Trajectories in the Course of Body Mass Index After Spinal Cord Injury

Objective

To identify different trajectories of the course of body mass index (BMI) after spinal cord injury (SCI) and to study whether other cardiovascular risk factors (blood pressure, lipid profile) follow the same trajectories.

Design

Multicenter prospective cohort study with measurements at the start of active rehabilitation, after 3 months, at discharge, and 1 and 5 years after discharge.

Setting

Rehabilitation centers.

Participants

Persons with a recent SCI (N=204).

Interventions

Not applicable.

Main Outcome Measure

BMI trajectories.

Results

Three BMI trajectories were identified: (1) a favorable stable BMI during and after rehabilitation (±22–23kg/m²) (54%); (2) a higher but stable BMI during inpatient rehabilitation (±24kg/m²) and an increase after discharge (up to 29kg/m²) (38%); and (3) an increase in BMI during inpatient rehabilitation (from ±23 up to 28kg/m²) and leveling off after discharge (8%). Profile analyses showed that an unfavorable change in BMI was not accompanied by clear unfavorable changes in blood pressure or lipid levels.

Conclusions

BMI in people with SCI follows distinct trajectories. Monitoring body mass, food intake, and daily physical activity during and especially after inpatient SCI rehabilitation is important to prevent obesity and related cardiovascular risk factors.     

Being overweight or obese is associated with decreased mortality in critically ill patients: A retrospective analysis of a large regional Italian multicenter cohort

Purpose

To describe the epidemiology of obesity in a large cohort of intensive care unit (ICU) patients and study its impact on outcomes.

Methods

All 3902 patients admitted to one of 24 ICUs in the Piedmont region of Italy from April 3 to September 29, 2006, were included in this retrospective analysis of data from a prospective, multicenter study.

Results

Mean body mass index (BMI) was 26.0 ± 5.4 kg/m²: 32.8% of patients had a normal BMI, 2.6% were underweight, 45.1% overweight, 16.5% obese, and 2.9% morbidly obese. ICU mortality was significantly (P < .05) lower in overweight (18.8%) and obese (17.5%) patients than in those of normal BMI (22%). In multivariate logistic regression analysis, being overweight (OR = 0.73; 95%CI: 0.58-0.91, P = .007) or obese (OR = 0.62; 95%CI: 50.45-0.85, P = .003) was associated with a reduced risk of ICU death. Being morbidly obese was independently associated with an increased risk of death in elective surgery patients whereas being underweight was independently associated with an increased risk of death in patients admitted for short-term monitoring and after elective surgery.

Conclusions

In this cohort, overweight and obese patients had a reduced risk of ICU death. Being underweight or morbidly obese was associated with an increased risk of death in some subgroups of patients.     

Reference values for fasting insulin in 75 year old females and males

Objectives

Reference intervals for insulin are often based on fairly small study groups with unknown body mass index (BMI). They are also much younger than most patients seeking care. These values are not optimal for elderly patients, as many biological markers change over time and adequate reference intervals are important for correct clinical decisions.

Design and methods

We studied fasting insulin (f-insulin) values in a cohort of 698 75-year old non-diabetic males and females. The 2.5th and 97.5th percentiles for all individuals, males and females were calculated according to the recommendations of the International Federation of Clinical Chemistry on the statistical treatment of reference intervals.

Results

There was a strong positive correlation between BMI and f-insulin, which led to the calculation of separate reference intervals for individuals with BMI ≤ 30.

Conclusions

The reference interval for f-insulin for all study subjects was 1.74–18.27 mIU/L and for individuals with BMI ≤ 30 (n = 574) the reference interval was 1.66–15.05 mIU/L.     

Effect of Body Mass Index on Stroke Rehabilitation

Objective

To investigate the association between body mass index (BMI) and the functional progress of patients with stroke, admitted to a rehabilitation hospital.

Design

A retrospective cohort study.

Setting

A freestanding university rehabilitation hospital stroke unit.

Participants

All patients (N=819) admitted to the stroke unit of a rehabilitation hospital during the study.

Interventions

Not applicable.

