Plasma leptin and insulin levels in weight-reduced obese women with normal body mass index: relationships with body composition and insulin.

Obesity is a complex disease with multiple features that has confounded efforts to unravel its pathophysiology. As a means of distinguishing primary from secondary characteristics, we compared levels of fasting plasma leptin and insulin in a cohort of weight-reduced obese women who have attained and maintained a normal BMI for more than 1 year with the levels in cohorts of never-obese and currently obese women. Weight-reduced obese women showed decreased plasma concentrations of leptin and insulin compared with obese women, but these levels remained significantly higher than those of never-obese women. Plasma leptin levels were highly correlated with plasma insulin levels (r = 0.60, P < 0.001). To further explore relationships with body composition, total body fat was determined by dual-energy X-ray absorptiometry and body fat distribution by computed tomography in subsets of these groups. Weight-reduced obese women had a significantly greater percent body fat and subcutaneous abdominal fat mass than did the never-obese women, and these were highly correlated with plasma leptin (r = 0.90, P < 0.001, and r = 0.52, P < 0.001, respectively). In these weight-reduced obese women, visceral fat mass was similar to that of the never-obese. The insulin sensitivity index and first-phase insulin response were also comparable. These results demonstrate that higher leptin levels in weight-reduced obese women are related to the higher total fat and particularly the subcutaneous fat masses. Normalization of visceral fat mass in the weight-reduced obese was accompanied by normalization of insulin sensitivity index and first-phase insulin response. This study suggests that increases in plasma leptin and insulin in obesity are secondary features of the obese state.     

The association between body mass index and foot disorders in diabetic patients

BACKGROUND: Fifteen percent of individuals with diabetes develop a foot ulcer during their lifetime, and 85% of lower extremity amputations are preceded by an ulcer with or without infection. This study was done to determine the association between morbid obesity and foot ulcer or infection in patients with diabetes. METHODS: During a 66-month period, 133 patients were admitted to a tertiary care university medical center with a diagnosis of foot ulcer or foot infection. There were 79 men and 54 women, with an average age of 62 +/- 12 years. During hospitalization, 52 patients had peripheral angiography, 18 patients had invasive cardiac procedures, and 13 patients had peripheral vascular surgery. Twenty-two patients were receiving chronic hemodialysis. Seventy-four patients had surgical debridement of an ulcer. Thirty-two patients had bony stabilization of a Charcot foot. Partial or Syme amputations were done on 36 patients, and 26 patients had a transtibial or more proximal level of amputation. Medical records data allowed calculation of body mass index (BMI) for 82 patients. RESULTS: Mean BMI was 31 +/- 7 kg m2. Forty-six patients were obese (BMI > or = 30.0 kg m2), which is significantly higher than the national prevalence in adults (20.9%, p < 0.001). There was no correlation between BMI and length of hospitalization in the study patients. CONCLUSIONS: In a tertiary care medical center with a high proportion of very ill patients, there appeared to be a strong correlation between diabetes-associated foot morbidity and morbid obesity.     

The relationship between body mass index and footprint parameters in older people

BackgroundThe relationship of body mass index (BMI) with footprint parameters has been studied in paediatric populations, but there are limited data regarding the effects of BMI on parameters in the elderly.ObjectivesTo establish the relationship between BMI and static footprint parameters in the elderly population.Methods128 subjects aged 65 and above with no history of lower extremity surgical intervention and no significant lower extremity weakness were included in the current study. BMI and footprint parameters of arch angle, Chippaux–Smirak index (CSI), Staheli index (SI), arch index (AI) and footprint index (FI) were measured for each subject, and statistical analysis was done to investigate the correlation between BMI and the parameters.ResultsWeak correlations detected between all calculated indices and angles with BMI, except the left foot arch angle. CSI, SI and AI of the right foot were found to be positively correlated with BMI, while a negative correlation between the arch angle and FI of right foot was shown with BMI.ConclusionsThe results reveal a relationship between BMI and footprint parameters that are indicative of flatfoot in the elderly. This could be due either to confounding of the footprint measure by fat or possibly due to an as yet unknown structural change that requires further evaluation.     

