Obesity paradox does exist

Biomarkers of aging: from molecules and surrogates to physiology and function

Many countries face an unprecedented challenge in aging demographics. This has led to an exponential growth in research on aging, which, coupled to a massive financial influx of funding in the private and public sectors, has resulted in seminal insights into the underpinnings of this biological process. However, critical validation in humans has been hampered by the limited translatability of results obtained in model organisms, additionally confined by the need for extremely time-consuming clinical studies in the ostensible absence of robust biomarkers that would allow monitoring in shorter time frames. In the future, molecular parameters might hold great promise in this regard. In contrast, biomarkers centered on function, resilience, and frailty are available at the present time, with proven predictive value for morbidity and mortality. In this review, the current knowledge of molecular and physiological aspects of human aging, potential antiaging strategies, and the basis, evidence, and potential application of physiological biomarkers in human aging are discussed.

Impact of obesity on clinical outcomes in patients with high-risk pulmonary embolism: A comparative analysis

Background

Pulmonary embolism (PE) is a life-threatening cardiovascular condition with increasing global incidence. Obesity is a significant risk factor for PE, although its reported relationship with outcomes is inconsistent. This study aimed to investigate the impact of obesity on clinical outcomes in patients with high-risk PE.

Methods

We conducted a retrospective analysis of US adult patients hospitalized with high-risk PE from 2016 to 2019 using the National Inpatient Sample database. Patients were categorized into three groups based on BMI: non-obese, obese (30 to < 40 kg/m2), and severely obese (≥40 kg/m2). We compared baseline characteristics, in-hospital procedures, and outcomes among these groups. Multivariable logistic regression models assessed the relationship between obesity levels and in-hospital outcomes.

Results

Of 752,660 patients with PE, 29,610 (3.9 %) were classified as high-risk. The distribution among BMI categories was: non-obese (77.1 %), obese (8.8 %), and severely obese (14.1 %). Severely obese patients were younger (mean age 55.7 vs. 66.1 years for non-obese, p < 0.001) and more likely to be female (63.2 % vs. 51.4 % for non-obese, p < 0.001). After adjustment, obese and severely obese patients had lower odds of in-hospital mortality (obese: aOR 0.50, p < 0.001; severely obese: aOR 0.69, p < 0.001) and major adverse cardiovascular and cerebrovascular events (obese: aOR 0.50, p < 0.001; severely obese: aOR 0.72, p < 0.001).

Conclusion

Our study revealed an "obesity paradox" in high-risk PE patients, with obese and severely obese individuals showing lower mortality and fewer complications despite higher comorbidity rates. These findings emphasize the need for tailored risk assessment and treatment strategies in obese patients with high-risk PE.

PVAT adipocyte: energizing, modulating, and structuring vascular function during normotensive and hypertensive states

Hypertension represents the most common form of cardiovascular disease. It is characterized by significant remodeling of the various layers of the vascular system, including the outermost layer: the perivascular adipose tissue (PVAT). Given the tissue's pivotal role in regulating blood pressure, a comprehensive understanding of the changes that occur within PVAT during the progression of hypertension is essential. This article reviews the mechanisms through which PVAT modulates blood pressure, including the secretion of bioactive soluble factors, provision of mechanical support, and adipose-specific functions such as adipogenesis, lipogenesis, lipolysis, and extracellular matrix remodeling. Additionally, this review emphasizes the influence of hypertension on each of these regulatory mechanisms, thereby providing a deeper insight into the pathophysiological interplay between hypertension and PVAT biology.

An obesity paradox in preterm birth: A case control study

The March of Dimes Global action report indicated that preterm birth (PTB) rates are increasing in most countries. It is the most important cause of neonatal deaths and the second leading cause of death in children under age 5. Literature reporting the relationship between maternal pre-pregnancy body mass index (BMI) and PTB has previously yielded inconsistent conclusions. Our objective is to fill in the knowledge gap by evaluating the interaction of socio-economic status (SES) and BMI and its relationship to the rate of PTB. This is a case control study using the Natality Data of the National Vital Statistics System from the years 2020-2022. BMI was a significant factor in PTB for lower socioeconomic status (LSES) women. For every increase in BMI, there was a decrease in the probability of PTB (OR = 0.923, 95% CI 0.915-0.931, P < 0.001). Those who were LSES also had a curved relationship with PTB indicating that the as BMI increases, the odds of PTB decreases up until a BMI value, then the PTB rate increases. This relationship was not found in higher economic status women. Our study had two significant findings. We first found an obesity paradox in PTB for those mothers who are LSES. We also found that the relationship between BMI and PTB was not linear but curvilinear, bridging the gap in the conclusions of other studies. This study fills in the knowledge gap of BMI and PTB by adding the consideration of social class and by creating a polynomial BMI term.

Association between the weight-adjusted waist index and age-related macular degeneration: Results from NHANES 2005-2008

The present study aimed to explore the association between weight-adjusted waist index (WWI) levels, a newly proposed indicator for assessing obesity, and the risk of age-related macular degeneration (AMD). A cross-sectional analysis of 20,497 participants was conducted using the National Health and Nutrition Examination Survey (NHANES) 2005-2008 dataset. Trend tests, multivariable logistic regression, and smoothing curve fitting were performed to examine the association between WWI and the risk of AMD. In addition, subgroup analysis and interaction tests were used to test this association in different groups. A total of 5476 participants were included in the study, of whom 420 (7.7%) had AMD. The risk of age-related macular degeneration increased with increasing WWI in all models. In the fully adjusted model, a 55% increase in the prevalence of AMD was observed in the highest tertile (tertile 3: >11.52) of WWI (OR 1.55, 95% CI 1.09, 2.21) compared to the lowest tertile (tertile 1: <10.85). The interaction tests revealed that age, chronic kidney disease, and cardiovascular disease had significant interactions with WWI on AMD risk (P for interaction < .05). This study revealed that higher WWI levels were associated with increased risk of AMD, suggesting that managing obesity according to WWI may reduce AMD risk. However, additional research is warranted to corroborate our results.

Weight-adjusted waist index and its relationship with systemic inflammatory Index and metabolic indices in overweight and obese individuals: A cross-sectional study

BackgroundObesity- characterized by excessive adiposity- is associated with various comorbidities, including metabolic, cardiovascular, and liver diseases. Chronic low-grade inflammation is a key factor in complications associated with obesity. This study aimed to investigate the associations between systemic inflammatory indices (SIIs) and weight-adjusted waist index (WWI), alongside metabolic and liver function biomarkers in overweight and obese individuals.MethodThis cross-sectional study included 350 overweight or obese participants (body mass index (BMI) ≥ 25 kg/m2) from both genders. Weight, height, waist, hip, and neck circumferences were measured and BMI, WWI, and the ratios of waist to height (WHtR) and hip (WHR) were estimated. Fasting blood samples were taken to assess SII as well as metabolic parameters.ResultsIn this study, males had significantly higher weight and WC compared to females, whereas the mean level of WWI (p < 0001) and WHtR (p = 0.01) in women were greater than in men. A significant correlation was observed between WWI and SII (r = 0.113, p = 0.039), and other associations were observed between HbA1c levels (r = -0.117, p = 0.033) and monocyte-to-lymphocyte ratio (MLR), and fasting blood sugar (FBS) and neutrophil-to-lymphocyte ratio NLR (r = 0.110, p = 0.041). SII quartiles showed significant differences in aspartate aminotransferase AST levels (p < 0.001), and significant variations in WHtR and MLR were also observed (r = -0.112, p = 0.043).ConclusionOur results reveal strong and significant correlations between systemic inflammatory markers, including SII, MLR, and PLR, and important obesity measures, as well as metabolic and liver function parameters in individuals with obesity.

Abdominal obesity: A lethal factor in elderly male osteoporosis patients - insights from NHANES

BACKGROUND AND AIM

This study aims to investigate the relationship between A Body Shape Index (ABSI) Z-score and all-cause mortality among osteoporotic patients using data from the National Health and Nutrition Examination Survey (NHANES).

METHODS AND RESULTS

We analyzed NHANES data from 2005 to 2010, 2013 to 2014, and 2017 to 2018, focusing on individuals aged 50 and above with complete bone mineral density (BMD) data. The ABSI Z-score, calculated by adjusting waist circumference (WC) for height and weight, was used to independently assess abdominal fat beyond Body Mass Index (BMI). Mortality status was confirmed by linking NHANES data with the National Death Index (NDI), with follow-up until December 31, 2019. Weighted Cox proportional hazards models were employed for analysis, adjusting for age, gender, race, fracture history, anti-osteoporosis treatment history, diabetes, and cardiovascular disease (CVD). The study included 1596 participants. Higher ABSI Z-scores were significantly associated with increased all-cause mortality risk, especially among elderly male osteoporotic patients. This association remained robust after adjusting for multiple potential confounders.

CONCLUSION

The ABSI Z-score serves as a valuable non-invasive screening tool that effectively identifies osteoporotic patients at higher risk of mortality. These findings emphasize the importance of body management in health, supporting further research to explore the practical utility of ABSI Z-score in osteoporotic patients and how body management can enhance long-term survival rates.

Image-Based Measures of Obesity are Associated with Alterations in Metabolic Pathways in Non-small Cell Lung Cancer

BACKGROUND

Studies suggest that the obesity paradox in non-small cell lung cancer (NSCLC) results from the use of body mass index (BMI) as a measure of obesity. However, the mechanistic basis linking body fat and lung cancer behavior remains unclear. We examined the association of image-based measures of obesity with tumor gene expression to identify transcriptional signatures concordant with adiposity and their underlying biology.

PATIENTS AND METHODS

RNA-sequencing data for 143 NSCLC tumor samples generated by the ORIEN consortium was compiled with image-based measurements of total fat. Total fat area (TFA) was quantified at the third lumbar vertebra level using computed tomography images and the SliceOmatic software. Differential gene expression analysis was conducted between patients in the highest and lowest TFA tertiles. Utilizing a validated metabolic analysis pipeline, these differences in gene expression were used to enrich dysregulated metabolic pathways crucial in carcinogenesis.

RESULTS

We identified 1154 gene transcripts as differentially expressed (p ≤ 0.05 and log fold change ≥ 0.58) in metabolic pathways of normal physiology as well as cancer growth. Utilizing the metabolic pipeline, we found 58/114 metabolic pathways were significantly enriched (p ≤ 0.05) in the high TFA individuals, some of which are expected in obese individuals (lipids metabolism), and some were novel. Gene set enrichment analysis (GSEA) identified transcriptional alterations to inflammatory mediation, cell-signaling, and cellular respiration pathways based on TFA.

