Impact of Body Mass Index on All-Cause Mortality in Adults: A Systematic Review and Meta-Analysis

Background: Obesity is a risk factor for many diseases, diagnosed by calculating body mass index (BMI). Methods: To find an association between BMI and mortality in adults, we searched PubMed for articles published in the 21st century. Our review included 82 original studies, comprising 2.7 million patients and 23.4 million patient years. Results: The meta-analysis showed a U-shaped relationship between BMI and all-cause mortality risk, with the lowest mortality in the BMI range of 25-30 kg/m2. Subgroup analysis showed a J-shaped relationship, with greater risk in the highest BMI range (>35 kg/m2). Among the elderly, BMI values <20 kg/m2 were associated with the highest risk. Among diabetic patients, a U-shaped relationship was noticed, again with the highest risk in the lowest (<20 kg/m2) and highest BMI range (>35 kg/m2). Among patients with cardiovascular disease, the risk increased with BMI values <25 kg/m2 but did not noticeably change for BMI exceeding that value. Among cancer patients, the relationship was less pronounced than in other subgroups, with a slightly higher risk (>35 kg/m2). Conclusions: Our results show that the lowest mortality is observed among patients with BMI 25-30 kg/m2. Reduction of body mass should not be a universal recommendation in clinical practice, but it should be individualized.

Relationships of pregnancy and postpartum diet quality with offspring birth weight and weight status through 12 months

OBJECTIVE

This study examined relationships of maternal pregnancy and postpartum diet quality with infant birth size and weight status indicators through 12 months and tested whether breastfeeding duration modifies these associations.

METHODS

In the Pregnancy Eating Attributes Study (PEAS), dietary intake was assessed six times in 458 mothers who were followed from early pregnancy through 12 months postpartum (2014-2018). Logistic and linear mixed models estimated relationships of pregnancy and postpartum diet quality (Healthy Eating Index [HEI]) with offspring who were large-for-gestational-age (LGA) at birth, as well as BMI z score (BMIz) and weight-for-length z score (WFLz) at birth, 6 weeks, 6 months, and 12 months.

RESULTS

Pregnancy HEI was inversely related to LGA (odds ratio [OR] = 0.95, 95% CI: 0.92 to 0.98); HEI was also inversely related to WFLz (β = -0.01, 95% CI: -0.02 to -0.002) and BMIz (β = -0.009, 95% CI: -0.02 to -0.0009) from birth through 12 months. Postpartum HEI was inversely related to WFLz (β = -0.01, 95% CI: -0.02 to -0.0009) and BMIz (β = -0.008, 95% CI: -0.02 to 0.0007) in infants who were breastfed for at least 6 months, but not in those who were breastfed for a shorter duration.

CONCLUSIONS

Maternal diet quality during pregnancy (and during postpartum in mothers who breastfed for a longer duration) was inversely related to LGA and weight status indicators from birth through 12 months. Increasing maternal diet quality may have use for promoting healthy infant weight development.

Body Mass Index Within Multifactor Predictors of Ventral Hernia Recurrence: A Retrospective Cohort Study

Background A ventral hernia is a protrusion of the peritoneum through the defective abdominal wall. Several risk factors increase the likelihood of hernial recurrence. One of the most common risk factors is obesity, defined by the World Health Organization (WHO) as increased body mass index (BMI). Few studies have explored the effects of BMI and other factors on hernia recurrence. Hence, we aimed to investigate the role of increased BMI in hernia recurrence in conjunction with various risk factors such as age, sex, type of hernia, the time elapsed between the occurrence and recurrence, complications of hernia, and procedure. Methods This retrospective cohort study was conducted at King Abdulaziz University Hospital (KAUH). All the patients were admitted between 2015-2022. A total of 1676 medical records were obtained from all patients who underwent hernia repair more than once or were diagnosed with a recurrent hernia during the study period. Results Our study revealed an insignificant correlation between a BMI of more than 25 kg/m² and the recurrence of inguinal hernias, predominantly indirect hernias. Furthermore, overweight and obese patients experience a longer interval between the first and second hernia repairs. Interestingly, all the patients with inguinal and umbilical hernias had the same diagnosis at the second presentation. However, the findings also included a significant increase in umbilical hernias in individuals with a high BMI and higher recurrence rates among male patients with inguinal hernias. Conclusion BMI higher than 25 kg/m² increases recurrence rates for umbilical hernias but decreases the recurrence of inguinal hernias.

Obesity Is Indirectly Associated with Sudden Cardiac Arrest through Various Risk Factors

Although obesity is a well-established risk factor of cardiovascular event, the linkage between obesity and sudden cardiac arrest (SCA) is not fully understood. Based on a nationwide health insurance database, this study investigated the impact of body weight status, measured by body-mass index (BMI) and waist circumference, on the SCA risk. A total of 4,234,341 participants who underwent medical check-ups in 2009 were included, and the influence of risk factors (age, sex, social habits, and metabolic disorders) was analyzed. For 33,345,378 person-years follow-up, SCA occurred in 16,352 cases. The BMI resulted in a J-shaped association with SCA risk, in which the obese group (BMI ≥ 30) had a 20.8% increased risk of SCA compared with the normal body weight group (18.5 ≤ BMI < 23.0) (p < 0.001). Waist circumference showed a linear association with the risk of SCA, with a 2.69-fold increased risk of SCA in the highest waist circumference group compared with the lowest waist circumference group (p < 0.001). However, after adjustment of risk factors, neither BMI nor waist circumference was associated with the SCA risk. In conclusion, obesity is not independently associated with SCA risk based on the consideration of various confounders. Rather than confining the findings to obesity itself, comprehensive consideration of metabolic disorders as well as demographics and social habits might provide better understanding and prevention of SCA.

Morbid obesity increases death and dropout from the liver transplantation waiting list: A prospective cohort study

Liver transplant (LT) candidates with a body mass index (BMI) over 40 kg/m² have lower access to a liver graft without clear explanation. Thus, we studied the impact of obesity on the waiting list (WL) and aimed to explore graft proposals and refusal.

METHOD

Data between January 2007 and December 2017 were extracted from the French prospective national database: CRISTAL. Competing risk analyses were performed to evaluate predictors of receiving LT. Competitive events were (1) death/WL removal for disease aggravation or (2) improvement. The link between grade obesity, grafts propositions, and reason for refusal was studied.

RESULTS

15,184 patients were analysed: 10,813 transplant, 2847 death/dropout for aggravation, 748 redirected for improvement, and 776 censored. Mortality/dropout were higher in BMI over 35 (18% vs. 14% 1 year after listing) than in other candidates. In multivariate analysis, BMI>35, age, hepatic encephalopathy, and ascites were independent predictors of death/dropout. Candidates with a BMI ≥ 35 kg/m² had reduced access to LT, without differences in graft proposals. However, grafts refusal was more frequent especially for 'morphological incompatibility' (14.9% vs. 12.7% p < 0.01).

CONCLUSION

BMI over 35 kg/m² reduces access to LT with increased risk of dropout and mortality. Increased mortality and dropout could be due to a lower access to liver graft secondary to increased graft refusal for morphological incompatibility.

Examination of serum metabolome altered by cigarette smoking identifies novel metabolites mediating smoking-BMI association

OBJECTIVE

The authors hypothesize that an untargeted metabolomics study will identify novel mechanisms underlying smoking-associated weight loss.

METHODS

This study performed cross-sectional analyses among 1,252 participants in the Bogalusa Heart Study and assessed 1,202 plasma metabolites for mediation effects on smoking-BMI associations. Significant metabolites were tested for associations with smoking genetic risk scores among a subset of participants (n = 654) with available genomic data, followed by direction dependence analysis to investigate causal relationships between the metabolites and smoking and BMI. All analyses controlled for age, sex, race, education, alcohol drinking, and physical activity.

RESULTS

Compared with never smokers, current and former smokers had a 3.31-kg/m² and 1.77-kg/m² lower BMI after adjusting for all covariables, respectively. A total of 22 xenobiotics and 94 endogenous metabolites were significantly associated with current smoking. Eight xenobiotics were also associated with former smoking. Forty metabolites mediated the smoking-BMI associations, and five showed causal relationships with both smoking and BMI. These metabolites, including 1-oleoyl-GPE (18:1), 1-linoleoyl-GPE (18:2), 1-stearoyl-2-arachidonoyl-GPE (18:0/20:4), α-ketobutyrate, and 1-palmitoyl-GPE (16:0), mediated 26.0% of the association between current smoking and BMI.

CONCLUSIONS

This study cataloged plasma metabolites altered by cigarette smoking and identified five metabolites that partially mediated the association between current smoking and BMI.

The Burden of Childhood Asthma by Age Group, 1990-2019: A Systematic Analysis of Global Burden of Disease 2019 Data

BACKGROUND

Asthma is a common respiratory disease in children. We aimed to update information about the incidence and mortality and disability-adjusted life years (DALYs) of childhood asthma and provide evidence-based recommendations for childhood asthma prevention.

METHODS

Data were obtained from the Global Burden of Disease (GBD) study, which was conducted from 1990 to 2019 in 204 countries. First, we estimated incidence, mortality and DALY rates of childhood asthma using a Bayesian meta-regression model. Second, we analyzed the relationship between the sociodemographic index (SDI) and DALYs in different age groups. Third, we studied changes in trends of the age-standardized DALY rate between 1990 and 2019 based on age group, SDI, and risk factors.

