三维斑点追踪成像评估2型糖尿病伴腹型肥胖患者左心室心肌收缩功能

目的探讨三维斑点追踪成像(3D-STI)评估2型糖尿病(T2DM)伴腹型肥胖患者左心室心肌收缩功能的价值。方法收集56例T2DM患者,其中腹型肥胖组26例、无腹型肥胖组30例,以30名健康体检者为对照组。比较3组常规超声参数左心室舒张末期内径(LVDd)、二维射血分数(2D-EF)、相对室壁厚度(RWT)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、三维射血分数(3D-EF)以及应变参数左心室整体纵向应变(LVGLS)、左心室整体圆周应变(LVGCS)、左心室整体面积应变(LVGAS)、左心室整体径向应变(LVGRS)。结果常规超声参数及应变参数比较,腹型肥胖组LVDd、RWT、LVEDV、LVESV均较对照组、无腹型肥胖组升高(P均0.05),2D-EF、3D-EF均低于对照组(P均0.05)。腹型肥胖组、无腹型肥胖组LVGLS、LVGCS、LVGAS、LVGRS均较对照组减低(P均0.05),且腹型肥胖组均低于无腹型肥胖组(P均0.05)。结论 3D-STI可用于评估T2DM伴腹型肥胖患者左心室心肌收缩功能。     

Obesity Trends in the Surgical Population at a Large Academic Center: A Comparison between 1989–1991 to 2006–2008 Epochs

Background : Changes in the prevalence of obesity of surgical patients overtime and in relation to the general population have not been well characterized.

Methods : Height, weight, age and gender data of adult patients who underwent general anesthesia at our institution were abstracted. Reliable data was available for the years 1989–1991 and 2006–2008, and comparisons were made between these epochs. Additional comparisons were made between our Minnesota surgical patients and the general Minnesota population.

Results : Substantial changes in patient weight occurred with a decline in normal weight patients (body mass index [BMI] < 25.0) from 41.6% to 30.9% (P < 0.001), while the prevalence of obesity (BMI 30–34.9) increased from 14.9% to 20.6% (P < 0.001) and morbidly obesity (BMI > 35) from 7.1% to 14.8% (P < 0.001). Minnesota surgical patients had a higher prevalence of obesity in every demographic category (P < 0.001) compared to the general population. Conclusion : A substantial increase in the prevalence of obesity and morbid obesity among surgical patients at our institution occurred and the prevalence of obesity in our contemporary practice is higher than the general population. These observations most likely have profound implications on healthcare delivery resources, though its impact has yet to be determined.     

Risk factors for glucocorticoid-induced obesity in children with steroid-sensitive nephrotic syndrome

The objective of this work was to determine the prevalence of obesity, defined as BMI >95th percentile, in children treated with glucocorticoids for steroid-sensitive nephrotic syndrome (SSNS), and to identify risk factors for the development for glucocorticoid-induced obesity. The experimental design involved a cross-sectional study of 96 individuals (4 to 21 yrs) treated with glucocorticoids for SSNS and 186 healthy reference subjects. Logistic regression was used to generate odds ratios for obesity. Glucocorticoid exposure was classified as recent in the 54 subjects treated with glucocorticoids in the prior six months, and remote in the remaining 42 subjects. Recent exposure was associated with significantly increased odds of obesity [odds ratio (95% CI): 26.14 (7.54, 90.66)] in non-blacks only. Each one-unit increase in maternal BMI was associated with a 35% increase in the odds of obesity in recent SSNS subjects (p=0.003). The effect of maternal BMI on the odds of obesity was significantly greater in recent SSNS subjects than in reference subjects (test for interaction p=0.038). The odds of obesity were also significantly increased [odds ratio 5.22 (1.77, 15.41), p=0.003] in all subjects with remote glucocorticoid exposure (black and non-black). These results indicate that non-black race and increased maternal BMI are risk factors for glucocorticoid-induced obesity in subjects with recent exposure.Dr. Foster was supported by a National Research Service Award F32DK62637–01 and by a Duncan L. Gordon Fellowship from the Hospital for Sick Children Foundation, Toronto, Canada. The protocol was supported by NIH grants K08-DK02523 (MBL) and the General Clinical Research Center (M01RR00240) at the Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine.     

