Objective To analyze the impact of body mass index (BMI) on surgical difficulty and surgical reaction of patients with colorectal cancer served by West China Hospital, based on the current version of Database from Colorectal Cancer (DACCA). MethodsThe data of DACCA were updated on September 22, 2021. All data items included BMI, operative duration, anatomical difficulty, pelvic stenosis, abdominal obesity, adhesion in surgical area, abnormal mesenteric status, tissue or organ hypertrophy, intestinal quality in surgical area, surgery reaction, and perioperative complications of colorectal cancer module including temperature, flatus, pain, and mental status. The patients were divided into lean (BMI <18.5 kg/m2), normal (BMI 18.5–23.9 kg/m2), overweight (BMI 24.0–27.9 kg/m2), and obesity (BMI ≥28.0 kg/m2) by Chinese four classification method. ResultsAfter scanning, 6 311 data rows were analyzed. ① The effect of BMI on surgical difficulty: BMI was weakly positively correlated with operative duration (rs=0.096, P<0.001). The overweight and obesity patients were more likely to have anatomical abnormalities (rs=0.385, P<0.001 ), pelvic stenosis (rs=0.386, P<0.001), abdominal obesity (rs=0.567, P<0.001), and adhesion in surgical area (rs=0.043, P=0.004). There was difference in tissue or organ hypertrophy among patients with different BMI (χ2=39.988, P<0.001). It was also found that the lean patients were prone to develop ‘very heavy adhesions’ when adhesions occurred in surgical area, and to ‘mesangial contracture, short, fixed’ of abnormal mesenteric status, while the obesity patients were prone to ‘mesangial thickening’ of abnormal mesenteric status. There was no difference in intestinal quality among patients with different BMI (P>0.05). ② The effect of BMI on surgical reaction: BMI was weakly positively correlated with the overall assessment of surgical reaction (rs=0.049, P=0.001), and obesity patients were more likely to have severe surgical reaction. BMI was weakly negatively correlated with pain (rs=–0.058, P<0.001）and the lean patients were more likely to have pain that needed drug control. However, there were no differences in temperature, flatus, and mental status among patients with different BMI (P>0.05). ConclusionsHigh BMI of patients will affect several indicators including operative duration, anatomical difficulty, pelvic stenosis, abdominal obesity, adhesion in surgical area, abnormal mesenteric status, tissue or organ hypertrophy, resulting in increased difficulty of surgery. Although high BMI might affect overall response state after surgery, it will not affect temperature, flatus, and mental status, reflecting a relatively weak impact on surgical reaction.
Objective To review recent advancement of the relationship between obesity and gastric cancer. Method We searched PubMed, Medline, EMBASE, Cochrane Library databases, CNKI, and WanFang database for recent clinical trials about the impact of obesity on occurrence, surgery outcomes, and prognosis of gastric cancer. Results Obesity significantly increased the risk of adenocarcinoma of esophagogastric junction (AEG), increased difficulty in radical operation of gastric cancer and complications of perioperative period, but it had no effect on the long-term operative outcomes. The association between obesity and the survival of gastric cancer was not clear. However, the better survival was observed in most researches of gastric cancer patients with excess body weight. Conclusions The relationship between obesity and gastric cancer is very complex, and there is no consistent conclusion. A reasonable body weight by a healthy lifestyle is expected to decline the incidence of AEG.
Objective To evaluate the impact of body mass index （BMI） on short-term outcomes after intersphi-ncteric resection （ISR） for rectal cancer and anal cancer. Methods One hundred and ninety-nine cases of rectal cancer and anal cancer who were treated in Department of Gastrointestinal Surgery of West China Hospital of Sichuan University from Jan. 2009 to Dec. 2011 were enrolled retrospectively，and these cases were divided into underweight group （n=23），normal group （n=114），and overweight group （n=62） according to BMI. Postoperative indexes in early rehabilitation and complication of 3 groups were studied and compared. Results On the recovery indexes after ISR in early stage，there were no significant differences on the duration of first flatus，first defecation，first oral intake，first ambulation，and hospital stay among 3 groups （P＞0.05）. On the tube management，there were no significant differences on the duration of pulling out nasogastric tube and urinary catheter （P＞0.05），but duration of pulling out drain was longer in normal group and over-weight group （P＜0.05）. There were no significant differences on the incidence of postoperative complications among the 3 groups （P＞0.05），including anastomotic leakage，anastomotic bleeding，perianal infection，ileus，gastric retention，urinary retention， septicemia，wound infection，and recto-vaginal fistula. Conclusions BMI has little impact on short-term outcomes after ISR. Obesity does not increase the incidence of common complications for patients after ISR and does not influence recovery indexes with proper postoperative managements.
