Association of body mass index changes from childhood to adulthood with dyslipidemia in adults: Hanzhong adolescent cohort study

2020 ◽  
Author(s):  
Yue-Yuan Liao ◽  
Chao Chu ◽  
Yang Wang ◽  
Wen-Ling Zheng ◽  
Qiong Ma ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Weight Loss ◽  
Body Mass ◽  
Rural Areas ◽  
Normal Weight ◽  
Increased Risk ◽  
And Control ◽  
Early Weight Loss

Abstract Background Dyslipidemia is a disorder of lipid metabolism and associated with insulin resistance. The relationship between longitudinal body mass index (BMI) changes from childhood to adulthood and long-term dyslipidemia was explored in this study. Methods We assessed the longitudinal relationship between BMI changes since childhood and dyslipidemia among 1738 participants in rural areas of Hanzhong City, Shaanxi. All participants were initially examined between the ages of 6 and 15 years in 1987 and were reexamined in 1995, 2013 and 2017; the total follow-up duration was 30 years. Anthropometric measurements and blood biochemistry indexes were measured. Results We found that gradual progression of normal weight to overweight (OR = 1.65; 95% CI = 1.27, 2.15) or persistent overweight (OR = 2.45; 95% CI = 1.52, 3.96) from childhood to adulthood was associated with an increased risk of dyslipidemia in adulthood. And these risks were largely disappeared if the overweight or obesity during childhood was resolved by adulthood. The higher the BMI in adulthood and the younger the age at which overweight begins, the higher the risk of dyslipidemia. Conclusions Early weight loss and any degree of weight loss from childhood to adulthood can help improve dyslipidemia in adulthood. We further emphasize the importance of weight management and control in public health primary prevention.

Impact of body mass index on outcomes in European patients with atrial fibrillation: the ESC EHRA EORP Atrial Fibrillation General Long-Term registry (AFGen LT)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Boriani ◽  
M Proietti ◽  
C Laroche ◽  
L Fauchier ◽  
F Marin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Body Mass ◽  
Large Cohort ◽  
Funding Source ◽  
Increased Risk ◽  
Underweight Patients ◽  
The Impact

Abstract Introduction The impact of body mass index (BMI) on outcomes in patients with atrial fibrillation (AF) has been largely debated. Aims To describe the relationship between BMI categories and clinical outcomes in a large cohort of European AF patients. Methods We included all AF patients with available baseline BMI and creatinine clearance and 1-year follow-up data enrolled in the EORP-AF General Long-Term Registry. Outcomes considered were: i) a composite of any thromboembolic event (TE)/acute coronary syndrome (ACS)/cardiovascular (CV) death; ii) CV death; iii) all-cause death. Results A total of 7,759 patients were included in this analysis. Of these, 55 (0.7%) were underweight, 2,074 (26.7%) were normal weight, 3,170 (40.9%) were overweight, 1,703 (21.9%) were obese and 757 (9.8%) were severe obese. Mean age was progressively lower across the categories (p<0.0001), with proportion of patients aged≥75 years also progressively lower (52.7% in underweight to 19.4% in severe obese patients; p<0.001). Both underweight (41.8%) and severe obese (25.0%) patients were more likely symptomatic (p<0.001). Mean CHA2DS2-VASc score was higher in underweight patients (p=0.0325). Use of any oral anticoagulant therapy was progressively higher across the BMI categories (p<0.001). At 1-year follow-up the rate of all outcomes considered were highest for underweight patients and lowest in severe obese [Figure 1]. On univariate Cox regression analysis, being underweight was consistently associated to a higher risk for all outcomes, while increasing of weight categories was associated with progressively lower risk for adverse outcomes. After full adjustment with clinical and pharmacological characteristics, no effect of higher BMI classes was found for any outcome, but an independent association with an increased risk of CV death and all-cause death was seen for underweight patients (Table 1). Conclusions In a large cohort of European AF patients a progressively lower rate of outcomes was found across increasing BMI classes. After full adjustments, no significant association was found between the higher BMI classes and outcomes. Underweight was associated with an increased risk for CV death and all-cause death. Figure 1. Outcomes at 1-year Follow-up Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Since the start of EORP programme, several companies have supported it with unrestricted grants

