Indices of relative weight and obesity

Obesity paradox in heart failure: a heavy matter

Obesity and heart failure are two of the leading causes of morbidity and mortality in the world. The relationship between obesity and cardiovascular diseases is complex and not fully understood. While the risk of developing heart failure has been shown to be higher in patients who are obese, there is a survival advantage for obese and overweight patients compared with normal weight or low weight patients. This phenomenon was first described by Horwich et al. and was subsequently confirmed in other large trials. The advantage exists irrespective of the type, aetiology, or stage of heart failure. Patients with morbid obesity (body mass index >40 kg/m²), however, do not have the same survival advantage of their obese counterparts. There are several alternative indices of obesity available that may be more accurate than body mass index. The role of weight loss in patients with heart failure is unclear; thus, providing sound clinical advice to patients remains difficult. Future prospective trials designed to evaluate the link between obesity and heart failure will help us understand more fully this complex relationship.

Optimization of oncological ¹⁸F-FDG PET/CT imaging based on a multiparameter analysis

PURPOSE

This paper describes a method to achieve consistent clinical image quality in (18)F-FDG scans accounting for patient habitus, dose regimen, image acquisition, and processing techniques.

METHODS

Oncological PET/CT scan data for 58 subjects were evaluated retrospectively to derive analytical curves that predict image quality. Patient noise equivalent count rate and coefficient of variation (CV) were used as metrics in their analysis. Optimized acquisition protocols were identified and prospectively applied to 179 subjects.

RESULTS

The adoption of different schemes for three body mass ranges (<60 kg, 60-90 kg, >90 kg) allows improved image quality with both point spread function and ordered-subsets expectation maximization-3D reconstruction methods. The application of this methodology showed that CV improved significantly (p < 0.0001) in clinical practice.

CONCLUSIONS

Consistent oncological PET/CT image quality on a high-performance scanner was achieved from an analysis of the relations existing between dose regimen, patient habitus, acquisition, and processing techniques. The proposed methodology may be used by PET/CT centers to develop protocols to standardize PET/CT imaging procedures and achieve better patient management and cost-effective operations.

Vejle Diabetes Biobank - a resource for studies of the etiologies of diabetes and its comorbidities

Aims

Carefully designed and established biobanks are considered one of the most essential resources to foster biomedical research as they provide cost-effective and rapid access to a vast variety of biological materials and related anthropometrics allowing for testing of various biomarkers as well as numerous original and pertinent bioclinical hypotheses related to human disease etiology and prognosis. The objective of the present study was to present the baseline data, design, and methods used for the establishment of the Vejle Diabetes Biobank. Further aims included assessment of the prevalence of diabetes and quality of diabetes treatment in a specified Danish region.

Methods

The Vejle Diabetes Biobank was established from 2007 to 2010 as a regional Biobank containing blood, DNA, and urine samples from patients with diabetes and a gender- and age-matched control population aged 25–75 years. Anthropometrics were obtained by physical examination, questionnaires, and interviews at the time of inclusion into the Biobank. The cohort was linked to the Danish Civil Registration System, the Danish National Patient Registry, and the Danish National Prescription Registry.

Results

In total, 4,255 nondiabetic individuals and 3,320 patients with diabetes were included. Type 2 diabetes (T2D) patients had a higher body mass index (30 kg/m²) than type 1 diabetes (T1D) patients (25 and 26 kg/m² in women and men, respectively) and control subjects (25 and 27 kg/m² in women and men, respectively). Fasting levels of plasma triglycerides and blood pressure were higher in T2D patients (1.5 mmol/L and 148/85 mmHg, respectively) compared with T1D patients (0.9 mmol/L and 139/81 mmHg, respectively), whereas glycated hemoglobin (HbA1c), plasma high density lipoprotein, low density lipoprotein, and total cholesterol were lower in T2D patients (51 mmol/mol, 1.2 mmol/L, 2.2 mmol/L, and 4.2 mmol/L, respectively) compared with findings in T1D patients (61 mmol/mol, 1.6 mmol/L, 2.3 mmol/L, and 4.4 mmol/L, respectively). At the time of inclusion into the Biobank, 56% of the T2D patients and 25% of T1D patients had an HbA1c <7% (53 mmol/mol). Only 28% and 34% of the T2D patients, respectively, reached treatment target for blood pressure and lipids.

Conclusion

The Vejle Diabetes Biobank represents one of the largest open diabetes case-control cohorts in Denmark. The Biobank invites collaborative investigations of diabetes and diabetes complication etiologies as well as studies of prognostic or predictive biomarkers.

An Anthropometric Risk Index Based on Combining Height, Weight, Waist, and Hip Measurements

Body mass index (BMI) can be considered an application of a power law model to express body weight independently of height. Based on the same power law principle, we previously introduced a body shape index (ABSI) to be independent of BMI and height. Here, we develop a new hip index (HI) whose normalized value is independent of height, BMI, and ABSI. Similar to BMI, HI demonstrates a U-shaped relationship to mortality in the Third National Health and Nutrition Examination Survey (NHANES III) population. We further develop a new anthropometric risk index (ARI) by adding log hazard ratios from separate nonlinear regressions of the four indicators, height, BMI, ABSI, and HI, against NHANES III mortality hazard. ARI far outperforms any of the individual indicators as a linear mortality predictor in NHANES III. The superior performance of ARI also holds for predicting mortality hazard in the independent Atherosclerosis Risk in Communities (ARIC) cohort. Thus, HI, along with BMI and ABSI, can capture the risk profile associated with body size and shape. These can be combined in a risk indicator that utilizes complementary information from height, weight, and waist and hip circumference. The combined ARI is promising for further research and clinical applications.

Risk Indicators for Periodontitis in US Adults: NHANES 2009 to 2012

BACKGROUND

Through the use of optimal surveillance measures and standard case definitions, it is now possible to more accurately determine population-average risk profiles for severe (SP) and non-severe periodontitis (NSP) in adults (aged 30 years and older) in the United States.

METHODS

Data from the 2009 to 2012 National Health and Nutrition Examination Survey were used, which, for the first time, used the "gold standard" full-mouth periodontitis surveillance protocol to classify severity of periodontitis following suggested Centers for Disease Control/American Academy of Periodontology case definitions. Probabilities of periodontitis by: 1) sociodemographics, 2) behavioral factors, and 3) comorbid conditions were assessed using prevalence ratios (PRs) estimated by predicted marginal probability from multivariable generalized logistic regression models. Analyses were further stratified by sex for each classification of periodontitis.

