Pre-obese Patients Research Articles

Clinical Outcomes in Patients With Atrial Fibrillation Treated With Non-Vitamin K Oral Anticoagulants Across Varying Body Mass Index.

There are conflicting data on outcomes in patients with atrial fibrillation treated with non-vitamin K oral anticoagulants across varying body mass index (BMI). We investigated cardiovascular and bleeding risk in patients with atrial fibrillation with varying BMI. Observational cohort study from the Swedish oral anticoagulation registry between August 2, 2011, and December 31, 2018. Primary outcomes were mortality, ischemic stroke/systemic embolism, and major bleeding. Baseline BMI (kg/m2) was analyzed continuously and categorized: underweight (<18.5 kg/m2), normal weight (18.5 to <25 kg/m2), preobesity (25 to <30 kg/m2), and obesity class I to III (30 to <35, 35 to <40, and ≥40 kg/m2). Adjusted Cox models and nonlinear relationships of BMI were modeled using restricted cubic splines. Non-vitamin K oral anticoagulant-treated patients with atrial fibrillation were included (n=26 047). At baseline, 602 (2.3%) were underweight, 9101 (34.9%) were normal weight, 9970 (38.3%) were preobese, 4280 (16.4%) were obese class I, 1486 (5.7%) were obese class II, and 608 (2.3%) were obese class III. Underweight and obesity class III were in adjusted continuous analysis associated with increased mortality and major bleeding, with lowest risk observed among preobese patients with BMI 28.2 and 26.2 kg/m2, respectively. In adjusted categorical analysis, underweight was associated with increased mortality (hazard ratio [HR], 1.77 [95% CI, 1.57-1.99]) and nonsignificant higher risk of major bleeding (HR, 1.23 [95% CI, 0.95-1.58]). Similarly, obesity class III was associated with increased mortality (HR, 1.67 [95% CI, 1.40-1.99]) and major bleeding (HR, 1.68 [95% CI, 1.29-2.17]). No significant association was observed between higher BMI and ischemic stroke/systemic embolism. In non-vitamin K oral anticoagulant-treated patients with atrial fibrillation, there appears to be a U-shaped relationship between BMI and mortality and major bleeding.

Body mass index-dependent immunological profile changes after left ventricular assist device implantation.

Infection is a common complication following left ventricular assist device (LVAD) implantation. Patients with obesity are particularly at risk due to their high percentage of adipose tissue and the resulting chronic inflammatory state and resulting immunological changes. This study investigated changes of immunological parameters in relation to body mass index (BMI) during the first year after LVAD implantation. Blood samples were obtained prior to LVAD implantation and at 3 (1st FU), 6 (2nd FU) and 12 mo (3rd FU) after LVAD implantation. Patients were divided into three groups (normal weight: BMI of 18.5-24.9 kg/m2; n=12; pre-obesity: 25.0-29.9 kg/m2; n=15; obesity: ≥ 30.0 kg/m2; n=17) based on their BMI at the time of LVAD implantation. Flow cytometric analyses for CD4+ and CD8+ T cells, regulatory T cells (Tregs), B cells as well as dendritic cells (DCs) were performed. After LVAD implantation, obese patients (0.51 ± 0.20%) showed a higher proportion of overall DCs than normal-weight (0.28 ± 0.10%) and pre-obese patients (0.32 ± 0.11%, p<0.01) at 3rd FU. The proportion of BDCA3+ myeloid DCs was lower in obese patients (64.3 ± 26.5%) compared to normal-weight patients (82.7 ± 10.0%, pnormal-weight vs. obesity=0.05) at 2nd FU after LVAD implantation. The analysis of BDCA4+ plasmacytoid DCs revealed a reduced proportion in pre-obese (21.1 ± 9.8%, pnormal-weight vs. pre-obesity=0.01) and obese patients (23.7 ± 10.6%, pnormal-weight vs. obesity=0.05) compared to normal-weight patients (33.1 ± 8.2%) in the 1st FU. T cell analysis showed that CD4+ T cells of obese patients (62.4 ± 9.0%) significantly increased in comparison to pre-obese patients (52.7 ± 10.0%, ppre-obesity vs. obesity=0.05) and CD8+ T cells were lower in obese patients (31.8 ± 8.5%) than in normal-weight patients (42.4 ± 14.2%; pnormal-weight vs. obesity=0.04) at the 3rd FU. Furthermore, we observed significantly reduced proportions of Tregs in pre-obese patients compared to normal-weight and obese patients at 2nd FU (p=0.02) and 3rd FU (p=0.01) after LVAD implantation. This study reported changes of the innate and adaptive immune system of pre-obese and obese compared to normal-weight patients one year after LVAD implantation. DCs and their subsets, CD8+ T cells and Tregs were affected immune cell populations that indicate immunological changes which might increase the incidence of postoperative infection.

