Body mass index moderates the association between gait kinetics,body composition,and femoral knee cartilage characteristics

This study compared femoral cartilage characteristics between age- and sex-matched individuals with (n = 48, age = 22.8 ± 3.5 years; body mass index [BMI] = 33.1 ± 4.1 kg/m²) and without obesity (n = 48 age = 22.0 ± 2.6 years; BMI = 21.7 ± 1.7 kg/m²) and evaluated the associations between body composition, quadriceps function, and gait kinetics with femoral cartilage characteristics. Medial and lateral femoral cartilage thickness, medial:lateral thickness ratio and medial and lateral cartilage echo intensity were measured using ultrasound imaging. Body composition was assessed using air displacement plethysmography. Quadriceps function was assessed via maximal isometric knee extension. Three-dimensional gait biomechanics were recorded to extract peak external knee flexion and adduction moments, and peak loading rate of the vertical ground reaction force. Cartilage outcomes were compared between groups using one-way multivariate analysis of variance. Stepwise moderated regression evaluated the association between body composition, quadriceps function, and gait kinetics with femoral cartilage outcomes in individuals with and without obesity. Medial (75.24 vs 65.84; P < .001, d = 1.02) and lateral (58.81 vs 52.22; P < .001, d = 0.78) femoral cartilage echo intensity were higher in individuals with compared with those without obesity. A higher body fat percentage was associated with higher medial and lateral cartilage echo intensity (ΔR² = 0.09-0.12) in individuals with obesity. A higher knee adduction moment was associated with a larger medial:lateral thickness ratio (ΔR² = 0.09) in individuals without obesity. No associations were found between quadriceps function and cartilage outcomes. These findings suggest that high body fat in adults with obesity is associated with cartilage echo intensity. The obese body mass index was also associated with a lack of a positive relationship between cartilage thickness and joint loading during walking.     

Relationship Between Mortality and BMI After Fracture: A Population‐Based Study of Men and Women Aged ≥40 Years

Fractures in obese older individuals contribute significantly to the overall burden on primary health care, but data on their impact on mortality are lacking. We studied the association between obesity and mortality following hip and nonhip clinical fractures in a retrospective, population‐based cohort study. The Sistema d'Informació pel Desenvolupament de la Investigació en Atenció Primària (SIDIAP^Q) database contains primary care computerized medical records of a representative sample of >2.1 million people (35% of the population) in Catalonia (Spain), linked to hospital admissions data. We included in this analysis anyone aged 40 years and older suffering a hip or nonhip clinical fracture in 2007 to 2009 in the SIDIAP^Q database. The main exposure was the most recent body mass index (BMI) measured before fracture, categorized as underweight (<18.5 kg/m²), normal (18.5 to <25 kg/m²), overweight (25 to <30 kg/m²), and obese (≥30 kg/m²). Furthermore, the study outcome was all‐cause mortality in 2007 to 2009 as provided to SIDIAP^Q by the National Office of Statistics. Time to death after fracture was modeled using Cox regression. Multivariate models were adjusted for age, gender, smoking, alcohol intake, oral glucocorticoid use, and Charlson comorbidity index. Within the study period, 6988 and 29,372 subjects with a hip or nonhip clinical fracture were identified and followed for a median (interquartile range) of 1.17 (0.53–2.02) and 1.36 (0.65–2.15) years, respectively. Compared to subjects of normal weight, adjusted hazard ratios (HRs) for mortality in overweight and obese subjects were 0.74 (95% CI, 0.62–0.88; p = 0.001) and 0.74 (95% CI, 0.60–0.91; p = 0.004) after hip and 0.50 (95% CI, 0.32–0.77; p = 0.002), 0.56 (95% CI, 0.36–0.87; p = 0.010) after nonhip fracture. In conclusion, the highest mortality was observed in individuals with low BMI, but compared to subjects of normal weight, obese and overweight individuals survived longer following fracture. The latter observation is consistent with data reported in other chronic conditions, but the reasons for reduced mortality in obese and overweight subjects when compared to those of normal weight require further research. © 2014 American Society for Bone and Mineral Research.     

