Quartile Of Body Mass Index Research Articles

Changes in body mass index during childhood and risk of various asthma phenotypes: a retrospective analysis.

It is known that asthma is related to obesity but also to small birthweight. The objective of this study was to clarify this issue by assessing the putative relationship between the changes in corpulence between birth and childhood as assessed by body mass index (BMI) and asthma phenotypes. The following status in corpulence was assessed in 7781 schoolchildren using quartile of BMI at birth and at around 10 (9-11 years): underweight at birth and at around 10, underweight at birth and overweight at around 10, overweight at birth and underweight at around 10, overweight at birth and at around 10, and the reference group constituted by all the other children in whom corpulence changes were not extreme. Determination of asthma phenotypes (allergic, non-allergic, and exercise-induced asthma) was based on a clinical examination including skin prick tests, an exercise challenge test, and a questionnaire. The risk of allergic asthma was higher in children with persistent underweight, children with persistent overweight, and children becoming markedly more corpulent. In boys, the risk of allergic asthma was significantly higher for the less corpulent children at birth, regardless of whether they remained so or become overweight. In girls, the risk of allergic asthma was significantly higher in those with persistent overweight. There were no significant associations between BMI changes and non-allergic and exercise-induced asthma. We observed that some extreme changes in BMI, persistent underweight, and persistent overweight in childhood increased the risk of allergic asthma.

Associations between body mass index and lymph node metastases of patients with papillary thyroid cancer: A retrospective study.

Epidemiological studies suggest that obesity is a risk of thyroid cancer, especially papillary thyroid cancer (PTC). However, the associations of obesity and clinic–pathological features, especially the association of body mass index (BMI) and lymph node metastasis of thyroid cancer are unclear. Seven hundred ninety-six primary patients with PTC were enrolled in this retrospective cohort study. The relationships between BMI and clinic-pathological features of PTC were evaluated by logistic regression models based on the 5-point increase in BMI and BMI quartiles (underweight, normal weight, overweight, and obesity). The 5-point increase in BMI was strongly associated with extra-thyroidal invasion [odds ratio (OR) 2.201, P < 0.001], primary tumor size larger than 1 cm (OR 1.267, P = 0.027), advanced tumor node metastasis (TNM) staging (OR 1.479, P = 0.004), and multifocality (OR 1.31, P = 0.01) in multivariable-adjusted models. The relationships between BMI and lymph node metastasis of PTC were evaluated by Mann–Whitney U test. The mean number of positive central lymph nodes and lateral nodes were increased with the increase of BMI when BMI ≥18.5 kg/m2. It was not shown in underweight group. The present study found that increased BMI was associated with the lymph node metastases (LNMs) of patients with PTC, and other invasive features, including large tumor size, extra-thyroidal invasion, advanced TNM staging, and multifocality. Further studies with long-term follow-up are needed to confirm this finding.

Sleep duration is associated with body fat and muscle mass and waist-to-height ratio beyond conventional obesity parameters in Korean adolescent boys.

While evidence has supported a strong association between sleep duration and obesity globally, results from studies of children and adolescents have been conflicting, and information about a sex-specific association has been limited. This study aimed to investigate the association of sleep duration with various parameters of obesity among South Korean adolescents. This population-based, cross-sectional study analysed the data obtained from the Korea National Health and Nutrition Examination Surveys (KNHANES) 2009 and 2010. Data of 990 adolescents were analysed. Sleep duration was based on a self-reported questionnaire. Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), body fat percentage (BFP) and skeletal muscle index (SMI, appendicular skeletal muscle mass as a percentage of body weight) were assessed as parameters of obesity. Mean sleep duration in boys was associated inversely with BMI, WC, WHtR and BFP and positively with SMI. Proportions of the highest quartile of BMI, WC, WHtR and BFP and the lowest quartile of SMI increased significantly with increased sleep duration only in boys. Also, in boys, decreased sleep duration was associated significantly with the increased risk of the highest quartile of BMI, WC, WHtR and BFP and the lowest quartile of SMI, even after adjusting for confounding factors. However, in girls, there was no significant association between sleep duration and obesity parameters except WC. Periodic assessment of sleep duration in relation to body fat or muscle mass in male adolescents may be considered, especially in those who are at risk for obesity or related disorders.

