Significance Of Body Mass Index Research Articles

Nutritional interventions and BMI dynamics: A comprehensive analysis of growth outcomes in pediatric populations

Introduction: This review article emphasizes the significance of Body Mass Index (BMI) and insulin-like growth factor-1 (IGF1) in evaluating pediatric growth outcomes, particularly for those at risk of undernutrition. The review explores the long-term health consequences of early BMI trajectories, especially their association with cardiometabolic profiles in adulthood. The article also examines the correlation between BMI, insulin-like growth factor 1 (IGF-1), and growth velocity, focusing on their complex interactions in malnourished and obese pediatric populations. Methods: A comprehensive literature search was conducted using PubMed, Google Scholar, and Scopus from 1985 to 2024, focusing on BMI, height growth velocity, IGF1 levels, and the effects of nutritional interventions on pediatric growth outcomes. Studies were included if they focused on children aged 0-18 years and evaluated the impact of BMI and/or nutritional interventions on growth outcomes, with English language articles being prioritized. Review Results: A total of 15 studies involving 4737 participants were analyzed. The review highlights significant findings including the normalization of growth hormone (GH)-IGF axis post nutritional rehabilitation in malnourished children, the rapid response of IGF-1 levels to nutritional interventions, and the influence of protein-rich diets on catch-up growth. Studies also showed that early nutritional support, particularly through human milk, significantly affects IGF-1 levels and that dietary protein intake correlates with IGF-I concentrations and growth in toddlers. Long-term studies indicated that severe malnutrition can have enduring metabolic effects, necessitating sustained nutritional strategies. Discussion: The review highlights the significance of early nutritional support and its impact on IGF-1 levels, which are crucial for healthy growth trajectories. The findings advocate for careful monitoring of early growth rates to optimize long-term health outcomes and stress the importance of adequate protein intake during early childhood. Conclusions: A balanced approach to nutrition, focusing on the interplay between BMI, growth velocities, and IGF1 levels, is crucial in pediatric care. Strategic nutritional interventions, especially those rich in protein, can effectively manage growth outcomes across different BMI categories and improve health trajectories in pediatric populations. This review underscores the need for comprehensive strategies to address nutritional deficiencies and manage growth effectively from infancy through adolescence

Prognostic significance of body mass index and serum albumin as the indicators of nutritional status in small cell lung cancer

ABSTRACT Background Body mass index (BMI) and serum albumin (ALB) level are long-established markers that reflect the nutritional status and eventually the prognosis of cancer patients. The objective of the study was to determine the clinical significance of these factors and specify their roles in outcomes compared with performance status (PS) and weight loss (WL), which are considered the most significant patient-related prognostic factors in small cell lung cancer (SCLC) treated with platinum-etoposide-based chemotherapy. Methods A total of 378 patients with SCLC were enrolled in the study and analyzed retrospectively. Results BMI values were similar by clinical stage, whereas the percentages of the patients with WL, low serum ALB, and particularly poor (≥2) PS were significantly higher in patients with extended disease SCLC (ED-SCLC) compared to those with limited disease SCLC (LD-SCLC). In LD-SCLC, patients with poor PS lived for a significantly shorter time than patients with good PS (HR: 7.791, p = 0.0001); however, BMI (HR: 1.035, p = 0.8), WL (HR: 0.857, p = 0.5), and ALB (HR: 0.743, p = 0.3) had no significant effect on the outcome. In ED-SCLC, PS (HR: 4.257, p = 0.0001), WL (HR: 1.677, p = 0.001), and ALB (HR: 0.680, p = 0.007) had an impact on survival, but BMI did not (HR: 0.791, p = 0.08). In LD-SCLC, the univariate analysis showed that only poor PS was correlated with increased mortality (HR: 7.791, p = 0.0001); yet it lost significance in multivariate analysis. In ED-SCLC, poor PS (HR: 4.257, p = 0.0001), WL (HR: 1.667, p = 0.001), and a low ALB level (HR: 0.680, p = 0.007) were shown to be factors for poor prognosis in the univariate analysis; yet only PS remained significant in multivariate analysis (HR: 2.286, p = 0.001). Conclusion Even though BMI and serum albumin showed no prognostic value in SCLC patients treated with chemotherapy, PS was found to be the most significant prognostic factor in both LD- and ED-SCLC stages.

