Unit Increase In Body Mass Index Research Articles

Relationships Between Sport Nutrition Knowledge, Body Composition And Body Weight Goal In Female Soccer Players.

Sport nutrition knowledge may impact the quality of an athlete’s dietary intake. It is currently unknown how sport nutrition knowledge (SNK) influences body composition and what factors may contribute to an athlete’s body weight goal. PURPOSE: To examine relationships between SNK and body composition and identify predictors of body weight goal in female collegiate soccer players. METHODS: Twenty-six Division III female soccer athletes (height: 1.61 ± 0.30 m; body mass: 66.7 ± 7.5 kg; fat-free mass: 50.3 ± 6.5 kg; body fat %: 25.6 ± 5.1%) participated in the current study. All players had body composition assessed using air displacement plethysmography and completed a validated questionnaire designed to assess sport nutrition knowledge. Athletes were also asked questions about perceived dietary requirements and body weight goal. Pearson correlation coefficients were assessed to examine relationships between SNK and body fat percentage (BF %), fat-free mass, fat-mass, body mass (BM), body mass index (BMI), and perceived dietary requirements. Multinomial logistic regression was used to identify predictors of body weight goal. Paired sample t-tests were used to compare differences between calculated and perceived dietary needs. RESULTS: The mean number of questions answered correctly on the SNK questionnaire was 44.5 ± 11.2 %. An inverse relationship was observed between BF % and SNK (r = -0.391; p=0.044). Body mass, BMI and BF % were all significant predictors of body weight goal (p<0.05). For every 1% increase in BF % and 1 kg increase in BM, athletes were 1.3 times more likely to want to lose weight. For every 1 unit increase in BMI, athletes were 2.7 times more likely to want to lose weight. All players significantly underestimated daily energy (-578 ± 104.9 kcal/d, p<0.001) and carbohydrate (-283.7 ± 141.8 g/d, p<0.001) requirements when compared to their calculated required daily intakes. CONCLUSIONS: Division III female collegiate soccer players have a low sport nutrition knowledge base which was associated with a higher BF %. Players who had a higher BM, BF % and BMI were more likely to have weight loss as a body weight goal. Players also significantly underestimated their energy and carbohydrate requirements based on the demands of their sport. Players could likely benefit from a sport nutrition education intervention.

Self-Reported Weight and Height Among Idiopathic Intracranial Hypertension Patients.

Idiopathic intracranial hypertension (IIH) mostly affects overweight and obese women. Severe obesity is associated with poorer visual outcomes in IIH, and weight gain can precipitate IIH and increase the risk of recurrence. Conversely, weight loss can decrease intracranial pressure and is an effective IIH treatment. Therefore, accurate monitoring of weight and body mass index (BMI) is important to help guide the management of IIH patients. Our goal was to compare estimated and measured BMI among patients with presumed IIH and non-IIH controls to determine whether these vital signs should be systematically measured when evaluating patients for IIH. A retrospective chart review was performed of consecutive patients with reported and measured weight and height seen in one ophthalmology-based neuro-ophthalmology clinic for IIH between January 2, 2018 and September 10, 2018. Patients with IIH or presumed IIH were compared to non-IIH controls, matched according to age (±5 years), BMI (±5 kg/m unless ≥40 kg/m), sex, and race. Patients with confirmed IIH were asked to self-report their weight when seen in follow-up and they were weighed to compare their self-reported vs measured percent weight change. We included 379 subjects (140 patients; 239 controls) among whom 75 of the IIH patients were matched to non-IIH controls. Patients with presumed or definite IIH accurately estimated their height and generally underestimated their weight by a median of 1.8 kg (4 lb), resulting in a median BMI underestimate of 0.9 kg/m. There was no difference in BMI underestimation when comparing presumed or definite IIH patients to matched non-IIH controls while controlling for insurance status, smoking, diabetes, and vascular disease (P = 0.66). As BMI increased, all subjects underestimated their BMI more (by 0.9% per 10 measured BMI unit increase), when controlling for age, sex, and race (P < 0.003). Sixteen confirmed IIH patients were seen in follow-up. At initial neuro-ophthalmology consultation, these subjects underestimated their weight by a mean of 3.2%. At last follow-up they underestimated their weight by only 1.2% (P = 0.03). There was no evidence that IIH or presumed IIH patients had a different perception of their weight than non-IIH controls at initial neuro-ophthalmology consultation. Both patients and matched controls tended to underestimate their weight by the same amount, resulting in an overall BMI underestimation of approximately 1% per 10 measured BMI unit increase. Heavier subjects tended to underestimate their body weight and resultant BMI more, and IIH patients tended to estimate their weight more accurately at follow-up. Our results emphasize the need to systematically objectively measure the weight of presumed IIH patients seen in an ophthalmology clinic.

