Association of implantable defibrillator therapy risk with body mass index in systolic heart failure

Objectives

To determine whether risk for implantable cardioverter-defibrillator (ICD) therapy varies by body mass index (BMI) in systolic heart failure (HF).

Background

It is unknown whether obesity increases sudden death risk in patients with systolic HF.

Methods

Secondary analysis of patients with HF, left ventricular ejection fraction ≤0.40 and ICD (N = 464) was performed using Cox regression modeling to assess risk for first delivered ICD therapy, with patients grouped by BMI (kg/m²): normal (18.5 to <25), overweight (25 to <30), and obese (≥30).

Results

Overweight patients, compared with patients with normal BMI, had greater adjusted risk for first ICD therapy (HR 1.66; 95% CI 1.02–2.71; P = 0.04), whereas obese BMI was not associated with risk for first ICD therapy.

Conclusions

There was an inverted U-shaped relationship between BMI and risk for first ICD therapy among systolic HF patients, with highest risk in overweight BMI.     

The changes of neutrophil gelatinase-associated lipocalin in plasma and its expression in adipose tissue in pregnant women with gestational diabetes

Aims

To investigate plasma levels and the expression of neutrophil gelatinase-associated lipocalin (NGAL) in subcutaneous adipose tissue (SAT) in patients with gestational diabetes mellitus (GDM).

Methods

The study recruited 260 Chinese women divided into three groups: 96 were healthy pregnant women with pre-pregnancy body mass index (pre-pregnancy BMI) below 25 kg/m² (GROUP 1), 84 were women with GDM with pre-pregnancy BMI below 25 kg/m² (GROUP 2) and 80 were women with GDM with pre-pregnancy BMI over 25 kg/m² (GROUP 3). Laboratory and anthropometric measurements were recorded and NGAL plasma levels were determined by ELISA for subjects in all groups. Real-time RT-PCR and Western blotting were used to assess the relative mRNA and protein expression of NGAL and tumor necrosis factor-α (TNF-α) in SAT (30 cases in each group).

Results

Our results demonstrated statistically significant elevation in plasma NGAL concentrations in GROUP 2 and GROUP 3 compared with GROUP 1 (p < 0.001 for both group comparisons). Moreover, SAT NGAL mRNA (p < 0.001 and p < 0.001, respectively) and protein (p < 0.001 and p < 0.001, respectively) expression levels were higher in GROUP 3 than in both GROUP 1 and GROUP 2. Correlations were noted between the plasma NGAL concentration and various parameters of insulin resistance.

Conclusions

Plasma NGAL may play a role in the development of insulin resistance in GDM, and the high levels of NGAL expression in SAT in overweight women with GDM suggests that NGAL in SAT is associated with obesity in women with GDM.     

Non-HDL cholesterol is an independent risk factor for aspirin resistance in obese patients with type 2 diabetes

Objective

We evaluated the prevalence of aspirin resistance and predictive factors for aspirin resistance in Korean type 2 diabetes patients.

Approach and results

A total of 1045 type 2 diabetes patients from 11 hospitals who were taking aspirin (100 mg/day for ≥2 weeks) and no other antiplatelet agents were studied to evaluate aspirin resistance. Aspirin resistance was measured in aspirin reaction units using VerifyNow^®. Aspirin resistance was defined as ≥550 aspirin reaction units.Aspirin resistance was detected in 102 of the 1045 subjects (prevalence 9.8%). Aspirin resistance was associated with total cholesterol (P = 0.013), LDL-cholesterol (P = 0.028), and non-HDL cholesterol (P = 0.008) concentrations in univariate analysis. In multivariate logistic regression analysis, only non-HDL cholesterol was associated with aspirin resistance in obese (BMI >25 kg/m²) type 2 diabetes patients (adjusted odds ratio 3.55, 95% CI: 1.25–10.05, P = 0.017).

