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The relationship between arterial hypertension (AH) and excess weight in young populations is well established. This association involves several conditions including hyperinsulinemia, altered adipokine profile, elevated markers of subclinical inflammation, and inadequate habits, including physical inactivity. – In a study – conducted in the city of Rio de Janeiro, Brazil, an increased body mass index in adolescents was correlated with a higher prevalence of elevated blood pressure (BP) and higher risk of developing AH at young adult age. From a [...]

Higher body mass index (BMI) may have a protective effect on survival in patients with head and neck cancer. The aim of this study was to determine the effect of BMI on overall survival (OS) in veterans with head and neck squamous cell carcinoma (HNSCC).A cohort of 702 patients diagnosed with HNSCC between 1995 and 2019 were identified at the Washington DC Veterans Affairs Medical Center, and 342 patients were included for analysis. Records were queried for clinical-demographic data, BMI, and outcomes.HNSCC patients categorized as overweight or obese at time of diagnosis had a lower 3-year risk of death (p = 0.033) and improved OS (p 0.001) compared to patients who were underweight or normal weight. The majority of locoregional recurrences occurred in patients with low or normal pretreatment BMI.Higher BMI at diagnosis may have a protective effect on OS in veterans with HNSCC.

Background Z scores are the method of choice to report dimensions in pediatric echocardiography. Z scores based on body surface area (BSA) have been shown to cause systematic biases in overweight and obese children. Using aortic valve (AoV) diameters as a paradigm, the aims of this study were to assess the magnitude of z score underestimation in children with increased body mass index z score (BMI-z) and to determine if a predicting model with height and weight as independent predictors would minimise this bias. Methods In this multicentre, retrospective, cross-sectional study, 15,006 normal echocardiograms in healthy children 1-18 years old were analyzed. Residual associations with body size were assessed for previously published z score. BSA-based and alternate prediction models based on height and weight were developed and validated in separate training and validation samples. Results Existing BSA-based z scores incompletely adjusted for weight, BSA, and BMI-z and led to an underestimation of > 0.8 z score units in subjects with higher BMI-z compared with lean subjects. BSA-based models led to overestimation of predicted AoV diameters with increasing weight or BMI-z. Models using height and weight as independent predictors improved adjustment with body size, including in children with higher BMI-z. Conclusions BSA-based models result in underestimation of z scores in patients with high BMI-z. Prediction models using height and weight as independent predictors minimise residual associations with body size and generate well fitted predicted values that could apply to all children, including those with low or high BMI-z.

Background. The impact of insulin resistance on the probability of increase in thyroid cancer risk has been drawing a lot of attention of researchers lately. This problem is far from being completely solved. Studying this interrelationship may influence the effectiveness of the treatment of the mentioned widespread pathology. Purpose – to review present literature sources on research of interrelationship between insulin resistance and thyroid cancer, and also possible mechanisms of this relationship. Materials and methods. Literature search was performed manually by the keywords (thyroid cancer, insulin resistance, IGF-1, IGF-2, abdominal obesity, increase in body mass index, metformin), and also literature sources from evidential data bases PubMed, Web of Science were reviewed. Metaanalyses, systematic reviews and cohort studies were also taken into account. 148 literature sources were studied in total. The sources, which had been published within the last 10 years, were preferably selected. Results. Insulin resistance is viewed as an important independent factor of development of numerous malignancies. The carcinogenic activity of insulin resistance is caused by the resistance itself, as well as by the metabolic disorders related to it. It has been established that excessive weight and obesity are to a great extent attributed to more aggressive clinical pathological signs of thyroid cancer. Recent research showed a larger volume of thyroid and higher risk of knot forming in patients with insulin resistance. Thus, thyroid cancer is one of the main factors of thyroid transformation. Therapeutic methods of eliminating metabolic syndrome and associated hormonal diseases for prevention and therapy of oncologic diseases are drawing ever-greater scientific interest. The anti-tumor features of metformin and its capability of retarding carcinogenesis are shown in the studies. Conclusions. The given literature analysis has proved that the problem of treating malignant thyroid tumors and their metastasis is caused not only by morphological, cellular and molecular-biological features of the tumor itself, but also by insufficient knowledge about the interrelationship between insulin resistance, abdominal obesity, increase in body mass index, high-calorie diet and reduction of consumption of polyunsaturated fats, harmful impact of environment with molecular changes, specific for thyroid cancer. It is confirmed by a significant increase in thyroid cancer rate, especially papillary histotype, alongside with an increase in obesity rate. The studying of possibilities of decreasing incidence and mortality rates of oncologic pathology when using medications, which stabilize insulin and contribute to a decrease in degree of hyperinsulinemia, one of which is metformin, generates profound interest, Актуальність. Вплив інсулінорезистентності щодо можливості збільшення ризику раку щитоподібної залози (РЩЗ) останнім часом привертає все більшу увагу науковців. Ця проблема все ще далека від остаточного розв’язання. Вивчення цього зв’язку може позначитися на ефективності лікування зазначеної розповсюдженої патології. Мета роботи. Розглянути поточні літературні джерела, які висвітлюють дослідження взаємозв’язку між інсулінорезистентністю (ІР) та раком щитоподібної залози, а також можливі механізми такого зв’язку. Матеріали та методи. Пошук літератури було здійснено ручним методом за ключовими словами (рак щитоподібної залози, інсулінорезистентність, інсуліноподібний фактор росту – 1 та 2 (ІФР-1, ІФР-2), абдомінальне ожиріння, збільшення індексу маси тіла, метформін), а також розглянуто літературні джерела з доказових баз даних PubMed, Web of Science. Брали до уваги метааналізи, систематичні огляди та когортні дослідження. Всього було опрацьовано 148 джерел літератури. Перевага була віддана джерелам, опублікованим за останні 10 років. Результати та їх обговорення. Інсулінорезистентність розглядається як важливий незалежний чинник розвитку багатьох злоякісних новоутворень. Свою канцерогенну дію інсулінорезистентність чинить як самостійно, так і через пов’язані з нею метаболічні порушення. Встановлено, що надмірна маса тіла й ожиріння значною мірою пов’язані з більш агресивними клініко-патологічними ознаками РЩЗ. Недавні дослідження показали більший об’єм щитоподібної залози та вищий ризик утворення вузлів у пацієнтів з ІР. Вісь ІФР є одним з основних чинників трансформації щитоподібної залози. Терапевтичні підходи щодо усунення метаболічного синдрому й асоційованих із ним ендокринних порушень для профілактики та терапії онкологічних захворювань привертають все більший науковий інтерес. У дослідженнях продемонстровано протипухлинні властивості метформіну та його здатність гальмувати канцерогенез. Висновки. Поданий аналіз літератури довів, що проблема лікування злоякісних новоутворень щитоподібної залози та їхнього метастазування зумовлена не тільки морфологічними, клінічними та молекулярно-біологічними особливостями самої пухлини, а й недостатніми відомостями щодо зв’язку інсулінорезистентності, абдомінального ожиріння, збільшення індексу маси тіла, висококалорійного раціону харчування та зменшення вживання поліненасичених жирів, шкідливого впливу довкілля з молекулярними змінами, специфічними для раку щитоподібної залози. Це підтверджується значним зростанням захворюваності на рак щитоподібної залози, особливо папілярного гістотипу, паралельно зі зростанням поширеності ожиріння. Особливу увагу приділяють вивченню можливостей зниження захворюваності та смертності від онкологічної патології при застосуванні засобів, які стабілізують інсулін та сприяють зменшенню ступеня гіперінсулінемії, одним із яких є метформін