Does a rise in BMI cause an increased risk of diabetes?: Evidence from India.

Overnutrition increases the risk of diabetes. Evidence on the causal impact of overnutrition on diabetes is scarce for India. Considering a representative sample from India, this study examines the causal effect of a rise in the Body Mass Index (BMI) of an individual on the likelihood of being diabetic while addressing the issue of unobserved endogeneity between overnutrition and diabetes. The study considers individual level data from Demographic and Health Surveys (DHS) of India, namely, National Family Health Survey (NFHS) for the year 2015-16. The NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India. The survey covers females having age 15-49 years and males having age 15-54 years. The instrument variable approach is used to address the potential endogeneity in the relationship between BMI and diabetes. We instrument BMI of an individual by BMI of a non-biologically related household member. Ordered Probit, Probit and IV-Probit models are estimated using two alternative definitions for measuring diabetes-self-reported diabetes status and blood glucose levels (ordinal measure). The coefficients obtained from the Ordered Probit and Probit models are much smaller than those estimated by an IV-Probit model. The latter estimates the causal impact of a rise in BMI on diabetes by taking into account the effect of the unobserved genetic and other related factors. The likelihood of being diabetic is twice or more among the overweight and obese individuals as compared to non-overweight individuals in all the specifications. With a unit increase in BMI the probability of being diabetic increases by about 1.5% among overweight and obese individuals and by 0.5% among the non-overweight individuals in the IV-Probit model. Similar results from the Ordered Probit model show that on average, the overweight and obese individuals experience about 0.2% increase in the probability of being diabetic and about 0.4% increase in the probability of being prediabetic. Our study demonstrates that the likelihood of being both prediabetic and diabetic is higher among the overweight and obese individuals as compared to the non-overweight individuals. We also find that the level of risk of being prediabetic or diabetic differs across gender, wealth quintiles and regions and the effects are more severe among population in the urban areas, belonging to the richest wealth quintile and men. Our findings have significant implications for the policy formulation as diabetes has a substantial health and economic burden associated with it. Future studies may investigate the effect of abdominal obesity on diabetes.

Body mass index and risk of infections: a Mendelian randomization study of 101,447 individuals.

Body mass index (BMI) has been related to risk of infections. The aim of this study was to assess the shape of the association between BMI and risk of infections and to evaluate whether such associations represent causality. We included 101,447 individuals from The Copenhagen General Population Study who had BMI measured. Outcome was hospital contacts related to infections. The shape of the association between BMI and risk of infections was examined using restricted cubic spline Cox regression. To evaluate causality, we used Mendelian randomization, an epidemiological method that counteracts confounding and reverse causality by using genetic variation as instrumental variables. We created a genetic risk score based on five genetic variants causing lifelong higher BMI and used this score in instrumental variable analysis. During median follow-up of 8.8years, 10,263 hospital contacts related to infections were recorded. We found a U-shaped association between BMI and risk of any infection and pneumonia, and a linear association between BMI and risk of skin infection, urinary tract infection, and sepsis. In instrumental variable analyses, higher BMI was associated with increased risk of skin infection: odds ratio 1.12 (95% CI 1.03-1.22) for a genetically induced 1 unit increase in BMI. Observationally, low as well as high BMI was associated with increased risk of any infection and pneumonia, whereas only high BMI was associated with increased risk of skin infection, urinary tract infection, and sepsis. High BMI was causally associated with increased risk of skin infection.

Body mass index and B‐lines on lung ultrasonography in chronic and acute heart failure

