Sex-specific Cut-off Values Research Articles

The Evans’ Index revisited: New cut-off levels for use in radiological assessment of ventricular enlargement in the elderly

Background and purposeAssessment of ventricular enlargement is subjective and based on the radiologist’s experience. Linear indices, such as the Evans Index (EI), have been proposed as markers of ventricular volume with an EI≥0.3 indicating pathologic ventricular enlargement in any subject. However, normal range for EI measured on magnetic resonance imaging (MRI) scans are lacking in healthy elderly according to age and sex. We propose new age and sex specific cut-off values for ventricular enlargement in the elderly population. Materials and methods534 participants (53% women) aged 65–84 years; 226 patients with Alzheimer’s disease (AD), and 308 healthy elderly controls (CTR) from the AddNeuroMed and ADNI studies were included. The cut-off for pathological ventricular enlargement was estimated from healthy elderly categorized into age groups of 5 years range and defined as EI 97,5 percentile (mean+2SD). Cut-off values were tested on patients with Alzheimer’s disease and a small sample of patients with probable idiopathic normal pressure hydrocephalus (iNPH) to assess the sensitivity. ResultsThe range of the EI in healthy elderly is wide and 29% of the CTR had an EI of 0.3 or greater. The EI increases with age in both CTR and AD, and the overall EI for women were lower than for men (p<0.001). New EI cut off values for male/female: 65–69 years 0.34/0.32, 70–74 years 0.36/0.33, 75–79 years 0.37/0.34 and 80–84 years 0.37/0.36. When applying the proposed cut-offs for EI in men and women aged 65–84, they differentiated between iNPH and CTR with a sensitivity of 80% and for different age and sex categories of AD and CTR with a sensitivity and specificity of 0–27% and 91–98%, respectively. ConclusionThe range of the EI measurements in healthy elderly is wide, and a cut-off value of 0.3 cannot be used to differentiate between normal and enlarged ventricles in individual cases. The proposed EI thresholds from the present study show good sensitivity for the iNPH diagnosis.

The relation between birthweight, childhood body mass index, and overweight and obesity in late adolescence: a longitudinal cohort study from Norway, The Tromsø Study, Fit Futures

ObjectivesChildhood overweight/obesity is associated with later overweight/obesity. However, the association between birth weight and later overweight/obesity has not been established. The aim of this study was to investigate the relation...

Prognostic Indication of Sarcopenia for Wound Complication After Total Laryngectomy

<h3>Importance</h3> Postoperative wound complications after total laryngectomy (TL) increase hospital stay, costs, and delay adjuvant therapy when indicated. Recently, sarcopenia has been identified as a predictor of postoperative complications in patients undergoing major surgery but has not been assessed in head and neck surgery patients. <h3>Objective</h3> To determine the incidence of sarcopenia in patients with squamous cell carcinoma (SCC) undergoing TL and evaluate its association with the development of postoperative wound complications. <h3>Design, Setting, and Participants</h3> Retrospective medical chart review of 70 patients with SCC who underwent TL with cross-sectional abdominal imaging obtained preoperatively from 2004 to 2016 in a tertiary care hospital. Patients were determined to have sarcopenia present if the skeletal muscle index was calculated to be less than 38.5 cm²/m²for women and 52.4 cm²/m²for men. Demographic data included age, sex, smoking history, Charlson Comorbidity Index (CCI) score, prior radiation history, tumor stage, body mass index (BMI), and preoperative albumin levels. <h3>Main Outcomes and Measures</h3> Measurements of abdominal wall and paraspinal musculature at the cross-sectional L3 vertebral body were performed, normalized for height, and compared with previously defined sex-specific cutoff values to identify sarcopenia. Postoperative complications including all complications, wound-related complications, and pharyngo-cutaneous fistula (PCF) were determined. <h3>Results</h3> Sarcopenia was identified preoperatively in 54 (77%) patients. There was not a significant difference between the sarcopenia group and the nonsarcopenia group for any data except BMI (Cohen<i>d</i> = 1; 95% CI, 0.41-1.57) and preoperative albumin levels (Cohen<i>d</i> = 0.69; 95% CI, 0.11-1.25). Of 70 patients, 13 (24%) in the sarcopenia group developed a PCF compared with 0 (0%) without sarcopenia (OR, 1.32; 95% CI, 1.13-1.53). Similarly, 35 (50%) patients in the sarcopenia group developed a wound complication compared with 2 (13%) in the nonsarcopenia group (OR, 7.54; 95% CI, 1.56-36.4). On univariate analysis, sarcopenia was the only predictive factor of any complication (OR, 6.53; 95% CI, 1.84-23.23) and any wound complication (OR, 7.54; 95% CI, 1.56-36.4). On multivariable analysis of preoperative albumin levels and preoperative sarcopenia, only sarcopenia was a significant predictor for all complications (OR, 7.96; 95% CI, 1.39-45.29). <h3>Conclusions and Relevance</h3> Sarcopenia is an independent negative prognostic indicator for the development of all complications and wound complications after TL for the treatment of SCC.