Актуальность. Иммунная система представляет собой совокупность лимфоидной ткани, которая во взаимосвязи с другими адаптационными системами организма осуществляет специфический антигенно-структурный гомеостаз внутренней среды. Поэтому цель данного исследования — изучение динамики маркеров клеточного звена иммунитета у больных с повышенным индексом массы тела (ИМТ) при политравме. Материалы и методы. У 224 больных с политравмой с разной стартовой цифрой ИМТ в период 1-й день — 1 год с момента получения повреждений было проанализировано иммунологическое состояние — субпопуляционный состав лимфоцитов. Пациенты имели одинаковую тяжесть состояния на момент поступления по шкале АРАСНЕ ІІ — 14,0 ± 5,8 балла и были распределены на 3 стратифицированные клинические группы в зависимости от стартовых цифр антропометрических показателей и ИМТ. Так, в I группу вошли 88 пациентов с ИМТ на момент поступления до 29,9 (26,1 ± 3,1) кг/м2; во II группу — 84 больных с ИМТ на момент поступления 30,0–39,9 (35,2 ± 3,8) кг/м2; в III группу — 52 больных с ИМТ на момент поступления > 40,0 (46,2 ± 5,8) кг/м2. Контрольную группу составили 60 добровольцев. Исследование проводилось на 1-е, 3-и, 7, 14, 30 и 360-е сутки с момента получения политравмы. Результаты. Для больных с ИМТ ≥ 29,9 кг/м2 характерен кратковременный слабовыраженный дисбаланс регуляторных Т-клеток и Т-дефицит, что максимально проявляется в первую неделю заболевания, носит приспособительный характер, раннее восстановление (до 14-х суток) функций клеточного иммунитета, отсутствие следовой реакции в отдаленные сроки. Для больных с ИМТ 30,0–39,9 кг/м2 характерен Т-дефицит, что максимально проявляется в течение первого ее месяца, сочетается с незначительным дисбалансом субпопуляций Т-лимфоцитов, снижением мембранных функций этих клеток в сроки до 1 месяца, наличием удаленной неинтенсивной следовой реакции в виде снижения количества Т-лимфоцитов, Т-супрессоров, Т-активных лимфоцитов до нижней границы нормальных значений, высокоамплитудные колебания Т-хелперов/индукторов, с нарушением мембранных функций в сроки до 1 года. Для больных с ИМТ ≥ 40,0 кг/м2 характерен Т-дефицит во все сроки обследования с максимально выраженной интенсивностью. Наибольшие его проявления были определены в первый месяц болезни и сохранялись даже до 1 года. Отмечено снижение Т-лимфоцитов на 40 % и более от нормальных значений, которое сохранялось более одной недели и не имело тенденции к дальнейшему росту, прогрессирующее снижение Т-активных лимфоцитов более чем на 40 %, что сопровождалось выраженным нарушением взаимодействия регуляторных Т-клеток (Т-хелперов и Т-супрессоров). Выводы. Таким образом, у больных с повышенным индексом массы тела в каждой из групп сравнения был обнаружен индивидуальный ответ на механическую травму, что, скорее всего, обусловлено стартовым ИМТ исследуемых пациентов.

The results of investigation of features of morphofunctional state of cardiovascular system in adolescents with manifestations of metabolic syndrome depending on presence of hyperuricemia are presented. In the cardiorheumatology department of the hospital, 34 adolescent patients were observed. Criteria for inclusion in the study: the presence of increased blood pressure levels, increased body mass index values. Depending on serum uric acid levels, patients were divided into two groups: group 1 patients without hyperuricemia (n = 18) and group 2 patients with hyperuricemia (n = 16). Functional diagnostic methods were used: standard 12-channel electrocardiography, transtoral echocardiography, daily Holter monitoring. The main attention was paid to the study of the parameters of the left ventricle. Students t-test was used to determine the significance of the differences, the results at p 0.05 were considered reliable. It was established that adolescents with hyperuricemia were more often diagnosed with primary and secondary arterial hypertension, less often with labile arterial hypertension and autonomic dysfunction syndrome by hypertensive type, and adolescents without hyperuricemia were equally often diagnosed with primary arterial hypertension and labile arterial hypertension, autonomic dysfunction syndrome by hypertensive type. Signs of left ventricular remodeling according to echocardiography were more often noted in boys without hyperuricemia (62.5% of cases) than in girls without hyperuricemia (10%; p 0.01) and in boys with hyperuricemia (26.7%; p 0,05). The findings indicated more significant changes in the morphofunctional state of the cardiovascular system in adolescents with hypertensive conditions and manifestations of metabolic syndrome without hyperuricemia, which requires further study.