Weight loss and body mass index in relation to aspiration in patients treated for head and neck cancer: a long-term follow-up

2014 ◽  
Vol 22 (9) ◽  
pp. 2361-2369 ◽  
Author(s):  
Sandra Ottosson ◽  
Ulrika Lindblom ◽  
Peter Wahlberg ◽  
Per Nilsson ◽  
Elisabeth Kjellén ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Weight Loss ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Body Mass ◽  
Neck Cancer ◽  
Long Term Follow Up

Abstract MP82: Body Mass Index and Mortality in Chinese Adults with Newly Diagnosed Type 2 Diabetes

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Noel T Mueller ◽  
Andrew O Odegaard ◽  
Woon-Puay Koh ◽  
Myron D Gross ◽  
Jian-Min Yuan ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Body Mass Index ◽  
Body Mass ◽  
Mortality Risk ◽  
Normal Weight ◽  
Chinese Adults ◽  
Risk Of Death ◽  
Increased Risk

In Western populations normal weight adults at the time of incident type 2 diabetes (T2D) diagnosis have been reported to have higher mortality risk than overweight/obese adults. However, little investigation of this topic has occurred in Asian populations who tend to have relatively low body mass index (BMI = kg/m2) yet high rates of T2D. We investigated the association between BMI, reported prior to diagnosis of T2D, and mortality risk among a cohort of Chinese adults with T2D.We used data from the Singapore Chinese Health Study, including Chinese men and women aged 45-74 years of age, free of cancer, heart disease, stroke, and T2D at baseline (1993-1998), and followed for mortality through 2011. A total of 4,288 participants, contributing 57,220 person-years of follow-up, reported physician diagnosed incident T2D at two follow up interviews and reported height and weight at the previous interview, an average of 4.4 years prior to T2D diagnosis. Participants were classified according to WHO Asian-specific definitions as underweight (BMI <18.5), normal weight (18.5-23.49), overweight (23.5-27.49), and obese (≥ 27.5).During an average follow-up of 13.3 years, 470 of the 4,288 participants died: 159 from cardiovascular (CVD) causes and 311 from other causes. After adjustment for demographics, smoking status and alcohol consumption, there were no statistically significant differences in mortality rates across the BMI categories. However, the BMI-mortality association varied markedly by age. Among those who were ≤65 years of age, obesity, compared to normal weight, carried an increased risk of total mortality by 41% (4% to 92%) and of CVD mortality by 56% (-9% to 166%). However, among those >65 years of age we observed no association between BMI and mortality risk. Among Singaporean Chinese adults with type 2 diabetes, being obese prior to diagnosis was associated with increased risk of death in those who were ≤65 years of age, whereas among those >65 years there was no clear association between BMI and risk of mortality.

Abstract MP61: Body Mass Index and Mortality among Adults with Incident Type Diabetes: Results from Two Prospective US Cohort Studies

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Deirdre K Tobias ◽  
An Pan ◽  
Eric Ding ◽  
Chandra L Jackson ◽  
Eilis J O’Reilly ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Fixed Effects ◽  
Normal Weight ◽  
Health Study ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Never Smokers ◽  
Cvd Mortality

