Unit Increase In Body Mass Index Research Articles

Early Postoperative Outcomes of Super Morbid Obese Compared to Morbid Obese Patients After Ambulatory Surgery Under General Anesthesia: A Propensity-Matched Analysis of a National Database.

Patients with body mass index (BMI) ≥50 kg/m2, defined as super morbid obesity, represent the fastest growing segment of patients with obesity in the United States. It is currently unknown if super morbid obese patients are at greater odds than morbid obese patients for poor outcomes after outpatient surgery. The main objective of the current investigation is to assess if super morbid obese patients are at increased odds for postoperative complications after outpatient surgery when compared to morbid obese patients. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2017 to 2018 was queried to extract and compare patients who underwent outpatient surgery and were defined as either morbidly obese (BMI >40 and <50 kg/m2) or super morbidly obese (BMI ≥50 kg/m2). The primary outcome was the occurrence of medical adverse events within 72 hours of discharge. In addition, we also examine death and readmissions as secondary outcomes. A propensity-matched analysis was used to evaluate the association of BMI ≥50 kg/m2 versus BMI between 40 and 50 kg/m2 and the outcomes. A total of 661,729 outpatient surgeries were included in the 2017-2018 NSQIP database. Of those, 7160 with a BMI ≥50 kg/m2 were successfully matched to 7160 with a BMI <50 and ≥40 kg/m2. After matching, 17 of 7160 (0.24%) super morbid obese patients had 3-day medical complications compared to 15 of 7160 (0.21%) morbid obese patients (odds ratio [OR; 95% confidence interval {CI}] = 1.13 [0.57-2.27], P = .72). The rate of 3-day surgical complications in super morbid obese patients was also not different from morbid obese patients. Thirty-five of 7160 (0.48%) super morbid obese patients were readmitted within 3 days, compared to 33 of 7160 (0.46%) morbid obese patients (OR [95% CI] = 1.06 [0.66-1.71], P = .80). When evaluated in a multivariable analysis as a continuous variable (1 unit increase in BMI) in all patients, BMI ≥40 kg/m2 was not significantly associated with overall medical complications (OR [95% CI] = 1.00 [0.98-1.04], P = .87), overall surgical complication (OR [95% CI] = 1.02 [0.98-1.06], P = .23), or readmissions (OR [95% CI] = 0.99 [0.97-1.02], P = .8). Super morbid obesity is not associated with higher rates of early postoperative complications when compared to morbid obese patients. Specifically, early pulmonary complications were very low after outpatient surgery. Super morbid obese patients should not be excluded from outpatient procedures based on a BMI cutoff alone.

The Correlation Between Body Weight and Intraocular Pressure.

INTRODUCTION: Preflight body weight is a strong predictor of visual changes in spaceflight. To understand the effect of body weight on the eye, we examined the effect of increased body mass index on intraocular pressure on Earth.METHODS: We conducted a systematic review to summarize the relationship between weight parameters (including body mass index (BMI) and obesity indices), and intraocular pressure (IOP). Study selection and data extraction were performed in duplicate using EMBASE, MEDLINE, and CENTRAL, from database inception to the second week of April 2020.RESULTS: A total of 66 individual studies were included for qualitative analysis from the 1364 studies eligible for title and abstract screening. A total of 39 studies were available for quantitative analysis. The average BMI was 25.9 (range, 20.148.8) and the average IOP was 14.9 mmHg (range, 11.627.8). The overall pooled RR between BMI and elevated intraocular pressure (IOP) was 1.06 (95 CI%, 1.041.07), meaning for each unit increase in BMI one is 6 more likely of having higher IOP than baseline. Two studies assessed the effects of bariatric surgery, and both showed significant decreases in IOP postoperatively.CONCLUSION: A higher BMI was associated with increased IOP in ground-based studies. IOP also decreased with weight loss. These data support the idea that alterations in body weight affect intraocular pressures. Further research is needed to understand the relationship between body weight, IOP, and microgravity-induced visual changes. This finding may also be useful clinically.Khan S, Kirubarajan A, Lee M, Pitha I, Buckey JC Jr. The correlation between body weight and intraocular pressure. Aerosp Med Hum Perform. 2021; 92(11):886-897.

Body Composition and Physical Fitness Affect Central Hemodynamics in Young Children.