Age,Obesity Surgery,and Weight Loss

Some centers consider an age over 50 to be a contraindication for obesity surgery. This study was conducted to examine the relationship between age and one-year postoperative weight of patients receiving gastric restrictive surgery (n = 616) for morbid obesity. Patients were divided into four age groups (18-29, 30-39, 40-49, 50-65 years) matched for preoperative obesity. At one year there were no statistically significant differences in weight loss or postoperative obesity. There were four (0.6%) surgically related deaths. The mortality of patients aged 50 or older (1.1%) was not significantly higher than that of younger patients (0.6%). It was concluded that older age per se need not be a contraindication for surgery.     

Obesity and fractures in postmenopausal women

Low body mass index (BMI) is a recognized risk factor for fragility fracture, whereas obesity is widely believed to be protective. As part of a clinical audit of guidance from the National Institute of Health and Clinical Excellence (NICE), we have documented the prevalence of obesity and morbid obesity in postmenopausal women younger than 75 years of age presenting to our Fracture Liaison Service (FLS). Between January 2006 and December 2007, 1005 postmenopausal women aged less than 75 years with a low‐trauma fracture were seen in the FLS. Of these women, 805 (80%) underwent assessment of bone mineral density (BMD) by dual energy X‐ray absorptiometry (DXA), and values for BMI were available in 799. The prevalence of obesity (BMI 30 to 34.9 kg/m²) and morbid obesity (BMI ≥ 35 kg/m²) in this cohort was 19.3% and 8.4%, respectively. Normal BMD was reported in 59.1% of obese and 73.1% of morbidly obese women, and only 11.7% and 4.5%, respectively, had osteoporosis (p < .0001). Multiple regression analysis revealed significant negative associations between hip T‐score and age (p < .0001) and significant positive associations with BMI (p < .0001) and previous fracture (p = .001). Our results demonstrate a surprisingly high prevalence of obesity in postmenopausal women presenting to the FLS with low‐trauma fracture. Most of these women had normal BMD, as measured by DXA. Our findings have important public heath implications in view of the rapidly rising increase in obesity in many populations and emphasize the need for further studies to establish the pathogenesis of fractures in obese individuals and to determine appropriate preventive strategies. © 2010 American Society for Bone and Mineral Research     

Does obesity based on body mass index affect semen quality?—A meta-analysis and systematic review from the general population rather than the infertile population

Whether obesity affects the quality of semen has become the focus of research. However, there are some deficiencies in the past research, because the vast majority of known infertile patients were included in the study samples. Taking infertile men as the research object to analyse the impact of obesity on semen quality, which cannot accurately prove that the impact on semen quality is caused by obesity, because the impact on semen quality may also be caused by other factors. Therefore, we selected ordinary obese men rather than infertile patients to conduct a systematic review and meta-analysis of the effects of obesity on semen parameters. The results showed that obesity had no effect on sperm concentration (SMD: −0.15, 95% CI: −0.32 ~ 0.02, p = .088) and percentage of normal sperm morphology (SMD: −0.17, 95% CI: −0.66 ~ 0.32, p = .487), but decreased semen volume (SMD: −0.32, 95% CI: −0.52 ~ −0.12, p = .002), total sperm number (SMD: −0.77, 95% CI: −1.31 ~ −0.23, p = .005), percentage of forward progression (SMD: −0.95, 95% CI: −1.7 ~ −0.19, p = .014) and percentage of viability (SMD: −0.812, 95% CI: −1.532 ~ −0.093, p = .027). Therefore, obesity affects semen quality to a certain extent, and maintaining normal weight may be one of the effective ways to improve male fertility.     