A multicenter study to define sarcopenia in patients with end‐stage liver disease

Sarcopenia is associated with increased wait-list mortality, but a standard definition is lacking. In this retrospective study, we sought to determine the optimal definition of sarcopenia in end-stage liver disease (ESLD) patients awaiting liver transplantation (LT). Included were 396 patients newly listed for LT in 2012 at 5 North American transplant centers. All computed tomography scans were read by 2 individuals with interobserver correlation of 98%. Using image analysis software, the total cross-sectional area (cm2 ) of abdominal skeletal muscle at the third lumbar vertebra was measured. The skeletal muscle index (SMI), which normalizes muscle area to patient height, was then calculated. The primary outcome was wait-list mortality, defined as death on the waiting list or removal from the waiting list for reasons of clinical deterioration. Sex-specific potential cutoff values to define sarcopenia were determined with a grid search guided by log-rank test statistics. Optimal search methods identified potential cutoffs to detect survival differences between groups. The overall median SMI was 47.6 cm2 /m2 : 50.0 in men and 42.0 in women. At a median of 8.8 months follow-up, mortality was 25% in men and 36% in women. Patients who died had lower SMI than those who survived (45.6 versus 48.5 cm2 /m2 ; P < 0.001), and SMI was associated with wait-list mortality (hazard ratio, 0.95; P < 0.001). Optimal search method yielded SMI cutoffs of 50 cm2 /m2 for men and 39 cm2 /m2 for women; these cutoff values best combined statistical significance with a sufficient number of events to detect survival differences between groups. In conclusion, we recommend that an SMI < 50 cm2 /m2 for men and < 39 cm2 /m2 for women be used to define sarcopenia in patients with ESLD awaiting LT. Liver Transplantation 23 625-633 2017 AASLD.

Elevated Serum Uric Acid Levels Are Related to Cognitive Deterioration in an Elderly Japanese Population

Aims: The association between serum uric acid (UA) levels and cognitive function is controversial since UA can be a risk factor for cerebral ischemia as well as acting as a neuroprotective antioxidant. Methods: We conducted a cross-sectional analysis of 228 elderly participants and examined neuropsychological test results, clinical data as well as brain magnetic resonance imaging data. Patients: Overall, 64 participants were diagnosed with cognitive deterioration. To control for the effect of sex differences, 2 independent sets of single-variable and multivariate logistic regression analyses were performed with quartiles divided into non-sex-specific and sex-specific cutoff values for UA. Results: In non-sex-specific quartiles, the participants in the highest quartiles of UA levels were found to be at a significantly higher risk of cognitive deterioration than those in the lowest quartiles. In sex-specific quartiles, the highest quartile showed an increased risk of cognitive deterioration, and a greater than fourfold increase in the risk in the highest quartiles was confirmed using multivariate regression models. However, no significant association was observed between serum UA levels and the presence of white matter lesions. Conclusions: Elevated serum UA levels were independently associated with cognitive deterioration. UA might have unknown adverse effects on cognitive function, other than causing vascular pathology.

Sarcopenia Is Risk Factor for Development of Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt Placement.

