Fluid management for critical patients undergoing urgent colectomy

RATIONALE

The present study aimed to define thresholds for perioperative fluids and weight gain after urgent colectomies.

METHOD

Consecutive urgent colonic resections within an enhanced recovery pathway (2011-2017) were included. Primary outcomes were postoperative complications, stratified as overall (I-V) and major (IIIb-V) according to Clavien scale. Fluid-management-related thresholds were identified through receiver operating characteristics (ROC) analysis. Outcomes were compared for patients above vs below threshold, and multivariable logistic regression was performed to identify risk factors for overall complications.

RESULTS

Overall, complications were observed in 133 out of 224 patients (59%), severe complications in 43 patients (19%). For overall complications, area under ROC (AUROC) was 0.71, identifying a critical cut-off of 3 L of total IV fluid administration at the day of surgery (negative predictive value [NPV]: 90%). Further, a critical cut-off for postoperative weight gain of 2.3 kg at postoperative day (POD) 2 was identified (AUROC 0.7, NPV 92%). Multivariable analysis identified fluid administration of >3 L (OR 5.33; 95% CI, 2.36-12.02) and weight gain of >2.3 kg at POD 2 (OR 2.5; 95% CI, 1.13-5.53) as independent predictors for overall complications. Median length of stay was 7 (5-10) days in patients receiving <3 L at POD 0 and 13 (9-19) days in patients receiving >3 L (P < .001).

CONCLUSIONS

Fluid administration of 3 L at the day of surgery and weight gain of 2.3 kg at POD 2 may represent critical thresholds for adverse outcomes after urgent colectomy. The suggested thresholds need to be confirmed through independent validation.

Weight gain and integrase inhibitors

PURPOSE OF REVIEW

Weight gain and obesity among people living with HIV (PLWH) is a serious problem that occurs often after initiation of antiretroviral therapy but may be worse with integrase strand transfer inhibitors (INSTIs). This article comprehensively reviews available data and summarizes our current understanding of the topic.

RECENT FINDINGS

Recent studies support the concept that weight gain and treatment emergent obesity are worse with INSTI-based regimens, particularly dolutegravir. Women and nonwhites appear to be the most at risk, and the accompanying nucleoside reverse transcriptase inhibitor may play a role. Lipohypertrophy, an abnormal accumulation of visceral fat and/or ectopic fat depots, continues to be a problem among PLWH, but the role of INSTIs is inconsistent. The pathogenesis of weight gain and changes in body composition in HIV, especially with INSTIs, is poorly understood but may lead to serious comorbidities, such as cardiovascular disease and diabetes.

SUMMARY

Although INSTI-based regimens are highly efficacious for viral suppression, they appear to cause more weight gain and treatment emergent obesity than non-INSTI-based regimens and may increase the risk of weight-related comorbidities. More studies are needed to understand the pathogenesis of weight gain with INSTIs in PLWH, in order to prevent this serious complication.

Analysis of 'sensitive' periods of fetal and child growth

BACKGROUND

Birth weight and weight gain in infancy and early childhood are commonly studied as risk factors for later cardiometabolic diseases. In this study, we explore methods for quantifying weight gain during different age periods and for comparing the magnitude of the associations with later blood pressure.

METHODS

Based on data from a birth cohort study nested within a large cluster-randomized trial with repeated measures of weight from birth to 16 years of age, we compared the results of four analytic approaches to assess sensitive periods of growth in relation to blood pressure at age 16 years.

RESULTS

Approaches based on z-scores of weight or weight gain velocity (both standardized for age and sex) or on regression-based conditional weight standardized residuals yielded more coherent results than an approach based on absolute weight gain velocity. Weight gain standardized by sex and age was positively associated with blood pressure at 16 years at all postnatal age periods, but the magnitude of association was larger during adolescence (11.5-16 years) than during earlier intervals (0-3 months, 3-12 months, 1-6.5 years or 6.5-11.5 years).

CONCLUSIONS

Standardization of weight and weight gain by age and sex, or regression-based standardized residuals based on conditional weight, reflects relative gain and thus accounts for the rapid weight gains normally observed in early infancy and puberty. Adolescence appears to be a more sensitive period for relative weight gain effects on later blood pressure than earlier periods, even those of similar duration.

