Impact of Initial Body Mass Index (BMI) on Survival Outcome of Patients with Acute Leukemia (AL): Myth or Reality?

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3679-3679
Author(s):  
Mael Heiblig ◽  
Mohamed Elhamri ◽  
Véronique L'Héritier ◽  
Hélène Labussière-Wallet ◽  
Fiorenza Barraco ◽  
...  
Keyword(s):  
Body Mass Index ◽  
T Cell ◽  
Acute Leukemia ◽  
Body Mass ◽  
Research Funding ◽  
Prognostic Value ◽  
Cell Lineage ◽  
Normal Weight ◽  
Adult Patients ◽  
Obese Patients

Abstract Obesity is associated with an increased risk of mortality from cardiovascular causes and from malignancies while meta-analyses have evidenced a significant association between an elevated body mass index (BMI) and the risk to develop certain hematological malignancies including acute myeloid (AML) and acute lymphoid leukemia (ALL). Adipocytes are present in the bone marrow were it promote leukemic cells survival and resistance to treatment through the production of amino acids, free fatty acids, pro-inflammatory adipokines and cytokines. Obesity modifies the pharmacokinetic of numerous drugs while obese patients may be undertreated due to dosage capping based on ideal body weight. In addition, obesity increases the risk of treatment-related complication. Obesity adversely affects outcome in pediatric ALL (Butturini et al, J Clin Oncol 2007) and AML (Inaba et al, Cancer 2012). In contrast two retrospective studies based on the analysis of 63 (Lin et al, Leuk Lymphoma 2012) and 329 cases (Lee et al, Ann Hematol 2012) did not found any significant association between obesity and disease outcome in adult patients treated for AML. Here we have investigated whether the body mass index, determined at the time of diagnosis could impact disease outcome in adult patients treated for acute leukemia (AL). A total of 531 consecutive AL patients entered into clinical trials in our Institution between 1994 and 2012 were analyzed retrospectively. They included 343 AML, 146 ALL (102 B-lineage ALL, 41 T-lineage ALL and 3 undifferentiated cases) and 42 acute promyelocytic (APL) leukemias. Based on data collected at the time of diagnosis, BMI was calculated as weight (kg) divided by the square of height (m). Patients were stratified according to the World Health Organization (WHO) BMI classification: underweight (BMI < 18.5), normal weight (BMI 18.5 to <25), overweight (BMI 25 to <30) and obese (BMI ≥ 30). Baseline clinical and biological features and clinical outcome were compared according to this stratification. Overall, median BMI was 25.7 (16.5 - 46). Two hundred and thirty-three (54.1%) patients were under/normal weight, whereas 197 (45.9%) patients were overweight/obese. An increased BMI (>25) was associated with age > 60 (p<0.001), APL diagnosis (p=0.02), and circulating blasts percentage > 33% (p=0.049). The CR rate after 1stinduction course in underweight, normal, overweight and obese were 78.9%, 79.5%, 80.3%, and 90.1%, respectively. These differences were not statistically significant. The same results were observed when the comparisons were restricted to ALL, AML, in younger or older patients. With a 4.7 years median follow-up (95%CI: 4.0-5.1), median disease-free survival (DFS) and median overall survival (OS) were 13.3 and 22.1 months in AML and 20.8 and 36.5 months in ALL respectively. Medians were not reached in APL. Median OS and DFS (with 95% CI) were 23.1 (13.8-31.6 ) and 29.5 (18-34.1), 17.6 (13.7-22.8) and 32.1 (25.1-36.9), 17.9 (12.1-24.1) and 26.5 (18.6-41.9), and 20.3 (13.4-27.5) and 23.5 (20.3-32.4) months in underweight, normal, overweight and obese, respectively. These differences were not significant. There was no significant impact of BMI on complete response rate, DFS and OS in patients from the whole cohort when considering a cut-off for BMI at 25, and when analyzing according to age, AL subtypes, or to cytogenetics. Only BMI in patients with T- cell lineage ALL showed a significant impact on survival. In patients with BMI >25, median DFS was not reached with a 3-year DFS at 76%, while median DFS was 16.1 months with 3-year DFS at 13% for those with BMI <= 25 (p=0.005). Similarly, median OS was not reached in T-cell ALL patients with BMI > 25 versus 28.3 months in those with BMI <= 25 (3-year OS: 78% versus 41%, p= 0.04). In a model including factors of prognostic value in univariate analysis, multivariate analyses confirmed the prognostic value of BMI in T cell lineage-ALL when comparing overweight/obese patients with under/normal weight patients, but only in terms of DFS (HR=0.25; 95% CI (0.05 – 0.87); p=0.037) and not of OS. These findings provide further evidence that initial body size may have a potential prognostic impact in some subset of leukemia, and more specifically in T cell lineage-ALL. In this AL subtype, validation in larger prospective studies is however warranted. Disclosures Wattel: Novartis: Consultancy, Honoraria, Research Funding; Celgene: Consultancy, Honoraria, Research Funding; Jannsen: Consultancy, Honoraria, Research Funding; Pierre Fabre: Research Funding. Michallet:Genzyme: Consultancy; Oseus: Consultancy; Novartis: Research Funding; Celgene: Research Funding; BMS: lectures Other; Astellas: lectures Other; MSD: lectures Other. Nicolini:Novartis: Consultancy, Honoraria, Research Funding; BMS: Consultancy; Ariad: Honoraria; BMS: Honoraria.

