Indices of relative weight and obesity

Epidemiologic trends in overweight and obesity

Obesity in adults is associated with excess mortality and excess risk of coronary heart disease, hypertension, hyperlipidemia, diabetes, gallbladder disease, certain cancers, and osteoarthritis. Overweight children often become overweight adults, and overweight in adulthood is a health risk. Although childhood overweight may not always result in excess adult health risk, immediate consequences of overweight in childhood are psychosocial and also include cardiovascular risk factors such as hypertension, high cholesterol, and abnormal glucose tolerance. The causes of obesity are poorly understood, and both the prevention and the treatment of obesity are difficult. In this context, the ability to track epidemiologic trends in overweight and obesity is important.

A new conditioning regimen involving total marrow irradiation, busulfan and cyclophosphamide followed by autologous PBSCT in patients with advanced multiple myeloma

The overall survival of patients with advanced multiple myeloma (MM) undergoing high-dose chemotherapy and autologous stem cell transplantation (SCT) depends mainly on the quality of response. Thus, to improve the response rate, a new intensified high-dose chemoradiotherapy was evaluated in a phase I/II study. After induction chemotherapy, 89 patients (median age 51 years, range 32-60 years) with MM stage II/III received a conditioning regimen with total marrow irradiation (9 Gy), busulfan (12 mg/kg) and cyclophosphamide (120 mg/kg) followed by SCT. Regimen-related toxicity according to WHO criteria and response rates defined by EBMT/IBMTR were analyzed. The main toxicity was mucositis grade III/IV in 76%, and fever grade >I in 75% of patients. Three patients developed reversible veno-occlusive disease. Transplant-related mortality was 2%. Among patients with de novo and pretreated MM, a CR rate of 48 and 41%, respectively, was documented. With a median follow-up of 45 months, the actuarial median durations of event-free survival (EFS) and overall survival (OS) after transplant were 29 and 61 months for the whole group, 36 and 85 months for patients with de novo MM, respectively. Thus, administration of this intensified conditioning regimen was associated with tolerable toxicity, a high response rate and long EFS and OS.

Obesity and the risk of early and late mortality after coronary artery bypass graft surgery

BACKGROUND

Obesity is often considered to be a significant risk factor for postoperative mortality when selecting candidates for coronary artery bypass grafting (CABG).

METHODS

We included all patients undergoing a first isolated CABG at the Karolinska Hospital in Stockholm, Sweden, between 1980 and 1995 (n = 6728). Patients were categorized on the basis of body mass index (BMI): non-overweight (BMI <25 kg/m2), overweight (25 kg/m2 < or = BMI <30 kg/m2), and obese (BMI > or =30 kg/m2). Multivariate Cox regression was used to assess the risk of re-operation for bleeding, deep sternal wound infection, and early (< or =30 days) and late (< or =5 years) mortality rates.

RESULTS

The average length of follow-up was 6.5 years. There were 252 re-operations for bleeding, 53 deep sternal wound infections, and 628 deaths. Patients who were obese had a significantly lower risk of re-operation for bleeding (risk ratio [RR], 0.32; 95% CI, 0.19-0.53), but a greater risk of deep sternal wound infection (RR, 2.66; 95% CI, 1.21-5.88) compared with patients who were not overweight. However, patients who were obese and patients who were not overweight experienced similar 30-day (RR, 0.65; 95% CI, 0.34-1.27), 1-year (RR, 0.56; 95% CI, 0.29-1.10), and 5-year mortality rates (RR, 0.91; 95% CI, 0.66-1.25). Results for patients who were overweight were consistent with those of patients who were obese.

CONCLUSION

Patients who are obese are not at a greater risk of early and late mortality after CABG compared with patients who are not overweight, although they appear to have a lower risk of re-operation for bleeding and a greater risk of deep sternal wound infection. Therefore, obesity per se is not a contraindication for CABG.

Leptin might be a regulator of serum uric acid concentrations in humans

Increased serum urate concentration is a frequent finding in patients with hypertension. Since hyperuricemia is associated with obesity, renal disease, hyperlipidemia, and atherosclerosis, whether or not serum urate is a cardiovascular risk factor per se has remained elusive. The subjects were 210 Turkish male and 210 female adults over 20 years of age. None had diabetes mellitus, endocrine diseases, or renal or hepatic disease, and those receiving antihypertensive drugs, systemic corticosteroids, or lipid-lowering drugs were excluded. Height, weight, blood pressure, serum glucose, lipid profiles, serum insulin, DHEA-SO4, and leptin were measured in the morning after an overnight fast. Women had significantly higher mean leptin (20.3 +/- 0.88 ng/mL vs 5.78 +/- 0.39 ng/mL, P < 0.001) and lower mean uric acid (248.03 +/- 4.76 micromol/L vs 311.6 +/- 5.35 micromol/L, P < 0.001), triglyceride (1.42 +/- 0.06 mmol/L vs 1.61 +/- 0.06 mmol/L, P < 0.001), and DHEA-SO4 (3.02 +/- 0.17 micromol/L vs 4.43 +/- 0.19 micromol/L, P < 0.001) concentrations than men, even when adjusted for BMI. On univariate correlation analysis, leptin showed the strongest association with BMI in both sexes and also correlated significantly with BMI, insulin, uric acid, glucose, total cholesterol, and triglycerides in males and BMI, insulin, uric acid, total cholesterol, apo B, and creatinine in females after adjustment for age and BMI. A statistical model containing creatinine, leptin, insulin, and triglycerides accounted for 34% of the variance in serum uric acid levels in men, whereas another consisting of creatinine, triglycerides, leptin, SBP, and insulin explained 42% of the variance in serum uric acid in women. The present study suggests that leptin could be one of the possible candidates for the missing link between obesity and hyperuricemia. Our study may also suggest that hyperuricemia is not only a metabolic end product but also a marker of a major pressor or pathogenic mechanism underlying the hypertension in obesity.

Coriolus versicolor polysaccharide peptide slows progression of advanced non-small cell lung cancer

BACKGROUND

Non-small cell lung cancer (NSCLC) is a leading cause of cancer deaths, and over 60% of patients present with advanced stages. Although polysaccharide peptides (PSP), isolated from the fungus Coriolus versicolor, have been reported to have anti-tumor effects, its clinical efficacy has not been properly evaluated.

METHODS

Double-blind placebo-controlled randomized study to evaluate the effects of 28-day administration of PSP (Windsor Pharmaceutical, Hong Kong) on patients, who had completed conventional treatment for advanced NSCLC.

RESULTS

Thirty-four patients, with no significant difference in their baseline demographic, clinical or tumor characteristics, or previous treatment regimes (P>0.05) were recruited into each of the PSP and control arms. After 28-day treatment, there was a significant improvement in blood leukocyte and neutrophil counts, serum IgG and IgM, and percent of body fat among the PSP, but not the control, patients (P<0.05). Although the evaluable PSP patients did not improve in NSCLC-related symptoms, there were significantly less PSP patients withdrawn due to disease progression, than their control counterparts (5.9 and 23.5%, respectively; P=0.04; OR 4.00). There was no reported adverse reaction attributable to the trial medications.

CONCLUSION

PSP treatment appears to be associated with slower deterioration in patients with advanced NSCLC.

Inguinofemoral dissection for carcinoma of the vulva: effect of modifications of extent and technique on morbidity and survival

BACKGROUND

The aim of this study was to evaluate the impact of modifications of extent (medial inguinal and medial femoral lymphadenectomy, inguinal lymphadenectomy, inguinal and medial femoral lymphadenectomy, and inguinofemoral lymphadenectomy) and surgical technique of lymphadenectomy (including sartorius transposition, preservation of the fascia lata, and preservation of the saphenous vein) on morbidity, groin recurrence, and survival in patients with vulvar carcinoma.

STUDY DESIGN

A retrospective review of 194 patients with primary squamous cell cancer of the vulva was conducted. Clinical, surgical, histopathologic, postoperative short- and longterm complications, and followup data were collected from patient records.