CONCLUSIONS

Image-based measures of adiposity correlate with significant gene expression changes in NSCLC tumors. We have identified altered biological processes associated with obesity, including metabolic vulnerabilities, that can be leveraged in developing new treatment strategies.

Body Mass Index and Risk of All-Cause and Cardiovascular Disease Mortality in Patients With Type 2 Diabetes Mellitus

CONTEXT

The correlations between body mass index (BMI) and risk of all-cause and cardiovascular disease (CVD) mortality in patients with type 2 diabetes mellitus (T2DM) are still controversial.

OBJECTIVE

To explore the correlation between BMI and the risk of all-cause and CVD mortality in patients with T2DM.

METHODS

The data sources China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, PubMed, Web of Science, Embase, and The Cochrane Library were searched up until May 25, 2024. After adjusting for confounding factors, the original study on the association between BMI and all-cause and CVD mortality in patients with T2DM was analyzed. Number of all-cause and CVD mortality events, BMI, and basic characteristics were extracted.

RESULTS

Twenty-eight papers with a total of 728 321 participants were finally included. Compared to normal-weight patients with T2DM, the risk of all-cause (HR = 1.61; 95% CI [1.51, 1.72]; P = .000) and CVD (HR = 1.31; 95% CI [1.10, 1.54]; P = .002) mortality were increased in underweight patients; however, they were reduced (HR = 0.85; 95% CI [0.81, 0.89]; P = .000) and (HR = 0.86; 95% CI [0.78, 0.96]; P = .007), respectively in patients with overweight. Also, there were significant reductions in the risk of all-cause (HR = 0.85; 95% CI [0.78, 0.92]; P = .000) and CVD (HR = 0.81; 95% CI [0.74, 0.89]; P = .000] mortality in patients with mild obesity. The difference in the risk of all-cause mortality (HR = 0.98; 95% CI [0.80, 1.21]; P = .881) in patients with moderate obesity was not statistically significant.

CONCLUSION

We found that there were correlations between BMI and the risk of all-cause and CVD mortality in patients with T2DM. The obesity paradox remains.

The weight-adjusted-waist index predicts all-cause and cardiovascular mortality in hypertension

Background

Weight-adjusted-waist (WWI) is a novel indicator of obesity that reflects the degree of central obesity in the human body.

Objectives

The study aimed to explore the relationship between WWI and mortality in hypertensive individuals.

Methods

Cross-sectional data from the 2001-2018 National Health and Nutrition Examination Survey (NHANES) dataset were used in this study. The relationship between WWI and mortality was assessed using a weighted Cox proportional risk model; the nonlinear relationship was explored using restricted cubic splines. The robustness of the results was verified by subgroup and sensitivity analyses.

Results

A cohort of 11,556 people with a diagnosis of hypertension was included in this study. As a continuous variable, WWI was linked to higher rates of mortality from all-cause (HR = 1.23, 95% CI = 1.14, 1.33) and cardiovascular disease (CVD) (HR = 1.43, 95% CI = 1.23, 1.66) with hypertension in Model 3 adjusted for variables. Using WWI as a tertile categorical variable, individuals in the highest tertile had a 33% higher risk of all-cause death (HR = 1.33, 95% CI = 1.14, 1.56) and a 65% higher risk of CVD death (HR = 1.65, 95% CI = 1.19, 2.27) than individuals in the lowest tertile. According to the subgroup analysis, almost all groups showed a consistent positive correlation between WWI and mortality related to all-cause and CVD.

Conclusion

In adults with hypertension, there is a positive association between WWI and all-cause and CVD mortality.

The association between visceral fat metabolic score and stroke: mediation by declining kidney function

BACKGROUND

Stroke is a leading cause of mortality and disability worldwide. Metabolic Score for Visceral Fat (METS-VF), a metric of visceral obesity, has emerged as a novel predictor of metabolic diseases. However, its association with stroke remains unclear. This study investigates the relationship between METS-VF and the risk of stroke, as well as the potential mediating role of kidney function.

METHODS

Data from the 1999-2020 National Health and Nutrition Examination Survey (NHANES) were analyzed, including 19,109 participants. Weighted logistic regression models were used to assess the association between METS-VF and stroke risk, with restricted cubic splines employed to explore their non-linear relationships. Mediation analysis examined the role of kidney function, measured by estimated glomerular filtration rate (eGFR). Subgroup and sensitivity analyses, including propensity score matching (PSM) and multiple imputations, were conducted to ensure the robustness of the findings.

RESULTS

Higher METS-VF was significantly associated with an increased risk of stroke (OR = 2.78, 95% CI: 1.71-4.52, P < 0.001) after adjusting for multiple covariates. A non-linear relationship was observed, with stroke risk sharply increasing when METS-VF exceeded 7.00. Mediation analysis revealed that declining eGFR mediated 26.72% of the METS-VF-stroke association. Subgroup analysis indicated that the association was stronger in men (OR = 5.06, 95% CI: 2.80-9.12, P < 0.001) than in women (OR = 2.01, 95% CI: 1.03-3.92, P = 0.04, P for interaction = 0.01). Sensitivity analyses using PSM and multiple imputations confirmed the robustness of the results.

CONCLUSIONS

METS-VF is independently associated with stroke risk, showing a non-linear relationship, with a potential mediating role of declining kidney function.

Association of glycemic control with Long COVID in patients with type 2 diabetes: findings from the National COVID Cohort Collaborative (N3C)

INTRODUCTION

Elevated glycosylated hemoglobin (HbA1c) in individuals with type 2 diabetes is associated with increased risk of hospitalization and death after acute COVID-19, however the effect of HbA1c on Long COVID is unclear.

OBJECTIVE

Evaluate the association of glycemic control with the development of Long COVID in patients with type 2 diabetes (T2D).

RESEARCH DESIGN AND METHODS

We conducted a retrospective cohort study using electronic health record data from the National COVID Cohort Collaborative. Our cohort included individuals with T2D from eight sites with longitudinal natural language processing (NLP) data. The primary outcome was death or new-onset recurrent Long COVID symptoms within 30-180 days after COVID-19. Symptoms were identified as keywords from clinical notes using NLP in respiratory, brain fog, fatigue, loss of smell/taste, cough, cardiovascular and musculoskeletal symptom categories. Logistic regression was used to evaluate the risk of Long COVID by HbA1c range, adjusting for demographics, body mass index, comorbidities, and diabetes medication. A COVID-negative group was used as a control.

RESULTS

Among 7430 COVID-positive patients, 1491 (20.1%) developed symptomatic Long COVID, and 380 (5.1%) died. The primary outcome of death or Long COVID was increased in patients with HbA1c 8% to <10% (OR 1.20, 95% CI 1.02 to 1.41) and ≥10% (OR 1.40, 95% CI 1.14 to 1.72) compared with those with HbA1c 6.5% to <8%. This association was not seen in the COVID-negative group. Higher HbA1c levels were associated with increased risk of Long COVID symptoms, especially respiratory and brain fog. There was no association between HbA1c levels and risk of death within 30-180 days following COVID-19. NLP identified more patients with Long COVID symptoms compared with diagnosis codes.

CONCLUSION

Poor glycemic control (HbA1c≥8%) in people with T2D was associated with higher risk of Long COVID symptoms 30-180 days following COVID-19. Notably, this risk increased as HbA1c levels rose. However, this association was not observed in patients with T2D without a history of COVID-19. An NLP-based definition of Long COVID identified more patients than diagnosis codes and should be considered in future studies.

Cardiometabolic Trajectories Preceding Dementia in Community-Dwelling Older Individuals

Importance

Poor cardiometabolic health is a risk factor associated with cognitive impairment in later life, but it remains unclear whether cardiometabolic trajectories can serve as early markers associated with dementia.

Objective

To compare cardiometabolic trajectories that precede dementia diagnosis with those among individuals without dementia.

Design, Setting, and Participants

This case-control study analyzed a sample drawn from community-dwelling participants in the Aspirin in Reducing Events in the Elderly (ASPREE) study. Recruitment through primary care physicians occurred between March 2010 and December 2014, with participants followed up for a maximum of 11 years. Dementia cases were matched on sociodemographic characteristics and time of diagnosis to dementia-free controls. Data analysis was performed between February and June 2024.

Exposures

Body mass index (BMI), waist circumference, systolic and diastolic blood pressure, glucose levels, high- and low-density lipoprotein (HDL and LDL) and total cholesterol levels, and triglyceride levels were measured repeatedly between 2010 and 2022.

Main Outcomes and Measures

Dementia (Diagnostic and Statistical Manual of Mental Disorders [Fourth Edition] criteria) was adjudicated by an international expert panel.

Results

Among 5390 participants (mean [SD] age, 76.9 [4.8] years; 2915 women [54.1%]), there were 2655 individuals (49.3%) with less than 12 years of education. The study included 1078 dementia cases and 4312 controls. Up to a decade before diagnosis, dementia cases compared with controls had lower BMI for all years from -7 years (marginal estimate, 27.52 [95% CI, 27.24 to 27.79] vs 28.00 [95% CI, 27.86 to 28.14]; contrast P = 002) to 0 years (marginal estimate, 26.09 [95% CI, 25.81 to 26.36] vs 27.22 [95% CI, 27.09 to 27.36]; contrast P < .001) and lower waist circumference for all years from -10 years (marginal estimate, 95.45 cm [95% CI, 94.33 to 96.57 cm] vs 97.35 cm [95% CI, 96.79 to 97.92 cm]; contrast P = .003) to 0 years (marginal estimate, 93.90 [95% CI, 93.15 cm to 94.64 cm] vs 96.67 cm [95% CI, 96.30 to 97.05 cm]; contrast P < .001); cases also had a faster decline in BMI (linear change β, -0.13 [95% CI, -0.19 to -0.08]) and waist circumference (linear change β, -0.30 cm [95% CI, -0.51 to -0.08 cm]). Compared with controls, cases generally had higher HDL levels, in particular from 5 years (marginal estimate, 62.57 mg/dL [95% CI, 61.59 to 63.56 mg/dL] vs 60.84 mg/dL [95% CI, 60.35 to 61.34 mg/dL]; contrast P = .002) to 3 years (marginal estimate, 62.78 mg/dL [95% CI, 61.82 to 63.74 mg/dL] vs 61.08 mg/dL [95% CI, 60.60 to 61.56 mg/dL]; contrast P = .002) before dementia but with a decline in levels just before diagnosis (linear change β, -0.47 mg/dL [95% CI, -0.86 to -0.07 mg/dL]). Dementia cases had lower systolic blood pressure and triglyceride levels in the decade before diagnosis and higher LDL and total cholesterol levels, but these were not significantly different from controls.

