The impact of cesarean section on offspring overweight and obesity: a systematic review and meta-analysis

IntroductionThe effects of interventions targeting weight loss on physical health are well described, yet the evidence for mental health is less clear. It is essential to better understand the impact of weight management interventions on mental health to optimise care and minimise risk of harm. We will assess the effect of behavioural weight management interventions on mental health in adults with overweight and obesity.Methods and analysisThe systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. We will include behavioural weight management interventions with a diet and/or physical activity component focusing on weight loss for adults with a body mass index ≥25 kg/m2. Randomised controlled trials (RCTs) and cluster RCTs will be the only eligible study designs. Outcomes of interest will be related to mental health. The following databases were searched from inception to 07 May 2019: MEDLINE, Embase, Cochrane database (CENTRAL), PsycINFO, ASSIA, AMED and CINAHL. The search strategy was based on four concepts: (1) adults, defined as ≥18 years, with overweight/obesity, defined as BMI ≥25kg/m², (2) weight management interventions, (3) mental health outcomes and (4) study design. The search was restricted to English-language published papers, with no other restrictions applied. Two stage screening for eligibility will be completed by two independent reviewers, with two independent reviewers completing data extraction and risk of bias assessment. Data permitting, a random-effects meta-analysis of outcomes, subgroup analyses and meta-regression will be conducted. If not appropriate, narrative synthesis and ‘levels of evidence’ assessment will be completed.Ethics and disseminationEthical approval is not required as primary data will not be collected. The completed systematic review will be disseminated in a peer-reviewed journal, at conferences and contribute towards the lead author’s PhD thesis.PROSPERO registration numberCRD42019131659.

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Healthcare utilisation in overweight and obese children: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2019-035676 ◽

2020 ◽

Vol 10 (10) ◽

pp. e035676

Author(s):

Taimoor Hasan ◽

Tom S Ainscough ◽

Jane West ◽

Lorna Katharine Fraser

Keyword(s):

Systematic Review ◽

Outcome Measures ◽

Meta Analysis ◽

Healthcare Utilisation ◽

Normal Weight ◽

Overweight And Obesity ◽

Obese Children ◽

Outpatient Visits ◽

Ed Visits ◽

The Impact

ObjectiveThis systematic review and meta-analysis aims to systematically analyse the association of overweight and obesity with health service utilisation during childhood.Data sourcesPubMed, MEDLINE, CINAHL, EMBASE and Web of Science.MethodsObservational studies published up to May 2020 that assessed the impact of overweight and obesity on healthcare utilisation in children and adolescents were included. Studies were eligible for inclusion if the included participants were ≤19 years of age. Findings from all included studies were summarised narratively. In addition, rate ratios (RRs) and 95% CIs were calculated in a meta-analysis on a subgroup of eligible studies.Outcome measuresIncluded studies reported association of weight status with healthcare utilisation measures of outpatient visits, emergency department (ED) visits, general practitioner visits, hospital admissions and hospital length of stay.ResultsThirty-three studies were included in the review. When synthesising the findings from all studies narratively, obesity and overweight were found to be positively associated with increased healthcare utilisation in children for all the outcome measures. Six studies reported sufficient data to meta-analyse association of weight with outpatient visits. Five studies were included in a separate meta-analysis for the outcome measure of ED visits. In comparison with normal-weight children, rates of ED (RR 1.34, 95% CI 1.07 to 1.68) and outpatient visits (RR 1.11, 95% CI 1.02 to 1.20) were significantly higher in obese children. The rates of ED and outpatient visits by overweight children were only slightly higher and non-significant compared with normal-weight children.ConclusionsObesity in children is associated with increased healthcare utilisation. Future research should assess the impact of ethnicity and obesity-associated health conditions on increased healthcare utilisation in children with overweight and obesity.PROSPERO registration numberCRD42018091752

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Overweight and obesity as potential prognostic factors for severity and mortality in patients with COVID-19: A living systematic review protocol

10.31219/osf.io/t97ab ◽

2020 ◽

Author(s):

