title: Obesity and symptoms suggestive of gastroparesis in patients with type 2 diabetes and neuropathy.
abstract: BACKGROUND
  Associated with neuropathy, symptoms suggestive of gastroparesis are common in patients with type 2 diabetes mellitus (T2DM) and include nausea, vomiting, bloating and early satiety. Gastric motor abnormalities have been reported in obese patients, and obesity is associated with T2DM. An association between obesity and gastroparesis symptoms in diabetic patients with neuropathy has not been investigated.
  
  
  METHODS
  In this nested case-control study, 161 patients with neuropathy were identified from within a cross-sectional survey of 380 T2DM patients. Of these, 134 (83.2%, "cases") had at least one cardinal symptom suggestive of gastroparesis. The remaining symptom-free subjects served as controls. Logistic and general linear modeling was used to assess associations between obesity and the presence and number of symptoms.
  
  
  RESULTS
  Subjects were 66.6±10 years of age. Cases were significantly more likely than controls to be obese (89% vs. 77%, P=.04), female (55.6% vs. 33.3%) and hypertensive (90.2% vs. 63%, P=.001) and to report adherence to diet (87.4% vs. 66.7%, P=.007). In a logistic regression model including sex, hypertension, antiaggregant therapy, adherence to diet therapy and an obesity-by-sex interaction term, obesity emerged as a significant independent predictor of any cardinal symptom suggestive of gastroparesis (odds ratio 9.86, 95% confidence interval 1.4-69.2, P=.02). Obesity was also identified as a significant independent predictor of number of cardinal symptoms suggestive of gastroparesis in the general linear model. Obese subjects reported significantly more early satiety (61.5% vs. 35.2%, P=.001), fullness (63.7% vs. 40.8%, P=.004), bloating (70.3% vs. 49.3%, P=.006) and abdominal distention (71.4 vs. 50.7%, P=.007) than nonobese subjects. Further, obese subjects reported more cardinal symptoms suggestive of gastroparesis symptoms (4.2±2.4 vs. 3.1±2.5, P=.01).
  
  
  CONCLUSIONS
  Obesity emerged as a significant independent predictor of cardinal symptoms suggestive of gastroparesis in patients with T2DM and neuropathy. This finding suggests that mechanisms in addition to neuropathy play a role in the generation of symptoms suggestive of gastroparesis in this patient population.
authors.affiliation: Epidemiology and Research Unit, E. Wolfson Medical Center, Holon, Israel. mboaz8@yahoo.com
authors.forename: Mona
authors.initials: M
authors.lastname: Boaz
authors.forename: Julia
authors.initials: J
authors.lastname: Kislov
authors.forename: Ram
authors.initials: R
authors.lastname: Dickman
authors.forename: Julio
authors.initials: J
authors.lastname: Wainstein
mesh_terms: D000368:Aged; D015992:Body Mass Index; D016022:Case-Control Studies; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000178:diet therapy / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000150:complications / Q000503:physiopathology*; D003927:Diet, Diabetic; D005260:Female; D018589:Gastroparesis / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009765:Obesity / Q000150:complications / Q000503:physiopathology*; D010349:Patient Compliance; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors