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Objective: To demonstrate sexual dimorphism in serum leptin levels not only during puberty, but also in childhood in Japan. Design: Cross-sectional study. Setting: Hamamatsu-Hokuen study in Japan. Subjects: Body weight and height were measured in normal-weight Japanese children and adolescents (143 boys, 178 girls), and 161 boys and 129 girls whose percentage of overweight for the standard (%Wt) was more than+25%. Serum leptin levels were compared with %Wt. Subjects were divided into group 1 (6–10 y of age) and group 2 (11–15 y of age) according to their age. Results: In overweight subjects, leptin was more highly correlated with %Wt in boys of group 2 (r=0.67, P

Szivak, TK, Thomas, MM, Pietrzak, RH, Nguyen, DR, Ryan, DM, and Mazure, CM. Obesity Risk Among West Point Graduates Later in Life. J Strength Cond Res XX(X): 000-000, 2020-The purpose of this investigation was to evaluate sex differences in health and fitness outcomes among United States Military Academy (USMA) graduates (class years 1980-2011). Subjects (n = 701 men, 641 women, age: 45.7 ± 9.3 years) were surveyed as a part of a larger investigation on risk and resiliency factors among USMA graduates. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ) short form and calculation of weekly metabolic equivalents (METs). Overweight and obesity status were assessed by body mass index (BMI). Significance for the study was set at p ≤ 0.05. Obesity rates for men (30.1%) were significantly higher than for women (16.6%). Men reported significantly higher (p = 0.01) vigorous METs·wk (1,214.6 ± 1,171.6) than women (1,046.8 ± 1,133.2) despite significantly higher (p = 0.00) BMI values (28.75 ± 4.53 kg·m) than women (25.90 ± 5.48 kg·m). Women were 89% more likely to have ever been on a diet and reported higher (15.2%) Army Body Composition Program enrollment rates than men (6.3%). Obesity rates among men reflect trends seen in the broader military, Veteran, and U.S. adult populations, whereas obesity rates among women were lower. Men may be at a greater risk for obesity later in life despite higher self-reported physical activity; however, lean body mass and self-report bias should be considered. Because lifetime obesity may be influenced by factors other than physical activity, health initiatives should use a comprehensive approach early in the career of military officers.

Background Breastfeeding is said to prevent overweight and obesity in childhood but the evidence about its long-term impact on body size into adolescence and adulthood is scarce. We sought to examine the association between feeding types and subsequent physical size at the ages of 3, 6, 12, and 22 years. Methods The Ibaraki Children's Cohort (IBACHIL) Study, which began in 1992, involved a cohort of 4,592 Japanese children from 87 communities of a single prefecture whose parents answered health questionnaires about their child's health and life habits at the age of 3 years. Follow-up questionnaires were distributed to the same cohort when they were 6, 12, and 22 years old. Self-reported height and weight, body mass index (BMI), and overweight status at ages of 3 (n = 4,290), 6 (n = 1,999; proportion of participants analyzed = 47%), 12 (n = 2,227; 52%), and 22 (n = 1,459; 34%) years were compared according to feeding type (breastfeeding, formula feeding, and mixed feeding) during infancy. Results At the age of 3 years, multivariable adjusted-mean weight and prevalence of overweight were less for breastfed children than those formula-fed in both boys (weight: 14.6 kg vs 14.7 kg, P = 0.07, overweight: 6.3% vs 9.3%, P = 0.03) and in girls (14.0 kg vs 14.2 kg, P = 0.01 and 10.4% vs 13.6%, P = 0.06). However, there were no statistically significant differences in weight, BMI, and overweight at the ages of 6, 12, and 22 years according to feeding type. Conclusions Breastfeeding may prevent overweight in childhood, but its impact is not significant in adolescence and adulthood.

Objectives: The aim of this study was to evaluate serum lipid levels in patients under 50 years of agewith corneal arcus. Materials and Methods: This cross-sectional study was performed on patients under50 years of age referred to the ophthalmology clinic of Imam Reza Hospital in Ardabil who underwentcorneal arcus examination. Patients were enrolled in the study by census method.Information needed forpatients including age, sex, blood pressure, body mass index, history of smoking and alcohol consumption,history of serum lipid lowering drugs using, Xanthelasma, history of cardiovascular disease and history ofcerebrovascular events through history and examinationwere collectedby checklist.The collected data wereentered into SPSS version 22 software and then analyzed. Results: A total of 59 cases were included in thestudy. 36 (61%) of cases were male and 74.6% were overweight or obese. 50.8% of subjects had triglyceridesequal to or above 150 mg/dl. Additionally, 15.3% of cases with normal hyperlipidemia were using serumlipid-lowering drugs. There was no significant relationship between age and blood lipid levels (p> 0.05). Theprevalence of corneal arcus was higher at older ages and in people with a higher Body Mass Index (BMI), butthis association was not statistically significant. The intensity of corneal arcus was not significantly related toage, sex, serum lipid level and BMI (P> 0.05).Conclusion: The prevalence of corneal arcus increased withage. The prevalence of overweight, obesity and abnormal lipid profiles (specially triglyceride cholesterollevels) were remarkably but non-significantly high in our patients under 50 years of age with corneal arcus.

Background & aims Severe COVID-19 infection is characterized by an inflammatory response and lung injury that can evolve into an acute respiratory distress syndrome that needs support treatment in intensive care unit. Nutritional treatment is an important component of the management of critically ill patients and should be started in the first 48 h of ICU admission to avoid malnutrition. This study describes the characteristics of the patients treated in a tertiary hospital in Madrid during the months of March–May 2020 (first wave), the medical nutrition treatment employed and its influence in the clinical outcome of these patients. Methods This is a retrospective study including COVID-19 patients admitted in ICU that needed medical nutrition treatment (MNT). Collected variables included sex, age, BMI, underlying diseases, time from hospitalisation to ICU admission, type of respiratory support (invasive mechanical ventilation (IMV) or high flow nasal cannula (HFNC) or non-invasive ventilation (non-IMV)), caloric and protein requirements (25 kcal/kg adjusted body weight (ABW), 1.3 g/kg ABW/day), MNT type (enteral nutrition (EN), parenteral nutrition (PN), mixed EN + PN), total calories (including propofol) and proteins administered, percentage of caloric and protein goal in ICU day 4th and 7th, metabolic complications, acute kidney failure (AKF), length of stay (LOS) and mortality. Data are expressed as mean ± SD, median (IQR) or frequencies. Statistical analysis was performed with the IBM SPSS Statistics for Windows, Version 25.0. p

BACKGROUND & AIMS: Patients affected by COVID-19 may develop disease related malnutrition (DRM) due to the catabolic situation, symptoms that interfere with intake and prolonged hospital stay. This study aims to know the percentage of patients admitted for COVID-19 who required artificial nutrition (AN), their clinical characteristics, as well as the prevalence of DRM and the risk of sarcopenia at hospital discharge and after 6 months. MATERIAL AND METHODS: Observational, prospective study, with successive inclusion of adult patients admitted for COVID-19 in whom institutional nutritional support (NS) care protocol was applied. Those who received AN underwent a nutritional screening by Short Nutritional Assessment Questionnaire (SNAQ) and an assessment by Subjective Global Assessment (SGA) at hospital discharge, as well as a screening for sarcopenia (SARC-F test) and SNAQ re-test 15 days and 6 months after by a phone call. Symptoms related to food intake, anthropometric and analytical data were also collected. RESULTS: We evaluated 936 patients with a mean age of 63.7 ± 15.3 years; predominantly male (59.7%), overweight 41%, obesity 40.4%; hypertension 52.9%; diabetes mellitus 26.6% and cancer 10.4%. The stay hospital length was 17.3 ± 13.8 days and 13.6% patients died during hospitalization. The modality of nutritional support was: 86.1% dietary adaptation + oral nutritional supplements (ONS); 12.4% enteral nutrition (EN) by nasogastric (NG) tube; 0.9% parenteral nutrition (PN) and 0.6% EN plus PN. Focusing on patients who received AN, follow-up post discharge was possible in 62 out of 87 who survived. Of these, at the time of hospital discharge, 96.7% presented nutritional risk by SNAQ and 100% malnutrition by SGA (20% B; 80% C). During admission, 82.3% presented intense anorexia and the mean weight loss was 10.9 ± 6 Kg (p