Fat mass and fat distribution are associated with low back pain intensity and disability: results from a cohort study

BackgroundDetermining the association between body composition and low back pain (LBP) will improve our understanding of the mechanisms by which obesity affects LBP, and inform novel approaches to managing LBP. The aim of this study was to examine the relationship between body composition and LBP intensity and disability.MethodsA total of 5058 participants (44% men) of the Australian Diabetes, Obesity and Lifestyle Study were assessed for LBP intensity and disability using the Chronic Pain Grade Questionnaire (2013–2014). Body mass index (BMI) and waist circumference were directly obtained. Fat mass and percentage fat were estimated from bioelectrical impedance analysis at study inception (1999–2000).ResultsEighty-two percent of participants reported LBP, of whom 27% also reported LBP disability. BMI, waist circumference, percent fat, and fat mass were each positively associated with LBP intensity and disability at 12 years after adjustment for potential confounders. LBP intensity and disability showed significant dose-responses to sex-specific quartiles of BMI, waist circumference, percent fat and fat mass. For example, the adjusted OR for LBP intensity in women increased with increasing fat mass quartiles [Q1: 1, Q2: 1.05 (95%CI 0.84–1.32); Q3: 1.25 (1.00–1.57); and Q4: 1.78 (1.42–2.24); p < 0.001].ConclusionsFat mass and distribution are associated with LBP intensity and disability, suggesting systemic metabolic factors associated with adiposity play a major role in the pathogenesis of LBP. Clarifying the mechanisms will facilitate developing novel preventive and therapeutic approaches for LBP.

Longitudinal study of weight, energy intake and physical activity change across two decades in older Scottish women.

The perimenopausal and postmenopausal periods are times of pronounced physiological change in body mass index (BMI), physical activity and energy intake. Understanding these changes in middle age could contribute to formation of potential public health targets. A longitudinal cohort of 5119 perimenopausal women from the Aberdeen Prospective Osteoporosis Screening Study (APOSS) recruited between 1990 and 1994, with follow-up visits at 1997-1999 and 2009-2011. At each visit, participants were weighed, measured and completed socioeconomic and demographic questionnaires. Participants at the first visit were asked to recall body weights at 20, 30 and 40 years of age. We assessed trends in BMI, physical activity and energy intake across and within visits. Over 2 decades, obesity prevalence doubled from 14% to 28% of the participants, with 69% of participants being categorised as overweight or obese. Greater than 70% of participants gained >5% of their baseline BMI with weight gain occurring across all weight categories. Energy intake and physical activity levels (PALs) did not change during the 2 decades after menopause (p trend=0.06 and 0.11, respectively), but, within the second visit, energy intake increased concomitantly with a decrease in physical activity across increasing quartiles of BMI (p trend <0.001 for all). Overweight and obesity increased by over 50% over the course of 20 years. Weight gain occurred across the adult life course regardless of starting weight. The marked increase in dietary intake and decrease in PALs in middle age suggest a potential critical period for intervention to curb excess weight gain.

Abstract 11443: Higher Leptin Levels are Associated With Reduced Left Ventricular Mass and Left Ventricular Diastolic Stiffness in African American Women: Insights From the Genetic Epidemiology Network of Arteriopathy (GENOA) Study