scholarly journals Higher body mass index is associated with larger postoperative improvement in patient-reported outcomes following total knee arthroplasty

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
K Giesinger ◽  
JM Giesinger ◽  
DF Hamilton ◽  
J Rechsteiner ◽  
A Ladurner
Keyword(s):  
Body Mass Index ◽  
Total Knee Arthroplasty ◽  
Pain Relief ◽  
Body Mass ◽  
Knee Arthroplasty ◽  
Normal Weight ◽  
World Health ◽  
Obese Patients ◽  
Total Knee ◽  
The Impact

Abstract Background Total knee arthroplasty is known to successfully alleviate pain and improve function in endstage knee osteoarthritis. However, there is some controversy with regard to the influence of obesity on clinical benefits after TKA. The aim of this study was to investigate the impact of body mass index (BMI) on improvement in pain, function and general health status following total knee arthroplasty (TKA). Methods A single-centre retrospective analysis of primary TKAs performed between 2006 and 2016 was performed. Data were collected preoperatively and 12-month postoperatively using WOMAC score and EQ-5D. Longitudinal score change was compared across the BMI categories identified by the World Health Organization. Results Data from 1565 patients [mean age 69.1, 62.2% women] were accessed. Weight distribution was: 21.2% BMI < 25.0 kg/m2, 36.9% BMI 25.0–29.9 kg/m2, 27.0% BMI 30.0–34.9 kg/m2, 10.2% BMI 35.0–39.9 kg/m2, and 4.6% BMI ≥ 40.0 kg/m2. All outcome measures improved between preoperative and 12-month follow-up (p < 0.001). In pairwise comparisons against normal weight patients, patients with class I-II obesity showed larger improvement on the WOMAC function and total score. For WOMAC pain improvements were larger for all three obesity classes. Conclusions Post-operative improvement in joint-specific outcomes was larger in obese patients compared to normal weight patients. These findings suggest that obese patients may have the greatest benefits from TKA with regard to function and pain relief one year post-op. Well balanced treatment decisions should fully account for both: Higher benefits in terms of pain relief and function as well as increased potential risks and complications. Trial registration This trial has been registered with the ethics committee of Eastern Switzerland (EKOS; Project-ID: EKOS 2020–00,879)

Implications of Obesity on Endoscopic Sinus Surgery Postoperative Complications: An Analysis of the NSQIP Database

2020 ◽  
pp. 019459982095518
Author(s):  
Robert D. Wardlow ◽  
Isaac A. Bernstein ◽  
Cinthia P. Orlov ◽  
Nicholas R. Rowan
Keyword(s):  
Body Mass Index ◽  
Adverse Events ◽  
Body Mass ◽  
Endoscopic Sinus Surgery ◽  
Adult Patients ◽  
Sinus Surgery ◽  
Obese Patients ◽  
Improvement Program ◽  
Perioperative Bleeding ◽  
Chi Square Analysis