RESULTS

Inguinal lymphadenectomy and medial inguinal and medial femoral lymphadenectomy produced about half fewer nodes than did other surgical procedures. On the other hand, number of lymph nodes removed did not differ notably between inguinofemoral lymphadenectomy and inguinal and medial femoral lymphadenectomy. Logistic regression showed that obesity was associated with increased risk of cellulitis. Age greater than 70, obesity, and extent of lymphadenectomy increased wound breakdown risk. Factors associated with leg edema persisting for more than 6 months were: extent of lymphadenectomy, sartorius transposition, and adjuvant irradiation of groin area. With a mean followup time of 38 months, neither groin recurrence rate nor disease-specific survival markedly differed according to technique of lymphadenectomy.

CONCLUSION

Techniques of lymphadenectomy with preservation of fascia lata and saphenous vein are associated with a decreased risk of postoperative morbidity without jeopardizing outcomes.

Is percentage body fat differentially related to body mass index in Hispanic Americans, African Americans, and European Americans?

BACKGROUND

Limited research has been done to explore differences between ethnic groups, including Hispanic Americans (HAs), in the association between percentage body fat (PBF) and body mass index (BMI; in kg/m(2)); the numbers of HAs are increasing in the US population.

OBJECTIVE

We investigated whether the relation between PBF and BMI in adult HAs differed from that of African Americans (AAs) and European Americans (EAs).

DESIGN

We used a multiple regression model in which PBF measured with dual energy X-ray absorptiometry was predicted by the reciprocal of BMI (1/BMI; in m(2)/kg) in a sample of 487 men (n(EA) = 192, n(AA) = 148, and n(HA) = 147) and 933 women (n(EA) = 448, n(AA) = 304, and n(HA) = 181).

RESULTS

For men, our results showed no significant differences between HAs and EAs, AAs and EAs, or HAs and AAs in the slope of the line relating 1/BMI to PBF. In women, there were significant differences in PBF as predicted by BMI between HAs and EAs (P < 0.002) and AAs and HAs (P = 0.020), but not between AAs and EAs. When PBF was estimated on the basis of predicting equations, the trend of the predicted PBF value in women differed according to ethnic group and BMI category. At a BMI < 30, HAs tended to have more body fat than did EAs and AAs, and at a BMI > 35, EAs tended to have more body fat than did the other groups.

CONCLUSIONS

Our results show that the relation between PBF and BMI in HA women differs from that of EA and AA women.

Prolonged nicotine patch use in quitters with past abstinence-induced depressed mood

To test the efficacy of sustained nicotine patch use among at-risk smokers, 55 smokers with a history of abstinence-induced depressed mood were randomly assigned to either Nicotine Maintenance or Standard Treatment following preliminary high-dose patch treatment. The Nicotine Maintenance group received 21 mg transdermal nicotine for 8 additional weeks; the Standard Treatment group followed a tapered dosing regimen. Significant differences favoring the Nicotine Maintenance group were found in self-reported craving but not withdrawal. No difference was observed in continuous abstinence or in relapse rates. When dropouts who did not relapse during patch use were classified as successful, however, the Nicotine Maintenance group had significantly lower relapse rates. Rate of lapse in the Nicotine Maintenance group during post-trial tapering did not differ significantly from that in the Standard Treatment group during tapering in the trial, suggesting that the benefits of sustained dosing may persist only as long as dosing continues.

Esophageal variceal hemorrhage presenting as sudden death in outpatients

CONTEXT

Some autopsy studies have dealt with histologic features of esophageal varices after different therapeutic procedures. However, to the best of our knowledge, no reports have been published describing outpatient characteristics that are associated with fatal esophageal variceal hemorrhage in a medicolegal autopsy population.

OBJECTIVES

To (1) assess the incidence of sudden deaths from esophageal variceal hemorrhage in an unselected medicolegal autopsy population and (2) determine demographics of outpatients dying from esophageal variceal hemorrhage with special reference to blood alcohol concentrations at the time of death.

DESIGN

We performed a retrospective study of all autopsy cases of sudden death from esophageal variceal hemorrhage from a total of 6038 medicolegal autopsies performed over a 5-year period (1997-2001). We analyzed individual cases to determine gender, age, location and histology of bleeding esophageal varices, pathogenic mechanism for esophageal varices, concomitant underlying diseases contributing to fatal outcome, body mass index, circumstances at the death scene, and blood alcohol levels at the time of death. We reviewed the results of toxicologic analyses of alcohol concentrations in samples of femoral venous blood and urine obtained at autopsy; concentrations had been determined by gas chromatography with mass spectroscopy and enzymatic assays.

RESULTS

We identified 45 cases of fatal esophageal variceal hemorrhage that occurred out of hospital and presented as sudden death; the corresponding 5-year incidence in this autopsy population was 0.75%. All of the deceased were white; the male-female ratio was 1.6:1, and the mean age was 50.6 years. Ruptured esophageal varices were located in the lower third of the esophagus in 44 cases. Cirrhosis of the liver was present in all cases (alcoholic cirrhosis of the liver in 42 cases), and a hepatocellular carcinoma was present in 3 cases. Alcohol-induced pancreatic tissue alterations were frequently found. The results of toxicologic analysis were positive for alcohol in femoral venous blood and urine in 30 cases. Blood alcohol levels at the time of death were less than 100 mg/dL (21.7 mmol/L) in 15 cases, between 100 and 200 mg/dL (21.7 and 43.4 mmol/L) in 8 cases, and greater than 200 mg/dL (43.4 mmol/L) in the remaining 7 cases.

CONCLUSIONS

Apart from abnormalities in coagulation due to poor liver function in long-term alcohol users, acute alcohol intake may represent an important factor influencing mortality in individuals with esophageal variceal hemorrhage. Acute alcohol intake has transient effects on blood clotting time caused by ethanol and its main metabolites. In the present study, bloodstains at the death scene and unusual body positions of the deceased that aroused suspicion of a violent death were leading reasons for conducting a medicolegal autopsy. Apart from aspects of forensic pathology, the demographics of our study population are also noteworthy from the viewpoint of social medicine. The data we present stress the importance of fatal esophageal variceal hemorrhage as a relevant cause of sudden death occurring outside the hospital in socially isolated, alcohol-addicted individuals.

Health complaints and disabilities in patients supplied with foot orthoses for degenerative foot disorders

This exploratory study attempted to estimate the severity of health complaints and disabilities in patients supplied with foot orthoses for degenerative foot disorders in the Netherlands. Information on the severity and the distribution of the complaints in these patients is important to acquire insight in the problems which these patients experience, and moreover is essential for further research, especially for evaluating effects of patients undergoing foot orthosis treatment. Patients with degenerative foot disorders aged 18 years and over were recruited from nine orthopaedic workshops over a period of three months in 2000. One hundred and twenty-two (122) patients were included in the study. Two approaches were used to obtain data. Firstly, shoe technicians and orthotists inspected patients' feet and legs and interviewed them at their initial visit. Data on gender, age, height, weight, existing and prescribed orthotic devices were recorded on a report form. Secondly, patients were asked to fill in a questionnaire assessing type, location, frequency, intensity and duration of health complaints, and disability. Data indicate that females with degenerative foot disorders and foot orthoses are twice as common as men. Patients supplied with foot orthoses are twice as often overweight compared to subjects in the general population. Besides frequent and protracted pain there are also fatigue complaints, particularly in the feet and lower leg. Duration and frequency of the complaints suggest that these patients suffer from a chronic pain syndrome. In addition, the results indicate that the functional level of these patients is below that of the general population, in particular regarding physical activities.

Predictors of vulnerability to reduced body image satisfaction and psychological wellbeing in response to exposure to idealized female media images in adolescent girls

Predictors of change in body satisfaction, depressed mood, anxiety and anger, were examined following exposure to idealized female advertising images in Grades 7 and 10 girls. Stable body dissatisfaction, physical appearance comparison tendency, internalization of thin ideal, self-esteem, depression, identity confusion and body mass index (BMI) were assessed. One week later, participants viewed magazine images, before and after which they completed assessments of state body satisfaction, state depression, state anxiety and state anger. Participants were randomly allocated to view either images of idealized females (experimental condition) or fashion accessories (control condition). For both grades, there was a significant decrease in state body satisfaction and a significant increase in state depression attributable to viewing the female images. In Grade 7 girls in the experimental condition, decrease in state body satisfaction was predicted by stable body dissatisfaction and BMI, while significant predictors of decreases in the measures of negative affect included internalization of the thin-ideal and appearance comparison. In Grade 10 girls, reduction in state body satisfaction and increase in state depression was predicted by internalization of the thin-ideal, appearance comparison and stable body dissatisfaction. These findings indicate the importance of individual differences in short-term reaction to viewing idealized media images.

