Threshold Of Body Mass Index Research Articles

Transcarotid revascularization in obese patients.

Transcarotid revascularization (TCAR) is a minimally invasive hybrid surgical carotid stenting technique which utilizes cerebral flow reversal as embolic protection during carotid lesion manipulation. This investigation was performed to define the perioperative risks associated with this operation in the obese patient. A retrospective review of tandem carotid revascularization databases maintained at two high-volume health systems was performed to capture all TCARs performed between 2015 and 2022. A threshold of body mass index of 35kg/m2 defined the "obese" patient. Demographics, intraoperative, perioperative, and follow-up characteristics were compared using univariate analysis. We performed 793 TCAR procedures that qualified for study inclusion within the prespecified time. After applying our obesity definition, 129 patients qualified as obese and were compared to the remainder. There were no significant differences in baseline demographics as comparable Charlson Comorbidity Indices were noted between groups; however, obese patients had a significantly higher prevalence of hypertension, hyperlipidemia, and diabetes. Intraoperative, case complexity in the obese patients did not seem to be increased, as measured by operative time (68.4 ± 23.0 vs 64.2 ± 25.8min, p = 0.09), fluoroscopic time (4.9 ± 3.2 vs 4.6 ± 3.6min, p = 0.38), and estimated blood loss (40.6 ± 49.0 vs 46.6 ± 49.4min, p = 0.22). Similarly, no disparities were observed with respect to ipsilateral stroke (3.1 vs. 1.7%, p = 0.29), contralateral stroke (0 vs. 0.2%, p > 0.99), death (0 vs. 1.1%, p = 0.61), and stroke/death (3.1 vs. 3.0%, p > 0.99) in the 30-day perioperative period. Both cohorts were followed for approximately 1year (12.0 ± 13.4 vs 11.6 ± 13.4months, p = 0.76). During this period, rates of ipsilateral stroke (3.1% vs. 2.7%, p > 0.99), contralateral stroke (1.1 vs. 0.8%, p > 0.99), and death (4.7 vs. 6.2%, p = 0.68) were similar. TCAR performed in the obese population was not more challenging by intraoperative characteristics and did not result in a statistically higher incidence of adverse events in the perioperative phase.

Body Mass Index as a Continuous Predictor of Survival after Heart Transplantation

<h3>Purpose</h3> Both underweight and overweight recipients have poor outcomes after heart transplant (HT). However, the precise threshold of body mass index (BMI) as a predictor of heightened risk is unclear. We, therefore, examined the effect of BMI on short term survival as a continuous metric. <h3>Methods</h3> We identified adult patients listed for HT between 2000 and 2018 in the Scientific Registry of Transplant Recipients with recorded BMI at the time of listing. We calculated survival at 30 days and one year after HT and constructed Cox proportional hazards regression models adjusted for known recipient and donor risks. Recipient BMI was modeled using a restricted cubic spline with knots at 18, 25, 30, and 35 kg/m² with a value of 22 used as a referent. <h3>Results</h3> 37,068 adult HT recipients were included: median (25th, 75th percentile) BMI of 27 (23, 30) kg/m², recipient age 55 (46, 62) years, 27,668 (74.6%) men, and 9,683 (26.1%) with diabetes. After risk-adjustment, Cox proportional hazards regression showed a 3% increase in both 30-day (HR 1.031, 95% CI 1.024-1.037; p<0.0001) and 1-year mortality for every unit increase in recipient BMI (HR 1.025, 95% CI 1.022-1.033; p<0.0001). When modeled as a cubic spline, BMIs below 22 kg/m² had a neutral effect on both 30-day and 1-year mortality (although with wide confidence bars), with mortality risk steadily increasing in a non-linear fashion (Figure). <h3>Conclusion</h3> Increases in recipient BMI was associated with an incremental risk of 30-days and 1-year mortality following HT.

Urban Water Consumption Patterns in an Adult Population in Wuxi, China: A Regression Tree Analysis.

