BACKGROUND

Maternal malnutrition is a major cause of low birth weight (LBW) newborn outcome especially among adolescent mothers. It is one of the key drivers of child stunting and initiates the vicious cycle of intergenerational malnutrition. The body mass index prior to pregnancy or at the initial trimester is currently being used to establish the desired weight gain throughout pregnancy. However, Filipino adolescents often delay their first antenatal visit at a later stage of pregnancy. Without a baseline weight, the establishment of appropriate weight gain and nutritional status is often challenging. Mid-upper arm circumference (MUAC) was proven to be a good proxy measure of acute malnutrition, however, there was no global consensus on what MUAC cut-off point to use to identify pregnant adolescents at risk for delivering LBW babies. Finding the optimal cut-off could facilitate early identification and intervention of pregnant adolescents who are nutritionally at risk and could eventually break the cycle of intergenerational malnutrition.

The study aims to determine the association of maternal MUAC and the birth weight outcomes among newborn deliveries of adolescents in a tertiary hospital for a period of six months and to identify the optimal maternal MUAC cut-off point that can be used to predict low birth weight outcome among newborn deliveries of adolescents in a tertiary hospital.

A cross-sectional study was conducted among adolescents ages 10 to 19 years who delivered babies in a tertiary hospital in the Philippines for a period of six months. Maternal MUAC and LBW outcome were documented, and their association was determined using a logistic regression analysis. To measure diagnostic accuracy, the sensitivity, specificity, and the area under the curve were taken for each MUAC point. A receiver operating characteristic (ROC) curve was used to aid the MUAC cut-off determination.

Out of 237 newborn deliveries, 35% were noted with low birth weight while 65% had normal birth weight. Most of the mothers were in their late adolescence at 78%. The crude association for the MUAC cut-offs ≤23.00 cm, ≤23.50 cm, and ≤24.00 cm and LBW showed a significant value of 2.19, 2.25, and 2.39 at 95% CI, respectively. However, it is only the cut-off ≤24.00 cm that showed significant results for adjusted association by the logistic regression analysis. The MUAC cut-off ≤24.00 cm also showed a better trade-off value between the sensitivity and specificity. Furthermore, the optimal maternal MUAC measurement that predicts LBW newborn outcome points to ≤24.00 cm cut-off based on the ROC curve.

This study shows that the maternal MUAC is predictive of LBW outcome among adolescent deliveries.A MUAC cut-off of ≤24.00 cm was superior to lower cut-offs studied. The pregnant adolescents might need a higher MUAC cut-off than adults to allow timely intervention and prevention of poor neonatal outcomes. By doing this simple screening test, suspected pregnant adolescents can be easily identified and referred for further confirmatory testing.

OBJECTIVE

This study aimed to determine the association between Asia-Pacific classification of body mass index, waist circumference and waist hip ratio and clinical outcomes of COVID-19 moderate & severe patients at the height of the COVID-19 pandemic.

A This study involved adult patients diagnosed with COVID-19. 182 patients were analyzed and divided into 167 moderate and 15 severe COVID-19 patients. Primary outcomes (respiratory decompensation, septic shock, and mortality) of patients were compared among Asia Pacific BMI groups.

Among patients with moderate and severe COVID-19, 7 out of 10 patients were obese. Respiratory decompensation and sepsis were more frequently seen in obese patients. Obesity and waist circumference were significantly associated with the odds of respiratory decompensation (95% CI p=0.010 and p=0.002), however this association was not sustained upon adjustment for confounders. On univariate analysis, waist and hip circumferences were significantly associated with the odds of ICU admission (95% CI, p=.013 and p=.034), however after controlling for confounders, only hip ratio retained significant association. Among patients with severe COVID-19, there was insufficient evidence to support significant variations in distributions of outcomes of interest across Asia-Pacific BMI groups.

Our study emphasized that although respiratory decompensation and sepsis were more frequently seen in obese patients. progression of respiratory decompensation and mortality is not significantly associated with obesity as defined by the Asia Pacific BMI classification, warranting the need for larger prospective studies.

