How useful is body mass index for comparison of body fatness across age, sex, and ethnic groups?

Effects of Otago Exercise Program and aquatic exercise on fall risk in older adults: A systematic review

BACKGROUND

The aim of this systematic review was to determine the processes and forms of participation in Otago Exercise Program (OEP) and Aquatic exercise(AE) for the prevention of falls in older adults, and to compare the effectiveness of the two exercises as interventions for the prevention of falls in older adults.

METHODS

Using electronic databases such as PubMed, Web of Science, Embase, Scopus, and Google Scholar, we searched for relevant domestic and foreign papers in the last 15 years, and evaluated the methodology and quality of the report by both AMSTAR 2 and PRISMA scales to evaluate the methodology and reporting quality.

RESULTS

A total of 33 papers were included by searching various literatures related to the topic of this study and carefully reviewed by the researcher.

CONCLUSION

This systematic review confirms that OEP and AE effectively prevent falls in older adults by improving cognitive function, lower limb muscle strength, and balance. OEP significantly enhances muscle strength, while AE shows slight superiority in improving balance-related abilities like gait stability. These findings highlight the need for optimized training cycles in OEP and AE to maximize muscle adaptation. Both programs are safe and effective, with potential to reduce falls and enhance physical and cognitive functions. Tailored interventions, aligned with home health care guidelines and specific living environments, can improve quality of life. Future research should explore the optimal exercise modalities and intensities, and conduct longitudinal studies to assess long-term outcomes, particularly for older adults with specific health conditions.

Association of obesity on short- and long-term survival in patients with moderate to severe pneumonia-related ARDS: a retrospective cohort study

BACKGROUND

The incidence of obesity among patients admitted to the intensive care unit (ICU) is increasing, and pneumonia remains the leading cause of acute respiratory distress syndrome (ARDS). The association of obesity on both short- and long-term outcomes in patients with pneumonia-induced ARDS has been the subject of only limited research.

METHODS

We conducted a retrospective analysis of a prospective cohort consisting of ARDS patients who had microbiologically confirmed pneumonia and a PaO2/FiO2 ratio ≤ 150 mmHg. Patients were assessed for mortality at 28 days, 90 days, and at 1 year from the diagnosis of ARDS and compared between obese defined by a body mass index (BMI) ≥ 30 kg.m2 and non-obese patients. Models were adjusted for age, sex, COPD, coronary artery disease, immunodepression, severity score and acute kidney injury on admission to the ICU, severity of ARDS (PaO2/FiO2 ratio ≤ 100 mmHg), severe hypercapnia (PaCO2 ≥ 50 mmHg), ventilatory ratio and plateau pressure the first day of ARDS, influenza, COVID-19, pneumocystosis, and bacteria involved in pneumonia. We also investigated the continuous spectrum of BMI on the risk of mortality.

RESULTS

Of 603 patients, 227 patients (37.6%) were obese. Obesity was associated with female gender (p = 0.009), hypertension (p < 0.001), diabetes mellitus (p < 0.001), COVID-19 pneumonia (p = 0.008), and PaO2/FiO2 ratio ≤ 100 mmHg (p = 0.006). Obesity was independently associated with lower mortality at 28 days (adjusted Odds Ratio (OR) 0.55, 95% confident interval (CI) 0.33-0.90, p = 0.02) but not at 90 days (adjusted OR 0.70, 95% CI 0.45-1.09, p = 0.11) nor at 1 year from the diagnosis of ARDS (adjusted OR 0.73, 95% CI 0.47-1.13, p = 0.16). Mortality at 28 days was significantly lower in obese patients than in non-obese patients when propensity score matching was used (15.2% versus 22%, p = 0.04). BMI was also independently associated with lower mortality at 28 days (p = 0.038) but not with mortality at 90 days (p = 0.12) and 1 year (p = 0.12).

CONCLUSION

Our results suggest that in patients with pneumonia-related ARDS, obesity is independently associated with better survival at 28 days but not at 90 days and 1 year from the diagnosis of ARDS.

Role of obesity-related anthropometric indicators on cognitive function in obese older adults: A systematic review and meta-analysis

OBJECTIVES

The association between obesity and cognitive function in older adults remains inconsistent due to the use of various anthropometric indicators, such as body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR). More conclusive evidence is warranted. The aim of this study was to systematically summarize and synthesize the association between specific obesity-related anthropometric indicators (BMI, WC, and WHR) and cognitive function in obese older adults. Higher BMI, WC, or WHR is linked to cognitive decline in this population.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

A comprehensive literature search was carried out using PubMed, CINAHL, Scopus, Embase, and the Cochrane Library (from their inception to October 2023). Studies investigating the association between obesity indicators, including BMI, WC, WHR, and cognitive performance in older adults were included. The weighted mean difference (WMD), Odds Ratio, and 95 % confidence interval (CI) were used to estimate the pooled effect size. A random-effects model was employed as the main method. Subgroup analyses and the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach were assessed (registered number: CRD42023461770).

RESULTS

Thirty-three eligible studies, involving 83,251 participants, were included. Obese older adults, as assessed by WC, had lower Mini-Mental State Examination (MMSE) scores than non-obese counterparts (WMD -0.84, 95 % CI -1.64 to -0.05, very low certainty). Those measured by WHR had a 31 % higher risk of cognitive impairment (OR 1.31, 95 % CI 1.12 to 1.53, moderate certainty). Subgroup analysis revealed a lower Montreal Cognitive Assessment (MoCA) score in obese group classified by WHO criteria compared to controls (WMD -1.67, 95 % CI -2.94 to -0.39).

CONCLUSION

This review suggests an association between obesity, as measured by WHR and WC, and poorer cognitive performance in older adults. WHR is moderately recommended for identifying cognitive impairment-related obesity, while WC recommendations are limited by very low evidence certainty.

Rising Prevalence of Obesity and Primary Hyperaldosteronism: Co-incidence or Connected Circumstances Leading to Hypertension? A Narrative Review

While obesity and its associated complications, mainly diabetes and hypertension, have been the largest public health problems of modern world, the emerging data suggests an increasing prevalence of primary hyperaldosteronism (PA) as one of the most common undiagnosed causes of hypertension. We believe that rising prevalence of PA in the era of high rates of obesity is likely not a chance finding but is deeply intersected with the rising rates of obesity. Higher serum aldosterone concentrations and urinary aldosterone excretion have been observed in patients with increased body mass index or larger waist circumference. The in vitro and pre-clinical studies suggest that adipocytes not only synthesize and secrete aldosterone but also release factors which stimulate production of aldosterone from adrenal glands. Aldosterone excess causing ligand-dependent activation of the mineralocorticoid receptor (MR) has increasingly been recognized as one of the important mechanisms of obesity-related hypertension. The aldosterone excess in these cases can be labelled as acquired hyperaldosteronism to differentiate it from the non-obesity related classical cases of PA. Because of serious consequences, recognizing aldosterone excess in obesity is important, as it gives a more compelling reason for weight loss and guidance to choosing pharmacotherapy wisely. Dietary sodium restriction and mineralocorticoid receptor antagonists play important roles in the management of PA associated with obesity.

Using music as a mood regulator in everyday life is associated with unfavourable health and fitness outcomes in overweight adults

Individual traits and habits have shown to be associated with health and health behaviour. One such habit is how individuals use music. This study aimed to examine if using music as a mood regulator is related to risk factors of lifestyle diseases. Participants who joined the present Motivation Makes the Move! lifestyle intervention were overweight and sedentary adults (n = 76, ages 19-40). They answered questionnaires about physical activity and use of music. They also underwent a cardiopulmonary exercise test and their body composition was assessed. Additionally, the analyses' robustness was tested through controlling for physical, sociodemographic and psychological health related factors. We observed that despite the participants' self-reported commitment to regular physical activity, their fitness level was poor. Using music as a mood regulator was associated with lower cardiorespiratory fitness. Use of music was also positively linked to body fat percentage, although this finding did not remain significant after adjusting for age, educational level and experienced health. We urge future research to address the relationship between music use and risk factors of lifestyle diseases in a population sample.

The impact of metabolic heterogeneity of obesity and transitions on cardiovascular disease incidence in Chinese middle-aged and elderly population: A nationwide prospective cohort study

BACKGROUND

Previous studies indicated that metabolic heterogeneity of obesity would affect the risk of cardiovascular disease (CVD). However, the alterations in CVD risk associated with transitions between various metabolic health statuses influenced by obesity status remain unclear.

METHODS

We utilized data from the China Health and Retirement Longitudinal Study (CHARLS), a longitudinal cohort study involving Chinese residents aged 45 years and older. Baseline data were collected in 2011-2012, with follow-up surveys conducted up to 2020. Participants in the study were categorized into four body mass index-metabolic phenotypes: metabolically healthy normal weight (MHNW), metabolically healthy overweight/obesity (MHOO), metabolically unhealthy normal weight (MUNW) and metabolically unhealthy overweight/obesity (MUOO). Transitions in these phenotypes over 4 years were analysed. Cox regression models were used to assess the associations of these phenotypes and their transitions with CVD incidence.

RESULTS

Among 7721 participants, 1353 (17.5%) developed CVD during the follow-up period. Both overweight/obese and metabolically unhealthy statuses were associated with increased CVD risk. The highest risk was observed in the MUOO group (hazard ratio [HR]: 1.74, 95% confidence interval [CI]: 1.50-2.09, p < 0.0001), followed by the MUNW (HR 1.35, 95% CI: 1.13-1.66, p < 0.001) and MHOO (HR: 1.29, 95% CI: 1.08-1.56, p = 0.002) groups compared to the MHNW group. The deteriorations of obesity and metabolic health status elevated the incidence of CVD, whereas improvements in these statuses reduced the risk of CVD. Additionally, alterations in metabolic health status conferred greater benefits in overweight/obese individuals compared to those with normal weight.