Obesity-Related Pitfalls of Virtual versus True Non-Contrast Imaging-An Intraindividual Comparison in 253 Oncologic Patients.

Dual-source dual-energy CT (DECT) facilitates reconstruction of virtual non-contrast images from contrast-enhanced scans within a limited field of view. This study evaluates the replacement of true non-contrast acquisition with virtual non-contrast reconstructions and investigates the limitations of dual-source DECT in obese patients. A total of 253 oncologic patients (153 women; age 64.5 ± 16.2 years; BMI 26.6 ± 5.1 kg/m2) received both multi-phase single-energy CT (SECT) and DECT in sequential staging examinations with a third-generation dual-source scanner. Patients were allocated to one of three BMI clusters: non-obese: <25 kg/m2 (n = 110), pre-obese: 25-29.9 kg/m2 (n = 73), and obese: >30 kg/m2 (n = 70). Radiation dose and image quality were compared for each scan. DECT examinations were evaluated regarding liver coverage within the dual-energy field of view. While arterial contrast phases in DECT were associated with a higher CTDIvol than in SECT (11.1 vs. 8.1 mGy; p < 0.001), replacement of true with virtual non-contrast imaging resulted in a considerably lower overall dose-length product (312.6 vs. 475.3 mGy·cm; p < 0.001). The proportion of DLP variance predictable from patient BMI was substantial in DECT (R2 = 0.738) and SECT (R2 = 0.620); however, DLP of SECT showed a stronger increase in obese patients (p < 0.001). Incomplete coverage of the liver within the dual-energy field of view was most common in the obese subgroup (17.1%) compared with non-obese (0%) and pre-obese patients (4.1%). DECT facilitates a 30.8% dose reduction over SECT in abdominal oncologic staging examinations. Employing dual-source scanner architecture, the risk for incomplete liver coverage increases in obese patients.

Expression of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2/neu in gallbladder carcinoma in North Indian population

Background: Gallbladder carcinoma (GBC) although rare is most frequent malignant neoplasm of biliary tract system and sixth most common malignancy of digestive tract. GBC is more common in females and there are studies which show expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 neu (HER2/neu) in GBC suggesting possible molecules for targeted therapy, but results are inconsistent. Aims and Objectives: The aim of this study was to find out expression of ER, PR, and HER2/neu in GBC in North Indian population and their possible association with clinicopathological features. Materials and Methods: A total 59 resected cases of GBC diagnosed by histopathological examination were included in the study. Expression of ER, PR, and HER2/neu was accessed by immunohistochemistry method and correlated with various clinicopathological features. Results: ER expression was absent in all GBC cases. PR expression was present in only one case. Positive expression of HER2/neu was present in 13 (22%) cases, in which 12 cases were of conventional adenocarcinoma and one case was of papillary adenocarcinoma. Well and moderately differentiated tumor had significantly higher HER2/neu expression as compared to poorly differentiated tumors (P = 0.001). Pre-obese patients had significantly higher HER2/neu expression as compared to non-obese patients (P = 0.008). Conclusion: In our study, there was no expression of estrogen and PR in GBC in North Indian population. Although small in number, there is a subset of patients who overexpress HER2/neu receptor that may benefit from targeted therapy.

Association of body mass index with long-term outcomes after elective and semi-urgent percutaneous coronary intervention

Abstract Background While obesity is associated with cardiovascular mortality and morbidity, patients with higher body mass index (BMI) may have better outcomes post-percutaneous coronary intervention (PCI). This “obesity paradox” is controversial and needs clarification. Purpose We aimed to investigate the relationship between BMI and outcomes post-PCI in an Asian cohort. Methods A retrospective cohort study was performed on consecutive patients who underwent semi-urgent PCI for non-ST elevation myocardial infraction or unstable angina, and elective PCI for stable angina from January 2014 to December 2015 in a tertiary centre. Patients were underweight (BMI &amp;lt;18.5), normal weight (BMI 18.5–22.9), overweight (BMI 23–24.9), pre-obese (BMI 25–29.9) or obese (BMI ≥30), according to the WHO Asian classification. The primary endpoint was all-cause mortality. The secondary outcomes were subsequent events of stroke or transient ischemic attack, myocardial infarction (MI) and congestive cardiac failure (CCF). Results 1,610 patients were followed up for 3.71 (±0.97) years, 19.7% were female and mean age was 62.1 years (Table 1). BMI showed a U-shaped relationship with the incidence of death (p&amp;lt;0.001), MI (p=0.005), and CCF (p&amp;lt;0.001) (Figure 1A), which was also shown on Kaplan Meier analysis (Figures 1B-E). With reference to normal weight patients on multivariable Cox analysis, overweight (adjusted HR 0.64, 95% CI 0.42–0.97) and pre-obese (adjusted HR 0.55, 95% CI 0.38–0.80) patients had lower mortality. Underweight patients had higher risk (adjusted HR 2.12, 95% CI 1.01–4.46), while pre-obese patients had lower risk of MI (adjusted HR 0.56, 95% CI 0.34–0.92) compared to normal weight patients. Underweight and obese patients had higher risk of CCF (underweight: adjusted HR 3.05, 95% CI 1.45–6.42; obese: adjusted HR 1.86, 95% CI 1.03–3.35) compared to normal weight patients. Conclusion Patients at the lower and upper extremes of BMI demonstrated higher risk of mortality, MI and CCF post-PCI. Funding Acknowledgement Type of funding sources: None.

