Usefulness of body mass index to characterize nutritional status in patients with heart failure

The obesity paradox in heart failure (HF) is criticized because of the limitations of body mass index (BMI) in correctly characterizing overweight and obese patients, necessitating a better evaluation of nutritional status. The aim of this study was to assess nutritional status, BMI, and significance in terms of HF survival. Anthropometry and biochemical nutritional markers were assessed in 55 HF patients. Undernourishment was defined as the presence of ≥2 of the following indexes below the normal range: triceps skinfold, subscapular skinfold, arm muscle circumference, albumin, and total lymphocyte count. Patients were also stratified by BMI and followed for a median of 26.7 months. Across BMI strata, no patient was underweight, 31% were normal weight, 42% were overweight, and 27% were obese. Undernourishment was present in 53% of normal-weight patients, 22% of overweight patients, and none of the obese patients (p = 0.001). Undernourished patients had significantly higher mortality (p = 0.009) compared to well-nourished patients. In multivariate analysis, only undernutrition (hazard ratio 3.149, 95% confidence interval 1.367 to 7.253), New York Heart Association functional class (hazard ratio 3.374, 95% confidence interval 1.486 to 7.659), and age (hazard ratio 1.115, 95% confidence interval 1.045 to 1.189) remained in the model. Among nutritional indicators, subscapular skinfold was the best predictor of mortality; patients with subscapular skinfold in the fifth percentile had higher mortality (p = 0.0001). In conclusion, BMI does not indicate true nutritional status in HF. Classifying patients as well nourished or undernourished may improve risk stratification.     

Effects of nutritional and psychological status in gastrointestinal cancer patients on tolerance of treatment

AIM： To assess the effects of poor nutritional and psychological status on tolerance of cancer treatment and the recovery of physical performance status in patients with gastrointestinal cancer.
METHODS： An epidemiological survey with respect to nutritional and psychological status in patients with gastrointestinal cancer was conducted among 182 operated patients in four provincial-level hospitals from December 2005 to June 2006. The food frequency survey method, state-trait anxiety inventory （STAI） and depression status inventory （DSI） were used to obtain information about the diet and psychological status in the patients. Nutritional status in the participants was reflected by serum albumin （Alb）, hemoglobin （HB） and body mass index （BMI）.
RESULTS： Alb, protein intake and anxiety were associated with the severity of side effects of treatment. The adjusted relative risk （RR） for Alb, protein intake and anxiety was 3.30 （95% CI： 1.08, 10.10, P = 0.03）, 3.25 （95% CI： 1.06, 9.90, P = 0.04） and 1.48 （95% CI： 1.29, 1.70, P 〈 0.0001）, respectively. Moreover, calorie intake, HB and depression were associated with the recovery of physical performance status in the patients. Adjusted relative risk was 2.12 （95% CI： 1.09, 4.03, P = 0.028）, 2.05 （95% CI： 1.08, 3.88, P =0.026） and 1.07 （95% CI： 1.02, 1.12, P = 0.007）, respectively.
CONCLUSION： Both poor nutrition status and psychological status are independent risk factors for severe side effects of cancer treatment, and have impact on the recovery of physical performance status in patients after treatment.     

Body mass index and 25 hydroxyvitamin D status in patients with and without heart failure

The purpose of this pilot study was to assess the association between 25-hydroxyvitamin D (25[OH]D) concentrations, vitamin D intake, and sunlight exposure in patients with heart failure (HF) compared with healthy volunteers. Fourteen healthy volunteers 50 and older were recruited to compare with 14 patients with HF. Healthy volunteers were compared with HF patients by serum 25(OH)D concentrations, dietary vitamin D intake, weekly sunlight exposure, and other covariates. Independent sample t tests and linear regression models were used to compare differences between healthy volunteers and patients with HF. The mean serum 25(OH)D concentration was not significantly different between groups (healthy volunteers 25.7 ± 11.1 ng/mL, patients with HF 20.4 ± 10.2 ng/mL; P=.2) and no group effect was found in any multivariable models. Body mass index regardless of group was found to be inversely associated with serum 25(OH)D concentrations (P=.025). There was no difference in the dietary intake of vitamin D or calcium between groups. The healthy volunteers had a significantly greater amount of sunlight exposure but this did not result in higher 25(OH)D when compared with those with HF. Our findings suggest that body mass index has an important relationship with 25(OH)D concentrations regardless of a person being healthy or having HF.     