CONCLUSION

The study highlights the importance of maintaining and promoting metabolic health, particularly in overweight/obese individuals, to reduce CVD risk. Metabolic health status plays a more crucial role than obesity status in predicting CVD incidence.

Abdominal visceral and subcutaneous adipose tissue associations with postmenopausal breast cancer incidence

BACKGROUND

Obesity, classified by body mass index (BMI), is associated with higher postmenopausal breast cancer (BCa) risk. Yet, the associations between abdominal visceral (VAT) and subcutaneous adipose tissue (SAT) with BCa are unclear.

METHODS

We assessed BCa associations with abdominal VAT and SAT in a prospective cohort of postmenopausal women without a history of cancer and with 27 years follow-up (N = 9950), during which all new cancers were adjudicated. Dual-energy x-ray absorptiometry scans assessed adiposity at baseline, year 3, and year 6. Competing-risks multivariable sub-hazard ratios (SHR), with adjustments for sociodemographic, behavioral, reproductive, and anthropometric characteristics, were estimated for baseline and time-dependent associations between VAT, SAT, and incident BCa.

RESULTS

Participants averaged 63.3 ± 7.4 years of age and a BMI of 28.20 ± 5.72 kg/m2 at baseline. The models included 738 incident BCa case patients (N = 593 invasive; N = 145 in situ). Baseline VAT and SAT area were associated with statistically significantly increased BCa risk, by 36% and 19%, respectively. Increasing VAT/SAT ratio was associated with an 8% increase in incident BCa. Time-dependent models produced similar results. VAT and VAT/SAT associated BCa risk was highest for African American/Black women, although not statistically significantly different from other groups. Quartiles (Q) of VAT/SAT were also explored; the SHR for Q4 compared with Q1 was 1.49 (95% CI = 1.18 to 1.87).

CONCLUSION

Higher abdominal VAT and SAT are associated with an increased risk of postmenopausal BCa, and VAT/SAT may provide a distinctive risk estimate. Potential racial and ethnic differences require replication in a larger sample (Women's Health Initiative; NCT00000611; https://clinicaltrials.gov/study/NCT00000611).

Continental differences in the association between excess body weight and prognosis in triple-negative breast cancer: a meta-analysis

PURPOSE

The association between obesity and triple-negative breast cancer (TNBC) prognosis has been equivocal, with considerable heterogeneity between and within studies. Recent meta-analyses report adverse associations with overall survival (OS) and disease-free survival (DFS) in TNBC. We update this evidence and examine study- and disease-specific sources of heterogeneity.

METHODS

A systematic search of four databases was conducted until February 22, 2023. Random-effects meta-analyses were used to pool hazard ratios (HR) for OS, DFS, and breast cancer-specific mortality (BCSM). Subgroup analyses examined sources of study heterogeneity.

RESULTS

In meta-analyses of included studies (n = 33), significant associations were observed between excess body weight and worse OS (n = 24; HR = 1.20; 95%CI 1.20-1.34), DFS (n = 26; HR = 1.15; 1.05-1.27), and BCSM (n = 9; HR = 1.13; 1.00-1.27). In subgroup meta-analyses, significant inter-study survival differences were observed for study location (OS, DFS), time period of diagnoses (DFS), menopausal status (OS), and body mass index cut points examined (OS). Asian and European studies reported significant associations with OS (HR = 1.31; 1.11-1.54 and HR = 1.38; 1.00-1.89, respectively) and DFS (HR = 1.28; 1.07-1.54 and HR = 1.44; 1.13-1.84, respectively); however, no association was observed between obesity and TNBC prognosis in North American studies (OS: HR = 1.03; 0.89-1.19; DFS: HR = 1.05; 0.95-1.15). Location subgroup differences remained robust after excluding poor-quality studies. Post hoc analysis in the subset of studies reporting predominantly (≥ 70%) White sample showed no statistically significant associations for OS (HR = 1.13; 95%CI 0.96, 1.34), DFS (HR = 1.03; 95%CI 0.86, 1.23), or BCSM (HR = 1.08; 95%CI 0.91, 1.27).

CONCLUSION

This study further confirms that obesity is associated with poor prognosis in TNBC and identified subgroups at higher risk. Ethnic differences in the association between excess body weight and TNBC are reported. Further exploration of study and patient characteristics is needed to properly understand the populations most at risk.

Weight/height2: Mathematical overview of the world's most widely used adiposity index

A footnote in Adolphe Quetelet's classic 1835 Treatise on Man described his algebraic analysis of how body weight ( W ) varies with height ( H ) in adult males and females. Using data on 12 short and 12 tall subjects of each sex, Quetelet established the rule that W is approximately proportional ( ∝ ) to H2 in adults; that is, W ∝ H 2 when W ≈ α H 2 for some constant α . Quetelet's Rule ( W ∝ H 2 ), transformed and renamed in the twentieth century to body mass index ( BMI = W / H 2 ), is now a globally applied phenotypic descriptor of adiposity at the individual and population level. The journey from footnote to ubiquitous adiposity measure traveled through hundreds of scientific reports and many more lay publications. The recent introduction of highly effective pharmacologic weight loss treatments has heightened scrutiny of BMI's origins and appropriateness as a gateway marker for diagnosing and monitoring people with obesity. This contemporary context prompted the current report that delves into the biological and mathematical paradigms that underlie the simple index BMI = W / H 2 . Students and practitioners can improve or gain new insights into their understanding of BMI's historical origins and quantitative underpinning from the provided overview, facilitating informed use of BMI and related indices in research and clinical settings.

Exploring the Frontiers of Cell Temperature Measurement and Thermogenesis

The precise measurement of cell temperature and an in-depth understanding of thermogenic processes are critical in unraveling the complexities of cellular metabolism and its implications for health and disease. This review focuses on the mechanisms of local temperature generation within cells and the array of methods developed for accurate temperature assessment. The contact and noncontact techniques are introduced, including infrared thermography, fluorescence thermometry, and other innovative approaches to localized temperature measurement. The role of thermogenesis in cellular metabolism, highlighting the integral function of temperature regulation in cellular processes, environmental adaptation, and the implications of thermogenic dysregulation in diseases such as metabolic disorders and cancer are further discussed. The challenges and limitations in this field are critically analyzed while technological advancements and future directions are proposed to overcome these barriers. This review aims to provide a consolidated resource for current methodologies, stimulate discussion on the limitations and challenges, and inspire future innovations in the study of cellular thermodynamics.

Association of relative fat mass (RFM) index with diabetes-related mortality and heart disease mortality

Although studies have examined the association of the Relative Fat Mass (RFM, a novel anthropometric index used as a surrogate for whole-body fat percentage) with all-cause mortality, the association of RFM with diabetes-related mortality and heart disease mortality has not been thoroughly investigated. In addition, no study has compared the associations of RFM and waist circumference (a surrogate for intra-abdominal fat) with cause-specific mortality and all-cause mortality. In the present study, we addressed these knowledge gaps. We used data from the US National Health and Nutrition Examination Survey (NHANES) 1999-2018. NHANES III was used for validation. Analyses included 46,535 adults (mean age 46.5 years). During a median follow-up time of 9.7 years, 6,101 participants died (743 from diabetes; 1,514 from heart disease). Compared with BMI and WC, RFM was more strongly associated with diabetes-related mortality in both women and men, adjusting for age, ethnicity, education, and smoking status. All anthropometric measures were similarly strongly associated with heart disease mortality and all-cause mortality. RFM showed greater predictive discrimination of mortality. Similar results were found in NHANES III (n = 14,448). In conclusion, RFM is strongly associated with diabetes-related mortality, heart disease mortality, and all-cause mortality, and outperforms conventional adiposity measures for prediction of mortality.

Predicting complications in elderly patients undergoing oral cancer resection with free flap reconstruction in China: a retrospective cohort study using the modified Frailty Index and Prognostic Nutritional Index

OBJECTIVES

This study aimed to evaluate the predictive abilities of the 5-item modified Frailty Index (5-mFI), Prognostic Nutrition Index (PNI), and their combination in older adult patients undergoing oral cancer resection and free flap reconstruction.

DESIGN

Retrospective cohort study.

SETTING

Secondary care involving multiple centres treating older adult patients for oral cancer.

PARTICIPANTS

This study included a total of 1197 patients aged ≥60 years who underwent oral cancer resection with free flap reconstruction between January 2014 and December 2022. The study included patients aged ≥60 years with malignant tumours who underwent selective radical surgery, such as mandibulectomy, maxillectomy, glossectomy or laryngectomy, followed by free flap reconstruction under general anaesthesia. Exclusion criteria included the presence of any inflammatory disease affecting blood test results, incomplete clinical records or missing data for any of the five items in the 5-mFI. Patients were categorised into four groups based on PNI and 5-mFI values: (1) 'Control' (neither frail nor malnourished), (2) 'Frailty' (frail only), (3) 'Malnutrition' (malnourished only) and (4) 'Frailty+Malnutrition' (both frail and malnourished).

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the rate of complications within 30 days after surgery. Secondary outcomes included unplanned reoperation rates, length of postoperative hospital stay and the predictive performance of PNI, 5-mFI and their combination.

RESULTS

The overall complication rate within 30 days post-surgery was 34.6%. The Frailty+Malnutrition group exhibited the highest risk of complications, longer postoperative hospital stays and increased rates of unplanned reoperation compared with the Control, Frailty and Malnutrition groups. The combined PNI and 5-mFI model significantly improved the predictive value for postoperative complications compared with either PNI or 5-mFI alone.

CONCLUSIONS

Older adult patients undergoing oral cancer resection with free flap reconstruction face considerable risk from frailty and malnutrition. Although both 5-mFI and PNI independently demonstrated good predictive abilities for postoperative complications, the combined model provided the best prediction. These findings could help optimise preoperative management in this high-risk population.