Increased Serum Amyloid A Concentrations in Morbid Obesity Decrease after Gastric Bypass

Background: Obesity is considered a state of low-grade chronic inflammation, which may favor the development of cardiovascular diseases. Serum amyloid A (SAA) is an acute phase protein synthesized in response to infection, inflammation, injury, and stress. The aim of the present study was to compare the circulating concentrations of SAA and the mRNA expression in omental adipose tissue between lean and obese individuals and to analyze the effect of weight loss after gastric bypass. Methods: 16 lean volunteers (BMI 20.5 ± 0.6 kg/m²) and 24 obese patients (BMI 47.0 ± 1.2 kg/m²) were included in the study. Serum concentrations of SAA were measured by ELISA. In addition, the concentrations of SAA in 18 morbidly obese patients (7 male/11 female; BMI 44.6 ± 1.9 kg/m²) were measured before and after weight loss following Roux-en-Y gastric bypass (RYGBP). SAA expression in omental adipose tissue was quantified by RT-PCR in biopsies from obese patients undergoing RYGBP and from age-matched lean individuals subjected to Nissen fundoplication. Results: Obese patients exhibited significantly increased circulating SAA concentrations (6.6 ± 0.5 vs 39.3 ± 9.1 μg/ml; P<0.01) compared to lean subjects. A significant positive correlation was found between logSAA and body fat (r=0.631, P<0.0001). Obese patients showed significantly increased (P<0.05) mRNA expression of SAA in omental adipose tissue compared to lean subjects. Weight loss significantly decreased SAA concentrations after RYGBP (final BMI 28.5 ± 0.9 kg/m², P<0.0001 vs initial) from 47.5 ± 14.5 to 15.7 ± 2.9 μg/ml (P<0.05). Conclusion: It can be concluded that serum SAA and mRNA expression of SAA in omental adipose tissue are increased in obese patients contributing to the obesity-associated cardiovascular disease risk. Moreover, weight loss reduces SAA concentrations, which may contribute to the beneficial effects accompanying weight reduction.     

The impact of body mass index on semen parameters in infertile men

This hospital‐based, prospective study was conducted to evaluate the relationship between body mass index (BMI) and various semen parameters in infertile men. A total of 439 men presented for infertility evaluation were assessed by basic infertility evaluation measures including semen analysis and BMI calculation. The main outcome measure was the relationship between BMI groups [BMI: 18.5–24.9 kg/m² (normal weight), 25–29.9 kg/m² (overweight) and ≥30 kg/m² (obese)] and different semen parameters [volume, concentration, motility and morphology]. The mean BMI was 29.67 ± 5.89. Most of patients (82.91%) were overweight or obese. The 3 BMI groups were comparable in semen parameters (P > 0.05). BMI had a negative correlation with various semen parameters. However, this correlation was significant only with sperm concentration (P = 0.035). We concluded that sperm concentration was the only semen parameter which showed significant reduction with higher BMI in infertile men.     

Echocardiographic and Hemodynamic Evaluation of Cardiovascular Performance during Laparoscopy of Morbidly Obese Patients

Background: The effects of morbid obesity, pneumoperitoneum (PP) and body position on cardiac function during laparoscopy were studied. Methods: Transesophageal echocardiography (TEE) was performed on 10 obese patients (body mass index, BMI, 48.1±1.8 kg/m²) and 10 normal weight patients (BMI = 22.6±0.8 kg/m²) in supine, Trendelenburg and reverse Trendelenburg positions before and after PP. Left ventricular end-systolic wall stress (LVESWS) was calculated from invasive blood pressure (BP) values and LV dimensions obtained by TEE. Diastolic filling was assessed by mitral valve and pulmonary vein flow velocities. Results: LVESWS was higher in obese patients both at baseline (46.0±4.0x10³ dyn/cm²) and with PP (69.3±8.2x10³ dyn/cm²), than normal weight subjects (31.9±3.7x10³ dyn/cm² and 45.7±5.9x10³ dyn/cm²; P <0.05 obese vs normal weight patients at baseline). Systolic BP was not different between groups at baseline (normal weight 111±4 mmHg, obese 119±3 mmHg), but increased significantly with PP only in obese patients (normal weight 129±6 mmHg, obese 157±8 mmHg; P <0.05). Postural changes during PP had no impact on cardiac function in either obese or normal weight subjects. Conclusions: Anesthetized obese patients undergoing laparoscopy have higher LVESWS before pneumoperitoneum (due to increased end-systolic left ventricular dimensions) and during pneumoperitoneum (due to more pronounced increases in blood pressure). Since LVESWS is a determinant of myocardial oxygen demand, more aggressive control of blood pressure (ventricular afterload) in MO patients may be warranted to optimize the myocardial oxygen requirements.     