Can Q.Clear reconstruction be used to improve [68Ga]Ga-DOTANOC PET/CT image quality in overweight NEN patients?

Digital PET/CT allows Q.Clear image reconstruction with different Beta (β) levels. However, no definitive standard β level for [68Ga]Ga-DOTANOC PET/CT has been established yet. As patient's body mass index (BMI) can affect image quality, the aim of the study was to visually and semi-quantitatively assess different β levels compared to standard OSEM in overweight patients. Inclusion criteria: (1) patients with NEN included in a prospective CE-approved electronic archive; (2) [68Ga]Ga-DOTANOC PET/CT performed on a digital tomograph between September2019/March2021; (3) BMI ≥ 25. Images were acquired following EANM guidelines and reconstructed with OSEM and Q.Clear with three β levels (800, 1000, 1600). Scans were independently reviewed by three expert readers, unaware of clinical data, who independently chose the preferred β level reconstruction for visual overall image quality. Semi-quantitative analysis was performed on each scan: SUVmax of the highest uptake lesion (SUVmax-T), liver background SUVmean (SUVmean-L), SUVmax-T/SUVmean-L, Signal-to-noise ratio for both liver (LSNR) and the highest uptake lesion (SNR-T), Contrast-to-noise ratio (CNR). Overall, 75 patients (median age: 63years old [23-87]) were included: pre-obesity sub-group (25 ≤ BMI < 30, n = 50) and obesity sub-group (BMI ≥ 30, n = 25). PET/CT was positive for disease in 45/75 (60.0%) cases (14 obese and 31 pre-obese patients). Agreement among readers' visual rating was high (Fleiss κ = 0.88) and the β1600 was preferred in most cases (in 96% of obese patients and in 53.3% of pre-obese cases). OSEM was considered visually equal to β1600 in 44.7% of pre-obese cases and in 4% of obese patients. In a minority of pre-obese cases, OSEM was preferred (2%). In the whole population, CNR, SNR-T and LSNR were significantly different (p < 0.001) between OSEM and β1600, conversely to SUVmean-L (not significant). These results were also confirmed when calculated separately for the pre-obesity and obesity sub-groups β800 and β1000 were always rated inferior. Q.Clear is a new technology for PET/CT image reconstruction that can be used to increase CNR and SNR-T, to subsequently optimise overall image quality as compared to standard OSEM. Our preliminary data on [68Ga]Ga-DOTANOC PET/CT demonstrate that in overweight NEN patients, β1600 is preferable over β800 and β1000. Further studies are warranted to validate these results in lesions of different anatomical region and size; moreover, currently employed interpretative PET positivity criteria should be adjusted to the new reconstruction method.

Changes in weight following peroral endoscopic myotomy: results from a North American center.

Background and study aims Weight loss is a feature of untreated achalasia. While weight gain after achalasia treatment is expected, little data exist about the extent of it, particularly after peroral endoscopic myotomy (POEM). We aimed to describe the changes in weight after POEM. Patients and methods A retrospective analysis was performed of patients from March 2016 to March 2020 undergoing POEM by an experienced operator at an academic referral center in Kingston, Ontario, Canada. Data examined included pre- and post-POEM body mass index (BMI), procedural characteristics, and Eckardt scores. Results Ninety-two patients underwent POEM during the study period, for 77 of whom follow-up data were available including BMI. Prior to POEM, the median BMI was 26. Six patients (7.8 %) were considered to be underweight, 24 (31.2 %) were normal, 26 (33.8 %) were pre-obese, and 21 (27.2 %) were obese. At a median follow-up of 15 months, the clinical success rate was 95 %. Patients in the normal weight and pre-obesity categories had a significant increase in weight post-POEM. Of the underweight patients, two (33.3 %) moved up to a normal weight category and two (33.3 %) became pre-obese. In the normal BMI category, eight (37.5 %) became pre-obese and one patient (4.2 %) became obese. Ten of the 26 pre-obese patients (38.4 %) were obese post-POEM. Seven of the obese patients (33.3 %) reached Class III (morbid) obesity at follow-up. Conclusions Patients may experience a marked increase in BMI following POEM, with over one-third of patients becoming pre-obese, obese or morbidly obese at follow-up in our study in a North American population. Further study is required to analyze weight gain patterns post-POEM.