The role of body mass index on IgA nephropathy prognosis: a systematic review and meta-analysis

International Urology and Nephrology - Recent studies show that obese patients have worse outcomes in IgA nephropathy as compared to normal weight patients. We performed a systematic review and...     

The relationship between body mass index and post-dural puncture headache in obstetric patients

BackgroundDifficult epidural insertion and accidental dural puncture are more likely in the obese pregnant population. Low-level evidence suggests that the risk of post-dural puncture headache declines as body mass index increases.MethodsWe retrospectively reviewed prospective data on 18 315 obstetric epidural and combined spinal–epidural insertions, identifying 125 (0.7%) accidental dural punctures or post-dural puncture headaches between 2007 and 2012. The audit record and patient medical record were examined to determine patient body mass index, headache characteristics and use of a therapeutic epidural blood patch. Women were classified into two groups: non-obese (body mass index <30 kg/m², Group <30) or obese (body mass index ⩾30 kg/m², Group ⩾30). Statistical analysis was by chi-square or Fisher exact tests, with P < 0.05 considered significant.ResultsCompared to Group <30 (n = 65), women in Group ⩾30 (n = 60) did not significantly differ in the incidence of post-dural puncture headache (82% vs 80%, P = 0.83); its intensity (severe 36% vs. 23%, P = 0.34); or the need for epidural blood patch (57% vs. 54%, P = 0.81). Groups also did not differ significantly when confining analysis to those who had a witnessed accidental dural puncture (n = 93) or to women with a body mass index >40 kg/m² (n = 10) vs. Group <30.ConclusionThis retrospective study found no evidence that women of higher body mass index are less likely to develop a post-dural puncture headache or that the characteristics of the headache and use of epidural blood patch were different.     

The relationship of body mass index to intra-abdominal pressure as measured by multichannel cystometry

The aim of the study was to identify the possible relationship between body mass index and intra-abdominal pressure as measured by multichannel cystometry. A retrospective chart review of patients presenting for urodynamic evaluation between January 1995 and March 1996 was carried out. Variables identified included weight, height, intra-abdominal pressure and intravesical pressure as recorded on multi-channel cystometrogram at first sensation in the absence of detrusor activity. Body mass index was defined as weight in kilograms divided by height in square meters. Intra-abdominal pressure was measured intravaginally except in those cases of complete procidentia or severe prolapse, where it was measured transrectally. Adequate data were available on 136 patients. The mean age was 60.6 years (range 30–91); mean body mass index was 27.7 kg/m² (range 12.7–47.7); and mean intra-abdominal pressure was 27.5 cmH₂O (range 9.0–48.0). A strong association between intra-abdominal pressure and body mass index was demonstrated, with a Pearson coefficient correlation value of 0.76 (P<0.0001). Strong correlation was still demonstrated when those patients who had had the intra-abdominal pressure measured transrectally were separated out, thus eliminating any possible confounding factors between measurements of intra-abdominal pressure measured transvaginally versus transrectally. In addition a strong correlation between intravesical pressure and body mass index was also demonstrated, with a Pearson coefficient correlation value of 0.71 (P<0.0001). Of the 136 patients, 65 (47.8%) were ultimately diagnosed as having genuine stress urinary incontinence (GSUI), 35 (25.7%) with GSUI and a low-pressure urethra (maximum urethral closure pressure of less than 20 cmH₂O), and 18 (13.2%) with detrusor instability. The remaining 13.2% had severe prolapse. Our data demonstrate a significant correlation between body mass index and intra-abdominal pressure. These findings suggest that obesity may stress the pelvic floor secondary to chronic state of increased pressure, and may represent a mechanism which supports the widely held belief that obesity is a common factor in the development and recurrence of GSUI. EDITORIAL COMMENT: This is a very nice, simple study that addresses the question of increased body mass index being associated with increased intra-abdominal pressure. The authors demonstrate a strong correlation between body mass index and intra-abdominal pressures with the data in their patient population which remains even after potential confounding differences between intra-abdominal pressures measured transcrectally or transabdominally have been eliminated. The authors do an excellent job of reviewing the literature to support their premise that increased body mass index leading to increased intra-abdominal pressure may contribute to the incidence and recurrence of genuine stress incontinence in the obese patient.     