There are limited studies evaluating whether atrial fibrillation (AF) patients with increased BMI, age, and left atrial (LA) size have altered intracardiac electrogram (EGM) morphology. We analyzed left atrial intracardiac EGMs acquired during invasive electrophysiology study in 54 patients with AF. EGM correlations were assessed among AF risk factors including age, left atrial size, and BMI. BMI correlated positively with DF (r2 = 0.17, p = 0.009) and MP (r2 = 0.16, p = 0.01) with dominant frequency (DF) and mean spectral profile (MP) greater among obese individuals. Age was negatively associated with mean amplitude (r2 = 0.42, p < 0.001) and width (r2 = 0.32, p < 0.001); age was positively correlated with MP (r2 = 0.24, p < 0.001). LA size was negatively correlated with mean amplitude (r2 = 0.18, p = 0.03) and width (r2 = 0.23, p = 0.01); LA size was positively correlated with DF (r2 = 0.22, p = 0.01) and MP (r2 = 0.23, p = 0.01). Mean amplitude and width were decreased among subjects with a severely enlarged LA; DF and MP were increased in those with severely enlarged LA. The associations with BMI and LA size remained significant in multiple regression models that included age, male gender, time since AF diagnosis, and LVEF. EGM morphology of AF patients with increased BMI, older age, and an enlarged LA possessed decreased amplitude and decreased width and increased DF and MP. These findings suggest that atrial remodeling due to increased age, LA size, and BMI is associated with differences in local atrial activation, decreased refractoriness, and more heterogeneous activation. These novel findings point out clinical risk factors for atrial fibrillation that may affect electrogram characteristics.

Objective The accuracy of cell-free DNA aneuploidy screening varies by the chromosome assessed. The positive predictive value is consistently low for monosomy X (MX), at less than 30%. This study aims to investigate maternal age and other possible predictors of false-positive MX screening results in order to guide pre-test and post-test counselling. Methods A total of 52 499 NIPT samples were tested over 69 months, across three specialist obstetric services. Outcome data were available for 96 out of 107 cases high risk for MX. Cytogenetic outcomes were compared to clinical and demographic data to look for trends that may indicate higher likelihood of a false-positive NIPT result. Results The likelihood of a false-positive MX result significantly increased with the absence of ultrasound features suggestive of MX and with lower PAPP-A levels. Non-significant trends towards false-positive results were identified with increased maternal age, increased body mass index and Caucasian ethnicity. Conclusion Maternal age is not a reliable predictor of a false-positive result. Assessment of ultrasound findings and placental serology in the first trimester is important for appropriate post-test counselling and should continue to be a part of screening even when NIPT is used as a first-tier screening test.

Метою нашої роботи був аналіз функціонального стану ферментативної активності й кардіоспецифічних маркерів при травматичній хворобі у пацієнтів з підвищеним індексом маси тіла за допомогою системного багатофакторного аналізу. Аналіз математичних моделей стану ферментативної активності й кардіоспецифічних маркерів у всіх групах хворих визначив, що досліджуваний процес носить закономірний характер з періодами нестабільності стану серцево-судинної системи у відповідь на отримані ушкодження тим виразніше, чим більше у пацієнтів індекс маси тіла на момент надходження до стаціонару.

Purpose To investigate whether body mass index (BMI) percentile impacts the morphology of the capital femoral epiphysis in children and adolescents without hip disorders. Methods We assessed 68 subjects with healthy hips who underwent a pelvic CT for evaluation of appendicitis. There were 32 male patients (47%) and the mean age was 11.6 years (sd 2.3). The BMI (k/m2) was calculated for sex- and age-related percentiles according to the Centers for Disease Control and Prevention growth charts. CT images were segmented, and the epiphysis and metaphysis were reformatted using 3D software. We measured the epiphyseal tubercle (height, width and length), the metaphyseal fossa (depth, width and length) and the peripheral cupping of the epiphysis. All measurements were normalized to the diameter of the epiphysis. Pearson's correlation analysis was used to assess the correlations between the variables measured and BMI percentile adjusted for age. Results Following adjustment to age, increased BMI correlated to decreased tubercle height (r =-0.34; 95% confidence interval (CI) -0.53 to -0.11; p = 0.005), decreased tubercle length (r = -0.32; 95%CI -0.52 to -0.09; p = 0.008) and decreased tubercle width (r = -0.3; 95% CI -0.5 to -0.07; p = 0.01). There was no correlation between BMI and metaphyseal fossa and epiphyseal cupping measurements. Conclusion The association between increased BMI percentile and decreased epiphyseal tubercle size, without changes of the metaphyseal fossa and peripheral cupping suggests another morphological change of the femur that may be associated with decreased growth plate resistance to shear stress. Further study is necessary to investigate whether the epiphyseal tubercle size plays a role in the pathogenesis of slipped capital femoral epiphysis in obese children and adolescents. Level of Evidence Level IV

Purpose We aimed to examine whether sedentary screen time changes when transitioning from childhood to adolescence and whether children's screen time, separately for school days and weekends, affects body mass index (BMI) in adolescents. Methods This prospective 3-year follow-up study included 5,084 children with a mean (standard deviation) age of 11 (1) years at baseline and 14 (1) years at follow-up. Children reported screen time, more specifically, time spent viewing TV programs and using a computer outside school while sitting. We categorized children into light, medium, and heavy TV viewers and computer users separately for school days and weekends. We also calculated the age- and gender-specific BMI z-score (BMIz). Results Time spent viewing TV changed from baseline to follow-up on school days and on weekends (p

