Underweight Individuals Research Articles

Correlation of pupil to limbus diameter ratio (PLD ratio) with blood pressure and pulse rate in underweight females

There are no studies where the pupil to limbus diameter ratio was assessed in the underweight individuals. Hence, the present study was undertaken to observe the correlation of pupil to limbus diameter ratio (PLD ratio) with blood pressure and pulse rate in underweight females. A total of 30 underweight females were included in the present study after obtaining voluntary informed consent by convenient sampling. PLD ratio was measured manually by the two-box method. There was a positive correlation between the PLD ratio of the right eye with the blood pressure and pulse rate. However, it was not statistically significant. There was a negative correlation between the PLD ratio of the left eye and pulse rate but it was not statistically significant. There was a positive correlation between the PLD ratio and systolic blood pressure. However, it was not statistically significant. There was a positive correlation between the PLD ratio and diastolic blood pressure. However, it was not statistically significant. The study results suggest the correlation between the PLD ratio and the blood pressure and pulse rate. The insignificant of results may be due to less sample size.

Brazilian Food Handlers' Years of Work in the Foodservice and Excess Weight: A Nationwide Cross-Sectional Study.

This study aimed to evaluate the association between the years of work of food handlers in the foodservice and excess weight among Brazilian low-income food handlers. A total of 559 food handlers from all Brazilian regions were characterized using a questionnaire. Weight and height were measured to estimate the Body Mass Index and classify the individuals. The association between food handlers' years of work in the foodservice, anthropometric status, and other variables (gender, age group, educational level, participation in a government program and per capita income at home and energetic consumption) were performed using Pearson's chi-square test (p < 0.05). Multinomial logistic regression analyses were performed (p < 0.05) as well as sensitivity tests using the outcome continuously and transformed, excluding underweight individuals, in a multivariate linear regression model. Most of the sample was female (63.1%), aged between 21 and 40 years old (63.5%), and 53.3% had studied up to complete elementary school. Almost 41% of the food handlers had less than half the minimum wage per capita income. Of the evaluated individuals, 59.9% presented excess weight. There was an association with family per capita income (Odds Ratio - OR: 1.73; Confidence interval - CI95%: 1.09–2.75); handlers whose per capita income was ≤0.5 minimum wage had a 73% higher chance of obesity than those with higher income. Working in foodservive ≥3 years increased the chance of being overweight by 96% compared to those who work for <3 years (OR: 1.96; CI95%: 1.11–3.49). No significant association was found between the years of work of food handlers in the foodservice and obesity. Since work-related factors may contribute to the high prevalence of excess weight, including working in a food handling environment, the government and employers should consider workplace interventions. These would guide the food handlers in avoiding high rates of excess weight and their consequences on public health. Excess weight is an important driver of costs in the workplace associated with absenteeism, job change, and diseases. More studies are necessary to clarify the relationship between the factors related to work and the anthropometric status of food handlers since excess weight is multifactorial.

Impact of baseline body mass index on the outcomes of patients withneuroendocrine neoplasms.

To assess the impact of baseline body mass index (BMI) on the outcomes of patients with neuroendocrine neoplasms (NENs) in a population-based setting. Linked provincial administrative databases (within the province of Alberta, Canada), 2004-2019, were accessed, and patients with NENs and complete information about BMI near the time of diagnosis were reviewed. The impact of BMI on overall survival was evaluated through the use of Kaplan-Meier survival estimates and multivariable Cox regression modeling. A total of 1010 patients with NENs and BMI information were included. Using Kaplan-Meier survival estimates, survival outcomes were best with individuals with obesity and were worst with underweight individuals (P < 0.0001). The following factors were associated with worse overall survival, older age (HR: 1.02; 95% CI: 1.01-1.03), male sex (HR: 1.60; 95% CI: 1.32-1.93), higher Charlson comorbidity index (HR: 1.22; 95% CI: 1.13-1.31), non-small intestinal primary (HR for gastric primary versus small intestinal primary: 2.36; 95% CI: 1.44-3.85), stage 4 disease (HR: 2.67; 95% CI: 2.16-3.31), neuroendocrine carcinoma histology (HR: 1.76; 95% CI: 1.43-2.17), and underweight BMI (HR versus normal BMI: 1.74; 95% CI: 1.11-2.73). When the model was repeated using BMI as a continuous variable (rather than as a categorical variable), increasing BMI was associated with better overall survival (HR with increasing BMI: 0.97; 95% CI: 0.95-0.98). Lower BMI is associated with worse overall survival among patients with NENs. This finding was demonstrable regardless of the tumor's stage or histology.