绝经后女性体质量指数、体成分与骨密度的变化特征及关系

目的 探讨绝经后女性年龄、体质量指数（body mass index, BMI）及体成分的变化特征及与骨质疏松症之间的关系。方法 选取广州中医药大学第三附属医院2019年12月–2021年1月门诊收集的98名绝经后女性的体成分及骨密度资料,根据受试者的年龄和BMI分组,比较各年龄组及各BMI组的体成分差别,通过Spearman分析年龄、BMI及体成分对骨质疏松情况的影响,利用多元线性回归研究整体骨密度和整体骨矿含量的影响因素。结果 各个年龄组的整体骨密度（P＜0.001）及整体骨矿含量（P＜0.05）随年龄增加而下降,而各个BMI组的整体骨矿含量（P＜0.05）、整体肌肉质量（P＜0.001）、整体脂肪质量（P＜0.001）随BMI增加而增加。Spearman相关分析显示,随着年龄增加（P=0.005,r=0.281）,骨质疏松程度越严重;而随着BMI（P=0.019,r= – 0.237）、整体骨矿含量（P＜0.001,r= – 0.719）、肌肉质量（P=0.014,r= – 0.249）和脂肪质量（P=0.013,r= – 0.249）的增加,患骨质疏松的程度越轻。多元线性回归分析结果显示,年龄与绝经后女性整体骨密度（P=0.002,B= – 0.004）及整体骨矿含量呈负相关（P=0.000,B= – 0.013）;而整体肌肉质量（P=0.018,B=0.022）和整体脂肪质量（P=0.037,B=0.027）则与绝经后女性整体骨矿含量呈正相关。结论 年龄是绝经后女性患骨质疏松症的危险因素,而BMI、肌肉质量和脂肪质量是保护因素,有助于提高整体骨密度和整体骨矿含量。     

Impact of body mass index on primary immunoglobulin A nephropathy prognosis: a systematic review and meta-analysis

International Urology and Nephrology - The impacts of body mass index (BMI) on the prognosis of primary IgA nephropathy (IgAN) remain controversial. This systematic review and meta-analysis aimed...     

体重指数与女性骨质疏松症关系的Logistic回归分析

目的 探讨体重指数(body mass index BMI)是否是女性骨质疏松症(Osteoporosis OP)的危险因素.方法 收集2008年9月～2010年12月因腰腿疼痛在三峡大学第一临床医学院(宜昌市中心人民医院)康复科就诊的500例女性患者资料,经X线检查判断无骨质增生232例,采用法国DMS公司生产的双能X线骨密度仪测定腰椎(L2-4)正位骨密度(bone mineral density,BMD),记录其身高、体重(计算体重指数)、症状、运动、吸烟、饮酒等影响因素;测定腰椎(L2-4)骨密度,明确是否骨质疏松(OP);用t检验及X2检验比较骨质疏松症组和非骨质疏松症组的影响因素,用Logistic回归分析对象中各种可能影响骨质疏松症的因素及骨质疏松症发生的相关性.结果 骨质疏松症组和非骨质疏松症组比较:体重指数、运动情况、吸烟、饮酒比例有显著差异;根据多因素分析,体重指数、吸烟是骨质疏松症的危险因素,运动与偶尔饮酒是骨质疏松症的保护因素.BMI每增加一个单位,女性发生骨质疏松的风险增加2.003(P=0.034).结论 体重指数是女性骨质疏松的危险因素.     

