Higher Prevalence of Obesity in Gastric Cardia Adenocarcinoma Compared to Gastric Non-Cardia Adenocarcinoma

Background and Aims

Obesity is one of the main risk factors for gastric cardia adenocarcinoma (GCA) in the West. Also, recent studies have suggested that GCA is distinct from distal stomach tumor, with differing risk factors, tumor characteristics, and biological behavior. The objective of our research was to evaluate the relationship between obesity and GCA compared to non-cardia adenocarcinoma.

Materials and Methods

A total of 298 patients who were diagnosed with gastric adenocarcinoma and underwent surgery at Seoul National University Bundang Hospital were evaluated. Ninety-one cases were GCA, and 207 cases were non-cardiac adenocarcinoma. Obesity was estimated by body mass index (BMI, kg/m²). The degree of obesity was determined by using BMI <18.5, 18.5–23.9, 24–27.9, and ≥28 (kg/m²) as the cut-off points for underweight, normal weight, overweight, and obese, respectively. Association with obesity was estimated by odds ratio (OR) and 95% confidence interval (CI).

Results

Obesity was more prevalent in patients with GCA at the time of diagnosis for gastric cancer. Among obese persons with a BMI of 28 kg/m² or higher, the OR was 3.937 (95% CI, 1.492–10.389; p = 0.006) for GCA compared to non-cardia adenocarcinoma. For overweight individuals, the OR was 2.194 (95% CI, 1.118–4.305; p = 0.022). Multivariate analysis of age, Helicobacter pylori infection, smoking, stage, and BMI with logistic regression was performed. BMI was an independent risk factor for GCA (OR, 1.123; 95% CI, 1.037–1.217; p = 0.004).

Conclusion

Obesity was more prevalent in patients with GCA compared to that in patients with gastric non-cardia adenocarcinoma. Also, BMI was an independent risk factor for GCA.     

Effect of body mass index on early outcomes in patients undergoing coronary artery bypass surgery

OBJECTIVES: This study sought to quantify the effect of body mass index (BMI) on early clinical outcomes following coronary artery bypass grafting (CABG). BACKGROUND: Obesity is considered a risk factor for postoperative morbidity and mortality after cardiac surgery, although existing evidence is contradictory. METHODS: A concurrent cohort study of consecutive patients undergoing CABG from April 1996 to September 2001 was carried out. Main outcomes were early death; perioperative myocardial infarction; infective, respiratory, renal, and neurological complications; transfusion; duration of ventilation, intensive care unit, and hospital stay. Multivariable analyses compared the risk of outcomes between five different BMI groups after adjusting for case-mix. RESULTS: Out of 4,372 patients, 3.0% were underweight (BMI <20 kg/m(2)), 26.7% had a normal weight (BMI >or=20 and <25 kg/m(2)), 49.7% were overweight (BMI >or=25 and <30 kg/m(2)), 17.1% obese (BMI >or=30 and <35 kg/m(2)) and 3.6% severely obese (BMI >or=35 kg/m(2)). Compared with the normal weight group, the overweight and obese groups included more women, diabetics, and hypertensives, but fewer patients with severe ischemic heart disease and poor ventricular function. Underweight patients were more likely than normal weight patients to die in hospital (odds ratio [OR] = 4.0, 95% CI 1.4 to 11.1), have a renal complication (OR = 1.9, 95% confidence interval [CI] 1.0 to 3.7), or stay in hospital longer (>7 days) (OR = 1.7, 95% CI 1.1 to 2.5). Overweight, obese, and severely obese patients were not at higher risk of adverse outcomes than normal weight patients, and were less likely than normal weight patients to require transfusion (ORs from 0.42 to 0.86). CONCLUSIONS: Underweight patients undergoing CABG have a higher risk of death or complications than normal weight patients. Obesity does not affect the risk of perioperative death and other adverse outcomes compared to normal weight, yet obese patients appear less likely to be selected for surgery than normal weight patients.     