The impact of obesity on outcomes in patients receiving extracorporeal life support

Extracorporeal life support (ECLS) has been increasingly utilized to manage cardiac and pulmonary dysfunction. The impact of obesity on outcomes of ECLS is poorly defined. The purpose of the study was to compare in-hospital mortality, resource use, complications, and readmissions in obese versus non-obese patients receiving ECLS. We performed a retrospective cohort study of all adult ECLS patients with and without an obesity diagnosis using the 2010–2016 Nationwide Readmissions Database (NRD). Mortality, length of stay (LOS), hospital charges, complications, and readmissions were evaluated using multivariable logistic and linear regression. Of 23 876, patients who received ECLS, 1924 (8.1%) were obese. Obese patients received ECLS more frequently for respiratory failure (29.5% vs. 23.7%, P = .001). After adjustment for patient and hospital factors, obesity was not associated with increased odds of mortality (AOR = 1.06, P = .44) and was associated with decreased LOS (13.7 vs. 21.2 days, P < .001), hospital charges ($171 866 vs. $211 445, P < .001), and 30-day readmission (AOR = 0.71, P = .03). Obesity was also associated with reduced odds of hemorrhage (AOR = 0.43, P < .001), neurologic complications (AOR = 0.55, P = .004), and acute kidney injury (AOR=0.83, P = .04). After stratification by ECLS indication, obesity remained predictive of shorter LOS (AOR range: 0.53-0.78, all P < .05 ) and did not impact mortality (all P > .05). Respiratory support remains the most common indication for ECLS among obese patients. Among all patients, as well as by individual ECLS indication, obesity was not associated with increased odds of mortality. These findings suggest that obesity should not be considered a high-risk contraindication to ECLS.     

A Cost–Benefit Analysis of Bariatric Surgery on the South Plains Region of Texas

The regional economic burdens of obesity have not been fully quantified. This study incorporated bariatric surgery demographics collected from a large university hospital with regional economic and employment data to evaluate the cost of obesity for the South Plains region of Texas. Data were collected from patients who underwent laparoscopic gastric bypass and laparoscopic banding between September 2003 and September 2005 at Texas Tech University Health Sciences Center. A regional economic model estimated the economic impact of lost productivity due to obesity. Comparisons of lost work days in the year before and after surgery were used to estimate the potential benefit of bariatric surgery to the South Plains economy. Total output impacts of obesity, over $364 million, were 3.3% of total personal income; total labor income impacts neared $364 million, were 3.3% of total personal income; total labor income impacts neared 60 million: the losses corresponded to 2,389 lost output and2,389 lost output and 390 lost labor income per household. Obesity cost the South Plains over 1,977 jobs and decreased indirect business tax revenues by over 13 million. The net benefit of bariatric surgery was estimated at13 million. The net benefit of bariatric surgery was estimated at 9.9 billion for a discount rate of 3%, $5.0 billion for a discount rate of 5%, and $5.0 billion for a discount rate of 5%, and 1.3 billion for a discount rate of 10%. Potential benefits to the South Plains economy of performing bariatric surgery more than outweigh its costs.     

Response to diet‐induced obesity produces time‐dependent induction and progression of metabolic osteoarthritis in rat knees