Maternal obesogenic diet combined with postnatal exposure to high-fat diet induces metabolic alterations in offspring

Maternal obesity has been shown to impact the offspring health during childhood and adult life. This study aimed to evaluate whether maternal obesity combined with postnatal exposure to an obesogenic diet could induce metabolic alterations in offspring. Female CD1 mice were fed a control diet (CD, 11.1% of energy from fat) or with a high-fat diet (HFD, 44.3% of energy from fat) for 3 months. After weaning, pups born from control and obese mothers were fed with CD or HFD for 3 months. Both mothers and offspring were weighted weekly and several blood metabolic parameters levels were evaluated. Here, we present evidence that the offspring from mothers exposed to a HFD showed increased acetylation levels of histone 3 on lysine 9 (H3K9) in the liver at postnatal Day 1, whereas the levels of acetylation of H4K16, dimethylation of H3K27, and trimethylation of H3K9 showed no change. We also observed a higher perinatal weight and increased blood cholesterol levels when compared to the offspring on postnatal Day 1 born from CD-fed mothers. When mice born from obese mothers were fed with HFD, we observed that they gained more weight, presented higher blood cholesterol levels, and abdominal adipose tissue than mice born to the same mothers but fed with CD. Collectively, our results point toward maternal obesity and HFD consumption as a risk factor for epigenetic changes in the liver of the offspring, higher perinatal weight, increased weight gain, and altered blood cholesterol levels.

Pre-pregnancy nutritional status versus maternal weight gain and neonatal size

Background

Maternal weight during pregnancy may affect both, the course of pregnancy and the anthropometric parameters of the newborn. The steadily growing problem of excessive weight in reproductive-age women is associated with the risk for gestational obesity and its negative consequences for the infant.

Objectives

The aims of the study were to analyze the following: (i) maternal weight gain as compared to the pre-pregnancy BMI, and (ii) the link between maternal weight and other environmental factors versus neonatal size.

Material and methods

The study was conducted among 94 women in singleton term pregnancy, who delivered at the Department of Obstetrics, Gynecology and Oncology, Medical University of Warsaw. The American Institute of Medicine criteria for the recommended weight gain were followed. Multivariate logistic regression model and multiple regression analysis were used for statistical analysis.

Results

Normal weight gain was observed in only one-third of the subjects, while excess weight gain was detected in as many as 42.5% of the women. Active smokers were at a 4-fold higher risk for excess weight gain as compared to nonsmokers (OR 4.13, 95% CI 1.19 - 14.34, p = 0.026). Infants born to mothers with insufficient weight gain (24.5% of the mothers) were lighter by 302 g (p=0.0405) and shorter by 2.4 cm (p=0.0025) as compared to those born to mothers with normal weight gain.

Conclusions

Maternal weight gain in most of our subjects was not compliant with the current recommendations, regardless of the pre-pregnancy BMI. Inadequate pregnancy weight gain negatively affects the anthropometric parameters of the newborn.

High-Temperature Oxidation Behavior of Fe-1Cr-0.2Si Steel

In the case of Fe–1Cr–0.2Si steel, tube furnace oxidation was carried out for 120 min and 30 min. These studies, along with the high-temperature oxidation behavior of Fe–1Cr–0.2Si steel, were examined from 700 to 1100 °C. It has been observed that with an increase in the oxidation time, the oxidation weight gain per unit area of Fe–1Cr–0.2Si steel changed from a linear to a parabolic relationship. The time was shortened when the oxidation phase was linear. When the oxidation temperature exceeded 900 °C, the value of W_Transition decreased, and the oxidation rule changed. It could be considered that overall, the iron oxide structure of Fe–1Cr–0.2Si steel is divided into two layers. The formation of an outer oxide of iron is mainly caused by the outward diffusion of cation, while the inward diffusion of O ion forms the inner oxides of chromium and silicon. As the temperature increases, the thickness of the outer iron oxide gradually increases, and the thickness ratio of the inner mixed layers of chromium- and silicon-rich oxides decreases; however, the degree of enrichment of Cr and Si in the mixed layer increases. After high-temperature oxidation, Cr and Si did not form a composite oxide but were mechanically mixed in the form of FeCr₂O₄ and Fe₂SiO₄, and no significant delamination occurred.

