Wide Range Of Body Mass Index Research Articles

Brain dopamine responses to ultra-processed milkshakes are highly variable and not significantly related to adiposity in humans.

Ultra-processed foods high in fat and sugar may be addictive, in part, due to their purported ability to induce an exaggerated postingestive brain dopamine response akin to drugs of abuse. Using standard [11C]raclopride positron emission tomography (PET) displacement methods used to measure brain dopamine responses to addictive drugs, we measured postingestive striatal dopamine responses to an ultra-processed milkshake high in fat and sugar in 50 young, healthy adults over a wide body mass index range (BMI 20-45 kg/m2). Surprisingly, milkshake consumption did not result in significant postingestive dopamine response in the striatum (p=0.62) nor any striatal subregion (p>0.33) and the highly variable interindividual responses were not significantly related to adiposity (BMI: r=0.076, p=0.51; %body fat: r=0.16, p=0.28). Thus, postingestive striatal dopamine responses to an ultra-processed milkshake were likely substantially smaller than many addictive drugs and below the limits of detection using standard PET methods.

Emotional eating: elusive or evident? Integrating laboratory, psychometric and daily life measures

PurposeEmotional eating (EE) refers to eating in response to (negative) emotions. Evidence for the validity of EE is mixed: some meta-analyses find EE only in eating disordered patients, others only in restrained eaters, which suggest that only certain subgroups show EE. Furthermore, EE measures from lab-based assessments, ecological momentary assessment (EMA), and psychometric measures often diverge. This paper tested whether the covariance of these three different EE methods can be modeled through a single latent variable (factorial validity), and if so, how this variable would relate to restrained eating (construct validity), Body-Mass-Index (BMI), and subclinical eating disorder symptomatology (concurrent validity).Methods102 non-eating disordered female participants with a wide BMI range completed EE measures from three methods: psychometric questionnaires, a laboratory experiment (craving ratings of food images in induced neutral vs. negative emotion) and EMA questionnaires (within-participant correlations of momentary negative emotions and momentary food cravings across 9 days). Two measures for each method were extracted and submitted to confirmatory factor analysis.ResultsA one-factor model provided a good fit. The resulting EElat factor correlated positively with subclinical eating disorder symptoms and BMI but not with restrained eating.ConclusionsThe one-factor solution shows that the EE construct can validly be assessed with three different methods. Individual differences in EE are supported by the data and are related to eating and weight problem symptomatology but not to restrained eating. This supports learning accounts of EE and underscores the relevance of the EE construct to physical and mental health.Level of evidenceII (Evidence obtained from well-designed controlled trials without randomization).

Deep learning reconstruction vs standard reconstruction for abdominal CT: the influence of BMI.

This study aimed to evaluate the image quality and lesion conspicuity of the deep learning image reconstruction (DLIR) algorithm compared with standard image reconstruction algorithms on abdominal enhanced computed tomography (CT) scanning with a wide range of body mass indexes (BMIs). A total of 112 participants who underwent contrast-enhanced abdominal CT scans were divided into three groups according to BMIs: the 80-kVp group (BMI ≤ 23.9kg/m2), 100-kVp group (BMI 24-28.9kg/m2), and 120-kVp group (BMI ≥ 29kg/m2). All images were reconstructed using filtered back projection (FBP), adaptive statistical iterative reconstruction-V of 50% level (IR), and DLIR at low, medium, and high levels (DL, DM, and DH, respectively). Subjective noise, artifact, overall image quality, and low- and high-contrast hepatic lesion conspicuity were all graded on a 5-point scale. The CT attenuation value (in HU), image noise, and contrast-to-noise ratio (CNR) were quantified and compared. DM and DH improved the qualitative and quantitative parameters compared with FBP and IR for all three BMI groups. DH had the lowest image noise and highest CNR value, while DM had the highest subjective overall image quality and low- and high-contrast lesion conspicuity scores for the three BMI groups. Based on the FBP, the improvement in image quality and lesion conspicuity of DM and DH images was greater in the 80-kVp group than in the 100-kVp and 120-kVp groups. For all BMIs, DLIR improves both image quality and hepatic lesion conspicuity, of which DM would be the best choice to balance both. The study suggests that utilizing DLIR, particularly at the medium level, can significantly enhance image quality and lesion visibility on abdominal CT scans across a wide range of BMIs. • DLIR improved the image quality and lesion conspicuity across a wide range of BMIs. • DLIR at medium level had the highest subjective parameters and lesion conspicuity scores among all reconstruction levels. • On the basis of the FBP, the 80-kVp group had improved image quality and lesion conspicuity more than the 100-kVp and 120-kVp groups.

The effects of an 8-week mindful eating intervention on anticipatory reward responses in striatum and midbrain.

