Severe underweight decreases the survival rate in adult lung transplantation

Purpose

The body mass index (BMI) before lung transplantation (LT) is a benchmark of the post-LT survival. The aim of the study is to determine the BMI inadequate for the post-LT survival.

Methods

We examined the survival after LT in patients grouped into the following BMI categories: <18.5 kg/m² (underweight), 18.5–24.9 kg/m² (normal weight), 25–29.9 kg/m² (overweight), and ≥30.0 kg/m² (obese) according to the World Health Organization (WHO) criteria. A more detailed categorization was made for further evaluation of the underweight group: mild (17.0?≤?BMI?<?18.5 kg/m²) and severely underweight (BMI <17.0 kg/m²).

Results

There was no statistically significant difference in the post-LT survival between underweight and normal-weight patients (5-year survival: 78.7 vs. 76.1%). Patients with BMI <17.0 kg/m² had a worse prognosis than those with 17.0?≤?BMI?<?18.5 kg/m² (5-year survival: 70.3 vs. 90.0%).

Conclusions

Standard BMI categorization per the WHO criteria is inadequate for determining the post-LT survival, especially in underweight patients. For the nutritional evaluation of underweight pre-LT patients, BMI <17.0 kg/m² should be used instead of BMI <18.5 kg/m².

     

Does body mass index influence the outcome of midurethral sling procedures for stress urinary incontinence?

Introduction and hypothesis

Whether midurethral sling (MUS) procedures are as effective in obese women as they are in women of normal weight is still a matter of controversy. The objective of this study was to determine if body mass index (BMI) influences the outcome of MUS procedures for stress urinary incontinence (SUI).

Methods

We searched electronic databases including EMBASE, MEDLINE, Web of Science and Ovid evidence-based medicine reviews to identify studies that explored the association between BMI and outcomes of MUS procedures. The studies were rated using the Newcastle-Ottawa scale; the meta-analysis was performed using Review Manager 5.3 software.

Results

This review included 11 studies, 6 prospective cohort studies and 5 retrospective studies, with a total of 2,846 patients. The objective success rates of MUS in patients with BMI >25 kg/m² (overweight and obese) were lower than in patients with BMI 18.5 – <25 kg/m² (normal weight; RR?=?0.93, 95 % CI 0.89 – 0.97; P?=?0.002). The objective success rates were not significantly different between the overweight group (BMI 25 – <30 kg/m²) and the obese group (BMI ≥30 kg/m²; RR?=?0.95, 95 % CI 0.89 – 1.01; P?=?0.08). There were no significant differences in subjective outcomes among the different BMI groups: BMI ≥25 kg/m² versus 18.5 – <25 kg/m² (RR?=?1.03, 95 % CI 0.97 – 1.10; P?=?0.29), and BMI ≥30 kg/m² versus 25 – <30 kg/m² (RR?=?0.98, 95 % CI 0.92 – 1.04; P?=?0.55).

Conclusions

The objective success rates of MUS were lower in overweight and obese patients; however, the subjective outcomes of MUS were not significantly different among normal weight, overweight and obese patients. The MUS procedure is as effective in obese women as in women of normal weight, and therefore surgeons should not consider BMI >25 kg/m² as a risk factor when discussing the suitability of the MUS procedure in a patient with SUI.

     

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.

     

Acute appendicitis in overweight patients: the role of preoperative imaging

Background

The diagnosis of acute appendicitis in overweight patients is challenging due to the limited value of the clinical examination. The benefits of ultrasonography and abdominal CT have been studied in the general population, but there is limited data regarding their use in overweight and obese patients with suspected appendicitis. This study analyzes the role of preoperative radiological modalities in overweight patients with suspected appendicitis.

Methods

Retrospective analysis of a prospectively acquired database including 705 patients operated for suspected acute appendicitis. Patients were divided into two groups according to their BMI (BMI ≥25 kg/m² (n?=?242) and BMI <25 kg/m² (n?=?463)). The use of preoperative radiological modalities, laboratory findings and outcome parameters were analyzed.