Catherine Bonilla-Untiveros ◽

Saby Camacho-Lopez ◽

Eduard Baladia ◽

Luis E. Ortiz-Muñoz ◽

Gabriel Rada

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Grey Literature ◽

Overweight And Obesity ◽

Cochrane Central Register ◽

Suspected Infection ◽

Central Register ◽

Review Protocol ◽

The Impact ◽

Overweight Or Obesity

ObjectiveThis living systematic review aims to provide a timely, rigorous and continuously updated summary about the impact of overweight or obesity as a prognostic factor for severity and mortality in patients with COVID-19. DesignThis is a protocol of a living systematic review.Data sourcesWe will conduct searches in MEDLINE/PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), grey literature and in a centralized repository in L·OVE (Living OVerview of Evidence). L·OVE is a platform that maps PICO questions to evidence from Epistemonikos database. In response to the COVID-19 emergency, L·OVE was adapted to expand the range of evidence it covers and customised to group all COVID-19 evidence in one place. The search will cover the period until the day before submission to a journal.Eligibility criteria for selecting studies and methods We adapted an already published common protocol for multiple parallel systematic reviews to the specificities of this question. We will include all primary studies that assess patients with confirmed or suspected infection with SARS-CoV-2 and inform the relation of overweight or obesity with death or disease severity. Two reviewers will independently screen each study for eligibility, extract data, and assess the risk of bias. We will pool the results using meta-analysis and will apply the GRADE system to assess the certainty of the evidence for each outcome. A living, web-based version of this review will be openly available during the COVID-19 pandemic. We will resubmit it every time the conclusions change or whenever there are substantial updates.

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Impact of BMI on Growth Hormone Stimulation Tests in Children and Adolescents: A Systematic Review and Meta-Analysis

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1382 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A678-A678

Author(s):

Ozair Abawi ◽

Dieuwertje Augustijn ◽

Sanne Hoeks ◽

Yolanda B de Rijke ◽

Erica L T van den Akker

Keyword(s):

Systematic Review ◽

Growth Hormone ◽

Short Stature ◽

Meta Analysis ◽

Overweight And Obesity ◽

Individual Participant Data ◽

Study Heterogeneity ◽

Individual Participant ◽

Stimulation Tests ◽

The Impact

Abstract Background: Peak stimulated growth hormone (GH) levels are known to decrease with increasing BMI, possibly leading to overdiagnosis of GH deficiency (GHD) in children with overweight and obesity. However, current guidelines do not provide guidance how to interpret peak GH values of these children, nor has this been assessed systematically. The aim of this systematic review and meta-analysis was to study the effect of BMI on stimulated peak GH values in children, and to quantify to which extent peak GH values in children with obesity are decreased. Methods: We searched the Medline, Embase, Cochrane, Web of Science, and Google Scholar databases (13 July 2020) for studies reporting impact of BMI on peak GH in children. Where possible, individual participant data was extracted and/or obtained from the authors. Primary outcome was the association between peak GH values and BMI standard deviation score (SDS). Pooled correlation coefficients were calculated under a random effects model, and exploratory moderator analyses and meta-regression were performed. Study heterogeneity was assessed using the I2 statistic. For studies with available individual participant data, linear mixed-models regression analysis was performed with BMI SDS as predictor and ln(peak GH) as outcome, accounting for used GH stimulation agent (fixed effect) and study (random effect). This systematic review was performed in accordance to the PRISMA guidelines. Results: In total, 56 studies were included, providing data on n=5100 children (1346 with individual participant data). Across all studies, a pooled r of -0.37 (95% CI -0.44 to -0.31, n=2785) was found. Study heterogeneity was large (I2=58%). Pubertal status, sex, presence of syndromic obesity, and mean age and BMI SDS of the population did not significantly moderate the pooled r (all p>0.05). Individual participant data analysis revealed a beta of -0.11 (95% CI -0.08 to -0.15, p<0.001), i.e., per 1 point increase in BMI SDS, peak GH decreases by 11% (95% CI 7 to 14%). In the 8 studies performed in children referred for short stature, obesity was present in 27/893 (3.02%) children without GHD and in 36/615 (5.85%) children with GHD (p=0.0069). This corresponds to a RR of 1.43 (95% CI 1.14 to 1.78, p=0.002) for a diagnosis of GHD in children with short stature with obesity compared to children without obesity. Discussion: To our knowledge, this is the first systematic review and meta-analysis to investigate the impact of BMI on peak GH values in children, showing a significant negative correlation and risk of overdiagnosis of GHD in children with obesity. All in all, with ever-rising prevalence of pediatric obesity, our study highlights the urgent need for BMI (SDS)-specific cut-off values for GH stimulation tests in children.