Accumulating evidence suggests that increased neural responses during the anticipation of high-calorie food play an important role in the tendency to overeat. A promising method for counteracting enhanced food anticipation in overeating might be mindfulness-based interventions (MBIs). However, the neural mechanisms by which MBIs can affect food reward anticipation are unclear. In this randomized, actively controlled study, the primary objective was to investigate the effect of an 8-week mindful eating intervention on reward anticipation. We hypothesized that mindful eating would decrease striatal reward anticipation responses. Additionally, responses in the midbrain-from which the reward pathways originate-were explored. Using functional magnetic resonance imaging (fMRI), we tested 58 healthy participants with a wide body mass index range (BMI: 19-35 kg/m2), motivated to change their eating behavior. During scanning they performed an incentive delay task, measuring neural reward anticipation responses to caloric and monetary cues before and after 8 weeks of mindful eating or educational cooking (active control). Compared with the educational cooking intervention, mindful eating affected neural reward anticipation responses, with reduced caloric relative to monetary reward responses. This effect was, however, not seen in the striatum, but only in the midbrain. The secondary objective was to assess temporary and long-lasting (1 year follow-up) intervention effects on self-reported eating behavior and anthropometric measures [BMI, waist circumference, waist-to-hip-ratio (WHR)]. We did not observe effects of the mindful eating intervention on eating behavior. Instead, the control intervention showed temporary beneficial effects on BMI, waist circumference, and diet quality, but not on WHR or self-reported eating behavior, as well as long-lasting increases in knowledge about healthy eating. These results suggest that an 8-week mindful eating intervention may have decreased the relative salience of food cues by affecting midbrain but not striatal reward responses, without necessarily affecting regular eating behavior. However, these exploratory results should be verified in confirmatory research.The primary and secondary objectives of the study were registered in the Dutch Trial Register (NTR): NL4923 (NTR5025).

Five-Year Outcomes of Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome Among Female Patients: Higher Body Mass Index Is Associated With Reduced Clinically Significant Outcomes

To evaluate the impact of age, body mass index (BMI), and symptom duration on 5-year clinical outcomes among females following primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS). We conducted a retrospective review of a prospectively collected database of hip arthroscopy patients with a minimum 5-year follow-up. Patients were stratified by age (<30, 30-45, ≥45 years), BMI (<25.0, 25.0-29.9, ≥30.0), and preoperative symptom duration (<1 vs ≥1 year). Patient-reported outcomes were assessed using the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS). Pre- to postoperative improvement in mHHS and NAHS was compared between groups using the Mann-Whitney U test or Kruskal-Wallis test. Hip survivorship rates and minimum clinically important difference (MCID) achievement rates were compared with Fisher exact test. Predictors of outcomes were identified using multivariable linear and logistic regression. P values <.05 were considered significant. In total, 103 patients were included in the analysis with a mean age of 42.0 ± 12.6 years (range, 16-75) and mean BMI of 24.9 ± 4.8 (range, 17.2-38.9). Most patients had symptoms of duration ≥1 year (60.2%). Six patients (5.8%) had arthroscopic revisions, and 2 patients (1.9%) converted to total hip arthroplasty by 5-year follow-up. Patients with BMI ≥30.0 had significantly lower postoperative mHHS (P= .03) and NAHS (P= .04) than those with BMI <25.0. Higher BMI was associated with reduced improvement in mHHS (β= -1.14, P= .02) and NAHS (β= -1.34, P < .001) and lower odds of achieving the mHHS MCID (odds ratio [OR]= 0.82, P= .02) and NAHS MCID (OR= 0.88, P= .04). Older age was predictive of reduced improvement in NAHS (β= -0.31, P= .046). Symptom duration ≥1 year was predictive of higher odds of achieving the NAHS MCID (OR= 3.98, P= .02). Female patients across a wide range of ages, BMIs, and symptom durations experience satisfactory 5-year outcomes following primary hip arthroscopy, but higher BMI is associated with reduced improvement in patient-reported outcomes. Level III, retrospective comparative prognostic trial.

Accuracy of blood pressure measurement across BMI categories using the OptiBP™ mobile application