Evaluations of dieting prevention messages by adolescent girls

BACKGROUND

Dieting prevention interventions have been relatively unsuccessful and may be more effective if they concentrate on messages known to be relatively high on persuasive properties. We aimed to identify anti-dieting messages rated most strongly on persuasive dimensions and participant characteristics that predicted message evaluations in adolescent girls.

METHODS

Grade 7 and 8 girls completed questionnaires assessing risk factors for, and early symptoms of, eating disorders. Two weeks later, participants viewed on video seven messages (each 2-3 minutes long) frequently used to dissuade against dieting in prevention interventions and one control message. After viewing each message, participants rated it on a scale assessing the persuasive dimensions of Relevance, Believability, Emotional Response, and Intention to Diet.

RESULTS AND CONCLUSIONS

A quarter to a third of participants felt less likely to go on a diet after viewing the messages. "Skipping meals makes you feel starved so you overeat and feel bad" and "Don't be fooled by the fad diets promoted in the media" were rated most strongly. Higher dieting, body dissatisfaction, and negative affect were generally associated with lower persuasive ratings, suggesting the importance of intervention prior to the establishment of dieting behaviors after which there is more message resistance. Age was also a predictor of Believability for some messages, supporting the importance of ensuring the age appropriateness of messages.

Body size, dialysis dose and death risk relationships among hemodialysis patients

BACKGROUND

The normalized treatment ratio, Kt/V derived from urea kinetic models (UKM), is a commonly used measure of dialysis dose. This measure assumes that smaller patients with low volume of urea distribution (V) require proportionately less total treatment (Kt) than larger patients. The conclusion has been questioned because the UKM use assumptions that could make them invalid for accurately predicting a clinical outcome like survival. It is possible that a relationship exists between Kt and body size whereby a different Kt is required for different sizes. This study therefore explored the relationships among body size, Kt, and death risk focusing on possible interactions between Kt and size.

METHODS

The sample included 43,334 patients treated on January 1, 1999. Survival time was modeled using Kt or body size groups to evaluate the shape of the risk profiles. Kt and the size measures were then evaluated together as continuous functions both in main effects (that is, Kt and size) and interaction models to see if the association of Kt with risk might be different for different sizes. The size measures were body weight, weight adjusted statistically for height, body surface area (BSA), weight divided by height (wt/ht) and the body mass index (BMI).

RESULTS

The log of risk decreased in rough linear fashion for Kt, weight, weight for height, and BSA. The log-risk relationships were "reverse J-shaped" for wt/ht and BMI. The main effects models suggested improved survival with increasing Kt and all of the size measures. Adding an interaction term increased the benefit associated with increasing Kt and for weight, weight for height and BSA at low values of Kt and size. A significant, positive interaction term mitigated those effects at higher values. Thus, the death risk penalties associated with reducing Kt among small patients were as great as or greater than they were among large patients. A similar pattern was observed for V. Adding the interaction to the BMI model destroyed the main effects, so that there was no significant association between risk and either Kt or BMI. A cross-categorical model of BMI and Kt, however, revealed improving survival with increasing Kt among both low and high BMI patients throughout the range of Kt.

CONCLUSIONS

Evidence supporting the intuition that smaller patients require proportionately lower dialysis dose than larger patients was not found. To the contrary, smaller patients suffer as much risk as or more risk than larger patients from reducing Kt. Deciding dialysis treatment using a Kt/V based intuition may lead to avoidable under-dialysis particularly among small patients.

The Tripartite Influence model of body image and eating disturbance: a covariance structure modeling investigation testing the mediational role of appearance comparison

Recent theoretical approaches to the etiology of eating disorders and body image disturbances have begun to focus on multifactorial models. In the current study, the Tripartite Influence model was examined in a large sample of college females (ages 18-22). This model proposes that three primary core sources of influence--parents, peers and media--contribute to the development of body image and eating disturbances. Additionally, the model suggests that at least two factors mediate the relationship between influences and disturbance-appearance comparison and internalization of media information. In this study, appearance comparison was examined as a mediational link between peer, family and media influence variables and the outcome disturbance measures of eating dysfunction and body image dissatisfaction. Covariance structure modeling (CSM) was used to test the proposed pathways. The results indicated that appearance comparison mediated the effects of family and media influences on body dissatisfaction, which in turn influenced restrictive and bulimic behaviors. In addition, peer influences had a direct influence on restriction. Perfectionism was hypothesized to relate to body dissatisfaction, but was in fact found to influence appearance comparison. The findings were limited by the necessity of several modifications to the originally proposed models, yet offer replication and extension of previous work with appearance comparison and support for further testing of the Tripartite Influence model.

Changes in nutritional status and postoperative outcomes in elderly CABG patients

OBJECTIVES

To systematically examine the pattern of nutritional status over time in older people undergoing elective coronary artery bypass grafting (CABG) and the extent to which nutritional status affects health outcomes postdischarge.

DESIGN

The sample consisted of 91 community-dwelling English-speaking persons > or = 65 (72.27 +/- 4.85) years of age with normal cognitive function and no active cancer. Data collected prospectively at 3 time points (preoperatively, postoperatively on day 5, and 4 to 6 weeks postdischarge) included serum albumin, transferrin, and calculated Body Mass Index (BMI). The Short-Form 36 Health Status Survey Questionnaire was administered 4 to 6 weeks postdischarge as a primary health outcome measure.

RESULTS

Nutritional status changed over time. For albumin and transferrin, the pattern of change corresponded to the phases of surgical stress (P = 0.001). The BMI decreased from preoperative to 4 to 6 weeks postdischarge (P = 0.001), and this decrease explained 13.8% of the variance in physical health 4 to 6 weeks postdischarge (P = 0.008). The change in the BMI corresponds to an average weight loss of 5% from preoperative to postdischarge.

CONCLUSIONS

Older people undergoing CABG who lose significant weight from preoperative to postdischarge are more likely to have lower self-reported physical health.

The relationship between body mass index and pulse pressure in older adults with isolated systolic hypertension

BACKGROUND

Many longitudinal studies have reported excess cardiovascular mortality among lean hypertensive subjects, suggesting that obesity may mitigate the cardiovascular risk of hypertension. Available evidence also suggests that in middle-aged and older hypertensive subjects, pulse pressure may be a better predictor of cardiovascular complications. However, there are limited data on the relationship between body mass index (BMI) and pulse pressure.

METHODS

Using data from the Third National Health and Nutrition Examination Survey we assessed the convergence validity of pulse pressure as a predictor of cardiovascular complications and examined the relationship between BMI and pulse pressure in 1192 older adults with isolated systolic hypertension who were not receiving blood pressure medicine.

RESULTS

There was a good concordance between high pulse pressure and most of the selected cardiovascular risk factors examined in this study. Pulse pressure is higher in the lean (BMI < 25) than in the overweight (BMI > or = 25; 79 mm Hg vs 74 mm Hg, P < .001) and decreases significantly from 82 mm Hg in the first BMI quintile to 76 mm Hg in the fifth BMI quintile. Pulse pressure continues to decrease with increasing BMI until the index exceeds 30.1. This negative correlation persists in a multivariate model with statistical adjustment for age, sex, diabetes mellitus, and hypercholesterolemia.

CONCLUSION

The inverse relation between BMI and pulse pressure observed here may help to explain previous reports of increased cardiovascular risk among lean versus obese subjects with isolated systolic hypertension.

The effect of body mass index on complications from cardiac surgery in the oldest old

OBJECTIVES

Overweight (body mass index (BMI)>25) and obesity (BMI>30) are associated with adverse outcomes in the general population. In older people, an increased risk of adverse events was observed in leaner and overweight older subjects. We evaluated the association between BMI and cardiac surgery complications in subjects aged 75 and older.

DESIGN

Retrospective review of complication rates compiled as part of the New York State Department of Health Adult Cardiac Surgery Report.

SETTING

Academic tertiary care medical center.