Hepatic encephalopathy (HE) is an important complication in patients with cirrhosis who received transjugular intrahepatic portosystemic shunts (TIPS). We investigated whether a decrease in muscle mass was associated independently with the occurrence of HE after TIPS. We performed a prospective study of 46 consecutive patients with cirrhosis (mean age, 58.6 ± 9.1 y; mean model for end-stage liver disease score, 11.3 ± 3.3; mean Child-Pugh score, 7.6 ± 1.5) who received TIPS from January 2013 through December 2014 at a tertiary center in Rome, Italy. All patients underwent computed tomography analysis at the level of the third lumbar vertebrae to determine the skeletal muscle index; sarcopenia was defined by sex-specific cut-off values. We estimated the incidence of the first episode of HE after TIPS, taking into account the competing risk nature of the data (death or liver transplantation). Twenty-six patients (57%) were found to have sarcopenia. Twenty-one patients (46%) developed overt HE in the 7 ± 9 months after TIPS placement; all of these patients were sarcopenic, according to the skeletal muscle index. Of the 25 patients without HE after TIPS, only 5 had sarcopenia. In multivariate analysis, model for end-stage liver disease score (subdistribution hazard ratio, 1.16; 95% confidence interval, 1.01-1.34; P= .043) and sarcopenia (subdistribution hazard ratio, 31.3; 95% confidence interval, 4.5-218.07; P < .001) were associated independently with the development of HE after TIPS placement. In a prospective study of 46 patients with cirrhosis, we found muscle wasting, probably owing to reduced processing of ammonia, to be associated with the development of HE after TIPS placement. Sarcopenia should be considered in selecting patients for TIPS therapy. Nutritional status should be evaluated in patients with sarcopenia before TIPS placement, which might reduce the incidence of HE.

Ethnic and sex-specific cut-off values for adult obesity in the Suriname Health Study

Sex-specific body mass index (BMI) and waist circumference (WC) cut-off values have been validated for a limited number of ethnic groups. We aimed to derive these cut-off values for Amerindians, Creoles, Hindustani, Javanese, Maroons and Mixed living in Suriname. Data from individuals aged 20-65, in the Suriname Health Study was used to derive optimal cut-off values for BMI and WC for the prediction of hypertension (n=4910) and cardio-metabolic risk (n=2924). Results from the analysis with Receiver Operating Curves were calculated and compared these with recommended values. The area under the ROC curve was consistently higher for WC compared to BMI among Creoles, Hindustani, Maroons and Mixed. The BMI cut-off values ranged from 24.8kg/m2 for Creole men and 26.9kg/m2 for Maroon women to 28.4kg/m2 and 30.2kg/m2 for Amerindian men and women, respectively. The WC cut-off values ranged from 80.7cm for Maroon men, 86.7cm for Javanese women to 90.8cm for Hindustani men and 95.7cm for Amerindian women. Optimal BMI cut-off values approximated Asian cut-off values from the World Health Organization whilst those of WC for men approximated and for women exceeded cut-off values from the International Diabetes Federation. In most ethnic groups, we found better discriminatory power for WC compared to BMI in the relation with cardiovascular risk factors. The estimated BMI and WC cut-off values differed between ethnic groups. Further studies are needed to identify cut-off values related to the future risk of cardiovascular disease and mortality.

Clinical Effect of Sex-Specific Cutoff Values of High-Sensitivity Cardiac Troponin T in Suspected Myocardial Infarction

It is currently unknown whether the uniform (universal clinical practice for more than 2 decades) or 2 sex-specific cutoff levels are preferable when using high-sensitivity cardiac troponin T (hs-cTnT) levels in the diagnosis of acute myocardial infarction (AMI). To improve the management of suspected AMI in women by exploring sex-specific vs uniform cutoff levels for hs-cTnT. In an ongoing prospective, diagnostic, multicenter study conducted at 9 emergency departments, the present study evaluated patients enrolled from April 21, 2006, through June 5, 2013. The participants included 2734 adults presenting with suspected AMI. Duration of follow-up was 2 years, and data analysis occurred from June 5 to December 21, 2015. The final diagnosis was centrally adjudicated by 2 independent cardiologists using all available information, including measurements of serial hs-cTnT blood concentrations twice: once using the uniform 99th percentile cutoff value level of 14 ng/L and once using sex-specific 99th percentile levels of hs-cTnT (women, 9 ng/L; men, 15.5 ng/L). Diagnostic reclassification in women and men using sex-specific vs the uniform cutoff level in the diagnosis of AMI. Of the 2734 participants, 876 women (32%) and 1858 men (68%) were included. Median (interquartile range) age was 68 (55-77) and 59 (48-71) years, respectively. With the use of the uniform cutoff value, 127 women (14.5%) and 345 men (18.6%) received a final diagnosis of AMI. Among these, at emergency department presentation, levels of hs-cTnT were already above the uniform cutoff value in 427 patients (sensitivity, 91.3% [95% CI, 85%-95.6%] in women vs 90.7% [95% CI, 87.1%-93.5% in men]; specificity, 79.2% [95% CI, 76.1%-82.1%] in women vs 78.5% [95% CI, 76.4%-80.6%] in men). After readjudication using sex-specific 99th percentile levels, diagnostic reclassification regarding AMI occurred in only 3 patients: 0.11% (95% CI, 0.02-0.32) of all patients and 0.6% (95% CI, 0.13-1.85) of patients with AMI. The diagnosis in 2 women was upgraded from unstable angina to AMI, and the diagnosis in 1 man was downgraded from AMI to unstable angina. These diagnostic results were confirmed when using 2 alternative pairs of uniform and sex-specific cutoff values. The uniform 99th percentile should remain the standard of care when using hs-cTnT levels for the diagnosis of AMI.

