Body Mass Index Versus Body Fat Percentage in Prospective National Football League Athletes: Overestimation of Obesity Rate in Athletes at the National Football League Scouting Combine

Metabolic Surgery and Chronic Traumatic Encephalopathy: Perceptions of Former NFL Players

PURPOSE

Chronic traumatic encephalopathy (CTE) has been diagnosed in 91.7% of retired United States National Football League (NFL) players at postmortem. There is no treatment or cure for CTE. Most living former NFL athletes with probable CTE suffer from obesity and its comorbidities. Our previous reviews document the improvement in cognition following metabolic/bariatric surgery (MBS) (e.g., gastric bypass, sleeve gastrectomy). These operations might reduce microglial maladaptive states, thereby attenuating neurodegeneration and CTE-like neurocognitive impairment. The study evaluated former NFL players' views on metabolic surgery in relation to reduction of obesity and CTE risk.

MATERIALS AND METHODS

An online multiple-choice questionnaire (30 items, 125 response options, 10-min completion) developed in the Research Electronic Data Capture (REDCap) system was sent to 1,014 athletes screened in 2017-2022 by the Living Heart Foundation.

RESULTS

From 2/2022 to 7/2023, of 700 surveys opened, 72 (10.3%) of the retired players responded. Mean age was 61.6 ± 12.6 years; 45.0% had the disease of obesity with a mean BMI 35.5 ± 4.6 kg/m2. Thirty-three percent reported ≥ 2 obesity-related comorbidities; 40.3% memory-related TBI symptoms; 66.7% ≥ 1 cognitive symptom; 85.0% believed MBS was safe and effective but were unlikely to elect MBS for weight management. Yet, 57.0% of the entire cohort, and 68.8% of players with obesity were more likely to elect MBS if it could also reduce CTE risk.

CONCLUSIONS

Results of the study bode well for future research recruitment. Most surveyed retired NFL players with obesity believed MBS to be effective and would be more likely to undergo MBS if it also reduced CTE risk.

Actions speak louder than coaches: Eating disorder behaviour among student-athletes

The objective of the current study was to examine the prevalence of eating disorder behaviours among student-athletes at a small, non-NCAA (Canadian) university, while evaluating the influence of gender, type of sport, and perceived social support. Two hundred participants (130 female, 70 male) completed an online survey that assessed participants eating disorder behaviours (EAT-26), behaviours consistent with the Adonis Complex (ACQ) and perceived social support (modified MPSS). The results revealed significant differences in eating disorder behaviour between female and male athletes, with females scoring significantly higher; yet no differences were found between how female and male athletes scored on the Adonis Complex Questionnaire. Significant differences were found between lean-sport and non-lean sport athletes, with lean sport athletes exhibiting more eating disorder behaviours. Furthermore, non-lean sport male athletes were found to score significantly higher than lean-sport male athletes for the Adonis Complex. Perceived social support was found to be negatively correlated to eating disorder behaviours and when considering gender and type of sport, accounted for unique variance in eating disorder behaviour. These results suggest that student-athletes are susceptible to negative mental health outcomes, even within the context of a smaller (and non-NCAA) university context, and eating behaviours vary among athlete and sport type. The results highlight the importance of continued research in this area and of having support systems in place for student-athletes and increasing awareness of athletic staff and coaches as to the seriousness and prevalence of eating disorder behaviours.

Is There a Relationship Between Body Mass Index and Eating Disorder Symptoms in Professional Male Fashion Models?

This study is the first to examine the utility of body mass index (BMI) as an indicator of eating disorder (ED) pathology and fitness for employment for professional male fashion models. We assessed the relationship between experimenter-measured BMI, muscle mass, body fat percentage, and ED severity (EDE-Q score) in male models and nonmodels. Except for higher eating concern, the two groups displayed similar EDE-Q scores after controlling for age. Models relative to nonmodels endorsed significantly greater frequency of compulsive exercise and self-induced vomiting as a means of controlling shape or weight. BMI was a poor indicator of body fat percentage in models. Lower BMI in models, and higher BMI in nonmodels, was associated with higher EDE-Q scores. Interestingly, all the male models with clinically significant EDE-Q scores (≥4.0) had >18.5 experimenter-measured BMI. Higher muscle mass in models, and lower muscle mass in nonmodels, was associated with higher EDE-Q scores. Inversely, lower percentage body fat in models, and higher percentage body fat in nonmodels, was associated with higher EDE-Q scores. BMI, muscle mass, and percentage body fat were associated with ED tendencies in male models and nonmodels. Findings also suggest males with clinical ED symptoms would be overlooked if only low BMI (<18.5) was considered. These results may guide the development of more effective mandates to safeguard models' wellbeing, and men generally.

Investigating the Relationship between Body Mass Index, Cholesterol, and Cancer in United States Adults: A Cross-Sectional Study

The purpose of this cross-sectional study was to investigate the relationship between Body Mass Index (BMI), cholesterol, and cancer in United States (US) adults. Data were collected from the 2020 Medical Expenditure Panel Survey (MEPS). Eligible participants were US adults (≥18 years) with data on BMI, cholesterol, and cancer status, who were alive at the end of the data collection period. An adjusted logistic regression model assessed associations between eight possible combinations of BMI and cholesterol status (independent variable) with cancer diagnosis (dependent variable). Among 27,805 individuals in the 2020 MEPS data, 20,818 met the eligibility criteria (weighted N = 252,340,615). Of these 2668 (weighted N = 29,770,359) had cancer and 18,150 (weighted N = 222,570,256) did not have cancer. In the adjusted logistic regression model, underweight and normal weight individuals with high cholesterol were associated with higher odds of cancer (odds ratio, OR = 2.002, and 95% confidence interval, CI = 1.032-3.885, and OR = 1.326 and 95% CI = 1.047-1.681, respectively), while obese individuals with normal cholesterol were associated with lower odds of cancer (OR = 0.681; 95% CI = 0.543-0.853) compared to normal weight individuals with normal cholesterol. This study offers insights into specific groups of individuals who may be prioritized for cancer prevention. Further research is required to investigate these findings in additional subpopulations.