RESULTS

Globally, the number of deaths due to childhood asthma and the incidence and DALY rates were 12.9 thousand (95% UI 10.6 to 15.7), 22 million (95% UI 15 to 31), and 5.1 million (95% UI 3.4 to 7.5) in 2019, decreasing by 65.1% (95% UI 47.6 to 72.4), 5.3% (95% UI 2.6 to 8.8) and 30% (95% UI 18 to 41) from those in 1990, respectively. With the exception of high-SDI regions, the age-standardized DALY rate in all age groups in all SDI regions declined. In 2019, the age-standardized DALY rate in 1- to 4-year-old individuals was highest in low-SDI regions and that of 5- to 19-year-old individuals was highest in high-SDI regions. In contrast to low-SDI regions, individuals in high-SDI regions had a higher risk of DALYs due to asthma, except in those aged 1 to 4 years. A high body mass index (BMI) was a stronger risk factor than occupational asthmagens for childhood asthma.

CONCLUSION

Our findings provide insight into asthma prevention and treatment through the identification of key factors related to childhood asthma. Based on the data available, different risk factors according to age group and region/country suggest different prevention strategies, which is key for preventing childhood asthma.

Anthropometric Markers With Specific Cut-Offs Can Predict Anemia Occurrence Among Malaysian Young Adults

Objective: Anemia bears a high global prevalence with about 1.6 billion people living with this affliction. Malaysia carries the burden of 13.8% anemia prevalence which urges for extensive research directed to its prediction and amelioration. This is the first study that aims to (a) propose simple non-invasive predictive anthropometric markers and their specific cut-off values for early prediction of anemia among the young adults in Malaysia, (b) provide anemia prevalence based on both gender and ethnicity among young adults of Malaysia.

Method: The present cross-sectional study included 245 participants (113 men and 132 women) aged between 18 and 30 years. Anthropometric parameters were measured following the standard protocols. Blood samples were collected and hemoglobin levels were determined using the HemoCue haemoglobinometer (Hb 201+ System, Angelhom, Sweden) to detect the presence of anemia. The receiver operating characteristics (ROC) curve was employed to assess and compare the efficacy of anthropometric indices in the prediction of anemia. Data were analyzed using SPSS (v. 22.0, IBM, Chicago, IL, USA) and MedCalc (v. 19.05, Ostend, Belgium).

Result: The ROC analysis indicates that body mass index (BMI) is the best anthropometric marker with the highest area under the curve (AUC) and specificity (SP) for predicting the presence of anemia in young adults in Malaysia. Thus, the study proposes the optimal cut-off value of BMI for young men of Malaysia as 20.65 kg/m² (AUC: 0.889) and young women of Malaysia as 19.7 kg/m² (AUC: 0.904). The study also reports that Malaysian Indians have the highest prevalence of anemia (26.22%) followed by Malays (21.54%), “Others” (indigenous ethnic group) (20%), and Chinese (14.5%), with an overall higher prevalence of anemia in young adult women (21.96%) than in men (18.6%) of Malaysia.

Conclusion: The proposed anemia-predictive anthropometric markers with optimal cut-off values will aid early detection of anemia among young adults in Malaysia, and given its simple, inexpensive, and intelligible approach, it can be widely used. The ease of anemia prediction together with the reported distribution of anemia prevalence based on gender and ethnicity will facilitate in gauging the necessary extent of strategies of anemia management in the young adult population of Malaysia.

Waist Circumference and BMI Are Strongly Correlated with MRI-Derived Fat Compartments in Young Adults

Young adulthood is increasingly considered as a vulnerable age group for significant weight gain, and it is apparent that there is an increasing number of new cases of metabolic syndrome developing among this population. This study included 60 young adult volunteers (18-26 years old). All participants obtained a calculated total abdominal fat percentage, subcutaneous fat percentage, and visceral fat percentage using a semiautomatic segmentation technique from T1-weighted magnetic resonance imaging (MRI) images of the abdomen. The results show strongest correlation between abdominal fat and BMI (r = 0.824) followed by subcutaneous fat (r = 0.768), and visceral fat (r = 0.633) respectively, (p < 0.001 for all, after having been adjusted for age and gender). Among anthropometric measurements, waist circumference showed strong correlation with all fat compartments (r = 0.737 for abdominal, r = 0.707 for subcutaneous fat, and r = 0.512 for visceral fat; p < 0.001 for all). The results obtained from examining the blood revealed that there was a moderate positive correlation relationship between all fat compartments with triglyceride, high-density lipoprotein, and fasting glucose levels (p < 0.05 for all). This study suggests that both BMI and waist circumference could be used to assess the fat compartments and treatment targets to reduce the risk of metabolic disorders and health risks in the young adult population.

Effect of malnutrition and body composition on the quality of life of COPD patients

BACKGROUND

Pathological alterations in nutritional status may develop in Chronic Obstructive Pulmonary Disease (COPD) patients through production of inflammatory cytokines and inadequate diet.

OBJECTIVE

The aim of our study was to determine the correlation between nutritional status and quality of life of COPD patients.

METHODS

We evaluated the nutritional status of COPD patients of Hungarian National Koranyi Institute for Pulmonology using the Malnutrition Universal Screening Tool (MUST) and bioelectrical impedance analysis (BIA) between January 1 and June 1, 2019. Lung function, physical fitness, and respiratory muscle strength were included in the assessment.

RESULTS

Fifty patients (mean age was 66.3 ± 9.6 years) participated in our study. Mean body mass index (BMI) was 26.2 ± 6.1 kg/m2 and mean fat-free mass index (FFMI) was 16.8 ± 2.4 kg/m2. Overweight patients had better lung function values (FEV1ref%: 46.3 ± 15.2) than normal (FEV1ref%: 45.1 ± 20.9) and underweight patients (FEV1ref%: 43.8 ± 16.0). The Modified Medical Research Council Dyspnea Scale (mMRC) was significantly associated with various parameters; strongest correlation was found with FFMI (r = -0.537, P < 0.001), skeletal muscle mass index (SMMI) (r = -0.530, P < 0.001), and 6-minute walking distance (6MWD) (r = -0.481, P < 0.001).

CONCLUSIONS

Our results indicate that malnourished COPD patients may have reduced lung function and lower quality of life compared to normal weight patients. Thus, our findings suggest that nutritional therapy be included in the treatment of COPD patients combined with nutritional risk screening and BIA during the follow-up.

Second-Hand Smoke and Its Synergistic Effect with a Body-Mass Index of >24.9 kg/m2 Increase the Risk of Gout Arthritis in Indonesia

To analyze the association between smoking status (active smoking and exposure to Second-Hand Smoking (SHS)) and the synergistic effect of smoking status and BMI with gout risk, a community-based case-control design was undertaken among 385 participants, including 304 healthy controls and 81 gout patients from seven community health services. Adjusted Odd Ratios (AORs) and 95% Confidence Interval (CIs) of gout for active smoking and SHS were 3.26 (95% CI = 1.07~9.90) and 4.67 (95% CI = 2.18~10.00) compared to non-smokers. Time-dependent manner of active smoking and SHS significantly increased gout risk with AORs and 95% CIs of 5.95 (1.41~25.03) and 10.12 (3.51~29.14). Dose-dependency of active smokers and SHS showed AORs and 95% CIs of 5.15 (1.28~20.63) and 4.37 (1.33~14.28). Smoking 20 cigarettes (one pack) per day for one year is equivalent to one pack-year. Active smoking >20 pack-year and SHS > 26.5 pack-year increased gout risk with AORs and 95% CIs of 7.18 (1.53~33.67) and 9.95 (3.64~27.22). Participants who smoked (active smoking and SHS) and with Body Mass Index (BMI) of > 24.9 kg/m2 synergistically increased gout risk, with an AOR of 9.65 and 95% CI of 3.25~28.65, compared to BMI ≤ 24.9 kg/m2 and non-smoker. Smoking status (active smoking and SHS) and the synergistic effect of smoking status and BMI increased gout risk in Indonesia.

Body mass index combined with waist circumference can predict moderate chronic kidney disease: A retrospective study

Overweight and obesity may be associated with poor clinical outcome, including chronic kidney disease (CKD). However, whether body mass index (BMI), waist-to-hip ratio (WHR), and waist circumference (WC) are related to CKD is yet to be elucidated.A total of 7593 adults were divided into 4 groups based on the estimated glomerular filtration rate (eGFR) quartile. The eGFR was calculated with the CKD Epidemiology Collaboration. Multiple linear regression analyzed the association between eGFR and WHR, BMI, and WC. Logistic regression analysis determined whether the CKD patients were associated with WHR, BMI, and WC after adjusting for other variables.The mean age of the cohort was 72.34 ± 7.30 years. Multiple linear regression analysis showed that WC (P = .006) was associated with eGFR, although adjusted by lifestyle factor and biochemical indicators. The individuals in the underweight, overweight, and obese groups had significantly lower eGFR value than those in the healthy weight group in moderate CKD. The eGFR in the overweight group with WHR ≤0.894 was higher than in the healthy weight group with WHR >0.894 group (P = .036). Overweight with WHR ≤0.894 group had a longer WC with a pronounced increase in the hip circumference. Logistic regression analysis showed that the WC (OR = 1.362, P < .001) and BMI (OR = 1.227, P = .031) were independent risk factors for moderate CKD patients. Each standard deviation (SD) of high BMI and WC level was associated with 23.0% and 17.3% higher odds of moderate CKD (OR = 1.230, P = .017 and OR = 1.173, P = .021, respectively).WC is an independent risk factor for eGFR. Combined BMI and WC are important factors that would predict moderate CKD patients.