AimsIncreased body mass index (BMI) is common in heart failure (HF) patients and is associated with lower levels of N‐terminal pro‐brain natriuretic peptide (NT‐proBNP). We evaluated the influence of BMI on lung ultrasonography (LUS) findings indicative of pulmonary congestion (i.e. B‐lines) in patients with chronic and acute HF (AHF).Methods and resultsWe analysed ambulatory chronic HF (n = 118) and hospitalized AHF (n = 177) patients (mean age 70 years, 64% men, mean BMI 29 kg/m2, mean ejection fraction 42%) undergoing echocardiography and LUS in eight chest zones. B‐lines and chest wall thickness (skin to pleura) on ultrasound were quantified offline and blinded to clinical findings. NT‐proBNP was available in AHF patients (n = 167). In chronic HF, B‐line number decreased by 18% per 5 unit increase in BMI [95% confidence interval (CI) −35% to +5%, P = 0.11]. In AHF, the number of B‐lines decreased by 12% per 5 unit increase in BMI (95% CI −19% to −5%, P = 0.001), whereas NT‐proBNP concentration decreased by 28% per 5 unit increase in BMI (95% CI −40% to −16%, P < 0.001). For AHF, B‐line number declined to a lesser degree than NT‐proBNP concentration with increasing BMI (P = 0.020), and >6 B‐lines were observed in half of AHF patients with severe obesity. There was an inverse relationship between B‐line number and chest wall thickness, and this association varied by chest region.ConclusionsDespite an inverse relationship between B‐lines and BMI, B‐lines declined to a lesser degree than NT‐proBNP with increasing BMI. These data suggest that LUS may be useful in patients with HF despite obesity.

Application of Mendelian Randomization to Investigate the Association of Body Mass Index with Health Care Costs.

Causal effect estimates for the association of obesity with health care costs can be biased by reversed causation and omitted variables. In this study, we use genetic variants as instrumental variables to overcome these limitations, a method that is often called Mendelian randomization (MR). We describe the assumptions, available methods, and potential pitfalls of using genetic information and how to address them. We estimate the effect of body mass index (BMI) on total health care costs using data from a German observational study and from published large-scale data. In a meta-analysis of several MR approaches, we find that models using genetic instruments identify additional annual costs of €280 for a 1-unit increase in BMI. This is more than 3 times higher than estimates from linear regression without instrumental variables (€75). We found little evidence of a nonlinear relationship between BMI and health care costs. Our results suggest that the use of genetic instruments can be a powerful tool for estimating causal effects in health economic evaluation that might be superior to other types of instruments where there is a strong association with a modifiable risk factor.

461: Resource utilization in low-risk pregnant women after 39 weeks by body mass index

To compare medical resource utilization in the antepartum and intrapartum periods in low-risk women according to their body mass index (BMI). Secondary analysis of data from a multi-center randomized control trial of induction of labor at 390/7 - 394/7 weeks compared with expectant management in low-risk nulliparous women. The primary outcome of this analysis is time spent in L&D from admission to delivery. Antepartum and intrapartum patients’ utilization of resources were defined a priori in the parent trial. BMI at randomization was categorized into 4 groups (≥40, 30-39, 25-29, < 25 kg/m2). Multivariable generalized linear modeling and logistic regression were performed and 99% confidence intervals were calculated. 6,058 women, with data available, were included in the analysis with 53% with BMI ≥30 kg/m2. There were no differences in gestational age at randomization or in primary trial group assignments between the BMI groups (Table 1). Every 5-unit increase in BMI was associated with an average 11% increase in time spent in L&D. Increasing BMI was not associated with an increase in antepartum resource utilization with the exception of blood tests and urinalysis. However, BMI was associated with higher odds of intrapartum resource utilization and longer total hospital length of stay (LOS) from admission to discharge (Table 2). For example, every 5-unit increase in BMI was associated with an increase in the odds by 26% in administration of antibiotics, 58% increase in placement of intrauterine pressure catheter, and an average 5% increase in total inpatient LOS from admission to discharge. There were no interactions between primary trial assignment groups (induction vs expectant management) and BMI for any of these associations. We provide contemporary data on the effect of BMI on resource utilizations in low-risk women. Higher BMI was associated with longer time from admission to delivery and total hospital LOS as well as more frequent utilization of intrapartum resources. The increasing prevalence of obesity in the US puts significant burden on L&D resources.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Lung function, obesity and physical fitness in young children: The EXAMIN YOUTH study.