Understanding water intake variation is crucial for assessing human exposure to water pollutants. The correlation between water intake and demographic factors warrants further exploration. A cross-sectional study was conducted to estimate urban water consumption and its associated factors among adults in Wuxi, China, in 2015. The water consumption information was obtained by a 24-h self-report diary over seven consecutive days. A classification and regression tree (CART) analysis was applied to detect how water consumption varied with the demographic variables. Finally, a total of 1188 adults (18–87 years old) were included. The results demonstrated that the median water consumption of the adults was 1525 mL/day in summer and 1217 mL/day in winter. The results of the CART analysis demonstrated that body mass index (BMI) and age were the leading factors that were associated with water consumption in summer and winter, respectively. The water consumption threshold of BMI for men differed from women (23 kg/m2 vs. 18 kg/m2) in summer, and the threshold of age for men was also different from women (43 years vs. 21 years) in winter. In conclusion, the findings are useful for accurately assessing human exposure to water pollutants and identifying the high-risk subgroups.

DISORDERS OF LEFT VENTRICULAR DIASTOLIC FUNCTION AND ANTHROPOMETRIC PARAMETERS IN PATIENTS WITH ABDOMINAL OBESITY

Objective. T o evaluate diastolic function of the left ventricle and anthropometric parameters in patients with abdominal obesity (AO). Design and methods . We examined 438 patients aged 30 to 55 years (44,8 ± 0,3 years) with AO (IDF, 2005) and 115 patients (40,3 ± 0,8 years) without AO (comparison group). Two-dimensional transthoracic echocardiography was performed (GE Vivid 7 Dimension) in 2D mode, in M-mode, also Doppler studies were performed using pulsed, continuous-wave, color and tissue regimes of Doppler. Results. Based on echocardiography, 126 patients with AO and arterial hypertension (HTN) (28,8 %) (94 women and 32 men) had type I left ventricular diastolic dysfunction (LVDD). In patients with AO and without HTN, the E/A ratio and the E’ value were lower, and the DT and isovolumic relaxation time (IVRT), the E/E’ and LAVI ratio are higher than the same parameters in the comparison group (p < 0,0001). Only the ratio E/E’ was in accordance with the criteria for type 1 LVDD. We found positive correlations between the body mass index (BMI) and the IVRT (r = 0,3, p = 0,0001), BMI and the E/E’ ratio (r = 0,4, p = 0,0001), BMI and LAVI (r = 0,4, p = 0,0001), between the waist circumference (WC) and the IVRT (r = 0,3, p = 0,001), the WC and the E/E’ (r = 0,3, p = 0,0001), WC and LAVI (r = 0,4, p = 0,0001) in female with AO without HTN. In patients with AO and without HTN, there is a 3,7-fold increase in LVDD risk in case of BMI ≥ 30,0 kg/m 2 (odds ratio: 3,7, 95 % confidence interval: 1,2–9,0, p < 0,0001). Conclusions. The type I LVDD was found in patients with AO and HTN. in patients with AO without concomitant HTN, the risk of LVDD increases by 3,7 times with a threshold of body mass index ≥ 30,0 kg/m 2.

Extracranial Internal Carotid Artery Tortuosity and Body Mass Index.

Extracranial internal carotid artery (eICA) tortuosity may trigger cerebral ischemia, and body mass index (BMI) is a measure of body mass based on height and weight. The main purpose of this study is to determine the influence of BMI on the tortuosity of eICA. A total of 926 carotid artery angiograms were performed in 513 patients, of which 116 cases and matched controls were selected. Arterial tortuosity was defined as simple tortuosity, kinking, or coiling. The severity of tortuosity was measured by tortuosity index, formula: [(actual length/straight-line length - 1) × 100]. BMIs were different between the two groups [tortuosity: 27.06 kg/m2 (SD 2.81 kg/m2) versus none: 23.3 kg/m2 (SD 2.78 kg/m2); p < 0.001]. BMI was independently and significantly associated with eICA tortuosity (odds ratio 1.59; 95% confidence interval, 1.35-1.86; p < 0.001). eICA tortuosity index is linearly associated with BMI (exponential coefficient β = 1.067, p < 0.001). The optimal predictive threshold of BMI for eICA tortuosity was 25.04 kg/m2. The physiological mechanism underlying the reasons why higher BMI has negative influence on extracranial carotid artery tortuosity may be an intra-abdominal hypertension caused by a much higher amount of body fat stored in visceral adipose tissue. Our result reveals a novel role for greater BMI on the presence of eICA tortuosity. For each increase in BMI of 1 kg/m2, there is a corresponding 1.59-fold increase in the risk of developing eICA tortuosity. The severity of eICA tortuosity increases linearly with increased BMI.