Depo-medroxyprogesterone acetate, weight gain and amenorrhea among obese adolescent and adult women

Objective: The aim of the study was to evaluate the correlation between obesity and the use of depot medroxyprogesterone (DMPA) with regard to weight gain and changes in bleeding pattern.Methods: A retrospective chart review was conducted of women receiving 150 mg DMPA via intramuscular injection at inpatient and outpatient clinics at the University of Mississippi Medical Centre between 1 June 2012 and 31 December 2016. Body mass indices (BMI) were assessed at baseline and at the time of final injection. Data on race, medical history, age at first DMPA injection, number and timing of injections, reported side effects, indication for DMPA use and reason for discontinuation, if applicable, were collected.Results: Of the 240 women included in the study, 3.3% were underweight, 30.8% were normal weight, 23.3% were overweight, 15% were class I obese, 9.6% were class II obese and 17.9% were class III obese; 87.9% of the population were African American. Women gained 2.40 kg (95% confidence interval 1.34-3.45) while they were on DMPA (p < .01), which after adjusting for confounding variables was inversely associated with age at initial injection (β coefficient -0.13; p = .02). Amenorrhoea was the most commonly reported change in bleeding pattern.Conclusion: Women who started DMPA at an earlier age gained the most weight over time, independently of initial BMI. Similar rates of amenorrhoea were found among all BMI categories.

Effect of fiber source and particle size on chick performance and nutrient utilization

The addition of fiber in chick feeds is known to dilute nutrients; as a result, this may reduce nutrient digestibility and performance. However, recent studies suggest that moderate inclusion of insoluble fibers (2 to 3%) may stimulate gizzard development, which could result in better nutrient utilization and chick growth. The previous fiber sources evaluated were subject to wide fluctuation in their nutritional and chemical composition due to variation in processing. Miscanthus giganteus is a C4 grass purposefully grown for its fiber content which has a consistent fiber composition compared to food process residues. The objectives of this study were to determine the effect of dietary fiber source and particle size on day-old chick performance and nutrient digestibility. Day-old chicks (8 chicks per cage, 5 cages per treatment) were fed diets containing 3% of either sepiolite (SEP), cellulose (CEL), coarse beet pulp (BP), fine BP, coarse Miscanthus grass (MG), and fine MG. At the end of days 7, 14, and 21, chicks and experimental diets were weighed to compute average daily gain and feed intake. In addition, excreta from the previous 48 h of each data capture point was collected to determine nutrient digestibility. In general, chicks fed diets containing fiber consumed more feed, gained more weight, and had better feed conversion rate than birds fed the SEP diet. Particle size of the fiber had no effect on chick performance; however, nutrient utilization was higher (P < 0.05) for chicks fed coarse fiber particles compared to these fed fine fiber particles. Birds fed diets containing MG performed similar to chicks fed CEL (P > 0.05), but digestibility coefficients of birds fed BP diets were generally higher than chicks fed MG diets. In conclusion, chicks performed better with fiber in their diet and MG was comparable to CEL.

The relationship between pre-pregnancy BMI, gestational weight gain and neonatal birth weight: a retrospective cohort study

OBJECTIVES

Maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) have a meaningful impact on pregnancy and perinatal outcomes. The first aim of the study was to analyze the association between pre-pregnancy BMI and the prevalence of small for gestational age (SGA) and large for gestational age (LGA) outcomes. The second aim was to assess the relation- ship between pre-pregnancy BMI combined with gestational weight gain (GWG) and the prevalence of SGA and LGA measurements.

MATERIAL AND METHODS

The retrospective cohort study was conducted at Jagiellonian University Hospital in Cracow, Po- land from 2016 to 2017. During this time there were 2,123 deliveries. Patients with chronic diseases, multiple pregnancies, fetal defects and incomplete data were excluded. Finally, 474 cases were enrolled. Patients were divided into BMI groups (underweight, normal, overweight and obese) and into GWG groups (inadequate, adequate, excessive). Relationships between maternal BMI, GWG and newborn weight were examined.

RESULTS

There was no statistically significant association between maternal pre-pregnancy BMI and prevalence of SGA measurements. However, underweight women with inadequate GWG showed a higher risk to bear SGA babies (OR 5.2, 95% CI 1.57-17.18). Obese women with adequate GWG had higher risk of bearing LGA newborns (OR 5.48, 95% CI 1.15-26.13). High BMI correlated with excessive GWG (overweight: OR 3.0, 95% CI 1.84-3.87; obese OR 2.45, 95% CI 1.1-5.48).

