The Generative AI Meta-Evaluation (GAME) Study Framework: Global, Regional, and Country-Specific Unequal Difficulty of High BMI Intervention

Left Ventricular Function Across the Spectrum of Body Mass Index in African Americans: The Jackson Heart Study

The Obesity Paradox: Body Mass Index Complication Rates Vary by Gender and Age Among Primary Total Hip Arthroplasty Patients

BackgroundHigher body mass index (BMI) is associated with increased risk of incident atrial fibrillation (AF), but it is not known whether this relationship varies by race/ethnicity.Methods and ResultsEligible participants (6739) from MESA (Multi‐Ethnic Study of Atherosclerosis) were surveilled for incident AF using MESA hospital surveillance, scheduled MESA study ECG, and Medicare claims data. After a median 13.8 years of follow‐up, 970 participants (14.4%) had incident AF. With BMI modeled categorically in a Cox proportional hazards model, only those with grade II and grade III obesity had increased risks of AF (hazard ratio [HR], 1.50; 95% CI, 1.14–1.98, P=0.004 for grade II obesity and HR, 2.13; 95% CI, 1.48–3.05, P<0.0001 for grade III obesity). The relationship between BMI and AF risk was J‐shaped. However, the risk of AF as a function of BMI varied substantially by race/ethnicity (P value for interaction=0.02), with Chinese‐American participants having a much higher risk of AF with higher BMI and Black participants having minimal increased risk of AF with higher BMI.ConclusionsObesity is associated with an increased risk of incident AF, but the relationship between BMI and the risk of AF is J‐shaped and this relationship differs by race/ethnicity, such that Chinese‐American participants have a more pronounced increased risk of AF with higher BMI, while Black participants have minimal increased risk. Further exploration of the differential effects of BMI by race/ethnicity on cardiovascular outcomes is needed.

Our aim was to evaluate liver transplant outcomes involving donors with high macrosteatosis grafts in the obese modern liver transplant recipient population. A high-steatosis graft was defined as donor graft macrosteatosis ≥30% on biopsy. Recipient obesity was defined as body mass index (BMI) >35 adjusted for ascites. Raw and adjusted recipient liver transplant survival were evaluated and compared between 4 cohorts: (1) high-steatosis graft in high-BMI recipient; (2) low-steatosis graft in high-BMI recipient; (3) high-steatosis graft in normal-BMI recipient; and (4) low-steatosis graft in normal-BMI recipient. After adjustment for multiple factors, recipient high-BMI remained an independent predictor of posttransplant mortality at 30 days (P < 0.0001) and persisted at 1 year (P = 0.009). A high-steatosis graft was the strongest independent predictor of mortality at 30 days (hazard ratio 2.05, 1.66-2.53; P < 0.0001) and that effect was diminished but persistent at 1 year (1.27, 1.10-1.46; P = 0.001). Recipient high-BMI and a high-steatosis graft are both significant independent and equally powerful predictors of mortality after modern liver transplant. High-steatosis grafts transplanted into obese recipients have the highest mortality. The increase in mortality associated with a high-steatosis graft into a normal-BMI recipient is similar in magnitude to a low-steatosis graft placed into a high-BMI recipient.

The purpose of this study is to describe the changes in the age-standardized prevalence rate, incidence rate, and years lived with disability (YLDs) rate for gout disease and the associated risk factors in 21 North Africa and Middle East (NAME) countries from 1990 to 2019 based on age, gender, and socio-demographic index (SDI). From 1990 to 2019, the Global Burden of Disease (GBD) team performed a comprehensive systematic review of databases and disease-modeled analysis in the NAME countries. Age-standardized prevalence, incidence, and YLD rates, as well as the attributed burden to risk factors (high body mass index (BMI) and kidney dysfunction), were reported with 95% uncertainty intervals (UIs). The age-standardized YLDs estimated in 2019 and 1990 were 14.2 (95% UI 8.9-20.4) and 15.8 (10.0-22.7) per 100,000 populations, respectively, with an increase of 11.7% (7.1-16.4%) from 1990. The health indicators were all reported to be higher among males. The three countries with higher SDI that had the highest age-standardized YLDs rate in 2019 were Qatar (22.5 [14.5-32.7]), the United Arab Emirates (20.5 [12.9-29.9]), and Kuwait (19.0 [11.7-27.6]), while YLDs in 2019 attributable to high BMI and kidney dysfunction were estimated to be 7.2 (3.8-12.2) and 3.7 (2.3-5.5) per 100,000, respectively. According to our findings, the burden of gout in the NAME is higher than the reported global average and has risen from 1990 to 2019. Despite advances in gout treatment, NAME countries should prioritize preventive interventions to manage the disease's burden. Gout is the most common type of inflammatory arthropathy, and there have been no specific reports of this disease burden in the NAME countries, which account for nearly 8% of the global population. This report estimated that age-standardized YLDs increased by 11.7% (7.1%-16.4%) from 1990 to 2019 in this region. Consequently, these countries have to prioritize preventive interventions to manage the disease's burden.