A retrospective study investigating the clinical significance of body mass index in acute pancreatitis.

Acute pancreatitis is an unpredictable and potentially fatal condition for which no definitive cure is currently available. Our research focused on exploring the connection between body mass index, a frequently overlooked risk factor, and both the onset and progression of acute pancreatitis. A total of 247 patients with acute pancreatitis admitted to Jiangsu Provincial Hospital of Chinese Medicine from January 2021 to February 2023 were retrospectively reviewed. After screening, 117 patients with complete height and body weight data were selected for detailed assessment. Additionally, 85 individuals who underwent physical examinations at our hospital during this period were compiled to create a control group. The study received ethical approval from the ethics committee of Jiangsu Province Hospital of Chinese Medicine (Ref: No.2022NL-114-02) and was conducted in accordance with the China Good Clinical Practice in Research guidelines. A significant difference in body mass index (BMI) was observed between the healthy group and acute pancreatitis (AP) patients (p < 0.05), with a more pronounced disparity noted in cases of hyperlipidemic acute pancreatitis (p < 0.01). A potential risk for AP was identified at a BMI greater than 23.56 kg/m2 (AUC = 0.6086, p < 0.05). Being in the obese stage I (95%CI, [1.11-1.84]) or having a BMI below 25.4 kg/m2 (95%CI, [1.82-6.48]) are identified as risk factors for adverse AP progression. Moreover, BMI effectively predicts the onset of acute edematous pancreatitis and acute necrotizing pancreatitis (AUC = 0.7893, p < 0.001, cut-off value = 25.88 kg/m2). A higher BMI correlates with increased recurrence rates within a short timeframe (r = 0.7532, p < 0.01). Elevated BMI is a risk factor for both the occurrence and progression of AP, and underweight status may similarly contribute to poor disease outcomes. BMI is crucial for risk prediction and stratification in AP and warrants ongoing monitoring and consideration.

Unveiling the Significance of Body Mass Index in Diagnosis of Superior Mesenteric Artery Syndrome: A Hidden Link

Background &amp; Aims: The superior mesenteric artery syndrome (SMAS) is an uncommon syndrome characterized by the compression of the third part of the duodenum between the superior mesenteric artery (SMA) and abdominal aorta with resultant proximal duodenal dilatation. The radiological diagnosis of the SMAS is based on reduced angle and distance between the SMA and aorta in presence of proximal duodenal dilatation. A reduction in these is closely associated with depletion of the mesenteric fat between the vessels. Our primary aim is to establish the relationship, if any, of body mass index (BMI) with the angle and distance between the SMA and abdominal aorta in general population. Materials and Methods: This study was carried out in 200 patients who had undergone contrast enhanced computed tomography for various other complaints. Various parameters such as aortomesenteric distance (AMD) and aortomesenteric angle (AMA) along with the body mass indices were calculated. Pearson correlation coefficients were calculated to establish the relationship between BMI, AMD and AMA. Results: Pearson’s correlation coefficient for BMI and AMD was 0.868, indicating strong positive correlation and 0.577 for BMI and AMA, indicating moderate positive correlation. Furthermore, AMD and AMA also showed positive correlation with Pearson’s correlation coefficient of 0.568. Conclusion: There is significant positive correlation of BMI with AMD and AMA in general population suggesting people with low BMI are at an increased risk of developing SMAS. Keywords: Aortomesenteric angle, Aortomesenteric Distance, Body mass index, Superior mesenteric Artery Syndrome. Computed Tomography

Prognostic significance of body mass index in small-cell lung cancer: Exploring the relationship with skeletal muscle status.

