Pre-pregnancy Obesity and the Risk of Peripartum Cardiomyopathy

Objective The aim of this study is to evaluate the contribution of pre-pregnancy obesity and overweight to peripartum cardiomyopathy. Study Design This population-based study used linked birth record and maternal hospital discharge data from live births in California during 2007 to 2012 (n = 2,548,380). All women who had a diagnosis of peripartum cardiomyopathy during the childbirth hospitalization or who were diagnosed with peripartum cardiomyopathy during a postpartum hospital readmission within 5 months of birth were identified as cases. Pre-pregnancy body mass index (BMI, kg/m2) was classified as normal weight (18.5–24.9), overweight (25.0–29.9), obesity class 1 (30.0–34.9), obesity class 2 (35.0–39.9), and obesity class 3 (≥40). Because of small numbers, we excluded women with underweight BMI, and in some analyses, we combined obesity classes into one group. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) expressing associations between BMI and peripartum cardiomyopathy, adjusted for maternal age, race/ethnicity, education, health care payer, parity, plurality, and comorbidities. Results The overall prevalence of peripartum cardiomyopathy during hospital admissions was 1.3 per 10,000 live births (n = 320). Unadjusted ORs were 1.32 (95% CI: 1.01–1.74) for women with overweight BMI and 2.03 (95% CI: 1.57–2.62) for women with obesity, compared with women with normal pre-pregnancy BMI. Adjusted ORs were 1.26 (95% CI: 0.95–1.66) for overweight women and 1.38 (95% CI: 1.04–1.84) for women with obesity. The ORs suggested a dose–response relationship with increasing levels of obesity, but the 95% CIs for the specific classes of obesity included 1.00. Conclusion Pre-pregnancy obesity was associated with an increased risk of peripartum cardiomyopathy. These findings underscore the importance of BMI during pregnancy. There is a need to recognize the increased risk of peripartum cardiomyopathy in women with high BMI, especially in the late postpartum period. Key Points

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Body mass index and risk of all-cause mortality in normotensive and hypertensive adults: The Rural Chinese Cohort Study

Public Health Nutrition ◽

10.1017/s1368980021001592 ◽

2021 ◽

pp. 1-25

Author(s):

Qionggui Zhou ◽

Xuejiao Liu ◽

Yang Zhao ◽

Pei Qin ◽

Yongcheng Ren ◽

...

Keyword(s):

Cohort Study ◽

Population Based ◽

Normal Weight ◽

Sensitivity Analyses ◽

Hypertension Status ◽

Moderation Effect ◽

Increased Risk ◽

All Cause Mortality ◽

Chinese Cohort ◽

The Impact

Abstract Objective: The impact of baseline hypertension status on the BMI–mortality association is still unclear. We aimed to examine the moderation effect of hypertension on the BMI–mortality association using a rural Chinese cohort. Design: In this cohort study, we investigated the incident of mortality according to different BMI categories by hypertension status. Setting: Longitudinal population-based cohort Participants: 17,262 adults ≥18 years were recruited from July to August of 2013 and July to August of 2014 from a rural area in China. Results: During a median 6-year follow-up, we recorded 1109 deaths (610 with and 499 without hypertension). In adjusted models, as compared with BMI 22-24 kg/m2, with BMI ≤18, 18-20, 20-22, 24-26, 26-28, 28-30 and >30 kg/m2, the HRs (95% CI) for mortality in normotensive participants were 1.92 (1.23-3.00), 1.44 (1.01-2.05), 1.14 (0.82-1.58), 0.96 (0.70-1.31), 0.96 (0.65-1.43), 1.32 (0.81-2.14), and 1.32 (0.74-2.35) respectively, and in hypertensive participants were 1.85 (1.08-3.17), 1.67 (1.17-2.39), 1.29 (0.95-1.75), 1.20 (0.91-1.58), 1.10 (0.83-1.46), 1.10 (0.80-1.52), and 0.61 (0.40-0.94) respectively. The risk of mortality was lower in individuals with hypertension with overweight or obesity versus normal weight, especially in older hypertensives (≥60 years old). Sensitivity analyses gave consistent results for both normotensive and hypertensive participants. Conclusions: Low BMI was significantly associated with increased risk of all-cause mortality regardless of hypertension status in rural Chinese adults, but high BMI decreased the mortality risk among individuals with hypertension, especially in older hypertensives.