Background: The association of obesity with adverse COVID-19 outcomes is known, but unexplored in younger adults. Objective: To determine the association of obesity [body mass index (BMI) of ≥30] with severe COVID-19 outcomes in younger and older adults. Design: Retrospective cohort study. Participants: 391 patients with COVID-19 (226 younger adults aged 18-60 years, and 165 older adults aged >60 years). Setting: Southern Philippines Medical Center, Davao City, January 2021 to September 2021. Main outcome measures: Severe COVID-19 outcomes (high-flow oxygen administration, ICU admission, mechanical ventilation, death); odds ratio of severe outcomes in patients with BMI of ≥30. Main results: Of 391 patients (median age of 57 years), 286 had a BMI of <30, while 105 had a BMI of ≥30. Univariate regression analysis showed that a BMI of ≥30 was significantly associated with any severe COVID-19 outcomes (OR=2.68; 95% CI 1.68 to 4.27; p<0.001). This remained after adjusting for age, sex, hypertension, diabetes, and cardiovascular disease (adjusted OR=3.19; 95% CI 1.93 to 5.27; p<0.001). A BMI of ≥30 was also significantly associated with any severe outcomes among younger adults (adjusted OR=4.04; 95% CI 2.23 to 7.32; p<0.001), but not among older adults (adjusted OR=1.80; 95% CI 0.70 to 4.64; p=0.227). Conclusion In our study, among all adults, a BMI of ≥30 significantly increased the odds of experiencing any severe COVID-19 outcomes. This association was also observed in the younger adult subgroup, but not in the older adult subgroup.
SARS-CoV-2 ; Body Mass Index ; Immunity ; Critical Care

BACKGROUND: Chronic illnesses such as Type 2 diabetes mellitus (T2DM) and obesity have been implicated as risk factors in the development of cognitive impairment (CI), but despite this, definite association between the two conditions in increasing cognitive impairment risk is not well defined. OBJECTIVE: This study aims to examine the association between body mass index (BMI) and cognitive impairment (CI) in elderly patients with Type 2 diabetes mellitus. METHODS: This is a cross-sectional study conducted in the outpatient clinics of a private hospital in Manila which included elderly patients with Type 2 diabetes. BMI categories of the subjects were determined using the Asia-Pacific criteria and the Montreal Cognitive Assessment – Philippines (MOCA-P) was administered to subjects who fulfilled the inclusion criteria. Descriptive statistics were used to determine the prevalence of impaired cognition among subjects while risk ratio analysis was used to determine the correlation between BMI and CI. Correlation analysis and linear regression analysis were used to determine the presence of association between cognition (measured by MOCA-P scores) and BMI. For all analysis, a 95% level of significance was used. RESULTS: A total of 109 subjects from the outpatient clinics were included in the study. A high percentage of the study population (90.83%) had CI based on MOCA-P scores. Subjects that belonged to the extremes of BMI- underweight and obese class 2 had higher incidence of CI compared to the other groups. Underweight subjects had 1.103 (95% CI: 1.038 to 1.172) times likelihood of having impaired cognition (p-value 0.0016), while obese 2 subjects had 1.110 (95% CI: 1.040 to 1.184) times likelihood of having impaired cognition (p-value 0.0016). Regression analysis revealed that in subjects with diabetes of less than 10 years, cognition scores were negatively correlated to BMI (p-value 0.0454). Correlation analysis revealed that at the general population level, regardless of the external factors, increasing or decreasing BMI did not have significant effect on cognition scores. CONCLUSION Subjects who belonged to the extremes of BMI-underweight and obese class 2 – had higher incidence of CI compared to the other BMI groups. Among subjects with T2DM duration of less than 10 years, cognition scores tend to be negatively correlated to BMI.
diabetes mellitus, Type 2 ; cognitive impairment ; cognitive dysfunction ; Body Mass Index

Background: Hyperinsulinemia due to insulin resistance is hypothesized to act as a promotor of cancer growth. In addition to the direct effects of hyperinsulinemia on cancer cells, the stimulation of tumor cell growth can also be indirectly mediated through growth factors and receptors such as insulin-like growth factor 1 (IGF-1). Increased cancer risk is also associated with increased adipose tissue, such as in abdominal obesity, due to the higher risk of insulin resistance and hyperinsulinemia. Waist circumference is a parameter that indicates an individual's level of adiposity. In addition, the risk of cancer also increases in the elderly as they age. This study aims to assess the correlation between waist circumference and IGF-1 levels in the elderly population in Bali, Indonesia. Methodology: This study used a cross-sectional analytical design conducted in the Melinggih Village, Gianyar Regency. The study was conducted in September 2023. This study has been approved by the Research Ethics Commission number 2020/UN14.2.2.VII.14/LT/2023. The study population included elderly individuals residing in the Melinggih Village who were willing to participate. Data analysis encompassed descriptive analysis and the Spearman correlation test. Result: A total of 88 subjects participated in the study, consisting of 57 females (64.8%) and 31 males (35.2%). A statistically significant but weak correlation coexists between waist circumference and IGF-1 levels. Conclusion A weak but statistically significant positive correlation was found between waist circumference and IGF-1 levels in the elderly. However, because of the small sample size, another study with a bigger sample size with enough power to investigate this association needs to be done to validate the results of the current study.
Elderly ; Aged ; IGF-1 ; Insulin-Like Growth Factor I ; Waist Circumference

