Severe Obese Patients Research Articles

The effects of laparoscopic Roux-en-Y gastric bypass and one-anastomosis gastric bypass on glycemic control and remission of type 2 diabetes mellitus: study protocol for a multi-center randomized controlled trial (the DIABAR-trial)

BackgroundMetabolic surgery induces rapid remission of type 2 diabetes mellitus (T2DM). There is a paucity of high level evidence comparing the efficacy of the laparoscopic Roux-en-Y gastric bypass (RYGB) and the laparoscopic one-anastomosis gastric bypass (OAGB) in glycemic control. Also, the mechanisms that drive the conversion of T2DM in severe obese subjects to euglycemia are poorly understood.MethodsThe DIABAR-trial is an open, multi-center, randomized controlled clinical trial with 10 years follow-up which will be performed in 220 severely obese patients, diagnosed with T2DM and treated with glucose-lowering agents. Patients will be randomized in a 1:1 ratio to undergo RYGB or OAGB. The primary outcome is glycemic control at 12 months follow-up. Secondary outcome measures are diverse and include weight loss, surgical complications, psychologic status and quality of life, dietary behavior, gastrointestinal symptoms, repetitive bloodwork to identify changes over time, glucose tolerance and insulin sensitivity as measured by mixed meal tests, remission of T2DM, presence of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis in liver biopsy, oral and fecal microbiome, cardiovascular performance, composition of bile acids, and the tendency to develop gallstones.DiscussionThe DIABAR-trial is one of the few randomized controlled trials primarily aimed to evaluate the glycemic response after the RYGB and OAGB in severe obese patients diagnosed with T2DM. Secondary aims of the trial are to contribute to a deeper understanding of the mechanisms that drive the remission of T2DM in severe obese patients by identification of microbial, immunological, and metabolic markers for metabolic response and to compare complications and side effects of RYGB and OAGB.Trial registrationClinicalTrials.gov NCT03330756; date first registered: October 13, 2017.

Prevalence of Osteoporosis Assessed by DXA and/or CT in Severe Obese Patients.

The primary objective was to evaluate bone fragility prevalence on dual X-ray absorptiometry (DXA) and computed tomography (CT) in patients with severe obesity. The secondary objective was to evaluate the risk factors for bone fragility. This monocentric study was conducted in patients with grade 2 and 3 obesity. Bone mineral density (BMD) and T-score were studied on DXA, and the scanographic bone attenuation coefficient of L1 (SBAC-L1) was measured on CT. Among the 1386 patients included, 1013 had undergone both DXA and CT within less than 2 years. The mean age was 48.4 (±11.4) years, 77.6% were women, and the mean BMI was 45.6 (±6.7) kg/m². Eight patients (0.8%) had osteoporosis in at least one site. The mean SBAC-L1 was 192.3 (±52.4) HU; 163 patients (16.1%) were under the threshold of 145 HU. Older age (OR[CI95] = 1.1 [1.08–1.16]), lower BMD on the femoral neck and spine (OR[CI95] = 0.04[0.005–0.33] and OR[CI95] = 0.001[0.0001–0.008], respectively), and higher lean mass (OR[CI95] = 1.1 [1.03–1.13]) were significantly associated with an SBAC-L1 ≤ 145 HU in multivariate analysis. Approximately 16% of patients with severe obesity were under the SBAC-L1 threshold, while less than 1% were classified as osteoporotic on DXA.

Determining whether ethnic minorities with severe obesity face a disproportionate risk of serious disease and death from COVID-19: outcomes from a Southern California-based retrospective cohort study

ObjectiveObesity has been recognised as a risk factor for poor outcomes associated with COVID-19. Ethnic minorities with COVID-19 have been independently found to fare poorly. We aim to determine if...

