Weight Changes in Type 2 Diabetes and Cancer Risk: A Latent Class Trajectory Model Study

<b><i>Introduction:</i></b> Body mass index (BMI) is often elevated at type 2 diabetes (T2D) diagnosis. Using latent class trajectory modelling (LCTM) of BMI, we examined whether weight loss after diagnosis influenced cancer incidence and all-cause mortality. <b><i>Methods:</i></b> From 1995 to 2010, we identified 7,708 patients with T2D from the Salford Integrated Record database (UK) and linked to the cancer registry for information on obesity-related cancer (ORC), non-ORC; and all-cause mortality. Repeated BMIs were used to construct sex-specific latent class trajectories. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression models. <b><i>Results:</i></b> Four sex-specific BMI classes were identified; stable-overweight, stable-obese, obese-slightly-decreasing, and obese-steeply-decreasing; comprising 41%, 45%, 13%, and 1% of women, and 45%, 37%, 17%, and 1% of men, respectively. In women, the stable-obese class had similar ORC risks as the obese-slightly-decreasing class, whereas the stable-overweight class had lower risks. In men, the obese-slightly-decreasing class had higher risks of ORC (HR = 1.86, 95% CI: 1.05–3.32) than the stable-obese class, while the stable-overweight class had similar risks No associations were observed for non-ORC. Compared to the stable-obese class, women (HR = 1.60, 95% CI: 0.99–2.58) and men (HR = 2.37, 95% CI: 1.66–3.39) in the obese-slightly-decreasing class had elevated mortality. No associations were observed for the stable-overweight classes. <b><i>Conclusion:</i></b> Patients who lost weight after T2D diagnosis had higher risks for ORC (in men) and higher all-cause mortality (both genders) than patients with stable obesity.

Association of body image with physical activity, sleep, meal and smoking in obese male

Background and Study Aim. Body image is a multidimensional construct that involves mental representations of the body, feelings, cognitions, and behaviors. The objective was to compare body image among different categories of obesity, investigate the relationship between obesity and body image, and examine the association of physical activity, meal habits, sleep, and smoking with body image. Material and Methods. Fifty-five undergraduate students Mean age 19.7±0.90 were divide into three obese categories: Obese Class I (30 < 35 kg/m2), Obese Class II (35 < 40 kg/m2) and Obese Class III (≥40.00 kg/m2). Body Image measured through (MBSRQ-AS). Results. ANOVA revealed no significant difference among BMI categories on body image global score F (2,52) = 0.074, p = 0.928. Pearson product-moment correlation could not establish significant relationship between body image and BMI (r= -0.00, n=55, p= 0.998). We found a strong association of smoking with body image X(1) = 6.909, p=0.009. However, the statistical analysis of data could not establish any significant association of PA X(1) = 0.044, p=0.978; sleep X(1) = 2.403, p=0.121; and number of meals X(1) = 0.654, p=0.721; with body image among obese individuals. Conclusions. The university students exhibited low body image. Higher scores on Self-Classified Weight describe how individuals perceive their weight and how they believe others perceive it. The low scores on Appearance Evaluation determine unhappiness with their physical appearance. Interestingly, most students are getting sufficient sleep, and a high percentage of the students’ population is not smoking. The university needs to encourage physical activity and healthy eating behavior.

Body Mass Index and Long-Term Follow-Up Outcomes in Patients With Acute Myocardial Infarction by the Median of Non-HDL Cholesterol: Results From an Observational Cohort Study in China

Background: The association between obesity, non-HDL cholesterol, and clinical outcomes in subjects with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) is incompletely understood. The aim of this investigation was to explore the association between body mass index (BMI), non-high density lipoprotein (non-HDL) cholesterol, and long-term follow-up prognosis.Methods: This present study used data obtained by the Cardiovascular Center of Beijing Friendship Hospital Database Bank. We identified 3,780 consecutive AMI populations aged 25–93 years from 2013 to 2020. Participants were categorized as normal weight (18.5 ≤ BMI &lt;22.9 kg/m2), overweight (23.0 ≤ BMI &lt;24.9 kg/m2), obese class I (25.0 ≤ BMI &lt;29.9 kg/m2), and obese class II (BMI ≥ 30.0 kg/m2). The endpoint of interest was cardiovascular (CV) death, all-cause death, myocardial infarction (MI), stroke, unplanned revascularization, and cardiac hospitalization.Results:Participants with higher BMI were younger and more likely to be males compared with lower BMI groups. Elevated non-HDL cholesterol was present in 8.7, 11.0, 24.3, and 5.9% of the normal, overweight, obese class I, and obese class II groups, respectively. After multivariate adjustment, compared to normal-weight participants with decreased non-HDL cholesterol (reference group), obese participants with and without elevated non-HDL cholesterol had a lower risk of mortality (with obese class I and elevated non-HDL cholesterol: hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.28–0.67; with obese class I and decreased non-HDL cholesterol: HR, 0.68, 95% CI, 0.47–0.98; with obese class II and elevated non-HDL cholesterol: HR, 0.42, 95% CI, 0.20–0.87; with obese class II and decreased non-HDL cholesterol: HR, 0.35, 95% CI, 0.16–0.72).Conclusion: In AMI participants performing with PCI, obesity had a better long-term prognosis which probably unaffected by the level of non-HDL cholesterol.