The prevalence of obesity and physical inactivity in children are increasing globally. The study aimed to investigate the association of obesity and cardiorespiratory fitness (CRF) with patterns of lung function in young children. In this cross-sectional study, lung function, body mass index (BMI), blood pressure (BP) and CRF (shuttle run stages) were measured in an unselected cohort of 1246 children aged 7.2 ± 0.4 years. All parameters and lung function, such as the ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC), were assessed by standardized procedures for children. Statistical models were applied for systematic adjustment of potential confounders. Obese children had significantly higher FEV1 (Coef. (95% CI) (1.57 (1.50; 1.64) L) and FVC (1.75 (1.67; 1.83) L) compared to normal weight children (1.38 (1.37; 1.40) L; (1.53 (1.51; 1.54) L, respectively). However, with each unit increase of BMI, FEV1/FVC decreased (-0.003 (-0.005; -0.001)) due to a disproportional increase in FVC compared to FEV1. Per stage increase of CRF, FEV1 (0.017 (0.008; 0.025) L) and FVC increased (0.022 (0.012; 0.031) L)). In obese children, higher CRF was independently associated with higher FEV1/FVC (0.03 (0.5E-4; 0.06)) due to a higher increase of FEV1 over FVC with increasing fitness. The decrease of FEV1/FVC with increasing BMI suggests that childhood obesity is associated with an imbalance of ventilation and airway flow. In children with obesity, higher CRF is associated with an improved FEV1/FVC ratio. Physical exercise programs may have the potential to improve patterns of lung function in children with obesity.

P5743Overweight and obesity in adolescent men in Sweden and risk of early stroke

Abstract Background Increasing numbers of stroke cases in the young are reported in many countries, potentially at least partly due to rising rates of overweight and obesity. Most data on the effect of obesity on stroke is derived from middle aged populations; there is a comparative lack of information on the effect of excessive body weight in young people. Purpose We aimed to determine whether body mass index (BMI) at age 18 predicted early stroke events among men in Sweden. Methods Population-based Swedish cohort study of conscripts (n=1,668,921; mean age at baseline, 18.3 years) who enlisted during 1968–2005. Follow-up was done through linkage to the nationwide Swedish patient and death registries. Risk of a first hospitalization for stroke (any type) during follow-up (5–46 years) was calculated with Cox proportional hazards models. Objective baseline measures of fitness and cognition were included in the models in a second set of analyses. Results During follow-up there were 12,512 first hospitalizations for stroke (mean age at diagnosis, 48.5 (SD 9.4) years, maximum 64 years). Compared with men with BMI of 18.5 to 20.0 kg/m2, men with BMI 20 to &lt;22.5 and 22.5 to &lt;25.0 kg/m2 had hazard ratios (HR) of 1.06 (1.00–1.12) and 1.23 (1.14–1.31), respectively, for hospitalization for stroke, after adjustment for age, year of conscription, comorbidities at baseline, parental education, blood pressure, IQ, muscle strength, and fitness. Those with a BMI of ≥35 kg/m2 had an HR of 3.33 (2.46–4.51) for an event before the age of 65, compared to slim men. The multiple-adjusted risk per 1-unit increase in BMI was 1.07 (95% CI, 1.06–1.08). Conclusion We found a rise in risk of early hospitalisation for stroke detectable already at normal levels of body weight at age 18, and rising to more than 3-fold in the highest weight category. Given increasing levels of body weight, and prevalence of overweight, obesity, and severe obesity in young adults, the increased incidence of stroke in the young may potentially partly be explained by rising body weight, with an obvious potential for prevention.

P5297Body weight in adolescent men in Sweden and risk of an early acute coronary event

Abstract Background To improve cardiovascular disease (CVD) prevention, knowledge of early key risk factors, especially those that are modifiable such as overweight and obesity, is essential. Purpose We aimed to determine whether body mass index (BMI) at age 18 predicted early acute coronary events among men in Sweden. Methods Population-based Swedish cohort study of conscripts (n=1,668,921; mean age at baseline, 18.3 years) who enlisted during 1968–2005. Follow-up was done through linkage to the nationwide Swedish patient- and death registries. Risk of an acute coronary event (hospitalization for acute myocardial infarction or coronary death) during follow-up (5–46 years) was calculated with Cox proportional hazards models. Objective baseline measures of fitness and cognition were included in the models in a second set of analyses. Results During follow-up there were 22,412 acute coronary events (mean age at diagnosis, 50.2 (SD 7.4) years, maximum 64 years). Compared with men with BMI of 18.5 to 20.0 kg/m2, men with BMI 20 to &lt;22.5 and 22.5 to &lt;25.0 kg/m2 had hazard ratios (HR) of 1.17 (1.12–1.43) and 1.51 (1.44–1.59), respectively, for an acute coronary event, after adjustment for age, year of conscription, comorbidities at baseline, parental education, blood pressure, IQ, muscle strength, and fitness. Those with a BMI of ≥35 kg/m2 had an HR of 3.47 (2.75–4.39) for an event before the age of 65. The multiple-adjusted risk per 1-unit increase in BMI was 1.10 (95% CI, 1.09–1.10). Conclusion We found a rise in risk of an early acute coronary event detectable already at normal levels of body weight at age 18, and rising to more than 3-fold in the highest weight category. Given increasing levels of body weight, and prevalence of overweight and obesity in young adults, the current decrease in coronary heart disease incidence in Sweden may flatten or even reverse in the near future. Acknowledgement/Funding The Swedish Heart and Lung Foundation [2015-0438]; the Swedish Research Council [2013-5187,2013-4236]

A Look into Obstructive Sleep Apnea among Ethiopians.