Increased Risk of Cesarean Delivery in Severely Obese Patients Who Are Induced Electively or For Obese Status Alone [A212

INTRODUCTION: Prepregnancy obesity is reaching epidemic proportions in the United States. Maternal obesity alone is not an indication for induction of labor (IOL). Recent studies have shown that elective IOL >39 weeks does not increase cesarean delivery (CD) rates; however, patients with severe obesity (BMI >40) are not represented in many of these trials, creating a gap in our ability to provide patient-centered care. METHODS: A retrospective chart review of patients with BMI >40 between May 2016 and December 2020 at a single institution was conducted. Exclusion criteria included: scheduled CD, vaginal birth after cesarean delivery, repeat CD, multiple-gestation pregnancies, delivery <20 weeks, or intrauterine fetal demise. Demographic and other clinical features were analyzed using ANOVA and Fisher tests. The primary outcome was analyzed using linear and logistical regression models. RESULTS: There were 1,010 deliveries, of which 545 met study criteria. The median BMI was 43.9 (IQR, 41.8–48.5; range, 40.0–92.9). The groups by BMI classification were matched for age, gravida/para, and race. A total of 72.5% of patients were induced during this study period. Of patients who underwent IOL for obesity alone (n=99), 27% delivered via CD, versus 12% for patients who presented in spontaneous labor. Regression models showed significant association between increasing BMI and CD from BMI >40 to BMI 60. CONCLUSION: In patients with BMI >40 who undergo elective induction of labor, there is a significant increase in cesarean delivery rate as opposed to those who present in spontaneous labor.

Impact of body mass index on cryoablation of atrial fibrillation: Patient characteristics, procedural data, and long‐term outcomes

Ablation of atrial fibrillation in the context of obesity can be challenging. We sought to evaluate the role of cryoballoon pulmonary vein isolation (CB-PVI) in obese patients with symptomatic atrial fibrillation (AF). Patients with a BMI ≥ 25 kg/m2 and symptomatic AF who underwent CB-PVI were retrospectively enrolled. Three groups were defined (G1: BMI of 25-29 kg/m2 ; G2: BMI of 30-34 kg/m2 ; G3: BMI ≥ 35 kg/m2 ). 600 patients were included (59% male; 66 ± 11 years old); 337, 149, and 114 were assigned to G1, G2, and G3, respectively. Acute procedural success was recorded in 99.7% of patients. Procedural and fluoroscopy time were comparable but the radiation dose was significantly higher in G3. Procedural complications were 3% in G1, 5.4% in G2, and 8.8% in G3 (p = .01). The overall freedom from AF after 1-year was 77%. G3 had a significantly worse 1-year success rate compared to G1 and G2 (G3: 66.5% vs. G1: 78.4%; p = .015 and vs. G2: 82.5%; p = .008) with reduced 1-year success in paroxysmal AF (G1: 84.0%; G2: 86.3%; and G3: 69.6%) but not in persistent AF (G1: 68.7%; G2: 77.4%; and G3: 62.1%). G3 showed similar success rates irrespective of AF form (PAF: 69.6% vs. persAF 62.1%; p = .501). Cryoballoon ablation in obese patients can be effective with an acceptable safety profile, 77% of patients were in stable SR at 1 year. Severe obese patients (BMI ≥ 35) showed reduced procedural safety and 1-year success rate. In association with life style modification, CB ablation may represent a strategy to enhance rhythm control in the context of obesity.

The relationship between Lipocalin-2 level and hepatic steatosis in obese patients with NAFLD after bariatric surgery

BackgroundLipocalin-2 (LCN2) has a critical effect on obesity as well as its associated comorbidities. The present study focused on analyzing serum LCN2 levels of obese patients with nonalcoholic fatty liver disease (NAFLD) and on determining relationship of hepatic steatosis improvement with LCN2 levels after laparoscopic sleeve gastrectomy (LSG).MethodsThis work enrolled ninety patients with obesity and NAFLD. Twenty-three of them underwent LSG. Anthropometric and biochemical parameters and serum LCN2 levels were determined at baseline and those at 6-month post-LSG. Controlled attenuation parameter (CAP) measured by FibroScan was adopted for evaluating hepatic steatosis.ResultsAmong severe obesity patients, serum LCN2 levels were significantly increased (111.59 ± 51.16 ng/mL vs. 92.68 ± 32.68 ng/mL, P = 0.035). The CAP value was higher indicating higher liver fat content (360.51 ± 45.14 dB/m vs. 340.78 ± 45.02 dB/m, P = 0.044). With regard to surgical patients, liver function, glucose, and lipid levels were significantly improved after surgery. Serum LCN2 levels significantly decreased (119.74 ± 36.15 ng/mL vs. 87.38 ± 51.65 ng/mL, P = 0.001). Decreased CAP indicated a significant decrease in liver fat content (358.48 ± 46.13 dB/m vs. 260.83 ± 69.64 dB/m, P < 0.001). The decrease in LCN2 levels was significantly related to the reduced hepatic fat content and improvement in steatosis grade after adjusting for gender, age, and BMI decrease.ConclusionsSerum LCN2 levels are related to obesity and NAFLD. The decreased serum LCN2 levels could be an indicator of hepatic steatosis improvement.