Obesity ; Body Mass Index ; Leptin ; Inflammation ; Adipose Tissue

Objective: To investigate the distribution of blood pressure and analyze the associated factors of blood pressure of the elderly with type 2 diabetes in Jiangsu Province. Methods: The elderly over 60 years old participants with type 2 diabetes in the communities of Huai'an City and Changshu City, Jiangsu Province were selected in this study. They were divided into two groups: taking antihypertensive drugs and not taking antihypertensive drugs. The demographic characteristics, such as age and sex, and relevant factors were collected by questionnaire. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured by physical examination. The percentile of SBP and DBP in each age group of men and women were described. The kernel density estimation curve was used to show the blood pressure distribution. The trend of blood pressure with age was fitted by locally weighted regression. The logistic regression model was used to analyze relevant factors of blood pressure. Results: A total of 12 949 participants were included in this study, including 7 775 patients in the antihypertensive drug group and 5 174 patients in the group without antihypertensive drugs. The SBP of participants was concentrated at 140-160 mmHg, and their DBP was concentrated at 75-85 mmHg. There were significant differences in the distribution of blood pressure among the subgroups of body mass index (BMI) and rural areas whether taking antihypertensive drugs and not. For participants aged under 80 years old, the SBP showed an increasing trend with age and the DBP showed a decreasing trend with age. Age, BMI ≥24 kg/m², fasting blood glucose ≥7.0 mmol/L, living in rural areas and no smoking were influencing factors of the elevated SBP; BMI ≥24 kg/m², male, living in rural areas, no smoking, drinking alcohol and not receiving drug hypoglycemic treatment were influencing factors of the elevated DBP. Conclusion: The SBP of older diabetic adults in Jiangsu Province is at a high level, and the distribution of blood pressure is significantly different between men and women in taking antihypertensive drugs group. The SBP presents a rising trend and the DBP is decreasing at the age of 60-80 years. The blood pressure level of this population are mainly affected by age, BMI, urban and rural areas, smoking.
Adult ; Aged ; Humans ; Male ; Female ; Middle Aged ; Aged, 80 and over ; Blood Pressure/physiology* ; Diabetes Mellitus, Type 2/epidemiology* ; Antihypertensive Agents/therapeutic use* ; Smoking ; Body Mass Index ; Hypertension/epidemiology*

From January 2019 to December 2021, overweight and obese children who visited in health outpatient Center of Hunan Children's Hospital were studied to explore and analyze the rate, related factors and patterns of multimorbidity of overweight and obesity-related diseases in children in Hunan Province. Univariate and multivariate logistic regression models were used to analyze the multimorbidity-related factors of overweight and obesity-related diseases in children. Association rules (apriori algorithm) were used to explore the multimorbidity patterns of overweight and obesity-related diseases in children. A total of 725 overweight and obese children were included in this study. The multimorbidity rate of overweight and obesity-related diseases in children was 46.07% (334/725). Age, waist circumference, the frequency of food consumption such as hamburgers and fries and adding meals before bedtime were multimorbidity-related factors of overweight and obesity-related diseases in children. The multimorbidity associated with nonalcoholic fatty liver disease (NAFLD) was relatively common. The patterns with the top three support degrees were "NAFLD+dyslipidemia","NAFLD+hypertension" and "NAFLD+hyperuricemia". The patterns with the top three confidence and elevation degrees were "Hypertension+dyslipidemia => NAFLD","Hyperuricemia => NAFLD" and "NAFLD+hypertension => dyslipidemia".
Child ; Humans ; Overweight/complications* ; Non-alcoholic Fatty Liver Disease ; Pediatric Obesity/epidemiology* ; Hyperuricemia ; Multimorbidity ; Hypertension/epidemiology* ; Dyslipidemias ; Body Mass Index ; Risk Factors