Background: Recent evidence suggests that having normal weight at time of diagnosis of type 2 diabetes (T2D) is associated with an increased risk of premature death, compared to being overweight or obese; these studies were limited in their sample size and ability to adequately address residual confounding by smoking and reverse causation. Objective: To prospectively evaluate the association between body mass index (BMI) at T2D diagnosis and mortality in two large cohorts. Methods: Women and men with incident T2D from the Nurses’ Health Study (1978-2010; N=8,984) and Health Professionals Follow-up Study (1988-2010; N=2,443) were included if they were free of major chronic disease (cardiovascular disease [CVD], cancer) at T2D diagnosis. Participants’ self-reported body weight preceding diagnosis (mean 11 months) and height was used to calculate BMI (kg/m2). Cox proportional hazards models estimated the relative risk (HR) and 95% confidence interval (CI) for mortality across BMI categories. Multivariable models adjusted for age, smoking, baseline comorbidities (high blood pressure, cholesterol), and several other lifestyle factors. Fixed-effects meta-analyses were used to combine individual cohort estimates. Results: In all, 3,119 total deaths were observed over a follow-up of 36 years in women (18.7 deaths/1,000 person-years) and 26 years in men (25.2 deaths/1,000 person-years). A J-shaped association was observed across BMI categories (18.5-22.4, 22.5-24.9, 25.0-27.4, 27.5-29.9, 30.0-34.9, >35.0) and all-cause mortality (HR [CI] by category: 1.26[1.03, 1.55], 1[reference], 1.11[0.97, 1.28], 1.08[0.94, 1.25], 1.19[1.04, 1.37], 1.33[1.15, 1.55]). After stratifying by smoking status, a direct linear association was present among never smokers and a J-shaped relationship persisted among ever smokers. Excluding deaths in the first 4 years of follow-up and adjusting for BMI change prior to diagnosis further accentuated the linear relationship between BMI and all-cause mortality among never smokers (0.90[0.57, 1.43], 1.00 [reference], 1.19[0.91, 1.57], 1.20[0.91, 1.58], 1.27[0.97, 1.65], 1.50[1.14, 1.99]; p-trend<0.001). The association across BMI categories and CVD mortality was also linear among never smokers, and flat among ever smokers. In addition, among ever smokers, cancer mortality was highest among those with BMI 18.5-22.5. No clear trend was observed between BMI and mortality due to other causes. Excluding insulin users did not appreciably modify the associations. Conclusions: We found no evidence to support lower mortality rates among diabetics who were overweight or obese at diagnosis, compared to their normal-weight counterparts. In contrast, after accounting for confounding by smoking, we observed direct linear relationships between BMI and both all-cause and CVD mortality in our cohorts. Reducing other biases strengthened these relationships.

scholarly journals Body mass index and clinical outcomes in patients with intracerebral haemorrhage: results from the China Stroke Center Alliance

2021 ◽  
pp. svn-2020-000534
Author(s):  
Zhentang Cao ◽  
Xinmin Liu ◽  
Zixiao Li ◽  
Hongqiu Gu ◽  
Yingyu Jiang ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Hospital Mortality ◽  
Body Mass ◽  
Intracerebral Haemorrhage ◽  
Final Analysis ◽  
Normal Weight ◽  
Discharge Disposition ◽  
Increased Risk ◽  
Significant Difference ◽  
Stroke Center

Background and aimObesity paradox has aroused increasing concern in recent years. However, impact of obesity on outcomes in intracerebral haemorrhage (ICH) remains unclear. This study aimed to evaluate association of body mass index (BMI) with in-hospital mortality, complications and discharge disposition in ICH.MethodsData were from 85 705 ICH enrolled in the China Stroke Center Alliance study. Patients were divided into four groups: underweight, normal weight, overweight and obese according to Asian-Pacific criteria. The primary outcome was in-hospital mortality. The secondary outcomes included non-routine discharge disposition and in-hospital complications. Discharge to graded II or III hospital, community hospital or rehabilitation facilities was considered non-routine disposition. Multivariable logistic regression analysed association of BMI with outcomes.Results82 789 patients with ICH were included in the final analysis. Underweight (OR=2.057, 95% CI 1.193 to 3.550) patients had higher odds of in-hospital mortality than those with normal weight after adjusting for covariates, but no significant difference was observed for patients who were overweight or obese. No significant association was found between BMI and non-disposition. Underweight was associated with increased odds of several complications, including pneumonia (OR 1.343, 95% CI 1.138 to 1.584), poor swallow function (OR 1.351, 95% CI 1.122 to 1.628) and urinary tract infection (OR 1.532, 95% CI 1.064 to 2.204). Moreover, obese patients had higher odds of haematoma expansion (OR 1.326, 95% CI 1.168 to 1.504), deep vein thrombosis (OR 1.506, 95% CI 1.165 to 1.947) and gastrointestinal bleeding (OR 1.257, 95% CI 1.027 to 1.539).ConclusionsIn patients with ICH, being underweight was associated with increased in-hospital mortality. Being underweight and obese can both increased risk of in-hospital complications compared with having normal weight.

