BMI Range Research Articles

Effect of pregnancy and childbirth on perineal musculature in women with obesity. A longitudinal cohort study

ObjectiveEvaluating the changes of the perineal muscles in primigravid women with obesity (BMI ≥ 30) and to compare the progress with primigravid women in normal BMI range. MethodsA prospective longitudinal cohort study was carried out. The pregnant women were studied at three moments: at 12 weeks' gestation, at 34 weeks' gestation and at 12 weeks after delivery. During the ckeck-up, perinometric measurements were taken to determine basal tone (BT), maximum contractile force (FMax) and applied forced (AF). In addition, the Oxford test (MOS) was used. General statistical mixed models were used for the statistical study. ResultsFifty nulliparous pregnant women (25 with BMI ≥ 30 and 25 with BMI < 25) were recruited at the beginning of the study and 39 completed the entire study. Basal tone (BT) was 4.62 ± 0.24 Nw at the beginning of pregnancy and decreased to 4.18 ± 0.26 Nw after delivery. Contractile capacity was 5.56 ± 0.79 Nw at week 12 and increased to 6.34 ± 1.24 Nw after delivery. When comparing the FCMax at week 12 in obese VS normal weight pregnant women, values of 5.51 ± 87 Nw vs. 5.61 ± 0.71 Nw were observed (P = .941). Postpartum values were 6.72 ± 1.17 Nw vs 5.95 ± 1.21 Nw (P = .024), higher in the obese population. ConclusionsThere is an increase in contractile strength (Fmax) at 12 weeks postpartum in order to counteract the significant decrease in basal tone (BT). The body has compensatory mechanisms that allow recovery after 3 months postpartum, with greater muscle strength in obese patients.

OR07-02 Single-nucleus RNA-seq Studies In Human White Adipose Tissue Reveal Novel Adipocyte Subtypes And TSHZ3 As A Transcriptional Regulator Of Adipogenesis

Abstract Disclosure: V. Efthymiou: None. S.D. Kodani: None. A. Gupta: None. F. Shamsi: None. W. Ali: None. L. Poulos: None. A. Streets: None. Y. Tseng: None. M. Patti: Consulting Fee; Self; AstraZeneca, MBX-Biosciences, Hanmi Pharmaceutical. Other; Self; DSMB: Fractyl Health, Inc. Background and aim: White adipose tissue (WAT) is characterized by substantial functional and cellular heterogeneity, which may contribute to depot-dependent differences in risk for type 2 diabetes (T2D). Methods: We isolated nuclei from human subcutaneous (SAT) and intraabdominal (IAT) adipose biopsies obtained during abdominal surgery for single-nucleus RNA sequencing (snucRNA-seq), and applied scVI and VISION to integrate and analyze data. Additionally, we used siRNA-mediated knockdown to validate candidate transcriptional regulators in human adipogenic progenitor cells. Results: We analyzed the transcriptome of 117,717 high-quality nuclei from 22 biopsies (10 SAT, 12 IAT, 3 paired from same subject) obtained from 16 females and 3 males, with or without T2D, with BMI 45.4±10.3 kg/m2 (range 23.6-60.9). Both SAT and IAT depots had substantial cellular heterogeneity with 17 distinct clusters of adipose and non-adipose cell types. Distinct clusters of adipocytes were distinguished by high vs. low adiponectin expression (ADIPOQhi vs. ADIPOQlo). Adipose samples from males and participants with T2D had a higher proportion of ADIPOQlo adipocytes. ADIPOQlo adipocytes have distinct expression patterns, including upregulation of transcriptional regulators NR4A1 and ATF3, previously linked to adipose metabolic dysfunction.We utilized CheA3 analyses to identify transcription factors predicted to regulate genes differentially expressed between ADIPOQlo vs. ADIPOQhi. Among upstream regulators of ADIPOQlo gene expression was TSHZ3, a zinc-finger transcription factor previously linked to developmental processes. In our dataset, TSHZ3 is expressed in adipogenic progenitors and is downregulated during differentiation ex vivo. To test the role of TSHZ3 in adipogenic differentiation, we performed siRNA-mediated knockdown in a human subcutaneous white adipogenic progenitor cell line. TSHZ3 knockdown dramatically reduced adipogenesis vs. scrambled control, with reduction in lipid droplets and significant downregulation of adiponectin, leptin, CIDEA, AP2, FAS, PPARγ, and PGC1α. This effect was partially rescued by the PPARγ agonist rosiglitazone. Conclusion and perspectives: Our single-nucleus analysis reveals two distinct subtypes of mature adipocytes: ADIPOQhi vs. ADIPOQlo. We identify TSHZ3 as a key transcriptional regulator of adipogenesis which may contribute to differences in expression phenotypes between these populations. Overall, integrative bioinformatics analysis reveals distinct transcriptomic signatures between depots, between clusters, and across a range of BMI, that may be promising targets for understanding mechanisms by which specific adipose-resident cell populations mediate metabolic risk. Presentation: Thursday, June 15, 2023