Is There a Threshold of Body Mass Index for to Predict Extracorporeal Shock Wave Lithotripsy Success?

Is There a Threshold of Body Mass Index for to Predict Extracorporeal Shock Wave Lithotripsy Success?

Maternal Obesity Affects Inflammatory and Iron Indices in Umbilical Cord Blood

To determine the impact of maternal obesity and gestational weight gain across pregnancy on fetal indices of inflammation and iron status. Eighty-five healthy term newborns delivered via elective cesarean were categorized by 2 maternal body mass index (BMI) thresholds; above or below 30kg/m(2) or above or below 35kg/m(2). Umbilical cord plasma levels of C-reactive protein, interleukin (IL)-6, tumor necrosis factor (TNF)-α, ferritin, and hepcidin were assayed. Cytokines released by phytohemagglutinin-stimulated umbilical cord mononuclear cells (MNCs) were assayed. Maternal class II obesity, defined as BMI of 35kg/m(2) and above, predicted higher C-reactive protein and TNF-α in umbilical cord plasma (P<.05 for both), and also proinflammatory cytokines (IL-1β, IL-6, and TNF-α) from stimulated MNC (P<.05 for all). The rise in plasma TNF-α and MNC TNF-α was not linear but occurred when the threshold of BMI 35kg/m(2) was reached (P<.005, P<.06). Poorer umbilical cord iron indices were associated with maternal obesity. When ferritin was low, IL-6 was higher (P<.04), but this relationship was present primarily when maternal BMI exceeded 35kg/m(2) (P<.03). Ferritin was correlated with hepcidin (P<.0001), but hepcidin was unrelated to either maternal BMI or inflammatory indices. Class II obesity and above during pregnancy is associated with fetal inflammation in a threshold fashion. Although maternal BMI negatively impacted fetal iron status, hepcidin, related to obesity in adults, was related to iron status and not obesity in fetuses. Pediatricians should be aware of these relationships.

Obésité et ostéoporose

A low body mass index (BMI) is a usual risk factor for fracture. Any decrease of a unit of BMI is associated with a moderate (but significant) decreased risk of fracture. The association is higher for fragility fractures (particularly for hip fractures). However, after adjusting for bone mineral density (BMD), this association is no longer significant. It is now well established that the protective effect of increased weight on the risk of fracture occurs only up to a certain threshold of BMI (25 kg/m2). Beyond that threshold, the incidence of fractures no longer varies. After adjustment for BMD, it seems that a BMI over 30 kg/m2 may be associated with an increased risk of fracture. The publications indicating that obesity is not always protective regarding the occurrence of fractures are recent. The analysis of data (which are otherwise not all unanimous) is complex since the effect of obesity depends on the site of the fracture. In women, obesity seems to be associated with an increased risk of fracture for tibia (upper and lower extremity), femoral shaft and the upper extremity of the humerus. Conversely, obesity appears protective regarding wrist, hip and pelvis fractures. Gender should also be taken into account. For men, obesity (after adjustment for BMD) is a risk factor for hip fracture. For vertebral fractures, obesity would be a protective factor for men but favoring for women. In mechanistic terms, many unknowns remain. Beyond the mechanical stresses, which can be an obvious explanation to understand the increased incidence of certain fractures in obese; the complexity of adipose tissue should also be taken into account. This endocrine organ has in fact substantial metabolic properties. It is especially capable of secreting adipokines. The best known of these is leptin. Leptin (measured in the serum) has a protective effect on bone. Another adipokine, adiponectin, may also be involved in bone metabolism with an opposite action compared to leptin. In addition, obesity belongs to the category of disorders causing low level of inflammation. Thus, secretion by adipose tissue of pro-inflammatory cytokines could also be an interesting explanatory track.