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Childhood predictors of adult medically unexplained hospitalisations

The British Journal of Psychiatry ◽

10.1192/bjp.176.3.273 ◽

2000 ◽

Vol 176 (3) ◽

pp. 273-280 ◽

Cited By ~ 42

Author(s):

Matthew Hotopf ◽

Charlotte Wilson-Jones ◽

Richard Mayou ◽

Michael Wadsworth ◽

Simon Wessely

Keyword(s):

Hospital Admissions ◽

Population Based ◽

Physical Symptoms ◽

Childhood Experiences ◽

Persistent Abdominal Pain ◽

Increased Risk ◽

Medically Unexplained ◽

Health And Development ◽

Physical Diseases ◽

Unexplained Physical Symptoms

BackgroundIt has been suggested that adults with medically unexplained physical symptoms experienced greater ill-health then others (either in themselves or their families) during childhood.AimsTo test these hypotheses.MethodWe used data from the Medical Research Council (MRC) National Survey of Health and Development, a population-based cohort study established in 1946 (n=5362). Subjects were followed from birth in 1946 until 1989 (age 43 years). As outcome, we used operationally defined medically unexplained hospital admissions at age 15–43 years. Exposure variables included childhood illness, and illness in parents during the childhood of the subjects.ResultsThe risk set (n=4603) comprised individuals still in the Survey at age 15. Ninety-five unexplained hospital admissions were identified. Subjects whose mothers reported below-average health in the father were at increased risk of subsequent unexplained admissions. Below average reported health in the mother was not associated with this increased risk. Defined physical diseases in childhood were not associated, but persistent abdominal pain at age 7–15 years was.ConclusionsUnexplained hospital admissions are associated with certain childhood experiences of illness, but defined physical illness in childhood is not a risk factor.

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Metabolome-defined obesity and the risk of future diabetes and mortality

10.1101/2021.11.03.21265744 ◽

2021 ◽

Author(s):

Filip Ottosson ◽

Einar Smith ◽

Ulrika Ericson ◽

Salvatore Di Somma ◽

Paola Antonini ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Population Based ◽

Normal Weight ◽

Plasma Metabolites ◽

Italian Population ◽

Related Risk ◽

Increased Risk ◽

All Cause Mortality ◽

Future Diabetes

Background Obesity is a key risk factor for type 2 diabetes, however, up to 20% of patients are normal weight. Our aim was to identify metabolite patterns reproducibly predictive of BMI, and subsequently to test if lean individuals who carry an obese metabolome are at hidden high risk of obesity related diseases, such as diabetes. Methods We measured 109 metabolites in fasted plasma samples of 7663 individuals from two Swedish and one Italian population-based cohort. Ridge regression models were used to predict BMI using the plasma metabolites. Individuals with a predicted BMI either more than 5 kg/m2 higher (overestimated) or lower (underestimated) than their actual BMI were characterized as outliers and further investigated for obesity related risk factors and future risk of diabetes and mortality. Results The plasma metabolome could predict BMI in all cohorts (r2 = 0.48, 0.26 and 0.19). The overestimated group had a BMI similar to individuals correctly predicted as normal weight, similar waist circumference, were not more likely to change weight over time but had a 2 times higher risk of future diabetes and an 80 % increased risk of all-cause mortality. These associations remained after adjustments for obesity-related risk factors and lifestyle parameters. Conclusions We found that lean individuals with an obese metabolome, have an increased risk for diabetes and all-cause mortality compared to lean individuals with a healthy metabolome. Metabolomics may be used to identify hidden high-risk individuals, in order to initiate lifestyle and pharmacological interventions.

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Prevalence, repairs and complications of hypospadias: an Australian population-based study

Archives of Disease in Childhood ◽

10.1136/archdischild-2015-308809 ◽

2015 ◽

Vol 100 (11) ◽

pp. 1038-1043 ◽

Cited By ~ 28

Author(s):

Francisco Javier Schneuer ◽

Andrew J A Holland ◽

Gavin Pereira ◽

Carol Bower ◽

Natasha Nassar

Keyword(s):

