Li, Qiongzhen; Du, Xiangdong; Zhang, Yingyang; Yin, Guangzhong; Zhang, Guangya; Walss-Bass, Consuelo; Quevedo, João; Soares, Jair C; Xia, Haishen; Li, Xiaosi; Zheng, Yingjun; Ning, Yuping; Zhang, Xiang Yang
Obesity is a common comorbidity in schizophrenia. Few studies have addressed obesity in Chinese schizophrenia patients. The aims of this current study were to evaluate the prevalence, risk factors and clinical correlates of obesity in Chinese patients with schizophrenia. A total of 206 patients were recruited from a hospital in Beijing. Their clinical and anthropometric data together with plasma glucose and lipid parameters were collected. Positive and Negative Syndrome Scale (PANSS) was rated for all patients. Overall, 43 (20.9%) patients were obese and 67 (32.5%) were overweight. The obese patients had significantly higher glucose levels, triglyceride levels than non-obese patients. Females and patients with type 2 diabetes mellitus had increased risk for obesity. Correlation analysis showed that BMI was associated with sex, education levels, negative symptoms, total PANSS score, triglyceride levels and type 2 diabetes mellitus. Further stepwise regression analysis showed that sex, type 2 diabetes, education level, triglyceride and amount of smoking/day were significant predictors for obesity. Our study showed that the prevalence of obesity in Chinese patients with schizophrenia is higher than that in the general population. Some demographic and clinical variables are risk factors for obesity in schizophrenia. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.
Mariani, S; Costantini, D; Lubrano, C; Basciani, S; Caldaroni, C; Barbaro, G; Poggiogalle, E; Donini, L M; Lenzi, A; Gnessi, L
Obesity is increasing worldwide and is related to undesirable cardiovascular outcomes. Epicardial fat (EF), the heart visceral fat depot, increases with obesity and correlates with cardiovascular risk. SIRT1, an enzyme regulating metabolic circuits linked with obesity, has a cardioprotective effect and is a predictor of cardiovascular events. We aimed to assess the relationship of EF thickness (EFT) with circulating SIRT1 in patients with obesity. Sixty-two patients affected by obesity and 23 lean controls were studied. Plasma SIRT1 concentration was determined by enzyme-linked immunosorbent assay (ELISA). EFT was measured by echocardiography. Body mass index (BMI), waist circumference, heart rate (HR), blood pressure, and laboratory findings (fasting glucose, insulin, HbA1c, cholesterol, and triglycerides) were assessed. SIRT1 was significantly lower (P = 0.002) and EFT was higher (P < 0.0001) in patients with obesity compared with lean controls. SIRT1 showed a negative correlation with EFT and HR in the obesity group (ρ = -0.350, P = 0.005; ρ = -0.303, P = 0.008, respectively). After adjustment for obesity-correlated variables, multiple linear regression analysis showed that EFT remained the best correlate of SIRT1 (β = -0.352, P = 0.016). Circulating SIRT1 correlates with the visceral fat content of the heart. Serum SIRT1 levels might provide additional information for risk assessment of coronary artery disease in patients with obesity. Copyright © 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
Han, Fang; Hou, Ningning; Miao, Wei; Sun, Xiaodong
To determine whether intrarenal arterial resistance index (RI) value is related to increased urinary albumin excretion and whether RI value is an independent good indicator to evaluate early renal damage in nonhypertensive, nondiabetic obese subjects. Sixty-four nonhypertensive, nondiabetic obese patients (OB) and 35 age- and sex-matched normal healthy subjects were involved in this study. Clinical characteristics and blood biochemistry of all the subjects were measured. Urinary albumin/creatinine ratio (ACR) and sonographic evaluation of renal blood flow were determined. ACR and interlobar arterial RI were significantly higher in obese patients than those of normal healthy subjects. Interlobar arterial RI value was higher in patients with microalbuminuria than those with normoalbuminuria. Correlation analysis showed interlobar artery RI value had a positive correlation with ACR (r = 0.615, p < 0.01) and plasma free fatty acids (FFAs, r = 0.407, p < 0.01). ACR had a positive correlation with BMI (r = 0.380, p < 0.01), waist circumference (r = 0.414, p < 0.01), plasma FFAs (r = 0.537, p < 0.01). Multivariate regression analyses showed that ACR was best predicted by interlobar artery RI value even when body mass index, waist circumference, FFAs, and high-sensitive C reaction protein were added in the statistical analysis. Interlobar arterial RI may be an independent predictor of microalbuminuria in nonhypertensive, nondiabetic obese patients, and interlobar arterial RI could be a useful tool for assessment early renal damage in obese patients.
Laforest, Laurent; Van Ganse, Eric; Ritleng, Cécile; Desamericq, Gaelle; Letrilliart, Laurent; Moreau, Alain; Rosen, Sarah; Mechin, Hubert; Chamba, Genevieve
The correlates of quality of life (QOL), as measured by the OSQOL questionnaire were investigated in a convenience sample of overweight patients recruited in pharmacies. A convenience sample of patients with a Body Mass Index > or = 28 kg/m(2) were recruited in community-based pharmacies. Baseline characteristics and QOL dimensions (1-Physical state, 2-Vitality-desire to do things, 3-Relations with others, 4-Psychological state) were reported in self-completed questionnaires from which the risk of obtaining a low QOL was assessed for each dimension. QOL was inadequate for all dimensions in the 494 patients included in the study (median age = 61, 48% women, 21% professional persons/top executives). Older pre-obese and obese patients were more likely to report impaired physical functioning (OR = 2.02, 95%CI = [1.10-3.70]), but were less severely affected socially (OR = 0.32, 95%CI = [0.15-0.69]). Pre-obese and obese professional persons and top executives showed better physical capabilities (OR = 0.35, 95%CI = [0.15-0.81]) and increased vitality (OR = 0.47, 95%CI = [0.23-0.95]). Overall, men's psychological state was better than females' (OR = 0.46, 95%CI = [0.25-0.82]). A body-mass index > or = 35 kg/m(2) was significantly associated with poorer QOL scores on physical, relational and psychological dimensions. Our data highlighted the influence of the severity of excess weight, gender, age and socioeconomic status on QOL. These factors should be taken into account when interpreting QOL in pre-obese and obese persons.
Laforest, Laurent; Van Ganse, Eric; Ritleng, Cécile; Desamericq, Gaelle; Letrilliart, Laurent; Moreau, Alain; Rosen, Sarah; Mechin, Hubert; Chamba, Genevieve
Background The correlates of quality of life (QOL), as measured by the OSQOL questionnaire were investigated in a convenience sample of overweight patients recruited in pharmacies. Methods A convenience sample of patients with a Body Mass Index ≥ 28 kg/m2 were recruited in community-based pharmacies. Baseline characteristics and QOL dimensions (1-Physical state, 2-Vitality-desire to do things, 3-Relations with others, 4-Psychological state) were reported in self-completed questionnaires from which the risk of obtaining a low QOL was assessed for each dimension. Results QOL was inadequate for all dimensions in the 494 patients included in the study (median age = 61, 48% women, 21% professional persons/top executives). Older pre-obese and obese patients were more likely to report impaired physical functioning (OR = 2.02, 95%CI = [1.10-3.70]), but were less severely affected socially (OR = 0.32, 95%CI = [0.15-0.69]). Pre-obese and obese professional persons and top executives showed better physical capabilities (OR = 0.35, 95%CI = [0.15-0.81]) and increased vitality (OR = 0.47, 95%CI = [0.23-0.95]). Overall, men's psychological state was better than females' (OR = 0.46, 95%CI = [0.25-0.82]). A body-mass index ≥ 35 kg/m2 was significantly associated with poorer QOL scores on physical, relational and psychological dimensions. Conclusion Our data highlighted the influence of the severity of excess weight, gender, age and socioeconomic status on QOL. These factors should be taken into account when interpreting QOL in pre-obese and obese persons. PMID:19754928
Liu, Y-Z; Wang, K-Q; Ji, D-H; Zhang, L-C; Bi, M; Shi, B-Y
To investigate the correlations of MC4R and MSH2 with adult obesity, a total of 46 patients with early-stage colon cancer were treated in our hospital between February 2008 and February 2009 and were enrolled. Venous blood was regularly drawn from subjects of the observation group and 48 healthy subjects for 6 years. Expression levels of MC4R and MSH2 genes were tested using quantitative polymerase chain reaction analyses, and the ensuing proteins were determined using enzyme-linked immunosorbent assays and Western blotting and immunohistochemical analyses. Finally, correlations with body mass index (BMI) and the presence of colon cancer were identified using multivariate analyses. Compared with the control group, MSH2 mRNA and protein expression increased significantly over time (p < 0.05) in patients with colon cancer. Moreover, MSH2 expression was correlated with colon cancer progression, and MC4R mRNA and protein expression increase concurrently in comparison with the control group (p < 0.05). Also, the mean BMI among patients with colon cancer was 30.8, whereas that among control subjects was only 21.4. These data indicate a relationship between BMI and colon cancer. Expression of MSH2 in patients with colon cancer may promote the expression of the obesity gene MC4R, potentially contributing to body weight gains.
Fritche-Salazar, Juan Francisco; Vázquez-Castro, Nelva Marina; Rivera-Lara, Pedro; Pérez-Méndez, Oscar; Martínez-Herrera, Humberto; Gómez-Sánchez, Mario; Aranda-Frausto, Alberto; Herrera-Bello, Héctor; Luna-Luna, María; Arias Godínez, José Antonio
Background Severe aortic stenosis (AS), leads to pathological left ventricular remodeling that may worsen with concomitant overweight and obesity (OW/O). Methods We aimed to prospectively analyze the impact of OW/O on ventricular remodeling in severe AS, by evaluating the percentage of intraendomyocardial fibrosis (PIEF) and the percentage of infiltrating intraendocardial lipid vacuoles (PIELV) and its relationship to global longitudinal strain (GLS) in patients with OW/O. Results 44 patients with severe AS were included, 13 non-obese (29%) and 31 OW/O (71%), all of them with left ventricular ejection fraction ≥ 55%. GLS was evaluated with 2D speckle tracking. During valve replacement, an endocardial biopsy was obtained, where PIEF and PIELV were analyzed. Patients with higher PIEF and PIELV had greater body mass index (p < 0.0001) and worse GLS (p < 0.0053). A GLS cut-off point < -14% had a sensitivity of 75%, and a specificity of 92.8% to detect important PIEF (AUC: 0.928, 95% confidence interval: 0.798–1.00). On multivariate analysis, OW/O and PIELV were independently associated to the PIEF, and OW/O and PIEF were independently associated to GLS. A high correlation between the amount of PIELV and PIEF were found. Conclusion Patients with severe AS and OW/O have greater PIEF and PIELV, suggesting more pathological remodeling. GLS is useful to detect subclinical myocardial injury and is potentially useful for endomyocardial fibrosis detection. The presence of higher PIELF may be a trigger factor for the development of intraendomyocardial fibrosis. PMID:28090258
Villarejo, Cynthia; Fernández-Aranda, Fernando; Jiménez-Murcia, Susana; Peñas-Lledó, Eva; Granero, Roser; Penelo, Eva; Tinahones, Francisco J; Sancho, Carolina; Vilarrasa, Nuria; Montserrat-Gil de Bernabé, Mónica; Casanueva, Felipe F; Fernández-Real, Jose Manuel; Frühbeck, Gema; De la Torre, Rafael; Treasure, Janet; Botella, Cristina; Menchón, José Manuel
Objectives : The aims of our study were to examine the lifetime prevalence of obesity rate in eating disorders (ED) subtypes and to examine whether there have been temporal changes among the last 10 years and to explore clinical differences between ED with and without lifetime obesity. Methods : Participants were 1383 ED female patients (DSM-IV criteria) consecutively admitted, between 2001 and 2010, to Bellvitge University Hospital. They were assessed by means of the Eating Disorders Inventory-2, the Symptom Checklist-90—Revised, the Bulimic Investigatory Test Edinburgh and the Temperament and Character Inventory—Revised. Results : The prevalence of lifetime obesity in ED cases was 28.8% (ranging from 5% in anorexia nervosa to 87% in binge-eating disorders). Over the last 10 years, there has been a threefold increase in lifetime obesity in ED patients (p < .001). People with an ED and obesity had higher levels of childhood and family obesity (p < .001), a later age of onset and longer ED duration; and had higher levels of eating, general and personality symptomatology. Conclusions : Over the last 10 years, the prevalence of obesity associated with disorders characterized by the presence of binge episodes, namely bulimic disorders, is increasing, and this is linked with greater clinical severity and a poorer prognosis. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association. PMID:22383308
Background Health-related quality of life (HRQL) is poor in obese subjects and is a relevant outcome in intervention studies. We aimed to determine factors associated with poor HRQL in obese patients seeking weight loss in medical units, outside specific research projects. Methods HRQL, together with a number of demographic and clinical parameters, was studied with generic (SF-36, PGWB) and disease-specific (ORWELL-97) questionnaires in an unselected sample of 1,886 (1,494 women; 392 men) obese (BMI > 30 kg/m2) patients aged 20-65 years attending 25 medical units scattered throughout Italy. The clinics provide weight loss treatment using different programs. General psychopathology (SCL-90 questionnaire), the presence of binge eating (Binge Eating scale), previous weight cycling and somatic comorbidity (Charlson's index) were also determined. Scores on SF-36 and PGWB were compared with Italian population norms, and their association with putative determinants of HRQL after adjustment for confounders was assessed through logistic regression analysis. Results HRQL scores were significantly lower in women than in men. A greater impairment of quality of life was observed in relation to increasing BMI class, concurrent psychopathology, associated somatic diseases, binge eating, and weight cycling. In multivariate analysis, psychopathology (presence of previously-diagnosed mental disorders and/or elevated scores on SCL-90) was associated with lower HRQL scores on both psychosocial and somatic domains; somatic diseases and higher BMI, after adjustment for confounders, were associated with impairment of physical domains, while binge eating and weight cycling appeared to affect psychosocial domains only. Conclusions Psychopathological disturbances are the most relevant factors associated with poor HRQL in obese patients, affecting not only psychosocial, but also physical domains, largely independent of the severity of obesity. Psychological/psychiatric interventions are
Stengel, Andreas; Hofmann, Tobias; Goebel-Stengel, Miriam; Elbelt, Ulf; Kobelt, Peter; Klapp, Burghard F
Irisin was recently identified as cleavage product of fibronectin type III domain containing 5 (FNDC5) and shown to increase energy expenditure in mice and humans and therefore was discussed as potential treatment option in obesity. However, the regulation of irisin under conditions of severely altered body weight such as anorexia nervosa and obesity remains to be investigated. We analyzed circulating irisin levels over a broad spectrum of body weight in 40 patients with anorexia nervosa (mean body mass index, BMI 12.6±0.7 kg/m(2)), normal weight controls (22.6±0.9 kg/m(2)) and obese patients with BMI of 30-40 (36.9±1.2 kg/m(2)), 40-50 (44.9±1.1 kg/m(2)) and >50 (70.1±2.7 kg/m(2), n=8/group). Correlation analyses were performed between irisin and different body indices, parameters of body composition and hormones involved in various homeostatic processes. Obese patients showed higher circulating irisin levels compared to normal weight and anorexic patients (p<0.05) resulting in a correlation of irisin with body weight (r=0.47, p<0.01) and BMI (r=0.50, p<0.001). Plasma irisin was also positively correlated with fat mass (r=0.48, p<0.01), body cell mass (r=0.45, p<0.01) and fat free mass (r=0.40, p<0.05). Insulin levels were positively correlated with irisin (r=0.45, p<0.01), whereas circulating ghrelin, cortisol, thyroid-stimulating hormone or C-reactive protein were not (p>0.05). These data indicate that circulating irisin is affected under conditions of altered BMI with highest levels in severely obese patients. The increase of irisin under conditions of obesity may indicate a physiological function to improve glucose tolerance which is often impaired in obese subjects.
Saitoh, Sanae; Shimoda, Taeko; Hamamoto, Yukie; Nakaya, Yutaka; Nakajima, Shigeru
Context: Various studies have focused on the correlation between β2-adrenergic receptor (β2AR), the β3-adrenergic receptor (β3AR), and the uncoupling protein 1 (UCP1) polymorphisms and obesity in patients with type 2 diabetes mellitus (T2DM). Aims: We examined the correlation between these polymorphisms and body composition variables and between body composition and lifestyle variables in Japanese T2DM patients. Materials and Methods: Of the 48, T2DM outpatients in Kanagawa prefecture recruited for participation, 32 (6 men and 26 women) met the study criteria and were enrolled. Obesity-related gene polymorphisms were identified in 3 genes β3AR, UCP1, and β2AR using the SMart amplification process. Body composition variables were measured using a body composition analyzer. Data regarding food and nutrient consumption, family history, and lifestyle factors were collected via administration of questionnaires. Results: Because significant differences in body composition variables were found between men and women, statistical analysis was performed with data from the 25 female subjects only. On the basis of results of genetic testing, the subjects were divided into genotype groups for two-group and three-group comparison. The β3AR, UCP1, and β2AR polymorphisms and body composition significantly correlated with the percentage of subcutaneous fat in both arms as compared with the wild type or hetero groups with β3AR polymorphisms. However, physical activity correlated with several body composition variables. Conclusions: These results suggest that obesity in T2DM patients is not the result of presence of an obesity-related gene polymorphism but rather the absence of daily physical activity. PMID:25593829
Hoiberg, Anne; And Others
Results lend support to the other research findings and point to the difficulties that many overweight individuals have during a weight-reduction endeavor because they also must deal with the numerous psychological and physiological problems involved in overcoming a history of being obese. (Author)
Hemiup, Jeremy T.; Carter, Cathleen A.; Fox, Chester H.; Mahoney, Martin C.