Using a Bodily Weight-Fat Scale for Cuffless Blood Pressure Measurement Based on the Edge Computing System

Blood pressure (BP) measurement is a major physiological information for people with cardiovascular diseases, such as hypertension, heart failure, and atherosclerosis. Moreover, elders and patients with kidney disease and diabetes mellitus also are suggested to measure their BP every day. The cuffless BP measurement has been developed in the past 10 years, which is comfortable to users. Now, ballistocardiogram (BCG) and impedance plethysmogram (IPG) could be used to perform the cuffless BP measurement. Thus, the aim of this study is to realize edge computing for the BP measurement in real time, which includes measurements of BCG and IPG signals, digital signal process, feature extraction, and BP estimation by machine learning algorithm. This system measured BCG and IPG signals from a bodily weight-fat scale with the self-made circuits. The signals were filtered to reduce the noise and segmented by 2 s. Then, we proposed a flowchart to extract the parameter, pulse transit time (PTT), within each segment. The feature included two calibration-based parameters and one calibration-free parameter was used to estimate BP with XGBoost. In order to realize the system in STM32F756ZG NUCLEO development board, we limited the hyperparameters of XGBoost model, including maximum depth (max_depth) and tree number (n_estimators). Results show that the error of systolic blood pressure (SBP) and diastolic blood pressure (DBP) in server-based computing are 2.64 ± 9.71 mmHg and 1.52 ± 6.32 mmHg, and in edge computing are 2.2 ± 10.9 mmHg and 1.87 ± 6.79 mmHg. This proposed method significantly enhances the feasibility of bodily weight-fat scale in the BP measurement for effective utilization in mobile health applications.

Which Sex- and Gender-Based Explanatory Variables Are Associated With Memory Function Poststroke? A Cross-Sectional Analysis of the National Health and Aging Trends Study

OBJECTIVE

To identify sex- and gender-based variables associated with immediate and delayed recall in individuals with stroke.

DESIGN

This was a secondary analysis of data from the National Health and Aging Trends Study (NHATS) using general linear models with a standard stepwise approach.

SETTING

Community.

INTERVENTIONS

Not applicable.

PARTICIPANTS

Participants were eligible for the current analysis if they had a self-reported history of stroke at NHATS Round 1 (2011) and data available on our variables of interest. The final analyses included 366 participants for the immediate recall model and 365 participants for the delayed recall model.

MAIN OUTCOME MEASURES

Independent variables of interest included sex- (8 variables, for example biological sex, depression and anxiety, and comorbidities) and gender-related factors (14 variables, for example education, income, and independence with banking). The dependent variables of interest were the 10-word immediate and delayed recall tests, respectively.

RESULTS

Higher immediate recall scores were associated with younger age, female biological sex, independence with banking, higher income, giving financial gifts, not requiring assistance with activities of daily living, and higher education (P<.001-.04). Higher delayed recall scores were associated with younger age, higher body mass index, higher education, placing importance in socializing, and independence with banking (P<.001-.04).

CONCLUSIONS

We conducted the largest analysis to date of sex- and gender-based factors associated with cognition in individuals with stroke. Stroke rehabilitation scientists and clinicians may consider both biological and sociodemographic factors associated with cognitive function, which may guide holistic poststroke assessments and interventions.

Body Mass Index Is Associated With Orbital Pulley Degeneration Syndrome, Including Sagging Eye Syndrome

PURPOSE

Sagging eye syndrome (SES), esotropia with high myopia including heavy eye syndrome, and age-related esotropia (ARE)-collectively termed orbital pulley degeneration syndrome (OPDS)-are characterized by strabismus with orbital pulley lateral rectus-superior rectus band impairment. Herein, we examined body mass index (BMI) in OPDS to determine SES-associated anthropometric characteristics.

DESIGN

Retrospective cohort study.

METHODS

We compiled and analyzed the BMI of patients aged ≥50 years who underwent strabismus surgery at a single center in Shizuoka, Japan, between July 2020 and March 2023. BMI (kg/m2) was categorized into 4 groups: <18.5, 18.5 to 21.9, 22 to 24.9, and ≥25. As the boundary between OPDS and SES is ambiguous, we assumed a pure SES group by excluding patients with ARE and esotropia with high myopia from the OPDS group. Overall, 204 patients (age: 67.7 ± 9.7 years) were included in the study.

RESULTS

There were 78/126 and 49/119 patients in the OPDS/non-OPDS and SES/non-SES groups (age: 70.4 ± 9.5/66.0 ± 9.6 years, P = .002 and 75.0 ± 6.0/66.6 ± 9.5 years, P < .001; BMI: 21.2 ± 3.3/23.2 ± 3.0 kg/m2, P < .001 and 21.2 ± 3.3/23.1 ± 3.0 kg/m2, P = .003), respectively. In the BMI-stratified analysis, OPDS and SES were more prevalent in the <18.5 BMI group than in the 22 to 24.9 and ≥25 BMI groups (P < .001 and P = .006, respectively). Logistic regression analysis, adjusted for age and sex, showed that lower BMI was associated with a higher prevalence of OPDS and SES.

CONCLUSIONS

Patients with OPDS, including SES, had lower BMI than other patients with strabismus. Therefore, BMI may be a clinical clue to SES.

Changes in body composition in early breast cancer patients treated with aromatase inhibitors

PURPOSE

The aim of the study was to analyze the modification of total and regional body composition in early breast cancer patients treated with aromatase inhibitors (AIs).

METHODS

This is a prospective, single-center, observational, longitudinal study. Four-hundred and twenty-eight patients treated with adjuvant aromatase inhibitors were enrolled at the Medical Oncology and Breast Unit of Spedali Civili Hospital in Brescia from September 2014 to June 2022. Several body composition parameters including total and regional fat and lean body mass were investigated with dual-energy X-ray absorptiometry (DXA) scan at baseline and after 18 months of treatment with aromatase inhibitors.

RESULTS

A significant increase in fat body mass (mean + 7.2%, 95% confidence interval [CI]: 5.5;8.9%) and a reduction in lean body mass (mean -3.1%, 95% CI -3.9; -2.4) were documented in this population. The changes in fat and lean body mass varied considerably according to different body districts ranging between + 3.2% to + 10.9% and from-1.3% to -3.9%, respectively.

CONCLUSION

Aromatase inhibitor adjuvant therapy in early breast cancer is associated with changes in body composition, with a wide variability among different body districts, leading to a risk of sarcopenic obesity. Supervised physical exercise that focuses on single body parts that may display detrimental variations may be beneficial for AIs treated patients.

Obesity, aldosterone excess, and mineralocorticoid receptor activation: Parallel or intersected circumstances?

The obesity pandemic, with its associated comorbidities of hypertension and diabetes, constitutes a global public health issue. Importantly, there is an increasing prevalence of aldosterone excess related to obesity and resultant poor health outcomes. Nevertheless, the association between aldosterone and obesity still needs to be clarified. In this review, the authors discuss the role of white adipose tissue in linking obesity, aldosterone excess, and hypertension. The consequences of aldosterone excess in obesity are presented as genomic, non-genomic, and non-epithelial effects. Moreover, the authors emphasize the value of interference with aldosterone pathophysiology (as with mineralocorticoid antagonists) in obesity, thus reducing the adverse clinical impact of aldosterone in myocardial infarction, heart failure, kidney dysfunction, and associated mortality.

Exploring the interplay between body mass index and passive muscle properties in relation to grip strength and jump performance in female university students

Background

Women typically have a higher body fat content than men. Fat accumulation is associated with muscle weakness and alterations in mechanical properties. This study aims to determine the relationship between BMI and weight status with the mechanical properties of muscle and tendon. It was hypothesized that the stiffness and tone of the forearm muscle and Achilles tendon would be correlated with weight status and BMI.

Methods

A cross-sectional study was conducted with 136 female university students. Grip strength was assessed using a dynamometer, body composition was analyzed through bioimpedance, and countermovement jump performance was evaluated with a force platform. Stiffness and tone were measured using the MyotonPro device. ANOVA was used to compare grip strength and countermovement jump performance according to body composition. The Pearson correlation coefficient was used to examine bivariate associations.

Results

Relative grip strength decreased with an increase in fat content, while forearm muscle stiffness and tone decreased with rising weight status and BMI. Stiffness of the Achilles tendon increased with an increase in fat content and showed a significant positive correlation with BMI. Multiple regression analysis revealed a weak correlation between BMI, body composition, and stiffness of the forearm muscles.

Conclusion

The results of this study support the notion that the stiffness of the forearm muscles and Achilles tendon is correlated with BMI in young adult women. Furthermore, an increase in body fat percentage is linked to a decrease in mechanical properties and poorer muscle function.

Distinct biophysiological effects of Ramadan fasting and traditional intermittent fasting on markers of body fat storage. A real-life study

BACKGROUND

Ramadan Intermittent fasting (RIF) exerts beneficial metabolic effects and improves gastrointestinal motility. However, a comparison between RIF and the traditional 16-hours intermittent fasting (16IF), a strategy for weight loss, is lacking.

METHODS

A total of 34 subjects (median age 32.5 years, range 18-63 years; median BMI 24.5 Kg m-1², range 18.6-37.6 Kg m-1²) were assigned to RIF (N = 18) or 16IF (N = 16) for 30 days. We measured variations in anthropometric measures (BMI, waist, and abdominal circumference), serum insulin, glucose, cortisol, non-esterified fatty acid (NEFA), body fat composition (bioelectrical impedance analysis), and the ultrasonographic measurements of liver steatosis (Hepatorenal index, HRI) and thickness of subcutaneous (SAT) and visceral (VAT) fats.