Body mass index and health status in diabetic and non-diabetic individuals

Background/Objectives:

There is controversy regarding the existence of a body mass index (BMI) mortality paradox in diabetes, whereby the optimal BMI category is higher than it is in non-diabetic persons. To explore possible pathways to a mortality paradox, we examined the relationship of BMI with physical and mental health status in diabetic and non-diabetic persons.

Subjects/Methods:

We examined adjusted SF-12 Physical and Mental Component Summary (PCS-12 and MCS-12) scores by BMI (kg m⁻²) category (underweight, <20; normal weight, 20 to <25; overweight, 25 to <30; obese, 30 to <35; severely obese ⩾35) in adult diabetic and non-diabetic respondents to the 2000–2011 United States national Medical Expenditure Panel Surveys (N=119 161). Adjustors were age, sex, race/ethnicity, income, health insurance, education, smoking, comorbidity, urbanicity, geographic region and survey year.

Results:

In non-diabetic persons the adjusted mean PCS-12 score was highest (that is, most optimal) in the normal-weight category, whereas for diabetic persons the optimal adjusted mean PCS-12 score was in the overweight category (adjusted difference between non-diabetic and diabetic persons in the difference in PCS-12 means for overweight versus normal-weight category=0.8 points, 95% confidence interval; CI 0.1, 1.6; P=0.03). This paradoxical pattern was not evident for the MCS-12, and the adjusted difference between non-diabetic and diabetic persons in the difference in MCS-12 means for overweight versus obese persons was not significant (−0.3 points, 95% CI −0.9, 0.4; P=0.43). The findings were not significantly moderated by smoking status, cancer diagnosis or time period.

Conclusions:

The optimal BMI category for physical health status (but not mental health status) was higher among diabetic than non-diabetic persons. The findings are consistent with a BMI physical health status paradox in diabetes and, in turn, a mortality paradox.     

Body mass index and colon cancer screening:The road ahead

Screening for colorectal cancer(CRC) has been associated with a decreased incidence and mortality from CRC.However,patient adherence to screening is less than desirable and resources are limited even indeveloped countries.Better identification of individuals at a higher risk could result in improved screening efforts.Over the past few years,formulas have been developed to predict the likelihood of developing advanced colonic neoplasia in susceptible individuals but have yet to be utilized in mass screening practices.These models use a number of clinical factors that have been associated with colonic neoplasia including the body mass index(BMI).Advances in our understanding of the mechanisms by which obesity contributes to colonic neoplasia as well as clinical studies on this subject have proven the association between BMI and colonic neoplasia.However,there are still controversies on this subject as some studies have arrived at different conclusions on the influence of BMI by gender.Future studies should aim at resolving these discrepancies in order to improve the efficiency of screening strategies.     