Factors independently associated with cardiac troponin I levels in young and healthy adults from the general population.

Determinants of cardiomyocyte injury as quantified by high-sensitivity cardiac troponin I (cTnI) in young and healthy individuals, and sex-specific 99th percentiles are largely unknown. Our study included 2077 adults from the general population aged 25-41years without cardiovascular disease. cTnI was measured using a high-sensitivity assay. We performed stepwise backward linear regression analyses to identify variables independently associated with hs-cTnI levels, and calculated narrow-sense heritability from 1638-genotyped participants. Median age was 37years. cTnI was quantifiable in all but 11 participants (99.5%). Median (interquartile range) cTnI was significantly higher in men than in women [0.99 (0.71; 1.65) versus 0.47 (0.33; 0.71) ng/L, p<0.0001]. The 99th percentile of cTnI was 15.79ng/L in men and 5.11ng/L in women. Out of 46 variables, 22 independent determinants for cTnI were identified. The strongest associations were observed with sex, age, systolic blood pressure, heart rate, left ventricular mass, N-terminal pro B-type natriuretic peptide, and creatine kinase (all p<0.0001). The final model explained 36% of the overall cTnI variability. Heritability of cTnI was estimated to be 29% (p=0.005), but became non-significant when the residuals of the multivariable model were used for analysis (5%, p=0.36). Sex, age, and systolic blood pressure belong to the strongest determinants of hs-cTnI in healthy adults. The 99th percentile was three times higher in men compared to women. Hence, sex-specific cut-off values may be preferable when applying hs-cTnI for screening purposes. Our results may also improve the interpretation of cTn levels in daily clinical practice.

Association between uric acid and renal function in hypertensive patients: which role for systemic vascular involvement?

The role of systemic vascular involvement in mediating the association between serum uric acid (SUA) and renal function in hypertension has not been explored. Main purpose of our study was to investigate whether morphofunctional vascular changes, assessed as carotid intima-media thickness (cIMT) and aortic pulse wave velocity (aPWV), might mediate the association between SUA and renal damage. We enrolled 523 hypertensive subjects with or without chronic kidney disease and divided population into tertiles of SUA based on sex-specific cutoff values. cIMT and aPWV were higher in uppermost SUA-tertile patients when compared to those in the lowest ones (all P < .001). Uricemia strongly correlated with cIMT and aPWV at univariate analysis (P < .001) and with cIMT after adjustment for confounders (P < .001). Adjustment for cIMT attenuated the relationship between SUA and estimated glomerular filtration rate (P = .019). Systemic vascular changes seem partially to mediate the association between SUA and renal function in hypertensive patients, regardless of kidney function.

Tracking of overweight and obesity from early childhood to adolescencein a population-based cohort- the Tromsø Study, Fit Futures.