BackgroundDietary interventions did not prevent depression onset nor reduced depressive symptoms in a large multi-center randomized controlled depression prevention study (MooDFOOD) involving overweight adults with subsyndromal depressive symptoms. We conducted follow-up analyses to investigate whether dietary interventions differ in their effects on depressive symptom profiles (mood/cognition; somatic; atypical, energy-related).MethodsBaseline, 3-, 6-, and 12-month follow-up data from MooDFOOD were used (n = 933). Participants received (1) placebo supplements, (2) food-related behavioral activation (F-BA) therapy with placebo supplements, (3) multi-nutrient supplements (omega-3 fatty acids and a multi-vitamin), or (4) F-BA therapy with multi-nutrient supplements. Depressive symptom profiles were based on the Inventory of Depressive Symptomatology.ResultsF-BA therapy was significantly associated with decreased severity of the somatic (B = −0.03, p = 0.014, d = −0.10) and energy-related (B = −0.08, p = 0.001, d = −0.13), but not with the mood/cognition symptom profile, whereas multi-nutrient supplementation was significantly associated with increased severity of the mood/cognition (B = 0.05, p = 0.022, d = 0.09) and the energy-related (B = 0.07, p = 0.002, d = 0.12) but not with the somatic symptom profile.ConclusionsDifferentiating depressive symptom profiles indicated that food-related behavioral interventions are most beneficial to alleviate somatic symptoms and symptoms of the atypical, energy-related profile linked to an immuno-metabolic form of depression, although effect sizes were small. Multi-nutrient supplements are not indicated to reduce depressive symptom profiles. These findings show that attention to clinical heterogeneity in depression is of importance when studying dietary interventions.

Background Obstructive sleep apnea (OSA) is known to be an important contributory factor of coronary artery disease (CAD), but the extent of contribution of OSA in young patients suffering from CAD is not known. Thus, with an aim to detect OSA in young patients suffering from CAD by performing portable polysomnography (PSG), the present study was carried out at a tertiary care chest center. Methods A prospective study was carried out from June 2015 to June 2018, wherein 100 consecutive young (age less than 40 years), non-smoking patients with angiographically confirmed CAD, with no identifiable risk factors for cardiovascular diseases except obesity, were subjected to level 3 portable PSG studies. Results Of 100 patients with CAD, 80% had OSA (24% with mild OSA, 28% with moderate OSA, and 28% with severe OSA). Body weight and severity of OSA showed a significant correlation with a P-value of 0.033. SPSS software was used for statistical analysis. The categorical variables were compared using Fischer's exact test. Conclusion The study detected a significant number of young patients with angiographically confirmed CAD having OSA. A significant correlation was also observed between weight and severity of OSA, suggesting that overweight patients and patients with obesity have higher grades of OSA.

Objective: To describe serum levels of calcium, copper, selenium, magnesium, iron and zinc and evaluate their relationship with maternal socio-demographic characteristics and dietary variables in women in the first trimester of pregnancy. Method: Cross-sectional study with 1279 participants from the INMA cohorts. Results: The concentrations of the elements analyzed were within the normal range. Associations with higher levels of these metals were found for calcium with white meat intake (p = 0.026), for cop-per with excess body weight (p < 0.01), low social class (p = 0.03) and being multipara (p < 0.01), for magnesium with being over 35 years old (p = 0.001), high social class (p = 0.044), primiparous status (p = 0.002) and low daily intake of bread (p = 0.009) and legumes (p = 0.020); for zinc with university edu-cation (p = 0.039) and residence in Gipuzkoa (p < 0.01), and for selenium with residence in Valencia (p < 0.01), university education (p = 0.001), vitamin B6 supplementation (p = 0.006), fish intake (> 71 g/day) (p = 0.014) and having been born in Spain (p = 0.001). Further, lower iron levels were associated with being overweight (p = 0.021) or obese (p < 0.001) and vitamin B12 supplementation (p = 0.006). Conclusions: Our results suggest that trace elements in the analyzed cohorts are adequate for this stage of pregnancy. The variability in these elements is mainly linked to socio-demographic and anthropometric variables. This study is part of the INMA (Infancia y Medio Ambiente) project. It was supported by grants from Instituto de Salud Carlos III (FIS-FEDER: 06/0867, 09/00090, 13/1944, 16/1288, 19/1338; Miguel Servet-FEDER: CP15/0025; Miguel Servet-FSE: MS15/0025) , by the Council of Gipuzkoa (DFG15/009) and by the Health Department of the Basque Government.

Background The beneficial effects of urban open green space on residential health had few investigations in Taiwan. Methods A total of 40,375 participants older than 30-year-old attended the health screening program during 2007–2009 in the Metropolitan area in the New Taipei City. We defined urban open green spaces (UOGS) if land use belongs to parks, green, plaza, public schools and sport venues. Small public urban open space (SPUOS) is defined as UOGS with area less than 1 hector and with at least three of the followings: vegetations, sport facilities and benches. Greenness is defined as the mean Normalized Difference Vegetation Index (NDVI). Air quality was accessed by land use regression model. Logistic regression model was used to calculate odds ratios of diseases for proximity to UOGS or greenness. Results We found that CKD was significantly associated with proximity to SPUOS. No relationship was found between proximity to UOGS or NDVI and overweight or diabetes. The adjusted odds ratio of CKD comparing distance to SPUOS >200 m and ≤200 m was 1.144 (95% CI, 1.059–1.237). The effect of open space on CKD was similar if we incorporated public schools to SPUOS. Greenness was not associated with CKD. Subgroups analyses revealed the effect of SPUOS on CKD was more prominent in health residents, including in those who never smoke, no hypertension, no diabetes and no hypertriglyceridemia. Conclusion Proximity to SPUOS or schools is associated with lower risk of CKD for adults living in the Metropolitan area in New Taipei City.

Background Cancer risk is determined by specific factors, including body weight and dietary patterns. Accordingly, the World Cancer Research Fund/American Institute for Cancer Research published updated cancer prevention recommendations in 2018 based on comprehensive reviews of modifiable behaviors associated with cancer risk. Objective The objective of this study was to determine the extent to which US adults meet these evidence-based recommendations and how adherence differs by weight status. Design This was a cross-sectional study using nationally representative data from the 2005-2016 National Health and Nutrition Examination Survey (NHANES). Participants/setting Dietary intake data for 30,888 adults 18 years and older with normal body mass index (BMI), overweight, or obesity were analyzed. Main outcome measures Differences in dietary intakes and the proportion of adults meeting guidelines were compared across BMI categories. Statistical analyses performed Logistic regression and 1-way analysis of covariance were used to analyze differences in adherence to recommendations, controlling for age, sex, race/ethnicity, and family income as a percent of the federal poverty rate. Results Regarding fruit and nonstarchy vegetables, 62.8% of adults with normal BMI, 64.5% with overweight, and 70.1% with obesity fell short of recommendations. Regarding whole grains, 67.9% of adults with normal BMI, 70.2% with overweight, and 73.1% with obesity did not meet the recommendation. Regarding red meat, 36.7% of adults with normal BMI, 41.6% with overweight, and 43.5% with obesity consumed >18 oz/week, with a significant difference in mean intakes between adults with normal BMI and obesity (P Conclusions Few U.S. adults meet cancer prevention recommendations; adults with obesity are significantly less likely to do so. Future research should evaluate compounded risk resulting from obesity and poor dietary patterns inconsistent with current evidence-based guidelines, and inform targeted interventions to address these issues.

