Using body mass index ignores the intensive training of elite special force personnel

Frequency of polycystic ovarian morphology and other ultrasonographic findings in Iranian female athletes

OBJECTIVES

Polycystic ovary morphology and ovarian cysts are frequent and usually asymptomatic in young female individuals. The present study is the first to examine ovarian sonographic findings in asymptomatic female athletes from Iran. This study aimed to evaluate the frequency of such sonographic findings in healthy female athletes on a screening basis.

METHODS

In this cross-sectional observational study, 455 females from 16 provinces of Iran were evaluated by trans-abdominal sonography during their routine pre-participation medical evaluation.

RESULTS

The mean age of participants was 21.8 years (SD 5.3). The mean age at the beginning of exercise was 14.20 years (SD = 4.25). Menarche occurred at 11-20 years with a mean of 13.5 years (SD 1.5). Judokas had the lowest (12.1 years), and football players had the highest menarche age (14.6 years; as compared to 12.8 years in the Iranian female population). In 87.5 % of participants, the sonographic findings were within normal limits. 4.8 % of all examinations revealed polycystic ovary morphology (PCOM), 5.7 % of participants had a simple cyst(s), and 20.8 % of cysts had diameters >49 mm. In those athletes who began regular performance-oriented training before menarche, PCOM was found in only 2.4 %. There was a significant positive linear association between BMI groups and PCOM (p = 0.003), but not for simple cysts. Frequency of PCOM (p < 0.001) as well as ovarian cysts (p = 0.012) were significantly different among studied sport types. There was a significant positive correlation between delayed menarche status and PCOM (p = 0.017). However, no such relationship was found for simple cysts.

CONCLUSIONS

Maintaining a healthy body mass index and beginning regular exercise before menarche may have a preventative effect for polycystic ovary morphology in female athletes.

The Risk of Disordered Eating in Fitness Club Members-A Cross-Sectional Study

Fitness clubs may be environments where abnormal eating behaviors and excessive exercise are socially accepted, potentially putting individuals at risk for disordered eating (DE). This study examined the DE risk prevalence among gym members, comparing body appreciation, exercise motivation, frequency, BMI, and age across DE risk levels, and assessed the associated factors. A sample of 232 gym members (age: 39.6 ± 13.7) completed an online survey measuring DE risk (Eating Disorder Screen for Primary Care (ESP)), body appreciation (Body Appreciation Scale version 2), and exercise motivation (Behavioral Regulation in Exercise Questionnaire-2). One out of five (19.4%) were at risk of DE, while 15.5% and 11.6% reported having secretive eating behaviors and a history of eating disorders, respectively. Body weight impacted self-perception for 62.5% of the respondents. Those at DE risk had a higher mean BMI (26.23 ± 4.36 vs. 24.68 ± 3.61, p = 0.032) with a higher proportion of those with a BMI of 25-29.9 (46.67% vs. 29.41%, p = 0.027) compared to non-at-risk individuals. DE risk was associated with lower body appreciation (3.00 ± 3.60 versus 4.00 ± 3.70, p = ≤0.001), with body appreciation being the only factor associated with DE risk (OR = 0.24, 95% CI = 0.15, 0.39, p = ≤0.001).

Reporting on patient's body mass index (BMI) in recent clinical trials for patients with breast cancer: a systematic review

BACKGROUND

The proportion of patients with breast cancer and obesity is increasing. While the therapeutic landscape of breast cancer has been expanding, we lack knowledge about the potential differential efficacy of most drugs according to the body mass index (BMI). Here, we conducted a systematic review on recent clinical drug trials to document the dosing regimen of recent drugs, the reporting of BMI and the possible exclusion of patients according to BMI, other adiposity measurements and/or diabetes (leading comorbidity of obesity). We further explored whether treatment efficacy was evaluated according to BMI.

METHODS

A search of Pubmed and ClinicalTrials.gov was performed to identify phase I-IV trials investigating novel systemic breast cancer treatments. Dosing regimens and exclusion based on BMI, adiposity measurements or diabetes, documentation of BMI and subgroup analyses according to BMI were assessed.

RESULTS

495 trials evaluating 26 different drugs were included. Most of the drugs (21/26, 81%) were given in a fixed dose independent of patient weight. BMI was an exclusion criterion in 3 out of 495 trials. Patients with diabetes, the leading comorbidity of obesity, were excluded in 67/495 trials (13.5%). Distribution of patients according to BMI was mentioned in 8% of the manuscripts, subgroup analysis was performed in 2 trials. No other measures of adiposity/body composition were mentioned in any of the trials. Retrospective analyses on the impact of BMI were performed in 6 trials.