CONCLUSIONS

There is a considerable risk of giving birth to a SGA newborn for underweight women with inadequate GWG. There is a statistically significant association between maternal obesity and LGA outcomes. Our study shows that redefining the risks of abnormal neonatal weight considering both pre-pregnancy BMI and gestational weight gain can be useful in providing effective prevention during pregnancy.

Exploring Differences in the Role of Hospitalization on Weight Gain Based on Treatment Type From Randomized Clinical Trials for Adolescent Anorexia Nervosa

Background: This study explores the impact of weight gain during medical stabilization hospitalization on weight outcomes between three outpatient treatments for adolescent anorexia nervosa (AN): Adolescent Focused Therapy (AFT), Systemic Family Therapy (SyFT), and Family Based Treatment (FBT). Methods: A secondary analysis of weight gain data (N = 215) of adolescents (12-18 years) meeting DSM-IV criteria for AN (exclusive of amenorrhea criteria) who participated in two randomized clinical trials (RCTs) was conducted. Main outcomes examined were changes in weight restoration (≥95% expected body weight or EBW) and differences in weight change attributable to hospital weight gain. Results: Weight gain resulting from hospitalizations did not substantially change weight recovery rates. Hospital weight gain contributed most to overall treatment weight gain in AFT compared to FBT and SyFT. Conclusion: Brief medical stabilization weight gain does not contribute substantially to weight recovery in adolescents with AN who participated in RCTs.

Development of Obesity: The Driver and the Passenger

Obesity has reached epidemic proportions and is one of the greatest challenges for public health in the twenty-first century. The macronutrient composition of diets, in particular the amount and ratio of carbohydrates, fat and protein, have received considerable attention in recent decades due to its potential relevance to the development of obesity and weight loss. The effects of various macronutrients on body weight regulation are still under debate. High-carbohydrate diets, and particularly high-fat diets, have been blamed for the increase in the prevalence of obesity. This paper shows that neither fat nor carbohydrates are fattening per se. Mixed diets with substantial amounts of fat and high-glycemic carbohydrates, like current WDs, are required to promote weight gain and obesity. High-glycemic carbohydrates are the active partner (the "driver"), which promotes fat storage through its insulinogenic effect, while fat is the passive partner (the "passenger") on the way to obesity. Elevated insulin levels (postprandial, but more importantly due to hypersecretion and hyperinsulinemia) promote fat storage and play a key role in obesogenesis and the obesity epidemic. Furthermore, mixed diets high in high-glycemic carbohydrates and fat promote fetal programming, with long-term adverse impacts on the offspring, including insulin hypersecretion, (childhood) obesity and metabolic diseases. Maternal obesity and high weight gain during pregnancy have also been linked to deleterious effects on fetal programming. As the global obesity epidemic increasingly affects women of reproductive age, a significant percentage of fetuses will experience fetal programming with a tendency towards obesity - a self-reinforcing process that further fuels the epidemic. A change in lifestyle and diet composition is needed to prevent or limit the development of obesity and related diseases.

Modeling variation in the growth of wild and captive juvenile vervet monkeys in relation to diet and resource availability

OBJECTIVES

To compare longitudinal weight gain in captive and wild juvenile vervet monkeys and conduct an empirical assessment of different mechanistic growth models.

METHODS

Weights were collected from two groups of captive monkeys and two consecutive cohorts of wild monkeys until the end of the juvenile period (~800 days). The captive groups were each fed different diets, while the wild groups experienced different ecological conditions. Three different growth curve models were compared.

RESULTS

By 800 days, the wild juveniles were lighter, with a slower maximum growth rate, and reached asymptote earlier than their captive counterparts. There were overall differences in weight and growth rate across the two wild cohorts. This corresponded to differences in resource availability. There was considerable overlap in growth rate and predicted adult weight of male and females in the first, but not the second, wild cohort. Maternal parity was not influential. While the von Bertalanffy curve provided the best fit to the data sets modeled together, the Logistic curve best described growth in the wild cohorts when considered separately.

CONCLUSIONS

The growth curves of the two captive cohorts are likely to lie near the maximum attainable by juvenile vervets. It may be helpful to include deviations from these rates when assessing the performance of wild vervet monkeys. The comparison of wild and captive juveniles confirmed the value of comparing different growth curve models, and an appreciation that the best models may well differ for different populations. Choice of mechanistic growth model can, therefore, be empirically justified, rather than theoretically predetermined.

