体重指数与女性骨质疏松症关系的Logistic回归分析

目的 探讨体重指数(body mass index BMI)是否是女性骨质疏松症(Osteoporosis OP)的危险因素.方法 收集2008年9月～2010年12月因腰腿疼痛在三峡大学第一临床医学院(宜昌市中心人民医院)康复科就诊的500例女性患者资料,经X线检查判断无骨质增生232例,采用法国DMS公司生产的双能X线骨密度仪测定腰椎(L2-4)正位骨密度(bone mineral density,BMD),记录其身高、体重(计算体重指数)、症状、运动、吸烟、饮酒等影响因素;测定腰椎(L2-4)骨密度,明确是否骨质疏松(OP);用t检验及X2检验比较骨质疏松症组和非骨质疏松症组的影响因素,用Logistic回归分析对象中各种可能影响骨质疏松症的因素及骨质疏松症发生的相关性.结果 骨质疏松症组和非骨质疏松症组比较:体重指数、运动情况、吸烟、饮酒比例有显著差异;根据多因素分析,体重指数、吸烟是骨质疏松症的危险因素,运动与偶尔饮酒是骨质疏松症的保护因素.BMI每增加一个单位,女性发生骨质疏松的风险增加2.003(P=0.034).结论 体重指数是女性骨质疏松的危险因素.     

Genetic determination and correlation of body weight and body mass index (BMI) and cross-sectional geometric parameters of the femoral neck

Introduction This study aimed to examine the genetic determination of body weight, body mass index (BMI) and cross-sectional geometric parameters of the femoral neck including cross-sectional area (CSA), cortical thickness (CT), sectional modulus (Z), and buckling ratio (BR), and to test the genetic correlation between body weight/BMI and the femoral neck geometric parameters.Methods A total of 929 healthy subjects from 292 Chinese nuclear families was included. Femoral neck geometric parameters were estimated from bone mineral density (BMD) and bone area which were measured by dual energy X-ray absorptiometry (DXA).Results The heritability (h ²) estimate values were 0.643, 0.626, 0.626, 0.674, 0.405, and 0.615 for body weight, BMI, CSA, CT, Z, and BR, respectively. Body weight was significantly correlated with bone geometric parameters (p≤0.001) with genetic correlation (ρ _G ) values of 0.551, 0.457, 0.571, and −0.385, and bivariate heritability values of 0.304, 0.209, 0.326, and 0.148 for CSA, CT, Z, and BR, respectively. Similar correlations (p≤0.001) were observed between BMI and bone geometric parameters, with ρ _G values of 0.446, 0.432, 0.334, and −0.362, and values of 0.199, 0.187, 0.112, and 0.131 for CSA, CT, Z, and BR, respectively.Conclusion In summary, our study suggested that body weight, BMI, and femoral neck geometry were under strong genetic determination. The strong genetic correlations suggested that the genetic factors of bone geometry may be overlapped with those of body weight and BMI.     

A prospective analysis of the inter-relationship between lung volume reduction surgery and body mass index

Objectives: LVRS is thought to result in significant improvements in BMI. Patients with a higher BMI at the time of diagnosis of COPD are known to have better survival, and those with a low BMI prior to LVRS have significantly worse perioperative morbidity. We aimed to assess the influence of BMI on the outcome of LVRS in our own experience. Methods: Complete preoperative BMI data was available in 114 of 131 consecutive patients who have undergone LVRS since 1995. These patients were arbitrarily classified into three categories: underweight (BMI ≤ 19 kg/m²), normal (BMI 20–25 kg/m²) and overweight (BMI > 26 kg/m²). The in-hospital course and perioperative change in BMI at 3, 6, 12, 24 and 36 months were prospectively recorded for each category and compared. Results: There were no significant differences in preoperative variables except BMI. There were significantly more postoperative ITU admissions among the lowest two BMI groups (12/29, 18/58 and 3/27 patients, respectively, p = 0.02), and significantly shorter hospital stay in overweight patients [16 days (5–79) vs 18 days (6–111) vs 13 days (6–25), respectively, p = 0.005, expressed as median (range)]. However, there was no difference in survival between the three groups (p = 0.21). Postoperative physiological improvements in the first year were related to preoperative BMI for both FEV₁ (r = 0.29, p = 0.02) and DLCO (r = 0.33, p = 0.02). Postoperative BMI significantly increased in the underweight yet significantly decreased in the overweight at all time points. Conclusions: The perioperative course of LVRS and its physiological benefits are influenced by preoperative BMI. Whilst the treatment of the underweight is more complicated, LVRS may be the only way of increasing their BMI. Future work is needed to explore the roles of changing energy requirements and body composition following LVRS.     