Background: Leptin has been associated with left ventricular (LV) hypertrophy and heart failure in some epidemiologic studies while other studies have demonstrated a beneficial effect on cardiac remodeling and function. We hypothesized that leptin may play a role in protecting the heart from developing LV hypertrophy and stiffening. Methods and Results: We evaluated 1172 African Americans with preserved LV ejection fraction (EF &gt;50%) from the Genetic Epidemiology Network of Arteriopathy (GENOA) Study (mean age 62.9 years, 72% women). LV diastolic stiffness was assessed by echocardiography using the diastolic wall strain (DWS) indicator. Associations between leptin levels and indices of LV structure and function were evaluated using generalized estimating equations (GEE) approach with Gaussian distribution accounting for clustering in siblings. All models were adjusted for possible confounders including age, body mass index, systolic blood pressure, blood pressure lowering medication, coronary heart disease, current smoking status and estimated glomerular filtration rate and stratified by sex because leptin levels were three times higher in women than men (p &lt;0.001). After adjustment, higher leptin levels were associated with lower LV mass and less LV diastolic stiffness (p &lt;0.05, for both) in women, while there were no statistically significant associations between leptin levels and LV structure and function in men. In women, there were interactions between leptin levels and body mass index quartiles on LV mass and LV diastolic stiffness (p &lt;0.05, for both). Higher leptin levels were associated with lower LV mass and LV diastolic stiffness more in obese rather than in lean women (Figure). Conclusions: Higher leptin levels were associated with lower LV mass and LV diastolic stiffness in obese African American women. Leptin may play an important role in protecting the heart from developing precursors to heart failure in obese African American women.

Pregnancy urinary phthalate metabolite concentrations and gestational diabetes risk factors

BackgroundEpidemiologic studies suggest phthalate metabolite concentrations are associated with type 2 diabetes. GDM is a strong risk factor for type 2 diabetes. Little is known about phthalates and GDM risk factors (i.e. 1st trimester body mass index (BMI), gestational weight gain (GWG), and 2nd trimester glucose levels). MethodsA total of 350 women participating in Lifecodes pregnancy cohort (Boston, MA), delivered at term and had pregnancy urinary phthalate metabolite concentrations. Nine specific gravity-adjusted urinary phthalate metabolites were evaluated. General linear regression was used to assess associations between quartiles of phthalate metabolites and continuous 1st trimester BMI and late 2nd trimester blood glucose. Linear mixed models were used for total GWG. Multivariable logistic regression was used for phthalate concentrations and categorized GWG and impaired glucose tolerance defined as glucose≥140mg/dL based on a 50-gram glucose load test. Models were adjusted for potential confounders. ResultsThere were no associations between 1st trimester urinary phthalate metabolite concentrations and 1st trimester BMI. Mono-ethyl phthalate concentrations averaged across pregnancy were associated with a 2.17 increased odds of excessive GWG (95% CI: 0.98, 4.79). Second trimester mono-ethyl phthalate was associated with increased odds of impaired glucose tolerance (adj. OR: 7.18; 95% CI: 1.97, 26.15). A summary measure of di-2-ethylhexyl phthalate metabolite concentrations were inversely associated with impaired glucose tolerance (adj. OR: 0.25; adj. 95% CI: 0.08, 0.85). ConclusionsHigher exposure to mono-ethyl phthalate, a metabolite of the parent compound of di-ethyl phthalate, may be associated with excessive GWG and impaired glucose tolerance; higher di-2-ethylhexyl phthalate was associated with reduced odds of impaired glucose tolerance.

Body Mass Index Predicts 24-Hour Urinary Aldosterone Levels in Patients With Resistant Hypertension.

Prospective studies indicate that hyperaldosteronism is found in 20% of patients with resistant hypertension. A small number of observational studies in normotensive and hypertensive patients suggest a correlation between aldosterone levels and obesity while others could not confirm these findings. The correlation between aldosterone levels and body mass index (BMI) in patients with resistant hypertension has not been previously investigated. Our objective was to determine whether BMI is positively correlated with plasma aldosterone concentration, plasma renin activity, aldosterone:renin ratio, and 24-hour urinary aldosterone in black and white patients. We performed a cross-sectional analysis of a large diverse cohort (n=2170) with resistant hypertension. The relationship between plasma aldosterone concentration, plasma renin activity, aldosterone:renin ratio, 24-hour urinary aldosterone, and BMI was investigated for the entire cohort, by sex and race (65.3% white, 40.3% men). We demonstrate that plasma aldosterone concentration and aldosterone:renin ratio were significantly correlated to BMI (P<0.0001) across the first 3 quartiles, but not from the 3rd to 4th quartile of BMI. Plasma renin activity was not correlated with BMI. Twenty-four-hour urinary aldosterone was positively correlated across all quartiles of BMI for the cohort (P<0.0001) and when analyzed by sex (men P<0.0001; women P=0.0013) and race (P<0.05), and stronger for men compared with women (r=0.19, P<0.001 versus r=0.05, P=0.431, P=0.028) regardless of race. In both black and white patients, aldosterone levels were positively correlated to increasing BMI, with the correlation being more pronounced in black and white men. These findings suggest that obesity, particularly the abdominal obesity typical of men, contributes to excess aldosterone in patients with resistant hypertension.

