scholarly journals The Weight Problem: Overview of the Most Common Concepts for Body Mass and Fat Distribution and Critical Consideration of Their Usefulness for Risk Assessment and Practice

2021 ◽  
Vol 18 (21) ◽  
pp. 11070
Author(s):  
Dorothea Kesztyüs ◽  
Josefine Lampl ◽  
Tibor Kesztyüs
Keyword(s):  
Risk Assessment ◽  
Fat Distribution ◽  
Risk Groups ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Individual Risk ◽  
Limited Applicability ◽  
Prevalence Of Obesity ◽  
Risk Of Disease ◽  
Normal Weight Obesity

The prevalence of obesity already reached epidemic proportions many years ago and more people may die from this pandemic than from COVID-19. However, the figures depend on which measure of fat mass is used. The determination of the associated health risk also depends on the applied measure. Therefore, we will examine the most common measures for their significance, their contribution to risk assessment and their applicability. The following categories are reported: indices of increased accumulation of body fat; weight indices and mortality; weight indices and risk of disease; normal weight obesity and normal weight abdominal obesity; metabolically healthy obesity; the obesity paradox. It appears that BMI is still the most common measure for determining weight categories, followed by measures of abdominal fat distribution. Newer measures, unlike BMI, take fat distribution into account but often lack validated cut-off values or have limited applicability. Given the high prevalence of obesity and the associated risk of disease and mortality, it is important for a targeted approach to identify risk groups and determine individual risk. Therefore, in addition to BMI, a measure of fat distribution should always be used to ensure that less obvious but risky manifestations such as normal weight obesity are identified.

The BMI–adiposity conundrum in South Asian populations: need for further research

2019 ◽  
Vol 51 (4) ◽  
pp. 619-621 ◽  
Author(s):  
Nitin Kapoor ◽  
John Furler ◽  
Thomas V. Paul ◽  
Nihal Thomas ◽  
Brian Oldenburg
Keyword(s):  
Body Fat ◽  
South Asian ◽  
Scientific Literature ◽  
Normal Weight ◽  
Future Research ◽  
Asian Populations ◽  
Body Fat Content ◽  
Prevalence Of Obesity ◽  
Normal Weight Obesity ◽  
Diagnostic Modalities

AbstractHigh body fat in apparently lean individuals is a commonly described phenotype in individuals of Asian descent, but very limited consolidated scientific literature is available on this topic. This phenotype is known as ‘normal-weight obesity’ and may explain the large disparity between the prevalence of obesity (as measured by BMI) and diabetes that occurs in these individuals. Routine use of obesity indicators that best predict body fat content would help to identify these individuals in clinical practice. In this debate, we would like to highlight that even though fat and BMI have a good correlation, as suggested by Kryst et al. (2019), clinicians, public health researchers and policymakers should consider the use of these indicators in conjunction with each other rather than individually. Future research is needed on pathogenic mechanisms, diagnostic modalities and therapeutic options in these individuals which will help to further characterize and manage these patients appropriately.

scholarly journals Excess Body Weight and Pancreatic Disease

2021 ◽  
pp. 1-6
Author(s):  
Mats L. Wiese ◽  
Ali A. Aghdassi ◽  
Markus M. Lerch ◽  
Antje Steveling
Keyword(s):  
Body Weight ◽  
Risk Factor ◽  
Protective Effect ◽  
Visceral Obesity ◽  
Fat Distribution ◽  
Obesity Paradox ◽  
Pancreatic Disease ◽  
Normal Weight ◽  
Excess Body Weight ◽  
Negative Outcome

<b><i>Background:</i></b> Excess body weight (EBW) is a risk factor for various acute and chronic conditions. Conversely, the “obesity paradox” suggests a protective effect of higher body weight on some disease outcomes. This article discusses the role of EBW along the disease continuum of pancreatitis and pancreatic cancer (PC) in terms of incidence and outcome. <b><i>Summary:</i></b> Comparison of findings is hampered by the use of different methods to assess EBW. Nevertheless, in acute pancreatitis (AP) and PC, EBW, especially visceral obesity, presents a distinct risk factor and predictor of a negative outcome. Findings of a protective effect likely result from nonconsideration of fat distribution or other confounders. Regarding chronic pancreatitis (CP), few studies indicate lower incidence and a better outcome with higher body mass. However, there is insufficient evidence to confirm the existence of an obesity paradox. The precise mechanisms of how EBW affects the disease continuum require further elucidation but both common and disease-specific effects seem involved. <b><i>Key Messages:</i></b> EBW is associated with higher incidence and a negative outcome in AP and PC. The association with CP is less conclusive. Thus, maintaining normal weight is advisable at any stage of the disease continuum.