Background The purpose of this study is to assess the incidence and clinical characteristics of adolescent tibial tubercle fractures (TTFs) during the COVID-19 pandemic by sharing our experiences. Methods Pediatric patients aged between 0 and 18 years old with confirmed diagnosis of TTFs who were treated at our center between April 2020 and May 2020 were included in the study. In addition to demographics, mechanism injury, treatment modalities, complications were also noted. Results Sixteen patients were included in the study. The mean age was 14.8 ± 0.9 years (range: 13–16 years). The mean BMI of patients was 26.3 ± 2.3 kg/m2 (range: 23.2–30.4 kg/m2). According to the BMI-for-age percentiles growth chart, eight patients (50%) were overweight, and eight patients (50%) were at a risk of being categorized as overweight. The most common cause for the injury was jumping due to basketball (50%). Twelve of 16 patients were treated operatively by open reduction and internal fixation. The remaining 4 patients were treated non-operatively with long leg cast. Conclusion The incidence of TTFs was 16 cases over about two months during the pandemic isolation period. Our results demonstrated that all adolescent TTFs occurred during periods when outdoor activities were permitted. This finding may be explained by sudden athletic activity after prolonged immobilization. We observed that all of our patients were male and either overweight or at risk of being overweight.

We examined the interactive effects of copper (Cu) and overweight (overweight) and obesity on outcomes of burn patients. We posited that higher baseline Cu among burn patients with overweight or obesity will be associated with poor clinical outcomes vs. patients with a normal weight.A retrospective review was conducted on patients with ≥20% total burn surface area (TBSA) with an initial measurement of Cu. Patients were grouped by body mass index (BMI). The interactions between baseline Cu and BMI groups on multiple burn patient outcomes were examined in a series of multiple regression models.One-hundred-and-sixty patients met eligibility (age 43.9 ± 17.5, males 86.3%, normal weight:overweight:obesity = 53:38:69). BMI groups did not differ significantly on demographics, burn severity, or baseline biochemistry. Normal weight patients with higher baseline Cu had shorter ICU stay (ICUS), shorter length of stay (LOS), and had fewer operations (Ps0.05). In contrast, overweight and obese patients with higher baseline Cu had longer ICU stay (p = 0.001 and p = 0.034), LOS (p = 0.005 and p = 0.066), and increased operations (p = 0.001 and p = 0.067).Higher baseline Cu seems associated with adverse outcomes in overweight and obese burn patients. Further research is needed to confirm this association and explore the direction of causality.

Current guidelines consider obesity to be a relative contraindication to venoarterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock. The authors investigated the effect of body mass index (BMI) on clinical outcomes in patients treated with VA-ECMO for cardiogenic shock.This was a retrospective and observational study.University hospital.The study comprised 150 adult patients who underwent VA-ECMO for cardiogenic shock.The primary outcome was intensive care unit (ICU) mortality. Of the 150 included patients, 10 were underweight (BMI18.5 kg/m²), 62 were normal weight (BMI = 18.5-24.9 kg/m²), 34 were overweight (BMI = 25.0-29.9 kg/m²), 34 were obese class I (BMI = 30.0-34.9 kg/m²), and 10 were obese class II (BMI = 35.0-39.9 kg/m²). All-cause ICU mortality was 62% (underweight, 70%; normal weight, 53%; overweight, 65%; class I obese, 71%; class II obese, 70%). After multivariate logistic regression, BMI was not associated with ICU mortality (adjusted odds ratio [aOR] 0.99 [0.92-1.07], p = 0.8). Analysis by BMI category showed unfavorable mortality trends in underweight patients (aOR 3.58 [0.82-19.6], p = 0.11) and class I obese patients (aOR 2.39 [0.95-6.38], p = 0.07). No statistically significant differences were found among BMI categories in the incidences of complications.The results suggested that BMI alone should not be considered an exclusion criterion for VA-ECMO. The unfavorable trend observed in underweight patients could be the result of malnutrition.

Objective To develop an insight scale for Prader-Willi Syndrome (PWS), a genetically determined neurodevelopmental disorder with different psychopathological and behavioural problems. Methodology A sample of 36 PWS patients (58.3% women) attended at the Endocrinological Department of the Corporacio Sanitaria Parc Tauli (Sabadell, Barcelona) was evaluated. Insight was assessed by means of an adapted version of the Scale of Unawareness of Mental Disorder (SUMD), including three general insight dimensions: awareness of having a PWS, awareness of the effects of psychopharmacological medication and awareness of the social consequences, as well as three items that assess awareness of each particular symptom of the disease (obesity/overweight, excessive appetite and excessive food intake). Results The final Scale included six items and demonstrated an adequate internal consistency (Cronbach Alfa of 0.857 for Caregivers and 0.798 for Clinicians) but a high inter-rate variability. External validation using an Analytical-Visual Insight Scale was adequate. Conclusions The Adapted version for Prader-Willi patients of the Scale of Unawareness of Mental Disorder (APW-SUD) showed adequate psychometric properties and it is an easy to administer means to assess insight in this population.

Background After childbirth, most women do not lose the extra weight gained during pregnancy. This is important because postnatal weight retention contributes to the development of obesity in later life. Research shows that postnatal women living with overweight would prefer to weigh less, are interested in implementing weight loss strategies, and would like support. Without evidence for the benefit of weight management interventions during pregnancy, postnatal interventions are increasingly important. Research has focused on intensive weight loss programmes, which cannot be offered to all postnatal women. Instead, we investigated the feasibility of a brief intervention delivered to postnatal women at child immunisation appointments. This qualitative study explored the views of women who received the intervention and healthcare professionals who delivered it. Methods The intervention was delivered within the context of the national child immunisation programme. The intervention group were offered brief support encouraging self-management of weight when attending general practices to have their child immunised at two, three and four months of age. The intervention involved motivation and support from practice nurses to encourage women to make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme. Nurses provided external accountability for weight loss. Women were asked to weigh themselves weekly and record this on a weight record card. Nested within this trial, semi-structured interviews explored the experiences of postnatal women who received the intervention and nurses who delivered it. Results The intervention was generally acceptable to participants and child immunisation appointments considered a suitable intervention setting. Nurses were hesitant to discuss maternal weight, viewing the postnatal period as a vulnerable time. Whilst some caveats to implementation were discussed by nurses, they felt the intervention was easy to deliver and would motivate postnatal women to lose weight. Conclusions Participants were keen to lose weight after childbirth. Overall, they reported that the intervention was acceptable, convenient, and, appreciated support to lose weight after childbirth. Although nurses, expressed concerns about raising the topic of weight in the early postnatal period, they felt the intervention was easy to deliver and would help to motivate women to lose weight.

Adequate breast milk not only supports healthy growth, but also cognitive development and long-term health of the baby. It is recommended that babies should be exclusively breastfed for the first 6 months to get optimal growth, development and health. Infants who were exclusively breastfed had normal weight overall, and none were overweight (obese) or even malnourished. So that breast milk is the main, best and first natural food for babies given without additional food at least until the age of 4 months and if possible until the age of 6 months. Breast milk is proven to protect children against various infectious diseases such as diarrhea, ARI and others. The purpose of this study was to analyze differences in body weight and incidence of infection in infants 0-6 months who were given formula milk and exclusive breastfeeding in the Nibong Health Center Work Area, North Aceh Regency in 2021.Type of observational analytic research with cross-sectional study design. The research stages are: 1) Preliminary Survey 2) Data collection using questionnaires, 3) Data Processing and Analysis. The trial subjects of this study were parents who had babies aged 0-6 months as many as 126 people, 63 babies 0-6 months who were given exclusive breastfeeding and 63 babies 0-6 months who were given formula milk. Data were analyzed using bivariate analysis using independent T-test.The results of the study were that there was a difference in the weight of infants 0-6 months fed formula and breast milk (p=0.047), there was a difference in the incidence of diarrhea in infants 0-6 months fed formula and breast milk (p=0.00) and there was a difference in the incidence ARI for infants 0-6 months who were given formula milk and breast milk (p=0.04). Mandatory output in the form of an accredited national journal. The technology readiness level of this research is 2.