体重及体质量指数与骨质疏松性骨折发生的关系研究

目的探讨骨质疏松性骨折的发生与身高、体重及体质量指数(body mass index,BMI)的关系。方法回顾性分析我院自2012年以来符合骨质疏松诊断的患者1936例,诊断为骨质疏松性骨折患者472例,分析骨质疏松性骨折组与非骨折组之间身高、体重及BMI的差异,并根据不同部位骨折分组以及不同年龄层分析身高、体重、BMI与骨质疏松性骨折发生的关系。结果骨质疏松性骨折组体重、BMI均低于非骨折组(P0.01),而两组间身高比较差异无统计学意义。不同部位骨折分组中脊柱压缩性骨折组的BMI最高,而髋部骨折组的BMI最低(P0.05)。依不同BMI分组发现低体重组中髋部骨折占56.5%,而在超体重组中脊柱压缩性骨折占43.01%,两组比较差异有统计学意义(P0.05)。骨密度T值随BMI的增加而增加,两者呈显著正相关关系(P0.01)。结论体重、BMI对于骨质疏松性骨折的发生存在相关关系,BMI虽与骨密度T值呈正相关关系,但由于不同部位骨折的受力机制不同,其体重、BMI的增加与减少所造成的影响也不同,如低BMI易造成髋部骨折,高BMI易造成脊柱压缩性骨折。     

The relationship between foot posture index,ankle equinus,body mass index and intermetatarsal neuroma

Background

The main purpose of this study was to investigate the presence of an association between intermetatarsal neuroma and foot type, as measured by the Foot Posture Index. The study also examined whether there was a relationship between foot type and the interspace affected with intermetatarsal neuroma, and whether ankle equinus or body mass index had an effect.

Methods

In total, 100 participants were recruited from The University of Western Australia’s Podiatry Clinic, 68 of whom were diagnosed with inter-metatarsal neuroma from 2009 to 2015. There were 32 control participants recruited from 2014 to 2015. The age of subjects was recorded, as were weight and height, which were used to calculate body mass index. The foot posture index and ankle dorsiflexion were measured using standard technique. Independent t-tests and Kruskal-Wallis tests were used to compare differences in foot posture index, body mass index and ankle dorsiflexion between the inter-metatarsal neuroma and control groups. Multivariable logistic regression was also used to model relationships for outcome.

Results

The 68 intermetatarsal neuroma subjects had a mean age of 52 years (range 20 to 74 years) and comprised of 56 females and 12 males. The 32 control subjects had a mean age of 49 years (range 24 to 67 years) with 26 females and six males. There were no significant differences between the control and the intermetatarsal neuroma groups with respect to the mean foot posture index scores of the left and right foot (p?=?0.21 and 0.87, respectively). Additionally no significant differences were detected between the affected intermetatarsal neuroma interspace and foot posture index (p?=?0.27 and 0.47, respectively). There was no significant difference in mean body mass index between the intermetatarsal neuroma (26.9?±?5.7) and control groups (26.5?±?4.1) (p?=?0.72). There was, however, a significant difference in mean ankle dorsiflexion between the intermetatarsal neuroma and control groups (p?<?0.001 for both feet). Logistic regression models, adjusted for age, sex, foot posture index and body mass index estimated that the odds of having an intermetatarsal neuroma in the right foot increased by 61% (OR 1.61; 95% CI 1.32–1.96) with each one degree reduction of ankle dorsiflexion, and in the left foot by 43% (OR 1.43; 95% CI 1.22–1.69).

Conclusion

No relationships were found between foot posture index and body mass index with intermetatarsal neuroma, or between foot posture index and the interspaces affected. However, a strong association was demonstrated between the presence of intermetatarsal neuroma and a restriction of ankle dorsiflexion.