Objective: Central hemodynamics are related to cardiovascular (CV) outcomes in adults, but associations with childhood CV risk remain unclear. The study aimed to investigate the association of obesity, physical activity, and fitness with parameters of central pulse wave reflection in young prepubertal children.Methods: In this cross-sectional study, 1,324 primary school children (aged 7.2 ± 0.4 years) were screened for parameters of pulse wave reflection such as augmentation index (AIx), central pulse pressure (CPP), body mass index (BMI), and cardiorespiratory fitness (CRF) by standardized procedures for children.Results: The mean AIx and AIx@75 were 22.2 ± 7.7 and 29.2 ± 9.2%, respectively. With each unit increase in BMI, AIx [−0.226 (−0.328; −0.125)%] and AIx@75 [−0.444(−0.660; −0.229)%] decreased, whereas peak forward pulse wave increased (p < 0.001). Increasing BMI was associated with higher CPP, but did not remain significant after adjustment for CRF and heart rate. One unit increase in CRF was associated with lower AIx@75 [−0.509(−0.844; −0.173)%, p = 0.003] and lower reflection magnitude [RM: −0.559 (−0.890; −0.227), p = 0.001], independent of body weight and height. Girls had significantly higher AIx, AIx@75, peak backward pulse wave, and RM compared with boys.Conclusion: Childhood obesity was associated with higher CPP but lower augmentation of the reflected pulse wave in children. Assessment of central blood pressures appears to be a valuable asset to childhood CV risk screening. The validity of augmentation indices during childhood development and the association with early vascular aging in children need to be verified in long-term follow-up studies. Physical activity and fitness have the potential to improve vascular hemodynamics in susceptible children and, thus, counteract vascular aging.Trial registry: ClinicalTrials.gov: Exercise and Arterial Modulation in Youth. Identifier: NCT02853747; URL: https://clinicaltrials.gov/ct2/show/NCT02853747.

Physical Activity and Body Mass Index (BMI) as Predictors of Health-related Quality of Life in Montana Adults

Background: Health-related quality of life (HRQOL) is an important concept related to how health status affects a person’s life. Engaging in physical activity (PA) and maintaining healthy body weight are each linked to favorable HRQOL. However, the extent to which PA and body weight independently influence HRQOL is less known. The aim of this research was to examine how meeting PA guidelines and body mass index (BMI) affect a measure of HRQOL in adults. Methods: The Montana Behavioral Risk Factor Surveillance System (BRFSS, 2019) was used for this study. Three different PA guideline variables were used and included a two-level aerobic PA (APA) (met APA or did not meet APA) measure, a two-level muscle strengthening activity (MSA) (met MSA or did not meet MSA) measure, and a two-level PA guidelines (APA/MSA) (met both APA and MSA or did not meet both) measure. BMI was calculated from self-reported height and weight (kg/m2). HRQOL was assessed from a question asking participants to rate their general health with the following response options: “excellent”, “very good”, “good”, “fair” or “poor”. Multinomial logistic regression was used to examine the independent effects of PA and BMI on each HRQOL rating (relative to excellent) while controlling for sociodemographic variables. Results: Differences in HRQOL prevalence was seen within all sociodemographic variables except sex. Additionally, BMI was significantly (p Mean = 30.30, SE = 0.32) compared to those reporting excellent, very good or good health (Mean = 27.28, SE = 0.09), with a similar trend seen across all sociodemographic groups. The fully adjusted regression model including APA/MSA showed decreased odds of very good (OR = 0.75, 95% CI: 0.60 – 0.92), good (OR = 0.61, 95% CI: 0.49 – 0.78), fair (OR = 0.56, 95% CI: 0.40 – 0.78), and poor health (OR = 0.44, 95% CI: 0.28 – 0.69) (relative to excellent health) for adults meeting both APA and MSA. In the same model, increased odds was seen for very good (OR = 1.08, 95% CI: 1.06 – 1.10), good (OR = 1.15, 95% CI: 1.13 – 1.18), fair (OR = 1.19, 95% CI: 1.16 – 1.23), and poor health (OR = 1.16, 95% CI: 1.12 – 1.21) (relative to excellent health) for each 1-unit increase in BMI (1.00 kg/m2). Similar findings were seen in the separate APA model but not the MSA model. Conclusion: This study found that meeting PA guidelines and BMI were both independently related to HRQOL in adults. However, meeting MSA showed lower effects and inconsistent effects on HRQOL. Health promotion specialists concerned with improving HRQOL should promote both APA and MSA guidelines along with healthy body weight behavior. Physical activity programming should consider APA a priority over MSA for improving HRQOL in Montana adults.

Peripheral Airway Impairment and Dysanapsis Define Risk of Uncontrolled Asthma in Obese Asthmatic Children

