THE EFFECT OF OBESITY

2002 ◽  
Vol 35 (1) ◽  
pp. 107-129 ◽  
Author(s):  
RICHARD G. ROGERS ◽  
ROBERT A. HUMMER ◽  
PATRICK M. KRUEGER
Keyword(s):  
Normal Weight ◽  
Class Iii ◽  
Circulatory Disease ◽  
Risk Of Death ◽  
Diabetes Mortality ◽  
Disease Mortality ◽  
Obese Class ◽  
The Relationship ◽  
Age And Sex

This paper explores the relationship between body mass and risk of death among US adults. The National Health Interview Survey–Multiple Cause of Death linked data set is used for the years 1987–1997, and Cox proportional hazard models are employed to estimate the association between obesity, as measured by the body mass index (BMI), and overall, circulatory disease-specific and diabetes-specific mortality. A U-shaped relationship is found between BMI and overall mortality. Compared with normal weight individuals, mortality during the follow-up period is 34% higher among obese class II individuals and 77% higher among obese class III individuals, controlling for age and sex. A J-shaped relationship exists between circulatory disease mortality and obesity, with a slightly higher risk of death for all categories of BMI. The relationship between BMI and diabetes mortality is striking. Compared with normal weight individuals, obese class I individuals are 2·8 times as likely to die, obese class II individuals are 4·7 times as likely to die, and obese class III individuals are 9·0 times as likely to die of diabetes during the follow-up period, controlling for age and sex. These results demonstrate that obesity heightens the risk of overall and circulatory disease mortality, and even more substantially increases the risk of diabetes mortality. These mortality findings, together with the substantial recent increases in obesity, lend urgency to public health programmes aimed at reducing the prevalence and consequences of obesity.

scholarly journals Challenging the obesity paradox: extreme obesity and COPD mortality in the SUMMIT Trial

2021 ◽  
pp. 00902-2020
Author(s):  
Emily P. Brigham ◽  
Julie A. Anderson ◽  
Robert D. Brook ◽  
Peter M. A. Calverley ◽  
Bartolome R. Celli ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Proportional Hazards ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Class I ◽  
Class Iii ◽  
Obese Class ◽  
Class Iii Obesity ◽  
The Impact ◽  
The Relationship

Populations with COPD demonstrate higher survival in overweight and obese compared with normal weight; the “obesity paradox.” Relationships in less severe COPD are unclear, as is the impact of cardiovascular risk, and few studies include individuals at extremes of obesity.We examined the relationship between body mass index (BMI, defined as underweight: <20 kg·m−2, normal: 20–25 kg·m−2, overweight: 25-<30 kg·m−2, obese class I: 30-<35 kg·m−2, class II: 35-<40 kg·m−2, class III: ≥40 kg·m−2), morbidity, and mortality in the SUMMIT trial population (n=16 485), characterised by moderate COPD and heightened cardiovascular risk with a substantial proportion with class III obesity. The association between BMI category and time to event was modeled via proportional hazards (reference normal weight) adjusted for demographics and cardiorespiratory disease.Consistent with the paradox, underweight individuals demonstrated higher mortality (HR 1.31 (95%CI 1.04–1.64)), with lower mortality among overweight (HR 0.62 (95%CI 0.52–0.73)) and obese class I (HR 0.75 (95%CI 0.62–0.90)). However, mortality increased in obese class III (HR 1.36 (95%CI 1.00–1.86)). Death was primarily attributable to cardiovascular causes.Within a large, multinational cohort with moderate COPD and increased cardiovascular risk, the phenomenon of reduced mortality with obesity did not persist at BMI>40 kg·m−2, suggesting that obesity may not remain protective at the extremes in this population.