ObjectiveTo systematically review the association of body mass index (BMI) and mortality in chronic heart failure (CHF) pationts.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect cohort studies about the association of BMI and mortality in CHF patients from inception to June, 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 20 cohort studies involving 91 572 CHF patients were included. The results of meta-analysis showed that, compared to patients with normal weight, underweight individuals were associated with higher mortality (HR=1.48, 95%CI 1.36 to 1.62, P<0.001), whereas overweight (HR=0.86, 95%CI 0.78 to 0.94, P=0.002) and obese (HR=0.78, 95%CI 0.68 to 0.90, P=0.001) patients were associated with lower mortality.ConclusionCurrent evidence shows that underweight is associated with a higher risk of all-cause mortality among patients with CHF, whereas overweight and obese are associated with lower risk of all-cause mortality. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
ObjectiveTo investigate the effect of body mass index (BMI) on the outcome of posterior 360° fusion for single-level lumbar degenerative diseases. MethodsA retrospective study was carried on 302 cases of singlelevel lumbar degenerative diseases treated with posterior 360° fusion between September 2009 and September 2013. All patients were divided into 3 groups according to BMI: normal weight (BMI<24 kg/m2) in 105 cases (group A), overweight (24 kg/m2≤BMI< 28 kg/m2) in 108 cases (group B), and obese (BMI≥28 kg/m2) in 89 cases (group C). There was no significant difference in gender, age, disease duration, disease patterns, affected segments, preoperative Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI) among 3 groups (P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, and complications were recorded. The lumbar function was assessed by JOA score and ODI at pre- and post-operation (at 3, 6, and 24 months). ResultsThe operation time, intraoperative blood loss, and postoperative hospital stay of group C were significantly more than those of groups A and B (P<0.05), but no significant difference was found between group A and group B (P>0.05). The patients were followed up 24-45 months. Postoperative JOA score and ODI showed significant improvements in each group when compared with preoperative ones (P<0.05), but there was no significant difference among groups at each time point after operation (P>0.05). There was no significant difference in the incidence of total complications among 3 groups (χ2=3.288, P=0.193). The incidence of incision-related complications (infection and poor healing) in group C was significantly higher than that of groups A and B (P<0.05), but no significant difference was shown between group A and group B (P>0.05). However, there was no significant difference in cerebrospinal fluid leak, pseudarthrosis formation, and revision among 3 groups (P>0.05). ConclusionPosterior 360° fusion for single-level lumbar degenerative diseases can obtain good effectiveness in patients with different BMI, but patients whose BMI was ≥28 kg/m2 have longer operation time, more intraoperative blood loss, longer hospital stay, and higher incidence of postoperative incision-related complications.
ObjectiveTo analyze the latest epidemiological status of breast cancer in China, trends in morbidity and mortality from 1990 to 2019, and related prognostic risk factors.MethodsData on incidence and mortality of Chinese female breast cancer, their related age-standardized rates (ASRs) from 1990 to 2019, and attributable risk factors were obtained from the Global Burden of Disease (GBD) database, and data on disability-adjusted life years (DALYs) of 34 provinces in China were obtained from literature. Joinpoint regression analysis was used to analyze the trends of ASRs. The exposure levels of each attributable risk factor and the increased cancer burden were analyzed.ResultsThe incidence of breast cancer in Chinese females increased annually, from 17.07/100 000 in 1990 to 35.61/100 000 in 2019, while the mortality rate initially increased and decreased, and then exhibited an upward trend after 2016 and there was no obvious variation from 1990 (9.16/100 000) to 2019 (9.02/100 000). Among the 34 provinces of China, Shandong Province had the most serious breast cancer burden, while Macao Special Administrative Region had the lowest. Among the seven prognostic risk factors, high body mass index (BMI) contributed the most to the breast cancer burden and the exposure risk of a diet high in red meat had shown a significant increasing trend in the past 30 years. Therefore, the disease burden caused by a high red meat diet would be increasing.ConclusionsThe incidence rate of breast cancer in Chinese females is increasing. With the development of social economy and the change of people’s dietary habits, the breast cancer burden in China trends to become heavier and heavier. Therefore, it is necessary to conduct the "three early" prevention and treatment and advocate healthy and reasonable diet and living habits to reduce the burden of breast cancer to improve prognosis and quality of life.