Patient selection essential for computed tomography coronary angiography

Objective: Computed tomography coronary angiography (CTCA) has become a commonly used imaging modality in patients with suspected anginal symptoms but also in asymptomatic populations. This practice has raised concerns due to potential high radiation exposure in terms of adequate benefit to risk profile.Design: Demographics and CTCA scan details were collected from a consecutive series of 586 patients referred to a single community radiology practice for a CTCA.Results: Of the 586 patients, 271 (46.2%) were women. Mean age was 58.3 standard deviation (SD) 12.2, range 15–90 years, body mass index (BMI) 28.6 SD 5.9 kg/m2, and heart rate 60 SD 10 beats per minute. Mean total radiation was 4.79 SD 3.45 mSv (range 0.64–31.34). The mean radiation exposure in the lowest quartile of BMI and heart rate were 3.01 SD 1.84 mSv and 3.95 SD 2.72 mSv, compared to the highest 7.32 SD 3.51 mSv and 6.20 SD 4.38 mSv (p for trend <0.0001 in both).Conclusion: The radiation exposure in this consecutive series of patients is low in general but patient selection for CTCA imaging appears to be paramount. Patients with a high BMI and especially with high heart rate receive a higher dose of radiation.

Relationship Between C-Reactive Protein and Obesity in Adults

body fatness (3). Raised body mass index (BMI) is a major risk factor for non-communicable diseases such as: CVD (mainly heart disease and stroke), which were the lead- ing cause of death in 2012. In 2014, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 600 million were obese. Overall, about 13% of the world's adult populations (11% of men and 15% of women) were obese. In 2014, 39% of adults aged 18 years and over (38% of men and 40% of women) were overweight. The world- wide prevalence of obesity more than doubled between 1980 and 2014. In this cross-sectional study, A total of 260 adult healthy men and women that being agreed by the chan- cellor and research deputy of Islamic Azad University of Hamadan. BMI (weight/height 2 in kg/m 2 ) was calculated for each participant. Obesity is defined as BMI 30 kg/m 2 . Blood samples were collected into the tube. CRP mea- surements were performed in the laboratory. The serum was transferred into plastic tube. Plasma CRP levels were measured by means of a colorimetric competitive enzyme- linked immunosorbent assay (ELISA). The results showed that prevalence of overweigh was 42.4% and the relation- ship between overweigh and CRP was P = 0.006. Waist cir- cumference in excess of 89 cm in men was 12.7% and in women waist circumference in excess of 89 cm was 21%. The overall prevalence of general obesity was 16.9% and was closely linked to CRP. Subjects with elevated CRP had higher BMI, WC (Waist circumference). For elevated CRP, subjects in the highest BMI quartile had compared with subjects in the lowest BMI quartile. The result shows the re- lationship of CRP with BMI throughout the BMI spectrum (P = 0.0002). CRP levels were strongly correlated with BMI (P = 0.0002). Levels of CRP also increased steadily across WC quartiles (P = 0.0001). Waist circumference quartiles were also strongly associated with odds of elevated CRP. Men in the highest WC (91 cm) and women in the highest WC (89 cm) had an odd of elevated CRP of 5.24 (95% CI, 3.15 - 14.0). Consequently, WHO has the unique authority and the clear mandate to lead the development and implemen- tation of the global strategy for the prevention and control of non-communicable diseases and thereby to create a bet- ter environment for world health in 2020 and beyond.