Benefits of tafamidis in patients with advanced transthyretin amyloid cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Rapezzi ◽  
A.V Kristen ◽  
B Gundapaneni ◽  
M.B Sultan ◽  
M Hanna
Keyword(s):  
Disease Severity ◽  
Nyha Class ◽  
Funding Source ◽  
Class Iii ◽  
Private Company ◽  
Risk Of Death ◽  
6Mwt Distance ◽  
All Cause Mortality ◽  
Amyloid Cardiomyopathy

Abstract Background In the Tafamidis in Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT), tafamidis was shown to be an effective treatment for patients with transthyretin amyloid cardiomyopathy (ATTR-CM). Further assessment of the efficacy of tafamidis in patients with more advanced ATTR-CM would aid treatment decisions. Purpose To characterize the benefits of tafamidis in patients with advanced ATTR-CM. Methods In ATTR-ACT, ATTR-CM patients were randomized to tafamidis (n=264) or placebo (n=177) for 30 months. Efficacy outcomes included all-cause mortality and frequency of cardiovascular (CV)-related hospitalisations. Key secondary endpoints were change from baseline to Month 30 in 6MWT distance and KCCQ-OS score. Efficacy assessments in NYHA Class III patients at baseline (n=141) were a pre-specified analysis. In a post-hoc analysis, mortality and CV-related hospitalizations were assessed in all patients grouped into quartiles of increasing disease severity based on 6MWT distance at baseline. Longer-term all-cause mortality (as of 1 Aug 2019) was assessed in NYHA Class III patients utilizing data from ATTR-ACT patients who enrolled in a long-term, extension study (LTE) and continued treatment with higher dose tafamidis (n=55; median treatment duration 51.6 months); or, if previously treated with placebo, started tafamidis treatment (placebo/tafamidis; n=63 [50.1 months]). Results In advanced ATTR-CM patients (NYHA Class III), tafamidis reduced the risk of death (HR [95% CI] 0.837, [0.541, 1.295], P=0.4253), and the decline in 6MWT distance (LS mean [SE], 31.6 (22.1) m; P=0.1526) and KCCQ-OS score (LS mean [SE], 13.1 (5.0); P=0.0090), vs placebo. Paradoxically, there was a higher frequency of CV-related hospitalizations with tafamidis (RR [95% CI] vs placebo, 1.411 [1.048, 1.900]). In all patients by 6MWT quartile, CV-related hospitalizations/year with tafamidis and placebo increased with disease severity, with the exception that placebo-treated patients in the highest severity quartile had fewer CV-related hospitalisations (0.73) than those in the third quartile (0.92). Mortality with tafamidis and placebo increased, and was greater with placebo, in every quartile (Figure). Survival (NYHA Class III patients in ATTR-ACT and LTE) was improved with high dose tafamidis with longer term follow-up (HR vs placebo/tafamidis [95% CI], 0.6569 [0.4175, 1.0336]; P=0.0692). Conclusions These analyses, including longer-term follow-up, demonstrate that patients with advanced ATTR-CM benefit from tafamidis. The decrease in CV-related hospitalisations in more severe patients treated with placebo suggests that the comparatively greater hospitalisation frequency in NYHA Class III patients treated with tafamidis is a consequence of their lower mortality rate. Figure 1 Funding Acknowledgement Type of funding source: Private company. Main funding source(s): This study was sponsored by Pfizer

Potential Impact of BMI on the Aggressiveness of Presentation and Clinical Outcome of Differentiated Thyroid Cancer

2019 ◽  
Vol 105 (4) ◽  
pp. e1124-e1134
Author(s):  
Antonio Matrone ◽  
Giovanni Ceccarini ◽  
Marianna Beghini ◽  
Federica Ferrari ◽  
Carla Gambale ◽  
...  
Keyword(s):  
Risk Factor ◽  
Thyroid Cancer ◽  
Clinical Outcome ◽  
Differentiated Thyroid Cancer ◽  
Normal Weight ◽  
American Thyroid Association ◽  
131I Treatment ◽  
Therapeutic Attitude ◽  
The Relationship

Abstract Background Obesity is a risk factor for several cancers, including differentiated thyroid cancer (DTC). Moreover, it has also been investigated as a potential risk factor for aggressiveness of DTC, but the data gathered so far are conflicting. The aim of our study was to evaluate the relationship between body mass index (BMI), aggressiveness of DTC at diagnosis, and clinical outcome. Methods We evaluated 1058 consecutive DTC patients treated with total thyroidectomy and enrolled at the time of first radioactive iodine (131I) treatment. Patients were divided into 4 groups based on their BMI: underweight (&lt; 18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (≥ 30 kg/m2). Histological aggressiveness of DTC at the time of diagnosis and clinical outcome according to 2015 American Thyroid Association (ATA) guidelines were evaluated. Results No differences in histological features, ATA risk of recurrence, activity of 131I administered and prevalence of 131I avid metastatic disease after first131I treatment, have been demonstrated among the groups. Furthermore, at the end of follow up (median = 5.7 years), no differences were evident in the number of further treatments performed as well as in the clinical response. Conclusions In our study group of Caucasian subjects, we could not demonstrate any association between BMI and aggressiveness of DTC, neither at the time of diagnosis nor during follow-up. These data indicate that postsurgical assessment and therapeutic attitude for treatment and follow-up of DTC should be based on the class of risk applied to the general population, with no concern for BMI.