PARTICIPANTS

One thousand four hundred forty-eight subjects aged 75 and older who underwent cardiac surgery in an academic hospital between 1991 and 1999.

MEASUREMENTS

Subjects were divided into tertiles based on their BMI. Logistic regression was used in multivariate analyses examining the association between tertiles of BMI (<23, 23-26,>26) and complications from cardiac surgery, adjusting for age and gender or using a full model adjusting for history of diabetes mellitus, hypertension, myocardial infarction (MI), congestive heart failure, smoking, chronic obstructive pulmonary disease, peripheral vascular disease, renal disease, surgical priority, age, and gender.

RESULTS

Mean age was 79 (range 75-94); 58% of the subjects were male. The incidence of any postoperative complication, respiratory failure, or death was U-shaped, with higher incidence in the first tertile of BMI, followed by the last tertile and then the middle tertile. Subjects in the lowest tertile of BMI in the full model had a higher adjusted risk of stroke (odds ratio (OR) = 1.58, 95% confidence interval (CI) = 0.96-2.59), bleeding (OR = 1.71, 95% CI = 0.79-3.67), respiratory failure (OR = 1.65, 95%CI = 0.95-2.87), cardiovascular complications (stroke, MI, arrhythmia) (OR = 1.59, 95% CI = 0.93-2.73), and all complications (OR = 1.45, 95% CI = 1.05-2.00) than subjects in the middle tertile. The risk of most complications in subjects in the highest tertile of BMI was similar to that of subjects in the middle tertile except for wound infections (OR = 3.51, 95% CI = 0.92-13.33). The risk of death was higher in subjects in the lower tertile of BMI (OR = 1.97, 95% CI = 1.12-3.44) than in subjects in the middle tertile. The association between BMI and adverse cardiac surgical outcomes was stronger in men than women and decreased with advancing age.

CONCLUSIONS

In the geriatric population, subjects with lower BMI have a higher risk of complications and death from cardiovascular surgery than subjects with higher BMI. An increased BMI does not increase the risk of complications from cardiovascular surgery, with the exception of wound infections.

Validity of body mass index compared with other body-composition screening indexes for the assessment of body fatness in children and adolescents

BACKGROUND

Validation studies of height- and weight-based indexes of body fatness in children and adolescents have examined only small samples of school-age children.

OBJECTIVE

The objective was to validate the performance of age- and sex-specific body mass index (BMI) compared with the Rohrer index (RI) and weight-for-height in screening for both underweight and overweight in children aged 2-19 y.

DESIGN

Data from the third National Health and Nutrition Examination Survey (n = 11096) and a pooled data set from 3 studies that used dual-energy X-ray absorptiometry (n = 920) were examined. The receiver operating characteristic curve was used to characterize the sensitivity and specificity of these 3 indexes in classifying both underweight and overweight. Percentage body fat and total fat mass were determined by dual-energy X-ray absorptiometry. Subcutaneous fat was assessed on the basis of the average of triceps and subscapular skinfold thicknesses.

RESULTS

For children aged 2-19 y, BMI-for-age was significantly better than were weight-for-height and RI-for-age in detecting overweight when average skinfold thicknesses were used as the standard, but no differences were found in detecting underweight. When percentage body fat or total fat mass was used as the standard, BMI-for-age was significantly better than was RI-for-age in detecting overweight in children aged 3-19 y. No differences were found between BMI-for-age and weight-for-height in detecting overweight or underweight.

CONCLUSION

For children and adolescents aged 2-19 y, the performance of BMI-for-age is better than that of RI-for-age in predicting underweight and overweight but is similar to that of weight-for-height.

Smoking as subculture? Influence on Hispanic and non-Hispanic White women's attitudes toward smoking and obesity

Cultural stereotypes might help explain why smoking is less prevalent among Hispanic than non-Hispanic White women, whereas obesity is more prevalent. Hispanic (n = 130) and non-Hispanic White (n = 114) women rated their thoughts and feelings regarding a female smoker and an overweight woman. Ethnicity did not influence evaluations, but attitudes toward smokers were more positive among more acculturated Hispanic women, F(1, 66) = 9.9, p < .01. Less acculturated women evaluated an overweight woman more positively than a smoker, F(1, 28) = 5.65, p < .05; more acculturated women did the opposite, F( 1, 36) = 5.92, p < .05. Smokers evaluated smokers more positively than overweight women, F(1, 86) = 40.8, p < .01; nonsmokers did the opposite, F(l, 138) = 7.7, p < .01. Personal body weight did not influence evaluations. Acculturation and smoking status appear to have a greater influence than ethnicity or weight status on women's attitudes toward smoking and weight.

Gesundheitsverhalten von Grundschulkindern:

Zusammenfassung. Ziel der vorliegenden Studie war zu prüfen, ob Geschlechtsunterschiede im Gesundheitsverhalten im Grundschulalter durch Geschlechtsunterschiede in der defensiven Emotionsregulation erklärt werden können. Bei 248 Grundschulkindern wurden die defensive Emotionsregulation, das Gesundheitsverhalten sowie der Body-Mass-Index erfasst. Die Selbstberichtsdaten der Kinder wurden anhand der Mutterurteile validiert. Ferner wurde die Anzahl der krankheitsbedingten Fehltage in der Schule (Mutterbericht) erhoben. Die Ergebnisse zeigen u.a., dass Mädchen mehr auf ihre Zahnhygiene achten, vorsichtiger im Straßenverkehr teilnehmen, sich gesünder ernähren, weniger Interesse für Sport sowie für Fernsehen bzw. für das Spielen mit dem Computer zeigen, täglich länger schlafen und gefährliche Spiele meiden. Während Geschlechtsunterschiede im Sporttreiben und bei gefährlichen Spielen auf Jungen mit hoher defensiver Emotionsregulation zurückzuführen sind, spielen Jungen mit niedriger Defensivität länger mit dem Computer. Diese nichtdefensiven Jungen weisen auch das höchste relative Körpergewicht auf, fehlen aber seltener in der Schule. Unter Berücksichtigung der Ergebnisse werden die Kosten und der Nutzen der defensiven Emotionsregulation für das Gesundheitsverhalten diskutiert.

Age, sex, and body mass index in performance of selected locomotor and fitness tasks by children in grades K-2

The purpose of this study was to examine the contributions of 3 predictor variables (age, sex, and body mass index) to performance of 7 fundamental movement skills (locomotor; run, gallop, hop, leap, jump, skip, and slide) and 4 fitness tasks (grip strength, step test, sit and reach, and timed sit-ups) by 65 children in Grades K-2 (M=6 yr.). A multiple regression analysis indicated that running, leaping, and skipping improved with age. No sex differences were observed on any of the seven skills. In terms of the four fitness tasks, age was positively associated with timed sit-ups and grip strength and inversely associated with step-test performance. Sex was associated with step-test and sit and reach performance (girls performed better on both). Finally, body mass index was related to increased grip strength and fewer timed sit-ups.

Is adiposity at normal body weight relevant for cardiovascular disease risk?

OBJECTIVE

To examine the relation between adiposity and risk factors for cardiovascular disease (CVD) in normal weight (NW) individuals.

METHODS

Cross-sectional study using the sample of white people, aged from 17 to 60 y from the Québec Family Study and the Heritage Family Study. NW subjects with a body mass index (BMI) between 18.5 and 25 kg/m(2) (181 males and 265 females) and overweight (OW) subjects with a BMI between 25 and 30 kg/m(2) (133 males and 114 females) were retained for this study. NW subjects were divided into quintiles of each adiposity variable, then the quintiles and the OW group were evaluated for the presence of CVD risk factors. Using logistic regression analysis, the odds ratio (OR) for the prevalence of risk factors for each quintile of each adiposity variable and the OW group was estimated relative to the first quintile in NW subjects. Mean values of adiposity variables were compared between the subjects with and without risk factors. In these analyses, age and study cohort effects were taken into account.

MEASUREMENTS

Percentage body fat (%fat) and fat mass (FM) measured by underwater weighing were available as adiposity variables. Risk factors included systolic and diastolic blood pressure, LDL and HDL cholesterol, triglycerides and fasting glucose.