Knowledge of retropharyngeal carotid arteries in patients is important in order to avoid potential catastrophic injuries. Previous studies demonstrated that carotid arteries can change in position at or near the level of the hyoid bone on serial scans. We report the presence of wandering carotid arteries at the level of the cricoid cartilage and superiorly in the neck of a 74-year-old female patient over multiple months. The potential for carotid arteries to randomly change positions in the suprahyoid and infrahyoid neck should be known by clinicians to avoid misdiagnosing occult neck masses and to avoid potential arterial injury during neck surgery. Although the exact etiology for wandering carotid arteries remains uncertain, we propose that reduced axial tension on carotid arteries and increased body mass Index may play a causative role. Keywords: Retropharyngeal carotid arteries, Tortuous carotid arteries, Wandering carotid arteries

The rising trend of obesity in the United States has been a growing concern within the healthcare system for decades. Since the early 1960s, the prevalence of obesity has more than doubled among U.S. adults, and one out of every three Americans is now considered obese according to the National Health and Nutrition Examination Survey [1,2]. Significant medical comorbidities have been associated with obesity and increased Body Mass Index (BMI); these include hypertension, dyslipidemia, coronary artery disease, stroke, sleep apnea, type II diabetes mellitus and certain types of cancer.

Catherine E Lovegrove1,2 – catherine.lovegrove@nds.ox.ac.ukThomas Littlejohns3- thomas.littlejohns@ndph.ox.ac.ukNaomi Allen3- naomi.allen@ndph.ox.ac.ukSarah A Howles1,4- sarah.bounds@doctors.org.ukBenjamin W Turney 1,2- ben.turney@nds.ox.ac.uk 1 Department of Urology, Oxford University Hospitals NHS Trust, Oxford, Oxfordshire, UK2 University of Oxford Nuffield Department of Surgical Sciences, Oxford, Oxfordshire, UK3 University of Oxford Nuffield Department of Public Health, Oxford, Oxfordshire, UK4 Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK Objectives To investigate the relationship between measures of adiposity and risk of incident kidney stone disease. Patients and methods The UK Biobank is a prospective cohort study of ~500,000 participants whose height, weight, BMI, waist circumference, hip circumference, waist:hip ratio (WHR), total fat mass, fat-free mass, body-fat percentage and percentage truncal fat were measured at enrolment with linkage to medical records. ICD-10 and OPCS codes were used to identify individuals with a new diagnosis of nephrolithiasis from 2006-2010. Individuals with a history of kidney stones or incomplete data were excluded. Multivariate Cox-proportional hazard models were used to assess associations between anthropometric measures and incident kidney stones. Results From the UK Biobank, 493,410 individuals were identified for inclusion; 3,466 developed a kidney stone during the study period. Increasing weight, BMI, waist and hip circumferences, WHR, and body and truncal fat were associated with increased risk of incident kidney stone disease. However, after adjustment for BMI, only waist circumference and WHR remained significantly associated with risk of nephrolithiasis. In overweight patients, high (men 94-102cm, women 80-88cm) waist circumference or WHR (men >0.9, women >0.85) conferred >40% increased risk of stone formation. Conclusion This study indicates that android fat distribution is independently associated with increased risk of developing nephrolithiasis. Kidney stone disease is known to be associated with hypertension, cardiovascular disease, and diabetes, all of which are linked to android body shape. Our findings provide insight into anthropometric risk factors for stone disease, will facilitate identification of patients at greatest risk of stone recurrence, and will inform prevention strategies.

Background The serious health consequence that comes from disrupted and poor sleep quality is an increased risk for cardiac diseases and diabetes. The goal was to investigate the association of insulin resistance with sleep complains in ten years follow-up. Methods A randomized epidemiological follow up study with 835 subjects: 300 (35.9%) men and 535 (64.1%) women was performed in 2003 and in 2013. The Basic Nordic Sleep Questionnaire was used to assess the frequency of sleep complaints in the first and the follow up survey. Insulin resistance was evaluated by homeostasis model assessment of insulin resistance (HOMA-IR). The contingent was divided into 2 groups: insulin resistance group (HOMA-IR> 2.7) 33% and No- insulin resistance group (HOMA-IR ≤2.7) 67%. Results A statistically significantly increased number of persons with diabetes mellitus and high body mass index was seen in both groups after 10-year period; however, in insulin resistance group an increase was more expressed. A statistically significant change of sleep complains after 10-year period was seen in insulin resistance group; while in no-insulin resistance group there were no significant modifications. Individuals with insulin resistance were more likely to complain of difficulty falling asleep (from 11.2% to 17.8%, p = 0.031) and early wake up in the morning (from 12.6% to 24.5%, p = 0.003) after 10-year period. Daytime sleepiness was also more frequently observed among persons with insulin resistance (from 9.0% to 14.7, p = 0.037). They were more likely to use sleeping pills (from 4.0% to 8.3%, p = 0.034) and, not surprisingly, were more likely to use alcohol to improve sleep (from 1.1% to 4.4%, p = 0.012). Conclusions A statistically significant increase in body mass index and diabetes as well as difficulty to fall asleep, early waking up in the morning, severe drowsiness in the morning and daytime sleepiness was found in ten years follow-up in insulin resistance group. Key messages A statistically significant increase of sleep complains after ten years follow-up was seen in insulin resistance group. Insulin resistance and metabolic syndrome in parallel with disturbed sleep may lead to the development of diabetes in follow-up.