Surgical Procedures ◽

Hospital Admissions ◽

Primary Repair ◽

Population Based ◽

Late Complications ◽

Hospital Data ◽

Australian Population ◽

Post Surgery ◽

South Wales ◽

Increased Risk

ObjectiveTo investigate hypospadias’ prevalence and trends, rate of surgical repairs and post-repair complications in an Australian population.MethodsHypospadias cases were identified from all live-born infants in New South Wales, Australia, during the period 2001–2010, using routinely collected birth and hospital data. Prevalence, trends, surgical procedures or repairs, hospital admissions and complications following surgery were evaluated. Risk factors for reoperation and complications were assessed using multivariate logistic regression.ResultsThere were 3186 boys with hypospadias in 2001–2010. Overall prevalence was 35.1 per 10 000 live births and remained constant during the study period. Proportions of anterior, middle, proximal and unspecified hypospadias were 41.3%, 26.2%, 5.8% and 26.6%, respectively. Surgical procedures were performed in 1945 boys (61%), with 1718 primary repairs. The overall post-surgery complication rate involving fistulas or strictures was 13%, but higher (33%) for proximal cases. Complications occurred after 1 year post-repair in 52.3% of cases and up to 5 years. Boys with proximal or middle hypospadias were at increased risk of reoperation or complications, but age at primary repair did not affect the outcome.ConclusionOne in 285 infants were affected with hypospadias, 60% required surgical repair or correction and one in eight experienced complications. The frequency of late complications would suggest that clinical review should be maintained for >1 year post-repair.

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Generalised anxiety disorder and hospital admissions: findings from a large, population cohort study

BMJ Open ◽

10.1136/bmjopen-2017-018539 ◽

2018 ◽

Vol 8 (10) ◽

pp. e018539 ◽

Cited By ~ 5

Author(s):

Olivia Remes ◽

Nicholas Wainwright ◽

Paul Surtees ◽

Louise Lafortune ◽

Kay-Tee Khaw ◽

...

Keyword(s):

Anxiety Disorder ◽

Service Use ◽

Hospital Admissions ◽

Late Onset ◽

Large Population ◽

Population Based ◽

Generalised Anxiety Disorder ◽

Increased Risk ◽

Using Data ◽

Administrative Health Databases

ObjectiveGeneralised anxiety disorder (GAD) is the most common anxiety disorder in the general population and has been associated with high economic and human burden. However, it has been neglected in the health services literature. The objective of this study is to assess whether GAD leads to hospital admissions using data from the European Prospective Investigation of Cancer-Norfolk. Other aims include determining whether early-onset or late-onset forms of the disorder, episode chronicity and frequency, and comorbidity with major depressive disorder (MDD) contribute to hospital admissions.DesignLarge, population study.SettingUK population-based cohort.Participants30 445 British participants were recruited through general practice registers in England. Of these, 20 919 completed a structured psychosocial questionnaire used to identify presence of GAD. Anxiety was assessed in 1996–2000, and health service use was captured between 1999/2000 and 2009 through record linkage with large, administrative health databases. 17 939 participants had complete data on covariates.Main outcome measurePast-year GAD defined according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition.ResultsIn this study, there were 2.2% (393/17 939) of respondents with GAD. Anxiety was not independently associated with hospital admissions (incidence rate ratio (IRR)=1.04, 95% CI 0.90 to 1.20) over 9 years. However, those whose anxiety was comorbid with depression showed a statistically significantly increased risk for hospital admissions (IRR=1.23, 95% CI 1.02 to 1.49).ConclusionPeople with GAD and MDD comorbidity were at an increased risk for hospital admissions. Clinicians should consider that meeting criteria for a pure or individual disorder at one point in time, such as past-year GAD, does not necessarily predict deleterious health outcomes; rather different forms of the disorder, such as comorbid cases, might be of greater importance.

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Risk of rehospitalisation and death for vulnerable New Zealand children

Archives of Disease in Childhood ◽

10.1136/archdischild-2017-312671 ◽

2017 ◽

Vol 103 (4) ◽

pp. 327-334 ◽

Cited By ~ 6

Author(s):

Jane Oliver ◽

Tim Foster ◽

Amanda Kvalsvig ◽

Deborah A Williamson ◽

Michael G Baker ◽

...

