Association of Body Mass Index and Body Mass Index Change with Mortality in Incident Peritoneal Dialysis Patients

Although high body mass index (BMI) appears to confer a survival advantage in hemodialysis patients, the association of BMI with mortality in continuous ambulatory peritoneal dialysis (CAPD) patients is uncertain. We enrolled incident CAPD patients and BMI was categorized according to World Health Organization classification for Asian population. BMI at baseline and one year after the initiation of peritoneal dialysis (PD) treatment was assessed to calculate the BMI change (∆BMI). Patients were split into four categories according quartiles of ∆BMI. Kaplan-Meier method and Cox regression proportional hazard analysis were performed to assess the association of BMI on outcomes. A total of 1263 CAPD patients were included, with a mean age of 47.8 ± 15.0 years, a mean BMI of 21.58 ± 3.13 kg/m². During a median follow-up of 25.3 months, obesity was associated with increased risk for cardiovascular diseases (CVD) death (adjusted hazard ratio (AHR) 2.01; 95% CI 1.14, 3.54), but not all-cause mortality. Additionally, patients with more BMI decline (>0.80%) during the first year after CAPD initiation had an elevated risk for both all-cause (AHR: 2.21, 95% CI 1.23–3.95) and CVD mortality (AHR 2.31, 95% CI 1.11, 4.84), which was independent of baseline BMI values.     

Association of Serum Phosphate Levels and Anemia in Critically Ill Surgical Patients

Background: Deranged serum phosphate (Phos) levels are associated with anemia in hospitalized patients, but their relevance to critical illness is unclear. Therefore, our goal was to investigate whether abnormal Phos on admission to the surgical intensive care unit (ICU) is associated with anemia. Materials and Methods: We performed a retrospective analysis of data from an ongoing study of nutrition in critical illness. Serum Phos and hemoglobin levels were obtained at ICU admission. Normal Phos was defined as 2.5–4.0 mg/dL. To investigate the association between Phos and anemia, we performed logistic regression analyses, while controlling for age, sex, race, body mass index, Nutrition Risk Screening score, Deyo‐Charlson Comorbidity Index, creatinine, mean corpuscular volume, and serum albumin. Results: In total, 510 patients comprised the analytic cohort; 62% were anemic, 30% had Phos >4.0 mg/dL, and 14% had levels <2.5 mg/dL. Logistic regression analysis demonstrated each unit increment in Phos was associated with a 25% higher likelihood of anemia (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.04–1.50). Moreover, patients with Phos >4.0 mg/dL had a 68% higher likelihood of anemia compared with those with normal levels (OR, 1.68; 95% CI, 1.02–2.80). Patients with Phos <2.5 mg/dL were not more likely to be anemic compared with those with normal levels. Conclusion: Surgical ICU patients with admission Phos >4.0 mg/dL are more likely to be anemic compared with those with normal levels. Our findings support the need for studies to determine whether globally maintaining optimal Phos reduces the likelihood of anemia and whether ideal Phos during acute care hospitalization influences clinical outcomes.     

Impact of Obesity on Outcomes in Critically Ill Children

Purpose: To examine whether obesity confers a protective effect on critically ill pediatric patients, similar to what has been reported in critically ill adults. Methods: A retrospective cohort study including patients aged 2–18 years admitted to a 24‐bed pediatric intensive care unit from 2009 to 2014. Patients were divided into 1 of 3 weight categories: normal weight (body mass index [BMI], 5%–84.9%), overweight (BMI, 85%–94.9%), and obese (BMI ≥95%). Outcomes investigated included mortality, need for intubation, need for inotropic support, and duration of mechanical ventilation. Results: A total of 1817 patient encounters met inclusion criteria. There was no difference in Pediatric Index of Mortality 2 scores between groups. There was a significantly smaller percentage of overweight and obese patients requiring intubation (P = .003) and inotropic support (P = .031) compared with normal‐weight patients. Being overweight or obese was neither protective nor a risk factor for mortality with an adjusted odds ratio of 1.83 (confidence interval [CI], 0.82–3.85; P = .12) and 1.51 (CI, 0.70–3.12; P = .27) comparing the overweight and obese groups with the normal‐weight group, respectively. There was no difference in duration of mechanical ventilation between the normal‐weight and overweight and obese groups (P = .893 and 0.484, respectively). Conclusions: In critically ill pediatric patients, being overweight or obese was associated with decreased need for intubation and inotropic support compared with normal‐weight patients. However, being overweight or obese is neither protective nor a risk factor for mortality or duration of mechanical ventilation.     