Effects of maternal pre-pregnancy overweight on macrosomia in women with gestational diabetes mellitus

Objective To explore the relationship between maternal pre-pregnancy body mass index (BMI) and neonatal birth weight in women with gestational diabetes mellitus (GDM). Methods From the pregnant women who received prenatal care and delivered at the Department of Obstetrics and Gynecology of Peking University First Hospital between May 1, 2012 and November 1, 2013, 550 GDM women aged 20-49 years and with single gestation were enrolled in this study. According to the pre-pregnancy BMI, the GDM women were divided into overweight group (BMI ≥24.0, n=145) and non-overweight group (BMI<24.0, n=405). Gestational weight gain, glucose level of 75 g oral glucose tolerance test, glucose control, delivery mode and neonatal birth weight were compared between the two groups. The influencing factors for macrosomia and the relationship between maternal pre-pregnancy BMI and neonatal birth weight were analyzed. Independent sample t-test, Chi-square test, multivariate Logistic regression and Pearson correlation analysis were used for statistical analysis. Receiver operating characteristic (ROC) curve was used to determine the optimal threshold of pre-pregnancy BMI to predict macrosomia. Results Compared with the data of non-overweight group, fasting glucose level [(5.1±0.5) vs (5.3±0.5) mmol/L, t=-4.599], 1 h glucose level [(9.4±1.7) vs (9.8±1.6) mmol/L, t=-2.742], proportion of poor glucose control [20.5% (83/405) vs 33.1% (48/145), χ2=8.281], proportion of cesarean delivery [37.8% (153/405) vs 55.2% (80/145), χ2=13.160], neonatal birth weight [(3 306±424) vs (3 476±545) g, t=-3.374], and ratio of macrosomia [5.4% (22/405) vs 16.6% (24/145), χ2=16.291] were all higher in overweight group (all P<0.01). The mean gestational weight gain per week in overweight group was significantly lower than in non-overweight group [(336±123) vs (402±131) g, t=5.136, P<0.01]. Pre-pregnancy overweight (OR=4.009, 95%CI: 2.039-7.881), gestational weight gain per week (OR=1.003, 95%CI: 1.001-1.005) and fasting glucose level (OR=2.285, 95%CI: 1.326-3.938) were the influencing factors for macrosomia (all P<0.01). Pre-pregnancy BMI of GDM women was positively related with neonatal birth weight (r=0.179, P<0.01). Pre-pregnancy BMI ≥22.8 was defined as the optimal threshold to predict macrosomia (ROC area under curve=0.691). Conclusions Maternal pre-pregnancy overweight is a significant risk factor for macrosomia in women with GDM. GDM women with pre-pregnancy overweight should control glucose level and weight gain during pregnancy in order to reduce the risk of macrosomia. Key words: Diabetes, gestational; Body mass index; Obesity; Weight gain; Fetal macrosomia

Work and non-work stressors, psychological distress and obesity: evidence from a 14-year study on Canadian workers

ObjectiveThis study aimed to evaluate the contribution of work, non-work and individual factors to obesity with regard to gender-related differences, and to clarify the mediating role that psychological distress plays...

Clinical predictive criteria associated with live birth following elective single embryo transfer

ObjectiveWe aimed to define clinical criteria from the patients related to the occurrence of live birth in case of elective single embryo transfer (eSET). Study designWe analyzed retrospectively 409 eSET at day 2/3 between March 2005 and July 2012, proposed in case of (i) woman's age <37 years, (ii) first/second IVF0 cycle, (iii) ≥2 good quality embryos obtained (3–5/6–10 blastomeres at day 2/3 and <20% fragmentation), including one top embryo (4/8 cells). In all, 124/409 live births (30.3%) were obtained, separating patients into groups of women who had birth or not. Different clinical parameters of interest were compared between each group, using appropriate statistical tests at p<0.05 significance level. ResultsBy comparing Body Mass Index (BMI), we report a statistically higher BMI among women who did not deliver (24.6 vs. 23.4kg/m2; p=0.014). Using an analysis by BMI categories, we also precise a threshold of BMI≥30kg/m2, negatively associated with the occurrence of live birth. ConclusionBMI appears to be the only clinical parameter statistically associated with delivery following eSET strategy in a good prognosis infertile population.