Body mass index and mortality among hospitalized patients

BACKGROUND: Body mass index (weight in kilograms divided by the square of the height in meters [BMI]) is known to be associated with overall mortality. However, the effect of age on excess mortality from all causes associated with obesity is controversial. The aim of the present study is to determine the effect of age on the relationship between BMI and mortality. METHODS: We analyzed data from a large collaborative observational study group, the Italian Group of Pharmacoepidemiology in the Elderly (GIFA), that collected data on hospitalized patients. A total of 18,316 patients consecutively admitted to 79 clinical centers during 5 different surveys in 1998, 1991, 1993, 1995, and 1997 were enrolled in the present study. The main outcome measure was the relative hazard ratio of death for different levels of BMI. RESULTS: Mortality rate was lowest among men and women with BMIs from 25.0 through 27.4 kg/m(2) (relative risk, 0.24; 95% confidence interval, 0.15-0.38). The graphed relationship between BMI and mortality in younger patients was hyperbolic, with increased death rates at the lowest and highest BMI rankings. On the contrary, the older patients showed an increased death rate at the lowest BMIs with only a slight elevation at the highest BMIs (>35 kg/m(2)). CONCLUSIONS: Our results suggest that BMI, a simple anthropometric measure of nutritional status, is an important predictor of mortality among young and old hospitalized patients. Even when controlling for clinical and functional variables, a low BMI remained a significant and independent predictor of shortened survival. Furthermore, the finding of the high BMI associated with minimum hazard in elderly subjects supports some past findings and opposes others and, if confirmed, has important implications for geriatric clinical guidelines.     

Body mass index does not affect the survival of pancreatic cancer patients

AIM to evaluate the association of body mass index(b MI) with the overall survival of pancreatic ductal adenocarcinoma(PDAC) patients.METHODS A retrospective analysis of PDAC patients diagnosed in the National Cancer Center of China between January 1999 and December 2014 was performed. these patients were categorized into four b MI groups( 18.5, 18.5-22.9, 23-27.4 and ≥ 27.5 kg/m2). χ2 tests for comparison of the proportions of categorical variables, and Student's t-test or Mann-Whitney test for continuous variables were employed. Survival analysis was performed with the Kaplan-Meyer method. their HRs of mortality and 95%CIs were estimated using the Cox proportional hazards model.RESULTS With a median age of 59.6 years(range: 22.5-84.6 years), in total 1783 PDAC patients were enrolled in this study. their mean usual b MI was 24.19 ± 3.53 for the whole cohort. More than half of the patients(59.3%) experienced weight loss during the disease onset and progression. Compared with healthy-weight individuals, newly diagnosed patients who were overweight or obese had more severe weight loss during their disease onset and progression(P 0.001). Individuals who were overweight or obese were associated with positive smoking history(P 0.001). A significant difference in comorbidity of diabetes(P = 0.044) and coronary artery disease(P 0.001) was identified between high b MI and normal-weight patients. After a median follow-up of 8 mo, the survival analysis showed no association between b MI and the overall survival(P = 0.90, n = 1783). When we stratified the whole cohort by pancreatic cancer stage, no statistically significant association between b MI and overall survival was found for resectable(P = 0.99, n = 217), unresectable locally advanced(P = 0.90, n = 316) and metastatic patients(P = 0.88, n = 1250), respectively. the results did not change when we used the b MI at diagnosis.CONCLUSION Our results showed no significance of b MI for the overall survival of PDAC patients.     

Body mass index and mortality in acute myocardial infarction patients

BackgroundPrevious studies have described an “obesity paradox” with heart failure, whereby higher body mass index (BMI) is associated with lower mortality. However, little is known about the impact of obesity on survival after acute myocardial infarction.MethodsData from 2 registries of patients hospitalized in the US with acute myocardial infarction between 2003-2004 (PREMIER) and 2005-2008 (TRIUMPH) were used to examine the association of BMI with mortality. Patients (n = 6359) were categorized into BMI groups (kg/m²) using baseline measurements. Two sets of analyses were performed using Cox proportional hazards regression with fractional polynomials to model BMI as categorical and continuous variables. To assess the independent association of BMI with mortality, analyses were repeated, adjusting for 7 domains of patient and clinical characteristics.ResultsMedian BMI was 28.6. BMI was inversely associated with crude 1-year mortality (normal, 9.2%; overweight, 6.1%; obese, 4.7%; morbidly obese; 4.6%; P <.001), which persisted after multivariable adjustment. When BMI was examined as a continuous variable, the hazards curve declined with increasing BMI and then increased above a BMI of 40. Compared with patients with a BMI of 18.5, patients with higher BMIs had a 20% to 68% lower mortality at 1 year. No interactions between age (P = .37), sex (P = .87), or diabetes mellitus (P = .55) were observed.ConclusionsThere appears to be an “obesity paradox” among patients after acute myocardial infarction such that higher BMI is associated with lower mortality, an effect that was not modified by patient characteristics and was comparable across age, sex, and diabetes subgroups.     

