Browsing by Subject "Body Mass Index"
Now showing 1 - 6 of 6
- Results Per Page
- Sort Options
Item Free Flap Breast Reconstruction in Cancer Patients: Effect of BMI on Outcomes of the Deep Inferior Epigastric Perforator (DIEP) Flap(2016-01-19) Reddy, Nikitha; Cullins, Madeline; Kayfan, Samar; Pezeshk, Ronnie A.; Teotia, Sumeet S.; Haddock, Nicholas T.BACKGROUND: The Deep Inferior Epigastric (DIEP) flap has achieved marked acceptance in free flap breast reconstruction, yet the effect of body mass index (BMI) on the procedural outcome can vary depending on the literature. This study aims to evaluate the effect of BMI on flap and donor-site complications in patients undergoing DIEP flap reconstruction. METHODS: A retrospective analysis of 233 DIEP flaps in 135 patients was performed, and the patients were stratified as three groups based on BMI: Normal (BMI<25), Overweight (BMI 25-29.9), and Obese (BMI>30). Data with regard to age, smoking history, comorbid conditions, preoperative radiation, preoperative chemotherapy, and complications post-DIEP flap reconstruction at the flap and donor-sites was analyzed and compared among groups. RESULTS: Overweight patients had statistically higher rates of overall complications (p=0.001), umbilical wound (p=0.03), and return visits to the operating room during same hospital stay (p=0.004) compared to normal weight patients. Obese patients experienced statistically higher rates of overall complications (p=0.000023), return visits to operating room during same hospital stay (p=0.02), abdominal necrosis (p=0.0008), breast wound (p=0.019), umbilical wound (p=0.0053), and vacuum-assisted closure wound therapy (p=0.0006) compared to normal weight patients. There were no significant differences between the groups in regards to infection of the abdominal, breast, and umbilical sites, abdominal wound, abdominal seroma, breast necrosis, breast seroma, breast hematoma, umbilical necrosis, blood transfusion, pulmonary embolism, average OR time, average hospital length of stay, or loss of flap viability (p>0.05). Age distribution and preoperative radiation were not statistically different. Compared to normal-weight patients, overweight patients had significantly lower rates of smoking history and higher rates of hypertension, diabetes, and preoperative chemotherapy. Obese patients had statistically higher rates of preoperative chemotherapy compared to normal weight patients. These confounding factors between the groups are a limitation to the BMI control. CONCLUSION: Overweight and obese patients undergoing DIEP flap breast reconstruction are predisposed to statistically higher risk for the aforementioned complications than normal weight patients. However, there was no significant difference in loss of flap viability between the groups. Therefore, DIEP flap breast reconstruction is an appropriate option.Item Liver Fibrosis and Steatosis in HIV-Infected Patients: Impact of Race/Ethnicity, Gender, BMI, and ART(2019-04-02) Rucker, Danielle; Cutrell, James; Bedimo, Roger; Luque, AmnerisBACKGROUND: The advent of antiretroviral therapy (ART) led to a decline in morbidity and mortality related to AIDS and its related complications. With this decline, an increasing proportion of morbidity and mortality in people living with HIV (PLWH) is secondary to liver and cardiovascular disease. Previous studies have shown that PLWH have traditional risk factors for these diseases, such as obesity, as well as risk factors that are unique to their population, including direct metabolic effects of HIV and ART. Several factors, such as race, ethnicity, gender, and BMI, have been shown to have an impact on the course of liver steatosis and fibrosis in general population. The impact of these factors on the course of liver steatosis and fibrosis in the setting of hepatitis B and C co-infections in PLWH have been studied, but there is a paucity of literature detailing the impact in the absence of viral hepatitis co-infection. NAFLD, APRI, and FIB-4 scores have been shown to be effective noninvasive markers for clinically significant liver steatosis and fibrosis. However, these non-invasive markers have not been validated for use in patients without viral hepatitis co-infection. This study aims to determine if race, ethnicity, gender, BMI, and the specific ART regimen have a differential impact on non-invasive markers of liver steatosis and fibrosis in PLWH. OBJECTIVE: Determine if race, ethnicity, gender, BMI, and specific ART