Retrograde Intrarenal Surgery Is a Safe Procedure in Severe Obese Patients: Is It Reality or Prediction? A Propensity Score-Matching Analysis from RIRSearch Study Group

Objective: The aim of the study was to assess whether severely obese patients have an increased risk of complications during and after retrograde intrarenal surgery (RIRS). Materials and Methods: The data of 639 consecutive patients undergoing RIRS for the treatment of upper tract urinary stones were analyzed retrospectively. The patients were divided into two groups according to their body mass index numbers (Group 1, <35; Group 2, ≥35). The patients' demographics, stone characteristics, operative outcomes, and complication rates were compared between the groups. The primary objective was to examine whether the intraoperative and postoperative complication rates were higher in patients with a body mass index of ≥35 kg/m2. Results: After matching of confounding factors, Group 1 comprised 135 patients, and Group 2 comprised 47 patients. The baseline characteristics were similar between the groups. There were no significant differences between groups for intraoperative complication rates (11.8% and 12.8%, respectively; p = 0.97). There was statistically significant difference in favor of Group 2 for postoperative complication rates (12.6% and 29.7%; respectively, p < 0.01), overall complication rates (22.9% and 38.2%; respectively, p = 0.02), mean operation time (56.15 vs 66.45 minutes; respectively, p = 0.01), and length of stay (1.4 vs 2.1 days; p = 0.03). Stone-free rates (75.5% vs 85.1%; respectively, p = 0.17) did not differ between groups. Conclusions: RIRS is an efficient and feasible treatment option for upper urinary tract stones in severely obese patients. However, higher possibility of postoperative, especially infectious, complication rates should be considered in these patients.

Effects of sleeve gastrectomy on bone mass, microstructure of femurs and bone metabolism associated serum factors in obese rats

BackgroundSleeve gastrectomy (SG) is a profoundly effective operation for severe obese patients, but is closely associated with bone mass loss. Previous studies have reported changes of various serum factors which may be associated with bone mass loss after SG. However, those results are contradictory. In this study, we assessed the effects of SG on bone mass, microstructure of femurs, and changes in bone turnover markers (BTMs), serum adipokines, inflammatory factors and gastrointestinal hormones after SG in high-fat diet (HFD) induced obese rats.MethodsEight-week-old male Sprague–Dawley (SD) rats were fed with HFD to induce obesity. Then, SG and sham surgery were performed in anesthetized obese rats. SD rats in control group were fed with standard chow. Microstructure of femurs was scanned and analyzed by micro-computed tomography in control group, HFD sham group and HFD SG group. Serum inflammatory factors, adipokines markers, gastrointestinal hormones and BTMs were also measured.ResultsBone mineral density (BMD) of trabecular bone in both HFD sham group and HFD SG group were remarkably decreased compared with control group. All serum BTMs were significantly higher in HFD SG group than HFD sham group. In the meantime, serum levels of several important inflammatory factors, gastrointestinal hormones and adipokines such as tumor necrosis factor-α (TNF-α), interleukin (IL)-6, monocyte chemoattractant protein-1(MCP-1), ghrelin, insulin and leptin in HFD SG group were remarkably reduced compared with HFD sham group, whereas glucagon-like peptide-1 (GLP-1), adiponectin, fibroblast growth factor (FGF)-19 and FGF-21 were dramatically increased after SG. Protein tyrosine phosphatase 1B (PTP1B) was significantly increased in the HFD sham group than control group. Spearman’s correlation analysis indicated that serum osteocalcin (OC) and 25-hydroxy vitamin D3 (25(OH)D3) were positively correlated with BMD of trabecular bone, whereas serum PTP1B and TNF-α were negatively related to BMD of trabecular bone.ConclusionsSG aggravates bone mass loss and activates bone remodeling in obese rats. Levels of BTMs, adipokines, inflammatory factors, and gastrointestinal hormones could be affected by SG in obese rats. Serum PTP1B level might be associated with abnormal bone mass in obese rats.