RESULTS

At baseline, BMI, rates of liver steatosis and distribution of normal weight, overweight, and obese subjects were comparable between the two groups. Body weight significantly decreased at the end of fasting in both RIF (-4.2 % vs baseline, P = 0.002) and 16IF (-2.1 % vs baseline, P = 0.002). Waist and abdominal circumferences significantly decreased only in RIF as well as the amount of body fat. In subjects with liver steatosis, SAT and VAT significantly decreased following RIF, but not 16h-IF, as well as the ultrasonographic HRI.

CONCLUSION

Both 16IF and RIF are able, during 1-month, to reduce body weight. However, RIF but not 16IF also generates marked beneficial effects in terms of reduced subcutaneous fat and liver steatosis. Further studies urge to verify the effects of different models of IF in weight-cycling and long-term management of obesity and related dysmetabolic conditions, such as ectopic fat over-storage.

Association of visceral adiposity index and lipid accumulation products with prediabetes in US adults from NHANES 2007-2020: A cross-sectional study

BACKGROUND

The lipid accumulation product (LAP) and the visceral adiposity index (VAI) are suggested as dependable measures for assessing visceral fat levels. Prediabetes is recognized as a condition that precedes the potential onset of diabetes. The objective of this research is to investigate how VAI and LAP are related to prediabetes among the adult population in the United States.

METHODS

Information from the 2007-2020 National Health and Nutrition Examination Survey (NHANES) was scrutinized in a cross-sectional study. To evaluate the connection between VAI or LAP and the presence of prediabetes, both univariate analysis and multivariate logistic regression were utilized. Threshold effect analysis and fitted smoothing curves were used to delve into the non-linear association between VAI or LAP and prediabetes. Additional analyses were performed on specific subgroups, along with tests to explore potential interactions.

RESULTS

In general, 12,564 American adults were included. After full adjustment, prediabetes with VAI (OR: 1.128, 95% CI: 1.073-1.185) or LAP (OR: 1.006, 95% CI: 1.004-1.008) showed a positive correlation. Individuals in the 4th VAI quartile group faced a significant 61.9% elevated risk for prediabetes (OR: 1.619, 95% CI: 1.354-1.937) when contrasted to those in the 1st VAI quartile. Participants in the 4th LAP quartile group had a significant 116.4% elevated risk for prediabetes (OR: 2.164, 95% CI: 1.747-2.681) when contrasted to individuals of the 1st LAP quartile. Smooth curve fitting analysis revealed a nonlinear correlation of VAI or LAP and prediabetes, and threshold effect analysis was used to determine an inflection point of 4.090 for VAI and 68.168 for LAP.

CONCLUSIONS

The values of VAI and LAP are positively associated with the prevalence of prediabetes. The VAI and LAP indices may be used as predictors of prediabetes.

The obesity paradox exists for perioperative complications and mortality following lower extremity arterial bypass surgery

OBJECTIVE

The obesity paradox refers to a phenomenon by which obese individuals experience lower risk of mortality and even protective associations from chronic disease sequelae when compared with the non-obese and underweight population. Prior literature has demonstrated an obesity paradox after cardiac and other surgical procedures. However, the relationship between body mass index (BMI) and perioperative complications for patients undergoing major open lower extremity arterial revascularization is unclear.

METHODS

We queried the Vascular Quality Initiative for individuals receiving unilateral infrainguinal bypass between 2003 and 2020. We used multivariable logistic regression to assess the relationship of BMI categories (underweight [<18.5 kg/m2], non-obese [18.5-24.9 kg/m2], overweight [25-29.9 kg/m2], Class 1 obesity [30-34.9 kg/m2], Class 2 obesity [35-39.9 kg/m2], and Class 3 obesity [>40 kg/m2]) with 30-day mortality, surgical site infection, and adverse cardiovascular events. We adjusted the models for key patient demographics, comorbidities, and technical and perioperative characteristics.

RESULTS

From 2003 to 2020, 60,588 arterial bypass procedures met inclusion criteria for analysis. Upon multivariable logistic regression with the non-obese category as the reference group, odds of 30-day mortality were significantly decreased among the overweight (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.53-0.78), Class 1 obese (OR, 0.65; 95% CI, 0.52-0.81), Class 2 obese (OR, 0.66; 95% CI, 0.48-0.90), and Class 3 obese (OR, 0.61; 95% CI, 0.39-0.97) patient categories. Conversely, odds of 30-day mortality were increased in the underweight patient group (OR, 1.58; 95% CI, 1.16-2.13). Furthermore, a BMI-dependent positive association was present, with odds of surgical site infections with patients in Class 3 obesity having the highest odds (OR, 2.10; 95% CI, 1.60-2.76). Finally, among the adverse cardiovascular event outcomes assessed, only myocardial infarction (MI) demonstrated decreased odds among overweight (OR, 0.82; 95% CI, 0.71-0.96), Class 1 obese (OR, 0.78; 95% CI, 0.65-0.93), and Class 2 obese (OR, 0.66; 95% CI, 0.51-0.86) patient populations. Odds of MI among the underweight and Class 3 obesity groups were not significant.

CONCLUSIONS

The obesity paradox is evident in patients undergoing lower extremity bypass procedures, particularly with odds of 30-day mortality and MI. Our findings suggest that having higher BMI (overweight and Class 1-3 obesity) is not associated with increased mortality and should not be interpreted as a contraindication for lower extremity arterial bypass surgery. However, these patients should be under vigilant surveillance for surgical site infections. Finally, patients that are underweight have a significantly increased odds of 30-day mortality and may be more suitable candidates for endovascular therapy.

Body fat percentage vs body mass index in estimating basal cell carcinoma

Background

The role of body mass index (BMI) in basal cell carcinoma (BCC) risk remains controversial, and limited information is available regarding the relationship between other physical measurements and BCC. Several recent studies have found a positive effect of adiposity on improved survival when obesity was determined solely by BMI (the "obesity paradox"). We hypothesize that body fat percentage (BFP) may serve as a more sensitive risk factor for BCC than BMI.

Methods

The study conducted a retrospective analysis of clinical data from two distinct centers in China. Individual patient-level data were obtained from medical record reviews spanning January 1, 2015, to December 31, 2022. Associations with outcomes were analyzed using univariate and stratified analyses and assessed using multiple logistic regression with adjustment for confounding factors. Additionally, we performed a meta-analysis to further test the observations in our study.

Results

A total of 337 patients, ranging in age from 50 to 91 years, with a mean age of 66.88 (standard deviation 10.16), were included. We observed no significant association between BMI and BCC after adjusting for confounders (OR: 0.71, 95 % CI: 0.36-1.40, P = 0.3186). There was also no convincing effect in a meta-analysis (n = 158,741) (OR: 0.99, 95 % CI: 0.93-1.06, P = 0.8). Furthermore, BFP was found to be associated with BCC (OR: 2.64, 95 % CI: 1.17-5.97, P = 0.0196), supported by strong clinical evidence.

Conclusions

Our study supports the hypothesis that BFP is superior to BMI in assessing BCC risk. Multiple logistic regression analyses, coupled with meta-analysis, provided robust evidence that BFP is a sensitive risk factor for BCC, while BMI appears unrelated to risk. According to these findings, routine healthcare practices could benefit from utilizing BFP measurements. The reduction of body fat percentage in low-fat diets may be beneficial for adjuvant treatment of BCC.

Body mass index and survival among patients with advanced biliary tract cancer: a single-institutional study with nationwide data-based validation

BACKGROUND

Excess body weight may modulate the progression of various cancer types. The prognostic relevance of body mass index (BMI) has not been fully examined in patients with biliary tract cancer.

METHODS

Using a single-institutional cohort of 360 patients receiving gemcitabine-based chemotherapy for advanced biliary tract cancer, we examined the association of BMI with overall survival (OS). Using the Cox regression model with adjustment for potential confounders, we calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for OS according to BMI. The findings were validated using a Japanese nationwide inpatient database including 8324 patients treated at 201 hospitals.

RESULTS

In the clinical cohort, BMI was not associated with OS (Ptrend = 0.34). Compared to patients with BMI = 18.5-24.9 kg/m2, patients with BMI < 18.5 kg/m2 and ≥ 25.0 kg/m2 had adjusted HRs for OS of 1.06 (95% CI, 0.78-1.45) and 1.01 (95% CI, 0.74-1.39), respectively. There was no evidence on a non-linear relationship between BMI and OS (Pnonlinearity = 0.63). In the nationwide cohort, the null findings were validated (Ptrend = 0.18) with adjusted HRs of 1.07 (95% CI, 0.98-1.18) for BMI < 18.5 kg/m2 and 1.05 (95% CI, 0.96-1.14) for BMI ≥ 25.0 kg/m2 (vs. BMI = 18.5-24.9 kg/m2). In the clinical cohort, BMI was not associated with progression-free survival (Ptrend = 0.81).

CONCLUSIONS

BMI was not associated with survival outcomes of patients with advanced biliary tract cancer. Further research is warranted incorporating more detailed body composition metrics to explore the prognostic role of adiposity in biliary tract cancer.