Urban populations face unique health challenges. We used data from a cross-sectional comprehensive health risk assessment survey conducted at an urban family medicine center to explore demographic and clinical correlates of obesity among 923 adults ages 20-64 years. Based on univariate analyses, there were no significant differences for body mass index (BMI) categories or health status ratings by racial group. A logistic model revealed that obese respondents (BMI >30.0) were significantly less likely to be female, white and to report a body image of overweight. Overall, just 25% of persons with a BMI of >30 classified themselves as being overweight. A second logistic model revealed that respondents reporting a body image of overweight were significantly more likely to be age 50-64 years, female, white and to report their health as good or fair/poor, which may reflect differing cultural and social beliefs of how individuals perceive their weight. This misperception between calculated BMI and reported body image in this urban population may serve to moderate attempts to address weight control as a health issue. PMID:16396056
Bertola, Adeline; Ciucci, Thomas; Rousseau, Déborah; Bourlier, Virginie; Duffaut, Carine; Bonnafous, Stéphanie; Blin-Wakkach, Claudine; Anty, Rodolphe; Iannelli, Antonio; Gugenheim, Jean; Tran, Albert; Bouloumié, Anne; Gual, Philippe; Wakkach, Abdelilah
T-cell regulation in adipose tissue provides a link between inflammation and insulin resistance. Because of alterations in adipose tissue T-cell composition in obesity, we aimed to identify the antigen-presenting cells in adipose tissue of obese mice and patients with insulin resistance. Dendritic cells (DCs) and T cells were studied in mice and in two cohorts of obese patients. In lean mice, only CD11c+ DCs were detected in adipose tissue. Adoptive transfer of naive CD4+ T cells in Rag1−/− mice led to a predominant Th1 response in adipose tissue. In contrast, during obesity DCs (human CD11c+CD1c+ and mouse CD11chighF4/80low) accumulated in adipose tissue. CD11chighF4/80low DCs from obese mice induced Th17 differentiation. In patients, the presence of CD11c+CD1c+ DCs correlated with the BMI and with an elevation in Th17 cells. In addition, these DCs led to ex vivo Th17 differentiation. CD1c gene expression further correlated with homeostatic model assessment-insulin resistance in the subcutaneous adipose tissue of obese patients. We show for the first time the presence and accumulation of specific DCs in adipose tissue in mouse and human obesity. These DCs were functional and could be important regulators of adipose tissue inflammation by regulating the switch toward Th17 cell responses in obesity-associated insulin resistance. PMID:22596049
Lapidoth, Joakim de Man; von Hausswolff-Juhlin, Yvonne
The impression from Swedish eating disorder (ED) units is that there has been an increase in the number of overweight or obese patients. There is, however, no research studying whether these patients differ from normal-weight ED patients in other aspects than weight. Differences between normal-weight and overweight or obese ED patients could indicate that these groups of patients need different treatment approaches. The aim of this study was to investigate possible differences between normal-weight and overweight or obese ED patients in psychiatric and psychological pre-treatment variables. The study was based on data from a Swedish quality assurance system for ED care. In total, data from 3,798 adult patients with body mass index ≥ 18.5 were used. The sample included all normal-weight ED diagnoses. Significant differences between normal-weight, overweight and obese patients were found for five of eight self-image variables, for all eating disorder examination questionnaire subscales and for most key diagnostic symptoms. However, effect sizes were mostly small or very small. Overweight or obese patients did not display greater levels of psychiatric psychopathology than normal-weight patients. They did, however, show a tendency towards more negative self-image and more severe ED symptoms than normal-weight patients. Overweight and obesity in ED patients are thus not only associated with physical health problems, but also with mental health issues. Further studies are required to investigate the clinical relevance of these findings.
Prinz, Philip; Hofmann, Tobias; Ahnis, Anne; Elbelt, Ulf; Goebel-Stengel, Miriam; Klapp, Burghard F; Rose, Matthias; Stengel, Andreas
Bile acids may be involved in the regulation of food intake and energy metabolism. The aim of the study was to investigate the association of plasma bile acids with body mass index (BMI) and the possible involvement of circulating bile acids in the modulation of physical activity and eating behavior. Blood was obtained in a group of hospitalized patients with normal weight (BMI 18.5-25 kg/m(2)), underweight (anorexia nervosa, BMI < 17.5 kg/m(2)) and overweight (obesity with BMI 30-40, 40-50 and >50 kg/m(2), n = 14-15/group) and plasma bile acid concentrations assessed. Physical activity and plasma bile acids were measured in a group of patients with anorexia nervosa (BMI 14.6 ± 0.3 kg/m(2), n = 43). Lastly, in a population of obese patients (BMI 48.5 ± 0.9 kg/m(2), n = 85), psychometric parameters related to disordered eating and plasma bile acids were assessed. Plasma bile acids showed a positive correlation with BMI (r = 0.26, p = 0.03) in the population of patients with broad range of BMI (9-85 kg/m(2), n = 74). No associations were observed between plasma bile acids and different parameters of physical activity in anorexic patients (p > 0.05). Plasma bile acids were negatively correlated with cognitive restraint of eating (r = -0.30, p = 0.008), while no associations were observed with other psychometric eating behavior-related parameters (p > 0.05) in obese patients. In conclusion, these data may point toward a role of bile acids in the regulation of body weight. Since plasma bile acids are negatively correlated with the cognitive restraint of eating in obese patients, this may represent a compensatory adaptation to prevent further overeating.
Prinz, Philip; Hofmann, Tobias; Ahnis, Anne; Elbelt, Ulf; Goebel-Stengel, Miriam; Klapp, Burghard F.; Rose, Matthias; Stengel, Andreas
Bile acids may be involved in the regulation of food intake and energy metabolism. The aim of the study was to investigate the association of plasma bile acids with body mass index (BMI) and the possible involvement of circulating bile acids in the modulation of physical activity and eating behavior. Blood was obtained in a group of hospitalized patients with normal weight (BMI 18.5–25 kg/m2), underweight (anorexia nervosa, BMI < 17.5 kg/m2) and overweight (obesity with BMI 30–40, 40–50 and >50 kg/m2, n = 14–15/group) and plasma bile acid concentrations assessed. Physical activity and plasma bile acids were measured in a group of patients with anorexia nervosa (BMI 14.6 ± 0.3 kg/m2, n = 43). Lastly, in a population of obese patients (BMI 48.5 ± 0.9 kg/m2, n = 85), psychometric parameters related to disordered eating and plasma bile acids were assessed. Plasma bile acids showed a positive correlation with BMI (r = 0.26, p = 0.03) in the population of patients with broad range of BMI (9–85 kg/m2, n = 74). No associations were observed between plasma bile acids and different parameters of physical activity in anorexic patients (p > 0.05). Plasma bile acids were negatively correlated with cognitive restraint of eating (r = −0.30, p = 0.008), while no associations were observed with other psychometric eating behavior-related parameters (p > 0.05) in obese patients. In conclusion, these data may point toward a role of bile acids in the regulation of body weight. Since plasma bile acids are negatively correlated with the cognitive restraint of eating in obese patients, this may represent a compensatory adaptation to prevent further overeating. PMID:26089773
Acosta-Olivo, C; Gonzalez-Saldivar, J C; Villarreal-Villarreal, G; Torres-Botello, A; Gomez-Garcia, E; Tamez-Mata, Y; Peña-Martinez, V
The incidence of obesity has increased significantly worldwide. Our hypothesis was that patients with obesity have a more severe distal radius fracture and we realized a study to evaluate this correlation between obesity and severity of distal radius fractures caused by low-energy injuries. A total of 114 patients with distal radius fracture were examined in a cross-sectional, observational study. Fractures were classified according to the international AO-Müller/Orthopedic Trauma Association (AO/OTA) classification in order to determine the severity. The patient's Body Mass Index (BMI) was calculated and a Pearson correlation was performed. The patients were predominantly female, and left side was more frequently affected. Most of the fractures were AO/OTA type A (71 patients). The majority of the involved patients in our study were overweighed or obese. We do not observe a direct correlation between grade of obesity and distal radius fracture severity. Based on the results of this study obesity and severity of distal radius fractures do not correlate. Prognostic. Level IV. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Vuong, Jennifer; Qiu, Yuelin; La, Myanh; Clarke, Gwen; Swinkels, Dorine W; Cembrowski, George
Body mass index (BMI), the prevalent indicator of obesity, is not easily grasped by patients nor physicians. Waist circumference (WC) is correlated to obesity, is better understood and has a stronger relationship to the metabolic syndrome. We compiled WC, complete blood count (CBC) parameters as well as other pertinent data of 6766 25-55-year-old US volunteers sampled in the US National Health and Nutrition Examination Survey, in the years 2005-2010. To determine reference intervals of typical US patients visiting their clinician, we used minimal exclusion criteria. We compiled hemoglobin, red blood cell count, hematocrit, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration, mean cell hemoglobin (MCH), red cell distribution width (RDW), platelet count, mean platelet volume, and counts of white blood cells (WBC), neutrophils, lymphocytes, monocytes, eosinophils, and basophils. In addition, we also compiled serum C reactive protein and serum iron. The three major US races were studied and reference interval diagrams were constructed for each CBC parameter plotted against WC. WBC count, RDW, lymphocyte, neutrophil, and red blood cell count increase with WC. Conversely, serum iron and MCH and MCV decrease. These relationships may be related to insulin resistance and chronic activation of the immune system and the resulting low-grade inflammatory state. WC is a strong predictor for many CBC parameters, suggesting that WC should be taken into account when evaluating blood count results. Clinicians who take care of obese patients should be aware of altered hematology and investigate and treat accordingly.
Wofford, Marion R; Smith, Grant; Minor, Deborah S
Hypertension causes a significant disease burden in all racial and ethnic groups and is directly attributable to excess weight in most cases. The relationship between increasing body mass index and hypertension prevalence has been recognized for decades. Epidemiologic studies clearly demonstrate the correlation between body weight and blood pressure in obese and lean populations. Most patients with hypertension are overweight or obese, and loss of excess weight lowers blood pressure. Although the epidemiologic relationship is clear, the understanding of mechanisms linking hypertension and weight gain is still evolving. Lifestyle modifications and specific pharmacologic agents address many of the known mechanisms; however, blood pressure remains difficult to control in obese hypertensive patients. This review highlights the association of obesity and hypertension, identifies potential mechanisms for this association, and describes nonpharmacologic and pharmacologic strategies that offer potential benefits for the obese patient with hypertension.
van der Merwe, M-T
Psychological comorbidity is high in patients with obesity and is associated with a variety of medical and dietary problems as well as demographic, social and cognitive risk factors. Young overweight and obese women are at particular risk for developing sustained depressive mood, which is an important gateway symptom for major depressive disorder. Increased knowledge of behavioural risk factors has enabled patients with obesity to be classified on a psychological basis and this needs to be considered as part of a patient's clinical assessment and treatment strategy. Increased awareness of abnormal eating behaviour, together with profiling of personality traits, could improve treatment selection for obese women and improve the outcome of weight-loss programmes. Individualised antiobesity drug therapy may be required depending on the patient's psychological characteristics.
Graessler, J; Qin, Y; Zhong, H; Zhang, J; Licinio, J; Wong, M-L; Xu, A; Chavakis, T; Bornstein, A B; Ehrhart-Bornstein, M; Lamounier-Zepter, V; Lohmann, T; Wolf, T; Bornstein, S R
Roux-en-Y gastric bypass (RYGB) has become a prominent therapeutic option for long-term treatment of morbid obesity and type 2 diabetes mellitus (T2D). Cross talk and pathogenetic consequences of RYGB-induced profound effects on metabolism and gut microbiome are poorly understood. The aim of the present study therefore was to characterize intra-individual changes of gut microbial composition before and 3 months after RYGB by metagenomic sequencing in morbidly obese patients (body mass index (BMI)>40 kg m(-)(2)) with T2D. Subsequently, metagenomic data were correlated with clinical indices. Based on gene relative abundance profile, 1061 species, 729 genera, 44 phyla and 5127 KO (KEGG Orthology) were identified. Despite high diversity, bacteria could mostly be assigned to seven bacterial divisions. The overall metagenomic RYGB-induced shift was characterized by a reduction of Firmicutes and Bacteroidetes and an increase of Proteobacteria. Twenty-two microbial species and 11 genera were significantly altered by RYGB. Using principal component analysis, highly correlated species were assembled into two common components. Component 1 consisted of species that were mainly associated with BMI and C-reactive protein. This component was characterized by increased numbers of Proteobacterium Enterobacter cancerogenus and decreased Firmicutes Faecalibacterium prausnitzii and Coprococcus comes. Functional analysis of carbohydrate metabolism by KO revealed significant effects in 13 KOs assigned to phosphotransferase system. Spearmen's Rank correlation indicated an association of 10 species with plasma total- or low-density lipoprotein cholesterol, and 5 species with triglycerides. F. prausnitzii was directly correlated to fasting blood glucose. This is the first clinical demonstration of a profound and specific intra-individual modification of gut microbial composition by full metagenomic sequencing. A clear correlation exists of microbiome composition and gene function with
Cuthbertson, Daniel J.; Irwin, Andrew; Gardner, Chris J.; Daousi, Christina; Purewal, Tej; Furlong, Niall; Goenka, Niru; Thomas, E. Louise; Adams, Valerie L.; Pushpakom, Sudeep P.; Pirmohamed, Munir; Kemp, Graham J.
Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are effective for obese patients with type 2 diabetes mellitus (T2DM) because they concomitantly target obesity and dysglycaemia. Considering the high prevalence of non-alcoholic fatty liver disease (NAFLD) in patients with T2DM, we determined the impact of 6 months’ GLP-1 RA therapy on intrahepatic lipid (IHL) in obese, T2DM patients with hepatic steatosis, and evaluated the inter-relationship between changes in IHL with those in glycosylated haemoglobin (HbA1c), body weight, and volume of abdominal visceral and subcutaneous adipose tissue (VAT and SAT). We prospectively studied 25 (12 male) patients, age 50±10 years, BMI 38.4±5.6 kg/m2 (mean ± SD) with baseline IHL of 28.2% (16.5 to 43.1%) and HbA1c of 9.6% (7.9 to 10.7%) (median and interquartile range). Patients treated with metformin and sulphonylureas/DPP-IV inhibitors were given 6 months GLP-1 RA (exenatide, n = 19; liraglutide, n = 6). IHL was quantified by liver proton magnetic resonance spectroscopy (1H MRS) and VAT and SAT by whole body magnetic resonance imaging (MRI). Treatment was associated with mean weight loss of 5.0 kg (95% CI 3.5,6.5 kg), mean HbA1c reduction of 1·6% (17 mmol/mol) (0·8,2·4%) and a 42% relative reduction in IHL (−59.3, −16.5%). The relative reduction in IHL correlated with that in HbA1c (ρ = 0.49; p = 0.01) but was not significantly correlated with that in total body weight, VAT or SAT. The greatest IHL reduction occurred in individuals with highest pre-treatment levels. Mechanistic studies are needed to determine potential direct effects of GLP-1 RA on human liver lipid metabolism. PMID:23236362
Potential for Higher Treatment Failure in Obese Patients: Correlation of Elevated Body Mass Index and Increased Daily Prostate Deviations From the Radiation Beam Isocenters in an Analysis of 1,465 Computed Tomographic Images
Wong, James R. Gao Zhanrong; Merrick, Scott; Wilson, Paula; Uematsu, Minoru; Woo, Kevin; Cheng, C.-W.
Purpose: Recent clinical outcome studies on prostate cancer have reported the influence of patient's obesity on the biochemical failure rates after various treatment modalities. In this study, we investigated the effect of patient's physical characteristics on prostate shift in external beam radiotherapy (EBRT) and hypothesized that there maybe a correlation between patient physique and tumor shift. Methods and Materials: A retrospective analysis was performed using data for 117 patients who received image-guided radiation therapy (IGRT) for prostate cancer between January 2005 and April 2007. A total of 1,465 CT scans were analyzed. The standard deviations (SDs) of prostate shifts for all patients, along with patient weight, body mass index (BMI), and subcutaneous adipose-tissue thickness (SAT), were determined. Spearman rank correlation analysis was performed. Results: Of the 117 patients, 26.5% were considered normal weight, 48.7% were overweight, 17.9% were mildly obese, and 6.9% were moderately to severely obese. Notably 1.3%, 1.5%, 2.0%, and 21.2% of the respective shifts were greater than 10 mm in the left-right (LR) direction for the four patient groups, whereas in the anterior-posterior direction the shifts are 18.2%, 12.6%, 6.7%, and 21.0%, respectively. Strong correlations were observed between SAT, BMI, patient weight, and SDs of daily shifts in the LR direction (p < 0.01). Conclusions: The strong correlation between obesity and shift indicates that without image-guided radiation therapy, the target volume (prostate with or without seminal vesicles) may not receive the intended dose for patients who are moderate to severely obese. This may explain the higher recurrence rate with conventional external beam radiation therapy.