Factors that determine the relationship between obesity and poor outcomes in asthmatic children are not well understood. Dysanapsis and peripheral airway impairment (PAI) could provide an explanation in the obese asthmatic patient. To determine the effect of obesity on increased dysanapsis and PAI and establish the effect of obesity, dysanapsis, and PAI on increased risk of uncontrolled asthma. We evaluated 206 children with moderate to severe asthma, aged 4-18 years, to determine the relationship of body mass index (BMI) to increased dysanapsis and PAI, using reference values. We examined the probability of obesity, dysanapsis, and PAI increasing the risk of uncontrolled asthma by BMI categorically and BMI z scores using generalized linear model analyses. Compared with normal-weight children, overweight and obese children had increased forced vital capacity % predicted and obesity increased odds of dysanapsis by 2.32 (P=.04), while PAI showed an age-dependent effect, with increased odds of 2.09 for children younger than 12 years (P=.08) and 54.14 for those 12 years and older (P= .003). For each unit increase in BMI z score, there was an increased odds ratio of 1.57 for dysanapsis (P= .009), greater in males, OR of 3.10, P = .009, and of 1.39 for PAI for those younger than 12 years (P= .042) and of 4.60 for those 12 years and older (P= .002). Obesity's relationship to uncontrolled asthma was indirect, as not significant when adjusted for the direct effect of dysanapsis and PAI, which were highly significant predictors, with increased odds of 28.01 for dysanapsis for those younger than 12 years (P < .001) and of 3.09 for PAI (P= .005). Overweight and obesity significantly increase odds of dysanapsis and PAI, in an age and gender-specific manner, increasing the probability of uncontrolled asthma.

Body mass index and weight gain after middle adulthood are associated with risk of papillary thyroid cancer: A case–control study

BackgroundIt is unclear whether weight change after middle adulthood influences the risk of thyroid cancer. The aim of this study was to investigate associations between the risk of papillary thyroid cancer (PTC) and body mass index (BMI) and weight change after middle adulthood (age 35). MethodsA matched case–control study based on three hospitals included 516 pairs of cases newly diagnosed with PTC and controls. Current height and weight after defecation in the morning were measured by trained nurses. During measurement, all subjects were requested to wear lightweight clothing and no shoes. Weight at age 35 was self-reported. BMI and weight change were modeled as continuous and categorical variables. Conditional and unconditional logistic regression models were used to estimate the odds ratio (OR) and 95% confidence interval (95%CI) for the association between BMI and weight change after middle adulthood and PTC. ResultsAfter adjustment for covariates, measured BMI at the time of current diagnosis was positively associated with PTC (OR 1.16, 95%CI 1.10–1.21). According to WHO BMI guidelines for Asia-Pacific populations, the OR (95%CI) for PTC risk in obesity was 2.99 (1.92–4.67) compared to normal weight (p-trend <0.001). Moreover, PTC was positively associated with BMI at age 35; the OR (95%CI) for PTC risk per unit increase in BMI was 1.06 (1.02–1.11). Compared to stable weight (changed <0.5 kg/year), weight gain ≥1.0 kg/year after middle adulthood was positively associated with PTC (OR 2.57, 95%CI 1.39–4.76, p-trend <0.001). Compared to maintaining non-overweight status, the PTC risk was significantly increased in those individuals who gained weight and became overweight after middle adulthood (OR 3.82, 95%CI 2.50–5.85). ConclusionThis study showed that high BMI and obesity were positively associated with increased risk of PTC, and weight gain after middle adulthood also could elevate the PTC risk.

Long-term cost-effectiveness of interventions for obesity: A mendelian randomisation study.

The prevalence of obesity has increased in the United Kingdom, and reliably measuring the impact on quality of life and the total healthcare cost from obesity is key to informing the cost-effectiveness of interventions that target obesity, and determining healthcare funding. Current methods for estimating cost-effectiveness of interventions for obesity may be subject to confounding and reverse causation. The aim of this study is to apply a new approach using mendelian randomisation for estimating the cost-effectiveness of interventions that target body mass index (BMI), which may be less affected by confounding and reverse causation than previous approaches. We estimated health-related quality-adjusted life years (QALYs) and both primary and secondary healthcare costs for 310,913 men and women of white British ancestry aged between 39 and 72 years in UK Biobank between recruitment (2006 to 2010) and 31 March 2017. We then estimated the causal effect of differences in BMI on QALYs and total healthcare costs using mendelian randomisation. For this, we used instrumental variable regression with a polygenic risk score (PRS) for BMI, derived using a genome-wide association study (GWAS) of BMI, with age, sex, recruitment centre, and 40 genetic principal components as covariables to estimate the effect of a unit increase in BMI on QALYs and total healthcare costs. Finally, we used simulations to estimate the likely effect on BMI of policy relevant interventions for BMI, then used the mendelian randomisation estimates to estimate the cost-effectiveness of these interventions. A unit increase in BMI decreased QALYs by 0.65% of a QALY (95% confidence interval [CI]: 0.49% to 0.81%) per year and increased annual total healthcare costs by £42.23 (95% CI: £32.95 to £51.51) per person. When considering only health conditions usually considered in previous cost-effectiveness modelling studies (cancer, cardiovascular disease, cerebrovascular disease, and type 2 diabetes), we estimated that a unit increase in BMI decreased QALYs by only 0.16% of a QALY (95% CI: 0.10% to 0.22%) per year. We estimated that both laparoscopic bariatric surgery among individuals with BMI greater than 35 kg/m2, and restricting volume promotions for high fat, salt, and sugar products, would increase QALYs and decrease total healthcare costs, with net monetary benefits (at £20,000 per QALY) of £13,936 (95% CI: £8,112 to £20,658) per person over 20 years, and £546 million (95% CI: £435 million to £671 million) in total per year, respectively. The main limitations of this approach are that mendelian randomisation relies on assumptions that cannot be proven, including the absence of directional pleiotropy, and that genotypes are independent of confounders. Mendelian randomisation can be used to estimate the impact of interventions on quality of life and healthcare costs. We observed that the effect of increasing BMI on health-related quality of life is much larger when accounting for 240 chronic health conditions, compared with only a limited selection. This means that previous cost-effectiveness studies have likely underestimated the effect of BMI on quality of life and, therefore, the potential cost-effectiveness of interventions to reduce BMI.