Age-appropriate BMI cut-offs for malnutrition among older adults in India

With the increasing prevalence of obesity in India, body mass index (BMI) has garnered importance as a disease predictor. The current World Health Organization (WHO) body mass index (BMI) cut-offs may not accurately portray these health risks in older adults aged 60 years and above. This study aims to define age-appropriate cut-offs for older adults (60-74 years and 75 years and above) and compare the performance of these cut-offs with the WHO BMI cut-offs using cardio-metabolic conditions as outcomes. Using baseline data from the Longitudinal Ageing Study in India (LASI), classification and regression tree (CART) cross-sectional analysis was conducted to obtain age-appropriate BMI cut-offs based on cardio-metabolic conditions as outcomes. Logistic regression models were estimated to compare the association of the two sets of cut-offs with cardio-metabolic outcomes. The area under the receiver operating characteristic curve (AUC), sensitivity and specificity were estimated. Agreement with waist circumference, an alternate measure of adiposity, was conducted. For older adults aged 60-74 years and 75 years and above, the cut-off for underweight reduced from < 18.5 to < 17.4 and < 13.3 respectively. The thresholds for overweight and obese increased for older adults aged 60-74 years old from >  = 25 to > 28.8 and >  = 30 to > 33.7 respectively. For older adults aged 75 years and above, the thresholds decreased for both categories. The largest improvement in AUC was observed in older adults aged 75 years and above. The newly derived cut-offs also demonstrated higher sensitivity and specificity among all age-sex stratifications. There is a need to adopt greater rigidity in defining overweight/obesity among older adults aged 75 years and above, as opposed to older adults aged 60-74 years old among whom the thresholds need to be less conservative. Further stratification in the low risk category could also improve BMI classification among older adults. These age-specific thresholds may act as improved alternatives of the current WHO BMI thresholds and improve classification among older adults in India.

Testing the validity of online psychophysical measurement of body image perception

This body image study tests the viability of transferring a complex psychophysical paradigm from a controlled in-person laboratory task to an online environment. 172 female participants made online judgements about their own body size when viewing images of computer-generated female bodies presented in either in front-view or at 45-degrees in a method of adjustment (MOA) paradigm. The results of these judgements were then compared to the results of two laboratory-based studies (with 96 and 40 female participants respectively) to establish three key findings. Firstly, the results show that the accuracy of online and in-lab estimates of body size are comparable, secondly that the same patterns of visual biases in judgements are shown both in-lab and online, and thirdly online data shows the same view-orientation advantage in accuracy in body size judgements as the laboratory studies. Thus, this study suggests that that online sampling potentially represents a rapid and accurate way of collecting reliable complex behavioural and perceptual data from a more diverse range of participants than is normally sampled in laboratory-based studies. It also offers the potential for designing stratified sampling strategies to construct a truly representative sample of a target population.

Sexual dimorphism of adiposity and fat distribution among children and adolescents (8-18 year olds) from Poland

OBJECTIVES

The study aimed to analyze the sexual dimorphism of total body fat [BF%] and fat distribution among 8-18 year olds from Poland.

METHODS

The study included 2175 participants, divided into sex and age groups. Waist and hip circumferences, the thickness of six skinfolds, waist-to-hips ratio [WHR], the ratio of abdominal-to-suprailiac skinfolds, and the limb-to-trunk adiposity index were analyzed. Fat percentage were measured with a body composition analyzer (Tanita) with accuracy 0.1%. The Mollison's Index [MI] was used for calculating sexual dimorphism.

RESULTS

The value of MI for the WHR and its components (waist and hip circumferences) was negative (the boys were characterized by higher values of these parameters). The magnitude of the sex differences was lower in the younger age groups and the highest in the oldest groups. For adiposity [BF%], the average values were higher in females. In the younger age groups, girls had thicker skinfolds compared to boys, and this tendency was also observed in the older age groups, except for abdominal and suprailiac skinfolds. The values of the analyzed adiposity indicators also represented a tendency toward central allocation of fat tissue in boys.

CONCLUSIONS

In conclusion, sexual dimorphism of fat distribution and adiposity could be detected as early as 7 years of age. These differences can be identified using simple anthropometric methods, which are relatively cheap and easy to use, particularly in the field setting and large populations. The observation of changes in these features in children should be a recommended procedure aimed at early detection of overweight, obesity, as well as normal weight obesity or other metabolic disorders.

The Burden Cancer-Related Deaths Attributable to High Body Mass Index in a Gulf Cooperation Council: Results from the Global Burden of Disease Study 2019

BACKGROUND

BMI has been reported to be a major risk factor for the increased burden of several diseases. This study explores the burden of cancer linked to high body mass index (BMI) in Gulf Cooperation Council (GCC) countries and assesses the correlation with Socio-demographic Index (SDI).

METHOD

Using Global burden of disease (GBD) 2019 data, the authors quantified cancer burden through mortality, DALYs, age standardized mortality rate (ASMR), and age standardized DALYs rate (ASDR) across sexes, countries, cancer types, and years. Spearman's correlation tested ASMR against SDI. The authors estimated 95% uncertainty limits (UIs) for population attribution fraction (PAFs).

RESULTS

Between 1990 and 2019, all six GCC countries showed increased number of the overall cancer-related deaths (398.73% in Bahrain to 1404.25% in United Arab Emirates), and DALYs (347.38% in Kuwait, to 1479.35% in United Arab Emirates) reflecting significant increasing in deaths, and burden cancer attributed to high BMI. In 2019, across GCC countries, pancreatic, uterine, and kidney cancer accounted for 87.91% of the total attributable deaths associated with high BMI in females, whereas in male, colon and rectum cancer alone accounted for 26% of all attributable deaths associated with high BMI.

CONCLUSION

The study highlights the significant impact of high BMI on cancer burden in GCC countries. Moreover, the study identifies specific cancers, such as pancreatic, uterine, and kidney cancer in females, and colon and rectum cancer in males, as major contributors to attributable deaths, urging targeted prevention strategies at reducing weight and encouraging physical activity could greatly lessen the impact of diseases in the GCC countries.

Breaking Academic Silos: Pedagogical Recommendations for Equitable Obesity Prevention Training and Research During an Age of Nutrition Polarization

Introduction

Obesity is a preventable chronic condition and a risk factor for poor health and early mortality. Weight stigma and weight-neutral medicine are popular topics in social media that are often at odds with current medical guidelines on obesity treatment and prevention. This conflict may erode the public's trust in science, impede research progress on preventing obesity in marginalized groups, and uphold the ongoing and historical lack of diversity among nutrition trainees.

Methods

The authors conducted a series of student-led dialogue sessions with nutrition graduate students in Boston, Massachusetts, from March to May 2023 to understand perceptions of obesity research, health equity, and racism and discrimination. This article summarizes the lessons learned and provides pedagogical recommendations for jointly addressing obesity at the population level and the recruitment, training, and retention of diverse scholars, clinicians, and public health practitioners.

Results

Dialogue sessions revealed that students perceive a disproportionate focus on the harms of obesity as a chronic disease, highlighting that inadequate attention is given to weight stigma and discrimination. Some participants believed that weight-based discrimination is equally detrimental to individual health and wellbeing as having obesity. Discussions also emphasized the need to pinpoint the multidimensional and cultural manifestations of weight stigma, which necessitates collaboration across social sectors and academic disciplines. Students recognized the urgent need to apply an equity lens to obesity research and teaching but felt limited in their access to experts within nutrition science who specialize in racism, discrimination, eating disorders, and weight stigma.

Conclusions

This study identified concrete opportunities for urgently needed new training and research in population-level obesity prevention, emphasizing antiracism, harm reduction, and elimination of stigma and bias across multiple levels of science and society. Overall, the decision to use the BMI within pedagogy and training must be explicitly stated-research, population surveillance, decision-making, or treatment pedagogy and training-while acknowledging its strengths and limitations across diverse settings. Finally, the social determinants of obesity should incorporate not only weight stigma but also racism and multiple forms of discrimination.

The thermoneutral zone in women takes an "arctic" shift compared to men

Conventionally, women are perceived to feel colder than men, but controlled comparisons are sparse. We measured the response of healthy, lean, young women and men to a range of ambient temperatures typical of the daily environment (17 to 31 °C). The Scholander model of thermoregulation defines the lower critical temperature as threshold of the thermoneutral zone, below which additional heat production is required to defend core body temperature. This parameter can be used to characterize the thermoregulatory phenotypes of endotherms on a spectrum from "arctic" to "tropical." We found that women had a cooler lower critical temperature (mean ± SD: 21.9 ± 1.3 °C vs. 22.9 ± 1.2 °C, P = 0.047), resembling an "arctic" shift compared to men. The more arctic profile of women was predominantly driven by higher insulation associated with more body fat compared to men, countering the lower basal metabolic rate associated with their smaller body size, which typically favors a "tropical" shift. We did not detect sex-based differences in secondary measures of thermoregulation including brown adipose tissue glucose uptake, muscle electrical activity, skin temperatures, cold-induced thermogenesis, or self-reported thermal comfort. In conclusion, the principal contributors to individual differences in human thermoregulation are physical attributes, including body size and composition, which may be partly mediated by sex.

Female obesity: clinical and psychological assessment toward the best treatment

Obesity is a heterogeneous condition which results from complex interactions among sex/gender, sociocultural, environmental, and biological factors. Obesity is more prevalent in women in most developed countries, and several clinical and psychological obesity complications show sex-specific patterns. Females differ regarding fat distribution, with males tending to store more visceral fat, which is highly correlated to increased cardiovascular risk. Although women are more likely to be diagnosed with obesity and appear more motivated to lose weight, as confirmed by their greater representation in clinical trials, males show better outcomes in terms of body weight and intra-abdominal fat loss and improvements in the metabolic risk profile. However, only a few relatively recent studies have investigated gender differences in obesity, and sex/gender is rarely considered in the assessment and management of the disease. This review summarizes the evidence of gender differences in obesity prevalence, contributing factors, clinical complications, and psychological challenges. In addition, we explored gender differences in response to obesity treatments in the specific context of new anti-obesity drugs.

Defining Body Mass Index Using Weight and Length for Gestational Age in the Growth Assessment of Preterm Infants at Birth

OBJECTIVE

The objectives of this study were to describe (1) body mass indexes (BMIs) using weight and length for gestational age (GA) classifications, and (2) the additional information BMI, as a measure of body proportionality, provides for preterm infant growth assessment and care plans at birth.

STUDY DESIGN

Birth weight, length, and BMI of 188,646 preterm infants (24-36 weeks gestation) admitted to U.S. neonatal intensive care units (Pediatrix Clinical Data Warehouse, 2013-2018) were classified (Olsen curves) as small, appropriate, or large for GA (SGA < 10th, AGA 10-90th, LGA > 90th percentile for GA, respectively). The distribution for the 27 weight-length-BMI combinations was described.

