Analysis of Mortality in Traumatically Injured Patients Based on Body Mass Index and Mechanism Reveals Highest Mortality among the Underweight in Comparison with the Ideal Weight Patients

2017 ◽  
Vol 83 (4) ◽  
pp. 341-347
Author(s):  
Kevin Treto ◽  
Karen Safcsak ◽  
David Chesire ◽  
Indermeet S. Bhullar
Keyword(s):  
Body Mass Index ◽  
Blunt Trauma ◽  
Body Mass ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Penetrating Trauma ◽  
Gunshot Wounds ◽  
Protective Role ◽  
Ideal Weight ◽  
Significant Difference

The purpose of this study was to evaluate the effect of body mass index (BMI) on mortality after traumatic injury. The records of patients from 2012 to 2015 were retrospectively reviewed. The patients were stratified into the following groups based on admission BMI (kg/m2): underweight (UW) (BMI <19), ideal weight (IW) (BMI = 19–24.9), overweight (OW) (BMI = 25–29.9), obese (OB) (BMI = 30–39.9), and morbid obese (MO) (BMI >40). The groups were well matched with no significant differences in demographics and Injury Severity Score. Morality for the IW group was compared with the remaining BMI groups. A total of 6049 patients were identified. In comparison with IW group, the UW mortality was significantly higher (IW vs UW, 4.1% vs 8.8%, P = 0.001); however, the there was no significant difference with remaining groups. There was also no significant difference in mortality between IW and the remaining groups for patients that went directly to the operating room or for patients that had penetrating trauma (stab wounds and gunshot wounds). However, for blunt trauma, the mortality was significantly higher for UW (IW vs UW, 4.3% vs 9.4%, P = 0.001), no different for IW vs OW (4.3% vs 3.7%, P = 0.3), and significantly lower for IW vs OB (4.3% vs 2.8%, P = 0.04) and for IW vs MO (4.3% vs 1.0%, P = 0.03). After traumatic injuries, it is the underweight patients (BMI <19) and not the obese, that are at a significantly higher risk for overall mortality; this difference is especially evident after blunt trauma where obesity may actually confer a protective role.

Morbid Obesity Impacts Mortality in Blunt Trauma

2007 ◽  
Vol 73 (11) ◽  
pp. 1122-1125 ◽  
Author(s):  
A. Britton Christmas ◽  
Jennifer Reynolds ◽  
Ashley K. Wilson ◽  
Glen A. Franklin ◽  
Frank B. Miller ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Morbid Obesity ◽  
Injury Severity Score ◽  
Blunt Trauma ◽  
Body Mass ◽  
Severity Score ◽  
Injury Severity ◽  
Morbidly Obese ◽  
Normal Body Mass Index ◽  
Obese Patients

Twenty-six per cent of adults in the Unites States are obese and trauma remains a major cause of death. We assessed the impact of morbid obesity on mortality in patients with blunt trauma. We reviewed the records of patients with a body mass index 40 kg/m2 or greater injured by blunt trauma from 1993 to 2003 and compared them with a 4:1 control population with a normal body mass index and matched for sex and constellation of injuries. For comparison, patients were categorized by Injury Severity Score 9 or less or Injury Severity Score 10 or greater. Student t test and χ2 were used for statistical analysis. P < 0.05 was considered significant. One hundred seven morbidly obese patients were identified and compared with 458 control subjects with a normal body mass index and matched for sex and constellation of injuries. Although the morbidly obese patients were found to be significantly younger, those who incurred multiorgan injury experienced a significantly longer hospital length of stay and displayed a greater than fourfold increase in mortality when compared with the control subjects. Furthermore, the number of morbidly obese patients admitted over the 10-year period significantly increased by fourfold (0.4% to 1.5%). Over the last decade, there has been a significant increase in morbidly obese patients cared for in our trauma center. Although these patients were significantly younger with a similar Glasgow Coma Score as that of the control population, morbid obesity significantly increased mortality when the injury from blunt trauma transitioned from a single to a multiorgan injury.