The average effectiveness of electrical cardioversion in persistent atrial fibrillation (AF) is considered about 90%. The success is limited by arrhythmia longevity, essential heart pathology, excessive body mass, concomitant deceases. A novel developed in Russia class III intravenous medication “Refralon” (4-nitro-N-(1RS)-1(4-fluorophenyl)-2-(1-ethylpiperidin-4-ethyl) benzamide hydrochloride) seems to be promising in sinus rhythm restoration in such patients. The aim of the study was to assess the effectiveness of a novel class III intravenous medication “Refralon” in conversion to sinus rhythm in patients with permanent AF in whom electrical cardioversion was unsuccessful. Materials and methods 19 patients were included: 16 male and 3 female aged from 45 to 68 years old (59,9±5,84 (M±SD)). Left atrial size was 47±3,2 × 59±2,8 mm, BMI 38,5±7,0 kg/m2, arrhythmia duration from 2 to 21 months (6,7±4,99). Refralon was injected according to the approved manual in ICU; heart rhythm and rate, blood pressure, SpO2 were monitored. Dynamic assessment of QT and QRS duration was performed. Results In 17 of 19 patients (89,4%) sinus rhythm was restored. In 7 patients (41%) sinus rhythm was restored before 10 min, in 4 patients (24%) before one hour, in 4 patients (24%) before two hours, in 2 patients (11%) before six hours. In two patients sinus rhythm was not restored. In both target dose was not infused due to non-sustained ventricular tachycardia in one case, and QT prolongation in another. Conclusion In a small pilot study Refralon was highly effective in patients with persistent atrial fibrillation when electrical cardioversion was ineffective. All the patients had significantly increased BMI. The results may suggest the indication for Refralon usage in obese patients. Funding Acknowledgement Type of funding sources: None.

Background Insulin resistance is the primary cause of metabolic syndrome, which in turn reflects a real variety of risk factors, closely linked to each other. Thus, we aimed to investigate health-related quality of life scores according to the presence of insulin resistance among citizens of Palanga in Lithuania, in the survey in 2003 and 2013. Methods A randomized epidemiological study was performed out for 835 subjects. All study participants were evaluated according to for socio-demographic characteristics, behavioral factors, health-related quality of life and self-perceived health using questionnaires. Fasting blood samples were draw from all participants for biochemical tests for the glucose and insulin. Insulin resistance was evaluated by the homeostasis model assessment of insulin resistance. Results All study participants were stratified into groups without and with insulin resistance in the survey in 2003 and 2013 years follow up. Participants with insulin resistance were more likely to be male, with higher body mass index, had lower than higher education, and with moderate self-related health. In subjects with insulin resistance, after adjusting with various factors, logistic regression analysis showed, that within 10 years, a significantly higher chance of deteriorating health-related quality of life in the areas of: physical functioning (odss ratio [OR] = 1.15, p < 0.001), emotional role limitations (OR = 1.07, p = 0.034), social functioning (OR = 1.26, p = 0.004), pain (OR = 1.09, p = 0.005) and general health perception (OR = 1.07, p = 0.022). Conclusions People with insulin resistance are significantly more likely to have a deterioration in their health-related quality of life in the areas of physical functioning, emotional role limitations, social functioning, pain and general health perception after 10 years period. Key messages Over the course of ten years, significant changes were observed in domains of physical functioning, social functioning and general health perception in subjects with insulin resistance. Results of this study provide evidence that individuals with insulin resistance have a significantly higher chance of deteriorating health-related quality of life within 10 years.

Background Studies on impact of routine clinical parameters on mortality of patients on peritoneal dialysis (PD), especially among elderly, are inconsistent. Although association between body mass index (BMI) and systolic blood pressure (SBP) is well known, their joint role on PD patient evolution is not clear. We aimed to model the joint impact of BMI and SBP trajectories on a cohort of incident elderly PD patients. Methods Prospective multicenter cohort study with 674 patients. Repeated measurements were modeled by random effects multivariate linear model. For the time-to-event outcome, used Cox proportional hazards model with log-Gaussian frailty. Stochastic dependence is captured by allowing random effects of the linear model to be correlated with the frailty term of the survival model, allowing for different clinical interpretations. All sub-models were adjusted for age in years. Results Isolated current values effects of increased BMI and BPS showed both as protective factors (1% and 2% risk reduction, respectively, for each unitary increase). When jointly modeled BMI changed its effect to 5% risk reduction while BPS remained the same, showing great impacts on survival depending on the combination of trajectories. Conclusions Clinical parameters association and its impact on survival is complex, and estimation of isolated effects may provide biased survival curves leading to unrealistic prognosis. A multivariate joint modeling can be seen as a valuable tool for clinical protocols on patient evolution. Key message Modern clinical epidemiology must foster use of modern statistics

Aim To investigate the relationship between measures of adiposity and risk of incident kidney stone disease. Method The UK Biobank is a prospective cohort study of ∼500,000 participants whose height, weight, BMI, waist circumference, hip circumference, waist:hip ratio (WHR), total fat mass, fat-free mass, body-fat percentage, and percentage truncal fat were measured at enrolment with linkage to medical records. ICD-10 and OPCS codes identified individuals with a new diagnosis of nephrolithiasis from 2006-2010. Individuals with a history of kidney stones or incomplete data were excluded. Multivariate Cox-proportional hazard models were used to assess associations between anthropometric measures and incident kidney stones. Results From the UK Biobank, 493,410 individuals were identified for inclusion; 3,466 developed a kidney stone during the study period. Increasing weight, BMI, waist, and hip circumferences, WHR, and body and truncal fat were all associated with increased risk of incident kidney stone disease. However, after adjustment for BMI, only waist circumference and WHR remained significantly associated with risk of nephrolithiasis. In overweight patients, high (men 94-102cm, women 80-88cm) waist circumference or WHR (men >0.9, women >0.85) conferred >40% increased risk of stone formation. Conclusions This study indicates that android fat distribution is independently associated with increased risk of developing nephrolithiasis. Kidney stone disease is known to be associated with hypertension, cardiovascular disease, and diabetes, all of which have been linked to android body shape. Our findings provide insight into anthropometric risk factors for stone disease, will facilitate identification of patients at greatest risk of stone recurrence, and will inform prevention strategies.