Prediction of Resting Metabolic Rate in Critically Ill Patients at the Extremes of Body Mass Index

Background: Although estimation of energy needs by mathematical equation is common in practice, there is relatively little validation data for the equations. This is especially true at the upper and lower extremes of body size. The purpose of the current study was to provide validation data for several common equations in underweight and morbidly obese critically ill patients. Methods: In mechanically ventilated, critical care patients with body mass index ≤21.0 or ≥45.0 kg/m², indirect calorimetry was used to measure resting metabolic rate. Several equation methods were then compared with these measurements, including the Penn State equation, Faisy equation, Ireton‐Jones equation, Mifflin–St Jeor equation, Harris‐Benedict equation, and American College of Chest Physicians (ACCP) standard using ideal, actual, or metabolically active body weight. Results: Accuracy (percentage of estimates falling within 10% of measured) in the morbidly obese group was highest for the Penn State equation (76%) and lowest for the ACCP standard using actual body weight (0%). For the underweight group, the Penn State equation was accurate 63% of the time, but below a body mass index of 20.5, the accuracy rate dropped to 58%. No other equation was more accurate than this in the underweight patients. Conclusion: The Penn State equation is valid in morbid obesity, but the accuracy rate is much lower in underweight critically ill patients. A modification to the equation is suggested to improve accuracy in this group.     

Greater Nutrient Intake Is Associated With Lower Mortality in Western and Eastern Critically Ill Patients With Low BMI: A Multicenter,Multinational Observational Study

Background: Little is known about the impact of feeding adequacy by NUTrition Risk in the Critically Ill (NUTRIC) groups in critically ill patients with body mass index (BMI) <20. Our purpose was to assess whether adequacy of protein/energy intake impacts mortality in patients with BMI <20 in Western/Eastern intensive care units (ICUs) and high/low NUTRIC groups. Methods: Data from the International Nutrition Survey 2013–2014 were dichotomized into Western/Eastern ICU settings; BMI <20 or ≥20; and high (≥5)/low (<5) NUTRIC groups. Association of BMI <20 with 60‐day mortality was compared in unadjusted and adjusted (Western/Eastern, age, medical/surgical admission, high/low NUTRIC group) logistic regression models. The impact of adequacy of protein/energy on 60‐day mortality relationship was tested using general estimating equations in high/low NUTRIC groups, in unadjusted and adjusted models. Results: Western (n = 4274) patients had higher mean BMI (27.9 ± 7.7 versus (vs) 23.4 ± 4.9, P < 0.0001) than Eastern (n = 1375), respectively. BMI <20 was associated with greater mortality (adjusted odds ratio [OR] 1.30, 95% confidence interval [CI] 1.07–1.57), with no interaction between BMI group and Western/Eastern ICU site. Among patients with BMI <20 and high NUTRIC score, 10% greater protein and energy adequacy was associated with 5.7% and 5.5% reduction in 60‐day mortality, respectively. Results were not significantly different between Western and Eastern ICUs. Conclusions: The benefit of greater protein/energy intake in high‐NUTRIC patients was observed regardless of geographic origin or low BMI, suggesting a consistent response to nutrition support in this group. Clinical guidelines and research projects focused on improving care in high‐risk critically ill patients can be applied across geographic boundaries.     