Asthma severity, exacerbation risk, and controller treatment burden in underweight and obese children

OBJECTIVE: The relationship between weight status and asthma characteristics in children remains inadequately defined. Very little has been published on the risk of exacerbation, physician perception of severity, and the level controller treatment prescribed to underweight and obese children with asthma in a real-world setting. METHODS: We assessed the diagnostic severity, pulmonary function, exacerbation prevalence, and controller treatment level in 10,559 new asthma patients seen at one of four pediatric asthma subspecialty clinics among three BMI groups. Participants were analyzed by body mass index (BMI)-percentile based on Centers for Disease Control & Prevention classification. Multivariable logistic regression models were used to assess the associations between BMI-percentile cohort group and asthma outcomes. RESULTS. Underweight asthmatics were rare (2.5%) relative to obese asthmatics but appeared to have the greatest impairment in forced vital capacity and had the greatest controller treatment burden. Obese asthmatic children made up 26.2% of our cohort and were more likely to have severe disease (odds ratio (OR) 1.40, 95% confidence interval (CI) 1.06-1.85) and airflow obstruction (OR 1.36, 95% CI 1.16-1.59) compared to normal weight asthmatics. Obese asthmatics were not at greater risk for exacerbation (OR 1.41, 95% CI 0.64-3.11) or high treatment burden (OR 1.03, 95% CI 0.83-1.28). CONCLUSIONS. Obesity is more common than underweight status among children with asthma. Both underweight and obese children with asthma have worse lung function and asthma-related outcomes compared to similar normal weight children, though the phenotypic characteristics of underweight and obese asthmatics differed considerably.     

The association between obesity and screening mammography accuracy

BACKGROUND: Obesity is increasing among American women, especially as they age. The influence of obesity on the accuracy of screening mammography has not been studied extensively. METHODS: We analyzed 100 622 screening mammography examinations performed on members of a nonprofit health plan. The relationship between body mass index (weight in kilograms divided by the square of height in meters) and measures of screening accuracy was assessed. Body mass index was categorized as underweight or normal weight (<25), overweight (25-29), obesity class I (30-34), and obesity classes II to III (> or =35). RESULTS: Compared with underweight or normal weight women, overweight and obese women were more likely to be recalled for additional tests after adjusting for important covariates, including age and breast density (overweight odds ratio [OR], 1.17; 95% confidence interval [CI], 1.11-1.23); obesity class I OR, 1.27; 95% CI, 1.19-1.35; obesity classes II-III OR, 1.31; 95% CI, 1.22-1.41). As body mass index increased, women were more likely to have lower specificity (overweight OR, 0.86; 95% CI, 0.81-0.90; obesity class I OR, 0.79; 95% CI, 0.74-0.84; and obesity classes II-III OR, 0.77; 95% CI, 0.71-0.82). No statistically significant differences were noted in sensitivity. Adjusted receiver operating characteristic analysis showed statistically significant improvement in the area under the curve (AUC) for underweight or normal weight women (AUC = 0.941) vs overweight women (AUC = 0.916, P =.02) and underweight or normal weight women vs obesity classes II and III women (AUC = 0.904, P =.02). CONCLUSIONS: Obese women had more than a 20% increased risk of having false-positive mammography results compared with underweight and normal weight women, although sensitivity was unchanged. Achieving a normal weight may improve screening mammography performance.     