CONCLUSIONS

Patient adiposity is hardly considered as most novel drug treatments are given in a fixed dose. BMI is generally not reported in recent trials and few secondary analyses are performed. Given the prevalence of patients with obesity and the impact obesity can have on pharmacokinetics and cancer biology, more attention should be given by investigators and study sponsors to reporting patient's BMI and evaluating its impact on treatment efficacy and toxicity.

Phase angle at bioelectric impedance analysis is associated with detrimental sperm quality in idiopathic male infertility: a preliminary clinical study

Background

In 2020, 38% of adults were affected by obesity, while infertility globally affected 1 in 6 people at some stage of their lives.Body mass index (BMI) provides an easy but occasionally inaccurate estimation of body composition. To achieve a more precise assessment, bioelectric impedance analysis serves as a validated tool that administers electrical energy through surface electrodes. Phase angle as a function of the relationship between tissues resistance and reactance, is a trustworthy predictor of body composition and cell membrane integrity.

Objectives

We aim to assess whether there is an association between phase angle and seminal parameters, as well as sperm DNA fragmentation percentage.

Design

Semen samples of 520 idiopathic infertile patients were analyzed according to 2021 World Health Organization guidelines and evaluated for sperm DNA fragmentation rate. Each participants underwent bioelectric impedance analysis.

Results

Median age was 40 years old, median BMI was 26.3 kg/m2, median phase angle was 6.2°. In the logistic regression analysis adjusted for age and total intracorporeal water, phase angle (continuous) was significantly associated with oligozoospermia (odds ratio [OR]:0.4; p<0.01) and sperm morphology (OR: 0.65; p=0.05) and slightly with sperm DNA fragmentation (OR: 0.98; p=0.07). In subgroup analysis, the logistic regression analysis adjusted for the mentioned parameters showed that a phase angle between 6.2 and 7 (°) (OR: 0.63; p=0.02) and >7 (°) (OR: 0.12; p<0.01) were associated with a reduced risk of oligozoospermia compared to values <6.2 (°). Similarly, a phase angle between 6.2 and 7 (°) (OR: 0.57; p< 0.01 and OR: 0.58; p= 0.01) and PA > 7 (°) (OR: 0.12; p= 0.03 and OR: 0.21; p< 0.01) were associated with a reduced risk of lower sperm concentration and lower total sperm count, respectively, compared to a phase angle < 6.2 (°).

Conclusion

Our study suggests a negative association between phase angle and detrimental sperm parameters in male idiopathic infertility.

Obesity and lung cancer - is programmed death ligand-1 (PD-1L) expression a connection?

Introduction

In this retrospective study, the authors evaluated whether obesity-induced immunomodulation impacts the expression of programmed death ligand-1 (PD-1L) in lung cancer cells.Methods: A retrospective cross-sectional study was performed. The study included 67 patients. The data did not have a normal distribution.

Results

For women, using ANOVA test (p = 0.050) with post-hoc analysis, a statistically significant difference in expression was found between women with overweight and women with normal weight (p = 0.040).

Conclusions

Apart from the above, the authors did not find any statistically significant correlation between PD-1L expression on lung cancer cells and body mass index, either in the whole group or in histological subgroups.

The Prevalence of Hypertension and Obesity in Iranian Professional Drivers

Background

Professional driving is associated with overworking, lack of physical activity, and high stress, which are susceptible to cardiovascular diseases (CVDs). We aimed to determine the prevalence of hypertension and obesity in Iranian professional drivers.

Methods

Overall, 132,452 drivers were included by census sampling methods and those who did not pass periodic examinations were excluded. Demographics and anthropometric data, including height and weight and the driver's blood pressure, were recorded. The criteria for hypertension assumed as the systolic blood pressure ≥ 130 mm and/or diastolic blood pressure ≥ 80 mm, and the criteria for prehypertension assumed as 120-129 systolic and < 80 mm Hg. In addition, body mass index (BMI) ≥ 25 is assumed as overweight, and BMI ≥ 30 is assumed as obesity.

Results

Overall, 113,856 male drivers were included in the final analysis. The prevalence of HTN, pre-HTN, and abnormal blood pressure (HTN + pre-HTN) was calculated to be 14.2%, 57.4%, and 71.6%, respectively. Khuzestan, West Azerbaijan, and Yazd had the most prevalence of abnormal blood pressure. The prevalence of overweight, obesity, and abnormal weight (overweight + obesity) was calculated to be 50.9%, 22.6%, and 73.5%, respectively, and the northwest provinces had the highest prevalence of abnormal weight.