Obesity, and corresponding chronic‐low grade inflammation, is associated with the onset and progression of knee OA. The origin of this inflammation is poorly understood. Here, the effect of high fat, high sucrose (HFS) diet induced obesity (DIO) on local (synovial fluid), and systemic (serum) inflammation is evaluated after a 12‐week obesity induction and a further 16‐week adaptation period. For 12‐weeks of obesity induction, n = 40 DIO male Sprague–Dawley rats consumed a HFS diet while the control group (n = 14) remained on chow. DIO rats were allocated to prone (DIO‐P, top 33% based on weight change) or resistant (DIO‐R, bottom 33%) groups at 12‐weeks. Animals were euthanized at 12‐ and after an additional 16‐weeks on diet (28‐weeks). At sacrifice, body composition and knee joints were collected and assessed. Synovial fluid and sera were profiled using cytokine array analysis. At 12‐weeks, DIO‐P animals demonstrated increased Modified Mankin scores compared to DIO‐R and chow (p = 0.026), and DIO‐R had higher Mankin scores compared to chow (p = 0.049). While numerous systemic and limited synovial fluid inflammatory markers were increased at 12‐weeks in DIO animals compared to chow, by 28‐weeks there were limited systemic differences but marked increases in local synovial fluid inflammatory marker concentrations. Metabolic OA may manifest from an initial systemic inflammatory disturbance. Twelve weeks of obesity induction leads to a unique inflammatory profile and induction of metabolic OA which is altered after a further 16‐weeks of obesity and HFS diet intake, suggesting that obesity is a dynamic, progressive process. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1010–1018, 2016.     

Obesity and early complications following reduction mammaplasty: An analysis of 4545 patients from the 2005–2011 NSQIP datasets

Abstract

Reduction mammoplasty is a proven treatment for symptomatic macromastia, but the association between obesity and early postoperative complications is unclear. The purpose of this study was to perform a population level analysis in an effort to determine the impact of obesity on early complications after reduction mammaplasty. This study examined the 2005–2011 NSQIP datasets and identified all patients who underwent reduction mammoplasty. Patients were then categorised according to the World Health Organisation obesity classification. Demographics, comorbidities, and perioperative risk factors were identified among the NSQIP variables. Data was then analysed for surgical complications, wound complications, and medical complications within 30 days of surgery. In total, 4545 patients were identified; 54.4% of patients were obese (BMI > 30 kg/m²), of which 1308 (28.8%) were Class I (BMI = 30–34.9 kg/m²), 686 (15.1%) were Class II (BMI = 35–39.9 kg/m²), and 439 (9.7%) were Class III (BMI > 40 kg/m²). The presence of comorbid conditions increased across obesity classifications (p < 0.001), with significant differences noted in all cohort comparisons except when comparing class I to class II (p = 0.12). Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). This was further isolated when comparing morbidly obese patients to non-obese (p < 0.001), class I (p < 0.001), and class II (p = 0.01) patients. This population-wide analysis – the largest and most heterogeneous study to date – has demonstrated that increasing obesity class is associated with increased early postoperative complications. Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort.     

Epidemiology of Renal and Cardiovascular Risk Factors in Toba Aborigines

Objectives. To detect, educate, and control cardiovascular (CVD) risk factors, diabetes mellitus, hypertension, obesity, central obesity, and renal damage markers such as glomerular filtration rate (GFR) and proteinuria within a population of Toba aborigine people who live in the outskirts of Resistencia city, Chaco Province, Argentina. Methods. A sample was selected from four Toba communities. Blood and urine samples were drawn in their own homes. Proteinuria was considered positive when a urinary protein/urinary creatinine rate (uPr/uCr) ≥ 0.20. GFR was estimated by Levy formula, and the stages of chronic kidney disease (CKD) were as defined in the National Kidney Foundation Guidelines. Results. In all, 385 subjects were included, 36% males, mean age = 36.1 years old. The prevalence of CVD risk factors was as follows: hypertension in 97 (25.2%), proteinuria in 84 (21.8%), CKD in 93 (24.2%) [Stage 1 in 26 (6.8%), Stage 2 in 46 (12%), and Stage 3 in 21 (5.5%)]. No subjects showed CKD Stage 4 or 5. Being overweight was found in 129 (33.5%), obesity in 82 (21.3%), central obesity in 190 (49.4%), and diabetes in 8 (2.1%). The presence of CKD was associated with an increased prevalence in central obesity, hypertension, and diabetes, but not obesity. The adjusted relative risk for proteinuria was 2.79 (p ≤ 0.008) in subjects of at least 45 years of age, compared to subjects under 25 years. Conclusions. This group of aborigines showed a high prevalence of proteinuria and CVD risk factors and CKD not related to diabetes.     