C677T Polymorphism in the MTHFR Gene Is Associated With Risperidone-Induced Weight Gain in Schizophrenia

OBJECTIVE

To explore the association of methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism with risperidone-induced weight gain.

METHODS

We analyzed the association between MTHFR C677T polymorphism and risperidone-induced weight gain in 356 schizophrenia patients. The patients were treated with risperidone for 8 weeks. The height and body weight of the patients were measured before and 8 weeks after risperidone treatment. Blood DNA was genotyped for MTHFR C677T polymorphisms.

RESULTS

We found a significant association between MTHFR C677T polymorphism and body mass index (BMI) change after 8-week risperidone treatment. The BMI of carriers with different genotypes of MTHFR gene increased over 2-8 weeks. After 8 weeks of risperidone treatment, BMI added value (kg/m²) of CC or CT genotype carriers was significantly higher than that of TT genotype carriers [CC (4.47 ± 1.09), CT (4.54 ± 1.27), TT (2.31 ± 0.75), F = 5.634, P = 0.001]. Based on whether the rate of weight gain from baseline at 8 weeks of treatment exceeded 7%, it was divided into a weight gain group (n = 61) and a non-weight gain group (n = 295). The C allele frequency was significantly different between the two groups (48.4% vs 32.4%, χ² = 11.342, P = 0.001).

CONCLUSION

MTHFR C677T polymorphism was associated with risperidone-induced weight gain in Chinese Han population.

Modern pharmacological treatment of obese patients

There are many angles to consider in drug treatment of obese patients. On the one hand, some specific weight loss drugs are available, on the other, several drugs are associated with unintentional weight changes. When treating an obese patient for any given disease, several physiological changes may influence the pharmacokinetic properties of the drugs required. Thus, increased body weight may influence the efficacy and safety of some drug treatments. Even more complicated is the situation after weight reduction surgery. Due to the various changes to the gastrointestinal tract induced by the different surgical techniques used, and the dynamic changes in body composition thereafter, drug dosing has to be constantly reconsidered. Whereas all of these issues are of clinical importance, none of them have been investigated in the necessary depth and broadness to ensure safe and efficacious drug treatment of the massively obese patient. Individual considerations have to be based on comorbidities, concomitant medication, and on specific drug properties, for example, lipophilicity, volume of distribution, and metabolism. In this article we summarize the data available on different aspects of drug treatment in the obese patient with the hope of improving patient care.

The pain of weight gain: self-experimentation with overfeeding

The Vermont overfeeding studies were published 50 y ago and began a change in the acceptance of obesity as a bona fide area of academic interest. This article chronicles the experience of the author with acute weight gain while overfeeding, in the context of current obesity research, and presents a glimpse of things to come. The pain associated with acute overeating is illustrated by the firsthand experience of the author. The rapid return to normal weight contrasts with the difficulty that almost all people with obesity experience when they attempt to lose and maintain weight loss. Contrasting the response to overfeeding of individuals who are "resistant" to obesity with those who are obesity prone provides an avenue for unraveling the difficulties people with obesity face when they try to lose weight.

Weight Gain Over 6 Years in Young Adults: The Study of Novel Approaches to Weight Gain Prevention Randomized Trial

OBJECTIVE

The study objective was to determine whether two self-regulation interventions that reduced 3-year weight gain in young adults remain effective at 6 years.

METHODS

A randomized trial was conducted in two academic settings in 599 young adults, aged 18 to 35 years, with normal weight or overweight; 504 (84%) reconsented for a 6-year extension (Study of Novel Approaches to Weight Gain Prevention-Extended [SNAP-E]) with ongoing intervention and assessments. Weight gain over 6 years was compared for all assigned to Control, Large Changes (LC; lose 5-10 pounds initially), and Small Changes (SC; make small daily changes in intake and activity).

RESULTS

Weight change from baseline to 6 years did not differ significantly among the three groups (Control = 3.9 kg, SC = 4.1 kg, and LC = 2.8 kg). However, there was a significant age-by-treatment interaction (P = 0.002). Among those < 25 years old, weight gain from baseline to 6 years averaged 7.3 kg in the Control group and was reduced by almost 50% in LC and SC. LC also significantly reduced mean weight gain (area under the curve) over 6 years compared with Control or SC.