Discordance between Body-Mass Index and Body Adiposity Index in the Classification of Weight Status of Elderly Patients with Stable Coronary Artery Disease

Background and Aims: Body-mass index (BMI) is a popular method implemented to define weight status. However, describing obesity by BMI may result in inaccurate assessment of adiposity. The Body Adiposity Index (BAI) is intended to be a directly validated method of estimating body fat percentage. We set out to compare body weight status assessment by BMI and BAI in a cohort of elderly patients with stable coronary artery disease (CAD). Methods: A total of 169 patients with stable CAD were enrolled in an out-patient cardiology clinic. The National Research Council (US) Committee on Diet and Health classification was used for individuals older than 65 years as underweight BMI < 24 kg/m², normal weight BMI 24–29 kg/m², overweight BMI 29–35 kg/m², and obesity BMI > 35 kg/m². In case of BAI, we used sex- and age-specific classification of weight status. In addition, body fat was estimated by bioelectrical impedance analysis (BImpA). Results: Only 72 out of 169 patients (42.6%) had concordant classification of weight status by both BMI and BAI. The majority of the patients had their weight status either underestimated or overestimated. There were strong positive correlations between BMI and BImpA (FAT%) (R = 0.78 p < 0.001); BAI and BImpA (FAT%) (R = 0.79 p < 0.001); and BMI and BAI (R = 0.67 p < 0.001). BMI tended to overestimate the rate of underweight, normal weight or overweight, meanwhile underestimating the rate of obesity. Third, BMI exhibited an average positive bias of 14.4% compared to the reference method (BImpA), whereas BAI exhibited an average negative bias of −8.3% compared to the reference method (BImpA). Multivariate logistic regression identified independent predictors of discordance in assessing weight status by BMI and BAI: BImpA (FAT%) odds ratio (OR) 1.29, total body water (%) OR 1.61, fat mass index OR 2.62, and Controlling Nutritional Status (CONUT) score OR 1.25. Conclusions: There is substantial rate of misclassification of weight status between BMI and BAI. These findings have significant implications for clinical practice as the boundary between health and disease in malnutrition is crucial to accurately define criteria for intervention. Perhaps BMI cut-offs for classifying weight status in the elderly should be revisited.

Burden and determinants of multimorbidity among women in reproductive age group: a cross-sectional study based in India

Background: India's government is currently running several programs with a sole focus on women's health during their child-bearing years. However, none of these programs incorporate the management of chronic health conditions during the reproductive span. This issue is an emerging public health concern; therefore, the present study aims to identify the patterns and correlates of multimorbidity among women in reproductive age groups in India. Methods: The study utilizes nationally-representative cross-sectional data from the Demographic and Health Survey on 661,811 women in the reproductive age group of 15-49 years. The study uses information on seven chronic morbidities, namely asthma, cancers, heart disease, diabetes, tuberculosis, hypertension, and thyroid disorder. Descriptive, bivariate, and multivariable techniques were utilized to accomplish the study objective. Results: The findings show that 17.4 and 3.5 per 100 women of reproductive age suffered from any one morbidity and multimorbidity, respectively. Hypertension, diabetes, and thyroid disorders were commonly occurring morbidities. The prevalence of having any one morbidity or multimorbidity increased with age. Variables like religion, wealth, parity, menopause, consumption of tobacco and alcohol, body mass index, and type of diet were found to be significantly related to the burden of multimorbidity. The prevalence of multimorbidity was found to be higher for women who belong to the Southern, Eastern, and North-Eastern regions of India. Conclusions: Findings suggest the importance of multimorbidity in the context of women of reproductive age. Inclusion of chronic disease management strategies with maternal and child health services needs to be taken into consideration by the program and policymakers. The annexation of social marketing approaches at the primary level of healthcare would assist policy-makers in educating women about the importance of leading a healthy lifestyle. Practicing dietary diversity can help in maintaining optimal estrogen levels, which would further help in decreasing multimorbidity rates among women in India.

Cardiometabolic health during early adulthood and risk of miscarriage: a prospective study

Background: Several studies have found that women who are overweight or obese have an increased risk of miscarriage. There is also some evidence of associations of other aspects of cardiometabolic health, including blood pressure and lipids, with miscarriage risk, although these have not been examined to the same extent as body-mass index (BMI). Methods: Our objective was to investigate the risk of miscarriage according to pre-pregnancy cardiometabolic health. We examined pre-pregnancy levels of BMI, blood pressure, fasting insulin and metabolites profile at age 18 and risk of miscarriage by age 24. The study included adult female offspring in the Avon Longitudinal Study of Parents and Children with a pregnancy between 18 and 24 years of age (n=434 for BMI and blood pressure; n=265 for metabolites). We used log-binomial regression to calculate adjusted associations between cardiometabolic health measures and miscarriage. Results: The overall risk of miscarriage was 22%.  The adjusted relative risks for miscarriage were 0.96 (95% CI: 0.92-1.00) for BMI (per unit increase), 0.98 (0.96-1.00) for systolic blood pressure, and 1.00 (0.97-1.04) for diastolic blood pressure (per 1 mmHg increase).  Total cholesterol, total lipids and phospholipids in HDL-cholesterol were associated with increased likelihood of miscarriage, but none of the p-values for the metabolites were below the corrected threshold for multiple testing (p-value ≤0.003). Conclusions: Our findings indicate no strong evidence to support a relationship between pre-pregnancy cardiometabolic health and risk of miscarriage in young, healthy women who became pregnant before age 24. Future studies are necessary that are able to evaluate this question in samples with a wider age range.

The Association of Different Types of Leisure Time Physical Activities with Cardiometabolic Outcomes in Singapore-Findings from the Multi-Ethnic Cohort Study

The study aimed to investigate the association between leisure time physical activity (LTPA) subtypes and cardiometabolic outcomes in the Singapore Multi-Ethnic Cohort (MEC). Self-reported data on socio-demographics, lifestyle factors, LTPA subtypes, and health screening data on body-mass index (BMI), waist circumference (WC), systolic and diastolic blood pressure (SBP and DBP), triglycerides (TG), and HDL-and LDL cholesterol were collected. Multivariable linear regression analyses were used adjusting for confounders. The mean age of 9768 participants was 45.2 ± 12.5 years (57.3% female, 47.3% Chinese, 26.0% Malay, and 26.8% Indians). Overall, 65.8% engaged in LTPA, and walking, strength/fitness and running were most common. Higher total LTPA was associated with lower WC, DBP, TG, a trend towards lower BMI, and higher SBP and HDL. Running was beneficially associated with all outcomes except for SBP and LDL. Balance exercises (BMI, SBP and DBP), cycling (BMI, WC and HDL), and strength/fitness (BMI, WC, TG and HDL) were also favorably associated with a number of outcomes, whereas ball games (DBP and TG), dancing (HDL) and other LTPA (DBP) were only favorably associated with selected outcomes. Unfavorable associations were found for total LTPA (SBP), strength/fitness (SBP), golf (DBP) and swimming (BMI and WC). Further research is warranted to inform future health promotion efforts.

Burden and determinants of multimorbidity among women in reproductive age group: a cross-sectional study based in India

Background: India's government is currently running several programs with a sole focus on women's health during their child-bearing years. However, none of these programs incorporate the management of chronic health conditions during the reproductive span. This issue is an emerging public health concern; therefore, the present study aims to identify the patterns and correlates of multimorbidity among women in reproductive age groups in India. Methods: The study utilizes nationally-representative cross-sectional data from the Demographic and Health Survey on 661,811 women in the reproductive age group of 15-49 years. The study uses information on seven chronic morbidities, namely asthma, cancers, heart disease, diabetes, tuberculosis, hypertension, and thyroid disorder. Descriptive, bivariate, and multivariable techniques were utilized to accomplish the study objective. Results: The findings show that 17.4 and 3.5 per 100 women of reproductive age suffered from any one morbidity and multimorbidity, respectively. Hypertension, diabetes, and thyroid disorders were commonly occurring morbidities. The prevalence of having any one morbidity or multimorbidity increased with age. Variables like religion, wealth, parity, menopause, consumption of tobacco and alcohol, body mass index, and type of diet were found to be significantly related to the burden of multimorbidity. The prevalence of multimorbidity was found to be higher for women who belong to the Southern, Eastern, and North-Eastern regions of India. Conclusions: Findings suggest the importance of multimorbidity in the context of women of reproductive age. Inclusion of chronic disease management strategies with maternal and child health services needs to be taken into consideration by the program and policymakers. The annexation of social marketing approaches at the primary level of healthcare would assist policy-makers in educating women about the importance of leading a healthy lifestyle. Practicing dietary diversity can help in maintaining optimal estrogen levels, which would further help in decreasing multimorbidity rates among women in India.

