Unit Increase In Body Mass Index Research Articles

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.

Obesity and racial characteristics drive utilization of total joint arthroplasty at a younger age

BackgroundObesity is a growing public health problem. Obesity increases the risk of requiring total joint arthroplasty (TJA). The purpose of this study was to examine the effect of obesity on the propensity for TJA in patients at our institution. We hypothesized that obese patients would be younger and more likely to be races other than non-Hispanic whites when compared to a normal weight cohort. Methods568 consecutive patients undergoing primary TJA were reviewed. Demographic data and World Health Organization Body Mass Index (BMI) class were compared statistically, with age at time of TJA used as the main outcome of interest. ResultsThe average age at TKA was 68.3 years, while the average age at THA was 67.5 years (p = 0.447 between procedure groups). Increased BMI class was associated with decreased age at TJA: normal weight patients were 12.2 and 11.4 years older than class III obese patients at the time of TKA and THA, respectively (p < 0.001). Among TKA patients, obese patients, when compared to non-obese patients, were significantly less likely to be non-Hispanic whites (p = 0.016). Among THA patients, class III obese patients were significantly less likely to be non-Hispanic whites (p = 0.007). ConclusionsObesity is a risk factor for both TKA and THA at a younger age. For patients in the study, for each unit increase in BMI, the age at TKA decreased by 0.56 years and age at THA decreased by 0.52 years. Obese patients were less likely to be non-Hispanic whites than normal weight patients.

The Association between Body Mass Index and Health-Related Quality of Life in Treatment-Seeking Arab Adults with Obesity.

Few studies have thus far been carried out on Health-Related Quality of Life (HRQoL) and obesity in Arab-speaking countries, an issue that we therefore set out to investigate in this study. HRQoL was assessed by the validated Arabic version of the ORWELL 97 questionnaire in 129 treatment-seeking individuals with obesity referred to the Nutritional and Weight Management Outpatient Clinic at the Department of Nutrition and Dietetics of Beirut Arab University (BAU) in Lebanon, and 129 normal-weight participants of similar age and gender. Participants with obesity, regardless of gender, displayed higher total ORWELL 97 scores when compared with normal-weight controls, indicating that obesity is associated with lower HRQoL. Linear regression analysis showed that a higher body mass index (BMI) is associated with an increase in ORWELL 97 scores, but only among female, not male, participants with obesity (β = 2.89, 95% confidence interval (CI) = 1.43–4.53, p < 0.001). Moreover, logistic regression analysis showed that a one unit increase in BMI increases the odds of an ORWELL 97 score ≥ 71.75—considered indicative of a clinically significant impairment of HRQoL—by nearly 23% (odds ratio (OR), 95% CI = 1.23, 1.09–1.40, p < 0.05). If confirmed, our findings should prompt clinicians operating in Arab countries to encourage patients with obesity to initiate and persevere in weight-loss programs at the earliest opportunity.

Risk Factors and Predictors of Significant Chondral Surface Change From Primary to Revision Anterior Cruciate Ligament Reconstruction: A MOON and MARS Cohort Study

Background: Articular cartilage health is an important issue following anterior cruciate ligament (ACL) injury and primary ACL reconstruction. Factors present at the time of primary ACL reconstruction may influence the subsequent progression of articular cartilage damage. Hypothesis: Larger meniscus resection at primary ACL reconstruction, increased patient age, and increased body mass index (BMI) are associated with increased odds of worsened articular cartilage damage at the time of revision ACL reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: Subjects who had primary and revision data in the databases of the Multicenter Orthopaedics Outcomes Network (MOON) and Multicenter ACL Revision Study (MARS) were included. Reviewed data included chondral surface status at the time of primary and revision surgery, meniscus status at the time of primary reconstruction, primary reconstruction graft type, time from primary to revision ACL surgery, as well as demographics and Marx activity score at the time of revision. Significant progression of articular cartilage damage was defined in each compartment according to progression on the modified Outerbridge scale (increase ≥1 grade) or >25% enlargement in any area of damage. Logistic regression identified predictors of significant chondral surface change in each compartment from primary to revision surgery. Results: A total of 134 patients were included, with a median age of 19.5 years at revision surgery. Progression of articular cartilage damage was noted in 34 patients (25.4%) in the lateral compartment, 32 (23.9%) in the medial compartment, and 31 (23.1%) in the patellofemoral compartment. For the lateral compartment, patients who had >33% of the lateral meniscus excised at primary reconstruction had 16.9-times greater odds of progression of articular cartilage injury than those with an intact lateral meniscus (P < .001). For the medial compartment, patients who had <33% of the medial meniscus excised at the time of the primary reconstruction had 4.8-times greater odds of progression of articular cartilage injury than those with an intact medial meniscus (P = .02). Odds of significant chondral surface change increased by 5% in the lateral compartment and 6% in the medial compartment for each increased year of age (P ≤ .02). For the patellofemoral compartment, the use of allograft in primary reconstruction was associated with a 15-fold increased odds of progression of articular cartilage damage relative to a patellar tendon autograft (P < .001). Each 1-unit increase in BMI at the time of revision surgery was associated with a 10% increase in the odds of progression of articular cartilage damage (P = .046) in the patellofemoral compartment. Conclusion: Excision of the medial and lateral meniscus at primary ACL reconstruction increases the odds of articular cartilage damage in the corresponding compartment at the time of revision ACL reconstruction. Increased age is a risk factor for deterioration of articular cartilage in both tibiofemoral compartments, while increased BMI and the use of allograft for primary ACL reconstruction are associated with an increased risk of progression in the patellofemoral compartment.

Rapidly increasing body mass index among children, adolescents and young adults in a transitioning population, South Africa, 2008-15.

There is a global epidemic of overweight and obesity; however, this rate of increase is even greater in some low- and middle-income countries (LMIC). South Africa (SA) is undergoing rapid socioeconomic and demographic changes that have triggered a rapid nutrition transition. The paper focuses on the recent rate of change of body mass index (BMI) among children, adolescents and young adults, further stratified by key sociodemographic factors. We analysed mean BMI of 28247 individuals (including children) from 7301 households by age and year, from anthropometric data from four national cross-sectional (repeated panel) surveys using non-linear fitted curves and associated 95% confidence intervals. From 2008 to 2015, there was rapid rise in mean BMI in the 6-25 age band, with the highest risk (3-4+ BMI unit increase) among children aged 8-10 years. The increase was largely among females in urban areas and of middle-high socioeconomic standing. Prominent gains were also observed in certain rural areas, with extensive geographical heterogeneity across the country. We have demonstrated a major deviation from the current understanding of patterns of BMI increase, with a rate of increase substantially greater in the developing world context compared with the global pattern. This population-wide effect will have major consequences for national development as the epidemic of related non-communicable disease unfolds, and will overtax the national health care budget. Our refined understanding highlights that risks are further compounded for certain groups/places, and emphasizes that urgent geographical and population-targeted interventions are necessary. These interventions could include a sugar tax, clearer food labelling, revised school feeding programmes and mandatory bans on unhealthy food marketing to children.The scenario unfolding in South Africa will likely be followed in other LMICs.