Conclusion

Professional Iranian drivers have a high prevalence of abnormal blood pressure and weight associated with job-related risk factors. Preventive measures should be taken to confront a possible outbreak of CVDs in this population.

A New Approach Using BMI and FMI as Predictors of Cardio-Vascular Risk Factors among Mexican Young Adults

The study aimed to identify accurate cut-off points for waist circumference (WC), body fat percentage (BF%), body mass index (BMI), fat mass index (FMI), and fat-free mass index (FFMI), and to determine their effective accuracy to predict cardiovascular risk factors (CVRFs) among Mexican young adults. A cross-sectional study was conducted among 1730 Mexican young adults. Adiposity measures and CVRFs were assessed under fasting conditions. The optimal cut-off points were assessed using the receiver operating characteristic curve (ROC). Age-adjusted odds ratios (OR) were used to assess the associations between anthropometric measurements and CVRFs. The cut-off values found, in females and males, respectively, for high WC (≥72.3 and ≥84.9), high BF% (≥30 and ≥22.6), high BMI (≥23.7 and ≥24.4), high FMI (≥7.1 and ≥5.5), and low FFMI (≤16 and ≤18.9) differ from those set by current guidelines. High BMI in women, and high FMI in men, assessed by the 50th percentile, had the best discriminatory power in detecting CVRFs, especially high triglycerides (OR: 3.07, CI: 2.21-4.27 and OR: 3.05, CI: 2.28-4.08, respectively). Therefore, these results suggest that BMI and FMI measures should be used to improve the screening of CVRFs in Mexican young adults.

Autologous Fat Grafting in Reconstructive Breast Surgery: Clinically Relevant Factors Affecting the Graft Take

BACKGROUND

Autologous fat grafting is an effective tool for soft tissue augmentation in reconstructive breast surgery. Despite the major advantages of this minimally invasive approach, the unpredictability of graft survival presents challenges.

OBJECTIVES

No clear consensus on the optimal technique has yet been published and well-defined prospective studies investigating impairing factors are lacking. This aim of this study was to generate valuable fundamental data.

METHODS

Ten female patients undergoing elective autologous fat grafting after nipple-sparing mastectomy were enrolled. Punch biopsies and lipoaspirates were collected from the harvest site for histologic, gene expression, and scanning electron microscopic analysis. Noninvasive Lipometer measurements determining the subcutaneous adipose tissue thickness at the graft site were used to calculate the respective take rate. Patient- and surgery-related data were acquired and correlated with the take rate.

RESULTS

A statistically relevant correlation between the take rate and the existing mean subcutaneous adipose tissue thickness at the grafted breast prior to surgery was observed. An approximate correlation was identified regarding the number of previous grafting sessions, body weight, and BMI. No statistically significant correlation was demonstrated for age, harvest site, or the mean adipocyte size. A lower level of cell damage was observed in scanning electron microscopic samples of washed lipoaspirates; and a strong indirect correlation with the expression of the adipocyte markers FABP4 and PLIN1 was apparent.

CONCLUSIONS

Factors correlating to the take rate were identified. Future studies investigating the clinical relevance of each impairing factor are essential to contribute to the optimization of this valuable method.

LEVEL OF EVIDENCE: 4

Dietary Supplements Use among Athletes in Lebanon: Knowledge, Attitudes, Practices, and Correlates

Athletes are under the utmost pressure to reach excellence in their performance and achieve the desired outcomes in competitions, prompting them to use dietary supplements. Given the threats to both health and eligibility, it is crucial to observe the prevalence, sources of information, knowledge, attitudes, and practices (KAPs) among Lebanese athletes practicing their sports for at least two years. In the present paper, a cross-sectional study is performed using the snowball sampling method, in which a self-administered KAP questionnaire is used to collect data from 455 athletes (mean age: 27.4 ± 7.9 years; men: 73.1%) participating in four sports categories (ball games, combat sports, endurance sports, and weightlifting). Among the Lebanese athletes, the prevalence of dietary supplement (DS) use was 74%, where half of them had predominately used sports supplements. Athletes in Lebanon heavily rely on coaches (74%) and online sources, including webpages and social media (64%), as key information sources for DSs. The findings suggest that significant proportions of athletes show knowledge deficits and unsatisfactory attitudes towards multiple aspects related to supplementation. Moreover, education and sports type modulate the use of DSs among athletes. Furthermore, 34% reported using supplements without a recommendation from specialists, and 69% admitted to not reading the supplement's nutrition facts. This study urges the need for the regulation of concerned authorities and education programs to help overcome the existing challenges.