Main Outcome Measures

The primary study outcome measure was the FIM efficiency of patients by BMI category.

Results

For the 819 patients admitted during the observation period, BMI was compared with FIM score changes per day (FIM efficiency). After adjusting for age and sex, the FIM efficiency differed by BMI. The underweight group had the lowest FIM efficiency, followed by the obese and normal-weight subgroups. The overweight group had the highest FIM efficiency (P=.05) when compared with the obese subgroup.

Conclusions

Among patients admitted to an acute rehabilitation hospital for stroke rehabilitation, overweight patients had better functional progress than did patients in the other weight categories.     

The impact of body mass index on the physiology of patients with polytrauma

Purpose

Obesity is a growing problem in industrial nations. The aim was to test the hypothesis that overweight patients face early physiologic impairment.

Methods

A total of 651 patients were included in this retrospective study, with an injury severity score greater than 16 and 16 years or older. The sample was subdivided into 3 groups: body mass index (BMI) less than 25 kg/m², BMI of 25 to 30 kg/m², and BMI greater than 30 kg/m². Physiologic scores—Murray, Goris, Marshall and Sequential Organ Failure Assessment scores—were analyzed at admission and at the day of their maximum. Analysis of variance and χ² tests were used, and the significance level was set at P < .05.

Results

All 4 scores showed significant differences at their maxima according to the 3 BMI groups, respectively: Murray score (P < .001), Goris score (P < .05), Marshall score (P < .001), and Sequential Organ Failure Assessment score (P <.05). The injury severity score values of the 3 groups at admission were 27.6 ± 12.0, 29.6 ± 13.2, and 25.3 ± 9.2, respectively (P < .05). The overall mortality rates in the 3 groups were 15.1%, 21.0%, and 20%, respectively (P < .001).

Conclusions

Anticipating BMI-specific critical trauma problems will become mandatory for effective polytrauma treatment in industrialized nations given their increasing prevalence of obesity.     

The effects of bisphenol A (BPA) exposure on fat mass and serum leptin concentrations have no impact on bone mineral densities in non-obese premenopausal women

Objectives

Bisphenol A (BPA) exposure may promote obesity, but its effect on bone mineral density (BMD) has not been reported in humans. We aimed to examine the relationships between BPA exposure, body composition, serum estradiol, leptin, osteocalcin levels and BMDs in healthy premenopausal women.

Design and methods

In this cross-sectional study, a total of 246 healthy premenopausal women aged 20 years and older with regular menstrual cycles were investigated. Body mass index (BMI), fat mass, fat-free mass and BMDs were measured by DXA. Serum estradiol, leptin, osteocalcin, urinary BPA and NTx levels were also tested.

Results

Urinary BPA levels were positively associated with fat mass (r = 0.193, p = 0.006) and leptin (r = 0.236, p = 0.001) but not with fat-free mass after adjusting for age and BMI. BPA was not associated with serum estradiol levels, BMDs, or bone resorption marker NTx and bone formation parameter osteocalcin, either. A multivariate stepwise regression analysis confirmed that serum leptin levels were positively influenced by fat mass (β = 0.746, p < 0.001) and BPA (β = 0.127, p = 0.01) but negatively correlated with fat-free mass (β = − 0.196, p < 0.001). However, the changes of BMDs at the lumbar spine (β = 0.298, p < 0.001) and femoral neck (β = 0.305, p < 0.001) were primarily explained by fat-free mass, and were irrelevant of the fat mass, leptin or BPA exposure.

Conclusions

Although BPA exposure is related with increased amount of fat mass and elevated serum leptin levels, it has neutral effect on BMDs in premenopausal women, possibly due to the exclusive role of fat-free mass, which is unrelated to BPA in determining BMDs.     

Genetic polymorphism of S447X lipoprotein lipase (LPL) and the susceptibility to hypertension

Introduction

Lipoprotein lipase (LPL) is a rate-limiting enzyme responsible for the hydrolysis of triacylglycerol-rich lipoproteins releasing monoglycerides and free fatty acids, which are taken up by skeletal muscles and adipose tissue. S447X polymorphism in exon 9 of LPL gene on chromosome 8 p22 results from replacement of serine amino acid with a stop codon creating a restriction site. It has been hypothesized that the more common SS genotype is associated with a lower LPL activity compared with the infrequent SX/XX genotype.