Postnatal hypothalamic - pituitary - adrenal function in sheep is influenced by age and sex, but not by prenatal growth restriction

2011 ◽  
Vol 23 (2) ◽  
pp. 275 ◽  
Author(s):  
Jacqueline M. Wallace ◽  
John S. Milne ◽  
Lucy R. Green ◽  
Raymond P. Aitken
Keyword(s):  
Normal Weight ◽  
Growth Restriction ◽  
Hypothalamic Pituitary Adrenal ◽  
Maternal Undernutrition ◽  
Prenatal Growth ◽  
Cortisol Responses ◽  
The Relationship ◽  
Hpa Response ◽  
Age And Sex ◽  
Hpa Function

The relationship between impaired fetal nutrient supply and postnatal hypothalamic–pituitary–adrenal (HPA) function was examined in ovine models of prenatal growth restriction (GR) caused by small placental size (SP) or by maternal undernutrition (UN). Adrenocorticotrophin (ACTH) and cortisol responses following corticotrophin-releasing hormone (CRH) plus arginine vasopressin (AVP) challenge were examined at 9, 18 and 24 months in growth-restricted (GR-SP) and normal birthweight (control) females (Experiment 1), and at 6 months in growth-restricted (GR-SP, GR-UN) and normal weight males and females (Experiment 2). In Experiment 1, GR-SP offspring were born early, were 40% lighter at birth and had higher fractional weight gains to weaning than control offspring. Baseline ACTH and cortisol were independent of GR and cortisol decreased with age. GR did not affect the HPA response to CRH + AVP challenge at any stage, but ACTH increased with age. In Experiment 2, birthweight was greater in control offspring than in GR-UN offspring, which had a higher birthweight again compared with GR-SP offspring. Only the latter group was born early and exhibited rapid catch-up growth to weaning. Neither nutritional route to GR altered HPA function at 6 months. Males grew faster than females and HPA responses after stimulation were lower in males. Together, the results of these studies demonstrate that postnatal HPA function in sheep is influenced by age and sex, but not by GR.

P5680One-year outcomes of heart failure patients undergoing cardiac resynchronization therapy using adaptivCRT algorithm

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Briongos Figuero ◽  
A Estevez ◽  
M L Perez ◽  
J B Martinez-Ferrer ◽  
L Alvarez-Costa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Real Life ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Ventricular Pacing ◽  
Class Iii ◽  
Resynchronization Therapy ◽  
Risk Of Death