scholarly journals Subclinical Cardiac Organ Damage in Patients with Moderate to Severe Psoriasis

2021 ◽  
Vol 10 (11) ◽  
pp. 2440
Author(s):  
Anja Linde ◽  
Eva Gerdts ◽  
Kåre Steinar Tveit ◽  
Ester Kringeland ◽  
Helga Midtbø
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Treatment Initiation ◽  
Severity Index ◽  
Organ Damage ◽  
Left Ventricular ◽  
Infliximab Treatment ◽  
Increased Risk ◽  
Psoriasis Severity

We explored the association between subclinical cardiac organ damage (OD) with comorbidities and psoriasis severity in 53 psoriasis patients on infliximab treatment (age 47 ± 15 years, 30% women) and 99 controls without psoriasis (age 47 ± 11 years, 28% women). Cardiac OD was assessed by echocardiography as the presence of increased left ventricular (LV) relative wall thickness (RWT), LV hypertrophy or dilated left atrium. Psoriasis severity was graded using the psoriasis area and severity index (PASI). The prevalence of hypertension was 66% in psoriasis vs. 61% in controls (p = 0.54) and cardiac OD seen in 51 and 73%, respectively (p = 0.007). Psoriasis was associated with a lower prevalence of cardiac OD (odds ratio (OR) 0.32, 95% confidence interval (CI) 0.13–0.77, p = 0.01) independent of age, sex, smoking, body mass index, and hypertension. Among psoriasis patients, hypertension was associated with increased risk of subclinical cardiac OD (OR 6.88, 95% CI 1.32–35.98, p = 0.02) independent of age, sex, and body mass index. PASI at treatment initiation was associated with a higher RWT at follow-up, independent of sex, age, and hypertension (β 0.36, p = 0.006) while no association with current PASI was found. In conclusion, cardiac OD was less prevalent in psoriasis patients on infliximab treatment than controls. Hypertension was the major covariable for subclinical cardiac OD in psoriasis.

scholarly journals The association between body mass index and recovery from post-traumatic stress disorder after the nuclear accident in Fukushima

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Masato Nagai ◽  
Tetsuya Ohira ◽  
Masaharu Maeda ◽  
Seiji Yasumura ◽  
Itaru Miura ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Error Variance ◽  
Normal Weight ◽  
Post Traumatic Stress ◽  
Post Traumatic

AbstractPost-traumatic stress disorder (PTSD) and obesity share common risk factors; however, the effect of obesity on recovery from PTSD has not been assessed. We examined the association between body mass index (BMI) and recovery from PTSD after the Great East Japan Earthquake. We analyzed 4356 men and women with probable PTSD aged ≥ 16 years who were living in evacuation zones owing to the radiation accident in Fukushima, Japan. Recovery from probable PTSD was defined as Post-traumatic Stress Disorder Checklist-specific scores < 44. Using Poisson regression with robust error variance adjusted for confounders, we compared the prevalence ratios (PRs) and 95% confidence intervals (CIs) for this outcome in 2013 and 2014. Compared with point estimates for normal weight (BMI: 18.5–24.9 kg/m2), especially in 2013, those for underweight (BMI: < 18.5 kg/m2) and obesity (BMI: ≥ 30.0 kg/m2) tended to slightly increase and decrease, respectively, for recovery from probable PTSD. The multivariate-adjusted PRs (95% CIs) for underweight and obesity were 1.08 (0.88–1.33) and 0.85 (0.68–1.06), respectively, in 2013 and 1.02 (0.82–1.26) and 0.87 (0.69–1.09), respectively, in 2014. The results of the present study showed that obesity may be a useful predictor for probable PTSD recovery. Obese victims with PTSD would require more intensive support and careful follow-up for recovery.