Conclusions

The prevalence of aspirin resistance in Korean type 2 diabetes patients is 9.8%. Non-HDL cholesterol is an independent risk factor for aspirin resistance, especially in obese type 2 diabetes patients.     

Obesity with and without metabolic syndrome: Do vitamin D and thyroid autoimmunity have a role?

Aims

To investigate serum levels of thyroid stimulating hormone (TSH), anti-thyroid peroxidase antibody (TPO), and 25(OH)D in the presence or absence of metabolic syndrome in an obese population.

Methods

Data from a prospectively generated “Obesity Polyclinic” database that includes socio-demographic characteristics, anthropometric, and laboratory measurements of obese subjects were retrospectively analyzed. Subjects with body-mass index (BMI) ≥30 kg/m² were eligible. After detailed analysis and exclusion of unavailable cases, subjects diagnosed with and without metabolic syndrome were compared for TSH, anti-TPO, and 25(OH)D.

Results

Of the study participants (n = 548; men/women, 64/484), 277 were diagnosed with metabolic syndrome [Met-S (+)]. Met-S (+) patients had a higher mean BMI (36.4 vs. 32.3 kg/m², p < .001) and percentage body fat (PBF) (39.2 vs. 35.3%, p < .001), but similar TSH (2.1 vs. 2.2 mIU/mL, p = .759), anti-TPO (12 vs. 13 IU/mL, p = .483), 25(OH)D (13.2 vs. 12.6 ng/mL, p = .409), and calcium–phosphorus product (28.7 vs. 29.5 mg/dL, p = 0.275), compared to Met-S (−) subjects. When serum TSH, anti-TPO, and 25(OH)D levels were analyzed according to tertiles for comparisons of fasting plasma glucose, triglycerides, high-density lipoprotein cholesterol, BMI, and PBF, only 25(OH)D levels were negatively correlated with BMI and PBF.

Conclusions

Although decreased 25(OH)D levels were related to the degree of obesity in obese subjects, serum 25(OH)D levels per se did not seem to be associated with metabolic syndrome. The prevalence of thyroid autoimmunity and hypothyroidism were high in this obese sample; however, neither serum TSH nor anti-TPO levels correlated with metabolic syndrome. Our findings did not support the hypothesis that thyroid autoimmunity and/or vitamin D status have a role in the development of metabolic disturbances in the obese population.     

The effects of body mass index on surface electrocardiograms in young adults

Introduction

While BMI is known to affect ECG measurements, these effects have not been well characterized in young adults.

Methods

We retrospectively reviewed all ECGs performed in adults 18 to 35 years old at a single institution over a 30 year period. ECG measurements were derived electronically and stratified by WHO BMI category.

Results

A total of 55,218 ECGs were included. Increasing BMI led to increased P wave duration and decreasing P, R, and T wave axes. Additionally, while increasing BMI led to less R wave voltage, J point elevation, and T wave amplitude in patients with a BMI ≥ 18.5 kg/m², there was also a decrease in the measured parameters in patients with a BMI < 18.5 kg/m².

Discussion

BMI had significant effects on ECG measurements. For accurate assessment of ECGs, these data should be incorporated into established nomograms. Further investigation into the effects of BMI on the ECG is warranted.     

Síndrome de apnea-hipopnea del sueño en pacientes normopeso: características y comparación con pacientes con sobrepeso y obesidad

Objective

To determine the frequency of obstructive sleep apnoea (OSA) and metabolic syndrome (MS) in normal weight patients and their characteristics, and to compare these with overweight and obese patients.

Methods

We studied all patients with suspected OSA referred to the sleep laboratory from January to December 2009. OSA was diagnosed when the apnoea-hypopnoea index (AHI) was > 5 and symptoms were present. MS was diagnosed according to International Diabetes Federation (IDF) criteria. The patients were distributed into 3 groups according to body mass index (BMI): normal weight (< 25 kg/m²), overweight (25-29.9 kg/m²) and obese (≥ 30 kg/m²).