Objective To investigate the effect of body mass index (BMI) on the short-term effectiveness of high tibial osteotomy (HTO) in the treatment of varus knee arthritis. Methods The clinical data of 84 patients (84 knees) with varus knee arthritis treated with HTO between May 2016 and August 2020 were retrospectively analyzed. According to BMI, the patients were divided into normal group (32 patients in group A, BMI<25 kg/m2), overweight group (27 patients in group B, BMI>30 kg/m2), and obese group (25 patients in group C, BMI>30 kg/m2). The BMI of groups A, B, and C were (23.35±0.89), (26.65±1.03), and (32.05±1.47) kg/m2, respectively. There was no significant difference (P>0.05) in gender, age, surgical side, disease duration, and preoperative Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) score, knee range of motion, and hip-knee-ankle angle (HKA) between groups. The operation time, intraoperative dominant blood loss, and the decrease of hemoglobin on the 3rd day after operation were recorded and compared between groups. The improvement of knee joint function and pain status were evaluated by knee joint HSS score, knee range of motion, and VAS score before and after operation, and measuring the HKA of patients on X-ray film. During the follow-up, the X-ray films of the knee joint were reexamined to observe the position of the internal fixator and the healing of osteotomy. Results All patients completed the operation successfully and were followed up 8-40 months (mean, 19.3 months). There was no significant difference in follow-up time, operation time, intraoperative dominant blood loss, and the decrease of hemoglobin on the 3rd day after operation between groups (P>0.05). No operative complications such as severe vascular or nerve injury occurred. After operation, deep venous thrombosis of lower extremities occurred in 1 case in groups A and B respectively, and fat liquefaction of surgical incision occurred in 2 cases in group C. There was no significant difference in the incidence of perioperative complications between groups (3.1% vs. 3.7% vs. 8.0%) (P=0.689). During the follow-up, there was no bone nonunion, plate fracture or loosening. At last follow-up, HSS score, VAS score, knee range of motion, and HKA significantly improved in the 3 groups when compared with those before operation (P<0.05), but there was no significant difference in the differences of the above indexes between groups before and after operation (P>0.05). Conclusion BMI does not affect the short-term effectiveness of HTO in the treatment of varus knee arthritis. HTO can be selected for overweight and obese patients after standard medical treatment is ineffective.
Objective To explore relationship between body mass index and all-cause mortality or cancer-specific mortality of colorectal cancer. Methods The published articles relevant body mass index and colorectal cancer mortality were retrieved according to the inclusion and exclusion criteria from PubMed, Elsevier-Science Direct, and Web of Science databases. The meta-analysis was performed with RevMan 5.3 software. Results A total of 14 articles were eligible for the meta-analysis, involved 53 804 patients (colorectal cancer patients with underweight 1 853 cases, colorectal cancer patients with overweight 9 088 cases, colorectal cancer patients with obesity 4 463 cases). The results of meta-analysis showed that the colorectal cancer patients with obesity and underweight had the higher all-cause mortalities 〔RR=1.11, 95% CI (1.06, 1.16), P<0.000 01; RR=1.34, 95% CI (1.11, 1.61), P=0.002〕 and colorectal cancer-specific mortalities 〔RR=1.15, 95% CI (1.05, 1.24), P=0.001; RR=1.33, 95% CI (1.09, 1.62), P=0.005〕 as compared with the colorectal cancer patients with normal weight. The all-cause mortality and colorectal cancer-specific mortality had no significant differences between the colorectal cancer patients with overweight and the colorectal cancer patients with normal weight 〔RR=0.96, 95% CI (0.89, 1.04), P=0.31; RR=1.00, 95% CI (0.90, 1.12), P=0.98〕 . Conclusion Colorectal cancer patients with obesity and underweight might have a higher mortality rate.
ObjectiveTo collect the nutrition data in patients with chronic kidney disease (CKD) from stage 1 to 4 and provide the basis for further intervention by analyzing the specific problems of the patients. MethodsA total of 132 CKD patients from stage 1 to 4 were enrolled between December 2012 and December 2013. Nutritionists used inbodyS10ww as a body composition analyzer to test the patients. The data from inbodyS10ww and laboratory indexes were analyzed on marasmus, overweight and obesity, risk of malnutrition, malnutrition, anemia and hypoalbuminemia. ResultsThe percentage of marasmus in those CKD patients was 3.0%, overweight and obesity was 39.4%, the risk of malnutrition was 22.7%, malnutrition was 19.7%, anemia was 34.1%, and hypoalbuminemia was 9.8%. ConclusionOur search shows that combining the application of anthropometry and laboratory indexes can evaluate the nutritional status of patients with CKD. The most common nutritional problems in CKD patients include malnutrition, overweight and obesity, risk of malnutrition, and anemia. As for hypoalbuminemia, it is low in early CKD patients.