scholarly journals OP0220 ASSESSING THE EFFECT OF INCREASED BODY MASS INDEX ON RESPONSE TO TNF INHIBITORS IN ESTABLISHED RHEUMATOID ARTHRITIS: RESULTS FROM THE METEOR DATABASE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 137.1-137
Author(s):  
M. Dey ◽  
S. S. Zhao ◽  
R. J. Moots ◽  
R. B. M. Landewé ◽  
N. Goodson
Keyword(s):  
Rheumatoid Arthritis ◽  
Body Mass Index ◽  
Body Mass ◽  
Personalised Medicine ◽  
Normal Weight ◽  
Sensitivity Analyses ◽  
Established Rheumatoid Arthritis ◽  
Eular Response ◽  
Significant Difference ◽  
Das28 Remission

Background:Rheumatoid arthritis (RA) is associated with increased body mass index (BMI)- 60% of patients are either overweight or obese. Obesity in RA has been shown to predict reduced response to biologic therapy including tumour-necrosis-factor inhibitors (TNFi) [1]. However, it is not clear whether increased BMI influences response to all TNFi drugs in RA.Objectives:1.To explore whether BMI is associated with response to TNFi in patients with established rheumatoid arthritis (estRA), including those newly-starting on these drugs.Methods:Participants with estRA (>1year since diagnosis) taking biologic medications, registered on METEOR (international database of RA patients), 2008-2013, were included. EULAR response, DAS28 remission (including components), and treatment regimens were recorded at baseline, 6, and 12 months. WHO definitions of overweight (BMI≥ 25) and obese (BMI≥30) were explored as predictors of TNFi response (good EULAR response and DAS28 remission) using normal BMI as comparator. Logistic and linear regression models (controlling for age, gender, smoking, and baseline outcomes) and sensitivity analyses were performed. Subgroup analyses were performed for grouped TNFi and individual TNFi (infliximab, IFX; adalimumab, ADA; etanercept, ETN).Results:247 patients with estRA were taking a biologic at 6 months, and 231 patients were taking a biologic at 12 months. Obese patients taking any biologic were significantly less likely to achieve DAS28 remission (OR 0.33 [95%CI 0.12-0.80]) or good EULAR response (OR 0.37 [95%CI 0.16-0.81]) after 6 months, compared to those of normal BMI; this was also demonstrated in those co-prescribed methotrexate (DAS28 remission: OR 0.23 [95%CI 0.07-0.62]; good EULAR response: OR 0.39 [95%CI 0.15-0.92]). These associations did not remain statistically significant at the 12 months assessment.Regarding specific anti-TNF therapies, RA patients treated with monoclonal antibody (-mab) TNFis (IFX/ADA/ GOL) were significantly less likely to achieve good EULAR response at 6 months if they were obese RA (n=38), compared to those of normal weight (n=44) (OR 0.17 [95%CI 0.03-0.59]). A similar non-significant difference was demonstrated for DAS28 remission, and 12-month remission. Specifically, obese individuals were significantly less likely to achieve good EULAR response at 6 months with IFX (OR 0.09 [95%CI 0.00-0.61]; n=20), and significantly less likely to achieve DAS28 remission at 6 months when newly-starting ADA (OR 0.14 [95%CI 0.01-0.96]; n=17), compared to those of normal weight. There were no significant differences in remission outcomes between individuals of different BMI taking ETN. A small number of individuals stopped taking their respective biologic after 6months; reason for cessation was not recorded.Similar outcomes were seen in patients already established on anti-TNF therapy, with overweight and obese individuals less likely overall to be in DAS28 remission at all time points.Conclusion:In established RA, obesity is associated with reduced treatment response to -mab TNFi. No association between increased BMI and response to ETA was observed. Using BMI to direct biologic drug choice could prove to be a simple and cost-effective personalised-medicine approach to prescribing.References:[1]Schäfer M, Meißner Y, Kekow J, Berger S, Remstedt S, Manger B, et al. Obesity reduces the real-world effectiveness of cytokine-targeted but not cell-targeted disease-modifying agents in rheumatoid arthritis. Rheumatology. 2019 Nov 20.Disclosure of Interests:Mrinalini Dey: None declared, Sizheng Steven Zhao: None declared, Robert J Moots: None declared, Robert B.M. Landewé Consultant of: AbbVie; AstraZeneca; Bristol-Myers Squibb; Eli Lilly & Co.; Galapagos NV; Novartis; Pfizer; UCB Pharma, Nicola Goodson: None declared