Objectives

To investigate the effect of genetic polymorphism of LPL S447X in blood pressure and its atherogenic phenotype.

Materials and Methods

S447X variant genotype of LPL were determined by polymerase reaction (PCR) restriction fragment length polymorphism assay in 50 hypertensive patients and 50 normotensive as a control group. Anthropometric measurements and serum lipoproteins were also determined in both groups.

Results

The frequency of (SS) genotype was 78% in hypertensive group compared to 66% in normotensive group. Carrier of (SS) genotype were at higher risk of developing hypertension (OR, 1.8; 95% CI, 0.8-4.4) when compared with carrier of other genotypes. Furthermore, they showed atherogenic phenotype manifested by central obesity and dyslipidemia. Odds ratios were 1.8 and 2.6, respectively.

Conclusion

It was found that carriers of (SS) genotype were at high risk of developing hypertension.     

Bone properties by nanoindentation in mild and severe osteogenesis imperfecta

Background

Osteogenesis imperfecta is a heterogeneous genetic disorder characterized by bone fragility. Previous research suggests that impaired collagen network and abnormal mineralization affect bone tissue properties, however, little data is yet available to describe bone material properties in individuals with this disorder. Bone material properties have not been characterized in individuals with the most common form of osteogenesis imperfecta, type I.

Methods

Bone tissue elastic modulus and hardness were measured by nanoindentation in eleven osteotomy specimens that were harvested from children with osteogenesis imperfecta during routine surgeries. These properties were compared between osteogenesis imperfecta types I (mild, n = 6) and III (severe, n = 5), as well as between interstitial and osteonal microstructural regions using linear mixed model analysis.

Findings

Disease severity type had a small but statistically significant effect on modulus (7%, P = 0.02) and hardness (8%, P < 0.01). Individuals with osteogenesis imperfecta type I had higher modulus and hardness than did those with type III. Overall, mean modulus and hardness values were 13% greater in interstitial lamellar bone regions than in osteonal regions (P < 0.001).

Interpretation

The current study presents the first dataset describing bone material properties in individuals with the most common form of osteogenesis imperfecta, i.e., type I. Results indicate that intrinsic bone tissue properties are affected by phenotype. Knowledge of the material properties of bones in osteogenesis imperfecta will contribute to the ability to develop models to assist in predicting fracture risk.     

Cardiopulmonary Exercise Testing Is Well Tolerated in People With Alzheimer-Related Cognitive Impairment

Objective

To retrospectively assess whether cardiopulmonary exercise testing would be well tolerated in individuals with Alzheimer disease (AD) compared with a nondemented peer group.

Design

We retrospectively reviewed 575 cardiopulmonary exercise tests (CPETs) in individuals with and without cognitive impairment caused by AD.

Setting

University medical center.

Participants

Exercise tests (N=575) were reviewed for nondemented individuals (n=340) and those with AD-related cognitive impairment (n=235).

Interventions

Not applicable.

Main Outcome Measures

The main outcome measure for this study was reporting the reason for CPET termination. The hypothesis reported was formulated after data collection.

Results

We found that in cognitively impaired individuals, CPETs were terminated because of fall risk more often, but that overall test termination was infrequent—5.5% versus 2.1% (P=.04) in peers without cognitive impairment. We recorded 6 cardiovascular and 7 fall risk events in those with AD, compared with 7 cardiovascular and 0 fall risk events in those without cognitive impairment.

Conclusions

Our findings support using CPETs to assess peak oxygen consumption in older adults with cognitive impairment caused by AD.     

The obesity paradox in surgical intensive care patients with peritonitis

Purpose

Although obesity is usually regarded as a risk factor in surgical patients, various observations have revealed a better outcome in the obese. This finding is called the obesity paradox. To which group of patients the paradox applies and even whether it exists at all are matters of controversial discussion.