Multimorbidity and complex multimorbidity in Brazilians with severe obesity

To investigate the prevalence of multimorbidity and complex multimorbidity and their association with sociodemographic and health variables in individuals with severe obesity. This is a baseline data analysis of 150 individuals with severe obesity (body mass index ≥ 35.0 kg/m2) aged 18–65 years. The outcomes were multimorbidity and complex multimorbidity. Sociodemographic, lifestyle, anthropometric and self-perceived health data were collected. Poisson multiple regression was conducted to identify multimorbidity risk factors. The frequency of two or more morbidities was 90.7%, three or more morbidities was 76.7%, and complex multimorbidity was 72.0%. Living with four or more household residents was associated with ≥ 3 morbidities and complex multimorbidity. Fair and very poor self-perceived health was associated with ≥ 2 morbidities, ≥ 3 morbidities and complex multimorbidity. A higher BMI range (45.0–65.0 kg/m2) was associated with ≥ 2 morbidities and ≥ 3 morbidities. Anxiety (82.7%), varicose veins of lower limbs (58.7%), hypertension (56.0%) were the most frequent morbidities, as well as the pairs and triads including them. The prevalence of multimorbidity and complex multimorbidity in individuals with severe obesity was higher and the risk for multimorbidity and complex multimorbidity increased in individuals living in households of four or more residents, with fair or poor/very poor self-perceived health and with a higher BMI.

Glycated serum proteins and albumin but not glycated albumin show negative correlation with BMI in an overweight/obese, diabetic population from the United States

Background and aimsMultiple previously published studies have shown a weak to medium, negative correlation between BMI and glycated albumin (GA). However, many of these studies were in populations with a narrow range of BMI. It is unknown whether this trend exists if a wider BMI range is used. This is an important question for proper interpretation of GA levels in obese populations.Materials and methods:A retrospective analysis of clinical trial data (NCT02519309) was performed. After appropriate exclusions, 334 subjects remained. These included 73.7% with type 2 diabetes (T2D) diagnosis and 26.3% with prediabetes. BMI ranged from 24.8–86.9 kg/m2. Laboratory data were measured in a CLIA-certified laboratory using commercially available, automated methods.Results:No significant, negative correlation was seen between GA and BMI. However, individual components (glycated serum proteins and albumin) as well as the GA/HbA1c ratio show a weak, negative correlation with BMI for all subjects and those with T2D. The strongest negative correlation was with albumin. Examination by traditional BMI subgroups also showed statistically significant differences for those with T2D, but not for the prediabetic cohort. Correlations between BMI and C-reactive protein were similar in those with diabetes and prediabetes; however, correlation between BMI and insulin was stronger in those with diabetes.Conclusion:Negative correlations between BMI and albumin or BMI and glycated serum proteins persist in diabetic populations that are obese and overweight, even when a statistically significant negative correlation is not observed between BMI and GA. Inflammation or insulin-mediated changes in protein synthesis could be contributors to these negative correlations, but BMI-related changes to the glomerulus could also affect clearance of albumin or glycated proteins and should be examined.