Background/Objectives It has been suggested that the association between shift work and chronic disease is mediated by an increase in obesity. However, investigations of the relationship between shift work and obesity reveal mixed findings. Using a recently developed exposure assessment tool, this study examined the association between shift work and obesity among Canadian women from two studies: a cohort of university alumni, and a population-based study. Methods Self-administered questionnaire data were used from healthy, currently employed females in a population-based study, the Ontario Women’s Diet and Health case-control study (n = 1611 controls), and from a subset of a of university alumni from the Canadian Study of Diet, Lifestyle, and Health (n = 1097) cohort study. Overweight was defined as BMI=25 to

PurposeThe clinical significance of body mass index (BMI) on long-term outcomes has not been extensively investigated in Asian patients with colorectal cancer (CRC). This study aims to describe the association between BMI and survival, plus providing BMI cut-off value for predicting prognosis in CRC patients.Materials and MethodsA total of 1,182 patients who had undergone surgery for stage I-III CRC from June 2004 to February 2014 were included. BMI was categorized into four groups based on the recommendation for Asian ethnicity. The optimal BMI cut-off value was determined to maximize overall survival (OS) difference. ResultsIn multivariable analysis, underweight BMI was significantly associated with poor OS (hazard ratio [HR], 2.38; 95% confidence interval [CI], 1.55 to 3.71; p < 0.001) and obese BMI was associated with better OS (HR, 0.72; 95% CI, 0.53 to 0.97; p=0.036) compared with the normal BMI. Overweight and obese BMI were associated with better recurrence-free survival (HR, 0.64; 95% CI, 0.42 to 0.99; p=0.046 and HR, 0.58; 95% CI, 0.38 to 0.89; p=0.014, respectively) compared with the normal BMI group. BMI cutoff value was 20.44 kg/m2. Adding the BMI cutoff value to cancer staging could increase discriminatory performance in terms of integrated area under the curve and Harrell’s concordance index. ConclusionCompared to normal BMI, underweight BMI was associated with poor survival whereas obese BMI was associated with better survival. BMI cut-off value of 20.44 kg/m2 is a useful discriminator in Asian patients with CRC.

Abstract. Background: The aim of this study was to assess the effects of supplementation with flaxseed on anthropometric measurements, lipid profile, insulin resistance, and inflammatory biomarkers in overweight and obese adults. Methods: Fifty overweight and obese adults with body mass index (BMI) of 30.72 ± 3.31 kg/m2 participated in this study. Participants were randomly assigned to take lifestyle advice or lifestyle advice plus 30 g/day milled flaxseed for 12 weeks. The primary outcome was body weight; secondary outcomes included other anthropometric parameters, lipid profile and inflammatory biomarkers. Results: At the end of the study, the following significant mean differences were seen in flaxseed and control groups, respectively: weight [−9.36 vs. −3.09 kg; P 2; P Conclusion: These results suggest that flaxseed supplementation in addition to lifestyle modification is significantly superior to lifestyle modification alone for weight loss. More studies with different dosages of flaxseed are needed to find the optimal dosage. This trial was registered at clinicaltrials.gov as NCT02410668.

Objective To examine whether patterns of body mass index (BMI) percentile gains across childhood predict BMI percentile, overweight and obesity, waist circumference, and elevated or prehypertensive blood pressure at age 15. Methods Trained technicians in the Study of Early Child Care and Youth Development assessed children's weight and height from birth to 15 years and waist circumference and blood pressure at age 15 (n = 1,132). Children's BMI percentile trajectories from age 2 to age 13 along with 28 demographic and social covariates were used to predict BMI percentile, waist circumference, overweight, obesity, and elevated or prehypertensive blood pressure. Linear and logistic regressions were used to predict BMI percentile, overweight, obesity, waist circumference, and elevated or prehypertensive blood pressure. Results Children were classified into one of four BMI percentile trajectories: "low stable" (28.4%), "low-to-high" (11.8%), "median stable" (29.0%), and "high rising" (30.7%). Children in trajectory classes characterized by persistent above average BMI percentile or by periods of rapid BMI percentile gains were more likely than their peers to experience poor weight and elevated or prehypertensive outcomes in adolescence. Trajectory class membership explained substantially more variance in adolescent health outcomes than demographic covariates alone. Estimated maternal BMI was a key independent predictor of adolescent outcomes. Conclusions Different patterns of BMI percentile gains, namely those with rapid gains or persistently above average BMI percentile, from ages 2-13 predicted weight, waist circumference, and elevated or prehypertensive blood pressure at age 15, above and beyond demographic and social characteristics.

OBJECTIVE To compare weight status and body mass index z-scores (BMIz) of refugee children upon arrival to the Southeastern US and after resettlement with age- and sex-matched controls of nonrefugee children. METHODS We identified refugee children resettled between July 2014 and June 2018 to Forsyth County, NC. Refugees were assigned age- and sex-matched controls (3 controls:1 refugee) who received care at the same health care site, were Medicaid insured, and had height and weight recorded at time of their matched refugee's resettlement plus at least 2 additional visits. BMI and BMIz were calculated. Pearson chi-square test assessed differences in weight status at the time of refugee resettlement and at the last measured time point. Multilevel linear mixed-effects regression models assessed change in BMIz by refugee status, adjusting for sex, race/ethnicity, age, and time since resettlement. RESULTS This study examined 139 pediatric refugees and 417 nonrefugee controls; 46% were female. At the time of resettlement, refugees had a higher rate of underweight (3.3% vs 1.9%), higher rate of healthy weight (68.9% vs 48.2%), and lower rate of overweight/obesity (27.8% vs 50%), compared to controls P

Purpose: This work aims to determine the association between vitamin D deficiency and metabolic syndrome in overweight and obese adolescents from Ukraine.Methods: Anthropometric measurements were taken and general and biochemical examinations were performed on 136 obese and overweight adolescents and 60 adolescents with normal body weight. The vitamin D status was determined using 25-hydroxyvitamin D (25(OH)D) (calcidiol) levels in blood serum. To establish the factors influencing vitamin D status, the subjects were asked to answer a questionnaire and 2007 International Diabetes Federation diagnostic criteria were used to determine the incidence of metabolic syndrome. All research results were processed statistically.Results: A calcidiol sufficiency level was found in 3.9% of obese adolescents and 6.7% of overweight adolescents. Metabolic syndrome was found in 64.4% of obese adolescents with vitamin D deficiency, and in 26.2% of overweight adolescents. Factors associated with an increased risk of developing vitamin D deficiency in adolescents with metabolic syndrome included male sex (p=0.042), low income per family member (p=0.040), daily milk consumption of up to 1 cup per day (p=0.001), physical activity (p=0.001), duration of outdoor stays (p=0.001), and passive rest in front of a computer or television (p=0.001). Adolescents with metabolic syndrome were found predominance of body mass index (p

Introduction This study aimed to investigate the association of diet quality (DQ) and dietary acid load (DAL) with insulin resistance (IR) in overweight children and adolescents. Materials and methods The study was conducted on 135 overweight participants aged 6–17 years. DQ was assessed using the Healthy Eating Index 2015 (HEI-2015) and the HEI-2015-TUBER, revised in accordance with the Turkey Dietary Guidelines (TUBER). Estimation of DAL was made calculating the potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores. Results The HEI-2015-TUBER score was lower in those with IR than in those without IR (p = 0.021). Higher PRAL and NEAP scores were found in those with IR (p = 0.060 and p = 0.044, respectively). Moreover, a one-unit increase in the HEI-2015-TUBER score and the DAL score was associated with a reduction of 4.2% and a rise of approximately 3% in IR risk, respectively. Conclusions Healthy eating habits in overweight paediatric groups may help to reduce the IR risk, improving DQ and decreasing DAL.