Evidence suggests that girls spend much time on social networking sites (SNS), often more than boys do. It has been proposed that this may have to do with sex-based differences in the need and approaches for socialization. We posit that adolescent girls are also unique in that they are developing physiologically and start menstruating. Based on prior research, we hypothesize that the onset of menstruation can drive physiological changes (increased body mass index (BMI)), which together with common behavioral–psychological (social and emotional) responses to menstruation can contribute to an increase in SNS use. We therefore aim to test whether BMI partially mediates the relationship between menstruation and SNS use in adolescent girls. Results based on a large nationally representative sample in the United Kingdom suggest that the age of menarche was negatively associated with daily hours of SNS use, and that BMI elevation partially mediated this association. These results extend the negative effects of the early onset of menstruation and imply that BMI control strategies may help to reduce the use of SNS in girls who experience menarche at an earlier age.

Diabetes, obesity and increased body mass index are associated with changes in metabolism that lead to an inadequate reservoir or use of ATP in the heart and susceptibility to arrhythmia. Lack of availability of ATP and abnormal levels of metabolic end products can cause gene reprogramming and electrical remodelling that make myfibers susceptible to arrhythmia. Understanding the metabolic aberrations that lead to arrhythmia require better understanding of cardiac metabolism. Here, I discuss metabolic genes, enzymes and reducing equivalents and functional aspects of metabolic-induced arrhythmia with a special focus on atrial induced arrhythmia. It appears that normalisation of altered Kv1.5 channel, an oxygen sensing ion channel and fulfillment of oxygen demand by myocardium might offer a new strategy for preventing alterations of repolarisation that cause arrhythmia.

Obesity is regarded nowadays as one of the worldwide medical and psychosocial problem so that many researches had been dealt with the underlying causes of resistant obesity and increased body mass index “BMI”. Recent data demonstrate the strong association between the presence of obesity with specific gene called fat mass and obesity associated gene (FTO). Many single nucleotide polymorphisms (SNPs) was detected that are discovered that closely related to the increased incidence of obesity among populations, notably rs9939609 and rs17817449 SNPs. To evaluate the presence of these SNPs as a predisposing factor in obese persons with BMI exceeds 30. A 100 obese persons were selected randomly along with 50 body-fitted people as a control group. Molecular detection of these SNPs was done by RT-PCR followed by statistical analysis. there was significant increase in expression of AA genotype of FTO rs9939609 SNP in obese persons in comparison to non-obese group (0.60 ± 0.04 versus 0.28 ± 0.06 respectively at P> 0.002) and significant increase in expression of GG genotype of FTO rs1781744 SNP in obese persons in comparison to non-obese group 0.59 ± 0.04 versus 0.22 ± 0.05 respectively at P> 0.001)

Increased body mass index (BMI) and HIV are each associated with hypertension. This study tested interactions between BMI and detectable plasma viral load (pVL) on hypertension among 659 persons living with HIV (PLWH). All participants were categorized into four subgroups based on BMI (

The aim of our work was to analyze the functional state of the humoral immunity in traumatic disease in patients with an increased body mass index (IBMI). Using the systemic multivariate analysis, the integral indices of the B-system of immunogenesis were determined on the basis of a dynamic study of 1344 complex immunograms in 224 patients with IBMI with polytrauma with different starting figures for BMI in the period 1 day to 1 year from the moment of injury. Patients were divided into 3 groups depending on the starting BMI figures. It was revealed that changes in humoral processes in traumatic disease in patients with IBMI persist for a long time; the degree of damage to the B-system and the orientation of the reactions in the examined patients are of a similar nature; the manifestations and adequacy of the compensation processes and the severity of the acquired pathology of this subsystem depend on the patient's BMI, since the initial integral indicators in the comparison groups did not differ much.

It is known that adipose tissue is the site of the formation of proinflammatory cytokines - tumour necrosis factor alpha (TNF-α) and some interleukins. The aim of our work was to analyze changes in the level of TNF-α, interleukins 6, 8 (IL-6, IL-8) in the blood serum of 224 patients with an increased body mass index who had a polytrauma with different initial body mass index through the period of 1 day – 1 year since the moment of injury. It has been revealed that patients with a BMI of ≤ 29.9 are characterized by an increase in the control numbers of IL-6 from day 1 to day 7, an increase in the level of IL-8 from day 1 to day 3, and an increase in the level of TNF-α from day 1 to day 3. For patients with obesity II - III, an excess of IL-6 was detected from day 1 to day 30, an increase in the level of IL-8 from day 1 to day 3, and an increase in the level of TNF-α from day 1 to day 30. Patients with a BMI ≥ 40.0 demonstrate an increase in the IL-6 control figures during the year from the moment of receiving polytrauma, followed by a decrease to the 360th day, an increase in the level of IL-8 from day 1 to day 3, an increase in the TNF level -α from the day 1 to day 3. It has been found out that the indicators we studied directly reflect the adaptation status of patients with increased body mass index and polytrauma, which presentation depends on the body mass index, that is, on the amount of adipose tissue. It is apparent that it is pro-inflammatory cytokinins - IL-6, IL-8, TNF-α that are able to simulate the expected result, as they determine vigilance, stimulation or inhibition of growth, including immune cells, their differentiation, and functional activation.