Neural, physiological, and psychological markers of appetitive conditioning in anorexia nervosa: a study protocol

BackgroundAnorexia nervosa (AN) is a chronic and disabling psychiatric condition characterized by low hedonic drive towards food, and is thought to be inclusive of altered dimensions of reward processing. Whether there exists a fundamental aberrancy in the capacity to acquire and maintain de novo hedonic associations—a critical component of hedonic responding—has never been studied in AN.MethodsThis multi-modal study will employ a 2-day Pavlovian appetitive conditioning paradigm to interrogate the (1) acquisition, (2) extinction, (3) spontaneous recovery and (4) reinstatement of appetitive learning in adolescents and young adults with AN. Participants will be 30 currently ill, underweight individuals with AN; 30 weight-restored individuals with AN; and 30 age-matched healthy controls, all aged 12–22 years. All subjects will undergo clinical assessment, followed by the 2-day appetitive conditioning task during which fMRI, pupillometry, heart rate deceleration, and subjective ratings will be acquired.DiscussionThis study will be the first to interrogate appetitive conditioning in AN—a disorder characterized by altered hedonic responding to food. Results will help establish objective biomarkers of appetitive conditioning in AN and lay the groundwork for developing novel lines of treatment for AN and other psychiatric disorders involving diminished ability to experience pleasure and reward.Trial registration: Pending.Intended registry Clinicaltrials.gov.

Association between being underweight and excess body weight before SARS coronavirus type 2 infection and clinical outcomes of coronavirus disease 2019: Multicenter study

ObjectivesThe present study aimed to identify associations between extremes in body weight status (underweight and excess body weight) before a COVID-19 diagnosis and clinical outcomes in patients infected with SARS coronavirus type 2. MethodsA multicenter cohort study was conducted in eight different states in northeastern Brazil. Demographic, clinical (previous diagnosis of comorbidities), and anthropometric (self-reported weight and height) data about individuals who tested positive for COVID-19 were collected. Outcomes included hospitalization, mechanical ventilation, and death. Multivariable logistic regression models, adjusted based on age, sex and previous comorbidities, were used to assess the effects of extremes in body weight status on clinical outcomes. ResultsA total of 1308 individuals were assessed (33.6% were elderly individuals). The univariable analyses showed that only hospitalization was more often observed among underweight (3.2% versus 1.2%) and overweight (68.1% versus 63.3%) individuals. In turn, cardiovascular diseases were more often observed in all clinical outcomes (hospitalization: 19.7% versus 4.8%; mechanical ventilation: 19.9% versus 13.5%; death: 21.8% versus 14.1%). Based on the multivariable analysis, body weight status was not associated with risk of hospitalization (underweight: odds ratio [OR]: 1.10; 95% confidence interval [CI] 95%, 0.50–2.41 and excess body weight: OR: 0.81; 95 CI, 0.57–1.14), mechanical ventilation (underweight: OR: 0.92; 95% CI, 0.52–1.62 and excess weight: OR: 0.90; 95% CI, 0.67–1.19), and death (underweight: OR: 0.61; 95% CI, 0.31–1.20 and excess body weight: OR 0.88; 95% CI, 0.63–1.23). ConclusionsBeing underweight and excess body weight were not independently associated with clinical outcomes in patients with COVID-19 in the herein analyzed cohort. This finding indicates that the association between these variables may be confounded by both age and comorbidities.