Objective: To analyze the incidence of preterm birth based on pre-pregnancy body mass index (BMI) stratification and explore the associated factors of preterm birth among pregnant women at different BMI stratifications. Methods: From February 2018 to December 2020, pregnant women who participated in China Birth Cohort Study (CBCS) and gave birth at Beijing Obstetrics and Gynecology Hospital were enrolled as the study subjects. Electronic Data Capture System and standard structured questionnaires were used to collect data related to pre-pregnancy, pregnancy, and delivery for pregnant women. Pregnant women were divided into the low-weight group, normal-weight group and overweight group based on their pre-pregnancy BMI. A Cox proportional hazards model was used to analyze the associated factors of preterm birth among pregnant women with different BMI before pregnancy. Results: A total of 27 195 singleton pregnant women were included, with a preterm birth rate of 5.08% (1 381/27 195). The preterm birth rates in the low-weight group, normal-weight group and overweight group were 4.29% (138/3 219), 4.63% (852/18 390) and 7.00% (391/5 586) respectively (P<0.001). After adjusting for relevant factors, the Cox proportional hazards model showed that the risk of preterm birth in the overweight group was 1.457 times higher than that in the normal-weight group (95%CI: 1.292-1.643). Preeclampsia-eclampsia (HR=2.701, 95%CI: 1.318-5.537) was the associated factor for preterm birth in the low-weight group. Advanced maternal age (HR=1.232, 95%CI: 1.054-1.441), history of preterm birth (HR=4.647, 95%CI: 3.314-6.515), vaginal bleeding in early pregnancy (HR=1.613, 95%CI: 1.380-1.884), and preeclampsia-eclampsia (HR=3.553, 95%CI: 2.866-4.404) were associated factors for preterm birth in the normal-weight group. Advanced maternal age (HR=1.473, 95%CI: 1.193-1.818), history of preterm birth (HR=3.209, 95%CI: 1.960-5.253), vaginal bleeding in early pregnancy (HR=1.636, 95%CI: 1.301-2.058), preeclampsia-eclampsia (HR=2.873, 95%CI:2.265-3.643), and pre-gestational diabetes mellitus (HR=1.867, 95%CI: 1.283-2.717) were associated factors for preterm birth in the overweight group. Conclusion: Pre-pregnancy overweight is an associated factor for preterm birth, and there are significant differences in the associated factors of preterm birth among pregnant women with different BMI before pregnancy.
Pregnancy ; Infant, Newborn ; Female ; Humans ; Body Mass Index ; Overweight/epidemiology* ; Premature Birth/epidemiology* ; Pre-Eclampsia/epidemiology* ; Cohort Studies ; Eclampsia ; Incidence ; Risk Factors ; Thinness/epidemiology*

Objective: To comprehensively evaluate the physical health level of students of different school-age segments in four regions of Anhui province using the entropy weight approximation ideal solution ranking method (TOPSIS), and to provide a scientific method and basis for conducting school health work evaluation. Methods: Using the physical fitness survey data of four regions in Anhui province, the entropy weight method was used to draw the weights of various indicators for different school-age segments of men and women. Then, the TOPSIS method was used to evaluate the school-age segments of men and women in the four regions. Finally, the physical health level of students in four regions was classified according to the results of entropy weight TOPSIS and the rank sum ratio method. Results: A total of 10 127 students were included in this study, with an average age of (11.85±3.82) years, including 5 050 males (49.8%) and 5 072 urban students (50.1%). The results of the entropy weight method showed that the weight of body mass index of boys was similar to that of girls in each school-age segment. According to the TOPSIS and rank sum ratio analysis, the physical health level of students in the four regions of Anhui province was different. The physical health score of Suzhou was 0.617 4 points, which was classified as the best grade. The scores of Hefei and Wuhu were 0.556 3 and 0.411 2, which were classified as middle. Jiju City scored 0.381 9 points, which was classified as poor. Conclusion: TOPSIS combined with rank sum ratio can reflect the level of students' physical health, which can be applied to the evaluation of students' physical health and provide a basis for monitoring students' physical health .
Male ; Humans ; Female ; Child ; Adolescent ; Entropy ; Health Status ; Physical Fitness ; Students ; Body Mass Index