We investigated the prognostic significance of body mass index in small-cell lung cancer and explored whether skeletal muscle status affects the body mass index-survival relationship. This retrospective study evaluated data from patients who underwent platinum-etoposide chemotherapy for small-cell lung cancer between March 2010 and December 2021. Skeletal muscle status was assessed using non-contrast computed tomography images of baseline positron-emission tomography-computed tomography, with the skeletal muscle index defined as the cross-sectional area of skeletal muscle divided by height squared, and the average attenuation values of skeletal muscle. Cox proportional hazards regression analysis was used to determine the correlations of body mass index, skeletal muscle metrics, and overall survival. We analysed the data of 1146 Asian patients (1006 men and 140 women, with a median age of 67years [interquartile range: 61-72years]), including 507 and 639 patients with limited and extensive disease, respectively. Being underweight, defined as a body mass index <18.5kg/m2 , was associated with shorter overall survival, independent of clinical covariates in both the limited-disease (hazard ratio, 1.77; 95% confidence interval, 1.01-3.09) and extensive-disease (hazard ratio, 1.71; 95% confidence interval, 1.18-2.48) groups. The prognostic value of being underweight remained significant after additional adjustment for skeletal muscle index and attenuation in both limited-disease (hazard ratio, 1.96; 95% confidence interval, 1.09-3.51) and extensive-disease (hazard ratio, 1.75; 95% confidence interval, 1.17-2.61) groups. Being underweight is an independent poor prognostic factor for shorter overall survival in Asian patients with small-cell lung cancer, regardless of skeletal muscle status.

Burden of illness, risk factor and physical activity in cardiovascular disease- A review

Cardiovascular illness encompasses a group of diseases affecting the blood vessels and the structure of the heart, and it remains one of the most prevalent non-communicable diseases worldwide. Over the years, the rate of death from cardiovascular diseases has shown a significant decline in several high-income countries, primarily due to reductions in risk factors and advancements in cardiovascular disease management. Nonetheless, the global burden of cardiovascular diseases remains substantial, with an estimated 55 million deaths occurring in 2017, out of which 17.7 million were attributed to cardiovascular disease. The focus of this review is to explore the burden of illness, risk factors, and physical activity levels in populations affected by cardiovascular diseases. Studies have identified 14 potentially modifiable risk factors that were strongly associated with cardiovascular disease and mortality, surpassing the significance of body mass index (BMI), as evidenced by the PURE (Prospective Urban and Rural Epidemiology) study and prior research. While cardiovascular deaths have decreased in several developed countries, there has been a significant increase in low- and middle-income countries. Physical activity has emerged as a critical factor in reducing the risk of mortality and major cardiovascular events, regardless of the type of physical activity and other risk factors. The Physical Activity Guidelines (PAG) for Americans in 2008 recommended a range of moderate and vigorous physical activity and highlighted its inverse association with all-cause mortality, cardiovascular disease mortality, and incident CVD. Emphasizing the importance of physical activity, this low-cost approach holds tremendous potential in reducing deaths and cardiovascular diseases on a global scale. Overall, this review highlights the ongoing global challenge of cardiovascular diseases and underscores the importance of preventive measures, including promoting physical activity, to improve cardiovascular health and reduce the burden of illness worldwide.

Nomogram for predicting pulmonary embolism in gynecologic inpatients with isolated distal deep venous thrombosis.

To investigate the incidence of isolated distal deep venous thrombosis (IDDVT) concurrent with pulmonary embolism (PE) in gynecologic inpatients, analyze the risk factors for IDDVT with PE, and establish a nomogram model for IDDVT patients with PE. A total of 260 patients were diagnosed with IDDVT between December 2017 and November 2020. The incidence of PE in these patients was determined using computed tomography pulmonary angiography. Logistic regression analysis was used to identify the related risk factors. On this basis, nomogram risk prediction models were established. Among 260 patients with IDDVT, 106 (40.8%) had concurrent PE, of whom 74 (28.5%) experienced silent PE. Univariate logistic analysis demonstrated statistical significance for body mass index (BMI; P = 0.044), glucocorticoid therapy (P = 0.009), hypertension (P < 0.001), and diabetes (P < 0.001). Multivariate logistic analysis revealed that these were independent risk factors for IDDVT with PE that retained statistical significance. A nomogram based on these factors was constructed to predict PE in patients with IDDVT. Its receiver operating characteristic (ROC) showed an area under the curve of 0.710 (95% confidence interval 0.642-0.779), with prediction sensitivity of 64.2% and prediction specificity of 76.6%. In the present study, a high prevalence of PE was found in gynecologic inpatients with IDDVT. Glucocorticoid therapy, hypertension, diabetes, and BMI were independent risk factors for IDDVT patients with PE. Taking these risk factors into account, a nomogram risk prediction model was developed to help facilitate early detection of concurrent PE.