Cardiometabolic health during early adulthood and risk of miscarriage: a prospective study

Background: Several studies have found that women who are overweight or obese have an increased risk of miscarriage. There is also some evidence of associations of other aspects of cardiometabolic health, including blood pressure and lipids, with miscarriage risk, although these have not been examined to the same extent as body-mass index (BMI). Methods: Our objective was to investigate the risk of miscarriage according to pre-pregnancy cardiometabolic health. We examined pre-pregnancy levels of BMI, blood pressure, fasting insulin and metabolites profile at age 18 and risk of miscarriage by age 24. The study included adult female offspring in the Avon Longitudinal Study of Parents and Children with a pregnancy between 18 and 24 years of age (n=434 for BMI and blood pressure; n=265 for metabolites). We used log-binomial regression to calculate adjusted associations between cardiometabolic health measures and miscarriage. Results: The overall risk of miscarriage was 22%.  The adjusted relative risks for miscarriage were 0.96 (95% CI: 0.92-1.00) for BMI (per unit increase), 0.98 (0.96-1.00) for systolic blood pressure, and 1.00 (0.97-1.04) for diastolic blood pressure (per 1 mmHg increase).  Total cholesterol, total lipids and phospholipids in HDL-cholesterol were associated with increased likelihood of miscarriage, but none of the p-values for the metabolites were below the corrected threshold for multiple testing (p-value ≤0.003). Conclusions: Pre-pregnancy cardiometabolic health in late adolescence was not associated with miscarriage risk in young, healthy women who became pregnant before age 24.

Long-Term Effects of Continuous Positive Airway Pressure (CPAP) Therapy on Obesity and Cardiovascular Comorbidities in Patients with Obstructive Sleep Apnea and Resistant Hypertension-An Observational Study

BACKGROUND

We sought to investigate whether long-term continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA) and resistant hypertension (RHTN) could attenuate the cardiovascular disease risk by lowering their body-mass index (BMI).

METHODS

This was a long-term observational study of RHTN patients diagnosed with OSA. Patients were evaluated with polysomnography initially and after a mean follow-up period of four years. The patients were divided into two groups based on their compliance to CPAP therapy.

RESULTS

33 patients (aged 54.67 ± 7.5, 18 men, 54.5%) were included in the study, of which 12 were compliant to CPAP therapy. A significant reduction in BMI at follow-up was noted in patients compliant to CPAP therapy (1.4 ± 3.5 vs. -1.6 ± 2.5, p = 0.006). We also noted a large effect size reduction in abdominal circumference at follow-up in the CPAP group. At follow-up evaluation, the mean heart rate (b/min) was lower in the CPAP group (58.6 ± 9.5 vs. 67.8 ± 7.8), while arrhythmia prevalence increased between initial (28.6%) and follow-up (42.9%) evaluation with an intermediate effect size in non-compliant patients.

CONCLUSIONS

In our cohort of OSA patients with RHTN, long-term adherence to CPAP therapy was associated with weight loss and improvement in cardiac rhythm outcomes.

Menopausal Transition, Body Mass Index, and Prevalence of Mammographic Dense Breasts in Middle-Aged Women

The interrelationship between menopausal stage, excessive adiposity and dense breasts remains unclear. We aimed to investigate the relationship between menopausal stage and dense-breast prevalence in midlife women while considering a possible effect modification of being overweight. The present cross-sectional study comprised 82,677 Korean women, aged 35–65 years, who attended a screening exam. Menopausal stages were categorized based on the Stages of Reproductive Aging Workshop (STRAW + 10) criteria. Mammographic breast density was categorized according to Breast Imaging Reporting and Data System (BI-RADS). Dense breasts were defined as BI-RADS Breast Density category D (extremely dense). The prevalence of dense breasts decreased as menopausal stage increased (p-trend < 0.001), and this pattern was pronounced in overweight women than non-overweight women (p-interaction = 0.016). Compared with pre-menopause, the multivariable-adjusted prevalence ratios (and 95% confidence intervals) for dense breasts were 0.98 (0.96–1.00) in early transition, 0.89 (0.86–0.92) in late transition, and 0.55 (0.52–0.59) in post-menopause, among non-overweight women, while corresponding prevalence ratios were 0.92 (0.87–0.98), 0.83 (0.77–0.90) and 0.36 (0.31–0.41) among overweight women. The prevalence of dense breasts was inversely associated with increasing menopausal stages and significantly decreased from the late menopausal transition, with stronger declines among overweight women.

Overall and abdominal obesity and prostate cancer risk in a West African population: An analysis of the Ghana Prostate Study

Obesity has been associated with an increased risk of advanced prostate cancer. However, most studies have been conducted among North American and European populations. Prostate cancer mortality appears elevated in West Africa, yet risk factors for prostate cancer in this region are unknown. We thus examined the relationship between obesity and prostate cancer using a case-control study conducted in Accra, Ghana in 2004 to 2012. Cases and controls were drawn from a population-based sample of 1037 men screened for prostate cancer, yielding 73 cases and 964 controls. An additional 493 incident cases were recruited from the Korle-Bu Teaching Hospital. Anthropometric measurements were taken at enrollment. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR) and prostate cancer, adjusting for potential confounders. The mean BMI was 25.1 kg/m² for cases and 24.3 kg/m² for controls. After adjustment, men with BMI ≥ 30 kg/m² had an increased risk of prostate cancer relative to men with BMI < 25 kg/m² (OR 1.86, 95% CI 1.11-3.13). Elevated WC (OR 1.76, 95% CI 1.24-2.51) and WHR (OR 1.46, 95% CI 0.99-2.16) were also associated with prostate cancer. Associations were not modified by smoking status and were evident for low- and high-grade disease. These findings indicate that overall and abdominal obesity are positively associated with prostate cancer among men in Ghana, implicating obesity as a potentially modifiable risk factor for prostate cancer in this region.

Maternal Birth Weight and BMI Mediate the Transgenerational Effect of Grandmaternal BMI on Grandchild's Birth Weight

OBJECTIVE

The aims of this study are to examine the potential association between grandmaternal BMI and grandchild's birth weight (BW) and whether maternal BW and BMI mediate this association.

METHODS

Data of 209 grandmother-mother pairs and 355 grandchildren from the Isle of Wight birth cohort in the UK were analyzed using path analysis.

RESULTS

An indirect effect of grandmaternal BMI on increasing grandchild's BW was mediated by maternal BW and BMI at age 18 years (indirect effects: β = 2.3 g/unit increase in grandmaternal BMI via maternal BW and β = 4.4 g via maternal BMI; P = 0.04). These two mediating effects of maternal BW and BMI confounded one another. Grandmaternal smoking during pregnancy had an indirect effect on decreasing grandchild's BW, dependent on maternal smoking during pregnancy and BW (indirect effects: β = -36.1 g compared with nonsmoking grandmothers via maternal smoking during pregnancy and β = -27.2 g via maternal BW; P = 0.005). Neither direct effect between grandmaternal BMI and grandchild's BW nor that between grandmaternal smoking during pregnancy and grandchild's BW was statistically significant.

CONCLUSIONS

Larger grandmaternal BMI indirectly increased grandchild's BW via maternal BW and BMI. Grandmaternal smoking during pregnancy indirectly reduced grandchild's BW via maternal smoking during pregnancy and BW.

Anthropometric Indices and Some Aspects of Physical Fitness in Croatian Adolescents by Gender

Background. The main purpose of this study was to explore the body-mass index and waist circumference associated with physical fitness by gender. Methods. In this cross-sectional study, we included 1036 adolescents (55.4% girls) from eight randomly selected secondary schools within the city of Zagreb (Croatia). Body-mass index and waist circumference were objectively measured. Physical fitness included three tests: (1) 1 min sit-ups, (2) standing long jump and (3) a sit-and-reach test. Associations were calculated using linear regression models. Results. Boys had higher body-mass index and waist circumference values, compared to girls (p < 0.001). They also performed better in 1 min sit-ups and the standing long jump tests (p < 0.001), while girls obtained higher values in the sit-and-reach test (p < 0.001). In boys, body-mass index and waist circumference were associated with 1 min sit-ups and the standing long jump. In girls, waist circumference was also associated with 1 min sit-ups and the standing long jump, while body-mass index was only associated with this standing long jump. Conclusions. Our study shows that anthropometric indices have non-linear associations with physical fitness tests in a large sample of Croatian adolescents. Screening for thinness and obesity to predict the level of physical fitness should be of a great interest.

Eating disorders among Moroccan medical students: cognition and behavior

Introduction and aim

Eating disorders (EDs) are complex, multifactorial diseases linked to biological, developmental, psychological, and sociocultural factors. Medical students are among subjects at high risk of EDs. The aim of the present investigation was to evaluate EDs among 710 Moroccan medical students with a focus on cognition and behavior related to EDs.

Methods

Sociodemographic, economic, and clinical data were collected. Validated questionnaires, such as the SCOFF (Sick, Control, One Stone, Fat, Food) questionnaire and the Eating Disorder Inventory 2 (EDI2), were administered.