BackgroundObesity is a serious childhood health problem today. Studies have shown that overweight and obesity tend to be stable (track) from birth, through childhood and adolescence, to adulthood. However, existing studies are heterogeneous; there is still no consensus on the strength of the association between high birth weight or high body mass index (BMI) early in life and overweight and obesity later in life, nor on the appropriate age or target group for intervention and prevention efforts. This study aimed to determine the presence and degree of tracking of overweight and obesity and development in BMI and BMI standard deviation scores (SDS) from childhood to adolescence in the Fit Futures cohort from North Norway.MethodsUsing a retrospective cohort design, data on 532 adolescents from the Fit Futures cohort were supplemented with height and weight data from childhood health records, and BMI was calculated at 2–4, 5–7, and 15–17 years of age. Participants were categorized into weight classes by BMI according to the International Obesity Taskforce’s age- and sex-specific cut-off values for children 2–18 years of age (thinness: adult BMI <18.5 kg/m2, normal weight: adult BMI ≥18.5- < 25 kg/m2, overweight: adult BMI ≥25- < 30 kg/m2, obesity: adult BMI ≥30 kg/m2). Non-parametric tests, Cohen’s weighted Kappa statistic and logistic regression were used in the analyses.ResultsThe prevalence of overweight and obesity combined, increased from 11.5 % at 2–4 years of age and 13.7 % at 5–7 years of age, to 20.1 % at 15–17 years of age. Children who were overweight/obese at 5–7 years of age had increased odds of being overweight/obese at 15–17 years of age, compared to thin/normal weight children (crude odds ratio: 11.1, 95 % confidence interval: 6.4–19.2). Six out of 10 children who were overweight/obese at 5–7 years of age were overweight/obese at 15–17 years of age.ConclusionsThe prevalence of overweight and obesity increased with age. We found a moderate indication of tracking of overweight/obesity from childhood to adolescence. Preventive and treatment initiatives among children at high risk of overweight and obesity should start before 5–7 years of age, but general preventive efforts targeting all children are most important.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-016-0599-5) contains supplementary material, which is available to authorized users.

Proposal for new diagnostic criteria for low skeletal muscle mass based on computed tomography imaging in Asian adults

ObjectivesLow skeletal muscle, referred to as sarcopenia, has been shown to be an independent predictor of lower overall survival in various kinds of diseases. Several studies have evaluated the low skeletal muscle mass using computed tomography (CT) imaging. However, the cutoff values based on CT imaging remain undetermined in Asian populations. MethodsPreoperative plain CT imaging at the third lumbar vertebrae level was used to measure the psoas muscle mass index (PMI, cm2/m2) in 541 adult donors for living donor liver transplantation (LDLT). We analyzed PMI distribution according to sex or donor age, and determined the sex-specific cutoff values of PMI to define low skeletal muscle mass. ResultsPMI in men was significantly higher than observed in women (8.85 ± 1.61 cm2/m2 versus 5.77 ± 1.21 cm2/m2; P < 0.001). PMI was significantly lower in individuals ≥50 y than in younger donors in both men and women (P < 0.001 and P < 0.001, respectively). On the basis of the younger donor data, we determined the sex-specific cutoff values for the low skeletal muscle mass were 6.36 cm2/m2 for men and 3.92 cm2/m2 for women (mean − 2 SD). ConclusionData from healthy young Asian adults were used to establish new criteria for low skeletal muscle mass that would be applicable for defining sarcopenia in Asian populations.

S&T-55 SARCOPENIA AND THE MODIFIED GLASGOW PROGNOSTIC SCORE ARE SIGNIFICANT PREDICTORS OF PATIENT SURVIVAL IN METASTATIC RENAL CELL CARCINOMA PATIENTS RECEIVING FIRST-LINE SUNITINIB TREATMENT