Objective To evaluate the influence of body mass index on postoperative adverse events in adult patients undergoing endoscopic sinus surgery. Study Design Retrospective cohort study. Setting Database of the American College of Surgeons NSQIP (National Surgical Quality Improvement Program) from 2006 to 2018. Methods The NSQIP database was queried for adult patients undergoing endoscopic sinus surgery. The total sample (N = 1546) was stratified by nonobese (18.5 kg/m2≤ body mass index <30 kg/m2) and obese (≥30 kg/m2). Demographics, comorbidities, intraoperative variables, and postoperative adverse events were compared via chi-square analysis and multivariable logistic regression. Results Obese patients accounted for 49.7% (n = 768) of the cohort. Obese patients had a higher American Society of Anesthesiologists classification (class III, 45.1% vs 29.5%; P < .001), rate of diabetes (18.2% vs 7.2%, P < .001), and rate of hypertension requiring medication (43.1% vs 23.0%, P < .001). Nonobese patients were more likely to be >58 years of age (23.4% vs 29.0%, P = .02) and have disseminated cancer (<1% vs 3.2%, P < .001). The obese cohort had a lower frequency of surgical complications (3.0% vs 5.4%, P = .027), driven by frequency of perioperative bleeding (1.8% vs 3.7%, P = .022). There was no statistical difference in medical complications ( P = .775), unplanned readmissions ( P = .286), unplanned reoperations ( P = .053), or 30-day mortality ( P > .999). After multivariable adjustment, obese subjects had decreased odds of any surgical complication (adjusted odds ratio [aOR], 0.567; 95% CI, 0.329-0.979), perioperative bleeding (aOR, 0.474; 95% CI, 0.239-0.942), and any adverse postoperative event (aOR, 0.740; 95% CI, 0.566-0.968). Conclusion Obesity does not increase the risk of 30-day adverse outcomes following endoscopic sinus surgery and may even be protective against perioperative bleeding.

Appendicitis, Body Mass Index, and CT: Is CT More Valuable for Obese Patients than Thin Patients?

2011 ◽  
Vol 77 (4) ◽  
pp. 471-475 ◽  
Author(s):  
Courtney A. Coursey ◽  
Rendon C. Nelson ◽  
Ricardo D. Moreno ◽  
Mayur B. Patel ◽  
Craig A. Beam ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Normal Weight ◽  
Morbidly Obese ◽  
Negative Appendectomy ◽  
Obese Patients ◽  
Procedure Code ◽  
Preoperative Ct ◽  
The Difference ◽  
Underweight Patients

The purpose of our study is to determine whether body mass index (BMI = weight in kg/height in meters2) was related to the rate of negative appendectomy in patients who underwent preoperative CT. A surgical database search performed using the procedure code for appendectomy identified 925 patients at least 18 years of age who underwent urgent appendectomy between January 1998 and September 2007. BMI was computed for the 703 of these 925 patients for whom height and weight information was available. Patients were stratified based on body mass index (BMI 15-18.49 = underweight; 18.5-24.9 = normal weight; 25–29.9 = overweight; 30-39.9 = obese; > 40 = morbidly obese). Negative appendectomy rates were computed. Negative appendectomy rates for patients who did and did not undergo preoperative CT were 27 per cent and 50 per cent for underweight patients, 10 per cent and 15 per cent for normal weight patients, 12 per cent and 17 per cent for overweight patients, 7 per cent and 30 per cent for obese patients, and 10 per cent and 100 per cent for morbidly obese patients. The difference in negative appendectomy rates for overweight patients, obese patients, and morbidly obese patients who underwent preoperative CT as compared with patients in the same BMI category who did not undergo preoperative CT was statistically significant ( P ≤ 0.001). The negative appendectomy rates for overweight patients, obese patients, and morbidly obese patients who underwent preoperative CT were significantly lower than for patients in these same BMI categories who did not undergo preoperative CT.