Overweight patients benefit from high tibial osteotomy to the same extent as patients with normal weights but show inferior mid-term results

PurposeThe purpose of this prospective study was to analyze the impact of obesity on the clinical and radiological outcomes 6 years after open-wedge high tibial osteotomy (HTO).MethodsA total of 120 prospectively recorded patients with medial compartment osteoarthritis underwent open-wedge HTO between 2008 and 2011. The study cohort was frequently examined over a minimum of a 6-year follow-up. The cohort was divided into three groups according to body mass index (BMI): normal weight patients (BMI < 25 kg/m2), pre-obese patients (BMI 25–30 kg/m2) and obese patients (BMI > 30 kg/m2). Clinical and functional outcomes (Oxford Knee Score, Hospital for Special Surgery Score, Lequesne Score, Tegner Activity Scale), subjective health-related quality of life (SF-36), change in mechanical limb alignment (mTFA) as well as conversion to unicompartmental or total knee arthroplasty (TKA) were evaluated. To compare clinical scoring between the groups, univariate variance analysis was applied. Changes in outcome variables over time were analyzed with dependent t tests.ResultsFrom 120 patients, 85 were followed-up over a 6.7-year period on average (6–11.8 years) after HTO. The mean BMI was 28.6 ± 4.6 kg/m2. Each group showed a significant pre- to postoperative increase in all recorded scores (p < 0.05). In absolute terms, both mental and clinical scores of overweight patients did not reach the peak values of the normal weighted population during the period of observation. There was a conversion to TKA in 10.5% after an average of 50.1 ± 25.0 months following surgery. A total of five complications occurred without significant differences (BMI < 25: n = 1, BMI 25–30: n = 2, BMI > 30: n = 2; n.s.). There was a mean pre- to postoperative (six weeks after surgery) correction difference of 6.9° ± 3.2° (mTFA) with higher loss of correction over time in overweight patients.ConclusionIn terms of clinical outcome and health-related quality of life, overweight patients may receive a benefit from open-wedge HTO to the same extent as patients with normal weights and show similar complication rates. However, they have inferior preoperative clinical and functional results and mid-term results after open-wedge HTO compared to patients with normal weights.Level of evidenceLevel III.

Nutritional status and other predictors of immune response recovery among HIV-AIDS patients receiving antiretroviral therapy in Dr. Sardjito Hospital, Yogyakarta, Indonesia: a retrospective cohort study

Introduction: Nutritional status and immune response of Human Immunodeficiency Virus-Acquired Immune Deficiency Syndrome (HIV-AIDS) patients are closely connected. There are limited studies assessing the influence of Body Mass Index (BMI) on immune response recovery among HIV patients in Indonesia. This study aimed to identify the BMI and other predictors of immune response recovery among HIV-AIDS patients following two years of Antiretroviral (ARV) therapy. Methods: This research was a retrospective cohort study among HIV-AIDS patients who started ARV therapy from January 2014 to December 2016 at Dr. Sardjito Hospital, Yogyakarta. Data were collected from ARV registry and medical reports. Data were analysed using linear regression. Results: A total of 255 patients were included in the study, with a median BMI of 20.07 kg/m2. Results showed that BMI was not significantly correlated with immune response recovery at the 6th, 12th, 18th, and 24th months of ARV therapy (p&gt;0.05). But, the increase in cluster of differentiation 4 (CD4) cell count was higher in overweight and pre-obese patients than underweight patients, especially in the 18th and 24th months of therapy. Factors related to immune response recovery were the regularity of treatment at the 12th, 18th, and 24th months of ARV therapy, and the use of Tenofovir at 18th-month therapy (p&lt;0.05). Conclusion: Immune response recovery was higher in overweight and pre-obese patients. Using Tenofovir type ARV and doing treatment regularly can increase CD4 cell counts. Underweight patients need to enhance their nutritional status to improve their immune response during ARV therapy.

Reverse J-shaped relationship between body mass index and in-hospital mortality of patients hospitalized for heart failure in Japan.