regimen will modulate changes in non-invasive markers of liver steatosis and fibrosis. METHODS: All patients initiating ART at the Parkland Memorial Hospital HIV clinic from 2009-2017 were analyzed. Exposure to ART was defined as concurrent receipt of at least two nucleoside reverse transcriptase inhibitor (NRTI) drugs plus at least one protease inhibitor (PI), non-nucleoside reverse transcriptase inhibitor (NNRTI), or integrase inhibitor (INSTI). The existing patient database includes demographics (notably, gender, race, and ethnicity), CD4 and HIV RNA levels, co-morbidities, laboratory values (most notably, liver function tests), ART regimen, and body mass index (BMI). An analysis of yearly changes in BMI was calculated based on specific ART drugs, and differences between groups stratified by gender or race/ethnicity were compared. For subjects who meet certain pre-determined liver function test minimums, non-invasive markers for liver fibrosis (APRI, NAFLD, and FIB-4 scores) will be utilized and trended over time. Manual chart extraction will be examined for patients with clinically-indicated imaging (abdominal ultrasound, computed tomography, or magnetic resonance imaging) to estimate the incidence and prevalence of liver fibrosis or steatosis in this population and to determine whether race/ethnicity or gender modifies these risks. RESULTS: The difference in yearly BMI change was statistically significant for the INSTI dolutegravir (DTG; p=<0.01) between Blacks and non-Hispanic whites (NHW) but not for any other ART drugs tested. The difference in yearly BMI change showed a trend for statistical significance for DTG (p=0.06) between Hispanics and NHW but not for any other ART drugs tested. The difference in yearly BMI change by ART drug in men versus women was statistically significant for atazanavir (ATV; p=0.03), darunavir (DRV;p=<0.01), lopinavir (LPV; p=0.03), and dolutegravir (DTG; p=<0.01) but not with elvitegravir (EVG; p=0.72). CONCLUSIONS AND NEXT STEPS: Our preliminary results indicate that particular ART drugs, principally the INSTI DTG, appear to be associated with greater BMI gains than other agents. Additionally, in PLWH on ART, women demonstrated greater BMI gains than men, and Blacks and Hispanics demonstrated greater BMI gains than NHW in our cohort. The next steps will be to analyze the trends of APRI, FIB-4, and NAFLD scores over time in our cohort as non-invasive markers of liver fibrosis and to determine the demographic, HIV, and ART-related factors associated with higher rates of liver fibrosis. We will also conduct a review of clinically-indicated abdominal imaging for evidence of hepatic fibrosis in a subset of our cohort to validate the use of these non-invasive markers in PLWH without viral hepatitis. Given that HIV has been transformed into a chronic disease and that PLWH are now living decades on these ART regimens, it is of paramount importance to determine the long-term metabolic and hepatic consequences of these medications to better inform patient care and practice guidelines. We believe that our large cohort of demographically diverse PLWH on contemporary ART regimens and with detailed clinical follow-up data offers an important population to further our understanding of these critical issues.Item [UT Southwestern Medical Center News](2007-08-13) Morales, KatherineItem [UT Southwestern Medical Center News](2007-12-18) Shear, Kristen HollandItem Weight Change in Underweight or Obese Patients Awaiting Lung Transplantation Does Not Impact Post-Trasplant Survival(2017-01-17) Li, Kevin; Huffman, Lynn; Pruszynski, Jessica E.; Wait, Michael; Bajona, PietroBACKGROUND: Lung transplantation remains the definitive treatment for end-stage COPD, respiratory complications of cystic fibrosis, and interstitial lung diseases. However, long-term survival after lung transplantation remains poor, with an overall 5-year survival rate of 54%. Initial selection of lung transplant candidates includes evaluation of body mass index (BMI), since obesity is a relative contraindication to lung transplantation. However, BMI changes occurring while waiting for transplantation may not reflect initial listing BMI and may be associated with poorer long-term survival. OBJECTIVE: To determine the effects of pre-transplant BMI change on long-term survival following lung transplantation. METHODS: A retrospective chart review of adult lung transplantations performed between January 2004 and May 2016 was conducted. Patient