMH levels and nutritional parameters. Our results were in line with previous observations, showing that AMH levels decreased significantly at 12 months after bariatric surgery, in parallel with a non-significant reduction in AFC. Both ovarian reserve markers showed a later stabilization up to the end of the study. Of note, postoperative AMH levels were positively correlated with key androgen and insulin resistance-related parameters.

Understanding the Relationship between Child Malnutrition and Cognitive Development: An Analysis of the Ecuadorian Case

The analysis of the relationship between childhood malnutrition and cognitive development in children contributes significantly to the literature, given that nutritional status is recognized as a determinant factor for health and cognitive and psychosocial development during early childhood. Malnutrition at these stages can lead to imbalances in nutritional needs, which, in turn, can influence cognitive development. Our research was based on a representative sample of 4,568 children under 5 years of age from the 2018 National Health and Nutrition Survey (ENSANUT). We used a linear regression model and quantile regressions to estimate heterogeneous relationships in the studied relationship. Our results show that child undernutrition decreases by 0.25 BMI points with respect to those children who did not report child undernutrition. In addition, we have evidence that an increase in BMI at the extremes of the cognitive development distribution (Q0.10 and Q0.90) has a greater effect on children with lower and higher cognitive development. Another important finding is that males are more likely to have high cognitive development. Likewise, a greater number of siblings at home reduces cognitive development by -0.1032 points. Our data also reveal that more hours in front of the TV could reduce the risk of high cognitive development, while the number of hours of play causes the opposite effect, as the coefficient reveals that children with more hours of play have 0.1034 points less cognitive development. From our findings, the importance of exploring the neurodevelopmental processes involved in malnutrition is highlighted. In this article, we examine the basic psychomotor process, which is characterized by the child's ability to carry out bodily movements and mental representations, as well as symbolic expressions that allow him or her to relate constructively to people and objects.

Weight and metabolic changes in early psychosis-association with daily quantification of medication exposure during the first hospitalization.

The most common causes of death in schizophrenia are cardiovascular disorders, which are closely related to metabolic syndrome/obesity. To better understand the development of metabolic alterations early in the course of illness, we quantified daily medication exposure in the first days of the first hospitalization for psychosis and related it to changes in weight and metabolic markers. We recruited participants with first episode psychosis (FEP, N = 173) during their first psychiatric hospitalization and compared them to controls (N = 204). We prospectively collected weight, body mass index, metabolic markers, and exact daily medication exposure at admission and during hospitalization. Individuals with FEP gained on average 0.97 ± 2.26 BMI points or 3.46 ± 7.81 kg of weight after an average of 44.6 days of their first inpatient treatment. Greater antipsychotic exposure was associated with greater BMI increase, but only in people with normal/low baseline BMI. Additional predictors of weight gain included type of medication and duration of treatment. Medication exposure was not directly related to metabolic markers, but higher BMI was associated with higher TGC, TSH, and lower HDL. Following inpatient treatment, participants with FEP had significantly higher BMI, TGC, prolactin, and lower fT4, HDL than controls. During their first admission, people with FEP, especially those with normal/low baseline BMI, showed a rapid and clinically significant weight increase, which was associated with exposure to antipsychotics, and with metabolic changes consistent with metabolic syndrome. These findings emphasize weight monitoring in FEP and suggest a greater need for caution when prescribing metabolically problematic antipsychotics to people with lower BMI.

