Henry Oliveros

Obesity and Mortality in Critically Ill Adults: A Systematic Review and Meta‐analysis

IntroductIon The obesity pandemic continues expanding unabated. Currently, 66% of adults in the United States are overweight or obese, and this figure is expected to rise to 75% by 2015 (1). Although obesity is a wellrecognized risk factor for mortality from cardiovascular disease and cancer (2–4), it is uncertain whether it could influence the acute risk of death in critically ill patients. While some studies conducted in intensive care units (ICUs) indicate increased risk of death for overweight or obese patients (5–8), others have reported inverse (9–17) or null (18–21) associations. It is relevant to examine to what extent obesity is a risk factor for mortality in critically ill patients, given that BMI has been proposed as a criterion to routinely predict survival of patients at the time of admission to the ICU (5,12,22). We conducted a systematic review and meta-analysis of published research papers that addressed the association between overweight or obesity and mortality in critically ill adults. The aims of the review were to investigate whether overweight and obesity are independent predictors of mortality, duration of stay, or multiple organ dysfunction (MOD) in patients admitted to the ICU.

Micronutrient status in middle childhood and age at menarche: Results from the Bogotá School Children Cohort

Childhood intake of animal foods is associated with age at first menstrual period (menarche). It is unknown whether the micronutrients present in these foods could explain this association. Our objective was to investigate the associations of micronutrient status biomarkers in middle childhood with age at menarche. We quantified circulating Hb, ferritin, mean corpuscular volume, Zn, vitamin B12, erythrocyte folate and retinol in 1464 pre-menarcheal girls aged 5-12 years in Bogotá, Colombia, and followed them for a median 5·7 years for the occurrence and date of menarche. We estimated median age at menarche and hazard ratios (HR) with 95 % CI by levels of each biomarker with use of Kaplan-Meier survival probabilities and Cox regression, respectively. Median age at menarche was 12·4 years. Middle childhood Hb was inversely related to age at menarche whereas plasma ferritin was positively associated with this outcome in a linear manner. HR of menarche for every 1 sd of Hb (11 g/l) and ferritin (23·2 µg/l) were 1·11 (95 % CI 1·04, 1·18; P=0·001) and 0·94 (95 % CI 0·88, 0·99; P=0·02), respectively, after adjustment for baseline age, C-reactive protein concentration, maternal age at menarche and parity and socioeconomic status. The association with ferritin was stronger in girls aged 9-10 years at baseline. Additional adjustment for baseline height- and BMI-for-age did not change the results. We conclude that higher Fe status in middle childhood is related to later age at menarche whereas Hb concentrations are inversely associated with age at onset of menses.