BackgroundHigh body mass index in type 2 diabetes mellitus patients has been known to cause adverse impacts in treatment and prevention of diabetes-related complications. High body mass index has further been linked with poor control of blood pressure, cholesterol, and blood glucose levels among individuals with type 2 diabetes mellitus. So this study aimed to assess the magnitude of high body mass index and its associated factors among type 2 diabetes mellitus patients attending follow-up clinics at hospitals in Wolaita zone, Southern Ethiopia, 2021. MethodsInstitution-based cross-sectional study was conducted from March 24 up to May 25, 2021. Sampled type 2 diabetes mellitus patients attending follow-up clinics at hospitals in the Wolaita zone were included. The sample size was determined using epi info version 7 and the final sample was 526. A systematic random sampling technique was used to select the study participants. Data were entered using epidata version 3.1 and analyzed using Statistical package software for social science version 25. Binary logistic regression was done to determine the relationship of each independent variable with the dependent variable. Both bivariable and multivariable analyses were conducted and those variables that showed a p-value less than 0.25 were the candidate for multivariable analysis. Then multivariable analysis by the step-wise backward method used and variables that showed p-value less than 0.05 with 95% CI were reported as statistically significant factors. ResultThe magnitude of high body mass index was 49.9 %(CI: 45.4, 54). Female gender (AOR 1.978, CI (1.349, 2.901), alcohol drinking of 2–3 times per week (AOR: 2.442, CI (1.315, 4.432:), poor dietary practice (AOR: 1.964, CI (1.347, 2.864), being hypertensive (AOR: 1.543, CI (1.037, 2.296), and low physical activity (AOR: 3.108, CI (1.722, 5.609) were significantly associated with high body mass index. Conclusion and RecommendationThe magnitude of the high body mass index in this study was high. Being female, alcohol drinking 2–3 times per week, poor dietary practice, being hypertensive and low physical activity were significant factors associated with high body mass index in the study area. Health promotion and preventive programs such as dietary modification, alcohol restriction and physical exercise should be added to the therapeutic programs.

Prognostic Value of Body Mass Index in Stage II/III Colon Cancer: Posthoc Analysis From the TOSCA Trial

Global, regional and national burden and trends of disease attributable to high body mass index in adolescents and young adults from 1990 to 2021.

BackgroundHigh body-mass index (BMI) is a major modifiable risk factor for gynecological cancers, yet its contribution to the global cancer burden remains incompletely characterized. This study provides a comprehensive analysis of the current burden of gynecological cancers attributable to high BMI and projects future trends through 2050.MethodsWe analyzed data from the Global Burden of Disease (GBD) 2021 study, examining uterine and ovarian cancers attributable to high BMI across 204 countries and territories. Burden was quantified using deaths and disability-adjusted life years (DALYs). Temporal trends were identified using joinpoint regression analysis, while future burden was projected using Bayesian Age-Period-Cohort (BAPC) models. We evaluated relationships between socio-demographic index (SDI) and cancer burden to identify development-associated patterns.ResultsBetween 1990 and 2021, global deaths from gynecological cancers attributable to high BMI increased by 143.4% (from 20,743–50,479), with corresponding DALYs rising by 141.7% (from 561,515–1,357,395). Rising age-standardized rates indicated increasing individual-level risk. While burden was highest in high-SDI regions, the most rapid increases occurred in low- and middle-SDI settings. Cancer-specific patterns varied, with uterine cancer showing consistent increases across all SDI quintiles, while ovarian cancer exhibited decreasing trends in high-SDI regions after 2003. Projections indicate a 2.6-fold increase in deaths by 2050, with differential growth by cancer type: a 3.2-fold increase for ovarian cancer versus 2.3-fold for uterine cancer.ConclusionsThe global burden of gynecological cancers attributable to high BMI has increased substantially and is projected to accelerate through 2050, particularly in developing regions. These findings underscore the urgent need for targeted obesity prevention strategies within comprehensive cancer control programs to avert a substantial proportion of future gynecological cancer cases.