The Association between Television Viewing and Preschool Child Body Mass Index

This paper is a conceptual and methodological review of the literature on the impact of TV on preschoolers' weight status. A systematic search, of papers published between January 1995 and January 2010, identified twenty-six relevant studies. Fifteen of these were cross-sectional in design and eleven adopted a prospective design; a positive association between hours of TV and child adiposity was found in all but three studies. Although assessed in a limited number of studies, diet may mediate the relationship between TV viewing and BMI. Another likely mediator may be the content of TV programs watched; only three studies examined this association and findings were inconsistent. Our review revealed that research examining mediating effects is limited, focusing more on simple cross-sectional or prospective relationships between TV habits and child body mass index. Further investigation of the mechanisms by which TV viewing affects preschool weight gain is needed.     

超重幼儿血清瘦素水平与体质指数关系的研究

目的 研究超重肥胖幼儿瘦素(leptin,LP)水平与体质指数(body mass index,BMI)的关系。方法 采用卧式身高仪测量儿童身高,电子秤称量体重。利用酶联免疫吸附法(ELISA)测定血清LP水平。采用t检验、Kruskal-Wallis H检验、秩转换的方差分析、Spearman秩相关分析统计数据。结果 共检查238例(男121例,女117例)健康幼儿,正常组152例,超重组61例,肥胖组25例;三组间血清LP水平比较差异均有统计学意义(P<0.05);幼儿血清LP水平与体质指数(body mass index,BMI)之间有正相关性(r_s=0.718,P<0.05);三组间BMI比较差异有统计学意义(P<0.05);三组内男、女童BMI之间比较,差异均无统计学意义(P>0.05)。 结论 随着BMI增加,血清LP水平呈上升趋势,二者之间存在正相关,表明肥胖幼儿可能存在LP抵抗。     

Clinical Outcomes in Critically Ill Patients Associated With the Use of Complex vs Weight‐Only Predictive Energy Equations

Background: The energy intake goal is important to achieving energy intake in critically ill patients, yet clinical outcomes associated with energy goals have not been reported. Methods: This secondary analysis used the Improving Nutrition Practices in the Critically III International Nutrition Surveys database from 2007–2009 to evaluate whether mortality or time to discharge alive is related to use of complex energy prediction equations vs weight only. The sample size was 5672 patients in the intensive care unit (ICU) ≥4 days and a subset of 3356 in the ICU ≥12 days. Mortality and time to discharge alive were compared between groups by regression, controlling for age, sex, admission type, Acute Physiology and Chronic Health Evaluation II score, ICU geographic region, actual energy intake, and obesity. Results: There was no difference in mortality between the use of complex and weight‐only equations (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.86–1.15), but obesity (OR, 0.83; 95% CI, 0.71–0.96) and higher energy intake (OR, 0.65; 95% CI, 0.56–0.76) had lower odds of mortality. Time to discharge alive was shorter in patients fed using weight‐only equations (hazard ratio [HR], 1.11; 95% CI, 1.01–1.23) in patients staying ≥4 days and with greater energy intake (HR, 1.19; 95% CI, 1.06–1.34) in patients in the ICU ≥12 days. Conclusion: These data suggest that higher energy intake is important to survival and time to discharge alive. However, the analysis was limited by actual energy intake <70% of goal. Delivery of full goal intake will be needed to determine the relationship between the method of determining energy goal and clinical outcomes.     