Impact of BMI on the Survival of Renal Cell Carcinoma Patients Treated with Targeted Therapy: A Systematic Review and Meta-Analysis

It is unclear whether obese renal cell carcinoma (RCC) patients treated with targeted therapy have better survival. We conducted this meta-analysis to assess the prognostic significance of body mass index (BMI) in RCC patients treated with targeted therapy. We systematically searched PubMed, Embase, Cochrane Library, and Web of Science by November 17, 2021. We calculated effect outcomes using random-effects and fixed-effects models. Fifteen articles were identified. We found that RCC patients treated with targeted therapy with BMI over 25 obtained better overall survival (OS) (hazard ratio [HR] = 0.69, 95% confidence interval [CI] = 0.58–0.82, I2 = 75.5%, p < 0.001) and progression-free survival (PFS) (HR = 0.71, 95%CI = 0.55–0.92, I2 = 69.7%, p = 0.006) than patients with BMI below 25. Obese (BMI over 30) patients had remarkably better OS (HR = 0.77, 95%CI = 0.70–0.85, I2 = 0.0%, p = 0.439) and PFS (HR = 0.86, 95%CI = 0.77–0.97, I2 = 0.0%, p = 0.934) than patients with BMI below 25. Overweight (BMI over 25 but below 30) patients also had better OS (HR = 0.86, 95%CI = 0.79–0.93, I2 = 17.7%, p = 0.295) and PFS (HR = 0.82, 95%CI = 0.74–0.90, I2 = 0.0%, p = 0.904) than patients with BMI below 25. When using BMI as continuous variable, patients with high BMI also obtained significantly better OS (HR = 0.92, 95%CI = 0.88–0.96, I2 = 0.0%, p = 0.806). Therefore, higher BMI was associated with greater OS and PFS in RCC patients treated with targeted therapy.

Abstract 6492: Body mass index characterization of patients undergoing neoadjuvant chemotherapy for breast cancer: Correlation with survival

Abstract Background: The significance of body mass index (BMI) on treatment outcomes of neoadjuvant chemotherapy for breast cancer and impact on overall survival is not well understood. We reviewed our single institution data on BMI of patients who underwent curative intent neoadjuvant chemotherapy for breast cancer. Methods: An IRB-approved retrospective review identified demographics (including BMI), disease presentation, response to treatment, and outcomes. ER and PR status were categorized as low positive (1-9%), positive (≥ 10%) and negative. Treatment response was noted as percent residual cellularity(complete 0%, almost complete &amp;lt; 10%, good 10-30%, moderate &amp;gt;30-80% and poor &amp;gt;80%) in the surgical specimen. Cox proportional hazards models were used to assess relationships with overall survival. Results: 372 patients underwent curative-intent from 2005-2020; mean age was 51.0 years (SD=11.8); mean BMI was 28.6 (SD=6.3). Median follow-up was 4.3 years. There are significant differences in BMI among racial groups: American Indian (mean 31, SD 6.35), black (mean 30.1, SD 6.89), white (mean 28.3, SD 6.11) (p=0.001). There are significant differences in BMI between Hispanic and non-Hispanic patients: Hispanic (mean 29.6, SD 6.07), non-Hispanic (mean 27.5, SD 6.44), (p=0.001). Hormone receptor status (ER, PR, HER2 status) was not significantly associated with BMI, nor was treatment response either as complete pathologic response (p=0.52) or percent residual cellularity (p=0.98). BMI was not significantly associated in tumor shrinkage noted by changes in T stage or N stage categorizations from pre- to post-NAC. BMI was significantly associated with overall survival through interactions with ER status (p=0.01), and residual percent cellularity (p=0.02). ER- vs. ER+ risk was higher for those with low (HR, 95% CI=7.87, 2.60-23.8 at BMI=20) and moderate (HR, 95% CI=3.25, 1.68-6.33 at BMI=27.5). A five-point higher BMI was associated with a 1.6-fold higher mortality risk for those with complete percent residual cellularity (95% CI: 1.1-2.4), but this risk differential was not observed for those with good, moderate, or poor residual percent residual cellularity. Conclusions: In our study, BMI was significantly associated with race and Hispanic ethnicity. Although there were no significant association of BMI with treatment response to neoadjuvant chemotherapy, there appears to be a significant relationship between BMI and overall patient survival, through its interactions with other prognostic factors. Future research efforts should focus on exploring reductions in BMI through modifications of diet and exercise in improving survival of breast cancer patients, particularly those with higher risk tumors. Citation Format: Sangeetha Prabhakaran, Vernon S. Pankratz, Christopher F. McNicoll, Jacklyn M. Nemunaitis, Nadja Falk, Jain Zhou. Body mass index characterization of patients undergoing neoadjuvant chemotherapy for breast cancer: Correlation with survival. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6492.