Prognostic variables for shockwave lithotripsy (SWL) treatment success: no impact of body mass index (BMI) using a third generation lithotripter

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Therapy success in SWL treatment differs between individuals. According to recent studies done with first and second generation lithotripters, different prognostic variables like stone size, stone location, stone composition, age of patient and BMI have been shown to have prognostic relevance for outcome after SWL treatment. This study has been performed with a newer, third generation lithotripter. According to this study, BMI has no impact on SWL treatment success. Therefore, SWL treatment with newer generation lithotripters should be considered for the treatment of kidney stones in overweight and obese patients.

OBJECTIVE

? To investigate the effect of different variables including body mass index (BMI) on therapy outcome in patients with upper urinary tract stones treated with a third generation lithotripter, as BMI has been reported to be an independent predictor for stone‐free status after extracorporeal shockwave lithotripsy (SWL) performed with first or second generation lithotripters.

PATIENTS AND METHODS

? In all, 172 patients with kidney stones with a mean (range) size of 9.2 (3.0–32.0) mm were included in the study. ? In all, 91 patients (52.9%) were treated with a ureteric stent in situ. ? For SWL therapy a third generation, electromagnetic lithotripter (Siemens Lithoskop^TM) was used. Stone‐free status was reached, when no more treatable stones were present (no stone or stone < 3 mm). ? BMI, stone size and localization, age, gender, treatment parameters and ureteric stent in situ were evaluated for their prognostic relevance on therapy success.

RESULTS

? The mean (range) BMI of all patients was 27.8 (19.0–58.6) kg/m². ? Patients were categorized into two groups: A) patients that were stone free after one treatment; B) patients with residual stones. The mean (sd ) BMI was 27.4 (4.6) kg/m² and 28.4 (6.1) kg/m² for A and B, respectively. ? Univariate and multivariate analysis for freedom of stones showed that only stone size (P < 0.01) and presence of a ureteric stent (P= 0.01) were independent prognostic variables. ? BMI had no significant influence on therapy outcome (P= 0.51).

CONCLUSIONS

? Using a third generation lithotripter, BMI was not an independent predictor of stone‐free rate after SWL therapy of kidney stones. ? This effect might be attributed to a greater penetration depth of the shockwave energy. Stone size and a ureteric stent in situ were the only variables with prognostic significance.     

The association of elevated body mass index (BMI) with complications and outcomes following anatomic total shoulder arthroplasty: a systematic review