Obstructive Sleep Apnea (OSA) is prevalent throughout the world. However, there are currently limited data concerning the prevalence of OSA in populations that originate from developing countries; the prevalence of OSA is expected to rise in these countries. OSA is poorly characterized amongst Ethiopians, and our study is the first to describe clinical characteristics of OSA among Ethiopians. We conducted a retrospective study of primarily Ethiopian patients at an internal medicine clinic in Rockville, Maryland. All patients (n=24) were evaluated for daytime sleepiness using the Epworth Sleepiness Scale (ESS) and received physical examinations and polysomnograms (PSG) by either portable monitoring (Itamar WatchPAT 200 device) or in-lab. Statistical analyses were performed in R. Linear regression model of Body-Mass Index (BMI) and Apnea-Hypopnea Index (AHI) indicated that for every 1-unit increase in BMI, there was a 0.8657-unit increase in AHI (p<0.05). Pearson's correlation coefficient indicateda positive linear relationship between BMI and AHI (0.47) (p<0.05). Adjusted linear regression model for AHI and oxygen saturation indicated that for every 1-unit increase of AHI, there was a 0.8452-unit decrease in nocturnal oxygen saturation (p<0.05). Pearson's correlation coefficient did not demonstrate significance between AHI and oxygen desaturation (p=0.062). Patients received either continuous positive airway pressure (CPAP) (n=15) or oral appliance therapy (n=3). All patients who complied with therapy reported improved sleep quality, snoring resolution, and improved daytime alertness. Practitioners in developing countries should suspect OSA in the right clinical setting and offer diagnostic and therapeutic services when available.

Preoperative Factors Predicting Admission to the Intensive Care Unit After Kidney Transplantation.

ObjectiveTo identify preoperative factors predicting early admission (within 30 days) of adult kidney transplant recipients to the intensive care unit (ICU).Patients and MethodsThis is a single-center retrospective study of consecutive kidney transplant recipients between January 1, 2007, and December 31, 2016. Children (aged <18 years) and patients who underwent simultaneous multiorgan transplantation were excluded from the analysis. Associations between demographic, transplant-related, and comorbidity variables with ICU admission within 30 days of transplantation were analyzed using univariate and multivariate logistic regression models.ResultsOf the 1527 eligible patients, 305 (20%) required early ICU admission. In univariate analysis, older age, higher body mass index (BMI), previous transplantation, myocardial infarction, congestive heart failure, obstructive pulmonary disease, longer ischemia time, pretransplant dialysis, and transplantation from a deceased donor were associated with increased odds of ICU admission. After multivariate adjustment, every 10-year increase in recipient age (odds ratio [OR], 1.26; 95% CI, 1.12-1.42; P<.001), 5-unit increase in BMI (OR, 1.11; 95% CI, 1.00-1.22; P=.049), pretransplant dialysis (OR, 1.57; 95% CI, 1.19-2.08; P=.002), and deceased donor transplantation (OR, 1.82; 95% CI, 1.29-2.55; P<.001) were associated with the increased risk of ICU admission. Preemptive transplantation (OR, 0.64; 95% CI, 0.48-0.84; P=.002) and living donor kidney transplantation (OR, 0.55; 95% CI, 0.39-0.77; P<.001) were associated with lower odds of ICU admission after transplantation.ConclusionRecipient age, BMI, and the need for pretransplant dialysis are associated with a higher risk of early ICU admission after kidney transplantation, whereas living donor kidney transplantation and preemptive transplantation decrease these odds. Early referral of patients with end-stage renal disease for preemptive transplantation and living donor kidney transplantation can significantly reduce transplant-related ICU admissions.

