objective To analyze the impact of body mass index (BMI) on medical and surgical complications of colorectal cancer patients served by West China Hospital, based on the current version of Database from Colorectal Cancer (DACCA). Methods The data of DACCA was updated on September 27, 2021. The data included BMI, surgical complications, liver nodules, liver function, renal nodules, renal function, operation history, medical complications, diabetes, hypertension, pneumonia, pulmonary nodules, pulmonary function, heart disease, thrombosis, and cardiac function. Results After scanning, 5 305 data rows were included. BMI was divided by Chinese four classification methods. The analysis results showed that in terms of surgical complications, obese patients were more likely to be complicated with surgical complications of digestive system (χ2= 43.883, P<0.001) and reproductive system (χ2=13.139, P=0.004). Lean patients were more likely to have surgical complications of urinary system (χ2=223.415, P<0.001), and obese patients had liver function (H=61.521, P<0.001) and renal function (H=9.994, P=0.019) might be even worse. In terms of operation history, BMI in colorectal cancer patients had nothing to do with the number of times of operation (H=6.262, P=0.100), and operation history of each system or department (P>0.05). Regarding to medical complications, with the increase of BMI, the risk of colorectal cancer patients with diabetes mellitus (χ2=118.597, P<0.001), or hypertension (χ2= 163.334, P< 0.001) increased. Patients with low BMI were more likely to have pneumonia (H=7.899, P= 0.048) and worse pulmonary function (H=40.673, P<0.001). Conclusions The analysis results of DACCA database show that BMI is not related to the occurrence of any special surgical history included in the research. Because the internal and external complications of patients are closely related to the treatment plan and prognosis, we should pay more attention to the obese patients in the process of clinical treatment, and they are more likely to have multisystemic abnormalities and various abnormal indicators than other patients. For thin patients, we should pay more attention to their lung function and inflammatory lesions, so as to improve the clinical therapeutic effect.
ObjectiveTo explore the value of sarcopenia index (SI) in the diagnosis of malnutrition in colorectal cancer patients.MethodsA retrospective study was carried out to study on 126 colorectal cancer patients who underwent chemotherapy in West China Hospital of Sichuan University between January 2015 and June 2019. SI and body mass index (BMI) were used for malnutrition diagnosis, and the detection rate of malnutrition was compared.ResultsThe detection rate of malnutrition diagnosed by SI (92.1%) was higher than that by BMI (38.1%) with a statistical difference (P<0.001). Subgroup analysis showed: the detection rate of malnutrition diagnosed by SI vs. BMI in male patients was 97.0% vs. 28.4%, with a statistical difference (P<0.001), and that in female patients was 86.4% vs. 49.2%, with a statistical difference (P<0.001); the detection rate of malnutrition diagnosed by SI vs. BMI in elderly patients (≥65 years) was 92.6% vs. 27.8%, with a statistical difference (P<0.001), and that in young and middle-aged patients (<65 years) was 91.7% vs. 45.8%, with a statistical difference (P<0.001).ConclusionUsing SI to diagnose malnutrition for colorectal cancer patients is worth popularizing for it can discover hidden malnutrition patients.
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.
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.