Eating Disorders Risk Assessment and Body Esteem among Amateur and Professional Football Players

BACKGROUND

The purpose of this study was to assess the risk of eating disorders and attitudes toward one's own body among football players at amateur and professional levels.

METHODS

The study included 90 players from football clubs located in the Upper Silesia Metropolitan Area, participating in the 4th and 5th leagues in Poland. A survey questionnaire was used to conduct the study, which consisted of a metric section, an Eating Attitudes Test, and Body Esteem Scale questionnaires. The players were divided into two groups according to their sports level.

RESULTS

Results showed that 24.4% of players were overweight, while 75.6% had a normative body weight. Approximately 16.7% met the criteria indicating susceptibility to an eating disorder. Body Esteem Scale interpretations revealed moderate body appraisal among players.

CONCLUSIONS

Both amateur and professional athletes showed no significant difference in eating disorder risk, but professionals rated their bodies higher. Social media use, particularly on Twitter and Instagram, is correlated with eating disorders, with longer daily use associated with lower body ratings.

Obesity Disparities Among Adult Single-Race and Multiracial Asian and Pacific Islander Populations

Importance

Despite increasing numbers of multiracial individuals, they are often excluded in studies or aggregated within larger race and ethnicity groups due to small sample sizes.

Objective

To examine disparities in the prevalence of obesity among single-race and multiracial Asian and Pacific Islander individuals compared with non-Hispanic White (hereafter, White) individuals.

Design, Setting, and Participants

This cross-sectional study used electronic health record (EHR) data linked to social determinants of health and health behavior data for adult (age ≥18 years) members of 2 large health care systems in California and Hawai'i who had at least 1 ambulatory visit to a primary care practitioner between January 1, 2006, and December 31, 2018. Data were analyzed from October 31, 2022, to July 31, 2023.

Exposure

Self-identified race and ethnicity provided in the EHR as a single-race category (Asian Indian, Chinese, Filipino, Japanese, Native Hawaiian only, Other Pacific Islander, or White) or a multiracial category (Asian and Pacific Islander; Asian, Pacific Islander, and White; Asian and White; or Pacific Islander and White).

Main Outcomes and Measures

The main outcome was obesity (body mass index [BMI] ≥30.0), based on last measured height and weight from the EHR. Logistic regression was used to examine the association between race and ethnicity and odds of obesity.

Results

A total of 5229 individuals (3055 [58.4%] male; mean [SD] age, 70.73 [11.51] years) were examined, of whom 444 (8.5%) were Asian Indian; 1091 (20.9%), Chinese; 483 (9.2%), Filipino; 666 (12.7%), Japanese; 91 (1.7%), Native Hawaiian; 95 (1.8%), Other Pacific Islander; and 888 (17.0%), White. The percentages of individuals who identified as multiracial were as follows: 417 (8.0%) were Asian and Pacific Islander; 392 (7.5%), Asian, Pacific Islander, and White; 248 (4.7%), Asian and White; and 414 (7.9%), Pacific Islander and White. A total of 1333 participants (25.5%) were classified as having obesity based on standard BMI criteria. Obesity was highest among people who identified as Asian, Pacific Islander, and White (204 of 392 [52.0%]) followed by those who identified as Other Pacific Islander (47 of 95 [49.5%]), Native Hawaiian (44 of 91 [48.4%]), and Pacific Islander and White (186 of 414 [44.9%]). After accounting for demographic, socioeconomic, and health behavior factors, people who identified as Asian, Pacific Islander, and White (odds ratio [OR], 1.80; 95% CI, 1.37-2.38) or Pacific Islander and White (OR, 1.55; 95% CI, 1.18-2.04) had increased odds of obesity compared with White individuals. All single-race Asian groups had lower odds of obesity compared with White individuals: Asian Indian (OR, 0.29; 95% CI, 0.20-0.40), Chinese (OR, 0.22; 95% CI, 0.17-0.29), Filipino (OR, 0.46; 95% CI, 0.35-0.62), and Japanese (OR, 0.38, 95% CI, 0.29-0.50).

Conclusions and Relevance

In this study, multiracial Asian and Pacific Islander individuals had an increased prevalence of obesity compared with many of their single-race counterparts. As the number of multiracial individuals increases, it will be important for clinical and public health systems to track disparities in these populations.

Assessment of the performance of the body mass index in diagnosing obesity in community-dwelling older adults in Latin American and Caribbean countries

BACKGROUND

The body mass index (BMI) ≥30 kg/m2 is the universally accepted cut-off point for defining obesity; however, its accuracy in classifying obesity in older adults is poorly understood.

OBJECTIVES

To assess the performance of the BMI cut-off point ≥30 kg/m2 in classifying obesity in older adults, using the fat mass index (FMI) and fat mass percentage (FM%) as reference criteria; and to establish region- and sex-specific BMI-based cut-off points to classify obesity in older adults.

METHODS

The present study is a secondary analysis derived from a cross-sectional project that included a sample of 1463 older adults from ten Latin American and Caribbean countries. Volunteers underwent total body water measurements using the deuterium dilution technique to determine FMI and FM%. Accuracy of the BMI and derived cutoff points was assessed by the area under the receiver operating characteristic curve (AUC).

RESULTS

The BMI cut-off point ≥30 kg/m2 had low sensitivity for classifying obesity in these older adults compared to the FMI and FM%. The AUC values for the optimal BMI-derived cut-off points showed an acceptable-to-outstanding discriminatory capacity in diagnosing obesity defined by the FMI. There was also a better balance between sensitivity and specificity than with the values obtained by a BMI ≥30 kg/m2 in older subjects in both regions.

CONCLUSION

The BMI cut-off point ≥30 kg/m2 had poor sensitivity for accurately diagnosing obesity in older adults from two regions. The region- and sex-specific BMI-derived cut-off points for defining obesity using the FMI are more accurate in classifying obesity in older men and women subjects from both regions.