Background: Studies of transgender/gender diverse (TGD) youth indicate a high prevalence of overweight/obesity and concern for unhealthy weight management behavior. This study describes the associa...

Background/aims We investigated the effect of metabolic dysfunction-associated fatty liver disease (MAFLD) on future mortality and cardiovascular disease (CVD) using a prospective community-based cohort study. Methods Individuals from two community-based cohorts who were 40 to 70 years old were prospectively followed for 16 years. MAFLD was defined as a high fatty liver index (FLI ≥60) plus one of the following conditions: overweight/obesity (body mass index ≥23 kg/m2), type 2 diabetes mellitus, or ≥2 metabolic risk abnormalities. Nonalcoholic fatty liver disease (NAFLD) was defined as FLI ≥60 without any secondary cause of hepatic steatosis. Results Among 8,919 subjects (age 52.2±8.9 years, 47.7% of males), 1,509 (16.9%) had MAFLD. During the median follow-up of 15.7 years, MAFLD independently predicted overall mortality after adjustment for confounders (hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.05 to 1.69) but NAFLD did not (HR, 1.20; 95% CI, 0.94 to 1.53). MAFLD also predicted CVD after adjustment for age, sex, and body mass index (HR, 1.35; 95% CI, 1.13 to 1.62), which lost its statistical significance by further adjustments. Stratified analysis indicated that metabolic dysfunction contributed to mortality (HR, 1.51; 95% CI, 1.21 to 1.89) and CVD (HR, 1.27; 95% CI, 1.02 to 1.59). Among metabolic dysfunctions used for defining MAFLD, type 2 diabetes mellitus in MAFLD increased the risk of both mortality (HR, 2.07; 95% CI, 1.52 to 2.81) and CVD (HR, 1.42; 95% CI, 1.09 to 1.85). Conclusions MAFLD independently increased overall mortality. Heterogeneity in mortality and CVD risk of subjects with MAFLD may be determined by the accompanying metabolic dysfunctions.

Background Weight loss medications have been shown to be effective for weight loss and reducing disease state risk in patients who are overweight or obese. However, it is unknown what impact pharmacists have on weight loss when providing medication management services. Objective To evaluate weight loss outcomes and clinic utilization of a pharmacist-run weight-loss pharmacotherapy service. Setting VA Tennessee Valley Healthcare System (TVHS) in Nashville, TN Practice description Patients enrolled in the MOVE! weight loss program were referred to a clinical pharmacy specialist (CPS) who was able to assess comorbidities, prescribe weight loss medication, and provide ongoing follow-up via telehealth visits. Practice innovation This is the first description of a pharmacist-run weight loss pharmacotherapy clinic. This model expanded the role of pharmacists at TVHS, where CPS involvement was previously limited to chart reviews when medication recommendations were requested. Evaluation This prospective quality improvement project evaluated patients seen by the CPS in the first 6 months of clinic implementation. Primary outcomes included change in weight and proportion of patients with at least 5% weight loss at the end of study period. Results were compared with patients seen by preventative medicine providers (PMPs) in the same time frame. Results A total of 79 patients were seen in the CPS clinic and 40 met inclusion criteria. The clinic utilization rate was 100%. Mean weight change was -3.6 ± 5.7 kg (p less than 0.0005) and 25% of patients followed by the CPS lost at least 5% body weight. In the PMP clinic, 29 patients demonstrated a mean weight change of -1.6 ± 6.0 kg (p=0.15 compared to baseline) and 17.2% lost at least 5% body weight. Conclusion This pharmacist-led weight loss clinic demonstrated statistically significant reductions in weight and was able to expand access to care for patients seeking weight loss services.

Objective To identify the prevalence of pre-pregnancy overweight/obesity in pregnant women and its relationship with socio-demographic factors and to describe the maternal and perinatal outcomes in a Barcelona hospital (Spain). Method A descriptive cross-association study, with retrospective data collection, was performed Barcelona Hospital. The data of 5447 pregnant women who delivered at >=23 weeks of gestation were included. Body Mass Index (BMI) data were categorised into World Health Organization classifications. p values Results The prevalence of pre-pregnancy obesity was 8.4% and 18.9% for overweight. Gestational diabetes was more frequent in pre-pregnancy overweight/obesity (OR 1.92: 95% CI 1.54–2.40 and OR 3.34: 95% CI 2.57–4.33), as were preeclampsia (OR 2.08: 95% CI 1.55–2.79 and OR 3.35: 95% CI 2.38–4.71), induction of labour (OR 1.19: 95% CI 1.02–1.38 and OR 1.94: 95% CI 1.57–2.10), caesarean section (OR 1.41: 95% CI 1.21–1.65 and OR 2.68: 95% CI 2.18–3.29), prematurity (OR 1.28: 95% CI 1–1.65 and OR 1.79: 95% CI 1.32–2.44) and macrosomia (OR 1.87: 95% CI 1.43–2.46 and OR 2.03: 95% CI 1.40–2.93). Conclusions One in four pregnant women had pre-pregnancy overweight or obesity. This study shows the relationship between pre-pregnancy overweight or obesity with adverse maternal and perinatal outcomes.

OBJECTIVES To investigate peripheral enthesitis with power Doppler ultrasound (PDUS) in patients presenting low back pain (LBP) and metabolic syndrome (MetS) in comparison with patients with only LBP, to correlate US scores with clinical-anthropometric characteristics, and to define any relationship between enthesitis and concurrent diffuse idiopathic hyperostosis syndrome (DISH). METHODS Sixty outpatients with LBP and MetS, evaluated with multi-site entheseal PDUS, scoring inflammatory and structural damage changes, were retrospectively analyzed. A group of 60 subjects with LBP, without MetS and evaluated with the same protocol, was analyzed as the control group. RESULTS Patients showed overweight (BMI 29.8) and low-grade inflammatory state (C-reactive protein [CRP] 0.58mg/dL, erythrosedimentation rate [ESR] 20.2mm/h). Enthesitis was demonstrated in 52 (86%) patients (17.6% entheses), and in 8 controls (13.3%) (p

Background Obesity is associated with reduced postoperative mortality among patients undergoing cardiovascular surgery. However, body mass index cannot differentiate abdominal fat composition. This study evaluated the relationships between total abdominal, subcutaneous, and visceral fat composition and postoperative mortality in East Asian patients undergoing cardiovascular surgery. Methods Adult patients who underwent cardiovascular surgery between October 2004 and December 2016 were retrospectively included. Total, subcutaneous, and visceral fat areas were measured from cross-sectional computed tomography images. The relationships between each fat composition and mortality were evaluated. Results In all, 3661 patients were analyzed, and overall mortality was 19.9% (729 died) during the 4.6-year median follow-up period. The risks of all-cause and cardiac-cause mortality decreased as subcutaneous fat composition increased (adjusted hazard ratio 0.997; 95% confidence interval, 0.994 to 1.000; and adjusted hazard ratio 0.994; 95% confidence interval, 0.989 to 0.999; P = .02 and P = .01, respectively). No association was detected between the total and visceral fat area and mortality. Conclusions Reduced abdominal subcutaneous fat, but not the total or visceral fat composition, was associated with higher all-cause and cardiac-cause mortality after cardiovascular surgery in East Asian patients, consisting mainly of normal weight or overweight patients.