The Prognostic Significance of Body Mass Index in Patients Undergoing Nephrectomy for Nonmetastatic Renal Cell Carcinoma

Purpose: The aim of this study was to evaluate the impact of body mass index (BMI) on survival in patients with nonmetastatic renal cell carcinoma (RCC) treated with radical or partial nephrectomy.Materials and Methods: Between June 1994 and December 2021, 482 patients with RCC underwent radical or partial nephrectomy. Among those patients, 21 patients with lymph node or distant metastasis were excluded. The medical records of the remaining 461 patients were retrospectively reviewed. The prognostic significance of various clinicopathological variables, including BMI, was evaluated in univariate and multivariate analyses.Results: Of the total 461 patients, 171 (37.1%) were categorized as normal-weight, 118 (25.6%) as overweight, and 172 (37.3%) as obese. Forty-eight patients (10.4%) developed local recurrence or distant metastasis, and 26 patients (5.6%) died from the disease during the follow-up period. In the multivariate analysis, BMI (p=0.017), tumor size (p&lt;0.001), T stage (p&lt;0.001), Fuhrman nuclear grade (p=0.016), and lymphovascular invasion (p=0.012) were independent predictors of recurrence-free survival. Furthermore, BMI (p=0.025), tumor size (p&lt;0.001), T stage (p&lt;0.001), Fuhrman nuclear grade (p=0.047), and lymphovascular invasion (p=0.033) were independent predictors of cancer-specific survival.Conclusions: Our results suggest that overweight and obese patients with nonmetastatic RCC treated with radical or partial nephrectomy have a more favorable prognosis. These findings indicate that BMI could be an important factor for predicting recurrence or survival in patients undergoing nephrectomy for nonmetastatic RCC.

Association of Body Mass Index for Pre-pregnant Mothers and Weight Gain during Pregnancy with the Outcome of Baby's Birth Weight

Pre-pregnancy mother's body mass index plays a role in increasing or decreasing maternal weight. Maternal body mass index is a prominent indicator for the nutritional status of pregnant women who can be at risk of increasing the occurrence of births with low birth weight babies. This study aims to analyze the relationship between pre-pregnancy body mass index and the occurrence of low birth weight babies at Abdul Moeloek General Hospital Bandar Lampung, Indonesia. This study uses an observational analytic research design with a cross sectional approach. The population in this study were all post-partum mothers who gave birth at the Abdul Moeloek Regional Hospital in Bandar Lampung and involved a sample of 79 respondents who were taken using the consecutive sampling technique. Sampling was carried out based on inclusion and exclusion criteria that met the research criteria until the desired number of samples was met. Analysis of the research data is the chi-square test and logistic regression test. The results showed that the two independent variables, namely the pre-pregnant mother's body mass index and weight gain during pregnancy, had a significant relationship to the baby's birth weight. The significance of body mass index is p-value=0.004 and the significance of weight gain during pregnancy is p-value=0.000. Thus the body mass index of pre-pregnant women and weight gain during pregnancy can affect low birth weight babies at Abdul Moeloek Hospital Bandar Lampung.

Significance of body mass index on thoracic ossification of the ligamentum flavum in an East Asian population

Significance of body mass index on thoracic ossification of the ligamentum flavum in an East Asian population

The obesity paradox in Japanese COVID-19 patients.