Conclusions and Relevance

In this study of older individuals, decline in BMI, waist circumference, and HDL occurred up to a decade before dementia diagnosis. These findings provide insights into cardiometabolic changes preceding dementia and the potential for early monitoring and intervention.

Evidence from NHANES 2011-2014: a correlation between the weight-adjusted-waist index and cognitive abilities in the United States

Background

Obesity exerts a significant detrimental impact on cognitive function. The weight-adjusted waist index (WWI) serves as a more precise indicator of visceral obesity that is independent of weight, in contrast to body mass index (BMI). Still, little research has been conducted on the interrelation between WWI and cognitive abilities. This investigation explored the link between WWI and older Americans' cognitive function.

Methods

Utilizing data from the 2011-2014 National Health and Nutrition Examination Cross-Sectional Survey, multiple linear regression analysis was used to assess the influence of WWI on cognitive abilities in those over 60. Three cognitive assessments were administered: the Animal Fluency Test (AFT), the Digit Symbol Substitution Test (DSST), and the Word Learning and Recall Module from the Coalition to Establish a Registry for Alzheimer's Disease (CERAD). We implemented threshold effects analysis and smoothed curve fitting to elucidate the nonlinear relationship. Additionally, we analyzed subgroups to check for variability.

Results

There were 2,762 participants, including1,504 (54.45%) females and 1,258 (45.55%) males. 53.77% of them had completed high school or above, and their average age was 69.05 ± 6.62. After controlling for confounding variables, the improved model predicted a negative connection between WWI and CERAD-Total, AFT, and DSST scores (all p < 0.05). Furthermore, we performed a smoothenable curve fitting between WWI and cognitive function scores, resulting in a nonlinear connection and a threshold saturation effect. We also executed subgroup analyses and interaction tests based on gender, race, educational background, marital status, diabetes, body mass index, alcohol consumption, hypertension, smoking habits, stroke, depression, and sleep quality to assess whether the relationship between WWI and cognitive function was affected by heterogeneity across different population segments. The subgroup analysis found no significant differences in cognitive performance associated with WWI across the various subgroups.

Conclusion

Higher WWI levels are associated with impaired cognitive function in Americans aged 60 and older.

Associations of Regional Body Fat With Risk of Cardiovascular Disease and Mortality Among Individuals With Type 2 Diabetes

CONTEXT

It is largely unknown whether regional fat accumulation is associated with risk of cardiovascular disease (CVD) and mortality among individuals with type 2 diabetes (T2D), who often exhibit changes in relative fat distribution and have increased CVD risk.

OBJECTIVE

To prospectively examine the association between regional body fat and risk of CVD in individuals with T2D and to determine whether the associations are independentof traditional measures of obesity.

METHODS

The main analysis included 21 472 participants with T2D from the UK Biobank. Regional body fat was measured by bioelectric impedance assessment. Cox proportional-hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs.

RESULTS

Over a median of 7.7 years of follow-up, 3976 CVD events occurred. After multivariable adjustment, upper and lower body fat were independently and oppositely associated with CVD risk among patients with T2D. Higher arm fat percentage was linearly associated with increased CVD risk (Pnonlinear > .05), while higher trunk fat percentage was nonlinearly associated with increased CVD risk (Pnonlinear < .05). In contrast, higher leg fat percentage was nonlinearly associated with lower CVD risk (Pnonlinear < .05). When comparing extreme quartiles, the multivariable-adjusted HR (95% CI) of CVD was 0.72 (0.58-0.90) for leg fat percentage, 1.63 (1.29-2.05) for arm fat percentage, and 1.27 (1.06-1.52) for trunk fat percentage. Similar patterns of associations were observed for all-cause and CVD mortality. In addition, leg fat percentage, but not other regional fat percentage, was associated with CVD risk independently of traditional measures of obesity.

CONCLUSION

Among people with T2D, arm fat and trunk fat were positively, whereas leg fat was inversely, associated with the risk of CVD and mortality. These findings highlight the importance of considering both the amount and the location of body fat when assessing CVD and mortality risk among individuals with T2D.

Correlation between weight-adjusted waist index and coronary heart disease: NHANES 1999-2020

Background

The weight adjusted waist index (WWI) represents a novel indicator for assessing central obesity. The objective of this study is to investigate the association between WWI and coronary heart disease (CHD).

Method

The data of 44,528 participants in total were gathered from NHANES database from 1999 to 2020. WWI is calculated as the waist circumference (WC, cm) divided by the square root of the body weight (kg), and CHD was determined based on participants' self-reports. The association between WWI and CHD was examined using multiple logistic regression analysis, restrictive cubic spline (RCS), receiver operating characteristic (ROC) curve, mediation analysis, subgroup and interaction analyses.

Result

This was a cross-sectional investigation. A total of 44,528 participants were included [50.23% male; mean WWI 10.89 (0.01) cm/√kg]. The multivariate logistic regression analysis revealed that in three models, one-standard-deviation increment in WWI was associated with an increased probability of CHD occurrence by 2.39 (2.22,2.57),1.47 (1.32,1.65), and 1.15 (1.00,1.32) times, respectively. Additionally, RCS analysis indicated a linear relationship between WWI and CHD. and the ROC analysis results showed that the discriminatory power of WWI for CHD was superior to that of body mass index (BMI) and WC. Glycated hemoglobin (HbA1c) partially mediated the relationship between WWI and CHD. Subgroup and interaction analyses confirmed that age, systolic blood pressure, and diabetes status had a significant impact on the association between WWI and CHD (P for interaction <0.05).

Conclusion

The level of WWI has been demonstrated to be associated with an increased risk of CHD. Specifically, as WWI increases, the risk of CHD becomes higher. On this basis, it is hypothesized that WWI may potentially serve as an independent risk factor for CAD, thereby highlighting the substantial value of WWI in the identification and management of CHD.

The Impact of Comorbid Dementia and Diabetes Mellitus on Hospital Patients' Outcomes: A Systematic Review and Meta-analysis

INTRODUCTION

Previous reviews have demonstrated that dementia and diabetes mellitus, separately, can worsen the hospital outcomes of patients. Unfortunately, there are no systematic evaluations regarding the hospital outcomes of patients with dementia and diabetes mellitus as a comorbidity. Therefore, our review aimed to determine any differences in hospital length of stay, hospital mortality, and hospital readmission between patients with the comorbidity and patients without.

METHODS

Searches were conducted of Medline, CINHAL, EMBASE, PsychINFO, Web of Science and Google Scholar for original studies. All studies were quality assessed using the Joanna Briggs Institute critical appraisal tools. Where possible, studies were pooled in a meta-analysis to generate odds ratios (OR) with 95% confidence intervals (CI).

RESULTS

Sixteen studies were included in this review. When comparing patients with the comorbidity to patients with dementia, the difference in length of stay was inconclusive, and there was no difference in the odds of hospital mortality (OR = 0.98, 95% CI 0.91-1.06). However, patients with the comorbidity had increased odds of 30-day readmission compared to patients with dementia alone (OR = 1.20, 95% CI 1.14-1.26). When comparing patients with the comorbidity to patients with diabetes, those with the comorbidity had a longer length of stay and but no difference in the odds of hospital mortality (OR = 1.48, 95% CI 0.84-2.62). Additionally, those with the comorbidity may have worse readmission outcomes than those with diabetes alone.

CONCLUSIONS

Our findings suggest that patients with comorbid dementia and diabetes mellitus may have worse hospital outcomes. Therefore, we recommend further research to assess these patients' hospital outcomes to resolve the discrepancies found.

Sex differences in the association between body mass index and quality of life among Korean older adults; evidence from a Community Health Survey in South Korea

BACKGROUND

The high prevalence of underweight individuals is an important issue that has become increasingly common. Therefore, this study investigated the association between body mass index (BMI) and health-related quality of life (HRQoL) among Korean older adults using a nationwide population-based survey.

METHODS

Data from the 2021 Community Health Survey were used for this study. The study population was a total of 70,700 respondents. HRQoL was assessed using the EuroQoL health-related quality of life scale. Multiple logistic regression was applied to analyze the ORs for moderate or severe problems in the five EQ-5D dimensions. In addition, we performed multiple linear regression to identify the association between the total EQ-5D score and BMI after adjusting for age, marital status, income, education, health behaviors, and the presence of diabetes or hypertension.

RESULTS

Of the participants, 4.3% were underweight (3.3% of men and 5.1% of women). Being underweight is associated with poor HRQoL in both men and women. The relationship between obesity and HRQoL varied by sex. Men with pre-obesity and obesity were less likely to have "moderate or severe" problems in all EQ-5D dimensions, excluding mobility. However, women with obesity were more likely to have "moderate or severe" problems across EQ-5D dimensions, excluding anxiety/depression.

CONCLUSIONS

Being underweight is associated with poor HRQoL among Korean older adults. Policy attention must be directed toward maintaining proper weight and promoting nutritional health at older ages, given that the number of older adults is expected to continue to increase.

Weight-adjusted waist index predicts metabolic syndrome in Caucasian patients with obesity

Introduction

Background and aims: the usefulness of the weight-adjusted waist index (WWI) among persons with metabolic syndrome (MS) has not been previously evaluated. The objective of this study was to evaluate the ability of WWI to predict MS in a Caucasian population with obesity. Methods: we conducted a cross sectional study in 2162 Caucasian patients with obesity. Anthropometric data (weight, height, body mass index [BMI], waist circumference, [WWI]), bioimpedanciometer parameters (total fat mass [FM], skeletal muscle mass [SMM] and skeletal muscle mass index [SMMi]), blood pressure, presence of MS and biochemical parameters were recorded and compared by tertiles of WWI. Results: a total of 1,176 subjects had MS (54.4 %) and 986 did not show MS (45.6 %). Compared with the lowest WWI category Q1 (< 11.24 cm/√kg), the prevalence of MS increased in the logistic regression model adjusted by sex and age in the Q3 group (OR = 2.53, 95 % CI = 1.71-3.23; p = 0.001). In addition, the prevalence of MS was higher in the Q3 group than in Q2 (OR = 1.65, 95 % CI = 1.25-2.17; p = 0.005). Finally, the prevalence of MS in Q2 was higher than in the Q1 group (OR = 1.21, 95 % CI = 1.06-3.11; p = 0.01). The area under the curve (AUC) to assess the ability of WWI to identify MS showed values of 0.811 (0.687-0.871; p = 0.001). The cut-off point according to the Youden index was 11.59, with sensitivity and specificity of 70 % and 93.4 %, respectively. Conclusion: we described a good accuracy of WWI to identify MS an independent association between WWI in Caucasian patients with obesity.