Body Mass Index and Disability in Chinese Nonagenarians and Centenarians

ObjectivesTo examine the potential association between body mass index (BMI) and activities of daily living (ADLs) and instrumental activities of daily living (IADLs) disabilities in a population-based sample of Chinese nonagenarians and centenarians.MethodsThis study analyzed data obtained from a survey conducted in 870 elderly Chinese adults aged 90 years or older in Dujiangyan. The participants were divided into 4 groups according to the World Health Organization (WHO) Asia criteria of underweight, normal weight, overweight, and obesity in BMI (<18.5, 18.5–23.0, 23.0–25.0, ≥25.0 kg/m², respectively) and to BMI quartile (<16.8, 16.8–18.9, 18.9–21.1, ≥21.1 kg/m², respectively). The ADL and IADL disabilities were measured using the physical self-maintenance scale (PSMS) and IADL scale developed by Lawton and Brody, respectively.ResultsThe participants included in the current statistical analyses were 233 men and 505 women. The mean age was 93.5 ± 3.2 years (ranging from 90 to 108 years). Using the WHO Asia criteria, the prevalence of underweight and obesity were 43.9% and 6.6%, respectively. In long-lived women, the prevalence of ADL and IADL disabilities was significantly higher in either the underweight group (39.4% and 72.9%, respectively) or the obesity group (38.1% and 77.7%, respectively) compared with the normal weight group (31.4% and 60.8%, respectively). After adjusting for relevant covariates, the underweight group and obesity group showed significantly increased odds ratios (ORs) for either ADL (1.5 and 1.8, respectively) or IADL disability (1.9 and 1.4, respectively). Similar results were found when using the BMI quartile. However, in long-lived men, no significant difference was found with respect to the prevalence of ADL or IADL disability and adjusted ORs among the different BMI groups.ConclusionsAmong Chinese long-lived adults, the risk of ADL and IADL disability was higher for women with both extremely low and high BMIs, but this pattern was not found in men.     

中国九市城郊0～7岁儿童的体块指数

【目的】分析中国7岁以下儿童体块指数(BMI)的变化规律，提供儿童BMI人群参照值。【方法】根据1995年第三次中国九市城郊7岁以下儿童体格发育调查所获得的数据，采用九市0～7岁157362名健康男女儿童(其中城区79154人，郊区78208人)的身高(3岁以下为身长)、体重测量值，分城、郊、男、女22个年龄组．分别计算出各自的BMI百分位数值并绘制曲线。【结果】分别按年龄、性别、城郊计算出了0～7岁儿童BMI的第3、10、25、50、75、85、90、95、97百分位数值；通过比较分析证实：九市0～7岁儿童的BMI存在性别、城郊和地区差异，十年问绝大多数年龄组BMI值有不同程度的增长。【结论】九市0～7岁儿童BMI人群参照值，可为研究和制定儿童超重肥胖的判断标准提供科学依据。     

Association of Body Mass Index with Ischemic and Hemorrhagic Stroke

Data on the association between body mass index (BMI) and stroke are scarce. We aimed to examine the association between BMI and incident stroke (ischemic or hemorrhagic) and to clarify the relationship between underweight, overweight, and obesity and stroke risk stratified by sex. We analyzed the JMDC Claims Database between January 2005 and April 2020 including 2,740,778 healthy individuals (Median (interquartile) age, 45 (38–53) years; 56.2% men; median (interquartile) BMI, 22.3 (20.2–24.8) kg/m²). None of the participants had a history of cardiovascular disease. Each participant was categorized as underweight (BMI <18.5 kg/m²), normal weight (BMI 18.5–24.9 kg/m²), overweight (BMI 25.0–29.9 kg/m²), or obese (BMI ≥ 30 kg/m²). We investigated the association of BMI with incidence stroke in men and women using the Cox regression model. We used restricted cubic spline (RCS) functions to identify the association of BMI as a continuous parameter with incident stroke. The incidence (95% confidence interval) of total stroke, ischemic stroke, and hemorrhagic stroke was 32.5 (32.0–32.9), 28.1 (27.6–28.5), and 5.5 (5.3–5.7) per 10,000 person-years in men, whereas 25.7 (25.1–26.2), 22.5 (22.0–23.0), and 4.0 (3.8–4.2) per 10,000 person-years in women, respectively. Multivariable Cox regression analysis showed that overweight and obesity were associated with a higher incidence of total and ischemic stroke in both men and women. Underweight, overweight, and obesity were associated with a higher hemorrhagic stroke incidence in men, but not in women. Restricted cubic spline showed that the risk of ischemic stroke increased in a BMI dose-dependent manner in both men and women, whereas there was a U-shaped relationship between BMI and the hemorrhagic stroke risk in men. In conclusion, overweight and obesity were associated with a greater incidence of stroke and ischemic stroke in both men and women. Furthermore, underweight, overweight, and obesity were associated with a higher hemorrhagic stroke risk in men. Our results would help in the risk stratification of future stroke based on BMI.     