scholarly journals Cardiac Changes in Overweight and Obese Patients

2016 ◽  
Vol 54 (3) ◽  
pp. 161-172 ◽  
Author(s):  
Teodora Gabriela Alexescu ◽  
Angela Cozma ◽  
Adela Sitar-Tăut ◽  
V. Negrean ◽  
M.I. Handru ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Left Ventricle ◽  
Diastolic Dysfunction ◽  
Body Mass ◽  
Body Surface ◽  
Interventricular Septum ◽  
Normal Weight ◽  
The Body ◽  
Obese Patients ◽  
Left Ventricle Mass

Abstract Background. Obesity and overweight are two pathologies that are more and more frequent in the XXIst century diagnosis and are causing high morbidity and mortality rates in the general population, especially through cardiovascular complications.Aims. Identification and early diagnosis of cardiac changes in overweight and obese patients. Material and method. We carried out a sectional, analytical and observational study on 111 subjects: 27 normal weight subjects and 84 overweight and obese patients, which were submitted to a clinical exam, biochemical exams and 2D ultrasound.Results. The presence of diastolic dysfunction is twice more frequent in overweight patients in comparison to normal weight ones (30% vs 15%) and 5 times more frequent in obese patients than normal weight ones (75% vs 15%). The size increase of the interventricular septum is correlated with the body mass index, there being statistically significant differences between normal weight vs overweight vs obese patients, as well as between overweight and obese ones. Within the whole group and within the groups, both the left ventricle mass (g) as well as the left ventricle mass to body surface ratio (g/m²) are statistically significantly higher in patients with present diastolic dysfunction (E/A < 1). This indicates a relation between the presence of diastolic dysfunction, increased left ventricle mass and body mass index (p < 0.05).Conclusions. Overweight and obese patients, unlike normal weight ones, present early cardiac changes, such as: a decrease of left ventricle ejection fraction, diastolic dysfunction, thickening of the interventricular septum, increase of the left ventricle mass both per se as well as in ratio to body surface.

scholarly journals An Analysis of the Potential Relationship of Triglyceride Glucose and Body Mass Index With Stroke Prognosis

2021 ◽  
Vol 12 ◽  
Author(s):  
Zongyi Hou ◽  
Yuesong Pan ◽  
Yindong Yang ◽  
Xiaofan Yang ◽  
Xianglong Xiang ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Ischemic Stroke ◽  
Body Mass ◽  
Normal Weight ◽  
Inverse Association ◽  
Stroke Outcome ◽  
Obese Patients ◽  
Stroke Patients ◽  
Tyg Index ◽  
All Cause Mortality

Background: The inverse association between obesity and outcome in stroke patients (known as the obesity paradox) has been widely reported, yet mechanistic details explaining the paradox are limited. The triglyceride glucose (TYG) index has been proposed as a marker of insulin resistance. We sought to explore possible associations of the TYG index, body mass index (BMI), and stroke outcome.Methods: We identified 12,964 ischemic stroke patients without a history of diabetes mellitus from the China National Stroke Registry and classified patients as either low/normal weight, defined as a BMI &lt;25 kg/m2, or overweight/obese, defined as a BMI ≥ 25 kg/m2. We calculated TYG index and based on which the patients were divided into four groups. A Cox or logistic regression model was used to evaluate the association between BMI and TYG index and its influence on stroke outcomes, including stroke recurrence all-cause mortality and poor outcome (modified Rankin Scale score of 3–6) at 12 months.Results: Among the patients, 63.3% were male, and 36.7% were female, and the mean age of the patient cohort was 64.8 years old. The median TYG index was 8.62 (interquartile range, 8.25–9.05). After adjusting for multiple potential covariates, the all-cause mortality of overweight/obese patients was significantly lower than that of the low/normal weight patients (6.17 vs. 9.32%; adjusted hazard ratio, 0.847; 95% CI 0.732–0.981). The difference in mortality in overweight/obese and low/normal weight patients with ischemic stroke was not associated with TYG index, and no association between BMI and TYG index was found.Conclusion: Overweight/obese patients with ischemic stroke have better survival than patients with low/normal weight. The association of BMI and stroke outcome is not changed by TYG index.

scholarly journals The Function of Large Vessels in Normal-Weight and Overweight Children With Psoriasis During Methotrexate Therapy