Purpose Obesity is a clear risk factor for hypertension. Blood pressure (BP) measurement in obese patients may be biased by cuff size and upper arm shape which may affect the accuracy of measurements. This study aimed to assess the accuracy of the OptiBP smartphone application for three different body mass index (BMI) categories (normal, overweight and obese). Materials and methods Participants with a wide range of BP and BMI were recruited at Lausanne University Hospital’s hypertension clinic in Switzerland. OptiBP estimated BP by recording an optical signal reflecting light from the participants’ fingertips into a smartphone camera. Age, sex and BP distribution were collected to fulfil the AAMI/ESH/ISO universal standards. Both auscultatory BP references and OptiBP BP were measured and compared using the simultaneous opposite arms method, as described in the 81060-2:2018 ISO norm. Subgroup analyses were performed for each BMI category. Results We analyzed 414 recordings from 95 patients: 34 were overweight and 15 were obese. The OptiBP application had a performance acceptance rate of 82%. The mean and standard deviation (SD) differences between the optical BP estimations and the auscultatory reference rates (criterion 1) were respected in all subgroups: SBP mean value was 2.08 (SD 7.58); 1.32 (6.44); −2.29 (5.62) respectively in obese, overweight and normal weight subgroup. For criterion 2, which investigates the precision errors on an individual level, the threshold for systolic BP in the obese group was slightly above the requirement for this criterion. Conclusion This study demonstrated that the OptiBP application is easily applicable to overweight and obese participants. Differences between the reference measure and the OptiBP estimation were within ISO limits (criterion 1). In obese participants, the SD of mean error was outside criterion 2 limits. Whether auscultatory measurement, due to arm morphology or the OptiBP is associated with increasing bias in obese still needs to be studied.

Association of body mass index and its classifications with gray matter volume in individuals with a wide range of body mass index group: A whole-brain magnetic resonance imaging study.

AimTo examine the association of body mass index (BMI) [kg/m2] and its classifications (underweight [BMI < 18.5], normal [18.5 ≤ BMI < 25], overweight [25 ≤ BMI < 30], and obese [BMI ≥ 30]) with brain structure in individuals with a wide range of BMI group.Materials and methodsThe participants included 382 right-handed individuals (mean age: 46.9 ± 14.3 years, 142 men and 240 women). The intelligence quotient was assessed using the Japanese Adult Reading Test. Voxel-based morphometry (VBM) and diffusion tensor imaging (DTI) were performed to analyze the association of BMI and its classifications with gray and white matter structures, respectively.ResultsAccording to VBM, BMI was significantly and negatively correlated with the bilateral cerebellum exterior volumes. In group comparisons, the right cerebellum exterior volume was significantly lower in the overweight or obese group than in the underweight or normal group, while the bilateral cuneus and calcarine cortex, left cuneus, and left precuneus volume was significantly lower in the underweight group than in the non-underweight group. Sex-related stratification analyses for VBM revealed that BMI was significantly and negatively correlated with the bilateral cerebellum exterior volumes only in women. In group comparisons, the left cerebellum exterior volume was significantly lower in obese women than in non-obese women. The left thalamus proper and the right cerebellum exterior volumes were significantly lower in overweight or obese group than in underweight or normal group in men and women, respectively. The bilateral cuneus and calcarine cortex, left cuneus and carcarine cortex, and bilateral cuneus volume was significantly lower in underweight men than in non-underweight men. In contrast, there were no notable findings on DTI.ConclusionOur results suggest association of continuous BMI, being overweight or obese, and being underweight with decreased gray matter volume in individuals with a wide range of BMI group. Furthermore, sex-related differences are seen in the association of BMI and its classifications with regional gray matter volume reductions. Abnormally high or low BMIs may have a negative influence on regional gray matter volumes.

Circulating Spexin Is Associated with Body Mass Index and Fat Mass but Not with Physical Activity and Psychological Parameters in Women across a Broad Body Weight Spectrum.

Spexin (SPX) is a novel, widely expressed peptide, with anorexigenic effects demonstrated in animal models and negatively correlated with body mass index (BMI) in humans. It increases locomotor activity in rodents and is elevated in human plasma following exercise. Studies have also shown an effect of stress and anxiety on SPX’s expression in different brain structures in animals. The relationships between plasma SPX and physical activity, body composition, and patient-reported outcomes such as perceived stress, depressiveness, anxiety, and eating behaviors are unknown and were examined in this study over a wide BMI range. A total of 219 female (n = 68 with anorexia nervosa; n = 79 with obesity; n = 72 with normal weight) inpatients were enrolled. Perceived stress (PSQ 20), anxiety (GAD 7), depressiveness (PHQ 9), and eating disorder pathology (EDI 2), as well as BMI, bioimpedance analysis, and accelerometry, were measured cross-sectionally at the beginning of treatment and correlated with plasma SPX levels (measured by ELISA) obtained at the same time. Plasma SPX levels were negatively associated with BMI (r = −0.149, p = 0.027) and body fat mass (r = −0.149, p = 0.04), but did not correlate with perceived stress, anxiety, depressiveness, eating behavior, energy expenditure, and physical activity (p > 0.05). The results replicate the negative correlation of SPX with BMI and fat mass, but do not support the hypothesis that peripheral SPX plays a role in the regulation of stress, depressiveness, anxiety, eating behavior, or physical activity.

Seasonal Variation of Testosterone Levels in a Large Cohort of Men.

