Analysis of the Effects of Maternal Body Mass Index and Gestational Weight Gain on Maternal and Neonatal Outcomes in Twin Pregnancy

Objective:To investigate the effects of maternal body mass index(BMI)and gestational weight gain on maternal and neonatal outcomes in twin pregnancies.Methods:Five hundred cases of twin pregnancies were divided into a low body weight group(68 cases),a normal weight group(355 cases),an overweight group(65 cases),and an obesity group(12 cases)according to the World Health Organization(WHO)Body Mass Index(BMI)classification guidelines Results:Comparison of weight gain during different pregnancies revealed that pregnant women were mainly of low weight and average weight.The higher the BMI before pregnancy,the higher the incidence of excessive weight gain during pregnancy.The incidences of gestational diabetes mellitus(GDM)and premature rupture of membranes in women with low weight gain were significantly higher than those in women with average weight gain and high weight gain(P<0.05).The incidences of gestational hypertension,preeclampsia,and anemia in women with high weight gain were significantly higher than those in women with low weight gain and average weight gain(P<0.05).The incidence of neonatal birth weight,fetal distress,and macrosomia in the high weight gain group was significantly higher than those in the low weight gain and average weight gain groups(P<0.05).The birth weight of newborns in low-weight gain mothers was significantly lower than that of normal-weight gain mothers(P<0.05).Conclusion:Poor maternal and infant outcomes were common in women with insufficient or excessive weight gain during pregnancy.Therefore,for women with twin pregnancies,weight management is crucial to ensure maternal and infant health.

Impact of body mass index on adverse kidney events in diabetes mellitus patients: A systematic-review and meta-analysis

BACKGROUND The incidence of chronic kidney disease among patients with diabetes mellitus(DM)remains a global concern.Long-term obesity is known to possibly influence the development of type 2 diabetes mellitus.However,no previous meta-analysis has assessed the effects of body mass index(BMI)on adverse kidney events in patients with DM.AIM To determine the impact of BMI on adverse kidney events in patients with DM.METHODS A systematic literature search was performed on the PubMed,ISI Web of Science,Scopus,Ovid,Google Scholar,EMBASE,and BMJ databases.We included trials with the following characteristics:(1)Type of study:Prospective,retrospective,randomized,and non-randomized in design;(2)participants:Restricted to patients with DM aged≥18 years;(3)intervention:No intervention;and(4)kidney adverse events:Onset of diabetic kidney disease[estimated glomerular filtration rate(eGFR)of<60 mL/min/1.73 m2 and/or microalbuminuria value of≥30 mg/g Cr],serum creatinine increase of more than double the baseline or end-stage renal disease(eGFR<15 mL/min/1.73 m2 or dialysis),or death.RESULTS Overall,11 studies involving 801 patients with DM were included.High BMI(≥25 kg/m2)was significantly associated with higher blood pressure(BP)[systolic BP by 0.20,95%confidence interval(CI):0.15–0.25,P<0.00001;diastolic BP by 0.21 mmHg,95%CI:0.04–0.37,P=0.010],serum albumin,triglycerides[standard mean difference(SMD)=0.35,95%CI:0.29–0.41,P<0.00001],low-density lipoprotein(SMD=0.12,95%CI:0.04–0.20,P=0.030),and lower high-density lipoprotein(SMD=–0.36,95%CI:–0.51 to–0.21,P<0.00001)in patients with DM compared with those with low BMIs(<25 kg/m2).Our analysis showed that high BMI was associated with a higher risk ratio of adverse kidney events than low BMI(RR:1.22,95%CI:1.01–1.43,P=0.036).CONCLUSION The present analysis suggested that high BMI was a risk factor for adverse kidney events in patients with DM.

Lean body mass index is a marker of advanced tumor features in patients with hepatocellular carcinoma