Several lines of evidence demonstrated body mass index (BMI) to be inversely associated with outcomes of patients with HF, so-called obesity paradox. However, the relationship between BMI and outcomes of patients with HF in Japan has been poorly understood. This study sought to explore the relationship between BMI and in-hospital mortality of patients hospitalized for heart failure (HF) in Japan and whether BMI at hospital admission could be used for the risk stratification of hospitalized HF patients. We studied 407,722 patients hospitalized for HF between January 2010 and March 2018, using the Diagnosis Procedure Combination database, a national inpatient database in Japan. Patients were categorized into four groups: underweight (BMI < 18.5kg/m2), 66,342 patients (16.3%); normal (18.5-24.9kg/m2), 240,801 patients (59.1%); pre-obesity (25.0-29.9kg/m2), 76,954 patients (18.9%); and obesity (≥ 30.0kg/m2), 23,625 patients (5.8%). Pre-obese and obese patients were younger and more likely to be male. Advanced HF symptoms were more common among underweight patients. Multivariable logistic regression analysis fitted with generalized estimating equation showed that, compared with normal weight patients underweight patients had higher in-hospital mortality (odds ratio 1.50, 95% confidence interval 1.45-1.55), whereas pre-obese patients (odds ratio 0.80, 95% confidence interval 0.77-0.83) and obese patients (odds ratio 0.90, 95% confidence interval 0.84-0.97) had lower in-hospital mortality. Restricted cubic spline showed a reverse J-shaped relationship between BMI and in-hospital mortality with the bottoms of splines around BMI 26kg/m2. In conclusion, underweight patients had higher, and pre-obese and obese patients had lower in-hospital mortality compared to patients with normal weight patients. Furthermore, restricted cubic spline indicated a reverse J-shaped relationship between BMI and in-hospital mortality. Our findings are informative for the risk stratification of patients hospitalized for HF according to BMI.

RETRACTED ARTICLE: Quality of life in endometrial cancer survivors: single institution experience in Slovakia

BackgroundTo evaluate the association between body mass index (BMI) and quality of life among endometrial cancer survivors.MethodsWomen diagnosed with endometrioid endometrial cancer at the Slovakian university hospital between January 2010 and December 2018 were identified. Three hundred ninety women diagnosed with endometrial cancer were invited to participate. Quality of life was measured using the EORTC (European Organisation for Reseach and Treatment of Cancer) quality of life questionnaires (QLQ-C30 and QLQ-EN24). Univariate and multiple regression analyses were used to determine associations between BMI and quality-of-life outcome variables.T-test was used to determine differences between groups.Results337 (95.2%) women completed the questionnaire. 131 (38.8%) were pre-obese, 111 (32.9%) were class I and II obese and 29 (8.6%) were class III obese. Women with highher BMI experienced poorer physical, emotional and social functioning compared to normal weignt and pre-obese pacients (p < 0.05). Class I-III obese women had significantly more lymphoedema (59% v. 41%, p = 0.048) and dyspnea (73% v. 27%, p = 0.029), and experienced more fatigue (68% v, 32%, p = 0.036) and pain (65% v. 35%, p = 0.041).ConclusionsClass I-III obesity was associated with poorer quality of life in endometrial cancer survivors. Increasing BMI was inversely associated with QoL. Pre-obese and obese patients should be informed about greater incidence of pain, fatigue and dyspnea. Lifestyle changes (e.g., dietary interventions, physical activity) might reduce obesity and improve quality of life among endometrial cancer survivors.

2213Impact of BMI on clinical outcomes in all-comers patients with coronary artery disease undergoing PCI: insights from the Global Leaders study

Abstract Background It is uncertain if the obesity paradox still exists in contemporary PCI practice. Purposes We aimed to assess an association between baseline BMI and clinical outcomes at 2 years after PCI and to determine if the outcomes between two antiplatelet strategies depend on baseline BMI. Methods Global Leaders study compared 23-month ticagrelor monotherapy after 1 month of dual antiplatelet therapy (experimental strategy) with 12-month aspirin monotherapy after 12 months of conventional DAPT (reference strategy) in patients undergoing PCI with biolimus-A9 eluting stent. Primary outcome of current study was 2-year all-cause mortality after PCI. Secondary outcomes were net adverse clinical event (NACE) and individual components of the composite endpoint. Association between baseline BMI and outcomes were determined in the Cox model. Non-linearity was assessed using restrict cubic spline function. Patients were categorized according to WHO BMI categories; underweight (BMI &lt;18.5), healthy weight (BMI 18.5–24.9), pre-obese state (BMI 25–29.9) and obesity (BMI ≥30). Interaction between BMI categories and antiplatelet strategies were assessed. Results BMI was available in 15,966 out of 15,968 patients with a median of 27.7 kg/m2 (IQR 25.0–30.7). Baseline BMI had a reverse J-shaped association with 2-year all-cause mortality. 3901 patients (24.4%) were in the group of healthy weight, 79 patients (0.5%) were under-weight, 7220 patients (45.2%) were pre-obese and 4766 patients (29.8%) were obese. Due to small number of underweight patients, outcomes after PCI were compared among three groups; healthy weight, overweight, and obesity. Pre-obese and obese patients had lower risk of 2-year all-cause mortality than healthy-weight patients (HR pre-obesity vs. healthy-weight 0.71, 95% CI 0.58–0.88, HR obesity vs. healthy-weight 0.69, 95% CI 0.54–0.87). The risk of 2-year NACE was similar among three groups (healthy weight vs. pre-obesity; HR 1.04, 95% CI 0.94–1.16, healthy weight vs. obesity; HR 1.04, 95% CI 0.93–1.16). No significant difference in risk of any stroke, any MI, and BARC3 or 5 bleeding was found among three groups. Pre-obese patients had higher risk of revascularization than patients with healthy weight (HR 1.19, 95% CI 1.04–1.35). The risk of revascularization in obese patients was numerically higher than healthy-weight patients (HR 1.14, 95% CI 0.99–1.31). For BARC 3 or 5 bleeding at 2 years, ticagrelor monotherapy was more favorable in obese patients (HR reference/experimental 1.63, 95% CI 1.06–2.52) while conventional DAPT strategy was more favorable in pre-obese patients (HR experimental/reference 0.76, 95% CI 0.55–1.05) (P interaction 0.02). No interaction between treatment strategy, BMI, and other outcomes was seen. BMI and all-cause mortality and NACE Conclusions An obesity paradox, an association between elevated BMI and lower mortality, is still evident in this large PCI population. Effect of two antiplatelet strategies on bleeding may depend on baseline BMI.