Objectives The aim of the study was to evaluate in a large cohort of males with a wide range of age, metabolic status, and coexistent morbidities whether month of blood test performance was associated with total and bioavailable testosterone levels independent of age, body mass index (BMI), existing cardiovascular disease (CVD), and CVD risk factors. Methods Cross-sectional study includes data from computerized medical records of 27,328 men aged 20–70, treated by the largest healthcare organization in Israel, who had undergone testosterone measurement. In 7,940 subjects with available sex-hormone-binding globulin levels, bioavailable testosterone was calculated. Results Total and bioavailable testosterone levels gradually decreased with age and BMI (P < 0.001) and were significantly lower in men with diabetes, hypertension, hyperlipidemia, and known CVD, but were higher in current smokers compared with nonsmokers (P < 0.001). Hormone levels were highest in August-October declined after and lowest in March. Overall, both total and bioavailable testosterone levels were significantly lower in March compared to August-October (P < 0.001). In a linear regression analysis, age, BMI, current smoking, and month of testing were independently associated with total (P < 0.001) and bioavailable testosterone levels (P=0.002), and diabetes was associated with total testosterone (P < 0.001). Conclusion In a large cohort of men with a wide range of age, BMI, and comorbidities, month of testing was independently associated with total and bioavailable testosterone levels. These data provide strong evidence that seasonal variation has to be considered in clinical practice.

1441-P: Fidelity of BMI and Waist Circumference as Adiposity Measures in White and Black Adults

Background: Body mass index (BMI) and waist circumference (WC) are routine clinical estimates of obesity. We tested the fidelity of BMI and WC against direct body fat measures in Black (B) vs. White (W) Americans. Subjects and Methods: We analyzed the relationship between BMI vs. total fat, WC vs. trunk fat, and weight vs. lean fat free mass (FFM) in healthy B and W adults. Assessments included clinical exam, biochemistries and a 75-g OGTT. All subjects had normal fasting and 2-hr OGTT glucose levels. Total fat mass, trunk fat mass and FFM were measured using DXA. Results: The participants (n=376; 217 B, 159 W) had an age range of 18-65 years and BMI range of 16.8-66.3 kg/m2 (mean 30.1) . The W vs. B values were: age 46.5 ± 10.5 vs. 42.5 ± 10.3 y, P=0.0003; BMI 28.8 ± 6.78 vs. 31.2 ± 7.40, P=0.0015; total fat mass 29.4 ± 13.21 vs. 31.8 ± 13.76 kg, P=0.11; trunk fat mass 14.77 ± 6.96 vs. 15.34 ± 7.50 kg, P=0.48; FFM 50.12 ± 11.9 vs. 53.± 11.74 kg, P= 0.03. There were tight correlations between adiposity measures: total fat and BMI (r=0.90 in W, 0.92 in B) ; trunk fat and WC (r=0.85 in W, 0.82 in B) ; FFM and weight (r=0.83 in W, 0.87 in B) , with heterogeneity by sex and race. White men and women (vs B) tended to have more body fat per unit BMI or WC and less FFM per unit weight. We assessed 3 integrated ratios (total Fat/BMI, trunk Fat/Waist, FFM/Weight) by sex and race. Total fat/BMI was higher (P&amp;lt;0.0001) in W vs. B (men: 0.946 ± 0.159 vs. 0.833 ± 0.210; women: 1.36 ± 0.189 vs. 1.25 ± 0.164) . Trunk fat/waist was higher in W vs. B men (0.294 + 0.043 in W vs. 0.257 + 0.072, P=0.0046) but similar in women. In contrast, FFM/weight ratio showed no race disparities (men: 0.696 ± 0.055 vs. 0.678 ± 0.200; women: 0.586 ± 0.1vs 0.579 ± 0.076) . The proportion with &amp;gt;3 metabolic syndrome markers was 24.5% in W and 15.7% in B. Conclusion: Among otherwise healthy subjects with a wide BMI range, African Americans had lower body fat than Whites. This finding that argues for ethnic-specific BMI cut-offs for obesity classification. Disclosure Z.Liu: None. A.A.Patel: None. S.Dagogo-jack: Consultant; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Janssen Pharmaceuticals, Inc., Medtronic, Merck &amp; Co., Inc., Sanofi. Funding American Diabetes Association (7-07-MN-13) ; NIH, R01 DK067269

Variations in LA Volume Indexation Across Different Ethnicities in Healthy Subjects With Normal Body Mass Index (BMI)