RESULTS

Wide ranges of values were observed for adiposity variables. HDL cholesterol, triglycerides and fasting glucose in NW males and HDL cholesterol in NW females were significantly correlated with all adiposity variables. For males, higher quintiles of adiposity variables in the NW group and the OW group tended to have higher ORs compared to the first quintiles for the risk factor variables. The fifth quintiles of all adiposity variables had the highest ORs (3.15 for %fat and 3.77 for FM) and they were significantly different from the first quintiles. OW males had ORs similar to those of the fifth quintiles for the risk factor variables. On the other hand, for females, the relatively linear associations were less clear in the NW group. In NW males, the subjects with at least one risk factor had significantly higher %fat and FM than the subjects without risk factors. In NW females, no significant difference was observed for these adiposity variables between the subjects with and without risk factors.

CONCLUSION

NW males with elevated adiposity had higher prevalence of risk factors than NW males with less adiposity and the prevalence in the former was rather similar to that seen in OW males. On the other hand, measures of adiposity added little additional information to the BMI classification of NW on CVD risk factors in females.

Postmenopausal survivors of breast cancer at risk for osteoporosis: nutritional intake and body size

Postmenopausal survivors of breast cancer for whom hormone replacement therapy is contraindicated are at risk for development of osteoporosis. The primary purpose of this article is to describe, in a sample of 30 postmenopausal survivors of breast cancer, their calcium and vitamin D intake compared with recommended dietary guidelines for those nutrients for postmenopausal women not taking hormone replacement therapy and the body mass index of these women as nutritional status risk factors for development of osteoporosis. Bone health and presence of osteoporosis were determined by bone mineral density testing of the spine, hip, and forearm. To obtain calcium and vitamin D intake, including supplements, 3-day diet records were completed; height and weight measures were used to calculate body mass index. The sample participants ranged in age from 42 to 65 years; the majority (56%) had been menopausal or off hormone replacement therapy for 5 years or less, and 70% had completed breast cancer treatment for 5 years or less (except tamoxifen). The majority (63%) were of medium body frame size; 30% were of small frame size. The mean body mass index (27.3) and mean weight (160 lbs) indicate that these women, as a group, were over-weight. Although a large percent (63%) were taking calcium supplements, the mean daily intake (diet and supplements) of calcium (1,353 mg) and vitamin D (403 IU) was less than the recommended dietary guidelines for these nutrients in this population. At study entry, 80% of the women were osteopenic (60%) or osteoporotic (20%) and none was receiving treatment/prevention for osteoporosis; only 1 had a previous known osteoporosis diagnosis. This is a special group of women for whom screening and preventive strategies for osteoporosis are imperative.

Parent influences in the transmission of eating and weight related values and behaviors

Early adolescent boys (n = 587) and girls (n = 619) and a parent completed questionnaires, that assessed child dieting behaviors, body dissatisfaction and tendency to overeat, child's current and ideal size, mother and father dieting, and encouragement of the child to diet.

Body mass index: a measure for longevity

Body mass index has important predictive value for mortality and morbidity both in normal subjects and in those suffering from particular pathologies. However, body mass index was introduced as a measure of body fat, which might not be expected to have such wide implications for various pathological conditions. We argue here that body mass index may actually be a measure for longevity. Our arguments are based on a well-established allometric scaling law for physiological time. The time between heart beats, the time between respirations, and longevity all scale as body weight to the 1/4 power in mammalian species ranging from shrews to blue whales. We find that body mass index also scales with body weight to the 1/4 power in humans from birth to one year of age, and again from approximately 5 to 17 years of age. On the assumption that in these two growth phases humans scale as do species, we postulate that body mass index is a measure of longevity.

Body mass index growth in a sample of U.S. children: repeated measures data analysis of the Minneapolis Children's Blood Pressure Study

Longitudinal assessments of the body mass index (BMI) in children and adolescents are limited. The purpose of the study was to describe the growth patterns of the BMI in children and young adults. Black and White children of Minneapolis Children's Blood Pressure Study (MCBPS) were 6 to 9 years old at entry and were followed for 12 years at 19 separate visits. Those with at least five visits (n = 1,302) were included for analysis, using non-linear mixed effects models in conjunction with the Gompertz curve. The growth patterns of four sex-ethnic groups were different at three levels: starting level (SL) (kg/m(2)), asymptote level (AL) (kg/m(2)), and peak growth age (PGA) (in years). In this context, SL is the average BMI level at age 6, AL is the average BMI level when growth diminishes, and PGA is the average age at which the rate of growth in the BMI peaks. The SL (16.3 +/- 0.1) for White males was significantly greater than SL in the other three sex-ethnic groups, among which there were no significant differences. There was a significant ethnic difference in AL between Black females (25.5 +/- 0.3) and White females (24.4 +/- 0.2) and a marginally significant difference in AL between Black females and Black males (24.4 +/- 0.3). For PGA, only sex differences were significant: Black females reached the peak at the earliest age at (11.5 +/- 0.1) years, followed by White females (11.7 +/- 0.1), Black males (12.6 +/- 0.1), and White males (12.8 +/- 0.1).

Use of nonvitamin, nonmineral dietary supplements among college students

The authors assessed the use of nonvitamin, nonmineral (NVNM) dietary supplements in a college population. They found that the use of NVNM dietary supplements among college students might be higher than that of other population groups and that the types of NVNM products they use differ from those used by an older population. Of the 272 students who completed the questionnaire, 48.5% reported they took an NVNM supplement during the past 12 months. The most frequently used NVNM products were echinacea, ginseng, and St John's wort. Of the 27 students who took NVNM products to promote weight loss, 81.5% had body mass index (BMI) values in the acceptable range. Eleven of the 19 participants who reported an adverse reaction to an NVNM supplement continued to take the products despite negative effects. Users and nonusers of NVNM supplements did not differ significantly by age, ethnicity, gender, perceived dietary adequacy, or by exercise patterns.

Is there a role for gastric accommodation and satiety in asymptomatic obese people?

OBJECTIVE

The relationships of gastric accommodation and satiety in moderately obese individuals are unclear. We hypothesized that obese people had increased gastric accommodation and reduced postprandial satiety. The objective of this study was to compare gastric accommodation and satiety between obese and non-obese asymptomatic subjects.

RESEARCH METHODS AND PROCEDURES

In 13 obese (body mass index [BMI] > or = 30 kg/m(2); mean BMI, 37.0 +/- 4.9 kg/m(2)) and 19 non-obese control subjects (BMI < 30 kg/m(2); mean BMI, 26.2 +/- 2.9 kg/m(2)), we used single photon emission computed tomography to measure fasting and postprandial gastric volumes and expressed the accommodation response as the ratio of postprandial/fasting volumes. The satiety test measured maximum tolerable volume of ingestion of liquid nutrient meal (Ensure) and symptoms 30 minutes after cessation of ingestion.

RESULTS

Total fasting and postprandial gastric volumes and the ratio of postprandial/fasting gastric volume were not different between asymptomatic obese and control subjects. However, the fasting volume of the distal stomach was greater in obese than in control subjects. Maximum tolerable volume of ingested Ensure and aggregate symptom score 30 minutes later were also not different between obese and control subjects.

DISCUSSION

Asymptomatic obese individuals (within the BMI range of 32.6 to 48 kg/m(2)) did not show either increased postprandial gastric accommodation or reduced satiety. These data suggest that gastric accommodation is unlikely to provide an important contribution to development of moderate obesity.

Body mass index for chronic hemodialysis patients: stable hemodialysis and mortality

Body mass index (BMI) is used as a reference for weight control programs in the general population and in morbidity and mortality studies in diabetes patients. However, the implications of BMI in chronic hemodialysis patients is unclear. We studied the BMI of chronic hemodialysis patients, focusing on problems encountered during outpatient hemodialysis therapy and on 2-year mortality. Outpatients with chronic hemodialysis (n = 258; 144 men, 114 women) were divided into four groups: (i) patients with stable hemodialysis; (ii) patients with marked hypotension requiring catecholamine infusion during hemodialysis; (iii) patients with excessive interdialysis weight gain requiring occasional additional hemodialysis; and (iv) patients with troublesome hemodialysis due to other causes. The statistical differences between the average BMI among these groups were evaluated, and were subdivided into sex, age and the duration of hemodialysis history. The 2-year mortality rates of these patients were also studied according to their BMI. In patients under 60 years of age, those with excessive interdialysis weight gain had statistically larger BMI (23.2; n = 35) compared to patients with good hemodialysis control (20.1; n = 178), regardless of gender and hemodialysis history. The mortality rate was at a minimum at approximately 20 BMI in patients under 60 years of age. However, lower BMI was associated with a greater mortality rate in patients 60 years or over. For chronic hemodialysis patients, the BMI associated with stable hemodialysis and minimum mortality is approximately 20, in those under 60 years of age. The BMI of aged hemodialysis patients should be considered separately in morbidity and mortality studies.