BACKGROUND Obesity is an independent risk factor for the development of hepatocellular carcinoma(HCC)and may influence its outcomes.However,after diagnosis of HCC,like other malignancies,the obesity paradox may exist where higher body mass index(BMI)may in fact confer a survival benefit.This is frequently observed in patients with advanced HCC and cirrhosis,who often present late with advanced tumor features and cancer related weight loss.AIM To explore the relationship between BMI and survival in patients with cirrhosis and HCC.METHODS This is a retrospective cohort study of over 2500 patients diagnosed with HCC between 2009-2019 at two United States academic medical centers.Patient and tumor characteristics were extracted manually from medical records of each institutions'cancer registries.Patients were stratified according to BMI classes:<25 kg/m^(2)(lean),25-29.9 kg/m^(2)(overweight),and>30 kg/m^(2)(obese).Patient and tumor characteristics were compared according to BMI classification.We performed an overall survival analysis using Kaplan Meier by the three BMI classes and after adjusting for Milan criteria.A multivariable Cox regression model was then used to assess known risk factors for survival in patients with cirrhosis and HCC.RESULTS A total of 2548 patients with HCC were included in the analysis of which 11.2%(n=286)were classified as noncirrhotic.The three main BMI categories:Lean(n=754),overweight(n=861),and obese(n=933)represented 29.6%,33.8%,and 36.6%of the total population overall.Within each BMI class,the non-cirrhotic patients accounted for 15%(n=100),12%(n=94),and 11%(n=92),respectively.Underweight patients with a BMI<18.5 kg/m^(2)(n=52)were included in the lean cohort.Of the obese cohort,42%(n=396)had a BMI≥35 kg/m^(2).Out of 2262 patients with cirrhosis and HCC,654(29%)were lean,767(34%)were overweight,and 841(37%)were obese.The three BMI classes did not differ by age,MELD,or Child-Pugh class.Chronic hepatitis C was the dominant etiology in lean compared to the overweight and obese patients(71%,62%,49%,P<0.001).Lean patients had significantly larger tumors compared to the other two BMI classes(5.1 vs 4.2 vs 4.2 cm,P<0.001),were more likely outside Milan(56%vs 48%vs 47%,P<0.001),and less likely to undergo transplantation(9%vs 18%vs 18%,P<0.001).While both tumor size(P<0.0001)and elevated alpha fetoprotein(P<0.0001)were associated with worse survival by regression analysis,lean BMI was not(P=0.36).CONCLUSION Lean patients with cirrhosis and HCC present with larger tumors and are more often outside Milan criteria,reflecting cancer related cachexia from delayed diagnosis.Access to care for hepatitis C virus therapy and liver transplantation confer a survival benefit,but not overweight or obese BMI classifications.

In-hospital outcomes in COVID-19 patients with non-alcoholic fatty liver disease by severity of obesity:Insights from national inpatient sample 2020

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)increases the risk of cardiovascular diseases independently of other risk factors.However,data on its effect on cardiovascular outcomes in coronavirus disease 2019(COVID-19)hospitalizations with varied obesity levels is scarce.Clinical management and patient care depend on understanding COVID-19 admission results in NAFLD patients with varying obesity levels.AIM To study the in-hospital outcomes in COVID-19 patients with NAFLD by severity of obesity.METHODS COVID-19 hospitalizations with NAFLD were identified using International Classification of Disease-10 CM codes in the 2020 National Inpatient Sample database.Overweight and Obesity Classes Ⅰ,Ⅱ,and Ⅲ(body mass index 30-40)were compared.Major adverse cardiac and cerebrovascular events(MACCE)(all-cause mortality,acute myocardial infarction,cardiac arrest,and stroke)were compared between groups.Multivariable regression analyses adjusted for sociodemographic,hospitalization features,and comorbidities.RESULTS Our analysis comprised 13260 hospitalizations,7.3% of which were overweight,24.3% Class Ⅰ,24.1% Class Ⅱ,and 44.3% Class Ⅲ.Class Ⅲ obesity includes younger patients,blacks,females,diabetics,and hypertensive patients.On multivariable logistic analysis,Class Ⅲ obese patients had higher risks of MACCE,inpatient mortality,and respiratory failure than Class Ⅰ obese patients.Class Ⅱ obesity showed increased risks of MACCE,inpatient mortality,and respiratory failure than Class I,but not significantly.All obesity classes had non-significant risks of MACCE,inpatient mortality,and respiratory failure compared to the overweight group.CONCLUSION Class Ⅲ obese NAFLD COVID-19 patients had a greater risk of adverse outcomes than class Ⅰ.Using the overweight group as the reference,unfavorable outcomes were not significantly different.Morbid obesity had a greater risk of MACCE regardless of the referent group(overweight or Class Ⅰ obese)compared to overweight NAFLD patients admitted with COVID-19.