scholarly journals Body mass index and clinical outcomes in patients with intracerebral haemorrhage: results from the China Stroke Center Alliance

2021 ◽  
pp. svn-2020-000534
Author(s):  
Zhentang Cao ◽  
Xinmin Liu ◽  
Zixiao Li ◽  
Hongqiu Gu ◽  
Yingyu Jiang ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Hospital Mortality ◽  
Body Mass ◽  
Intracerebral Haemorrhage ◽  
Final Analysis ◽  
Normal Weight ◽  
Discharge Disposition ◽  
Increased Risk ◽  
Significant Difference ◽  
Stroke Center

Background and aimObesity paradox has aroused increasing concern in recent years. However, impact of obesity on outcomes in intracerebral haemorrhage (ICH) remains unclear. This study aimed to evaluate association of body mass index (BMI) with in-hospital mortality, complications and discharge disposition in ICH.MethodsData were from 85 705 ICH enrolled in the China Stroke Center Alliance study. Patients were divided into four groups: underweight, normal weight, overweight and obese according to Asian-Pacific criteria. The primary outcome was in-hospital mortality. The secondary outcomes included non-routine discharge disposition and in-hospital complications. Discharge to graded II or III hospital, community hospital or rehabilitation facilities was considered non-routine disposition. Multivariable logistic regression analysed association of BMI with outcomes.Results82 789 patients with ICH were included in the final analysis. Underweight (OR=2.057, 95% CI 1.193 to 3.550) patients had higher odds of in-hospital mortality than those with normal weight after adjusting for covariates, but no significant difference was observed for patients who were overweight or obese. No significant association was found between BMI and non-disposition. Underweight was associated with increased odds of several complications, including pneumonia (OR 1.343, 95% CI 1.138 to 1.584), poor swallow function (OR 1.351, 95% CI 1.122 to 1.628) and urinary tract infection (OR 1.532, 95% CI 1.064 to 2.204). Moreover, obese patients had higher odds of haematoma expansion (OR 1.326, 95% CI 1.168 to 1.504), deep vein thrombosis (OR 1.506, 95% CI 1.165 to 1.947) and gastrointestinal bleeding (OR 1.257, 95% CI 1.027 to 1.539).ConclusionsIn patients with ICH, being underweight was associated with increased in-hospital mortality. Being underweight and obese can both increased risk of in-hospital complications compared with having normal weight.

scholarly journals Clinical characteristics and longitudinal changes of patients with non-alcoholic fatty liver disease in 2 decades: the NAGALA study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Takuro Okamura ◽  
Yoshitaka Hashimoto ◽  
Masahide Hamaguchi ◽  
Akihiro Obora ◽  
Takao Kojima ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Liver Disease ◽  
Fatty Liver ◽  
Body Mass ◽  
Fatty Liver Disease ◽  
Abdominal Ultrasonography ◽  
Alcoholic Fatty Liver ◽  
The Past ◽  
Significant Difference ◽  
Alcoholic Fatty Liver Disease