RESULTS

Likelihood of total periodontitis (TP) increased with age for overall and NSP relative to non-periodontitis. Compared with non-Hispanic whites, TP was more likely in Hispanics (adjusted [a]PR = 1.38; 95% confidence interval 95% CI: 1.26 to 1.52) and non-Hispanic blacks (aPR = 1.35; 95% CI: 1.22 to 1.50), whereas SP was most likely in non-Hispanic blacks (aPR = 1.82; 95% CI: 1.44 to 2.31). There was at least a 50% greater likelihood of TP in current smokers compared with non-smokers. In males, likelihood of TP in adults aged 65 years and older was greater (aPR = 2.07; 95% CI: 1.76 to 2.43) than adults aged 30 to 44 years. This probability was even greater in women (aPR = 3.15; 95% CI: 2.63 to 3.77). Likelihood of TP was higher in current smokers relative to non-smokers regardless of sex and periodontitis classification. TP was more likely in men with uncontrolled diabetes mellitus (DM) compared with adults without DM.

CONCLUSIONS

Assessment of risk profiles for periodontitis in adults in the United States based on gold standard periodontal measures show important differences by severity of disease and sex. Cigarette smoking, specifically current smoking, remains an important modifiable risk for all levels of periodontitis severity. Higher likelihood of TP in older adults and in males with uncontrolled DM is noteworthy. These findings could improve identification of target populations for effective public health interventions to improve periodontal health of adults in the United States.

Associations among height, body mass index and intelligence from age 11 to age 78 years

Background

Intelligence is related to both height and body mass index (BMI) at various stages of life. Several studies have demonstrated longitudinal relationships between these measures, but none has established whether height and intelligence, or BMI and intelligence are linked from childhood through to older age.

Methods

We assessed the relations between these measures over an interval of up to 67 years using data from the 36-Day Sample, an initially-representative sample of Scottish people born in 1936, assessed at age 11 years (N = 6,291) and again at 77–78 years (N = 722). This paper focuses on the 423 participants (6.7 % of the original sample) who provided relevant data in late adulthood.

Results

Height and intelligence were significantly positively associated in childhood (β = .23) and late adulthood (β = .21–.29). Longitudinal correlations also showed that childhood intelligence predicted late-adulthood height (β = .20), and childhood height predicted late-adulthood cognitive ability (β = .12–.14). We observed no significant relationship between BMI and intelligence either in childhood or in late adulthood, nor any longitudinal association between the two in this sample.

Conclusions

Our results on height and intelligence are the first to demonstrate that their relationship spans almost seven decades, from childhood through to late adulthood, and they call for further investigation into the mechanisms underlying this lifelong association.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-016-0340-0) contains supplementary material, which is available to authorized users.

The hot body issue: Weight and caption tone in celebrity gossip magazines

While representations of bodies and weight have been studied in regards to fashion and fitness magazines, little research exists that examines such representations in celebrity gossip magazines. Using data collected through content analysis of 262 photo-caption units published in June 2015 issues of American celebrity gossip magazines, this study examines representations of bodies within the genre and the relationship between the gender, race, and body size of pictured celebrities and the tone of accompanying captions. Results indicate that celebrity gossip magazines critique the bodies of both female and male subjects, but that women are more likely to be the subject of negative comments than men. Underweight women and overweight men are especially targeted for criticism. Latinos are praised more often than other racial groups. The implications of these representations are discussed.

Body Mass Index, Body Shape Satisfaction, and Weight Control Behaviors among Korean Girls

The present study investigated the relations among Body Mass Index, body shape satisfaction, and weight control behaviors among Korean girls. Subjects were 266 girls ( M age = 16.6 yr., SD = .9), recruited from two girls' high schools in Seoul, Korea. Based on Body Mass Index, 73.7% were normal weight, 22.9% were underweight, and 3.4% were overweight. 174 girls (65.4%) indicated that they were currently using any weight control method. Weight control behaviors differed significantly by Body Mass Index category, with girls whose Body Mass Indexes indicating normal weight being more likely to claim they used weight control behaviors. Also, the girls who rated themselves as dissatisfied with their body shape were more likely to report weight control behaviors.

From Undernutrition to Overnutrition: The Evolution of Overweight and Obesity among Young Men in Switzerland since the 19th Century

OBJECTIVE

The global obesity epidemic continues, new approaches are needed to understand the causes. We analyzed data from an evolutionary perspective, stressing developmental plasticity.

METHODS

We present diachronical height, weight, and BMI data for 702,902 Swiss male conscripts aged 18-20 years, a representative, standardized and unchanged data source.

RESULTS

From 1875 to 1879, the height distribution was slightly left-skewed; 12.1% of the conscripts were underweight, overweight and obesity were rare. The BMI-to-height relationship was positive but not linear, and very short conscripts were particularly slim. Since the 1870s, Swiss conscripts became taller, a trend that markedly slowed in the 1990s. In contrast, weight increased in two distinct steps at the end of the 1980s and again after 2002. Since 2010, BMI did not increase but stabilized at a high level.

CONCLUSIONS

The body of young men adapted differently to varying living conditions over time: First, less investment in height and weight under conditions of undernutrition and food uncertainty; second, more investment in height under more stable nutritional conditions; third, development of obesity during conditions of plateaued height growth, overnutrition, and decreasing physical activity. This example contributes to the evaluation of hypotheses on human developmental plasticity.

Body mass index: Has epidemiology started to break down causal contributions to health and disease?

OBJECTIVES

To review progress in understanding the methods and results concerning the causal contribution of body mass index (BMI) to health and disease.

METHODS

In the context of conventional evidence focused on the relationship between BMI and health, this review considers current literature on the common, population-based, genetic contribution to BMI and how this has fed into the developing field of applied epidemiology.

RESULTS

Technological and analytical developments have driven considerable success in identifying genetic variants relevant to BMI. This has enabled the implementation of Mendelian randomization to address questions of causality. The product of this work has been the implication of BMI as a causal agent in a host of health outcomes. Further breakdown of causal pathways by integration with other "omics" technologies promises to deliver additional benefit.