Body mass index, physical activity, and risk of renal cell carcinoma

OBJECTIVE: To investigate the association between obesity and risk of renal cell carcinoma and to examine whether the association is modified by physical activity. SUBJECTS: A population-based case-control study of 406 patients with renal cell carcinoma and 2434 controls conducted in Iowa. METHODS: Information was collected on weight at the ages 20-29, 40-49, and 60-69 years, height, nonoccupational physical activity, diet, and other lifestyle factors. Renal cell carcinoma risk was estimated by odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for age, total energy intake, and other confounding factors. RESULTS: Height and total energy intake were not associated with risk in either sex. In men, neither physical activity nor level of obesity in any period of life was significantly associated with risk. In women, lower physical activity was associated with higher risk (OR=2.5; 95% CI=1.2-5.2 comparing exercise <1 time/month to >1 time/day). Compared with women in the lowest quartile for BMI, the risks of renal cell carcinoma for women in the highest 10% of BMI in their 20s, 40s, and 60s were 1.4 (CI=0.6-3.1), 1.9 (CI=0.9-4.2), and 2.3 (CI=0.9-6.0), respectively. When analyses were limited to self-respondent data, the corresponding ORs were 2.9 (CI=1.2-7.4), 3.2 (CI=1.3-7.5), and 2.1 (CI=0.7-6.4), respectively. There was little evidence that physical activity modifies the association of BMI with renal cell carcinoma. CONCLUSION: Nonoccupational physical activity was inversely associated and obesity was positively associated with risk of renal cell carcinoma among women. The risk appeared to be greater for women in the highest 10% of BMI in their 40s. Our finding of little evidence of an interaction between physical activity and BMI requires confirmation.     

Obesity and central obesity as risk factors for incident dementia and its subtypes: a systematic review and meta-analysis

While dementia affects 6–10% of persons 65 years or older, industrialized countries have witnessed an alarming rise in obesity. However, obesity's influence on dementia remains poorly understood. We conducted a systematic review and meta‐analysis. PUBMED search (1995–2007) resulted in 10 relevant prospective cohort studies of older adults (40–80 years at baseline) with end points being dementia and predictors including adiposity measures, such as body mass index (BMI) and waist circumference (WC). There was a significant U‐shaped association between BMI and dementia (P = 0.034), with dementia risk increased for obesity and underweight. Pooled odds ratios (OR) and 95% confidence intervals (CI) for underweight, overweight and obesity compared with normal weight in relation to incident dementia were: 1.36 (1.07, 1.73), 0.88 (0.60, 1.27) and 1.42 (0.93, 2.18) respectively. Pooled ORs and 95% CI for obesity and incident Alzheimer's disease (AD) and vascular dementia were 1.80 (1.00, 3.29) vs. 1.73 (0.47, 6.31) and were stronger in studies with long follow‐up (>10 years) and young baseline age (<60 years). Weight gain and high WC or skin‐fold thickness increased risks of dementia in all included studies. The meta‐analysis shows a moderate association between obesity and the risks for dementia and AD. Future studies are needed to understand optimal weight and biological mechanisms.     

Impact of obesity as a mortality predictor in high-risk patients with myocardial infarction or chronic heart failure: a pooled analysis of five registries

AIMS: To explore the influence of obesity on prognosis in high-risk patients with myocardial infarction (MI) or heart failure (HF). METHODS AND RESULTS: Individual data of 21 570 consecutively hospitalized patients from five Danish registries were pooled together. After a follow-up of 10.4 years, all-cause mortality using multivariate model and adjusted hazard ratios (HR) with 95% confidence intervals were calculated. Compared with normal weight [body mass index (BMI) 18.5-24.9 kg/m2], obesity class II (BMI >or= 35 kg/m2) was associated with increased risk of death in patients with MI but not HF [HR = 1.23 (1.06-1.44), P = 0.006 and HR = 1.13 (0.95-1.36), P = 0.95] (P-value for interaction = 0.004). Obesity class I (BMI 30-34.9 kg/m2) was not associated with increased risk of death in MI or HF [HR = 0.99 (0.92-1.08) and 1.00 (0.90-1.11), P > 0.1]. Pre-obesity (BMI 25-29.9 kg/m2) was associated with decreased death risk in MI but not HF [HR = 0.91 (0.87-0.96), P = 0.0006 and 1.04 (0.97-1.12), P = 0.34] (P-value for interaction = 0.007). Underweight (BMI < 18.5 kg/m2) patients were in increased death risk regardless of MI or HF [HR = 1.54 (1.35-1.75) and 1.37 (1.18-1.59), P < 0.001]. CONCLUSION: In patients with MI but not HF, the relationship between BMI and mortality is U-shaped with highest mortality in underweight and obese class II, but lowest in the other BMI classes.     