Psoriasis has been linked to obesity, although data on the incidence of psoriasis according to body mass index (BMI) are limited.To compare incidence of psoriasis among patients stratified by BMI category (normal or underweight, overweight, obese class 1, obese class 2/3).Retrospective cohort analysis of a demographically heterogeneous sample of over 1.5 million patients in the United States between January 1, 2008 and September 9, 2019.Crude incidence of psoriasis per 10,000 person-years was 9.5 (95% confidence interval [CI], 9.1-10.0) among normal or underweight patients, 11.9 (95% CI, 11.4-12.4) among overweight patients, 14.2 (95% CI, 13.6-14.9) among obese class 1 patients, and 17.4 (95% CI, 16.6-18.2) among obese class 2/3 patients. Compared to patients with BMI 25.0, those who were overweight (adjusted hazard ratio, 1.19; 95% CI, 1.12-1.27; P .001), obese class 1 (adjusted hazard ratio, 1.43; CI, 1.34-1.53; P .001) and obese class 2/3 (adjusted hazard ratio, 1.83; CI, 1.71-1.95; P .001) significantly greater risks for developing psoriasis.Influence of obesity on psoriasis severity could not be measured.BMI independently influences the development of psoriasis. There appears to be a graded association between BMI and risk of psoriasis.

Childhood obesity is a public health challenge. Between 1999 and 2012, the prevalence in Mexico of overweight and obesity in schoolchildren went from 25.5 to 32 %.To report current prevalence of overweight and obesity in schoolchildren from the municipality of Durango, Mexico.Cross-sectional survey conducted between January 2017 and December 2018. A total of 24,600 children aged between six and 11 years from 138 schools of the municipality of Durango were included. The body mass index reference values established by the World Health Organization were used to determine the presence of overweight and obesity.The prevalence of overweight was 19.7 %, of obesity, 16 %, and of overweight and obesity combined, 35.7 %. In the six-year-old group, a prevalence of overweight-obesity of 25.4 % was found, and in the 11-year-old group, 41.1 %.The prevalence of overweight-obesity in children aged from 6 to 11 years in the municipality of Durango is higher than those reported in the national survey by states in 2012 and in the 2016 national survey; a trend towards an increase with age was observed.La obesidad infantil es un reto de salud pública. Entre 1999 y 2012, en México la prevalencia de sobrepeso y obesidad (SO) en niños escolares pasó de 25.5 a 32 %.Reportar la prevalencia actual de SO en niños escolares del municipio de Durango, México.Encuesta transversal realizada entre enero de 2017 y diciembre de 2018. Se incluyeron 24 600 niños de seis a 11 años, de 138 escuelas del municipio de Durango. Se utilizaron los valores de referencia del índice de masa corporal establecidos por la Organización Mundial de la Salud para determinar la presencia de SO.La prevalencia de sobrepeso fue de 19.7 %, la de obesidad de 16 % y la de SO de 35.7 %. En el grupo de seis años se encontró una prevalencia de SO de 25.4 % y en el de 11 años, de 41.1 %.La prevalencia de SO en niños de seis a 11 años del municipio de Durango es más elevada que la reportada en la encuesta nacional por entidad federativa en 2012 y la nacional en 2016; se observó tendencia al incremento en la prevalencia conforme aumenta la edad.

During the first 1000 days of life is the basis for a child's future health established.To evaluate the impact of a prenatal educational intervention in pregnant women on the nutritional status of the child from birth to 4 months of age.Quasi-experimental intervention design in women with at least 12 weeks of gestation, who were randomly assigned to an intervention group (IG) to participate in five group and three individual sessions on feeding practices and maternal perception of the child's weight and signals of hunger-satiety; the control group (CG) received routine care that included at least three prenatal consultations.Thirty women were included in each group. After the intervention, women in the CG practiced less exclusive breastfeeding, were more likely to underestimate or overestimate the children's weight, and perceived hunger-satiety signals with less intensity (p0.05). 80 % of the infants in the IG had normal weight, whereas 63 % of those in the CG had a combination of overweight and obesity (p0.05).The prenatal education program in pregnant women showed a significant effect on postnatal nutritional status of infants four months after birth.Durante los primeros 1000 días de vida se establece la base para la salud futura de un niño.Evaluar el impacto de una intervención educativa prenatal en mujeres embarazadas sobre el estado nutricional del hijo desde el nacimiento hasta los cuatro meses de edad.Diseño cuasiexperimental de intervención con mujeres a partir de la semana 12 de gestación, asignadas aleatoriamente a un grupo de intervención (GI) para recibir cinco sesiones grupales y tres individuales sobre prácticas de alimentación y percepción materna del peso del hijo y de señales de hambre-saciedad; el grupo control (GC) recibió atención de rutina que incluía al menos tres consultas prenatales.30 mujeres conformaron cada grupo. Después de la intervención, las mujeres del GC practicaron menos lactancia materna exclusiva, fueron propensas a subestimar o sobrestimar el peso del hijo y percibieron con menor intensidad las señales de hambre-saciedad (p0.05). El 80 % de los lactantes del GI presentaron peso normal y 63 % de los niños del GC, una combinación de sobrepeso y obesidad (p0.05).El programa de educación prenatal en mujeres embarazadas mostró un efecto significativo en el estado nutricional de los lactantes después de cuatro meses del nacimiento.

Binge-eating disorder (BED) is associated with overweight/obesity, physical inactivity, and disturbances in affective functioning. While research suggests that physical activity (PA) may have beneficial effects on BED symptoms, little is known about the daily correlates of PA. As a first step in understanding the processes linking PA and binge eating, this study examined associations between PA (i.e., self-reported time engaged in moderate-to-vigorous PA), affective functioning (i.e., positive and negative affect, body satisfaction, emotion regulation), and eating-related cognitions and behaviors (i.e., craving, overeating, loss of control eating) measured via ecological momentary assessment (EMA). Adults with BED (N = 91) completed a seven-day EMA protocol during which they completed repeated measures of these variables. Results indicated individuals who reported greater time engaged in PA over the EMA protocol evidenced higher positive affect and body satisfaction, and lower overeating (between-subjects effects). No significant within-subjects effects were observed. Findings demonstrate that individual differences in PA levels were related to more adaptive affective functioning and eating regulation in daily life. Results highlight the relevance of PA in BED, and the need for future studies to identify the timescale of these relationships using objective measurements of PA.

Background: Despite the burgeoning data on the double burden of malnutrition (DBM) in sub-Saharan Africa, longitudinal studies to examine malnutrition amongst first-episode schizophrenia are uncommon in the modern literature. Aim: To determine the extent of nutritional variations amongst persons with schizophrenia at intervals of 1-year treatment follow-up. Setting: This study was conducted at the Federal Neuropsychiatric Hospital, Enugu, Nigeria. Methods: Consecutive incident cases that fulfilled the criteria for schizophrenia were recruited into the study. After a baseline assessment, 206 incident cases of schizophrenia were followed up at 4th, 8th, 12th weeks, 6 months and 1 year for indicators of nutritional outcome. The body mass index (BMI) was used to measure the nutritional status amongst the study participants. Changes in the BMI across intervals of follow-up were examined using repeated measures analysis of variance, whereas the socio-demographic and clinical variables were evaluated as predictors of outcome using multiple regression analysis. Results: After 1 year of treatment with antipsychotics, the prevalence of underweight decreased from 19.9% (95% CI, 19.8% – 20.0%) at baseline to 16.0% (95% CI, 15.9% – 16.1%) at 1 year, but the prevalence of overweight/obesity increased from 29.1% (95% CI, 29.0% – 29.2%) at baseline to 43.2% (95% CI, 43.0% – 43.3%) at 1 year of follow-up. The predictors of BMI at 1 year were antipsychotic medication (32.7% variance), duration of vagrancy (24.0%) and age at onset (20.0%). Conclusion: The finding of coexistence of undernutrition and overnutrition across the intervals of treatment follow-up underscores the need for comprehensive interventions to address both extremes of malnutrition amongst patients with schizophrenia.