CONCLUSIONS

Gaps remain in our understanding of BMI as a risk factor for health and disease, and while promising, applied genetic epidemiology should be considered alongside alternative methods for assessing the impact of BMI on health. Potential limitations, relating to inappropriate or nonspecific measures of obesity and the improper use of genetic instruments, will need to be explored and incorporated into future research aiming to dissect BMI as a risk factor.

Influence of body mass index and age on the lung function of obese women

Abstract Introduction: Obesity and aging may cause changes in lung function. Objective: to assess whether body mass, body mass index (BMI) and age influences vital capacity (VC) and forced expiratory volume in the first second (FEV1) in women. Methods: 81 women aged between 30 and 75 years participated in the study. The sample included obese and morbidly obese, non-smoking, sedentary individuals without chronic lung disorders. Anamnesis, anthropometric and spirometric evaluations were performed. Statistical analysis was carried out using the Pearson correlation and Spearman tests, adopting a significance level of 5%. Results: It was observed that age had significant and negative correlations with VC and its components: inspiratory reserve volume (IRV), expiratory reserve volume (ERV) and tidal volume (TV), and with FEV1. There was also a significant positive correlation between body mass and VC and IRV and a significant negative correlation between BMI and ERV. Conclusion: Pulmonary function declines over time. Body mass appears to exert a greater influence on IRV, whereas a greater BMI is associated with a decline in ERV.

A GWA study reveals genetic loci for body conformation traits in Chinese Laiwu pigs and its implications for human BMI

Pigs share numerous physiological and phenotypic similarities with human and thus have been considered as a good model in nonrodent mammals for the study of genetic basis of human obesity. Researches on candidate genes for obesity traits have successfully identified some common genes between humans and pigs. However, few studies have assessed how many similarities exist between the genetic architecture of obesity in pigs and humans by large-scale comparative genomics. Here, we performed a genome-wide association study (GWAS) using the porcine 60 K SNP Beadchip for BMI and other four conformation traits at three different ages in a Chinese Laiwu pig population, which shows a large variability in fat deposition. In total, 35 SNPs were found to be significant at Bonferroni-corrected 5 % chromosome-wise level (P = 2.13 × 10^-5) and 88 SNPs had suggestive (P < 10^-4) association with the conformation traits. Some SNPs showed age-dependent association. Intriguingly, out of 32 regions associated with BMI in pigs, 18 were homologous with the loci for BMI in humans. Furthermore, five closest genes to GWAS peaks including HIF1AN, SMYD3, COX10, SLMAP, and GBE1 have been already associated with BMI in humans, which makes them very promising candidates for these QTLs. The result of GO analysis provided strong support to the fact that mitochondria and synapse play important roles in obesity susceptibility, which is consistent with previous findings on human obesity, and it also implicated new gene sets related to chromatin modification and Ig-like C2-type 5 domain. Therefore, these results not only provide new insights into the genetic architecture of BMI in pigs but also highlight that humans and pigs share the significant overlap of obesity-related genes.

Novel Anthropometry Based on 3D-Bodyscans Applied to a Large Population Based Cohort

Three-dimensional (3D) whole body scanners are increasingly used as precise measuring tools for the rapid quantification of anthropometric measures in epidemiological studies. We analyzed 3D whole body scanning data of nearly 10,000 participants of a cohort collected from the adult population of Leipzig, one of the largest cities in Eastern Germany. We present a novel approach for the systematic analysis of this data which aims at identifying distinguishable clusters of body shapes called body types. In the first step, our method aggregates body measures provided by the scanner into meta-measures, each representing one relevant dimension of the body shape. In a next step, we stratified the cohort into body types and assessed their stability and dependence on the size of the underlying cohort. Using self-organizing maps (SOM) we identified thirteen robust meta-measures and fifteen body types comprising between 1 and 18 percent of the total cohort size. Thirteen of them are virtually gender specific (six for women and seven for men) and thus reflect most abundant body shapes of women and men. Two body types include both women and men, and describe androgynous body shapes that lack typical gender specific features. The body types disentangle a large variability of body shapes enabling distinctions which go beyond the traditional indices such as body mass index, the waist-to-height ratio, the waist-to-hip ratio and the mortality-hazard ABSI-index. In a next step, we will link the identified body types with disease predispositions to study how size and shape of the human body impact health and disease.

Changes in Body Mass Index and Late Postoperative Outcomes in Elderly Coronary Artery Bypass Grafting Patients: A Follow-up Study

The purpose of this study was to describe the extent to which late postoperative health outcomes vary as a function of change in body mass index (BMI) in persons 65 years of age undergoing elective coronary artery bypass grafting (CABG). The mean age of the 90 persons in the original sample was 72.27 (±4.85) years. At follow-up (x = 18.73,s = 2.56 months postsurgery), 90% (n = 79 alive,n = 2 deceased, proxy completed interview) were contacted; 73% (n = 59) completed the telephone interview; and 9% (n = 8) were alive but lost to follow-up. BMI (kg/m2) was calculated from self-reported weight at follow-up. Outcomes included the Physical Component Summary (PCS) scale of the SF-36 Health Survey and readmission data. Thex (s ) for BMI at preoperative, postoperative, postdischarge, and follow-up were 28.1 (4.9) kg/ m2 , 28.76 (4.9) kg/m2, 27.11 (4.8) kg/m2, and 27.95 (4.7) kg/m2, respectively. BMI changed over time,P < 0.05. Those who were readmitted lost more weight between preoperative and postdischarge than those who were not readmitted (x BMI = –2.26 vs.x BMI = –1.35),t = 2.17,df = 27.05,P = 0.04. Those who lost less weight between preoperative and postdischarge were less likely to be readmitted,.2 = 5.755 (1),P = 0.02, with 25% sensitivity and 92% specificity. Thex (sx) for PCS at preoperative, postdischarge, and follow-up were 36.93 (1.62), 35.72 (1.27), and 42.26 (1.45), respectively, reflecting change over time,F = 11.43 (2),P < 0.001. At follow-up, older elective CABG patients do not appear to regain weight lost between preoperative and postdischarge; however, self-reported physical health is improved. Also, initial weight loss is related to readmissions.