Impact of body mass index on early outcome and late survival in patients undergoing coronary artery bypass grafting or valve surgery or both

The influence of body mass on outcome after cardiac surgery remains controversial. The aim of this study was to analyze the impact of body mass index (BMI) on early and late outcomes in a large series of patients who underwent cardiac surgery. We retrospectively analyzed 5,950 consecutive patients who underwent cardiac surgery between January 1998 and September 2006. Patients were divided into 4 groups defined by BMI (weight divided by square of height [kilograms divided by meters squared]): underweight (20 to 25 to 30 kg/m2): 22%, n=1,292. Analysis was further refined by performing subgroup analysis according to the surgical procedure (valve surgery, coronary artery bypass grafting, and combined valve/coronary artery bypass grafting). Main outcome measure was the association between BMI and hospital mortality, postoperative morbidities, and late survival. Hospital mortality was 3.4% (n=203). There was no association between BMI and hospital mortality in the entire patient population. Multivariate analysis revealed obesity as an independent predictor of hospital mortality in patients who underwent valve surgery (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.2 to 4.5, p=0.018). Obesity was associated with an increased risk for sternal infection (OR 1.8, 95% CI 1.1 to 2.9, p=0.013), whereas underweight correlated with postoperative bleeding (OR 2.0, 95% CI 1.1 to 3.6, p=0.017). Underweight was an independent predictor for decreased long-term survival (OR 1.8, 95% CI 1.3 to 2.5, p<0.001). In conclusion, cardiac surgery can be performed safely in both underweight and obese patients but carries a higher postoperative rate of major complications.     

Association of smoking status with obesity and diabetes among elderly people

The present study was aimed to examine associations of current and ex-smoking status with obesity and diabetes among elderly people. Nationwide study of Finnish elderly people based on biennial surveys from 1985 to 1995, were used to study 7482 people aged 65-79 years. Smoking status included non-, ex-light, ex-heavy, current light, and current heavy smokers. Obesity was set as body mass index (BMI) > or = 30. Information of smoking, BMI, and diabetes was based on self-reports. Logistic regression was used as the main method of analyses. Compared to non-smokers (reference category), ex-heavy smokers had higher (odds ratio, 1.42; 95% confidence interval: 1.09, 1.85) and current light smokers (OR, 0.46; 95% CI: 0.31, 0.69) lower relative risk of obesity. Current light smokers had also lower and ex-heavy smokers higher rate of diabetes than non-smokers. Ex-heavy smokers had a higher risk of obesity (OR, 1.75; 95% CI: 1.30, 2.36) and diabetes (OR, 1.48; 95% CI: 1.10, 2.01) than ex-light smokers. Same pattern for current smokers was found. Heavy ex- and current elderly smokers are at risk of obesity and diabetes. Thus, heavy smokers should be emphasized in programs promoting smoking cessation.     

Asthma Severity,Exacerbation Risk,and Controller Treatment Burden in Underweight and Obese Children