Results

We studied 475 patients: 7.60% normal weight and 56.4% obese. Most patients in the normal weight group were women, snorers, non-smokers, non-drinkers and were significantly younger and with a smaller neck and waist circumference than obese and overweight patients. OSA was diagnosed in 90.10%: 77.70% normal weight. OSA in these patients was mostly mild, and there were differences between the diagnosis of OSA and the BMI classified. MS was diagnosed in 64.40%: 33.33% normal weight. There was a higher probability of MS as the BMI increased. OSA and MS frequency in normal weight patients was 22% and in obese patients was 70.52%. OSA in normal weight patients was related with gender and age. There was no relationship between OSA and MS, or between otorhinolaryngological malformations and OSA in normal weight patients. Eight normal weight patients with OSA were treated with continuous positive airway pressure (CPAP) therapy.

Conclusions

The frequency of OSA in normal weight patients was lower than in overweight and obese patients. The frequency of concomitant OSA and MS was lower in normal weight patients than in obese subjects. Normal weight patients were mostly women, younger and had no toxic habits. In normal weight patients, age and gender were predictive factors for OSA, but OSA and MS were not related.     

Long-term weight change in adulthood and incident diabetes mellitus: MY Health Up Study

Aim

To investigate whether long-term weight/BMI change in adulthood has a significant impact on the incidence of diabetes, independent of attained weight status.

Methods

A number of 13,700 participants (2962 men and 10,738 women) aged 36 to 55 years were followed for up to 5 years using data from annual health checkups. Incident cases of diabetes were identified from self-reports or single fasting plasma glucose measurements (≥7.0 mmol/l). Weight/BMI change was calculated from participants’ weight/BMI values at age 20 years and weight/BMI values at a given point during follow-up and used as a time-dependent variable in age-stratified multivariate Cox proportional hazards models.

Results

During the 5 year follow-up, 408 participants (137 men and 271 women) developed diabetes. Even after adjusting for BMI during follow-up and other possible confounders, weight/BMI gain since age 20 years was significantly associated with an increased risk of developing diabetes. The hazard ratios were: 2.30 (95% confidence interval (CI): 1.31–4.04) for those who gained 6.0 to <10.0 kg and 3.09 (95% CI: 1.79–5.34) for those who gained ≥10.0 kg [reference: <2.0 kg change]; and 2.61 (95% CI: 1.58–4.31) for those who gained 3.0 to <5.0 kg/m² and 3.70 (95% CI: 2.22–6.16) for those who gained ≥5.0 kg/m² [reference: <1.0 kg/m² change].

Conclusions

The results indicate that long-term weight/BMI gain in adulthood is a significant predictor for the development of diabetes, independent of attained weight status. Because weight gain within the normal weight range could increase the risk of diabetes, non-obese people should also be warned against possible weight gain.     

The obesity paradox in men with coronary heart disease and heart failure: The role of muscle mass and leptin

Aims

We have investigated the role of muscle mass, natriuretic peptides and adipokines in explaining the obesity paradox.

Background

The obesity paradox relates to the association between obesity and increased survival in patients with coronary heart disease (CHD) or heart failure (HF).

Methods

Prospective study of 4046 men aged 60–79 years followed up for a mean period of 11 years, during which 1340 deaths occurred. The men were divided according to the presence of doctor diagnosed CHD and HF: (i) no CHD or HF ii), with CHD (no HF) and (iii) with HF.

Results

Overweight (BMI 25–9.9 kg/m²) and obesity (BMI ≥ 30 kg/m²) were associated with lower mortality risk compared to men with normal weight (BMI 18.5–24.9 kg/m²) in those with CHD [hazards ratio (HR) 0.71 (0.56,0.91) and 0.77 (0.57,1.04); p = 0.04 for trend] and in those with HF [HR 0.57 (0.28,1.16) and 0.41 (0.16,1.09; p = 0.04 for trend). Adjustment for muscle mass and NT-proBNP attenuated the inverse association in those with CHD (no HF) [HR 0.78 (0.61,1.01) and 0.96 (0.68,1.36) p = 0.60 for trend) but made minor differences to those with HF [p = 0.05]. Leptin related positively to mortality in men without HF but inversely to mortality in those with HF; adjustment for leptin abolished the BMI mortality association in men with HF [HR 0.82 (0.31,2.20) and 0.99 (0.27,3.71); p = 0.98 for trend].