Body Dissatisfaction in a Diverse Sample of Young Men Who Have Sex With Men: The P18 Cohort Study

Young men who have sex with men (YMSM) may be at greater risk for body dissatisfaction, compared to their heterosexual peers. However, differences within YMSM populations are understudied, precluding the identification of YMSM who are at greatest risk. This study examined body dissatisfaction in a racially/ethnically diverse sample of YMSM ages 18-19 in New York City. Using cross-sectional data from the baseline visit of a longitudinal cohort study of YMSM (N = 591), body dissatisfaction was assessed using the Male Body Attitudes Scale. Three outcomes were modeled using linear regression: (1) overall body dissatisfaction, (2) muscularity dissatisfaction, and (3) body fat dissatisfaction. Covariates in the models included race/ethnicity, sexual orientation, BMI, gay community affiliation, and internalized homonegativity. White YMSM experienced greater body dissatisfaction across the three models. Internalized homonegativity was a statistically significant predictor of dissatisfaction across the three models, though its association with body dissatisfaction was relatively small. The findings point to future avenues of research, particularly qualitative research to explore demographic and cultural nuances in body attitudes among YMSM.

Should Body Mass Index Affect the Choice of Probe Frequency in the Clinical Assessment of Varicose Veins Using Hand-Held Doppler?

Objective:

The aim of this study was to determine whether an increased body mass index should influence the choice of continuous-wave Doppler probe frequency in the clinical assessment of patients with varicose veins.

Design:

Prospective assessment of the effect of raised body mass index on the accuracy of clinical assessment of venous reflux using 4 and 8 MHz Doppler probes compared with duplex scanning.

Setting:

The ultrasound department of a university teaching hospital.

Patients:

Seventy-two patients with symptomatic primary varicose veins (108 limbs), who had not undergone previous injection sclerotherapy or surgical treatment.

Main outcome measures:

Measurement of body mass index and assessment of reflux with hand-held Doppler using 4 and 8 MHz probes immediately followed by duplex scanning.

Results:

There was no significant difference between the 4 and 8 MHz Doppler probes in the accuracy of detection of reflux at the sapheno-femoral junction, in the long saphenous vein or at the sapheno-popliteal junction in the whole patient group or in the obese subgroup.

Conclusion:

Body mass index should not influence the choice of probe frequency (between 4 and 8 MHz) in the clinical assessment of patients with primary previously untreated varicose veins.

Face morphology: Can it tell us something about body weight and fat?

This paper proposes a method for an automatic extraction of geometric features, related to weight parameters, from 3D facial data acquired with low-cost depth scanners. The novelty of the method relies both on the processing of the 3D facial data and on the definition of the geometric features which are conceptually simple, robust against noise and pose estimation errors, computationally efficient, invariant with respect to rotation, translation, and scale changes. Experimental results show that these measurements are highly correlated with weight, BMI, and neck circumference, and well correlated with waist and hip circumference, which are markers of central obesity. Therefore the proposed method strongly supports the development of interactive, non obtrusive systems able to provide a support for the detection of weight-related problems.

Hematological toxicity of carboplatin for gynecological cancer according to body mass index

PURPOSE

The aim of the present study was to analyze how patient weight affects the hematological toxicity of carboplatin and whether this toxicity is more prevalent in overweight patients.

METHODS

We performed a retrospective 2-year study of patients diagnosed with a gynecological cancer and whose treatment regimen contained carboplatin (AUC dose = 5 or 6) and paclitaxel (dose = 175 mg/m(2)) every 3 weeks (CP scheme). We recorded all severe hematological events (thrombocytopenia, neutropenia, and/or anemia grade III/IV) according to the CTCAE v4.03, as well as treatment modifications and the need for granulocyte colony-stimulating factors (G-CSF) and/or erythropoietin (EPO) or packed red blood cells (PRBC). Patients with a body mass index (BMI) ≥27 kg/m(2) were considered as overweight (OW) and those with a BMI <27 kg/m(2) were considered as normal weight (NW).

RESULTS

Fifty-two patients met the inclusion criteria (21 patients in the OW group, 31 patients in the NW group). The OW group showed a higher incidence of thrombocytopenia (95% confidence intervals (CI) 1.51-27.72; p < 0.02) and anemia (95% CI 1.06-33.63; p < 0.05). Moreover, this was reflected in a greater number of changes in the usual CP regimen (95% CI 2.19-44.32; p < 0.01). The need for G-CSF and/or EPO/PRBC was also significantly higher in the OW group (95% CI 1.08-12.16; p < 0.04).

CONCLUSIONS

Carboplatin dosing based on real weight in obese patients resulted in increased hematologic toxicity, mainly thrombocytopenia. Dose adjustment based on other descriptors of weight, such as adjusted weight, may be better tolerated by patients. However, future studies are needed to demonstrate not only better safety of carboplatin but also improved survival rates.

A Spatial Analysis of Body Mass Index and Neighborhood Factors in Community-Dwelling Older Men and Women

The spatial distribution of obesity among the older population can yield insights into the influence of contextual factors associated with this public health problem. We tested the relationship between neighborhood-level characteristics and body mass index (BMI) using global and local spatial statistics of geographic clustering, using data derived from a random-digit-dial sample of 5,319 community-dwelling adults aged 50 to 74 residing in 1,313 census tracts in New Jersey. Geographically weighted regression modeled associations between BMI clusters and neighborhood characteristics, including metrics of structure, safety, demographics, and amenities. Across the sample panel, average BMI was 28.62 kg/m(2) for women and 28.25 kg/m(2) for men. There was significant spatial clustering of obesity by census tract, varying by gender across the state. Neighborhood characteristics were more strongly related to BMI for women than men. This research illuminates the role of neighborhood contextual factors and will assist community planners, officials, and public health practitioners as they address the rise in obesity.

Lower limit of normal based spirometric abnormalities associated with radiographic abnormality in an elderly cohort at low risk for exposure

BACKGROUND

Although the relation between radiographic abnormalities and spirometric impairment in people with asbestosis has been studied extensively, the extent of spirometric impairment associated with milder radiographic abnormalities is not established.

OBJECTIVE

To test associations between mild radiographic abnormalities and Lower Limit of Normal (LLN)-based spirometry interpretation.

METHODS

Spirometry and CXRs were collected for 1,026 at low risk of exposure to pneumoconiotic agents participants in a medical screening program.

RESULTS

Individuals with each type of isolated or combined International Labour Organization (ILO) abnormalities had up to over sixfold statistically significant increase in odds of LLN-based restrictive pattern physiology (OR = 1.96, 95%CI 1.03-3.73 for parenchymal to OR = 6.09, 95%CI 1.94-19.10 for parenchymal and pleural) compared to those with normal films.