Percentile Rankings and Position Differences for Absolute and Allometrically Scaled Performance Measures From the National Football League Scouting Combine

ABSTRACT

Gillen, ZM. Percentile rankings and position differences for absolute and allometrically scaled performance measures from the National Football League scouting combine. J Strength Cond Res 37(12): e613-e624, 2023-This study aimed to provide percentile rankings for absolute and allometrically scaled performance measures for National Football League (NFL) Scouting Combine subjects and determine if allometric scaling affected position-specific differences in performance measures. Subjects included American football players ( n = 3,015) who participated in the NFL Scouting Combines between 2015 and 2019. Subjects were divided into position groups: defensive backs (DBs, n = 562), defensive linemen (DL, n = 498), linebackers (LBs, n = 395), offensive linemen (OL, n = 505), running backs (RBs, n = 303), tight ends (TEs, n = 165), quarterbacks (QBs, n = 165), and wide receivers (WRs, n = 422). Performance measures included 40-yd dash time (with 10- and 20-yd split times), bench press repetitions to failure, vertical jump height, broad jump distance, pro-agility time, and L-cone drill time. Descriptive statistics were computed for all performance metrics and allometrically scaled performance metrics. One-way analyses of variance tested for position group differences for absolute and allometrically scaled performance measures. Percentile rankings for absolute and allometrically scaled performance measures were determined. Position-specific differences for absolute performance measures indicated that DB and WR tended to be faster, jump higher and further, and have greater change-of-direction capabilities compared with LB, QB, RB, and TE, who scored better in these respects than OL and DL. Allometric scaling revealed that DL, LB, RB, and TE tended to have superior performance than DB and WR, with QB and OL having the poorest performance. This study provides percentile rankings and the equation and parameters by which coaches and practitioners may allometrically scale data for evaluations of normalized performance measures from the NFL Scouting Combine.

Optimal Cut-Off Values for Body Mass Index and Fat Mass Index Based on Age in Physically Active Males Using Receiver Operating Characteristic Curve

This study aims to redefine obesity cut-off points for body mass index (BMI) and fat mass index (FMI) according to the different age groups of physically active males. Healthy physically active volunteers (N = 1442) aged 18-57 years (y), with a mean BMI = 22.7 ± 2.8 kg/m2, and mean FMI = 4.3 ± 1.7 kg/m2 were recruited from various fitness centers. BMI was calculated and individuals were categorized according to the Asia-Pacific BMI criterion of ≤22.9 kg/m2 and the previous WHO-guided BMI criterion of ≤24.9 kg/m2. FMI was also calculated for the study participants with a cut-off of 6.6 kg/m2. Redefining of BMI and FMI cut-off values was carried out based on different age groups categorized with a difference of 10 y and 5 y using the receiver operating characteristic (ROC) curve and Youden's index. For the entire study population, BMI redefined cut-off points for overweight and obesity were 23.7 kg/m2 and 24.5 kg/m2, respectively, while FMI redefined cut-off points for overweight and obesity were 4.6 kg/m2 and 5.7 kg/m2, respectively. With 10 y of age group difference, a constant BMI and FMI values were observed, while with 5 y of age group difference, a constant increase in the BMI cut-offs was observed as the age group increased, i.e., from 23.3 kg/m2 in 20-24 y to 26.6 kg/m2 in ≥45 y and a similar trend was seen in FMI cut-offs. To conclude, our study suggests that age-dependent BMI and FMI cut-off points may provide appropriate measurements for physically active males as the age group increases.

Comparisons of Baseline Obesity Prevalence and Its Association with Perceived Health and Physical Performance in Military Officers

Increasing obesity rates among USA military members vary by age, pay grade, and measurement methods and threaten force fitness and readiness. Limited research has directly measured obesity among officers; those enrolled in graduate school at the Command and General Staff College (CGSC) face additional demands and increased obesity risk. This study compared obesity measurements and performance on the Army Physical Fitness test and self-rated health for a sample of mostly CGSC officers. Participants (n = 136, 75.7% male, 79.6% officers) completed body composition measures; BMI, body fat percentage (BF%), waist circumference (WC), and waist-to-height ratio (WHtR) estimated obesity rates and were compared for discordance. Army Physical Fitness Test pass/fail rates and self-reported perceived health were compared with each obesity classification. Obesity prevalence was 18.5-39.7%, differing by sex and measure. BMI, WC, and WHtR underestimated obesity compared to BF% at least 21% of the time. WHtR had the lowest discordance with BF%. Soldiers categorized as obese were significantly more likely to fail the fitness test and report lower self-rated health than non-obese soldiers. Overall, obesity rates among our primarily officer sample were higher than previous studies, particularly for women. Interventions to address obesity are necessary among military officers to optimize human performance.

Healthspan and chronic disease burden among young adult and middle-aged male former American-style professional football players

OBJECTIVE

To examine the relationships between age, healthspan and chronic illness among former professional American-style football (ASF) players.

METHODS

We compared age-specific race-standardised and body mass index-standardised prevalence ratios of arthritis, dementia/Alzheimer's disease, hypertension and diabetes among early adult and middle-aged (range 25-59 years) male former professional ASF players (n=2864) with a comparator cohort from the National Health and Nutrition Examination Survey and National Health Interview Survey, two representative samples of the US general population. Age was stratified into 25-29, 30-39, 40-49 and 50-59 years.

RESULTS

Arthritis and dementia/Alzheimer's disease were more prevalent among ASF players across all study age ranges (all p<0.001). In contrast, hypertension and diabetes were more prevalent among ASF players in the youngest age stratum only (p<0.001 and p<0.01, respectively). ASF players were less likely to demonstrate intact healthspan (ie, absence of chronic disease) than the general population across all age ranges.

CONCLUSION

These data suggest the emergence of a maladaptive early ageing phenotype among former professional ASF players characterised by premature burden of chronic disease and reduced healthspan. Additional study is needed to investigate these findings and their impact on morbidity and mortality in former ASF players and other athlete groups.