Impact of body mass index (BMI) on treatment outcomes to immune checkpoint blockade (ICB) in metastatic renal cell carcinoma (mRCC).

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 566-566 ◽  
Author(s):  
Aly-Khan A. Lalani ◽  
Wanling Xie ◽  
Ronan Flippot ◽  
John A. Steinharter ◽  
Lauren Christine Harshman ◽  
...  
Keyword(s):  
Cox Regression ◽  
Objective Response ◽  
Progression Free Survival ◽  
Risk Groups ◽  
Obesity Paradox ◽  
Immune Checkpoint Blockade ◽  
Normal Weight ◽  
First Line ◽  
Line Of Therapy ◽  
High Bmi

566 Background: An elevated BMI is associated with improved survival in mRCC patients treated with oral targeted therapies (TT); however, this relationship in the contemporary treatment landscape is unknown. We investigated the effect of BMI on outcomes in mRCC patients treated with PD-1/PD-L1 ICB. Methods: We analyzed 147 patients with mRCC who received ICB alone or in combination with VEGF or other therapies. The association of BMI with objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) was evaluated using logistic and Cox regression models, adjusted for known prognostic factors including International Metastatic RCC Database Consortium (IMDC) risk groups, line of therapy, ECOG (0 vs ≥1), and histology. Results: Median follow up was 25.5 (4.3-78.6) months (mos). Median time on ICB was 5.1 ( < 0.1-69.7) mos. Overall, most patients were male (71%), had clear cell histology (85%), and were intermediate risk (60%). 43% received first-line ICB and 45% received ICB in combination therapy (37% with VEGF inhibition, 8% with other therapies). At ICB initiation, 46 (31%) patients were considered underweight/normal weight (BMI < 25 kg/m2), 56 (38%) overweight (BMI 25-30 kg/m2), and 45 (31%) obese (BMI > 30 kg/m2). Patients with high BMI (≥ 25) had improved OS (median 34.3 vs 16.7 mos, 2-yr OS 61 vs 42%, p = 0.016) compared to those with low BMI ( < 25), with an adjusted hazard ratio (HR) = 0.74 (0.44-1.26). ORR (33 vs 28%, p = 0.7) and PFS (median 8.2 vs 5.9 mos, p = 0.4) did not statistically differ. Patients who experienced a BMI change from ≥ 25 at start of first-line TT to < 25 at start of subsequent-line ICB displayed shorter OS (adjusted HR = 2.25 (0.94-5.35)) compared to those with no change. Conclusions: High BMI appears to be associated with improved OS in mRCC patients treated with ICB. This contemporary data is consistent with the “obesity paradox” demonstrated in the TT era. Validation with the IMDC database and examination of underlying mechanisms are ongoing.

Risk score – valuable tool for individual risk assessment?

2008 ◽  
Vol 56 (S 1) ◽  
Author(s):  
B Osswald ◽  
G Thomas ◽  
U Tochtermann ◽  
V Gegouskov ◽  
D Badowski-Zyla ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Risk Score ◽  
Individual Risk ◽  
Individual Risk Assessment

scholarly journals Risk Assessment of Large-Scale Infrastructure Projects—Assumptions and Context

2020 ◽  
Vol 11 (1) ◽  
pp. 109
Author(s):  
Jana Korytárová ◽  
Vít Hromádka
Keyword(s):  
Risk Assessment ◽  
Economic Efficiency ◽  
Large Scale ◽  
Cash Flows ◽  
Statistical Characteristics ◽  
Individual Risk ◽  
Dependent Variables ◽  
Research Findings ◽  
Input Variables ◽  
Individual Risk Factors