Keyword(s):

At Risk ◽

New Zealand ◽

Home Environment ◽

Hospital Admissions ◽

Discharge Data ◽

Kaplan Meier ◽

At Risk Children ◽

Increased Risk ◽

Cox Proportional Hazard Models ◽

Social Environmental

ObjectivesThere is considerable need to improve the effectiveness of healthcare to reduce morbidity and mortality. Child hospitalisations are influenced by determinants of health, including the home environment. Our aims were: (1) To investigate whether children hospitalised with potentially avoidable conditions thought to be associated with the home have an increased risk of rehospitalisation and death, (2) To investigate whether children hospitalised with particular subgroups of potentially avoidable conditions have an increased risk of rehospitalisation and death, (3) To assess the usefulness of these subgroups for identifying at-risk children.DesignWe used four existing groups of potentially avoidable conditions developed based on expert opinion: 1. the potentially avoidable hospitalisations (PAH) group, associated with social/environmental conditions, 2. the potentially avoidable hospitalisations attributable (at least in part) to the home environment (PAHHE) group, 3. the crowding group, and 4. the Ministry of Health (MoH) group. We analysed national New Zealand hospital discharge data (2000–2014). Rehospitalisation and death were described using Kaplan-Meier curves. Group effectiveness for identifying at-risk children was assessed using Cox proportional hazard models with children hospitalised for non-PAH conditions as comparison.ResultsIn total, 1425085 hospital admissions occurred, for 683115 unique children. Rehospitalisation was relatively common (71.0%). Death was rare (0.6%). All groups performed moderately well identifying at-risk children. Children with PAH have increased risk of rehospitalisation (adjusted HR (aHR):2.30–3.60) and death (aHR:3.07–10.44). PAH group had highest sensitivity (75.1%). The MoH group has the highest positive predictive value (rehospitalisation: 86.2%, death: 2.5%).ConclusionsChildren in the MoH group are very likely to benefit from housing interventions. Rehospitalisation and early mortality are useful assessment measures. Rehospitalisation exerts a considerable burden, and child deaths are catastrophic.

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Impact of Inherited Bleeding Disorders on Maternal Bleeding and Other Pregnancy Outcomes: A Population-Based Cohort Study

Blood ◽

10.1182/blood-2021-149673 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 493-493

Author(s):

Arafat Ul Alam ◽

Cynthia M. Wu ◽

Venu Jain ◽

Haowei Linda Sun

Keyword(s):

Cohort Study ◽

Pregnancy Outcomes ◽

Research Funding ◽

Population Based ◽

Diagnostic Code ◽

Bleeding Disorders ◽

Live Births ◽

Increased Risk ◽

Significant Change

Abstract Introduction: Increasing rate of postpartum hemorrhage (PPH) has been observed between 2003 and 2010 in Canada. Given that bleeding disorders contribute to the risk of PPH, it is important to identify the current trend in PPH in the last decade and assess the impact of inherited bleeding disorders on maternal bleeding and other pregnancy outcomes. Methods: This is a retrospective population-based cohort study using the Alberta Pregnancy Birth Cohort. The creation of this cohort using multiple linked administrative databases has been previously described. Number of deliveries per year in Alberta, Canada was determined by Vital Statistics birth registry from 2010 to 2018 and was linked with Discharge Abstract Database (DAD) to identify cases of PPH and other pregnancy outcomes. PPH was defined as a blood loss of ≥500 ml following vaginal delivery or ≥1000 ml following Caesarean section, or as a diagnosis noted by a health care provider. All diagnoses and procedures were identified by International Classification of Diseases (ICD)-10 codes and Canadian Classification of Interventions (CCI) codes, respectively. Previous validation study of diagnostic code for PPH in DAD showed high sensitivity and specificity. Inherited bleeding disorders including von Willebrand disease, hemophilia carriers, platelet function disorder, and hereditary deficiencies of other coagulation factors were identified by presence of at least two ICD codes. All analyses were restricted to hospitalized deliveries with live births. Temporal trend of PPH rate was assessed by Mann-Kendall test. Univariate logistic regression analyses were used to compute odds of pregnancy outcomes among women with inherited bleeding disorders compared with those without at their index pregnancies during the study period. Results: Between 2010 to 2018, 311,657 women had a total of 452,846 pregnancies with live births. The mean age of the study cohort was 29 years. Most (90%) of them reached term pregnancies. The total number of PPH was 47,602 (10.5 per 100 deliveries). The rate of PPH did not have any significant change from 10.3 in 2010 (95% confidence interval [CI] 10.0-10.6) to 10.8 (95% CI 10.6 -11.1) in 2018 (P for trend =0.28) [Figure 1]. Among 311,657 women, 345 (0.1%) had a diagnosis of inherited bleeding disorders [Table 1]. Women with bleeding disorders were more likely to experience PPH (odds ratio [OR] 1.4; 95% CI 1.1-1.9), antepartum hemorrhage (OR 4.3; 95% CI 2.9-6.4) and had a 3-fold increased risk of undergoing hysterectomy (OR 3.1; 95% CI 1.8-5.2). The bleeding cohort had 3.8 (95% CI: 2.4-6.0) times greater risk of being transfused with blood products. We observed a trend towards higher odds of caesarean delivery in women with bleeding disorders compared with those without (OR 1.2, 95% CI 0.9-1.5), albeit not statistically significant. However, there was no significant difference in prolonged labor, obstetric hematoma, low birth weight baby and induced labour. Conclusion: Despite a rise in the rate of PPH between 2003-2010, we observed no significant change in the rate of PPH in Alberta between 2010-2018. Women with inherited bleeding disorders are at an increased risk of bleeding events during pregnancy and childbirth. Further investigation into quality of care among this patient population is ongoing to identify areas for improvement. Figure 1 Figure 1. Disclosures Wu: BMS-Pfizer: Honoraria, Research Funding; Leo Pharma: Honoraria; Pfizer: Honoraria; Servier: Honoraria; Bayer: Research Funding; Daiichi-Sankyo: Research Funding. Sun: Pfizer: Consultancy; Novo Nordisk: Consultancy; Bayer: Consultancy; Octapharma: Consultancy, Research Funding; Shire: Consultancy.