Body Mass Index and Body Fat Percentage in Assessment of Obesity Prevalence in Saudi Adults

Objective To assess the obesity prevalence in body mass index （BMI） and body fat percentage Saudi adults according to the international standards of （BF%）. Methods Five hundred and thirty healthy Saudi adults aged 18-72 years （mean 36.91＋15.22 years） were enrolled in this study. Their body composition was assessed by bioelectrical impendence analysis with a commercially available body composition analyzer. Standard BMI and BF% values were used to define obesity. Results The prevalence of underweight, normal underweight, overweight and obesity in Saudi adults according to the BMI criteria （〈18.5 kg/mz, 18.5-24.4 kg/m2, 25-29.9 kg/m2, 30 k＆/m2 and above, respectively） was 2.5%, 30.2%, 33.6%, and 33.8%, respectively, whereas the obesity prevalence was 60% （n=31g） in Saudi adults according to the BF% criteria （25% for males and 30% for females）, which was significantly higher than that according to BMI criteria. However, it was 50.6% （n=268） when the BMI cutoff point was 27.5 kg/m2, proposed by WHO for the Asian population. Kappa analysis showed that the obesity prevalence defined by BMI and BF% was higher in females than in males （k=0.530 vs k=0.418, P〈O.O001）. The sensitivity and specificity of BMI （30 kg/m2 and 27.5 kg/m2） were 54.1% and 96.7% and 76.4% and 88.2%, respectively, for obesity. A lower BMI cutoff point （26.60 kg/m2） was proposed in this study, which gave the maximum sensitivity （84.3%） and specificity （85.4%）, with a moderate kappa agreement （k=0.686）. Moreover, the obesity prevalence at this cutoff point （56.4%） was significantly higher than that recommended by WHO. Conclusion The specificity of BMI for obesity is high and its sensitivity is low in both sexes. Its sensitivity can be increased by changing BMI cutoff to a lower value. The choice of BF% reference is of great influence for the assessment of obesity prevalence according to the BMI.

Ethnic Differences in Body Mass Index and Prevalence of Obesity in School Children of Urumqi City, Xinjiang, China

Objective To investigate the prevalence of obesity and distribution of body mass index （BMI） in school children of four ethnic groups in Urumqi, Xinjiang, China. Methods A total of 55 508 school children of Han, Hui, Uygur and Kazak nationalities aged 8-18 years were selected by a cluster sampling from a districts of Urumqi City for anthropometrie measurement and demographic survey. Prevalence of obesity and overweight and distribution of body mass index （BMI） by gender, age, and nationality were analyzed and compared. Cutoff points of BMI for defining obesity and overweight were based on the proposal set by the Working Group on Obesity in China （WGOC） to assess age-, gender- and nationality-specific prevalence of obesity and overweight. Results Prevalence of obesity was 5.34%, 6.78%, 3.39 %, and 1.22% for boys and 2.61%, 1.83%, 1.78%, and 1.40% for girls of Han, Hui, Uygur and Kazak nationalities, respectively. Prevalence of obesity tended to decrease with age overall, whereas that of overweight increased with age in Han children. Conclusions Prevalence of obesity in school children in Urumqi varies with their nationalities and is lower than that of an average national level and a level of western countries. Obesity is more prevalent in boys than in girls of Urmuqi overall, which is just the opposite in Kazak children. Han boys and Hui girls have the highest prevalence of obesity and Kazak boys and girls have the lowest ones. Prevalence of obesity decreases with age, but that of overweight shows a different trend.

Higher body mass index deteriorates postoperative outcomes of pancreaticoduodenectomy

Background:Previous studies presented controversies in impact of body mass index(BMI)on perioper-ative complications in pancreatectomy,and mainly focused on Western population.This study aimed to explore the impact of BMI on perioperative outcomes in Chinese patients undergoing pancreaticoduo-denectomy.Methods:Seven hundred and seven adult patients undergoing open pancreaticoduodenectomy between January 2005 and December 2016 at Ruijin Hospital were studied retrospectively and categorized as obese(BMI≥25 kg/m^2),overweight(BMI≥23 kg/m^2 and<25 kg/m^2),or normal weight(BMI≥18.5 kg/m^2 and<23 kg/m^2).Associations of these BMI groups with perioperative outcomes were evaluated.Results:The overweight and obese groups experienced higher risk of clinically related postoperative pan-creatic fistula(CR-POPF)(7.6%vs.9.9%vs.17.6%,P=0.002)and re-operation(1.1%vs.2.5%vs.5.1%,P=0.017),and longer systemic inflammation response syndrome(SIRS)duration[2(1–9)d vs.2(1–7)d vs.3(1–10)d,P=0.003]and postoperative hospital stay[19(2–84)d vs.19(7–158)d vs.23(8–121)d,P=0.023]than the normal weight group did.The multiple logistic regression models showed obese as an independent risk factor for CR-POPF(P=0.013).The multiple linear regression analysis confirmed BMI as a predictor for prolonged postoperative hospital stay(P=0.005).Conclusions:Higher BMI results in higher morbidity of Chinese patients undergoing open pancreaticoduo-denectomy.Pancreaticoduodenectomy is still a safe surgery procedure for overweight and obese patients,with intensive perioperative management.