47 Awareness of Obesity and Morbid Obesity Amongst General Population: A Pilot, Cross-Sectional Survey Study

Abstract Aim The aim of this study is to ascertain level of awareness regarding morbid obesity (MO) in patients visiting a GP surgery. Method A seven-question survey was created to assess population awareness of obesity. The questions assessed participant awareness of the BMI definition, causes, management, and co-concomitant diseases related to obesity. The participants were recruited on a voluntary basis at a GP surgery in Manchester. Results A total of 226 participants completed the obesity awareness survey. 73.1% of respondents reported that they were aware of obesity being a disease. However, only 59.29% felt that they knew the difference between obesity and MO. The correct BMI range defining obesity was selected by 28.34% of respondents. Majority of the respondents chose “multifactorial” (44.69%) as the cause of obesity, followed by overeating (34.07%), lack of exercise (27.43%), and hormonal imbalance (5.31%). 59.29% felt that MO should be treated aggressively with majority selecting a combined treatment approach (Surgical + Medical + Lifestyle changes) (54.87%). Diabetes (86.73%), depression (73.45%), obstructive sleep apnea (54.52%), and chronic obstructive pulmonary disease (54.54%) were selected most commonly as diseases-related to MO. Only 38.94% and 36.73% thought that reflux disease and hypertension were related to MO, respectively. Interestingly, only 0.88% picked all four MO-related diseases accurately, while 35.40% picked at least three diseases correctly. Conclusions Obesity awareness in the general population appears to be suboptimal. There is a need to introduce appropriate interventions to improve the knowledge of public regarding obesity with the view of reducing the prevalence of obesity and subsequently related healthcare costs.

Association between oocyte donors’ or recipients’ body mass index and clinical outcomes after first single blastocyst transfers—the uterus is the most affected

ObjectiveTo assess if high BMI in either oocyte donors or recipients is associated with poorer outcomes after first single blastocyst transfers. DesignRetrospective study including 1394 first blastocyst single embryo transfers (SETs) conducted by 1394 recipients during oocyte donation cycles with the gametes retrieved from 1394 women (Jan2019-July2021). Four BMI clusters were defined for both donors and recipients (underweight: <18.5; normal weight: 18.5-24.9; over-weight: 25-29.9; obese: ≥30). Subjects1394 recipients, 42.4±4.0 years old and with a BMI 23.2±3.8, and 1394 donors, 26.1±4.2 years old and with a BMI 21.9±2.5. InterventionAll oocytes were vitrified at two egg banks and warmed at eight IVF clinics part of the same network. ICSI, blastocyst culture and either fresh or vitrified-warmed SETs were conducted. Putative confounders were investigated, and the data adjusted through regression analyses. Main outcome measuresThe primary outcome was the live birth rate (LBR) per SET according to donors’ and/or recipients’ BMI. The main secondary outcome was the miscarriage rate (<22nd gestational weeks) per clinical pregnancy. ResultsThe LBR per blastocyst SET showed no significant association with donors’ BMI. Regarding recipients’ BMI, instead, the multivariate-OR was significant in obese versus normal weight recipients (0.58, 95%CI 0.37-0.91, p=0.019). The miscarriage rate per clinical pregnancy was also significantly associated with recipients’ obesity with a multivariate-OR of 2.31 (95%CI 1.18-4.51, p=0.014) versus normal weight patients. A Generalized Additive Model (GAM) method was used to represent the relationship between predicted LBR or miscarriage rates with donors’ or recipients’ BMI; it pictured a scenario where the former outcome moderately but continuously decreases with increasing recipients’ BMI to then sharply decline in the BMI range 25-35. The miscarriage rate, instead, increases almost linearly with respect to both donors’ and recipients’ increasing BMI. ConclusionObesity mostly effects the uterus, especially due to higher miscarriage rates. Yet, poorer outcomes can be appreciated already with a BMI of 25 in both oocyte donors and recipients. Finer markers of nutritional homeostasis are therefore desirable, recipients should be counselled about poorer expected outcomes in case of overweight/obesity, and oocyte banks should avoid assigning oocytes from overweight donors to overweight/obese recipients.

Pregnancy Outcomes of Assisted Reproductive Technology (ART) Cycle Complicated by Ovarian Hyperstimulation Syndrome (OHSS): Case Series Study.