Influence of antibiotics given during labour and birth on body mass index z scores in children in the All Our Families pregnancy cohort.

Little is known about obesity risk associated with intrapartum antibiotic prophylaxis (IAP). Our objective was to determine if maternal antibiotic exposure during birth is associated with child body mass index (BMI) z scores in the first 3 years of life. In 2008 to 2010, 3388 pregnant women were recruited to the All Our Families study. Here, we included women with available data from obstetrical records on antibiotic use during birth (n=1303) and children with at least one valid BMI z score (final sample n=1262). The primary outcome was infant BMI z score at 1, 2 and 3 years of age. IAP occurred in 432 of 1262 women. Children exposed to IAP had significantly higher mean [standard error (SE)] BMI z scores (1.071 [0.087] unit) at 1year of age compared to non-exposed infants (0.744 [0.064] unit). Although the association was no longer significant after adjustment for confounding factors in the growth trajectory model, IAP resulted in a 0.255 unit increase in BMI z score at 1year of age. Differences in BMI z score between exposed and non-exposed at baseline (year 1) only remained significant in sensitivity analysis. The potential association between maternal IAP and increased infant BMI z score at 1year of age should be confirmed in other cohorts and warrants investigation of interventions to mitigate this possible risk.

Association Between Body Mass Index and Outcomes in Venoarterial Extracorporeal Membrane Oxygenation

The association between obesity, or elevated body mass index (BMI), and outcomes in patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) has not been well established. Recent studies in patients receiving venovenous ECMO did not detect an association between obesity and increased mortality. The purpose of this retrospective observational study is to evaluate the association between BMI and survival in patients receiving VA-ECMO for cardiogenic shock. All patients >18 years of age supported on VA-ECMO for refractory cardiogenic shock in a single academic center between 2009 and 2019 were included. ECMO outcomes, including successful ECMO decannulation and 30-day survival, were analyzed after stratification according to BMI. Multivariable and univariate logistic regression were used to assess the association between BMI and VA-ECMO outcomes. Of the total patients (n = 355) cannulated for VA-ECMO, 61.7% of the patients survived to ECMO recovery/decannulation, 45.5% of the patients survived to 30 days after ECMO decannulation, and 38.9% of the patients survived to hospital discharge with no statistically significant differences among the BMI groups. Multivariable logistic regression did not reveal any associations between obesity as defined by BMI and survival to ECMO decannulation (odds ratio [OR] 1.07 per 5 unit increase in BMI, 95% confidence interval [CI], 0.86-1.33; P = .57), 30-day survival (OR = 0.91, 95% CI, 0.73-1.14; P = .41) or survival to hospital discharge (OR = 0.95, 95% CI, 0.75-1.20; P = .66). Despite potential challenges to cannulation and maintaining adequate flow during ECMO, this single centered, retrospective observational study did not detect association between BMI and survival to ECMO decannulation, 30-day survival, or survival to hospital discharge for patients requiring VA-ECMO for refractory cardiogenic shock. These data suggest that obesity alone should not exclude candidacy for VA-ECMO.The primary outcome in this retrospective study was survival of the ECMO therapy (survival to ECMO decannulation), defined as surviving >24 hours after decannulation without a withdrawal of care. Secondary outcomes included survival at 30 days and survival to hospital discharge.

The association between overweight and obesity on bone mineral density in 12 to 15 years old adolescents in China.

Overweight/obesity can influence bone mineral accretion, but the conclusions are not consistent. We aimed to examine the association between bone mineral density (BMD) levels and body mass index (BMI) in 12 to 15 years old adolescents.We performed a cross-sectional study including 8365 adolescents. BMD was evaluated using a quantitative ultrasound device. Z scores for BMI were evaluated using World Health Organization references. Logistic regression models were performed to evaluate the association between BMD levels and BMI.Totally 1866 (22.3%) adolescents had low /reduced BMD, and boys had a higher rate than girls (72.6% vs 27.4%, P < .001). The rates of thinness, normal weight, overweight, and obesity were 2.8%, 57.1%, 22.3%, and 17.8%, respectively. The multivariable-adjusted (age, sex, systolic blood pressure, and height Z score) ORs (95% CIs) of low/reduced BMD associated with BMI groups (thinness, normal [reference], overweight, and obesity) were 0.59 (0.39–0.89), 1.00, 1.61 (1.41–1.84), and 1.98 (1.69–2.30), respectively (Ptrend < .001). This positive association existed in boys and girls though the differences were not significant between normal weight and thin girls. The multivariable-adjusted ORs for each 1-unit increase in BMI Z score were 1.36 (1.24–1.49) for girls, and 1.23 (1.16–1.30) for boys, and 1.26 (1.20–1.32) for all participants.We observed a positive association between BMI and low/reduced BMD in 12 to 15 years old adolescents. More attention should be paid on overweight and obese adolescents to reduce the risk of low BMD. Further studies are needed to explore the mechanisms of this association.