Abstract Background In this study, to clarify the evolving background of people with non-alcoholic fatty liver disease (NAFLD), we compared the current prevalence of NAFLD with that of 2 decades ago. Methods We included two cohorts. The past cohort was from 1994 to 1997 and included 4279 men and 2502 women. The current cohort was from 2014 to 2017 and included 8918 men and 7361 women. NAFLD was diagnosed by abdominal ultrasonography. Results The prevalence of NAFLD increased in both genders throughout these 2 decades (18.5% in the past cohort and 27.1% in the current cohort for men; and 8.0% in the past cohort and 9.4% in the current cohort for women). The prevalence of hyperglycemia increased, whereas the prevalence of low high-density lipoprotein cholesterol levels and hypertriglyceridemia significantly decreased. There was no significant difference in the mean body mass index. Multivariate analysis revealed that the prevalence of obesity and body mass index were significantly associated with the prevalence of NAFLD in both the past and current cohorts. Conclusions The incidence of NAFLD significantly increased throughout these 2 decades, and obesity is the most prevalent factor. Thus, body weight management is an essential treatment option for NAFLD.

Body Mass Index and Outcomes in Critically Injured Blunt Trauma Patients: Weighing the Impact

2007 ◽  
Vol 204 (5) ◽  
pp. 1056-1061 ◽  
Author(s):  
Mark A. Newell ◽  
Michael R. Bard ◽  
Claudia E. Goettler ◽  
Eric A. Toschlog ◽  
Paul J. Schenarts ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Blunt Trauma ◽  
Body Mass ◽  
Trauma Patients ◽  
The Impact

The role of the platelet profile in the prediction of gestational diabetes

2021 ◽  
pp. 50-54
Keyword(s):  
Body Mass Index ◽  
Blood Glucose ◽  
Gestational Diabetes ◽  
Pregnant Women ◽  
Body Mass ◽  
First Trimester ◽  
Oral Glucose ◽  
Mean Corpuscular Hemoglobin ◽  
Lymphocyte Ratio ◽  
Significant Difference

Objective: In our study, the results of oral glucose tolerance test (OGTT) and other hemogram parameters of pregnant women with and without gestational diabetes mellitus (GDM) were compared. The aim of our study is to investigate the benefit of these parameters in predicting GDM risk. Material and Method: The study was planned as a descriptive, retrospective and cross-sectional study. It was included 218 pregnant women who applied to the Gynecology and Obstetrics Clinic of Amasya Sabuncuoğlu Şerefeddin Training and Research Hospital between January 01, 2019 and January 31, 2020. It was examined complete blood count parameters, ultrasound findings, complete urinalysis, first trimester blood glucose, body mass index, age, and gravide parameters the patients we included in the study. The results were analyzed retrospectively and was evaluated the statistical significance relationship with gestational diabetes. Results: There was no statistically significant difference in age, body mass index (BMI), obesity status and number of gravida between the pregnant women who were examined and those without GDM (p> 0.05). The hemoglobin, platelet count, mean platelet volume (MPV), mean corpuscular volume (MCV), mean corpuscular hemoglobine (MCH), and mean corpuscular hemoglobin concentration (MCHC) values, and neutrophil, lymphocyte, monocyte and basophil counts, urine density and femur length were statistically significant. There was no difference (p> 0.05). No statistically significant difference was found in terms of neutrophile lymphocyte ratio (NLR), neutrophile monocyte ratio (NMR), platelet lymphocyte ratio (PLR), monocyte eosinophil ratio (MER), platelet MPV ratio (PMPVR), and platelet neutrophile ratio (PNR) values (p> 0.05) Conclusion: HbA1c, hematocrit and blood glucose in the first trimester may be predictors of GDM. In addition, we think that further studies are needed in a prospective design in more patients in terms of others parameters.