Conclusion

The lower mortality risk associated with excess weight in men with CHD without HF may be due to higher muscle mass. In men with HF, leptin (possibly reflecting cachexia) explain the inverse association.     

Trends in leisure time physical activity,smoking, body mass index and alcohol consumption in Danish adults with and without diabetes: A repeat cross-sectional national survey covering the years 2000 to 2010

Aims

In recent decades there has been an increased focus on non-pharmacological treatment of diabetes. The aim of this study was to investigate trends in leisure time physical activity (PA), smoking, body mass index (BMI), and alcohol consumption reported in 2000, 2005 and 2010 by Danish subjects with diabetes.

Methods

Data comprised level of leisure time PA (inactive; moderate active; medium active; high active); smoking; BMI; and alcohol consumption, provided by The Danish Health and Morbidity Surveys. Participants older than 45 years with or without diabetes were included from cross-sectional analyses from 2000, 2005 and 2010.

Results

In participants with diabetes, leisure time PA levels increased from 2000 to 2010: The percentage of those that were physically active increased from 53.5% to 78.2% (p < 0.001; women) and from 67.8% to 79.1% (p = 0.01; men). The prevalence of daily smokers was reduced from 27.2% to 16.4%, p = 0.015, in women with diabetes. In men with diabetes, BMI increased from 27.2 ± 4.0 to 28.6 ± 5.1 kg m⁻², p = 0.003, and men who exceeded the maximum recommendation for alcohol consumption increased from 9.4% to 19.0%, p = 0.007. The leisure time PA level was reduced in participants with diabetes compared to participants without diabetes throughout the study.

Conclusions

The percentage of physically active Danish participants older than 45 years with diabetes increased from 2000 to 2010, and the most beneficial trends in life style were observed among the women. These trends may have serious implications for cardiovascular risk in Danish patients with diabetes.     

Is there a skeletal muscle mass threshold associated with the deterioration of insulin sensitivity in sedentary lean to obese postmenopausal women?

Aim

The purpose of this study was to determine an optimal cut-off point of skeletal muscle mass, using appendicular lean body mass (LBM) index, that identifies at risk individuals with deteriorated insulin sensitivity, using an established quantitative insulin sensitivity index (QUICKI) cut-off.

Methods

We performed a cross-sectional analysis in 231 lean and obese (BMI: 18.7–51.0 kg/m²) menopausal women. Fasting plasma glucose and insulin were obtained to calculate QUICKI as an index of insulin sensitivity. Skeletal muscle mass was measured as appendicular LBM by DXA and expressed as appendicular LBM index [appendicular LBM (kg)/height (m²)]. Cut-offs were determined using receiver operating characteristic (ROC) curve analyses.

Results

The best cut-off value for skeletal muscle mass index to identify menopausal women with reduced insulin sensitivity was 7.025 kg/m² which had a sensitivity of 69.5% and specificity of 58.2%.

Conclusion

Our results suggest that sedentary postmenopausal women with an appendicular skeletal muscle mass index above 7.025 kg/m² may be at greater risk of insulin resistance. Prospective studies are needed to validate our result.     

Beneficial effects of liraglutide on adipocytokines,insulin sensitivity parameters and cardiovascular risk biomarkers in patients with Type 2 diabetes: A prospective study

Aims

To evaluate the effects of liraglutide after 14 weeks of treatment on serum adipokines, insulin resistance index and cardiovascular risk biomarkers in overweight or obese T2DM patients unable to achieve glycemic control with metformin alone or in association with a sulfonylurea in daily clinical practice.