Materials and methods

We retrospectively analyzed 253 consecutive patients with surgical peritonitis and sepsis who needed intensive care for more than 2 days postoperative. Patients were assigned to groups according to body mass index (BMI), and groups were compared with respect to outcome parameters.

Results

In the 4 BMI groups—less than 21, 21 to 25, 26 to 30, and more than 30 kg/m²—mortality rate at 28 days was 73%, 50%, 42%, and 31%, respectively. The relative risk of death at 28 days in the BMI greater than 30 kg/m² group compared to the normal weight group (BMI, 21-25.9 kg/m²) was 0.66 (95% confidence interval, 0.28-0.94). However, mortality rate at 5 years was 90%, 70%, 69%, and 75%, respectively. Patients in the lowest BMI range were less likely to be discharged home. Intensive care unit and hospital length of stay was longest in the group of highest BMI, and that group had the best mean survival (386 days for BMI > 30 kg/m² vs 113 days for BMI < 21 kg/m²).

Conclusions

The “obesity paradox” may exist in patients with surgical peritonitis. Short-term but not long-term outcomes were improved in the obese. Concerns about obesity as a special risk factor in patients with peritonitis are not warranted according to our findings.     

Triceps-surae musculotendinous stiffness: Relative differences between obese and non-obese postmenopausal women

Background

There is a lack of research into the relationship between obesity and muscle–tendon unit stiffness in postmenopausal women. Muscle–tendon unit stiffness appears to affect human motion performance and excessive and insufficient stiffness can increase the risk of bone and soft tissue injuries, respectively. The aim of this study was to investigate the relationship between muscle–tendon unit stiffness and obesity in postmenopausal women.

Methods

105 postmenopausal women (58 [SD 5.5] years) participated. Four groups (normal weight, pre-obese, obesity class I and obesity class II) were defined according World Health Organization classification of body mass index. The ankle muscle–tendon unit stiffness was assessed in vivo with a free oscillation technique using a load of 30% of maximal voluntary isometric contraction.

Findings

ANOVA shows significant difference in muscle–tendon unit stiffness among the groups defined (P < 0.001). Post hoc analysis reveals significant differences between the following groups: normal weight–pre-obese; normal weight–obesity class I and normal weight–obesity class II. The normal weight group had stiffness of 15789 (SD 2969) N/m, pre-obese of 19971 (SD 3678) N/m, obesity class I of 21435 (SD 4295) N/m, and obesity class II of 23497 (SD 1776) N/m.

Interpretation

Obese subjects may have increased muscle–tendon unit stiffness because of fat infiltration in leg skeletal muscles, range of motion restrictions and stability/posture reasons and might be more predisposed to develop musculoskeletal injuries. Normal weight group had identical stiffness values to those reported in studies where subjects were not yet menopausal, suggesting that stiffness might not be influenced by menopause.     

The Role of Adiponectin as a Compensatory Mediator for the Primary Secretory Defect in Latent Autoimmune Diabetes in Adults

Background

Increased adiposity in patients with newly diagnosed type 2 diabetes mellitus (DM), as well as in patients who do not have DM, affects the regulation of insulin sensitivity and the metabolic effects of adiponectin.

Objective

The goal of this study was to investigate the relationship between plasma adiponectin levels and obesity in patients developing DM mainly due to an early decline in β-cell function.

Methods

We studied 29 patients with latent autoimmune diabetes in adults (LADA), 38 patients with type 1 DM, and 55 healthy volunteers.

Results

Plasma adiponectin levels, adjusted for body mass index (BMI), were higher in patients with type 1 DM than in controls (P < 0.001) and similar to those in patients with LADA (P = 0.464). Plasma adiponectin levels were higher in LADA patients compared with controls (P < 0.001). In LADA patients, plasma adiponectin levels, adjusted for BMI, correlated significantly with insulin resistance (β coefficient, –6.453 [2.772]; P = 0.028). Interestingly, this relationship in LADA patients was significant in more overweight patients (β coefficient, –7.142 [3.249]; P = 0.048) but not in leaner patients (P = 0.571), a finding that was not confirmed through the results in the controls (P = 0.520 and P = 0.992, respectively).