Ovarian hyperstimulation syndrome (OHSS) is a frequent, potentially lethal side effect of assisted reproductive technology (ART), distinguished by symptoms such as ovarian enlargement, ascites, and pleural effusion. This study is designed to study the effect of assisted reproductive technology (ART) cycle complicated by OHSS on pregnancy outcomes. A case series study at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia, was executed to examine the pregnancy outcomes in in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles. Fifteen patients were admitted to the IVF unit between January 2015 and December 2021. Data were retrieved from patients' medical records, and descriptive statistical methods were employed to analyze participants' data. The study assessed pregnancy outcomes for 15 female participants (mean age=31.1 years, SD=3.46) with a BMI range of 20-40 (mean BMI=29.6, SD=6.4), of whom 33.3% were classified as obese. The primary factor of infertility was anovulation (66.7%), followed by male factors (20%). About 26.7% of those affected by OHSS had moderate OHSS, and 73.3% had severe OHSS, with 100% of those with severe OHSS having undergone three embryo transfers. None of the participants developed gestational diabetes mellitus (DM), but one participant had high blood sugar levels (6.67% of total participants), with a mean glucose of 6.3±2.0. There were no instances of preeclampsia, gestational hypertension, abnormal placentas, or congenital abnormalities in newborns among the participants. Preterm deliveries were common, with 33.3% delivering between 32 and 37 weeks, 6.7% before 28 weeks, and 33.3% within 28-32 weeks. Overall, 73.3% of the participants experienced pregnancy, and the birth mode was almost evenly split between vaginal and cesarean birth. In conclusion, this research provides an exploration into the outcomes of pregnancies in women undergoing assisted reproductive technology treatments complicated by ovarian hyperstimulation syndrome. It shows anovulation as a prevalent cause of infertility and a noteworthy incidence of severe OHSS. Despite these challenges, a significant number of women were able to experience pregnancy, although preterm deliveries and abortions were common. The delivery methods were fairly balanced between vaginal birth and cesarean section. These findings underscore the necessity for more effective strategies to manage OHSS and improve pregnancy outcomes in ART procedures.

Lipid Peroxidation as a Possible Factor Affecting Bone Resorption in Obese Subjects-Preliminary Research.

Oxidative stress, which promotes bone catabolism, also affects the quality of bone tissue. We aimed to assess the impact of metabolic disorders and oxidant-antioxidant imbalance associated with primary obesity on bone resorption and formation processes. Anthropometric parameters, metabolic variables, oxidative stress indicators (malondialdehyde, vitamins A and E, uric acid, superoxide dismutase, catalase, glutathione peroxidase, type 1 paraoxonase, iron-reducing plasma antioxidant power) and markers of bone turnover (type I procollagen N-terminal propeptide and the type I collagen C-terminal cross-linked telopeptide; P1NP and CTX) were assessed in 108 Polish participants. Under the influence of oxidative stress, both enzymatic and non-enzymatic defense mechanisms were stimulated in obese subjects, especially in women, who had increased lipid peroxidation and activity of catalase (particularly in first-degree obesity) and decreased vitamin E concentration. The process of lipid peroxidation, as well as the weakening of the bone formation, was strongly manifested in women at a BMI range of 35.0-39.9 kg/m2 but not at BMI > 40.0 kg/m2, but it had a comprehensive negative impact on bone turnover in obese men. Obesity and its degree of advancement significantly affected the decrease in the concentration of the marker of bone formation-P1NP-only in the plasma of women. Excessive body weight had no effect on the value of the bone resorption marker in plasma, regardless of gender. Our results confirm the existence of the "obesity paradox" in the aspect of bone tissue metabolism and suggest that a specific body weight threshold changed the molecular response of the tissue.

Acylated- and unacylated ghrelin during an oral glucose tolerance test in humans at risk for type 2 diabetes mellitus

Background/ObjectivesThe orexigenic peptide hormone ghrelin has been implicated in the pathophysiology of obesity and type 2 diabetes mellitus through its effects on nutrient homeostasis. Ghrelin is subject to a unique post-translational acyl modification regulating its biochemical activity.Subjects/MethodsIn this study we aimed to investigate the relation of acylated (AcG) as well as unacylated ghrelin (UnG) with body weight and insulin resistance in the fasting (n = 545) and post-oral glucose tolerance test (oGTT) state (n = 245) in a metabolically well characterized cohort covering a broad range of BMI (17.95 kg/m²–76.25 kg/m²).ResultsFasting AcG (median 94.2 pg/ml) and UnG (median 175.3 pg/ml) were negatively and the AcG/UnG ratio was positively correlated with BMI (all p < 0.0001). Insulin sensitivity (ISI) correlated positively with AcG (p = 0.0014) and UnG (p = 0.0004) but not with the AcG/UnG ratio. In a multivariate analysis, including ISI and BMI, only BMI, but not ISI was independently associated with AcG and UnG concentrations. Significant changes of AcG and UnG concentrations were detectable after oGTT stimulation, with slight decreases after 30 min and increases after 90–120 min. Subject stratification into BMI-divergent groups revealed more pronounced AcG increases in the two groups with BMI < 40 kg/m².ConclusionOur data demonstrate lower concentrations for both AcG and UnG with increasing BMI as well as an increased proportion of the biologically active, acylated form of ghrelin giving point to pharmacologic intervention in ghrelin acylation and/or increase in UnG for treatment of obesity despite decreased absolute AcG levels.