Left atrial volume (LAV) is central to diastolic function evaluation and has demonstrated prognostic value. Guidelines recommend LAV indexation to BSA; however recent studies demonstrate allometric height is superior. Our aim was examine indexation by allometric height and BSA for different ethnicities. Using the World Alliance of Societies of Echocardiography (WASE) normal cohort, subjects with “normal” BMI (18.5-27.5kg/m2 [Asian], 18.5-30kg/m2 [other populations]) were classified by race: White, Black, Asian, or Other. Biplane LAV was indexed to BSA and allometric height; exponents of height for each ethnicity was derived (linear regression of logarithmic transformation of LAV=a(height)b). Indices (heightb) were assessed using Spearman’s correlation of LAV/heightb to raw LAV and body size (heightb). 1,366 subjects, (653 female (47.8%), mean age 47±17years; White:524, Black:149, Asian:523 and Other:170) were evaluated. LAV measurements were lowest in the Asian group (mean 41.5±13.4mL vs 49.1±17.0mL White, 50.6±14.3mL Black, 46.7±13.2mL Other; p<0.001). The calculated allometric height exponent for all subjects was 1.87, but varied across ethnicities (2.21 for White, 1.19 Black, 1.14 Asian, and 1.43 Other). The height exponents for each race were good indexation markers; indexed LAV correlated well with raw LAV (r∼1), without overcorrection by the index (r∼0) and was similar to BSA indexation (Figure). Despite normal BMI, there was disparity in LAV indexation across races. With respect to allometric height indexation, different exponents need to be derived based on race. Future validation studies are required in subjects with a wide BMI range.

Efficacy of dapagliflozin in heart failure with reduced ejection fraction according to body mass index.

AimsIn heart failure with reduced ejection fraction (HFrEF), there is an ‘obesity paradox’, where survival is better in patients with a higher body mass index (BMI) and weight loss is associated with worse outcomes. We examined the effect of a sodium–glucose co‐transporter 2 inhibitor according to baseline BMI in the Dapagliflozin And Prevention of Adverse‐outcomes in Heart Failure trial (DAPA‐HF).Methods and resultsBody mass index was examined using standard categories, i.e. underweight (<18.5 kg/m2); normal weight (18.5–24.9 kg/m2); overweight (25.0–29.9 kg/m2); obesity class I (30.0–34.9 kg/m2); obesity class II (35.0–39.9 kg/m2); and obesity class III (≥40 kg/m2). The primary outcome in DAPA‐HF was the composite of worsening heart failure or cardiovascular death. Overall, 1348 patients (28.4%) were under/normal‐weight, 1722 (36.3%) overweight, 1013 (21.4%) obesity class I and 659 (13.9%) obesity class II/III. The unadjusted hazard ratio (95% confidence interval) for the primary outcome with obesity class 1, the lowest risk group, as reference was: under/normal‐weight 1.41 (1.16–1.71), overweight 1.18 (0.97–1.42), obesity class II/III 1.37 (1.10–1.72). Patients with class I obesity were also at lowest risk of death. The effect of dapagliflozin on the primary outcome and other outcomes did not vary by baseline BMI, e.g. hazard ratio for primary outcome: under/normal‐weight 0.74 (0.58–0.94), overweight 0.81 (0.65–1.02), obesity class I 0.68 (0.50–0.92), obesity class II/III 0.71 (0.51–1.00) (P‐value for interaction = 0.79). The mean decrease in weight at 8 months with dapagliflozin was 0.9 (0.7–1.1) kg (P < 0.001).ConclusionWe confirmed an ‘obesity survival paradox’ in HFrEF. We showed that dapagliflozin was beneficial across the wide range of BMI studied.Clinical Trial Registration: ClinicalTrials.gov NCT03036124.

Original burger (traditional) or burger with mushroom addition? A social representation approach to novel foods

Currently, consumers’ interest in healthy products has attracted the attention of academia and the meat industry, which has focused mainly on incorporating ingredients with healthier properties. In this context, the aim of this study was to investigate the social representation of original burgers and burgers with mushroom addition considering different sexes and body mass indexes (BMIs) of individuals. Thus, 209 Brazilians answered a word association task followed by a word classification based on their importance and valence for original burgers and burgers with the addition of mushrooms. To obtain the structure of social representation, the words were positioned into four distinct zones based on their frequency of elicitation and importance. Also, the polarity index was used to give a connotation to the words. Three groups of consumers were identified. The first group (consumers with class-1 obesity of both sexes) associated the original burger with positive categories (cheese, juicy, seasoned, food, tasty, joy, salad and delicious). The second one (female consumers with pre-obesity and class-1 obesity) associated the burger with the addition of mushrooms with the elements price, different, vegetarian, flavor, gourmet and healthy. Finally, the third group (men and women for both stimuli and with a wide range of BMI) characterized burgers with sensory attributes, feelings and moments of consumption. In conclusion, the social representation of the original burger and the burger with the addition of mushrooms differed among consumers, suggesting that the main associations can be the main motivations for the consumption of a certain product.

Association between elevated serum triglycerides and asthma in patients with obesity: An explorative study.