Results

The male:female ratio was 0.53, mean age was 21±2 years, 11.1% of participants were underweight, 13.4% were overweight, and 1.8% were obese. A middle socioeconomic level was found in 84.9% of cases. The prevalence of EDs in students was 32.8% (37.6% among females and 23.7% among males) and that of weight-control behaviors 18.5%. Increased body-mass index values were significantly associated with dieting (P<0.001), fasting (P=0.044), and the use of appetite suppressants (P=0.037).

Conclusion

It appears that the impact of EDs is high, affecting a third of medical students, with significant use of harmful weight-control behaviors. We also found that dimensions of bulimia, perfectionism, body dissatisfaction, and ineffectiveness, parts of the core of EDs, were found in future medical practitioners.

Laboratory-Assessed Markers of Cardiometabolic Health and Associations with GIS-Based Measures of Active-Living Environments

Active-living-friendly environments have been linked to physical activity, but their relationships with specific markers of cardiometabolic health remain unclear. We estimated the associations between active-living environments and markers of cardiometabolic health, and explored the potential mediating role of physical activity in these associations. We used data collected on 2809 middle-aged adults who participated in the Canadian Health Measures Survey (2007⁻2009; 41.5 years, SD = 15.1). Environments were assessed using an index that combined GIS-derived measures of street connectivity, land use mix, and population density. Body mass index (BMI), systolic blood pressure (SBP), hemoglobin A1c, and cholesterol were assessed in a laboratory setting. Daily step counts and moderate-to-vigorous intensity physical activity (MVPA) were assessed for seven days using accelerometers. Associations were estimated using robust multivariable linear regressions adjusted for sociodemographic factors that were assessed via questionnaire. BMI was 0.79 kg/m² lower (95% confidence interval (CI) -1.31, -0.27) and SBP was 1.65 mmHg lower (95% CI -3.10, -0.20) in participants living in the most active-living-friendly environments compared to the least, independent of daily step counts or MVPA. A 35.4 min/week difference in MPVA (95% CI 24.2, 46.6) was observed between residents of neighborhoods in the highest compared to the lowest active-living-environment quartiles. Cycling to work rates were also the highest in participants living in the highest living-environment quartiles (e.g., Q4 vs. Q1: 10.4% vs. 4.9%). Although active-living environments are associated with lower BMI and SBP, and higher MVPA and cycling rates, neither daily step counts nor MVPA appear to account for environment⁻BMI/SBP relationships. This suggests that other factors not assessed in this study (e.g., food environment or unmeasured features of the social environment) may explain this relationship.

Timing of Maternal Depression and Sex-Specific Child Growth, the Upstate KIDS Study

OBJECTIVE

Equivocal findings have been reported on the association between maternal depression and children's growth, possibly because of the limited attention to its disproportionate impact by child sex. The relationship between the timing of maternal depression and children's growth was assessed in a population-based prospective birth cohort, with particular attention to sex differences.

METHODS

The Upstate KIDS Study comprised 4,394 children followed through 3 years of age from 2008 to 2010. Maternal depression was measured antenatally by linkage with hospital discharge records before delivery and postnatally by depressive symptoms reported from questionnaires. Children's growth was measured by sex- and age-specific weight, height, weight for height, and BMI. Adjusted linear mixed effects models were used to estimate growth outcomes for the full sample and separately by plurality and sex.

RESULTS

Antenatal depression was associated with lower weight for age (-0.24 z score units; 95% confidence interval [CI]: -0.43, -0.05) and height for age (-0.26 z score units; 95% CI: -0.51, -0.02) among singleton boys. Postnatal depressive symptoms were associated with higher weight for height (0.21 z score units; 95% CI: 0.01, 0.42) among singleton girls.

CONCLUSIONS

The findings of this study suggest that antenatal depression was associated with lower weight and smaller height only for boys, whereas postnatal depressive symptoms were associated with higher weight for height only for girls. The timing of depression and the mechanisms of sex-specific responses require further examination.

Residential proximity to major roadways, fine particulate matter, and adiposity: The framingham heart study

OBJECTIVE

Higher traffic-related air pollution has been associated with higher body mass index (BMI) among children. However, few studies have assessed the associations among adults.

METHODS

Participants (N = 2,372) from the Framingham Offspring and Third Generation cohorts who underwent multidetector-computed tomography scans (2002-2005) were included. Residential-based proximity to the nearest major roadway and 1-year average levels of fine particulate matter (PM_2.5 ) air pollution were estimated. BMI was measured at Offspring examination 7 (1998-2001) and Third Generation examination 1 (2002-2005); subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) were measured using multidetector-computed tomography. Linear regression models were used for continuous BMI, SAT, and VAT and logistic models for the binary indicator of obesity (BMI ≥30 kg/m² ), adjusting for demographic variables, individual- and area-level measures of socioeconomic position, and clinical and lifestyle factors.

RESULTS

Participants who lived 60 m from a major roadway had 0.37 kg/m² higher BMI (95% CI: 0.10 to 0.65 kg/m² ), 78.4 cm³ higher SAT (95% CI: 4.5 to 152.3 cm³ ), and 41.8 cm³ higher VAT (95% CI: -4.7 to 88.2 cm³ ) than those who lived 440 m away.

CONCLUSIONS

Living closer to a major roadway was associated with higher overall and abdominal adiposity.

Identification of Predictors for Weight Reduction in Children and Adolescents with Overweight and Obesity (IDA-Insel Survey)

INTRODUCTION

Worldwide, overweight and obesity are known as posing serious health risks. Successful methods of prevention and therapy for overweight and obesity have remained elusive. It was the aim of the present trial to identify parameters and determinants to guarantee long-term weight reduction.

PATIENTS AND METHODS

In total 143/159 children and adolescents (90%) with overweight and obesity completed the prospective, multicenter trial (age 13.9 ± 2.4 years, BMI 31.2 ± 5.4 kg/m², BMI-SDS 2.51 ± 0.57). During a six-week rehabilitation patients participated in a structured treatment and teaching program (STTP). Following the inpatient treatment the children and adolescents were monitored over a period of 24 months (physical examination, measurements of BMI, BMI-SDS, body composition, carotid intima-media thickness, laboratory parameters, blood pressure, and standardized questionnaires to assess socio-demographic, socio-economic parameters, eating behavior, well-being, quality of life, intelligence, intrafamilial conflicts, self-efficacy, resilience, sense of coherence, stress-management, social support, and actual body shape).

RESULTS

66% of the children and adolescents showed non-normal laboratory parameters as well as higher blood pressure and/or an increased carotid intima-media thickness. Mean thickness of carotid intima-media was 0.53 ± 0.09 mm (range, 0.40-0.80); 15% of the patients showed a normal range (<0.45 mm), 40% slightly elevated (0.45-0.50 mm) and 45% an elevated (>0.50 mm) thickness. After an inpatient treatment lasting 40.4 ± 4.1 (range, 28-49) days, children and adolescents reached a mean weight reduction of 5.52 ± 3.94 (0.4-13.3) kg (p < 0.01) accompanied by a reduction of body fat mass. Performing multivariate analyses, the most important psychological factors associated with long-term weight reduction were identified (R-square = 0.53): Well-being (β = -0.543), resilience (β = 0.434) and intrafamilial conflicts (β = 0.315).

CONCLUSION

The different parameters (i.e., resilience, intrafamilial conflicts, structured daily schedule) have demonstrated their utility and strategies should be developed allowing an adaption of these into the STTPs and the integration of intervention into the therapeutic setting.

Physical and physiological effectiveness of an overall health care program for middle-aged Japanese women with mild obesity: A pilot study

This study aimed to verify the effectiveness of an overall health care program (OHCP) for middle-aged Japanese women through assessing physical and physiological changes. The OHCP consisted of diet modification with natural alternative foods, walking and stretching exercises, and body massage and cupping treatments. Sixty-seven participants were assigned to one of three groups during a 3-year study period (2011–2013). The OHCP was performed for 3 months in each year. After the OHCP, most participants had significant decreases in the blood levels of triglycerides, low-density lipoprotein cholesterol, total cholesterol, alkaline phosphatase, γ-glutamyl transferase, and cholinesterase; body weight; body fat percentage; and body-mass index. The oxidative stress markers varied among the study years; however, a significant decrease in blood reactive oxygen-derived metabolites and a significant increase in the relative antioxidative potential were observed in 2013. In 2013, participants who were randomly selected for autonomic nervous activity measurements immediately before and after body massage and cupping treatments showed a significant predominance in parasympathetic nervous activity after the treatments. These results indicate that the OHCP in the present study is an effective and prompt method as a complementary treatment to improve the pre-obese or mild obese status without any noticeable physiological stress in most middle-aged women. However, because of the limitations of this study, the findings of this study need to be confirmed.

Coming unmoored: disproportionate increases in obesity prevalence among young, disadvantaged white women

OBJECTIVES

Since the 1980s, older, low-educated White women experienced an unprecedented decrease in life expectancy. We investigated whether a similar phenomenon was evident among younger women for obesity.

METHODS

Using the National Health and Nutrition Examination Survey, age-adjusted changes were estimated in the prevalence of overall and abdominal obesity (BMI ≥ 30 kg/m(2) , waist circumference > 88 cm) between 1988-1994 and 2003-2010 among non-Hispanic White women aged 25-44 years, stratified by educational attainment (<high school (HS), HS, some college, college degree). To address bias from secular increases in educational attainment, White women's changes in obesity prevalence were compared to changes among similarly educated Black women.