PurposeObesity has been associated with increased perioperative complications following shoulder arthroplasty, though this finding has not been consistently reported. The purpose of this systematic review is to summarize the correlation between elevated body mass index (BMI) and the prevalence of perioperative complications and clinical outcomes following anatomic total shoulder arthroplasty (aTSA).MethodsAn extensive literature search of PubMed, Embase, ScienceDirect, and Google Scholar was conducted up until October 2020. Clinical studies that specifically examined the association between BMI and/or various categories of obesity with perioperative complications and functional outcomes following aTSA were included. Public databases (NIS, ACS-NSQIP, PearlDiver, and statewide databases) were largely excluded from the analysis unless procedural codes allowed for differentiation between reverse total shoulder arthroplasty (rTSA) and aTSA.ResultsEleven studies were included in this systematic review - 9 studies reported solely on perioperative complications, 1 study solely on functional outcomes, and 1 study on both complications and outcomes following aTSA. Seven papers had a MINORS (Methodological Index for Non-Randomized Studies) score of <16, indicating low methodological quality. There was no association found between elevated BMI and overall perioperative medical and surgical complications, surgical site infection (SSI), re-operation without revision, aseptic revision, periprosthetic fracture, intraoperative blood loss, need for blood transfusion, 90-day re-admission, absolute hospital LOS or short-term mortality. There is an increased risk for overall revision following aTSA and need for extended hospital LOS in patients with elevated BMI. Range of motion of the operative shoulder, pain, and patient reported outcome measures (PROMs) have generally demonstrated significant improvement following unconstrained arthroplasty.DiscussionIncreasing BMI was not found to be associated with an elevated risk for the majority of perioperative complications following aTSA. Range of motion and patient reported functional outcomes can be expected to improve, even amongst morbidly obese patients.Level of EvidenceLevel IV; Review Article     

Estrogen receptor alpha gene polymorphisms and bone mineral density: haplotype analysis in women from the United Kingdom.

Genetic factors are important in the pathogenesis of osteoporosis and the estrogen receptor has been suggested as a possible candidate gene for regulation of bone mineral density (BMD). We investigated the relationship between PvuII, XbaI, and dinucleotide (TA)n repeat polymorphisms of the estrogen receptor alpha (ER-alpha) gene and BMD in a study of women from northeast Scotland in the United Kingdom. No significant association was observed between BMD values at the lumbar spine (LS) and femoral neck (FN) in relation to PvuII and XbaI polymorphisms individually, but haplotype analysis showed that BMD values (Z score) were significantly lower in those who carried the Px haplotype (n = 36) compared with those who did not (n = 170) at both the LS (mean +/- SEM; -0.775 +/- 0.125 vs. -0.285 +/- 0.082;p = 0.002) and the FN (-0.888 +/- 0.130 vs. -0.335 +/- 0.083; p = 0.0006). In keeping with this, the Px haplotype also was found to be an independent predictor of LS BMD (p = 0.019) and FN BMD (p = 0.005) in a multiple regression analysis model that included other possible predictors of BMD including age, years since menopause (YSM), hormone-replacement therapy (HRT) use, weight, and height. This model explained 15.7% and 23.4% of the total observed variance in LS and FN BMD, respectively, with the Px haplotype accounting for approximately 3% of the variance at both sites. Although the TA repeat polymorphism was in strong linkage disequilibrium (LD) with the PvuII (chi2 = 109.8; p < 0.0001) and XbaI (chi2 = 97.2; p < 0.0001) polymorphisms, there was no overall association between TA repeat number and BMD. We conclude that polymorphisms of the ER-alpha gene are significantly related to BMD in our population and that this association is dependent on the Px haplotype, suggesting that it is the Px haplotype, or a linked polymorphism, that confers risk.     

Outcomes of bariatric surgery in extreme obesity: results from the United Kingdom National Bariatric Surgery Registry for patients with a body mass index >70 kg/m2