This article deals with the partial outputs of large-scale infrastructure project risk assessment, specifically in the field of road and motorway construction. The Department of Transport spends a large amount of funds on project preparation and implementation, which however, must be allocated effectively, and with knowledge of the risks that may accompany them. Therefore, documentation for decision-making on project financing also includes their analysis. This article monitors the frequency of occurrence of individual risk factors within the qualitative risk analysis, with the support of the national risk register, and identifies dependent variables that represent part of the economic cash flows for determining project economic efficiency. At the same time, it compares these dependent variables identified by sensitivity analysis with critical variables, followed by testing the interaction of the critical variables’ effect on the project efficiency using the Monte Carlo method. A partial section of the research was focused on the analysis of the probability distribution of input variables, especially “the investment costs” and “time savings of infrastructure users” variables. The research findings conclude that it is necessary to pay attention to the setting of statistical characteristics of variables entering the economic efficiency indicator calculations, as the decision of whether or not to accept projects for funding is based on them.

scholarly journals The Obesity Paradox and Heart Failure: A Systematic Review of a Decade of Evidence

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Emmanuel Aja Oga ◽  
Olabimpe Ruth Eseyin
Keyword(s):  
Heart Failure ◽  
Weight Status ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Conclusive Evidence ◽  
Study Endpoint ◽  
Nyha Classification ◽  
Improved Outcomes ◽  
Observational Cohort

There is scientific consensus that obesity increases the risk of cardiovascular diseases, including heart failure. However, among persons who already have heart failure, outcomes seem to be better in obese persons as compared with lean persons: this has been termed theobesity paradox, the mechanisms of which remain unclear. This study systematically reviewed the evidence of the relationship between heart failure mortality (and survival) and weight status. Search of the PubMed/MEDLINE and EMBASE databases was done according to the PRISMA protocol. The initial search identified 9879 potentially relevant papers, out of which ten studies met the inclusion criteria. One study was a randomized clinical trial and 9 were observational cohort studies: 6 prospective and 3 retrospective studies. All studies used the BMI, WC, or TSF as measure of body fatness and NYHA Classification of Heart Failure and had single outcomes, death, as study endpoint. All studies included in review were longitudinal studies. All ten studies reported improved outcomes for obese heart failure patients as compared with their normal weight counterparts; worse prognosis was demonstrated for extreme obesity (BMI>40 kg/m2). The findings of this review will be of significance in informing the practice of asking obese persons with heart failure to lose weight. However, any such recommendation on weight loss must be consequent upon more conclusive evidence on the mechanisms of the obesity paradox in heart failure and exclusion of collider bias.

scholarly journals Rates of violence in patients classified as high risk by structured risk assessment instruments

2014 ◽  
Vol 204 (3) ◽  
pp. 180-187 ◽  
Author(s):  
Jay P. Singh ◽  
Seena Fazel ◽  
Ralitza Gueorguieva ◽  
Alec Buchanan
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Risk Groups ◽  
Evidence Base ◽  
Assessment Tools ◽  
Current Evidence ◽  
Assessment Instruments ◽  
Individual Liberty ◽  
Current Evidence Base ◽  
Study Heterogeneity

BackgroundRates of violence in persons identified as high risk by structured risk assessment instruments (SRAIs) are uncertain and frequently unreported by validation studies.AimsTo analyse the variation in rates of violence in individuals identified as high risk by SRAIs.MethodA systematic search of databases (1995–2011) was conducted for studies on nine widely used assessment tools. Where violence rates in high-risk groups were not published, these were requested from study authors. Rate information was extracted, and binomial logistic regression was used to study heterogeneity.ResultsInformation was collected on 13 045 participants in 57 samples from 47 independent studies. Annualised rates of violence in individuals classified as high risk varied both across and within instruments. Rates were elevated when population rates of violence were higher, when a structured professional judgement instrument was used and when there was a lower proportion of men in a study.ConclusionsAfter controlling for time at risk, the rate of violence in individuals classified as high risk by SRAIs shows substantial variation. In the absence of information on local base rates, assigning predetermined probabilities to future violence risk on the basis of a structured risk assessment is not supported by the current evidence base. This underscores the need for caution when such risk estimates are used to influence decisions related to individual liberty and public safety.

scholarly journals Financial and Labor Benefits of the Individual TB Risk Assessment Model for Annual TB Screening