Purpose To assess the impact of increased body mass index on intraoperative indicators and early postoperative clinical and functional results in total knee arthroplasty Materials and methods We studied 74 patients with severe gonarthrosis. The patients were divided into four groups, depending on their body mass index (BMI). The first group consisted of 27 people (comparison group) with normal BMI (18.5–24.9). The second group included 22 persons with a BMI range of 25–34.9. The third group included 16 patients with BMI that ranged 35–39.9, and the fourth group included nine patients with BMI ≥ 40. Results The results of the study confirmed the fact of a slight increase in the duration of the operation and intraoperative blood loss in patients with obesity. However, a three-month period examination after surgery showed comparable efficacy of arthroplasty in reducing pain and functional outcomes achieved in all groups. Conclusion Total knee arthroplasty is effective in severe gonarthrosis in all patients, regardless of BMI. Anatomical and functional status of patients improved significantly in the postoperative period in all groups of the patients studied.

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

Background Whether body mass index (BMI) is causally associated with the risk of being diagnosed with or dying from any cancer remains unclear. Weight reduction has clinical importance for cancer control only if weight gain causes cancer development or death. We aimed to answer the question 'does genetically predicted BMI influence my risk of being diagnosed with or dying from any cancer'. Methods We used a Mendelian randomisation (MR) approach to estimate causal effect of BMI in 46,155 white-British participants aged between 40 and 69 years at recruitment (median age at follow-up 61 years) from the UK Biobank, who developed any type of cancer, among whom 6998 died from cancer. To derive MR instruments for BMI, we selected up to 390,628 cancer-free participants. Results For each standard deviation (4.78 units) increase in genetically predicted BMI, we estimated a causal odds ratio (COR) of 1.07 (1.02–1.12) and 1.28 (1.16–1.41) for overall cancer risk and mortality, respectively. The corresponding estimates were similar for males and females, and smokers and non-smokers. Conclusions Higher genetically predicted BMI increases the risk of being diagnosed with or dying from any cancer. These data suggest that increased overall weight may causally increase overall cancer incidence and mortality among Europeans.

Increased body mass index (BMI) is an independent risk factor for stillbirth. The purpose of this study was to determine an optimal time of delivery at term in obese women in order to decrease the risk of stillbirth in this population.We conducted a retrospective population-based cohort study using the CDC's Period Linked Birth-Infant Death and Fetal Death data. The study population included all singleton, term births with a recorded pre-pregnancy BMI that occurred between 2014 and 2017. Unconditional logistic regression analyses were used to estimate the risk of stillbirth in each BMI class at each gestational week from 37 weeks and onwards comparing with births to normal-weight women at 41 weeks.Of 12,742,980 births in our cohort, 46.8% were to women with a normal BMI, 26.9% were to women who were classified as overweight, 14.5% were to women in obesity class I, 7.3% in obesity class II, and 4.8% in obesity class III. Within each BMI class, the risk of stillbirth increased with gestational age, with the most pronounced rises in risk occurring at later gestational ages. In a dose-response relationship, the risk of stillbirth exceeded that of a normal BMI pregnancy at 41 weeks at the following gestational age and BMI category: obese class 1 at 39 weeks (OR 1.15 95% CI 1.00-1.31), obese class II at 38 weeks (OR 1.21 95% CI 1.04-1.41) and obese class III at 37 weeks (OR 1.30 95% CI 1.11-1.52).Compared to women with a normal BMI at 41 weeks, there was a higher risk of stillbirth at term in women with each increase in BMI class. Consideration should be given to early induction among these women to reduce the risk of stillbirth.

Objective This study aimed to identify factors associated with surgeon perception of robot‐assisted radical prostatectomy (RARP) difficulty. Patients and Methods This study surveyed surgeons performing RARP between 2017 and 2018 and asked them to rate operative conditions and difficulty as optimal, good, acceptable, or poor. These answers were stratified as optimal or suboptimal for this study. Associations between surgeon responses and variables hypothesized to affect surgical difficulty, including anatomic factors such as pelvic diameter and prostate volume:pelvic diameter ratio, were assessed. Results Between November 2017 and September 2018, a total of 100 patients were prospectively enrolled in the study of which 58 cases were rated as optimal and 42 were rated as suboptimal. Of the evaluated variables, only increasing clinical T stage (odds ratio [OR] 1.49, 95% confidence interval [CI] 1.03–2.15, p = 0.03) and increasing body mass index (BMI) (OR 1.14, 95% CI 1.03–1.26, p = 0.01) were associated with increased difficulty; 90‐day complication rates were similar between the optimal and suboptimal cohorts (17.3% vs. 23.8%, respectively; p = 0.5). The number of patients with previous surgery, pelvic diameter, and prostate size:pelvic diameter ratio were not significantly different between cohorts (p > 0.05 for all). Operative time (ρ = 0.23, p = 0.02) and estimated blood loss (EBL) (ρ = 0.38, p = 0.0001) were correlated with suboptimal difficulty. Conclusion The factors associated with surgeon‐reported RARP difficulty were patient BMI and clinical T stage among surgeons with significant RARP experience. These data should be incorporated into surgical decision making and patient counseling prior to performing a RARP.

OBJECTIVES: To analyze the relationship between parenting stress and maternal child feeding styles with preschooler's body mass index. METHODS: A total of 344 mother-child dyads from ten public kindergartens from Monterrey Nuevo Leon, Mexico; participated in the study. Mothers answered 1) The Parental Stress Scale to identified parenting stress, and) The Caregiver Feeding Style Questionnaire was used to identify the mother's feeding style. Child's weight and height were measured. Body Mass Index was obtained and classify according to World Health Organization. RESULTS: 51.7 (n = 178) mothers reported high parenting stress. The authoritarian feeding style was more frequent in mothers with high parenting stress 33.1 (n = 59), while mothers with low parenting stress presented an indulgent feeding style (38.6%, n = 64). Mothers with an indulgent style had children with a high BMI. Maternal factors such as styles and preschool BMI were identified as predictors of parenting stress, variance explained 7.3%. CONCLUSIONS: High maternal parenting stress is related to authoritarian feeding style. A style has been considered a predictor of childhood overweight-obesity. It is recommended to continue studying those maternal factors that potentiate the risk of overweight-obesity in childhood, as well as interventions aimed at reducing parenting stress and the use of healthier feeding styles. FUNDING SOURCES: ….