Association Between Urban Adolescents’ Weight Status And Self-efficacy During Small Groups And Full-class Exergaming

PURPOSE: To examine if urban-dwelling adolescents’ weight status is associated with physical activity-related self-efficacy during small groups and full-class exergaming sessions in a school setting. METHODS: Forty-seven urban adolescents (84% African American; 25 males; X̅BMI = 24.3 ± 3.1 kg/m2) completed two separate 15-minute exergaming sessions: (1) Xbox One Kinect Just Dance in small groups (n = 3-4); and (2) Xbox One Kinect Just Dance as a full-class (n = 23-24). Participants’ height (cm) and weight (kg) were measured using a stadiometer and digital weight scale, respectively, and body mass index (BMI) was calculated from these data as kg/m2. Participants’ exergaming-related self-efficacy was assessed immediately after each exergaming session via the validated Self-Efficacy Survey. Pearson product-moment correlation coefficients (r) examined the association between participants’ BMI and self-efficacy during the two exergaming sessions and simple linear regression was conducted to examine how well BMI could predict self-efficacy in either session. Significance level was set at p < 0.05 and effect sizes were calculated using the coefficient of determination (r2). RESULTS: We observed no association between participants’ BMI and self-efficacy during the small groups session, r(45) = 0.01, p = 0.96. However, participants’ BMI was strongly negatively associated with self-efficacy during the full-class session, r(45) = -0.79, p < 0.01, such that those with higher BMI demonstrated lower self-efficacy. The regression equation for predicting self-efficacy from BMI during the full-class session was = 6.95 – 0.14(x), and the effect size (r2 = 0.627) indicated that participants’ BMI accounted for a large portion (62.7%) of the observed variance in participants’ self-efficacy during this exergaming session. The 95% confidence interval for the slope to predict self-efficacy from BMI was -0.17 to -0.11 (i.e., for each unit increase in BMI during the full-class session, self-efficacy decreases by approximately 0.11 to 0.17 points). CONCLUSION: Findings suggested increased weight status to be strongly associated with lower self-efficacy during full-class exergaming. We postulate that body image-related factors may be responsible. Future experimental trials are warranted to examine causality.

Sex Differences in the Association Between Obesity and Cognitive Impairment in a Low-Income Elderly Population in Rural China: A Population-Based Cross-Sectional Study.

Background: Obesity is a potentially modifiable risk factor for cognitive impairment. However, sex-specific relationships between obesity and cognitive impairment in late life remain unclear.Objective: We aimed to assess sex differences in the association between various obesity parameters and cognitive impairment in a low-income elderly population in rural China.Methods: A population-based cross-sectional study was conducted to collect basic information from elderly residents aged 60 years and older from April 2014 to August 2014 in rural areas of Tianjin, China. Obesity parameters, including body mass index (BMI) and waist circumference (WC), and Mini Mental State Examination scores were measured, and the relationships between these variables were assessed.Results: A total of 1,081 residents with a mean age of 67.70 years were enrolled in this study. After adjusting for age, educational attainment, smoking status, drinking status, physical exercise participation, and the presence of diabetes and hyperlipidemia, blood pressure group; a high BMI was found to be associated with an increased prevalence of cognitive impairment in elderly women. Each 1-unit increase in BMI was associated with a 5.9% increase in the prevalence of cognitive impairment. WC was related to the prevalence of cognitive impairment in elderly men, and each 1-cm increase in WC was associated with a 4.0% decrease in the prevalence of cognitive impairment. However, there were no significant associations between WC and cognitive function in women or between BMI and cognitive impairment in men.Conclusion: A greater WC was positively associated with better cognitive function in low-income elderly men in rural China, whereas a higher BMI was associated with an increased risk of cognitive impairment in elderly women, independent of sociodemographic, lifestyle, and health-related comorbid factors. Our results suggest weight management of elderly women in rural China may have cognitive benefits. However, randomized controlled trials would be needed to confirm causality.

Effect of Body Weight on Age at Onset in Huntington Disease: A Mendelian Randomization Study.