Conclusions

In patients with LADA, increases in plasma adiponectin levels, after adjustment for BMI, could act as a mediator for improvement in insulin sensitivity and thus compensate for the primary secretory defect. This effect seems more profound in more overweight subjects than in leaner subjects.     

Waist Circumference Provides an Indication of Numerous Cardiometabolic Risk Factors in Adults With Cerebral Palsy

Objective

To report the prevalence of cardiometabolic risk factors in a cohort of adults with cerebral palsy (CP) and to investigate the ability of anthropometric measures to predict these factors.

Design

Cross-sectional study.

Setting

Testing took place in a laboratory setting.

Participants

Adults with CP (N=55; mean age, 37.5±13.3y; Gross Motor Function Classification System levels, I–V) participated in this study.

Interventions

Not applicable.

Main Outcome Measures

Total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, glucose, insulin, and C-reactive protein levels were measured from a fasting venous blood sample. Insulin resistance was calculated using the Homeostasis Model Assessment (HOMA-IR) index. Blood pressure, body mass index (BMI), waist circumference (WC), waist-hip ratio, and waist-height ratio were also measured. The metabolic syndrome (MetS) was defined according to the 2009 Joint Interim Statement.

Results

The prevalence of the MetS was 20.5% in ambulatory adults and 28.6% in nonambulatory adults. BMI was associated with HOMA-IR only (β=.451; P<.01). WC was associated with HOMA-IR (β=.480; P<.01), triglycerides (β=.450; P<.01), and systolic blood pressure (β=.352; P<.05). Receiver operating characteristic curve analysis revealed that WC provided the best indication of hypertensive blood pressure, dyslipidemia, HOMA-IR, and the presence of multiple risk factors (area under the curve, .713–.763).

Conclusions

A high prevalence of the MetS was observed in this relatively young sample of adults with CP. WC was a better indicator of a number of risk factors than was BMI and presents as a clinically useful method of screening for cardiometabolic risk among adults with CP.     

Multitasking in Multiple Sclerosis: Can It Inform Vocational Functioning?

Objective

To examine associations between multitasking ability defined by performance on a complex task integrating multiple cognitive domains and vocational functioning in multiple sclerosis (MS).

Design

Survey data collection.

Setting

Laboratory with referrals from an outpatient clinic.

Participants

Community-dwelling individuals with MS (N=30) referred between October 2011 and June 2012.

Interventions

Not applicable.

Main Outcome Measures

The modified Six Elements Test (SET) to measure multitasking ability, Fatigue Severity Scale to measure fatigue, several neuropsychological measures of executive functioning, and vocational status.

Results

Among the sample, 60% of individuals have reduced their work hours because of MS symptoms (cutback employment group) and 40% had maintained their work hours. Among both groups, SET performance was significantly associated with performance on several measures of neuropsychological functioning. Individuals in the cutback employment group demonstrated significantly worse overall performance on the SET (P=.041). Logistic regression was used to evaluate associations between SET performance and vocational status, while accounting for neuropsychological performance and fatigue. The overall model was significant (χ²₃=8.65, P=.032), with fatigue [Exp(B)=.83, P=.01] and multitasking ability [Exp(B)=.60, P=.043] retained as significant predictors.

Conclusions

Multitasking ability may play an important role in performance at work for individuals with MS. Given that multitasking was associated with vocational functioning, future efforts should assess the usefulness of incorporating multitasking ability into rehabilitation planning.     

Patterns and prognostic value of troponin, interleukin-6, and leptin after pediatric open-heart surgery

Purpose

Leptin and interleukin-6 (IL-6) are inversely correlated and associated with decreased survival in critically ill patients. We investigated changes in leptin, IL-6, and troponin in children undergoing open-heart surgery, hypothesizing that IL-6 and troponin will increase after cardiopulmonary bypass (CPB) and will be negatively correlated with leptin.