Quantitative analysis of normal major salivary glands using computed tomography

OBJECTIVES

We sought to calculate the size and the computed tomography (CT) number of normal parotid and submandibular glands and to evaluate their relationship with respect to sex, age, and obesity in the Korean population.

STUDY DESIGN

The authors investigated the axial CT images of 42 healthy volunteers. The maximum cross-sectional area (MCSA) was used as an indicator of the size of the gland. Three regions of interest on axial scans were selected to calculate the mean CT number.

RESULTS

There was a significant decrease in the mean MCSA of the submandibular gland and the CT number of both glands with age. The MCSA of the submandibular gland in males was larger than that in females. There was a close correlation between the parotid and the submandibular glands with respect to the CT number, as well as between the left and right glands with respect to the MCSA and the CT number. The body mass index was positively correlated with the MCSA of the parotid gland, whereas the body mass indexes and the CT numbers of both glands were negatively correlated.

CONCLUSIONS

Both age and obesity are closely correlated with the size and the CT number of the major salivary glands. Moreover, the correlation between the CT numbers of the parotid and the submandibular glands may be used for diagnostic purposes.

The role of nutritional status and insulin-like growth factor in reduced physical growth in hepatosplenic Schistosoma mansoni infection

The influence of nutritional status and hormonal growth activity on the impaired somatic development of adolescents with the hepatosplenic clinical form of Schistosoma mansoni infection (HS), the intestinal form with high (IH) or low (IL) egg output and non-infected (NI) individuals was evaluated (in Comercinho, Minas Gerais State, Brazil, in 1996-97) by measuring body mass index (BMI), insulin-like growth promoting factor (IGF-I) and its carrier protein (IGFBP-3). BMI, IGF-I and IGFBP-3 concentrations were significantly lower in the HS group compared with the IH and the NI groups, irrespective of age. BMI did not remain associated with the clinical form in the bi-variate model that included IGF-I and BMI or IGFBP-3 and BMI, suggesting that in these groups IGF-I and IGFBP-3 levels were related to the clinical form but independent of nutritional status. It is suggested that physical growth impairment in hepatosplenic S. mansoni infection results from the synergistic action of both hepatic damage and nutritional restriction.

Changes in the demographics and perioperative care of stage IA(2)/IB(1) cervical cancer over the past 16 years

OBJECTIVES

The aim of this study was to determine whether there have been any significant changes in the demographics and perioperative care of FIGO stage IA(2)/IB(1) cervical cancer over the past 16 years and, if so, to quantify them.

METHODS

Since July 1984, all patients with FIGO stage IA(2)/IB(1) cervical cancer undergoing radical surgery by members of our division have been entered into a prospective database. Selection for surgery has been unchanged over the past 16 years. Since March 1994 and November 1996, one surgeon has performed radical vaginal trachelectomy and laparoscopic assisted radical vaginal hysterectomy, respectively. Statistical analysis used Spearman's correlation analysis, the proportional hazards regression model of Cox, and the Mantel-Hanzel test was performed. Due to the number of statistical analyses, statistical significance was defined as P < 0.01.

RESULTS

Eight hundred sixty-four patients have undergone radical surgery (784 radical hysterectomy, 42 radical vaginal trachelectomy, 32 radical vaginal hysterectomy, 6 radical abdominal trachelectomy) for FIGO stage IA(2)/IB(1) carcinoma of the cervix by members of our division since 1984. There have been no changes in the median age (40 years), tumor size (2.0 cm), incidence of capillary lymphatic space involvement (47%), or positive pelvic lymph nodes (6%) over the past 16 years. The median Quetelet index (24.6), depth of tumor invasion (squamous cell carcinomas only) (6.0 mm), and proportion of patients with comorbid conditions (17%) have increased over time (P = 0.001, P = 0.003, and P < 0.001, respectively). Pathologically, there has been an increase in the proportion of adenocarcinomas (28%) and a decrease in the proportion of grade 3 tumors (28%) (P < 0.001 and P < 0.001, respectively). The median operating time (2.8 h), hospital stay (7.0 days), blood loss (600 cc), allogeneic blood transfusion (23%), postoperative infections (13%), and noninfectious complications (6%) have all decreased (P < 0.001, P < 0.001, P < 0.001, P < 0.001, P < 0.001, and P = 0.002, respectively). There has been no change in the incidence of positive surgical margins (3%), adjuvant radiation (13%), or recurrence-free survival (2 and 5 years, 94 and 90%, respectively) after a median follow-up of 45 months.

CONCLUSION

Despite no substantive changes in the selection criteria for surgery and the small time interval studied (16 years), almost all indices of operative and postoperative morbidity analyzed have decreased significantly. These changes have occurred without an increase in the use of adjuvant radiation or decrease in recurrence-free survival. Although little progress has been made in the cure rates associated with surgical management of FIGO stage IA(2)/IB(1) cervical cancer during this time interval, it appears that the morbidity of surgery has decreased.

The role of global negative self-evaluations in the influence of body weight on weight and eating concerns

The aim of this study was to test a model based on the assumption that a social comparison-process of body mass index could lead to weight and eating concerns by lowering self-evaluation. Three hundred and ninety-five girls from five age cohorts (in grades five through nine at the time of data collection) participated in a questionnaire-based study. Support for a model where global negative self-evaluations played a mediating role was found among the oldest girls who perceived slimness norms among their peers. Among girls not perceiving a norm of thinness, and among younger girls perceiving such a norm, the model found no support. The proposed model gives an explanation of how the dynamic process of social norms of thinness, body weight and self-evaluation, can cause some girls to become concerned about their body weight.

Limits of body mass index to detect obesity and predict body composition

Body mass index (BMI) is commonly used to identify obesity. In this study, we determined how accurately BMI could determine body composition and identify obese from non-obese individuals. Fat-free mass and body fat were determined with bioelectrical impedance. Adiposity was calculated as body fat per body mass and as body fat divided by body height (m2). Obesity was defined as a BMI of at least 30 kg/m2 or an amount of body fat of at least 25% of total body mass for men and at least 30% for women. Obesity as defined by percentage of body fat was always present with a BMI of at least 30 kg/m2. However, 30% of men and 46% of women with a BMI below 30 kg/m2 had obesity levels of body fat. The greatest variability in the prediction of percentage of body fat and body fat divided by height (m2) from regression equations using BMI was at a BMI below 30 kg/m2. In conclusion, using impedance-derived body-fat mass as the criterion, people with BMI of at least 30 kg/m2 are obese. However, significant numbers of people with a BMI below 30 kg/m2 are also obese and thus misclassified by BMI. Percent of body fat and body fat divided by height (m2) are predictable from BMI, but the accuracy of the prediction is lowest when the BMI is below 30 kg/m2. Therefore, measurement of body fat is a more appropriate way to assess obesity in people with a BMI below 30 kg/m2.

Association of the maternal experience and changes in adiposity measured by BMI, waist:hip ratio and percentage body fat in urban Brazilian women

The aim of the present study was to determine the association between the maternal experience and changes in adiposity measured by BMI, percentage body fat (PBF) and waist:hip ratio (WHR). In a cross-sectional study, 203 women were recruited at health care and educational facilities in Brasilia, Brazil. These women were divided into three groups: fifty-three nulliparous (no full-term pregnancy); sixty-three primiparous (one full-term pregnancy); eighty-seven multiparous (two or more full-term pregnancies). Socio-economic, behavioural, reproductive and dietary data were collected. All the women were measured for weight, height, skinfold thicknesses and waist and hip circumferences. Analysis of covariance was used to measure the differences among the three groups in relation to BMI, PBF, and WHR, controlling for the following covariates: age; socio-economic status; use of oral contraceptives; smoking; energy intake level; cooking oil intake; physical activity level; lactation score; parity. The three groups of women differed significantly for BMI (P = 0.04), PBF (P = 0.0008), and WHR (P = 0.0001). Multiparous women presented higher BMI (P = 0.01) and PBF (P = 0.03) compared with primi- and nulliparous groups. PBF was also associated with age and high socio-economic status. Primi- and multiparous women showed a higher WHR than nulliparous women (P < 0.0001). Age and smoking habit were also factors associated with higher WHR.