Methods

Prospective study in 59 consecutive overweight or obese (BMI ≥ 25 kg/m²) T2DM patients unable to achieve glycemic control (HbA1c > 7%, 53 mmol/mol) with metformin alone or in association with sulfonylurea that require initiation of liraglutide in progressive dose increase up to 1.8 mg/day subcutaneously. Weight, body composition, blood pressure, glucose, HbA1c, C-peptide, insulin, plasma lipids, adipokines (leptin, adiponectin, resistin and visfatin) as well as cardiovascular biomarkers (IL-6 and TNF-a) levels were measured fasting at baseline and 14 weeks after liraglutide initiation.

Results

14 weeks of liraglutide treatment significantly reduced HbA1c, BMI and total body fat mass by 0.9%, 1.4 kg/m² and 0.5% respectively. Statistically significant lower insulin resistance and higher insulin secretion was found by HOMA-IR 8.4 (1.6) vs 4.6 (0.9) mol m IU/L² and HOMA-B 48.2 (9.0) vs 87.6 (16.3) μIU/mmol. Statistically significantly higher levels of visfatin 6.3 (2.1) vs 6.8 (2.1) ng/ml and resistin 3.6 (2.0) vs 4.3 (2.3) ng/ml were also observed after treatment. Baseline visfatin was negatively correlated with basal fasting plasma glucose r = −0.360 (p < 0.05).

Conclusions

Liraglutide treatment for 14 weeks in daily clinical practice led to reduction of BMI and improvement of glucose control and insulin sensitivity and resistance parameters. Additionally, circulating levels of adipokines and pro-inflammatory factors could play an important role in GLP-1 treatment response.     

Self-initiated changes in physical activity levels improve cardiometabolic profiles: A longitudinal follow-up study

Background and aims

While studies have described the importance of higher physical activity levels (PAL) in weight loss, the impact of self-initiated PAL on health status warrants further study. We aimed to prospectively examine the effects of self-initiated longitudinal PAL changes on body mass index (BMI) and cardiometabolic parameters in normal weight, overweight and obese adults.

Prevalence and determinants of metabolically healthy obesity in Spain

Background and aims

Obesity is a heterogeneous disorder, so some obese individuals do not have cardiometabolic abnormalities (CA) which mediate the association between obesity and coronary heart disease. This study assessed the prevalence of metabolically healthy obesity and its determinants in Spain.

Methods

The data were taken from a cross-sectional study conducted in 2008–2010 among 11,520 individuals representative of the population of Spain aged ≥18 years. Normal-weight was defined as body mass index (BMI) <25 kg/m², and obesity as BMI ≥30 kg/m². Six CA were considered: elevated blood pressure, low high-density lipoprotein cholesterol, and elevated levels of triglycerides, fasting glucose, homeostasis model assessment of insulin resistance value, and C-reactive protein. Then, two phenotypes were defined: healthy (0–1 CA) and abnormal (≥2 CA).

Results

The prevalence of metabolically healthy obesity was 6.5% overall (95% confidence interval: 6.0–7.1), and corresponds to 28.9% of obese individuals. Lower age, being female, current smoking, moderate alcohol consumption, and high level of physical activity were independently associated with the healthy phenotype among the obese. The prevalence of normal weight with a metabolically abnormal phenotype was 6.4% overall (95% confidence interval: 5.8–6.9) and corresponds to 16.8% of normal-weight subjects. Factors associated with this phenotype in normal-weight persons were higher age, being male, never smoking, no alcohol consumption and larger waist circumference.

Conclusion

Metabolically healthy obesity represents almost one-third of the obese population in Spain. Since this was a cross-sectional study, the association of metabolic healthy obesity with smoking consumption, alcohol intake and physical activity warrants more research.     