RESULTS

Relative increases in overall obesity were disproportionately larger for low-educated (<HS) compared to college-educated White women: 12.3 (95% CI: 3.1, 21.5) percentage points (ppts). For overall and abdominal obesity, general trends indicated dissimilar racial differences by educational attainment. For instance, overall obesity increased more in Blacks than Whites among college-educated (9.9 ppts) but not low-educated (-2.5 ppts) women.

CONCLUSIONS

Contemporary young, low-educated White women showed indications of disproportionate worsening of overall obesity prevalence compared to more educated White and similarly educated Black women. Low education levels are more powerful indicators of obesity risk among contemporary White women than 30 years ago.

Factors Associated with Underestimation of Weight Status among Caucasian, Latino, Filipino, and Korean Americans--DiLH Survey

OBJECTIVE

To describe weight misperception and to examine the influence of sociodemographic factors on underestimation of weight status in Caucasian, Latino, Filipino, and Korean Americans.

DESIGN

Data from 886 non-pregnant adults who participated in a cross-sectional survey administered in English, Spanish, and Korean were analyzed. The actual weight status derived from the participants' body mass index (BMI) categories and their perceived weight status were compared. A multiple logistic regression model was used to explore if underestimation of weight status was associated with ethnicity, sex, and education level.

RESULTS

Caucasians, Latinos, Filipinos, and Koreans represented 19.4%, 26.8%, 27.4%, and 26.4%, respectively, of the total sample of 886. Overall, two in three participants correctly perceived their weight status, but 42% of Latinos underestimated their weight status and 22% of Koreans overestimated their weight status. Latino ethnicity, male, and low education (high school) were related to greater underestimation of weight status (P < .05). In contrast, Korean ethnicity was related to less underestimation of weight status (P < .05).

CONCLUSIONS

Misperception of weight status should be counted in any efforts to develop a weight management intervention for Latino and Korean Americans.

Waist related anthropometric measures - simple and useful predictors of coronary artery disease in women

AIM

To compare the waist related anthropometric measures like waist circumference, waist-to-height ratio (WHtR), waist - hip ratio (WHR) and body mass index (BMI) as predictors of coronary artery disease (CAD) in women.

METHODS

The study included 88 women aged 40-80 years. Waist circumference, hip circumference, height, weight, age, and other covariates were collected by questionnaire. The primary endpoint was incident coronary heart disease that was reported by physician. The data was analyzed statistically using χ(2)-test for quantitative data and student t-test. The significance of the results as determined in 95.0% confidence interval.

RESULTS

The mean age was 59.07 ± 11.53 in the study group and 54.36 ± 10.84 in the control group. The waist circumference in the study group was higher (95.443 ± 11.187) than the control group (74.886 ± 6.672) (p < 0.001). The mean waist to hip ratio (WHR) was 0.96 ± 0.08 in the study group and 0.78 ± 0.06 in the control group (p < 0.001). The mean waist to height ratio (WHtR) was 0.62 ± 0.07 in the study group and 0.48 ± 0.04 in the control group (p < 0.001). Waist derived measures were superior to BMI in predicting CAD. The unadjusted AUC (95% Confidence Interval) was 0.008 (0.006-0.095) for WHtR, 0.001 (0.00 0.002) for waist - hip ratio, and 1 (0.323-1.766) for body mass index.

CONCLUSION

Waist related anthropometric measures are important predictors as CAD risk factors among middle-aged and older women, as compared to BMI.

Prognostic significance of pre-treatment neutrophil: lymphocyte ratio in Japanese patients with breast cancer

BACKGROUND

The neutrophil:lymphocyte ratio (NLR) has been reported to reflect systemic inflammation and to have independent prognostic value for patients with various cancers. In this study, we analyzed the association between NLR and clinicopathological factors and verified the significance of NLR as a prognostic factor for Japanese patients with breast cancer.

PATIENTS AND METHODS

A total of 167 Japanese female patients with stage I-III breast cancer were retrospectively recruited into this study. Associations with clinicopathological factors and NLR were assessed, and disease-free survival and breast cancer-specific survival were estimated.

RESULTS

In multivariate analysis, lymph node metastases and NLR were significantly associated with disease-free survival and breast cancer-specific survival. NLR was significantly higher in patients with lower body-mass index.

CONCLUSION

Preoperative NLR may be an independent prognostic factor for survival in Japanese patients with breast cancer. Reduction of body mass index has been implicated in NLR elevation, particularly in postmenopausal women.

Intercorrelations of lipoprotein subfractions and their covariation with lifestyle factors in healthy men

So far, little is known about the effect of nutrition and lifestyle on the composition of circulating lipoprotein subfractions. In the current study, we measured the correlations among physical activity, nutrient intake, smoking, body-mass index (BMI), and age with the concentration of triglycerides, cholesterol, phospholipids, and apolipoproteins (ApoA1, ApoA2 and ApoB) in subfractions of LDL and HDL in 265 healthy working men. Concentrations of cholesterol, phospholipids, and ApoB in small, dense atherogenic LDL particles (sdLDL) correlated negatively (p<0.001) with those of cholesterol, phospholipids, and ApoA1 in HDL2, respectively. Age correlated positively with sdLDL while increasing BMI correlated with an atherogenic shift of cholesterol, phospholipids, and ApoB from large, buoyant LDL (lbLDL) to sdLDL and decreasing concentrations of HDL2 constituents. Physical activity and alcohol intake correlated negatively with sdLDL constituents and positively with HDL2 components. Consumption of monounsaturated fatty acids (MUFA) correlated with a lower ratio of sdLDL to HDL2 cholesterol. A favorable lipoprotein subfraction profile linked to a reduced risk of cardiovascular disease in men was associated with physical activity, moderate alcohol consumption, and dietary intake of MUFA, which might be exploited in future interventions for prevention of age- and BMI-associated atherogenic shifts of lipoprotein subfractions.

Associations of maternal pre-pregnancy and gestational body size with offspring longitudinal change in BMI

OBJECTIVES

Studies demonstrate associations between changes in obesity-related phenotypes and cardiovascular risk. Although maternal pre-pregnancy BMI (mppBMI) and gestational weight gain (GWG) may be associated with adult offspring adiposity, no study has examined associations with obesity changes. Associations of mppBMI and GWG with longitudinal change in offspring's BMI (ΔBMI) were examined, and whether associations are explained by offspring genetics was assessed.

METHODS

A birth cohort of 1400 adults, with data at birth, age 17 and 32 years was used. After genotyping offspring, genetic scores, predictive of exposures and outcome were created, and linear regression models with and without scores were fit to examine the associations of mppBMI and GWG with ΔBMI.

RESULTS

A one SD change in mppBMI and GWG was associated with a 0.83 and a 0.75 kg/m² increase in ΔBMI, respectively. The association between mppBMI and offspring ΔBMI was slightly attenuated (12%) with the addition of genetic scores. In the GWG model, a significant substantial 28.2% decrease in the coefficient was observed.

CONCLUSIONS

This study points to an association between maternal excess weight in pregnancy and offspring BMI change from adolescence to adulthood. Genetic factors may account, in part, for GWG/ΔBMI association. These findings broaden observations that maternal obesity-related phenotypes have long-term consequences for offspring health.

Sleep cyclic alternating pattern in otherwise healthy overweight school-age children

STUDY OBJECTIVES

To compare sleep microstructure (cyclic alternating pattern, CAP) characteristics in otherwise healthy overweight (OW) and normal weight (NW) children.

DESIGN

Polysomnographic cross-sectional study.

SETTING

Sleep laboratory.

PARTICIPANTS

Fifty-eight (26 NW and 32 OW) 10-year-old children.

INTERVENTIONS

N/A.

MEASUREMENTS AND RESULTS

Participants were part of a longitudinal study beginning in infancy and free of sleep disorders. Groups were based on body-mass index (BMI) z-score. From polysomnographic overnight recordings, sleep-waking states were scored according to international criteria. CAP analysis was performed visually during NREM sleep. Conventional sleep parameters were similar between groups. BMI was positively related to CAP rate and CAP sequences but inversely related to CAP B phase duration. Differences between groups were confined to slow-wave sleep (SWS), with OW children showing higher CAP rate, CAP cycles, and CAP A1 number and index and shorter CAP cycles and B phase duration. They also showed more CAP class intervals shorter than 30 s, and a suggestive trend for fewer intervals longer than 30 s.

CONCLUSIONS

Cyclic alternating pattern characteristics in children related to nutritional status and were altered in overweight subjects during slow-wave sleep. We suggest that the more frequent oscillatory pattern of electroencephalographic slow activity in overweight subjects might reflect less stable slow-wave sleep episodes.