Effects of obesity on sperm retrieval,early embryo quality and clinical outcomes in men with nonobstructive azoospermia undergoing testicular sperm aspiration‐intracytoplasmic sperm injection cycles

The objective of this study was to assess the effects of body mass index (BMI) on sperm retrieval, early embryo quality and clinical outcomes in patients with nonobstructive azoospermia (NOA) undergoing testicular sperm aspiration‐intracytoplasmic sperm injection (TESA‐ICSI). A total of 3,005 infertile couples were evaluated between January 2010 and June 2017, including 1585 normal‐weight (BMI < 25 kg/m²), 847 overweight (BMI 25–29.99 kg/m²) and 573 obese (BMI ≥ 30 kg/m²) patients. We found no significant relationship between BMI and sperm retrieval rate (22.4%, 24.3% and 25.1%, p = 0.327) or sperm motility. Among the 705 patients with NOA who underwent TESA‐ICSI cycles, obese individuals had lower T levels and higher E2 levels than normal‐weight and overweight individuals. However, there were no significant differences in other male hormones (follicle stimulating hormone [FSH], luteinizing hormone [LH], or prolactin [PRL]) among the groups. We also found that the sperm parameters, embryo quality and clinical outcomes of patients with NOA undergoing TESA‐ICSI were not influenced by high BMI levels. In conclusion, this study demonstrated a lack of obvious effects of obesity on sperm retrieval, early embryo quality and clinical outcomes in infertile men undergoing TESA‐ICSI cycles, although T and E2 levels were affected.     

Body weight at developmental age in siblings born to mothers before and after surgically induced weight loss

BackgroundTo gain insight into the role of epigenetic factors in determining body weight in adolescence, we studied the body weight of siblings born to the same mother before and after biliopancreatic diversion (BPD) for obesity. The study was performed in a university hospital during a 20-year period.MethodsThe siblings born before and after BPD were retrospectively rated by their mother as normal, overweight, or obese at 1, 6, and 12 years.ResultsAt 1 and 6 years, the body weight was rated as similar in the subsets. However, at 12 years of age, a greater percentage of those born before BPD were considered overweight (42% versus 33%) and obese (22% versus 3%; P <.009) than their counterparts born after BPD. Considering only the subjects aged 21–25 years at the study period, the body weight and body mass index in subjects born before BPD were greater (P <.02 and P <.012, respectively) than in those born after BPD (79.5 ± 16.5 kg versus 66.7 ± 11.8 kg, and 27.5 ± 3.9 kg/m² versus 23.4 ± 3.7 kg/m², respectively).ConclusionThe results of the present study, in which the influences of the genetic pattern and environmental and educational factors were minimized, show that adolescents born to post-BPD mothers weigh less than their siblings born to the same mother before BPD when she was still obese. An insulin-resistant milieu during pregnancy could account for the greater body weight later in adolescence.     

25-Hydroxycholecalciferol response to single oral cholecalciferol loading in the normal weight,overweight, and obese

Summary

After a single cholecalciferol load, peak serum 25-hydroxycholecalciferol (25OHD) is lower in individuals with a higher body mass index (BMI), probably due to it being distributed in a greater volume. Its subsequent disappearance from the serum is slower the higher the individual’s BMI, probably due to the combination of a larger body volume and a slower release into the circulation of vitamin D stored in adipose tissue.

Introduction

The aim of the study is to examine 25-hydroxycholecalciferol (25OHD) response to a single oral load of cholecalciferol in the normal weight, overweight, and obese.

Methods

We considered 55 healthy women aged from 25 to 67 years (mean?±?SD, 50.8?±?9.5) with a BMI ranging from 18.7 to 42 kg/m² (mean?±?SD, 27.1?±?6.0). The sample was divided into three groups by BMI: 20 were normal weight (BMI?≤?25 kg/m²), 21 overweight (25.1?≤?BMI?≤?29.9 kg/ m²), and 14 obese (BMI?≥?30 kg/m²). Each subject was given 300,000 IU of cholecalciferol orally during lunch. A fasting blood test was obtained before cholecalciferol loading and then 7, 30, and 90 days afterwards to measure serum 25OHD, 1,25 dihydroxyvitamin D [1,25 (OH)₂D], parathyroid hormone (PTH), calcium (Ca), and phosphorus (P). Participants’ absolute fat mass was measured using dual energy X-ray absorptiometry (DEXA).