Abstract Background Adaptive cardiac resynchronization therapy (aCRT) algorithm provides synchronized left ventricular (LV) only pacing and ambulatory optimization of the intrinsic atrioventricular and interventricular conduction intervals. Studies reporting morbidity and mortality outcomes of aCRT carriers in daily clinical practice are lacking. Purpose To determine in a real-life setting, whether 1-year outcomes were different among CRT carriers undergoing aCRT pacing and those under conventional biventricular (biV) pacing. Methods Symptomatic heart failure (HF) patients with sinus rhythm undergoing first CRT-defibrillator implant were selected from the UMBRELLA nationwide registry (2012–2017). The primary endpoint was the composite of all-cause mortality or HF hospitalization at 12-month follow-up. HF admission was defined as hospitalization due to symptoms requiring intravenous diuretic treatment. Primary healthcare records were used to prospectively collect all data. Results Two hundred and six patients were collected (66.1±8.7 years; 73.3% male). Eighty-seven out of 206 patients were implanted with an aCRT capable device, but this algorithm was activated at implant and remained enabled at 1-year in 59 patients (aCRT group). The other 147 patients composed the non-aCRT group. At implant left bundle branch block was present in 93% of patients, 69.6% of population was in functional class III or IV and mean left ventricle ejection fraction was of 26.5±5.6%. Non-ischemic cardiomyopathy was present in 63.1% of patients and optimal medical treatment was achieved in majority of population (92% of patients with beta-blockers; angiotensin-converting enzyme inhibitorsor angiotensin II receptor blockersin 89%). The percentage of ventricular pacing through 12 months was 96.1±9.4% in non-aCRT patients and 97.5±2.7% in aCRT patients (p=0.261). In aCRT patients, LV-only pacing accounted for a mean of 53.3±37.6% of all ventricular pacing. After 12-month follow-up period, 25 patients (12.1%) met the primary composite endpoint of death or HF hospitalization. Nine patients died and nineteen patients were admitted due to worsening HF. There was no difference in the risk of all-cause death or HF hospitalization between aCRT and non-aCRT patients (10.2% vs. 12.9% respectively; OR=0.76, CI: 0.29–2.01, p=0.585) Conclusions In this contemporary cohort of HF patients undergoing CRT with high percentages of ventricular pacing, clinical performance of aCRT algorithm was adequate. The risk of death or HF hospitalization was low and no differences were observed at one-year follow-up. Future randomized studies will clarify the role of this algorithm in CRT carriers. Acknowledgement/Funding None

scholarly journals Using the General Social Survey – National Death Index cohort to study the relationship between neighbourhood fear and mortality in the USA

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e030330
Author(s):  
Erin Grinshteyn ◽  
Peter Muennig ◽  
Roman Pabayo
Keyword(s):  
Fear Of Crime ◽  
General Social Survey ◽  
National Death Index ◽  
Social Survey ◽  
Time To Death ◽  
Risk Of Death ◽  
Increased Risk ◽  
Adjusted Model ◽  
The Relationship

ObjectivesFear of crime is associated with adverse mental health outcomes and reduced social interaction independent of crime. Because mental health and social interactions are associated with poor physical health, fear of crime may also be associated with death. The main objective is to determine whether neighbourhood fear is associated with time to death.Setting and participantsData from the 1978–2008 General Social Survey were linked to mortality data using the National Death Index (GSS-NDI) (n=20 297).MethodsGSS-NDI data were analysed to assess the relationship between fear of crime at baseline and time to death among adults after removing violent deaths. Fear was measured by asking respondents if they were afraid to walk alone at night within a mile of their home. Crude and adjusted HRs were calculated using survival analysis to calculate time to death. Analyses were stratified by sex.ResultsAmong those who responded that they were fearful of walking in their neighbourhood at night, there was a 6% increased risk of death during follow-up in the adjusted model though this was not significant (HR=1.06, 95% CI 0.99 to 1.13). In the fully adjusted models examining risk of mortality stratified by sex, findings were significant among men but not women. Among men, in the adjusted model, there was an 8% increased risk of death during follow-up among those who experienced fear at baseline in comparison with those who did not experience fear (HR=1.08, 95% CI 1.02 to 1.14).ConclusionsResearch has recently begun examining fear as a public health issue. With an identified relationship with mortality among men, this is a potential public health problem that must be examined more fully.

Second Malignancies After Autologous Hematopoietic Cell Transplantation (AHCT) for Multiple Myeloma (MM): A Center for International Blood and Marrow Transplant Research (CIBMTR) Analysis

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 591-591
Author(s):  
Girindra Raval ◽  
Anuj Mahindra ◽  
Xiaobo Zhong ◽  
Ruta Brazauskas ◽  
Robert Peter Gale ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Multivariate Analysis ◽  
General Population ◽  
Cumulative Incidence ◽  
Incidence Rates ◽  
High Dose ◽  
Risk Of Death ◽  
Age And Sex