The impact of CPT1B rs470117, LEPR rs1137101 and BDNF rs6265 polymorphisms on the risk of developing obesity in an Italian population

ObjectiveThis study aimed to analyze 11 single nucleotide polymorphisms (SNPs) belonging to 9 genes involved in metabolic pathways (BDNF rs6265; PNPLA3 rs2294918 and rs2076212; CIDEA rs11545881; NTRK2 rs2289658; ALOX12 rs1126667; ALOX12B rs2304908; LEPR rs1137101; CPT1B rs470117 and rs8142477; rs2305507 CPT1A) in obese patients and controls. MethodsPolymorphisms were analyzed in 300 severe obese patients undergoing bariatric surgery (body mass index >30 kg/m2) and 404 control subjects in order to evaluate their association with obesity and clinical variables. ResultsOur findings showed significant differences for the allelic distributions of CPT1B rs470117 and LEPR rs11371010 in obese subjects compared to controls. The BDNF rs6265 correlates with obesity only when associated with the other two SNPs. In particular, for CPT1B rs470117 and LEPR rs1137101, the rare allele was associated with a reduced risk of developing the obese phenotype, whereas the simultaneous presence of the common C allele for rs470117 and A allele for rs1137101 was more frequent in obese patients (p = 0.002, OR = 1.417). A significant association between CPT1B rs470117 and steatosis was found. Moreover, we observed that by associating the rare allele T of the BDNF rs6265 with the most common alleles of the SNPs CPT1B rs470117 and LEPR rs1137101, the combination of T-C-A alleles was associated with a higher risk of developing an obese phenotype (p = 0.001, OR = 1.6679). ConclusionsOur results suggest that SNPs CPT1B rs470117 and LEPR rs1137101 taken individually and in association with BDNF rs6265 may be involved in an increased risk of developing obese phenotype in an Italian cohort.

Impact of a patient engagement support intervention (PHEinAction) on pre-bariatric surgery patients: a qualitative evaluation study

Literature highlights the need of feasible interventions where psychological, emotional and behavioral support strategies are leveraged to engage bariatric surgery patients taking care for their health. This study explores severe obese patients' self-reported outcomes with a nurse-led intervention providing patient engagement support ("PHEinAction") before bariatric surgery. A qualitative evaluation study through semi-structured interviews and self-report ques-tionnaires was led. in an Italian public hospital. Patient Health Engagement Scale was adminis-tered before, at the end, and three months after the intervention. Individual interviews were conducted within the three months after the intervention. Changes in questionnaires were ana-lyzed using paired t-tests, interviews using a thematic inductive approach. Among 17 partici-pants, there was a significant improvement in engagement scores from 2.7 at baseline to 3.3 at the end and to 3.5 three months later. PHEinAction had an impact on patients awaiting bari-atric surgery, with changes in engagement scores and in how they lived their obesity, their in-terpersonal relationships, and their self-care. This study offers preliminary support that PHEinAction helps patients with obesity on the behavioral change path. It is worthwhile to do a larger-scale randomized trial to evaluate its effect.

Body composition assessment using bioelectrical impedance analysis (BIA) in a wide cohort of patients affected with mild to severe obesity

Obesity is characterized by fat mass excess (FM), extra cellular water increase (ECW) and, with ageing, decrease in fat free mass (FFM). The validity of body impedance analysis (BIA) in patients with mild to severe obesity is still debated. The purpose of this study is to describe the Resistance (Rz) and Reactance (Xc) values obtained by Body Impedance Analysis (BIA) in a wide cohort of Italian patients with mild to severe obesity. The secondary endpoint is to describe the resulting body composition values (as percentage and indexes) in this population. The study enrolled adult in-patients with mild to severe obesity (classified with class I, II and III obesity) undergoing clinical care rehabilitation program for obesity complications and weight loss. BIA values were grouped by sex, BMI and age classes. A total of 8303 patients with obesity, aged 18 to 90y, were studied. The Resistance (Rz) and Reactance (Xc) were reported by sex, age and BMI classes. In women and men both, the phase angle (PhA) decreases with increasing BMI (kg/m2) and the resulting BIA vector was significantly shifted. The FM index (FMI) was higher (p<0.0001) in women while FFM index (FFMI) was higher in men (p<0.0001) and significantly associated with BMI. FFMI decreased with age in both sex (p<0.0001). Skeletal mass (SM) presents a progressive reduction in relation to age and gender both. The present BIA-based body composition analysis in a wide cohort of mild to severe obese patients revealed a significantly decreased Rz and Xc values with a consequent significant decrease of PhA in a BMI-dependent manner. The body compartments estimation with available equations was BMI, sex and age dependent. These observational results could be the basis for the development of new equations adapted for patients suffering from obesity.