CONCLUSIONS

Although the interventions did not reduce weight gain at 6 years for the full cohort, they were effective in those < 25 years old. Future efforts should focus on young adults aged 18 to 24.9 and test more intensive interventions with more diverse participants.

Effects of long-term antipsychotics treatment on body weight: A population-based cohort study

BACKGROUND

Antipsychotics are often prescribed for long-term periods, however, most evidence of their impact on body weight comes from short-term clinical trials. Particularly, impact associated with dosage has been barely studied.

AIMS

The aim of this study was to describe the short- and long-term change in body weight of people initiated on high or low doses of the three most commonly prescribed second-generation antipsychotics.

METHODS

Retrospective cohorts of individuals with a diagnosed psychotic disorder observed from 2005 to 2015 in the UK primary care. The exposure was the first prescription of olanzapine, quetiapine or risperidone. The main outcome was change in body weight four years before and four years after initiation of antipsychotic treatment, stratified on sex and 'low' or 'high' dose.

RESULTS

In total, 22,306 women and 16,559 men were observed. Olanzapine treatment was associated with the highest change in weight, with higher doses resulting in more weight gain. After 4 years, given a high dose of olanzapine (> 5 mg), women gained on average +6.1 kg; whereas given a low dose (⩽ 5 mg), they gained +4.4 kg. During the first six weeks of olanzapine treatment, they gained on average +3.2 kg on high dose and +1.9 kg on low dose. The trends were similar for men. Individuals prescribed risperidone and quetiapine experienced less weight gain in both the short- and long-term.

CONCLUSIONS

Olanzapine treatment was associated with the highest increase in weight. Higher doses were associated with more weight gain. Doctors should prescribe the lowest effective dose to balance mental-health benefits, weight gain and other adverse effects.

Prevalence and determinants of gestational weight gain among pregnant women in Niger

Low gestational weight gain (GWG) and low mid-upper arm circumference (MUAC) are associated with adverse pregnancy outcomes. We aimed to assess the prevalence and determinants of low GWG and low MUAC among pregnant women in rural Zinder, Niger. A community-based survey was conducted among 1,384 pregnant women in the catchment areas of 18 integrated health centers in the region of Zinder, Niger. Weight and MUAC were measured during an in-home visit and again 1 month later, when haemoglobin concentration and micronutrient status were also assessed. The prevalence of low GWG was defined based on the 2009 United States Institute of Medicine (U.S. IOM) guidelines (<0.35 kg/week) and less than the third centile of the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) standards. Factors associated with GWG and MUAC were identified using logistic regression models adjusting for season, village, and gestational age. The median (interquartile range) age was 25.0 (20.7, 30.0) years, and 16.4% were ≤19 years. The prevalence of low GWG were 62.9% and 27.5% according to 2009 IOM and less than the third INTERGROWTH-21st centile, respectively; 24.9% had low MUAC. Higher α-1-acid glycoprotein (OR = 1.7, 95% CI [1.1, 2.8]) and C-reactive protein (OR = 1.2, 95% CI [1.02, 1.50]) increased the odds of low GWG. Adolescents (OR = 2.7, 95% CI [1.8, 4.0]), housewives (OR = 1.97, 95% CI [1.36, 2.86]), and those who reported recent food assistance (OR = 1.80, 95% CI [1.04, 3.11]) had higher odds of low MUAC. Prevalence of low GWG and low MUAC was high among pregnant women. Determinants of GWG and MUAC included socio-economic, demographic, and biological factors, although only markers of inflammation were consistent predictors across different definitions of low GWG.

Gender Differences and Other Factors Associated with Weight Gain Following Initiation of Infliximab: A Post Hoc Analysis of Clinical Trials

BACKGROUND

In our clinical practice, women often report excess weight gain with infliximab (IFX) use. There are currently no studies investigating weight gain after antitumor necrosis factor therapy in patients with inflammatory bowel disease. The objective of this study was to evaluate the association of clinical factors, with a particular focus on sex and weight gain in patients with moderate to severe Crohn's disease (CD) or ulcerative colitis (UC) initiating IFX.

METHODS

Data was extracted from ACCENT I, ACCENT II, ACT 1, and SONIC; included patients received IFX for induction or maintenance of remission of CD or UC. Patients treated with azathioprine (IFX 0 mg/kg) were included as controls. Baseline demographics, clinical characteristics, and weight at each follow-up for the study duration were collected. In addition to descriptive statistics, adjusted mixed effects models were used to test the association between clinical variables and weight gain.