Tumor apelin immunoreactivity is correlated with body mass index in ovarian high grade serous carcinoma

ABSTRACTOvarian cancer has a high mortality rate. Serous carcinoma is the most common subtype and can be detected by distant or lymph node metastasis in advanced stages. Apelin, an adipokine associated with obesity, and its receptor, APJ, participate in lymphatic invasion. Angiogenesis also can affect lymph node involvement in serous ovarian carcinomas. We investigated apelin/APJ receptor immunoreactivity in stages III and IV ovarian cancer with or without lymph node involvement and correlated the results with body mass index (BMI) to determine whether the potential relation of the two affects the outcome of the cancer. We investigated 30 patients diagnosed between 2014 and 2016 with high grade serous ovarian cancer. Tumor:stroma ratio, indirect immunoperoxidase method, H-score and MATLAB analysis were performed. In obese and pre-obese patients, tumor apelin immunoreactivity was stronger than for patients with normal BMI. Tumor:stroma ratio was correlated with survival and lymph node involvement. Strong apelin and moderate APJ immunoreactivity was detected in both lymph node negative and positive patients. BMI was related to both survival outcome and apelin immunoreactivity. BMI, adipokines such as apelin, and the stromal compartment play critical roles in advanced stage serous carcinomas.

Prescribing Pattern of Antidiabetic Drugs Amongst Pre-Obese Diabetic Patients in a Tertiary Care Hospital- An Observational Study

Background: In order to improve the prescription quality and rational prescription pattern promotion there is an inevitable need to investigate the factors that affect doctors' prescription patterns. Diabetes is a common non communicable disease. It leads to high morbidity and mortality due to the disease itself and its diverse complications like CAD, hypertension, renal complication, retinal damage, neurological disorders, generalised infections etc. With such multifactorial background of high prevalence, progressive nature of the disease, availability of multiple therapeutic regimens prescribed on trial and error basis, the treatment is individualized and neither complete nor satisfactory. Objectives: This study was undertaken to analyse the current prescribing pattern in pre-obese patients of type 2 diabetes mellitus with regard to drug/drugs precription, dose, and duration of treatment and frequency of change of drugs. Methods: This is a prospective, parallel group, comparitive observational study. The enrolled pre-obese patients were divided as a) New diabetic b) Old diabetic (&lt;3 years duration). Each category was further divided into four subgroups according to the treatment recieved a)Monotherapy-Metforminb)Combination therapy-Metformin+another antidiabetic groups, preferably sulfonylureas, alphaglucosidase inhibitors or DPP 4 inhibitors c)Triple therapy( Metformin+SU+Voglibose or Gliptins or Glitazones) d)Insulin with other oral hypoglycemic drugs. Results: In the study of prescribing pattern, it was observed that most prescriptions in this tertiary care hospital were found to be in compliance with the ADA guidelines. Metformin monotherapy was prescribed as initial treatment. Sulphonylureas/Gliptins/Alpha glucosidase inhibitors/thiazolidinediones were used as second line therapy mostly anyone, in addition to metformin or as monotherapy according to patient requirement, tolerability and cost.Conclusions: The antidiabetic medications prescribed in this hospital, were found to be in compliance with ADA guidelines

Pre/post-surgical investigation of some angiogenic factors due to cancer and obesity