2020 ◽  
Vol 41 (S1) ◽  
pp. s234-s234
Author(s):  
Kristin Sims ◽  
Roger Stienecker
Keyword(s):  
Risk Assessment ◽  
Health Care ◽  
Assessment Model ◽  
Health Care Personnel ◽  
Individual Risk ◽  
Tuberculosis Screening ◽  
Hospital System ◽  
National Tuberculosis ◽  
The Individual ◽  
The Cost

Background: Since 1991, US tuberculosis (TB) rates have declined, including among health care personnel (HCP). Non–US born persons accounted for approximately two-thirds of cases. Serial TB testing has limitations in populations at low risk; it is expensive and labor intensive. Method: We moved a large hospital system from facility-level risk stratification to an individual risk model to guide TB screening based on Tuberculosis Screening, Testing, and Treatment of US Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019. This process included individual TB risk assessment, symptom evaluation, TB testing for M. tuberculosis infection (by either IGRA or TST) for HCP without documented evidence of prior LTBI or TB disease, with an additional workup for TB disease for HCP with positive test results or symptoms compatible with TB disease. In addition, employees with specific job codes deemed high risk were required to undergo TB screening. Result: In 2018, this hospital system of ~10,000 employees screened 7,556 HCP for TB at a cost of $348,625. In 2019, the cost of the T Spot test increased from $45 to $100 and the cost of screening 5,754 HCP through October 31, 2019, was $543,057. In 2020, it is anticipated that 755 HCP will be screened, saving the hospital an estimated minimum of $467,557. The labor burden associated with employee health personnel will fall from ~629.66 hours to 62.91 hours. The labor burden associated with pulling HCPs from the bedside to be screened will be reduced from 629.66 hours to 62.91 hours as well. Conclusion: Adoption of the individual risk assessment model for TB screening based on Tuberculosis Screening, Testing, and Treatment of US Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019 will greatly reduce financial and labor burdens in healthcare settings when implemented.Funding: NoneDisclosures: None

Abstract P72: The Obesity Paradox: Association Between Body Mass Index (BMI) and Disability After Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Brianna R Helms
Keyword(s):  
Body Mass Index ◽  
Ischemic Stroke ◽  
Functional Status ◽  
Hospital Discharge ◽  
Body Mass ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Stroke Recurrence ◽  
Inverse Association ◽  
Stroke Patients

Background: Present rise in the incidence of obesity has led to several opposing reports regarding the association between obesity and stroke outcomes. The objective of this study was to investigate a proposed paradoxical relationship between body mass index (BMI) and functional status in ischemic stroke patients at time of hospital discharge. Methods: Saint Francis Hospital Comprehensive Stroke Center patient databases were utilized in identifying 948 patients eligible for retrospective chart review over a period of 15 months. Subjects were divided into 4 groups according to BMI: underweight (BMI < 18.5 kg/m 2 ), normal weight (BMI 18.5-24.9 kg/m 2 ), overweight (BMI 25.0-29.9 kg/m 2 ), and obese (BMI ≥ 30.0 kg/m 2 ). Covariates, such as age, gender, prior to event modified Rankin scale (mRS), stroke recurrence, and smoking, were considered. Functional status and disability of stroke patients was scored via mRS at hospital discharge. Ordered logistic regression, Pearson’s chi-squared test, and Pearson’s r correlation were used for analysis to assess the association of BMI and functional status in ischemic strokes. Results: Of 948 eligible subjects, 49.9% were female and mean (SD) age was 69.4 (14.5) years. According to BMI, 22 (2.3%) were underweight, 247 (26.1%) normal weight, 319 (33.7%) overweight, and 360 (37.9%) obese. After adjusting for covariates, ischemic stroke patients with an increased BMI (OR, 0.98; 95% CI, 0.96-0.99) were not associated with increased disability risk upon discharge. Obese (16.2%) and overweight (14.1%) patients discharged with a mRS of 0 (back to baseline) or 1 more frequently compared to normal weight (6.1%) and underweight (0.21%) patients ( P <0.001). Furthermore, an inverse association between BMI status and disability was significantly evident ( r = -0.17, P < 0.001). Conclusion: Obese and overweight stroke patients discharge with a lower risk of disability than normal weight and underweight patients, supporting the existence of the “obesity paradox” in stroke. An inverse association between obesity status and functional outcome was identified and remained significant regardless of covariates.

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