Results

Ultrasonography was the preferred radiological assessment in our cohort (68 % in BMI <25 kg/m and 52.4 % in BMI ≥25 kg/m²). However, it was non-conclusive in 42 % of overweight as compared to 6 % in patients with a BMI?<?25 (p?<?0.0001). This difference was particularly obvious between female patients (8 % of non-conclusive US for BMI <25 kg/m² vs 52 % for BMI ≥25 kg/m², p?<?0.0001). Significantly more CT scans were performed in overweight patients (37 % vs. 20 %; p <0.0001). The accuracy of CT did not differ according to BMI (85 % vs. 88 %; p?=?0.76). Preoperative radiological imaging did not significantly delay surgery. Laparoscopy was the preferred approach for both groups (98.2 % vs 98.7 %, P?=?0.86) with an overall conversion rate of 4 %. The overall rate of negative appendectomy was 10 %.

Conclusions

The role of ultrasonography in patients with BMI ≥25 kg/m² with suspected acute appendicitis is questionable due to its high rate of non-conclusive findings. Therefore, abdominal CT scans should be preferred to investigate suspected appendicitis in overweight patient if clinical findings are not conclusive.

     

Changes in bone mineral density over time by body mass index in the health ABC study

Summary

Obesity appears protective against osteoporosis in cross-sectional studies. However, results from this longitudinal study found that obesity was associated with bone loss over time. Findings underscore the importance of looking at the longitudinal relationship, particularly given the increasing prevalence and duration of obesity among older adults.

Introduction

Cross-sectional studies have found a positive association between body mass index (BMI) and bone mineral density (BMD), but little is known about the longitudinal relationship in US older adults.

Methods

We examined average annual rate of change in BMD by baseline BMI in the Health, Aging, and Body Composition Study. Repeated measurement of BMD was performed with dual-energy X-ray absorptiometry (DXA) at baseline and years 3, 5, 6, 8, and 10. Multivariate generalized estimating equations were used to predict mean BMD (femoral neck, total hip, and whole body) by baseline BMI (excluding underweight), adjusting for covariates.

Results

In the sample (n?=?2570), 43 % were overweight and 24 % were obese with a mean baseline femoral neck BMD of 0.743 g/cm², hip BMD of 0.888 g/cm², and whole-body BMD of 1.09 g/cm². Change in total hip or whole-body BMD over time did not vary by BMI groups. However, obese older adults lost 0.003 g/cm² of femoral neck BMD per year more compared with normal weight older adults (p?<?0.001). Femoral neck BMD change over time did not differ between the overweight and normal weight BMI groups (p?=?0.74). In year 10, adjusted femoral neck BMD ranged from 0.696 g/cm² among obese, 0.709 g/cm² among normal weight, and 0.719 g/cm² among overweight older adults.

Conclusions

Findings underscore the importance of looking at the longitudinal relationship between body composition and bone mineral density among older adults, indicating that high body mass may not be protective for bone loss over time.

     

Body mass index,risk of allogeneic red blood cell transfusion,and mortality in elderly patients undergoing hip fracture surgery

Summary

Despite improvements in preoperative and postoperative treatment, hip fracture surgery may lead to blood transfusion. Little is known about the impact of body mass index on transfusion risk and subsequent mortality. Opposite overweight and obese patients, underweight patients had increased risk of transfusion and death within 1 year of surgery.

Introduction

Despite improvements in preoperative and postoperative treatment of hip fracture patients, hip fracture surgery may lead to blood loss. We examined the risk of red blood cell transfusion (as an indirect measure of blood loss) and subsequent mortality by body mass index level in patients aged 65 and over undergoing hip fracture surgery.

Methods

This is a population-based cohort study using medical databases. We included all patients who underwent surgery for hip fracture during 2005–2013. We calculated the cumulative risk of red blood cell transfusion within 7 days of surgery treating death as a competing risk and, among transfused patients, short- (8–30 days postsurgery) and long-term mortality (31–365 days postsurgery).

