The causal relationship between obesity and skin and soft tissue infections: A two-sample Mendelian randomization study

The Impact of Obesity on Readmission and Healthcare Costs in Patients with Skin and Subcutaneous Tissue Infections

Purpose

Obesity is a global public health issue linked to worsened skin and subcutaneous tissue infections (SSTIs), complicating clinical management and increasing healthcare costs. This study aimed to evaluate obesity's influence on hospitalization duration, readmission rates, and healthcare costs among patients with SSTIs, with an emphasis on sex-specific patterns.

Patients and Methods

This retrospective cohort study analyzed data from South Korea's national healthcare database. The study population comprised adults hospitalized with SSTIs between 2015 and 2020. Obesity measures included body mass index (BMI) and waist circumference (WC), categorized by standard thresholds. Statistical analyses included Cox proportional hazards models for hospitalization duration, while multivariable logistic regression evaluated readmission risks. Healthcare costs were analyzed using generalized linear models, with sex-stratified analysis to examine clinical and economic outcome disparities.

Results

Male patients demonstrated an inverse relationship between BMI and hospitalization duration and costs, with minimal WC influence. Conversely, female patients exhibited positive associations between both obesity measures and hospitalization outcomes. SSTI-related readmissions within two years increased with rising BMI and WC across both sexes (p < 0.001). Estimated readmission costs showed significant sex-specific variations, increasing 55% among males with WC ≥ 100 cm versus < 80 cm and 132% among females with WC ≥ 95 cm versus < 75 cm.

Conclusion

Obesity substantially impacts SSTI clinical severity and economic costs, with distinct sex-specific disparities. Implementing tailored antimicrobial regimens, weight management strategies, and sex-specific treatment protocols is essential for outcome optimization and cost reduction. Future research should prioritize sex-specific interventions and resource allocation strategies in SSTI management.

Health Implications Associated with Fat-Free Mass: A Phenome-Wide Mendelian Randomization Study

INTRODUCTION

Fat-free mass (FFM) is a critical component of the human body, with implications for various diseases.

METHODS

We conducted a comprehensive analysis integrating a phenome-wide association study (PheWAS), a two-sample Mendelian randomization (MR) analysis, and a systematic review to investigate the associations between FFM and health outcomes.

RESULTS

PheWAS identified 183 phenotypes enriched for FFM associations, including diseases, body composition, and lifestyle factors. A two-sample MR analysis using the FinnGen and UK Biobank dataset revealed significant associations between genetically determined FFM and 36 disease outcomes, including cardiovascular diseases, metabolic disorders, and musculoskeletal conditions. The mediation MR analysis indicates that FFM indirectly influences the levels of five biomarkers in visceral adipose tissue. A systematic review identified consistent associations between FFM and several diseases, including type 2 diabetes and cervical disc disorders. Moreover, new associations such as low back pain and ovarian cancer were discovered.

CONCLUSION

These findings challenge the conventional notion of FFM as a protective factor in health, suggesting that higher FFM levels may be linked to an increased risk of various diseases. Further clinical studies are warranted to validate these findings and elucidate the underlying mechanisms.

Causal relationship of obesity and adiposity distribution on risk of ventral hernia

PURPOSE

Ventral hernia (VH) is a common surgical disease. Previous studies suggested that obesity is an important risk factor for VH. However, the causal relationship between fat distribution and the risk of VH is still unclear. This study used Mendelian randomization (MR) to evaluate their causal relationship.

METHODS

We used the body mass index (BMI), body fat percentage, and body fat mass to represent general obesity and utilized the volume of abdominal subcutaneous adiposity tissue, visceral adiposity tissue, waist circumference, hip circumference, and waist-to-hip ratio to represent abdominal adiposity. The data were extracted from the large-scale genome-wide association study of European ancestry. We used two-sample MR to infer causality, using multivariate MR to correct the effects of confounding factors.

RESULTS

Increased BMI, body fat percentage, body fat mass, visceral adiposity tissue, waist circumference, and hip circumference rather than subcutaneous adiposity tissue or waist-to-hip ratio, were causally associated with a higher risk of VH. The results of multivariate MR suggested that body fat percentage was causally associated with a higher risk of VH after adjusting for body mass index, diabetes, and smoking.

CONCLUSION

General obesity, increased visceral adiposity tissue, waist circumference, and hip circumference rather than subcutaneous adiposity tissue or the waist-to-hip ratio were causally associated with a higher risk of VH. These findings provided a deeper understanding of the role that the distribution of adiposity plays in the mechanism of VH.

Unveiling the Uncommon: A Rare Case of Group A Streptococcus Axillary Lymphadenitis With Ambiguous Presentation Leading to Multiple Misdiagnoses

Axillary lymphadenitis in adults presents a diagnostic challenge due to its diverse etiology and variable clinical manifestations. We present a rare case of suppurative Group A Streptococcus (GAS) axillary lymphadenitis secondary to a puncture wound, emphasizing the critical importance of differential diagnosis and immediate intervention. A 36-year-old male initially presented with left axillary pain and discomfort following a traumatic injury to the left thumb. Despite multiple healthcare encounters and misdiagnoses including viral illness and shingles, the patient's condition deteriorated, manifesting as fever, edema, and erythema in the left axilla. This case underscores the paramount significance of considering lymphadenitis in patients with axillary symptoms, particularly following trauma or skin breaches. Early recognition and appropriate management are crucial to prevent grave complications such as abscess formation, thrombophlebitis, and bacteremia. Streptococcal axillary lymphadenitis should be included at the forefront of the differential diagnosis to expedite treatment and mitigate potential life-threatening consequences associated with delayed diagnosis.