2019 ◽  
Vol 15 (6) ◽  
pp. 447-454
Author(s):  
Nikolay N. Murashkin ◽  
Olga V. Kogevnikova ◽  
Alexander I. Materikin
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Research Funding ◽  
Skin Lesions ◽  
Normal Weight ◽  
Primary Data ◽  
Scientific Advice ◽  
Cytostatic Therapy ◽  
Large Arteries ◽  
Large Vessels

Background.In recent years, the opinion has been established that skin manifestations of psoriasis are associated with the damage of other organs and systems, and that psoriatic lesions have a systemic nature, and therefore the term ‘psoriatic disease’ is increasingly used in scientific literature. Among psoriasis comorbidities, metabolic disorders and cardiovascular diseases are of particular clinical importance.Our aim wasto study the effect of systemic cytostatic therapy with methotrexate on the remodelling processes of large vessels in children with psoriasis who have normal and increased body mass index.Methods.The primary data was collected by extracting data from medical records and case follow-up records. The subsequent accumulation, storage, grouping and primary sorting of research data were carried out using a personal computer and Excel application package. Clinical evaluation of the severity of psoriasis and skin lesions was assessed by calculating the PASI index. Non-invasive oscillometric arteriography was performed on a portable ArterioGraph (TensioMed Ltd, Hungary).Results.A direct significant correlation has been established between the revealed impairments of the function of large arteries and the indicators of fat metabolism, the severity of psoriasis and body mass index. During the systemic pathogenetic cytostatic therapy with methotrexate, a significant positive dynamics of the function parameters of large arteries was revealed in children with psoriasis who have both normal and increased body mass index.Conclusion.The undertaken studies showed that methotrexate is an effective and safe agent for treating psoriasis in children aged from 3 to 18 years, has a positive effect on the function of large vessels.Nikolay N. Murashkin — receiving research funding from pharmaceutical companies Jansen, Eli Lilly. Receiving fees for scientific advice from Galderma, Pierre Fabre, Bayer, Astellas, Libriderm.Alexander I. Materikin — receiving research funding from pharmaceutical company Eli Lilly. Receiving fees for scientific advice from Bioderma, Libriderm.

scholarly journals Effect of weight loss on early left atrial myopathy in obese patients without known cardiovascular disease

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
O Deal ◽  
J Rayner ◽  
A Stracquadanio ◽  
R Wijesurendra ◽  
S Neubauer ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Body Mass Index ◽  
Weight Loss ◽  
Body Mass ◽  
Left Atrial ◽  
Normal Weight ◽  
Obese Patients ◽  
Weight Loss Intervention ◽  
Reservoir Function ◽  
Lv Mass

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): BHF & NIHR BRC Introduction Obesity is strongly associated with increased risk of heart failure and ischaemic stroke independently of associated co-morbidities. Left atrial (LA) reservoir dysfunction, a marker of atrial distensibility and compliance, is an early pathophysiological change which precedes the onset of cardiovascular disease in patients with obesity. It is unclear whether a weight loss intervention may be sufficient to reverse LA reservoir dysfunction. Purpose To longitudinally assess whether a weight loss intervention normalizes LA reservoir function by cardiac magnetic resonance (CMR) feature-tracking in patients with obesity and only subclinical cardiovascular disease and compared this age and sex matched non-obese normal weight controls. Methods A total of 45 patients with severe obese (age = 45 ± 11 years, body mass index = 39.1 ± 6.7 kg/m2, 51 ± 18 kg of excess body weight [EBW], 67% female) underwent CMR for quantification of LA and left ventricular (LV) size and function before and a median of 373 days following weight loss intervention. Weight loss was achieved by means of a very-low calorie diet (N = 28; 800 kcal/day) or by bariatric surgery (N = 17). A total of N = 27 non-obese healthy controls (age = 41 ± 12 years, body mass index = 22.3 ± 2.4 kg/m2, 75% female) underwent the same CMR protocol once. Results At baseline, patients with obesity displayed signs of atrial myopathy with increased LA volume and reduced LA reservoir function as compared to normal-weight controls (both P &lt; 0.05, Figure 1) alongside increased LV mass and hyper-normal LV ejection fraction [LVEF] (both p &lt; 0.01). As expected, weight loss led to a significant reduction of LA volume and LV mass with normalization of LVEF regardless of the degree of weight loss achieved (all P &lt; 0.05, Figure 2). By contrast, only a large weight loss (&gt;46.6% EBW, in red in Figure 2) was sufficient to improve and normalize the LA reservoir function (P &lt; 0.05, Figure 2).  On the other hand, moderate or milder weight loss (in orange and red) had no significant effect on LA reservoir function (both P &gt; 0.05). Conclusion Successful weight loss can completely revert early LA myopathic phenotype in obese patients without known cardiovascular disease although this can be achieved only with larger weight loss targets.