Kassab, Sawsan; Syed Sulaiman, Syed Azhar; Abdul Aziz, Noorizan
Introduction Obesity is a chronic disease that has become one of major public health issue in Malaysia because of its association with other disease states including cardiovascular disease and diabetes. Despite continuous efforts to educate the public about the health risks associated with obesity, prevalence of the disease continues to increase. Dosing of many medications are based on weight, limited data are available on how antimicrobial agents should be dosed in obesity. The aim of this case presentation is to discuss dose of antibiotic in obese patient. Case report: Patient: GMN, Malay, Female, 45 year old, 150kg, transferred from medical ward to ICU with problems of fever, orthopnea, sepsis secondary to nosocomial pneumonia. She was admitted to hospital a week ago for SOB on exertion, cyanosis, mildly dyspneic, somasthenia, bilateral ankle swelling. There was no fever, cough, chest pain, clubbing, flapping tremor. Her grand father has pre-morbid history of obesity, HPT, DM and asthma. She was non alcoholic, smoker, and not on diet control. The diagnosis Pickwickian syndrome was made. Patient was treated with IV Dopamine 11mcg/kg/min, IV Morphine 4mg/h. IV GTN 15mcg/min, IV Ca gluconate 10g/24h for 3/7, IV Zantac 50mg tds, IV Augmentin 1.2g tds, IV Lasix 40mg od, IV Plasil 10mg tds, S.c heparin 5000IU bd. patient become stable and moved to medical ward to continue her treatment. Discussion: The altered physiologic function seen in obese patients is a concern in patients receiving antimicrobial agents because therapeutic outcomes depend on achieving a minimum inhibitory concentration (MIC). The therapeutic effect of any drug can be altered when any of the 4 pharmacokinetic processes (absorption, distribution, metabolism, or elimination) are altered. Decreased blood flow rates and increased renal clearance in obese patients can affect drug distribution and elimination. Changes in serum protein levels can change the metabolism and distribution of drugs that are
tract infection and one episode C obesity. The clinical records of these patients were reviewed in of sinusitis. Two patients had documented bacteremias...veloped pneumonia and two developed tracheobronchitis. 0 Research, seven of whom clearly fulfilled the criteria for morbid There were one urinary
Pouliot, Yves; Lamarche, Benoît; Beaulieu, Jean-François; Hould, Frédéric S.; Richard, Denis; Tchernof, André; Levy, Emile
Context Lactoferrin (Lf) is an important protein found on mucosal surfaces, within neutrophils and various cells, and in biological fluids. It displays multiple functions, including iron-binding as well as antimicrobial, immunomodulatory and anti-inflammatory activities. Although Lf ingestion has been suggested to cause adiposity reduction in murine models and humans, its relationship with insulin resistance (IR) has not been studied thoroughly. Objective To establish the association between circulating Lf levels, glucose status and blood lipid/lipoprotein profile. Methods Two independent cohorts were examined: lean to moderately obese women admitted for gynecological surgery (n = 53) and severely obese subjects undergoing biliopancreatic diversion (n = 62). Results Although body mass index (BMI) and total body fat mass were negatively associated with Lf, IR (assessed by the HOMA-IR index) was positively and independently associated with plasma Lf concentrations of the first cohort of lean to moderately obese women. These observations were validated in the second cohort in view of the positive correlation between plasma Lf concentrations and the HOMA-IR index, but without a significant association with the body mass index (BMI) of severely obese subjects. In subsamples of severely obese subjects matched for sex, age and BMI, but with either relatively low (1.89 ± 0.73) or high (13.77 ± 8.81) IR states (according to HOMA-IR), higher plasma Lf levels were noted in insulin-resistant vs insulin-sensitive subjects (P<0.05). Finally, Lf levels were significantly higher in lean to moderately obese women than in severely obese subjects (P<0.05). Conclusion Our findings revealed that plasma Lf levels are strongly associated with IR independently of total adiposity, which suggests an intriguing Lf regulation mechanism in conditions of obesity and IR. PMID:27902700
Tran, Minh-Ha; Foster, Clarence E; Kalantar-Zadeh, Kamyar; Ichii, Hirohito
The World Health Organization estimated that in 2014, over 600 million people met criteria for obesity. In 2011, over 30% of individuals undergoing kidney transplant had a body mass index (BMI) 35 kg/m2 or greater. A number of recent studies have confirmed the relationship between overweight/obesity and important comorbidities in kidney transplant patients. As with non-transplant surgeries, the rate of wound and soft tissue complications are increased following transplant as is the incidence of delayed graft function. These two issues appear to contribute to longer length of stay compared to normal BMI. New onset diabetes after transplant and cardiac outcomes also appear to be increased in the obese population. The impact of obesity on patient survival after kidney transplantation remains controversial, but appears to mirror the impact of extremes of BMI in non-transplant populations. Early experience with (open and laparoscopic) Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy support excellent weight loss (in the range of 50%-60% excess weight lost at 1 year), but experts have recommended the need for further studies. Long term nutrient deficiencies remain a concern but in general, these procedures do not appear to adversely impact absorption of immunosuppressive medications. In this study, we review the literature to arrive at a better understanding of the risks related to renal transplantation among individuals with obesity. PMID:27011911
Manuel, Ari R; Hart, Nicholas; Stradling, John R
Introduction Only a third of obese patients develop chronic ventilatory failure. This cross-sectional study assessed multiple factors potentially associated with chronic ventilatory failure. Materials/patients and methods Participants had a body mass index (BMI) >30 kg/m2, with or without chronic ventilatory failure (awake arterial partial pressure of carbon dioxide >6 kPa or base excess (BE) ≥2 mmols/L). Factors investigated were grouped into domains: (1) obesity measures, (2) pulmonary function, (3) respiratory and non-respiratory muscle strength, (4) sleep study derivatives, (5) hypoxic and hypercapnic responses, and (6) some hormonal, nutritional and inflammatory measures. Results 71 obese participants (52% male) were studied over 27 months, 52 (SD 9) years and BMI 47 (range 32–74) kg/m2. The best univariate correlates of BE from each domain were: (1) dual-energy X-ray absorptiometry measurement of visceral fat (r=+0.50, p=0.001); (2) supine forced expiratory volume in 1 s (r=−0.40, p=0.001); (3) sniff maximum pressure (r=−0.28, p=0.02); (4) mean overnight arterial oxygen saturation (r=−0.50, p<0.001); (5) ventilatory response to 15% O2 breathing (r=−0.28, p=0.02); and (6) vitamin D (r=−0.30, p=0.01). In multivariate analysis, only visceral fat and ventilatory response to hypoxia remained significant. Conclusions We have confirmed that in the obese, BMI is a poor correlate of chronic ventilatory failure, and the best independent correlates are visceral fat and hypoxic ventilatory response. Trial registration number NCT01380418. PMID:26918192
Sweeting, Helen; Wright, Charlotte; Minnis, Helen
(a) To examine how self-reported well-being, weight-related concerns, self-image, peer relationships and psychiatric disorders are associated with obesity at ages 11 and 15 years. (b) To identify and describe those who "slim down" (become nonobese) or "become obese". A cohort of 2127 school pupils was surveyed at ages 11 and 15 years. At each age, those with body mass index above the 95th percentile for age and gender were categorized as obese. Characteristics associated with obesity, "slimming down" and "becoming obese" were examined using ANOVA and chi-square procedures for univariate, and logistic regression for multivariate analyses. At age 11, 9.6% (males) and 10.5% (females) were obese, compared with 10.5% (males) and 11.6% (females) at age 15. "Slimming down" occurred for 3.5% of the total sample, whereas 4.5% "became obese." Obesity was associated with significant but small differences in low mood (males at 11) and self-esteem (males at 11, females at both ages), and reduced rates of behavior disorders (data on psychiatric disorders available only at age 15). Obesity was associated with weight-related worries, dieting, and poor self-rated appearance, but not most measures of peer relationships, except that obese 11-year-olds experienced greater victimization, partly accounting for their poorer well-being. In comparison with the continuously nonobese, those who "became obese" had lower prior self-esteem and greater victimization, but improvements in well-being and relative reductions in victimization by age 15. "Slimming down" was related to neither prior nor subsequent well-being in comparison with continual obesity, but was associated with better age 15 mood in comparison with continual nonobesity. Although overweight was fairly stable, there were shifts in and out of the obese category during adolescence. Obesity during this life-stage, though strongly related to worries about putting on weight and self-report dieting, was associated with only small
Zabena, Carina; González-Sánchez, José L; Martínez-Larrad, María T; Torres-García, Antonio; Alvarez-Fernández-Represa, Jesús; Corbatón-Anchuelo, Arturo; Pérez-Barba, Milagros; Serrano-Ríos, Manuel
Obesity has emerged as one of the most serious public health concerns in the twenty-first century. the fat mass and obesity associated gene (FTO) has been found to contribute to the risk of obesity in humans. Our aims in this study were to investigate the association of rs9939609 single nucleotide polymorphism (SNP) of the FTO gene with different obesity-related parameters, to assess the FTO gene expression in subcutaneous and visceral adipose tissues from morbidly obese and its correlations with other adipocytokine gene expressions. The association between the rs9939609 FTO gene variant and obesity related parameters in 75 obese/morbidly obese adult patients and 180 subjects with body mass index (BMI) < 30 kg/m(2) (control group) was examined. Gene expression analyses: subcutaneous adipose tissue samples were obtained from 52 morbidly obese and five subjects with BMI < 30 kg/m(2). Visceral adipose tissue was also obtained from 35 morbidly obese patients. Weight, height, BMI, SBP, DBP, fasting glucose, lipid profile, proinsulin, insulin, leptin, and adiponectin (RIA) of patients were also obtained. Insulin resistance by HOMA(IR). rs9939609 of FTO genotyping using allele discrimination in real-time PCR. Genomic study of RNA extraction of adipose tissue and real-time PCR (RT-PCR) of adipocytokines and a housekeeping gene were quantified using TaqMan probes. Relative quantification was calculated using the DeltaDelta Ct formula. The minor-(A) allele frequency of rs9939609 FTO gene in the whole population was 0.39. A strong association between this A allele and obesity was found, even after age-sex adjustment (p = 0.013). We found higher levels of FTO mRNA in subcutaneous adipose tissue from morbidly obese than in the control group (p = 0.021). FTO gene expression was lower in visceral than in subcutaneous adipose depot. However, this finding did not reach the level of statistical significance. A negative correlation between subcutaneous FTO gene expression and serum
Gallos, Lazaros; Barttfeld, Pablo; Havlin, Shlomo; Sigman, Mariano; Makse, Hernan
Obesity levels have been universally increasing. A crucial problem is to determine the influence of global and local drivers behind the obesity epidemic, to properly guide effective policies. Despite the numerous factors that affect the obesity evolution, we show a remarkable regularity expressed in a predictable pattern of spatial long-range correlations in the geographical spreading of obesity. We study the spatial clustering of obesity and a number of related health and economic indicators, and we use statistical physics methods to characterize the growth of the resulting clusters. The resulting scaling exponents allow us to broadly classify these indicators into two separate universality classes, weakly or strongly correlated. Weak correlations are found in generic human activity such as population distribution and the growth of the whole economy. Strong correlations are recovered, among others, for obesity, diabetes, and the food industry sectors associated with food consumption. Obesity turns out to be a global problem where local details are of little importance. The long-range correlations suggest influence that extends to large scales, hinting that the physical model of obesity clustering can be mapped to a long-range correlated percolation process.
Chen, Hui; Qian, Lei; Lv, Qiangsheng; Yu, Jianxiu; Wu, Wei; Qian, Haixin
Objectives: Persistent low-grade chronic inflammation is common in type 2 diabetes (T2D) and obesity. To date, the underlying molecular mechanism is not well understood. In this study, we aimed to investigate gut microbiota and the expression of monocyte surface molecules in obese T2D subjects who underwent Roux-en-Y gastric bypass (RYGB) surgery. Methods: Twenty-four T2D patients were enrolled. Gut microbiota was assessed by measuring bacterial DNA. The phenotypes and biological functions of monocytes, and the expression of monocyte surface molecules were examined by flow cytometry. Results: RYGB led to significant alterations in the phenotypes of monocytes. Moreover, the ability of monocyte migration was significantly decreased after RYGB (P<0.05), which was consistent with reduced Chemokine-receptors CCR2 expression of CD14+CD16+ monocytes (P<0.05) and CX3CR1 expression of the three monocytes subsets (P<0.05). RYGB also resulted in a shift of gut microbiota in the obese T2D patients. Spearman’s rank correlation coefficient showed a link between gut microbiota and monocyte subsets where the increased Bacteroidetes was negatively correlated with the variation of CD14dimCD16+ monocyte percentage (r=-0.477, P<0.05). Furthermore, the decreased counts of Escherichia were positively correlated with the variation of TNF-α secretion (r=0.442, P<0.05) and TLR4 (r=0.425, P<0.05) expression onCD14+CD16+ monocytes. Conclusions: This study, for the first time, demonstrated a link between the changes in gut microbiota and alterations in both phenotypes and functions of monocytes after RYGB, which may contribute significantly to the low-grade chronic inflammation in obese T2D patients. PMID:28386350
Chen, Hui; Qian, Lei; Lv, Qiangsheng; Yu, Jianxiu; Wu, Wei; Qian, Haixin
Objectives: Persistent low-grade chronic inflammation is common in type 2 diabetes (T2D) and obesity. To date, the underlying molecular mechanism is not well understood. In this study, we aimed to investigate gut microbiota and the expression of monocyte surface molecules in obese T2D subjects who underwent Roux-en-Y gastric bypass (RYGB) surgery. Methods: Twenty-four T2D patients were enrolled. Gut microbiota was assessed by measuring bacterial DNA. The phenotypes and biological functions of monocytes, and the expression of monocyte surface molecules were examined by flow cytometry. Results: RYGB led to significant alterations in the phenotypes of monocytes. Moreover, the ability of monocyte migration was significantly decreased after RYGB (P<0.05), which was consistent with reduced Chemokine-receptors CCR2 expression of CD14(+)CD16(+) monocytes (P<0.05) and CX3CR1 expression of the three monocytes subsets (P<0.05). RYGB also resulted in a shift of gut microbiota in the obese T2D patients. Spearman's rank correlation coefficient showed a link between gut microbiota and monocyte subsets where the increased Bacteroidetes was negatively correlated with the variation of CD14(dim)CD16(+) monocyte percentage (r=-0.477, P<0.05). Furthermore, the decreased counts of Escherichia were positively correlated with the variation of TNF-α secretion (r=0.442, P<0.05) and TLR4 (r=0.425, P<0.05) expression onCD14(+)CD16(+) monocytes. Conclusions: This study, for the first time, demonstrated a link between the changes in gut microbiota and alterations in both phenotypes and functions of monocytes after RYGB, which may contribute significantly to the low-grade chronic inflammation in obese T2D patients.
Amann, Benedikt; Mergl, Roland; Torrent, Carla; Perugi, Giulio; Padberg, Frank; El-Gjamal, Nadja; Laakmann, Gregor
Obesity and its related disorders are growing epidemic across the world. Research on links between the bipolar spectrum and obesity has proliferated in the last few years. As some forms of abnormal temperament are considered as subtypes of the soft bipolar spectrum, we aimed to evaluate abnormal temperaments in morbidly obese patients. Using a short version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego, we investigated abnormal depressive, cyclothymic, hyperthymic, irritable or anxious temperament in 213 patients with morbid obesity compared to a control group of 90 patients admitted prior to organ transplantation. Additionally, the Beck-Depression Inventory (BDI) and the Self-Report Manic Inventory (SRMI) were applied to assess current mood status. The obese group showed statistically significantly more psychiatric comorbidities compared to the control group. Abnormal temperaments were significantly more often observed in patients with morbid obesity rather than in controls. Cyclothymic, irritable and anxious temperaments showed specificity to obesity. Obese patients had significantly higher scores on the BDI, while no difference for SRMI scores was found among the whole groups. All temperaments were positively correlated with BDI and SRMI in the obese group. The control group was not matched for demographic characteristics. Our results need replication but indicate an affective overlap in the form of abnormal temperament and depressive symptoms in obese patients, whereas mood swings should be evaluated and early mood stabilization considered for patients with significant weight gain to prevent obesity or to reduce already existing overweight. Studies of mood stabilizers and prospective observations would shed further insight on this complex interface of a major clinical and public health issue.
Amin, Mohamed N.; Mosa, Amany A.; El-Shishtawy, Mamdouh M.