Comparison of salivary leptin levels between underweight and overweight individuals and its role in orthodontic tooth movement

Introduction: The Aim of this study is to compare the concentration of salivary leptin levels between underweight and overweight individuals and its significance in orthodontic tooth movement. Methods: Fourty five underweight and overweight female subjects were taken in this study and they are divided into two groups, group I (underweight) and group II (overweight) depending on their mean body mass index. Angles class I malocclusion with bimaxillary protrusion were taken into this study. All subjects underwent upper first premolar extraction, and distal force is applied with lacebacks to maxillary canine. Salivary leptin samples were collected before force application (To), one hour after appliance placement T2, and one month after appliance placement (T3). Results: Overweight individuals show increased salivary leptin concentration three times greater than underweight individuals. Orthodontic tooth movement is decreased in overweight individuals when compared with underweight individuals. Conclusions: Increased salivary leptin levels showed a decreased tooth movement in overweight individuals than underweight individuals who showed decreased salivary leptin levels. Obese individuals require more orthodontic treatment duration time when compared with lean individuals.

Trajectories of body weight change and survival among mCRC patients treated with systemic therapy: Pooled analysis from the ARCAD database.

80 Background: Higher baseline body mass index is associated with improved survival in metastatic CRC (mCRC). Whether weight gain or loss after mCRC diagnosis is associated with survival remains largely unknown. Methods: We analyzed individual patient data from 3504 patients with previously untreated mCRC enrolled in five phase III randomized trials (AVF2017g, AVF2192g, CRYSTAL, N9741, OPUS) conducted between 2000 and 2006. Weight measurements were prospectively collected at 3 months after diagnosis and then up to 5 years. Patients were categorized into three groups based on the percent weight change at 3 months: stable weight or gain, weight loss up to 5% of baseline weight, and ≥5% weight loss of baseline weight. Cox models were used to assess the prognostic associations of weight change at 3 months with overall survival (OS) and progression-free survival (PFS), adjusting for baseline BMI, age, sex, performance score, chemotherapy backbone (oxaliplatin vs. irinotecan), and biologics type (cetuximab vs. bevacizumab). Sub-analyses included Cox models adjusted for additional clinical-pathological factors (primary tumor sidedness [right colon vs. left colon-rectum], and BRAF status; N=1,511). Results: Median percent weight change at 3 months was -0.5% (IQR -4.0 to+1.6%). OS was better in patients with weight stability or gain than in those with weight loss (up to 5% or ≥5%; (Table). Results were consistent for PFS for patients with ≥5% weight loss of baseline weight, as well as for sub-analyses. Conclusions: Patients losing weight during the first 3 months of systemic therapy for metastatic colorectal cancer have significantly shorter overall survival than those with stable or increasing weight. Degree of weight loss is proportional to the observed increased risk of death and remains evident among underweight, normal weight and obese individuals. Further studies examining possible usefulness of on-treatment early weight loss as a novel intermediary end-point are needed.[Table: see text]

Frequent mental distress among adults in the United States and its association with socio-demographic characteristics, lifestyle, and chronic health condition

Frequent mental distress (FMD) is a measure of poor mental health days for at least 14 days out of 30 days. It is one of the important dimensions of the health-related quality of life. The underlying causes of FMD are diverse. However, the issue has not been explored extensively due to the lack of reliable data on mental health. The aim of this study was to examine the level and trends of FMD among the adults of the United States (US) and identify the socio-demographic, lifestyles, and chronic health outcomes related correlates of FMD. The data for the study was obtained from the publicly available 2019 Behavioral Risk Factor Surveillance System (BRFSS) in the US, covering a large sample of 418,268 adult respondents from all the 50 states and participating territories. Respondents from each state and territory were identified by selecting the telephone number from the telephone directory following a systematic sampling design. To examine the trends in the prevalence of FMD, data from the 2010-2018 BRFSS were also utilized. Both descriptive and inferential statistical techniques, including multiple logistic regression models were employed to analyze the data. Results indicated that about 12% of the adults in the US experienced FMD, and the prevalence of FMD is increasing over time. Females, students, adults aged below 35 years, multiracial, less educated, single, low income, and underweight individuals were found to have a higher risk of FMD. FMD was found to be significantly associated with unhealthy lifestyles and chronic health conditions. This study findings highlight the importance of interventions for mental health promotion and mental illness prevention, substance use prevention, screening and treatment services of FMD, and increased provision of resources to address social and economic determinants of FMD.