Evaluation of Body Composition in CrossFit® Athletes and the Relation with Their Results in Official Training

CrossFit^® is a high-intensity sport that combines weightlifting, gymnastic skills, and cardiovascular exercises. To find the anthropometric references that define the optimal body composition, it is essential to first find an optimal body composition for one's physical preparation. The objective of this study is to describe the anthropometric characteristics of 27 Spanish CrossFit^® athletes, 19 males aged 39 years old (24-44) and 8 females aged 28 years old (23-40), and how these characteristics influenced their performance. The athletes performed the Fran, Cindy, and Kelly workouts, establishing minimum marks, and the CrossFit Total workout to assess maximum strength. Significant differences were not found in time and repetitions between sexes in skill training, although there was a positive correlation r = 0.876 (p < 0.001) between muscle mass and the Total CrossFit result. We can conclude that the CrossFit^® athlete has a low amount of fat mass and a small relative size, which is an advantage when training with bodyweight exercises, and a high muscle mass that provide benefits when strength training. In addition, despite executing movements from a multitude of disciplines, the physical demands for lifting heavy loads resulted in the anthropometric values of athletes being more similar to elite weightlifting athletes than in other sports.

Fat–fat-free index in body mass assessment in young people

The study aimed to personalize the classification of body weight using the fat–fat-free (FFF) index with the percentage of body fat and to develop classification standards for the FFF index for men aged 18–25 years. Moreover, 1,642 adolescents (1,200 ♀) were examined. Using body composition analyzers, weight was determined, as well as overall and segmental body composition. Based on the obtained values for fat mass and fat-free tissue mass, an overall FFF index was calculated. According to the BMI classification, 9% of ♀ and 6% of ♂ are underweight, 29% of ♀ and 13% of ♂ are overweight, and 5% of the subjects are obese. Women and men classified in the same group according to BMI differed statistically significantly in terms of body weight, FM%, and FFM. In contrast to BMI and FM%, the FFF used takes into account the ratio of fat mass to fat-free tissue and muscle tissue mass. The proposed classification of FFF was made taking into account the differences that arise with sexual development and physiological changes occurring in ontogeny. Assessment of body mass using the FFF index should be used as part of preventive screening for the early diagnosis and prevention of overweight and thus many chronic diseases for which overweight or obesity is a risk factor.

Effects of a 4-month active weight loss phase followed by weight loss maintenance on adaptive thermogenesis in resting energy expenditure in former elite athletes

PURPOSE

Despite adaptive thermogenesis (AT) being studied as a barrier to weight loss (WL), few studies assessed AT in the resting energy expenditure (REE) compartment after WL maintenance. The aim of this study was twofold: (1) to understand if AT occurs after a moderate WL and if AT persists after a period of WL maintenance; and (2) if AT is associated with changes in body composition, hormones and energy intake (EI).

METHODS

Ninety-four participants [mean (SD); BMI, 31.1(4.3)kg/m²; 43.0(9.4)y; 34% female] were randomized to intervention (IG, n = 49) or control groups (CG, n = 45). Subjects underwent a 1-year lifestyle intervention, divided in 4 months of an active WL followed by 8 months of WL maintenance. Fat mass (FM) and fat-free mass (FFM) were measured by dual-energy X-ray absorptiometry and REE by indirect calorimetry. Predicted REE (pREE) was estimated through a model using FM, FFM. EI was measured by the "intake-balance" method.

RESULTS

For the IG, the weight and FM losses were - 4.8 (4.9) and - 11.3 (10.8)%, respectively (p < 0.001). A time-group interaction was found between groups for AT. After WL, the IG showed an AT of -85(29) kcal.d^-1 (p < 0.001), and remained significant after 1 year [AT = - 72(31)kcal.d^-1, p = 0.031]. Participants with higher degrees of restriction were those with an increased energy conservation (R = - 0.325, p = 0.036 and R = - 0.308, p = 0.047, respectively). No associations were found between diet adherence and AT. Following a sub-analysis in the IG, the group with a higher energy conservation showed a lower WL and fat loss and a higher initial EI.

CONCLUSION

AT in REE occurred after a moderate WL and remained significant after WL maintenance. More studies are needed to better clarify the mechanisms underlying the large variability observed in AT and providing an accurate methodological approach to avoid overstatements. Future studies on AT should consider not only changes in FM and FFM but also the FFM composition.

Oxygen uptake efficiency slope in healthy normal weight young males: an applicable framework for calculation and interpretation

Background

The oxygen uptake efficiency slope (OUES) is considered a reliable indicator of cardiorespiratory fitness in young and clinical populations who cannot achieve maximal effort during a graded exercise test. However, OUES accuracy depends on the data points used for its calculation and it is still not clear if the submaximal OUES can accurately assess CRF in healthy young males.

Objective

We investigated the association between peak oxygen uptake and peak and submaximal OUES, and the agreement between submaximal OUES and peak OUES in male adolescents and young adults.

Methods

In this cross-sectional, observational study, fifty normal weight healthy participants (age 14-22 years, peak oxygen uptake 43.8 ± 7.3 mL·min^-1·kg^-1) performed a graded exercise test on a cycle ergometer and pulmonary gas exchange was assessed using breath-by-breath analysis. Peak oxygen uptake, and oxygen consumption at the aerobic and at the anaerobic threshold were determined as the 30-s average of the oxygen consumption values. Peak OUES (up to peak) and submaximal OUES (up to the aerobic and anaerobic thresholds) were calculated from the logarithmic relation between oxygen consumption and pulmonary ventilation.

Results

Very strong correlations were observed between peak oxygen uptake and peak OUES (r = 0.80-0.88) while fair-to-very strong correlations were observed between the peak oxygen uptake and the two submaximal OUES (r = 0.32-0.81). The level of agreement between peak OUES and OUES up to the anaerobic threshold (r = 0.89-0.93; Typical percentage error 6%; Intraclass correlation coefficient = 0.89-0.93) was greater than the one between the peak oxygen uptake with OUES up to the aerobic threshold (r = 0.39-0.56; Typical percentage error 15%; Intraclass correlation coefficient = 0.38-0.56).