Results

The fat mass of the normal weight subjects was significantly lower than that of the overweight, which in turn was lower than that of the obese participants. Serum 25OHD levels increased significantly in all groups, peaking 1 week after the cholecalciferol load. Peak serum 25OHD levels were lower the higher the individuals’ BMI. After peaking, the 25OHD levels gradually decreased, following a significantly different trend in the three groups. The slope was similar for the overweight and obese, declining significantly more slowly than in the normal weight group. In the sample as a whole, there was a weakly significant negative correlation between fat mass and baseline 25OHD level, while this correlation became strongly significant at all time points after cholecalciferol loading.

Conclusions

The lower peak 25OHD levels seen in the obese and overweight is probably due to the cholecalciferol load being distributed in a larger body volume. The longer persistence of 25OHD in their serum could be due to both their larger body volume and a slower release into the circulation of the vitamin D stored in their adipose tissue.

     

The Effects on Obesity Related Peptides of Laparoscopic Gastric Band Applications in Morbidly Obese Patients

Background: The aim of this study was to examine the relationship between weight loss and resistin, apelin, chemerin, and visfatin after laparoscopic adjustable gastric banding (LAGB). Methods: The study group consisted of 19 patients who were operated on for morbid obesity (BMI: 48.7 ± 6.6 kg/m²), and 22 healthy, normal-weight (BMI: 22.9 ± 2.5 kg/m²) subjects formed the control group. We obtained blood samples from the study subjects at three different times: before undergoing surgery and at one month and 6 months after surgery. Blood was obtained once from the control group. Results: Significant weight loss was achieved at one and 6 months after surgery. Plasma levels of apelin, resistin, chemerin, and visfatin were higher in morbidly obese patients compared with the control group. Obesity-related peptides decreased one month and 6 months after surgery. Conclusions: Elevated plasma resistin, apelin, chemerin, and visfatin levels in morbidly obese patients are gradually reduced after weight loss. According to these findings, LAGB surgery is found to be an important and efficient means for morbidly obese patients both to lose weight and to develop a better metabolic risk profile in a short time period.     

Serum 25-Hydroxyvitamin D in Obese Spanish Adults: the Camargo Cohort Study

Objectives

To describe the 25(OH)D status in Spanish obese postmenopausal women and men ≥?50 years, to compare their results with those of the overweight or normal weight population, and to determine whether differences are observed between both sexes and with seasonal variation throughout the year.

Patients and Methods

We studied 2597 subjects (1826 postmenopausal women and 771 men ≥?50 years). Serum concentrations of 25(OH)D, intact parathyroid hormone (PTH), aminoterminal propeptide of type I collagen (PINP), and C-terminal telopeptide of type I collagen (CTX) were determined by electrochemiluminiscence (Elecsys 2010, Roche). Bone mineral density (BMD) was measured by DXA. Participants were divided according to body mass index (BMI) groups (normal ≥?20 and <?25 kg/m², overweight ≥?25 and?<?30 kg/m², or obese ≥?30 kg/m²).

Results

Obese people had lower serum 25(OH)D values (20.9?±?8.2 ng/ml) than overweight (23.3?±?8.8 ng/ml; p?<?0.0001) or normal-weight subjects (24.4?±?8.9 ng/ml; p?<?0.0001). They have also lower levels of both PINP and CTX. In contrast, PTH concentrations and BDM values were higher in obese individuals. When stratifying by sex, the difference in serum concentration of 25(OH)D remained significant in women, but not in men, persisted throughout the year, and was inversely correlated with BMI and waist circumference.

Conclusions

Despite lower serum 25(OH)D concentrations and higher PTH levels, obese and overweight women have higher lumbar spine and hip BMD and lower bone remodeling markers than normal weight women, suggesting that low serum 25(OH)D levels do not negatively affect bone health.