RESULTS

At birth, most infants were appropriate for weight (80.0%), length (82.2%), head circumference (82.9%), and BMI (79.9%) for GA. Birth weight for GA identified approximately 20% of infants as SGA or LGA. Infants born SGA (or LGA) for both weight and length ("proportionate" in size) were usually appropriate for BMI (59.0% and 75.6%). BMI distinguished disproportionate weight for length in infants with SGA or LGA weight at birth (58.3%, 49.9%). BMI also identified 11.4% of AGA weight infants as small or large for BMI ("disproportionate" in size) at birth; only using weight for GA missed these underweight/overweight for length infants.

CONCLUSION

The unique, additional information provided by birth BMI further informs individualized preterm infant growth assessment by providing an assessment of an infant's body proportionality (weight relative to its length) in addition to the routine assessment of weight, length, and head circumference for GA and may better inform care plans and impact outcomes.

KEY POINTS

· Most preterm infants were born AGA for all growth measures.. · AGA weight infants may be under- or overweight for length.. · BMI distinguished body disproportionality in SGA/LGA infants.. · Recommend BMI assessed along with weight, length and head.. · Further research on BMI in preterm infants is needed..

Understanding the spectrum of cardiovascular risk in women - A primer for prevention

Cardiovascular disease (CVD) is the leading cause of death in women worldwide and the lifetime risk of CVD in women is similar to men. However, the pathophysiology of CVD varies between women and men necessitating a sex-specific understanding of cardiovascular (CV) risk. A belief that women have a lower CVD risk than men, and an underrepresentation in clinical research for many years has led to a paucity of evidence in the prevention and management of CVD in women. Many recent efforts have tried to bridge the gap. As a result, we now know that traditional risk factors impact CVD risk differently in women when compared with men. There are also numerous sex-specific and pregnancy related risk factors that modify the risk and can predict the future development of CVD in women. This is important as risk calculators, in general, tend to misclassify risk in young women with nontraditional CVD risk factors. To address this, guidelines have introduced the concept of risk enhancers that can suggest a higher risk. The use of coronary artery calcium score can further accurately delineate risk in these women, leading to an appropriate matching of therapy to underlying risk. This review discusses implementation strategies that are essential to mitigate disparities in CVD outcomes and optimizing CVD risk in women.

Dose-response relationships between body-mass index and pressure injuries occurrence in hospitalized patients: A multi-center prospective study

BACKGROUND

Pressure injuries (PIs) are one of the leading potentially preventable hospital-acquired complications associated with prolonged hospital length, poor quality of life and financial burden. The relationship between body mass index (BMI) and PIs occurrence is controversial.

OBJECTIVE

The aim of this study was to further examine relationships between BMI and PIs occurrence in hospitalized patients.

DESIGN

A multi-center prospective study.

SETTING

39 hospitals located in northwest China from April 2021 to July 2023.

PARTICIPANTS

175,960 hospitalized patients aged over 18 years were enrolled, and 170,800 patients were included in the final analysis.

METHODS

BMI and clinical characteristics were assessed at baseline. PIs assessment were performed by trained nurses, with data recorded for the presence, the location and stage of each PI. For staging PIs, the National Pressure Ulcer Advisory Panel（NPUAP） staging system were used. The multivariate logistic regressions analysis and restricted cubic splines (RCS) models were used to explore associations between BMI and PIs, adjusting for potential confounders.

RESULTS

Of 175,960 participants, 5160 were excluded from analyses. The multivariate logistic regression model identified a positive relationship between under-weight BMI and risk of PIs occurrence (OR = 1.60, 95% CI:1.18-2.17). We also found U shaped association between BMI and PIs occurrence (non-linear P < 0.001). BMI less than 23 kg/m2 significantly increased risk of PIs, and there was a tendency to increase risk of PIs at BMI higher than 30 kg/m2. We stratified participants by sex to further investigate their association and found the risk of PIs increases substantially in women at BMI below 17 kg/m2 and in men at BMI below 23 kg/m2.

CONCLUSIONS

The present study indicated that there was an approximate U shaped relationship between BMI and PIs occurrence, and this association was potentially different between men and women.

Age- and height-dependent bias of underweight and overweight assessment standards for children and adolescents

Background

Precision in evaluating underweight and overweight status among children and adolescents is paramount for averting health and developmental issues. Existing standards for these assessments have faced scrutiny regarding their validity. This study investigates the age and height dependencies within the international standards set by the International Obesity Task Force (IOTF), relying on body mass index (BMI), and contrasts them with Japanese standards utilizing the percentage of overweight (POW).

Method

We scrutinized a comprehensive database comprising 7,863,520 children aged 5-17 years, sourced from the School Health Statistics Research initiative conducted by Japan's Ministry of Education, Culture, Sports, Science, and Technology. Employing the quantile regression method, we dissected the structure of weight-for-height distributions across different ages and sexes, quantifying the potentially biased assessments of underweight and overweight status by conventional criteria.

Results

Applying IOFT criteria for underweight assessment revealed pronounced height dependence in males aged 11-13 and females aged 10-11. Notably, a discernible bias emerged, wherein children in the lower 25th percentile were classified as underweight five times more frequently than those in the upper 25th percentile. Similarly, the overweight assessment displayed robust height dependence in males aged 8-11 and females aged 7-10, with children in the lower 25th percentile for height deemed obese four or five times more frequently than their counterparts in the upper 25th percentile. Furthermore, using the Japanese POW criteria for assessment revealed significant age dependence in addition to considerably underestimating the percentage of underweight and overweight cases under the age of seven. However, the height dependence for the POW criterion was smaller than the BMI criterion, and the difference between height classes was less than 3-fold.

Conclusion

Our findings underscore the intricacies of age-dependent changes in body composition during the growth process in children, emphasizing the absence of gold standards for assessing underweight and overweight. Careful judgment is crucial in cases of short or tall stature at the same age, surpassing sole reliance on conventional criteria results.

The Impact of Multimorbidity Patterns on Changes in Physical Activity and Physical Capacity Among Older Adults Participating in a Year-Long Exercise Intervention

This study investigated the impact of multimorbidity patterns on physical activity and capacity outcomes over the course of a year-long exercise intervention, and on physical activity 1 year later. Participants were 314 physically inactive community-dwelling men and women aged 70-85 years, with no contraindications for exercise at baseline. Physical activity was self-reported. Physical capacity measurements included five-time chair-stand time, 6-minute walking distance, and maximal isometric knee-extension strength. The intervention included supervised and home-based strength, balance, and walking exercises. Multimorbidity patterns comprised physician-diagnosed chronic disease conditions as a predictor cluster and body mass index as a measure of obesity. Multimorbidity patterns explained 0%-12% of baseline variance and 0%-3% of the change in outcomes. The magnitude and direction of the impact of unique conditions varied by outcome, time point, and sex. Multimorbid older adults with no contraindications for exercise may benefit from multimodal physical training.

Accurate surgical posterior tibial slope alteration can be achieved in total knee arthroplasty regardless of surgeon skill level or local soft tissue thickness-A retrospective radiograph-based study

PURPOSE

To retrospectively report on the impact of local soft tissue thickness and surgeon skill level on the accuracy of surgical posterior tibial slope (PTS) alteration achieved in patients undergoing total knee arthroplasty (TKA) utilising lateral knee radiographs.

METHODS

Pre- and postoperative radiographs of 82 patients undergoing primary TKA using conventional mechanical alignment technique were measured by two observers and subjected to quality criteria for accurate measurement of the PTS. All patients underwent a standardised surgical approach for PTS alteration: cruciate-retaining (CR) cases with preoperative PTS ≤ 10° were set for reconstruction of the preoperative PTS. Cases indicated for posterior-stabilised (PS) design and/or with a preoperative PTS > 10° were set for 3° of postoperative PTS. Pretibial subcutaneous fat (PSF) and surgeon skill level were analysed for their predictive quality regarding the accuracy of surgical PTS alteration achieved.

RESULTS

The overall mean postoperative PTS was significantly lower than the preoperative values (6.2°, SD 2.7 vs. 7.7°, SD 3.2; p = 0.002103). Neither local soft tissue thickness, namely PSF, nor surgeon skill level was found to be a predictor of the accuracy of surgical PTS alteration achieved. Among cases set for PTS reconstruction, 25.9% and 42.6% achieved a postoperative PTS within ±1° and ±2° of preoperative values, respectively. In patients with a PTS > 10° or those indicated for PS design, slope reduction was achieved with a mean postoperative PTS of 6.5°. Furthermore, 14.3% and 32.1% of cases were within ±1° and ±2° of 3, respectively.

CONCLUSION

This study demonstrates that accurate surgical alteration of the PTS is possible in TKA regardless of local knee soft tissue thickness or surgeon skill level. This proves the clinical feasibility of both targeted reduction as well as reconstruction of the PTS in TKA.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.

Effect of body mass index on inpatient rehabilitation outcome after stroke in a Southeast Asian cohort: a prospective study

INTRODUCTION

We examined the association between admission body mass index (BMI) and discharge rehabilitation functional outcome using the functional independence measure (FIM) in a Southeast Asian cohort of stroke patients during inpatient rehabilitation.

METHODS

A prospective, observational cohort study of stroke patients admitted to a single inpatient rehabilitation unit was conducted. Using the World Health Organization Asian standards, BMI was classified as underweight (<18.5 kg/m 2 ), normal (18.5-22.9 kg/m 2 ) and overweight (≥23 kg/m 2 ). The primary outcome measure was discharge FIM, and secondary outcomes included FIM gain, FIM efficiency and FIM effectiveness.