You have accessJournal of UrologyScience & Technology Posters1 Apr 2016S&T-55 SARCOPENIA AND THE MODIFIED GLASGOW PROGNOSTIC SCORE ARE SIGNIFICANT PREDICTORS OF PATIENT SURVIVAL IN METASTATIC RENAL CELL CARCINOMA PATIENTS RECEIVING FIRST-LINE SUNITINIB TREATMENT Hiroki Ishihara, Tsunenori Kondo, Kenji Omae, Toshio Takagi, Jumpei Iizuka, Hirohito Kobayashi, and Kazunari Tanabe Hiroki IshiharaHiroki Ishihara More articles by this author , Tsunenori KondoTsunenori Kondo More articles by this author , Kenji OmaeKenji Omae More articles by this author , Toshio TakagiToshio Takagi More articles by this author , Jumpei IizukaJumpei Iizuka More articles by this author , Hirohito KobayashiHirohito Kobayashi More articles by this author , and Kazunari TanabeKazunari Tanabe More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2884AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cancer-related cachexia is significantly associated with patient outcome. Therefore, we aimed to evaluate the impact of cachexia on the survival of metastatic renal cell carcinoma (mRCC) patients receiving first-line sunitinib treatment. METHODS Seventy-one patients were retrospectively evaluated. Sarcopenia was diagnosed according to sex-specific consensus cutoff values of skeletal muscle and body mass indexes. The skeletal muscle index was measured using pre-treatment computed tomography images. Moreover, the modified Glasgow prognostic score (mGPS), was measured based on C-reactive protein (CRP) and albumin levels (score: 2, CRP>1.0 mg/dL and albumin<3.5 gd/L; score 1, CRP>1.0 mg/dL; score 0, CRP=1.0 mg/dL). Progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan-Meier method and Cox proportional hazard models. RESULTS Overall, 45 (63.4%) mRCC patients had sarcopenia, while 53 (74.6%), 10 (14.1%), and 8 (11.3%) patients had an mGPS of 0, 1, and 2, respectively. The correlations between sarcopenia and mGPS was marginally significant (p=0.0534). Sarcopenic patients had significantly inferior PFS and OS compared to non-sarcopenic patients (median PFS 7.6 vs. 18.2 months, p=0.0004 and OS 22.3 months vs. not reached, p=0.0019, respectively). Patients with higher mGPS also had significantly inferior PFS and OS (median PFS 11.5, 10.9, and 4.12 months for score 0, 1, and 2, p<0.0001 and OS 47.2, not reached, and 5.28 months, p<0.0001, respectively). Multivariate analysis revealed that sarcopenia was an independent predictor of shorter PFS (p=0.0258), whereas the mGPS was an independent predictor of shorter OS (p=0.0026). CONCLUSIONS Sarcopenia and the mGPS, are independent prognostic factors in mRCC patients receiving first-line sunitinib treatment. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e330-e331 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Hiroki Ishihara More articles by this author Tsunenori Kondo More articles by this author Kenji Omae More articles by this author Toshio Takagi More articles by this author Jumpei Iizuka More articles by this author Hirohito Kobayashi More articles by this author Kazunari Tanabe More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Association Between Uric Acid and Renal Hemodynamics: Pathophysiological Implications for Renal Damage in Hypertensive Patients.

The role of vascular renal changes in mediating the association between serum uric acid (SUA) and renal damage is unclear. The purposes of this study were to investigate the relationship between SUA and renal resistive index (RRI), assessed by duplex Doppler ultrasonography, and to assess whether hemodynamic renal changes may explain the association between SUA and renal damage in hypertensive patients. A total of 530 hypertensive patients with and without chronic kidney disease were enrolled and divided into SUA tertiles based on sex-specific cutoff values. RRI and albuminuria were greater and glomerular filtration rate (GFR) was lower in the uppermost SUA tertile patients when compared with those in the lowest tertiles (all P<.001). Moreover, SUA strongly correlated with RRI (P<.001) in all patients. However, RRI did not seem to explain the relationship between SUA and renal damage, and GFR significantly related with SUA in the overall population (P<.001) even after adjustment for RRI.

Health-Related Quality of Life in Relation to Obesity Grade, Type 2 Diabetes, Metabolic Syndrome and Inflammation.

