{
  "abstract": "Introduction Individuals who are underweight or obese may have altered gut-brain signalling. This study investigated the association between body mass index (BMI) and the prevalence and burden of Rome IV disorders of gut-brain interaction (DGBI).Methods This cross-sectional analysis utilised data from the Rome Foundation Global Epidemiology Study, conducted in 2017-2018 across 26 countries. Associations between BMI and Rome IV DGBI in adults (≥18 years) were analysed across BMI categories and for each 5 kg/m 2 increment above 25 kg/m2 using mixed logistic regression models (odd ratios [OR]) adjusted (aOR) for age, sex, diabetes, psychological distress, and healthcare utilisation. Additional analyses evaluated anatomical DGBI groups, overlapping disorders, and validated psychometric scales: PROMIS-10 quality of life (QoL) scales (physical and psychological health), patient health questionnaire (PHQ)-4 (anxiety and depression), and PHQ-12 (somatic symptom severity).Results The prevalence of any DGBI followed a U-shaped pattern across BMI categories. DGBI affected 46.36% (95%CI 44.33-48.40%) of underweight participants, decreased to 39.43% (95%CI 38.80%-40.06%) in those with normal BMI, and increased to 52.86% (95%CI 49.76-55.95%) among individuals with obesity class III. Compared with the normal BMI reference, the aOR for at least one DGBI was similar among individuals who were underweight (1.02; 95%CI 0.93-1.12) but increased progressively among individuals who were overweight (1.10; 95%CI 1.05-1.15), obese class I (1.20; 95%CI 1.13-1.29), class II (1.23; 95%CI 1.11-1.36), and class III (1.52; 95%CI 1.32-1.74). Each 5 kg/m 2 increment above a BMI of 25 kg/m2 was associated with an 8% (95%CI 4-11%) increase in the likelihood of any DGBI. Associations between BMI and DGBI were strongest for oesophageal (aOR per 5 kg/m2 BMI increase of 1.11; 95%CI 1.05-1.17) and gastroduodenal disorders (aOR per 5 kg/m2 BMI increase of 1.09; 95%CI 1.05-1.08) (figure 1). Bowel disorders were the most prevalent DGBI overall, affecting 33.14% of participants with normal BMI and 41.83% of those who were obese class III (aOR per 5 kg/m2 increase of 1.05; 95%CI 1.01-1.08). Anorectal disorders showed no statistically significant incremental increase in odds (aOR per 5 kg/m2 BMI increase of 1.05; 95%CI: 1.00-1.10; p>0.05). Statistically significant increases in odds of DGBI per 5 kg/m2 BMI rise above 25 kg/m2 were identified among those with two and three overlapping DGBI (aOR 1.06; 95%CI 1.01-1.11 and 1.12; 95%CI 1.04-1.20, respectively), but not among those with one and four overlapping DGBI (figure 1). Higher BMI categories were associated with lower PROMIS-10 scores, irrespective of DGBI status. The PHQ-4 and PHQ-12 scores rose progressively with increasing BMI.Conclusions Higher, but not lower, BMI is associated with increased prevalence and symptom burden of DGBI. Obesity confers the highest odds for overlapping disorders and psychological disturbances.Abstract P406 Figure 1Association between BMI and DGBI by gastrointestinal anatomic region (top panel) and overlapping disorders (bottom panel). Odds ratios (OR) were adjusted for age, sex, diabetes, PHQ-4 score, and healthcare access. The reference category was BMI 18.5-25 kg/m2. The OR per 5 kg/m2 increase in BMI, along with its 95% confidence interval (95%CI), was calculated only for participants with BMI >25 kg/m2. The area of each square is proportional to the information content of the reference category. Abbreviations: BMI, body mass index; DGBI, disorder of gut brain interaction; PHQ-4, patient health questionnaire-4",
  "authors": [
    {
      "affiliations": [
        "University of Nottingham, Nottingham, United Kingdom"
      ],
      "name": "Mohsin Butt"
    },
    {
      "affiliations": [
        "Case Western Reserve University, Cleveland, United States of America"
      ],
      "name": "Daniel M Simadibrata"
    },
    {
      "affiliations": [
        "Northwestern University, Chicago, United States of America"
      ],
      "name": "Benjamin D Liu"
    },
    {
      "affiliations": [
        "Case Western Reserve University, Cleveland, United States of America"
      ],
      "name": "Zaid Al-Fakhouri"
    },
    {
      "affiliations": [
        "Thomas Jefferson University, Philadelphia, United States of America"
      ],
      "name": "Laith Alomari"
    },
    {
      "affiliations": [
        "Universiti Sains Malaysia, Kota Bharu, Malaysia"
      ],
      "name": "Kueh Y Cheng"
    },
    {
      "affiliations": [
        "University of North Carolina at Chapel Hill, Chapel Hill, United States of America"
      ],
      "name": "Olafur S Palsson"
    },
    {
      "affiliations": [
        "Ben-Gurion University of the Negev, Beer-Sheva, Israel"
      ],
      "name": "Ami D Sperber"
    },
    {
      "affiliations": [
        "McMaster University, Hamilton, United States of America"
      ],
      "name": "Shrikant I Bangdiwala"
    },
    {
      "affiliations": [
        "Cleveland Clinic, Cleveland, United States of America"
      ],
      "name": "Anthony Lembo"
    },
    {
      "affiliations": [
        "Universiti Sains Malaysia, Kota Bharu, Malaysia"
      ],
      "name": "Yeong Y Lee"
    }
  ],
  "title": "P406 Body mass index and its association with disorders of gut-brain interaction: a large global population analysis",
  "uid": "56633ee5-2862-5aff-a6ea-e9572e9b7a2d"
}