RESULTS

Two hundred and forty-seven stroke subjects were enrolled. The mean age of the cohort was 59.48 (standard deviation [SD] 12.35) years; 64.4% ( n = 159) were male and 52.6% ( n = 130) had ischaemic stroke. The distributions of underweight, normal and overweight based on BMI on admission were 10.9% ( n = 27), 33.2% ( n = 82) and 55.9% ( n = 138), respectively, and the distributions upon discharge were 11.7% ( n = 29), 38.1% ( n = 94) and 50.2% (n = 124), respectively. Significant small decreases in BMI from admission to discharge were found (median [interquartile range] 23.58 [23.40-24.70] vs. 23.12 [22.99-24.21]; P < 0.001). Similarly, clinically significant FIM gains (mean ΔFIM 26.71; 95% confidence interval 24.73, 28.69, P < 0.001) were noted after a median length of stay of 36 days. No significant relationships were found between BMI and discharge FIM ( P = 0.600), FIM gain ( P = 0.254), FIM efficiency ( P = 0.412) or FIM effectiveness ( P = 0.796).

CONCLUSION

Findings from this study unequivocally support the benefits of acute inpatient stroke rehabilitation. Patients in the obese BMI range tended to normalise during rehabilitation. Body mass index, whether underweight, normal or overweight, did not correlate with discharge FIM.

Metabolic trade-offs in childhood: Exploring the relationship between language development and body growth

During human childhood, brain development and body growth compete for limited metabolic resources, resulting in a trade-off where energy allocated to brain development can decrease as body growth accelerates. This preregistered study explores the relationship between language skills, serving as a proxy for brain development, and body mass index at three distinct developmental stages, representing different phases of body growth. Longitudinal data from 2002 children in the EDEN mother-child cohort were analyzed using structural equation modeling. Our findings reveal a compelling pattern of associations: girls with a delayed adiposity rebound, signaling slower growth rate, demonstrated better language proficiency at ages 5-6. Importantly, this correlation appears to be specific to language skills and does not extend to nonverbal cognitive abilities. Exploratory analyses show that early environmental factors contributing to enhanced cognitive development, such as higher parental socio-economic status and increased cognitive stimulation, are positively associated with both language skills and the timing of adiposity rebound in girls. Overall, our findings lend support to the existence of an energy allocation trade-off mechanism that appears to prioritize language function over body growth investment in girls.

Human cold adaptation: An unfinished agenda v2.0

BACKGROUND

Research on human extreme cold climate adaptations has benefitted from a recent resurgence since Ted Steegmann laid out his Human Cold Adaptation Agenda in 2007. Human biologists have drastically expanded our knowledge in this area during the last 15 years, but we still have a great deal more work to do to fulfill the cold climate adaptation agenda.

METHODS

Here, I follow Steegmann's example by providing a review of cold climate adaptations and setting forth a new, expanded agenda.

RESULTS

I review the foundational work on cold climate adaptations including classic Bergmann, Allen, and Thomson rules as well as early work assessing metabolic differences among Indigenous cold climate populations. From there, I discuss some of the groundbreaking work currently taking place on cold climate adaptations such as brown adipose tissue (a heat generating organ), physical activity levels, metabolic rates, and behavioral/cultural mechanisms. Finally, I present a path forward for future research with a focus on some of the basic extreme cold adaptations as well as how human biologists should approach the effects of climate change on human health and well-being, particularly within a cold climate context.

CONCLUSION

The Arctic has felt the dramatic effects of climate change sooner and more acutely than other parts of the world, making it an ideal location for studying both cold climate adaptations and climate change resilience. Human biologists have a great deal to contribute to the conversation on not only adaptations to extreme cold, but also the ways in which climate change is being embodied by cold climate populations.

Relative Body Mass Index Improves the BMI Percentile Performance for Detection and Monitoring of Excess Adiposity in Adolescents

Obesity is defined as excess adipose tissue; however, commonly used methods may under-detect adiposity in adolescents. This study compared the performance of body mass index percentile (BMI%) and relative body mass index (RBMI) in identifying excess body fat percentage (BF%) and estimated RBMI cut points to better stratify severity of adiposity. In 567 adolescents ages 11-19 year, BF% measured by DXA was used to compare BMI% and RBMI performance at different degrees of adiposity. RBMI cut points for adiposity detection were derived via ROC curve analysis. BF% was strongly correlated with BMI% (r = 0.889, p < 0.001) and RBMI (r = 0.901, p < 0.001). However, RBMI exhibited less dispersion and better discriminated the relationship with BF% independent of age, race, and gender. Both BMI% and RBMI performed similarly for detecting high BF% (≥25 BF% in males; ≥30 BF% in females). Nonetheless, the relationship of BMI% with BF% was diminished among leaner adolescents. RBMI detected overweight in 21.3% more females and 14.2% more males. RBMI improved the detection of excess adiposity in individuals otherwise classified as having normal weight or overweight by BMI%. RBMI is a valuable and accessible tool for earlier detection, intervention, and effective follow-up of excess adiposity in youth at higher risk for complications.

Facilitators and barriers to behavior change in overweight and obesity management using the COM-B model

Introduction

Increasing overweight and obesity rates represent one of the global public health challenges. COM-B is a theoretical model used to identify areas to target to achieve behavior change. It identifies three factors that are needed for any behavior to occur: capability, opportunity, and motivation. We aimed to assess the potential facilitators and barriers to behavior change in weight management using the COM-B.

Methods

The study included 139 people with overweight and obesity (mean age 48.81 ± 14.49 years; 64.5% female; body mass index 32.64 ± 6.51 kg/m2; waist-to-height ratio 0.62 ± 0.10) from primary care settings. All participants completed the Brief Measure of Behavior Change (COM-B), the General Self-Efficacy Scale (GSE), the Rosenberg Self-esteem Scale (RSE), and the Overall Evaluation of Health (OEH). Multiple linear regression was performed to analyse the data.

Results

The associations between sociodemographic and clinical variables and COM-B domains attenuated or were no longer significant when psychological resources were added to the regression models. Self-efficacy was identified as a stronger facilitator of health behavior change (p < 0.001) when compared to self-esteem (p < 0.05). No associations between automatic motivation and psychological resources were identified, however. Automatic motivation was found to be associated with higher age, being in a relationship, and better health.

Discussion

Behavioral interventions for weight management should specifically target different components of COM-B. Self-efficacy and self-esteem may play a significant role in individual capabilities, opportunities, and reflective motivation and should be included in tailored public health interventions. Health programs targeting younger and single people, and people with chronic conditions may help to promote sustainable behavior change.

Phenotyping obesity: A focus on metabolically healthy obesity and metabolically unhealthy normal weight

Over the past 4 decades, research has shown that having a normal body weight does not automatically imply preserved metabolic health and a considerable number of lean individuals harbour metabolic abnormalities typically associated with obesity. Conversely, excess adiposity does not always equate with an abnormal metabolic profile. In fact, evidence exists for the presence of a metabolically unhealthy normal weight (MUHNW) and a metabolically healthy obese (MHO) phenotype. It has become increasingly recognised that different fat depots exert different effects on the metabolic profile of each individual by virtue of their location, structure and function, giving rise to these different body composition phenotypes. Furthermore, other factors have been implicated in the aetiopathogenesis of the body composition phenotypes, including genetics, ethnicity, age and lifestyle/behavioural factors. Even though to date both MHO and MUHNW have been widely investigated and documented in the literature, studies report different outcomes on long-term cardiometabolic morbidity and mortality. Future large-scale, observational and population-based studies are required for better profiling of these phenotypes as well as to further elucidate the pathophysiological role of the adipocyte in the onset of metabolic disorders to allow for better risk stratification and a personalised treatment paradigm.

Body composition and cancer survival: a narrative review

Interest in understanding the relationship between body composition and cancer survival has remained strong for decades, with a number of recent systematic reviews on the topic. However, the current state of evidence is based on heterogeneous exposure definitions based on anthropometry, yielding inconsistent findings with regard to this association. Recently the field has taken an exciting direction with the application of radiological assessments to measure specific aspects of body composition, yet reconciliation of findings from these modern assessment tools with those from the historic use of anthropometric data proves challenging. In this paper, I briefly review the biological basis for a link between body composition and cancer survival and summarize the epidemiological evidence with consideration to specific exposure measures. As enthusiasm is building around novel assessments, I conclude with a discussion of issues that researchers should be aware of when interpreting results from these new modalities.

Promoting healthy populations as a pandemic preparedness strategy: a simulation study from Mexico

Background

The underlying health status of populations was a major determinant of the impact of the COVID-19 pandemic, particularly obesity prevalence. Mexico was one of the most severely affected countries during the COVID-19 pandemic and its obesity prevalence is among the highest in the world. It is unknown by how much the COVID-19 burden could have been reduced if systemic actions had been implemented to reduce excess weight in Mexico before the onset of the pandemic.

Methods

Using a dynamic epidemic model based on nationwide data, we compare actual deaths with those under hypothetical scenarios assuming a lower body mass index in the Mexican population, as observed historically. We also model the number of deaths that would have been averted due to earlier implementation of front-of-pack warning labels or due to increases in taxes on sugar-sweetened beverages and non-essential high-energy foods in Mexico.

Findings

We estimate that 52.5% (95% prediction interval (PI) 43.2, 61.6%) of COVID-19 deaths were attributable to obesity for adults aged 20-64 and 23.8% (95% PI 18.7, 29.1%) for those aged 65 and over. Had the population BMI distribution remained as it was in 2000, 2006, or 2012, COVID-19 deaths would have been reduced by an expected 20.6% (95% PI 16.9, 24.6%), 9.9% (95% PI 7.3, 12.9%), or 6.9% (95% PI 4.5, 9.5%), respectively. If the food-labelling intervention introduced in 2020 had been introduced in 2018, an expected 6.2% (95% PI 5.2, 7.3%) of COVID-19 deaths would have been averted. If taxes on sugar-sweetened beverages and high-energy foods had been doubled, trebled, or quadrupled in 2018, COVID-19 deaths would have been reduced by an expected 4.1% (95% PI 2.5, 5.7%), 7.9% (95% PI 4.9, 11.0%), or 11.6% (95% PI 7.3, 15.8%), respectively.