RESULTS

There were 1273 patients included for analysis; the majority was white (91%), with CD (81%), and half of patients (50%) were women. Upon univariate analysis, IFX dose, African American race, diagnosis of CD, elevated C-reactive protein, and low hematocrit and albumin were associated with weight gain (P < 0.001). Upon adjusted analysis, sex was significantly associated with weight gain (P = 0.009), with women experiencing a lower percentage increase from baseline weight than men (3.9% increase vs 4.3% increase).

CONCLUSIONS

When starting IFX, those with markers of severe disease and with a diagnosis of CD are likely to gain more weight. Adjusting for confounding variables, women actually gain less weight than men after IFX treatment, although this difference is not clinically relevant.

Preeclampsia in women with pregestational diabetes - a cohort study

Aims: To evaluate risk factors for preeclampsia (PE) in women with pregestational diabetes.Methods: Retrospective cohort study of women with pregestational diabetes cared for at a specialized prenatal care facility. Maternal characteristics at booking and during pregnancy were studied for their association with preeclampsia. Multivariable models were tested using Poisson regression with robust estimates; results were expressed as relative risk (RR) and 95% confidence interval (CI).Results: Preeclampsia was diagnosed in 62 of 206 women (30%, 95% CI 24-37%). Previous chronic hypertension was found in 53 subjects (26%; 95% CI 20-32%), of whom 41 (77%, 95% CI 64-88) were type 2 women. Type 1 diabetes, chronic hypertension, systolic blood pressure >124 mmHg at booking and gestational weight gain, either total or excessive for body mass index category, behaved as independent risk factors.Conclusions: In women with pregestational diabetes, some risk factors may predict PE, similar to those found in non-diabetic pregnant women. Two non-modifiable factors (type of diabetes and chronic hypertension) and two modifiable ones (systolic blood pressure levels and gestational weight gain) were found relevant in this cohort. A policy of close monitoring of blood pressure and weight gain, aiming adequate weight gain, may be added to current recommended measures. The high prevalence of PE in women with prepregnancy diabetes, especially those with initial pregnancy systolic blood pressure >124 mmHg, supports a policy of early institution of low dose aspirin. Further multicentric studies will help define the role of these risk factors as contributors to PE in pregestational diabetes.

[Challenges of the use of antipsychotics in children and adolescents]

The more frequent prescription of antipsychotics with high proportion of off label use, in particular for children and adolescents, is seen in many countries, including European Union, United States and Russian Federation. In accordance to current clinical guidelines, second-generation antipsychotics are preferred in clinical practice due to the higher tolerability compared to the first-generation antipsychotics. However, second-generation antipsychotics in children and adolescents, especially in continuous use, are associated with cardiac abnormalities and metabolic disorders, including hyperglycemia, and the risk of type 2 diabetes, weight gain and obesity, an increase in prolactin synthesis and hyperlipidemia. The adverse effects of antipsychotics in children and adolescents determine the need for more balanced approaches to their use, careful monitoring of the safety of treatment and the development of measures to prevent and correct side-effects of these drugs.

Improved Use of Human Milk, Growth, and Central Line Utilization With Standard Feeding Roadmap in an Academic NICU

BACKGROUND

Before the initiation of a standardized feeding roadmap in our regional, level IV academic neonatal intensive care unit, utilization of central lines was high, and initiation of enteral feeds delayed in the very low-birth-weight population (<1500 g). Given our review of the literature, it appeared that the standardization of feeding advancement would likely result in improved performance in both issues.

METHODS

This was a retrospective cohort comparison of very low-birth-weight patients before initiation of any feeding roadmap with a second cohort following completion of the final roadmap. Infants were examined retrospectively in 2 historical cohorts: Phase 1, infants fed before roadmap development and rollout, October 1, 2012-March 31, 2013; and Phase 2, following promulgation of the final feeding roadmap, January 1, 2017-June 30, 2017.

RESULTS

During Phase 2, we observed a significant reduction in median (interquartile range) days to first feed (3 [1] vs 1 [1] [P < 0.0001]) and utilization of a second central line (35% vs 12% [P < 0.01]). Weight gain was significantly improved from before roadmap implementation to final, mean (SD) (g/d, 21 [5] vs 24 [4]; [P < .0001]). Percentage of first enteral feedings that were human milk also increased significantly from 71% to 91% (P = 0.0007).