Obesity paradox in patients with hypertension and coronary artery disease

Purpose

An obesity paradox, a “paradoxical” decrease in morbidity and mortality with increasing body mass index (BMI), has been shown in patients with heart failure and those undergoing percutaneous coronary intervention. However, whether this phenomenon exists in patients with hypertension and coronary artery disease is not known.

Methods

A total of 22,576 hypertensive patients with coronary artery disease (follow-up 61,835 patient years, mean age 66 ± 9.8 years) were randomized to a verapamil-SR or atenolol strategy. Dose titration and additional drugs (trandolapril and/or hydrochlorothiazide) were added to achieve target blood pressure control according to the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure targets. Patients were classified into 5 groups according to baseline BMI: less than 20 kg/m² (thin), 20 to 25 kg/m² (normal weight), 25 to 30 kg/m² (overweight), 30 to 35 kg/m² (class I obesity), and 35 kg/m² or more (class II-III obesity). The primary outcome was first occurrence of death, nonfatal myocardial infarction, or nonfatal stroke.

Results

With patients of normal weight (BMI 20 to <25 kg/m²) as the reference group, the risk of primary outcome was lower in the overweight patients (adjusted hazard ratio [HR] 0.77, 95% confidence interval [CI], 0.70-0.86, P <.001), class I obese patients (adjusted HR 0.68, 95% CI, 0.59-0.78, P <.001), and class II to III obese patients (adjusted HR 0.76, 95% CI, 0.65-0.88, P <.001). Class I obese patients had the lowest rate of primary outcome and death despite having smaller blood pressure reduction compared with patients of normal weight at 24 months (−17.5 ± 21.9 mm Hg/−9.8 ± 12.4 mm Hg vs −20.7 ± 23.1 mm Hg /−10.6 ± 12.5 mm Hg, P <.001).

Conclusion

In a population with hypertension and coronary artery disease, overweight and obese patients had a decreased risk of primary outcome compared with patients of normal weight, which was driven primarily by a decreased risk of all-cause mortality. Our results further suggest a protective effect of obesity in patients with known cardiovascular disease in concordance with data in patients with heart failure and those undergoing percutaneous coronary intervention.     

Incremental Lowering of Low-Density Lipoprotein Cholesterol With Ezetimibe 20 mg vs 10 mg Daily in Patients Receiving Concomitant Statin Therapy

Background

Ezetimibe is typically administered at a dose of 10 mg daily, with few reports of use at other doses. We compared plasma concentrations of low-density lipoprotein (LDL) cholesterol and other lipid variables in patients with dyslipidemia who were receiving ezetimibe 10 mg and then 20 mg daily.

Methods

A retrospective chart review identified 27 patients who received ezetimibe 10 mg and then 20 mg daily at different times; 15 participants were receiving stable statin therapy and 12 were not receiving concomitant statins. Plasma concentrations of lipids, creatine kinase (CK), and aspartate transaminase (AST) were determined. Plasma concentrations of ezetimibe and ezetimibe glucuronide were measured in a second group of patients.

Results

Patients taking statins and ezetimibe 20 mg had further reductions in total and LDL cholesterol of 7.1% and 10.3%, respectively (both P < 0.05) than did those receiving the 10-mg dose. No difference between 20-mg and 10-mg dosing was seen among patients not receiving statins. Plasma concentrations of ezetimibe and its active metabolite were about 2-fold higher (P < 0.05) in patients taking ezetimibe 20 mg than in those receiving 10 mg daily. All patients tolerated ezetimibe 20 mg without side effects.

Conclusions

Ezetimibe 20 mg daily reduced total and LDL cholesterol further in patients receiving statin therapy compared with 10 mg daily. Prospective studies are required to show whether the higher plasma levels of ezetimibe and its active metabolite in patients taking the 20-mg dose have any detrimental effects. Increasing the ezetimibe dose to 20 mg daily might be an interesting potential approach for patients who fail to reach lipid targets on ezetimibe 10 mg daily along with maximally tolerated doses of statin.     