The association between weight-adjusted-waist index and psoriasis: A cross-sectional study based on NHANES 2009 to 2014

Weight-adjusted-waist index (WWI) is an anthropometric indicator of central obesity, which is calculated by dividing the waist circumference (WC) by the squared weight. The purpose of this study was to investigate the association between WWI and psoriasis in adults. Multivariate logistic regression and smoothing curve fitting were used to investigate the relationship between WWI and psoriasis based on data from the National Health and Nutrition Examination Survey (NHANES) 2009 to 2014. Subgroup analysis and interaction tests were employed to examine the population-level stability of this connection. There was a positive association between WWI and psoriasis in 15,932 participants > 20 years of age. In the fully adjusted model, each 1-unit increase in WWI was associated with a 14% increase in the risk of developing psoriasis [1.14 (1.01, 1.32)]. Participants in the highest quartile of WWI had a 38% higher risk of developing psoriasis than those in the lowest quartile [1.38 (1.01, 1.94)]. This positive association was more pronounced in males. WWI is positively associated with psoriasis in US adults. Our findings imply that WWI has the potential to improve psoriasis prevention in the general population.

Impact of the obesity paradox on 28-day mortality in elderly patients critically ill with cardiogenic shock: a retrospective cohort study

BACKGROUND

Previous studies have shown that the obesity paradox exists in cardiovascular disease (CVD), giving patients a survival advantage, but controversy remains as to whether it applies to patients with cardiogenic shock (CS), especially in the elderly. We therefore aimed to determine whether obesity affects 28-day prognosis in elderly patients with CS.

METHODS

We used clinical data from the Medical Information Market in Critical Care IV (MIMIC-IV) database. Critical patients with CS were categorized into two groups based on age; age < 65 years and ≥ 65 years were classified as young adult patients and elderly patients, respectively. Patients were then categorized into two subgroups based on their body mass index (BMI), one with a BMI ≥ 30 kg/m2 and the other with a BMI < 30 kg/m2. The primary outcome was a 28-day prognosis. Secondary outcomes were mechanical ventilation status, length of hospitalization, and length of ICU stay.

RESULTS

1827 patients from the MIMIC-IV ICU database were analyzed, of which 571 patients were < 65 years old and 1256 patients were ≥ 65 years old. According to multifactorial logistic analysis, BMI > 30 kg/m2 was not a 28-day risk factor for death in elderly patients critically ill with CS (Overweight OR 1.28, P = 0.221; Obesity OR 1.15, P = 0.709; Severe obesity OR 1.46, P = 0.521; using normal weight as a reference). In contrast, underweight was a risk factor (OR 2.42, P = 0.039). Kaplan-Meier curves showed that in the older age group, 28-day survival was significantly higher in patients with BMI ≥ 30 kg/m2 compared to those with BMI < 30 kg/m2 [261 (66.75%) vs. 522 (60.35%), P = 0.024].

CONCLUSION

Underweight affects the 28-day prognosis of critically ill elderly patients with CS. In contrast, overweight and or obesity do not appear to have a significant impact on the prognosis of these patients.

Evaluating a new obesity indicator for stroke risk prediction: comparative cohort analysis in rural settings of two nations

BACKGROUND

While the TyG index has been studied in relation to stroke risk, there is a lack of research integrating fat distribution indicators like Body Roundness Index (BRI) and Fat Mass Index (FMI). Additionally, comparative studies across multiple regions are scarce. This study investigates the association between obesity-related parameters and stroke incidence, examining the mediation effects of multimorbidity, using data from rural areas in China and the United Kingdom.

METHODS

This cohort study included 60,685 participants (6,980 from China and 53,705 from UK). The obesity-related parameters were calculated using established formulas. The TyG index was determined as ln [TG (mg/dL) × GLU (mg/dL) / 2]. Additionally, composite indices were created by multiplying the TyG index by BMI, WC, FMI, and RBI to assess obesity-related risks. Cox regression analyses were employed on the relationship between Triglyceride Glucose index related parameters and stroke risk. Multiple mediation analysis was applied to assess the contributions of multimorbidity to obesity indicators in stroke occurrence.

RESULTS

After excluding those who developed stroke within two years of enrollment, the Chinese cohort (6,638 subjects, median follow-up 4.33 years) had 237 ischemic and 21 hemorrhagic strokes. The UK cohort (53,631 subjects, median follow-up 13.85 years) had 742 ischemic and 316 hemorrhagic strokes. Chinese residents had lower BMI but higher visceral obesity (BRI), higher prevalence of multimorbidity, and higher stroke incidence compared to UK residents. Cox analyses demonstrated significant associations between BMI/TyG indices and ischemic stroke in both Chinese and UK populations, which diminished after adjusting for multimorbidity. In the Chinese rural cohort, only TyG-BRI (HR:1.13, 95%CI:0.99-1.30) approached statistical significance after full adjustment for mediators. In contrast, in the UK cohort, significant associations persisted for most TyG Index indicators when full adjustment for mediators, including BMI (HR: 1.17, 95% CI: 1.09-1.26), TyG-BMI (HR: 1.16, 95% CI: 1.07-1.26), TyG-WC (HR: 1.13, 95% CI: 1.03-1.25), TyG-FMI (HR: 1.17, 95% CI: 1.07-1.28), and TyG-RBI (HR: 1.15, 95% CI: 1.06-1.24). TyG-BRI also showed the best predictive performance for ischemic stroke in Chinese rural residents (AUC > 0.7) and exhibited an almost linear relationship with ischemic stroke occurrence. Additionally, TyG-BRI presented a U-shaped relationship with the risk of hemorrhagic stroke incidence in the UK (p overall = 0.041, p non-linear = 0.017). Multimorbidity mediated the relationship between TyG indices, and ischemic stroke incidence in both cohorts. The mediation percentage for multimorbidity was higher than the sum of individual chronic diseases, with a higher mediation percentage in the Chinese cohort (up to 51%) compared to the UK cohort (up to 27.2%).

CONCLUSIONS

Chinese rural residents exhibit higher levels of visceral obesity compared to residents in UK, leading to greater stroke susceptibility mediated by multimorbidity. These findings underscore the importance of comprehensive management of multimorbidity for stroke prevention. The TyG-BRI may serve as a promising predictor of ischemic stroke incidence among rural community residents.

Association Between the Weight-Adjusted Waist Index and OSA Risk: Insights from the NHANES 2017-2020 and Mendelian Randomization Analyses

Background

Obesity is a significant risk factor for obstructive sleep apnea (OSA). The weight-adjusted-waist index (WWI) reflects weight-independent centripetal obesity. Our study aims to evaluate the relationship between WWI and OSA.

Methods

The data used in the current cross-sectional investigation are from the National Health and Nutrition Examination Survey (NHANES), which was carried out between 2017 and 2020. We utilized weighted multivariable-adjusted logistic regression to evaluate the relationship between WWI and the risk of OSA. In addition, we applied various analytical methods, including subgroup analysis, smoothing curve fitting, threshold effect analysis and the receiver operating characteristic (ROC) curve. To further explore the relationship, we conducted a MR study using genome-wide association study (GWAS) summary statistics. We performed the main inverse variance weighting (IVW) method along with other supplementary MR methods. In addition, a meta-analysis was conducted to provide an overall evaluation.

Results

WWI was positively related to OSA with the full adjustment [odds ratio (OR)=1.14, 95% confidence interval (95% CI): 1.06-1.23, P<0.001]. After converting WWI to a categorical variable by quartiles (Q1-Q4), compared to Q1 the highest WWI quartile was linked to an obviously increased likelihood of OSA (OR=1.26, 95% CI: 1.06-1.50. P=0.01). Subgroup analysis revealed the stability of the independent positive relationship between WWI and OSA. Smoothing curve fitting identified a saturation effect of WWI and OSA, with an inflection point of 11.62. In addition, WWI had the strongest prediction for OSA (AUC=0.745). Sensitivity analysis was performed to verify the significantly positive connection between WWI and stricter OSA (OR=1.18, 95% CI: 1.05-1.32, P=0.005). MR meta-analysis further supported our results (OR=2.11, 95% CI: 1.94-2.30, P<0.001). Sensitivity analysis confirmed the robustness and reliability of these findings.

Conclusion

WWI was significantly associated with the risk of OSA, suggesting that WWI could potentially serve as a predictor for OSA.

Association of weight-adjusted waist index with all-cause and cause-specific mortality among cancer survivors: a cohort study of the NHANES 1999-2018

Background

Obesity is becoming more widely acknowledged as a chronic illness that raises the risk of oncogenesis. This inquiry aimed to look into the correlation between cancer patient mortality and obesity, as measured by the weight-adjusted waist index (WWI).

Methods

We used continuous data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 as the benchmark, with a follow-up validity period of December 31, 2019. First, we assessed the correlation between WWI and the all-cause and cause-specific execution of cancer sufferers using multivariable Cox proportional hazards models. Second, a smoothed curve fit was utilized to examine the relationship between WWI and both cause-specific and all-cause mortality in cancer patients. Lastly, we analyzed the relationship between WWI and both cause-specific and all-cause mortality in cancer patients, to find out if this link held across the population subgroup evaluation and impact analyses were used as well during the last step.

Results

With a median follow-up of 87.8 months, 1,547 (34.7%) of the 4,463 cancer patients had deceased. Among them, 508 (11.4%) succumbed to cancer, while 322 (7.2%) passed away due to cardiovascular disease. Multivariate Cox proportional hazards model of mortality among cancer patients revealed an all-cause mortality hazard ratio [HR=1.13; 95% CI (1.04, 1.23)] and cardiovascular mortality [HR=1.39; 95% CI (1.16, 1.67)]. Furthermore, for each unit increase in WWI, all-cause mortality was significantly higher in male cancer survivors than in female cancer survivors.