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P01.06 Overweight and obesity as biomarkers for survival outcomes and immune related adverse events undergoing immunotherapy – a systematic review and meta-analysis

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2021-itoc8.10 ◽

2021 ◽

Vol 9 (Suppl 1) ◽

pp. A5.2-A6

Author(s):

P Trinkner ◽

S Günther ◽

M von Bergwelt ◽

D Cordas dos Santos ◽

S Theurich

Keyword(s):

Systematic Review ◽

Adverse Events ◽

Cancer Patients ◽

Meta Analysis ◽

Normal Weight ◽

Overweight And Obesity ◽

Obese Patients ◽

Increased Risk ◽

Underweight Patients ◽

The Impact

BackgroundThe impact of overweight/obesity in cancer patients treated with immune checkpoint inhibitors (ICIs) is controversial. To further contribute to this debate, we performed a systematic review and meta-analysis of published articles evaluating the effects of overweight/obesity on survival and immune-related adverse events (irAEs).Materials and MethodsIn analogy to Cochrane recommendations, systematic literature searches included all published articles in PubMed until February 2021 with key terms ‘obesity’ and ‘overweight’ and ICI treatment irrespective of cancer entity and ICI used. Further selection criteria for meta-analysis included WHO cut-offs for overweight/obesity. For the random effects meta-analysis, we used Hazard Ratios (HR) for overall and progression-free survival (OS, PFS) and Odds Ratios (OR) for occurrence of irAEs with corresponding 95% confidence intervals (95%CI), respectively.ResultsA total of 30 studies (12,895 patients, 38% female) selected for meta-analysis revealed a superior survival of overweight/obese patients (PFS: HR 0.9, 95%CI 0.77-1.04, p = 0.11; OS: 0.74, 95%CI 0.63-0.92, p = 0.0005) compared to normal weight patients. In subgroup analyses based on sex, overweight/obese male patients showed increased survival (PFS: HR 0.79, 95%CI 0.63-1.00, p = 0.05; OS: 0.71, 95%CI 0.58-0.86, p = 0.0005), whereas overweight/obese female patients had similar survival probabilities compared to their normal weight counterparts (PFS: HR 1.01, 95%CI 0.69-1.47, p = 0.96; OS: HR 0.73, 95%CI 0.48-1.10, p = 0.13). Underweight patients showed inferior survival (PFS: HR 1.48, 95%CI 1.07-2.04, p = 0.02; OS: HR 1.86, 95%CI 1.13-3.04, p = 0.01). In addition, overweight/obese patients had a higher risk of developing irAEs with grade ≥ 3 (OR 1.91, 95%CI 1.18-3.10, p = 0.008).ConclusionsOur meta-analysis revealed that overweight/obesity is a beneficial factor for PFS and OS in a mixed cohort of cancer patients undergoing ICI treatment accompanied by an increased risk of severe irAEs. The differences between overweight/obese males and overweight/obese females might point to sex specific adipose distribution patterns and interactions of sex steroids on a molecular level. A significant number of studies included underweight patients into normal weight control groups which led to a compromised interpretation of the data and should be addressed in future studies.Disclosure InformationP. Trinkner: None. S. Günther: None. M. von Bergwelt: None. D. Cordas dos Santos: None. S. Theurich: None.