Conclusions

. The peak OUES is a better indicator of aerobic fitness than the OUES up to the anaerobic threshold in healthy, young males. The OUES up to the anaerobic threshold is a valid alternative to peak OUES.

Association of waist to height ratio with 2.4 kilometers running time among male police populations

BACKGROUND: Body anthropometrics are biologically predetermined, while morphology responds to energy intake and output and stressors, thus impacting health. Fitness is impacted by these bodily characteristics. OBJECTIVE: This study determined to what degree anthropomorphic measures and age of police officers determined 2.4 km running performance. METHODS: Age, height, weight, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and 2.4 km running time (RUN) of 1916 male police officers were directly measured and analyzed. After determining correlations of anthropomorphic variables with RUN. Stepwise linear regressions evaluated individual associations of age, height, weight, BMI, WC, and WHtR with RUN, to determine the model with the highest predictive value of RUN performance. RESULTS: WHtR was the strongest RUN predictor (r = 0.672, R2 = 0.451, p < 0.001), while the best predictive model apart from WHtR also included age and BM (R2 = 0.556, p < 0.001). CONCLUSIONS: WHtR was the strongest anthropomorphic predictor of RUN performance. As a predictor, WHtR provides information on both anthropometric and morphology components of police officers. Its utilization among police occupations may be more effective than BMI as it better relates to performance.

Obesity in Polish Children and Parents' Perception of Their Children's Weight Status: The Results of the SOPKARD-Junior Study

One way to counteract the spread of obesity in children is its early recognition by parents. Therefore, the aim of this study was to investigate whether parents’ perception of their children’s BMI category was consistent with their actual BMI assessment and to determine potential influential factors. The study was conducted as part of the “A program for the early detection of risk factors for lifestyle diseases SOPKARD-Junior” (SOPKARD-Junior), a preventive health program implemented in public elementary schools from 2017 to 2019. The results from 381 children with a mean age of 11.67 (SD = 1.52) were analyzed. Height and weight were measured and BMI was calculated. Surveys were conducted to assess parents’ perceptions of their child’s weight, along with their sociodemographic status. Nearly one in three parents were unable to correctly identify their children’s weight; 25.0% underestimated it, and 6.0% overestimated it. Underestimation was observed along with an increase in the children’s BMI weight category, with as many as 57.1% of parents of obese children misclassifying their weight. The child’s BMI was the only significant predictor of incorrect assessment. Polish parents cannot properly assess their children’s BMI, especially when their child is overweight or obese. In children, weight and height measurements should be taken regularly, rather than allowing weight category to be dependent upon parental weight assessments.

Anthropometric cut-points for discriminating diabetes and the metabolic syndrome among Arabs and Asians: the Kuwait Diabetes Epidemiology Program

This study aimed to determine anthropometric cut-points for screening diabetes and the metabolic syndrome (MetS) in Arab and South Asian ethnic groups in Kuwait and to compare the prevalence of the MetS based on the ethnic-specific waist circumference (WC) cut-point and the International Diabetes Federation (IDF) and American Heart Association/National Heart, Lung, and Blood Institute WC criteria. The national population-based survey data set of diabetes and obesity in Kuwait adults aged 18-60 years was analysed. Age-adjusted logistic regression and receiver operating characteristic (ROC) analyses were conducted to evaluate for 3589 individuals the utility of WC, waist:height ratio (WHtR) and BMI to discriminate both diabetes and ≥3 CVD risk factors. Areas under the ROC curve were similar for WC, WHtR and BMI. In Arab men, WC, WHtR and BMI cut-offs for diabetes were 106 cm, 0·55 and 28 kg/m2 and for ≥3 CVD risk factors, 97 cm, 0·55 and 28 kg/m2, respectively. In Arab women, cut-offs for diabetes were 107 cm, 0·65 and 33 kg/m2 and for ≥3 CVD risk factors, 93 cm, 0·60 and 30 kg/m2, respectively. WC cut-offs were higher for South Asian women than men. IDF-based WC cut-offs corresponded to a higher prevalence of the MetS across sex and ethnic groups, compared with Kuwait-specific cut-offs. Any of the assessed anthropometric indices can be used in screening of diabetes and ≥3 CVD risk factors in Kuwaiti Arab and Asian populations. ROC values were similar. The WC threshold for screening the MetS in Kuwaiti Arabs and South Asians is higher for women.

Agreement of measures between measured body adiposity and calculated indices of fatness in sedentary and active male and female students

Study aim: Our study was undertaken to analyze agreement between measured body fat and different indices of fatness in students of both sexes and with different physical activity.

Materials and methods: A total of 330 students not engaged in regular physical activity (150 males and 180 females) and 356 students (180 males and 176 females) engaged in regular physical activity due to their study program (5–7 h/week) were recruited. In all participants body adiposity was measured from skinfold thickness. In addition, calculated indices of fatness based on waist (WC) and hip circumference (HC), such as abdominal volume index (AVI), body adiposity index (BAI) and relative fat mass (RFM) were calculated.

Results: The analysis of Bland-Altman plots revealed that agreement between measured and calculated body fat was found for RFM and BAI in sedentary and active men and for BAI in sedentary women, but not for measured body fat and RFM in sedentary women and for RFM and BAI in active women.

Discussion: Our study showed that in young adult Poles of both sexes and with different physical activity, the calculated obesity rates should be used with caution, especially in women, as an indicator of total body fat.

Association Between Obesity and Lower Short- and Long-Term Mortality in Coronary Care Unit Patients: A Cohort Study of the MIMIC-III Database

INTRODUCTION

Obesity has long been considered an independent risk factor for cardiovascular diseases (CVD), even in the COVID-19 pandemic. However, recent studies have found that a certain degree of obesity may be beneficial for patients who have already suffered from CVD, which is called the "obesity paradox". Our objective was to investigate whether the obesity paradox existed in coronary care unit (CCU) patients and the relationship between body mass index (BMI) and short- and long-term mortality.