Patients and Methods

Serial blood samples were collected from 21 patients 24 hours before and up to 48 hours after surgery.

Results

Leptin levels decreased by 50% during CPB (P < .001), then gradually increased, reaching baseline levels 12 hours after surgery. The IL-6 levels increased (P < .001) during CPB, peaking 2 hours after surgery and remaining slightly elevated at 24 hours after surgery (P < .001). Leptin and IL-6 were negatively correlated (R = −0.448, P < .001). Troponin levels increased during CPB (P < .001). Postoperative leptin and troponin were inversely correlated (r = −0.535, P < .001). Patients with modest elevations in troponin levels (<20 μg/L) had a shorter aortic clamp and CPB time (P < .01), lower IL-6 peak levels (P = .03), and shorter duration of ventilation and inotropic support compared with patients with peak troponin levels greater than 20 μg/L.

Conclusions

Lower leptin and higher IL-6 levels correlated with troponin, a marker of myocardial injury. Because leptin may have cardioprotective effects, the postoperative drop in its levels may further contribute to myocardial dysfunction.     

Predicting Peripheral Venous Access Difficulty in the Emergency Department Using Body Mass Index and a Clinical Evaluation of Venous Accessibility

Background

Peripheral venous (PV) cannulation, one of the most common technical procedures in Emergency Medicine, may prove challenging, even to experienced Emergency Department (ED) staff. Morbid obesity (body mass index [BMI] ≥ 40) has been reported as a risk factor for PV access failure in the operating room.

Objectives

We investigated PV access difficulty in the ED, across BMI categories, focusing on patient-related predicting factors.

Methods

Prospective, observational study including adult patients requiring PV lines. Operators were skilled nurses and physicians. PV accessibility was clinically evaluated before all cannulation attempts, using vein visibility and palpability. Patient and PV placement characteristics were recorded. Primary outcome was failure at first attempt. Outcome frequency and comparisons between groups were examined. Predictors of difficult cannulation were explored using logistic regression. A p-value <0.05 was considered significant.

Results

PV lines were placed in 563 consecutive patients (53 ± 23 years, BMI: 26 ± 7 kg/m²), with a success rate of 98.6%, and a mean attempt of 1.3 ± 0.7 (range 1–7). Failure at the first attempt was recorded in 21% of patients (95% confidence interval [CI] 17.6–24.4). Independent risk factors were: a BMI ≥ 30 (odds ratio [OR] 1.98, 95% CI 1.09–3.60), a BMI < 18.5 (OR 2.24; 95% CI 1.07–4.66), an unfavorable (OR 1.66, 95% CI 1.02–2.69), and very unfavorable clinical assessment of PV accessibility (OR 2.38, 95% CI 1.15–4.93).

Conclusion

Obesity, underweight, an unfavorable, and a very unfavorable clinical evaluation of PV accessibility are independent risk factors for difficult PV access. Early recognition of patients at risk could help in planning alternative approaches for achieving rapid PV access.     

Bioequivalence of Liposome-Entrapped Paclitaxel Easy-To-Use (LEP-ETU) Formulation and Paclitaxel in Polyethoxylated Castor Oil: A Randomized,Two-Period Crossover Study in Patients With Advanced Cancer

Background

Preclinical studies comparing paclitaxel formulated with polyethoxylated castor oil with the sonicated formulation of liposome-entrapped paclitaxel (LEP) have demonstrated that LEP was associated with reduced toxicity while maintaining similar efficacy. Preliminary studies on the pharmacokinetics in patients support earlier preclinical data, which suggested that the LEP Easy-to-Use (LEP-ETU) formulation and paclitaxel formulated with castor oil may have comparable pharmacokinetic properties.

Objectives

Our objectives were: (1) to determine bioequivalence of paclitaxel pharmaceutically formulated as LEP-ETU (test) and paclitaxel formulated with castor oil (reference); and (2) to assess the tolerability of LEP-ETU following intravenous administration.