Body mass index and all-cause mortality in a 21st century U.S. population: A National Health Interview Survey analysis.

Much of the data on BMI-mortality associations stem from 20th century U.S. cohorts. The purpose of this study was to determine the association between BMI and mortality in a contemporary, nationally representative, 21st century, U.S. adult population. This was a retrospective cohort study of U.S. adults from the 1999-2018 National Health Interview Study (NHIS), linked to the National Death Index (NDI) through December 31st, 2019. BMI was calculated using self-reported height & weight and categorized into 9 groups. We estimated risk of all-cause mortality using multivariable Cox proportional hazards regression, adjusting for covariates, accounting for the survey design, and performing subgroup analyses to reduce analytic bias. The study sample included 554,332 adults (mean age 46 years [SD 15], 50% female, 69% non-Hispanic White). Over a median follow-up of 9 years (IQR 5-14) and maximum follow-up of 20 years, there were 75,807 deaths. The risk of all-cause mortality was similar across a wide range of BMI categories: compared to BMI of 22.5-24.9 kg/m2, the adjusted HR was 0.95 [95% CI 0.92, 0.98] for BMI of 25.0-27.4 and 0.93 [0.90, 0.96] for BMI of 27.5-29.9. These results persisted after restriction to healthy never-smokers and exclusion of subjects who died within the first two years of follow-up. A 21-108% increased mortality risk was seen for BMI ≥30. Older adults showed no significant increase in mortality between BMI of 22.5 and 34.9, while in younger adults this lack of increase was limited to the BMI range of 22.5 to 27.4. The risk of all-cause mortality was elevated by 21-108% among participants with BMI ≥30. BMI may not necessarily increase mortality independently of other risk factors in adults, especially older adults, with overweight BMI. Further studies incorporating weight history, body composition, and morbidity outcomes are needed to fully characterize BMI-mortality associations.

Is High Body Mass Index Protective or Detrimental in Surgical Fixation of Hip Fractures?: A Spline Regression Analysis of 22,388 Patients.

We aimed to characterize the association between BMI as a continuous variable and 30-day postoperative outcomes following hip fracture surgery through:1)30-day readmission and reoperation; 2)local wound-related; and 3)systemic complications. The National Surgical Quality Improvement Program(NSQIP) database(January 2016-December,2019) was queried for patients undergoing hip fracture ORIF. Baseline patient demographics, comorbidities, and patient outcomes were recorded. Multivariable regression models accounted for baseline demographics, comorbidities, and fracture patterns. Significant associations were analyzed using spline regression models to evaluate the continuous association between BMI and the aforementioned outcomes. Spline models demonstrated a U-shaped curve for the odds of 30-day readmission and 30-day reoperation with nadirs at the BMI of 27.5Kg/m2 and 22.0Kg/m2. The odd ratios of superficial infection, deep infection, any wound complication, and inability to weight bear on POD 1 rose progressively starting at a BMI of 25.6Kg/m2, 35.5Kg/m2, 25.6Kg/m2, and 32.7Kg/m2 respectively. Odds of 30-day mortality, transfusion, pneumonia, and delirium were greatest at the lowest recorded BMI (11.9Kg/m2). BMI has a U-shaped association with 30-day readmission and reoperation. Conversely, the highest risk of mortality and systemic complications (transfusion, pneumonia, and delirium) were within the lower BMI range, with diminishing risk as BMI increased. Local wound complications and systemic sepsis exhibited a third unique pattern with progressive rise in odds as BMI increased. The odds of any-complications demonstrated a U-shaped pattern with a nadir in the overweight to obese I categories, suggesting patients may be at lowest risk within this range. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Exploring Obesity and Associated Health Conditions among Doctors in Khulna City

