The Role of Disease Severity in Influencing Body Mass Index in People with Hemophilia Open Access

McNamara, Meredithe Claire (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/wh246s306?locale=en
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Abstract

ABSTRACT

Background: Hemophilia is a heredity bleeding disorder characterized by deficiency of clotting factor VIII or IX. Severity of hemophilia is determined by the blood levels of the deficient factor. The life expectancy for those affected now approaches that of the general population. Paralleling this trend, rates of chronic diseases including obesity are increasing among patients with hemophilia (PWH). It is not known how the severity of disease influences weight gain in PWH. HIV, chronic liver disease and decreased physical activity are more common in severe cases and may also cause weight gain. The central hypothesis of this study is that PWH with severe disease have higher body mass index (BMI) than those with mild and moderate disease.

Methods: To investigate the relationship between disease severity and BMI, a cross-sectional study was performed. Eighty-eight adult males with hemophilia were enrolled. Intermediary variables such as infectious complications of factor replacement (HIV and chronic liver disease from hepatitis C) and physical activity were also studied.

Results: Patients with mild disease had 13.81% higher BMI (95% CI 2.92-25.85, p = 0.012) than those with severe disease and patients with moderate disease had 9.36% higher BMI (95% CI -1.03-18.91, p = 0.079) than those with severe disease, after controlling for age. Among HIV negative subjects, patients with mild disease had 17.39% higher BMI (95% CI, p = 0.016) than those with severe disease and patients with moderate disease had 18.08% higher BMI (95% CI, p = 0.018) than those with severe disease. There were no patients with mild disease and HIV in this cohort.

Conclusions: This study suggests that mild and moderate hemophilia are associated with higher BMI than severe hemophilia, which is the opposite of the original hypothesis. The analysis also suggested that physical activity mediates the relationship. Effect modification by HIV status was detected. Further study into the cause of differences in BMI associated with disease severity is warranted and should evaluate family history, diet and socioeconomic status.

Table of Contents

TABLE OF CONTENTS

INTRODUCTION................ .........................................................................................1

BACKGROUND................. .........................................................................................3

METHODS.......................... .........................................................................................8

RESULTS.................................................... .................................................................13

DISCUSSION.................................... ...........................................................................18

TABLES....................... ................................................................................................24

APPENDIX ..................... ............................................................................................31

REFERENCES................ .............................................................................................32

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