Background: Children experience seasonal variations in growth whereby height increases most in spring and least in autumn, and weight increases least in spring and most in autumn. We hypothesized that activity restriction caused by efforts to contain the spread of coronavirus disease 2019 (COVID-19) would result in increased body mass index (BMI) in children, differing from conventional seasonal growth variations. Methods: We included 169 children who visited endocrine clinics of three hospitals in Korea at regular intervals under the same conditions for two years. Visit dates were D1 (January, 2019), D2 (July, 2019), D3 (January, 2020) before the COVID-19 outbreak, and D4 (July, 2020) during the pandemic. Differences in the z-score for height (HT), weight (WT), and BMI among time points and between spring seasons (i.e., S1–S3) were compared. Results: There were significant differences in BMIz among time points, which decreased from D1–D2 and increased from D2–D3 and D3–D4. WTz significantly increased from D2–D3 and D3–D4. BMIz values of S1 (spring 2019) and S3 (spring 2020) were −0.05 and 0.16, respectively, showing significant differences. WTz values between S1 and S3 were significantly different (−0.02 vs. 0.13). Conclusions: In 2019, there were conventional seasonal variations in BMIz, which declined in spring and increased in autumn, while in 2020, BMIz increased even in spring. The COVID-19 pandemic may have affected seasonal variations in the growth of children attending endocrine clinics.

Funding Acknowledgements Type of funding sources: None. Introduction Obesity is known to be risk factor for incidence of cardiovascular (CV) events. However, the association between the reduction of body mass index (BMI) and incidence of cardiovascular event is not well established in elderly Asian population. Methods From the National Health Insurance Service-Senior (≥60 years) cohort from 2002 to 2013, 13,038 participants over 75 years old without baseline comorbidities (mean age: 78.4 ± 3.2 years 5243 (40.2%) male) were included in this study. We measured the change of BMI from first to second visit for health check-up within mean 23.6 ± 5.8months of follow-up. We categorized the reduction of BMI as five group according to the amount of change in BMI in overall patients (group 1: BMI change Results In the overall patients, new-onset AF, stroke, acute MI, and CV death was occurred in the 494 patients (3.5%), 775 patients (5.9%), 16 patients (0.1%), and 458 patients (3.5%) respectively. The Kaplan-Meier curve showed significant cumulative incidence rate of CV death in group 1 (Log rank p Conclusions In the elderly Asian population over 75 years old, the reduction of body weight affected worse effect on the incidence of stroke and CV death in overall patient and high BMI (≥25) group. It needs careful consideration to reduce BMI in the elderly Asian population even with high BMI (≥25) for purpose of CV events.

Introduction: Obesity is an established risk factor for ischemic stroke but the association of increased body mass index (BMI) with survival after ischemic stroke remains controversial. Many studies have shown that increased BMI has a “protective” effect on survival after stroke while other studies have debunked the obesity paradox. This study aimed at examining the relationship between BMI and all-cause mortality at one year in first-time ischemic stroke patients using data extracted from different resources including electronic health records. Methods: We analyzed consecutive ischemic stroke patients captured in the Geisinger NeuroScience Ischemic Stroke (GNSIS) database. Survival in first-time ischemic stroke patients was analyzed using Kaplan-Meier estimator, stratified by different BMI categories. The predictors of mortality at one-year were assessed using a multivariate Cox proportional hazards model. Results: Among 6,703 first-time adult ischemic stroke patients, mean age was 70.2 ±13.5 years and 52% were men. Of these patients, 24% patients were non-overweight (BMI < 25), 34% were overweight (BMI 25-29.9) and 41% were obese (BMI ≥ 30). One-year survival probability was significantly higher in overweight patients (87%, 95% CI: [85.6 - 88.4], p Conclusion: Our results support the obesity paradox in ischemic stroke patients as shown by a significantly decreased hazard ratio for one-year mortality among overweight and obese patients in comparison to non-overweight patients.

Introduction: An increased Body Mass Index (BMI) has an adverse effect on the socio-economic and healthcare sectors and may influence metabolic status. High sensitivity C-reactive Protein (hs-CRP) is an emerging biomarker. The association between dyslipidaemia and obesity is well established, and has been found to be the risk factors for CVD. Aim: To study the relationship of hs-CRP with BMI, lipid profile and magnesium among obese and overweight non-diabetic non-hypertensive Sudanese women. Materials and Methods: A cross-sectional study was conducted on 90 women in Khartoum state (Sudan), aged between 20 and 43 years, from June to November 2019. The study included three groups of women based on BMI. hs-CRP was measured by using latex immunoturbidimetric method, lipid profile was evaluated using Biosystems colourimetric methods and magnesium by a chemical method. Results were computed using Statistical Package for the Social Sciences (SPSS) version 20.Results: There was significant increase in the mean values of hs-CRP, Total Cholesterol (TC), Triglyceride (TG), Low Density Lipoprotein Cholesterol (LDL-C), and a significant decrease in the mean values of High Density Lipoprotein Cholesterol (HDL-C) and magnesium in obese and overweight women, when compared to normal body weight women. Pearson’s correlation coefficient revealed a positive correlation between hs-CRP, and BMI, Waist-To-Hip Ratio (WHR), TC, TG, and LDL-C (p-value

The Corona crisis limits the mobility of people and it proves that many people have an increased body mass index. A lot of people want to increase their fitness and to boost their immune system. There is a run-on fitness schools and fitness equipment for the home environment. At fitness schools, fitness coaches are available for personalized instructions and supervision. Fitness in the home environment lacks personalized instruction and supervision and can cause serious injuries. In this paper a digital coach will be introduced providing digital support and supervision. The digital coach offers personalized fitness program, supervises athletes during fitness exercises and provides a supporting system concerning injuries. A prototype of the developed system can be downloaded as an app on a smart phone.