The Impact of Body-Mass Index on Cardiopulmonary Fitness in Chinese Heart Failure Patients

Introduction Body-mass index (BMI) and cardiopulmonary fitness measured by peak oxygen consumption (VO2peak) are inversely related among healthy Caucasians. However, knowledge of Chinese heart failure patients remains scant because they experience significant impaired cardiopulmonary fitness, and Asians have lower BMI cut-offs than whites. Hypothesis Evaluate whether Asian-specific BMI cut-offs for overweight (23 kg/m2) and obese (27.5 kg/m2) reflect significant VO2peak changes, and BMI's impact on VO2peak in Chinese heart failure patients. Methods In this cross-sessional study, data was collected from 70 heart failure patients with NYHA class I∼IV (83% II) and mean ejection fraction of 46.3% in Guangdong Provincial Hospital of Chinese Medicine. Height and weight were measured to calculate BMI; and VO2peak was measured via symptom-limited bicycle exercise test. Participants were categorized as healthy (BMI 18.5-22.9 kg/m2), overweight (BMI 23-27.4 kg/m2), or obese (BMI ≥27.5 kg/m2). Those with BMI below 18.5 kg/m2 were excluded. Between-group differences were identified by one-way ANOVA and post-hoc analysi. Spearman's correlation coefficients and binary linear regression evaluated the relationship between BMI and VO2peak. p Results Among 70 patients, 24 (34%) were classified healthy (BMI >18 kg/m2), 34 (49%) overweight (BMI 23-27.4 kg/m2), and 12 (17%) obese (BMI ≥27.5 kg/m2). VO2peak differed between the three BMI groups (p=0.017); and the obese group had significantly lower VO2peak than the heathy group (-3.9 mL/kg/min, 95%CI: -6.6, -1.2). When patients were sex-age stratified (young: Conclusion Asian-specific BMI cut-offs are useful clinical instruments for detecting statistically relevant decreases in VO2peak among heart failure patients. A negative association exists between BMI and VO2peak, especially in those under 60. For each 1.5 unit increase in BMI, reducing VO2peak showed a clinically significant 1 mL/kg/min decrease among heart failure patients. Larger sample-size research could reveal robust quantitative relationships between BMI and cardiopulmonary fitness.

Body Mass Index and prostatic-specific antigen are predictors of prostate cancer metastases in patients undergoing robot-assisted radical prostatectomy and extended pelvic lymph node dissection.

The aim of this study was to investigate the risk factors contributing to multiple lymph node invasion (LNI) in patients with prostate cancer (PCa) undergoing extended pelvic lymph node dissection (ePLND) during robot assisted radical prostatectomy (RARP). A total of 211 patients who underwent RARP and ePNLD from June 2013 to March 2017 were classified according to lymph node status in the surgical specimen (absent, single or multiple). Risk factors of LNI were evaluated by the multinomial logistic regression model. A receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to assess the efficacy of factors and model evaluation. On multivariate analysis, the risk of multiple LNI, was independently increased by Body Mass Index (BMI) (odds ratio [OR] 1.194; P=0.026) and prostate-specific antigen (PSA) (OR=1.089; P=0.014) when compared to patients without LNI. ROC curves indicated that both BMI (AUC=0.702) and PSA (AUC=0.732) had fair discrimination power. For each unit of increase in PSA, the odds of multiple lymph node invasion increased by 8.9% and for each unit increase of BMI, the odds of multiple LNI increased by 19.4%. The risk of multiple LNI was independently predicted by PSA and BMI with fair discrimination power.

Higher Body Mass Index in Adolescence Predicts Cardiomyopathy Risk in Midlife.

Modifiable lifestyle factors in relation to risk for cardiomyopathy, a common and increasing cause of heart failure in the young, have not been widely studied. We sought to investigate a potential link between obesity, a recognized predictor of early heart failure, in adolescence and being diagnosed with cardiomyopathy in adulthood. This was a nationwide register-based prospective cohort study of 1 668 893 adolescent men (mean age, 18.3 years; SD, 0.7 years) who enlisted for compulsory military service from 1969 to 2005. At baseline, body mass index (BMI), blood pressure, and medical disorders were registered, along with test results for fitness and muscle strength. Cardiomyopathy diagnoses were identified from the National Hospital Register and Cause of Death Register during an up to 46-year follow-up and divided into categories: dilated, hypertrophic, alcohol/drug-induced, and other. Hazard ratios were calculated with Cox proportional hazards models. During follow-up (median, 27 years; Q1-Q3, 19-35 years), 4477 cases of cardiomyopathy were identified, of which 2631 (59%) were dilated, 673 (15%) were hypertrophic, and 480 (11%) were alcohol/drug-induced. Increasing BMI was strongly associated with elevated risk of cardiomyopathy, especially dilated, starting at levels considered normal (BMI, 22.5-<25 kg/m2; hazard ratio, 1.38 [95% CI, 1.22-1.57]), adjusted for age, year, center, and baseline comorbidities, and with a >8-fold increased risk at BMI ≥35 kg/m2 compared with BMI of 18.5 to <20 kg/m2. For each 1-unit increase in BMI, similarly adjusted hazard ratios were 1.15 (95% CI, 1.14-1.17) for dilated cardiomyopathy, 1.09 (95% CI, 1.06-1.12) for hypertrophic cardiomyopathy, and 1.10 (1.06-1.13) for alcohol/drug-induced cardiomyopathy. Even mildly elevated body weight in late adolescence may contribute to being diagnosed with cardiomyopathy in adulthood. The already marked importance of weight control in youth is further strengthened by these findings, as well as greater evidence for obesity as a potential important cause of adverse cardiac remodeling that is independent of clinically evident ischemic heart disease.