#4659 PREVALENCE OF LIVER STEATOSIS MEASURED BY MULTIFREQUENCY BIOIMPEDANCE IN PATIENTS WITH CKD

Abstract Background and Aims The increase in visceral fat is one of the factors that contribute to the increased cardiovascular risk associated with CKD. There are few data on the prevalence of hepatic steatosis in patients with CKD. The Maltron multifrequency BIA offers us the possibility of evaluating it. The purpose of this study was to determine the prevalence of hepatic steatosis by means of multifrequency bioimpedance and to correlate it with its presence by ultrasound or CT in patients with CKD on Advanced CKD(ACKD) and HD. Methods We carried out a study of body composition with BIA in 315 patients, analyzing with the Maltron monitor Bioscan i-touch8 the determination of hepatic steatosis and its classification into 4 stages of involvement (normal, mild, moderate, moderately-severe and severe steatosis. We also correlated with ultrasound studies that had In order to see coincidence, we also obtained data from 9 patients without CKD.We established global steatosis prevalence and in CKD and HD and correlated with GOT,GPT,GGT,MIS, waist/height ratio, mass-fat and BMI. Results 315 patients evaluated for CKD 151 (48%) and HD 163 (52%), 67.9% men aged 70.79 ± 12.87 years (sig difference between CKD and HD (72.4 ± 2.7) vs 69.2 ±14.3) p0.023. Globally we found healthy liver in 37.9% and steatosis in 61.3% appearing mild-13.4%, moderate 11.8%, light-high 11.4% and high 24.5%. We observed healthy liver in 35.1% in ACKD vs 40.5% in HD. We did not find significant differences between liver enzyme values between healthy liver and steatosis at a global level. We established correlation/coincidence between ultrasound/CT and BIA in 72 patients. We found a healthy liver BIA-ECHO correlation in 43 cases (93.4%), steatosis by BIA coincides with ECHO in 41.6%. If we combine healthy liver + mild steatosis by BIA, the BIA-Echo healthy liver coincides in 92.7% and steatosis in 50%. Establishing cut-off points for BMI, % fat mass and waist/height index using COR curves, we obtain areas-under-the-curve 0.828, 0.738 and 0.853 respectively, being Waist-height index (WC 0.6) with better sensitivity 80% and specificity 71, 3%. If we determine the area of fat mass with another tool, we see AUC 0.838 with 72.3% specificity and 91.3% sensitivity to detect normal liver. Conclusion 1) A high prevalence of hepatic steatosis due to IAB appears in patients with CKD greater in CKD than in HD. 2) There is a good correlation with ECO for a healthy liver and there are parameters that correlate well in a healthy liver diagnosis. 3) Specific studies of Ultrasound-BIA are needed to validate the diagnosis of steatosis.

New Drugs for Obesity, Is the Excitement Affordable?

New Drugs for Obesity, Is the Excitement Affordable?

RF24 | PSUN126 A Very-Low Calorie Diet Can Reduce Insulin Resistance and Cause Remission of Diabetes Mellitus and Hypertriglyceridemia in a Patient With Familial Partial Lipodystrophy Type 2

Abstract Background Lipodystrophy syndromes are associated with inadequate adipocyte capacity that results in an earlier threshold for ectopic deposition and metabolic dysfunction. We have previously reported that patients with familial partial lipodystrophy (FPLD) present with metabolic severity equivalent to what is observed at 8-12 BMI points higher in a population with common obesity. Currently, there is no strong evidence that any specific diet is the preferred treatment, but bariatric surgery has been reported to improve metabolic outcomes in a few patients. Here, we report the effect of an aggressive calorie-restricted diet in a patient with FPLD who showed remarkable benefit after 16 weeks of the intervention. Clinical Case This is a 38-year-old female diagnosed with FPLD type 2, with LMNA p. R482Q mutation who had a history of recurrent pancreatitis, NAFLD, impaired ovulation, and diabetes mellitus. She had a short-term goal of improving her metabolic state rapidly to achieve pregnancy by IVF. Upon presentation, body weight was 81.6kg, BMI 23.2kg/m2, HbA1c 7.7% and triglycerides 215mg/dL. She was started on very-low calorie diet (VLCD) (800 kcal/day) employing a formula total liquid diet meal replacement: 160 kcal per shake (18g total carbohydrates, 15g net carbohydrates, 3.5g fat, and 16g protein) with the goal to reduce body weight by 15% as has been described for patients in the University of Michigan Weight Management Program. After 1 week on diet, she discontinued glucose and lipid lowering therapies. After 12-weeks of VLCD followed by 4 weeks of transition to low-calorie diet (incorporating 3 meal replacements, one meal, and ad libitum non-starchy vegetables), we observed 12.3kg of body weight and a 1.4% decrease in HbA1c. Insulin resistance was reduced by 66.7 and 61.5% (HOMA-IR and ADIPO-IR, respectively). Fasting insulinemia was reduced by 64.2%. We also performed an OGTT with 75g of glucose for 180 min and observed a decrease in the area under the curve of insulin (-33.2%), triglycerides (-40.7%), and free fatty acids (-34%). DEXA scan showed a reduction in total body fat of 16%. Liver fat via the chemical shift MRI method was reduced from 10±2% to 2±1%. She did not experience any adverse events during the intervention. More importantly, her egg retrieval rate and egg quality during IVF were far superior to past attempts. Conclusion This case illustrates the strong effect and safety of a VLCD intervention in a patient with lipodystrophy. We observed rapid reduction in body weight, and in insulin resistance leading to the remission of diabetes mellitus, hypertriglyceridemia and fatty liver disease. Moreover, there was improved response to ovulation induction. Our data encourage the use of this medical approach for other patients with similar metabolic and reproductive abnormalities due to adipose tissue distribution abnormalities. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Sunday, June 12, 2022 12:36 p.m. - 12:41 p.m.