Reference Walking Speeds for Healthy Young Adults in Qatar: Moderating Effect of Obesity and Physical Activity

Walking speed (WS) is considered an important indicator for overall health. Despite this, there is a paucity of data relating to WS values in the Arab region. The present study aims to establish preferred (PWS) and maximal walking speeds (MWS) in young adults in Qatar and examine how gender, body mass index, and physical activity (PA) components influence WS. One hundred ninety-six healthy participants (age: 22 ± 2 years; 60% females) performed a standardized walking test on a flat 10-m pathway, completed the short form of the International PA Questionnaire, and had their height and weight measured. PWS and MWS were normalized for height (rPWS and rMWS). Results. Females demonstrated slower PWS, MWS, and rMWS compared to males. Moreover, MWS and rMWS were lower in obese participants compared to underweight, normal weight and overweight individuals. There was a significant positive relationship only between vigorous PA and rPWS and rMWS. This is the first study to establish reference WS values for healthy young adults in Qatar. Overall, we demonstrated that WS was lower compared to similar adults worldwide. The established healthy walking values can serve as reference for clinical evaluations within Qatar. Future PA guidelines and public health interventions should focus on WS values.

Combined alcohol use and weight status effects on mortality risk among adults: Analysis of the National Health Interview Survey linked mortality files, 2001–2015

BackgroundBoth alcohol use and weight status have been linked to increased mortality risk, but evidence of their joint effect is limited. The goal of this study was to examine the combined effects of alcohol and weight status (BMI classes: underweight, normal, overweight, obesity) on mortality using nationally representative data. MethodsUsing data from public-use National Health Interview Survey-Linked Mortality Files (NHIS-LMF), 2001–2011, linked to prospective mortality follow-up through December 2015, we used age-period-cohort Cox proportional hazards models to examine all-cause and cause-specific mortality associated with the joint effects of alcohol use and BMI on 209,317 individuals aged 35–85. ResultsIndividuals with an underweight BMI status had higher all-cause and cause-specific mortality risks than those with a normal BMI status and light/moderate alcohol intake. All-cause mortality risks were 148% (hazard ratio [HR] 2.48, 95% CI 1.60–3.83) higher in underweight heavy drinkers than light/moderate drinkers with normal BMI status. Obese heavy drinkers had a 16% higher chance of dying from all-cause mortality (HR 1.16, 95% CI 1.00–1.35). Individuals in the unknown alcohol and BMI category have a higher chance of death from all-cause (HR 1.35, 95% CI 1.14–1.59) or cause-specific (CVD HR 1.75, 95% CI 1.14–2.69 and Cancer HR 1.33, 95% CI 1.01–1.76). ConclusionsAlcohol drinking levels result in heightened all-cause and cause-specific mortality risks; the risks are compounded among underweight, obese, and unknown BMI individuals across all or cause-specific mortality.

Psychopathological Symptoms and Well-Being in Overweight and Underweight Adolescents: A Network Analysis.

Overweight and underweight adolescents have an increased risk of psychological problems and reduced quality of life. We used a network analysis approach on a variety of psychopathology and well-being variables to identify central factors in these populations. The network analysis was conducted on data of 344 overweight adolescents (>90th BMI-percentile) and 423 underweight adolescents (<10th BMI-percentile) drawn from a large community sample (10–19 years) including behavioral and emotional problems (Youth Self-Report), eating disorder risk (SCOFF) and well-being variables (KIDSCREEN). Additionally, psychopathology and well-being scores of overweight and underweight individuals were compared with 1.560 normal weight adolescents. Compared to their normal weight peers, overweight adolescents showed elevated psychopathology and eating disorder risk as well as reduced well-being. Underweight adolescents reported increased levels of internalizing problems but no increased eating disorder risk or reduced well-being. The network analysis revealed that anxious/depressed mood and attention problems were the most central and interconnected nodes for both overweight and underweight subsamples. Among underweight individuals, social problems and socially withdrawn behavior additionally functioned as a bridge between other nodes in the network. The results support psychological interventions focusing on improving mood, coping with negative emotions and tackling inner tension.

Association Between Waist Circumference and the Prevalence of (Pre) Hypertension Among 27,894 US Adults.