Background: Adults with a high body mass index (BMI) have an increased risk of developing asthma. To explore the impact of increased lipids on the presence of asthma, this study investigated the relationship between lipid levels and inflammatory markers in patients with asthma and controls with obesity. Objective: We hypothesized that higher lipid levels are more prevalent in patients with obesity and asthma. Methods: In this explorative cohort study, 96 patients with asthma and 45 controls were included. All the patients participated in one of three asthma studies; two of these studies included only patients with obesity. An asthma diagnosis was defined by the presence of typical clinical symptoms, reversible airway obstruction (+12% improvement in forced expiratory volume in the first second of expiration after bronchodilator), or bronchial hyperreactivity (Histamine PC20 < 8 mg/mL), or a fractional exhaled nitric oxide of > 50 ppb. We compared lipid levels and neutrophils and eosinophils in patients with asthma and the controls with a wide BMI range (17.8-63.8 kg/m²). Multivariable logistic regression was used to analyze the data. Results: Serum triglycerides were statistically significantly higher in patients with obesity and asthma adjusted for BMI, blood eosinophils, and statin use (odds ratio [OR] 2.56 [95% confidence interval, 1.34-4.88]; p = 0.004). Inclusion or exclusion of those who used long-acting β2-agonists and inhaled corticosteroids led to comparable adjusted ORs for blood triglyceride and blood eosinophils levels. Conclusion: Elevated serum triglycerides were associated with the presence of asthma in patients with obesity. This indicated that elevated triglycerides might be a yet unrecognized trait that contributed to the development of asthma. The precise cause and effect of these high triglyceride levels in the patients with asthma and with obesity were not determined in this study.Clinical trial Trial registration NCT03278561, <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.clinicaltrials.gov">www.clinicaltrials.gov</ext-link>; NL4262, NL3056, trialregister.nl.

Crohn's Disease Increases the Mesothelial Properties of Adipocyte Progenitors in the Creeping Fat.

Our understanding of the interplay between human adipose tissue and the immune system is limited. The mesothelium, an immunologically active structure, emerged as a source of visceral adipose tissue. After investigating the mesothelial properties of human visceral and subcutaneous adipose tissue and their progenitors, we explored whether the dysfunctional obese and Crohn’s disease environments influence the mesothelial/mesenchymal properties of their adipocyte precursors, as well as their ability to mount an immune response. Using a tandem transcriptomic/proteomic approach, we evaluated the mesothelial and mesenchymal expression profiles in adipose tissue, both in subjects covering a wide range of body-mass indexes and in Crohn’s disease patients. We also isolated adipose tissue precursors (adipose-derived stem cells, ASCs) to assess their mesothelial/mesenchymal properties, as well as their antigen-presenting features. Human visceral tissue presented a mesothelial phenotype not detected in the subcutaneous fat. Only ASCs from mesenteric adipose tissue, named creeping fat, had a significantly higher expression of the hallmark mesothelial genes mesothelin (MSLN) and Wilms’ tumor suppressor gene 1 (WT1), supporting a mesothelial nature of these cells. Both lean and Crohn’s disease visceral ASCs expressed equivalent surface percentages of the antigen-presenting molecules human leucocyte antigen—DR isotype (HLA-DR) and CD86. However, lean-derived ASCs were predominantly HLA-DR dim, whereas in Crohn’s disease, the HLA-DR bright subpopulation was increased 3.2-fold. Importantly, the mesothelial-enriched Crohn’s disease precursors activated CD4+ T-lymphocytes. Our study evidences a mesothelial signature in the creeping fat of Crohn’s disease patients and its progenitor cells, the latter being able to present antigens and orchestrate an immune response.

Acute Improvement in Intraoperative EMG During Common Fibular Nerve Decompression in Patients with Symptomatic Diabetic Sensorimotor Peripheral Neuropathy: EMG and Clinical Attribute Interrelations.

Electromyographic (EMG) recordings of the fibularis longus and tibialis anterior muscles were performed intraoperatively during nerve decompression (ND) of the common fibular nerve (CFN) in patients with symptomatic diabetic sensorimotor peripheral neuropathy. Patient demographics and clinical attributes were compared against changes in EMG after ND and analyzed for possible correlations. Intraoperative changes in CFN EMG were analyzed for correlations against sex, age, body mass index (BMI), hemoglobin A1c (A1c), and type and duration of diabetes. Statistically significant changes were found between EMG changes and patient attributes, but no individual correlations were established. Significant EMG improvement was observed for both men and women (p < 0.0001 and p < 0.05, respectively), age groups (4th decade: p < 0.05; 5th decade: p < 0.05; 6th decade: p < 0.01; 7th decade: p < 0.005), diabetes duration (0-9 years: p = 0.002; 10-19 years: p = 0.002; 20-29 years: p = 0.03), and for type 1 and 2 diabetes (type 1: p < 0.005; type 2: p < 0.001). EMG improvement was greater in patients with the highest BMI levels (30-34.9: p = 0.014; 35-39.9: p = 0.013; > 39.9: p = 0.043), and highest A1c levels (> 6.4%; p < 0.0001). Although long-term clinical studies are needed, these results provide insight into which patients might benefit most from this surgery. These results also suggest that surgical ND can produce an acute improvement in nerve function for both men and women, for people with type 1 and 2 diabetes, and across a wide range of ages, BMI, A1c levels, and disease duration.