Impact of body mass index on short-term outcomes of laparoscopic gastrectomy in Asian patients: A meta-analysis

AIM To perform a meta-analysis to investigate the correlation between body mass index(BMI) and the shortterm outcomes of laparoscopic gastrectomy(LG) for gastric cancer(GC) in Asian patients. METHODS The Pub Med, Cochrane, EMBASE, and Web of Science databases were searched for studies that focused on the impact of obesity on the short-term outcomes of LG for GC in Asian patients who were classified into a high BMI(BMI ≥ 25 kg/m^2) or low BMI group(BMI < 25 kg/m^2). The results are expressed using the pooled odds ratio(OR) for binary variables and standard mean difference(SMD) for continuous variables with 95%confidence interval(CI), and were calculated according to the fixed-effects model while heterogeneity was not apparent or a random-effects model while heterogeneity was apparent.RESULTS Nine studies, with a total sample size of 6077, were included in this meta-analysis. Compared with the low BMI group, the high BMI group had longer operative time(SMD = 0.26, 95%CI: 0.21 to 0.32, P < 0.001), greater blood loss(SMD = 0.19, 95%CI: 0.12 to 0.25, P < 0.001), and fewer retrieved lymph nodes(SMD =-0.13, 95%CI: 0.18 to 0.07, P < 0.001). There was no significant difference between the high and low BMI groups in postoperative complications(OR = 1.12, 95%CI: 0.95 to 1.33, P = 0.169), the duration of postoperative hospital stay(SMD = 0.681, 95%CI:-0.05 to 0.07, P = 0.681), postoperative mortality(OR = 1.95, 95%CI: 0.78 to 4.89, P = 0.153), or time to resuming food intake(SMD = 0.00, 95%CI:-0.06 to 0.06, P = 0.973).CONCLUSION Our meta-analysis provides strong evidence that despite being associated with longer operative time, greater blood loss, and fewer retrieved lymph nodes, BMI has no significant impact on the short-term outcomes of LG for GC in Asian patients, including postoperative complications, the duration of postoperative hospital stay, postoperative mortality, and time to resuming food intake. BMI may be a poor risk factor for shortterm outcomes of LG. Other indices should be taken into account.

Decreased Gastric Body Mucosa Obestatin Expression in Abdominal Obesity Patients With Normal Body Mass Index

The aim of the study was to investigate whether the expression of obestatin in gastric body mucosa in abdominal obesity patients with normal body mass index （BMI） is different compared with healthy controls. Twenty abdominal obesity patients with normal BMI and twenty healthy controls were included in the study. The number of obestatin-positive cells in gastric body mucosa was significantly lower in abdominal obesity patients with normal BMI than that in healthy subjects.

Effect of body mass index on functional outcomes following arthroplasty procedures