Body mass index and chronic unexplained gastrointestinal symptoms: an adult endoscopic population based study

BACKGROUND: We aimed to determine whether obese subjects experience more gastro-oesophageal reflux (GORS) symptoms than normal subjects, and further to determine if this association was explained by oesophagitis or medications that lower oesophageal sphincter pressure. METHODS: In a representative Swedish population, a random sample (n = 1001, mean age 53.5 years, 51% women) had upper endoscopy. GORS was defined as any bothersome heartburn or acid regurgitation. RESULTS: The prevalence of obesity (body mass index > or =30) was 16%; oesophagitis was significantly more prevalent in obesity (26.5%) than in normal subjects (9.3%). There were associations between obesity and GORS (odds ratio (OR) 2.05 (95% confidence interval (CI) 1.39, 3.01)), epigastric pain (OR 1.63 (95% CI 1.05, 2.55)), irritable bowel symptoms (OR 1.58 (95% CI 1.05, 2.38)), any abdominal pain (OR 1.59 (95% CI 1.08, 2.35)), vomiting (OR 3.11 (95% CI 1.18, 8.20)), retching (OR 1.74 (95% CI 1.1.3, 2.67)), diarrhoea (OR 2.2 (95% CI 1.38, 3.46)), any stool urgency (OR 1.60 (95% CI 1.04, 2.47)), nocturnal urgency (OR 2.57 (95% CI 1.33, 4.98)), and incomplete rectal evacuation (OR 1.64 (95% CI 1.09, 2.47)), adjusting for age, sex, and education. When subjects with oesophagitis and peptic ulcer were excluded, only diarrhoea, incomplete evacuation, and vomiting were significantly associated with obesity. The association between GORS and obesity remained significant adjusting for medication use (OR 1.9 (95% CI 1.3, 3.0)). CONCLUSIONS: GORS is associated with obesity; this appears to be explained by increased upper endoscopy findings in obesity.     

血液透析患者踝臂指数与微炎症状态、营养状况的关系

目的 探讨血液透析患者踝臂指数与微炎症状态、营养状况的相关关系.方法 选择本院行血液透析患者115例.将踝臂指数(ABI)＜ 0.90作为筛查亚临床外周动脉疾病(PAD)的方法,根据ABI值分为低ABI组(ABI ＜0.90)、正常ABI组(ABI≥0.9).检测指标包括:(1)微炎症指标:白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α、超敏C反应蛋白(hs-CRP);(2)营养状况指标:使用改良定量SGA评估法(MQSGA),并测定血清白蛋白(Alb)、前白蛋白(PA)、血清转铁蛋白(TF).分析ABI与微炎症状态、营养状况的相关关系.结果 (1)低ABI组hs-CRP、IL-6、TNF-α、MQSGA高于正常ABI组,Alb低于正常ABI组,差异有统计学意义(P＜0.01);(2)双变量相关分析结果显示:ABI与年龄、透析龄、hs-CRP、IL-6、TNF-α、MQSGA呈明显负相关(r=-0.699、-0.588、-0.716、-0.603、-0.590和-0.591,P＜0.01),与Alb呈明显正相关(r=0.691,P＜0.01);(3)年龄、透析龄、hs-CRP、Alb、MQSGA为ABI下降的独立危险因素.结论 血液透析患者有较高的PAD发生率,微炎症状态、营养不良可能与PAD的发生密切相关.     