Purpose: To investigate the effect of obesity on mortality and invasive respiratory care (IRC) in patients with COVID-19. Methods: We studied 1,105 patients for 34 months and collected data. The primary outcome was all-cause death at 29 days. The secondary outcome was IRC indicated by a pulse oximetry rate below 93% at a mask oxygenation rate of 5 L/min or more. Results: Age- and sex-adjusted multivariate regression analysis for 29-day deaths showed the significance of body mass index (BMI) > 19.6 kg/m2 (odds ratio 0.117, 95% confidence interval 0.052-0.265, P<0.001). The graphs with BMI in the abscissa showed, within a BMI between 11 and 25 kg/m2, a decreasing pattern for mortality and IRC rate, and no increase in overweight. Conclusion: In Japanese COVID-19 patients, the risk of mortality and the IRC rate decreased in underweight patients and remained low in overweight patients, suggesting the importance of the obesity paradox.

The Effect of Body Mass Index on Survival in Lung Cancer

The prognostic significance of body mass index in lung cancer and the direction of this relationship are not yet clear. This study aimed to evaluate the relationship between BMI and overall survival time of advanced-stage lung cancer patients treated in a center in Turkey, a developing country. In this study, the data of 225 patients diagnosed with stage III or stage IV lung cancer between 2016 and 2020 were analyzed. The effects of BMI and other variables on survival were examined by Cox regression analysis for NSCLC and SCLC. For NSCLC and SCLC, being underweight compared to the normal group, being diagnosed at a more advanced stage, and having a worse performance score were associated with a significantly higher risk of death. Other variables significantly associated with survival were gender, type of radiotherapy for NSCLC, age group, and family history for SCLC. This study showed that being underweight relative to the normal group was associated with worse survival for NSCLC and SCLC but did not support the obesity paradox. Studies that are representative of all BMI categories and free of bias are needed to understand the BMI-lung cancer survival relationship clearly.

The clinical significance of body mass index in the early evaluation of acute biliary pancreatitis

ObjectiveObesity has increased across the globe in recent years and is considered an established risk factor for many diseases. The main objective was to investigate the early assessment value of Body Mass Index (BMI) in the prediction of severity in acute biliary pancreatitis (ABP) and by using BMI to evaluate the severity of ABP. MethodsThe retrospective analysis was designed to assess the relationship between Body Mass Index and the severity of acute pancreatitis in Beijing Jishuitan Hospital from January 2019 to December 2021. The SPSS 24.0 software was used for statistical analysis, Logistic Regression, and ROC curve for the factors affecting the severity of acute biliary pancreatitis. ResultsA total of 259 ABP patients were analyzed in our study. The BMI was significantly correlated with the Ranson scoring and MCTSI scoring (p = 0.000, 0.000). The difference in BMI in different severity of ABP patients was statistically significant (p = 0.000). The Logistic Regression analyses confirmed that BMI was an independent risk factor for the severity of ABP (p = 0.035). Combined detection of BMI, WBC, serum calcium, and SAMY in prognosis of the severity of acute pancreatitis positive rate is higher than single positive rate. ConclusionThe BMI gradually increased with the severity of acute pancreatitis and was an independent risk factor for the condition. Combined detection of BMI and medical tests can effectively improve acute pancreatitis patients' clinical diagnostic accuracy and early treatment, and help to reduce complications.

Significance of body mass index on thoracic ossification of the ligamentum flavum in Chinese population.