AIM: To evaluate the body mass index(BMI) change in arthroplasty patients and its impact on the patients' functional results. METHODS: Between October 2010 and May 2013, 606 patients who were operated due to gonarthrosis, coxarthrosis, aseptic loosening of the total knee and hip prosthesis were evaluated prospectively. Patients were operated by three surgeons in three medical centers. Patients who were between 30-90 years of age and who were underwent total knee arthroplasty, total hip arthroplasty, revision knee arthroplasty, or revision hip arthroplasty were included in the study. We excluded the patients who cannot tolerate our standard postoperative rehabilitation program. Additionally, patients who had systemic inflammatory diseases, diabetes mellitus, or endochrinopathies were excluded from the study. The remaining 513 patients comprised our study group. Preoperative functional joint scores, height, weightand BMI of all patients were recorded. We used the Knee Society Score(KSS) for knee and Harris Hip Score(HHS) for hip patients. Postoperative functional scores were measured at 1^(st), 6^(th) and 12^(th) months and recorded separately at outpatient visits. RESULTS: The mean age of the patients was 64.7(range: 30-90) years(207 males/306 females) and the mean follow-up duration was 14.3(range: 12-26) mo. We found that arthroplasty patients had weight gain and had an increase in BMI at the postoperative 1^(st), 6^(th) and 12^(th) months. The mean BMI of the patients was 27.7 preoperatively, 27.8 at the postoperative 1^(st) month, 28.1 at the 6^(th) month and 28.6 at the 12^(th) month(P < 0.01). At the last visit, the mean postoperative HHS of the hip arthroplasty patients was 82.2 ± 7.12(preoperatively, 52.3; 1st month, 78.2; 6^(th) month, 81.1; 12^(th) month, 82.2), and the mean KSS of the knee arthroplasty patients was 79.3 ± 4.31(preoperatively, 35.8; 1^(st) month, 75.2; 6^(th) month, 79.1; 12^(th) month, 79.3). Worse functional results were noted in the patients who had a BMI increase, however, this correlation was statistically significant only at the postoperative 6^(th) month(P = 0.03). CONCLUSION: To prevent the negative functional effects of this weight gain during the postoperative period, arthroplasty patients should be advised for weight control and risky patients should consult with a dietician.

Body mass index and COVID-19 outcomes:A retrospective cross-sectional study at a tertiary care center in India

Objective:To determine the association between body weight and COVID-19 outcomes.Methods:This is a retrospective cohort study of COVID-19 patients admitted in a dedicated COVID-19 hospital,a tertiary health care center,between May and June 2021.Demographic data and baseline variables,including age,sex,body mass index(BMI),and comorbidities were collected.Outcomes(death or mechanical ventilation)of the patients with different BMI,age,comorbidities,and qSOFA scores were compared.Besides,the risk factors for death or mechanical ventilation were determined.Results:The mean age of the subjects was(51.8±14.7)years old,and 233(74.2%)were male.There were 103(32.8%)patients with normal weight,143(45.5%)patients were overweight,and 68(21.7%)patients were obese.In-hospital deaths and need of mechanical ventilations were significantly higher in the obese and the overweight group compared to the normal weight group,in age group≥65 years compared to<65 years,in patients with≥1 comorbidities compared to patients without comorbidities,in patients with qSOFA scores≥2 compared to patients with qSOFA scores<2.There was a significantly increased risk of death(RR:4.1,95%CI 1.0-17.4,P=0.04)and significantly increased need of mechanical ventilation(RR:5.2,95%CI 1.8-15.2,P=0.002)in the obese patients compared with those with normal weight after controlling other covariates.Conclusion:Obesity is one of the significant risk factors for adverse outcomes in COVID-19 patients and should be considered during management.

Adverse pregnancy outcomes in women with high pre-pregnancy body mass index

Background/Aims: Obesity along with high prepregnancy body mass index (PP-BMI) is known to cause many adverse pregnancy outcomes. In Thailand, there is not much study showing both the prevalence and complications of these conditions. The objectives of this study were to estimate the prevalence of prepregnancy overweight and obesity and their impacts on adverse pregnancy outcomes. Methods: This study was a cross sectional study. Data were collected retrospectively from hospital electronic database along with manual retrieval from medical charts and labor records. Data of all delivery women from 1st February 2011 to 31st August 2012 were collected. When excluded cases with incomplete data and those without PP-BMI, 5420 cases were into analysis. Descriptive and inferential data analyses were used with both univariate and multivariate methods. Results: The proportion of pregnant women with overweight and obesity were 11.1% and 3.9%. After multiple logistic regression analysis was done, women in obesity group were correlated with having 1, 2 and 3 complications. They were also correlated with preeclampsia, gestational diabetes, cesarean section, higher birth weight group and long neonatal length. Conclusions: This Thai prevalence of obesity in pregnancyshould alarm health care providers to be more prepared, for a future health problem of the country. Many complications that come with obese pregnant women that were reported in western countries also happen in Thai population. Decreasing body weight before conception, giving correct health education, well planned pregnancy;antenatal lifestyle intervention and even gestational weight gain restricttion could help avoiding these uneventful morbidities.

