Body mass index of married Bangladeshi women: trends and association with socio-demographic factors

Body mass index (BMI) is a good indicator of nutritional status in a population. In underdeveloped countries like Bangladesh, this indicator provides a method that can assist intervention to help eradicate many preventable diseases. This study aimed to report on changes in the BMI of married Bangladeshi women who were born in the past three decades and its association with socio-demographic factors. Data for 10,115 married and currently non-pregnant Bangladeshi women were extracted from the 2007 Bangladesh Demographic and Health Survey (BDHS). The age range of the sample was 15-49 years. The mean BMI was 20.85 ± 3.66 kg/m(2), and a decreasing tendency in BMI was found among birth year cohorts from 1972 to 1992. It was found that the proportion of underweight females has been increasing in those born during the last 20 years of the study period (1972 to 1992). Body mass index increased with increasing age, education level of the woman and her husband, wealth index, age at first marriage and age at first delivery, and decreased with increasing number of ever-born children. Lower BMI was especially pronounced among women who were living in rural areas, non-Muslims, employed women, women not living with their husbands (separated) or those who had delivered at home or non-Caesarean delivery.     

Body mass index: risk predictor for cosmetic day surgery

Body mass index (BMI; weight per unit surface area) is the scientific yardstick by which overweight is gauged relative to the population norm. The contrary association between obesity and diabetes or hypertension is only too well known. Less appreciated is the heightened sensitivity to respiratory depressants such as sedatives and analgesics in the obese (BMI >/= 30) and the increased incidence of sleep apnea in the morbidly obese (BMI >/= 35)-either or both of which raise the risk of cosmetic surgery when sedation or anesthesia is contemplated. Guided by the BMI, a gender-independent measure of fatness, the surgeon now can inform the patient of her or his relative operative risk and offer an objective rationale for advising overnight hospitalization rather than office-based day surgery.The BMI is readily calculated when height and weight are expressed in metric units, much less so when measured in foot-pound units. In fact, the calculations are sufficiently cumbersome that the BMI remains underused in U.S. office surgery. The author's complimentary "BMI Calculator"-an Excel workbook available on-line to society members-is designed so that office staff need enter only height (in feet and inches) and weight (in pounds) to print the BMI for the patient's permanent record.The BMI places patient weight relative to height in proper perspective for aesthetic surgery, whether with sedation or under general anesthesia. The BMI ought to be as routine a part of the preoperative assessment as blood pressure or hemoglobin content.     

Body mass index and basal androstenedione are independent risk factors for miscarriage in polycystic ovary syndrome

Background

There is limited literature investigating the effects of body mass index (BMI) and androgen level on in vitro fertilization (IVF) outcomes with a gonadotropin-releasing hormone (GnRH)-antagonist protocol in polycystic ovary syndrome (PCOS). Androgen-related variation in the effect of body mass index (BMI) on IVF outcomes remains unknown.

Methods

In this retrospective study, 583 infertile women with PCOS who underwent IVF using the conventional GnRH-antagonist protocol were included. Patients were divided into four groups according to BMI and androgen level: overweight- hyperandrogenism(HA) group, n?=?96, overweight-non-HA group, n?=?117, non-overweight-HA group, n?=?152, and non-overweight-non-HA group, n?=?218.

Results

A significantly higher number of oocytes were retrieved, and the total Gn consumption as well Gn consumption per day was significantly lower, in the non-overweight groups than in the overweight groups. The number of available embryos was significantly higher in the HA groups than in the non-HA groups. Clinical pregnancy rate was of no significant difference among four groups. Live-birth rates in the overweight groups were significantly lower than those in non-overweight-non-HA group (23.9, 28.4% vs. 42.5%, P<0.05). The miscarriage rate in overweight-HA group was significantly higher than that in non-overweight-non-HA group (45.2% vs. 14.5%, P<0.05). Multivariate logistic regression analysis revealed that BMI and basal androstenedione (AND) both acted as significantly influent factors on miscarriage rate. The area under the curve (AUC) in receiver operating characteristic (ROC) analysis for BMI and basal AND on miscarriage rate were 0.607 (P?=?0.029) and 0.657 (P?=?0.001), respectively, and the cut-off values of BMI and basal AND were 25.335?kg/m² and 10.95?nmol/L, respectively.

Conclusions

In IVF cycles with GnRH-antagonist protocol, economic benefits were seen in non-overweight patients with PCOS, with less Gn cost and more retrieved oocytes. BMI and basal AND were both significantly influential factors with moderate predictive ability on the miscarriage rate. The predictive value of basal AND on miscarriage was slightly stronger than BMI.

     

Body mass index in Serbian Roma

Stature and body mass were measured in 346 individuals belonging to three Roma groups from metropolitan Belgrade western Serbia. As with the majority of Serbian Roma, the participants in this study have been historically disadvantaged and their situation was further aggravated during the recent political crises. Surprisingly, the body mass index (BMI) of Serbian Roma is relatively high compared with western Europeans and is inconsistent with the view that Serbian Roma are predisposed to high rates of chronic energy deficiency (∼4%). While the majority of individual Roma display BMI values within the normal range (WHO, 1995), certain groups have a moderate to high proportion of individuals (∼35%) who could be classified as overweight and some who approach at-risk levels for clinical obesity.     