METHODS

We performed a cohort analysis of 3,502 adult CCU patients from the Medical Information Mart for Intensive Care III (MIMIC-III) database. The patients were divided into four groups according to the WHO BMI categories. Both multivariable logistic regression and Cox regression were used to reveal the relation between BMI and mortality. Subgroup analyses were performed based on Simplified Acute Physiology Score (SAPS) and age.

RESULTS

After adjusting for confounders, obese patients had 33% and 30% lower mortality risk at 30-day and 1-year (OR 0.67, 95% CI 0.51 to 0.89; HR 0.70, 95% CI 0.59 to 0.83; respectively) compared with normal-weight patients, while the underweight group were opposite, with 141% and 81% higher in short- and long-term (OR 2.41, 95% CI 1.37 to 4.12; HR 1.81, 95% CI 1.34 to 2.46; respectively). Overweight patients did not have a significant survival advantage at 30-day (OR 0.91, 95% CI 0.70 to 1.17), but did have a 22% lower mortality risk at 1-year (HR 0.78; 95% CI 0.67 to 0.91). The results were consistent after being stratified by SAPS and age.

CONCLUSION

Our study supports that obesity improved survival at both 30-day and 1-year after CCU admission, and the obesity paradox existed in CCU patients.

Physical Characteristics and Physical Fitness Profiles of Korean Taekwondo Athletes: A Systematic Review

This study aimed to present a standard and normal distribution of Taekwondo athletes’ physical characteristics and physical fitness profiles using a systematic review. A systematic search was conducted using four Korean databases (Research Information Sharing Service, National Digital Science Library, DBpia, and Korean Studies Information Service System). From 2010 to 2020, we reviewed 838 papers on Taekwondo athletes’ physical characteristics and physical fitness factors (e.g., body composition, muscle strength, muscular endurance, flexibility, cardiorespiratory fitness, power, agility, balance, speed, and reaction time). Of them, 24 papers were selected and analyzed. The criteria for selecting the physical characteristics and physical fitness factors for data extraction were set to have a total sample size of more than 30 individuals and included two or more studies. The sample size and average and standard deviation of physical characteristics and physical fitness factors were extracted from each selected study. In this study, the estimation error of all variables, except for the eyes-closed single-leg stance (15.71%), was less than 8%. Therefore, it was confirmed that there was no problem with the validity of the estimated values. These results could be used as an essential objective basis for evaluating the physical characteristics and physical fitness profiles of Taekwondo athletes in most countries worldwide and setting training goals.

Caution, "normal" BMI: health risks associated with potentially masked individual underweight-EPMA Position Paper 2021

An increasing interest in a healthy lifestyle raises questions about optimal body weight. Evidently, it should be clearly discriminated between the standardised "normal" body weight and individually optimal weight. To this end, the basic principle of personalised medicine "one size does not fit all" has to be applied. Contextually, "normal" but e.g. borderline body mass index might be optimal for one person but apparently suboptimal for another one strongly depending on the individual genetic predisposition, geographic origin, cultural and nutritional habits and relevant lifestyle parameters-all included into comprehensive individual patient profile. Even if only slightly deviant, both overweight and underweight are acknowledged risk factors for a shifted metabolism which, if being not optimised, may strongly contribute to the development and progression of severe pathologies. Development of innovative screening programmes is essential to promote population health by application of health risks assessment, individualised patient profiling and multi-parametric analysis, further used for cost-effective targeted prevention and treatments tailored to the person. The following healthcare areas are considered to be potentially strongly benefiting from the above proposed measures: suboptimal health conditions, sports medicine, stress overload and associated complications, planned pregnancies, periodontal health and dentistry, sleep medicine, eye health and disorders, inflammatory disorders, healing and pain management, metabolic disorders, cardiovascular disease, cancers, psychiatric and neurologic disorders, stroke of known and unknown aetiology, improved individual and population outcomes under pandemic conditions such as COVID-19. In a long-term way, a significantly improved healthcare economy is one of benefits of the proposed paradigm shift from reactive to Predictive, Preventive and Personalised Medicine (PPPM/3PM). A tight collaboration between all stakeholders including scientific community, healthcare givers, patient organisations, policy-makers and educators is essential for the smooth implementation of 3PM concepts in daily practice.

Sex-specific differences in somatic investment and strategies of physical activity among Portuguese schoolchildren

OBJECTIVES

Physical activity (PA) is required for healthy growth, development, and maturation and plays an important role in the prevention of overweight and obesity in childhood and adolescence. Sex-differences in PA levels are well documented, with boys spending more time in PA, especially in moderate-to-vigorous activities. Following the Life History Theory, our aim is to study if PA affects the fat tissues increases during childhood and juvenile phases in both sexes.

METHODS

Time spent in sedentary, light, and moderate-to-vigorous PA levels were measured in a sample of 415 Portuguese children and juveniles (207 females/208 males; aged 6-11 years), using an accelerometer for 7 days. Skinfolds related with body fat were objectively collected and socioeconomic status factors were reported using a parental questionnaire.

RESULTS

The outcomes show that girls' and boys' fat variables increased during the end of the childhood and the juvenile phase. However, these variables were differently affected by PA. Girls increased fat variables with the sedentary activity while boys decreased fat variables with moderate-to-vigorous PA. Alike, active boys but not girls reduced the fat increase tendency with age.

CONCLUSIONS

Although both sexes displayed a general fat increment with age, moderate-to-vigorous PA dampens the increase only in boys. In fact, active girls increased body fat in the same manner as non-active girls. From an evolutionary perspective, it could explain sex-specific somatic strategies related to future reproduction or, with future mating and intrasexual competition.