Association between general and abdominal obesity with high blood pressure: difference between genders

ObjectiveTo assess the association between general and abdominal obesity with high blood pressure in adolescents of both genders from the public school system. MethodsThis was an epidemiological, descriptive, exploratory study, with a quantitative approach and local scope whose sample consisted of 481 high school students (aged 14–19), selected by using a random cluster sampling strategy. Blood pressure was measured through the use of automated monitor and was considered high when the pressure values were at or above the 95th percentile. The analyses were performed using the chi‐squared test and binary logistic regression. ResultsThe prevalence of high blood pressure was 6.4%, and it was higher among boys (9.0% vs. 4.7%, p<0.05). There was no significant difference between general (p=0.903) and abdominal obesity (p=0.157) when genders were compared. After adjusting for age, high blood pressure was associated with general (OR=6.4; p<0.001) and abdominal obesity (OR=7.0; p<0.001) only among boys, when comparing the fourth quartile with the first quartile of body mass index (≤18.6kg/m2vs. ≥23.5kg/m2) and waist circumference (≤69cm vs. ≥80.1cm). ConclusionIt was observed that general and abdominal obesity are associated with high blood pressure only in boys, regardless of age.

Higher Body Mass Index and Increased Prevalence of Paranasal Sinus Disease.

BackgroundWe hypothesized that higher body mass index (BMI) was associated with increased prevalence of paranasal sinus disease and examined the hypothesis in Japanese adults.MethodsThis was a cross-sectional study including 1350 Japanese adults aged 40 years or more who participated in a health check-up program focusing on brain diseases and metabolic syndrome. Participants were divided into quartiles of BMI levels. Paranasal sinus disease was confirmed by a head MRI scan. The association between BMI and paranasal sinus disease was examined using logistic regression analysis, which was adjusted for age, sex, waist:hip ratio, hemoglobin A1c, systolic blood pressure, smoking status, alcohol intake, and white blood cell count.ResultsOf the 1350 participants, 151 (11.2%) had paranasal sinus disease. In relation to those in the lowest quartile of BMI, the odds ratios of having the disease among those in the 2nd, 3rd, and 4th quartiles of BMI were 1.89 (95% confidence interval [CI], 1.03–3.48), 2.26 (95% CI, 1.20–4.23) and 2.26 (95% CI, 1.14–4.51), respectively. When BMI was analysed as a continuous variable, an increase of one unit in BMI was significantly associated with increased odds of having the disease, with an OR of 1.08 (95% CI, 1.01–1.16).ConclusionsThe present study suggests that patients with higher BMI are more likely to have paranasal sinus disease.

Mitochondrial Epigenetic Changes Link to Increased Diabetes Risk and Early-Stage Prediabetes Indicator.

Type 2 diabetes (T2D) is characterized by mitochondrial derangement and oxidative stress. With no known cure for T2D, it is critical to identify mitochondrial biomarkers for early diagnosis of prediabetes and disease prevention. Here we examined 87 participants on the diagnosis power of fasting glucose (FG) and hemoglobin A1c levels and investigated their interactions with mitochondrial DNA methylation. FG and A1c led to discordant diagnostic results irrespective of increased body mass index (BMI), underscoring the need of new biomarkers for prediabetes diagnosis. Mitochondrial DNA methylation levels were not correlated with late-stage (impaired FG or A1c) but significantly with early-stage (impaired insulin sensitivity) events. Quartiles of BMI suggested that mitochondrial DNA methylation increased drastically from Q1 (20 < BMI < 24.9, lean) to Q2 (30 < BMI < 34.9, obese), but marginally from Q2 to Q3 (35 < BMI < 39.9, severely obese) and from Q3 to Q4 (BMI > 40, morbidly obese). A significant change was also observed from Q1 to Q2 in HOMA insulin sensitivity but not in A1c or FG. Thus, mitochondrial epigenetic changes link to increased diabetes risk and the indicator of early-stage prediabetes. Further larger-scale studies to examine the potential of mitochondrial epigenetic marker in prediabetes diagnosis will be of critical importance for T2D prevention.