     

Effect of the body mass index on outcomes of flexible ureterorenoscopy

The aim of the study to compare outcomes of flexible ureterorenoscopy in patients with different body mass index (BMI) scores and to explore whether the BMI has an effect on outcomes of RIRS. Five hundred and two patients who underwent flexible URS in 3 centers between 2008 and 2012 for the management of single upper urinary tract calculi were retrospectively reviewed. Patients were categorized as normal weight BMI 18.5 to 24.99 kg/m², overweight 25 to 29.99 kg/m², obese 30 to 39.99 kg/m² and morbid obese >40 kg/m².The groups were assessed in terms of demographic parameters including age, gender, stone size, intraoperative and postoperative variables. The mean patient age was 41.3 ± 15.51 (18–81) years and with an average BMI 26.68 ± 5.2 kg/m² (16.64–55.15 kg/m²). Of the patients, 43.2 % had normal weight (NW), 32.2 % were overweight (OW), 21.9 % were obese (O) and 2.5 % were morbidly obese (MO). Stone-free rates after single procedure in NW, OW, O, MO groups were 60.8, 61.7, 73.6, 61.5 %, respectively (p = 0.079). Overall targeted stone-free rates were also similar in four groups (88.9, 90.1, 93.6, 90.4 %, p = 0.586). There were no statistically significant differences in the frequency of complications and mean hospitalization time among the groups (p > 0.05). In conclusion, this study demonstrated that flexible URS is a valuable option for the treatment of kidney stone in both obese and non-obese patients. BMI did not influence the postoperative outcomes.     

Bariatric Surgery Cannot Prevent Tryptophan Depletion Due to Chronic Immune Activation in Morbidly Obese Patients

Background: Increased activity of the immuno-modulatory enzyme indoleamine-2,3-dioxygenase (IDO) during immune activation, results in tryptophan depletion. Tryptophan metabolic changes reduce serotonin production and cause mood disturbances, depression, and impaired satiety, ultimately leading to increased food intake and obesity. Bariatric surgery significantly diminishes immune mediators by substantial weight reduction. We examined IDO-mediated tryptophan-catabolism in morbidly obese patients compared to lean individuals. Methods: Serum concentrations of kynurenine and tryptophan, calculated kynurenine to tryptophan ratios (kyn trp-1) as an indirect estimate of IDO activity, and neopterin levels reflecting IFN-γ mediated immune activation, were assessed before and after bariatric surgery. The study population included 22 morbidly obese individuals and 20 normal-weight volunteers. Results: Median weight loss after 24.4±5.1 months was 40.6 kg resulting in a reduction of BMI from 44.1 kg/m² to 29.9 kg/m² (P<0.001). Preoperative kyn trp-1 in morbidly obese patients was significantly increased compared to the control group (41.6±20.1 mmol/mol vs 26.5±5.1 mmol/mol; P<0.001). Postoperative weight reduction did not lead to normalization of kyn trp-1 (37.9±14.0 mmol/mol). As a consequence, tryptophan levels were significantly lower in morbidly obese patients (pre-: 51.5±9.2 μmol L⁻¹ and postoperatively: 46.9±7.6 μmol L⁻¹) when compared with those of normal-weight controls (64.8±9.5 μmol L⁻¹; P<0.001). In addition, neopterin levels were elevated in the study population pre- and postoperatively compared to normal-weight volunteers (both P<0.001). Conclusions: Tryptophan depletion in morbidly obese patients is due to chronic immune activation and persists in spite of significant weight reduction following bariatric surgery. This might thereby be responsible for diminished serotonin functions, leading to unchanged satiety dysregulation and a reward-deficiency-syndrome.     

BMI and fracture risk in older men: The osteoporotic fractures in men study (MrOS)

Low body mass index (BMI) is a risk factor for fracture, but little is known about the association between high BMI and fracture risk. We evaluated the association between BMI and fracture in the Osteoporotic Fractures in Men Study (MrOS), a cohort of 5995 US men 65 years of age and older. Standardized measures included weight, height, and hip bone mineral density (BMD) by dual‐energy X‐ray absorptiometry (DXA); medical history; lifestyle; and physical performance. Only 6 men (0.1%) were underweight (<18.5 kg/m²); therefore, men in this category were excluded. Also, 27% of men had normal BMI (18.5 to 24.9 kg/m²), 52% were overweight (25 to 29.9 kg/m²), 18% were obese I (30 to 34.9 kg/m²), and 3% were obese II (35 to 39.9 kg/m²). Overall, nonspine fracture incidence was 16.1 per 1000 person‐years, and hip fracture incidence was 3.1 per 1000 person‐years. In age‐, race‐, and BMD‐adjusted models, compared with normal weight, the hazard ratio (HR) for nonspine fracture was 1.04 [95% confidence interval (CI) 0.87–1.25] for overweight, 1.29 (95% CI 1.00–1.67) for obese I, and 1.94 (95% CI 1.25–3.02) for obese II. Associations were weaker and not statistically significant after adjustment for mobility limitations and walking pace (HR = 1.02, 95% CI 0.84–1.23, for overweight; HR = 1.12, 95% CI 0.86–1.46, for obese I, and HR = 1.44, 95% CI 0.90–2.28, for obese II). Obesity is common among older men, and when BMD is held constant, it is associated with an increased risk of fracture. This association is at least partially explained by worse physical function in obese men. © 2011 American Society for Bone and Mineral Research.     