Does FMI Correlate Better than BMI with the Occurrence of Metabolic Changes in Obese Patients? Study Based on 2007 Consecutive Mexican Patients

BACKGROUND

The body mass index (BMI) is the most commonly used anthropometric indicator. However, it does not discern among the different body components. The body fat content, expressed as fat mass index (FMI), is an accurate way to estimate adiposity. Since most metabolic diseases are associated with excess fat tissue, our aims were to comparatively analyze the frequency of associated metabolic abnormalities in patients with different obesity degrees based on BMI and FMI and to determine the best cut-off value of both indicators to predict metabolic abnormalities.

METHODS

From a cohort of 2007 patients, BMI and FMI were calculated using DXA. Individuals were classified into the different obesity degrees according to the reference ranges from the World Health Organization (WHO) and the National Health and Nutrition Examination Survey (NHANES). A comparative analysis between BMI, FMI, and their correlation to the presence of metabolic alterations was performed.

RESULTS

BMI underestimated the degree of obesity when compared with FMI. Spearman's rank-order correlation for both indexes resulted in very high coefficients (rho Spearman's = 0.857; p = 0.0001). The prevalence of metabolic alterations increased as BMI and FMI also increased. Despite the high positive statistical correlation between BMI and FMI, it was seen that some comorbidities were more specifically related to one particular index.

CONCLUSIONS

There were no significant differences between the BMI and the FMI for predicting the degree of obesity. Likewise, there were no significant differences between them for the prediction of metabolic alterations.

Normal weight obesity and the risk of diabetes in Chinese people: a 9-year population-based cohort study

We evaluated the risk of developing diabetes in Chinese individuals with normal weight obesity (NWO). This 9-year population-based cohort study was based on the China National Diabetes and Metabolic Disorders Survey. A total of 1128 subjects without diabetes were included. Body fat percentage (BF%) was assessed by electrical bioimpedance. NWO was defined as subjects with a normal BMI (< 24 kg/m²) and an excess BF% (≥ 24% in men; ≥ 33% in women). Of 1128 individuals, 528 individuals were normal weight non-obese (NWNO), 118 (10.5%) were normal weight obese (NWO), 63 were overweight non-obese (OWNO), and 419 were overweight obese (OWO). During a follow-up of 9.0 years (interquartile range: 8.9–9.3), 113 (10.0%) individuals developed diabetes. The incidence rates of diabetes in NWNO, NWO, OWNO and OWO people were 5.69 (27 cases), 11.30 (12 cases), 3.53 (2 cases) and 19.09 (72 cases) per 1000 person-years, respectively. Cox regression analyses indicated multivariate-adjusted hazard ratios of diabetes in NWO, OWNO and OWO people were 2.110 (95% CI 1.026–4.337, p = 0.025), 0.441 (95% CI 0.101–1.928, p = 0.232) and 3.465 (95% CI 2.163–5.551, p < 0.001), respectively, relative to NWNO people. Chinese people with NWO are at increased risk of developing diabetes. We strongly suggest the incorporation of BF% measurement into the regular physical examination in Chinese medical practice.

Higher Body Mass Index Adversely Affects Knee Function After Anterior Cruciate Ligament Reconstruction in Individuals Who Are Recreationally Active

OBJECTIVE

Our aim was to investigate the effect of body mass index (BMI) levels on quadriceps and hamstring strength and functional outcomes up to 6 months after anterior cruciate ligament reconstruction (ACLR) with hamstring tendon autograft (HTG).

DESIGN

Prospective, controlled study.

SETTING

University clinical laboratory.

PATIENTS

Ninety-one participants who had undergone unilateral ACLR with HTG were divided into 2 groups according to their BMI. The participants whose BMI were between 18.5 and 24.9 kg/m were included in group 1 (n = 50, age: 27.2 ± 6.7 years, BMI: 22.3 ± 1.6 kg/m) and those whose BMI > 24.9 kg/m were included in group 2 (n = 41, age: 30.2 ± 6.9 years, BMI: 28.0 ± 2.4 kg/m).

INTERVENTIONS

Quadriceps and hamstring strength, functional performance including hop, jump, and balance performance, and IKDC score.

MAIN OUTCOME MEASURES

Maximum voluntary isometric contraction of the quadriceps and hamstring muscles and the body mass were measured at 1, 3, and 6 months after surgery. Absolute peak torques and normalized peak torques to body weight for both limbs were recorded. Functional outcomes were evaluated at 6 months after surgery.

RESULTS

Normalized quadriceps strength improvement was lower in group 2 when compared with group 1 (F(2,178) = 6.23, P = 0.003). Group 2 also demonstrated lower scores in functional performance (P < 0.05). Normalized hamstring and absolute quadriceps and hamstring strength improvement was not affected by higher BMI level (P > 0.05).

CONCLUSIONS

Higher BMI levels adversely affect quadriceps strength capacity and performance in patients who have undergone ACLR with HTG. Clinicians should consider BMI levels of patients when assessing and targeting muscle recovery because it could negatively affect the success of the ACLR rehabilitation.

Effects of Daily Probiotics Supplementation on Anxiety Induced Physiological Parameters among Competitive Football Players

Competitive football players who undergo strenuous training and frequent competitions are more vulnerable to psychological disorders. Probiotics are capable of reducing these psychological disorders. The present study aimed to determine the effect of daily probiotics supplementation on anxiety induced physiological parameters among competitive football players. The randomized, double-blinded, placebo-controlled trial was conducted on 20 male footballers who received either probiotics (Lactobacillus Casei Shirota strain 3 × 1010 colony forming units (CFU) or a placebo drink over eight weeks. Portable biofeedback devices were used to measure the electroencephalography, heart rate, and electrodermal responses along with cognitive tests at the baseline, week 4, and week 8. Data were statistically analyzed using mixed factorial ANOVA and results revealed that there is no significant difference between the probiotic and placebo groups for heart rate (61.90 bpm ± 5.84 vs. 67.67 bpm ± 8.42, p = 0.09) and electrodermal responses (0.27 µS ± 0.19 vs. 0.41 µS ± 0.12, p = 0.07) after eight weeks. Similarly, brain waves showed no significant changes during the study period except for the theta wave and delta wave at week 4 (p < 0.05). The cognitive test reaction time (digit vigilance test) showed significant improvement in the probiotic group compared to the placebo (p < 0.05). In conclusion, these findings suggest that daily probiotics supplementation may have the potential to modulate the brain waves namely, theta (relaxation) and delta (attention) for better training, brain function, and psychological improvement to exercise. Further research is needed to elucidate the mechanism of current findings.