A Descriptive Analysis of Traction Splint Utilization and IV Analgesia by Emergency Medical Services

2017 ◽  
Vol 32 (6) ◽  
pp. 631-635 ◽  
Author(s):  
Joshua Nackenson ◽  
Amado A. Baez ◽  
Jonathan P. Meizoso
Keyword(s):  
Emergency Medical Services ◽  
Blunt Trauma ◽  
Injury Severity ◽  
Femur Fracture ◽  
Descriptive Analysis ◽  
Penetrating Trauma ◽  
Physical Exam ◽  
Medical Services ◽  
Prehospital Treatment ◽  
Emergency Medical

AbstractStudy ObjectivesTraction splinting has been the prehospital treatment of midshaft femur fracture as early as the battlefield of the First World War (1914-1918). This study is the assessment of these injuries and the utilization of a traction splint (TS) in blunt and penetrating trauma, as well as intravenous (IV) analgesia utilization by Emergency Medical Services (EMS) in Miami, Florida (USA).MethodsThis is a retrospective study of patients who sustained a midshaft femur fracture in the absence of multiple other severe injuries or severe physiologic derangement, as defined by an injury severity score (ISS) <20 and a triage revised trauma score (T-RTS)≥10, who presented to an urban, Level 1 trauma center between September 2008 and September 2013. The EMS patient care reports were assessed for physical exam findings and treatment modality. Data were analyzed descriptively and statistical differences were assessed using odds ratios and Z-score with significance set at P≤.05.ResultsThere were 170 patients studied in the cohort. The most common physical exam finding was a deformity +/- shortening and rotation in 136 patients (80.0%), followed by gunshot wound (GSW) in 22 patients (13.0%), pain or tenderness in four patients (2.4%), and no findings consistent with femur fracture in three patients (1.7%). The population was dichotomized between trauma type: blunt versus penetrating. Of 134 blunt trauma patients, 50 (37.0%) were immobilized in traction, and of the 36 penetrating trauma victims, one (2.7%) was immobilized in traction. Statistically significant differences were found in the application of a TS in blunt trauma when compared to penetrating trauma (OR=20.83; 95% CI, 2.77-156.8; P <.001). Intravenous analgesia was administered to treat pain in only 35 (22.0%) of the patients who had obtainable IV access. Of these patients, victims of blunt trauma were more likely to receive IV analgesia (OR=6.23; 95% CI, 1.42-27.41; P=.0067).ConclusionAlthough signs of femur fracture are recognized in the majority of cases of midshaft femur fracture, only 30% of patients were immobilized using a TS. Statistically significant differences were found in the utilization of a TS and IV analgesia administration in the setting of blunt trauma when compared to penetrating trauma.NackensonJ, BaezAA, MeizosoJP. A descriptive analysis of traction splint utilization and IV analgesia by Emergency Medical Services.Prehosp Disaster Med. 2017;32(6):631–635.

scholarly journals Body mass index and carpal tunnel syndrome

2000 ◽  
Vol 58 (2A) ◽  
pp. 252-256 ◽  
Author(s):  
JOAO ARIS KOUYOUMDJIAN ◽  
MARIA DA PENHA ANANIAS MORITA ◽  
PAULO RICARDO FERNANDO ROCHA ◽  
RAFAEL CARLOS MIRANDA ◽  
GUSTAVO MACIEL GOUVEIA
Keyword(s):  
Body Mass Index ◽  
Carpal Tunnel Syndrome ◽  
Body Mass ◽  
Carpal Tunnel ◽  
Ring Finger ◽  
Additional Increase ◽  
Significant Difference ◽  
Tunnel Syndrome ◽  
Increasing Risk ◽  
Sensory Latency