CONCLUSION

Implementation of a standardized feeding roadmap was associated with a reduction in days to first enteral feeds, an increase in the primary use of human milk for initiation of enteral feeds, and a decrease in the utilization of central lines while improving weight gain in very low-birth-weight infants.

Association Between Sugar-Sweetened Beverage Consumption as Meal Substitutes, Workload, and Obesity in Nurses: A Cross-Sectional Study

Background: High occupational stress has been associated with altered eating behaviors and obesity. Occupational stress is reported to be high in Asian countries. Furthermore, many Asian countries are increasingly consuming Western-type foods (e.g., incorporating drinks with meals) which collectively may also be contributing to obesity. Therefore, the aim of this study was to examine (a) associations between sugar-sweetened beverage (SSB) consumption as meal replacement and obesity and (b) associations between workload and substituting meals with SSB in nurses. Methods: A representative sample of 854 hospital-based nurses completed a structured questionnaire about SSB consumption, workload, and body mass index (BMI). Log binomial regression models were employed to test associations between SSBs and obesity rates and associations between workload and SSBs. Results: Most participants (57.6%) consumed SSBs as meal replacements during work. This was related to high workloads during shifts. Substituting SSBs for meals was significantly associated with increased likelihood of obesity (aPRR = 1.4, 95% CI (1.1, 1.7)). Workload was positively associated with SSB intake as meal substitutes (aPRR = 1.4, 95% CI (1.2, 1.6)). Conclusions: Our findings show that SSBs are used as meal substitutes and is due to the workload demands. Sugar-sweetened beverage consumption is also positively associated with the increased likelihood of obesity. Interventions that modify workloads and decrease SSB consumption may improve workers’ eating behaviors and health.

Exposure to traffic noise and gestational weight gain and postpartum weight retention: a cohort study

OBJECTIVES

Transportation noise has been associated with markers of obesity. We aimed to investigate whether road traffic and railway noise were associated with weight gain during and after pregnancy.

METHODS

Among the women participating in the Danish National Birth Cohort, 74 065 reported on weight before and during the pregnancy (gestational week 30) and 52 661 reported on weight before and 18 months after pregnancy. Residential address history from conception to 18 months after pregnancy was obtained in national registers, and road traffic and railway noise were modelled for all addresses. Associations between noise and gestational weight gain (GWG) and postpartum weight retention (PPWR) were analysed using the linear and log-binomial regression.

RESULTS

A 10 dB(A) higher road traffic noise was associated with an increase in GWG of 3.8 g/week (95% CI 2.3 to 5.3) and PPWR of 0.09 kg (95% CI 0.02 to 0.16). For PPWR, this association seemed confined to women who were overweight (0.17 kg, 95% CI 0.02 to 0.32) or obese (0.49 kg, 95% CI 0.26 to 0.73) before pregnancy. Further adjustment by nitrogen dioxide reduced GWG risk estimates and slightly increased PPWR risk estimates. Railway noise ≥65 dB(A) was associated with an increase in GWG of 4.5 g/week (95% CI -2.7 to 11.6) and PPWR of 0.26 kg (95% CI -0.09 to 0.60) compared with levels <55 dB(A).

CONCLUSIONS

Our findings suggest that road traffic noise is associated with weight gain during and after the pregnancy, which adds to the literature linking transportation noise to adiposity.

Mother and Infant Predictors of Rapid Infant Weight Gain

Objective. To examine characteristics of the infant and mother associated with rapid infant weight gain (RIWG). Methods. Electronic health records (N = 4626) of term infants born were reviewed. Multivariable logistic regression examined the presence of RIWG (vs not) using participant characteristics in the whole sample and in stratified groups. Results. The prevalence of RIWG was 18.7%. Predictors of RIWG were infant male sex, younger infant gestational age, firstborn (vs later born) status, maternal Black or Other (Asian, American Indian, etc), non-Hispanic race/ethnicity (vs White non-Hispanic), Medicaid (vs non-Medicaid insurance), and maternal cigarette smoking status (vs never smoker). The regression model explained between 7.0% and 11.4% of the variance in RIWG. There were few differences in predictors of RIWG in stratified samples. Conclusions. Early childhood obesity intervention efforts may target the modifiable risk factors for RIWG starting prenatally.