Effectiveness of Direct Oral Anticoagulants in Obese Adults With Atrial Fibrillation: A Systematic Review of Systematic Reviews and Meta-Analysis

Background: Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia. Obesity is an independent risk factor for AF. Anticoagulants have been strongly recommended by all international guidelines to prevent stroke. However, altered pathophysiology in obese adults may influence anticoagulant pharmacology. Direct oral anticoagulants (DOACs) in the context of obesity and AF have been examined in recent systematic reviews. Despite the similarities in included studies, their results and conclusions do not agree.Methods and Results: The protocol for this review was registered with PROSPERO (CRD42020181510). Seven key electronic databases were searched using search terms such as “atrial fibrillation,” “obese,*” “overweight,” “novel oral anticoagulant,” “direct oral anticoagulant,” “DOAC,” “NOAC,” “apixaban,” dabigatran,” “rivaroxaban,” and “edoxaban” to locate published and unpublished studies. Only systematic reviews with meta-analyses that examined the effect of DOACs in overweight or obese adults with AF, published in the English language, were included. A total of 9,547 articles were initially retrieved. After removing the duplicates, title and abstract review and full-text review, five articles were included in the systematic review. From these only RCTs were included in the meta-analyses. There was disagreement within the published systematic reviews on DOACs in obesity. The results from our meta-analysis did not show any significant difference between all body mass index (BMI) groups for all outcomes at both 12 months and for the entire trial duration. Non-significant differences were seen among the different types of DOACs.Conclusion: There was no difference between the BMI classes in any of the outcomes assessed. This may be due to the limited number of people in the trial that were in the obese class, especially obese class III. There is a need for large prospective trials to confirm which DOACs are safe and efficacious in the obese class III adults and at which dose.

Maternal Obesity and Its Associated Factors and Outcomes in Klang Valley, Malaysia: Finding from National Obstetric Registry

Introduction: Maternal obesity presents significant health risks to mothers and their fetuses. This study aimed to determine the proportion, associated factors and outcomes of maternal obesity among pregnant women in Klang Valley, Malaysia. Methods: A retrospective cross-sectional study was conducted between January 2018 and March 2018 using secondary data from the Malaysian National Obstetric Registry (NOR) for the year 2015. All pregnant women with first-trimester booking at 12 weeks and below that were registered with the NOR and met the inclusion and exclusion criteria were included in the study. Descriptive statistics and multiple logistic regression analysis were used. Data were analysed using SPSS version 22.0. A total of 2113 respondents were included in this study to determine the proportion, associated factors and outcomes of maternal obesity. Regarding the univariate and multivariate analyses, respondents were classified into two groups: normal and obese. The obese group comprised overweight and obese mothers. The underweight group was excluded in the subsequent analysis. Results: Out of the 2113 respondents, 7.1% were underweight, 41.7% were of normal weight, 28.6% were overweight, 15.9% were in obese class I, 4.6% were in obese class II, and 2.1% were in obese class III according to the WHO (1995) reference. However, when the MOH (2003) cutoff point was used, there was a marked increase in the proportion of respondents in the overweight categories by 2.7% and obesity class I by 12.8%. The Indian (AdjOR 2.06, 95% CI: 1.11, 3.83, p=0.021) and Malay (AdjOR 1.75, 95% CI: 1.02, 3.00, p=0.040) ethnicities, as well as both multiparity (AdjOR 1.46, 95% CI: 1.23, 1.73, p <0.001) and grand multiparity (AdjOR 2.41, 95% CI: 1.78, 3.26, p <0.001), were significantly associated with maternal obesity. There were significant association between maternal obesity with hypertensive disorder in pregnancy (p=0.025), caesarean section delivery (p=0.002) and macrosomic infant (p <0.001). Conclusion: The identification of risk factors for maternal obesity is important to facilitate intervention programmes focused on improving the pregnancy outcomes for a high-risk group of women.