Aims: This study aimed to investigate the association between waist circumference and the prevalence of (pre) hypertension.Methods: Cross-sectional data from the 2007–2018 National Health and Nutrition Examination Survey were analyzed. The historical trend of abdominal obesity was assessed by the Cochran–Armitage trend test. After preprocessed by the multiple imputation strategy, we used generalized additive models to assess the association of waist circumference with systolic/diastolic blood pressure and performed correlation analysis by the Spearman correlation coefficient. Moreover, we used multivariable logistic regression (non-adjusted, minimally adjusted, and fully adjusted models), restricted cubic spline, and sensitivity analysis to investigate the association between waist circumference and (pre) hypertension.Results: A total of 27,894 participants were included in this study. In the fully adjusted model, waist circumference was positively associated with (pre) hypertension with odds ratios (95% confidence intervals) of 1.28 (1.18–1.40) in the young group and 1.23 (1.15–1.33) in the old group. Restricted cubic spline showed a higher prevalence of (pre) hypertension with the increase of waist circumference. In the subgroup analysis, waist circumference showed a robust trend across all BMI categories with odds ratios (95% confidence intervals) of 3.33 (1.29–8.85), 1.35 (1.17–1.57), 1.27 (1.13–1.41), and 1.09 (1.01–1.17) in underweight, normal weight, overweight, and obese individuals, respectively.Conclusion: This study highlighted waist circumference as a significant biomarker to evaluate the risk of (pre) hypertension. Our results supported the measure of waist circumference regardless of BMI when evaluating the cardiometabolic risk related to fat distribution.

Association between body mass index and the risk of atrial fibrillation and ischemic stroke according to age: a nationwide population-based cohort study

Abstract Background Atrial fibrillation (AF) and ischemic stroke (IS) are two significant cardiovascular diseases that confer an enormous healthcare burden. A limited study comprehensively evaluated the association between full ranges of body mass index (BMI), including underweight, and AF or IS risks, especially in the different age subgroups. Purpose We investigated the association between BMI and AF and IS incidence according to the Korean population's age groups. Methods This was a nationwide population-based cohort study using data from the Korea National Health Insurance Service, including 9 194 477 healthy adults who underwent a medical examination in 2009. We stratified the study population into three age subgroups: age 20–39 (young, 33.1%), age 40–64 (middle-aged, 56.3%), and age over 65 years (elderly, 10.6%). In each age group, the individuals were categorized based on BMI (kg/m2) into underweight (&amp;lt;18.5), normal (18.5 to &amp;lt;23), overweight (23 to &amp;lt;25), obese I (25 to &amp;lt;30), and obese II (≥30). The first occurrences of AF and IS were followed up until December 31, 2018. According to BMI in each age group, the risks of AF and IS were analyzed by Cox proportional hazards regression with 95% confidence intervals (CI) by adjusting age, sex, lifestyle behaviors, and comorbidities. Results Overall, both underweight and higher BMI were associated with an increased risk of AF and stroke across all age groups. The increased risk of AF for patients with obese II was slightly accentuated compared to patients with normal BMI in the young population than elderly population (hazard ratio [HR] 1.78, 95% CI 1.63–1.94 for age 20–39 years; HR 1.55, 95% CI 1.48–1.61 for age ≥65 years, respectively). For underweight individuals, however, the increased risk of AF became more prominent in the elderly: HR and 95% CI was 1.12 (1.07–1.17) in the age over 65 years old, and 1.05 (0.94–1.16) in the age 20–39. Regarding IS, the young group presented a considerable increment in the magnitude of HRs in both underweight and higher BMI groups. However, the association between the BMI and stroke risk became attenuated in the elderly: HRs and 95% CI in underweight and obese II individuals were 1.10 (0.93–1.30) and 2.223 (1.99–2.49) in the age 20–39 group, whereas 0.97 (0.93–1.01) and 1.03 (0.98–1.08) in the age over 65 years old. Conclusions Underweight as well as obesity was associated with increased risks of AF and IS in the general population. In both AF and IS, the gradient of risks according to BMI was apparent at young ages; thus, maintaining normal body weight should be warranted in early life. An interplay of several factors other than BMI may contribute to ischemic stroke in the old ages, requiring integrated risk management in older patients. Funding Acknowledgement Type of funding sources: None.

Dyslipidemia Is Associated With Increased Risk of Achilles Tendon Disorders in Underweight Individuals to a Greater Extent Than Obese Individuals: A Nationwide, Population-Based, Longitudinal Cohort Study.