Conclusions

Our study reveals substantial correlations between WWI and all-cause and cardiovascular mortality in US cancer survivors, helping to identify cancer survivors at higher risk of death and thus potentially guiding targeted interventions.

Metabolically 'extremely unhealthy' obese and non-obese patients with diabetes and the risk of cardiovascular events: a French nationwide cohort study

BACKGROUND

Non-obese patients with diabetes mellitus (DM) are becoming more prevalent, but their cardiovascular risk (CV) especially when accompanied with cardio-renal-metabolic co-morbidities (hypertension, chronic kidney disease, hyperlipidemia) is not well characterised. The aim of the study was to assess the CV risk among patients with DM in relation to obesity and cardio-renal-metabolic co-morbidities.

MATERIALS AND METHODS

This was a cohort study of all patients with DM without a history of major adverse cardiovascular event who were hospitalized for any reason in France in 2013 with at least 5 years of follow-up. They were categorized by the presence of obesity vs no obesity, as well as three cardio-renal-metabolic co-morbidities: hypertension, chronic kidney disease, hyperlipidemia. 'Extremely unhealthy' patients with DM were defined as those having all 3 co-morbidities.

RESULTS

There were 196,112 patients (mean age 65.7 (SD 13.7) years; 54.3% males) included into the analysis. During a mean follow-up of 4.69 ± 1.79 years, when adjusted for multiple covariates, the non-obese and 'extremely unhealthy' obese patients had the highest risk of CV death [aHR 1.40 (95% CI, 1.22-1.61) and 1.48 (95% CI, 1.25-1.75), respectively]. The 'extremely unhealthy' obese had the highest risk of MACE-HF [aHR 1.84 (95% CI, 1.72-1.97)] and new-onset AF [aHR 1.64 (95% CI, 1.47-1.83)].

CONCLUSION

Both non-obese and obese patients with DM with associated cardio-renal-metabolic co-morbidities are an 'extremely unhealthy' phenotype with the highest risk of CV death and CV events.

Adipose tissue in older individuals: a contributing factor to sarcopenia

Sarcopenia is a geriatric syndrome characterized by a functional decline in muscle. The prevalence of sarcopenia increases with natural aging, becoming a serious health problem among elderly individuals. Therefore, understanding the pathology of sarcopenia is critical for inhibiting age-related alterations and promoting health and longevity in elderly individuals. The development of sarcopenia may be influenced by interactions between visceral and subcutaneous adipose tissue and skeletal muscle, particularly under conditions of chronic low-grade inflammation and metabolic dysfunction. This hypothesis is supported by the following observations: (i) accumulation of senescent cells in both adipose tissue and skeletal muscle with age; (ii) gut dysbiosis, characterized by an imbalance in gut microbial communities as the main trigger for inflammation, sarcopenia, and aged adipose tissue; and (iii) microbial dysbiosis, which could impact the onset or progression of a senescent state. Moreover, adipose tissue acts as an endocrine organ, releasing molecules that participate in intricate communication networks between organs. Our discussion focuses on novel adipokines and their role in regulating adipose tissue and muscle, particularly those influenced by aging and obesity, emphasizing their contributions to disease development. On the basis of these findings, we propose that age-related adipose tissue and sarcopenia are disorders characterized by chronic inflammation and metabolic dysregulation. Finally, we explore new potential therapeutic strategies involving specialized proresolving mediator (SPM) G protein-coupled receptor (GPCR) agonists, non-SPM GPCR agonists, transient receptor potential (TRP) channels, antidiabetic drugs in conjunction with probiotics and prebiotics, and compounds designed to target senescent cells and mitigate their pro-inflammatory activity.

Association between stroke and relative fat mass: a cross-sectional study based on NHANES

BACKGROUND

This study was aimed at investigating the correlation between the occurrence of stroke and relative fat mass (RFM), a novel metric for determining total body fat.

METHODS

This cross-sectional study employed the National Health and Nutrition Examination Survey (NHANES) dataset, which encompassed the years 2005 to 2018 to assess the independent relationship between RFM and stroke. Moreover, multinomial logistic regression, subgroup analysis, smooth curve fitting, and interaction testing were also used.

RESULTS

This study included 35,842 participants and 1,267 (3.53%) of them were diagnosed with stroke. Fully adjusted Models showed that RFM was positively associated with stroke (odds ratio [OR] = 1.02; 95% confidence interval [CI] = 1.01-1.03). The odds of having a stroke in quartile 4 were significantly elevated by 44%, compared to quartile 1 (OR = 1.44,95%CI:1.09-1.90). In addition, a subgroup analysis also demonstrated that age and BMI significantly impacted the association between RFM and stroke (P for interaction<0.01).

CONCLUSIONS

Elevated RFM is associated with increased odds of stroke, suggesting that RFM may have potential value in the prevention and management of stroke.

Assessing the effect of body mass index on perioperative outcomes and short-term recurrence after paraesophageal hernia repair

Previous assessments suggest that surgical results of paraesophageal hernia (PEH) repair were negatively impacted by increasing levels of obesity. A better understanding of the association of obesity on outcomes of PEH repair will support surgeons making evidence-based decisions on the surgical candidacy of individual patients. This single institution retrospective cohort study included 884 consecutive patients with giant PEH undergoing surgical repair between 1 January 2000 and 30 June 2020. Preoperative body mass index (BMI) was documented at the time of surgery. Main outcomes included perioperative blood loss, length of hospital stay, major complications, early hernia recurrence, and mortality. The mean (standard deviation [SD]) age at surgery was 68.4 (11.1), and 645 (73.0%) were women. Among the 884 patients, 875 had a documented immediate preoperative BMI and were included in the analysis. Mean (SD) BMI was 29.24 (4.91) kg/m2. Increasing BMI was not associated with increased perioperative blood loss (coefficient, 0.01; 95% confidence interval [CI], -0.01 to 0.02), prolonged length of stay (coefficient, -0.01; 95% CI, -0.02 to 0.01), increased incidence of recurrent hernia (odds ratio [OR], 1.03; 95% CI, 0.95-1.10), or increased major complications (OR, 0.93; 95% CI, 0.82-1.05). The 90-day mortality rate was 0.3%. Furthermore, when compared with the normal weight group, overweight and all levels of obesity were not related to unfavorable outcomes. No association was found between BMI and perioperative outcomes or short-term recurrence in patients undergoing PEH repair. Although preoperative weight loss is advisable, a higher BMI should not preclude or delay surgical management of giant PEH.

Associations of body mass index, waist circumference and the weight-adjusted waist index with daily living ability impairment in older Chinese people: A cross-sectional study of the Chinese Longitudinal Healthy Longevity Survey

AIM

To investigate the associations of body mass index (BMI), waist circumference (WC) and the weight-adjusted waist index (WWI) with the impairment of activities of daily living (ADL) in older Chinese people.

METHODS

A total of 13 260 participants aged 65 years and older from the 2018 Chinese Longitudinal Healthy Longevity Survey were included in this cross-sectional study. BMI, WC and the WWI were calculated from measurements of height, weight and WC. Binary logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). Non-linear correlations were investigated using restricted cubic spline curves.

RESULTS

In multivariate logistic regression fully adjusted for confounding variables, our analyses revealed significant associations between WC and WWI and ADL impairment, with adjusted ORs (95% CI) of 1.01 (1.00, 1.01) and 1.08 (1.03, 1.12), respectively. Meanwhile, participants with a high WWI had a higher risk of ADL impairment compared with those with a low WWI, with an adjusted OR (95% CI) of 1.12 (1.02, 1.23). Subgroup analyses showed that only the association between WWI and ADL impairment did not differ in any of the different populations. In addition, we found that BMI, WC and WWI were non-linearly associated with ADL impairment.

CONCLUSIONS

There are significant associations between WC and WWI and ADL impairment in older Chinese people. The findings show the ability of the WWI to serve as a comprehensive and effective indicator of obesity in older Chinese people and emphasize the importance of assessing WWI in screening and preventing ADL impairment in older people.

The obesity paradox in younger adult patients with sepsis: analysis of the MIMIC-IV database

BACKGROUND

The obesity paradox suggests that individuals with obesity may have a survival advantage against specific critical illnesses, including sepsis. However, whether this paradox occurs at younger ages remains unclear. Therefore, we aimed to investigate whether obesity could improve survival in younger adult patients with sepsis.

METHODS

We used clinical data sourced from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients with Sequential Organ Failure Assessment score ≥2 and suspected infection at the time of ICU admission were identified as having sepsis, following the Sepsis-3 definition. Individuals were classified into the obesity (BMI ≥30 kg/m²) and non-obesity (BMI <30 kg/m²) groups. Patients aged <50 and ≥50 years were categorized as younger adult patients and older patients, respectively.

RESULTS

Of 73,181 patients in the MIMIC-IV ICU database, 18,120 satisfied the inclusion criteria: 2642 aged <50 years and 15,478 aged ≥50 years. The Kaplan-Meier curve showed that obesity was not associated with an improved mortality rate among younger adult patients with sepsis (log-rank test: P = 0.197), while obesity exhibited a survival benefit in older patients with sepsis (log-rank test: P < 0.001). After propensity score matching, in-hospital mortality did not differ significantly between the obesity and non-obesity groups (13.3% vs. 12.2%; P = 0.457) in the younger adult patients with sepsis. Multivariate logistic regression analysis revealed that BMI was not an independent risk factor for in-hospital mortality in younger adult patients with sepsis (underweight: adjusted odds ratio [aOR] 1.72, P = 0.076; overweight: aOR 0.88, P = 0.437; obesity: aOR 0.93, P = 0.677; and severe obesity: aOR 1.22, P = 0.580, with normal weight as the reference).

CONCLUSION

Contrary to findings regarding older patients with sepsis, our findings suggest that the obesity paradox does not apply to younger adult patients with sepsis.

Cardiac autonomic neuropathy modified the association between obesity and hypoglycemia in type 2 diabetes

BACKGROUND

Previous studies have shown that increasing body mass index (BMI) was associated with decreased hypoglycemia in type 2 diabetes, but it remains uncertain whether this finding could be applied to patients with and without cardiac autonomic neuropathy (CAN).