Methods

Patients with advanced cancer were studied in a randomized, 2-period crossover bioequivalence study. Patients received paclitaxel 175 mg/m² administered as an intravenous infusion over 180 minutes, either as a single-treatment cycle of the test formulation followed by a single-treatment cycle of the reference formulation, or vice versa.

Results

Thirty-two of 58 patients were evaluable and were included in the analysis for bioequivalence. Mean total paclitaxel C_max values for the test and reference formulations were 4955.0 and 5108.8 ng/mL, respectively. Corresponding AUC_0-∞ values were 15,853.8 and 18,550.8 ng·h/mL, respectively. Treatment ratios of the geometric means were 97% (90% CI, 91%–103%) for C_max and 84% (90% CI, 80%–90%) for AUC_0-∞. These results met the required 80% to 125% bioequivalence criteria. The most frequently reported adverse events after LEP-ETU administration were fatigue, alopecia, and myalgia.

Conclusion

At the studied dose regimen, LEP-ETU showed bioequivalence with paclitaxel formulated with polyethoxylated castor oil.     

Morbidly obese patients receive delayed ED care: body mass index greater than 40 kg/m2 have longer disposition times

Objectives

Our study compares treatment times of morbidly obese patients (body mass index [BMI] >40 kg/m²) with patients having BMI less than 35 kg/m².

Methods

We used an institutional review board–approved, retrospective, sequential, cohort, data analysis of emergency department (ED) medical records from our county teaching hospital (January 2010). Our data set of 102 morbidly obese patients (World Health Organization class 3 [BMI >40 kg/m²]) was compared with that of 195 normal or mildly obese patients (World Health Organization class 0 or 1 [BMI <35 kg/m²]). Inclusion was limited to patients of Emergency Severity Index level 2 and 3 who presented for triage. The primary outcome variable was total length of stay for patients discharged home from the ED.

Results

Morbidly obese patients take significantly longer to disposition than normal or mildly obese patients (difference, 101 minutes [95% CI, 55-146]; P < .0001). The mean length of stay for patients with BMI less than 35 kg/m² was 287 minutes in contrast to 388 minutes for patients with BMI greater than 40 kg/m². Computed tomography use was significantly less likely in the BMI class 0 and 1 groups compared with the BMI class 3 group (0.41 [79/195] vs 0.56 [57/102]; difference, 0.15 [95% CI, 0.03-0.27]; P = .012).

Conclusions

In our institution, morbidly obese patients take significantly longer to disposition home than patients of more normal weight.     

Leptin Is Associated With Exaggerated Brain Reward and Emotion Responses to Food Images in Adolescent Obesity

OBJECTIVE

In the U.S., an astonishing 12.5 million children and adolescents are now obese, predisposing 17% of our nation’s youth to metabolic complications of obesity, such as type 2 diabetes (T2D). Adolescent obesity has tripled over the last three decades in the setting of food advertising directed at children. Obese adults exhibit increased brain responses to food images in motivation-reward pathways. These neural alterations may be attributed to obesity-related metabolic changes, which promote food craving and high-calorie food (HCF) consumption. It is not known whether these metabolic changes affect neural responses in the adolescent brain during a crucial period for establishing healthy eating behaviors.

RESEARCH DESIGN AND METHODS

Twenty-five obese (BMI 34.4 kg/m², age 15.7 years) and fifteen lean (BMI 20.96 kg/m², age 15.5 years) adolescents underwent functional MRI during exposure to HCF, low-calorie food (LCF), and nonfood (NF) visual stimuli 2 h after isocaloric meal consumption.

RESULTS

Brain responses to HCF relative to NF cues increased in obese versus lean adolescents in striatal-limbic regions (i.e., putamen/caudate, insula, amygdala) (P < 0.05, family-wise error [FWE]), involved in motivation-reward and emotion processing. Higher endogenous leptin levels correlated with increased neural activation to HCF images in all subjects (P < 0.05, FWE).

CONCLUSIONS

This significant association between higher circulating leptin and hyperresponsiveness of brain motivation-reward regions to HCF images suggests that dysfunctional leptin signaling may contribute to the risk of overconsumption of these foods, thus further predisposing adolescents to the development of obesity and T2D.