Results

Among 56,420 patients, 47.7 % received at least one red blood cell transfusion within 7 days of surgery. In patients with normal weight, the risk was 48.8 % compared with 57.0 % in underweight patients (adjusted RR?=?1.11; CI 1.08–1.15), 42.1 % in overweight patients (adjusted RR?=?0.89; CI 0.86–0.91), and 42.2 % in obese patients (adjusted RR?=?0.87; CI 0.84–0.91). Among transfused patients, adjusted HRs for short-term mortality were 1.52 (CI 1.34–1.71), 0.70 (CI 0.61–0.80), and 0.58 (CI 0.43–0.77) for underweight, overweight, and obese patients, respectively, compared with normal-weight patients. The corresponding adjusted HRs for long-term mortality were 1.45 (CI 1.33–1.57), 0.80 (CI 0.74–0.86), and 0.58 (CI 0.50–0.69). Similar association between BMI and mortality was observed also among non-transfused patients.

Conclusions

Underweight patients had a higher risk of red blood cell transfusion and death in the first year of surgery than normal-weight patients, even when controlling for age and comorbidity. Opposite findings were seen for overweight and obese patients.

     

Obesity Does Not Impact Perioperative or Postoperative Outcomes in Patients with Inflammatory Bowel Disease

Background

While the prevalence of obesity in IBD patients is rapidly increasing, it is unclear if obesity impacts surgical outcomes in this population. We aim to investigate the effects of BMI on perioperative and postoperative outcomes in IBD patients by stratifying patients into BMI groups and comparing outcomes between these groups.

Methods

This is a retrospective cohort study where IBD patients who underwent intestinal surgeries between the years of 2000 to 2014 were identified. The patients were divided into groups based on BMI: underweight (BMI <18.5), normal weight (BMI 18.5–24.9), overweight (BMI 25–29.9), and obese (BMI ≥30). Preoperative patient demographics, operative variables, and postoperative complications were collected and compared between BMI groups.

Results

A total of 391 surgeries were reviewed (34 underweight, 187 normal weight, 105 overweight, and 65 obese) from 325 patients. No differences were observed in preoperative patient demographics, type of IBD, preoperative steroid or biologic mediator use, or mean laboratory values. No differences were observed in percent operative procedures with anastomosis, surgeries converted to open, estimated blood loss, intraoperative complications, and median operative time. Thirty-day postoperative complication rates including total complications, wound infection, or anastomotic leak were similar between groups. There was a statistically significant increased postoperative bleeding risk (p?=?0.029) in underweight patients. The relative percent for increased postoperative bleeding risk between BMI groups was as follows: 2.9 % in underweight, zero in normal weight, 2.9 % in overweight, and zero in obese.

Conclusion

Obesity does not appear to impact intraoperative variables nor does obesity appear to worsen postoperative complication rates in IBD patients.

     

Prevalence and Determinants of Vitamin D Deficiency Among the Overweight and Obese Singaporeans Seeking Weight Management Including Bariatric Surgery: a Relationship with Bone Health

Purpose

Low vitamin D status is prevalent worldwide and has been linked to a variety of pathologies including obesity in adults. The severity of vitamin D deficiency amongst the overweight and obese Singaporeans is not well documented. The purpose of this prospective observational study was to assess the prevalence and determinants of vitamin D deficiency in a multi-ethnic Asian population referred for weight management, including those seeking bariatric surgery.

Materials and Methods

This was a cross-sectional study conducted among 111 consecutive subjects referred to a single institution weight management service in Singapore. The data collected included their anthropometric data, body mass index (BMI), body fat percentage, waist circumference, 25-hydroxyvitamin D [25(OH)D] and other bone turnover markers.

Results

The average BMI among the 111 subjects was 40.1?±?8.2 kg/m² and mean age of 40?±?10 years. Vitamin D deficiency was found in 75.7% of the population. There was a significant negative association of vitamin D with adiposity markers including BMI (r?=???0.31), body fat percentage (r?=???0.34) and waist circumference (r?=???0.26). Predictors of vitamin D deficiency included age?>?50 years, female gender, waist circumference and body fat percentage.