METHODS

The study included 7789 participants with type 2 diabetes from action to control cardiovascular risk in diabetes (ACCORD) trail. CAN was defined as SDNN < 8.2 ms and RMSSD < 8.0 ms. Obesity was defined as BMI ≥ 30 kg/m2. Outcomes were identified as severe hypoglycemia requiring any assistance (HAA) or requiring medical assistance (HMA). We assessed the association between obesity and severe hypoglycemia in type 2 diabetes with or without CAN using COX regression models adjusted for baseline characteristics.

RESULTS

Over a median follow-up of 4.7 years, a total of 893 participants developed HAA and 584 participants developed HMA. Compared with non-obesity, obesity was associated with lower risk of severe hypoglycemia (HAA: hazard ratio [HR] 0.51, 95% confidence interval [CI] 0.38-0.68, P < 0.001; HMA: HR 0.57, 95% CI 0.40-0.82, P = 0.002) in CAN present group, but not in CAN absent group (HAA: HR 0.98, 95% CI 0.83-1.16, P = 0.830; HMA: HR 0.97, 95% CI 0.79-1.19, P = 0.754). Similarly, increasing BMI was associated with reduced severe hypoglycemic events in participants with CAN, but not in participants without CAN.

CONCLUSIONS

CAN modifies the association between obesity and hypoglycemia in type 2 diabetes. Type 2 diabetic individuals with CAN who are under weight control should pay attention to hypoglycemic events.

TRIAL REGISTRY

http://www.

CLINICALTRIALS

gov . Unique identifier: NCT00000620.

From NAFLD to MAFLD and MASLD: a tale of alcohol, stigma and metabolic dysfunction

Liver steatosis is a frequent finding in clinical practice and it is estimated to affect 30% of the general adult population worldwide. It became one of the leading causes of end-stage liver disease and hepatocellular carcinoma. From its first description, a diagnosis of nonalcoholic fatty liver disease (NAFLD) required the exclusion of excessive alcohol consumption and concomitant chronic liver diseases of different origins, making it a diagnosis of exclusion. In recent years, the need to stress the strict association between liver steatosis and metabolic dysfunction (i.e., insulin resistance, overweight/obesity, type 2 diabetes, and metabolic syndrome), as well as the desire to define a condition in a positive rather than negative way, led to new definitions and new diagnostic criteria. Metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed by Eslam et al. in 2020. More recently, a Delphi consensus endorsed by several international hepatologic societies proposed a new terminology [metabolic dysfunction-associated steatotic liver disease (MASLD)] and a new set of diagnostic criteria. The MAFLD and MASLD definitions have a good degree of concordance. They mainly differ in the number of metabolic derangements needed to define “metabolic dysfunction” in normal-weight individuals and in alcohol consumption. Indeed, while MAFLD does not exclude patients with significant alcohol consumption, the recent Delphi consensus included the metabolic dysfunction and alcohol-related liver disease (MetALD) disease entity, a condition in which steatosis, metabolic dysfunction, and moderate alcohol intake coexist. In the present narrative review, we underline the strengths and possible limitations of each definition and summarize available evidence from epidemiologic studies evaluating the clinical usefulness of each set of diagnostic criteria.

Investigating the Obesity Paradox in Colorectal Cancer: An Analysis of Prospectively Collected Data in a Diverse Cohort

BACKGROUND

Prior studies are inconclusive regarding the effect of obesity on mortality in persons with colorectal cancer (CRC). We sought to determine the association of pre-diagnosis body mass index (BMI) trajectories on mortality after CRC diagnosis.

METHODS

Utilizing the Multiethnic Cohort, we included adults aged 18-75 between 1 January 1993 and 1 January 2019 with a diagnosis of CRC and at least three available BMIs. The primary exposure, BMI, was subjected to group-based trajectory modeling (GBTM). We evaluated all-cause and CRC-specific mortality, using Cox proportional hazard (PH) models.

RESULTS

Of 924 persons, the median age was 60 years, and 54% were female. There was no statistically significant association between pre-cancer BMI trajectory and either all-cause or cancer-specific mortality. In competing risk analysis, the risk of CRC-specific mortality was higher for African Americans (HR = 1.56, 95% CI [1.00-2.43], p = 0.048) and smokers (HR = 1.59, 95% CI [1.10-2.32], p = 0.015). Risk of all-cause mortality was higher for Hawaiian persons (HR = 2.85, 95% CI [1.31-6.21], p = 0.009) and persons with diabetes (HR = 1.83, 95% CI [1.08-3.10], p = 0.026).

CONCLUSIONS

Pre-diagnosis BMI trajectories were not associated with mortality after CRC diagnosis, whereas race/ethnicity, diabetes, and smoking were associated with an increased risk of death. Our findings suggest the obesity paradox alone does not account for mortality after CRC diagnosis.

The Link Between Weight-Adjusted-Waist Index and Psoriasis in Adults: A Cross-Sectional Study Based on 2009-2014 and 2003-2006 Data

Purpose

The weight-adjusted-waist index (WWI) is a new indicator that may be used to assess obesity. However, there has never been any prior research indicating a link between psoriasis and WWI. Hence, the aim of this investigation is to search for the correlation between the two.

Patients and Methods

Cross-sectional analyses used National Health and Nutrition Examination Survey (NHANES) data from 2003 to 2006 and 2019 to 2014. Through multivariate logistic regression, the connection between Psoriasis and WWI was explored, while subgroup analyses aimed to identify possible causes. Furthermore, Smoothed curve fitting was also performed to further understand the association. The non-linear connection was examined through the use of threshold effects.

Results

There were 21,916 participants over the age of 20 in the research. Psoriasis and WWI were revealed to be positively correlated [1.25 (1.14, 1.38)] using multivariate logistic regression analysis. This association was observed in both men [1.50(1.29,1.78)] and hypertensive patients [1.37(1.16,1.62)] in subgroup analysis. Furthermore, we noticed a curvilinear association between WWI and psoriasis, wherein the inflection point was identified as 10.15. To the left of the inflection point, there existed a negative correlation [0.12(0.02,0.91)] while to the right, a positive one [1.68(1.03,2.72)].

Conclusion

According to our findings, psoriasis and WWI are related, although more extensive prospective research is still required to support this conclusion.

Comparison of Classically and Machine Learning Generated Survival Prediction Models for Patients With Spinal Metastasis - A meta-Analysis of Two Recently Developed Algorithms

STUDY DESIGN

A systemic review and a meta-analysis. We also provided a retrospective cohort for validation in this study.

OBJECTIVE

(1) Using a meta-analysis to determine the pooled discriminatory ability of The Skeletal Oncology Research Group (SORG) classical algorithm (CA) and machine learning algorithms (MLA); and (2) test the hypothesis that SORG-CA has less variability in performance than SORG-MLA in non-American validation cohorts as SORG-CA does not incorporates regional-specific variables such as body mass index as input.

METHODS

After data extraction from the included studies, logit-transformation was applied for extracted AUCs for further analysis. The discriminatory abilities of both algorithms were directly compared by their logit (AUC)s. Further subgroup analysis by region (America vs non-America) was also conducted by comparing the corresponding logit (AUC).

RESULTS

The pooled logit (AUC)s of 90-day SORG-CA was .82 (95% confidence interval [CI], .53-.11), 1-year SORG-CA was 1.11 (95% CI, .74-1.48), 90-day SORG-MLA was 1.36 (95% CI, 1.09-1.63), and 1-year SORG-MLA was 1.57 (95% CI, 1.17-1.98). All the algorithms performed better in United States than in Taiwan (P < .001). The performance of SORG-CA was less influenced by a non-American cohort than SORG-MLA.

CONCLUSION

These observations might highlight the importance of incorporating region-specific variables into existing models to make them generalizable to racially or geographically distinct regions.

[Frailty, Sarcopenia and Osteoporosis]

Frailty, sarcopenia and osteoporosis are entities specific to the elderly, who share some risk factors. For this reason, their relationship has been studied in different works, which have provided disparate results, probably because these studies have not always focused on the same aspects. This article reviews the relationship of frailty and sarcopenia with osteoporosis.

Association Between Low Kidney Function and Excess Weight Concerning Unfavourable Periodontal Health among Community-dwelling Older Japanese Women

PURPOSE

To investigate the association of low renal function and overweight with poor periodontal condition in community-dwelling older Japanese women.

MATERIALS AND METHODS

In total, 359 older women (age range: 55-74 years) participated in this study. Two periodontal parameters - the number of teeth with a probing pocket depth (PPD) or clinical attachment level (CAL) ≥ 4 mm - were used as the dependent variables. The principal independent variables were low renal function as defined by the estimated glomerular filtration rate (eGFR) and overweight as defined by the body mass index. Poisson regression analysis was used to calculate the ratio of means (RM).

RESULTS

The RMs of the number of teeth with a PPD or CAL ≥ 4 mm in an adjusted model without an interaction term were 1.21- or 1.27-fold higher among those with an eGFR < 60, while those among the participants with an eGFR < 60 in the adjusted model with interaction terms for the number of teeth with a PPD or CAL ≥ 4 mm were 1.43- or 1.36-fold higher. In addition, increments of periodontal risk with low renal function and overweight showed a slightly smaller to negative trend.

CONCLUSION

The present findings suggest a connection between unfavourable periodontal health and both renal function and being overweight among older Japanese women. A weak negative interaction was also found between poor renal condition and overweight in relation to periodontal condition.

Dynapenic abdominal obesity and the risk of depressive symptoms in middle-aged and older Chinese adults: Evidence from a national cohort study

BACKGROUND

Population-based evidence on the relationship between dynapenic abdominal obesity and depressive symptoms is rare. We aimed to prospectively investigate the relationship between dynapenic abdominal obesity and depressive symptoms among middle-aged and older Chinese adults.

METHODS

A total of 9322 participants free of depressive symptoms in the China Health and Retirement Longitudinal Study were included. The participants were divided into four groups: non-dynapenic/non-abdominal obesity (ND/NAO), non-dynapenic/abdominal obesity (ND/AO), dynapenic/non-abdominal obesity (D/NAO) and dynapenic/abdominal obesity (D/AO) according to the sex-specific grip strength (<28 kg for men and <18 kg for women) and waist circumference (≥85 cm for men and ≥80 cm for women) that in line with the Chinese criteria. Depressive symptoms was defined as a score of ≥12 for the 10-item Center for Epidemiological Studies Depression Scale. Logistic regression model was used to explore the association between dynapenic abdominal obesity and depressive symptoms.