CONCLUSIONS

The findings from this study confirm the association of mild profusion abnormalities with clinically relevant, LLN-based lung function abnormalities.

Body mass index values of conscripts in the Polish lands under Prussian rule in the late 19th and early 20th centuries

The Body Mass Index (BMI) of conscripts from the Polish lands under Prussian rule and its causative factors and changes over time was to characterize. A total of 9965 conscripts aged 20 were examined. Differences in the mean BMI were tested using one-way analysis of variance ANOVA and Tukey's-test (post-hoc test). Factor analysis and multiple regression were employed. The highest BMI values characterized sons of peasants, workers and craftsmen, and the lowest, sons of intelligentsia: the difference for peasants/intelligentsia -0.59kg/m(2) (p=0.0004), and that for workers/intelligentsia and craftsmen/intelligentsia, 0.48 and 0.5kg/m(2) (p=0.0004 and p=0.0057, respectively). The difference in BMI of conscripts from the first and last birth cohorts was 0.61kg/m(2) (p=0.0001). The highest BMI values were noted in conscripts from villages (21.50kg/m(2)), and the lowest, in those from towns (21.15kg/m(2)) and cities (21.19kg/m(2)). The differences for village/town and village/city were statistically significant (p=0.0026 and p=0.0026, respectively). The BMI difference between Poles and Germans was 0.35kg/m(2) (higher value among Poles).

Aortic Valve Disease and Vascular Mechanics: Two-Dimensional Speckle Tracking Echocardiographic Analysis

PURPOSE

Degenerative aortic valve disease (AVD) is a complex disorder that goes beyond valve itself, also undermining aortic wall. We aimed to assess the ascending aortic mechanics with two-dimensional speckle tracking echocardiography (2DSTE) in patients with aortic regurgitation (AR) and hypothesized a relationship with degree of AR. Aortic mechanics were then compared with those of similarly studied healthy controls and patients with aortic stenosis (AS); finally, we aimed to assess the prognostic significance of vascular mechanics in AVD.

METHODS

Overall, 73 patients with moderate-to-severe AR and 22 healthy subjects were enrolled, alongside a previously examined cohort (N = 45) with moderate-to-severe AS. Global circumferential ascending aortic strain (CAAS) and strain rate (CAASR) served as indices of aortic deformation; corrected CAAS was calculated as CAAS/pulse pressure (PP). Median clinical follow-up was 438 days.

RESULTS

In patients with severe (vs. moderate) AR, CAASR (1.53 ± 0.29/sec vs. 1.90 ± 0.62/sec, P < 0.05) and corrected CAAS (0.14 ± 0.06%/mmHg vs. 0.19 ± 0.08%/mmHg, P < 0.05) were significantly lower, whereas CAAS did not differ significantly. Measurers of aortic mechanics (CAAS, corrected CAAS, CAASR) differed significantly (all P < 0.01) in patients with AS and AR and in healthy subjects, with lower values seen in patients with AS. In follow-up, survival rate of AVD patients with baseline CAASR >0.88/sec was significantly higher (log rank, 97.4% vs. 73.0%; P = 0.03).

CONCLUSIONS

Quantitative measures of aortic mechanics were lower for AS patients, suggesting a more significant derangement of aortic elastic properties. In the context of AVD, vascular mechanics assessment proved useful in gauging clinical prognosis.

Weight Loss in Obese Patients With Heart Failure

BACKGROUND

In heart failure (HF), weight loss (WL) has been associated with an adverse prognosis whereas obesity has been linked to lower mortality (the obesity paradox). The impact of WL in obese patients with HF is incompletely understood. Our objective was to explore the prevalence of WL and its impact on long-term mortality, with an emphasis on obese patients, in a cohort of patients with chronic HF.

METHODS AND RESULTS

Weight at first visit and the 1-year follow-up and vital status after 3 years were assessed in 1000 consecutive ambulatory, chronic HF patients (72.7% men; mean age 65.8±12.1 years). Significant WL was defined as a loss of ≥5% weight between baseline and 1 year. Obesity was defined as body mass index ≥30 kg/m(2) (N=272). Of the 1000 patients included, 170 experienced significant WL during the first year of follow-up. Mortality was significantly higher in patients with significant WL (27.6% versus 15.3%, P<0.001). In univariable Cox regression analysis, patients with significant WL had 2-fold higher mortality (hazard ratio 1.95 [95% CI 1.39-2.72], P<0.001). In multivariable analysis, adjusting for age, sex, body mass index, New York Heart Association functional class, left ventricular ejection fraction, HF duration, ischemic etiology, diabetes, and treatment, significant WL remained independently associated with higher mortality (hazard ratio 1.89 [95% CI 1.32-2.68], P<0.001). Among obese patients with HF, significant WL was associated with an even more ominous prognosis (adjusted hazard ratio for death of 2.38 [95% CI 1.31-4.32], P=0.004) than that observed in nonobese patients (adjusted hazard ratio 1.83 [95% CI 1.16-2.89], P=0.01).

CONCLUSIONS

Weight loss ≥5% in patients with chronic HF was associated with high long-term mortality, particularly among obese patients with HF.

Body composition in chronic kidney disease

PURPOSE OF REVIEW

To summarize the latest information on body composition among patients with chronic kidney disease and its association with outcomes.

RECENT FINDINGS

Obesity is increasing among patients with end-stage renal disease and is more prevalent when direct measures of adiposity are used rather than BMI. High BMI is not associated with better survival among patients with earlier chronic kidney disease or after kidney transplantation, suggesting that excess fat is most protective among the sickest patients. Despite the positive association between BMI and survival among patients with end-stage renal disease, visceral fat is associated with coronary artery calcification and adverse cardiovascular events. Muscle wasting is prominent among patients with chronic kidney disease, sometimes even in the setting of obesity. Obesity and muscle wasting are associated with worse physical functioning. Indicators of low muscle size and strength are associated with higher mortality. Some interventions can affect body composition, but whether they affect survival has not been determined.

SUMMARY

Recent studies show that a high BMI is not protective for all patients with chronic kidney disease and is associated with poor physical functioning and frailty. Visceral adiposity is associated with adverse cardiovascular outcomes. Sarcopenia is common among patients with end-stage renal disease and is associated with worse physical performance and higher mortality.