Abstract 388: Body Mass Index Predicts Major leeding Risks in Patients on Warfarin

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Adedotun A Ogunsua ◽  
Sunkaru Touray ◽  
Justin K Liu ◽  
Jorge Escobar ◽  
Tiffany Ip ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Bleeding Event ◽  
Bleeding Risk ◽  
Normal Weight ◽  
Class I ◽  
Minor Bleeding ◽  
Obese Patients ◽  
Bleeding Events ◽  
One Year

Background: Despite the lack of an optimum dosing strategy in obese patients, warfarin remains the most commonly used anticoagulant. Body mass index (BMI) > 30 has been linked to increased time to obtain a therapeutic institutionalized normalized ratio (INR) on initiation of warfarin as well as higher maintenance dose. Obese patients have higher dosage requirements, however, few studies have examined the relationship between warfarin and bleeding events in these patients. Aim: We examined the performance of BMI in predicting the incidence of bleeding at an anticoagulation clinic (ACC) over a one year period. Methods: 863 patients followed in an ACC were evaluated for bleeds according to BMI over a one year period. BMI was defined as weight (kg)/height (m2). CHADS2VASC scores were calculated. Major (gastrointestinal, intracerebral and retroperitoneal hemorrhage) and minor bleeding events (epistaxis, hematuria, vaginal and skin bleeds) were ascertained. Results: 71 ( 8.2%) of the 863 patients had a bleeding event, the mean age of the cohort was 69.5 years, and 44% were females. BMI categories were normal weight (21%), overweight (38%), obese class I, (21%), II (9 %), and III (11.3%) respectively. The prevalence of major and minor bleeding events were 35.2% and 64.8% respectively. In univariate analyses, hazard ratio for major bleeding risks increased with higher obesity categories (HR 1.30, 1.85, and 1.93 for class I,II, III respectively). In multivariable adjusted model, obesity (BMI>30) significantly increased the risk of major bleeds. (HR 1.84, P<.001) (Table 1). Conclusion: Bleeding risk is higher in obese compared to normal weight individuals who are on warfarin. Risk is higher with increasing BMI. This result suggests that BMI plays a role in bleeding events in patients on warfarin. Future studies are needed to understand the mechanism by which obesity increases bleeding risk for patients on warfarin and whether similar risk exist for the novel oral anticoagulants.

scholarly journals Effect of Body Mass Index on Outcomes of Peritoneal Dialysis Patients in India

2014 ◽  
Vol 34 (4) ◽  
pp. 399-408 ◽  
Author(s):  
Narayan Prasad ◽  
Archana Sinha ◽  
Amit Gupta ◽  
Raj Kumar Sharma ◽  
Dharmendra Bhadauria ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Peritoneal Dialysis ◽  
Body Mass ◽  
Patient Survival ◽  
Normal Weight ◽  
Obese Patients ◽  
Reference Category ◽  
Technique Survival ◽  
Patients With Diabetes ◽  
Underweight Patients