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Impact of body mass index on critically ill COVID-19 patients admitted in a tertiary care hospital : a retrospective observational study

Asian Journal of Medical Sciences ◽

10.3126/ajms.v13i1.41396 ◽

2022 ◽

Vol 13 (1) ◽

pp. 3-7

Author(s):

Savita Gupta ◽

Varun Goel ◽

Nazia Nazir ◽

Saurabh Srivastava ◽

Anurag Srivastava

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Health Care Organization ◽

Tertiary Care ◽

Normal Weight ◽

Care Organization ◽

Care Hospital ◽

Predisposing Factor ◽

Obesity Class ◽

Increased Risk

Background: Increased body mass index (BMI) is a known risk factor for respiratory infection and is being recognized as a predisposing factor in the COVID‐19 pandemic caused by the severe acute respiratory syndrome coronavirus‐2. Aims and Objectives: This study aimed to assess the association between different body mass index categories with severe COVID-19 patients leading to death. Materials and Methods: This retrospective study of six months included the laboratory-confirmed COVID-19 patients admitted to an ICU of a tertiary care academic health care organization. The medical records were reviewed at least 14 days after admission. Results: 484 patients were included, and BMI data were available for 306 patients. 40.19% had a normal weight, 26.79% were overweight, 17.97% had BMI 30-34.9 Kg/m2 and 15.03% had BMI ≥ 35 Kg/m2. Overall, 58 patients (18.95%) died within 14 days of ICU admission, 50.98% were discharged alive or referred from the hospital within 14 days, and 30.06% remained hospitalized at 14 days. After controlling for all covariates, there was a significantly increased risk of mortality in the patients with obesity class I (RR 2.03, 95% CI 1.07-3.85, P = 0.030) and patients with obesity class II & III (RR 2.83, 95% CI 1.54–5.22, P <0.001) compared with those with normal BMI. Conclusions: Obesity was associated with an unfavorable outcome among patients with COVID-19. Patients with obesity should be more closely monitored when hospitalized for COVID-19 as there is increasing evidence of relation of severity of COVID-19 and obesity which appears to be a factor in the health risks.

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Association between Gestational Weight Gain Adequacy and Adverse Maternal and Neonatal Outcomes

American Journal of Perinatology ◽

10.1055/s-0038-1672196 ◽

2018 ◽

Vol 36 (06) ◽

pp. 615-623 ◽

Cited By ~ 2

Author(s):

Han-Yang Chen ◽

Suneet Chauhan

Keyword(s):