The Relationship Between Prognostic Nutritional Index and All-Cause Mortality in Critically Ill Patients: A Retrospective Study

Purpose

The effectiveness and prognostic value of the prognostic nutritional index (PNI) in critically ill patients are unknown. Hence, this study aimed to analyze the relationship between the PNI and all-cause mortality in critically ill patients.

Patients and Methods

Patient data were obtained from the Multiparameter Intelligent Monitoring in Intensive Care III database. The relationship between the PNI and in-hospital mortality was analyzed using receiver operating characteristic curve analysis and a logistic regression model. Propensity score matching (PSM) was used to eliminate the bias caused by confounding factors. The Kaplan-Meier curve and Cox regression model were used to test the effect of the PNI on 30-, 90-, 180-, and 365-day mortality.

Results

A low PNI score is an independent risk factor for in-hospital mortality in critically ill patients. A total of 3644 cases were successfully matched using PSM. The PSM group with balanced covariates obtained similar results in the three models, which were statistically significant. The Kaplan-Meier curve and Cox regression model showed that the PNI was negatively correlated with 30-, 90-, 180-, and 365-day all-cause mortality.

Conclusion

The PNI score is an independent risk factor for all-cause mortality in critically ill patients, where a low PNI score is associated with increased mortality.

Body fatness in sedentary and active students with different body mass index

Study aim: Numerous data have indicated that body fat stores undergo complicated regulation by genetic and environmental factors, including physical activity. However, the majority of studies did not take into account this aspect of lifestyle in proposed body fat limits. In this context it seems that a more precise and reliable classification of body fat is provided by the American Council on Exercise (ACE), which distinguishes individuals not only with respect to sex but also activity level.

Material and methods: A total of 793 students (312 sedentary and 481 active) volunteered to participate in the study. Among sedentary participants 147 were male and 165 female. Among active subjects 206 were male and 275 were female. Active subjects were engaged in different modes of physical activity according to the study program. In all participants body mass index (BMI) was calculated. In participants with BMI 18.5–24.9 and BMI ≥ 25 body fat was determined using four skinfold measurements. Thereafter participants were classified according to the percentage of body fat using ranges for males and females provided by the American Council on Exercise (ACE) (essential fat, athletes, fitness, average and obese fatness).

Results: None of the sedentary and active males with BMI 18.5–24.9 had high (obese) fat. In contrast, in sedentary males with BMI ≥ 25 16.4% were obese vs. 1.8% of obese active ones. In sedentary females BMI from 18.5 to 24.9 did not exclude obesity, which was found in 16.9% of participants. In sedentary females with BMI ≥ 25 most of the subjects (97.1%) were obese. In contrast, in active females with BMI ≥ 25 a similar percentage of participants had average and obese fat (53.3% and 46.7, respectively).

Discussion: Our study clearly demonstrated that BMI as a simple measure of body composition provides false information concerning true adiposity in physically active male and female students. A similar BMI did not exclude marked differences in the percentage of body fat in sedentary and active students.

Optimal Body Fat Percentage Cut-Off Values in Predicting the Obesity-Related Cardiovascular Risk Factors: A Cross-Sectional Cohort Study

BACKGROUND

Reliable obesity assessment is essential in evaluating the risk of cardiovascular risk factors (CRFs). Non-availability of clearly defined cut-offs for body fat percentage (BF%), as well as a widespread application of surrogate measures for obesity assessment, may result in incorrect prediction of cardio-metabolic risk.

PURPOSE

The study aimed to determine optimal cut-off points for BF%, with a view of predicting the CRFs related to obesity.

PATIENTS AND METHODS

The study involved 4735 (33.6% of men) individuals, the Polish-Norwegian Study (PONS) participants, aged 45-64. BF% was measured with the aid of bioelectrical impedance analysis (BIA) method. The gender-specific cut-offs of BF% were found with respect to at least one CRF. A P-value approach, and receiver operating characteristic curve analyses were pursued for BF% cut-offs, which optimally differentiated normal from the risk groups. The associations between BF% and CRFs were determined by logistic regression models.

RESULTS

The cut-offs for BF% were established as 25.8% for men and 37.1% for women. With the exception of dyslipidemia, in men and women whose BF% was above the cut-offs, the odds for developing CRFs ranged 2-4 times higher than those whose BF% was below the cut-offs.

CONCLUSION

Controlling BF% below the thresholds indicating an increased health hazard may be instrumental in appreciably reducing overall exposure to developing cardio-metabolic risk.