BackgroundHealth-related quality of life (HR-QoL) may be compromised in obese individuals, depending on the presence of other complications. The aim of this study is to assess the effect of obesity-related conditions on HR-QoL. These conditions are i) grade of obesity with and without type 2 diabetes (T2D), ii) metabolic syndrome (MetS), and iii) level of inflammation.MethodsFrom the Dutch LifeLines Cohort Study we included 13,686 obese individuals, aged 18–80 years. HR-QoL was measured with the RAND 36-Item Health Survey which encompasses eight health domains. We calculated the percentage of obese individuals with poor HR-QoL, i.e. those scoring below the domain and sex specific cut-off value derived from the normal weight population. Logistic regression analysis was used to calculate the probability of having poor domain scores according to the conditions under study.ResultsHigher grades of obesity and the additional presence of T2D were associated with lower HR-QoL, particularly in the domains physical functioning (men: odds ratios (ORs) 1.48–11.34, P<0.005, and women: ORs 1.66–5.05, P<0.001) and general health (men: ORs 1.44–3.07, P<0.005, and women: ORs 1.36–3.73, P<0.001). A higher percentage of obese individuals with MetS had a poor HR-QoL than those without MetS. Furthermore, we observed a linear trend between inflammation and the percentage of obese individuals with poor scores on the HR-QoL domains. Individuals with MetS were more likely to have poor scores in the domains general health, vitality, social functioning and role limitations due to emotional problems. Obese women with increased inflammation levels were more likely to have poor scores on all domains except role limitations due to emotional problems and mental health.ConclusionsThe impact of obesity on an individual’s quality of life is enhanced by grade of obesity, T2D, MetS and inflammation and are mainly related to reduced physical health. The mental well-being is less often impaired.

Normative data for the Strengths and Difficulties Questionnaire for young children in Australia

The aim of this study was to report normative data for the parent-reported Strengths and Difficulties Questionnaire (SDQ) from a large population cohort of young children aged 4-6 years from Victoria, Australia, to establish age- and sex-specific cut-off values for future use, and to determine the scale reliability of the SDQ for children aged 4-6 years. Parents of children (n = 53 372) entering their first year of school in Victoria in 2010 completed a survey via a 15-page School Entrant Health Questionnaire reporting on the physical and emotional well-being of their child (including the SDQ), use of child health and other support services, and a range of socio-demographic variables. Reliability was assessed and norms generated. Appropriate cut-off values for each SDQ scale and total difficulties scale were generated for each age group separately for each sex. The five scales of the SDQ and total difficulties scale generally had acceptable internal reliability. Mean SDQ scale scores differed for both sex and age, although only a narrow age range is examined in this study. Cut-off values were marginally higher for girls (lower for prosocial) and generally increased with age. This study has utilised a large Australian population sample of children to generate age- and sex-specific cut-off values that define SDQ scores as 'normal', 'borderline' or 'abnormal' for Australian children aged 4-6 years.

Sex differences of troponin test performance in chest pain patients

BackgroundCurrent guidelines recommend troponin as the preferred biomarker to diagnose acute myocardial infarction (AMI) irrespective of the patient's sex. Recent reports have shown that sex-specific cut-offs should be considered but studies investigating sex-differences in the diagnostic accuracy of cardiac troponins are sparse. ObjectiveTo evaluate whether the diagnostic performance of cardiac troponin at admission (cTn) under routine conditions is influenced by patient's sex. MethodsBetween 15th of February 2009 and 15th of February 2010, women (n=1648) and men (n=2305) who presented to the emergency department with chest pain (n=3954) were enrolled.The diagnostic performance of the routine, contemporary sensitive cTn assays (TnI; Stratus® CS, Siemens and TnT; Roche Diagnostics) at baseline for the diagnosis of non-ST-elevation myocardial infarction (NSTEMI) was analyzed. ResultsNSTEMI was diagnosed in 7.3% (n=287) of all patients. Men were more likely to be diagnosed with NSTEMI (8.8%; n=202) as compared to women (5.2%; n=85; p<0.001). Sensitivity was 56.1% (95% CI: 44.7–67.0%) in women and 70.1% (95% CI: 63.1–76.4%) in men. Specificity was 96.8% (95% CI: 95.6–97.7%) in women and 94.5% (95% CI: 93.3–95.6%) in men. This resulted in a lower positive predictive value (PPV) for women (53.5%; 95% CI: 42.4–64.3) as compared to men (60.8%; 95% CI: 54.1–67.2) and a slightly higher negative predictive value (NPV) for women: 97.1% (95% CI: 96.0–97.9) vs. 96.3% (95% CI: 95.2–97.2) in men. ConclusionsThe findings of this study underline that the performance of cTn for the diagnosis of NSTEMI depends on a patient's sex, with a lower sensitivity and NPV in women. The definition and implementation of sex-specific cut-off values for cTn into clinical routine seems to be highly recommendable.

Gestational Weight Gain and Overweight in Children Aged 3-6 Years.