Objective: Obesity is one of the important health problem for developed and developing countries. Due to literature some obesity related factors may trigger the tumor formation. For tumor development, tumoregenic cell and tissue needs to oxygen and nutrients. Once the tumor has developed, it stimulates the angiogenesis by producing chemical signals and grows by supplied oxygen and nutrients with newly formed vessels. Aim of this study is to compare some angiogenic factors before and after surgery which will supply more information about the link between the cancer and obesity. Material and Methods: Serum samples were obtained before and 48 hours after surgery. Adrenomedullin, vascular endothelial growth factor, hipoxia inducible factor1-α and matrix metallo proteinase-2 levels were investigated in cancerous and noncancer patients. Angiogenic factors were assayed by ELISA method. Results: Higher levels of angiogenic factor were detected in cancer tissues more than in non-cancer tissues, in pre-obese and obese patients. It is seen that in humans, in post-operated patients angiogenic factors are higher in obese individuals, while non-cancer patients are also higher in obese groups and angiogenic factors which stimulate angiogenesis. Conclusion: In the treatment of cancer, as defined previously the anti-angiogenic factors should be considered and applied as epigenetic phenomen. Due to our finding cancer related elevated angiogenic and growth factor biochemicals had been also increased in obes population and in cancer patients with surgical intervention. In the light of literature and our findings, instead of drugs, radiation therapy or surgery, which have many side effects in the treatment of cancer, we need to focus to this epigenetic phenomen for cancer patients. In general, we can say that both obesity and surgical applications lead to an increase in angiogenic factor levels, and that the healing process of wounds causes a marked increase in angiogenic factor levels

The effects of pre-obesity on quality of life, disease activity, and functional status in patients with ankylosing spondylitis.

OBJECTIVE:This study was an investigation of effects of pre-obesity on clinical characteristics and quality of life in patients with ankylosing spondylitis (AS).METHODS:Total of 28 AS patients and 30 age- and sex-matched healthy controls were included in the study. Patients and controls with any systemic inflammatory disease and/or cognitive and mental problems were excluded. Disease activity and functional capacity were measured using the Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index. For quality of life assessment, 36-Item Short Form Health Survey was used in both groups, and AS group also responded to Ankylosing Spondylitis Quality of Life questionnaire.RESULTS:There was no significant difference in sociodemographic characteristics between AS patients and healthy controls (p>0.05). Mean quality of life scores were significantly lower in the pre-obese AS patients compared with controls (p<0.05). Functional capacity was positively and significantly associated with body mass index (BMI) (p=0.024) and disease activity was significantly associated with female gender (p=0.011).CONCLUSION:Increased BMI in patients with AS is factor that affects quality of life, disease activity, and functional capacity. Multidisciplinary rehabilitation programs will support improved quality of life for pre-obese patients with AS.

Association between body mass index and in-hospital outcomes: Analysis of the nationwide inpatient database.

Over one-third of American adults (36%) are obese and more than two-thirds (69%) are overweight. The impact of obesity on hospitalization outcomes is not well understood. To examine the association between body mass index (BMI) and overall, cancer, chronic obstructive pulmonary disease (COPD), asthma, and cardiovascular disease (CVD)-specific in-hospital mortality; postsurgical complications; and hospital length of stay (LOS). Cross-sectional study. Representative sample of US hospitals included in the Health Cost and Utilization Project Nationwide Inpatient Sample database. We obtained data for patients admitted with a primary diagnosis of cancer, COPD, asthma, and CVD. In-hospital mortality, postsurgical complications, and hospital LOS. A total of 800,417 patients were included in this analysis. A higher proportion of Blacks (26.8%; 12.5%) and Whites (23.3%; 8.7%) had BMI of 40 to 49.9 and ≥50, respectively, compared with Hispanics (20.4%; 7.3%). Compared with normal BMI patients, the odds of in-hospital mortality increased 3.6-fold (odds ratio [OR] 3.62, 95% confidence interval [CI]: 3.37-3.89) for preobese patients, 6.5-fold (OR: 6.52, 95% CI: 5.79-7.34) for patients with BMI: 30 to 31.9, 7.5-fold (OR: 7.57, 95% CI: 6.67-8.59) for patients with BMI: 34 to 35.9, and 1.6- fold (OR: 1.77, 95% CI: 1.56-1.79) for patients with BMI ≥ 50. Compared with normal BMI patients, preobese and overweight patients had shorter hospital stays (β preobese: -1.58, 95% CI: -1.63, -1.52); however, no clear trends were observed for postsurgical complications. The majority of hospitalized patients in this analysis had a BMI > 30, and higher BMI was associated with increased risk of mortality and longer hospital stay.

Colorectal cancer surgery for obese patients: Financial and clinical outcomes of a Dutch population-based registry.