Proinflammatory profile of visceral adipose tissue and oxidative stress in severe obese patients carrying the variant rs4612666 C of NLRP3 gene.

The activation of NLRP3 inflammasome machinery has a central role in obesity-induced inflammation. Genetic studies well support the involvement of functional variants of NLRP3 and its negative regulator, CARD8, in the pathogenesis of complex diseases with an inflammatory background. We have investigated the influence of NLRP3 (rs4612666; rs10754558) and CARD8 (rs204321) genetic variants in both the inflammatory status of visceral adipose tissue (VAT) from patients with severe obesity and in the systemic oxidative stress before and after sleeve-gastrectomy (SLG). Twenty-three consecutive severe obese patients candidate to SLG were enrolled in the study. Visceral adipose tissue (VAT) biopsies, obtained during SLG, were used to evaluate the expression of NLRP3, IL-1β, IL-6, and MCP-1 by real-time RT-PCR. DNA was extracted from peripheral blood lymphocytes and genotyped by RFLP analysis. Before and 3 months after SLG, all patients underwent the assessment of oxidative stress, biochemical parameters, and body composition as measured by bioelectrical impedance analysis (BIA). Increased expression of NLRP3, IL-6, IL-1β, and MCP-1 mRNA was observed in VAT of rs4612666 C variant carriers, in which higher oxidative stress was also detected as compared to non-carrier individuals. In all patients, oxidative stress, biochemical and BIA parameters improved after SLG, regardless of genotype. No significant correlations were found with the other genetic variants. Our results suggest that the NLRP3 rs4612666 C variant may promote a worse pro-inflammatory milieu and higher oxidative stress, thus leading patients to a more severe obesity phenotype. A larger study is needed to confirm this assumption and to investigate the impact of the NLRP3 rs4612666 C variant on severe obesity.

The impact of severe obesity on home health care agency admission: An organizational perspective

ABSTRACT Home health care is a growing treatment option for older adults who wish to remain in their homes and communities. However, the growing number of older adults with severe obesity presents a challenge for home health professionals. This study utilizes survey data from 128 home health care agencies in Arkansas and Pennsylvania to explore home health care agencies’ decision-making in admitting patients with severe obesity. The responding agencies indicated that concerns about adequate staffing levels were the primary barriers to entry for severe obesity patients. Existing research on the intersection of obesity and home health care is sparse, and this study adds an organizational perspective to the scant literature on the topic. Additional research on this topic is advised to accommodate the expected growth in home health care utilization and rising obesity rates among older adults.

Dietary intake after gastric bypass surgery in severe obese patients

Dietary intake after gastric bypass surgery in severe obese patients

Evaluation the mid-term outcomes of gastric bypass surgery in severe obese patients: A 2-years follow-up study in Iran

Rationale: Roux-en-Y Gastric Bypass (RYGB) has been established as an effective bariatric technique for treating morbid obese patients, but there are questions about long-term results. Our aim is to assess the benefits of RYGB in the first 2 years after surgery.