Impact of body mass index on outcomes of 48281 patients undergoing first time cadaveric liver transplantation

AIM: To investigate possible disparities in perioperative morbidity and mortality among different body mass index(BMI) groups and to simulate the impact that these differences might have had on the cohort of patients undergoing cadaveric liver transplantation(LT).METHODS: All adult recipients undergoing first time LT for benign conditions and receiving a whole graft from brain-dead donors were selected from the united network of organ sharing registry. From January 1994 to June 2013, 48281 patients satisfied the inclusion criteria and were stratified by their BMI. The hypothesis that abnormal BMIs were independent predictors of inferior outcomes was tested with univariate and multivariate regression analyses.RESULTS: In comparison to normal weight recipients, underweight and morbidly obese recipients had increased 90-d mortality(adjusted OR = 1.737; 95%CI: 1.185-2.548, P = 0.005)(adjusted OR = 1.956; 95%CI: 1.473-2.597, P = 0.000) respectively and inferior patients' survivals(adjusted HR = 1.265; 95%CI: 1.096-1.461, P = 0.000)(adjusted HR = 1.157; 95%CI: 1.031-1.299, P = 0.013) respectively. Overall, patients' 5-year survival were 73.9% for normal-weight, 71.1% for underweight, 74.0% for overweight, 74.4% for class Ⅰ obese, 75.0% for class Ⅱ obese and 71.5% for class Ⅲ obese recipients. Analysis of hypothetical exclusion of underweight and morbidly obese patients from the pool of potential LT candidates would have improved the overall survival of the entire cohort by2.7%(95%CI: 2.5%-3.6%).CONCLUSION: Selected morbidly obese patients undergoing LT for benign conditions had 5-year survival rates clinically comparable to normal weight recipients. Impact analysis showed that exclusion of high-risk recipients(underweight and morbid obese patients) would not significantly improve the overall survival of the entire cohort of patients requiring LT.

High pre-delivery body mass index also caused adverse pregnancy outcomes

Background/Aims: It is known that high pre-preg-nancybody mass index (BMI) and high gestational weight gain both can cause many adverse pregnancy outcomes. High pre-delivery BMI (PD-BMI), though theoretically could do similar effects, is rarely been studied. The objectives of this study were to show the distribution of PD-BMI of the delivery women and to identify its correlation with adverse pregnancy outcomes. Methods: This study was a cross sectional study. Data were collected retrospectively from hospital electronic database of Lampang Regional Hospital (LPH) along with manual retrieval from medical charts and labor records. Data of all pregnant women who delivered at labor room were collected from 1st February 2011 to 31st August 2012. After preterm and multifetal pregnancies were excluded, 4999 cases were into the analysis. Descriptive and inferential data analyses were used with both univariate and multivariate methods. Results: In this group of women, 93.9% were in the PD-BMI range of 20.0 -34.9 kg/m2. After multivariate analysis was used, higher PD-BMI was shown to be correlated with higher cesarean section, neonates weighing ≥3500 gmand long neonatal length with relative risk (RR) and 95% confidence interval (95% CI) of 1.11 (1.09 - 1.13), 1.15 (1.12 - 1.17) and 1.07 (1.05 - 1.09), respectively. Conclusions: High PD-BMI was correlated with multiple adverse pregnancy outcomes. Interestingly, their effect sizes were much smaller comparing to high pre-pregnancy BMI and high gestational weight gain. It confirmed the current recommendations to monitor pre-pregnancy BMI and gestational weight gain to avoid unwanted morbidities.

Perioperative outcomes and survival of radical cystectomy as a function of body mass index