From the Circulation Family of Journals.

From the Circulation Family of Journals.

The Association Between Adiposity and Inpatient Hospital Costs in the UK Biobank Cohort.

BackgroundHigh adiposity is associated with higher risks for a variety of adverse health outcomes, including higher rates of age-adjusted mortality and increased morbidity. This has important implications for the management of healthcare systems, since the endocrinal, cardiometabolic and other changes associated with increased adiposity may be associated with substantial healthcare costs.MethodsWe studied the association between various measures of adiposity and inpatient hospital costs through record linkage between UK Biobank and records of inpatient care in England and Wales. UK Biobank is a large prospective cohort study that aimed to recruit men and women aged between 40 and 69 from 2006 to 2010. We applied generalised linear models to cost per person year to estimate the marginal effect of adiposity, and average adjusted predicted costs of adiposity.ResultsValid cost and body mass index (BMI) data from 457,689 participants were available for inferential analysis. Some 54.4% of individuals included in the analysis sample had positive inpatient healthcare costs over the period of follow-up. Median hospital costs per person-year of follow-up were £89, compared to mean costs of £481. Mean BMI overall was 27.4 kg/m2 (standard deviation 4.8). The marginal effect of a unit increase in BMI was £13.61 (99% confidence interval £12.60–£14.63) per person-year of follow up. The marginal effect of a standard deviation increase in BMI was £69.20 (99% confidence interval £64.98–£73.42). The marginal effect of becoming obese was £136.35 (99% confidence interval £124.62–£148.08). Average adjusted predicted inpatient hospital costs increased almost linearly when modelled using continuous measure of adiposity. Sensitivity analysis of different scenarios did not substantially change these conclusions, although there was some evidence of attenuation of the effects of adiposity when controlling for waist-hip ratios, and when individuals who self-reported any pre-existing conditions were excluded from analysis.ConclusionsHigher adiposity is associated with higher inpatient hospital costs. Further scrutiny using causal inferential methods is warranted to establish if further public health investments are required to manage the large healthcare costs observationally associated with overweight and obesity.Electronic supplementary materialThe online version of this article (10.1007/s40258-018-0450-2) contains supplementary material, which is available to authorized users.

The impact of obesity on the effectiveness of spinal cord stimulation in chronic spine-related pain patients