Summary An increasing number of governments worldwide have introduced a tax on sugar-sweetened beverages (SSB) for public health. However, the adoption of such a policy is still debated in many other countries, such as in the Netherlands. We investigated Dutch stakeholder views on taxation of SSB and perceived barriers and facilitators to its adoption in the Netherlands. Semi-structured interviews were conducted in 2019 with 27 stakeholders from health and consumer organizations, health professional associations, trade associations, academia, advisory bodies, ministries and parliamentary parties. Data were analysed using a thematic content approach. The findings reveal that, between and within sectors, stakeholders expressed contradictory views on the effectiveness, appropriateness and (socio)economic effects of an SSB tax. Perceived barriers to the adoption of an SSB tax in the Netherlands included an unfavourable political context, limited advocacy for an SSB tax, a strong lobby against an SSB tax, perceived public opposition, administrative load and difficulties in defining SSB. Perceived facilitators to its adoption included an increasing prevalence of overweight, disappointing results from voluntary industry actions, a change of government, state budget deficits, a shift in public opinion, international recommendations and a solid legal basis. In conclusion, this study shows that several challenges remain to be overcome for the adoption of an SSB tax in the Netherlands. Similar research on stakeholder views in other countries may further inform SSB tax policy processes.

Introduction and objectives Childhood obesity trends are plateauing in Spain, but limited information is available about how they differ by region. This study assessed childhood and adolescent the prevalence and incidence of overweight and obesity from 2005 to 2017 across 8 Spanish regions. Methods This longitudinal study used height and weight measurements from 2.5 million children aged 2 to 17 years to calculate overweight and obesity, according to the World Health Organization (WHO) guidelines. Data were obtained from The Base de datos para la Investigacion Farmacoepidemiologica en Atencion Primaria, and the Information System for Research in Primary Care. Prevalence and incidence rates and trends from 2005 to 2017 were calculated and stratified by age, sex, and region. Results The overall obesity prevalence increased in boys and girls from age 2 (0.8%; 95%CI, 0.8-0.9 in both sexes) until peaking at age 7 in girls (17.3%; 95%CI, 17.1-17.5) and age 9 in boys (24.1%; 95%CI 23.9-24.3). The highest and lowest obesity prevalences were observed in Murcia and Navarre. Overall obesity prevalence trends decreased from 2005 to 2017 in all age-sex groups and in most regions. Highest obesity incidence rates were found in children aged 6 to 7 years, (4.5 [4.5-4.5] and 3.5 [3.5-3.5] new obesity cases per 100 person-years in boys and girls, respectively). Boys had higher prevalence and incidence rates than girls across all regions. Overweight/obesity prevalence and incidence rates and their trends were consistently higher than the obesity results, although a similar pattern was observed across sex and age. Conclusions Overweight and obesity prevalence slightly decreased in Spain from 2005 to 2017, but regional, sex, and age differences persisted. Because incidence peaked around the age of 6 years, it may be important to begin health promotion programs at an early age.

Increased fruit and vegetable consumption (FVC) beneficially impacts hypertension, yet researchers have not synthesized the effects of FVC interventions on blood pressure (BP) among overweight or obese individuals. Therefore, we aimed to examine if diets with increased FVC decrease BP in overweight and obese persons and explore effects of moderators, study methods, participants, intervention, and source characteristics.A thorough literature search was conducted in CINAHL, ProQuest DissertationTheses, Scopus, PubMed, The Cochrane Library, and Web of Science. Last search was conducted on February 28, 2020. Inclusion criteria consisted of randomized controlled trials, an increased FVC intervention, and a body mass index (BMI) ≥25. Studies were independently coded and evaluated for bias using Cochrane Collaboration's tool for assessing study bias. The Grading of Recommendations Assessment, Development and Evaluation tool was used to evaluate the body of evidence, which was found to be moderate. Data was analyzed using Stata 16SE Software. We used a random effects model, comparing mean differences. Moderator analysis was conducted using meta-regression for continuous variables and meta-analytic ANOVA analog for categorical variables. Publication bias was assessed using funnel plot symmetry, Begg and Mazumdar's rank and correlation, Egger's test of the intercept, and Duval and Tweedie's trim and fill.Ten studies met criteria, which included 6862 participants. Overall, effects of FVC interventions on systolic blood pressure (SBP) was 2.16 mmHg (p 0.001) and -0.55 mmHg (p = 0.39) for diastolic blood pressure (DBP). Moderator analyses showed greater drops in SBP from samples recruited from the community and medical schools (vs. health care/programs), interventions that used the DASH diet, and measured intake with food diaries. When concealed allocation was used and fidelity checked, there were less decreases in SBP than when it was not used. The amount of FVC significantly moderated the effects of SBP and DBP with greater increased FVC leading to greater decreases in SBP and DBP.Our findings are encouraging in that FVC improves blood pressure. However, outcomes are limited by the small number of studies that met inclusion criteria, significant heterogeneity, possible publication bias, and several studies had quality concerns. Tests for publication bias indicated none and most heterogeneity among studies was explained with moderator analysis our findings should be interpreted with caution.Increased FVC decreased SBP and DBP in obese and overweight individuals which may lower the risk of cardiovascular events. In the future, researchers might conduct higher quality studies and report quality indicators. Researchers might examine the effects of interventions for specific subgroups (overweight vs obese, younger vs older) and explore the impacts of diet-assisted technologies.

OBJECTIVE To determine the effect of obesity on rates of systemic complication in operatively treated acetabular fractures. DESIGN Retrospective Case Control study. SETTING Level 1 Trauma CenterPatients/Participants: All patients with acetabular fractures managed operatively from January 2015-December 2019. Patients were divided into groups based on their Body Mass Index (Normal weight=BMI 40). INTERVENTION Operative management of an acetabular fracture. MAIN OUTCOME MEASUREMENT Systemic complications including mortality, sepsis, pneumonia, acute respiratory distress syndrome, deep vein thrombosis, pulmonary embolism, or venous thrombotic event. RESULTS A total of 428 patients were identified. 109 (25.4%) were normal weight, 133(31.1%) were overweight, 133(31.1%) were obese, and 53(12.4%) were morbidly obese. The rate of systemic complications was 17.5% and overall mortality rate was 0.005%. There were no significant differences between the different BMI groups in all-cause complication or any individual complication. When the morbidly obese group was compared to all other patients, there were also no significant differences in all-cause complication or any individual complications. CONCLUSION In conclusion, in this study there was no association with increasing BMI and inpatient systemic complications after operative management of acetabular fractures. As we continue to refine our understanding of how obesity affects outcomes after acetabular fracture surgery, other indices of obesity might prove more useful in predicting complications. In the obese population, there are well-documented risks of postoperative infections and challenges in obtaining an anatomic reduction, but the fear of postoperative systemic complications should not deter surgeons from undertaking operative management of acetabular fractures in the obese population. As the prevalence of obesity in trauma patients continues to increase, it is incumbent upon us to continue to improve our understanding of optimal treatment for our patients. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

OBJECTIVES To compare risk of reoperation for femoral neck fracture patients undergoing fixation with cancellous screws (CS) or sliding hip screws (SHS) based on surgeon fellowship (trauma-fellowship-trained versus non-trauma-fellowship-trained). DESIGN Retrospective review of FAITH data. SETTING Eighty-one centers across eight countries. PATIENTS/PARTICIPANTS 819 patients ≥ 50 years-old with low energy hip fractures requiring surgical fixation. INTERVENTION Patients were randomized to CS or SHS in the initial dataset. MAIN OUTCOME MEASUREMENTS The primary outcome was risk of reoperation. Secondary outcomes included death, serious adverse events, radiographic healing, discharge disposition, and use of ambulatory devices postoperatively. RESULTS There was no difference in risk of reoperation between the two surgeon groups (p > 0.05). Patients treated by orthopaedic trauma surgeons were more likely to be overweight/obese and have major medical comorbidities (p < 0.05). There was a higher risk of serious adverse events, higher likelihood of radiographic healing, and higher odds of discharge to a facility for patients treated by trauma-fellowship-trained surgeons (p < 0.05). CONCLUSIONS Based on this data, risk of reoperation for low energy femoral neck fracture fixation is equivalent regardless of fellowship training. The higher likelihood of radiographic healing noted in the trauma-trained group does not appear to have a major clinical implication as it did not affect risk of reoperation between the two groups. Patient-specific factors present pre-injury, such as body habitus and medical comorbidities, may account for the lower odds of discharge to home and higher risk of postoperative medical complications for patients treated by orthopaedic trauma surgeons. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Purpose: We investigated the relationship of 25-hydroxyvitamin D (25[OH]D) level with obesity and atherosclerosis in Japanese adolescents.Methods: We examined 492 children (247 boys and 245 girls) aged 12–13 years. The serum 25(OH)D level was compared among underweight, healthy weight, and overweight children. Spearman correlation coefficient analysis was performed to examine the relationships between the 25(OH)D level and body mass index (BMI), plasma lipids, and blood pressure and to compare the latter between the normal (≥20 ng/mL) and low (