RESULTS

After an approximately 3-year of follow-up, 1810 participants (19.4 %) developed depressive symptoms. The multivariable-adjusted odds ratio for the D/AO versus ND/NAO was 1.61 (95 % CI: 1.31-1.98) for depressive symptoms. In addition, this relationship was more profound in participants aged<60 years (OR = 2.27, 95 % CI: 1.60-3.22) than participants aged ≥60 (OR = 1.36, 95 % CI: 1.05-1.77; P-interaction = 0.04). However, dynapenic obesity (defined by body mass index) was not linked to depressive symptoms.

LIMITATIONS

Causal link and residual confounding were not addressed because of the observational study design.

CONCLUSIONS

Dynapenic abdominal obesity was associated with an increased risk of depressive symptoms, especially among those aged<60 years.

Lifestyle risk factors and all-cause and cause-specific mortality in the Mexico City prospective study: Assessing the influence of reverse causation

BACKGROUND

We examined the association between individual lifestyle risk factors with all-cause and cause-specific mortality.

METHODS

Prospective cohort study including 155,002 participants from the Mexico City Prospective Study. Cox regression models were used to estimate the association between individual lifestyle risk factors and all-cause and cause-specific mortality. Participants with prevalent diseases at baseline and participants who died during the first 2, 5, 10, and 15 years of follow-up were excluded to account for reverse causation.

RESULTS

27,469 people died during 18.3 years of follow-up years. Overweight and moderate alcohol consumption were inversely associated with all-cause mortality, while low physical activity and smoking were positively associated when all participants were included, regardless of prevalent disease or duration of follow-up. The direction of the association of overweight with all-cause mortality changed from inverse to positive after excluding the first 10 years of follow-up. Compared with normal weight, the hazard ratio (95 % confidence interval) was 1.17 (1.13,1.22) for obesity after excluding those who died in the first 5 years of follow-up and 1.71 (1.59,1.84) after excluding the first 15 years of follow-up. The magnitude of the association of alcohol intake, low physical activity, and smoking with mortality attenuated, whereas for fruits and vegetables increased, after excluding longer periods of follow-up.

LIMITATIONS

The data were collected exclusively in Mexico City; lifestyle risk factors were self-reported and thus prone to misclassification bias.

CONCLUSIONS

Reverse causation may influence both the magnitude and the direction of the associations between lifestyle risk factors and mortality.

Chinese visceral adiposity index and its transition patterns: impact on cardiovascular and cerebrovascular diseases in a national cohort study

BACKGROUND

Obesity affects approximately 800 million people worldwide and may contribute to various diseases, especially cardiovascular and cerebrovascular conditions. Fat distribution and content represent two related yet distinct axes determining the impact of adipose tissue on health. Unlike traditional fat measurement indices, which often overlook fat distribution, the Chinese visceral adiposity index (CVAI) is a novel metric used to assess visceral fat accumulation and associated health risks. Our objective is to evaluate its association with the risk of cardiovascular and cerebrovascular diseases.

METHODS

A nationwide longitudinal study spanning 9 years was conducted to investigate both the effects of baseline CVAI levels (classified as low and high) and dynamic changes in CVAI over time, including maintenance of low CVAI, transition from low to high, transition from high to low, and maintenance of high CVAI. Continuous scales (restricted cubic spline curves) and categorical scales (Kaplan-Meier curves and multivariable Cox regression analyses) were utilized to evaluate the relationship between CVAI and cardiovascular and cerebrovascular diseases. Furthermore, subgroup analyses were conducted to investigate potential variations.

RESULTS

Totally 1761 individuals (22.82%) experienced primary outcomes among 7717 participants. In the fully adjusted model, for each standard deviation increase in CVAI, there was a significant increase in the risk of primary outcomes [1.20 (95%CI: 1.14-1.27)], particularly pronounced in the high CVAI group [1.38 (95%CI: 1.25-1.54)] compared to low CVAI group. Regarding transition patterns, individuals who consistently maintained high CVAI demonstrated the highest risk ratio compared to those who consistently maintained low CVAI [1.51 (95%CI: 1.31-1.74)], followed by individuals transitioning from low to high CVAI [1.22 (95% CI: 1.01-1.47)]. Analysis of restricted cubic spline curves indicated a positive dose-response relationship between CVAI and risk of primary outcomes (p for non-linear = 0.596). Subgroup analyses results suggest that middle-aged individuals with high CVAI face a notably greater risk of cardiovascular and cerebrovascular diseases in contrast to elderly individuals [1.75 (95% CI: 1.53-1.99)].

CONCLUSION

This study validates a significant association between baseline levels of CVAI and its dynamic changes with the risk of cardiovascular and cerebrovascular diseases. Vigilant monitoring and effective management of CVAI significantly contribute to early prevention and risk stratification of cardiovascular and cerebrovascular diseases.

Mortality risk relationship using standard categorized BMI or knee-height based BMI - does the overweight/lower mortality paradox hold true?

BACKGROUND

The body mass index (BMI) is prone to misclassification of obesity due to age-related height loss and resulting measurement errors. Knee-height based BMI (KH-BMI) has not been previously studied in relation to mortality risk in older adults.

AIM

To evaluate the age- and sex-specific mortality risk relationship using classic BMI and knee height predicted BMI (KH-BMI) overweight and obesity in a 15-year follow-up study including older Swedish adults aged 60-93 years.

METHODS

A 15-year follow-up study among 2,786 individuals aged ≥ 60 years. Height, weight and KH were measured. KH-predicted height was estimated using formulated gender-specific equations. Classic BMI and KH-BMI (kg/m2) were calculated. Mortality data was obtained from the Swedish death registry. Questionnaires were used to collect data on obesity-related lifestyle factors and comorbidities.

RESULTS

Cox regression revealed that using the classic BMI, when comparing with the normal/underweight reference group, there was a mortality risk among overweight men (HR = 0.67, 0.52-0.87), overweight women (HR = 0.79, 0.65-0.97), and obese men (HR = 0.60, 0.41-0.89) aged ≥ 80 years old. Using the KH-BMI, only overweight men and overweight women aged ≥ 80 years had a lower mortality risk, men (HR = 0.71, 0.55-0.92); women (HR = 0.77, 0.62-0.95) after adjusting for obesity-related lifestyle factors and comorbidities.

DISCUSSION

There is evidence that obesity is overestimated by the BMI, in comparison with the KH-BMI classification. In terms of mortality risk and after adjusting for height, there remains a paradoxical protective association between overweight and mortality.

CONCLUSION

Regardless of classic BMI or KH-BMI estimation, overweight men and women aged ≥ 80 years had a lower mortality risk compared to normal/underweight men and women ≥ 80 years.

Multiplicative effect of frailty and obesity on postoperative mortality following spine surgery: a deep dive into the frailty, obesity, and Clavien-Dindo dynamic

BACKGROUND/OBJECTIVES

Obesity is a global health challenge that affects a large proportion of adults worldwide. Obesity and frailty pose considerable health risks due to their potential to interact and amplify one another's negative effects. Therefore, we sought to compare the discriminatory thresholds of the risk analysis index (RAI), 5-factor modified frailty index (m-FI-5) and patient age for the primary endpoint of postoperative mortality.

SUBJECTS/METHODS

We included spine surgery patients ≥18 years old, from the American College of Surgeons National Quality Improvement program database from 2012-2020, that were classified as obese. We performed receiver operating characteristic curve analysis to compare the discrimination threshold of RAI, mFI-5, and patient age for postoperative mortality. Proportional hazards risk-adjusted regressions were performed, and Hazard ratios and corresponding 95% Confidence intervals (CI) are reported.

RESULTS

Overall, there were 149 163 patients evaluated, and in the ROC analysis for postoperative mortality, RAI showed superior discrimination C-statistic 0.793 (95%CI: 0.773-0.813), compared to mFI-5 C-statistic 0.671 (95%CI 0.650-0.691), and patient age C-statistic 0.686 (95%CI 0.666-0.707). Risk-adjusted analyses were performed, and the RAI had a stepwise increasing effect size across frailty strata: typical patients HR 2.55 (95%CI 2.03-3.19), frail patients HR 3.48 (95%CI 2.49-4.86), and very frail patients HR 4.90 (95%CI 2.87-8.37). We found increasing postoperative mortality effect sizes within Clavein-Dindo complication strata, consistent across obesity categories, exponentially increasing with frailty, and multiplicatively enhanced within CD, frailty and obesity strata.

CONCLUSION

In this study of 149 163 patients classified as obese and undergoing spine procedures in an international prospective surgical database, the RAI demonstrated superior discrimination compared to the mFI-5 and patient age in predicting postoperative mortality risk. The deleterious effects of frailty and obesity were synergistic as their combined effect predicted worse outcomes.

Effect of Body Mass Index on Effectiveness of CT versus Invasive Coronary Angiography in Stable Chest Pain: The DISCHARGE Trial

Background Recent trials support the role of cardiac CT in the evaluation of symptomatic patients suspected of having coronary artery disease (CAD); however, body mass index (BMI) has been reported to negatively impact CT image quality. Purpose To compare initial use of CT versus invasive coronary angiography (ICA) on clinical outcomes in patients with stable chest pain stratified by BMI category. Materials and Methods This prospective study represents a prespecified BMI subgroup analysis of the multicenter Diagnostic Imaging Strategies for Patients with Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) trial conducted between October 2015 and April 2019. Adult patients with stable chest pain and a CAD pretest probability of 10%-60% were randomly assigned to undergo initial CT or ICA. The primary end point was major adverse cardiovascular events (MACE), including cardiovascular death, nonfatal myocardial infarction, or stroke. The secondary end point was an expanded MACE composite, including transient ischemic attack, and major procedure-related complications. Competing risk analyses were performed using the Fine and Gray subdistribution Cox proportional hazard model to assess the impact of the relationship between BMI and initial management with CT or ICA on the study outcomes, whereas noncardiovascular death and unknown causes of death were considered competing risk events. Results Among the 3457 participants included, 831 (24.0%), 1358 (39.3%), and 1268 (36.7%) had a BMI of less than 25, between 25 and 30, and greater than 30 kg/m2, respectively. No interaction was found between CT or ICA and BMI for MACE (P = .29), the expanded MACE composite (P = .38), or major procedure-related complications (P = .49). Across all BMI subgroups, expanded MACE composite events (CT, 10 of 409 [2.4%] to 23 of 697 [3.3%]; ICA, 26 of 661 [3.9%] to 21 of 422 [5.1%]) and major procedure-related complications during initial management (CT, one of 638 [0.2%] to five of 697 [0.7%]; ICA, nine of 630 [1.4%] to 12 of 422 [2.9%]) were less frequent in the CT versus ICA group. Participants with a BMI exceeding 30 kg/m² exhibited a higher nondiagnostic CT rate (7.1%, P = .044) compared to participants with lower BMI. Conclusion There was no evidence of a difference in outcomes between CT and ICA across the three BMI subgroups. Clinical trial registration no. NCT02400229 © RSNA, 2024 Supplemental material is available for this article.