Is Body Mass Index a Risk Factor for Isolated Off‐Pump Coronary Revascularization?

Abstract Objective: The influence of body mass index (BMI) as a risk factor for isolated off‐pump coronary artery bypass (OPCAB) surgery is unknown. We postulated that BMI ≥ 30 kg/m² would adversely affect outcomes following OPCAB at our institution. Methods: From 2002 to 2009, we selected 742 patients (primary, N = 709 [95.6%], re‐operative, N = 33 [4.45%]) who underwent isolated OPCAB for analysis. Patients were stratified into groups by BMI: non‐obese (BMI < 30 kg/m²) and obese (BMI ≥ 30 kg/m²). Preoperative risk, operative characteristics, and postoperative outcomes were analyzed. Risk‐adjusted models evaluated the occurrence of any complication and mortality. Results: Overall crude mortality was 1.5% (11/742). When compared to non‐obese (26.12 ± 2.72 kg/m²) recipients, the obese (35.81 ± 5.69 kg/m²) comprised younger patients (62.46 ± 9.96 years, p < 0.001). Number of diseased vessels, Left ventricular ejection fraction, and baseline renal function was equivalent across groups. Diabetes (53.24%) and hypertension (90.59%) were more prevalent among obese patients (p < 0.001, respectively). Internal mammary artery utilization (p = 0.47), endoscopic vein harvest (p = 0.74), and intra‐aortic balloon pump use (p = 0.58) were similar between groups. Interestingly, postoperative blood product requirement was lower in obese versus non‐obese recipients (47.35% vs. 56.72%, p < 0.01). Furthermore, intensive care unit stay (p = 0.93), mortality (p = 0.56), and discharge to home (p = 0.09) remained equivalent between groups. Importantly, multivariable logistic regression did not identify BMI ≥ 30 kg/m² as an independent predictor of any complication (p = 0.21) or mortality (p = 0.74). Conclusions: Obesity does not influence operative characteristics or effect outcomes after OPCAB. BMI ≥ 30 kg/m² should not be considered a prohibitive risk factor in isolated off‐pump coronary revascularization. (J Card Surg 2011;26:565‐571)     

Renal Transplantation in Obese Patients: Experience in an Argentine Center

Possible complications of renal transplants in obese patients have raised concerns among nephrologists. We describe the outcomes of 110 renal transplant patients according to body mass index (BMI). Recipient BMI was calculated by using height and weight at time of transplantation and categorized according to World Health Organization guidelines. The patients' BMI values were as follows: underweight, n = 8 (7.27%); normal weight, n = 55 (50%); overweight, n = 30 (27.27%); and obese, n = 17 (15.45%). Mean age was significantly different among groups: underweight, 27.62 ± 7.57 years; normal weight, 44.98 ± 15.55 years; overweight, 50.53 ± 13.90 years; and obese, 52.11 ± 10.41 years (P < .05). Donor age and mean time of dialysis treatment were comparable in all groups. Underweight patients had a significantly larger proportion of living donors than those with higher BMIs. Calculated glomerular filtration rate (using the Modification of Diet in Renal Disease equation) were significantly different among the groups at 30, 60, and 90 days' posttransplantation. At 180 days, however, it was comparable: underweight, 62.96 ± 40.77 mL/min/1.73 m²; normal weight, 53.55 ± 26.23 mL/min/1.73 m²; overweight, 47.52 ± 16.37 mL/min/1.73 m²; and obese, 46.19 ± 17.56 mL/min/1.73 m² (P = .34). Incidence of delayed graft function was as follows: underweight, 0%; normal weight, 30.4%; overweight, 53.3%; and obese, 64.1% (P < .05). The incidence of surgical complications, incidence of rejection within the first 6 months' posttransplantation, and graft and patient survival rates over 6 months did not differ among the groups. Because transplantation in obese patients may be associated with higher risks and costs, the evaluation of each center experience is imperative. Longer term assessments are warranted, but our short-term results show that outcomes in overweight or obese renal transplant patients are comparable to those in patients with lower BMI.     