Weight Gain ◽

Gestational Weight Gain ◽

Neonatal Morbidity ◽

Error Variance ◽

Normal Weight ◽

Adverse Outcomes ◽

Live Births ◽

Gestational Weight ◽

Increased Risk ◽

Regression Adjustment

Objectives To estimate the prevalence of gestational weight gain (GWG) adequacy according to the 2009 guidelines, and to examine the association between GWG adequacy and the adverse outcomes, stratified by prepregnancy body mass index (BMI). Study Design A retrospective cohort study, using the 2011 to 2013 U.S. linked birth/infant death datasets, restricted to nonanomalous singleton live births at 37 to 41 weeks. The adverse outcomes included composite maternal morbidity (CMM), composite neonatal morbidity (CNM), and neonatal and infant mortalities. We used multivariable Poisson's regression models with robust error variance to examine the association between GWG adequacy and adverse outcomes. Results Of 8,656,791 singleton live births, 20, 32, and 48% had inadequate, adequate, and excessive GWG, respectively. After multivariable regression adjustment, compared with adequate GWG, excessive GWG had 1.10 (1.08–1.13) and 1.12 (1.10–1.14) times higher risk of CMM and CNM, respectively; similar findings were observed in BMI subgroups. Compared with adequate GWG, inadequate GWG had 1.14 (1.03–1.26) and 1.12 (1.07–1.18) times higher risk of neonatal and infant mortalities, respectively. Similar results were noted among women with normal weight. Conclusion Excessive GWG was associated with an increased risk of CMM and CNM, while inadequate GWG was associated with a higher risk of neonatal and infant mortalities.

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Abstract P288: Utility of BMI in Determining Excess Adiposity in Children and Adolescents Across the Obesity Spectrum: NHANES 1999-2006

Circulation ◽

10.1161/circ.133.suppl_1.p288 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

Justin R Ryder ◽

Alex Kaiser ◽

Kyle D Rudser ◽

Stephen R Daniels ◽

Aaron S Kelly

Keyword(s):

Body Fat ◽

Severe Obesity ◽

Fat Distribution ◽

Normal Weight ◽

Cut Points ◽

Obesity Class ◽

Excess Adiposity ◽

Class 1 ◽

High Degree ◽

Age And Sex

Introduction: Excess adiposity in youth is associated with a number of cardiometabolic complications. However, normative data defining excess adiposity cut-points utilizing gold-standard measures of adiposity [e.g. dual energy X-ray absorptiometry (DXA)] are lacking in youth. Moreover, the proportion of youth within a given BMI-based obesity category with excess adiposity is not well described. Therefore, we generated pediatric body fat distribution curves using DXA data from the National Health and Nutrition Examination Survey (NHANES) to identify cut-points and evaluate the accuracy of BMI in determining excess adiposity among youth. Hypothesis: A high proportion of youth with severe obesity using BMI based definitions (class 2 and 3) will have excess adiposity as measured by DXA. Heterogeneity and misclassification will be increasingly common across youth with obesity (class 1), overweight, and normal-weight. Methods: DXA data from NHANES 1999-2006 (Males (M) = 5,933; Females (F) = 4,532) were utilized for this analysis. Normal-weight (<85th BMI-percentile), overweight (≥85th-<95th BMI-percentile), class 1 obesity (≥95th BMI-percentile-<1.2 times the 95th percentile), class 2 obesity (≥1.2-<1.4 times the 95th BMI-percentile), and class 3 obesity (≥1.4 times the 95th percentile) were defined using Center for Disease Control based definitions for age and sex. Excess adiposity was defined using cohort-specific cut-points of the 75th, 85th, and 90th percentile for DXA-derived body fat by age and sex determined using quantile regression models with natural cubic splines (df=6). Results: Nearly all youth with class 3 obesity (100% M, 100% F; 97% M, 99.3% F; and 94.7% M, 95.9% F; for 75th, 85th, and 90th DXA-percentile respectively) and a high proportion of those with class 2 obesity (98% M, 99% F; 92.2% M, 90.6% F; and 76.2% M, 76.3% F; for 75th, 85th, and 90th DXA-percentile respectively) had excess adiposity. A high degree of discordance was observed between BMI and DXA-derived excess adiposity among youth with class 1 obesity (81.4% M, 85.5% F; 52.7% M, 59.6% F; and 32.9% M, 36.9% F; for 75th, 85th, and 90th DXA-percentile respectively). Only a small proportion of youth with overweight or normal weight had excess adiposity. Conclusions: The vast majority of youth with severe obesity defined by BMI-based obesity categories have excess adiposity, regardless of the cut-point used. Significant discordance was observed between DXA-derived excess adiposity in youth with obesity and overweight suggesting a high degree of misclassification using BMI-based definitions.

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