Reproductive outcomes in oocyte donation cycles are associated with donor BMI.

When adjusting for recipient BMI, is donor body mass index (BMI) associated with IVF outcomes in donor oocyte IVF cycles? Increasing oocyte donor BMI is associated with a reduction in clinical pregnancy and live birth rates. Increased BMI has been associated with suboptimal reproductive outcomes, particularly in assisted reproductive technology (ART) cycles. However, it remains unclear if this association implies an effect of BMI on oocyte quality and/or endometrial receptivity. A retrospective cohort study of two hundred and thirty five consecutive fresh donor oocyte IVF cycles from 1 January 2007 through 31 December 2013 at the Massachusetts General Hospital (MGH) Fertility Center. Analyses included a total of 202 oocyte donors and 235 total cycles. Following adjustments for recipient BMI, the relationship between donor BMI (categorized into quartiles) and IVF outcomes was assessed. In the entire (anonymous and known) donor population, a reduced odds of clinical pregnancy (P-trend = 0.046) and live birth (P-trend = 0.06) was observed with increasing BMI quartile. Compared with quartile 1 (BMI 17.8-21.1), odds ratio (OR) (95% CI) of clinical pregnancy was 0.9 (0.4-2.0), 0.5 (0.2-1.1) and 0.5 (0.2-1.1), and OR of live birth was 1.1 (0.5-2.6), 0.6 (0.3-1.2) and 0.6 (0.3-1.2) for quartiles 2 through 4 respectively. In anonymous donors only, the odds of clinical pregnancy (P-trend = 0.02) and live birth (P-trend = 0.03) also declined as BMI quartile increased. Compared with quartile 1 (BMI 17.8-21.1), odds ratio (OR) (95% CI) of clinical pregnancy was 0.7 (0.3-1.7), 0.5 (0.2-1.1) and 0.4 (0.1-0.9), and OR of live birth was 0.9 (0.4-2.2), 0.5 (0.3-1.2) and 0.4 (0.2-1.1) for quartiles 2 through 4 respectively. Limitations include the retrospective design, sample size and data from a single institution. Clinical application may not be limited to oocyte donors, though caution should be used prior to applying these principles to the general population. Data should not be interpreted to mean that all oocyte donors should be restricted to a BMI of less than 21.2 kg/m(2). Following adjustments for the respective BMI of the oocyte donor and recipient, this study demonstrates an association of preconception BMI with subsequent IVF outcomes. The observations of this study are consistent with prior animal studies, suggest a possible effect of BMI at the oocyte level prior to fertilization and implantation, and warrant further investigation. None.

Association between general and abdominal obesity with high blood pressure: difference between genders

ObjectiveTo assess the association between general and abdominal obesity with high blood pressure in adolescents of both genders from the public school system. MethodsThis was an epidemiological, descriptive, exploratory study, with a quantitative approach and local scope whose sample consisted of 481 high school students (aged 14–19), selected by using a random cluster sampling strategy. Blood pressure was measured through the use of automated monitor and was considered high when the pressure values were at or above the 95th percentile. The analyses were performed using the chi-squared test and binary logistic regression. ResultsThe prevalence of high blood pressure was 6.4%, and it was higher among boys (9.0% vs. 4.7%, p<0.05). There was no significant difference between general (p=0.903) and abdominal obesity (p=0.157) when genders were compared. After adjusting for age, high blood pressure was associated with general (OR=6.4; p<0.001) and abdominal obesity (OR=7.0; p<0.001) only among boys, when comparing the fourth quartile with the first quartile of body mass index (≤18.6kg/m2vs. ≥23.5kg/m2) and waist circumference (≤69cm vs. ≥80.1cm). ConclusionIt was observed that general and abdominal obesity are associated with high blood pressure only in boys, regardless of age.