Objective. The relationship between weight status and asthma characteristics in children remains inadequately defined. Very little has been published on the risk of exacerbation, physician perception of severity, and the level controller treatment prescribed to underweight and obese children with asthma in a real-world setting. Methods. We assessed the diagnostic severity, pulmonary function, exacerbation prevalence, and controller treatment level in 10,559 new asthma patients seen at one of four pediatric asthma subspecialty clinics among three BMI groups. Participants were analyzed by body mass index (BMI)-percentile based on Centers for Disease Control & Prevention classification. Multivariable logistic regression models were used to assess the associations between BMI-percentile cohort group and asthma outcomes. Results. Underweight asthmatics were rare (2.5%) relative to obese asthmatics but appeared to have the greatest impairment in forced vital capacity and had the greatest controller treatment burden. Obese asthmatic children made up 26.2% of our cohort and were more likely to have severe disease (odds ratio (OR) 1.40, 95% confidence interval (CI) 1.06–1.85) and airflow obstruction (OR 1.36, 95% CI 1.16–1.59) compared to normal weight asthmatics. Obese asthmatics were not at greater risk for exacerbation (OR 1.41, 95% CI 0.64–3.11) or high treatment burden (OR 1.03, 95% CI 0.83–1.28). Conclusions. Obesity is more common than underweight status among children with asthma. Both underweight and obese children with asthma have worse lung function and asthma-related outcomes compared to similar normal weight children, though the phenotypic characteristics of underweight and obese asthmatics differed considerably.     

Influence of obesity on cardiovascular risk. Twenty-three-year follow-up of 22,025 men from an urban Swedish population

OBJECTIVE: To assess to what extent the incidence of coronary events and death related to smoking, hypertension, hyperlipidemia and diabetes is modified by obesity. DESIGN: Prospective cohort study. SUBJECTS: A total of 22 025 men aged 27 to 61-y-old at entry. MEASUREMENTS: Incidence of coronary events (CE, ie acute myocardial infarctions and deaths due to chronic ischaemic heart disease) and death during 23 y of follow-up was studied in relation to body mass index (BMI), heart rate, blood pressure, blood lipids, glucose and insulin, lifestyle factors, history of angina pectoris, history of cancer, self-reported health and socio-economic conditions. RESULTS: At the end of follow-up 20% of the obese men were no longer alive, and 13% had had a coronary event. Incidence of CE was 16% lower (RR (relative risk) 0.84; 95% confidence interval (CI) 0.65-1.10) among underweight (n=1171), 24% higher (RR 1.24; CI 1.12-1.37) among overweight (n=7773), and 76% higher (RR 1.76; 95% CI 1.49-2.08) among obese men (n=1343) than it was among men with normal BMI (n=11 738). The risk associated with overweight and obesity remained statistically significant after adjustment for potential confounders (RR 1.18; CI 1.07-1.31; and 1.39; 1.17-1.65, respectively). The association between BMI and mortality was J-shaped. In all, 1.7% of the obese men were smokers with hypertension, hyperlipidaemia and diabetes, 16.3% were not exposed to any of these risk factors. The cardiovascular risk associated with obesity was small in the absence of other risk factors. Between smoking and obesity there was a statistically significant synergistic effect. CONCLUSIONS: Obesity is associated with an increased incidence of coronary events and death. The risk associated with obesity is substantially increased by exposure to other atherosclerotic risk factors, of which smoking seems to be the most important. The preventive potential of these associations should be evaluated in controlled trials.     

The association between obesity and asthma is stronger in nonallergic than allergic adults

STUDY OBJECTIVE: To determine the modifying effects of sex and allergy history on the association between body mass index (BMI) and asthma prevalence. DESIGN: Cross-sectional study of 86,144 Canadians who were 20 to 64 years of age in 2000-2001. SETTING: A national survey. Measurements and analysis: Self-reported asthma, allergy history, height, and weight. Logistic regression analysis was used to detect effect modification and to adjust for covariates. Population weight and design effects associated with complex survey design were taken into consideration. RESULTS: The adjusted odds ratios (ORs) for obesity associated with asthma was 1.85 (95% confidence interval [CI], 1.65 to 2.07) for women and 1.21 (95% CI, 1.05 to 1.40) for men. One unit of increased BMI was associated with an approximate 6% increase in asthma risk in women, and 3% in men. A stronger association between obesity and asthma was observed in nonallergic women than in allergic women, with the adjusted ORs being 2.53 (95% CI, 2.11 to 3.04) and 1.57 (95% CI, 1.36 to 1.82), respectively. For men, the corresponding ORs were 1.30 (95% CI, 1.05 to 1.62) and 1.18 (95% CI, 0.98 to 1.53), respectively. CONCLUSIONS: Obesity is likely to have a larger effect on nonallergic asthma. The greater prevalence of nonallergic asthma in women may explain the stronger obesity-asthma association seen in women compared with men and children who have a greater prevalence of allergic asthma.     