Elevated Patient Body Mass Index Does Not Negatively Affect Self-Reported Outcomes of Thoracolumbar Surgery: Results of a Comparative Observational Study with Minimum 1-Year Follow-Up

Study Design Retrospective study. Objective Quantify the effect of obesity on elective thoracolumbar spine surgery patients. Methods Five hundred consecutive adult patients undergoing thoracolumbar spine surgery to treat degenerative pathologies with minimum follow-up of at least 1 year were included. Primary outcome measures included Numerical Rating Scales for back and leg pain, the Short Form 36 Physical Component Summary and Mental Component Summary, the modified Oswestry Disability Index, and patient satisfaction scores collected preoperatively and at 3, 6, 12, and 24 months postoperatively. Secondary outcome measures included perioperative and postoperative adverse events, postoperative emergency department presentation, hospital readmission, and revision surgeries. Patients were grouped according to World Health Organization body mass index (BMI) guidelines to isolate the effect of obesity on primary and secondary outcome measures. Results Mean BMI was 30 kg/m(2), reflecting a significantly overweight population. Each BMI group reported statistically significant improvement on all self-reported outcome measures. Contrary to our hypothesis, however, there was no association between BMI group and primary outcome measures. Patients with BMI of 35 to 39.99 visited the emergency department with complaints of pain significantly more often than the other groups. Otherwise, we did not detect any differences in the secondary outcome measures between BMI groups. Conclusions Patients of all levels of obesity experienced significant improvement following elective thoracolumbar spine surgery. These outcomes were achieved without increased risk of postoperative complications such as infection and reoperation. A risk-benefit algorithm to assist with surgical decision making for obese patients would be valuable to surgeons and patients alike.

Why are there race/ethnic differences in adult body mass index-adiposity relationships? A quantitative critical review

Body mass index (BMI) is now the most widely used measure of adiposity on a global scale. Nevertheless, intense discussion centers on the appropriateness of BMI as a phenotypic marker of adiposity across populations differing in race and ethnicity. BMI-adiposity relations appear to vary significantly across race/ethnic groups, but a collective critical analysis of these effects establishing their magnitude and underlying body shape/composition basis is lacking. Accordingly, we systematically review the magnitude of these race-ethnic differences across non-Hispanic (NH) white, NH black and Mexican American adults, their anatomic body composition basis and potential biologically linked mechanisms, using both earlier publications and new analyses from the US National Health and Nutrition Examination Survey. Our collective observations provide a new framework for critically evaluating the quantitative relations between BMI and adiposity across groups differing in race and ethnicity; reveal new insights into BMI as a measure of adiposity across the adult age-span; identify knowledge gaps that can form the basis of future research and create a quantitative foundation for developing BMI-related public health recommendations.

Finding big shots: small-area mapping and spatial modelling of obesity among Swiss male conscripts

BACKGROUND

In Switzerland, as in other developed countries, the prevalence of overweight and obesity has increased substantially since the early 1990s. Most of the analyses so far have been based on sporadic surveys or self-reported data and did not offer potential for small-area analyses. The goal of this study was to investigate spatial variation and determinants of obesity among young Swiss men using recent conscription data.

METHODS

A complete, anonymized dataset of conscription records for the 2010-2012 period were provided by Swiss Armed Forces. We used a series of Bayesian hierarchical logistic regression models to investigate the spatial pattern of obesity across 3,187 postcodes, varying them by type of random effects (spatially unstructured and structured), level of adjustment by individual (age and professional status) and area-based [urbanicity and index of socio-economic position (SEP)] characteristics.

RESULTS

The analysed dataset consisted of 100,919 conscripts, out of which 5,892 (5.8 %) were obese. Crude obesity prevalence increased with age among conscripts of lower individual and area-based SEP and varied greatly over postcodes. Best model's estimates of adjusted odds ratios of obesity on postcode level ranged from 0.61 to 1.93 and showed a strong spatial pattern of obesity risk across the country. Odds ratios above 1 concentrated in central and north Switzerland. Smaller pockets of elevated obesity risk also emerged around cities of Geneva, Fribourg and Lausanne. Lower estimates were observed in North-East and East as well as south of the Alps. Importantly, small regional outliers were observed and patterning did not follow administrative boundaries. Similarly as with crude obesity prevalence, the best fitting model confirmed increasing risk of obesity with age and among conscripts of lower professional status. The risk decreased with higher area-based SEP and, to a lesser degree - in rural areas.

CONCLUSION

In Switzerland, there is a substantial spatial variation in obesity risk among young Swiss men. Small-area estimates of obesity risk derived from conscripts records contribute to its understanding and could be used to design further studies and interventions.

Critical care of obese patients during and after spine surgery

Obesity is one of the most prevalent health problems facing the United States today, with a recent JAMA article published in 2014 estimating the prevalence of one third of all adults in the United States being obese. Also, due to technological advancements, the incidence of spine surgeries is growing. Considering these overall increases in both obesity and the performance of spinal surgeries, it can be inferred that more spinal surgery candidates will be obese. Due to this, certain factors must be taken into consideration when dealing with spine surgeries in the obese. Obesity is closely correlated with additional medical comorbidities, including hypertension, coronary artery disease, congestive heart failure, and diabetes mellitus. The pre-operative evaluation may be more difficult, as a more extensive medical evaluation may be needed. Also, adequate radiographic images can be difficult to obtain due to patient size and equipment limitations. Administering anesthesia becomes more difficult, as does proper patient positioning. Post-operatively, the obese patient is at greater risk for reintubation, difficulty with pain control, wound infection and deep vein thrombosis. However, despite these concerns, appropriate clinical outcomes can still be achieved in the obese spine surgical candidate. Obesity, therefore, is not a contraindication to spine surgery, and appropriate patient selection remains the key to obtaining favorable clinical outcomes.

How well does the standard body mass index or variations with a different exponent predict human lifespan?

OBJECTIVE

The objective was twofold: (1) to estimate for each individual the body mass index (BMI) which is associated with the lowest risk of death, and (2) to study variants of the BMI formula to determine which gives the best predictions of death.

METHODS

Treating BMI = mass/height(2) as a continuous variable and estimating its interaction effects with several other variables, this study analyzed the NIH-AARP study data set of approximately 566,000 individuals and fit Cox proportional hazards models to the survival times.