Body mass index and employment status: A new look

Earlier literature has usually modelled the impact of obesity on employment status as a binary choice (employed, yes/no). I provide new evidence on the impact of obesity on employment status by treating the dependent variable as a as a multinomial choice variable. Using data from a representative English survey, with measured height and weight on parents and children, I define employment status as one of four: working; looking for paid work; permanently not working due to disability; and, looking after home or family. I use a multinomial logit model controlling for a set of covariates. I also run instrumental variable models, instrumenting for Body Mass Index (BMI) based on genetic variation in weight. I find that BMI and obesity significantly increase the probability of “not working due to disability”. The results for the other employment outcomes are less clear. My findings also indicate that BMI affects employment through its effect on health. Factors other than health may be less important in explaining the impact of BMI/obesity on employment.     

The cost-effectiveness of screening for colorectal cancer

Background

Published decision analyses show that screening for colorectal cancer is cost-effective. However, because of the number of tests available, the optimal screening strategy in Canada is unknown. We estimated the incremental cost-effectiveness of 10 strategies for colorectal cancer screening, as well as no screening, incorporating quality of life, noncompliance and data on the costs and benefits of chemotherapy.

Methods

We used a probabilistic Markov model to estimate the costs and quality-adjusted life expectancy of 50-year-old average-risk Canadians without screening and with screening by each test. We populated the model with data from the published literature. We calculated costs from the perspective of a third-party payer, with inflation to 2007 Canadian dollars.

Results

Of the 10 strategies considered, we focused on three tests currently being used for population screening in some Canadian provinces: low-sensitivity guaiac fecal occult blood test, performed annually; fecal immunochemical test, performed annually; and colonoscopy, performed every 10 years. These strategies reduced the incidence of colorectal cancer by 44%, 65% and 81%, and mortality by 55%, 74% and 83%, respectively, compared with no screening. These strategies generated incremental cost-effectiveness ratios of $9159, $611 and $6133 per quality-adjusted life year, respectively. The findings were robust to probabilistic sensitivity analysis. Colonoscopy every 10 years yielded the greatest net health benefit.

Interpretation

Screening for colorectal cancer is cost-effective over conventional levels of willingness to pay. Annual high-sensitivity fecal occult blood testing, such as a fecal immunochemical test, or colonoscopy every 10 years offer the best value for the money in Canada.Colorectal cancer is the fourth most common cancer diagnosed in North America and the second leading cause of cancer death.^1,2 An effective population-based screening program is likely to decrease mortality associated with colorectal cancer^3–6 through earlier detection and to decrease incidence by allowing removal of precursor colorectal adenomas.^7,8 Professional societies and government-sponsored committees have released guidelines for screening of average-risk individuals for colorectal cancer by means of several testing options.^9–12 These tests vary in sensitivity, specificity, risk, costs and availability. With no published studies designed to directly compare screening strategies, decision analysis is a useful technique for examining the relative cost-effectiveness of these strategies.^13–21 Previous studies have shown that screening for colorectal cancer is cost-effective at conventional levels of willingness to pay, but no single strategy has emerged as clinically superior or economically dominant.²² The interpretations of economic evaluations in this area have been limited because investigators have not simultaneously accounted for the positive effects of screening on quality of life, the effect of noncompliance with screening schedules, and the greater efficacy and cost of more modern chemotherapy regimens for colorectal cancer. Furthermore, no study has included all of the strategies recommended in the 2008 guidelines of the US Multi-Society Task Force on Colorectal Cancer.¹⁰Our objective was to estimate the incremental cost-effectiveness of 10 strategies for colorectal cancer screening, as well as the absence of a screening program. The current study is more complete than earlier studies because we included information on quality of life, noncompliance with screening and the efficacy observed in recent randomized trials of colorectal cancer treatments. The complete model is available in Appendix 1 (available at www.cmaj.ca/cgi/content/full/cmaj.090845/DC1). This article focuses on the comparison of no screening and three screening strategies:¹ low-sensitivity guaiac fecal occult blood test,² performed annually; fecal immunochemical test,³ performed annually; and colonoscopy, performed every 10 years. These three tests are currently being used or considered for population-based screening of average-risk individuals in some Canadian provinces.     

Body mass index and the risk of head and neck cancer in the Chinese population

ObjectiveTo investigate potential associations between body mass index (BMI) and head and neck cancer (HNC) risk in an East Asian population.MethodsWe conducted a hospital-based multicenter case-control study in East Asia including 921 cases and 806 controls. We estimated the odds ratios (ORs) and 95% confidence intervals (95% CI) for HNC risks by using logistic regression, adjusting on potential confounders.ResultsCompared to normal BMI at interview (18.5–<25 kg/m²), being underweight (BMI < 18.5 kg/m²) was associated with a higher HNC risk (OR = 2.71, 95% CI 1.40–5.26). Additionally, obesity (BMI > 30 kg/m²) was associated with a lower HNC risk (OR = 0.30, 95% CI 0.16–0.57). Being underweight at age 20 was also associated with an increased risk of HNC. However, being underweight at 5 years or 2 years before interview was not associated with a higher risk of HNC.ConclusionWe observed an inverse association between BMI and HNC risk, which is consistent with previous studies in other geographic regions. Being underweight at age 20 was also associated with a higher risk of HNC, suggesting that reverse causality was not the main source of the association.     