Undernutrition at PICU Admission Is Predictor of 60-Day Mortality and PICU Length of Stay in Critically Ill Children

BackgroundThere are few studies that assess the role of different nutritional assessment variables at pediatric intensive care unit (PICU) admission in predicting clinical outcomes.ObjectiveTo identify nutritional variables in the first 4 days of PICU stay that predict 60-day mortality and time to discharge alive from the PICU.DesignSingle-center prospective study in Southern Brazil, conducted between July 2013 and February 2016. At PICU admission, children with z scores <−2 for body mass index (BMI)-for-age, mid-upper arm circumference (MUAC)-for-age, and triceps skinfold thickness (TSF)-for-age were considered as undernourished.Participants/settingThere were 199 patients, aged <15 years, with PICU stay >48 hours.Main outcome measuresSixty-day mortality and time to discharge alive from the PICU.Statistical analysis performedCox regression model was applied to determine predictors of 60-day mortality and time to discharge alive from the PICU.ResultsMedian age was 23.1 months (interquartile range=3.9 to 89.1), and 63% were male, with 18% prevalence of undernutrition at admission by BMI-for-age. Median PICU stay was 7 days (interquartile range=4 to 12), and 60-day mortality was 12%. After adjusting for sex, age, Pediatric Index of Mortality 2, and presence of complex chronic conditions, undernutrition based on BMI-for-age (hazard ratio [HR]=3.75; 95% CI=1.41 to 9.95; P=0.008), MUAC-for-age (HR=7.62; 95% CI=2.42 to 23.97; P=0.001), and TSF-for-age (HR=4.01; 95% CI=1.14 to 14.15; P=0.031) was associated with higher risk of 60-day mortality. Based on MUAC-for-age with the same adjustment model, undernourished children had longer time to discharge alive from the PICU (HR=0.45; 95% CI=0.21 to 0.98; P=0.045).ConclusionsUndernutrition at PICU admission based on different anthropometric variables was predictive of 60-day mortality and longer time to discharge alive from the PICU.     

Bidirectional Associations between Restrained Eating and Body Mass Index in Middle Childhood

The nature of the association between dietary restraint and weight has been examined in adult samples, but much less is known about this relationship among children. The current study examined the transactional associations among restrained eating behavior and weight among boys and girls during middle childhood. Data for this study came from 263 children participating in the Families and Schools for Health Project (FiSH), a longitudinal study of the psychosocial correlates of childhood obesity. Participants were interviewed by trained researchers in their third- and fourth-grade year when they completed questionnaires and anthropometric assessments. Dietary restraint was assessed using the restrained eating subscale of the Dutch Eating Behavior Questionnaire (DEBQ), and weight was assessed using Body Mass Index z-scores (BMIz). Bidirectional associations between variables were examined using cross-lagged models controlling for children’s sex, ethnicity, and weight in first grade. Results indicated that weight in grade 3 was related to greater dietary restraint in grade 4 (B = 0.20, p = 0.001), but dietary restraint in grade 3 was not associated with weight in grade 4 (B = 0.01, p = 0.64). Neither child sex nor race/ethnicity were associated with BMIz or dietary restraint at either time point. Findings from this study advance the existing limited understanding of eating behavior development among children and show that weight predicts increases in children’s dietary restraint in middle childhood.