Introduction: The study sought to investigate the effect of weight change on hepatic steatosis (HS) incidence with or without liver fibrosis in metabolically healthy overweight or obese individuals. Methods: A cohort of 14,779 metabolically healthy men and women who were overweight or obese (body mass index ≥23 kg/m 2) and free from HS and an intermediate or high probability of fibrosis at baseline were followed for a median of 5.2 years. Metabolic health was defined as freedom from the components of metabolic syndrome and a homeostatic model assessment of insulin resistance 5.0%, relative to the no weight change group (–0.9% to 0.9%) were 0.52 (0.44–0.60), 0.83 (0.75–0.92), 1.21 (1.10–1.33), and 1.51 (1.36–1.69), respectively. Clinically relevant weight loss of >5% was also associated with a lowered risk of HS with intermediate or high probability of advanced fibrosis. In mediation analyses, associations remained significant, although adjustment for metabolic risk factors was attenuating. Discussion: Clinically relevant weight loss was associated with a reduced risk of developing nonalcoholic fatty liver disease with or without intermediate or high probability of advanced fibrosis in metabolically healthy overweight or obese individuals.

Objective Peripherally inserted central catheters (PICC) guarantee a stable and safe vascular access to administer irritants or vesicants therapies. However, they may occasionally be affected by relevant thrombotic complications especially in patients with hypercoagulability such as oncological patients. Among the identification of independent risk factors, the role of body mass index (BMI) ≥25 kg/m2 is now emerging in literature with conflicting results. The aim of this systematic review is to analyze the available scientific literature in order to determine whether BMI could represent a risk factor in the development of thromboembolic event among cancer patients with PICCs. Data sources and review methods A scientific literature review was performed in Pubmed, Embase and Cinahl from Jan 1, 2010 to September 10, 2020 in which we identified 100 records. Of these, 88 were excluded and 14 were reviewed in full text. Among the reviewed records, 6 articles satisfied the inclusion criteria for analysis. These criteria included the English language, oncological patients with PICCs, the evaluation of catheter-related thrombosis as well as the stratification of patients according to BMI. Studies off topic and lacking data on PICC related complications among overweight and underweight patients were excluded. The includedstudies, judged with Newcastle-Ottawa Scale, was fair-lower quality. The primary endpoint was the relative risk (RR) of PICC-related thrombosis of overweight/obese vs normal weight/underweight (i.e., BMI ≥25 vs Results A total of 2431 patients were included in the analysis. Overall, 15.1% of patients developed PICC-related thrombosis within a median time of 23.2 days (range 11.0-42.5) after PICC implantation. Concerning BMI, 52.6% of the entire population was overweight/obese. We assessed the proportion of patients with PICC-related thrombotic events in the two groups, with 28% (95% CI, 12%-45%) of events registered in the overweight/obese patients cohort, and 13% (95% CI, 6%-19%) in the normal weight/underweight cohort. The pooled relative risk (RR) was 2.06 (95% CI, 1.21-3.49, p Conclusion This review showed a two-fold risk of thrombosis in overweight/obese compared to normal weight/underweight oncological patients with PICCs. Underweight condition could also play a role in thrombosis development, especially in nasopharyngeal and digestive system cancer. Future prospective studies are needed to achieve reliable results and produce useful conclusion.

Excess body weight (EBW) is the second most important and potentially modifiable risk factor of cancer in Germany. The longer and the more excess body weight a person has, the higher the cancer risk. About 60 % of adult Germans have EBW (BMI ≥ 25.0 kg/m²) and more than 23 % are obese (BMI ≥ 30.0 kg/m²). Excess body weight is causally associated with colorectal, esophageal (adenocarcinoma), gastric (cardia), pancreatic, biliary, hepatocellular, kidney, thyroid, breast (postmenopausal), endometrial and ovarian cancer as well as multiple myeloma and meningioma. In recent years, more and more young adults (20–40 years) were diagnosed with EBW-associated tumors. People with EBW should be encouraged to join programs of cancer screening. Keeping a healthy weight is a major public health concern in Germany.

The prevalence of metabolic syndrome (MetS) is more common in patients with hypertension and is associated with an increased risk of target organ damage and/or cardiovascular disease (CVD). Omentin-1 is a beneficial adipokine considered to play a role in MetS and MetS-related states such as obesity, diabetes, and coronary artery disease. The aim of this study was to determine the relationship between circulating omentin-1 levels and MetS uncomplicated by diabetes or CVD (nascent MetS) in patients with hypertension. In this study, 110 patients (54 men, 49%; average age: 49.72±11.32 years) treated for hypertension but without overt diabetes and/or CVD were enrolled. 66 patients were stratified into MetS (+) (group 1) and 44 patients into MetS (−) (group 2) according to the American Heart Association/National Heart, Lung, and Blood Institute criteria. The triglyceride glucose (TyG) index was used to assess insulin resistance. Circulating omentin-1 levels in venous blood samples were measured by an ELISA kit. Circulating omentin-1 levels in patients with MetS were significantly lower than in patients without MetS (46.35 ng/mL (42.70–57.70 ng/mL) vs 130.95 ng/mL (62.83–236.48 ng/mL), p

BACKGROUND There are limited data on influence of body mass index (BMI) on outcomes of acute myocardial infarction-cardiogenic shock (AMI-CS). METHODS Adult AMI-CS admissions from 2008 to 2017 were identified from the National Inpatient Sample and stratified by BMI into underweight ( 24.9 kg/m2). Outcomes of interest included in-hospital mortality, invasive cardiac procedures use, hospitalization costs, and discharge disposition. RESULTS Of 339,364 AMI-CS admissions, underweight and overweight/obese constitute 2356 (0.7%) and 46,675 (13.8%), respectively. In 2017, compared to 2008, there was an increase in underweight (adjusted odds ratio [aOR] 6.40 [95% confidence interval {CI} 4.91-8.31]; p

Problem Excessive gestational weight gain in women who are overweight or obese puts them at risk of poor short- and long-term outcomes for maternal and neonatal health. Several interventions have been trialled to encourage women who are overweight or obese to limit gestational weight gain during pregnancy. Aim The aim of this review was to analyse the evidence on interventions to limit gestational weight gain in pregnant women who are overweight or obese. Method An integrative review guided by the Joanna Briggs Institute approach was conducted. An unlabeled search query of pregnancy, weight, and obesity was conducted in Medline, Scopus and CINAHL, limited to English language, 2010–2020 publications, and primary research on humans. Unlabeled search query of “((pregnancy outcome) OR (prenatal care) OR (pregnancy complications)) AND ((weight loss) OR (weight gain) OR (weight management)) AND (obesity) was used. Additional 9 records were identified through reference lists. Following a critical appraisal, 21 primary research articles were included in this review. A thematic synthesis was undertaken. Findings Four major themes were identified. These are (1) mixed findings of lifestyle interventions for weight management, (2) ineffectiveness of probiotics or metformin for weight management, (3) psycho-behavioural interventions for weight management, and (4) midwifery role as an integral component in multidisciplinary intervention for weight management. Conclusion The literature suggests a need for longer duration of behavioural lifestyle intervention sessions led by the same midwife trained in motivational interviewing to limit weight gain in pregnant women who are overweight or obese.