Abstract Abstract 591 Background: Survival of patients with MM has improved over the past two decades, in part due to the use of AHCT. Increasingly, second primary malignancies (SPMs) are observed in MM survivors. Determining the baseline incidence and risk factors associated with SPMs after AHCT is important to assess risk and to evaluate the risk-benefit ratio of newer therapies. Methods: We analyzed the incidence of SPMs in 3784 MM patients receiving (“upfront”) AHCT for MM within 18 months of diagnosis between 1990 and 2010 and reported to the CIBMTR. Cumulative incidence rates of SPMs were estimated taking into account the competing risk of death. For each transplant recipient, the number of person-years at risk was calculated from the date of transplantation until date of last contact, death, or diagnosis of SPM, whichever occurred first. Incidence rates for all invasive cancers in the general population were obtained from the SEER database. Age-, sex-, and race- specific incidence rates for overall SPMs and particular anatomical sites were applied to the appropriate person-years at risk to compute the expected numbers of cancers. Observed–to –expected (O/E) ratios were calculated, and Poisson distribution 99% confidence intervals (CIs) were generated. Poisson regression model was used to analyze risk factors for overall SPMs and AML/MDS. Results: Pre-transplant therapy included novel agents in 56% including thalidomide (35%), lenalidomide (9%), bortezomib (16%) or their combinations (11%). Majority (80%) received high dose melphalan conditioning. Post-transplant maintenance therapy included thalidomide (16%), lenalidomide (8%), bortezomib (9%) and interferon (6%). Median follow-up of survivors was 52 months (range 3 to 192 months).With 12707 person years of follow up, 153 new malignancies were reported with a crude rate of 1.2 SPM per 100 person years of follow up. Observed/Expected [O/E] ratio for all SPMs was 0.99 (99% CI, 0.80–1.22). Cumulative incidence of SPM overall was 2.48% (95% CI, 1.96–3.05) at 3 years and 6.0% (95% CI, 4.96–7.10) at 7 years [Figure 1]. Individual SPMs observed significantly more frequently than expected are summarized in Table 1. The cumulative incidence of MDS/AML was 0.5% (95% CI, 0.28–0.78) at 3 years and 1.3 (95% CI, 0.85– 1.9%) at 7 years. Majority had MM progression prior to diagnosis of SPM (65 of 102 patients overall and 15 of 23 patients for MDS/AML). In multivariate analysis, significant risk factors for development of SPMs included: obesity [Hazard ratio = HR 1.89(95%CI, 1.21–2.93), p=0.0047 for BMI>30 vs. BMI<25], older age: [HR10.53 (95%CI, 1.46–75.82), p=0.0195] for 60–69 year olds and HR14.4 (95%CI, 1.89–109.75), p=0.01 for 70+ year olds compared to the 18–39 year old group. Specific conditioning regimens did not correlate with the risk of SPM. The low number of MDS/AML (33 events out of 3784 cases) limited the power of multivariate analysis. Increasing age was significantly associated with development of MDS (HR10.77, (95%CI,92.09–55.51), p=0.004 for 70+ year old vs. 40–49 year olds). Conclusion: In this large cohort of AHCT recipients for MM, the incidence of MDS/AML, melanoma and other skin cancers was significantly higher compared to age and sex matched general population. However the overall risk of SPM was similar to that expected for age and sex matched population. It was also similar to the placebo arms of recent reports by McCarthy Pl et al and Attal M et al (N Engl J Med. 10; 366(19):1770–91). Lenalidomide (8%) or thalidomide maintenance (16%) used in a small subset of patients with comparatively short follow up, was not associated with risk of SPM in the analysis of the overall cohort. Disclosures: Gale: Celgene: Employment. Brandenburg:Celgene: Employment, Equity Ownership. Lonial:Millennium, Celgene, Novartis, BMS, Onyx, Merck all Consultancy. Krishnan:Celgene and Millennium: Consultancy, Speakers Bureau. Dispenzieri:Celgene and Millennium: Research Funding. Hari:Celgene: Consultancy, Honoraria.

scholarly journals The impact of maternal obesity on completion of fetal anomaly screening

2017 ◽  
Vol 45 (9) ◽  
Author(s):  
Kelly-Ann Eastwood ◽  
Ciara Daly ◽  
Alyson Hunter ◽  
David McCance ◽  
Ian Young ◽  
...  
Keyword(s):  
Maternal Obesity ◽  
World Health Organisation ◽  
Normal Weight ◽  
World Health ◽  
Fetal Anomaly ◽  
Class Iii ◽  
Fetal Medicine ◽  
Obese Class ◽  
The World ◽  
The Impact