The lactase persistence genotype is associated with body mass index and dairy consumption in the D.E.S.I.R. study

Objective

The T allele of a functional polymorphism (rs4988235: LCT-13910 C > T), close to the lactase gene, correlates with lactase persistence (LP) in adults. The LP genotype (TT + TC) has been associated with a higher BMI in European populations in cross-sectional studies. In the French D.E.S.I.R. cohort, a high consumption of dairy products was associated with a lower body weight gain over 9-years, and with a lower incidence of high plasma glucose levels and/or the metabolic syndrome. Our aim was to test in this study, the association of rs4988235 with BMI and related metabolic diseases, in interaction with dairy product consumption.

Methods

Among 5212 subjects from D.E.S.I.R., 3575 Caucasians born in mainland France were genotyped and followed over 9 years.

Results

Those with the LP genotype (frequency: 78.5%) had a higher dairy product consumption, at inclusion and at year-9 (P < 0.001). They also had a higher BMI at both time points (difference = 0.3 kg/m², P = 0.05), but this effect was restricted to medium/high dairy product consumers (difference = 0.5 kg/m², P = 0.006). This genotype was also associated with the metabolic syndrome (IDF definition), but this association disappeared after adjustment for BMI. In the whole population, the C allele was associated with a higher prevalence of impaired fasting glycemia and/or type 2 diabetes.

Conclusions

The lactase persistence genotype was shown to be associated with a higher BMI in a longitudinal study, mainly in those consuming high amounts of dairy products. The association of the C allele, responsible for lactase non-persistence, with the risk of hyperglycemia needs to be replicated.     

Association of high body mass index with development of interstitial fibrosis in patients with IgA nephropathy

Background

The worldwide prevalence of obesity is increasing. Obesity is associated with a variety of chronic diseases, including chronic kidney disease. Several studies suggested that body mass index (BMI) could be an independent risk factor for progression of IgA nephropathy (IgAN). However, whether high BMI is associated with progression of IgAN remains uncertain.

Methods

This retrospective study included patients with biopsy proven IgAN from 2006 to 2017 in Sichuan Provincial People’s Hospital. BMI was categorized according to the WHO Asian guideline: underweight (<?18.5?kg/m²), normal weight (18.5-25?kg/m²), overweight (25-28?kg/m²) and obese (≥28?kg/m²). The main outcome was development of end-stage renal disease (ESRD) or a decline in eGFR by at least 30%. The association of BMI and IgAN progression was determined by propensity-score-matched cohort analysis.

Results

Four hundred eighty one patients with IgAN were finally enrolled in this study. The mean age was 37?±?11?years and 40.3% were men. There was no significant difference in clinical and pathological characteristics among the four-group patients categorized by BMI. After matching with propensity scores, no significant correlation between BMI and renal outcomes was seen. However, compared with the reference group (18.5≦BMI≦25?kg/m²), being overweight (odd ratio [OR], 2.28; 95%CI: 1.06–4.88; P?=?0.034) and obese (OR, 3.43; 95%CI: 1.06–11.04; P?=?0.039) was associated with a high risk of interstitial fibrosis. In the cross figure demonstrating the association of BMI subgroup and interstitial fibrosis on renal outcomes, ORs of interstitial fibrosis groups were higher than those of no interstitial fibrosis. Compared with other BMI subgroups, patients with 18.5-25?kg/m² had lowest ORs.

Conclusions

High BMI and interstitial fibrosis were associated with progression of IgAN. Interstitial fibrosis appears to be common in IgAN patients with elevated BMI.

     

Acute changes in lipoprotein subclasses during exercise

Objective

Lipids are important substrates for oxidation in the basal fasting state and during exercise. Studies have demonstrated beneficial changes in lipoprotein subclass composition the day after an exercise bout. However, the acute effect of exercise on TG concentration and lipoprotein subclass composition remains unclear.