Background:The association between dyslipidemia and Achilles tendinopathy (AT) or Achilles tendon rupture (ATR) remains controversial, although some studies have examined this topic.Purpose:To evaluate the correlation of dyslipidemia and the risk of AT or ATR, and its association with body mass index (BMI), by assessing data from a nationwide population-based cohort.Study Design:Cohort study; Level of evidence, 3.Methods:We used the National Health Insurance database, which includes the entire population of the Republic of Korea, to evaluate participants in the National Health Screening Program between January 2009 and December 2010. Participants diagnosed with AT or ATR before December 31, 2017, were selected. The variables assessed were age, sex, frequency of high-intensity exercise per week, BMI, waist circumference, systolic blood pressure, and levels of low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and fasting blood glucose. Multivariate Cox proportional hazards regression was used for data analysis.Results:A total of 16,830,532 participants were included. Of these, 125,814 and 31,424 participants developed AT and ATR, respectively. A higher level of LDL-C was associated with an increased risk of AT (adjusted hazard ratio [HR], 1.16) and ATR (adjusted HR, 1.18). A slightly increased risk of AT was observed in participants with higher TG levels (adjusted HR, 1.03), whereas higher HDL-C level was associated with a slight risk reduction for AT (adjusted HR, 0.95). However, no significant association was observed between higher TG or HDL-C levels and ATR. In the underweight group (BMI <18.5 kg/m2), a higher LDL-C level was associated with an increased risk of AT and ATR by 37% and 116%, respectively, compared with lower LDL-C. Higher LDL-C level was associated with an increased risk of AT and ATR by 10% and 16%, respectively, in the obese group (BMI ≥25 kg/m2).Conclusion:Dyslipidemia was related to the development of AT and ATR. The association of higher LDL-C levels with AT and ATR risk was more pronounced in underweight than in overweight and obese individuals.

The Relationship Between Obesity and Amputation-free Survival in Patients Undergoing Lower-limb Revascularisation for Chronic Limb-threatening Ischaemia: A Retrospective Cohort Study

The obesity paradox is a well-documented phenomenon in cardiovascular disease, however it remains poorly understood. We aimed to investigate the relationship between body mass (as measured by body mass index [BMI]) and 1-year amputation-free survival (AFS) for patients undergoing lower limb revascularisation for chronic limb-threatening ischaemia (CLTI). A retrospective analysis was undertaken of all consecutive patients undergoing lower limb revascularisation for CLTI at the Leicester Vascular Institute between February 2018-19. Baseline demographics and outcomes were collected using electronic records. BMI was stratified using the World Health Organization criteria. One-year AFS (composite of major amputation/death) was the primary outcome. Kaplan-Meier survival analysis and adjusted Cox's proportional hazard models were used to compare groups to patients of normal mass. One-hundred and ninety patients were included. Overall, no difference was identified in 1-year AFS across all groups (pooled P=0.335). Compared to patients with normal BMI (n=66), obese patients (n=43) had a significantly lower adjusted combined risk of amputation/death (aHR 0.39, 95% CI 0.16-0.92, P=0.032), however no significant differences were observed for overweight (aHR 0.89, 95% CI 0.47-1.70, P=0.741), morbidly obese (aHR 1.15, 95% CI 0.41-3.20, P=0.797) and underweight individuals (aHR 1.86, 95% CI 0.56-6.20, P=0.314). In the context of CLTI, obesity is potentially associated with favourable amputation-free survival at 1 year, compared to normal body mass. The results of this study support the notion of an obesity paradox existing within CLTI and question whether current guidance on weight management requires a more patient-specific approach.

Mortality and Exacerbation Risk by Body Mass Index in Patients with COPD in TIOSPIR and UPLIFT.