Previous studies have explored people's perceptions of weight-related terminology; however, to date, limited data has explored the emotional response to weight-related terms used by healthcare professionals (HCPs). This study explored the preferences and emotional responses of terms used by HCPs to describe body weight and of parents to describe their children's weight. A total of 2911 adults completed an online cross-sectional survey, with 1693 living with overweight or obesity (mean age 49.2 years [SD 12.5], female (96%), median body mass index (BMI) 31.4kg/m2 [28.1, 36.5]). The survey explored preferences of 22 weight-related terms using a 5-point Likert scale and their emotional response to these terms (using 7-core emotions). Parents also indicated preferences and emotional responses to terms used to describe their children's weight. Respondents completed the modified weight bias internalization scale to examine how this may impacted preferences. 'Weight', "unhealthy weight" and "overweight" were the three preferred terms, while "super obese", "chubby", and "extra-large" were least preferred in people living with overweight and obesity. Parents preferred 'weight', "unhealthy weight" and "body mass index", and least preferred "fat", "extra-large" and "extremely obese" when describing their children's weight. All terms elicited a negative emotional response. The most commonly emotion was sadness for terms to describe adult's bodyweight, and anger for terms used to describe children's weight. All BMI categories reported disgust with terms incorporating "obese". Our results offer novel insight into the preferred terminology and emotional responses to terminology used by HCPs for both adults and parents to describe their children's weight.

Impact of body mass index on overall survival in patients with metastatic breast cancer

Health hazards of obesity have been recognized for centuries, appearing, for example, in writings attributed to Hippocrates. From the later decades of the 20th century through the present, there have been numerous epidemiological studies of the relationship between excess weight and the total, or all-cause, mortality rate,1 a critical cumulative measure of the public health impact of any health condition. Using body mass index (BMI), an indicator of relative weight for height (weight [kg]/height [m]2) and a frequently used surrogate for assessment of excess body fat, these studies have found linear, U-shaped, or J-shaped relationships between total mortality and BMI. That is, in some studies, both the thin and the obese were more likely to die than those in between. There is, however, always a point at which increasing BMI is associated with increasing mortality risk, but the BMI at which this occurs varies across studies and populations.2 Currently,3 overweight in adults is defined as a BMI of 25.0 to <30.0 kg/m2 and obesity as a BMI of ≥30.0 kg/m2 (Table 1). A number of studies have found no significant relationship between BMI in the overweight range and mortality rate4 and have shown the nadir of mortality risk to be in the overweight range. In particular, commentaries in both the lay press5–7 and scientific literature2,8,9 subsequent to recent reports from National Health and Nutrition Examination Surveys (NHANES)10,11 have highlighted the confusion and controversy regarding this issue. Some have interpreted the recent data to mean that overweight is not detrimental to health and is not in itself a public health concern and that drawing attention to the need for weight loss in this range will have negative effects on the health and well-being of the general population.8 Others have argued …

BackgroundHigh body mass index (BMI) has become the leading risk factor of disease burden in high-income countries. While recent studies have suggested that the risk of cancer related to obesity is mediated by time, insights into the dose-response relationship and the cumulative impact of overweight and obesity during the life course on cancer risk remain scarce. To our knowledge, this study is the first to assess the impact of adulthood overweight and obesity duration on the risk of cancer in a large cohort of postmenopausal women.Methods and FindingsParticipants from the observational study of the Women’s Health Initiative (WHI) with BMI information from at least three occasions during follow-up, free of cancer at baseline, and with complete covariate information were included (n = 73,913). Trajectories of BMI across ages were estimated using a quadratic growth model; overweight duration (BMI ≥ 25 kg/m2), obesity duration (BMI ≥ 30 kg/m2), and weighted cumulative overweight and obese years, which take into account the degree of overweight and obesity over time (a measure similar to pack-years of cigarette smoking), were calculated using predicted BMIs. Cox proportional hazard models were applied to determine the cancer risk associated with overweight and obesity duration. In secondary analyses, the influence of important effect modifiers and confounders, such as smoking status, postmenopausal hormone use, and ethnicity, was assessed. A longer duration of overweight was significantly associated with the incidence of all obesity-related cancers (hazard ratio [HR] per 10-y increment: 1.07, 95% CI 1.06–1.09). For postmenopausal breast and endometrial cancer, every 10-y increase in adulthood overweight duration was associated with a 5% and 17% increase in risk, respectively. On adjusting for intensity of overweight, these figures rose to 8% and 37%, respectively. Risks of postmenopausal breast and endometrial cancer related to overweight duration were much more pronounced in women who never used postmenopausal hormones. This study has limitations because some of the anthropometric information was obtained from retrospective self-reports. Furthermore, data from longitudinal studies with long-term follow-up and repeated anthropometric measures are typically subject to missing data at various time points, which was also the case in this study. Yet, this limitation was partially overcome by using growth curve models, which enabled us to impute data at missing time points for each participant.ConclusionsIn summary, this study showed that a longer duration of overweight and obesity is associated with an increased risk of developing several forms of cancer. Furthermore, the degree of overweight experienced during adulthood seemed to play an important role in the risk of developing cancer, especially for endometrial cancer. Although the observational nature of our study precludes inferring causality or making clinical recommendations, our findings suggest that reducing overweight duration in adulthood could reduce cancer risk and that obesity prevention is important from early onset. If this is true, health care teams should recognize the potential of obesity management in cancer prevention and that excess body weight in women is important to manage regardless of the age of the patient.