Pre-transplant obesity in heart transplantation: Are there predictors of worse outcomes?

Objective. Morbid obesity is increasingly observed in patients being evaluated for heart transplantation and represents a relative contraindication. We sought to evaluate the influence of pre-transplant obesity on morbidity and mortality after heart transplantation. Design. We retrospectively reviewed 90 consecutive patients with preoperative obesity (BMI ≥ 30) and 90 age matched patients with normal weight (BMI 19 – 26) who underwent heart transplantation at our institution between January 1997 and December 2005. Results. Morbidly obese patients experienced higher rates of pre-transplant diabetes (29% vs 15%, p < 0.05) and prolonged waiting time before transplantation (191.4±136.1 vs 117.4±143.2 days, p < 0.001). There were no significant differences in post-operative complications including rejection and major and minor infections. There was no difference in actuarial survival between the obese and control groups after a mean follow-up of 4.26±2.95 years (p = 0.513, log-rank statistic 0.452). Causes of death did not differ. Cox proportional hazard analysis revealed increased association of peripheral vascular disease (HR 31.718, p = 0.001), and pre operative inotropic support (HR 33.725, p = 0.013) with increased mortality in the obese group. Conclusions. This study suggests morbid obesity does not affect survival or rates of infection and rejection after heart transplantation.     

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.     

Durable left ventricular assist device implantation in extremely obese heart failure patients

Left ventricular assist devices (LVADs) have improved clinical outcomes and quality of life for those with end‐stage heart failure. However, the costs and risks associated with these devices necessitate appropriate patient selection. LVAD candidates are becoming increasingly more obese and there are conflicting reports regarding obesity’s effect on outcomes. Hence, we sought to evaluate the impact of extreme obesity on clinical outcomes after LVAD placement. Consecutive LVAD implantation patients at our center from June 2008 to May 2016 were studied retrospectively. We compared patients with a body mass index (BMI) ≥40 kg/m² (extremely obese) to those with BMI < 40 kg/m² with respect to patient characteristics and surgical outcomes, including survival. 252 patients were included in this analysis, 30 (11.9%) of whom met the definition of extreme obesity. We found that patients with extreme obesity were significantly younger (47[33, 57] vs. 60[52, 67] years, P < 0.001) with fewer prior sternotomies (16.7% vs. 36.0%, P = 0.04). They had higher rates of pump thrombosis (30% vs. 9.0%, P = 0.003) and stage 2/3 acute kidney injury (46.7% vs. 27.0%, P = 0.003), but there were no differences in 30‐day or 1‐year survival, even after adjusting for age and clinical factors. Extreme obesity does not appear to place LVAD implantation patients at a higher risk for mortality compared to those who are not extremely obese; however, extreme obesity was associated with an increased risk of pump thrombosis, suggesting that these patients may require additional care to reduce the need for urgent device exchange.     

Perioperative outcomes of severely obese children undergoing tonsillectomy

Background: Sleep‐disordered breathing, a common condition in obese children, is a frequent indication for tonsillectomy. Objective: The purpose of this study was to examine the association between obesity and perioperative complications in children undergoing tonsillectomy. Methods/Materials: A sample of 100 severely obese children (body mass index for age [BMIA], ≥ 98th percentile) between ages 2 and 18 years who underwent tonsillectomy at Mayo Clinic Rochester was randomly selected. Each severely obese child was age (±2 years) and sex matched to two normal weight children (BMIA between 25th and 75th percentiles) undergoing tonsillectomy during the study period, and their medical records were reviewed. Results: Severely obese children had a significantly higher incidence of comorbid conditions including respiratory disorders and severe systemic disorders or syndromes. Severely obese children had a higher frequency of perioperative airway complications (15.0% vs 2.0%). From posthoc analyses, severe obesity remained a significant risk factor for perioperative adverse events after adjusting for the presence of severe systemic disorders or syndromes (OR 8.8; 95% CI 2.8–27.5, P < 0.001) and also after adjusting for preoperative respiratory disorders (OR 7.7; 95% CI 2.5–24.3, P < 0.001). When children with planned admissions were excluded from the analysis, severe obesity was associated with an increased rate of unplanned hospital admission (OR 3.80, 95% CI 1.8–7.9, P < 0.001). Conclusions: Severe obesity in children undergoing tonsillectomy is independently associated with an increased risk of perioperative complications. It appears that both severe obesity and systemic comorbid condition contribute to higher proportions of inpatient tonsillectomies performed in our institution.     