RationaleThere is an association between body mass index (BMI) and mortality in chronic obstructive pulmonary disease (COPD), with underweight individuals having higher mortality risk. Mortality and exacerbation risks among individuals with higher BMI are unclear.ObjectivesTo examine the relationship between BMI and adverse outcomes in COPD.MethodsThis post hoc analysis included data from TIOSPIR (Tiotropium Safety and Performance in Respimat) (N = 17,116) and tiotropium-treated patients in UPLIFT (Understanding Potential Long-term Impacts on Function with Tiotropium) (N = 2,986). BMI classes (underweight [BMI < 20 kg/m2], normal weight [BMI 20 to <25 kg/m2], overweight [BMI 25 to <30 kg/m2], obesity class I [BMI 30 to <35 kg/m2], obesity class II [BMI 35 to <40 kg/m2], and obesity class III [BMI ⩾ 40 kg/m2]) were examined for adjusted associations with mortality, exacerbation, and nonfatal cardiovascular event risk using over 50,000 patient-years of cumulative follow-up data. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox regression models.ResultsIn TIOSPIR, obesity prevalence was 22%, overweight 32%, and underweight 12%. The proportion of females was highest in obesity classes II and III. Overweight and obese participants had better baseline lung function versus other BMI classes; underweight participants were more likely to be current smokers. Underweight participants had a significantly higher risk of death (HR, 1.88; 95% CI, 1.62–2.20; P < 0.0001) and severe exacerbations (HR, 1.31; 95% CI, 1.16–1.47; P < 0.0001) versus normal-weight participants; however, overweight and obese participants were at lower to no additional risk. Results from UPLIFT were similar to TIOSPIR.ConclusionsThese results suggest that there is a strong association between body weight, COPD events, and risk of death. A holistic management approach taking into account respiratory and cardiovascular risk factors and nutritional status is needed to improve the general well-being of patients with COPD.

Impact of dietary counselling on the nutritional status and quality of life among pulmonary tuberculosis patients - A randomized control trial

Background & aimUndernutrition and TB have a bidirectional relationship, which is especially relevant in the Indian context. Undernutrition is an established risk factor for the progression of latent TB infection to active TB. Undernutrition at the population level contributes to an estimated 55% of annual TB incidence in India. TB leads to weight loss, wasting, and worsening of nutritional status. Hence, the present study aimed to determine the impact of dietary counselling on the nutritional status and the health-related quality of life of PTB patients. Materials & methodThis was an interventional study (randomized controlled trial) that involved patients with PTB. 46 patients (23 patients as experimental and 23 patients as a control group) were enrolled in the study from June 2019 to February 2020 and they were divided into 2 categories based on BMI (underweight and normal weight). The special dietary counselling was given to the experimental group patients and the normal protocol was followed with the control group. The patients were followed up, till completion of treatment i.e., 6 months from enrolment. ResultsIn our study, nearly half of the patients were underweight and DM was the predominant comorbidity. The BMI increased after dietary counselling in the experimental group than the control group (P = 0.0053) in underweight individuals. Total protein (P = 0.0025), and serum albumin (P = 0.0048) levels were found to be significantly improved in the experimental group. SGRQ symptom score (P = 0.0036) has significantly reduced in the experimental group in underweight individuals than the control group. ConclusionPersonalized dietary counselling was found to have a positive impact on BMI, total protein, and albumin levels in the experimental group, especially in underweight individuals. Besides, the quality of life measured using SGRQ showed that symptom score were also significantly reduced in the experimental group than the control group.

Association Between Body Mass Index and Admission Hemoglobin and Lactate Dehydrogenase in Patients Admitted for Sickle Cell Disease — A Retrospective Study

▪Introduction:Based on data in children, the presence of obesity may be associated with a milder variant of sickle cell disease. Data in children suggests that patients able to attain a normal or above normal body mass index (BMI) have better health outcomes than patients with low BMI. The association between BMI and severity of sickle disease in adults is less well studied. The present retrospective study aims to examine the association between increasing body mass index and markers of disease and flare severity in adults with sickle cell disease.Methods:A retrospective chart review was conducted at a tertiary care hospital from 2010 to 2016. Data on 156 patients was collected. Data collected included BMI, complete blood counts (on admission and baseline at prior visit), lactate dehydrogenase levels (LDH), serum chemistries and medications administered during hospitalization. BMI was examined as a continuous variable as well as categorical, with patients split into normal weight (BMI 20-25), underweight (BMI <20) and obese categories (BMI >25).Results:Of the 156 individuals included in the study, 29 (19%) were underweight, 81 (52%) were normal weight and 46 (29%) were obese. Increasing BMI was associated with increased admission hemoglobin (β=0.93;p=0.008) (Figure 1a), a higher value of lowest hemoglobin during hospitalization (β=0.10; p=0.023) and lower values of LDH (β=-19; p=0.025) (Figure 1b). As compared to underweight individuals, obese or normal weight individuals tended to have higher values of hemoglobin throughout hospitalization, as well as lower values of LDH, although this was not consistent across all study subgroups (Table 1).Discussion:The present study suggests that the presence of obesity, or indeed normal weight status is associated with improved laboratory parameters in adult patients with sickle cell disease. It is possible that obesity or normal weight status is a protective risk factor characterized by milder sickle crises. However, the presence of milder disease characteristics (as determined by higher hemoglobin and lower LDH levels) may represent a milder variant of sickle cell disease that “allows” patients to achieve normal or above normal body weights. A greater understanding of the mechanism underlying this phenomenon is required in order to determine optimal therapeutic strategies and clinical impact. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Challenging the obesity paradox: extreme obesity and COPD mortality in the SUMMIT trial.