Estrogen: a master regulator of bioenergetic systems in the brain and body

Estrogen is a fundamental regulator of the metabolic system of the female brain and body. Within the brain, estrogen regulates glucose transport, aerobic glycolysis, and mitochondrial function to generate ATP. In the body, estrogen protects against adiposity, insulin resistance, and type II diabetes, and regulates energy intake and expenditure. During menopause, decline in circulating estrogen is coincident with decline in brain bioenergetics and shift towards a metabolically compromised phenotype. Compensatory bioenergetic adaptations, or lack thereof, to estrogen loss could determine risk of late-onset Alzheimer's disease. Estrogen coordinates brain and body metabolism, such that peripheral metabolic state can indicate bioenergetic status of the brain. By generating biomarker profiles that encompass peripheral metabolic changes occurring with menopause, individual risk profiles for decreased brain bioenergetics and cognitive decline can be created. Biomarker profiles could identify women at risk while also serving as indicators of efficacy of hormone therapy or other preventative interventions.

Polymorphisms of transcription factor-7-like 2 (TCF7L2) gene in Tunisian women with polycystic ovary syndrome (PCOS)

BACKGROUND AND AIMS

Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects women in their child-bearing age, and is often associated with insulin resistance and type 2 diabetes (T2DM). Given the overlap between PCOS and T2DM, we investigated the association of transcription factor-7-like 2 (TCF7L2) variants rs4506565, rs7903146, rs12243326, and rs12255372 with the susceptibility to PCOS.

SUBJECTS AND METHODS

Study subjects comprised 119 Tunisian women with PCOS (mean age 29.8±4.7years), and 150 control women (mean age 30.6±5.9years). TCF7L2 genotyping was done by the allelic discrimination/real-time PCR method.

RESULTS

Minor allele frequencies (MAFs) of rs4506565 (P=0.61), rs7903146 (P=0.68), rs12243326 (P=0.56), and rs12255372 (P=0.60) were comparable between PCOS cases and control subjects. As the four tested TCF7L2 variants were in linkage disequilibrium, 4-locus (rs4506565, rs7903146, rs12243326, rs12255372) haplotype analysis demonstrated that haplotype 2111 was initially negatively associated with PCOS [P=0.035; OR (95% CI)=0.13 (0.02-0.85)], which was later lost upon correcting for multiple comparisons [Pc=0.248].

CONCLUSION

Our data suggest that there is weak or no contribution of TCF7L2 gene polymorphism to PCOS in Tunisian women. Further studies with larger samples are necessary to confirm this observation.

The Associations of Indices of Obesity with Lipoprotein Subfractions in Japanese American, African American and Korean Men

BACKGROUND

Both indices of obesity and lipoprotein subfractions contribute to coronary heart disease risk. However, associations between indices of obesity and lipoprotein subfractions remain undetermined across different ethnic groups. This study aims to examine the associations of indices of obesity in Japanese Americans (JA), African Americans (AA) and Koreans with lipoprotein subfractions.

METHODS

A population-based sample of 230 JA, 91 AA, and 291 Korean men aged 40-49 was examined for indices of obesity, i.e., visceral and subcutaneous adipose tissue (VAT and SAT, respectively), waist circumference (WC), and body-mass index (BMI), and for lipoprotein subfractions by nuclear-magnetic-resonance spectroscopy. Multiple regression analyses were performed in each of the three ethnic groups to examine the associations of each index of obesity with lipoprotein.

RESULTS

VAT had significant positive associations with total and small low-density lipoprotein (LDL) and a significant negative association with large high-density lipoprotein (HDL) in all three ethnicities (p < 0.01). SAT, WC, and BMI had significant positive associations with total and small LDL in only JA and Koreans, while these indices had significant inverse associations with large HDL in all ethnic groups (p < 0.01). Compared to SAT, VAT had larger R² values in the associations with total and small LDL and large HDL in all three ethnic groups.

CONCLUSIONS

VAT is significantly associated with total and small LDL and large HDL in all three ethnic groups. The associations of SAT, WC, and BMI with lipoprotein subfractions are weaker compared to VAT in all three ethnic groups.

Effects of prediabetes and diabetes on left ventricular and coronary microvascular functions

BACKGROUND

Coronary flow reserve (CFR) provides independent prognostic information in diabetic patients with known or suspected coronary artery disease. However, there have been no substantial data to evaluate CFR in prediabetics. Accordingly, we aimed to evaluate CFR in subjects with prediabetes using second harmonic transthoracic Doppler echocardiography.

METHODS AND RESULTS

We measured CFR of 65 subjects with prediabetes, 45 patients with overt type 2 diabetes, and 43 sex and age matched normoglycemic healthy subjects with normal glucose tolerance. Ages, gender, existence of hypertension or hypercholesterolemia, smoking status were similar among the groups. CFR was significantly lower in diabetics (2.15 ± 0.39) than in prediabetics (2.39 ± 0.45) and controls (2.75 ± 0.35); in addition, it was significantly lower in prediabetics than controls. Only 2 (5%) of control subjects had abnormal CFR (<2) but 11 (17%) prediabetic subjects and 19 (42%) diabetic patients had abnormal CFR. We found that only age (β=-0.31, P<0.01) and presence of the diabetes (β=-0.57, P<0.01) were significant predictors of lower CFR in a multivariable model that adjusted for other variables. CFR was significantly and inversely correlated with age (r=-0.15, P=0.04), fasting glucose level (r=-0.27, P=0.001), postprandial glucose level (r=0.43, P<0.001), hemoglobin A1C level (r=-0.34, P<0.001), LDL cholesterol level (r=0.22, P=0.009), mitral A velocity (r=-0.27, P=0.001) and Tei index (r=-0.19, P=0.02), whereas mitral E/A ratio, mitral Em (r=0.18, P=0.02), mitral Em/Am ratio (r=0.23, P=0.004) were significantly and positively correlated with CFR.

CONCLUSION

CFR is impaired in subjects with prediabetics, but this impairment is not as severe as that in diabetics.

Plasma levels of cathepsins L, K, and V and risks of abdominal aortic aneurysms: a randomized population-based study

BACKGROUND

Cathepsin L (CatL), cathepsin K (CatK), and cathepsin V (CatV) are potent elastases implicated in human arterial wall remodeling. Whether plasma levels of these cathepsins are altered in patients with abdominal aortic aneurysms (AAAs) remains unknown.

METHODS AND RESULTS

Plasma samples were collected from 476 male AAA patients and 200 age-matched male controls to determine CatL, CatK, and CatV levels by ELISA. Student's t-test demonstrated significantly higher plasma CatL levels in AAA patients than in controls (P < 0.0001), whereas CatK and CatV levels were lower in AAA patients than in controls (P = 0.052, P = 0.025). ROC curve analysis confirmed higher plasma CatL levels in AAA patients than in controls (P < 0.001). As potential confounders, current smoking and use of angiotensin-converting enzyme (ACE) inhibitors, aspirin, clopidogrel, and statins associated with significantly increased plasma CatL. Pearson's correlation test demonstrated that plasma CatL associated positively with CatS (r = 0.43, P < 0.0001), body-mass index (BMI) (r = 0.07, P = 0.047) and maximal aortic diameter (r = 0.29, P < 0.001), and negatively with lowest measured ankle-brachial index (ABI) (r = -0.22, P < 0.001). Plasma CatL remained associated positively with CatS (r = 0.43, P < 0.0001) and aortic diameter (r = 0.212, P < 0.001) and negatively with ABI (r = -0.10, P = 0.011) after adjusting for the aforementioned potential confounders in a partial correlation analysis. Multivariate logistic regression analysis indicated that plasma CatL was a risk factor of AAA before (odds ratio [OR] = 3.04, P < 0.001) and after (OR = 2.42, P < 0.001) the same confounder adjustment.

CONCLUSIONS

Correlation of plasma CatL levels with aortic diameter and the lowest ABI suggest that this cysteinyl protease plays a detrimental role in the pathogenesis of human peripheral arterial diseases and AAAs.

College expectations in high school mitigate weight gain over early adulthood: Findings from a national study of American youth

OBJECTIVE

Research conducted on school-based interventions suggests that school connectedness protects against a variety of risk behaviors, including substance abuse, delinquency and sedentary behavior. The line of research is extended by examining the link between college expectations and early adult weight gain using nationally representative panel data from thirty cohorts of American high school seniors followed prospectively to age 30 in the Monitoring the Future Study (1986-2009).

DESIGN AND METHODS

Growth mixture models identified two latent classes of trajectories of body mass index (BMI) from age 19 to 30: a persistently overweight class (BMI ≥ 25) and a second class exhibiting more moderate growth in BMI to age 30.

RESULTS

Compared to those who did not expect to graduate from college, students fully expecting to graduate from college had 34% lower odds of being in the persistently overweight class (adjusted odds ratio = 0.66, 95% confidence interval = 0.54, 0.81), controlling for academic performance and socioeconomic status.

CONCLUSIONS

Successful prevention of obesity early in the life course is based on a multifactorial approach incorporating strategies that address the contexts in which adolescents are embedded. The school setting may be one avenue where successful educational attachment could have positive consequences for subsequent weight gain in early adulthood.

Initial experience with the use of foetal/neonatal bovine acellular dermal collagen matrix (SurgiMend™) for tissue-expander breast reconstruction

BACKGROUND

Acellular dermal matrix (ADM) is commonly used in staged breast reconstruction using tissue expanders (TEs). The literature on human ADM has reported variable outcomes, and there is a paucity of data for xenogenic sources of ADM. The aim of this study is to evaluate the early complications, risk factors and outcomes using SurgiMend™ in staged breast reconstruction.