Changes in Inflammatory Biomarkers Across Weight Classes in a Representative US Population: A Link Between Obesity and Inflammation

Background  Obesity has been linked with a chronic state of inflammation which may be involved in the development of metabolic syndrome, cardiovascular disease, non-alcoholic steatohepatitis, and even cancer. The objective of this study was to examine the association between obesity class and levels of inflammatory biomarkers from men and women who participated in the 1999–2004 National Health and Nutrition Examination Survey (NHANES). Methods  Serum concentrations of C-reactive protein (CRP) and fibrinogen were measured among US participants of the 1999–2004 NHANES. We examined biomarker levels across different weight classes with normal weight, overweight, and obesity classes 1, 2, and 3 were defined as BMI of <25.0, 25.0–29.9, 30.0–34.9, 35.0–39.9, and ≥40.0, respectively. Results  With CRP levels for normal weight individuals as a reference, CRP levels nearly doubled with each increase in weight class: +0.11 mg/dl (95% CI, 0.06–0.16) for overweight, +0.21 mg/dl (95% CI, 0.16–0.27) for obesity class 1, +0.43 mg/dl (95% CI, 0.26–0.61) for obesity class 2, and +0.73 mg/dl (95% CI, 0.55–0.90) for obesity class 3. With normal weight individuals as a reference, fibrinogen levels increase with increasing weight class and were highest for obesity class 3 individuals, +93.5 mg/dl (95% CI, 72.9–114.1). Individuals with hypertension or diabetes have higher levels of CRP and fibrinogen levels compared to individuals without hypertension or diabetes, even when stratified according to BMI. Conclusions  There is a direct association between increasing obesity class and the presence of obesity-related comorbidities such as diabetes and hypertension with high levels of inflammatory biomarkers. Presented at the 49th annual meeting of the Society for Surgery of the Alimentary Tract May 20, 2008, San Diego, CA.     

Body mass index and complications following major gastrointestinal surgery: a prospective,international cohort study and meta‐analysis

Aim

Previous studies reported conflicting evidence on the effects of obesity on outcomes after gastrointestinal surgery. The aims of this study were to explore the relationship of obesity with major postoperative complications in an international cohort and to present a meta‐analysis of all available prospective data.

Methods

This prospective, multicentre study included adults undergoing both elective and emergency gastrointestinal resection, reversal of stoma or formation of stoma. The primary end‐point was 30‐day major complications (Clavien–Dindo Grades III–V). A systematic search was undertaken for studies assessing the relationship between obesity and major complications after gastrointestinal surgery. Individual patient meta‐analysis was used to analyse pooled results.

Results

This study included 2519 patients across 127 centres, of whom 560 (22.2%) were obese. Unadjusted major complication rates were lower in obese vs normal weight patients (13.0% vs 16.2%, respectively), but this did not reach statistical significance (P = 0.863) on multivariate analysis for patients having surgery for either malignant or benign conditions. Individual patient meta‐analysis demonstrated that obese patients undergoing surgery for malignancy were at increased risk of major complications (OR 2.10, 95% CI 1.49–2.96, P < 0.001), whereas obese patients undergoing surgery for benign indications were at decreased risk (OR 0.59, 95% CI 0.46–0.75, P < 0.001) compared to normal weight patients.

Conclusions

In our international data, obesity was not found to be associated with major complications following gastrointestinal surgery. Meta‐analysis of available prospective data made a novel finding of obesity being associated with different outcomes depending on whether patients were undergoing surgery for benign or malignant disease.     