Populations with COPD demonstrate higher survival in overweight and obese compared with normal weight; the “obesity paradox”. Relationships in less-severe COPD are unclear, as is the impact of cardiovascular risk, and few studies include individuals at extremes of obesity. We examined the relationship between body mass index (BMI; defined as underweight: <20 kg·m−2, normal: 20–25 kg·m−2, overweight: 25– <30 kg·m−2, obese class I: 30– <35 kg·m−2, class II: 35– <40 kg·m−2 and class III: ≥40 kg·m−2), morbidity, and mortality in the SUMMIT trial population (n=16 485), characterised by moderate COPD and heightened cardiovascular risk with a substantial proportion with class III obesity. The association between BMI category and time to event was modelled via proportional hazards (reference normal weight) adjusted for demographics and cardiorespiratory disease. Consistent with the paradox, underweight individuals demonstrated higher mortality (hazard ratio (HR) 1.31 (95% CI 1.04–1.64)), with lower mortality among overweight (HR 0.62 (95% CI 0.52–0.73)) and obese class I (HR 0.75 (95% CI 0.62–0.90)). However, mortality increased in obese class III (HR 1.36 (95% CI 1.00–1.86)). Death was primarily attributable to cardiovascular causes. Within a large, multinational cohort with moderate COPD and increased cardiovascular risk, the phenomenon of reduced mortality with obesity did not persist at BMI >40 kg·m−2, suggesting that obesity may not remain protective at the extremes in this population.

Associations of the pre-pregnancy weight status with anaemia and the erythropoiesis-related micronutrient status.

The coexistence of underweight (UW) and overweight (OW)/obese (OB) at the population level is known to affect iron deficiency (ID) anaemia (IDA), but how the weight status affects erythropoiesis during pregnancy is less clear at a population scale. This study investigated associations between the pre-pregnancy BMI (pBMI) and erythropoiesis-related nutritional deficiencies. Anthropometry, blood biochemistry and 24-h dietary recall data were collected during prenatal care visits. The weight status was defined based on the pBMI. Mild nutrition deficiency-related erythropoiesis was defined if individuals had an ID, folate depletion or a vitamin B12 deficiency. The Nationwide Nutrition and Health Survey in Taiwan (Pregnant NAHSIT 2017-2019). We included 1456 women aged 20 to 45 years with singleton pregnancies. Among these pregnant women, 9·6 % were UW, and 29·2 % were either OW (15·8 %) or OB (13·4 %). A U-shaped association between the pBMI and IDA was observed, with decreased odds (OR; 95 % CI) for OW subjects (0·6; 95 % CI (0·4, 0·9)) but increased odds for UW (1·2; 95 % CI (0·8, 2·0)) and OB subjects (1·2; 95 % CI (0·8, 1·8)). The pBMI was positively correlated with the prevalence of a mild nutritional deficiency. Compared to normal weight, OB pregnant women had 3·4-fold (3·4; 95 % CI (1·4, 8·1)) higher odds for multiple mild nutritional deficiencies, while UW individuals had lowest odds (0·3; 95 % CI (0·1, 1·2)). A dietary analysis showed negative relationships of pBMI with energy, carbohydrates, protein, Fe and folate intakes, but positive relationship with fat intakes. The pre-pregnancy weight status can possibly serve as a good nutritional screening tool for preventing IDA during pregnancy.