Waist Circumference and Related Anthropometric Indices Are Associated with Metabolic Traits in Severely Obese Subjects

Increased waist circumference (WC) and related anthropometric indices have been shown to be, independently of body weight and body mass index (BMI), associated with adverse metabolic traits in many populations. It is unknown, however, whether WC also predicts adverse metabolic traits in severely obese subjects displaying a BMI greater than 35 kg/m². To address this question, we analyzed a dataset including 838 severely obese patients (597 women, BMI 44.6?±?6.2 kg/m²; 241 men, BMI 44.3?±?5.7 kg/m²). Body weight, height, WC, hip circumference, and blood pressure were measured in all subjects along with the following metabolic blood markers: fasting glucose, insulin, glycolized hemoglobin levels, triglycerides, total cholesterol, low- and high-density cholesterol, and uric acid. Multivariate regression analyses indicated that WC as well as related anthropometric indices, in particular those accounting for subjects’ height, were associated with many metabolic variables independently of body weight and BMI. In general, height-adjusted WC indices were more closely associated with metabolic traits in women than in men. Collectively, our findings suggest that body fat distribution also plays an important role in determining metabolic traits in severely obese subjects and that WC represents a valuable marker of abdominal/visceral obesity in this population.     

Association of MR relaxation and cartilage deformation in knee osteoarthritis

We assessed the relationship between cartilage MR relaxation times and biomechanical response of tibiofemoral articular cartilage to physiological loading in healthy subjects and patients with osteoarthritis (OA). Female subjects above 40 years of age with (N₁ = 20) and without (N₂ = 10) OA were imaged on a 3T MR scanner using a custom made loading device. MR images were acquired with the knee flexed at 20° with and without a compressive load of 50% of the subject's bodyweight. The subjects were categorized based on the clinical MRI scoring of medial and lateral cartilage surfaces. Data were stratified twice into two equal groups (low and high) at the median value of T_1ρ and T₂ relaxation time. The change in contact area and cartilage deformation was measured within these groups. Paired Student's t‐test (α = 0.05) was used to analyze the effect of loading on contact area and deformation. The average area of the contact region in the medial compartment was significantly higher in OA subjects compared with normal subjects in both unloaded (314 ± 112 mm² vs. 227 ± 106 mm², p = 0.023) and loaded (425 ± 128 mm² vs. 316 ± 107 mm², p = 0.01) conditions. The overall relative change of cartilage thickness in the medial compartment was significantly higher than the lateral compartment (?5.3 ± 9.9% vs. ?1.9 ± 9.2%, p = 0.042). When cartilage was divided into deep and superficial layers, superficial layers showed higher changes in relaxation time (T_1ρ and T₂) than the changes in relaxation time of whole cartilage (Normal: 12.5% vs. 6.9%; OA: 10.9% vs. 4.6%). The average T_1ρ and T₂ times, change in area of contact region, and change in cartilage thickness in subjects with OA were higher when compared to normal subjects. This study provides support for a relationship between the mechanical response of cartilage to physiological loading (cartilage‐on‐cartilage contact area and cartilage deformation) and MR relaxation times (T_1ρ and T₂) in both OA patients and normal subjects. © 2011 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 30:919–926, 2012     

Improvement in glycemic control by gastric electrical stimulation (TANTALUSTM) in overweight subjects with type 2 diabetes