Advanced glycation end products (AGEs) are complex, heterogenous molecules generated by glycation and oxidation of proteins in vivo, which are thought to markedly increase in diabetic patients. One of the recently identified AGEs is carboxy methyl lysine (CML), which is the main ligand of receptors for advanced glycation end products (RAGE). The present study aimed to assess the effect of obesity on such pathways in presence and absence of Type 2 diabetes mellitus. CML, soluble receptors for advanced glycation end products (sRAGE), HbA1C, lipid profile, liver function tests and kidney function tests were determined in 29 diabetic obese, 29 diabetic non-obese, 15 non-diabetic obese and 15 non-diabetic non-obese subjects. The study compared obese and non-obese subjects in presence and absence of type 2 diabetes. The results showed a significant increase in CML and a significant decrease in sRAGE in each of the diabetic obese group when compared with the diabetic non-obese group and the non-diabetic obese group when compared with the non-diabetic non-obese group. A significant positive correlation was found between CML and markers of obesity (body mass index and waist/hip ratio). These results suggest that obesity can increase CML independent of diabetes and support the reports that CML could be generated from both sugars and lipids. The present study suggests that treatment using glycation inhibitors like aminoguanidine or recombinant sRAGE will not only retard the diabetic complications, but may also have a prophylactic effect. PMID:23675236
Obesity is associated with an increased risk of premature death and represents a fast growing worldwide health problem that is reaching epidemic proportions. Obesity significantly increases the risk of developing metabolic disorders, hypertension, coronary heart disease, stroke, and several types of cancer. However, a subgroup of 'healthy' obese patients seems to be protected against metabolic and cardiovascular obesity comorbidities. This review focuses on potential mechanisms underlying the healthy obese subphenotype. Individuals with obesity typically develop type 2 diabetes, dyslipidemia, fatty liver disease, gout, hypertension, and cardiovascular disease. In the past years it became clear that up to 30% of obese patients are metabolically healthy with insulin sensitivity similar to healthy lean individuals, lower liver fat content, and lower intima media thickness of the carotid artery than the majority of metabolically 'unhealthy' obese patients. Recent studies suggest that protection against development of hepatic steatosis, ectopic fat deposition, inflammation of visceral adipose tissue, and adipose tissue dysfunction contributes to healthy obesity. For the stratification of obesity treatment, definition of metabolically healthy or high-risk phenotypes will facilitate the identification of the obese person who will benefit the most from early lifestyle, bariatric surgery, or pharmacological interventions.
Ingrande, Jerry; Lemmens, Hendrikus Jm
Anesthesiologists are increasingly being faced with treating obese patients. Physiologic and anthropometric associated with obesity-most notably increases in cardiac output, changes in tissue perfusion and increases in total body weight (TBW), lean body weight (LBW), and fat mass affect the pharmacokinetics (PK) of anesthetic agents. In addition, redundancy of airway tissue, obstructive and central sleep apnea and CO2 retention affect the pharmacodynamics (PD) of anesthetics and narrow the therapeutic window of numerous anesthetic drugs. Safe and effective pharmacologic management of the obese patient requires a thorough understanding of how obesity affects the PK and PD of anesthetics.
Barat, Pascal; Meiffred, Marie-Claire; Brossaud, Julie; Fuchs, Dietmar; Corcuff, Jean-Benoit; Thibault, Helene; Capuron, Lucile
Alterations in endocrine functions and low-grade systemic inflammation represent fundamental characteristics of obesity. These biological systems have been repeatedly linked to fatigue symptoms. The aim of the study was to assess the relationship between fatigue dimensions and metabolic/inflammatory markers in a sample of non-diabetic obese children. The possibility that inflammation-induced alterations in tryptophan metabolism relates to specific dimensions of fatigue was also investigated in a subsample of patients. The study was conducted in 41 obese children, median aged 12 [9-15] years, recruited in a pediatric tertiary center. Three dimensions of fatigue (e.g., general fatigue, sleep/rest, cognitive fatigue) were assessed using the Pediatric Quality of Life Inventory Multidimentional Fatigue Scale. In addition, a principal component analysis was performed to identify fatigue dimensions that were specific to the population under study. This analysis extracted five relevant dimensions corresponding respectively to concentration, energy, self-perceived cognitive efficiency, sleep/rest and motivation/anhedonia. Blood samples were collected for the measurement of inflammatory and metabolic markers, including high sensitivity C-reactive protein (hs-CRP), insulin, uricemia and glycaemia. Tryptophan, kynurenine and neopterin levels were also determined in a subsample of 17 patients. In the whole population under study, cognitive fatigue and reduced motivation/anhedonia were associated with BMI, independently of sex and age. The dimension of reduced motivation/anhedonia was associated with insulin resistance and inflammatory biomarkers. The association with insulin resistance persisted when the extent of fat mass (BMI-SDS) was taken into account. No association was found between tryptophan metabolism and specific dimensions of fatigue, but kynurenine and the kynurenine/tryptophan ratio correlated with insulin and HOMA-IR. These data indicate that insulin resistance in
Barros, Fernando de; Setúbal, Sergio; Martinho, José Manoel; Ferraz, Loraine; Gaudêncio, Andressa
Obesity is an epidemic and chronic disease that can bring other comorbidities to the patient. Non-alcoholic fatty liver disease is present in up to 90% of these patients and can progress to hepatitis and hepatocarcinoma. The relationship of this liver disease and obesity is already well known; however, it is possible that some parameters of the comorbidities are more related than others in the pathophysiology of the disease. Was analyzed the relationship between non-alcoholic fatty liver disease (NAFLD) and the comorbidities of metabolic syndrome in morbidly obese patients. Was involved ultrasonography and laboratory assessment of obese patients before bariatric surgery. NAFLD was assessed using the same sonography parameters for all patients. Based on the results, the patients were divided into groups with and without NAFLD. Comparisons between them involved clinical and laboratory variables such as fasting blood glucose, insulin, HOMA-IR (homeostasis model assessment - insulin resistance), glycated hemoglobin, total cholesterol and fractions, triglycerides, alanine aminotransferase, aspartate aminotransferase, gamma glutamyl transferase, C-reactive protein, albumin and ferritin. Patients who reported alcohol abuse (defined as the consumption of >14 drinks per week) or who had hepatitis were excluded. Eighty-two patients (74 women and 8 men) were studied, of whom 53 (64.6%) had NAFLD and 29 (35.4%) did not. The levels of glycated hemoglobin (p=0.05) and LDL cholesterol (p=0.01) were significantly altered in patients with NAFLD. However, weight, body mass index and excess weight did not differ significantly between the groups (p=0.835, p=0.488 and p=0.727, respectively). Altered LDL cholesterol and glycated hemoglobin levels were related to the presence of NAFLD. A obesidade é doença epidêmica e crônica que pode trazer outras comorbidades ao paciente. A doença hepática gordurosa não alcoólica está presente em até 90% desses pacientes e pode evoluir para
Watanabe, Yoko; Saito, Isao; Henmi, Ikuyo; Yoshimura, Kana; Maruyama, Kotatsu; Yamauchi, Kanako; Matsuo, Tatsuhiro; Kato, Tadahiro; Tanigawa, Takeshi; Kishida, Taro; Asada, Yasuhiko
Objective: Despite the fact that the total energy intake of Japanese people has decreased, the percentage of obese people has increased. This suggests that the timing of meals is related to obesity. The purpose of the study was to investigate the relationship between the timing of meals and obesity, based on analyses of physical measurements, serum biochemical markers, nutrient intake, and lifestyle factors in the context of Chrononutrition. Participants and Methods: We analyzed data derived from 766 residents of Toon City (286 males and 480 females) aged 30 to 79 years who underwent detailed medical examinations between 2011 and 2013. These medical examinations included. (1) physical measurements (waist circumference, blood pressure, etc.); (2) serum biochemical markers (total cholesterol, etc.); (3) a detailed questionnaire concerning lifestyle factors such as family structure and daily habits (22 issues), exercise and eating habits (28 issues), alcohol intake and smoking habits; (4) a food frequency questionnaire based on food groups (FFQg); and (5) a questionnaire concerning the times at which meals and snacks are consumed. Results: The values for body mass index (BMI) and waist circumference were higher for participants who ate dinner less than three hours before bedtime (<3-h group) than those who ate more than three hours before bedtime (>3-h group). The Chi-square test showed that there was a significant difference in eating habits, e.g., eating snacks, eating snacks at night, having dinner after 8 p.m., and having dinner after 9 p.m., between the <3-h group and the >3-h group. Multiple linear regression analysis showed that skipping breakfast significantly influenced both waist circumference (β = 5.271) and BMI (β = 1.440) and that eating dinner <3-h before going to bed only influenced BMI (β = 0.581). Conclusion: Skipping breakfast had a greater influence on both waist circumference and BMI than eating dinner <3-h before going to bed. PMID:25648986
Yang, Yan; Qiao, Jie; Li, Mei-zhi
To investigate the correlation between interleukin-1β (IL-1β), interleukin-1 receptor antagonist (IL-1ra) and the obesity of polycystic ovary syndrome (PCOS). (1) From Oct. 2006 to Jan. 2007, 118 PCOS patients were enrolled in this study in Peking University Third Hospital, which were divided into 56 patients in obese PCOS group and 62 patients in non-obese PCOS group according to the WHO International Obesity Task Force Asia-Pacific criteria [body mass index (BMI) 25 kg/m(2)]. The polymorphism of IL-1β gene promoter region, exon-5 and intron 2 of IL-1ra gene were detected by PCR. (2) Twenty-nine obese PCOS patients and 31 non-obese PCOS patients were selected randomizedly serum levels of IL-1β, IL-1ra were measured by ELISA, in the mean time, serum levels of fasting glucose, fasting insulin and the total white blood cell, hypersensitive C-reactive protein levels were measured. (1) Genetic test:the frequency of TT genotype and T allele of IL-1β promoter region (-511) in obese PCOS patients were significantly higher than those in non-obese patients (44.6% vs. 11.3%, 63.4% vs. 39.5%, all P < 0.05). The frequency of IL-1raI/V genotype and V allele of IL-1ra gene were 19.6% and 9.8% in obese PCOS patients, which were significantly higher than those in non-obese group (3.2% and 1.6%, P < 0.05). (2) Serological test:serum level of IL-1β and IL-1ra of (149 ± 36) and (284 ± 97) ng/L in obese PCOS group which were significantly higher than those in non-obese PCOS group [(96 ± 42) and (208 ± 84) ng/L, P < 0.05]. Fasting blood glucose, fasting insulin and hypersensitive C-reactive protein and white blood cell count were (5.1 ± 0.7) mmol/L, (17 ± 9) mU/L, (1.5 ± 0.6) mg/L and (7.0 ± 2.3) × 10(9)/L in obese PCOS group, which were significantly higher than in non-obese PCOS group [(4.9 ± 0.5) mmol/L, (11 ± 8) mU/L, (0.9 ± 0.4) mg/L and (5.9 ± 1.3) × 10(9)/L, P < 0.05]. (3)The correlation between interleukin and BMI: serum levels of IL-1β (r = 0.673) and IL-1
Imber, David Ae; Pirrone, Massimiliano; Zhang, Changsheng; Fisher, Daniel F; Kacmarek, Robert M; Berra, Lorenzo
With a rising incidence of obesity in the United States, anesthesiologists are faced with a larger volume of obese patients coming to the operating room as well as obese patients with ever-larger body mass indices (BMIs). While there are many cardiovascular and endocrine issues that clinicians must take into account when caring for the obese patient, one of the most prominent concerns of the anesthesiologist in the perioperative setting should be the status of the lung. Because the pathophysiology of reduced lung volumes in the obese patient differs from that of the ARDS patient, the best approach to keeping the obese patient's lung open and adequately ventilated during mechanical ventilation is unique. Although strong evidence and research are lacking regarding how to best ventilate the obese surgical patient, we aim with this review to provide an assessment of the small amount of research that has been conducted and the pathophysiology we believe influences the apparent results. We will provide a basic overview of the anatomy and pathophysiology of the obese respiratory system and review studies concerning pre-, intra-, and postoperative respiratory care. Our focus in this review centers on the best approach to keeping the lung recruited through the prevention of compression atelectasis and the maintaining of physiological lung volumes. We recommend the use of PEEP via noninvasive ventilation (NIV) before induction and endotracheal intubation, the use of both PEEP and periodic recruitment maneuvers during mechanical ventilation, and the use of PEEP via NIV after extubation. It is our hope that by studying the underlying mechanisms that make ventilating obese patients so difficult, future research can be better tailored to address this increasingly important challenge to the field of anesthesia. Copyright © 2016 by Daedalus Enterprises.
Pin, Maja; Štimac, Davor
Pancreatic cancer is an aggressive tumor with a very poor prognosis, lack of early diagnostic symptoms and highly resistant to therapy. Its incidence is approximately equal to the mortality rate. Even though in recent years progress has been made in defining the morphological and key genetic changes, it is still unclear which factors trigger its occurrence. Some risk factors are age, gender and race, genetic susceptibility, dietary factors, fever, chronic pancreatitis, diabetes and physical inactivity. Studies have shown that an increase in BMI consequently leads to an increased risk of malignancies, including pancreatic cancer. Research based on adipokines and their role in obesity and the occurrence of pancreatic cancer are the potential for a possible future therapeutic interventions.
Stephan, Jean-Marie; Goodheart, Michael J; McDonald, Megan; Hansen, Jean; Reyes, Henry D; Button, Anna; Bender, David
Morbid obesity is a known risk factor for the development of endometrial cancer. Several studies have demonstrated the overall feasibility of robotic-assisted surgical staging for endometrial cancer as well as the benefits of robotics compared with laparotomy. However, there have been few reports that have evaluated robotic surgery for endometrial cancer in the supermorbidly obese population (body mass index [BMI], ≥50 kg/m(2)). We sought to evaluate safety, feasibility, and outcomes for supermorbidly obese patients who undergo robotic surgery for endometrial cancer, compared with patients with lower body mass indices. We performed a retrospective chart review of 168 patients with suspected early-stage endometrial adenocarcinoma who underwent robotic surgery for the management of their disease. Analysis of variance and univariate logistic regression were used to compare patient characteristics and surgical variables across all body weights. Cox proportional hazard regression was used to determine the impact of body weight on recurrence-free and overall survival. The mean BMI of our cohort was 40.9 kg/m(2). Median follow up was 31 months. Fifty-six patients, 30% of which had grade 2 or 3 tumors, were supermorbidly obese with a BMI of ≥50 kg/m(2) (mean, 56.3 kg/m(2)). A comparison between the supermorbidly obese and lower-weight patients demonstrated no differences in terms of length of hospital stay, blood loss, complication rates, numbers of pelvic and paraaortic lymph nodes retrieved, or recurrence and survival. There was a correlation between BMI and conversion to an open procedure, in which the odds of conversion increased with increasing BMI (P = .02). Offering robotic surgery to supermorbidly obese patients with endometrial cancer is a safe and feasible surgical management option. When compared with patients with a lower BMI, the supermorbidly obese patient had a similar outcome, length of hospital stay, blood loss, complications, and numbers of lymph
To determine the correlation of C-reactive protein (CRP) with fasting triglycerides (TG) among pre-obese and obese patients without established diagnosis of coronary artery disease (CAD). A comparative cross-sectional study. Mayo Hospital, Lahore, from January to June 2010. Patients with BMI > 23 kg/m2 aged between 18 - 65 years were inducted and above variables were studied. Patients with signs of fluid retention, collagen vascular disease, CAD, patients on corticosteroids, immunomodulators or lipid lowering medications and febrile patients were not recruited. Body mass index was also determined. Independent sample t-test was applied to see the mean difference of age, CRP level and triglycerides level in relation to gender. Chi-square test was used to see the association between qualitative variables. ANOVA was applied to see CRP and fasting serum TG level in relation to BMI categories. Pearson correlation and simple linear regression was applied to see the dependency of CRP and triglycerides with BMI. P-value ² 0.05 was taken as significant. Raised CRP was major finding among all groups of BMI. Most of obese and pre-obese patients were young and middle aged and belonged to pre-obese group followed by class-1 and class-2 obesity. CRP level increased with body mass index. No such trend was observed for triglycerides. There was an intermediate positive correlation between CRP and BMI and triglycerides and BMI showed a weak negative correlation. If BMI increases by 1 unit on the average, CRP rises by 0.239 times and this unit rise was significant. Whereas 1 unit rise increase in triglycerides on the average cause CRP to decrease -0.006 times but this value was insignificant. Raised CRP and high fasting TG were major findings in all age groups especially among young and middle aged people. Obesity, hypertriglyceridemia and raised CRP are interrelated suggesting that obesity is not only linked to hypertriglyceridemia but vascular inflammation among pre-obese and obese
Penatti, M I B; Lira, F S; Katashima, C K; Rosa, J C; Pimentel, G D
Obesity is a chronic disease characterized by increased accumulation of body fat. We evaluated the socioeconomic aspects, body composition, risk of metabolic complications associated with obesity, eating habits and lifestyle in both women and men adults and elderly with body mass index (BMI) > 40 kg/m². Among the subjects studied, 79% (n = 32) are female, 5% (n = 2) smokers, 39% (n = 16) use alcohol and only 24% (n = 10) are practitioners of physical exercise. The higher food intake was breads, followed by rice. The daily intake of fruits and vegetables is low. Positive correlation between consumption of sugar and BMI and abdominal circumference (AC) was observed. In summary, was found that morbidly obese patients that looking for nutritional counseling presents increased body fat, poor eating habits and sedentary lifestyle.