RESULTS

For each individual, a "personalized optimal BMI," the BMI for that individual which, according to the model, is associated with the lowest risk of death, is estimated. The average personalized optimal BMI is approximately 26, which is in the current "overweight" category. In fact, mass/height is a better predictor of death on the data set than BMI itself.

CONCLUSIONS

The model suggests that an individual's "optimal" BMI depends on his or her features; "one-size-fits-all" recommendations may be not best.

Hypoadiponectinemia and the presence of metabolic syndrome in patients with chronic kidney disease: results from the KNOW-CKD study

BACKGROUND

In patients with chronic kidney disease, metabolic syndrome has been demonstrated to be the culprit behind diverse complications. Adiponectin is known to have anti-atherogenic and cardio-protective effects. Meanwhile, the relationship between adiponectin and metabolic syndrome in patients with chronic kidney disease has not been clarified. The aim of this study was to elucidate the relationship between adiponectin level and metabolic syndrome in patients with chronic kidney disease.

METHODS

The KoreaN Cohort Study for Outcome in Patients with Chronic Kidney Disease is a cohort study that enrolled subjects with chronic kidney disease throughout South Korea. From February 2011 to July 2014, data were collected from 1332 patients with chronic kidney disease.

RESULTS

The mean age of the patients was 53.5 years and 803 patients (60.7%) were men. The median adiponectin level was 10.7 μg/mL and 585 (44.3%) patients had metabolic syndrome. In multiple linear regression analysis, log adiponectin was positively associated with high-density lipoprotein cholesterol levels (β = 0.006), whereas it was negatively associated with serum albumin (β = -0.284), triglyceride (log β = -0.288), high sensitivity C-reactive protein (log β = -0.058) levels and estimated glomerular filtration rate (β = -0.005). Multiple logistic regression analysis indicated that low adiponectin level was independently associated with a higher risk of metabolic syndrome (per 1 μg/mL increase; odds ratio = 0.953, 95% confidence interval = 0.898-0.970, P < 0.001) after adjustment for multiple confounding factors.

CONCLUSIONS

Hypoadiponectinemia is independently associated with the presence of metabolic syndrome in patients with chronic kidney disease.

Capitalizing on mobile technology to support healthy eating in ethnic minority college students

OBJECTIVE

To evaluate the capacity of a mobile technology-based intervention to support healthy eating among ethnic minority female students.

PARTICIPANTS

Forty-three African American and Hispanic female students participated in a 3-week intervention between January and May 2013.

METHODS

Participants photographed their meals using their smart phone camera and received motivational text messages 3 times a day. At baseline, postintervention, and 10 weeks after the intervention, participants reported on fruit, vegetable, and sugar-sweetened beverage consumption. Participants were also weighed at baseline.

RESULTS

Among participants with body mass index (BMI) ≥25, fruit and vegetable consumption increased with time (p < .01). Among participants with BMI <21, consumption of fruit decreased (p < .05), whereas the consumption of vegetables remained stable. No effects were found for sugar-sweetened beverage consumption.

CONCLUSION

Mobile technology-based interventions could facilitate healthy eating among female ethnic minority college students, particularly those with higher BMI.

Beyond BMI: Conceptual Issues Related to Overweight and Obese Patients

BMI is widely used as a measure of weight status and disease risks; it defines overweight and obesity based on statistical criteria. BMI is a score; neither is it biologically sound nor does it reflect a suitable phenotype worthwhile to study. Because of its limited value, BMI cannot provide profound insight into obesity biology and its co-morbidity. Alternative assessments of weight status include detailed phenotyping by body composition analysis (BCA). However, predicting disease risks, fat mass, and fat-free mass as assessed by validated techniques (i.e., densitometry, dual energy X ray absorptiometry, and bioelectrical impedance analysis) does not exceed the value of BMI. Going beyond BMI and descriptive BCA, the concept of functional body composition (FBC) integrates body components into regulatory systems. FBC refers to the masses of body components, organs, and tissues as well as to their inter-relationships within the context of endocrine, metabolic and immune functions. FBC can be used to define specific phenotypes of obesity, e.g. the sarcopenic-obese patient. Well-characterized obesity phenotypes are a precondition for targeted research (e.g., on the genomics of obesity) and patient-centered care (e.g., adequate treatment of individual obese phenotypes such as the sarcopenic-obese patient). FBC contributes to a future definition of overweight and obesity based on physiological criteria rather than on body weight alone.

Body adiposity index performance in estimating body fat in a sample of severely obese Brazilian patients

Background/objectives

The body adiposity index (BAI) estimates the amount of body fat (BF) in humans. In Mexican-American and African-American populations, BAI has performed better than body mass index (BMI). The aim of this study was to evaluate the performance of BAI in estimating percentage (BF%) in severely obese Brazilian patients, with air displacement plethysmography (ADP) used as the reference method.

Subjects/methods

Estimation of BF% by ADP, anthropometric measurements (height, abdominal and hip circumferences, body weight, and BMI) and BAI calculation were performed in 72 obese subjects (BMI ≥ 30 kg/m²) aged 30–55 years.

Results

The mean BF% estimates ± standard deviation were 52.1 ± 5.7 % for ADP and 47.7 ± 7.4 % for BAI, with a positive Pearson correlation (r_p = 0.66) and a positive Lin’s concordance correlation (r_c = 0.479) observed between these methods. The 95 % limits of individual agreement between BAI and ADP ranged from -5.769 % to 16.036 %, with BAI exhibiting an average positive bias of 5.13 % compared to the reference method. For each studied variable, BAI exhibited a systematic bias, as evidenced by a tendency for low BF% values to be overestimated.

Conclusion

For Brazilian patients with severe obesity, BAI does not provide an accurate estimate of BF%.

Ethnic differences in sleep duration and morning-evening type in a population sample

This cross-sectional population study examined associations of sleep duration and morning-evening type with sociodemographic and cardiometabolic disease in adults participating in the UK Biobank study (N = 439 933). Multivariable Poisson regression models of sleep duration and morning-evening type with a robust error variance were generated to estimate adjusted prevalence ratios and their 95% confidence intervals. All models were adjusted for sex, race, college attendance, employment status and age. Twenty five percent of the sample reported short sleep; 27% were morning, 64% intermediate and 9% evening type. Black ethnicity emerged as most strongly associated with sleep behavior. Short sleep was twice as prevalent, and morning versus intermediate type was 1.4 times more prevalent in Black than White participants. The greater prevalence of short sleep and morning type among Blacks suggests that sleep-based approaches to improving cardiometabolic outcomes may require a more multidimensional approach that encompasses adequate sleep and circadian alignment in this population.