Interpretation

Public health interventions targeting underlying population health, including non-communicable chronic diseases, is a promising line of action for pandemic preparedness that should be included in all pandemic plans.

Funding

This study received funding from Bloomberg Philanthropies, awarded to Juan A. Rivera from the National Institute of Public Health; Community Jameel, the UK Medical Research Council (MRC), Kenneth C Griffin, and the World Health Organization.

Impact of obesity in asthma: Possible future therapies

Obesity is one of the factors associated with the severity of asthma. Obesity is associated with aggravation of the pathophysiology of asthma, including exacerbations, airway inflammation, decreased pulmonary function, and airway hyperresponsiveness. The present review addresses the characteristics of asthma with obesity, focusing especially on the heterogeneity caused by the degree of type 2 inflammation, sex differences, the onset of asthma, and race differences. To understand the severity mechanisms in asthma and obesity, such as corticosteroid resistance, fatty acids, gut microbiome, and cytokines, several basic research studies are evaluated. Finally, possible future therapies, including weight reduction, microbiome-targeted therapies, and other molecular targeted therapies are addressed. We believe that the present review will contribute to better understanding of the severity mechanisms and the establishment of novel treatments for severe asthma patients with obesity.

Long-Term Health Outcomes of Limb Salvage Compared with Amputation for Combat-Related Trauma

BACKGROUND

There are little long-term health data, particularly in terms of body composition and development of metabolic syndromes, to help surgeons to guide the decision between limb salvage and amputation in patients with limb-threatening trauma. The purpose of this study was to compare long-term health outcomes after high-energy lower-extremity trauma between patients who underwent attempted flap-based limb salvage or amputation.

METHODS

We performed a retrospective review of servicemembers with a minimum 10-year follow-up who underwent flap-based limb salvage followed by unilateral amputation or continued limb salvage after combat-related, lower-extremity trauma between 2005 and 2011. Patient demographic characteristics, injury characteristics, and health outcomes including body mass index (BMI) and development of metabolic disease (e.g., hyperlipidemia, hypertension, heart disease, and diabetes) were compared between treatment cohorts. Adjusted BMIs were calculated for the amputation cohort to account for lost surface area. We performed multivariable and propensity score analysis to determine the likelihood of developing obesity or metabolic disease.

RESULTS

In this study, 110 patients had available long-term follow-up (mean, 12.2 years) from the time of the injury. Fifty-six patients underwent limb salvage and 54 patients underwent unilateral amputation. There was no difference in preinjury BMI (p = 0.30). After adjusting for limb loss, the amputation cohort had a trend toward higher BMIs at ≥1 years after the injury, a higher rate of obesity, and a greater increase in BMI from baseline after the injury. The development of metabolic comorbidities was common after both amputation (23 [43%] of 54) and limb salvage (27 [48%] of 56). With the numbers available, we were unable to demonstrate a difference in risk for the development of hypertension, hyperlipidemia, diabetes, heart disease, or any comorbidity other than obesity (p > 0.05).

CONCLUSIONS

Amputations may be medically necessary and may decrease pain, improve mobility, and/or expedite return to activity compared with limb salvage after similar injuries. However, limb loss may negatively impact metabolic regulation and may contribute to a higher risk of obesity despite beneficial effects on mobility.

LEVEL OF EVIDENCE

Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

The Biological Basis of Sex Differences in Athletic Performance: Consensus Statement for the American College of Sports Medicine

ABSTRACT

Biological sex is a primary determinant of athletic performance because of fundamental sex differences in anatomy and physiology dictated by sex chromosomes and sex hormones. Adult men are typically stronger, more powerful, and faster than women of similar age and training status. Thus, for athletic events and sports relying on endurance, muscle strength, speed, and power, males typically outperform females by 10%-30% depending on the requirements of the event. These sex differences in performance emerge with the onset of puberty and coincide with the increase in endogenous sex steroid hormones, in particular testosterone in males, which increases 30-fold by adulthood, but remains low in females. The primary goal of this consensus statement is to provide the latest scientific knowledge and mechanisms for the sex differences in athletic performance. This review highlights the differences in anatomy and physiology between males and females that are primary determinants of the sex differences in athletic performance and in response to exercise training, and the role of sex steroid hormones (particularly testosterone and estradiol). We also identify historical and nonphysiological factors that influence the sex differences in performance. Finally, we identify gaps in the knowledge of sex differences in athletic performance and the underlying mechanisms, providing substantial opportunities for high-impact studies. A major step toward closing the knowledge gap is to include more and equitable numbers of women to that of men in mechanistic studies that determine any of the sex differences in response to an acute bout of exercise, exercise training, and athletic performance.

Local Soft-Tissue Thickness vs. Body Mass Index as Predictors of Complications After Total Knee or Hip Arthroplasty: A Literature Review

» Body mass index (BMI) is a nonspecific measure of general fat composition that demonstrates little conclusive or definitive association with surgical site complications after total knee and total hip arthroplasty.» Quantifying soft-tissue thickness (STT) around the joint of interest has shown positive correlations with complications and is arguably a better predictor than BMI.» In this literature review, 14 articles (7 discussing hips and 7 discussing knees) discussing the association of STT, BMI, and surgical site complications after total hip and knee arthroplasty were scrutinized and summarized to present relevant information necessary to compare STT with BMI.» Five of the 7 studies involving hips and 4 of the 7 studies involving knees show a positive relationship between STT and outcomes including complications and infection, with some claiming STT as a stronger predictor of surgery site problems than BMI.» Since many variables, such as STT measurement technique, surgical outcomes, sample sizes, and surgical approach, varied between the studies, definitive inferences are difficult to make and future studies of bigger sample size and higher power should focus on the described measurement techniques.

The Impact of Longitudinal Patterns of Adolescent Sleep Duration on Adult C-Reactive Protein (CRP), Waist-To-Height Ratio, and Body Mass Index (BMI) Among Black and White Individuals

PURPOSE

To assess the impact of longitudinal adolescent sleep duration on adult C-reactive protein (CRP), waist-to-height ratio (WtHR), and body mass index (BMI) by race.

METHODS

Participants (N = 2,399; Mage = 15.7; 40.2% male; 79.2% White, 20.8% Black; Grades 7-12 at Wave I) from the Add Health database provided self-reported sleep duration in Waves I-IV. During Wave V, CRP, WtHR, and BMI were objectively measured. Trajectory analysis was performed using a group-based modeling approach. Chi-square test determined racial differences between groups. General linear models determined relationships between trajectory group, race, and group/race interaction with Wave V CRP, WtHR, and BMI.

RESULTS

Three sleep trajectories emerged: Group 1 "shortest" (24.4%), Group 2 "stable recommended" (67.6%), and Group 3 "varied" (8%). Black individuals and older individuals were more likely to be in Group 1 compared with Group 2. Regardless of race, individuals with patterns of sleep duration increasing to above what is recommended across waves (Group 3) had elevated CRP. Individuals with stable patterns of adequate sleep (Group 2) had lower WtHR. Black individuals with consistently stable patterns of adequate sleep duration had lower BMI compared to those with low sleep duration.

DISCUSSION

Black individuals were more likely to obtain chronically short sleep during the transition from adolescence to adulthood, highlighting a significant health disparity. Poor longitudinal sleep predicted elevated CRP and WtHR. Sleep only impacted BMI for Black individuals. This may relate to racial differences in BMI measurement.

Hip circumference has independent association with the risk of hyperuricemia in middle-aged but not in older male patients with type 2 diabetes mellitus

BACKGROUND

Obesity and type 2 diabetes mellitus (T2DM) are risk factors for hyperuricemia. However, which anthropometric indices can better predict incident hyperuricemia in patients with T2DM remains inconsistent. This study aimed to examine the associations between hyperuricemia and different anthropometric indices in middle-aged and older male patients with T2DM.

METHODS

In this retrospective study, a total of 1447 middle-aged (45-65 years, n = 791) and older (≥ 65 years, n = 656) male patients with T2DM were collected from December 2015 to January 2020 at Shanghai Xinhua Hospital. Hyperuricemia was defined as a serum uric acid level above 7.0 mg/dL. Weight, height, waist circumference (WC) and hip circumference (HC) were measured by trained nurses at visit.

RESULTS

The median uric acid level of subjects was 5.6 (interquartile ranges: 4.7-6.7) mg/dl, and 279 (19.3%) were hyperuricemia, with 146 (18.5%) in the middle-aged group, and 133 (20.3%) in the older group. After adjusting for age, duration of T2DM, fasting plasma glucose and insulin, homeostasis model assessment-β, aspartate aminotransferase, triglycerides, high-density lipoprotein cholesterol and estimated glomerular filtration rate, body mass index (BMI), WC, HC, and waist-to-height ratio (WHtR) were associated with a higher risk of hyperuricemia in both middle-aged and older group (P < 0.05). After further adjusting for BMI and WC, HC still showed a positive relationship with the risk of hyperuricemia (Odds Ratio = 1.51, 95% confidence intervals: 1.06-2.14) in the middle-aged group, but such relationship was not found in the older group. Moreover, according to receiver operating characteristic analysis, the optimal cutoff value was 101.3 cm of HC for hyperuricemia screening in the middle-aged male patients with T2DM.

CONCLUSION

In middle-aged male patients with T2DM, more attention should be paid to HC with the cutoff value of 101.3 cm in clinical practice for early recognition of individuals with a high risk of hyperuricemia for targeted guidance on disease prevention, such as community screening.