Association between obesity measures and albuminuria: A population-based study

AimsThe effects of obesity on the micro vascular diseases have drawn much attention. The aim of the study was to investigate the relationship between obesity measures and albuminuria in Chinese population. MethodsWe conducted a population-based cross-sectional study in 8600 subjects aged 40years or older from a community in Guangzhou. Urinary albumin excretion and creatinine were measured and urinary albumin-to-creatinine ratio (ACR) was calculated as urinary albumin divided by creatinine. Low-grade albuminuria was classified as the highest quartile of ACR in participants without increased urinary albumin excretion. Increased urinary albumin excretion was defined according to the ACR ranges greater or equal than 30mg/g. ResultsPearson’s correlation analysis and multivariate linear regression analysis revealed that body mass index (BMI), waist circumference and body fat content were significantly correlated with ACR (all P<0.01). Prevalence of low-grade albuminuria and increased urinary albumin excretion gradually increased across the BMI, waist circumference and body fat content quartiles (all P for trend<0.0001). Compared with participants in quartile 1 of BMI, waist circumference and body fat content, participants in quartile 4 had increased prevalence of low-grade albuminuria and increased urinary albumin excretion in logistic regression analysis after adjustment for age, sex, physical activity, fasting plasma glucose, triglycerides, low-density lipoprotein cholesterol and HbA1c (all P<0.05). ConclusionObesity measures are associated with urinary albumin excretion in middle-aged and elderly Chinese.

Obesity-associated hypertension is ameliorated in patients with TLR4 single nucleotide polymorphism (SNP) rs4986790.

BackgroundObesity is strongly associated with hypertension. Despite numerous mechanistic links the association is not fully understood. Western diet increases uptake of Toll-Like receptor 4 (TLR4) ligands such as free fatty acids or endotoxin. We recently demonstrated that TLR4 ligands are involved in the development of hypertension. We hypothesized that TLR4 ligands are involved in obesity-associated hypertension and investigated the TLR4 single nucleotide polymorphism (SNP rs 498790). This SNP is frequent, associated with cardiovascular disease and characterized by blunted response upon exposure to TLR4 ligands.MethodsWe investigated 3657 patients undergoing coronary angiography. Blood pressure was determined in standardized manner prior angiography. The diagnosis of hypertension was based on record data. Patients were characterized for TLR4 single nucleotide polymorphism (SNP) rs4986790. Patients were stratified according to quartiles of Body mass index (BMI) and according to the polymorphism. The association between the TLR4 polymorphism and blood pressure in obese patients (BMI > 30 kg/m2) was investigated by multivariate regression analysis.ResultsOut of 3657 patients 3017 patients fulfilled inclusion criteria. In the whole cohort a significant increase of SBP, pulse pressure and diagnosis of hypertension was observed across BMI quartiles. By contrast, no significant increase of SBP, pulse pressure or diagnosis of hypertension was observed in the 319 cases with TLR4 SNP rs4986790 across BMI quartiles. These obese cases had significantly lower SBP, lower pulse pressure (7.0 and 7.6 mmHg) and less diagnosis of hypertension as controls. In obesity the TLR4 SNP rs4986790 was an independent predictor of SBP.ConclusionSystolic blood pressure increase with obesity was blunted in cases with TLR4 SNP rs4986790.

Accumulation of epicardial adipose tissue increases coronary morbidity in non-obese patients with suspected coronary artery disease