Low-grade systemic inflammation in overweight children

OBJECTIVE

Human adipose tissue expresses and releases the proinflammatory cytokine interleukin-6, potentially inducing low-grade systemic inflammation in persons with excess body fat. To limit potential confounding by inflammation-related diseases and subclinical cardiovascular disease, we tested the hypothesis that overweight is associated with low-grade systemic inflammation in children.

DESIGN AND SETTING

The third National Health and Nutrition Examination Survey, 1988-1994, a representative sample of the US population.

PARTICIPANTS

A total of 3512 children 8 to 16 years of age.

OUTCOME MEASURES

Elevated serum C-reactive protein concentration (CRP; >/=.22 mg/dL) and white blood cell count (10(9) cells/L).

RESULTS

Elevated CRP was present in 7.1% of the boys and 6.1% of the girls. Overweight children (defined as having a body mass index or a sum of 3 skinfolds (triceps, subscapula, and supra-iliac) above the gender-specific 85th percentile) were more likely to have elevated CRP than were their normal-weight counterparts. After adjustment for potential confounders, including smoking and health status, the odds ratio (OR) was 3.74 (95% confidence interval [CI]: 1.66-8.43) for overweight boys and the OR was 3.17 (95% CI: 1.60-6.28) for overweight girls, based on the body mass index. Based on the sum of 3 skinfolds, these ORs were 5.11 (95% CI: 2.36-11.06) and 2.89 (95% CI: 1.49-5.59) for boys and girls, respectively. Overweight was also associated with statistically significant higher white blood cell counts. The results were similar when restricted to healthy, nonsmoking, nonestrogen-using children.

CONCLUSIONS

In children 8 to 16 years of age, overweight is associated with higher CRP concentrations and higher white blood cell counts. These findings suggest a state of low-grade systemic inflammation in overweight children. inflammation, obesity, children.

Procollagen IIC-peptide as a marker for assessing mechanical risk factors of knee osteoarthritis: effect of obesity and varus alignment

OBJECTIVE

To ascertain by cross sectional examination whether the concentration of procollagen IIC-peptide in joint fluid significantly correlates with mechanical risk factors of knee osteoarthritis (OA), such as obesity (body mass index) and varus alignment (lateral femorotibial angle).

METHODS

The concentrations of procollagen IIC-propeptide in synovial fluid were measured by a sandwich enzyme immunoassay of 65 patients with the same radiological stage of primary knee OA-that is, Ahlbäk stage I. The relations between procollagen IIC-peptide and body mass index and lateral femorotibial angle were examined using simple regression analysis and multiple regression analysis.

RESULTS

Significant positive correlations were found between procollagen IIC-propeptide concentrations and body mass index (r=0.479, p<0.0001), and between procollagen IIC-propeptide concentrations and lateral femorotibial angle (r=0.375, p=0.0021). Significant correlations were also found by multiple regression analysis. The multiple correlation coefficient of body mass index and femorotibial lateral angle to the procollagen IIC-propeptide concentrations was 0.547 (p<0.0001).

CONCLUSIONS

The findings suggest that synthesis of type II collagen by chondrocytes is enhanced by abnormal mechanical stress, in this case obesity and varus alignment. It is concluded that procollagen IIC-propeptide concentrations in joint fluid are a useful marker of early OA.

Overweight as an adverse prognostic factor for non-Hodgkin's lymphoma patients receiving high-dose chemotherapy and autograft

Despite detailed evaluation of disease-associated prognostic factors, little is known about the impact of overweight in autograft programs for non-Hodgkin's lymphoma (NHL) patients. In order to address this issue, 121 NHL patients were retrospectively evaluated. They had been upfront (92 patients) or in relapse (29 patients) and received high-dose sequential (HDS) chemotherapy including peripheral blood progenitor cell (PBPC) autograft. Body mass index (BMI) was calculated as weight in kilograms divided by the square of the height in meters; overweight was defined as BMI > or = 28. Univariate and multivariate analyses were used to determine the prognostic implication of overweight and other known prognostic indicators on overall (OS) and event-free (EFS) survival for the entire group and overweight and non-overweight (reference) subgroups. With a median follow-up of 3 years, the estimated 5-year OS and EFS for the entire group were 58% and 49%, respectively. Twenty-eight patients (23%) had BMI > or = 28. Their median OS and EFS were 2.2 and 1.4 years, respectively, whereas median OS and EFS for the reference group have not been reached, with a 5-year projection of 65 and 55%, respectively (P < 0.002). On multivariate analysis, the risk of death among overweight patients was 2.9 (CI, 1.3-6.2) times that of the reference group; using EFS as the end point, a similar association between overweight and survival was observed. In conclusion, in high-risk NHL patients undergoing intensive chemotherapy and PBPC autografting overweight is associated with a poorer outcome.

Nutritional status of hemodialysis patients with secondary hyperparathyroidism

The repercussions of secondary hyperparathyroidism on the nutritional status of chronic renal failure patients have not been well established. Therefore, the aim of this study was to compare the nutritional indices of hemodialysis patients with and without secondary hyperparathyroidism. Sixteen hemodialysis patients with serum parathyroid hormone (PTH) levels higher than 420 pg/ml (hyperparathyroidism group) were matched for gender, age and length of dialysis treatment to 16 patients with serum PTH between 64 and 290 pg/ml (control group). The following parameters were assessed: anthropometric indices (body mass index, skinfold thickness, midarm muscle circumference and body fat), 4-day food diaries, protein catabolic rate, biochemical indices (blood urea nitrogen, serum creatinine, albumin, ionized calcium, inorganic phosphorus, serum alkaline phosphatase, PTH, pH and HCO(3)) and dialysis efficiency. We did not observe differences in the anthropometric indices between the two groups. Only calcium intake was significantly different between groups (307.9 mg/day for the hyperparathyroidism group vs 475.8 mg/day for the control group). Protein catabolic rate tended to be higher in the hyperparathyroidism group compared to the control group (1.3 vs 0.9 g kg(-1) day(-1); P = 0.08). Except for blood urea nitrogen (86.4 vs 75.7 mg/dl), alkaline phosphatase (175 vs 65 U/l) and PTH (898 vs 155 pg/ml), no other differences were found between groups in the biochemical indices studied. PTH was directly correlated with protein catabolic rate (r = 0.61; P<0.05) and length of dialysis (r = 0.53; P<0.05) only in the hyperparathyroidism group. Considering the indices used, we could not demonstrate the deleterious effect of high PTH levels on the nutritional status of hemodialysis patients. Indirect evidence, however, suggests an action of PTH on protein metabolism.

Criteria for definition of overweight in transition: background and recommendations for the United States

Overweight and obesity are leading nutrition-related disorders of clinical and public health concern. Assessment and classification of these conditions are dependent on specific body mass index (BMI; in kg/m(2)) cutoff points. US government agencies are making the transition to a revised BMI definition of overweight from that previously recommended for general use. The purpose of this article is to inform the broader medical and scientific communities of the transition that is underway in the United States to identify and classify overweight among adults by using BMI. Historical background on the use of BMI in a variety of applications, as reported in US federal government agency documents, provides an understanding of previous and current weight-for-height guidelines and the basis for arriving at them. On the basis of the current Dietary Guidelines for Americans, US government agencies are moving toward the use of criteria for overweight and obesity that are consistent with current international standards. Clinicians, researchers, and journal editors should be aware of the transition toward a common definition of healthy weight, overweight, and obesity. To facilitate comparisons and reporting of data, others are encouraged to consider making this transition as well.