     

LDL-cholesterol and insulin are independently associated with body mass index in adult cystic fibrosis patients

BackgroundThe median life expectancy of cystic fibrosis (CF) patients has increased dramatically over the last few years and we now observe a subset of patients with a body mass index (BMI) exceeding 25 kg/m². The aim of this study was to characterize these individuals and to identify factors associated with higher BMI.MethodsThis is a cross sectional study including 187 adult CF subjects. Percent predicted forced expiratory volume in 1 s (%FEV₁), blood lipid profiles as well as fasting glucose and insulin levels were evaluated. Subjects also had an oral glucose tolerance test (OGTT) and the area under the curve (AUC) for glucose and insulin was calculated. CF subjects were then stratified according to the following BMI categories: underweight: BMI ≤ 18.5 kg/m²; normal weight: 18.5 kg/m² < BMI < 25 kg/m²; and overweight or obese: BMI ≥ 25 kg/m².ResultsOverweight subjects were older and less likely to have enzyme supplementation compared to the other two groups. Furthermore, this group exhibits higher levels of fasting insulin, total and LDL-cholesterol as well as insulin AUC. Further analyses demonstrated that BMI correlated with %FEV₁, fasting insulin, insulin AUC, total cholesterol, LDL-cholesterol and the ratio of HDL-cholesterol to total cholesterol and that %FEV₁, insulin AUC and LDL-cholesterol were independent associated with BMI.DiscussionOverweight CF subjects have higher fasting insulin and insulin AUC as well as total and LDL-cholesterol. Furthermore, we also demonstrated that LDL-cholesterol, insulin AUC are independently associated with BMI in a population of adult CF subjects.     

糖尿病肾病与糖尿病视网膜病变的相关性研究进展

糖尿病肾病(DN)和糖尿病视网膜病变(DR)均是糖尿病的微血管病变，是目前成人终末期肾病(ESRD)和致盲的重要原因，两者在发生、发展过程中具有一定平行性，又存在不平行性。DN和DR可预测彼此的发生、发展，但目前对于两者之间的关系尚未明确。因此，本文就DN与DR之间的相关性的研究进展作一综述，为临床诊断治疗提供帮助。     

糖尿病肾病患者血浆血管性血友病因子水平的变化

我们分析了70例2型糖尿病患者和35例健康对照者血浆血管性血友病因子(vWF)水平的变化及其临床意义,总结如下.     

Plasma total homocysteine concentration in nephrotic patients with idiopathic membranous nephropathy.

BACKGROUND: The atherothrombotic risk pattern of the nephrotic syndrome resembles that of hyperhomocysteinemia. However, the effect of nephrotic range proteinuria on homocysteine metabolism has never been studied. METHODS: The study included 11 male nephrotic patients with idiopathic membranous nephropathy who underwent a treatment trial with adrenocorticotrophic hormone and 11 male non-nephrotic, renal function-matched control subjects. The nephrotic patients were studied before and after the treatment, which induced a marked reduction in urinary protein excretion and a moderate improvement in renal function in all cases. RESULTS: Plasma total homocysteine (tHcy) concentration did not change significantly during treatment, whereas the nephrotic patients had significantly lower tHcy than the non-nephrotic patients (14.2 +/- 3.4 micromol/l vs 19.0 +/- 5.4 micromol/l). tHcy correlated significantly with serum concentrations of creatinine (r = 0.53, P < 0.05) and albumin (r = 0.43, P < 0.05), glomerular filtration rates (GFRs) (iohexol clearances) (r = -0.42, P < 0.05) and urinary albumin excretion (r = -0.47, P < 0.05). CONCLUSION: The expected tHcy-lowering effect of improved renal function may have masked a tHcy-elevating effect due to reduced proteinuria leading to no net change in tHcy during treatment. The notion of an increase in tHcy associated with remission of the nephrotic syndrome is in accordance with the significantly lower tHcy in the nephrotic renal patients compared with the non-nephrotic renal function-matched patients, and the relationships between tHcy and serum albumin concentrations as well as urinary albumin excretion. Thus, the results of this small study suggest that nephrotic range proteinuria directs homocysteine metabolism towards a decrease in tHcy. However, the findings need to be confirmed in larger patient populations and in different varieties of the nephrotic syndrome.