Body mass index and colorectal cancer prognosis: a systematic review and meta-analysis

Colorectal cancer is one of the most common cancers worldwide. However, it is unclear what influence body mass index (BMI) has on colorectal cancer prognosis. We conducted a systematic review and meta-analysis of observational studies to examine the association of BMI with colorectal cancer outcomes. We searched MEDLINE and EMBASE databases from inception to February 2015 and references of identified articles. We selected observational studies that reported all-cause mortality, colorectal cancer-specific mortality, recurrence and disease-free survival according to BMI category. Random-effects meta-analyses were conducted to combine estimates. We included 18 observational studies. Obese patients had an increased risk of all-cause mortality [relative risk (RR) 1.14; 95 % confidence interval (CI) 1.07–1.21], cancer-specific mortality (RR 1.14; 95 % CI 1.05–1.24), recurrence (RR 1.07; 95 % CI 1.02–1.13) and worse disease-free survival (RR 1.07; 95 % CI 1.01–1.13). Underweight patients also had an increased risk of all-cause mortality (RR 1.43; 95 % CI 1.26–1.62), cancer-specific mortality (RR 1.50; 95 % CI 1.20–1.87), recurrence (RR 1.13; 95 % CI 1.05–1.21) and worse disease-free survival (RR 1.27; 95 % CI 1.13–1.43). Overweight patients had no increased risk for any of the outcomes studied. Both obese and underweight patients with colorectal cancer have an increased risk of all-cause mortality, cancer-specific mortality, disease recurrence and worse disease-free survival compared to normal weight patients.     

Body mass index and mortality in patients with idiopathic pulmonary fibrosis

BACKGROUND: To examine the relationship between body mass index (BMI) and mortality in patients with idiopathic pulmonary fibrosis (IPF). METHODS: We studied a cohort of patients with IPF who were seen at the Mayo Clinic Rochester from 1994 through 1996. These patients met the current consensus definition of IPF. We excluded patients who had received prior treatment for IPF, had no follow-up data, or had no pulmonary function results available at the index visit. RESULTS: Of the 197 patients fulfilling the inclusion criteria, the mean (+/- SD) age was 71.4 +/- 8.9 years, 137 patients (70%) were men, and the mean BMI was 28.2 +/- 4.6. These patients were categorized by BMI into the following three groups: < 25; 25 to 30; and >/= 30. There were 46 patients (23%) with a BMI of < 25 who had a median survival time of 3.6 years (1-year survival rate, 76% [95% confidence interval (CI), 65 to 90%]; 3-year survival rate, 54% [95% CI, 41 to 70%]). The second group consisted of 85 patients (43%) with a BMI between 25 and 30 who had a median survival time of 3.8 years (1-year survival rate, 84% [95% CI, 76 to 92%]; 3-year survival rate, 58% [95% CI, 48 to 70%]). The final group consisted of 66 patients (34%) with a BMI of >/= 30 and who had a median survival time of 5.8 years (1-year survival rate, 91% [95% CI, 84 to 98%]; 3-year survival rate, 69% [95% CI, 58 to 81%]). Using a proportional hazards regression model, survival was significantly associated with BMI (hazard ratio, 0.93 for each 1-U increase in BMI; 95% CI, 0.89 to 0.97; p = 0.002) with increased BMI being associated with better survival. CONCLUSION: Higher BMI was associated with better survival in patients with IPF.     

体质指数与收缩性心力衰竭预后的相关性

目的 在没有心血管疾病的正常人群中,超重和肥胖会增加死亡风险.然而,某些慢性疾病患者,低体质指数(BMI)与病死率增加相关.研究旨在探讨BMI对收缩性心力衰竭(心衰)患者预后的影响.方法 对540例经超声心动图证实左室射血分数≤45%的陈旧性心肌梗死和扩张型心肌病患者进行随访,平均年龄58.53岁,其中男性84.2%.结果 在随访期间(中位随访时间24个月),共有92例死亡,其中87例患者心原性死亡,92例因心衰再次入院.与BMI≥28.0 kg/m~2肥胖的收缩性心衰患者比较,低体重(BMI<18.5 kg/m~2)和正常体重(BMI≥18.5 kg/m~2、<24.0 ks/mm~2)收缩性心衰患者全因病死率、心原性病死率、心衰病死率和总心脏事件率均显著升高(均为P<0.05),OR(95%CI)分别是5.44(1.78～16.66)、4.30(1.71～10.82),5.42(1.77～16.59)、4.00(1.59～10.10),8.94(2.37～33.74)、4.97(1.52～16.20),2.10(1.09～4.07)、1.79(1.14～2.82).多元Cox回归校正年龄、性别、NYHA分级、左室射血分数值以后,BMI分组对收缩性心衰患者全因病死率(OR=0.77,P<0.05)、心原性病死率(OR=0.78,P<0.05)和心衰病死率(OR=0.79,P<0.05)仍有显著影响.结论 收缩性心衰患者BMI低是预后差的一个独立预测因素.在南陈旧性心肌梗死和扩张型心肌病所致的收缩性心衰患者中,与肥胖患者相比,极低体重和正常体重患者全因病死率、心原性病死率和心衰病死率较高.     