METHODS

An Institutional Review Board (IRB)-approved, retrospective analysis of a single surgeon's experience was performed. From August 2009 to May 2011, 65 patients underwent staged breast reconstruction using 95 sheets of SurgiMend™. The nominal TE fill volume was 383 ± 83 cc (range 250-550), mean intra-operative fill volume was 148 ± 86 cc (range 0-350) and mean final fill volume was 413 ± 176 cc (range 100-800). The mean clinic follow-up time was 16.9 ± 8.7 months; mean age was 50.9 ± 11.7 years; and average body mass index (BMI) was 26.0 ± 5.5 kg m(-2). Correlation with risk factors and clinical outcomes were analysed.

RESULTS

The incidences of postoperative complications were: haematoma 3.2%, seroma 7.5% and re-operation due to infection 2.1%. Age, diabetes mellitus, and hypertension had a significant correlation with an increased overall complication rate. With respect to early complications, such as infection requiring re-operation, diabetes demonstrated a trend with an odds ratio of 11.69.

CONCLUSION

This study demonstrates that the use of SurgiMend™ is associated with low early complication rates and is well tolerated in staged breast reconstruction.

Haplotype kernel association test as a powerful method to identify chromosomal regions harboring uncommon causal variants

For most complex diseases, the fraction of heritability that can be explained by the variants discovered from genome-wide association studies is minor. Although the so-called "rare variants" (minor allele frequency [MAF] < 1%) have attracted increasing attention, they are unlikely to account for much of the "missing heritability" because very few people may carry these rare variants. The genetic variants that are likely to fill in the "missing heritability" include uncommon causal variants (MAF < 5%), which are generally untyped in association studies using tagging single-nucleotide polymorphisms (SNPs) or commercial SNP arrays. Developing powerful statistical methods can help to identify chromosomal regions harboring uncommon causal variants, while bypassing the genome-wide or exome-wide next-generation sequencing. In this work, we propose a haplotype kernel association test (HKAT) that is equivalent to testing the variance component of random effects for distinct haplotypes. With an appropriate weighting scheme given to haplotypes, we can further enhance the ability of HKAT to detect uncommon causal variants. With scenarios simulated according to the population genetics theory, HKAT is shown to be a powerful method for detecting chromosomal regions harboring uncommon causal variants.

The burden of obesity on blood pressure is reduced in older persons: the SardiNIA study

INTRODUCTION

Being overweight or obese increases the risk of elevated blood pressure. However differences of their effects on blood pressure in different age groups are not clear.

OBJECTIVE

The aim of the present study was to evaluate differences of the effects of adiposity on the odds of having hypertension in different age groups.

DESIGN AND METHODS

Three thousand fifty-six subjects (1,532 women and 1,524 men) consist of the drug naïve subjects from the SardiNIA study. Logistic regression models with backward elimination were used to determine and compare the association between categories of obesity on hypertension within young (≤ 39), middle aged (40-59), and older (60+) subjects. Additional terms controlled for in the model were smoking and alcohol intake status.

RESULTS

The relationship of body mass index (BMI) on hypertension differed by age, as indicated by the significant interaction term of age with BMI (P <0.01). Older subjects had higher odds of having hypertension than younger subjects but these odds were lower for obese than for lean subjects (OR 10.45, 95% CIs 4.58-23.85 in obese versus OR 33.89, 95% CIs 17.94-64.02 in lean subjects). A similar trend was also observed in middle aged subjects.

CONCLUSIONS

This study shows that among men and women, older age was associated with a lesser effect of BMI on the odds of having hypertension.

The independent association between 25-hydroxyvitamin D and adiponectin and its relation with BMI in two large cohorts: the NHS and the HPFS

Low 25-hydroxyvitamin D (25(OH)D) and adiponectin levels are both associated with obesity and cardiovascular disease. Cross-sectional studies have suggested that 25(OH)D concentrations are positively associated with adiponectin, and that this relation may strengthen with increasing BMI. However, these studies had small samples sizes and did not account for many known confounders of adiponectin levels. We evaluated whether 25(OH)D was independently associated with circulating adiponectin in two large populations, and whether BMI modified this relationship. Cross-sectional analyses were performed on 1,206 women from the Nurses' Health Study I (NHS) and 439 men from the Health Professionals Follow-Up Study. Multivariable linear regression was used to analyze the independent association between 25(OH)D and adiponectin after controlling for potential confounders. Effect modification by BMI was examined by creating interaction terms between vitamin D and BMI. 25(OH)D concentrations were positively associated with circulating adiponectin in univariate analyses, and also independently associated with adiponectin after multivariable adjustments in both populations (women: β = 0.06, P < 0.001; men: β = 0.07, P < 0.05). BMI did not significantly modify the relation between 25(OH)D and adiponectin in either population. Higher 25(OH)D concentrations were independently associated with higher adiponectin concentrations in large populations of women and men. Since lower levels of 25(OH)D and adiponectin are associated with higher cardio-metabolic risk, assessing the effect of vitamin D supplementation on adiponectin levels is warranted.

Obesity and variants of the GHRL (ghrelin) and BCHE (butyrylcholinesterase) genes

Ghrelin coded by the GHRL gene is related to weight-gain, its deactivation possibly depending on its hydrolyzation by butyrylcholinesterase (BChE) encoded by the BCHE gene, an enzyme already associated with the body mass index (BMI). The aim was to search for relationships between SNPs of the GHRL and BCHE genes with BChE activity, BMI and obesity in 144 obese and 153 nonobese Euro-Brazilian male blood donors. In the obese individuals, a significant association with higher BChE activity, in the 72LM+72MM; –116GG genotype class (GHRL and BCHE genes, respectively) was noted. No significant differences were found otherwise, through comparisons between obese and control individuals, of genotype and allele frequencies in SNPs of the GHRL gene (Arg51Gln and Leu72Met), or mean BMI between 72LL and 72LM+72MM genotypes. Although there appears to be no direct relationship between the examined GHRL SNPs and BMI, the association of the 72M SNP with higher BChE activity in obese subjects probably points to a regulatory mechanism, thereby implying the influence of the GHRL gene on BChE expression, and a consequential metabolic role in the complex process of fat utilization.

Effect of nutritional supplements on immune function and body weight in malnourished adults

In the United States, approximately 5% of the population is malnourished or has low body weight, which can adversely affect immune function. Malnutrition is more prevalent in older adults and is often a result of energy imbalance from various causes. Dietary supplementation to promote positive energy balance can reverse malnutrition, but has not been assessed for its effect on immune parameters. This 8-week clinical feeding trial evaluated the effect of a commercially available, high-protein, high-energy formula on body weight and immune parameters in 30 adult volunteers with body-mass indices (BMI) <21 kg/m². After the intervention, participants gained a mean of 3.74 lbs and increased BMI by 0.58 kg/m². The intervention improved lean body mass and limited body fat accumulation. However, no clinically significant improvements in immune measures were observed. These results support the use of high-protein, high-energy supplements in the treatment of underweight/malnutrition. Further investigation utilizing feeding studies of longer duration, and/or studying severely malnourished individuals may be needed to detect an effect on immune parameters of weight gain promoted by nutritional supplements.

Study of association between common variation in the insulin-like growth factor 2 gene and indices of obesity and body size in middle-aged men and women

CONTEXT

The IGF2 gene (IGF2) plays a key role in growth and is a candidate for association with obesity. Previous studies have reported that polymorphisms in IGF2 are associated with body weight and body mass index (BMI), but the results have been inconsistent.

OBJECTIVES

The aim of this study was primarily to confirm the association with BMI and, secondarily, to study the associations with other indices of body size.

METHODS

In a sample of 2797 women and 2203 men aged 39-79 participating in the Norfolk arm of the European Prospective Investigation of Cancer, we genotyped three single nucleotide polymorphisms (SNPs) in the IGF2 gene that were previously associated with BMI [6815 A/T, 1156 T/C (G/A), and 820 G/A (ApaI)].

RESULTS

No significant associations were observed between these SNPs and BMI. However, all three SNPs were significantly associated with height (P = 0.03 to 0.001). In a backward elimination regression analysis, two SNPs, 1156 T/C (G/A) and 820 G/A, remained independently associated with height (P = 0.003 and P = 0.038, respectively). Haplotype analysis of these two SNPs showed that carriers of the GA haplotype were shorter than carriers of each of the other three haplotypes (P < 0.001 for all comparisons).

CONCLUSIONS

We did not confirm the previously reported associations between IGF2 polymorphisms and BMI. However, our results suggest that common variation in the IGF2 gene may be associated with adult height. IGF2 could be considered as a candidate gene for future research on mechanisms for the association between height and chronic diseases, such as cancer, diabetes, and coronary heart disease.

Echocardiographic assessment of epicardial adipose tissue--a marker of visceral adiposity

Visceral adipose tissue predicts an unfavorable cardiovascular and metabolic risk profile in humans. Existing methods to assess visceral adipose tissue have been limited. Thus, echocardiographic assessment of epicardial adipose tissue as a marker of visceral adiposity was suggested. The technique has been shown to be a very reliable method and an excellent measure of visceral adiposity. In this article, epicardial adipose tissue's localization on the heart, function, method of assessment and reliability as a marker of visceral adiposity is briefly reviewed. Areas of the technique requiring further study are identified.