AIM: To evaluate the perioperative and long term outcomes of cystectomy in obese patients.METHODS: This is a retrospective review of 580 patients for whom radical cystectomy(RC) was performed for primary urothelial bladder cancer between November 1996-April 2013 at a single institution. Body mass index(BMI) was available for 424 patients who were categorized as underweight(< 18.5), normal(18.5-24.9), overweight(25.0-29.9), and obese(≥ 30). Baseline demographics, perioperative outcomes, and survival were assessed. Overall survival(OS) and disease specific survival(DSS) was estimated by Kaplan-Meier method. Medians were compared using the Mann-Whitney U Test. Categorical variables were compared using the χ2 test. A P-value of < 0.05 was considered statistically significant. Statistical analyses were performed using the Software Package for the Social Sciences(SPSS), Version 20(International Business Machines SPSS, Chicago, IL, United States). RESULTS: The median age of all patients was 69 years(inter-quartile range 60-75) and median followup was 23.4 mo(8.7-55.1). Patients were characterized as underweight [9,(2.1%)], normal [113,(26.7%)],overweight [160,(37.8%)], or obese [142,(33.5%)]. Estimated blood loss during RC was higher in the obese group(800 m L) as compared to the normal weight group(500 m L). However, need for transfusion(47.7% vs 52.1%), number of lymph nodes resected(32 vs 30), length of stay(9 d vs 8 d), and 30-d readmission(29.7% vs 25.2%) between obese and normal BMI patients were similar. Obese patients underwent ileal neobladder diversion in 42% of cases, compared to 24% of normal BMI patients(0.003). Normal BMI and obese patients had comparable urinary incontinence(21.4% vs 25.6%, P = 0.343), and need for intermittent catheterization(14.3% vs 5.2%, P = 0.685) at 2 years follow-up. Overall survival was better in obese compared to normal BMI patients on univariate analysis, with median survival of 67 mo vs 37 mo, respectively(P = 0.031). Disease specific survival in these populations followed the same Kaplan Meier curve, with the obese group having a significantly improved OS, P = 0.016. Underweight patients had a significantly worse prognosis, with a median overall survival of 19 mo(P = 0.018). Disease specific survival was significantly worse in the underweight group compared to the obese group, P = 0.007. On multivariate analysis underweight patients remained at increased risk for death(HR = 3.1, P = 0.006), as were older patients(HR = 1.6, P = 0.006), those with multiple nodal metastases(HR = 3.7, P = 0.007), and those who had received neoadjuvant chemotherapy(HR = 2.0, P = 0.015).CONCLUSION: Perioperative outcomes and survival following RC in obese patients is comparable with nonobese patients. Underweight patients have the worst OS and DSS.

Analysis of TCM Syndrome Characteristics of 122 Cases of Simple Obesity in Germany and its Correlation with Body Mass Index

Objective:To investigate the distribution of TCM syndromes,the regularity of syndrome differentiation and the correlation between syndromes and body mass index(BMI)of simple obesity in Germany.Methods:From July 2020 to May 2021,122 patients with simple obesity were collected from the Bad Koetzting hospital of Beijing University of Chinese Medicine.The basic information of age,gender,height,weight and TCM syndrome were collected.The distribution of syndrome and its correlation with BMI were analyzed by frequency analysis and single sample chi square test.Results:According to the frequency,the syndrome distribution of simple obesity was as follows:yin deficiency and internal heat type,liver stagnation and qi stagnation type,qi stagnation and blood stasis type,spleen and kidney deficiency type,spleen deficiency and dampness resistance type and stomach heat and dampness resistance type.The BMI of spleen kidney deficiency type was the highest,while that of stomach heat dampness stagnation type was the lowest.There was no significant difference in BMI between stomach heat and dampness stagnation type,liver qi stagnation type,qi stagnation and blood stasis type(P=0.110,P=0.111).There was no significant difference in BMI between yin deficiency and internal heat type and liver stagnation,qi stagnation and blood stasis type(P=0.175,P=0.437).However,there were significant differences in BMI among other TCM syndromes(P<0.01).Conclusion:The most common TCM syndrome type of simple obesity in Germany is yin deficiency and internal heat type,and the highest BMI value is spleen and kidney deficiency type,and there is a certain correlation between BMI value and different TCM syndrome types of simple obesity.

A body mass index ≥25 kg/m2 is associated with a poor prognosis in patients with acute pancreatitis: a study of Japanese patients

BACKGROUND:In Asian population, there is limited infor mation on the relevance between obesity and poor outcomes in acute pancreatitis(AP). The objective of this study was to examine the clinical impact of obesity based on body mass index(BMI) on prognosis of AP in Japanese patients.METHODS:A total of 116 patients with AP were enrolled in this study. Univariate and multivariate logistic regression analyses were performed to examine relations between BMI and patients’ outcomes. Additionally, to investigate whether including obesity as a prognostic factor improved the predic tive accuracy of a Japanese prognostic factor score(PF score)a receiver-operating characteristic(ROC) curve analysis of mortality was conducted.RESULTS:Multiple logistic regression analyses revealed that BMI ≥25 kg/m2was associated with a significant higher mor tality [odds ratio(OR)=15.8; 95% confidence interval(CI):1.1-227; P=0.043]. The area under the ROC curve(AUC) for the combination of PF score and BMI ≥25 kg/m2(AUC=0.881;95% CI:0.809-0.952) was higher than that for the PF score alone(AUC=0.820; 95% CI:0.713-0.927)(P=0.034).CONCLUSIONS:The negative impact of a high BMI on the prognosis of AP was confirmed in a Japanese population Including BMI ≥25 kg/m2 as an additional parameter to PF score enhanced the predictive value of the PF score for AP-related mortality.