Impact of body mass index on outcomes in European patients with atrial fibrillation: the ESC EHRA EORP Atrial Fibrillation General Long-Term registry (AFGen LT)

Abstract Introduction The impact of body mass index (BMI) on outcomes in patients with atrial fibrillation (AF) has been largely debated. Aims To describe the relationship between BMI categories and clinical outcomes in a large cohort of European AF patients. Methods We included all AF patients with available baseline BMI and creatinine clearance and 1-year follow-up data enrolled in the EORP-AF General Long-Term Registry. Outcomes considered were: i) a composite of any thromboembolic event (TE)/acute coronary syndrome (ACS)/cardiovascular (CV) death; ii) CV death; iii) all-cause death. Results A total of 7,759 patients were included in this analysis. Of these, 55 (0.7%) were underweight, 2,074 (26.7%) were normal weight, 3,170 (40.9%) were overweight, 1,703 (21.9%) were obese and 757 (9.8%) were severe obese. Mean age was progressively lower across the categories (p&amp;lt;0.0001), with proportion of patients aged≥75 years also progressively lower (52.7% in underweight to 19.4% in severe obese patients; p&amp;lt;0.001). Both underweight (41.8%) and severe obese (25.0%) patients were more likely symptomatic (p&amp;lt;0.001). Mean CHA2DS2-VASc score was higher in underweight patients (p=0.0325). Use of any oral anticoagulant therapy was progressively higher across the BMI categories (p&amp;lt;0.001). At 1-year follow-up the rate of all outcomes considered were highest for underweight patients and lowest in severe obese [Figure 1]. On univariate Cox regression analysis, being underweight was consistently associated to a higher risk for all outcomes, while increasing of weight categories was associated with progressively lower risk for adverse outcomes. After full adjustment with clinical and pharmacological characteristics, no effect of higher BMI classes was found for any outcome, but an independent association with an increased risk of CV death and all-cause death was seen for underweight patients (Table 1). Conclusions In a large cohort of European AF patients a progressively lower rate of outcomes was found across increasing BMI classes. After full adjustments, no significant association was found between the higher BMI classes and outcomes. Underweight was associated with an increased risk for CV death and all-cause death. Figure 1. Outcomes at 1-year Follow-up Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Since the start of EORP programme, several companies have supported it with unrestricted grants

Facing obesity in pain rehabilitation clinics: Profiles of physical activity in patients with chronic pain and obesity-A study from the Swedish Quality Registry for Pain Rehabilitation (SQRP).

The obesity epidemic has influenced pain rehabilitation clinics. To date, little is known about baseline level of physical activity (PA) in patients referred to pain rehabilitation clinics. We aimed to investigate the PA levels of patients referred to pain rehabilitation clinics and to evaluate the effect of excess weight on PA level. Data were obtained from the Swedish Quality Registry for Pain Rehabilitation between 2016 and 2017. These data included PA time (everyday PA and physical exercise per week), Body Mass Index (BMI), sociodemographic factors, chronic pain and psychological aspects (e.g., pain intensity, depressive and anxiety symptoms and insomnia problems). Insufficient PA was defined as less than 150 minutes per week. We performed logistic regressions as well as orthogonal partial least square regression to estimate the effects of excess weight on PA. Over one-fourth of the patients were classified as obese (BMI ≥30 kg/m2, 871/3110, 25.3%) and nearly one-third of these patients were classified as severely obese (BMI ≥35 kg/m2, 242/871, 27.8%). Time estimations for physical exercise varied among the BMI groups, but patients in the higher BMI category were more likely to spend less time on everyday PA. Compared to normal weight, mild obesity [odds ratio (OR) 0.65, 95% confidence interval (CI) 0.53-0.81] and severe obesity (OR 0.56, 95% CI 0.42-0.74) were associated with less PA. Mild obese patients had an elevated risk of 65% and severe obese patients had an elevated risk of 96% for insufficient PA. Increased pain intensity was positively related to insufficient PA (OR 1.17, 95% CI 1.06-1.29) among the obese patients. Having low PA is very common for patients referred to pain rehabilitation clinics, especially for those with comorbid obesity. As a first step to increase PA, obese patients need to be encouraged to increase the intensity and amount of less painful daily PA.

The correlation between BMI and COVID-19 outcomes

Background: The novel coronavirus (SARS-CoV-2) disease spread all over the world and lead to global pandemic, has different outcomes on patients depends on many factors, such as comorbidity, obesity, age and associated with significant morbidity and mortality. Objective: the study amid to determine the effect of abnormal BMI in patients with coronavirus disease (COVID-19) on their disease outcomes. Methods: the study involved analyzing the data of 210 post COVID-19 patients, which was collected through answering specific questions related to the relation of dieses outcomes and patients BMI. Results: the mean age of patients was 34.7, 77 were female and 133 were males, 11% did suffer from shortness of breath of those who suffered from shortness of breath 70% were overweight and above normal BMI. 60% of moderately obese and 85% of severely obese people show symptoms for more than a week. Conclusions: There is a correlation between BMI and COVID-19 outcomes, represented through moderate and severe obese patients were suffered from COVID-19 symptoms for longer duration than others.