Carpal tunnel syndrome (CTS) has been correlated to body mass index (BMI) increase. The present study was done in a Brazilian population to compare BMI values in the following groups: first, CTS vs. controls subjects, and, second CTS groups of increasing median sensory latency (MSL). According to MSL > or = 3.7 ms (wrist-index finger, 14 cm), median/ulnar sensory latency difference > or = 0.5 ms (ring finger, 14 cm) or median palm-to-wrist (8 cm) latency > or = 2.3 ms (all peak-measured), 141 cases (238 hands) had CTS confirmation. All were symptomatic; previous surgery and polyneuropathy were excluded; mean age 50.3; 90.8% female. Controls subjects (n=243; mean age 43.0; 96.7% female) and CTS cases had BMI calculated (kg/m²). Controls subjects had a mean BMI of 25.43±4.80 versus 28.38±4.69 of all CTS cases, a statistically significant difference (p < 0.001). The CTS groups of increasing MSL severity do not show additional increase in BMI (28.44 for incipient, 28.27 for mild, 28.75 for moderate and 29.0 for severe). We conclude that CTS cases have a significant correlation with higher BMI when compared to controls subjects; however, higher BMI do not represent a statistically significant increasing risk for more severe MSL.

scholarly journals The Relationship of Perceived Body Image, Body Mass Index and Physical Activity with Weight Status among Students at King Abdulaziz University Hospital

2021 ◽  
pp. 218-227
Author(s):  
Futoon S. Alobiri ◽  
Roaa A. Alharbi ◽  
Mohammed R. Algethami ◽  
Raghdah H. Ateeq ◽  
Aseel M. Badurayq ◽  
...  
Keyword(s):  
Physical Activity ◽  
Body Mass Index ◽  
Body Image ◽  
Body Weight ◽  
Body Mass ◽  
Body Satisfaction ◽  
Weight Status ◽  
Rating Scale ◽  
Significant Difference ◽  
King Abdulaziz University

Aim: Identify the relation between poor esteem for body image and weight-related behaviors. The results will help increase awareness and improve students’ lifestyles to have a better body image and achieve ideal body weight. Methods: A cross-sectional study was conducted among King Abdulaziz University medical students (n= 460) between July to the end of August 2019. Data was collected using the International physical activity questionnaire (IPAQ), figure rating scale (FRS) and analyzed using SPSS software. Result: The results showed that the average Body Mass Index (BMI) was 24.80 ± 11.89. Participant sex was an important factor influencing the prevalence of obesity; male students were more obese than female students with a significant difference (p<0.001). The level of body satisfaction was also affected by gender. Students in preclinical years were more likely to gain weight more than clinical years students. Conclusion: The results show a significant relationship between body satisfaction and gender (P<0.0001) despite having diverse BMIs. Overweight and obese males and females' participants had the lowest body satisfaction. Females who were too thin and had low BMIs described themselves as normal, while males describe themselves as too thin. Conversely, females with high BMIs described themselves as too fat, while males described themselves as normal. This could be due to different factors. Also, underweight females and males have high body satisfaction, which can lead to dangerous behaviors to maintain low body weight which cause negative health consequences.

scholarly journals Insulin resistance in relation to clinical, endocrine and metabolic profile of infertile women with polycystic ovary syndrome

2021 ◽  
Vol 14 (1) ◽  
pp. 1-6
Author(s):  
Shakeela Ishrat ◽  
Marufa Hossain ◽  
Subrata Kumar Biswas
Keyword(s):  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
Body Mass Index ◽  
Waist Circumference ◽  
Polycystic Ovary Syndrome ◽  
Body Mass ◽  
Polycystic Ovary ◽  
Ovary Syndrome ◽  
Infertile Women ◽  
Significant Difference

The objective of this study is to explore how hyperinsulinemia and insulin resistance relate to the clinical, endocrine and metabolic factors in the infertile women with polycystic ovary syndrome. This study was conducted on 121 consecutive infertile women with polycystic ovary syndrome attending the Infertility unit from January 2017 to December 2017. They were divided into two groups: insulin resistant and insulin sensitive. There was significant difference in body mass index and waist circumference between the two groups. Serum lipids were not associated with insulin resistance. Hyperinsulinemia was significantly associated with metabolic syndrome. Reducing body mass index and waist circumference may improve insulin resistance in infertile women with polycystic ovary syndrome. Screening the infertile women with polycystic ovary syndrome for hyperinsulinemia and insulin resistance and subsequent counseling is recommended to address the long-term risks of metabolic syndrome.

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