Secular Changes on the Distribution of Body Mass Index among Chinese Children and Adolescents, 1985-2010

Objective To analyze the change in Body Mass Index （BMI） distribution among Chinese children and adolescents for the development of more effective intervention for childhood obesity. Methods Data on the national students＇ constitution and health survey between 1985 and 2010 was used for this study. Subjects were students aged 7-18 randomly selected from 30 provinces in China. BMI for-age curves were developed by LMS method, and the trend of BMI distribution was determined by comparing the upper BMI percentiles and analyzing the skew shift of distribution between 2985 and 2010. Results An overall positive swift trend of BMI between 1985 and 2010 was observed among the Chinese school-age children and adolescents. The average median of the BMI increased from 16.8 and 17.0 ks/m2 to 18.2 and 17.9 kg/m2 in 25 years, with increments 0.56 and 0.36 kg/m2 per decade for males and females, respectively. The more obvious increments were found at the high BMI. The total increments of BMI in this period were 4.03 and 2.20 kg/m2 at the 85th, 6.24 and 3.57 kg/m2 at the 95th, and 6.99 and 4.27 kg/m2 at the 97th percentiles, for males and females, respectively. Conclusion Obvious increments were observed at high BMI of the Chinese children and adolescents. More effective interventions should be taken for control and prevention of obesity and its health consequence for these subgroups. It is necessary to establish a risk-complex system consisting of the identification of BMI scope, the screen of the disease risk factors and the assessment of excessive adiposity.

Benefit of laparoscopic liver resection in high body mass index patients

AIM: To explore the impact of body mass index(BMI) on surgical outcomes in patients undergoing laparoscopic liver resection(LLR).METHODS: From January 2010 to February 2015, sixty-eight patients who underwent primary partial liver resection in our institute were retrospectively reviewed. Surgical outcomes of LLR were compared with those of open liver resection(OLR). In addition, we analyzed associations with BMI and surgical outcomes.RESULTS: Among 68 patients, thirty-nine patients underwent LLR and 29 were performed OLR. Significant difference in operation time, blood loss, and postoperative hospital stay was observed. There were no signi ficant di fferences in mortali ty and morbidity in two groups. Twenty-two patients(32.4%) were classified as obese(BMI ≥ 25). A statistically significant correlation was observed between BMI and operation time, between BMI and blood loss in OLR, but not in LLR. The operation time and blood loss of OLR were significantly higher than that of LLR in obese patients. Open liver resection and BMI were independent predictors for prolonged operation time and increased blood loss in multivariate analysis.CONCLUSION: The present study demonstrated that BMI had influenced to surgical outcomes of OLR. LLR was less influenced by BMI and had great benefit in obese patients.

Body mass index is not associated with sperm-zona pellucida binding ability in subfertile males

Lifestyle factors, such as weight and nutritional status may affect male fertility, including sperm fertilization ability. The objective of this retrospective study was to evaluate the association between body mass index （BMI） and sperm-zona pellucida binding ability assessed according to the zona binding （ZB） test, which has been described to be a relevant diagnostic tool for the prediction of in vitro fertilization （IVF） ability. Three hundred and six male patients from couples diagnosed with primary idiopathic or mild male factor infertility were included. Correlations between BMI and semen parameters according to ZB test indices were assessed, together with frequencies of positive and negative tests across the BMI categories. In this selected population, BMI was not related to conventional semen parameters or sperm quality assessed according to the ability of spermatozoa to bind to the zona pellucida. The previously described poor outcomes of IVF procedures in cases of male obesity could be due to other sperm defects, such as alterations of sperm capacitation or acrosome reaction. The link between male BMI and biological outcomes during IVF procedures, such as fertilization rates, should be further evaluated.