Despite Low Obesity Rates, Body Mass Index Under-Estimated Obesity among Russian Police Officers When Compared to Body Fat Percentage

In some countries, obesity rates among police officers are higher than the general public, despite physically demanding jobs. Obesity rates based on body mass index (BMI) may lack accuracy as BMI does not directly address body composition. Since data are lacking for obesity rates among Russian police officers, this study documented and compared officer obesity rates to the adult Russian population and compared the accuracy of body mass index (BMI) for obesity classification to two direct measures of body composition. Moscow region police officers (N = 182, 84% men) underwent height, weight, waist circumference (WC), and body fat percentage (BF%) bioelectrical impedance measurements during annual medical examinations. BMI-defined obesity rates were 4.6% for men and 17.2% for women, which were >3 and >1.8 times lower than Russian adults, respectively. WC-defined obesity rates were similar to BMI (3.3% for men and 10.3% for women), but BF%-defined obesity rates were much higher (22.2% for men and 55.2% for women). Although obesity rates were lower than those found among police officers in other countries, BMI alone was not a particularly accurate method for classifying weight status among Russian police officers.

Comparison of obesity classification methods among college students

The purpose of this study was to compare obesity classification methods (body mass index (BMI)), abdominal girth (AG), and body fat percentage (BF%)), among college students. College students (n=5943) completed an objective fitness assessment, where height and weight (used to calculate BMI), AG, and BF% (using Bioelectrical Impedance Analysis) were assessed. Correlation and chi-square tests for independence analyses examined relationships between variables and obesity classification methods; and, the sensitivity and specify of BMI using AG and BF% were calculated. Significant correlations were found between BMI and BF% for men (r=0.775, p<0.001) and women (r=0.849, p<0.001); BMI and AG for men (r=0.868, p<0.001) and women (r=0.858, p<0.001); and, BF% and AG for men (r=0.749, p<0.001) and women (r=0.767, p<0.001). There were significant associations between BMI, AG, and BF% for both sexes. Obesity categorization differed significantly between methods. In men and women, respectively, 47.6% and 44.1% classified as normal weight based on BF% were classified as overweight or obese based on BMI (Men: χ2=1547, p<0.001; Women: χ2=1127, p<0.001). In men and women, respectively, 48.3% and 24.0% classified as normal based on AG were classified as overweight or obese using BMI (Men: χ2=1274, p<0.001; Women: χ2=996, p<0.001). Comparing AG and BF%, 25.1% of men and 18.6% of women classified as normal based on AG were classified as overweight or obese using BF% (Men: χ2=1412, p<0.001; Women: χ2=421, p<0.001). Obesity classification differed significantly between methods, and BMI demonstrated relatively poor predictive value with respect to obesity classification. Thus, caution should be applied when using BMI to diagnose obesity among college students.

Defining Exposures in Professional Football: Professional American-Style Football Players as an Occupational Cohort

Studies of professional American football players have shown that football-related activities lead to acute injuries and may have long-term adverse health outcomes including osteoarthritis, neurocognitive impairment, and cardiovascular disease. However, the full complement of what constitutes professional football exposure has yet to be effectively articulated. Most likely, professional football exposure encompasses a multifaceted array of experiences including head impacts and joint stresses, long-term pain medication use, dietary restrictions, and strenuous training regimens. To study the health of professional American football players, characterizing the group as an occupational cohort and taking advantage of methods established within the discipline of occupational epidemiology may be beneficial. We conducted a narrative review of existing football research, occupational epidemiological methods papers, and occupational medicine studies. Here we describe the traditional occupational epidemiological approach to assessing exposure in a novel cohort and show how this framework could be implemented in studies of professional football players. In addition, we identify the specific challenges associated with studying an elite athletic occupational group, including the healthy worker effect and other types of selection and information biases, and explore these in the context of existing studies of football-related health. The application of well-established occupational epidemiological methods to professional football players may yield new insights into the effects of playing exposure and may provide opportunities for interventions to reduce harm.

Weight Gain and Health Affliction Among Former National Football League Players

BACKGROUND

Professional American-style football players are among the largest athletes across contemporary sporting disciplines. Weight gain during football participation is common, but the health implications of this early-life weight gain remain incompletely understood. We sought to define weight trajectories of former professional American-style football athletes and to establish their relationship with 5 common health afflictions (cardiovascular disease, cardiometabolic disease, neurocognitive impairment, sleep apnea, and chronic pain).

METHODS

A health survey was distributed to former National Football League (NFL) players. Former players reported body weight at 4 time points (high school, college, professional, and time of survey response) as well as maximal retirement weight. Logistic regression was used to assess associations between weight gain during football participation and health affliction.

RESULTS

In this cohort of former NFL players (n = 3,506, age 53 ± 14 years), mean weight increase from high school to time of survey response was 40 ± 36 pounds, with the majority of weight gain occurring during periods of football participation (high-school-to-college and college-to-professional). The prevalence of health afflictions ranged from 9% (cardiovascular disease) to 28% (chronic pain). Weight gain during football participation was independently associated with risk of multiple later-life health afflictions in models adjusted for football exposure, lifestyle variables, and post-career weight gain.

CONCLUSIONS

Early-life weight gain among American-style football athletes is common and is associated with risk of adverse health profiles during later-life. These findings establish football-associated weight gain as a key predictor of post-career health and raise important questions about the central role of targeted weight gain in this population.