Conclusion

Vitamin D deficiency is prevalent among this target population in Singapore regardless of ethnicity. In particular, the elderly, females, those with larger waist circumference and body fat percentage were significantly associated with lower serum 25(OH)D level. Hence, routine screening for the overweight and obese subjects in multi-ethnic Singapore seeking weight management is indicated.

     

Discrepancies Between BMI and Classic Cardiovascular Risk Factors

Background

Obesity is related to increased cardiovascular risk. It is unknown whether increasing levels of obesity also increase levels of cardiovascular risk factors and systemic inflammation. This study describes the relationship between classic cardiovascular risk factors and inflammatory markers with BMI in a group of obese and non-obese subjects.

Materials and Methods

Obese subjects (BMI ≥?30 kg/m²; n?=?576; mean ± SD BMI 43.8?±?7.58 kg/m²) scheduled for bariatric surgery were included. The reference population consisted of non-obese volunteers (BMI < 30 kg/m²; n?=?377, BMI 25.0?±?2.81 kg/m²). The relationship between BMI quintiles and the levels of cardiovascular risk factors was analyzed. Adipose tissue volumetry was performed in 42 obese subjects using abdominal CT scans.

Results

The obese group included more women and subjects with type 2 diabetes mellitus, hypertension, and current smoking behavior. In obese subjects, HDL-C and triglycerides decreased with increasing BMI. Systolic and diastolic blood pressure, total cholesterol, LDL-C, and apoB were not related to BMI in the obese group, in contrast to the non-obese group. Inflammatory markers CRP, leukocyte count, and serum complement C3 increased with increasing BMI in the obese group, while these relations were less clear in the non-obese group. The subcutaneous adipose tissue surface was positively correlated to BMI, while no correlation was observed between BMI and visceral adipose tissue.

Conclusions

Markers of inflammation are strongest related to BMI in obese subjects, most likely due to increased adipose tissue mass, while cardiovascular risk factors do not seem to deteriorate above a certain BMI level. Limited expansion capacity of visceral adipose tissue may explain these findings.

     

Influence of body mass index on revision rates after primary total knee arthroplasty

Purpose

Studies demonstrate that revision rates after primary total knee arthroplasty (TKA) tend to be higher in obese patients. However, the existence of a body mass index (BMI) threshold remains unexplored.

Methods

We conducted a prospective cohort study of 2442 primary TKAs in 2035 patients (69.1 % women; mean age 72 years; mean follow-up 93 months, range 38–203). We evaluated the influence of BMI in five categories on all-cause revision after TKA using incidence rates (IR), hazard ratios (HR), and Kaplan–Meier survival analysis. Adjustment for baseline imbalances was performed using Cox regression analysis.

Results

Over the study period, 71 revisions occurred. Revision rates were 3.2 cases/1000 patient-years for patients of normal weight, 3.4/1000 for overweight patients and 3.0/1000 for patients classified as obese class I. At BMI?≥?35, a significant increase in revision was noted. Comparing BMI?≥?35 vs. < 35, there were 6.4 vs. 3.2 /1000. Crude HR was 2.0 [95 % confidence interval (CI) 1.2–3.3, p?=?0.009], and the adjusted HR was 2.1 (95 % CI 1.2–3.6, p?=?0.008).

Conclusion

All-cause revision rates after primary TKA doubled in patients with a BMI of 35 but were similar in those with a BMI <35.

     

Bariatric Surgery Provides a “Bridge to Transplant” for Morbidly Obese Patients with Advanced Heart Failure and May Obviate the Need for Transplantation

Background

In patients with advanced heart failure, morbid obesity is a relative contraindication to heart transplantation due to higher morbidity and mortality in these patients.

Methods

We performed a retrospective analysis of consecutive morbidly obese patients with advanced heart failure who underwent bariatric surgery for durable weight loss in order to meet eligibility criteria for cardiac transplantation.