43: First-in-human clinical trial of a new robot-assisted surgical system for total laparoscopic hysterectomy

Versius is a new tele-operated robotic surgical system designed to assist surgeons in performing minimal access surgery (MAS). Versius has been developed broadly in line with recommendations from the IDEAL (Idea, Development, Exploration, Assessment, Long-term study) collaboration for surgical research.1,2 Versius is currently undergoing a first-in-human clinical study to confirm the safety and effectiveness of the device when performing MAS procedures. The aim of this study was to perform an interim analysis to confirm the safety of the device when performing total laparoscopic hysterectomy (TLH) procedures (aligned with IDEAL Stage 2a). This is an interim analysis of an ongoing prospective, cohort, clinical study designed to confirm the safety of Versius when performing minor or intermediate surgical procedures. All potentially eligible patients were identified from hospital surgical lists and approached directly by their surgeon or existing clinical team. Subjects provided consent before the start of surgery and the study was reviewed and approved by the Institutional Ethics Committee (DGCI registration No. ECR/15/Inst/Maha/2013/RR-16). All surgeons completed and passed the validated 3.5-day Versius training program immediately prior to the start of the study. Patients completed a pre-operative screening visit prior to surgery and were followed up on post-operative Day 30 (+/- 7 days) and Day 90 (+/- 7 days). Procedures were completed at the Deenanath Mangeshkar Hospital and Research Center, Erandawne, Pune, Maharashtra, India. The first 15 TLH procedures performed using Versius have been included for analysis (Table 1). One procedure was converted to open surgery due to the patient’s raised body mass index (BMI); all other procedures were completed as planned and without recorded complication. Surgical indications included adenomyosis, abnormal uterine bleeding, uterine fibrosis, endometriosis and menorrhagia. Patients were aged 28–51 years (median: 40 years) and represented a wide range of BMIs, 21.8–47.8 kg/m2 (median: 26.3 kg/m2). Operating time ranged between 110–345 mins (median: 205 mins) and all patients had an estimated blood loss <500 mL. Median stay in hospital was 4 days (range: 3–7 days). No adverse events were reported at the 30-day follow-up. Surgeons and surgical teams were able to successfully complete robot-assisted TLH using the Versius system without experiencing any device-related difficulties. The first-in-human cases presented here justify continued patient recruitment onto the Versius clinical trial and progression to major procedures. Additional recruitment and analysis will ensure continued alignment with the IDEAL Framework Stage 2b.1

Examining the association between body trust and body mass index with quantile regression.

Schachter's externality theory posits a connection between the inability to eat according to internal cues and higher body mass index (BMI); however, related work has not investigated associations between body trust and the wide range of BMIs found in general samples. This study examined the association between body trust and BMI across levels of BMI to determine whether this relationship differed as a function of BMI level. Participants were 534 adults (55.4% female), mean age 36years, BMIs 15.13-67.90 (M = 27.89, SD = 7.25), recruited via MTurk. They completed self-report assessments of body trust, height, and weight. Quantile regression was utilized to estimate effects of body trust on BMI at five equidistant quantiles of BMI. Overall linear regression analyses indicated that body trust was significantly negatively associated with BMI. Quantile regression revealed a significant negative relationship at each quantile of BMI, and Wald tests indicated the association was significantly stronger at the 0.7 and 0.9 quantiles than at the 0.1, 0.3, and 0.5 quantiles, which did not differ. Quantile regression identified a stronger relationship between body trust and BMI at 0.7 and 0.9 quantiles than at 0.1, 0.3, and 0.5 quantiles of BMI. Results align with the externality hypothesis, which suggests those at higher weights experience difficulty using internal cues to guide eating. A weaker-than-expected association between body trust and low BMI may be due to restricted range (few low-BMI participants). Replication in eating disorder samples is merited. Level V, cross-sectional descriptivestudy.