AbstractObjective:To examine the impact of maternal obesity on completion of fetal anomaly screening.Methods:A retrospective analysis of 500 anomaly scans (19+0–21+6 weeks) was included. Women were categorised according to the World Health Organisation (WHO) body mass index (BMI) classification: normal weight (18.50–24.99 kg/mResults:Image quality deteriorated as BMI increased and was significantly different across the BMI categories (P<0.001). Performance was poorest in imaging of the fetal chest and was significantly different across BMI categories (P<0.001). In obese class III, 33% of four-chamber cardiac views and 38% of outflow tract views were not obtained. In total, 119 women (23.6%) had an incomplete scan. In obese class III, 44.1% of scans were incomplete compared with 10.2% in the normal BMI category (P<0.001). Of 117 women attending for repeat scans, 78.6% were complete, 11.1% were incomplete, 6.8% were advised to re-attend and 3.4% were referred to Fetal Medicine.Conclusion:Maternal obesity has a significant impact on completion of fetal anomaly screening.

scholarly journals Saliva and Blood Asprosin Hormone Concentration Associated with Obesity

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Kader Ugur ◽  
Suleyman Aydin
Keyword(s):  
Salivary Gland ◽  
Salivary Glands ◽  
Weight Control ◽  
Normal Weight ◽  
Class Iii ◽  
Tissue Mass ◽  
Obese Class ◽  
Gland Tissue ◽  
Treatment Of Obesity ◽  
Normal Weight Control

Background. The aim was to investigate the amounts of saliva and serum asprosin in order to determine whether it is related to obesity and whether salivary glands synthesize asprosin or not.Methods. A total of 116 underweight, normal weight, overweight, and obese (class I, class II, and class III) volunteers participated in the study. Saliva and blood samples were collected simultaneously from the participants. The amounts of asprosin in saliva, salivary gland tissue supernatants, and bloods were determined by ELISA, whereas asprosin synthesis sites of salivary gland tissues were determined immunohistochemically.Results. The amount of asprosin from the lowest to the highest was in the order as follows: underweight, normal weight (control), overweight, and obese classes I and III. The lowest level of asprosin was detected in underweight individuals. It was also found that the interlobular striated ducts and the interlobular ducts of the submandibular and parotid salivary glands produce asprosin. According to these data, the asprosin level is related with obesity as the amount increases in accordance with increasing body mass index (BMI). On the other hand, there is also a relationship between the underweight and asprosin because the amount decreases with BMI decrease.Conclusions. Asprosin, a new adipokine, may be a novel indicator of adipose tissue mass. Therefore, we anticipate that antiasprosin preparations may be an alternative in the treatment of obesity in the future.

Impact of maternal body mass index on the cesarean delivery rate in Germany from 1990 to 2012

2015 ◽  
Vol 43 (4) ◽  
Author(s):  
Ioannis Kyvernitakis ◽  
Christine Köhler ◽  
Stephan Schmidt ◽  
Björn Misselwitz ◽  
Jasmin Großmann ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Cesarean Delivery ◽  
Body Mass ◽  
Early Pregnancy ◽  
Normal Weight ◽  
Class I ◽  
Class Iii ◽  
The Past ◽  
Obese Class ◽  
Maternal Bmi

AbstractMaternal obesity is a risk factor for cesarean delivery (CD). The aim of this analysis was to determine the association between early-pregnancy body mass index (BMI) and the rate of CD over the past two decades.We retrospectively analyzed data from the perinatal quality registry of singleton deliveries in the state of Hesse in Germany from 1990 to 2012. We divided the patients into groups according to the WHO criteria for BMI: underweight (<18.5), normal weight (18.5–<25), overweight (25–<30), obese class I (30–<35), obese class II (35–<40), and obese class III (≥40).The analysis included 1,092,311 patients with available data regarding maternal BMI and mode of delivery. The CD rates for underweight (<18.5), normal weight (18.5–<25), overweight (25–<30), obese class I (30–<35), obese class II (35–<40), and obese class III (≥40) women increased from 14.4%, 16.1%, 19.5%, 22.3%, 25%, and 26.9% in the year 1990 to 27.9%, 31.4%, 38.8%, 45.1%, 50.2%, and 55.2% in the year 2012, respectively (P<0.001).Maternal BMI in early pregnancy is linearly associated with the incidence of CD. We found a disproportionate increase of CD in morbidly obese women compared with the CD incidence in the reference BMI population over the past two decades.

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