Background: Obesity is a global health concern with increasing prevalence and adverse health implications. While healthcare professionals play a critical role in promoting health and well-being, doctors themselves may be susceptible to obesity and its associated health conditions. Objectives: This study employed a cross-sectional design to collect data on obesity and associated health conditions among doctors in Khulna City. Methods: The study targeted doctors practicing at Khulna Medical College. A random sampling method will be employed to ensure representation. Data were collected from 110 doctors through a combination of self-report measures, BMI, and medical records review. Participants' age, gender, and years of medical practice including personal habits were recorded using a structured questionnaire through face-to-face interviews. Results: in the total sample of 110 respondents, there were 62 males (56.36%) and 48 females (43.64%). Mean age 40.25 and SD±7.9. In the "No smoker" category, there were 8 male respondents, accounting for 7.27% of the total, and 48 female respondents, representing 43.64% of the total. In the BMI range of 18.5-24.9, there were 34 respondents (30.91% of the total). Out of these, 23 were male (20.91% of the total) and 11 were female (10% of the total). Conclusion: By addressing the issue of obesity among doctors, it can contribute to their health, enhance their professional capacity, and ultimately improve healthcare outcomes.

Comparison and effect of plain and calcium fortified yogurt on glycemic responses, anthropometrics and metabolic biomarkers

Metabolic syndromes including obesity and diabetes are the most common health issues due to insulin resistance, disturbance in glucose homeostasis, lack of exercise, and improper diet. The current study was planned to evaluate the potential effects of regular diet with fortified yogurt on blood glycemia and anthropometric responses. Plain yogurt was procured from the local market, and then it was fortified with calcium. Furthermore, the subsequent effect of fortified yogurt on blood glucose, insulin, and anthropometric measurements was assessed at different time intervals. A total of 40 healthy females and males aged about 20 years with a normal BMI range (20–24.9 kg/m2) were recruited within the Government College University Faisalabad. Participants filled out the habits Performa, stress factors questionnaire, and activity questionnaire. Blood glucose (BG) and visual analogous scale (VAS) performs were also taken in the fasting stage and then assigned treatment was given. After 15, 30, 45, 60, 90, and 120 min intervals VAS and BG estimation was carried out. The results shows that fortified yogurt contained a higher amount of calcium. Likewise, a similar trend was observed for the desire to eat, a feeling of fullness, palatability, physical comfort, and overall acceptability. The results obtained from various analyses were statistically evaluated.

Incidence of kinesiophobia in patients with osteoarthritis knee an observational cross-sectional study

Background: The effects of kinesiophobia on pain perception in osteoarthritis patients have remained elusive. The intension of this study is to assess psychometric aspect of pain, functional activity, and kinesophobia in patients with chronic osteoarthritic knee pain. Methods: The study was time bound observational cross-section study, including 50 patients. Kinesiophobia was assessed using Tampa scale of kinesiophobia (TSK-11), while physical function and pain are assessed using WOMAC and VAS scores. Patients were included as per inclusion criteria in the OPD in Department of Orthopedics, AIIMS, Rishikesh, India. Results: It was observed 64% of patients were females while 36% were males. 46% patients had BMI range of 18.5-24.9, while 26% had BMI &gt;=30, 20% had BMI between 25-29.9 and 8% of patients had BMI &lt;18.5. Mean BMI was 25.44±5.70 with minimum BMI of 14 and maximum BMI of 38. It was observed female patients mean WOMAC score was 44.44±19.41, while mean VAS score 4.25±1.05 and mean TSK-11was 33.34±12.57, male patients mean WOMAC score was 35.39±13.62 while mean VAS score was 4.39±0.92, mean TSK-11 was 35.78±14.52. It was observed that there was no substantial difference on basis of gender in all three parameters when compared. This study suggests, there was no significant association between Age and VAS score (p-value 0.017) with Pearson correlation of 0.335. Conclusions: Prospective therapies for kinesiophobia should attempt to reduce pain intensity and functionality improvement.

Meta-analysis and construction of simple-to-use nomograms for approximating testosterone levels gained from weight loss in obese men.