Breastfeeding and lowering the risk of childhood obesity

Breastfeeding might confer protection against obesity later in life, but the evidence is inconclusive. We tested the hypothesis that breastfeeding is associated with a reduced risk of obesity in a population-based sample of 32200 Scottish children studied at age 39-42 months in 1998 and 1999. Obesity was defined as body-mass index (BMI) at the 95th and 98th percentiles or higher. The prevalence of obesity was significantly lower in breastfed children, and the association persisted after adjustment for socioeconomic status, birthweight, and sex. The adjusted odds ratio for obesity (BMI > or = 98th percentile) was 0.70 (95% CI 0.61-0.80). Our results suggest that breastfeeding is associated with a reduction in childhood obesity risk.     

超重和肥胖与动脉僵硬度的相关性研究

目的 分析超重和肥胖与动脉僵硬度的关系.方法 选取2007至2009年江苏省社区自然人群4585名为研究对象进行回顾性研究.以体质指数(BMI)评价超重和肥胖,肱踝脉搏波传导速度(baPWV)评价动脉僵硬度.将BMI分别作为连续变量(以l kg/m2递增)和等级变量(体重正常、体重过轻、超重和肥胖)进行logistic多因素逐步回归分析,评价高动脉僵硬度风险和人群归因危险度百分比,并通过受试者工作(ROC)曲线分析BMI对高动脉僵硬度的预测价值.结果 (1)控制年龄后,男性和女性的BMI与baPWV均呈正相关(r值分别为0.213和0.186,P均＜0.01).超重、肥胖人群baPWV和高动脉僵硬度发生率均高于正常组(P均＜0.01).(2)logistic回归模型校正年龄、性别、高血压因素后,连续变量BMI致高动脉僵硬度的OR值为1.146(95％CI:1.117～1.175,P＜0.01);当BMI为等级变量时,体重过轻OR值为0.369(95％ CI:0.141～0.962,P＜0.05),超重和肥胖OR值分别为1.576(95％CI:1.333～1.863,P＜0.01)和2.087(95％CI:1.615 ～2.698,P＜0.01).超重和肥胖者高动脉僵硬度的人群归因危险度百分比分别为19.1％和11.6％.(3) BMI评估高动脉僵硬度的ROC曲线下面积为0.661(95％ CI:0.645 ～0.678,P＜0.01),BMI预测高动脉僵硬度的最佳分割值为24.25 kg/m2.结论 超重和肥胖人群的动脉僵硬度高于体重正常人群.超重和肥胖是独立于年龄、性别、高血压之外的高动脉僵硬度危险因素.     

Hospital admissions associated with body mass index in Canadian adults

OBJECTIVE: To examine the associations between excess weight and health-care utilization in general Canadian population. DESIGN: A national survey with a multistage stratified sampling design. SUBJECTS: A total of 113 603 adults 20 years of age or more in 2003. MEASUREMENTS: Self-reported overnight stay as an in-patient during the past 12 months, length of stay, height and weight. RESULTS: The 12-month cumulative incidence of being an in-patient was 6.6% for men and 10.4% for women, with the length of stay in median of 3 nights for the patients. The adjusted odds ratio for obesity associated with being an in-patient was 1.24 (95% confidence interval: 1.109, 1.40) for men and 1.25 (1.14, 1.37) for women. The association between obesity and being an in-patient was significant or marginally significant in all categories of length of stay with an exception of the '1 night' category for men. Underweight men and women had an increased risk of approximately 30%. Underweight was only significantly associated with being an in-patient with a stay of '>7 nights' in both sexes, and only small proportion of participants were underweight. Obesity contributed slightly more than 4% of being an in-patient in the Canadian adults. The population attributable fraction was very small for underweight because of low proportion of cases in that category. CONCLUSION: Obesity burdens the universal health-care system in Canada.     