Association of Body Mass Index with Mortality in Patients with Cardiogenic Shock following Acute Myocardial Infarction: A Contemporary Danish Cohort Analysis

<b><i>Aims:</i></b> The obesity paradox suggests a better prognosis in overweight or obese patients with heart failure and acute myocardial infarction (AMI) than patients with normal weight. Few studies have investigated the association between BMI and mortality in patients with AMI complicated by cardiogenic shock (AMICS). The aim of this study was to evaluate the association between BMI and 30-day mortality in patients with AMICS. <b><i>Methods and Results:</i></b> A retrospective study of 1,716 patients with AMICS treated at 2 tertiary centers in south-eastern Denmark between 2010 and 2017. Patients undergoing revascularization and who were admitted to the intensive care unit were included (<i>n</i> = 1,216). BMI was available in 1,017 patients (83.6%). Patients were divided according to the WHO classification as normal weight BMI &#x3c;24.9 kg/m² (<i>n</i> = 453), overweight BMI 25–29.9 kg/m² (<i>n</i> = 391), obese class 1 BMI 30–34.9 kg/m² (<i>n</i> = 131), and obese class 2 + 3 BMI &#x3e;35 kg/m² (<i>n</i> = 42). Differences in baseline characteristics, in-hospital treatment, and the primary outcome of all-cause mortality at 30 days were examined. Obese patients had more comorbidities such as diabetes, hypertension, and dyslipidemia than patients with normal weight. Need for renal replacement therapy was higher among obese patients (normal weight, 19% vs. obese class 2 + 3, 35%, <i>p</i> = 0.02); otherwise, no difference in management was found. No difference in 30-day mortality was observed between groups (normal weight 44%, overweight 38%, obese class 1 41%, and obese class 2 + 3 45% at 30 days; ns). <b><i>Conclusions:</i></b> Thirty-day mortality in patients with AMICS was not associated with the BMI category. Thus, evidence of an “obesity paradox” was not observed in this contemporary cohort of patients with AMICS in Denmark.

Obesity and revision surgery, mortality, and patient-reported outcomes after primary knee replacement surgery in the National Joint Registry: A UK cohort study

Background One in 10 people in the United Kingdom will need a total knee replacement (TKR) during their lifetime. Access to this life-changing operation has recently been restricted based on body mass index (BMI) due to belief that high BMI may lead to poorer outcomes. We investigated the associations between BMI and revision surgery, mortality, and pain/function using what we believe to be the world’s largest joint replacement registry. Methods and findings We analysed 493,710 TKRs in the National Joint Registry (NJR) for England, Wales, Northern Ireland, and the Isle of Man from 2005 to 2016 to investigate 90-day mortality and 10-year cumulative revision. Hospital Episodes Statistics (HES) and Patient Reported Outcome Measures (PROMs) databases were linked to the NJR to investigate change in Oxford Knee Score (OKS) 6 months postoperatively. After adjustment for age, sex, American Society of Anaesthesiologists (ASA) grade, indication for operation, year of primary TKR, and fixation type, patients with high BMI were more likely to undergo revision surgery within 10 years compared to those with “normal” BMI (obese class II hazard ratio (HR) 1.21, 95% CI: 1.10, 1.32 (p < 0.001) and obese class III HR 1.13, 95% CI: 1.02, 1.26 (p = 0.026)). All BMI classes had revision estimates within the recognised 10-year benchmark of 5%. Overweight and obese class I patients had lower mortality than patients with “normal” BMI (HR 0.76, 95% CI: 0.65, 0.90 (p = 0.001) and HR 0.69, 95% CI: 0.58, 0.82 (p < 0.001)). All BMI categories saw absolute increases in OKS after 6 months (range 18–20 points). The relative improvement in OKS was lower in overweight and obese patients than those with “normal” BMI, but the difference was below the minimal detectable change (MDC; 4 points). The main limitations were missing BMI particularly in the early years of data collection and a potential selection bias effect of surgeons selecting the fitter patients with raised BMI for surgery. Conclusions Given revision estimates in all BMI groups below the recognised threshold, no evidence of increased mortality, and difference in change in OKS below the MDC, this large national registry shows no evidence of poorer outcomes in patients with high BMI. This study does not support rationing of TKR based on increased BMI.