scholarly journals POS1383 THE ASSOCIATION BETWEEN BARIATRIC SURGERY AND DUPUYTREN DISEASE: A COHORT STUDY FROM SWEDISH NATIONWIDE HEALTHCARE REGISTRIES

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 974.3-975
Author(s):  
T. Burkard ◽  
J. Lane ◽  
D. Holmberg ◽  
A. M. Burden ◽  
D. Furniss
Keyword(s):  
Bariatric Surgery ◽  
Body Mass Index ◽  
Weight Loss ◽  
Cohort Study ◽  
Secondary Care ◽  
High Body Mass Index ◽  
Null Result ◽  
Increased Risk ◽  
Dupuytren Disease

Background:Dupuytren disease (DD) is multifactorial, with several genetic and environmental risk factors contributing to disease susceptibility. High body mass index, however, was suggested to be protective of DD.1 The impact of weight loss among obese patients on DD has not been assessed to date.Objectives:To assess the association between bariatric surgery and DD in a secondary care setting.Methods:We performed a propensity score (PS)-matched cohort study using data from Swedish nationwide healthcare registries (patient registry [secondary care], causes of death registry, prescribed drug registry). Patients aged 30-79 years who underwent bariatric surgery between 2006 and 2019 were matched to up to 2 obese bariatric surgery-free patients (called unexposed patients) based on their PS. PS-matching was carried out in risk set sampling to reduce selection bias, within 4 sequential cohort entry blocks to account for time trend biases. The outcome DD was defined as a diagnosis of DD in secondary care or partial or total fasciotomy of wrist or hand. After a 1-year run-in period, patients were followed in an “as-treated” approach. We applied Cox proportional hazard regression to calculate hazard ratios (HR) with 95% confidence intervals (CIs) of incident DD among bariatric surgery patients when compared to obese unexposed patients overall, and in subgroups of age, sex, bariatric surgery type, and by duration of follow-up.Results:A total of 34 959 bariatric surgery patients were PS-matched to 54 769 obese unexposed patients. A total of 71.6% of bariatric surgery patients were women. Bariatric surgery patients had a mean age of 45.5 years and a mean follow-up of 6.9 years. All patient characteristics in obese unexposed patients were highly similar. We observed 126 and 136 severe DD cases among bariatric surgery and obese unexposed patients, respectively. The risk of DD was significantly increased in bariatric surgery patients compared to obese unexposed patients (HR = 1.30, 95% CI 1.02-1.65). The risk of DD was higher in women (HR = 1.36, 95% CI 1.00-1.84) than in men (HR = 1.05, 95% CI 0.70-1.58). Age did not modify the risk of DD among bariatric surgery patients compared to obese unexposed patients. Malabsorptive bariatric surgery yielded an increased risk of DD when compared to obese unexposed patients (HR = 1.33, 95% CI 1.04-1.71), while restrictive bariatric surgery yielded a null result. The risk of DD increased with duration of follow-up (>5 years of follow-up: HR = 1.63, 95% CI 1.14-2.34, null result in earlier follow-up).Conclusion:Our results suggest that substantial weight loss is associated with a latent increased risk of severe DD in an obese population. This observation further strengthens current evidence that high body mass index is protective against DD. The latency of risk increase of DD after bariatric surgery may suggest that slowly adapting metabolic changes may be part of the mechanism of DD emergence.References:[1]Hacquebord JH, Chiu VY, Harness NG. The Risk of Dupuytren Surgery in Obese Individuals. J Hand Surg Am. 2017, 42: 149–55.Acknowledgements:We thank Prof. Dr. Jesper Lagergren (Karolinksa Institutet, Stockholm, Sweden) for hosting Dr. Theresa Burkard for a research stay at the Upper Gastrointestinal Surgery Group and making the data available for use. Furthermore, we thank Dr. Giola Santoni (Karolinksa Institutet, Stockholm, Sweden) for her technical support.Disclosure of Interests:None declared

scholarly journals Correlation of Body Mass Index with Oncologic Outcomes in Colorectal Cancer Patients: A Large Population-Based Study