Which Is More Important Diet or Exercise for Obese Patients?

Abstract Objectives The obese population is increasing worldwide and Japanese are no exception. It is a natural hope that obese patients want to lose weight effectively and not lose as much muscle mass as possible. In our study, we examined which diet or exercise regimen could most effectively reduce body weight and reduce muscle loss in severe obese patients. Methods This study was an open-label randomized controlled trial carried out in Shinkomonji Hospital, Kitakyushu, JAPAN. Total 16 patients with severe obesity (body mass index ≥35 kg/m2) were randomly divided into the Normal Formula Diet (NFD) and Protein Rich Formula Diet (PRFD) groups. The participants of each group were randomly assigned to the aerobic and resistance exercise groups. All participants were hospitalized for one month. During hospitalization, the nutritional composition was predetermined as 50% carbohydrate, 20% protein, and 30% lipid of total 800 kcal in the NFD group, and 30% carbohydrate, 40% protein, and 30% lipid of total 800 kcal in the PRFD group. In the aerobic exercise group, an exercise intensity of 4 to 6 METs was performed at 2100 METs × min/week. In the resistance exercise group, an exercise intensity of 6 to 8 METs was performed at 2100 METs × min/week. Muscle mass was measured every week by bioelectrical impedance assay using the InBody S10 body composition analyzer (InBody Japan Inc., Tokyo, Japan). Results The mean body weight was 124.3 kg and the mean age was 38 years with a gender distribution of 50% male. One month later, the rate of body weight loss was PRFD-aerobic (–25 kg, −20.2%), PRFD-resistance (–21 kg, −16.9%), NFD-aerobic (–18 kg, −14.5%), and NFD-resistance (–16 kg, −12.9%) groups. These were significantly larger in order (P = 0.041). The rate of muscle loss was PRFD-resistance (–8 kg, −6.5%), NFD-resistance (–11 kg, −8.9%), PRFD-aerobic (–12 kg, −9.6%), and NFD-aerobic (–14 kg, −11.3%) groups. These were significantly smaller in order (P = 0.048). In all groups, participants’ renal function did not worsen one month after admission. Conclusions Our study showed the most effective way to lose weight was diet therapy, especially to reduce carbohydrates and increase protein. Exercise therapy was the most effective way for muscle retention, especially resistance exercise was considered to be more effective than aerobic one. Funding Sources None.

Influence of BMI and geographical region on prescription of oral anticoagulants in newly diagnosed atrial fibrillation: The GLORIA-AF Registry Program

ObjectiveTo investigate the association between body mass index (BMI) and oral anticoagulant (OAC) prescription in atrial fibrillation (AF). MethodsPatients with newly diagnosed non-valvular AF (<3 months) with ≥1 stroke risk factors enrolled in the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) in Asia, Europe and North America were evaluated. ResultsThe cohort (n = 13,793) comprised patients from all BMI categories (kg/m2): 1.4% were underweight (<18.5), 27.3% had a normal BMI (18.5 to <25), 37.9% were overweight (25 to <30), 19.3% were moderately obese (30 to <35), and 12.7% were morbidly obese (≥35). The highest proportion of Asians had a BMI of 18.5 to <25 kg/m2, while the highest proportion of patients from Europe and North America were overweight and a substantial proportion of North Americans morbidly obese. In the multivariable analysis, the probability ratio of non-prescription of OAC, as compared to normal BMI, decreased for overweight (RR = 0.907), moderately obese (RR = 0.802) and severe very severe obese patients (RR = 0.659). Moreover, the probability ratio of non-prescription of OACs was increased in the Asia or North America regions, as compared with Europe, in patients aged <65 years or female patients, as well as in patients with prior bleeding or vascular disease. ConclusionsThe distribution of BMI differed among the continents. An increased BMI was associated with a lower probability of non-prescription of OACs, as compared with a normal BMI. The probability of non-prescription of OACs was increased in the Asia or North America regions, as compared with Europe.