BackgroundWe explored the relationship between epicardial adipose tissue (EAT) volume, body mass index (BMI) and the incidence of major coronary events in non-obese patients with suspected coronary artery disease (CAD). MethodsWe measured EAT volume in a cohort of 722 patients who had undergone coronary computed tomography, and recorded subsequent occurrences of major coronary events (cardiac death and acute coronary syndrome), simultaneously evaluating all coronary events and all-cause death. ResultsEighteen patients experienced major coronary events: there were five cardiac deaths and 13 cases of acute coronary syndrome. BMI was inversely predictive of major coronary events (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.63–0.87; p<0.001), but not for all-cause death. EAT volume predicted all coronary events (HR per 10mL, 1.11; 95% CI, 1.03–1.19; p=0.003). Although there was a trend suggestive of an inverse association with major coronary events, this was not statistically significant (HR per 10mL, 1.10; 95% CI; 1.00–1.21; p=0.059), and there was no significant relationship with all-cause death. When stratified by the first quartile (QI) of BMI (≤21.4kg/m2) and median EAT volume (107mL), the event rates in the high EAT volume and BMI QI group were significantly higher than those of other groups (adjusted HR, 5.45; 95% CI, 1.51–25.3 p=0.009, compared with the low EAT volume and BMI QI group). ConclusionOur findings suggest that suspected CAD patients with low BMI but high EAT volume are at an increased risk of major coronary events, but not all-cause death.

Joint effects of serum uric acid and body mass index on risk of prehypertension in Chinese population

BackgroundThere are few data available on the association between serum uric acid (UA) and prehypertension when hypertension prevention efforts may be applicable. MethodsWe performed a cross-sectional study to evaluate risk of prehypertension and its association with serum UA and other confounding factors. Levels of serum UA, blood pressure, body mass index (BMI) and some related factors were detected. ResultsParticipants with prehypertension had higher levels of serum UA and BMI. Compared to those with normotension, the multivariate-adjusted odds ratios [ORs, 95% confidence interval (CI)] for men with prehypertension were 1.33 (95% CI, 1.08–3.91) of serum UA and 1.21 (95% CI, 1.17–1.29) of BMI. In women, the ORs were 1.96 (95% CI, 1.21–3.46) and 1.28 (95% CI, 1.14–2.46), respectively. Increasing serum UA and BMI were associated with increased risk of prehypertension. Compared with the lowest quartiles, the highest serum UA and BMI quartiles entailed >4.4 times greater risk of prehypertension. In sex-specific analysis, OR was 2.41 (95% CI, 1.55–3.75) for men and 7.37 (95% CI, 4.16–13.0) for women. ConclusionsBoth high serum UA and high BMI are associated with risk of prehypertension. Individuals with higher serum UA and BMI simultaneously have a higher risk for prehypertension, especially for women.

Prevalence of non-responsiveness to an indigenous recombinant hepatitis B vaccine: A study among South Indian health care workers in a tertiary hospital

Background and Aim: Health care workers (HCW) are at higher risk of contracting HBV infection. Non-response to HBV vaccine is one of the major impediments to prevent healthcare associated HBV infection (HAHI). We estimated the prevalence of non-responsiveness to initial 3-dose regimen of an indigenous recombinant HBV vaccine (GeneVac-B) among South Indian HCWs and typed the HLA in non-responders. Study Design and Method: Of the 778 subjects screened over 1 year, 454 completed all three doses of the hepatitis B vaccination. Anti-HBs titers were estimated by microparticle enzyme immunoassay AxSYM AUSAB, (Abbott, Germany). HLA typing was done using SSP-PCR assay AllSet+™ Gold SSP (Invitrogen, USA). Results: The overall seroconversion rate (anti-HBs > 10 mIU/mL) was 98.89% wherein 90.8% had titers >1000mIU/mL, 7.6% had titers 100–1000mIU/mL, 0.43% had titers < 100 mIU/mL and 1.1% were non-responsive (<10 mIU/mL) to the initial 3-dose regimen. Antibody titers <1000 mIU/mL were significantly associated with the highest quartile of body mass index (BMI) (P < 0.001). We found no significant difference in seroprotection rate between gender (P = 0.088). There was no difference in seroprotection rates among various ethnic groups (P = 0.62). Subjects who were non-responsive in our study had at least one HLA allele earlier known to be associated with non-responsiveness to the vaccine. Conclusion: Our findings suggest that non-response to HBV vaccine is not a major impediment to prevent HAHI. Robust seroprotection rates can be achieved using this indigenous HBV vaccine. However, gender and BMI might influence the level of anti-HBs titers. We recommend the use of this cost effective HBV vaccine as well as postvaccination anti-HBs testing to prevent HAHI among HCWs.