Obesity-induced hypogonadism, which manifests as erectile dysfunction and a lack of libido, is a less visible and under-recognized obesity-related disorder in men. We examined the impact of weight loss on total (TT) and free testosterone (FT) levels, and constructed nomograms to provide an easy-to-use visual aid for clinicians. Meta-analysis was conducted using RevMan (v5.3) and expressed in standardized mean differences (SMD) for testosterone. Parallel-scale nomograms were constructed from baseline and target body mass index values to estimate the gain in testosterone. In total, 44 studies were included, comprising 1,774 participants and 2,159 datasets, as some studies included several datasets at different time points. Weight loss was controlled by low calorie diet (LCD) in 19 studies (735 participants, 988 datasets), by bariatric surgery (BS) in 26 studies (1,039 participants, 1,171 datasets), and by both in one study. The median follow-up was 26weeks (interquartile range=12-52). The range of baseline mean age was 21-68yr, BMI: 26.2-71.2kg/m2 , TT: 7-20.2nmol/L and FT: 140-583pmol/L. TT levels increased after weight loss by LCD: SMD (95%CI)=2.5nmol/L (1.9-3.1) and by BS: SMD=7.2nmol/L (6.0-8.4); the combined TT gain was 4.8nmol/L (3.9-5.6). FT levels increased after weight reduction by LCD: SMD=19.9pmol/L (7.3-32.5) and by BS: SMD=58.0pmol/L (44.3-71.7); the combined gain was 42.2pmol/L (31.4-52.9). Greater amounts of total and free testosterone could be gained by weight loss in men with higher baseline BMI, or lower levels of SHBG, TT and FT, while gain in TT was relatively greater in older and FT in younger age. Age-stratified nomograms revealed that compared to older men (>40yr), younger men (≤40yr) gained less TT but more FT for a given weight loss. Both TT and FT levels increased after weight loss, relatively greater with higher baseline BMI, or lower levels of SHBG, TT and FT. Nomograms constructed from a large number of participants with a wide range of BMI and testosterone values provide an evidence-based and simple-to-use tool in clinical practice.

Port Site Infections after Elective Laparoscopic Cholecystectomy at a Tertiary Care Centre of Jharkhand: A Prospective Observational Study

Introduction: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic gallstone disease. However post-operative complications of elective laparoscopic cholecystectomy could not be ignored. Port site infection is one of the most common complications after laparoscopic surgeries. Materials and Methods: 251 Patients of both sexes with age group 23 to 65 years having symptomatic gall stone disease were studied. A prospective observational study was performed in the Department of General Surgery of Tata Main Hospital in collaboration with Manipal Tata Medical College, Jamshedpur, Jharkhand. The study was conducted from September 2022 to April 2023. Ethical clearance was obtained from the Institutional Ethics Committee and all relevant data were retrieved from hospital records. Routinely all the patients were given prophylactic broad spectrum antibiotics Ceftriaxone 1g stat by intravenous infusion at the of induction of an anaesthesia. Post-operatively all patient received ceftriaxone 1gm twice daily for 24. Metronidazole 500 mg added thrice daily intravenous infusion for 72 hours in case of spillage of bile or stone or pus and those with acute cholecystitis. All data were collected in preformed format and statistical analysis was done. Results: The mean age of studied patients group ranging from 23 to 65 years are 41.6 years. Majority (220/251, 87.64%) of the patients were female. Majority of the patients were in the BMI range of 18.5-40kg/m2 (47%). Spillage of bile and gall Stones, umbilical port approach, high BMI and surgery in acute phase are associated with high incidence of port site infection; such incidence of biliary spillage was reported with 20(7.96%) cases. Port Site Infection (PSI) was occurred in 13 patients (11 females and 2 males), which constituted 5.17% of the study population. Out of these cases, 1(7.6%) case was deep seated and rests 2 were superficial infection. Conclusion: Special consideration should be taken in chronic deep surgical site. Infection like port site persistent sinus. Most of the PSIs are superficial which got cured with regular dressing and more common in females.

New Drugs for Obesity, Is the Excitement Affordable?

New Drugs for Obesity, Is the Excitement Affordable?