ObjectiveWeight loss is associated with clinical progression in Huntington disease (HD), but whether body weight causally affects disease onset or progression is unknown. Therefore, we aimed to assess whether genetically determined variations in body weight are causally related to age at onset in HD.MethodsUsing data from different recent genome-wide association studies, we performed a 2-sample mendelian randomization (MR) analysis to assess whether genetic markers of body mass index (BMI) are causally related to residual age at onset in HD, i.e., the difference between observed and expected age at onset based on mutation size. Our study had a statistical power of 90% to detect a causal effect of ≥3.8 months per BMI unit change at a type I error rate of 0.05.ResultsInverse-variance weighted MR estimates showed that a higher genetically determined BMI was not causally related to residual age at onset in HD (β = −0.44 years per unit increase in BMI, confidence interval: −1.33 to 0.46, p = 0.34). All other complementary (nonparametric) MR regression methods yielded similar results.ConclusionsAlthough maintaining a healthy and stable body weight remains important in patients with HD, promoting weight gain with the aim of delaying disease onset or slowing down disease progression should be discouraged. Our findings point toward the existence of underlying pathologic processes that dictate both the rate of clinical progression and weight loss in HD, which need further elucidation as targeting these pathways, rather than body weight per se, could be of therapeutic value.

Increasing adiposity and the presence of cardiometabolic morbidity is associated with increased Covid-19-related mortality: results from the UK Biobank

BackgroundAlthough obesity, defined by body mass index (BMI), has been associated with a higher risk of hospitalisation and more severe course of illness in Covid-19 positive patients amongst the British population, it is unclear if this translates into increased mortality. Furthermore, given that BMI is an insensitive indicator of adiposity, the effect of adipose volume on Covid-19 outcomes is also unknown.MethodsWe used the UK Biobank repository, which contains clinical and anthropometric data and is linked to Public Health England Covid-19 healthcare records, to address our research question. We performed age- and sex- adjusted logistic regression and Chi-squared test to compute the odds for Covid-19-related mortality as a consequence of increasing BMI, and other more sensitive indices of adiposity such as waist:hip ratio (WHR) and percent body fat, as well as concomitant cardiometabolic illness.Results13,502 participants were tested for Covid-19 (mean age 70 ± 8 years, 48.9% male). 1582 tested positive (mean age 68 ± 9 years, 52.8% male), of which 305 died (mean age 75 ± 6 years, 65.5% male). Increasing adiposity was associated with higher odds for Covid-19-related mortality. For every unit increase in BMI, WHR and body fat, the odds of death amongst Covid19-positive participants increased by 1.04 (95% CI 1.01–1.07), 10.71 (95% CI 1.57–73.06) and 1.03 (95% CI 1.01–1.05), respectively (all p < 0.05). Referenced to Covid-19 positive participants with a normal weight (BMI 18.5–25 kg/m2), Covid-19 positive participants with BMI > 35 kg/m2 had significantly higher odds of Covid-19-related death (OR 1.70, 95% CI 1.06–2.74, p < 0.05). Covid-19-positive participants with metabolic (diabetes, hypertension, dyslipidaemia) or cardiovascular morbidity (atrial fibrillation, angina) also had higher odds of death.ConclusionsAnthropometric indices that are more sensitive to adipose volume and its distribution than BMI, as well as concurrent cardiometabolic illness, are associated with higher odds of Covid-19-related mortality amongst the UK Biobank cohort that tested positive for the infection. These results suggest adipose volume may contribute to adverse Covid-19-related outcomes associated with obesity.

In Children with Sickle Cell Anemia, Low Baseline BMI Is Associated with a Longitudinal Decline in FEV1 % Predicted