Challenging the obesity paradox: extreme obesity and COPD mortality in the SUMMIT Trial

Populations with COPD demonstrate higher survival in overweight and obese compared with normal weight; the “obesity paradox.” Relationships in less severe COPD are unclear, as is the impact of cardiovascular risk, and few studies include individuals at extremes of obesity.We examined the relationship between body mass index (BMI, defined as underweight: <20 kg·m−2, normal: 20–25 kg·m−2, overweight: 25-<30 kg·m−2, obese class I: 30-<35 kg·m−2, class II: 35-<40 kg·m−2, class III: ≥40 kg·m−2), morbidity, and mortality in the SUMMIT trial population (n=16 485), characterised by moderate COPD and heightened cardiovascular risk with a substantial proportion with class III obesity. The association between BMI category and time to event was modeled via proportional hazards (reference normal weight) adjusted for demographics and cardiorespiratory disease.Consistent with the paradox, underweight individuals demonstrated higher mortality (HR 1.31 (95%CI 1.04–1.64)), with lower mortality among overweight (HR 0.62 (95%CI 0.52–0.73)) and obese class I (HR 0.75 (95%CI 0.62–0.90)). However, mortality increased in obese class III (HR 1.36 (95%CI 1.00–1.86)). Death was primarily attributable to cardiovascular causes.Within a large, multinational cohort with moderate COPD and increased cardiovascular risk, the phenomenon of reduced mortality with obesity did not persist at BMI>40 kg·m−2, suggesting that obesity may not remain protective at the extremes in this population.

Association of physical activity on exercise motivation and body mass index among university students

Background and Study Aim. Motivation as a psychological feature that arouses and energizes people to action towards physical activity and makes them sustain to a physically active behavior. Motivation leads to increased participation in physical activity. The objective of this study was to determine the association of physical activity to exercise motivation of university students at different levels of body mass index. Material and Methods. 140 undergraduate students Mean age 19±0.70 years randomly categorized into underweight <18.5 kg/m2 [n= 37: 26.4%]; normal-weight 18.5-24.9 kg/m2 [n= 31: 22.1%]; obese ≥30.00 kg/m2 [n=37: 26.4%] and obese class III ≥40.00 kg/m2 [n=35: 25%]. Exercise motivation measured through BREQ-2. Results. ANOVA revealed highly significant difference among BMI categories on intrinsic regulation (p=0.007<.05) and identified regulation (p=0.006<.05). Obese class III students differed on external regulation (p=0.003) and introjected regulations (p=0.011). The association of physical activity to exercise motivation revealed that students who engaged more time in physical activities had significantly higher scores on identified regulation (p < 0.05) and intrinsic regulation (p < 0.01). Conclusions. The results suggested that university students in all BMI categories were internally motivated. The normal weight students exhibited high intrinsic and identified regulation, which reflected as better autonomous motivation. Physical activity had strong association with intrinsic regulation and identified regulation. Obese class students exhibited higher degree of extrinsic motivation and amotivation. Students who engaged more time in physical activity had better intrinsic motivation.

Multimorbidity Accumulation among Middle-Aged Americans: Differences by Race/Ethnicity and Body-Mass Index

BACKGROUND Obesity and multimorbidity are more prevalent among U.S. racial/ethnic minority groups. Evaluating racial/ethnic disparities in disease accumulation according to body-mass index (BMI) may guide interventions to reduce multimorbidity burden in vulnerable racial/ethnic groups. METHODS We used data from the 1998-2016 Health & Retirement Study on 8,106 participants aged 51-55 at baseline. Disease burden and multimorbidity (≥2 co-occurring diseases) were assessed using seven chronic diseases: arthritis, cancer, heart disease, diabetes, hypertension, lung disease, and stroke. Four BMI categories were defined per convention: normal, overweight, obese class 1, and obese class 2/3. Generalized estimating equations models with inverse probability weights estimated the accumulation of chronic diseases. RESULTS Overweight and obesity were more prevalent in non-Hispanic Black (82.3%) and Hispanic (78.9%) than non-Hispanic White (70.9 %) participants at baseline. The baseline burden of disease was similar across BMI categories, but disease accumulation was faster in the obese class 2/3 and marginally in the obese class 1 categories compared with normal BMI. Black participants across BMI categories had a higher initial burden and faster accumulation of disease over time, while Hispanics had a lower initial burden and similar rate of accumulation, compared with Whites. Black participants, including those with normal BMI, reach the multimorbidity threshold 5-6 years earlier compared with White participants. CONCLUSIONS Controlling weight and reducing obesity early in the lifecourse may slow the progression of multimorbidity in later life. Further investigations are needed to identify the factors responsible for the early and progressing nature of multimorbidity in Blacks of non-obese weight.