PHILADELPHIA–Stiff-legged walking (FKW) for decades has been linked to a lower risk of death due to acute respiratory distress syndrome (ARDS) – a type of orthopedic disorder that may affect children and young adults. A new analysis of the European Prospective Investigation into Nutrition (EPINE) data revealed an interaction between FKW and low-grade inflammation, a factor that predicts disease severity. Results from a cohort of 104 elderly patients and 49 healthy subjects showed that patients with FKW had significantly lower than predicted risk values for all-cause mortality and cardiovascular disease mortality associated with the development of ARDS.Study authors reported that unpublished data suggest that their analysis excluding patients with ARDS is consistent with the findings of the 6-month body mass index (BMI) scanning program being conducted in the Framingham Heart Study of children and young adults. This new analysis, published in JAMA, appears to confirm this work by critically examining the relationship between BMI and ARDS risk factors. In the analysis, the researchers considered two potential confounders: the proportion of patients with a BMI of 20 or less and age when they arrived in Framingham at the scan. They also considered the time since MRI test results were obtained and whether the patient had had previous heart or lung surgery. The researchers then explored the indirect effects of BMI on participants’ risk of death at six-month follow-up from their assessments, finding a borderline significant negative influence with no clear adverse effects. This effect was independent of both the time since MRI test results were obtained and whether patients had had orthopedic, GI, or lung surgery. Further, a relatively small effect of low-grade inflammation on mortality in the first cohort was also observed.
“With obesity, FKW and similar syndromes have been well-studied for its potential role in diseases of the musculoskeletal system and its risk prediction for these diseases,” explained Alexey Oshbayev, MD, Ph.D., MPH, assistant professor of pediatrics at the University of Pennsylvania Perelman School of Medicine and senior research associate at the Center for Pediatric Injury Research (CPIR) at the University of Pennsylvania, Philadelphia, PA, and senior research scholar at the National Institute of Environmental Health Sciences in Greece. “In previous studies using JAMA, we have found an association between FKW and mortality, which points to lower mortality in patients who have had heart attacks, but not in those without. However, recently we have seen the opposite. In the Framingham cohort, we looked at the unadjusted mortality scores – cardiovascular disease mortality, coronary artery disease mortality, and fracture hospitalization – as well as FKW and found that patients with FKW, even when they have ARDS, had a higher proportion of patients with GI, lung, or heart disease mortality than did patients without ARDS. This finding suggests that there is a role for FKW in the outcome of patients with ARDS.”
So-called incrementally invasive procedures – systemic, single-photon absorptiometry, positron emission tomography, or high-energy transcranial magnetic stimulation – are strongly associated with FKW, which can define end-stage renal disease and lead to long-term kidney damage. FKW has also been found to predict brain atrophy and hippocampal atrophy in young adolescents and adults and to be related to neurocognitive impairment between ages 15 and 20 years. Of note, FKW, which is associated with higher risks of physical ailments, has been associated with poor childhood contact and cognitive impairment in first and second-year high school students.
Of the 44 European countries that participated in the EPINE study, 19 — including the United Kingdom— reported a higher than predicted BMI of 20/-0.6; 52 — assessed a BMI of 20/-1.26; and 66 — graded an overweight BMI of 25/-0.9. BMI and BMI are considered clinically important for determining body mass index (BMI) in adults. BMI itself and BMI adjusted for fat mass and hemoglobin A1c are considered clinically essential for prediction of the risk of ARDS. Subjects most affected by ARDS, and with a BMI of between 25 and 33, displayed lower risk scores for ARDS:a 9-point risk adjusted by 0.05 kg/m2b 4-point risk adjusted by 0.06 kg/m2b 7-point risk adjusted by 0.06 kg/m2c 10-point risk adjusted by 0.06 kg/m2d 25-point risk adjusted by 0.04 kg/m2d and 30-point risk adjusted by 0.03 kg/m2d