ObjectiveTo determine whether gestational weight gain (GWG) was associated with increased odds of childhood overweight after accounting for pre-pregnancy BMI.MethodsIn a prospective cohort study based on a premarital and perinatal health care system in China, data of 100 612 mother-child pairs were obtained. The main exposure was GWG as both a continuous and categorical variable. The outcome measure was overweight, defined by age- and sex-specific cutoff values for body mass index (BMI) in children aged 3–6 years.ResultsA 1-kg increase in maternal GWG was associated with an increase of 0.009 (95% confidence interval [CI]: 0.007–0.010, P < 0.001) in children’s mean BMI; in the subgroup of pre-pregnancy overweight/obese mothers, the increase in children’s BMI was 0.028 (95% CI, 0.017–0.039, P < 0.001). Excessive GWG played an important role in childhood overweight when adequate GWG was used as the reference, with an odds ratio (OR) of 1.21 (95% CI, 1.12–1.29). The risk was highest (OR 2.22; 95% CI, 1.79–2.76) in the children of mothers who were overweight/obese before pregnancy and gained excessive weight during pregnancy.ConclusionsGreater maternal GWG was associated with greater offspring BMI, and the risk of overweight was doubled in children whose mothers were overweight/obese before pregnancy and gained excessive weight during pregnancy. As a result, maintenance of appropriate weight gain during pregnancy and prophylaxis of maternal overweight/obesity before pregnancy should be a strategy for preventing childhood overweight/obesity.

Prospective cross-sectional study on faecal immunochemical tests: sex specific cut-off values to obtain equal sensitivity for colorectal cancer?

BackgroundFaecal immunochemical tests (FITs) are commonly used in colorectal cancer (CRC) screening. Diagnostic accuracy of FIT differs between males and females. This so far unexplained difference could result in a dissimilarity in screening outcome between both sexes. The aim of this study is to compare sensitivity and specificity of a FIT between males and females, and study potential explanatory variables.MethodsIn this cross-sectional study, data were prospectively collected. 3,022 subjects performed a FIT prior to complete colonoscopy. Sensitivity, specificity, and ROC curves were compared for both sexes. Potential explanatory variables of the relation between sensitivity and sex were explored.ResultsAt all cut-off values, FIT sensitivity for CRC was higher (range 13-23%) and specificity was lower (range 2-4%) in males compared to females. At 75 ng/ml, sensitivity for CRC was 93% in males compared to 71% in females (p = 0.03), and specificity was 90% in males compared to 93% in females (p = <0.05). For advanced adenomas, males had a slightly higher sensitivity and lower specificity (not significant). At 75 ng/ml, sensitivity for advanced adenomas was 33% in males compared to 29% in females (p = 0.46), and specificity was 93% in males compared to 95% in females (p = 0.22). ROC curves were similar for both sexes, and equal combinations of sensitivity and specificity could be achieved by adjusting the cut-off values. For CRC, the difference in sensitivity could not be explained by age or location of the tumour.ConclusionsFIT has a higher sensitivity and a lower specificity for CRC in males than in females. Equal test characteristics can be achieved by allowing separate cut-off values for both sexes. Location and age do not explain the observed differences in sensitivity.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-014-0217-7) contains supplementary material, which is available to authorized users.

Overweight and Obesity among the Adolescent School Students in Belgaum City

The World Health Organization defines obesity as a 'global epidemic'. An overweight adolescent has a 70% chance of becoming obese. Overweight and obese adolescents are at higher risk for developing long-term chronic diseases. So the present study objective is to estimate the prevalence of overweight and obesity among adolescent school students A sample size of 300 adolescent students was taken to do a cross-sectional study. Body weight and height were recorded and body mass index was categorized based on age-and sex-specific cut-off values as per International Obesity Task Force reference growth charts. Proportions of obese, overweight and underweight children were calculated and subjected to chi-square and logistic regression tests at the p < 0.05 significance level. The overall prevalence of overweight and obesity in the present study were 12% and 3.3% respectively. The highest prevalence was among those aged 15 years i.e. 36.7%. The prevalence of overweight and obesity was higher among the subject who did not practice physical activity and whose family income was more than 10,000 per month. Prevalence of overweight and obesity among adolescents student in Belgaum city was high which is statistically associated with less physically activity and monthly income of parent.