Impact of maternal pre-pregnancy body mass index on maternal,fetal and neonatal adverse outcomes in the worldwide populations: A systematic review and meta-analysis

ObjectiveSystematic review and meta-analysis conducted to investigate the effect of stratified pre-pregnancy maternal body mass index on twenty maternal and fetal/neonatal adverse outcomes.MethodsPubMed, Google Scholar, Medline, Embase, Web of Science databases were searched from inception till July 11, 2020. Cohort studies were included. The pooled odds ratio with 95% confidence interval was reported considering the random effect and the quality effect model. The sub-group analysis and meta-regression were conducted for BMI cut-offs, geographical region, source of BMI, and sample size.ResultsOverall, 86 studies representing 20,328,777 pregnant women were included in this meta-analysis. Our study reveals that overweight and obese mothers are at increased odds of cesarean delivery, elective cesarean delivery, emergency cesarean delivery, gestational diabetes, gestational hypertension, induction of labor, postpartum hemorrhage, pre-eclampsia, pre-term premature rupture of membrane, and the fetuses/neonates of overweight and obese mothers are at increased risk of admission in the newborn intensive care unit, APGAR scores less than 7 at 5 min, large for gestational age, macrosomia, extreme pre-term birth in pregnant mothers compared with standard BMI mothers. However, the underweight mothers showed increased odds for small for gestational age infant and pre-term birth, whereas obese mothers were at higher risk for post-term birth and stillbirths. The subgroup and meta-regression analyses have shown the impact of BMI cut-offs, geographical region, source of BMI, and sample size on several maternal, fetal/neonatal adverse outcomes.ConclusionThe meta-analysis confirmed the association of elevated pre-pregnancy maternal BMI with higher odds of adverse maternal and fetal/neonatal outcomes.     

Body mass index and the risk of infection - from underweight to obesity

BackgroundNutritional status is a well-known risk factor for metabolic and endocrine disorders. Recent studies suggest that dietary intake also affects immune function and as a consequence infection risk.AimsThis reviews aims to give an overview on the effect of body weight on infection rate at different periods of life.SourcesClinically relevant prospective, cross-sectional and case–control community-based studies are summarized.ContentIn children and adolescents underweight is a significant risk factor for infection especially in developing countries, probably reflecting malnutrition and poor hygienic standards. Data from industrialized countries suggest that infection rate is also increased in obese children and adolescents. Similarly, several studies suggest a U-shaped increased infection rate in both underweight and obese adults. In the latter, infections of the skin and respiratory tract as well as surgical-site infections have consistently been reported to be more common than in normal-weight participants. Paradoxically, mortality of critically ill patients was reduced in obesity in some studies.ImplicationsSeveral studies in children or adults suggest that both underweight and obesity are associated with increased infection risk. However, confounding factors such as malnutrition, hygienic status and underlying disease or co-morbidities might aggravate accurate assessment of the impact of body weight on infection risk.     

Utility of palm and hand surface area in approximating burn extent in Burundian adults and children

The use of palm and hand surface areas to approximate the extent of burns is as widespread as it is facile. However, direct comparison of measured palm and hand surface areas to total body surface areas (TBSA) have demonstrated variable accuracy in different patient populations. We measured the palm and hand surface areas of 353 Burundian adults and children, including 23 underweight children and compared those values with 0.5% and 1%, respectively, of the calculated TBSA via Mosteller, Dubois, and Haycock formulae. We used Student’s t-test to analyze for significant departure from predicted values. For 100 Burundian adults with a median BMI of 21.7 the palm and hand surface areas represented 0.40% and 0.77% TBSA, respectively. For 253 Burundian children, the mean palm and hand surface are represented 0.44% and 0.86% TBSA, respectively. Subgroup analysis of underweight children (BMI < 18.5 or Z-score ≤?2 weight for height) revealed values of 0.45% and 0.88% for palm and hand areas. Our data indicate that using values of 0.5% TBSA for the palm and/or 1% TBSA for the hand overestimates the actual burn extent and would be improved with a correction factor for Burundian patients.     