Results

Seven patients (4 M/3 F, age range 31–56 years) with left ventricular ejection fraction (LVEF) ≤25 % underwent laparoscopic bariatric surgery. Median preoperative body mass index (BMI) was 42.8 kg/m² (range 37.5–50.8). There were no major perioperative complications in six of seven patients. Median length of hospital stay was 5 days. There was no mortality recorded during complete patient follow-up. At a median follow-up of 406 days, median BMI reduction was 12.9 kg/m² (p?=?0.017). Postoperative LVEF improved to a median of 30 % (interquartile range (IQR) 25–53 %; p?=?0.039). Two patients underwent successful cardiac transplantation. Two patients reported symptomatic improvement with little change in LV function and now successfully meet listing criteria. Three patients showed marked improvement of their LVEF and functional status, thus removing the requirement for transplantation.

Conclusions

Bariatric surgery can achieve successful weight loss in morbidly obese patients with advanced cardiac failure, enabling successful heart transplantation. In some patients, cardiac transplantation can be avoided through surgical weight loss.

     

Prevalence and correlates of 25-hydroxyvitamin D deficiency in the Chronic Kidney Disease in Children (CKiD) cohort

Background

Vitamin D plays an important role in the mineral and bone disorder seen in chronic kidney disease (CKD). Deficiency of 25-hydroxyvitamin D (25OHD) is highly prevalent in the adult CKD population.

Methods

The prevalence and determinants of 25OHD deficiency (defined as a level <20 ng/ml) were examined longitudinally in 506 children in the CKiD cohort. Predictors of secondary hyperparathyroidism and the determinants of 1,25-dihydroxyvitamin D (1,25(OH)₂D) levels were also evaluated.

Results

Deficiency of 25OHD was observed in 28 % of the cohort at enrollment. Significant predictors of 25OHD deficiency were older age, non-white race, higher body mass index, assessment during winter, less often than daily milk intake, non-use of nutritional vitamin D supplement and proteinuria. Lower values of glomerular filtration rate (GFR), serum 25OHD, calcium and higher levels of FGF23 were significant determinants of secondary hyperparathyroidism. Lower GFR, low serum 25OHD, nephrotic-range proteinuria, and high FGF23 levels were significant determinants of serum 1,25(OH)₂ D levels.

Conclusions

Deficiency of 25OHD is prevalent in children with CKD and is associated with potentially modifiable risk factors such as milk intake, nutritional vitamin D supplement use, and proteinuria. 25OHD deficiency is a risk factor for secondary hyperparathyroidism and decreased serum 1,25(OH)₂D in children with CKD.

     

The Role of Attachment in Body Weight and Weight Loss in Bariatric Patients

Purpose

The aim of this study is to explore the role of attachment styles in obesity.

Material and Methods

The present study explored differences in insecure attachment styles between an obese sample waiting for bariatric surgery (n = 195) and an age, sex and height matched normal weight control group (n = 195). It then explored the role of attachment styles in predicting change in BMI 1 year post bariatric surgery (n = 143).

Results

The bariatric group reported significantly higher levels of anxious attachment and lower levels of avoidant attachment than the control non-obese group. Baseline attachment styles did not, however, predict change in BMI post surgery.

Conclusion

Attachment style is different in those that are already obese from those who are not. Attachment was not related to weight loss post surgery.

     

Übergewicht in der Ätiologie der Gonarthrose

Problem

Osteoarthritis of the knee joint is one of the important and highly functionally impairing diseases of the musculoskeletal system in adults. The spectrum of causes of knee arthritis is broad. Obesity is one of the main causes in the etiology of osteoarthritis of the knee. In particular, knowledge of the cause and effect relationship between obesity and knee osteoarthritis are important in the assessment of claims of occupational disease BK 2112 (knee osteoarthritis due to long-term kneeing).

Objective and methods

This article is based on a literature review of cohort studies with regard to the question whether obesity is a risk factor in the etiology of osteoarthritis of the knee.

Results

A total of 26 cohort studies were identified. Based on the proven cohort studies it can be shown that a significant association exists between obesity and physical occurrence of osteoarthritis of the knee joint. Compared with normal weight subjects the risk of occurrence of the disease is doubled in obese subjects per category of overweight (overweight 25-30 kg/m², obese over 30 kg/m²). A dose-response relationship with respect to the degree of obesity is clearly demonstrated.