Hyperestrogenism: a relevant risk factor for the development of cancer from endometriosis

OBJECTIVE

Endometriosis is extremely common in developed countries. Obesity is a major health concern and may cause hyperestrogenism. Hormonal replacement, particularly unopposed estrogens after hysterectomy, is becoming popular. Because endometriosis is ectopic endometrium, hyperestrogenism (either endogenous or exogenous) may cause hyperplasia or transformation into cancer. This study was conducted to describe the main clinical and pathologic features of malignancies in endometriosis and define the treatment and outcome and to compare patients who had cancer arising in endometriosis with patients who had endometriosis but no cancer.

METHODS

Patients who had tumors from endometriosis diagnosed from 1986 to 1997 were analyzed retrospectively. Each patient was matched with two control patients (endometriosis without cancer) treated during the same study interval. Clinical and epidemiologic variables were compared to identify risk factors for the development of cancer.

RESULT

We identified 31 patients with cancer developing from endometriosis. Fifteen women were obese, 9 had a history of endometriosis, and 9 were taking unopposed estrogen. Endometrioid adenocarcinoma was the most common histologic type (16 patients). When the patients with cancer were compared with controls, no significantly higher risk for the development of cancer was found with prolonged use of unopposed estrogens or with higher body mass index, but a trend was observed. When obesity and use of unopposed estrogens were considered together, the difference was statistically significant (P = 0.05).

CONCLUSION

Hyperestrogenism, either endogenous or exogenous, is a significant risk factor for the development of cancer from endometriosis. The prevalences of endometriosis, obesity, and use of hormonal replacement therapy in women in developed countries are increasing, and this trend justifies the assumption that cancer developing in endometriosis might become more common in the future.

Obesity and postoperative oxygenation after coronary artery bypass grafting

OBJECTIVE

The relationship between obesity and postoperative oxygenation after coronary artery bypass grafting was studied.

METHODS

Subjects were 68 patients undergoing solitary coronary artery bypass grafting--49 men and 19 women with a mean age of 64 years--divided into 3 groups by body mass index: group L with a body mass index of < 20 kg/m2 (n = 10), group M with a 20 < or = body mass index < 25 (n = 46), and group H with a 25 < or = body mass index (n = 12). Perioperative oxygenation was evaluated using respiratory indices measured preoperatively and 3 and 15 hours postoperatively.

RESULTS

Postoperative respiratory indices significantly increased from 0.23 to 0.67 (p < 0.001) at 3 hours and to 0.97 (p < 0.01) at 15 hours postoperatively in group L, from 0.27 to 0.80 (p < 0.001) and to 0.94 in group M, and from 0.31 to 1.39 (p < 0.001) and to 1.45 in group H. The postoperative respiratory index in group H was significantly higher (p < 0.01) than that in groups M and L both at 3 and 15 hours postoperatively. Multivariate analysis showed that the coefficients of determination of body mass index to postoperative respiratory index, 23% at 3 hours and 16% at 15 hours postoperatively, were the highest among perioperative factors.

CONCLUSIONS

Obesity is a major factor impairing postoperative oxygenation. Careful management in a semirecumbent position and/or nasal intermittent positive pressure ventilation may thus be required in obese patients.

An alternative to body mass index for standardizing body weight for stature

Although body mass index (BMI) has been adopted by WHO as an international measure of obesity, it lacks a theoretical basis, and empirical evidence suggests it is not valid for all populations. We determined standard weight-for-height using a model calibrated by multivariate analysis of observational data on body dimensions and health status in the USA (NHANES III). A multiple linear regression model based on a simple mathematical formulation accurately described the observed weight variations in this normal adult population. A standardized reference model using just two measurements (upper arm length and sitting height), readily applied in both clinical and research settings using lookup tables, improved explanatory power substantially compared to the best BMI formulation (r(2) increased 16.3% for males, 21.1% for females). Physical dysfunction and self-reported poor health showed strong trends with excess body weight. These findings need confirmation from larger population samples.

Relation of generalized and central obesity to cardiovascular risk factors and prevalent coronary heart disease in a sample of American Indians: the Strong Heart Study

OBJECTIVE

To examine the hypothesis linking measures of obesity including body mass index (BMI), waist circumference (waist) and percentage body fat to coronary heart disease (CHD) prevalence and its risk factors in American Indians.

DESIGN

The Strong Heart Study assesses the prevalence of CHD and its risk factors in American Indians in Arizona, Oklahoma and South/North Dakota. Participants underwent a physical examination and an electrocardiogram; anthropometric and blood pressure measurements were taken, as were measurements of glucose, lipoproteins, fibrinogen, insulin, hemoglobin A1c and urinary albumin.

PARTICIPANTS

Data were available for 4549 men and women between 45 and 74 y of age.

MEASUREMENTS

Obesity, measured using body mass index, waist circumference and percentage body fat, was correlated with prevalent CHD and its risk factors.

RESULTS

More than 75% of participants were overweight (BMI>25 kg/m2). Measures of obesity were greater in women than in men, in younger than in older participants, and in participants with diabetes than in nondiabetic participants. CHD risk factors were associated with measures of obesity but, except for insulin concentration, changes in metabolic variables with increasing obesity were small. Associations were not stronger with waist than with BMI. The prevalence of CHD in those whose BMI and/or waist measurements lay in the lowest and highest quintiles, by gender and diabetic status, was similar.

CONCLUSIONS

Although CHD risk factors are associated with obesity in American Indians, distribution of obesity (ie waist) is no more closely related to risk factors than is generalized obesity (ie BMI), and changes in CHD risk factors with obesity were small. Thus, the relations among obesity, body fat distribution and CHD risk may differ in this population.

Comparing the urea reduction ratio and the urea product as outcome-based measures of hemodialysis dose

The urea reduction ratio (URR) and normalized treatment ratio (Kt/V) are related quantities that have become accepted measures of hemodialysis dose. Recent studies, however, have suggested that they combine two elements, both favorably associated with clinical outcome, as a single ratio. These elements, Kt and V, may offset each other, producing a complex quantity that does not reflect a true relationship between dialysis exposure and clinical outcome. This project explored and compared the associations of the URR and the ¿urea clearance x time¿ product (Kt) with mortality in a large sample of hemodialysis patients (37,108 patients) during 1998. Survival analyses using conventional techniques were the primary analytic tools. The relationship between URR and survival was U-shaped or J-shaped, with greater relative mortality at both extremes of the URR distribution than at its middle. Thus, identifying a threshold for adequate dialysis was not possible unless one considers also a threshold for overdialysis. Conversely, the association between Kt and outcome was much simpler, reflecting progressive improvement over the range of Kt evaluated here. These analyses suggest that such measures as URR and Kt/V are compound and complex, and that a simpler, more direct, measure, such as the Kt, should be considered to describe hemodialysis dose.

Hormone replacement therapy and interrelation between serum interleukin-6 and body mass index in postmenopausal women: a population-based study

Postmenopausal women are at increased risk to develop osteoporosis, coronary artery disease, heart failure, and hypertension. Interleukin-6 (IL-6) may be a pathogenetic element in these disorders. Serum IL-6 levels increase during aging and seem to be related to increased body fat mass. In the present retrospective study we aimed to investigate the role of hormone replacement therapy (HRT) on serum IL-6 levels and the interrelation of IL-6 and body fat mass. Parameters were assessed in a population-based sample of postmenopausal women (n = 302) and, for comparison, 245 men of the same age. Women with HRT (n = 92) had significantly lower serum IL-6 levels compared to subjects without HRT, which was independent of age, antihypertensive therapy, smoking habits, and blood pressure (1.5 +/- 0.1 vs. 2.9 +/- 0.6 pg/mL; P = 0.017). In women without HRT, the body mass index (BMI) was correlated with serum IL-6 levels (P < 0.001). Multivariate analysis controlling simultaneously for the effects of blood pressure and heart rate confirmed the positive correlation (P = 0.001). However, in subjects with HRT no such correlation between IL-6 and BMI was demonstrated, which was confirmed after controlling covariates. In male subjects, BMI correlated with serum IL-6 (P = 0.009), which was, however, blunted after controlling for blood pressure and heart rate, probably indicating an influence of the sympathetic nervous system on this interrelation. In conclusion, women receiving HRT display lower serum IL-6 levels and a blunted interrelation of IL-6 and BMI. As IL-6 may be a pathogenetic factor in age-related diseases, HRT-related inhibition of IL-6 secretion could be an important element for the favorable effects of HRT in postmenopausal women.