BackgroundBariatric and metabolic surgery (BMS) is an established safe, effective, and durable treatment for obesity and its complications. However, there is still a paucity of evidence on surgery outcomes in patients suffering from extreme obesity.ObjectivesThis study aimed to evaluate outcomes of BMS in weight loss and the resolution of co-morbidities in patients with a body mass index (BMI) ≥70kg/m².SettingNational Health Service and private hospitals in the United Kingdom.MethodsThis cohort study analyzed prospectively collected records from the UK National Bariatric Surgery Registry of patients with a BMI ≥70 kg/m² undergoing Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), or adjustable gastric band (AGB) between January 2009 and June 2014.ResultsThere were 230 patients (64% female) eligible for inclusion in the study: 22 underwent AGB; 102 underwent SG, and 106 underwent RYGB. Preoperative weight and BMI values were comparable (76 ± 7 kg/m² for AGB; 75 ± 5 kg/m² for SG; 74 ± 5 kg/m² for RYGB). The median postoperative follow-up was 13 months for AGB (10–22 mo), 18 for SG (6–28 mo), and 15 for RYGB (6–24 mo). Patients undergoing RYGB and SG exhibited the greatest postoperative total body weight loss (35 ± 13% and 31 ± 15%, respectively; P = .14), which led to postoperative BMIs of 48 ± 10 kg/m² and 51 ± 11 kg/m², respectively (P = .14). All procedures conferred a reduction in the incidence of co-morbidities, including type 2 diabetes, and led to improved functional statuses. The overall complication rate was 7%, with 3 deaths (1%) within 30 days of surgery.ConclusionThis study found that primary BMS in patients with a BMI >70kg/m² has an acceptable safety profile and is associated with good medium-term clinical outcomes. RYGB and SG are associated with better weight loss and great improvements in co-morbidities than AGB. Given the noninferiority of SG outcomes and SG’s potential for further conversion to other BMS procedures if required, SG may be the best choice for primary BMS in patients with extreme obesity.     

体重指数与肾结石ESWL治疗后常见并发症的关系

目的 探讨体重指数（BMI）与体外冲击波碎石术（ESWL）术后常见并发症的关系。方法 选取2020年1月至2020年12本院收治的213例因肾结石需行ESWL治疗的患者,按《中国成人超重和肥胖症预防控制指南》分为A组（58例,BMI<18.5 kg/m²）、B组（120例,18.5 kg/m²≤BMI<24 kg/m²）、C组（35例,BMI≥24 kg/m²）。比较三组患者术前1 d和术后第1天的血肌酐和血中性粒细胞明胶酶相关脂质运载蛋白(NGAL),术后第1天复查泌尿系B超,按Clavien-Dindo分级对各组术后并发症进行评分并进行比较。结果 213例患者的碎石能量为（95.4±15.1）J,冲击次数为（1 230±310）次,碎石时间（21.6±10.2）min。与术前1 d相比,三组术后1 d的NGAL升高,差异有统计学意义（P<0.05）。 与C 组相比,A、B组术后1 d的血肌酐、NGAL升高,差异均有统计学意义（均P<0.05）;与B组相比,A组术后1 d的血肌酐、NGAL升高,差异均有统计学意义（均P<0.05）。A组出现Clavien Ⅰ级并发症者8例、Clavien Ⅱ级并发症者4例,Clavien Ⅲ级并发症者1例;B组出现Clavien Ⅰ级并发症者6例、Clavien Ⅱ级并发症者2例,C组出现Clavien Ⅰ级并发症者2例,三组并发症比较,差异有统计学意义（P<0.05）。结论 BMI对于肾结石ESWL术后出现并发症有一定影响,BMI越低出现术后常见并发症概率越大。     

Habitual levels of physical activity influence bone mass in 11-year-old children from the United Kingdom: findings from a large population-based cohort.