BackgroundObesity represents an urgent problem that needs to be properly addressed, especially among children. Public and global health policy- and decision-makers need timely, reliable quantitative information to develop effective interventions aimed at counteracting the burden generated by high body mass index (BMI). Few studies have assessed the high-BMI-related burden on a global scale.Methods and findingsFollowing the methodology framework and analytical strategies used in the Global Burden of Disease Study (GBD) 2017, the global deaths and disability-adjusted life years (DALYs) attributable to high BMI were analyzed by age, sex, year, and geographical location and by Socio-demographic Index (SDI). All causes of death and DALYs estimated in GBD 2017 were organized into 4 hierarchical levels: level 1 contained 3 broad cause groupings, level 2 included more specific categories within the level 1 groupings, level 3 comprised more detailed causes within the level 2 categories, and level 4 included sub-causes of some level 3 causes. From 1990 to 2017, the global deaths and DALYs attributable to high BMI have more than doubled for both females and males. However, during the study period, the age-standardized rate of high-BMI-related deaths remained stable for females and only increased by 14.5% for males, and the age-standardized rate of high-BMI-related DALYs only increased by 12.7% for females and 26.8% for males. In 2017, the 6 leading GBD level 3 causes of high-BMI-related DALYs were ischemic heart disease, stroke, diabetes mellitus, chronic kidney disease, hypertensive heart disease, and low back pain. For most GBD level 3 causes of high-BMI-related DALYs, high-income North America had the highest attributable proportions of age-standardized DALYs due to high BMI among the 21 GBD regions in both sexes, whereas the lowest attributable proportions were observed in high-income Asia Pacific for females and in eastern sub-Saharan Africa for males. The association between SDI and high-BMI-related DALYs suggested that the lowest age-standardized DALY rates were found in countries in the low-SDI quintile and high-SDI quintile in 2017, and from 1990 to 2017, the age-standardized DALY rates tended to increase in regions with the lowest SDI, but declined in regions with the highest SDI, with the exception of high-income North America. The study’s main limitations included the use of information collected from some self-reported data, the employment of cutoff values that may not be adequate for all populations and groups at risk, and the use of a metric that cannot distinguish between lean and fat mass.ConclusionsIn this study, we observed that the number of global deaths and DALYs attributable to high BMI has substantially increased between 1990 and 2017. Successful population-wide initiatives targeting high BMI may mitigate the burden of a wide range of diseases. Given the large variations in high-BMI-related burden of disease by SDI, future strategies to prevent and reduce the burden should be developed and implemented based on country-specific development status.

Gallbladder and biliary tract cancers (GBTCs) are aggressive with poor prognosis, often undetected until advanced stages. High Body Mass Index (BMI) is a significant risk factor, contributing substantially to GBTC mortality and Disability-Adjusted Life Years (DALYs). This study aimed to quantify the global burdens of GBTCs attributable to high BMI from 1990 to 2021, thereby developing more rational prevention and treatment strategies for GBTC. Data were extracted from the Global Burden of Disease (GBD) 2021. Age-standardized rates of mortality (ASMR), and DALYs (ASDR) for GBTCs due to high BMI were calculated by years, genders, ages, geographical locations, and sociodemographic index (SDI). The estimated annual percentage change (EAPC) was calculated to evaluate the temporal trends from 1990 to 2021. Decomposition and frontier analyses were conducted to understand the driving forces behind burden changes and to identify top-performing countries. Inequality analysis was conducted to assess burden disparities across different SDI levels. The disease burden was forecasted through 2035 using the Bayesian age period cohort (BAPC) model. Globally, ASMR and ASDR for GBTCs related to high BMI decreased from 1990 to 2021; however, the absolute number of deaths and DALYs cases more than doubled, and similar patterns are projected to continue over the next 14 years in the absence of intervention. High SDI regions showed higher burdens due to higher obesity rates, population growth, and aging, while low SDI regions faced higher EAPCs due to limited resources. Moreover, this inequality has become more significant. Females were more susceptible across all age groups. Notable variations in burden management were observed among countries, with some low SDI nations demonstrating superior performance to high SDI countries. Despite the decline in rates, the burden of GBTCs attributable to high BMI remains substantial, underscoring the need for targeted prevention strategies for high BMI, particularly in high SDI regions. Gender and age disparities necessitate tailored health interventions.