Introduction: Sickle cell anemia (SCA) is the most common genetic disease identified in newborns in the United States, and pulmonary complications are the second most common cause of hospital admissions. Children with SCA commonly experience impaired growth, delayed puberty, elevated metabolic rate and increased protein turnover. These factors may contribute to a decreased body weight, specifically fat-free mass, despite seemingly adequate caloric intake. Multiple studies have reported significantly lower body mass index (BMI) in children with SCA, compared to age-matched children without SCA.In children with cystic fibrosis, there is a well-established relationship between low BMI, malnutrition, and a decline in lung function. A normal body weight has been associated with a slower decline in pulmonary function and a decrease in mortality. Pulmonary cachexia syndrome is a distinct phenomenon in adults with chronic lung disease defined as a disproportionate cytokine driven loss of skeletal muscle. Patients frequently have low BMI (<20kg/m2), low fat-free body mass, with a normal caloric intake. Pulmonary cachexia has been most prominently studied in the chronic obstructive pulmonary disease (COPD) population. Although children and adults with SCA can develop chronic lung disease, pulmonary cachexia syndrome and the impact of nutritional status on pulmonary function has yet to be defined in this population. Lung function decreases with age in the sickle cell population and FEV1% predicted < 80% has been found to be associated with early death in adults with SCA.As children with SCA in the US survive into adulthood, nutritional status may be a contributing factor in chronic lung disease. In a prospective longitudinal multi-center cohort study of children with SCA we hypothesize that a lower BMI is associated with a significant decline in FEV1% predicted over time.Methods: In the NIH sponsored prospective, multicenter, Sleep and Asthma Cohort (SAC) study, children with SCA, defined as HbSS or HbSβ°, unselected for respiratory disease, were enrolled from 3 large clinical centers. Study certified pulmonary function technicians performed spirometry with central review. Participants had a minimum of 3 spirometry measurements performed at least 12 months apart (mean 4.4. years apart). Predicted values were determined for FEV1 based on the Global Lung Index (GLI) 2012 multi-ethnic reference equations. Height and weight were used to calculate BMI at study entry. In a multivariable model, the following independent covariates were used to predict a longitudinal change in FEV1 % predicted: baseline BMI, sex, history of asthma (defined as a physician diagnosis as well as the use of either inhaled corticosteroids or bronchodilator), baseline labs such as hemoglobin, reticulocyte count, white blood cell count, and the use of hydroxyurea at any point in the study period.Results: A total of 197 participants with SCA between the ages of 6 -19.3 years (mean age of 11) were included in the analysis. Mean BMI of the cohort at study entry was 16.9 kg/m2. Participants were followed over a range of 1.1 - 6.5 years from baseline to endpoint. In a multivariable model, for every one unit increase in BMI there was an increase in FEV1 % predicted of 0.68% (P=0.017). FEV1 % predicted declined by 0.4% for every additional year of age (p=0.020). Sex, asthma history, hemoglobin, reticulocyte count, white blood cell count, and hydroxyurea therapy were not significantly associated with a decline in FEV1 % predicted over time. The two significant risk factors for a decrease in FEV1 % predicted over time were increasing age and decreased BMI at baseline.Conclusions: In a large prospective cohort study of an unselected group of children with SCA, low baseline BMI is associated with a more significant decline in FEV1% predicted over time. Longer prospective studies are needed to determine if the decline in FEV1% predicted is reversible with disease modifying therapy and nutritional modifications. [Display omitted] DisclosuresRodeghier:Rodeghier consultants: Consultancy.

Body Mass Index Predicts Cardiovascular Risk Factors and Inflammatory Status in Postmenopausal Women

ObjectivesSome studies have shown that hormonal changes during menopause transition may lead to weight gain. Higher body mass index (BMI) may be beneficial for bone health but not for heart health. However, these phenomena are still unclear. The present study aimed to determine whether BMI is associated with cardiovascular risk factors, and bone and inflammatory biomarkers in osteopenic postmenopausal women. MethodsIn a cross-sectional study, 132 healthy osteopenic postmenopausal women (1 to 10 years) not on hormone therapy (HT) and other pharmacological agents known to affect bone were recruited. Overnight fasting blood and urine samples were collected. Multiple linear regression analyses were conducted to examine the associations between BMI and changes in CVD risk factors and inflammatory and bone biomarkers. ResultsHigher BMI was significantly associated with elevated serum fasting glucose, C-reactive protein (CRP), apolipoprotein B (ApoB), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) levels after controlling for age, years of menopause, physical activity level, and total energy intake. Based on the regression model, every one unit increase in BMI was predicted to increase fasting glucose, CRP, ApoB, TC, LDL, TG by 1.0 mg/dL, 0.1 mg/L, 1.6 mg/dL, 2.8 mg/dL, 3.2 mg/dL, and 3.3 mg/dL, respectively. BMI was not associated with bone formation and resorption biomarkers. ConclusionsBMI is a good predictor of inflammatory marker and CVD risk factors but not bone biomarkers in postmenopausal women. Future studies are needed to examine the associations of body composition (lean mass and fat mass) on CVD risk factors and bone biomarkers. Funding SourcesN/A.

Is Breast Cancer Risk Associated with Menopausal Hormone Therapy Modified by Current or Early Adulthood BMI or Age of First Pregnancy?

Simple SummaryMenopausal hormone therapy (MHT) increases risk of developing breast cancer (BC), and women are often advised to avoid its use for this reason. In this analysis we examined the size of this effect using data from a large cohort of women attending breast cancer screening in Manchester, UK. We additionally explored the extent to which risk from MHT might be modified by current BMI, early adulthood body mass index (BMI) (age 20 years), and age of first pregnancy. Identifying modifying effects would help enable better estimation of risk associated with MHT for an individual woman. Results indicated that women using combined oestrogen and progestagen MHT were at greater risk than those receiving oestrogen-only MHT. The Relative risk associated with MHT was less for obese women than non-obese women. After adjustment for current BMI, the effect of MHT did not appear to be substantially modified by early BMI or age of pregnancy.Menopausal hormone therapy (MHT) has an attenuated effect on breast cancer (BC) risk amongst heavier women, but there are few data on a potential interaction with early adulthood body mass index (at age 20 years) and age of first pregnancy. We studied 56,489 women recruited to the PROCAS (Predicting Risk of Cancer at Screening) study in Manchester UK, 2009-15. Cox regression models estimated the effect of reported MHT use at entry on breast cancer (BC) risk, and potential interactions with a. self-reported current body mass index (BMI), b. BMI aged 20 and c. First pregnancy >30 years or nulliparity compared with first pregnancy <30 years. Analysis was adjusted for age, height, family history, age of menarche and menopause, menopausal status, oophorectomy, ethnicity, self-reported exercise and alcohol. With median follow up of 8 years, 1663 breast cancers occurred. BC risk was elevated amongst current users of combined MHT compared to never users (Hazard ratioHR 1.64, 95% CI 1.32–2.03), risk was higher than for oestrogen only users (HR 1.03, 95% CI 0.79–1.34). Risk of current MHT was attenuated by current BMI (interaction HR 0.80, 95% CI 0.65–0.99) per 5 unit increase in BMI. There was little evidence of an interaction between MHT use, breast cancer risk and early and current BMI or with age of first pregnancy.