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3592
Author(s):  
Chong-Chi Chiu ◽  
Chung-Han Ho ◽  
Chao-Ming Hung ◽  
Chien-Ming Chao ◽  
Chih-Cheng Lai ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Body Mass Index ◽  
Body Weight ◽  
Body Mass ◽  
Survival Rates ◽  
Normal Weight ◽  
P Value ◽  
Administrative Claims ◽  
The Impact

It has been acknowledged that excess body weight increases the risk of colorectal cancer (CRC); however, there is little evidence on the impact of body mass index (BMI) on CRC patients’ long-term oncologic results in Asian populations. We studied the influence of BMI on overall survival (OS), disease-free survival (DFS), and CRC-specific survival rates in CRC patients from the administrative claims datasets of Taiwan using the Kaplan–Meier survival curves and the log-rank test to estimate the statistical differences among BMI groups. Underweight patients (<18.50 kg/m2) presented higher mortality (56.40%) and recurrence (5.34%) rates. Besides this, they had worse OS (aHR:1.61; 95% CI: 1.53–1.70; p-value: < 0.0001) and CRC-specific survival (aHR:1.52; 95% CI: 1.43–1.62; p-value: < 0.0001) rates compared with those of normal weight patients (18.50–24.99 kg/m2). On the contrary, CRC patients belonging to the overweight (25.00–29.99 kg/m2), class I obesity (30.00–34.99 kg/m2), and class II obesity (≥35.00 kg/m2) categories had better OS, DFS, and CRC-specific survival rates in the analysis than the patients in the normal weight category. Overweight patients consistently had the lowest mortality rate after a CRC diagnosis. The associations with being underweight may reflect a reverse causation. CRC patients should maintain a long-term healthy body weight.

scholarly journals Physical activity modifies the risk of atrial fibrillation in obese individuals: The HUNT3 study

2018 ◽  
Vol 25 (15) ◽  
pp. 1646-1652 ◽  
Author(s):  
Lars E Garnvik ◽  
Vegard Malmo ◽  
Imre Janszky ◽  
Ulrik Wisløff ◽  
Jan P Loennechen ◽  
...  
Keyword(s):  
Physical Activity ◽  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Confidence Interval ◽  
Body Mass ◽  
High Body Mass Index ◽  
Overweight And Obesity ◽  
Hazard Ratio ◽  
Increased Risk

Background Atrial fibrillation is the most common heart rhythm disorder, and high body mass index is a well-established risk factor for atrial fibrillation. The objective of this study was to examine the associations of physical activity and body mass index and risk of atrial fibrillation, and the modifying role of physical activity on the association between body mass index and atrial fibrillation. Design The design was a prospective cohort study. Methods This study followed 43,602 men and women from the HUNT3 study in 2006–2008 until first atrial fibrillation diagnosis or end of follow-up in 2015. Atrial fibrillation diagnoses were collected from hospital registers and validated by medical doctors. Cox proportional hazard regression analysis was performed to assess the association between physical activity, body mass index and atrial fibrillation. Results During a mean follow-up of 8.1 years (352,770 person-years), 1459 cases of atrial fibrillation were detected (4.1 events per 1000 person-years). Increasing levels of physical activity were associated with gradually lower risk of atrial fibrillation ( p trend 0.069). Overweight and obesity were associated with an 18% (hazard ratio 1.18, 95% confidence interval 1.03–1.35) and 59% (hazard ratio 1.59, 95% confidence interval 1.37–1.84) increased risk of atrial fibrillation, respectively. High levels of physical activity attenuated some of the higher atrial fibrillation risk in obese individuals (hazard ratio 1.53, 95% confidence interval 1.03–2.28 in active and 1.96, 95% confidence interval 1.44–2.67 in inactive) compared to normal weight active individuals. Conclusion Overweight and obesity were associated with increased risk of atrial fibrillation. Physical activity offsets some, but not all, atrial fibrillation risk associated with obesity.

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