demographics, survival status, and date of death, hours on the mechanical ventilator (MV hours), and ICU length of stay (ICU LOS) were collected. Cases were categorized as underweight (BMI < 20 kg/m2) or obese (BMI > 30 kg/m2), with change in BMI from time of listing to time of transplantation as subsets. Kaplan-Meier plots were constructed to summarize differences in overall survival between BMI groups. The log rank test was used to assess differences between survival curves. A Z-test using Greenwood's formula was performed to compare post-transplant survival rates at 1, 3, and 5 years. P-values were adjusted using the false discovery rate (FDR). RESULTS: There were 460 cases included in this study. The group sizes were as follows: underweight and lost weight (BMI < 20 kg/m2 -), 35; underweight and gained weight (BMI < 20 kg/m2 +), 47; obese and lost weight (BMI > 30 kg/m2 -), 61; obese and gained weight (BMI > 30 kg/m2 +), 25. Patients with initial BMI between 20.1 kg/m2 - 29.9 kg/m2 were assigned to the control group (n = 292). There were no differences in 1-year, 3-year, or 5-year survival rates (1-year: control 87.6%; BMI < 20 kg/m2 -, 91.3%; BMI < 20 kg/m2 + 86.4%; BMI > 30 kg/m2 - 93.%; BMI > 30 kg/m2 + 71.2%; all comparisons non-significant [NS]) (3-year: 71.1%; 49.2%; 54.1%; 69.8%; 56.6%, NS) (5-year: 61.1%; 35.1%; 45.9%; 49.1%; 50.9%, NS). Kaplan-Meier plots similarly showed no differences in overall survival (p = 0.203). There were no significant differences among the groups in ICU LOS or MV hours. CONCLUSION: Weight change in obese or underweight patients prior to lung transplantation does not affect overall survival. Therefore, BMI > 30 kg/m2 at the time of listing may not be a relative contraindication to lung transplantation.Item Weight Changes and Weight Measurements in Hospitalized Burn Patients(2017-01-17) Mendez-Romero, Denisse; Wolf, Steven E.; Clark, Audra T.; Phelan, Herb; Arnoldo, BrettINTRODUCTION: Burns are associated with significant changes in body weight due to resuscitation volumes leading to increased weight and a hypermetabolic state and prolonged bed rest resulting in wasting of lean body mass and weight loss. The actual weight changes and frequency of weight measurements throughout hospitalization have not been well described across time. The purpose of this study was to describe these in more detail. METHODS: A review was conducted of 232 thermally injured patients hospitalized in a large, ABA-verified burn center from February 2016 to September 2016. Patients were seen daily by a nutritionist and received tube or oral feeding as appropriate. Demographics, hospital length of stay, and all weight measurements were collected. RESULTS: Over 8 months, 232 burn patients were admitted. The mean (±SD) age was 33 ± 24 years, median TBSA was 7% (IQR 13-3) and men were 67.37% of the sample. Patients had a 4.92% ± 1.40% (mean ± SEM) increase in weight from baseline at hospital day 7(n=40). The mean weight changes of hospitalized patients were -1.57% ± 4.46% at 30 days (n=13), -6.66% ± 4.47% at 45 days (n=10), -13.83% ± 3.74% at 60 days (n=7), and -23.93% ± 12.26% at 130 days (n=2). The maximum length of stay was 205 days and this subject had a weight loss of 33.33% from baseline. Composite data of mean change of weight from baseline over time was plotted with an R2 value of 0.6 for both linear and third order regression. Patients with a length of stay between 7 to 14 days (n=49), 15 to 30 days (n=15), 31 to 60 days (n=9) and more than 60 days (n=9) had a daily weight recorded only 7.4%, 20.6%, 35.5% and 47% of their inpatient days, respectively. CONCLUSIONS: Burn patients demonstrate an increase in body weight within the first week of hospitalization likely related to resuscitation followed by a consistent decline. Patients with stays greater than one month have a decline in weight below their baseline and can lose as much as a third of their body mass even in the setting of nutritional support and rehabilitation efforts. Additionally, these data show that weight is measured more often as length of stay increases. Weight is often used as a marker of nutritional status, although this may not be appropriate in the setting of large fluid shifts and obesity. Additionally, patients might be losing muscle mass in favor of body fat. It is important to recognize long-term weight trends in the burn population, but further investigation is needed regarding the predictors of significant weight loss and associated outcomes.