We examined the influence of habitual levels of physical activity on bone mass in childhood by studying the relationship between accelerometer recordings and DXA parameters in 4457 11-year-old children. Physical activity was positively related to both BMD and bone size in fully adjusted models. However, further exploration revealed that this effect on bone size was modified by fat mass. INTRODUCTION: Exercise interventions have been reported to increase bone mass in children, but it is unclear whether levels of habitual physical activity also influence skeletal development. MATERIALS AND METHODS: We used multivariable linear regression to analyze associations between amount of moderate and vigorous physical activity (MVPA), derived from accelerometer recordings for a minimum of 3 days, and parameters obtained from total body DXA scans in 4457 11-year-old boys and girls from the Avon Longitudinal Study of Parents and Children. The influence of different activity intensities was also studied by stratification based on lower and higher accelerometer cut-points for moderate (3600 counts/minute) and vigorous (6200 counts/minute) activity, respectively. RESULTS: MVPA was positively associated with lower limb BMD and BMC adjusted for bone area (aBMC; p < 0.001, adjusted for age, sex, socio-economic factors, and height, with or without additional adjustment for lean and fat mass). MVPA was inversely related to lower limb bone area after adjusting for height and lean mass (p = 0.01), whereas a positive association was observed when fat mass was also adjusted for (p < 0.001). Lower limb BMC was positively related to MVPA after adjusting for height and lean and fat mass (p < 0.001), whereas little relationship was observed after adjusting for height and lean mass alone (p = 0.1). On multivariable regression analysis using the fully adjusted model, moderate activity exerted a stronger influence on lower limb BMC compared with light activity (light activity: 2.9 [1.2-4.7, p = 0.001]; moderate activity: 13.1 [10.6-15.5, p < 0.001]; regression coefficients with 95% confidence intervals and p values). CONCLUSIONS: Habitual levels of physical activity in 11-year-old children are related to bone size and BMD, with moderate activity exerting the strongest influence. The effect on bone size (as reflected by DXA-based measures of bone area) was modified by adjustment for fat mass, such that decreased fat mass, which is associated with higher levels of physical activity, acts to reduce bone size and thereby counteract the tendency for physical activity to increase bone mass.     

‘The bigger they come…’: the relationship between body mass index and severity of ankle fractures

Ankle fractures requiring either manipulation under anaesthetic or open reduction and internal fixation can lead to prolonged morbidity. This prospective study investigates the possible relationship between obesity and the severity of ankle fractures following low velocity injuries. The body mass index (BMI) of patients with displaced malleolar fractures was compared with that of patients with undisplaced malleolar fractures. A BMI of 18 to 25 kg/m² is considered to be the ‘desirable’ range for both men and women. Fractures considered ‘severe’ were those associated with disruption of the ankle joint, with more than one malleolar fragment, and requiring manipulation under anaesthesia or open reduction and internal fixation. The mean BMI of patients with displaced fractures (28.25 kg/m²) was significantly higher than that (24.58 kg/m²) of those with undisplaced fractures (P=0.0001). Obesity is associated with increased severity of ankle fractures following low velocity injuries.     

中老年女性血清25羟维生素D水平与骨密度、体质量指数的调查研究

目的调查深圳市中老年女性人群血清25羟维生素D水平、骨密度(bone mineral density,BMD)和体质量指数(body mass index,BMI)并探讨其相关性,为骨质疏松症(osteoporosis,OP)的防治提供相应的依据。方法收集2018年10月至2019年2月于深圳平乐骨伤科医院(坪山区中医院)参与调查的中老年女性212例[年龄50～84岁,平均(60. 1±7. 8)岁],测量受试者的身高、体重,计算BMI,根据BMI分成体重过低组(6例)、正常体重组(112例)和超重组(94例),分别测量各组骨密度和血清25羟维生素D水平。采用Spearman相关分析观察指标间的相关性。结果体重过低组、正常体重组和超重组三组的OP患病率依次为:83. 3%、58. 0%和57. 4%,三组的差异不具有统计学意义(P0. 05)。正常体重组的25羟维生素D与BMD、BMI均不存在相关关系(P0. 05),BMD与年龄的关系呈负相关,与身高、体重均呈正相关(P0. 05),但是与BMI之间则不存在相关性(P0. 05)。在超重组中,25羟维生素D与BMI呈负相关,BMD与年龄呈负相关,与身高呈正相关(P0. 05),但是与体重、BMI之间的相关性无统计学意义(P0. 05)。结论在BMI正常范围内,高体重是OP的保护因素,而超重时则不存在此关系。且超重对中老年女性的血清25羟维生素D水平可产生负面影响。过重的体重可能不利于OP的防治,中老年女性应控制体重在正常范围内。