Assessment of Short-term Blood Pressure Variability in Patients With Ascending Aortic Dilatation

BACKGROUND

Blood pressure variability (BPV) is a novel parameter related to adverse cardiovascular findings and events, especially in hypertensive patients. The aim of the present study was to investigate the relationship between short-term BPV and ascending aortic dilatation (AAD).

HYPOTHESIS

Hypertensive patients with AAD may exhibit higher short-term BPV compared to hypertensive patients with normal diameter ascending aorta and BPV may be correlated with aortic sizes.

METHODS

Seventy-six hypertensive patients with AAD and 181 hypertensive patients with a normal-diameter ascending aorta were retrospectively enrolled in the study. Clinical data, echocardiographic characteristics, and 24-hour ambulatory blood pressure monitoring characteristics were compared between the 2 groups. Standard deviation (SD) and Δ of BP were used as parameters of BPV.

RESULTS

Although 24-hour mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were similar between the 2 groups, the SD of SBP and SD of DBP values were significantly higher in AAD patients (17.2 ± 6.8 vs 13.8 ± 3.5, P < 0.01; and 12.1 ± 5.1 vs 10.7 ± 3.1, P = 0.02, respectively). Daytime SD of SBP values were higher in AAD patients, whereas nighttime SD of SBP values did not differ between groups. In multivariate linear regression analysis, 24-hour SD of SBP, 24-hour Δ SBP, daytime SD of SBP, daytime Δ SBP, and left ventricular mass index were independently correlated with aortic size index.

CONCLUSIONS

Our study revealed higher levels of short-term BPV in hypertensive patients with AAD. This conclusion warrants further study.

A Larger Body Mass Index is Associated with Increased Atherogenic Dyslipidemia, Insulin Resistance, and Low-Grade Inflammation in Individuals with Metabolic Syndrome

BACKGROUND

The consequences of increased body mass index (BMI) on the metabolic disorders associated with metabolic syndrome (MetS) have not been thoroughly examined.

METHODS

We analyzed data from 262 individuals, 97 men and 165 women (aged 18-70 years), classified with MetS to investigate whether variations in BMI could be associated with parameters of dyslipidemia, insulin resistance, or low-grade inflammation. We hypothesized that increases in BMI would positively correlate with the major dysregulations in metabolism that define MetS. For this purpose, individuals were separated into four subgroups based on their BMI: normal weight (<25 kg/m(2)), overweight (≥25 to <30 kg/m(2)), obese (≥30 to <40 kg/m(2)), and morbidly obese (≥40 kg/m(2)).

RESULTS

As expected, body weight and waist circumference increased significantly as BMI increased (P < 0.0001). Both systolic and diastolic blood pressure were lower in the normal BMI group compared with the other three BMI groups (P = 0.001). Markers of HDL metabolism were adversely impacted in elevated BMI groups, as both high-density lipoprotein cholesterol (HDL-C) and large HDL decreased as BMI increased (P = 0.01). BMI was negatively correlated with HDL-C (r = -0.193, P = 0.002), HDL size (r = (-)0.227, P = 0.002), and large HDL (r = -0.147, P = 0.037). In addition, plasma insulin was highest in subjects classified as morbidly obese (P < 0.0001). There was also a strong positive correlation between BMI and plasma insulin (r = 0.413, P < 0.0001), whereas adiponectin, a marker of insulin sensitivity, was negatively correlated with BMI (r = -0.288, P = 0.001). Finally, BMI was positively correlated with proinflammatory C-reactive protein (r = 0.312, P = 0.0001) and interleukin-6 (r = 0.238, P = 0.001).

CONCLUSIONS

The data from this study suggest that the physiological factors associated with increased BMI exacerbate the metabolic abnormalities characteristic of MetS.

A non-randomized clinical trial to assess the impact of nonrigid, inelastic corsets on spine function in low back pain participants and asymptomatic controls

BACKGROUND CONTEXT

Although previous studies suggest braces/corsets can reduce acute pain, no prior study has assessed back function after bracing with both self-reported and objective measures. Use of both self-reported and objective measures of spine function together may be important given evidence they assess unique aspects of function.

PURPOSE

The aim was to assess both self-reported and objective measures of spinal function before, and after, use of a nonrigid, inelastic lumbar brace.

STUDY DESIGN/SETTING

This was a non-randomized clinical trial.

PATIENT SAMPLE

The sample included acute low back pain (LBP) participants and asymptomatic controls.

OUTCOME MEASURES

Oswestry Disability Index (ODI), spinal stiffness, and muscle endurance were the outcome measures.

METHODS

Three groups were studied: -LBP/-Brace (n=19), -LBP/+Brace (n=18), and +LBP/+Brace (n=17). Both groups of braced participants were instructed to wear the brace continually for 2 weeks with the exception of bedroom and bathroom activities. Before and after the 2-week period, three measures of spinal function were performed: spinal stiffness via motorized indentation of the L3 spinous process, a modified Sorensen test (timed lumbar extension against gravity), and the ODI. Repeated measures analyses of variance were conducted for all three outcomes.

RESULTS

Among the groups, ODI scores decreased significantly for the +LBP/+Brace group (p<.001) compared with the other two groups. The +LBP/+Brace mean ODI score decreased 3.71 points (95% confidence interval [CI] 2.01-5.40) compared with the -LBP/-Brace group and decreased 3.48 points (95% CI 1.77-5.20) compared with the -LBP/+Brace group. Change scores for the Sorensen test were significantly increased in the +LBP/+Brace group (p=.037) compared with the -LBP/-Brace group (22.47s 95% CI 8.14-36.80). Spinal stiffness did not change significantly between groups.

CONCLUSIONS

This study demonstrates that lumbar function assessed by self-reported and objective measures does not worsen when nonrigid, inelastic bracing is used for short periods of time for those with, or without, back pain. These data add to the existing literature that suggests short-term use of nonrigid, inelastic bracing for acute LBP does not decrease spinal function when measured separately with subjective or objective tools.