BACKGROUND CONTEXTChronic pain and obesity are both on the rise. Spinal cord stimulation has gained increasing popularity in the pain management field for the treatment of spine-related chronic pain, however to-date, the correlation between the spinal cord stimulator effectiveness and increasing body mass index (BMI) has not been fully established. PURPOSEWe aimed to investigate the correlation between patients’ BMI and the percentage of pain relief as well as opioid utilization in chronic spine-related pain patients treated with spinal cord stimulation. STUDY DESIGNRetrospective cohort study. PATIENT SAMPLEPatients with chronic spine-related pain who were treated with a spinal cord stimulator. OUTCOME MEASURESEleven-point numeric rating scale for pain and opioid utilization. METHODSFollowing Institutional Review Board approval, data from all eligible subjects who had undergone successful spinal cord stimulation (SCS)-trial defined as ≥50% decrease in pain followed by SCS implant were collected and statistically analyzed. Patients were divided into four groups according to BMI. Self-reported pain scores on the 11-point numerical rating scale were collected at baseline, 6 months and 12 months post SCS-implant visits. Opioid utilization, if any, was collected at baseline and 12 months post-SCS implant. RESULTSIn all, 181 patients were included. Thirty-three were under and/or normal weight (≤24.9 kg/m2), 72 overweight (25.0–29.9 kg/m2), 63 obese (30.0–39.9 kg/m2), and 13 morbidly obese (≥40.0 kg/m2). The estimated coefficients from multivariable linear regression analysis were −1.91% (95% CI: −2.82% to −0.991%) and −1.48% (95% CI: −2.30% to −0.660%) reduction in pain improvement per unit increase of BMI for 6 months and 12 months scores, respectively. The estimated coefficient of disability status was −15.3% (95% CI: −22.1% to −8.48%). The estimated coefficient for 12 month opioid equivalence was −0.08% (95% CI: −0.14 to −0.021), per` 1 mg unit increase of morphine opioid equivalency. The data showed a statistically significant negative association between increasing BMI and SCS effectiveness at 6 and 12 months post-SCS therapy with a 2% reduction in efficacy for every unit increase of BMI after adjusting for confounding factors and a 20% better response in underweight and/or normal patients over the morbidly obese individuals which was not related to baseline pain score level. The significant difference in pain scores at 6 months (p = .0003) and 12 months (p = .04) post-SCS implant between obese and nonobese patients was not attributable to differences in baseline pain scores. There was no significant change in opioid utilization between baseline and 12 months post-SCS therapy. CONCLUSIONA negative association between SCS effectiveness and increasing BMI was found, whereas, no significant difference was noted amongst the various BMI cohorts and the daily opioid consumption.

Body mass index and cancer risk among Chinese patients with type 2 diabetes mellitus

BackgroundObesity and diabetes are two risk factors for cancer. To evaluate the association of body mass index (BMI) with cancer risk in diabetic patients may improve current understanding of potential mechanisms.MethodsA retrospective cohort study was conducted in 51,004 newly diagnosed T2DM patients derived from an electronic health record (EHR) database of Minhang district in Shanghai, China. Incident cancer cases and all-cause deaths occurred before September 30, 2015 were identified by linking with the Shanghai Cancer Registry and the Shanghai Vital Statistics. To examine the potential non-linear and linear relationships of BMI and cancer risk, Cox proportional hazard models with and without restricted cubic spline functions were used, respectively.ResultsA non-linear association was observed between BMI and overall cancer incidence in men younger than 60 years old (p for non-linearity = 0.009). Compared with those having BMI of 25.0 kg/m2, the cancer risk increased in those with either lower or higher BMI. In women older than 60 years old, linear dose-response relationships were observed between BMI and the risk of both overall cancer and breast cancer. As each unit increase in BMI, the overall cancer risks elevated by 3% (95%CI: 1–5%) and the breast cancer risks increased by 7% (95%CI: 1–13%). No significant association was observed between BMI and other common cancer sites.ConclusionsOur results show that the effect of BMI on cancer risk in Chinese patients with T2DM may vary by gender, age and cancer subtypes, suggesting different underlying biological mechanisms.

Factors influencing change in walking ability in patients with heart failure undergoing exercise-based cardiac rehabilitation

ObjectivesExercise-based cardiac rehabilitation (CR) is an effective intervention for patients with heart failure (HF), in which one of the main targets is to increase physical capacity. In the HF population this is traditionally assessed using distance covered during a walking test. This study aims to establish the extent to which change in walking ability, in HF patients attending CR, is determined by patient characteristics and service provision. MethodsThe study utilised routine clinical data from the National Audit of Cardiac Rehabilitation to perform a robust analysis. Change, in metres, between pre- and post-CR six-minute walk tests was calculated. Multivariate linear regression models were used to explore the relationship between patient characteristics, service-level variables, and change in metres walked. ResultsComplete and valid data from 633 patients was analysed, and a mean change of 51.30 m was calculated. Female gender (−34.13 m, p = 0.007), being retired (−36.41 m, p = 0.001) and being married/in a relationship (−32.54 m, p = 0.023) were all significant negative predictors of change. There was an additional negative relationship with body mass index (BMI) whereby for every unit increase in BMI, predicted change reduces by 2.48 m (p = 0.006). ConclusionsThis study identified significant patient-level characteristics strongly associated with limited improvement in walking ability following CR. Improving physical capacity is a core component of CR, therefore services should aim to account for baseline characteristics identified in this study as part of tailoring the CR intervention around the individual. Pre- and post-CR physical capacity assessments, which constitute minimum standards for CR, are worryingly low and should be given high priority.