ObjectiveTo systematically review the dose-response relationship between body mass index (BMI) and all-cause mortality in the elderly with frailty.MethodsPubMed, EMbase, Web of Science, CNKI, VIP, WanFang Data, and CBM databases were electronically searched to collect cohort studies on the association of BMI and mortality in frail adults from inception to November 2019. Two reviewers independently screened literature, extracted data and assessed risk bias of included studies; Stata 15.0 software was then used to analyze the dose-response analysis of BMI and mortality by restricted cubic spline function and generalized least squares method.ResultsA total of 4 cohort studies involving 12 861 frail adults were included. Meta-analysis results showed that compared with normal BMI, the frail elderly who were overweight (HR=0.80, 95%CI 0.74 to 0.88, P<0.001) and obese (HR=0.89, 95%CI 0.79 to 1.00, P=0.047) had lower all-cause mortality. The results of dose-response meta-analysis showed that there was a non-linear relationship between BMI and all-cause mortality in the elderly with frailty (P value for nonlinearity was 0.035), for which the elderly with frailty had a BMI nadir of 27.5-31.9 kg/m2. For linear trends, and when BMI was less than 27.5 kg/m2, the risk of all-cause death was reduced by 4% for every 1 kg/m2 increase in BMI (RR=0.96, 95%CI 0.90 to 1.03, P=0.320), when BMI was greater than 27.5 kg/m2, the risk of all-cause death increased by 4% for every 1 kg/m2 increase in BMI (RR=1.04, 95%CI 1.03 to 1.05, P<0.001).ConclusionsThere is a paradox of obesity and a significant nonlinear relationship between BMI and all-cause mortality in the frailty elderly, with the lowest all-cause mortality in the frailty elderly at BMI 27.5-31.9 kg/m2. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusions.
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.
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 prevalence of chronic obstructive pulmonary disease (COPD) with lipid metabolism disorders patients in Chengdu. MethodsWe randomly selected four communities from urban and rural areas in Chengdu between February and December, 2010, with multistage cluster random sampling method; 1 931 residents aged from 40 to 70 received special questionnaire from the BOLD Study, lung examination, blood biochemical examination, and physical examination. ResultsThe prevalence of COPD was 60.26% (91/151) with dyslipidemia; while non-COPD was 68.17% (972/1 428), and the difference was significant (P<0.05), in which the most obvious difference is triglycerides (TG). The prevalence of COPD was 6.62% (10/151) with underweight; while non-COPD was 4.97% (71/1 428), and the difference was significant (P<0.001). The prevalence of COPD was 21.19% (32/151) with abdominal obesity; while non-COPD was 30.81% (440/1 428), and the difference was significant (P<0.05). ConclusionThe prevalence of COPD with lipid metabolism disorders is lower than which with non-COPD in Chengdu. It provides an evidence for the nutrition support therapy in the treatment of COPD.
目的 观察与分析体重异常老年男性血清前列腺特异性抗原（T-PSA）与生长激素（GH）水平及影响因素。 方法 以2009年1月－2012年6月，血清GH＜5 ng/mL、血清T-PSA＜4.5 ng/mL的老年男性共296例作为观察对象，依据体质量指数分为低体重组、正常体重组、超重组及肥胖组。依据年龄分为60～64、65～69、70～74及≥75岁四组。测定296例入选对象的血清T-PSA及GH并进行分析。 结果 随着年龄增长，血清T-PSA、GH渐增高。≥75岁年龄组血清T-PSA高于其他三组，差异无统计学意义（P＞0.05）。≥75岁年龄组血清GH高于其他三组，差异有统计学意义（P＜0.01）。超重组及肥胖组血清T-PSA低于正常体重组，差异有统计学意义（P＜0.01）。低体重组血清T-PSA稍低于正常体重组，差异无统计学意义（P＞0.05）。肥胖组血清GH低于超重及正常体重组，差异无统计学意义（P＞0.05）。低体重组血清GH低于正常体重组，差异无统计学意义（P＞0.05）。单因素相关分析显示血清T-PSA与年龄、GH正相关；与BMI负相关；与收缩压（SBP）、舒张压（DBP）、空腹血糖（FPG）及血脂不相关。血清GH与年龄、T-PSA、SBP、DBP正相关；与BMI、FPG及血脂不相关。校正年龄、BMI后，血清T-PSA与GH仍呈正相关。 结论 随着年龄增长，老年男性血清T-PSA、GH渐增高。老年男性非肢端肥大症者血清T-PSA与血清GH水平及BMI有关联，血清GH水平较高者，血清T-PSA也较高；血清T-PSA与BMI负相关。
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.