The objective of this study was to explore the association among adverse events, body mass index (BMI), and hospital costs after colorectal cancer surgery in a country with an intermediate BMI distribution. All colorectal cancer procedures in 29 Dutch hospitals listed in a 2010-2012 population-based database and with a BMI > 18.5 were included (n = 8687). Hospital costs were measured uniformly and based on time-driven activity-based costing. The BMI classification of the World Health Organization was used. Patients in obesity classes 1 (23.6% [after risk-adjustment OR 1.245, CI 1.064-1.479, P = 0.007]) and ≥2 (28.1% [after risk-adjustment OR 1.816, CI 1.382-2.388, P < 0.001]) were associated with more severe complications and higher hospital costs (€14,294, +9.6%, after risk-adjustment +7.9%, P < 0.001; and €15,913 +22.0%, after risk-adjustment +21.2%, P < 0.001, respectively) than normal weight patients (20.8% and €13,040, respectively). Pre-obese patients had significantly lower mortality rates (2.7%, after risk-adjustment, OR 0.756, CI 0.577-0.991, P = 0.042) than normal-weight patients (3.9%). Obese surgical colorectal cancer patients in a country with an intermediate BMI distribution are associated with a significant increase in hospital costs because these patients suffer from more severe complications. This is the first study to provide evidence for the "obesity-paradox" for mortality in colorectal cancer surgery. J. Surg. Oncol. 2016;113:489-495. © 2016 Wiley Periodicals, Inc.

The obesity epidemic makes life difficult for patients with herniated lumbar discs – and for back-surgeons: Increased risk of complications

[ In this issue of the Scandinavian Journal of Pain, Jarvimaki et al. ocus on problems and complications arising in pre-obese and bese patients who need back surgery, discectomy in particular 1]. The epidemic of obesity has reached the Nordic countries, and or persons above 60 years of age, Western Europe has prevalence bout 20% for men and about 30% for women [2]. Excess bodyweight is among the highest risk factors for ncreased burden of disease globally, contributing to development f ischaemic heart disease, hypertension, osteoarthritis, diabetes ellitus, and stroke, cancer of the colon, breast and endometrium 2]. In their survey of lumbar discectomy patients, Jarvimaki et al. ound that outcomes of surgery with respect to functional disabilty, depressed mood, and social activities were worse among those ith BMI in the obese category (BMI >30 kg/m2) [1]. Both the prebese (BMI >25 and <30) and the obese patients gained weight uring the postoperative follow-up time of about 2 years. It is almost self-evident that technical difficulties for the sureon doing minimally invasive discectomies will be more severe hen operating on an obese patient compare with a non-obese atient. This may be the reason for a higher prevalence of reoperaions among their obese patients [1]. Postoperative complications nd cost significantly increase compared with none-obese patients 3]. Similarly, the anaesthesia team will have more challenges aneshetizing an obese patient; turning an obese patient under full eneral anaesthesia to the prone position is also not a trivial underaking. The increased costs are due to longer operating time, longer naesthesia time, more often admission to the intensive care unit s well as longer hospital stay [3]. We therefore agree hole-heartily with Jarvimaki et al. [1] that bese patients with prolapsed lumbar disc must be helped lose

Obesity has an impact on outcome in lumbar disc surgery

PurposeTo investigate the effect of obesity on outcome in lumbar discectomy. MethodsA cross-sectional postal survey; a self-made questionnaire, Beck depression inventory IA (BDI IA) and the Oswestry low back disability questionnaire (ODI) were sent to the patients, who had undergone lumbar disc surgery in the Oulu University Hospital between June 2005 and May 2008. Patients were divided into three groups according to BMI: normal, pre-obese and obese. The ODI was also examined in the framework of the international classification of functioning, disability and health (ICF) to investigate its ability to describe various dimensions of functioning (body structure and functions, activities and participation). ResultsThe postal survey was sent to 642 patients, of whom 355 (55%) replied. Males dominated in the pre-obese (66%) and obese (62%) groups (p=0.01). Normal-weighted and pre-obese patients had lower BDI scores compared to obese patients (mean BDI: 8.0, 7.6, 11.2, respectively, p=0.035). Total ODI score was highest in the obese group compared to normal-weighted or pre-obese (20.3, 18.6, 26.4, respectively, p=0.011). When ODI was linked to the ICF there were significant differences in all activity domains (mobility, self-care and interpersonal interactions and relationships) and the mobility component of the participation domain between the weight groups. Conclusions and implicationsObesity has an impact on outcome in lumbar discectomy. Obese patients had higher scores in BDI and ODI indicating mild mood disturbances and moderate functional disability. According to ICF, functional disability of obese patients was observed to some extent in all activity domains. Obese patients will be more frequently present for disc surgery and increased morbidity risk must be recognized. We need a strategy to rehabilitate and activate obese patients pre- and postoperatively.