Association of changes in waist circumference, waist-to-height ratio and weight-adjusted-waist index with multimorbidity among older Chinese adults: results from the Chinese longitudinal healthy longevity survey (CLHLS)

BACKGROUND

The association of changes in waist circumference (WC), waist-to-height ratio (WHtR) and weight-adjusted-waist index (WWI) with subsequent risk of multimorbidity remains unclear among older Chinese adults. Therefore, we aimed to assess this association by utilizing data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS).

METHODS

Our study was based on the 2011/2012 wave of the CLHLS whose follow-up surveys were conducted in 2014 and 2017/2018. A total of 2900 participants aged 65 and above at baseline were enrolled. WC, WHtR, and WWI were calculated from measured height, weight, and waist circumference. Multimorbidity refers to the coexistence of two or more of 18 chronic diseases. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95%CIs) to evaluate the effect of three-year changes in WC, WHtR, and WWI on the risk of multimorbidity.

RESULTS

During a mean follow-up time of 4.2 (2.0) years, 906 multimorbidity cases were identified. Compared to participants in the persistently low WC group, those in the WC gain group and the persistently high WC group had a higher multimorbidity risk with adjusted HRs (95%CI) of 1.23 (1.01-1.50) and 1.34(1.14-1.58), respectively. Participants in the WHtR gain group and the persistently high WHtR group also had higher risks of multimorbidity with HRs (95%CI) of 1.35 (1.08-1.67) and 1.27 (1.05-1.53), respectively, relative to the persistently low WHtR group. Compared to the persistently low WWI group, those in the WWI loss group had a lower risk of multimorbidity with HRs (95%CI) of 0.80 (0.66-0.98). For every standard deviation increase in WC, WHtR, and WWI over three years, the risk of multimorbidity was higher by 12% (95%CI: 1.05-1.19), 13% (95%CI: 1.06-1.20), and 12% (95%CI: 1.05-1.20), respectively.

CONCLUSIONS

Associations of changes in WC, WHtR and WWI with multimorbidity are significant among older Chinese adults. The findings highlight the importance of evaluating changes in WC, WHtR, and WWI in screening and prevention of multimorbidity in older adults.

The Association between Obesity and Reduced Weight-Adjusted Bone Mineral Content in Older Adults: A New Paradigm That Contrasts with the Obesity Paradox

The relationship between body weight and bone mass in the elderly remains unclear, and whether obesity is a protective factor is still a matter of debate. For this reason, the aim of this study is to assess the association between body mass index (BMI) and bone mineral content adjusted by body weight, expressed as a percentage (w-BMC%), and to test the validity of the obesity paradox in this context. A cohort of 1404 older adults was categorized according to the World Health Organization's BMI cut-off points and completed a total and segmental body composition measurement by means of a dual X-ray absorptiometry scan. Individuals with obesity displayed a lower mean w-BMC% (3.06 ± 0.44%; 2.60 ± 0.37%) compared to those who were normal-weight (3.95 ± 0.54%; 3.38 ± 0.48%) and overweight (3.06 ± 0.44%; 3.04 ± 0.37%) in both genders. Linear regression analysis also showed a negative association between BMI and w-BMC% in males (β = -0.09; p < 0.001) and females (β = -0.06; p < 0.001). Finally, among individuals with obesity, and after adjusting for age, the linear regression models revealed a significant decrease of 0.75% and 0.28% in w-BMC% for every one-unit increase in the trunk fat/appendicular lean mass ratio in both males (β = -0.749; p < 0.0001) and females (β = -0.281; p < 0.001). In conclusion, we suggest a new paradigm regarding the impact of obesity on bone mass, in which the former does not appear to be a protective factor of the latter, especially in individuals with central obesity and low muscle mass.

Subcutaneous fat predicts bone metastasis in breast cancer: A novel multimodality-based deep learning model

OBJECTIVES

This study explores a deep learning (DL) approach to predicting bone metastases in breast cancer (BC) patients using clinical information, such as the fat index, and features like Computed Tomography (CT) images.

METHODS

CT imaging data and clinical information were collected from 431 BC patients who underwent radical surgical resection at Harbin Medical University Cancer Hospital. The area of muscle and adipose tissue was obtained from CT images at the level of the eleventh thoracic vertebra. The corresponding histograms of oriented gradients (HOG) and local binary pattern (LBP) features were extracted from the CT images, and the network features were derived from the LBP and HOG features as well as the CT images through deep learning (DL). The combination of network features with clinical information was utilized to predict bone metastases in BC patients using the Gradient Boosting Decision Tree (GBDT) algorithm. Regularized Cox regression models were employed to identify independent prognostic factors for bone metastasis.

RESULTS

The combination of clinical information and network features extracted from LBP features, HOG features, and CT images using a convolutional neural network (CNN) yielded the best performance, achieving an AUC of 0.922 (95% confidence interval [CI]: 0.843-0.964, P< 0.01). Regularized Cox regression results indicated that the subcutaneous fat index was an independent prognostic factor for bone metastasis in breast cancer (BC).

CONCLUSION

Subcutaneous fat index could predict bone metastasis in BC patients. Deep learning multimodal algorithm demonstrates superior performance in assessing bone metastases in BC patients.

Association of visceral fat area or BMI with arterial stiffness in ideal cardiovascular health metrics among T2DM patients

BACKGROUND

"Obesity paradox" occurs in type 2 diabetes mellitus (T2DM) patients when body mass index (BMI) is applied to define obesity. We examined the association of visceral fat area (VFA) as an obesity measurement with arterial stiffness in seven ideal cardiovascular health metrics (ICVHMs).

METHODS

A total of 29 048 patients were included in the analysis from June 2017 to April 2021 in 10 sites of National Metabolic Management Centers. ICVHMs were modified from the recommendations of the American Heart Association. Brachial-ankle pulse wave velocity (BaPWV) ≥ 1400 cm/s was employed to evaluate increased arterial stiffness. Multivariate regression models were used to compare the different effects of BMI and VFA on arterial stiffness.

RESULTS

Lower VFA was more strongly associated with low BaPWV than lower BMI when other ICVHMs were included (adjusted odds ratio [OR], 0.85 [95% confidence interval [CI], 0.80-0.90] vs OR 1.08 [95% CI, 1.00-1.17]). Multivariable-adjusted ORs for arterial stiffness were highest in patients with the VAT area VFA in the range of 150-200 cm2 (adjusted OR, 1.26 [95% CI 1.12-1.41]). Compared with participants with VAT VFA < 100 cm2 , among participants with higher VAT VFA, the OR for arterial stiffness decreased gradually from 1.89 (95% CI, 1.73-2.07) in patients who had ≤1 ICVHM to 0.39 (95% CI, 0.25-0.62) in patients who had ≥5 ICVHMs.

CONCLUSION

In patients with T2DM, using VAT for anthropometric measures of obesity, VFA was more relevant to cardiovascular risk than BMI in the seven ICVHMs. For anthropometric measures of obesity in the ICVHMs to describe cardiovascular risk VFA would be more optimal than BMI.

Low Body Mass Index Patients Undergoing an Anterior Lumbar Fusion May Have an Increased Risk of Perioperative Complications

BACKGROUND

Previous research has shown that underweight patients may be at a greater risk of experiencing postsurgical complications. The purpose of this study was to investigate the association between body mass index (BMI) and postoperative complications following single-level anterior lumbar fusion (ALF).

METHODS

All single-level elective ALF procedures performed between 2010 and 2020 were identified in the PearlDiver Mariner Database. Patients were separated into 6 groups based on the World Health Organization BMI classifications. Differences in postsurgical complications (ie, deep vein thrombosis, pulmonary embolism, surgical site infection, hardware malfunction, wound dehiscence, and blood transfusion) among BMI categories were assessed using a χ2 contingency test.

RESULTS

Results indicated that underweight patients (BMI <20) were at a significantly greater risk of developing deep vein thromboses, experiencing hardware malfunction, and requiring blood transfusion compared with any other BMI classification (P < 0.001). Results also demonstrated that underweight individuals had similar risks of developing surgical site infection and wound dehiscence compared with patients classified as having obesity class III.

CONCLUSION

Underweight patients may be at a greater risk than currently believed of experiencing postoperative complications following single-level ALF procedures.

CLINICAL RELEVANCE

Patients with a BMI of 20 or less should be carefully evaluated prior to surgical intervention to ensure they are optimized for surgery.

LEVEL OF EVIDENCE: 3

BMI trajectory in adulthood in relation to all-cause and cause-specific mortality: A retrospective cohort study in Taiwan

A dynamic change of weight over time has been known as an important factor that impacts mortality risk. The aims of this study were to identify the heterogeneity of BMI trajectory groups and to examine the association of the trajectories of BMI and all-cause and cause-specific mortality. The data for this study were obtained from a large prospective cohort study in Taiwan between 1998 and 2019 that was linked to the National Death Registry for death information. The participants were stratified into four groups by age and gender; self-reported demographics and measured BMI data were used. We used group-based trajectory analysis to identify the distinct trajectories of changes in BMI. A Cox proportional hazards model was used to assess the hazard ratio (HR) of all-cause and cause-specific mortality risk. Data were analyzed in April 2020 and included 89,886 participants. Four trajectory groups were identified by the pattern of BMI change over time. Our study shows that different trajectories were associated with mortality. Our findings suggest that the mortality risk differs in each trajectory group and in each age and gender stratification. It appears that obesity is a protective factor in cancer-related mortality in females but not in males in group of old age participants; low-normal weight is a risk factor in respiratory-related mortality in all participants. Our findings can be used to suggest the appropriate BMI in each age and gender groups and thereby earlier health interventions can be taken to avoid mortality.