Magalhães, Edno; Oliveira Marques, Felipe; Sousa Govêia, Cátia; Araújo Ladeira, Luis Cláudio; Lagares, Jader
Although the incidence of difficult laryngoscopy is similar in obese and non-obese patients, there are more reports of difficult intubation in obese individuals. Alternatives for the diagnosis and prediction of difficult intubation in the preoperative period may help reduce anesthetic complications in obese patients. The aim of this study was to identify predictors for the diagnosis of difficult airway in obese patients, correlating with the clinical methods of pre-anesthetic evaluation and polysomnography. We also compared the incidence of difficult facemask ventilation and difficult laryngoscopy between obese and non-obese patients, identifying the most prevalent predictors. Observational, prospective and comparative study, with 88 adult patients undergoing general anesthesia. In the preoperative period, we evaluated a questionnaire on the clinical predictors of the obstructive sleep apnea syndrome (OSAS) and anatomical parameters. During anesthesia, we evaluated difficult facemask ventilation and laryngoscopy. Descriptive statistics and correlation test were used for analysis. Patients were allocated into two groups: obese group (n=43) and non-obese group (n=45). Physical status, prevalence of snoring, hypertension, diabetes mellitus, neck circumference, and Mallampati index were higher in the obese group. Obese patients had a higher incidence of difficult facemask ventilation and laryngoscopy. There was no correlation between anatomical or clinical variable and difficult facemask ventilation in both groups. In obese patients, the diagnosis of OSAS showed strong correlation with difficult laryngoscopy. The clinical and polysomnographic diagnosis of OSA proved useful in the preoperative diagnosis of difficult laryngoscopy. Obese patients are more prone to difficult facemask ventilation and laryngoscopy. Copyright © 2013 Elsevier Editora Ltda. All rights reserved.
Crothers, Laura M.; Kehle, Thomas J.; Bray, Melissa A.; Theodore, Lea A.
The correlates and suspected causes of the intractable condition obesity are complex and involve environmental and heritable, psychological and physical variables. Overall, the factors associated with and possible causes of it are not clearly understood. Although there exists some ambiguity in the research regarding the degree of happiness in…
Crothers, Laura M.; Kehle, Thomas J.; Bray, Melissa A.; Theodore, Lea A.
The correlates and suspected causes of the intractable condition obesity are complex and involve environmental and heritable, psychological and physical variables. Overall, the factors associated with and possible causes of it are not clearly understood. Although there exists some ambiguity in the research regarding the degree of happiness in…
Adam, Christian; Standl, Thomas
Basically regional anaesthesia offers a lot of advantages compared with general anaesthesia for obese patients, e.g. avoiding airway manipulation and systemic application of opioids. Although anesthesiologists are increasingly faced with obesity, regional anaesthesia poses a challenge because of missing landmarks, increased depth of nerval structures and difficulties in positioning these patients. While obesity is not associated with an increased risk for severe complications in regional anaesthesia, a higher failure rate can be observed because of difficulties in performing the blocks. Ultrasound guidance may be an important aid but it is associated with specific phenomena caused by obesity. Further studies are needed to optimize regional anaesthesia techniques and dosing of local anaesthetics avoiding block failures as well to improve the patients' safety and outcome.
Gomes, Thayse Natacha; Katzmarzyk, Peter T; dos Santos, Fernanda K; Souza, Michele; Pereira, Sara; Maia, José A R
There are widespread differences in overweight/obesity prevalence in children, and understanding the reasons for this is very important. The present study aims: (I) to conduct a meta-analysis on overweight/obesity prevalence in Portuguese children; (II) to identify differences in biological and behavioural characteristics between normal-weight and overweight/obese children; and (III) to investigate the importance of individual- and school-level correlates of variation in children's BMI using multilevel modelling. A search was done for all published papers including Portuguese children during the last decade; further, 686 Portuguese children (9-11 years old) were sampled and their BMI, family income, maturity offset, nutritional habits, physical activity, sedentariness, sleep time, and school environment information were collected. Results showed a stabilization of overweight/obesity during the last decade, 30.6% (95%CI: 0.287-0.34) for boys, 28.4% (95%CI: 0.23-0.35) for girls, and 30.3% (95%CI: 0.27-0.34) for boys and girls together. Differences between weight groups were only found in individual-level biological traits. The multilevel analysis did not identify significant contributions of school-level variables to children's BMI variation. In conclusion, no increase was found in the prevalence of overweight/obesity among Portuguese children since 2000. Normal-weight and overweight/obese children only differ in individual-level characteristics, and school context variables were not related to variation in BMI.
Cameron, Adrian J; Waterlander, Wilma E; Svastisalee, Chalida M
Supermarkets provide healthy and affordable food options while simultaneously heavily promoting energy-dense, nutrient-poor foods and drinks. Store size may impact body weight via multiple mechanisms. Large stores encourage purchasing of more food in a single visit, and in larger packages. In addition they provide greater product choice (usually at lower prices) and allow greater exposure to foods of all types. These characteristics may promote purchasing and consumption. Our objective was to assess the relationship between supermarket size and obesity, which has rarely been assessed. Data on supermarket size (measured as total aisle length in metres) was from 170 stores in eight developed countries with Western-style diets. Data for national obesity prevalence was obtained from the UK National Obesity Observatory. We found a strong correlation between average store size and national obesity prevalence (r = 0.96). Explanations for the association between store size and national obesity prevalence may include larger and less frequent shopping trips and greater choice and exposure to foods in countries with larger stores. Large supermarkets may represent a food system that focuses on quantity ahead of quality and therefore may be an important and novel environmental indicator of a pattern of behaviour that encourages obesity.
Gisondi, Paolo; Del Giglio, Micol; Girolomoni, Giampiero
Psoriasis is an immune-mediated inflammatory skin disease frequently associated with metabolic disorders, including diabetes, dyslipidaemia and metabolic syndrome. Moreover, a growing number of studies confirm the association between psoriasis and obesity. It has been found that obesity, as measured by body mass index >30 kg/m(2), can double the risk of incident psoriasis. A positive correlation between different measures of adiposity and the severity of psoriasis has also been reported. Epidemiologic studies have also provided robust evidence confirming the association between obesity and psoriatic arthritis. Genetic, metabolic and environmental factors are all likely to contribute to these associations. Adipose tissue is an active endocrine and paracrine organ that has a key role in lipid and glucose metabolism as well as inflammation. Fat tissue is traditionally distributed into two main compartments with different metabolic characteristics, i.e. the subcutaneous and visceral adipose tissue. Particular attention has been devoted to visceral adiposity because of its contribution to inflammation and atherosclerosis. The association between psoriasis and obesity should be properly considered when choosing a systemic treatment, because it could exert negative effects on metabolic parameters, including liver enzymes, serum lipids and renal function. Obesity may increase the risk of liver and renal toxicity from methotrexate and cyclosporine. Moreover, obesity can compromise the effectiveness of systemic treatments for psoriasis (conventional and biological therapies). Dermatologists are also expected to promote a healthy lifestyle and weight loss for obese patients because they could improve metabolic parameters and responsiveness to psoriasis therapies.
Szczygielska, Anna; Widomska, Sylwia; Jaraszkiewicz, Magdalena; Knera, Patrycja; Muc, Kamil
Elevated levels of total and low density lipoprotein (LDL) cholesterol and low levels of high density lipoprotein (HDL) cholesterol are important risk factors for coronary heart disease. Another established predictor of cardiovascular disease is obesity. Obesity and overweight are widespread phenomena and they have reached epidemic proportions in the developed countries, including Poland. Only 30% of people in the Lublin region have normal weight (BMI<25). The aim of this study was to asses the relationship between BMI (body mass index) and blood lipids in the population of 83 people from Aleksandrow commune (64 women and 19 men aged 28-81) who spontaneously applied for medical examination performed as student research. Mean total cholesterol and triglycerides concentrations were higher in obese persons in comparison to normal weight subjects and HDL cholesterol concentration was lower in obese subjects as compared to normal and overweight individuals. Differences in mean concentrations of LDL cholesterol were not significant. A linear correlation between the degree of obesity and plasma level of LDL cholesterol and triglycerides was shown. In conclusion, obesity and overweight are accompanied by unfavourable blood lipids patterns and in a considerable proportion of overweight or obese patients other risk factors for coronary heart disease, such as hypertension, smoking, diabetes or family history of cardiovascular diseases coexist.
Hansen, Dominique; Dendale, Paul; Beelen, Milou; Jonkers, Richard A M; Mullens, Annelies; Corluy, Luk; Meeusen, Romain; van Loon, Luc J C
Elevated plasma free fatty acid (FFA), inflammatory marker, and altered adipokine concentrations have been observed in obese type 2 diabetes patients. It remains unclear whether these altered plasma concentrations are related to the diabetic state or presence of obesity. In this cross-sectional observational study, we compare basal plasma FFA, inflammatory marker, and adipokine concentrations between obese and non-obese type 2 diabetes patients and healthy, non-obese controls. A total of 20 healthy, normoglycemic males (BMI <30 kg/m(2)), 20 non-obese (BMI <30 kg/m(2)) and 20 obese (BMI >35 kg/m(2)) type 2 diabetes patients were selected to participate in this study. Groups were matched for age and habitual physical activity level. Body composition, glycemic control, and exercise performance capacity were assessed. Basal blood samples were collected to determine plasma leptin, adiponectin, resistin, tumor necrosis factor alpha (TNFalpha), interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP) and FFA concentrations. Plasma FFA, inflammatory marker (hsCRP, IL-6, TNFalpha), adipokine (adiponectin, resistin, leptin), and triglyceride concentrations did not differ between non-obese diabetes patients and healthy, normoglycemic controls. Plasma FFA, IL-6, hsCRP, leptin, and triglyceride levels were significantly higher in the obese diabetes patients when compared with the healthy normoglycemic controls (P < 0.05). Furthermore, plasma hsCRP and leptin levels were significantly higher in the obese versus non-obese diabetes patients (P < 0.05). Significant correlations between plasma parameters and glycemic control were observed, but disappeared after adjusting for trunk adipose tissue mass. Elevated plasma leptin, hsCRP, IL-6, and FFA concentrations are associated with obesity and not necessarily with the type 2 diabetic state.
Carnell, Susan; Benson, Leora; Chang, Ku-Yu Virginia; Wang, Zhishun; Huo, Yuankai; Geliebter, Allan; Peterson, Bradley S
Rates of adolescent obesity and overweight are high. The offspring of overweight parents are at increased risk of becoming obese later in life. Investigating neural correlates of familial obesity risk and current overweight status in adolescence could help identify biomarkers that predict future obesity and that may serve as novel targets for obesity interventions. Our primary aim was to use functional MRI to compare neural responses to words denoting high or low energy density (ED) foods and non-foods, in currently lean adolescents at higher compared with lower familial risk for obesity, and in overweight compared with lean adolescents. Secondary aims were to assess group differences in subjective appetite when viewing food and non-food words, and in objective ad libitum intake of high-ED foods in a laboratory setting. We recruited 36 adolescents (14-19y), of whom 10 were (obese/overweight "overweight"), 16 lean with obese/overweight mothers (lean high-risk, "lean-HR"), and 10 lean with lean mothers (lean low-risk, "lean-LR"). All underwent fMRI scanning while they viewed words representing high-ED foods, low-ED foods, or non-foods, and provided appetitive ratings in response to each word stimulus. They then consumed a multi-item ad libitum buffet meal. Food compared with non-food words activated a distributed emotion/reward system including insula and pregenual anterior cingulate cortex (ACC). Participants who were at increasing risk for obesity exhibited progressively weaker activation of an attentional/regulatory system including dorsolateral prefrontal cortex (PFC), dorsal ACC, and basal ganglia nuclei (activation was greatest in lean-LR, intermediate in lean-HR, and weakest in the overweight group). These group differences were most apparent for neural responses to high-compared with low-ED foods. Lean-HR (compared with lean-LR and overweight) adolescents reported greater desire for high-ED foods. Meal intake was greatest for the overweight, then lean
Zhao, Jia; Settles, Barbara H
To examine the individual, parental, and neighborhood environment correlates of children's physical activity and risk of obesity. Secondary data of 1514 children drawn from the Delaware Survey of Children's Health were used for analysis. A conceptual framework was developed based on the Social Determinants of Health and Environmental Health Promotion model and tested using structural equation modeling. Findings confirmed that parental support on physical activity and a favorable neighborhood environment predicted children's physical activity. However, the risk of overweight and obesity was not associated with parental support of physical activity and children's physical activity. Future preventive practice requires a multifaceted approach incorporating both individual and environmental changes.
Ip, Edward H.; Marshall, Sarah; Vitolins, Mara; Crandall, Sonia J.; Davis, Stephen; Miller, David; Kronner, Donna; Vaden, Karen; Spangler, John
Purpose Obesity bias has been shown to undermine the patient-doctor relationship and lead to substandard care. A valid and reliable instrument was developed to measure medical students’ attitudes and beliefs about obese patients. Method The authors conducted a literature search to identify validated measures of obesity bias. Since no appropriate scale was located, the decision to design a novel survey instrument, titled the NEW (Nutrition, Exercise and Weight Management) Attitudes Scale, was made. An expert panel generated items which were then discussed in focus groups of third year medical students. Experienced medical educators served as judges, weighting the items using a Thurstone scale. Second and fourth year medical students completed these items alongside two previously validated measures of obesity bias, the Anti-Fat Attitudes Questionnaire (AFA) and Beliefs About Obese Persons Scale (BAOP). Third year students completed the NEW scales before and after a simulated encounter with an obese standardized patient instructor. Results Thirty one items comprised the final instrument. A sample of 201 judges rated the positivity of items. A sample of 111 second and fourth year medical students completed the survey (mean score 24.4, range −37 to 76 out of a possible −118 to 118); Pearson correlations between AFA and BAOP were −0.47 and 0.23, respectively. Test-retest reliability was 0.89. Students scored 27% higher after completing the standardized patient-instructor encounter (P<.001). Conclusion The NEW Attitudes Scale had good validity and reliability and may be used in future studies to measure medical students’ attitudes towards obese patients. PMID:23269296
Vaughan, R W; Wise, L
Although obese patients have been shown to represent a particularly high risk group with respect to hypoxemia both pre and postoperatively, no data exist to delineate the intraoperative arterial oxygenation pattern of these patients. Furthermore, no one has studied the effects of a change in operative position or a subdiaphragmatic laparotomy pack on arterial oxygenation (PaO2). Sixty-four adults undergoing jejunoileal bypass for morbid exogenous obesity, with a mean weight of 142.0 +/- 31.4 kg and a mean age of 33.3 +/- 10.4 years, were studied. Twenty-five patients (Group I) were maintained in the supine position throughout the operative procedure, while the remaining 39 patients (Group II) were changed to a 15 degrees head down position 15 minutes after a control blood sample was taken. Four additional markedly obese patients were studied to determine the effect of an abdominal pack of PaO2 values. The following findings were demonstrated: 1) 40% oxygen did not uniformly produce adequate arterial oxygenation for intra-abdominal surgery in otherwise healthy obese patients; 2) placement of a subdiaphragmatic abdominal laparotomy pack without a change in operative position resulted in a consistent fall in PaO2 in each patient to less than 65 mm Hg even though 40% oxygen was being administered; and 3) a change from supine to a 15 degrees head down operative position resulted in a significant (P less than 0.001) reduction in mean PaO2 (73.0 +/- 26.3 mm Hg). Seventy-seven per cent of these patients demonstrated PaO2 values of less than 80 mm Hg on 40% oxygen. Because of these findings, serious consideration should be given to the routine use of the Trendelenberg position intraoperatively in obese patients. However, if one elects this posture, prudence would dictate careful monitoring and maintenance of arterial oxygenation. Certainly, in obese patients, the intraoperative combination of the head down position and a subdiaphragmatic laparotomy pack should be avoided
Monk, Terri G; Rietbergen, Henk; Woo, Tiffany; Fennema, Hein
A growing proportion of patients undergoing surgical procedures are obese, providing anesthesiologists with numerous challenges for patient management. The current pooled analysis evaluated recovery times following sugammadex reversal of neuromuscular blockade by body mass index (BMI) in general, and in particular, in patients with BMIs ≥30 kg/m (defined as obese) and <30 kg/m (defined as non-obese). Data were pooled from 27 trials evaluating recommended sugammadex doses for reversal of moderate [reappearance of the second twitch of the train-of-four (TOF); sugammadex 2 mg/kg] or deep (1-2 post-tetanic counts or 15 minutes after rocuronium; sugammadex 4 mg/kg) rocuronium- or vecuronium-induced neuromuscular blockade. All doses of sugammadex were administered based on actual body weight. The recovery time from sugammadex administration to a TOF ratio ≥0.9 was the primary efficacy variable in all individual studies and in the pooled analysis. This analysis comprised a total of 1418 adult patients treated with sugammadex; 267 (18.8%) of these patients had a BMI ≥30 kg/m. The average time to recovery of the TOF ratio to 0.9 was 1.9 minutes for rocuronium-induced blockade and 3.0 minutes for vecuronium-induced blockade. No clinically relevant correlation was observed between BMI and recovery time. The recommended sugammadex doses based on actual body weight provide rapid recovery from neuromuscular blockade in both obese and non-obese patients; no dose adjustments are required in the obese patient.