Conclusion

Obesity plays a significant role in the etiology of primary osteoarthritis of the knee joint.

     

Tipping the Scales: Liver Transplant Outcomes of the Super Obese

Objective

We aim to study outcomes in liver transplant recipients with body mass index (BMI) ≥50 using the United Network for Organ Sharing (UNOS) database.

Methods

We reviewed patients undergoing liver transplantation recorded in the UNOS database from 1988 to 2013. Of 104,250 liver transplant procedures, 123 were performed on super obese patients.

Results

Sixty-four percent of the super obese patients are female (64 %) and had a mean age 47 years (20–71). The mean BMI was 53.5 (50–72.86) and 16 % had diabetes. The mean Model for End-Stage Disease (MELD) score at transplant was 29.1 (6–53). It was found that BMI ≥50 increased 1.6-fold the risk of death within 30 days after liver transplantation. Graft failure was increased by 52 % and overall mortality was by 62 %. A 1:1 propensity score-matched analysis demonstrated that patients with BMI <50 have significantly better graft and overall patient survival than the super obese.

Conclusions

Overall, our data shows that BMI ≥50 is an independent predictor of perioperative mortality and graft and overall patient survival. Further studies are necessary to better understand predictors of outcomes in super obese patients.

     

Effect of concomitant vitamin D deficiency or insufficiency on lumbar spine volumetric bone mineral density and trabecular bone score in primary hyperparathyroidism

Summary

Lower vitamin D and higher parathyroid hormone (PTH) levels are associated with higher volumetric BMD and bone strength at the lumbar spine as measured by central quantitative computed tomography in primary hyperparathyroidism (PHPT), but there are no differences in bone microarchitecture as measured by trabecular bone score (TBS).

Introduction

The purpose of this study was to evaluate the association between 25-hydroxyvitamin D (25OHD) and volumetric bone mineral density (vBMD) and the TBS at the lumbar spine (LS) in PHPT.

Methods

This is a cross-sectional analysis of PHPT patients with and without low 25OHD. We measured vBMD with quantitative computed tomography (cQCT) and TBS by dual-energy X-ray absorptiometry (DXA) at the LS in 52 and 88 participants, respectively.

Results

In the cQCT cohort, those with lower vitamin D (<20 vs. 20-29 vs. ≥30 ng/ml) tended to be younger (p?=?0.05), were less likely to use vitamin D supplementation (p?<?0.01), and had better renal function (p?=?0.03). Those with 25OHD <20 ng/ml had 80 and 126 % higher serum PTH levels respectively vs. those with 25OHD 20–29 ng/ml (p?=?0.002) and 25OHD ≥30 ng/ml (p?<?0.0001). Covariate-adjusted integral and trabecular vBMD were higher in those with 25OHD 20–29 vs. those with 25OHD ≥30 ng/ml, but those with 25OHD <20 did not differ. Because there were few participants with 25OHD deficiency, we also compared those with vitamin D <30 vs. ≥30 ng/ml. Covariate-adjusted integral and trabecular vBMD were 23 and 30 % higher respectively (both p?<?0.05) in those with vitamin D <30 vs. ≥30 ng/ml. TBS was in the partially degraded range but did not differ by vitamin D status.

Conclusion

In mild PHPT, lower 25OHD is associated with higher PTH, but vitamin D deficiency and insufficiency using current clinical thresholds did not adversely affect lumbar spine skeletal health in PHPT. Further work is needed to determine if higher vBMD in those with lower vitamin D is due to an anabolic effect of PTH.

     

Nutritional Status of Children from Women with Previously Bariatric Surgery

Background

Number of pregnancies has been increasing in women of childbearing age after the gastric bypass.

Objective

The objective of this study was to evaluate the nutritional status of children of women submitted to gastric bypass.

Methods

We evaluated anthropometric, breastfeeding and biochemical profile, body composition, and dietary intake indicators of children of both sexes who were born alive after the surgery. For statistical analysis, were performed Shapiro-Wilk and ANOVA test (p < 0.05).