Body Mass Index and Survival in Men and Women Aged 70 to 75

OBJECTIVES: To examine in an older population all‐cause and cause‐specific mortality associated with underweight (body mass index (BMI)<18.5), normal weight (BMI 18.5–24.9), overweight (BMI 25.0–29.9), and obesity (BMI≥30.0). DESIGN: Cohort study. SETTING: The Health in Men Study and the Australian Longitudinal Study of Women's Health. PARTICIPANTS: Adults aged 70 to 75, 4,677 men and 4,563 women recruited in 1996 and followed for up to 10 years. MEASUReMENTS: Relative risk of all‐cause mortality and cause‐specific (cardiovascular disease, cancer, and chronic respiratory disease) mortality. RESULTS: Mortality risk was lowest for overweight participants. The risk of death for overweight participants was 13% less than for normal‐weight participants (hazard ratio (HR)=0.87, 95% CI=0.78–0.94). The risk of death was similar for obese and normal‐weight participants (HR=0.98, 95% CI=0.85–1.11). Being sedentary doubled the mortality risk for women across all levels of BMI (HR=2.08, 95% CI=1.79–2.41) but resulted in only a 28% greater risk for men (HR=1.28 (95% CI=1.14–1.44). CONCLUSION: These results lend further credence to claims that the BMI thresholds for overweight and obese are overly restrictive for older people. Overweight older people are not at greater mortality risk than those who are normal weight. Being sedentary was associated with a greater risk of mortality in women than in men.     

Body Mass Index and Risk of Adverse Cardiac Events in Elderly Patients with Hip Fracture: A Population-Based Study

OBJECTIVES: To determine whether obesity affects cardiac complications after hip fracture repair. DESIGN: A population‐based historical study using data from the Rochester Epidemiology Project. SETTING: Olmsted County, Minnesota. PARTICIPANTS: All urgent hip fracture repairs between 1988 and 2002. MEASUREMENTS: Body mass index (BMI) was categorized as underweight (<18.5 kg/m²), normal‐weight (18.5–24.9 kg/m²), overweight (25.0–29.9 kg/m²), and obese (≥30 kg/m²). Postoperative cardiac complications were defined as myocardial infarction, angina pectoris, congestive heart failure, or new‐onset arrhythmias within 1‐year of surgery. Incidence rates were estimated for each outcome, and overall cardiac complications were assessed using Cox proportional hazards models adjusted for age, sex, year of surgery, use of beta‐blockers, and the Revised Cardiac Risk Index. RESULTS: Hip fracture repairs were performed in 184 (15.6%) underweight, 640 (54.2%) normal‐weight, 251 (21.3%) overweight, and 105 (8.9%) obese subjects (mean age 84.2 ± 7.5; 80% female). Baseline American Society of Anesthesiologists (ASA) status was similar in all groups (ASA I/II vs III–V, P=.14). Underweight patients had a significantly higher risk of developing myocardial infarction (odds ratio (OR) 1.44, 95% confidence interval (CI)=1.0–2.1; P=.05) and arrhythmias (OR=1.59, 95% CI=1.0–2.4; P=.04) than normal‐weight patients. Multivariate analysis demonstrated that underweight patients had a higher risk of developing an adverse cardiac event of any type (OR=1.56, 95% CI=1.22–1.98; P<.001). Overweight and obese patients with hip fracture had no excess risk of any cardiac complication. CONCLUSION: The obesity paradox and low functional reserve in underweight patients may influence the development of postoperative cardiac events in elderly people with hip fracture.     