Vinciguerra, Federica; Baratta, Roberto; Farina, Maria Grazia; Tita, Patrizia; Padova, Giuseppa; Vigneri, Riccardo; Frittitta, Lucia
The prevalence of very severe obesity has increased progressively and faster than other classes of obesity over the last years. It is unclear whether the prevalence of obesity-related complications and health risks increases progressively or reaches a plateau above a certain degree of obesity. The aim of our study was to investigate whether the severity of obesity was correlated with the prevalence of type 2 diabetes mellitus (T2DM), impaired fasting glucose, impaired glucose tolerance (IGT), metabolic syndrome (MS), and cardiovascular diseases (CVDs) in a large cohort of patients with different degrees of obesity. A cross-sectional study was conducted in 938 obese patients without a previous diagnosis of diabetes. Patients were assigned to different categories of obesity: mild-moderate obesity (BMI 30-39.9 kg/m(2)), morbid obesity (BMI 40-49.9 kg/m(2)), and super-obesity (SO, BMI ≥50 kg/m(2)). The prevalence of IGF, IGT, screen-detected T2DM, MS, and CVD was higher in SO patients than in the other groups. Interestingly, the association between SO and either MS or CVD was independent of glucose tolerance status, indicating that factors other than glucose metabolism also favor cardio-metabolic complications in obese patients. In patients without screen-detected T2DM (n = 807), insulin sensitivity and secretion OGTT-derived indexes indicated that SO patients had the worst glucose homeostasis relative to the other categories of obesity, which was indicated by the most reduced disposition index in these patients, a predictor of future T2DM. In conclusion, SO patients have an extremely high prevalence of glucose metabolism deterioration, and cardio-metabolic complications are more prevalent in these patients compared to less obese patients.
Background Obesity is associated with increased risk of cardiovascular disease. Arterial stiffness assessed by carotid femoral pulse wave velocity (PWV) is an independent predictor of cardiovascular morbidity and mortality. We aimed to investigate how various measures of body composition affect arterial stiffness. Methods This is an analysis of cross-sectional baseline data from a controlled clinical trial addressing changes in arterial stiffness after either surgery or lifestyle intervention in a population of morbidly obese patients. High-fidelity applanation tonometry (Millar®, Sphygmocor®) was used to measure pulse wave velocity (PWV). Carotid femoral PWV is a direct measure of arterial stiffness and is considered to be the gold standard method. The Inbody 720 Body Composition Analyzer was used for bioelectrical impedance analysis (BIA). Spearman's correlation, independent samples t-test, chi-square tests, Fisher's exact test and multiple linear regression analyses were used as statistical methods. Results A total of 133 patients (79 women), with a mean (SD) age of 43 (11) years were included in the study. Men had a significantly higher prevalence of obesity related comorbidities and significantly higher PWV, 9.1 (2.0) m/s vs. 8.1 (1.8) m/s, p = 0.003, than women. In the female group, PWV was positively correlated with WC, WHtR, BMI and visceral fat area. In the male group, PWV was negatively correlated with BMI. Multiple linear regression analysis showed that increasing BMI, WC, WHtR, visceral fat area and fat mass were independently associated with higher PWV in women, but not in men, after adjustment for age, hypertension and type 2 diabetes. Conclusion Most measures of general and abdominal obesity were predictors of arterial stiffness in female morbidly obese patients. Trial registration ClinicalTrials.gov Identifier NCT00626964 PMID:21284837
Ito, Ryuichi; Narita, Shintaro; Huang, Mingguo; Nara, Taketoshi; Numakura, Kazuyuki; Takayama, Koichiro; Tsuruta, Hiroshi; Maeno, Atsushi; Saito, Mitsuru; Inoue, Takamitsu; Tsuchiya, Norihiko; Satoh, Shigeru; Habuchi, Tomonori
Although obesity increases the risk of renal cell carcinoma (RCC), obese patients with RCC experience longer survival than non-obese patients. However, the mechanism of this "obesity paradox" is unknown. We examined the impact of preoperative BMI, serum total adiponectin (sAd) level, total adiponectin secretion from perinephric adipose tissue, and intratumoral expression of adiponectin receptors on RCC aggressiveness and survival. We also investigated the mechanism underlying enhanced cancer aggressiveness in RCC cells stimulated with exogenous adiponectin. Overweight and obese patients had significantly lower grade cancers than normal patients in all patients and in those without metastasis (p = 0.003 and p = 0.027, respectively). Cancer-specific survival was significantly longer in overweight and obese patients than in normal patients in all patients (p = 0.035). There was a weak inverse correlation between sAd level and BMI in RCC patients (r = -0.344, p = 0.002). Tumor size was slightly correlated with sAd level, and high sAd was significantly associated with poor overall survival rates in patients with non-metastatic RCC (p = 0.035). Adiponectin levels in perinephric adipose tissue and intratumoral AdipoR1/R2 expression were not correlated with RCC aggressiveness or survival. Proliferation significantly increased in 786-O and Caki-2 cells exposed to exogenous adiponectin, whereas cell invasion and migration were unaffected. In addition, exogenous adiponectin significantly inhibited starvation- and metformin-induced apoptosis, and up-regulated p-AMPK and Bcl-xL levels. In summary, low BMI and high adiponectin levels are associated with aggressive cell behaviors and poor survival in surgically-treated RCC patients. The effects of adiponectin on proliferation and apoptosis might underlie the "obesity paradox" of RCC.
Chung, Kuo-Hsuan; Chiou, Hung-Yi; Chen, Yi-Hua
Evidence of associations between psychopathology and obesity in childhood remains inconsistent, and most studies have been conducted in Western countries. This study investigated psychological and physiological correlates of obesity in a community sample of children in Taiwan. In total, 302 children (157 overweight/obese and 145 healthy-weight children) were selected from first- and fourth-grade schoolchildren in eight elementary schools in 2009. These children participated in a comprehensive health examination, including a physical examination, blood sample analysis, and questionnaire administration. We found that regarding physiological characteristics, compared with the healthy-weight children, the overweight/obese children had significantly higher values for body fat estimated using the bioelectrical impedance method (p < 0.001), systolic blood pressure (p < 0.001), and diastolic blood pressure (p = 0.001); lower values for high-density lipoprotein (p < 0.001); and worse values for glutamic-pyruvic transaminase (p < 0.001), triglycerides (p < 0.001), and fasting blood glucose (p = 0.049). In logistic models adjusted for parental and child traits and physiological characteristics, children's overweight/obesity was significantly associated with lower self-concept (odds ratio [OR] = 0.96, 95% confidence interval [CI] = 0.93-0.99) and less disruptive behavior (OR = 0.96, 95% CI = 0.92-0.99). Less disruptive behavior and the lack of a higher prevalence of anxiety and depression in childhood obesity appear to be a unique pattern in Taiwan that warrants further investigation.
Gomes, Thayse Natacha; Katzmarzyk, Peter T.; dos Santos, Fernanda K.; Souza, Michele; Pereira, Sara; Maia, José A. R.
There are widespread differences in overweight/obesity prevalence in children, and understanding the reasons for this is very important. The present study aims: (I) to conduct a meta-analysis on overweight/obesity prevalence in Portuguese children; (II) to identify differences in biological and behavioural characteristics between normal-weight and overweight/obese children; and (III) to investigate the importance of individual- and school-level correlates of variation in children’s BMI using multilevel modelling. A search was done for all published papers including Portuguese children during the last decade; further, 686 Portuguese children (9–11 years old) were sampled and their BMI, family income, maturity offset, nutritional habits, physical activity, sedentariness, sleep time, and school environment information were collected. Results showed a stabilization of overweight/obesity during the last decade, 30.6% (95%CI: 0.287–0.34) for boys, 28.4% (95%CI: 0.23–0.35) for girls, and 30.3% (95%CI: 0.27–0.34) for boys and girls together. Differences between weight groups were only found in individual-level biological traits. The multilevel analysis did not identify significant contributions of school-level variables to children’s BMI variation. In conclusion, no increase was found in the prevalence of overweight/obesity among Portuguese children since 2000. Normal-weight and overweight/obese children only differ in individual-level characteristics, and school context variables were not related to variation in BMI. PMID:25372884
Chung, Kuo-Hsuan; Chiou, Hung-Yi; Chen, Yi-Hua
Evidence of associations between psychopathology and obesity in childhood remains inconsistent, and most studies have been conducted in Western countries. This study investigated psychological and physiological correlates of obesity in a community sample of children in Taiwan. In total, 302 children (157 overweight/obese and 145 healthy-weight children) were selected from first- and fourth-grade schoolchildren in eight elementary schools in 2009. These children participated in a comprehensive health examination, including a physical examination, blood sample analysis, and questionnaire administration. We found that regarding physiological characteristics, compared with the healthy-weight children, the overweight/obese children had significantly higher values for body fat estimated using the bioelectrical impedance method (p < 0.001), systolic blood pressure (p < 0.001), and diastolic blood pressure (p = 0.001); lower values for high-density lipoprotein (p < 0.001); and worse values for glutamic-pyruvic transaminase (p < 0.001), triglycerides (p < 0.001), and fasting blood glucose (p = 0.049). In logistic models adjusted for parental and child traits and physiological characteristics, children’s overweight/obesity was significantly associated with lower self-concept (odds ratio [OR] = 0.96, 95% confidence interval [CI] = 0.93–0.99) and less disruptive behavior (OR = 0.96, 95% CI = 0.92–0.99). Less disruptive behavior and the lack of a higher prevalence of anxiety and depression in childhood obesity appear to be a unique pattern in Taiwan that warrants further investigation. PMID:26612264
Background The aim of this study was to examine the psychometric properties of the Fatigue Severity Scale (FSS) to verify whether this instrument is a valid tool to measure fatigue in obese patients, and to examine the prevalence of fatigue in obese patients. Methods Before and after a three-week residential multidisciplinary integrated weight reduction program, 220 patients were asked to fill in the questionnaires: FSS, Profile of Mood States (Fatigue-Inertia subscale, POMS-Fatigue, and Vigor-Activity subscale, POMS-Vigor), and the Obesity-Related Well-Being (ORWELL-97). A subsample of 50 patients completed the questionnaire within two days. Results The prevalence of fatigue using a cut-off value of 4 for the FSS score was 59%. Correlations were found between FSS and POMS-Fatigue and -Vigor scores (r = 0.58 and 0.53, respectively). A relation was also found between FSS and ORWELL97 (r = 0.52, 0.42 to 0.61). From the factorial analysis only 1 factor was extracted explaining 63% of variance, with factor loading values ranging from 0.71 (item 7) to 0.87 (item 6). Intraclass Correlation Coefficient was 0.89 (0.82 to 0.94), while the agreement as measured using the Standard Error of Measurement was 0.43 (0.36 to 0.54) corresponding to 13% (11 to 17%). Cronbach’s alpha values ranged from 0.94 to 0.93. The internal responsiveness of FSS was comparable to the ORWELL97 (Standardized Response Mean = 0.50 and 0.44, respectively). Conclusions Fatigue is an important and frequent symptom in obese patients and therefore should be routinely assessed in both research and clinical practice. This can be achieved using the FSS, which is a short, simple, valid and reliable tool for assessing and quantifying fatigue in obese patients. PMID:23496886
Goode, Victoria; Phillips, Elayne; DeGuzman, Pamela; Hinton, Ivora; Rovnyak, Virginia; Scully, Kenneth; Merwin, Elizabeth
Patient safety and the delivery of quality care are major concerns for healthcare in the United States. Special populations (eg, obese patients) need study in order to support patient safety, quantify risks, advance education for healthcare-workers, and establish healthcare policy. Obesity is a complex chronic disease and is considered the second leading cause of preventable death in the United States with approximately 300,000 deaths per year. Obesity is recognized by the Agency for Healthcare Research and Quality (AHRQ) as a comorbid condition. These concerns emphasize the need to focus further research on the obese patient. Through the use of clinical and administrative data, this study examines the incidence of adverse outcomes in the obese surgical population through AHRQ Patient Safety Indicators (PSI) and allows for the engagement PSIs as measures to guide and improve performance. In this study, the surgical population was overwhelmingly positive for obesity. Body mass index (BMI) was also a significant positive predictor for 2 of 3 postoperative outcomes. This finding suggests that as BMI reaches the classification of obesity, the risk of these adverse outcomes increases. It further suggests there exists a threshold BMI that requires anticipation of alterations to systems and processes to revise outcomes. Copyright© by the American Association of Nurse Anesthetists.
Meule, A; Heckel, D; Jurowich, C F; Vögele, C; Kübler, A
Recent evidence suggests that palatable, high-calorie foods may have an addictive potential. Accordingly, obesity and overconsumption of such foods have been associated with addiction-like eating behaviour. The present study investigated whether individuals with obesity can be classified as food-addicted and which factors would differentiate between food-addicted and non-addicted individuals. We administered the German version of the Yale Food Addiction Scale and other questionnaires to obese individuals seeking bariatric surgery (N = 96). Results showed that 40% of the sample could be diagnosed as food-addicted. Food-addicted individuals reported more frequent food cravings, higher eating disorder psychopathology and more depressive symptoms than the non-addicted group. Age, body mass and gender distribution did not differ between groups. The food addiction group had higher attentional but similar motor and non-planning impulsivity, and had lower scores on the Alcohol Use Disorders Identification Test (AUDIT) compared with the non-addicted group. Scores on the AUDIT were associated with impulsivity in the non-addicted group only. We conclude that the prevalence of food addiction is higher in candidates for bariatric surgery compared with the general population and obese individuals not seeking bariatric surgery. A diagnosis of food addiction is associated with higher eating pathology and depression. Moreover, only attentional impulsivity, but not other dimensions of impulsivity, is associated with addictive eating. Finally, food addiction and impulsivity interactively predicted alcohol use, suggesting a crucial role of psychological variables and eating style in determining alcohol consumption in pre-bariatric patients, independent of body mass. © 2014 The Authors. Clinical Obesity © 2014 World Obesity.
Huang, Yueye; Yang, Jie; Li, Yan; Chen, Jiaqi; Song, Kexiu; Wang, Xingchun; Bu, Le; Cheng, Xiaoyun; Wang, Jiying; Qu, Shen
Objective. We aimed to investigate the relationship between FGF21 and obesity-related acanthosis nigricans (AN). Methods. 40 obese patients without AN (OB group), 40 obese patients with AN (AN group), and 40 healthy volunteers (control group, CON) were included in this study. Weight, BMI, lipid profile, FFA, UA, and CRP were measured in all participants. Oral glucose tolerance tests (OGTT) were performed and serum glucose and plasma insulin were measured. Serum FGF21 was measured by ELISA. Results. Compared with OB group, AN group had higher levels of fasting insulin and homeostasis model of assessment for insulin resistance (HOMA-IR) (P < 0.05), but lower serum levels of blood glucose. The difference of FGF21 among three groups was significant and AN group showed the highest serum level of FGF21 (P < 0.05). Serum FGF21 was most positively correlated with fasting insulin and HOMA-IR. Multiple logistic analysis showed that FGF21 was the independent risk factor for AN (OR 4.550; 95% CI 1.054–19.635; P = 0.042). Conclusion. AN patients had more serious hyperinsulinemia but better serum levels of blood glucose than OB. Increased FGF21 is associated with AN in obese patients and may be considered as compensatory response to the decreased insulin sensitivity. PMID:27190511
Cognolato, S; Silvestri, A; Fiorellini Bernardis, A L; Santonastaso, P
The aim of this study is to explore the effectiveness of a short-term psychodynamic oriented group therapy with a selected sample of obese patients. We selected, from the patients referred to the Eating Disorders Consultation Service, 7 obese patients. Selection criteria were as follows: 1) aged between 20 and 40; 2) absence of severe organic disorders, as determining factors for the onset of obesity; 3) absence of severe psychiatric symptomatology. In addiction the selected subjects had to be sufficiently motivated to take up a psychological treatment. Subject underwent a clinical semi-structured interview and two questionnaires (SCL90 and TFEQ) were administered. Patients were re-evaluated at the end of the treatment and a two-years follow-up has been carried out. The group was conducted by a psychiatric and a psychologist, supervised by a group therapist. The group therapy lasted 6 months with 75' minutes weekly sessions. When the therapy was over all subjects showed an improved clinical picture: two of them had a remarkable weight reduction and one subject reached his ideal weight. The weight loss and maintenance at follow-up compared favorably with the results reported for other psychological treatments for obesity. The group setting, for its homogeneity, allowed great cohesiveness and let the members achieve, an increased emotional awareness of their self-image. This experience seem to confirm the effectiveness of a short-term group therapy in an institutional setting.