ObjectivesWe studied the effect of body mass index (BMI) at peritoneal dialysis (PD) initiation on patient and technique survival and on peritonitis during follow-up.MethodsWe followed 328 incident patients on PD (176 with diabetes; 242 men; mean age: 52.6 ± 12.6 years; mean BMI: 21.9 ± 3.8 kg/m2) for 20.0 ± 14.3 months. Patients were categorized into four BMI groups: obese, ≥25 kg/m2; overweight, 23 – 24.9 kg/m2; normal, 18.5 – 22.9 kg/m2(reference category); and underweight, <18.5 kg/m2. The outcomes of interest were compared between the groups.ResultsOf the 328 patients, 47 (14.3%) were underweight, 171 (52.1%) were normal weight, 53 (16.2%) were overweight, and 57 (17.4%) were obese at commencement of PD therapy. The crude hazard ratio (HR) for mortality ( p = 0.004) and the HR adjusted for age, subjective global assessment, comorbidities, albumin, diabetes, and residual glomerular filtration rate ( p = 0.02) were both significantly greater in the underweight group than in the normal-weight group. In comparison with the reference category, the HR for mortality was significantly greater for underweight PD patients with diabetes [2.7; 95% confidence interval (CI): 1.5 to 5.0; p = 0.002], but similar for all BMI categories of nondiabetic PD patients. Median patient survival was statistically inferior in underweight patients than in patients having a normal BMI. Median patient survival in underweight, normal, overweight, and obese patients was, respectively, 26 patient–months (95% CI: 20.9 to 31.0 patient–months), 50 patient–months (95% CI: 33.6 to 66.4 patient–months), 57.7 patient–months (95% CI: 33.2 to 82.2 patient–months), and 49 patient–months (95% CI: 18.4 to 79.6 patient–months; p = 0.015). Death-censored technique survival was statistically similar in all BMI categories. In comparison with the reference category, the odds ratio for peritonitis occurrence was 1.8 (95% CI: 0.9 to 3.4; p = 0.086) for underweight patients; 1.7 (95% CI: 0.9 to 3.2; p = 0.091) for overweight patients; and 3.4 (95% CI: 1.8 to 6.4; p < 0.001) for obese patients.ConclusionsIn our PD patients, mean BMI was within the normal range. The HR for mortality was significantly greater for underweight diabetic PD patients than for patients in the reference category. Death-censored technique survival was similar in all BMI categories. Obese patients had a greater risk of peritonitis.

scholarly journals Is body mass index associated with the incidence of endometriosis and the severity of dysmenorrhoea: a case–control study in China?

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e037095
Author(s):  
Yunhui Tang ◽  
Mingzhi Zhao ◽  
Luling Lin ◽  
Yifei Gao ◽  
George Qiaoqi Chen ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Risk Factor ◽  
Body Mass ◽  
Case Control Study ◽  
Case Control ◽  
Normal Weight ◽  
Reproductive Age ◽  
Obese Patients ◽  
Obese Women ◽  
Control Study

ObjectiveEndometriosis is considered as a serious gynaecological disease in women at a reproductive age. Lower body mass index (BMI) is thought to be a risk factor. However, recent studies indicated that women with normal BMI were also more likely to develop endometriosis, suggesting the association with BMI is controversial. We therefore investigated the association of BMI and surgically diagnosed endometriosis in a cohort of Chinese women.DesignRetrospective case–control study.SettingTertiary hospital.Patients709 women with endometriosis and 807 age matched controls between January 2018 and August 2019.InterventionAge at diagnosis, parity, gravida, BMI and self-reported dysmenorrhoea status were collected and the association of BMI and endometriosis was analysed.Measurement and main resultsOverall, the median BMI was not different between patients and controls (21.1 kg/m2 vs 20.9 kg/m2, p=0.223). According to the BMI categories for Asians/Chinese by WHO (underweight: <18.5 kg/m2, normal weight: 18.5–22.99 kg/m2, overweight: 23–27.49 kg/m2, obese: ≥27.50 kg/m2), overall, there was no difference in the association of BMI and endometriosis (p=0.112). 60% of patients were of normal weight. However, the OR of obese patients (BMI over 27.50 kg/m2) having endometriosis was1.979 (95% CI 1.15 to 3.52, p=0.0185), compared with women with normal weight. 50.3% patients reported dysmenorrhoea, and the OR of developing severe dysmenorrhoea in obese patients (BMI over 27.50 kg/m2) was 3.64 (95% CI 1.195 to 10.15, p=0.025), compared with patients with normal weight.ConclusionOur data demonstrate that overall there was no association between BMI and the incidence of endometriosis, but there was a significant increase in the incidence of endometriosis in obese women, compared with women with normal weight. Obesity was also a risk factor for severe dysmenorrhoea.

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