Is nutrition labeling associated with decreased obesity? A quantitative approach to nutritional health policy in Ecuador.

Few studies assess consumer response to nutrition labeling, especially in less-developed countries. We analyzed the link between nutrition labeling and obesity in Ecuador using a representative cross-sectional sample of 29,770 individuals from the National Health and Nutrition Survey (ENSANUT) in 2018. Nutrition labeling reduced the probability of obesity in adolescent (12-18years old) and adult (18-59years old) people by 4% (CI: - 5.7, - 2.2) and 8.4% (CI: - 12.7, - 4.0), respectively. The magnitude of average treatment effect of using nutrition label on obesity ranged from 0.90 (CI: - 1.299, - 0.500) to 1 (CI: - 1.355, - 0.645) BMI points for adolescent, and from 1.16 (CI: - 1.554, - 0.766) to 1.80 (CI: - 2.791, - 0.811) BMI points for adult. The effect of nutrition labeling is greater among the less obese. We recommend that health policy makers and clinicians continue to promote nutrition labeling especially where obesity is not chronic, where nutrition labeling is most successful.

Prevalence and predictors of obstructive sleep apnea in snorers without excessive daytime sleepiness

Introduction Obstructive sleep apnea (OSA) can be presented by diverse phenotypes with or without excessive daytime sleepiness (EDS). The present study was conducted to detect the prevalence and the predictors of OSA in a sample of habitual snorers without EDS nor nocturnal observed apnea. Patients and methods A total of 61 adult participants complaining of habitual snoring were included in the study and subjected to OSA screening questionnaire, anthropometric measures, tonsil examination, modified Mallampati score, and full polysomnography. Univariate analysis and regression analysis were done to detect the association of OSA with participants’ characteristics and polysomnography data. The statistically significant variables were entered into the receiver operating characteristic curve to estimate the best cutoff values for predictors of OSA in habitual snorers. Results The studied patients were divided into two groups: 11.5% had no OSA [apnea–hypopnea index (AHI)&lt;5], and 88.5% had OSA. AHI values were significantly greater in males compared with females [45.2 (interquartile range: 29.9–62.6) in males versus 22.1 (interquartile range: 9.6–35.9) in females, P=0.001]. There was a statistically significant positive correlation between AHI and age (r=0.39). The best cutoff point of age to detect OSA group was more than 43 years with a sensitivity of 64.81%, specificity of 100%, and total accuracy of 0.86. The best cutoff point of BMI to detect OSA group was more than 37 kg/m2, with a sensitivity of 46.30%, specificity of 100%, and total accuracy of 0.75. Conclusion OSA should be investigated in habitual snorers even in the absence of EDS and nocturnal apnea, especially in older (&gt;43 years), obese (BMI &gt;37 kg/m2), and male patients.

Rates and risk factors of complications associated with operative treatment of pelvic fractures

PurposePost-operative complications following fixation of pelvic fractures can lead to mortality and increased morbidity. Available literature regarding complications is heterogeneous and knowledge on risk factors is limited. This study aims to identify the most common post-operative complications and their possible risk factors following pelvic fracture surgery.MethodsA retrospective cohort study was performed in two level-1 trauma centers in the Netherlands between January 2015 and January 2021. Included patients were all adult patients (≥ 18 years) with an operatively treated pelvic fracture (pelvic ring and/or acetabular fractures). Post-operative complications included surgical site infections (SSI), material-related complications, neurological complications, malunion/non-union and performed reoperations. A forward stepwise multivariable logistic regression analysis was used to identify any risk factors associated with these complications.ResultsComplications occurred in 55 (24%) of the 233 included patients. SSI’s were most common, occurring in 34 (15%) patients. Duration of surgery (odds ratio 1.01 per minute, 95% confidence interval 1.00–1.01) and obesity (odds ratio 1.10 per BMI point, 95% confidence interval 1.29–7.52) were independent risk factors for development of SSI. Less common post-operative complications were material-related complications (8%) and neurological damage (5%).ConclusionLimiting operation time by using less invasive and less time-consuming surgical approaches may reduce the risk of SSI. More awareness and post-operative screening for early signs of SSI is mandatory, especially in obese patients. Future research should include large prospective patient cohorts to determine risk factors for other post-operative complications associated with pelvic fracture surgery.