Oppert, J M; Balarac, N
Physical activity is recognized as an integral part of obesity treatment, in association with other therapeutic means. A major benefit of physical activity is the association with better long-term maintenance of weight loss. Physical activity has also positive psychological effects and increases quality of life. An evaluation of the usual level of physical activity and inactivity is needed for each patient. Physical activity counselling should be individualized and graded, in a perspective of individual progression. In subjects with massive obesity, remobilization based on physiotherapy techniques is the first step. All patients should be given simple advice to decrease sedentary behavior: use the stairs instead of the escalators, limit the time spent seated, etc. In general, current physical activity recommendations for the general population fit well with a majority of obese patients, i.e. a minimum of 30 minutes/day of moderate intensity physical activity (brisk walking or equivalent) on most, and preferably all, days of the week. Physical activities of higher intensities (endurance training programme) can be proposed on an individual basis. The type of physical activity required for long-term weight maintenance, and the question of adherence to physical activity recommendations in obese patients should be further investigated.
Scheen, A J; Lefebvre, P J
Obesity is a well-known risk factor for non-insulin-dependent (or Type 2) diabetes mellitus. Consequently, reduction of weight excess comes to the front line in the prevention and management of NIDDM. It is only when diet and physical exercise fail that drug treatment should be considered. Pharmacological treatment of obesity should favour drugs which not only promote weight loss, by reducing caloric intake and/or increasing thermogenesis and energy expenditure, but also, and especially, improve insulin sensitivity. Serotoninergic anorectic compounds (dexfenfluramine, fluoxetine) appear to possess, to some extent, all these properties. Metformin significantly reduces insulin resistance and improves glycaemic control without inducing weight gain, and even favouring some weight loss. This biguanide is now considered as the first line drug for the obese diabetic patient. Alpha-glucosidase inhibitors may help to reduce post-prandial glucose excursions but do not promote weight loss per se. Sulfonylureas can be prescribed to an obese patient when hyperglycaemia persists despite diet and the above-mentioned oral agents, but their use should be associated with reinforcement of dietary advices in order to prevent further weight increase; it is also the case for insulin therapy. Finally, drugs specifically stimulating thermogenesis and energy expenditure, new agents sensitizing tissues to the action of insulin and various compounds interfering with lipid metabolism are currently under extensive investigation with promising preliminary results in the obese diabetic patient. In conclusion, obesity remains a major problem in the management of Type 2 diabetes mellitus and this justifies the search for new, safe and effective, pharmacological approaches.
Goh, Graham Seow-Hng; Liow, Ming Han Lincoln; Mitra, Amit Kanta
To compare the outcome following total knee arthroplasty (TKA) in obese and non-obese Asian patients. 27 obese patients were compared with 27 non-obese controls matched for age, gender, diagnosis (osteoarthritis), prosthesis, preoperative Knee Society knee and function scores, preoperative Oxford Knee Score, and follow-up duration. All TKAs were performed by a single surgeon. Patients were assessed at 6 months and 2 years for the range of motion, Knee Society knee and function scores, Oxford Knee Score, and Short Form-36 Health Survey (SF-36). The obese and non-obese groups did not differ significantly in pre- and post-operative variables: range of motion, Knee Society knee and function scores, Oxford Knee Score, and SF-36 score. Using revision as an end-point, implant survival was 100%. There were no intra- or post-operative complications in either group. Obese and non-obese Asian patients achieved a comparable outcome following TKA.
Duke, Meredith C; Farrell, Timothy M
The prevalence of gastroesophageal reflux disease (GERD) has mirrored the increase in obesity, and GERD is now recognized as an obesity-related comorbidity. There is growing evidence that obesity, specifically central obesity, is associated with the complications of chronic reflux, including erosive esophagitis, Barrett's esophagus, and esophageal adenocarcinoma. While fundoplication is effective in creating a competent gastroesophageal junction and controlling reflux in most patients, it is less effective in morbidly obese patients. In these patients a bariatric operation has the ability to correct both the obesity and the abnormal reflux. The Roux-en-Y gastric bypass is the preferred procedure.
Aberle, Dwight; Charles, Hearns; Hodak, Steven; O’Neill, Daniel; Oklu, Rahmi; Deipolyi, Amy R.
With the rising epidemic of obesity, interventional radiologists are treating increasing numbers of obese patients, as comorbidities associated with obesity preclude more invasive treatments. These patients are at heightened risk of vascular and oncologic disease, both of which often require interventional radiology care. Obese patients pose unique challenges in imaging, technical feasibility, and periprocedural monitoring. This review describes the technical and clinical challenges posed by this population, with proposed methods to mitigate these challenges and optimize care. PMID:28082253
Papadimitriou-Olivgeris, Matthaios; Aretha, Diamanto; Zotou, Anastasia; Koutsileou, Kyriaki; Zbouki, Aikaterini; Lefkaditi, Aikaterini; Sklavou, Christina; Marangos, Markos; Fligou, Fotini
Background. The objective of this study was to assess the correlation between sepsis, obesity, and mortality of patients admitted to an Intensive Care Unit (ICU). Subjects and Methods. Data of all patients admitted to the ICU of a tertiary hospital during a 28-month period were retrospectively analyzed and included in the study. Results. Of 834 patients included, 163 (19.5%) were obese, while 25 (3.0%) were morbidly obese. Number of comorbidities (P < 0.001), bloodstream infection (P 0.033), and carbapenemase-producing Klebsiella pneumoniae colonization during ICU stay (P 0.005) were significantly associated with obesity, while nonobese patients suffered more frequently from spontaneous intracranial hemorrhage (P 0.038). Total ICU mortality was 22.5%. Increased mortality among obese ICU patients was observed. Sepsis was the main condition of admission for which obese patients had statistically lower survival than normal weight subjects (76.3% versus 43.7%; P 0.001). Mortality of septic patients upon admission was independently associated with SOFA score upon ICU admission (P 0.003), obesity (P 0.014), pneumonia (P 0.038), and development of septic shock (P 0.015). Conclusions. Our study revealed that sepsis upon ICU admission is adversely influenced by obesity but further studies are needed in order to assess the role of obesity in sepsis outcome.
Papadimitriou-Olivgeris, Matthaios; Zotou, Anastasia; Koutsileou, Kyriaki; Zbouki, Aikaterini; Lefkaditi, Aikaterini; Sklavou, Christina; Marangos, Markos; Fligou, Fotini
Background. The objective of this study was to assess the correlation between sepsis, obesity, and mortality of patients admitted to an Intensive Care Unit (ICU). Subjects and Methods. Data of all patients admitted to the ICU of a tertiary hospital during a 28-month period were retrospectively analyzed and included in the study. Results. Of 834 patients included, 163 (19.5%) were obese, while 25 (3.0%) were morbidly obese. Number of comorbidities (P < 0.001), bloodstream infection (P 0.033), and carbapenemase-producing Klebsiella pneumoniae colonization during ICU stay (P 0.005) were significantly associated with obesity, while nonobese patients suffered more frequently from spontaneous intracranial hemorrhage (P 0.038). Total ICU mortality was 22.5%. Increased mortality among obese ICU patients was observed. Sepsis was the main condition of admission for which obese patients had statistically lower survival than normal weight subjects (76.3% versus 43.7%; P 0.001). Mortality of septic patients upon admission was independently associated with SOFA score upon ICU admission (P 0.003), obesity (P 0.014), pneumonia (P 0.038), and development of septic shock (P 0.015). Conclusions. Our study revealed that sepsis upon ICU admission is adversely influenced by obesity but further studies are needed in order to assess the role of obesity in sepsis outcome. PMID:27777948
Lőrincz, Hajnalka; Katkó, Mónika; Harangi, Mariann; Somodi, Sándor; Gaál, Krisztina; Fülöp, Péter; Paragh, György; Seres, Ildikó
Chemerin is a recently described adipokine expressed primarily in the white adipose tissue. Compared with lean subjects, circulating chemerin levels are significantly elevated in obese individuals and correlate positively with the prevalence of various cardiovascular risk factors including altered lipoprotein levels. To date, the impact of chemerin on lipoprotein subfractions and its role in atherosclerotic processes are still unclear. Fifty nondiabetic obese (NDO) patients and 38 lean controls matched in age and gender were enrolled. Chemerin level was measured by ELISA. Low-density lipoprotein (LDL) and high-density lipoprotein (HDL) subfractions were detected by nongradient polyacrylamide gel electrophoresis (Lipoprint). We detected significantly higher serum chemerin levels in NDO patients compared with healthy controls (590·1 ± 190·3 ng/ml vs 405 ± 127·1 ng/ml, P < 0·001). A significant positive correlation was found between chemerin and LDL cholesterol levels, while chemerin showed a significant negative correlation with the level of HDL cholesterol. Significant positive correlation was detected between chemerin and the ratio of small dense LDL, while chemerin correlated negatively with the mean LDL size. Also, a significant negative correlation was found between serum chemerin and the ratio of large HDL subfraction, while there were significant positive correlations between chemerin levels and intermediate and small HDL subfraction ratios, respectively. Chemerin may be involved in the regulation of lipoprotein metabolism in obese patients who do not show apparent abnormalities of glucose metabolism. Early changes in the distribution of the lipoprotein subfractions may contribute to the progression of atherosclerosis, leading to increased cardiovascular risk. © 2013 John Wiley & Sons Ltd.
Al Maskari, Masoud Y; Alnaqdy, Adel A
Objective: To ascertain the relationship between serum leptin levels and related variables (weight, Body Mass Index (BMI) and fat percentage) in a group of Omani obese and non-obese healthy subjects. Methods: Leptin levels were assessed in serum samples from 35 obese Omanis and 20 non-obese healthy subjects. Results: There was a significant difference (p< 0.001) in serum leptin between the obese group (34.78 + 13.96 ng/ml) and the control non-obese subjects (10.6 ± 4.2 ng/ml). Leptin levels were higher in females compared to males. There was a significantly positive correlation between leptin levels in obese subjects with weight (p=0.002), body fat percentage (p=0.0001) and BMI (p=0.001). Conclusions: We concluded that serum leptin levels are higher in the Omani obese group and correlate positively with body fatness and obesity. PMID:21748132
Ríos-Martínez, Blanca P; Rangel-Rodríguez, Gabriela Alejandra
The perception of obese people has about themselves is often paradoxical, seeing themselves with several virtues and flaws that take them to have an ambiguous attitude about themselves. The aim was to evaluate the perception that the obese people has about their body and relationships. Multidimensional Body-Self Relations Questionnaire was applied; obtaining a descriptive analysis (mean and standard deviation) of each item and contrasting by gender (male and female) and proposal treatment (surgical and nonsurgical). Significant differences were found (p value<.05) between genders and type of treatment in some phrases of the applied questionnaire. Self-perception in the obese patient seems to be strongly related to the perception that society has of them, which is usually negative in relation to their appearance. Patients tend to perceive themselves as unappealing, although this perception is greater in patients canalized to surgical treatment; likewise, tendency to think about their appearance is greater in non-surgical patients. About personal care, it was found that participants pay less attention to improving their personal appearance, women having a slightly greater concern.
Gross, Mitchell; Ramirez, Cristina; Luthringer, Daniel; Nepomuceno, Edward; Vollmer, Robin; Burchette, James; Freedland, Stephen J
Obesity is associated with an aggressive form of prostate cancer and with alterations in androgen and estrogen metabolism. We hypothesized that changes in components of the sex steroid receptor axis may contribute to the clinical aggressiveness of prostate cancer in obese patients. A database was assembled containing clinical and pathological variables from 539 patients treated with radical prostatectomy at a single urban hospital between 1994 and 2002. Tissue microarrays were constructed from representative patients and expression of androgen receptor (AR), PSA, estrogen receptor alpha (ERalpha), estrogen receptor beta (ERbeta), and aromatase was examined. Higher BMI correlated strongly with black race, the presence of extra-capsular extension, and higher pathologic stage. Expression of AR, PSA, ERbeta and aromatase in cancerous epithelial cells did not differ according to obesity status. However, decreased expression of ERalpha and aromatase was observed in the stromal compartment surrounding non-cancerous acini in obese patients. We confirm the previously reported associations between obesity and aggressive clinical and pathologic features in our single-institution, urban teaching hospital. In comparing obese versus non-obese patients, there was no difference in expression of androgen or estrogen related proteins in cancerous epithelial cells. However, there was a down-regulation of ERalpha and aromatase in the stroma of obese patients. Our data suggest obesity may cause stromal changes in the sex steroid production and signaling pathways which may affect prostate cancer growth via intracrine/paracrine mechanisms. (c) 2008 Wiley-Liss, Inc.
Barros, Luísa L; Souza-Machado, Adelmir; Corrêa, Luciana B; Santos, Jéssica S; Cruz, Constança; Leite, Mylene; Castro, Lourdes; Coelho, Ana Carla; Almeida, Paula; Cruz, Alvaro A
Asthma is a public health problem as it leads to hospitalization and eventual death, particularly in its severe forms. Many studies have demonstrated an association between obesity and asthma. The aim of this study was to investigate the relationship between obesity and asthma control in a group of patients at a reference center for severe asthma in Brazil. This cross-sectional study was conducted in the outpatient central reference clinic of the Program for Control of Asthma in the State of Bahia. It included 508 subjects with severe asthma of both genders and above 18 years of age. All the participants answered a sociodemographic and a clinical questionnaire to collect information on their asthma and comorbidities, such as rhinitis and gastro-esophageal reflux disease (GERD). Participants also completed the Asthma Control Questionnaire, performed a spirometry test, and had their weight, height, and waist and hip circumferences registered. Logistic regression analysis demonstrated a positive association between body mass index (BMI) and uncontrolled asthma [odds ratio (OR) 1.5; 95% confidence interval (CI) 1.02-2.20]. Symptoms of chronic rhinitis and GERD were also significantly associated with uncontrolled asthma (OR 3.68, 95% CI 1.50-9.01; and OR 2.78, 95% CI 1.91-4.03, respectively). There was no correlation between waist-to-hip ratios and asthma control. In our sample of patients with severe asthma, those who were obese were more likely to have uncontrolled asthma than patients with a normal BMI. Nevertheless, this is not conclusive evidence for a direct causal association between obesity and poor asthma control. Future studies are necessary to dissect the relationship between obesity and asthma outcomes.
The workplace is one of many areas of life where obese people are unfairly treated. According to the literature obese women are particularly susceptible to discrimination in employment. There is a lack of polish researches of this subject. The main objective of this study was to analyze personal, subjective experiences related to weight bias and discrimination against obese people in the workplace of obese Polish women. The study was carried out in a hospital clinic for obesity management. A total of 420 women with BMI>30, aged 21 to 72, participated in group interviews focused on the weight bias and discrimination against obese people in the workplace. In the group of clinically obese women, 5.3% of subjects had experienced employment discrimination and 10.5% had been victims of verbal and social abuse in the workplace. The most common psycho-physical consequences of the weight stigma were emotional problems, lack of motivation and overeating in response to stress. Weight-based discrimination in the workplace poses a problem in Poland. The weight stigma and occupational discrimination lead to psycho-physical discomfort which exacerbates overeating and obesity.
Houston, Patricia A
Obese patients are a highly specialized population to manage within the health care system. Excess weight contributes to changes in patients' anatomy and physiology. Specialized equipment, including vascular access devices, is required to accommodate their needs. Research has shown that traditional methods of obtaining vascular access can prove unfruitful in the obese patient population. Choosing the most appropriate device in conjunction with practicing the most effective technique will improve vascular access outcomes for obese patients.
Nigro, E; Piombino, P; Scudiero, O; Monaco, M L; Schettino, P; Chambery, A; Daniele, A
Obesity is a chronic inflammatory disease significantly risen worldwide, especially among children. Adipokines, secreted from adipose tissue, are hormones involved in various cellular processes such as energy metabolism and inflammation. Among the others, adiponectin is gaining increasing interest for its insulin-sentitizing, anti-atherogenic and anti-inflammatory properties. This adipokine undergoes different post-translational modifications, after which it circulates as oligomers of high, medium and low molecular weight (HMW, MMW, LMW); HMW are the most biologically active oligomers. Serum adiponectin levels as well as the amount of its oligomers are inversely correlated to BMI and closely associated with obesity and related diseases. In this study, we analyzed total adiponectin expression and its oligomeric profile in saliva samples from 27 obese compared to 27 age- and sex-matched controls. Moreover, we compared adiponectin oligomerization between serum and saliva samples. The analysis of the different adiponectin oligomers reveals a slightly higher expression of total, HMW and LMW salivary adiponectin in obese patients compared to controls. Finally, FPLC analysis evidenced that HMW oligomers in saliva have a higher molecular weight than in serum confirming the presence of more complex oligomers in saliva, previously identified as super HMW (S-HMW). Saliva is considered a potential source of novel biomarkers for the diagnosis of metabolic disorders. The assessment of total adiponectin and its oligomeric profiles in saliva samples may represent a promising biological marker for the analysis of metabolic diseases.