Mendelian randomization: estimation of inpatient hospital costs attributable to obesity

BackgroundMendelian Randomization is a type of instrumental variable (IV) analysis that uses inherited genetic variants as instruments to estimate causal effects attributable to genetic factors. This study aims to estimate the impact of obesity on annual inpatient healthcare costs in the UK using linked data from the UK Biobank and Hospital Episode Statistics (HES).MethodsUK Biobank data for 482,127 subjects was linked with HES inpatient admission records, and costs were assigned to episodes of care. A two-stage least squares (TSLS) IV model and a TSLS two-part cost model were compared to a naïve regression of inpatient healthcare costs on body mass index (BMI).ResultsThe naïve analysis of annual cost on continuous BMI predicted an annual cost of £21.61 [95% CI £20.33 – £22.89] greater cost per unit increase in BMI. The TSLS IV model predicted an annual cost of £14.36 [95% CI £0.31 – £28.42] greater cost per unit increase in BMI. Modelled with a binary obesity variable, the naïve analysis predicted that obese subjects incurred £205.53 [95% CI £191.45 – £219.60] greater costs than non-obese subjects. The TSLS model predicted a cost £201.58 [95% CI £4.32 – £398.84] greater for obese subjects compared to non-obese subjects.ConclusionsThe IV models provide evidence for a causal relationship between obesity and higher inpatient healthcare costs. Compared to the naïve models, the binary IV model found a slightly smaller marginal effect of obesity, and the continuous IV model found a slightly smaller marginal effect of a single unit increase in BMI.

GEÇ ERGENLERDE VÜCUT KİTLE İNDEKSİ VE HALİTOZ ARASINDAKİ İLİŞKİ

Background: To the best our knowledge there is no study evaluating relationship between only body mass index (BMI) and halitosis. The aim of our study is to examine whether there is a relationship between BMI and halitosis. Material-Methods: For the study population, 200 undergraduate students in the late adolescent period (17-21 years) were evaluated. After the students completed a questionnaire; individuals with good oral hygiene habits (i.e. regular tooth brushing, no caries or filled teeth, no gum bleeding, no systemic diseases, and no drug use) were included in the study. After all the criteria were applied, 61 participants (Male:23, Female:38) were found suitable for the study and BMI of the participants was calculated. Halitosis was determined using organoleptic assessment and a portable sulfur monitor. T-test and simple linear regression model was used for statistical analysis. Results: The average BMI value was 21.71±3.09 for all participants. Linear regression analysis showed that participants’ organoleptic value increases by 0.008 times for each unit increase of BMI, however, the relationship was found not statistically significant (p= 0.829). A one unit increase of BMI value increases the halimeter measurements value by 0.573 times, but this result was not statistically significant (p= 0.893). Conclusion: We conclude that halitosis is independent of high BMI in itself. However, high BMI may be still a risk factor for halitosis due to problems associated with high BMI and related to halitosis, such as systemic diseases, increased risk of periodontitis, xerostomia, etc.

Mid- to Late-Life Body Mass Index and Dementia Risk: 38 Years of Follow-up of the Framingham Study.

Growing evidence relates body mass index (BMI) to poorer health outcomes; however, results across studies associating BMI and dementia are conflicting. A total of 3,632 Framingham Offspring participants aged 20 to 60 years at their second health examination (1979-1983) were included in this study, with 190 cases of incident dementia identified by 2017. Cox proportional hazards regression models were fitted to investigate the association of BMI at each of their 8 exams as a baseline for dementia risk and the associations between obesity and dementia across age groups. Spline models were fitted to investigate nonlinear associations between BMI and dementia. Each 1-unit increase in BMI at ages 40-49 years was associated with higher risk of dementia, but with lower risk after age 70 years. Obesity at ages 40-49 years was associated with higher risk of dementia. Overall, the relationship between BMI and dementia risk was heterogeneous across the adult age range. Monitoring BMI at different ages might mediate risk for dementia across an individual's lifetime.