Body composition in underweight elderly subjects: reliability of bioelectrical impedance analysis

BACKGROUND AND AIMS: In underweight elderly subjects it is important to estimate body composition and particularly fat-free mass (FFM). Bioelectrical impedance analysis (BIA) is a non-invasive method in determining FFM, but its usefulness in these frail subjects should be verified. The aim of this study is to verify in underweight elderly people the reliability of previously published BIA formulas in detecting FFM. METHODS: Fifty-seven hospitalized elderly subjects (27 males and 30 females) with body mass index <20 kg/m(2) were selected. In all subjects, FFM was detected by dual energy X-ray absorptiometry. Moreover, BIA measurements were performed at standard frequency (50 kHz and 800 microA) and FFM was derived using the main previous published BIA equations. Results: In men, Kyle and Rising equations gave acceptable estimates of FFM with a mean error, respectively, of 1+/-1.9 and 1.4+/-1.7 kg. Also RJL formula could be used after adjusting for a correction factor. In women, no equation seemed sufficiently reliable to estimate FFM. CONCLUSIONS: BIA method seems useful to evaluate body composition in underweight elderly men but it seems to have intrinsic limits in women. Nevertheless, the variability in behavior of the different equations suggests to be careful in adopting BIA equations.     

Prevalence and factors affecting underweight,overweight and obesity using Asian and World Health Organization cutoffs among adults in Nepal: Analysis of the Demographic and Health Survey 2016

ObjectiveThere is a little published data on prevalence and determinants of underweight, overweight and obesity among adults in Nepal. This study analysed the cross-sectional Nepal Demographic and Health Survey (NDHS) 2016 to obtain these using the World Health Organization (WHO) and Asian-specific cutoffs of body mass index (BMI).MethodsThe 2016 NDHS used a multistage cluster-sampling design to obtain data on major health indicators in Nepal. The BMI cutoffs for underweight was <18.5 kg/m². The BMI cutoffs for overweight/obesity as per the Asian and WHO classifications were ≥23, and ≥25 kg/m², respectively. After reporting the prevalence according to sex and background characteristics, multilevel logistic regression was conducted to estimate odds ratios.SubjectsThis analysis included 12,652 adults (5283 males and 7369 females) with a median age of 40 years (interquartile range [IQR]: 28–54).ResultsThe overall median BMI was 21.5 kg/m² (IQR:19.3–24.3). The overall prevalence of underweight was 16.7% (15.1% among males and 17.1% among females). The Asian-specific BMI cutoffs found the prevalence of overweight and obesity as 26.4% (27.4% among males and 25.6% among females) and 11.0% (7.7% among males and 13.3% among females), respectively. The WHO-recommended BMI cutoffs found 18.2% people overweight (16.7% among males and 19.3% among females) and 4.3% (2.5% among males and 5.6% among females) people obese. The prevalence and odds of extreme body weight categories (i.e., underweight, overweight and obesity) varied according to age, sex, education level, household wealth status, place, ecological zone and provinces of residence as per both recommended cutoffs. Overall, higher education level and wealth status were positively associated with overweight/obesity and inversely associated with underweight as per both cutoffs.ConclusionA large proportion Nepalese adults have either underweight, overweight or obesity, and could be at a greater risk of mortality and morbidity due to these extreme body weight categories. It is essential to address the factors or characteristics that are associated with the higher prevalence and likelihood of these extreme body weight categories to reduce the overall burden of underweight and overweight/obesity in Nepal.     

Malawian mothers’ attitudes towards the use of two supplementary foods for moderately malnourished children

The efficacy of lipid-based nutrient supplements (LNS) versus corn–soy blend (CSB) in promoting the growth of moderately malnourished children is currently being tested, but information about maternal attitudes towards the two supplements is lacking. This research studied 504 Malawian mothers’ attitudes about LNS and CSB through exit interviews completed at the end of three 12-week clinical trials and compared differences between the groups. Exploratory analyses of factors associated with withholding of supplements during fever, diarrhea, and cough were performed using logistic regression. Mothers generally had similar, positive attitudes towards LNS and CSB. Both supplements were said to be highly acceptable, children learned to eat them within two weeks, and mothers were willing to use them again. Mothers in the LNS group were reportedly more likely to withhold supplements from their children during cough, due to its sweetness, and were willing to pay more for a one-week supply of supplement than mothers in the CSB group. Maternal literacy was negatively and child's weight-for-height z-score was positively associated with withholding of supplements during illness. Our results indicate that the sweetness in LNS should be reduced, and programs using supplements in Malawi could include advice on appropriate feeding of supplements during illness.