Obesity affects outcomes of pancreatoduodenectomy

BackgroundObesity is a major global health problem, and it has reached epidemic proportions worldwide. Therefore, surgeons will confront an increasingly larger proportion of obese candidates for pancreatoduodenectomy (PD) in the future. Several small retrospective studies have been conducted to evaluate the role of Body Mass Index (BMI) in postoperative surgical complications after PD, with conflicting results. The aim of this study was to use a large multi-institutional database to clarify the impact of different levels of obesity after PD.MethodsThe American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was queried for patients who underwent PD from 2014 to 2016. Patients were categorized in the following six BMI groups: <18.5 (Underweight), 18.5–24.9 (Normal Weight), 25–29.9 (Overweight), 30–34.9 (Class I obesity), 35–39.9 (Class II Obesity) and >40 (Class III Obesity). The primary outcomes of interest were 30-day mortality and morbidity after PD among the six BMI groups.ResultsThe final population consists of 10,316 patients. Class III is associated with higher risk of 30-day mortality (OR 2.56, 95% CI 1.25–5.25, p = 0.011), major complications (OR 2.23, 95% CI 1.54–3.22, p < 0.001), clinically relevant postoperative pancreatic fistula (OR 2.48, 95% CI 1.89–3.24, p < 0.001), surgical site infections (OR 2.06, 95% CI 1.61–2.65, p < 0.001) and wound dehiscence (OR 3.47, 95% CI 1.7–7.1, p < 0.001) in multivariable analysis.ConclusionsIn conclusion, our study shows that obesity is significantly associated with higher risk of postoperative complications in patients undergoing PD and patients with BMI≥40 have increased risk of mortality after PD.     

Health correlates of overweight and obesity in adults aged 50 years and over: results from the Survey of Health, Ageing and Retirement in Europe (SHARE). Obesity and health in Europeans aged > or = 50 years

QUESTIONS UNDER STUDY: To examine the association between overweight/obesity and several self-reported chronic diseases, symptoms and disability measures. METHODS: Data from eleven European countries participating in the Survey of Health, Ageing and Retirement in Europe were used. 18,584 non-institutionalised individuals aged 50 years and over with BMI > or = 18.5 (kg/m2) were included. BMI was categorized into normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9) and obesity (BMI > or = 30). Dependent variables were 13 diagnosed chronic conditions, 11 health complaints, subjective health and physical disability measures. For both genders, multiple logistic regressions were performed adjusting for age, socioeconomic status and behaviour risks. RESULTS: The odds ratios for high blood pressure, high cholesterol, diabetes, arthritis, joint pain and swollen legs were significantly increased for overweight and obese adults. Compared to normal-weight individuals, the odds ratio (OR) for reporting > or = 2 chronic diseases was 2.4 (95% CI 1.9-2.9) for obese men and 2.7 (95% CI 2.2-3.1) for obese women. Overweight and obese women were more likely to report health symptoms. Obesity in men (OR 0.5, 95% CI 0.4-0.6), and overweight (OR 0.5, 95% CI 0.4-0.6) and obesity (OR 0.4, 95% CI 0.3-0.5) in women, were associated with poorer subjective health (i.e. a decreased risk of reporting excellent, very good or good subjective health). Disability outcomes were those showing the greatest differences in strength of association across BMI categories, and between genders. For example, the OR for any difficulty in walking 100 metres was non-significant at 0.8 for overweight men, at 1.9 (95% CI 1.3-2.7) for obese men, at 1.4 (95% CI 1.1-1.8) for overweight women, and at 3.5 (95% CI 2.6-4.7) for obese women. CONCLUSIONS: These results highlight the impact of increased BMI on morbidity and disability. Healthcare stakeholders of the participating countries should be aware of the substantial burden that obesity places on the general health and autonomy of adults aged over 50.