Body mass index as a continuous predictor of outcomes after expander-implant breast reconstruction.

Studies show that obesity is a risk factor for complications after expander/implant breast reconstructions. However, reports vary on the precise threshold of body mass index (BMI) as a predictor of heightened risk. We endeavored to link BMI as a continuous variable to overall complications in a single-surgeon series of expander-implant reconstructions. From 399 patients undergoing expander-implant reconstruction, 551 breasts were stratified to normal weight, overweight, and obese groups for analysis and comparison with previous studies. Logistic regression was performed to predict changes to risk profile per increment of BMI. Complication rates for obese and overweight patients were significantly greater than for normal weight patients, that is, 21.1% and 24.0% versus 10.4%, respectively (P < 0.005). A unit increase in BMI predicted a 5.9% increase in the odds of a complication occurring, and 7.9% increase in the odds of reconstruction ending in failure. By expanding the analysis of BMI to include patients who do not meet the traditional definition of obesity (BMI ≥ 30 kg/m), we demonstrated that simply overweight patients (25 ≤ BMI < 30 kg/m) had an elevated complication rate. Moreover, through regression analysis, we established that BMI as a continuous variable predicts outcomes from expander-based breast reconstruction.

The disproportionate economic burden associated with severe and complicated obesity: a systematic review

Burden of disease studies typically classify individuals with a body mass index (BMI) ≥ 30 kg m(-2) as a single group ('obese') and make comparisons to those with lower BMIs. Here, we review the literature on the additional economic burden associated with severe obesity or classes 3 and 4 obesity (BMI ≥ 40 kg m(-2) ), the fastest growing category of obesity, with the aim of exploring and disaggregating differences in resource use as BMI increases beyond 40 kg m(-2) . We recognize the importance of comparing classes 3 and 4 obesity to less severe obesity (classes 1 and 2) as well as quantifying the single sub-class impacts (classes 3 and 4). Although the latter analysis is the aim of this review, we include results, where found in the literature, for movement between the recognized subclasses and within classes 3 and 4 obesity. Articles presenting data on the economic burden associated with severe obesity were identified from a search of Ovid MEDLINE, EMBASE, EBSCO CINAHL and Cochrane Library databases. Data were extracted on the direct costs, productivity costs and resource use associated with severe obesity along with estimates of the multiplier effects associated with increasing BMI. Fifteen studies were identified, of which four disaggregated resource use for BMI ≥ 40 kg m(-2) . The multiplier effects derived for a variety of different types of costs incurred by the severely obese compared with those of normal weight (18.5 kg m(-2) < BMI < 25 kg m(-2) ) ranged from 1.5 to 3.9 for direct costs, and from 1.7 to 8.0 for productivity costs. There are few published data on the economic burden of obesity disaggregated by BMI ≥ 40 kg m(-2) . By grouping people homogenously above a threshold of BMI 40 kg m(-2) , the multiplier effects for those at the highest end of the spectrum are likely to be underestimated. This will, in turn, impact on the estimates of cost-effectiveness for interventions and policies aimed at the severely obese.