To investigate the risk factors for thoracic ossification of the ligamentum flavum (TOLF), especially the relationship between BMI and TOLF. A total of 856 individuals consisting of 326 controls without ossification of spinal ligaments and 530 TOLF inpatients who underwent thoracic spine decompression surgery at our hospital between January 2013 and September 2020 were included. All subjects were classified into 4 grades: Grade 0) control; Grade 1) single-segment TOLF; Grade 2) multi-segment TOLF; and Grade 3) TOLF combined thoracic ossification of the posterior longitudinal ligament (T-OPLL). Logistic regression analysis was performed to identify the risk factors for TOLF. The TOLF index was calculated to assess the severity of TOLF, and its relationship with BMI was investigated by correlation analysis. Overall, TOLF patients are most numerous in the 50-59 age group. Age and gender were considered as independent risk factors for Grades 1 and 2. BMI was identified as an independent risk factor for TOLF. Furthermore, BMI was significantly higher in Grade 1 (26.1 VS 24.5kg/m2, P = 0.0001), Grade 2 (28.2 VS 24.5kg/m2, P < 0.0001), and Grade 3 (29.1 VS 24.5kg/m2, P < 0.0001) than Grade 0. Notably, in TOLF patients without combined T-OPLL, BMI was positively correlated with TOLF index, while BMI was negatively correlated with age in younger individuals. BMI is a crucial risk factor for TOLF. It highlights the necessity of close follow-up of asymptomatic TOLF patients with high BMI to detect and treat their TOLF progression promptly.

Prospective Comparison of Longer Needle Lengths to Assess the Risk of OnabotulinumtoxinA-Associated Neck Pain in Patients with Chronic Migraine.

Background: We aimed to prospectively assess the role of needle length in improving the tolerability/safety profile of OnabotulinumtoxinA (BoNTA) for chronic migraine (CM) prophylaxis, with a specific focus on neck pain, based on patients’ body habitus and other variables. Methods: BoNTA was administered quarterly for two consecutive cycles, using the standard 0.5-inch 27 G needle at all pre-defined PREEMPT injection sites, except the left-hand side trapezius and paraspinal muscles, which were injected using longer needles of 1-inch 23 G at first and 1-inch 27 G at second infusion. Participants were interviewed at day 14 following each session for evidence of neck pain. The predictive significance of Body Mass Index (BMI) and other variables with neck pain was also examined. Results: A total of 100 consecutive CM patients were evaluated, and each patient served as her/his self-control. The incidence, duration and intensity of neck pain did not significantly differ using either 1-inch needle compared with standard 0.5-inch 27 G needle, although the incidence and characteristics of neck pain with the use of longer needles appeared slightly higher and more intense. The BMI index and other tested variables remained unrelated to neck pain. Conclusions: We were not able to identify significant differences or correlations in the incidence, characteristics and location of neck pain with the use of different needle length to inject BoNTA, although the use of the longer 1-inch needles likely increased the risk of this adverse event.

P478 The role of proactive measurement of adalimumab trough levels and antibodies to adalimumab in Greek patients with Inflammatory Bowel Disease

Abstract Background Therapeutic drug monitoring (TDM) of adalimumab trough levels (ADA-TLs) and antibodies to adalimumab (ADA-Abs) in patients with inflammatory bowel disease (IBD) is usually performed in a reactive setting when the disease flares. There is not enough evidence in favor of proactive TDM in these patients. Methods We aimed to evaluate the role of proactive measurement of ADA-TLs and ADA-Abs in IBD patients under treatment with adalimumab. Consecutive IBD patients on maintenance treatment with ADA, were included. ADA-TLs and Abs were measured using ELISA (Immunoguide, Aybayteche, Turkey) on serum samples drawn before ADA administration. At the same time serum biomarkers [Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cells (WBC), hemoglobin (Hgb), platelets (PLT)] as well as home-based fecal calprotectin (FC) ±3 months from blood sampling were assessed. After the measurements patients were followed and treatment changes made were recorded. Results A total of 52 patients receiving ADA maintenance therapy [48 CD, 4 UC, 31 males, mean age (±SD) 42.1±12.6 years, 8 on combination therapy with immunomodulators (IMMs), 23 under intensified dose (either 40mg/w or 80mg/2w)] were included. Median (IQR) time since ADA initiation was 31 (17.5–38.5) months and median value (IQR) of serum ADA-TLs was 8.24 μg/ml (3.32–10.02). Five out 52 (9.6%) were positive for ATIs (&amp;gt;3 AU/ml). Patients with positive Abs had median (IQR) ADA-TLs 0.41 μg/ml (0.10–0.71) statistically lower compared to those with negative Abs [8.86μg/ml (5.6–10.0) (p=0.0004)]. The correlations of ADA-TLs with disease characteristics, treatment and biomarkers in IBD patients are presented in Table 1. Elevated CRP was negatively associated with ADA-TLs. No other significant correlations were observed except a trend towards significance for body mass index (BMI) and ADA treatment duration (both p=0.09). After a median (IQR) follow up of 15 (11.5–16) months treatment optimization became necessary in 4 patients (8%) [adalimumab dose intensification in 2, change to a clinical trial medication in 1 and 1 underwent surgery] who initially had significantly lower ADA-TLs than the rest patients [median (IQR) ADA-TLs 0.51μg/ml (0.26-5.09-10.04) vs 8.62 (4.48–10.04); p=0.0362]. Conclusion Proactive measurement of ADA-TLs and Abs in patients under maintenance treatment with adalimumab may be worth using along with other parameters in the management of IBD patients. Additional long term research in larger populations focused on the optimal use of proactive TDM is needed.