Obesity,acute kidney injury and mortality in patients with sepsis: a cohort analysis

Although the prognostic effect of obesity has been studied in critically ill patients its impact on outcomes of septic patients and its role as a risk factor for acute kidney injury (AKI) is not consensual. We aimed to analyze the impact of obesity on the occurrence of AKI and on in-hospital mortality in a cohort of critically ill septic patients. This study is retrospective including 456 adult patients with sepsis admitted to the Division of Intensive Medicine of the Centro Hospitalar Lisboa Norte (Lisbon, Portugal) between January 2008 and December 2014. Obesity was defined as a body mass index of 30?kg/m² or higher. The Kidney Disease Improving Global Outcomes classification was used to diagnose and classify patients developing AKI. AKI occurred in 87.5% of patients (19.5% with stage 1, 22.6% with stage 2 and 45.4% with stage 3). Obese patients developed AKI more frequently than non-obese patients (92.8% versus 85.5%, p?=?.035; unadjusted OR 2.2 (95% CI: 1.04–4.6), p?=?.039; adjusted OR 2.31 (95% CI: 1.07–5.02), p?=?.034). The percentage of obese patients, however, did not differ between AKI stages (stage 1, 25.1%; stage 2, 28.6%; stage 3, 15.4%; p?=?.145). There was no association between obesity and mortality (p?=?.739). Of note, when comparing AKI patients with or without obesity in terms of in-hospital mortality there were also no significant differences between those groups (38.4% versus 38.4%, p?=?.998). Obesity was associated with the occurrence of AKI in critically ill patients with sepsis; however, it was not associated with in-hospital mortality.     

Sarcopenic Obesity and Its Temporal Associations With Changes in Bone Mineral Density,Incident Falls,and Fractures in Older Men: The Concord Health and Ageing in Men Project

Body composition and muscle function have important implications for falls and fractures in older adults. We aimed to investigate longitudinal associations between sarcopenic obesity and its components with bone mineral density (BMD) and incident falls and fractures in Australian community‐dwelling older men. A total of 1486 men aged ≥70 years from the Concord Health and Ageing in Men Project (CHAMP) study were assessed at baseline (2005–2007), 2‐year follow‐up (2007–2009; n = 1238), and 5‐year follow‐up (2010–2013; n = 861). At all three time points, measurements included appendicular lean mass (ALM), body fat percentage and total hip BMD, hand‐grip strength, and gait speed. Participants were contacted every 4 months for 6.1 ± 2.1 years to ascertain incident falls and fractures, the latter being confirmed by radiographic reports. Sarcopenic obesity was defined using sarcopenia algorithms of the European Working Group on Sarcopenia (EWGSOP) and the Foundation for the National Institutes of Health (FNIH) and total body fat ≥30% of total mass. Sarcopenic obese men did not have significantly different total hip BMD over 5 years compared with non‐sarcopenic non‐obese men (p > 0.05). EWGSOP‐defined sarcopenic obesity at baseline was associated with significantly higher 2‐year fall rates (incidence rate ratio [IRR] 1.66; 95% confidence interval [CI] 1.16–2.37), as were non‐sarcopenic obesity (1.30; 1.04–1.62) and sarcopenic non‐obesity (1.58; 1.14–2.17), compared with non‐sarcopenic non‐obese. No association with falls was found for sarcopenic obesity using the FNIH definition (1.01; 0.63–1.60), but after multivariable adjustment, the FNIH‐defined non‐sarcopenic obese group had a reduced hazard for any 6‐year fracture compared with sarcopenic obese men (hazard ratio 0.44; 95% CI 0.23–0.86). In older men, EWGSOP‐defined sarcopenic obesity is associated with increased fall rates over 2 years, and FNIH‐defined sarcopenic obese men have increased fracture risk over 6 years compared with non‐sarcopenic obese men. © 2016 American Society for Bone and Mineral Research.