Appropriate BMI cut-off values for identification of metabolic risk factors: Third national surveillance of risk factors of non-communicable diseases in Iran (SuRFNCD-2007)

Aim: To determine the appropriate threshold of body mass index (BMI) associated with increased risk of cardiovascular diseases in a large representative sample of an Iranian population.Subjects and methods: Data of third national surveillance of risk factors of non-communicable diseases (SuRFNCD-2007) were used in this study. Sensitivity, specificity, and shortest distance on the receiver-operating characteristic (ROC) curves were used to determine gender-specific optimal cut-offs of BMI for cardiometabolic risk factors including elevated blood pressure, low high-density lipoprotein cholesterol, high triglycerides, high fasting plasma glucose and for ≥ 2 of the aforementioned risk factors.Results: There was a continuous increase in the prevalence of cardiometabolic risk factors with increasing BMI (p < 0.001). At the BMI of 25–29 kg/m2 men were at higher risk of cardiovascular diseases compared to women (p < 0.001). The appropriate BMI cut-offs ranged from 24.6–26.1 kg/m2 for men and from 26.9–28.8 kg/m2 for women. The optimal BMI cut-offs for identifying any two or more of those risk factors were 25.2 and 27.3 kg/m2 in men and women, respectively.Conclusion: In men the appropriate BMI cut-offs are ∼25 kg/m2, while in women higher BMI values are associated with risk of cardiovascular diseases.

Relationship of Ghrelin and Leptin Hormones with Body Mass Index and Waist Circumference in a Random Sample of Adults

Objective To evaluate the relationship of ghrelin and leptin hormones with body mass index (BMI) and waist circumference in a population-based random sample of adult men and women subsequently categorized from normal weight to severely obese based on BMI criteria. The relationship between total ghrelin and leptin was also evaluated. Design A cross-sectional study was conducted on adults. Methods Two-hundred thirty-three men (n=107) and women (n=126) between the ages of 23 and 75 years were randomly selected from a database of over 600,000 adults who had previously participated in a population-based study conducted by the University of Utah Cardiovascular Genetics Program. Items collected included height, weight, waist circumference, and fasting blood samples. Blood samples were later thawed, and plasma leptin and total ghrelin levels were analyzed with radioimmunoassay kits. Results Leptin levels were directly associated with BMI ( r=0.72, P=0.001) and waist circumference ( r=0.71, P=0.0001), whereas total ghrelin was inversely associated with BMI ( r=−0.39, P=0.001) and waist circumference ( r=−0.37, P=0.001). There were also statistically significant linear changes in means across the BMI categories for both hormones. After controlling for BMI and waist circumference, the highly significant correlation of leptin with ghrelin ( r=−0.39) was reduced but still significant ( r=−0.17, P=0.01). Conclusion Leptin increases and ghrelin decreases were linear over the five BMI categories, suggesting there is no threshold of BMI where the hormone levels change abruptly. There remain other factors beyond current BMI and waist circumference that induce a correlation of these two hormones. Further understanding of the role that each of these hormones has in influencing appetite and body weight may provide insight into mechanisms involved with obesity.

Genome Scan for Human Obesity and Linkage to Markers in 20q13

Obesity is a highly prevalent, multigenic trait that predicts increased morbidity and mortality. Here we report results from a genome scan based on 354 markers in 513 members of 92 nuclear families ascertained through extreme obesity and normal body weight. The average marker interval was approximately 10 cM. We examined four correlated obesity phenotypes, including the body-mass index (BMI) (both as a quantitative trait and as a discrete trait with a threshold of BMI > or /=30 kg/m2) and percentage of fat (both as a quantitative trait and as a discrete trait with a threshold of 40%) as assessed by bioelectrical impedance. In the initial stage of the genome scan, four markers in 20q gave positive evidence for linkage, which was consistent across most obesity phenotypes and analytic methods. After saturating 20q with additional markers (25 markers total) in an augmented sample of 713 members from 124 families, we found linkage to several markers in a region, 20q13, previously implicated in both human and animal studies. Three markers (D20S107, D20S211, and D20S149) in 20q13 had empirical P values (based on Monte Carlo simulations, which controlled for multiple testing) < or /=. 01 for single-point analysis. In addition, the parametric, affecteds-only analysis for D20S476 yielded a LOD score of 3.06 (P=. 00009), and the affected-sib-pair test yielded a LOD score of 3.17 (P=.000067). Multipoint analyses further strengthened and localized these findings. This region includes several plausible candidate genes for obesity. Our results suggest that one or more genes affecting obesity are located in 20q13.