Materials/Methods

Sixteen lean, healthy individuals (8 men and 8 women) were recruited (age 20–30 years, BMI < 25 kg/m²). The subjects were studied during basal fasting conditions as well as during and after 90 min of cycling at 50% of VO₂peak. Lipoprotein subclass composition was measured with ¹H NMR spectroscopy.

Results

During exercise, LDL and HDL particle concentration increased significantly (p < 0.05) despite lower total TG concentration. In addition, exercise resulted in a shift towards smaller VLDL particles in men (p < 0.05), but VLDL–TG concentration was unaltered.

Conclusions

Acute exercise induces beneficial changes in lipoprotein subclass composition. These changes are similar to the effects of exercise training.     

A pilot study investigating the effects of continuous positive airway pressure treatment and weight-loss surgery on autonomic activity in obese obstructive sleep apnea patients

Background

We have previously demonstrated that severity of obstructive sleep apnea (OSA) as measured by the apnea–hypopnea index (AHI) is a significant independent predictor of readily-computed time-domain metrics of short-term heart rate variability (HRV).

Methods

We aimed to assess time-domain HRV measured over 5-min while awake in a trial of obese subjects undergoing one of two OSA therapies: weight-loss surgery (n = 12, 2 males, median and interquartile range (IQR) for BMI 43.7 [42.0, 51.4] kg/m², and AHI 18.1 [16.3, 67.5] events/h) or continuous positive airway pressure (CPAP) (n = 15, 11 males, median BMI 33.8 [31.3, 37.9] kg/m², and AHI 36.5 [24.7, 77.3] events/h). Polysomnography was followed by electrocardiography during wakefulness; measurements were repeated at 6 and 12–18 months post-intervention.

Results

Despite similar measurements at baseline, subjects who underwent surgery exhibited greater improvement in short-term HRV than those who underwent CPAP (p = 0.04).

Conclusions

Our data suggest a possible divergence in autonomic function between the effects of weight loss resulting from bariatric surgery, and the amelioration of obstructive respiratory events resulting from CPAP treatment. Randomized studies are necessary before clinical recommendations can be made.     

Bariatric surgery in morbidly obese patients improves the atherogenic qualitative properties of the plasma lipoproteins

Objective

The purpose of this study was to evaluate the effect of weight loss induced in morbidly obese subjects by Roux-en-Y gastric bypass bariatric surgery on the atherogenic features of their plasma lipoproteins.

Methods

Twenty-one morbidly obese subjects undergoing bariatric surgery were followed up for up to 1 year after surgery. Plasma and lipoproteins were assayed for chemical composition and lipoprotein-associated phospholipase A2 (Lp-PLA2) activity. Lipoprotein size was assessed by non-denaturing polyacrylamide gradient gel electrophoresis, and oxidised LDL by ELISA. Liver samples were assayed for mRNA abundance of oxidative markers.

Results

Lipid profile analysis revealed a reduction in the plasma concentrations of cholesterol and triglycerides, which were mainly associated with a significant reduction in the plasma concentration of circulating apoB-containing lipoproteins rather than with changes in their relative chemical composition. All patients displayed a pattern A phenotype of LDL subfractions and a relative increase in the antiatherogenic plasma HDL-2 subfraction (>2-fold; P < 0.001). The switch towards predominantly larger HDL particles was due to an increase in their relative cholesteryl ester content. Excess weight loss also led to a significant decrease in the plasma concentration of oxidised LDL (∼−25%; P < 0.01) and in the total Lp-PLA2 activity. Interestingly, the decrease in plasma Lp-PLA2 was mainly attributed to a decrease in the apoB-containing lipoprotein-bound Lp-PLA2.

Conclusion

Our data indicate that the weight loss induced by bariatric surgery ameliorates the atherogenicity of plasma lipoproteins by reducing the apoB-containing Lp-PLA2 activity and oxidised LDL, as well as increasing the HDL-2 subfraction.