Impact of body mass index and metabolic phenotypes on coronary artery disease according to glucose tolerance status

ObjectiveThis study aimed to examine the impact of obesity, as defined by body mass index (BMI), and a metabolically unhealthy phenotype on the development of coronary artery disease (CAD) according to glucose tolerance status.MethodsThis population-based retrospective cohort study included 123,746 Japanese men aged 18–72 years (normal glucose tolerance: 72,047; prediabetes: 39,633; diabetes: 12,066). Obesity was defined as a BMI ≥ 25 kg/m². Metabolically unhealthy individuals were defined as those with one or more of the following conditions: hypertension, hypertriglyceridaemia and/or low HDL cholesterol. A Cox proportional hazards regression model identified variables related to CAD incidence.ResultsThe prevalences of obese subjects with normal glucose tolerance, prediabetes and diabetes were 21%, 34% and 53%, whereas those for metabolically unhealthy people were 43%, 60% and 79%, respectively. Multivariate analysis showed that a metabolically unhealthy phenotype increases hazard ratios (HRs) for CAD compared with a metabolically healthy phenotype, regardless of glucose tolerance status (normal glucose tolerance: 1.98, 95% CI: 1.32–2.95; prediabetes: 2.91, 95% CI: 1.85–4.55; diabetes: 1.90, 95% CI: 1.18–3.06). HRs for CAD among metabolically unhealthy non-obese diabetes patients and obese diabetes patients with a metabolically unhealthy status were 6.14 (95% CI: 3.94–9.56) and 7.86 (95% CI: 5.21–11.9), respectively, compared with non-obese subjects with normal glucose tolerance and without a metabolically unhealthy status.ConclusionA metabolically unhealthy state can associate with CAD independently of obesity across all glucose tolerance stages. Clinicians may need to consider those with at least one or more conditions indicating a metabolically unhealthy state as being at high risk for CAD regardless of glucose tolerance status.     

血液透析治疗过程中胃肠营养补充对患者营养状态的影响

目的 观察血液透析治疗过程中胃肠营养补充对尿毒症患者营养状态的影响.方法 选择病情稳定的维持性血液透析患者54例,均有不同程度的营养不良.将54例患者随机分为研究组和对照组2组,每组各27例.研究组患者每次透析中经胃肠补充高蛋白、高热量营养液250 ml,观察2个月.采用自身对照及组间对照方式,评估两组患者营养状态的变化.结果 治疗后两组患者蛋白质、热量摄入均较治疗前增加（P＜0.01）,但组间比较差异无统计学意义（P＞0.05）;治疗后研究组患者血清白蛋白及握力增加,分别从（35.72±1.47） g/L到（37.34±0.99）g/L（P ＜0.01）、（24.52±3.07）kg到（26.63±3.04） kg（P ＜0.05）,且分别与对照组治疗后（35.92±1.57）g/L、（24.80±2.01）kg比较,差异均有统计学意义（P＜0.01、P＜0.05）.结论 血液透析治疗过程中胃肠营养补充能在短期内显著增加患者血清白蛋白及手握力,改善患者营养不良状况,且该方式经济、方便,患者依从性及耐受性好.