Association of Body Mass Index with Survival in Asian Patients with Colorectal Cancer.

PurposeThe clinical significance of body mass index (BMI) on long-term outcomes has not been extensively investigated in Asian patients with colorectal cancer (CRC). This study aims to describe the association between BMI and survival, plus providing BMI cutoff value for predicting prognosis in CRC patients.Materials and MethodsA total of 1,182 patients who had undergone surgery for stage I–III CRC from June 2004 to February 2014 were included. BMI was categorized into four groups based on the recommendation for Asian ethnicity. The optimal BMI cutoff value was determined to maximize overall survival (OS) difference.ResultsIn multivariable analysis, underweight BMI was significantly associated with poor OS (hazard ratio [HR], 2.38; 95% confidence interval [CI], 1.55 to 3.71; p < 0.001) and obese BMI was associated with better OS (HR, 0.72; 95% CI, 0.53 to 0.97; p=0.036) compared with the normal BMI. Overweight and obese BMI were associated with better recurrence-free survival (HR, 0.64; 95% CI, 0.42 to 0.99; p=0.046 and HR, 0.58; 95% CI, 0.38 to 0.89; p=0.014, respectively) compared with the normal BMI group. BMI cutoff value was 20.44 kg/m2. Adding the BMI cutoff value to cancer staging could increase discriminatory performance in terms of integrated area under the curve and Harrell’s concordance index.ConclusionCompared to normal BMI, underweight BMI was associated with poor survival whereas obese BMI was associated with better survival. BMI cutoff value of 20.44 kg/m2 is a useful discriminator in Asian patients with CRC.

The Prognostic Significance of Body Mass Index and Metabolic Parameter Variabilities in Predialysis CKD: A Nationwide Observational Cohort Study.

The association between variabilities in body mass index (BMI) or metabolic parameters and prognosis of patients with CKD has rarely been studied. In this retrospective observational study on the basis of South Korea's national health screening database, we identified individuals who received ≥3 health screenings, including those with persistent predialysis CKD (eGFR <60 ml/min per 1.73 m2 or dipstick albuminuria ≥1). The study exposure was variability in BMI or metabolic parameters until baseline assessment, calculated as the variation independent of the mean and stratified into quartiles (with Q4 the highest quartile and Q1 the lowest). We used Cox regression adjusted for various clinical characteristics to analyze risks of all-cause mortality and incident myocardial infarction, stroke, and KRT. The study included 84,636 patients with predialysis CKD. Comparing Q4 versus Q1, higher BMI variability was significantly associated with higher risks of all-cause mortality (hazard ratio [HR], 1.66; 95% confidence interval [95% CI], 1.53 to 1.81), P [for trend] <0.001), KRT (HR, 1.20; 95% CI, 1.09 to 1.33; P<0.001), myocardial infarction (HR, 1.19; 95% CI, 1.05 to 1.36, P=0.003), and stroke (HR, 1.19; 95% CI, 1.07 to 1.33, P=0.01). The results were similar in the subgroups divided according to positive or negative trends in BMI during the exposure assessment period. Variabilities in certain metabolic syndrome components (e.g., fasting blood glucose) also were significantly associated with prognosis of patients with predialysis CKD. Those with a higher number of metabolic syndrome components with high variability had a worse prognosis. Higher variabilities in BMI and certain metabolic syndrome components are significantly associated with a worse prognosis in patients with predialysis CKD.