Mesothelial Origin of Creeping Fat Progenitors in Crohn's Disease

Background: Our understanding of the origin of human adipose tissue is limited. In this regard, the development of in Crohn's disease is particularly puzzling. The mesothelium has recently emerged as a source of visceral adipose tissue in rodents. We therefore sought to investigate the mesothelial properties of human visceral and subcutaneous adipose tissue and progenitor cells. Additionally, we explored whether the dysfunctional environment of obesity and Crohn's disease influences adipose tissue and the mesothelial/mesenchymal properties of its precursors. Methods: We used a tandem transcriptomic/proteomic approach to evaluate mesothelial and mesenchymal markers in adipose tissue, both in subjects covering a wide range of body-mass index and in patients with Crohn's disease. We also isolated adipose tissue precursors (adipose-derived stem cells) from lean, obese and Crohn's disease fat depots and assessed their mesothelial/mesenchymal properties. Findings: Several mesothelial signature genes (LRRN4, MSLN, KRT8, CDH1, and WT1) were significantly upregulated in human visceral fat when compared to equivalent subcutaneous tissue. These data were corroborated at the protein level by proteomic analysis. No significant differences in mesothelial gene expression were found in visceral fat tissue between lean, obese and morbid-obese subjects and patients with Crohn's disease. However adipose-derived stem cells from mesenteric creeping fat had a markedly distinct mesothelial gene profile as compared with equivalent lean-derived cells, with significantly higher expression of the hallmark mesothelial genes MSLN and WT1, supporting a mesothelial nature of these cells. Interpretation: We present the first direct evidence for a mesothelial signature for human visceral adipose tissue and its progenitor cells, specifically for creeping fat in Crohn's disease. Funding Statement: This work was supported by grants from the Spanish Ministry of Science, Innovation and Universities (PI14/00228 and PI17/01503 to JV, SAF2015-65019-R to SF-V, BFU2015-70454-REDT and BFU2017- 90578-REDT to SF-V and MMM, BFU2016-76711-R to MMM and PI15/00143 and PI18/00037 to CS) co-financed by the European Regional Development Fund (ERDF). The Spanish Biomedical Research Center in Diabetes and Associated Metabolic Disorders (CIBERDEM) (CB07708/0012) is an initiative of the Instituto de Salud Carlos III. AM is a recipient of a postdoctoral fellowship from FJCI-2014-23060 and IJCI-2016-30572. SF-V acknowledges support from the Miguel Servet tenure-track program (CP10/00438 and CPII16/00008) of the Fondo de Investigacion Sanitaria, co-financed by the ERDF. C.S. acknowledges support from the ‘‘Ramon y Cajal’ program from MINECO (RYC2013-13186), cofinanced by the ERDF. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: All participants gave their informed consent, and the study was reviewed and approved by the ethics and research committee of University Hospital Joan XXIII in accordance with the tenets of the Helsinki Declaration. Participants of the fat sampling gave their informed written consent. The ethics and research committee of the Hospital Clinico Virgen de la Victoria approved the protocol.

Obesity is associated with impaired responsiveness to once‐daily low‐dose aspirin and in vivo platelet activation

BackgroundThe prevalence and degree of obesity is rising worldwide, increases cardiovascular risk, modifies body composition and organ function, and potentially affects the pharmacokinetics and/or pharmacodynamics of drugs. ObjectivesTo investigate the pharmacodynamics of once‐daily low‐dose aspirin in healthy obese subjects, and to assess whether body weight (BW) and body mass index (BMI) affect the pharmacology of aspirin. Patients/MethodsOtherwise healthy, obese (BMI > 30 kg/m2) subjects were studied before and after 3‐4 weeks of 100‐mg once‐daily aspirin intake. Aspirin pharmacodynamics were assessed according to serum thromboxane (TX) B2 levels measured at 4 hours, 24 hours (i.e., posologic interval) and 48 hours after the last witnessed intake; age‐matched and sex‐matched non‐obese controls were included. A previously calibrated pharmacokinetic/pharmacodynamic in silico model of aspirin was used to fit serum TXB2 data from obese subjects. At baseline, the major urinary TXA2 and prostacyclin metabolites, urinary isoprostane and plasma inflammatory biomarkers were measured. ResultsIn 16 obese subjects (aged 47 ± 11 years; BMI of 39.4 ± 5.1 kg/m2), residual serum TXB2 values between 4 and 48 hours after aspirin intake were increased 3‐ to 5‐fold as compared with controls. At 24 hours, the residual serum TXB2 level was log‐linearly associated with body size over a wide range of BMI and BW values, without any apparent threshold. The in silico model predicted that reduced aspirin bioavailability would be inversely related to body size and rescued by 200 mg of aspirin once daily or 85 mg twice daily. Baseline urinary TXA2 metabolite, isoprostane and plasma C‐reactive protein levels were significantly increased in obese subjects. ConclusionsObesity is associated with impaired aspirin responsiveness, largely because of body size. Impaired inhibition of platelet activation by conventional low‐dose aspirin may affect antithrombotic efficacy.