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Birth by Caesarean Section and Offspring Overweight and Obesity in Adult Life: A Systematic Review and Meta-analysis

10.20944/preprints202112.0106.v1 ◽

2021 ◽

Author(s):

Manuela Chiavarini ◽

Benedetta De Socio ◽

Irene Giacchetta ◽

Roberto Fabiani

Keyword(s):

Systematic Review ◽

Cesarean Section ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Adult Life ◽

Overweight And Obesity ◽

Risk Estimate ◽

Increased Risk ◽

Important Health

Overweight/obesity is one of the most important health problem worldwide. Birth by cesarean section has been shown to influence long-term health outcome including obesity. The aim of this systematic review-meta-analysis is to examine whether cesarean section increases the risk of offspring’ s overweight/obesity. The study follows the PRISMA and MOOSE guidelines. A systematic literature search was con-ducted on Scopus, PubMed, and WoS until December 2020. For inclusion, studies must have re-ported either (I) both Birth by cesarean section and adult (≥ 18 years) offspring BMI, (II) cohort or case–control study design and (III) a risk estimate. Heterogeneity testing was performed using Cochran's Q and I2 statistics. Publication bias was assessed by Egger’s test and Begg’s test. Me-ta-analysis was performed through a random effect model. Eleven studies with a combined population of 180.408 subjects were included in the meta-analysis. The overall analysis (n = 18) yielded a combined risk estimate for overweight/obesity of 1.19 (95% CI 1.08-1.31) and the test of heterogeneity resulted Q=53,37 (I2 = 70,37 %, P≤0•0001). The risk of offspring obesity is 1.23 (95% CI 1.09-1.39) and the test of heterogeneity resulted Q=39.50 (I2= 72,15%, P≤0•0001). Children born by cesarean section have an increased risk of developing obesity in adulthood

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Impact of cesarean section on timely initiation of breastfeeding in Ethiopia: a systematic review and meta-analysis

International Breastfeeding Journal ◽

10.1186/s13006-021-00399-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Temesgen Getaneh ◽

Ayenew Negesse ◽

Getenet Dessie ◽

Melaku Desta ◽

Habtamu Temesgen ◽

...

Keyword(s):

Systematic Review ◽

Cesarean Section ◽

Health Professionals ◽

Meta Analysis ◽

Cochrane Library ◽

Timely Initiation ◽

Skin Contact ◽

The Impact ◽

Timely Initiation Of Breastfeeding ◽

Initiation Of Breastfeeding

Abstract Background Timely initiation of breastfeeding is feeding of breast milk within one hour of birth, however, three in five babies were not breastfed in the first hour of birth globally. There is evidence that cesarean section is the major constraint for this low prevalence, but the impact of cesarean section on timely initiation of breastfeeding in Ethiopia is limited. Therefore, this meta-analysis aimed to provide evidence for policy makers, health professionals and program implementers. Methods This systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Electronic bibliographic databases such as PubMed/Medline, EMBASE, PsycINFO, CINHAL, Scopus, Google Scholar, Science Direct and Cochrane Library were used to search relevant studies and was conducted up to February 2021. Random effects model meta-analysis was applied to estimate the pooled impact of cesarean section on timely initiation of breastfeeding with 95% confidence intervals (CI). I2 statistical test and, funnel plot and Egger’s test were used to check heterogeneity and publication bias across included studies respectively. Results According to meta-analysis of 17 studies, the pooled estimate of timely initiation of breastfeeding among women who had cesarean section in Ethiopia was 40.1% (95% CI 33.29, 46.92). The meta-analysis of 29,919 study participants showed that cesarean section was associated with a 79% lower odds of timely initiation of breastfeeding compared with vaginal birth (OR 0.21; 95% CI 0.16, 0.28). Conclusions In Ethiopia, almost only one-third of mothers who gave birth by cesarean section initiate breastfeeding within one hour of birth, much lower than the pooled prevalence among general population. Special health promotion, intervention and healthcare provider support during immediate or early skin to skin contact, and having focused breastfeeding guidelines for post-operative patient and trained health professionals should be considered for mothers who give birth through cesarean section.

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