Body mass index in Central India: inter district variation

Basic causes of poor state of nutrition and infections in developing countries are poverty, low level of hygienic conditions and little access to preventive and health care. Central India is known for its high rate of population growth and mortality, which persisted over time along with a low level of social, economic and infrastructure development. In the present study the body mass index (BMI) of 31 populations residing in 38 districts of Central India (comprising the States of Madhya Pradesh and Chhattisgarh) is assessed. Anthropometric data collected by the Anthropological Survey of India were utilized in this context. The mean body mass index values of the populations of total backward and non-backward districts are found to be lower than that of well-to-do individuals of India (Bharati 1989, Khongsdier 1997, Reddy 1998), but it is not as low as that found among the South Indian populations (Ferro-Luzzi et al. 1992). In the present investigation, it is also found that the majority of the backward districts fall in the category of different grade of chronic energy deficiency (CED), while in the non-backward districts a considerably less number of districts follows this trend. A better level of the nutritional status among the populations of the non-backward districts corroborates the findings of the Ministry of Health and Family Welfare (NFHS 1992). It reveals that the apparently healthy individuals with CED grade I in the present study may be thin but physically active and healthy. The present study, however, narrates further intensive investigations in these populations, because the BMI as a measure of the CED should incorporate the aspects like morbidity and health status of a population.     

Effectiveness of mass screening for endometrial cancer

OBJECTIVE: To investigate the effectiveness of mass screening for endometrial cancer using Endocyte (Laboratoire CCD, Paris, France) endometrial smears. STUDY DESIGN: The study subjects were consecutive patients with documented endometrial cancer diagnosed between January 1, 1989, and December 31, 1997, at 22 hospitals in Japan. One hundred twenty-six cases were detected by mass screening and 1,069 diagnosed in outpatient clinics. We compared the stage of cancer at diagnosis and survival rate of patients in the two groups. RESULTS: Early stage was significantly more frequent in the screening group (P < .001); stage I comprised 88.1% of the screening group as compared with 65.3% of the outpatient group. Well-differentiated adenocarcinoma was significantly more frequent in the screening group (P < .01); grade 1 constituted 74.7% of the screening group as compared with 61.0% of the outpatient group. The five-year survival rate was significantly higher in the screening group than in the outpatient group (94.0% vs. 84.3%, P = .041). The crude hazard ratio (HR) of dying of endometrial cancer for the screening group as compared to the outpatient group was .47 (95% CI .22-.99, P = .048). HR became .96 (95% CI .45-2.08, P = .925) after adjustment for age, study area and cancer stage. CONCLUSION: The results suggest that an endometrial cancer screening program would lead to early detection and improved survival among women with endometrial cancer.     

Body mass and prostatic cancer: a prospective study.

Previous studies have suggested that increased body mass is associated with an increased risk of prostatic cancer, but these studies have been limited by the fact that they were based on a few simple measurements such as height and weight. Similar results were found in a prospective study of the incidence of prostatic cancer in a cohort of Japanese men born in 1900-19 and living in Hawaii. Further evaluation of the extensive anthropomorphic measurements made in this cohort suggested that the association between measures of body mass and prostatic cancer might be accounted for more by lean tissue than by fat tissue. There was a significant positive association of the risk of prostatic cancer with area of muscle in the arm but not with area of fat in the arm. Further research is needed on the biological mechanisms of carcinogenesis that may be related to both lean and fat tissue and the development of prostatic cancer.     

Body mass index and mortality in chronic obstructive pulmonary disease: a meta-analysis

Background

The association between body mass index (BMI) and mortality in patients suffering from chronic obstructive pulmonary disease (COPD) has been a subject of interest for decades. However, the evidence is inadequate to draw robust conclusions because some studies were generally small or with a short follow-up.

Methods

We carried out a search in MEDLINE, Cochrane Central Register of Controlled Trials, and EMBASE database for relevant studies. Relative risks (RRs) with 95% confidence interval (CI) were calculated to assess the association between BMI and mortality in patients with COPD. In addition, a baseline risk-adjusted analysis was performed to investigate the strength of this association.

Results

22 studies comprising 21,150 participants were included in this analysis. Compared with patients having a normal BMI, underweight individuals were associated with higher mortality (RR  = 1.34, 95% CI  = 1.01–1.78), whereas overweight (RR  = 0.47, 95% CI  = 0.33–0.68) and obese (RR  = 0.59, 95% CI  = 0.38–0.91) patients were associated with lower mortality. We further performed a baseline risk-adjusted analysis and obtained statistically similar results.

Conclusion

Our study showed that for patients with COPD being overweight or obese had a protective effect against mortality. However, the relationship between BMI and mortality in different classes of obesity needed further clarification in well-designed clinical studies.