Impact of a Multidisciplinary Approach on Cardiometabolic Risk Reduction in a Multiracial Cohort of Adults: A 1-Year Pilot Study.

Evidence examining specific effects of a multidisciplinary team (MDT) on cardiometabolic risk factors (CMRFs) among multi-ethnic patients in real-world clinical settings is lacking. This one-year retrospective chart review (2018) analyzed 598 adults (African American 59%, Hispanic 35%, and Caucasian 6%) with mean age of 43.8 ± 14.0 years. Qualifying patients with primary inclusion criteria of having body mass indices and blood pressure (BP) measurements in the first and last quarter of the study period were treated under an MDT protocol and compared to those qualifying for MDT but treated solely by a primary care provider (PCP). MDT included endocrinologist-directed visits, lifestyle counseling, and shared medical appointments. MDT patients experienced a greater reduction (β; 95% CI) in weight (−4.29 kg; −7.62, −0.97), BMI (−1.43 kg/m2; −2.68, −0.18), systolic BP (−2.18 mmHg; −4.09, −0.26), and diastolic BP (−1.97 mmHg; −3.34, −0.60). Additionally, MDT patients had 77%, 83%, and 59% higher odds of reducing ≥5% of initial weight, 1 BMI point, and ≥2 mmHg DBP, respectively. Improvements in hemoglobin A1C measurements were observed in the MDT group (insufficient data to compare with the PCP group). Compared to PCP only, MDT co-management improves CMRF related to adiposity and hypertension in a multiethnic adult cohort in real-world clinical settings. Patient access to best practices in cardiometabolic care is a priority, including the incorporation of culturally adapted evidence-based recommendations translated within a multi-disciplinary infrastructure, where competing co-morbidities are better managed, and associated research and education programs can promote operational sustainability.

Evaluating a pre-surgical health optimisation programme: a feasibility study

BackgroundHealth optimisation programmes are increasingly popular and aim to support patients to lose weight or stop smoking ahead of surgery, yet there is little published evidence about their impact. This study aimed to assess the feasibility of evaluating a programme introduced by a National Health Service (NHS) clinical commissioning group offering support to smokers/obese patients in an extra 3 months prior to the elective hip/knee surgery pathway.MethodsFeasibility study mapping routinely collected data sources, availability and completeness for 502 patients referred to the hip/knee pathway in February–July 2018.ResultsData collation across seven sources was complex. Data completeness for smoking and ethnicity was poor. While 37% (184) of patients were eligible for health optimisation, only 28% of this comparatively deprived patient group accepted referral to the support offered. Patients who accepted referral to support and completed the programme had a larger median reduction in BMI than those who did not accept referral (− 1.8 BMI points vs. − 0.5). Forty-nine per cent of patients who accepted support were subsequently referred to surgery, compared to 61% who did not accept referral to support.ConclusionsUse of routinely collected data to evaluate health optimisation programmes is feasible though demanding. Indications of the positive effects of health optimisation interventions from this study and existing literature suggest that the challenge of programme evaluation should be prioritised; longer-term evaluation of costs and outcomes is warranted to inform health optimisation policy development.

Changing Trends of Adverse Pregnancy Outcomes With Maternal Pre-pregnancy Body Mass Index: A Join-Point Analysis.