Background  The TANTALUS system (MetaCure Ltd.) is a minimally invasive implantable gastric stimulation modality that does not exhibit malabsorptive or restrictive characteristics. The device applies gastric contractility modulation (GCM) signals to the stomach antrum. The signals are delivered in synchronization to the native electrical activity of the stomach during meals. Retrospective analysis of previous studies indicated that type 2 diabetes mellitus (T2DM) subjects on oral medication with hemoglobin A1c (HbA1c) between 7.5% and 9.5% are the population with most potential benefit from the treatment. The current study includes subjects enrolled prospectively within that range of HbA1c. Aim  To prospectively investigate the potential effect of the TANTALUS system on glycemic control and weight in overweight subjects with T2DM. Methods  In this European multicenter, open-label study, 13 T2DM obese (6 male, 7 female, BMI 37.2 ± 1.0 kg/m², range 30.4–44.0 kg/m²) subjects treated with oral antidiabetic medications but with poor glycemic control (HbA1c ≥ 7%, range 7.3–9.5%) were implanted laparoscopically with the TANTALUS system. Results  Thirteen subjects that had completed 3 months of treatment showed a significant reduction in HbA1c from 8.0 ± 0.2% to 6.9 ± 0.1% (p < 0.05), whereas fasting blood glucose decreased from 175 ± 6 mg/dL to 127 ± 8 mg/dL (p < 0.05). The glycemic improvement was accompanied by reduction in weight from 104.4 ± 4.4 kg to 99.7 ± 4.8 kg, and in waist circumference from 122.3 ± 3.2 cm to 117.0 ± 3.0 cm. Conclusions  Interim results with the TANTALUS system suggest that this stimulation regime can potentially improve glucose levels and induce moderate weight loss in obese T2DM subjects on oral antidiabetic therapy with poor glycemic control. Further evaluation is required to determine whether this effect is due to induced weight loss and/or due to direct signal-dependent mechanisms.     

Is Lean Body Mass Decreased after Obesity Treatment by Adjustable Gastric Banding?

Background There is concern that surgically-induced weight loss in obese subjects is associated with a disproportionate decrease in lean body mass (LBM) and in skeletal muscle mass (SMM), a major constituent of LBM. To address this issue, 1) we measured total and regional body composition following gastric banding in a group of obese subjects, and 2) we compared these data to those of a non-surgical control group of similar age and body size. Methods Body composition was assessed by dualenergy X-ray absorptiometry (DEXA) before and after laparoscopic adjustable silicone gastric banding (LAGB) in 32 women (after 1 year: age 43.7 ± 8.4 years, BMI 36.4 ± 5.9 kg/m², mean ± SD), and in 117 control women (age 44.5 ± 7.5 years; BMI 36.7 ± 5.5 kg/m²) referred for non-surgical weight management, prior to weight loss. SMM was estimated using a published equation based on LBM of the extremities (appendicular LBM). Results 1 year after LAGB, body weight loss (−23.7 ± 11.6 kg, P < 10⁻⁶) was mainly due to decreased fat mass (−21.2 ± 11.2 kg, P < 10⁻⁶), and total LBM was modestly, although significantly, decreased (−2.1 ± 4.2 kg, P = 0.01). Appendicular LBM (−0.7 ± 2.7 kg) and total SMM (−0.9 ± 3.0 kg) were not significantly modified. None of the body composition variables was significantly decreased in weight-reduced subjects compared to the control group, especially appendicular LBM and total SMM. Conclusions Results provide no evidence for a decrease in appendicular LBM and total SMM with weight loss following LAGB. Follow-up of these obese patients revealed a very favorable pattern of change in total and regional body composition, with preservation of muscle mass.     

Adduction moment increases with age in healthy obese individuals

There is a need to understand how obesity and aging interact to cause an increased risk of medial knee osteoarthritis (OA). This study tested whether the knee adduction and flexion moments increase with age in healthy normal‐weight and obese adults, as well as the mechanism of this increase. We analyzed whether ground reaction force magnitude, knee alignment, step width, toe‐out angle, body volume distribution, and limb position (knee position relative to the pelvis center) are associated with the adduction moment and whether these variables also change with age. Ninety‐six healthy volunteers (60 normal‐weight and 36 obese) were tested using marker‐based gait analysis; knee alignment was based on marker positions during quiet standing. Adduction moment increased with age in obese (R² = 0.19), but not in normal‐weight individuals (R² = 0.01); knee flexion moment did not change with age in either group. In the obese, only knee alignment and limb position were related to the adduction moment (R² = 0.19 and 0.51), but only limb position changed with age (R² = 0.26). The resulting increase in adduction moment suggests greater medial compartment loads, which may combine with elevated levels of inflammation to contribute to the increased risk of medial OA in this population. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:1414–1422, 2013