Impact of Diet and Lifestyle Modification and Weight Reduction on Essential Hypertension

Objectives: This study was to assess the impact of diet and lifestyle modification with weight reduction on blood pressure in patients with essential hypertension and to impart awareness regarding the importance of dietary modifications, physical exercise, and weight reduction in controlling or reversing high blood pressure and prevention of end-organ damage. Methods: This was a prospective observational study among overweight or obese hypertensives. We included 60 consecutive patients, who after sticking to the diet and lifestyle advice achieved weight reduction. They all were overweight, or had a history of weight gain, and had hypertension, or were newly diagnosed to have persistent hypertension. They were motivated to achieve weight reduction and educated about healthy eating habits using diet charts and tips for lifestyle modifications. Sixty such consecutive subjects, without any secondary causes for hypertension, and who complied with the diet and lifestyle advised, and thus achieved weight reduction only were subjected to statistical analysis. Those who did not achieve weight reduction were not taken for analysis Results: 90 % of the subjects had their BMI above normal and the remaining 10% of subjects had an upper range of normal BMI, but all of them gave a history of weight gain. The majority of the subjects were having faulty dietary habits with increased carbohydrate intake as the primary reason for weight gain, besides having inadequate vegetables, fruits and protein intake, along with 15% consuming junk food on a daily basis. After lifestyle intervention, weight reduction was achieved in all the subjects studied, and there was a significant reduction in both systolic and diastolic blood pressures with the weight loss achieved, and it was statistically significant. The association of decrease in SBP with a decrease in weight was significant with a p-value of &lt;0.001. The mean initial systolic blood pressure was 154.13 mmHg (SD 13.31), and the follow up mean was 137.33 mmHg (SD 12.87). The mean decrease in SBP was 16.8mmHg, and the mean change in weight was 9.4 Kg. Most of the hypertensives had their drug number or dose decreased and some of them had their drugs stopped completely. Conclusions: Educating the subjects on balanced diet with restriction of carbohydrates with increased intake of vegetables, adequate fruits, ensuring adequate protein and adequate water intake was the key intervention. The results of the study strongly pointed towards the inevitable role diet, lifestyle and weight reduction had on the achievement of blood pressure control and even reversal of hypertension. Faulty dietary habits with excessive calorie intake, decreased vegetables and fruits, low physical activity and sedentary nature of work contributed to weight gain. Both systolic and diastolic BP decreased on weight reduction implying thereby weight gain as the primary cause for both. Awareness regarding the disease and its complications was very low. In addition, dietary malpractices were detected and halted, and this reinforced the positive results. It also had a favorable impact on the comorbidities they suffered from.

Deaths From Alcoholic and Diabetic Ketoacidosis at Autopsy-A Comparison Study.

Diabetes mellitus and alcoholism are common disorders that may result in sudden death. Ketoacidosis may occur in both conditions. Diagnosis is based on history, and post-mortem findings including biochemistry and toxicology. This study compares deaths from alcoholic and diabetic ketoacidosis from two centres with large autopsy workloads. In the study period 9332 deaths were autopsies with 151 deaths diagnosed as ketoacidosis (1.6%) with 82 (0.9 %) being diabetic ketoacidosis (DKA) and 48 (0.5%) alcoholic ketoacidosis (AKA) deaths. There were more male deaths in each group. The median age for DKA deaths was 51 years (range 19-79). The median age for AKA deaths was 55 years (range was 34-78). The BMI range in DKA deaths was 12.5 to 40.4 kg/m2, with a median of 21.9. The comparative figures for AKA deaths was a range of 11.3 - 38.3 with a median of 20.2. Acetone concentrations were statistically higher in diabetic compared with alcoholic deaths, mean of 33.7 mg/100 mL in DKA cases versus mean of 16.9 mg/100 mL in AKA cases. Both DKA and AKA deaths are seen more commonly in males than female and are typically people with low BMIs in their 50s.

Correlation of varying heights with cervical spondylosis.

Objective: To find correlation of varying heights with cervical spondylosis. Study Design: Case Control study. Setting: Department of Orthopedic and Radiology, Patel Hospital, Karachi. Period: June, 2019 to Dec, 2019. Material &amp; Methods: The personal, economical, and demographic features of the 88 cases and 88 controls were compared with the prevalence of cervical spondylosis. All subject’s heights were divided into four categories—short, average, tall and very tall and were correlated with cervical spondylosis as well as the various other characteristics stated above. The weight and height were calculated using the stadiometer and body weight and health scale Z-10, and lateral radiographs were taken using an Agfa Fuji Computerized radiography system. Results and Conclusion: The results showed that the average height individuals had more disease and were obese and it was also in direct relation with the increased working hours. The average height individuals i.e. height of (150-169cm) were prone for the disease and need to adopt measures to reduce the chances of the disease and choose healthy lifestyle for maintenance of healthy BMI range and consideration of good ergonomic tactics at office and moderate working hours.