ObjectiveAdverse pregnancy outcomes have been related to obesity and thinness; however, the changing trends of the specific outcome with pre-pregnancy BMI remain unknown. The aim of this study was to investigate the change in risk trends of specific adverse outcomes for different pre-pregnancy BMI and analyze the recommended BMI range for pre-pregnancy counseling.MethodsData were extracted from the medical records of 39 public hospitals across 14 provinces in China from 2011 to 2012. The eligibility criteria were singleton birth with delivery week ≥28 weeks. Join-point analysis was adopted to explore changing trends with pre-pregnancy BMI and calculate slopes and join points of different pregnancy complications.ResultsA total of 65,188 women were eligible for analysis. There were three categories of trend style. Continuously increasing trends were linear for intrahepatic cholestasis of pregnancy, postpartum hemorrhage, and low 1-min Apgar score, and non-linear for cesarean delivery with one join point of BMI 23, hypertension disorder in pregnancy with two join points of BMI 20 and 28, gestational diabetes mellitus with one join point of BMI 22, and macrosomia with one join point of BMI 19. The trend was continuously and linearly decreasing for anemia. The bidirectional trends were downward and upward for premature rupture of the membrane with join BMI 22, preterm premature rupture of the membrane with join BMI 22, placenta abruption with join BMI 23, preterm birth with join BMI 19, and low birth weight with join BMI 19.ConclusionsThe changes in the trends of specific outcomes differed with pre-pregnancy BMI. Our results suggested that a pre-pregnancy BMI ranging between 19 and 23 may help reduce the risk of poor maternal and neonatal outcomes.

Association of Postoperative Dieting, Exercise, Dietitian, and Surgeon Follow up With Bariatric Surgery Outcomes.

Although postoperative diet modification, exercise, and regular dietitian and surgeon follow-up are often recommended after bariatric surgery (BS), their impact on weight loss is unclear. A Retrospective chart review was conducted for patients who received sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB) between August 2000 and November 2017 with telephone follow-up. Multivariable logistic regression models were used for analyses. There were 514 patients included in our study. Most were female (76.3%), mean age was 46.9years (Standard Deviation [SD] = 11.8), and mean weight loss was 11.6 (SD = 6.5) BMI points at a mean follow-up of 7years (SD = 4.3). Current surgeon follow-up OR = 2.08 (P < .01) was positively associated with postoperative weight loss, while current dietitian follow-up=OR .41 (P < .01) was negatively associated. Current weight loss supplement use OR = .45 (P = .03) was associated with reduced willingness to undergo surgery again. Increasing preoperative BMI OR = 1.06 (P = .04) and increasing age OR = 1.04 (P = .02) were associated with improved quality of life (QoL) due to BS. Lack of surgeon follow-up and regular dietician consultation was associated with suboptimal weight loss after BS. Older age was positively associated with improved QoL, while current weight loss supplement use was associated with lower likelihood of undergoing surgery again, both independent of weight loss.

Preoperative Prediction of Body Mass Index of Patients with Type 2 Diabetes at 1 Year After Laparoscopic Sleeve Gastrectomy: Cross-Sectional Study.

Background: Very few models predict weight loss among type 2 diabetes mellitus (T2D) patients after laparoscopic sleeve gastrectomy (LSG). This retrospective study undertook such a task. Materials and Methods: We identified all patients >18 years old with T2D who underwent primary LSG at our institution and had complete data. The training set comprised 107 patients operated upon during the period April 2011 to June 2014; the validation set comprised 134 patients operated upon during the successive chronological period, July 2014 to December 2015. Sex, age, presurgery BMI, T2D duration, number of T2D medications, insulin use, hypertension, and dyslipidemia were utilized as independent predictors of 1-year BMI. We employed regression analysis, and assessed the goodness of fit and "Residuals versus Fits" plot. Paired sample t-tests compared the observed and predicted BMI at 1 year. Results: The model comprised preoperative BMI (β = 0.757, P = 0.026) + age (β = 0.142, P < 0.0001) with adjusted R2 of 0.581 (P < 0.0001), and goodness of fit showed an unbiased model with accurate prediction. The equation was: BMI value 1 year after LSG = 1.777 + 0.614 × presurgery BMI (kg/m2) +0.106 × age (years). For validation, the equation exhibited an adjusted R2 0.550 (P < 0.0001), and the goodness of fit indicated an unbiased model. The BMI predicted by the model fell within -3.78 BMI points to +2.42 points of the observed 1-year BMI. Pairwise difference between the mean 1-year observed and predicted BMI was not significant (-0.41 kg/m2, P = 0.225). Conclusions: This predictive model estimates the BMI 1 year after LSG. The model comprises preoperative BMI and age. It allows the forecast of patients' BMI after surgery, hence setting realistic expectations which are critical for patient satisfaction after bariatric surgery. An attainable target motivates the patient to achieve it.