Results

The sample consisted of 13 children (61.6% female, mean age of 46 ± 22.3 months, BMI of 18.9 ± 3.3 kg/m²). The classification of BMI index by age showed that 46.1% of the children were normal weight and 30.8% obese. We observed a large percentage of children with deficiency of iron and vitamin A. 7.6 and 30.7% of children presented carbohydrate and lipid, respectively, lower than the recommendation. Fiber intake was inadequate in all children, calcium in 61.5%, vitamin A in 30.7%, and folate in 76.9% of them. Also, 84.6% presented sodium intake higher than the recommendations. The blood glucose levels were lower in children with maternal breastfeeding (65.5 ± 2.1 mg/dL, p < 0.05); furthermore, children breastfed with artificial and breast milk presented lower fat mass (3.8 ± 1.9 kg; p < 0.05).

Conclusion

Children from women with previously gastric bypass presented low birth weight; however, they are currently underweight or overweight and present important deficiency of iron and vitamin A and inadequate alimentary intake mainly of sodium and fibers. Breastfeeding may play a protective role in the development of obesity in these children.

     

Is obesity related with periprosthetic fractures around the knee?

Purpose

Periprosthetic fracture (PPF) is a devastating complication following primary total knee arthroplasty. Obesity is currently considered a risk factor for many complications in orthopaedics, but there is no evidence in literature about the relationship between obesity and PPF around the knee. The objective of this study was to determine whether obesity is associated with a higher incidence of PPF.

Methods

All patients diagnosed of a PPF around the knee from January 2010 to December 2013 were enrolled. Forty-nine PPF (47 women and 2 men) were included, and a total of 97 patients (80 women and 17 men) were randomly obtained as a control group. Body mass index (BMI) was obtained in both groups and classified as <25 (normal), overweight (25–29.9), obese (30–34.9), very obese (35–39.9), or morbid obesity (≥40). Both groups, were also divided into subpopulations depending on the age as follows: <70, 70–75, 75–80 and ≥80. Statistical analysis was performed to determine any difference in BMI ≥30 kg/m² distribution between groups.

Results

In the PPF group 61.22 % of the patients had a BMI over 30 kg/m² and likewise 62.88 % of the patients in the control group. No association was found between obesity and a higher risk of PPF (p?<?0.05).

Conclusion

As a conclusion, obesity (BMI ≥30 kg/m²) does not have any clinical relationship with the appearance of a periprosthetic fracture around the knee (相似文献   

Body mass index predicts insulin sensitivity during cardiac surgery: a prospective observational study

Purpose

Taking into account the previously described link between body weight and diabetes mellitus (DM) in non-surgical patients, and the understanding that the degree of intraoperative insulin resistance is a predictor of adverse clinical outcomes, we investigated the relationship between body mass index (BMI) and insulin sensitivity during cardiac surgery.

Methods

We prospectively enrolled 400 patients scheduled for elective cardiac surgery and divided them into groups based on the presence or absence of type-2 DM. They were further categorized into four subgroups based on their BMI: group 1- normal weight, BMI 18.5-24.9 kg·m^?2; group 2 - overweight, BMI 25-29.9 kg·m^?2; group 3 - obese, BMI 30-34.9 kg·m^?2; group 4 - morbidly obese, BMI ≥ 35 kg·m^?2. Insulin sensitivity was assessed using the hyperinsulinemic-normoglycemic clamp technique during surgery. We also analyzed the association of BMI, quality of postoperative glycemic control, and postoperative outcomes.

Results

A linear negative relationship between BMI and insulin sensitivity (r = 0.42, P < 0.001) was observed, independent of the patients’ diabetic state. There was also a positive correlation between BMI and postoperative glycemia (r = 0.30, P < 0.001) though the relationship between BMI and major and infectious complication was not significant (P = 0.56, P = 0.10, respectively).

Conclusions

Patient BMI may be used as a simple predictor of insulin sensitivity during cardiac surgery and as a predictor of the quality of postoperative glycemic control. A larger cohort will be necessary to evaluate the association of BMI, perioperative insulin resistance, and clinical outcomes.