Lavie, Carl J; Arena, Ross; Alpert, Martin A; Milani, Richard V; Ventura, Hector O
The management of cardiovascular diseases (CVD) in patients with obesity presents numerous challenges. Obesity has a negative effect on almost all of the major CVD risk factors, and adversely influences cardiovascular structure and function. Patients who are overweight or obese have a higher incidence of almost all CVDs compared with patients who are of normal weight. However, those who are overweight or obese seem to have a better short-term and medium-term prognosis after major CVD events and interventional procedures or cardiac surgeries than leaner patients, a phenomenon termed the 'obesity paradox'. In considering the mechanisms underlying this paradox, we review evidence of the deleterious consequences of obesity in patients with coronary heart disease, and the limited data on the benefits of weight loss in patients with CVD. Additional studies are needed on the efficacy of purposeful weight loss on cardiovascular outcomes to determine the ideal body composition for patients with CVD.
Rabin, Borsika A; Boehmer, Tegan K; Brownson, Ross C
Despite the growing agreement that modern environments fuel increased food consumption and decreased physical activity, few studies have addressed environmental and policy correlates of obesity. This study describes obesity patterns across Europe and identifies macroenvironmental factors associated with obesity prevalence at a national level. Data on obesity prevalence and indicators of the physical, economic, and policy environment were assembled from international databases for 24 European countries. Coefficient estimates between overall, male, and female obesity prevalence and each independent variable were calculated using linear regression. The obesity prevalence varied widely across countries and between genders with higher values in Central and Eastern European countries and lower values in France, Italy, and some Scandinavian countries. Statistically significant inverse associations were observed between overall and female obesity prevalence and variables from the following domains: economic (real domestic product), food (available fat), urbanization (urban population), transport (passenger cars, price of gasoline, motorways), and policy (governance indicators). There was also a negative association between overall obesity and available fruits/vegetables, and between female obesity and single-member households. Male obesity was inversely associated with available fruits/vegetables and density of motorways. The magnitude of the coefficient estimates suggests stronger associations for female obesity than for male obesity in all cases. This exploratory study suggests a need to conduct additional research examining the role of obesogenic environments in European countries, with a special focus on policy-related variables, and to further study gender-specific differences in obesity and its correlates.
Giannakis, G; Thünenkötter, T; Weiler, B; Urhausen, A
Aerobic exercise capacity is considered as an independent prognostic factor for cardiovascular disease and mortality. It is usually expressed in maximal oxygen consumption (VO2(max)) or metabolic equivalent (MET) and is measured by spiroergometry or calculated by a regression formula based on maximal performance achieved. Obesity is associated with reduced physical performance and increased cardiovascular mortality. The aim of our study was to describe the ergometric and cardiovascular profile of patients of an obesity clinic, and to compare a direct measure of VO2(max) with an indirect by a regression formula and to. 131 consecutive patients of an obesity clinic (95 females, 36 males) aged 16-75 years participated. The VO2(max) was measured by spiro-ergometry on a treadmill and estimated by a regression formula on the basis of the speed and grade of the treadmill. We have determined the relationship between Body mass index (BMI), Waist Circumference (WC) and the parameters VO2(max)/kg, MET, Performance Relative for Age, Heart Rate Recovery one minute after maximal effort (HRR), VO2(max) relative to a theoretical normal body weight (corresponding to a BMI of 25 kg/m2 (VO2(max)Rel25)), blood pressure, at rest and 5 minutes after exercise, Framingham Score and C-reactive protein (CRP). For the different age groups the VO2(max)/kg was below normal values (mean -23.4%). Measured VO2(max) was 15.2% lower than estimated by the regression formula. After adjusting to age and to a theoretical upper-limit normal body weight (corresponding to a BMI of 25 kg/m2) VO2(max)/kg was 5-20% (mean value 15%) higher than the reference values. VO2(max)/kg and HRR were correlated with BMI, WC and Framingham Score. 40% of the patients were already treated for hypertension, 55% had elevated blood pressure measurements at rest and 52% after exercise. Ergometric stress testing in obese subjects delivers important information that helps to evaluate the cardiovascular risk in this population
Hashimoto, Koshi; Tagami, Tetsuya; Yamakage, Hajime; Muranaka, Kazuya; Tanaka, Masashi; Odori, Shinji; Kono, Shigeo; Shimatsu, Akira; Ogawa, Yoshihiro; Satoh-Asahara, Noriko
Thyroid function is strongly associated with obesity. The aim of this study is to investigate whether serum free thyroxine (FT4) and/or thyrotropin (TSH) levels are associated with the efficacy of weight reduction therapy in obese patients. We enrolled a total of 283 obese patients and cross-sectionally investigated the association of serum FT4 and/or TSH levels with metabolic features. Furthermore, in 97 obese patients who received 6-month weight reduction therapy, we assessed the relationship of serum FT4 and/or TSH levels to the efficacy of weight reduction therapy. Neither baseline serum FT4 nor TSH levels showed any correlations with body weight (BW) and body mass index (BMI) in these obese patients. However, in 57 obese female patients who underwent weight reduction therapy for six months, serum FT4 levels prior to the therapy was negatively correlated with the degrees of reduction of BW (r = -0.354, p = 0.007) and BMI (r = -0.373, p = 0.004). The correlation between baseline serum FT4 levels with the efficacy of weight reduction therapy was not observed in obese male or postmenopausal female patients. This study demonstrates that baseline serum FT4 levels are associated with weight reduction in obese female premenopausal patients. Therefore, baseline FT4 levels can be used as a clinical, noninvasive, hormonal predictor of weight reduction efficacy in obese patients.
Singh, Navneet; Arthur, Heather M; Worster, Andrew; Iacobellis, Gianluca; Sharma, Arya M
This study reports an investigation to assess patients' and nurses' perceptions of equipment adequacy for obese patients presenting at an emergency department and to assess nurses' knowledge of equipment weight limits in the emergency department. The increasing weight of populations in many societies is a challenge to healthcare providers and facilities. Emergency department equipment, specifically, may be inadequate for patient care. Two questionnaires were developed. One was administered to 134 emergency department patients with suspected cardiac ischaemia; the other was administered to their respective nurses. Patient and nurse equipment adequacy scores were computed. Patients' self-reported height and weight were used to calculate body mass index. Waist circumference was measured. The data were collected in Canada in 2005. Patient equipment adequacy scores correlated inversely with both body mass index (r = -0.55, 95% CI = -0.70 to -0.41, P < 0.01) and waist circumference (r = -0.62, 95% CI = -0.75 to -0.48, P < 0.01). Nurse equipment adequacy scores were also inversely related to patient body mass index (r = -0.34, 95% CI = -0.50 to -0.18, P < 0.01) and waist circumference (r = -0.40, 95% CI = -0.56 to -0.24, P < 0.01). There was a weak correlation between nurse and patient equipment adequacy scores (r = 0.27, 95% CI = -0.44 to -0.10, P < 0.01). Small minorities of nurses reported accurate knowledge of weight limits for beds, commodes and toilets. Specialized equipment and staff education are needed for adequate management of obese patients in the emergency department.
Guebre-Egziabher, Fitsum; Sens, Florence; Nguyen-Tu, Marie-Sophie; Juillard, Laurent; Dubourg, Laurence; Hadj-Aissa, Aoumeur
Background and objectives Adequate estimation of renal function in obese patients is essential for the classification of patients in CKD category as well as the dose adjustment of drugs. However, the body size descriptor for GFR indexation is still debatable, and formulas are not validated in patients with extreme variations of weight. Design, setting, participants, & measurements This study included 209 stages 1–5 CKD obese patients referred to the Department of Renal Function Study at the University Hospital in Lyon between 2010 and 2013 because of suspected renal dysfunction. GFR was estimated with the Chronic Kidney Disease and Epidemiology equation (CKD-EPI) and measured with a gold standard method (inulin or iohexol) not indexed (mGFR) or indexed to body surface area determined by the Dubois and Dubois formula with either real (mGFRr) or ideal (mGFRi) body weight. Mean bias (eGFR−mGFR), precision, and accuracy of mGFR were compared with the results obtained for nonobese participants (body mass index between 18.5 and 24.9) who had a GFR measurement during the same period of time. Results Mean mGFRr (51.6±24.2 ml/min per 1.73 m2) was significantly lower than mGFR, mGFRi, and eGFRCKD-EPI. eGFRCKD-EPI had less bias with mGFR (0.29; −1.7 to 2.3) and mGFRi (−1.62; −3.1 to 0.45) compared with mGFRr (8.7; 7 to 10). This result was confirmed with better accuracy for the whole cohort (78% for mGFR, 84% for mGFRi, and 72% for mGFRr) and participants with CKD stages 3–5. Moreover, the Bland Altman plot showed better agreement between mGFR and eGFRCKD-EPI. The bias between eGFRCKD-EPI and mGFRr was greater in obese than nonobese participants (8.7 versus 0.58, P<0.001). Conclusions This study shows that, in obese CKD patients, the performance of eGFRCKD-EPI is good for GFR≤60 ml/min per 1.73 m2. Indexation of mGFR with body surface area using ideal body weight gives less bias than mGFR scaled with body surface area using real body weight. PMID:24482068
Rios-Diaz, Arturo J; Lin, Elissa; Williams, Katherine; Jiang, Wei; Patel, Vihas; Shimizu, Naomi; Metcalfe, David; Olufajo, Olubode A; Cooper, Zara; Havens, Joaquim; Salim, Ali; Askari, Reza
The "obesity paradox" has been demonstrated in chronic diseases but not in acute surgery. We sought to determine whether obesity is associated with improved outcomes in patients with severe soft tissue infections (SSTIs). The 2006 to 2010 Nationwide Inpatient Sample was used to identify adult patients with SSTIs. Patients were categorized into nonobese and obese (nonmorbid [body mass index 30 to 39.9] and morbid [body mass index ≥ 40]). Logistic regression provided risk-adjusted association between obesity categories and inhospital mortality. There were 2,868 records with SSTI weighted to represent 14,080 patients. Obese patients were less likely to die in hospital than nonobese patients (odds ratio [OR] = .42; 95% confidence interval [CI], .25 to .70; P = .001). Subanalysis revealed a similar trend, with lower odds of mortality in nonmorbid obesity (OR = .46; 95% CI, .23 to .91; P = .025) and morbid obesity (OR = .39; 95% CI, .19 to .80; P = .011) groups. Obesity is independently associated with reduced inhospital mortality in patients with SSTI regardless of the obesity classification. This suggests that the obesity paradox exists in this acute surgical population. Copyright © 2016 Elsevier Inc. All rights reserved.
Mehmetoglu, Idris; Yerlikaya, F. Hümeyra; Kurban, Sevil
The aim of the present study was to investigate correlation between plasma vitamin A, vitamin E, serum coenzyme Q10 levels and degree of insulin resistance in obese and normal weight people. The study was performed on 98 (21 Male, 77 Female) obese people and 78 (20 Male, 58 Female) control subjects. Vitamin A, E and coenzyme Q10 levels were adjusted to the lipid levels. Adjusted vitamin A and E and coenzyme Q10 levels of the obese female group were significantly lower than those of the control female group. Adjusted vitamin A and coenzyme Q10 levels of the obese male group were significantly lower than those of the control male group. Insulin resistance level of the obese female and male groups were significantly higher than that of the control female and male groups. There were no significant correlations between serum coenzyme Q10, plasma vitamin A and E levels and insulin resistance in obese and control subjects. Our findings show that it is essential to use the lipid adjusted levels of lipid soluble nutrients in obesity. Also, we have found no association between insulin resistance and vitamin A, vitamin E and coenzyme Q10 levels in obese subjects. PMID:22128213
Hernández Romero, Azael; Matta Campos, Juan; Mora Nieto, Alejandra; del Rivero, Leonel; Andrés Dionicio, Atenea Estela; Aguilar Ramírez, Pilar; Barthell Solís, Carlos; García González, América; Carreta Macías, Leticia; Murguía Corral, Ricardo; Vázquez Nava, Francisco; Almeida Arvizu, Víctor Manuel
The prevalence of asthma and obesity has increased last years implying important economical and social consequences. A relationship between asthma severity and obesity grade has been found. Therefore, it is necessary to evaluate if obesity decline has a beneficial impact on asthma severity. To evaluate the effect of obesity decline on control symptoms and asthma severity. Ninety-six patients with obesity and moderate chronic asthma were randomized to group A or B and were maintained for 40 days on a low calorie diet. At baseline and at the end of the study, symptoms, measurement of obesity, spirometry, inflammatory cytokines and immunoglobulin's levels were assessed. Diets' safety was evaluated based on laboratory test. Data were analyzed with Student's t test. After 40 days on a low calorie diet, in group A, there were significant decreases of obesity (p < 0.001) and IgE, symptoms almost disappeared (cough persisted in 20%) and medication was suspended in 80%. Group B had obesity decline but IgE levels remained (> 100 UI/mL), symptoms and drug regimen remained unchanged. Both diets were not harmful for patients. These results show that asthmatic obese patients maintained for 40 days on low calorie diet A, had obesity and IgE levels decrease and symptoms and asthma severity relief.
Fleischmann, Edith; Kurz, Andrea; Niedermayr, Monika; Schebesta, Karl; Kimberger, Oliver; Prager, Gerhard; Sessler, Daniel I.; Kabon, Barbara
Background: Wound infection risk is inversely related to subcutaneous oxygenation, which is reduced in obese patients and may be reduced even more during laparoscopic procedures. Methods: We evaluated subcutaneous tissue oxygenation (PsqO2) in 20 patients with a body mass index (BMI) ≥40 kg·m–2 (obese) and 15 patients with BMI <30 kg·m-2 (non-obese) undergoing laparoscopic surgery with standardised anaesthesia technique and fluid administration. Arterial oxygen tension was maintained near 150 mmHg. PsqO2 was measured from a surrogate wound on the upper arm. Data were analyzed with unpaired two-tailed t or Wilcoxon rank-sum tests; P < 0.05 was statistically significant. Data are given as mean (SD). Results: An FIO2 of 51% (13%) was required in obese patients to reach an arterial oxygen tension of 150 mmHg; however, an FIO2 of only 40% (7%) was required to reach the same oxygen tension in non-obese patients (P=0.007). PsqO2 was significantly less in obese patients: 41 (10) vs. 57 (15) mmHg (P<0.001). Conclusion: Obesity reduces the amount of inspired oxygen required to obtain a given arterial partial pressure and tissue oxygenation. Both factors probably contribute to high infection risk in obese patients. PMID:15978153
Li, Liangli; Zhang, Yifeng; Du, Hongyi; He, Ping; Li, Guiling; Liu, Xiuwei; Zhao, Shujing; Wu, Min; He, Gengsheng
To explore the relationship between expression of coiled-coil domain-containing protein 80(CCDC80) and obesity in serum and adipose tissues. A cross-sectional survey was conducted in a hospital in Tangshan in September 2010. 100 people including 78 healthy people and 22 with type-2 diabetes were recruited. Another 36 female patients with benign tumor of Obstetrics and Gynecology were also recruited. Demographic characteristics and serum samples were collected from all subjects, basic biochemical indicators were tested. All subjects were divided into 'Normal Weight' and 'Overweight and Obese' according to their BMI (BMI <24.0 kg/m(2); BMI≥24 kg/m(2)). Serum CCDC80 of the 100 subjects was detected by ELISA. Visceral and subcutaneous fat were derived from the other 36 female subjects, and Real-time PCR was used to detect CCDC80 mRNA expression in adipose tissues. Pearson correlation and multiple linear regression were used to analyze the correlation between serum or adipose CCDC80 expression and waist, BMI, and other biochemical indicators. The age of 100 subjects was (52.9±8.4) years old. 44% of them were women (44 cases) and 56% of them were men (56 cases). After dividing them into three groups according to their BMI, covariance analysis were conducted, and age and gender were adjusted. The HDL-C level was significantly different among three groups (F = 10.73, P < 0.001): 'Overweight and obese combined with diabetes' group ((0.90±0.06) mmol/L)< 'Overweight and obese' group ((1.14±0.04) mmol/L) < 'Normal weight' group ((1.28±0.05) mmol/L). The adjusted expression of serum CCDC80 of the 100 subjects was (5.84±0.16) pg/ml, (5.81±0.98) pg/ml among men and (5.97±0.89) pg/ml among women, and there was no significant difference (t = -0.812, P = 0.419) between genders. ANOVA revealed that there was no significant differences of the expression of serum CCDC80 among three groups (F = 1.06, P = 0.351), 'Normal weight' group was (5.84±0.16) pg/ml, 'overweight and
Sarzani, Riccardo; Guerra, Federico; Mancinelli, Lucia; Buglioni, Alessia; Franchi, Eliana; Dessì-Fulgheri, Paolo
The aim of this study was to evaluate whether body mass index (BMI) is independently correlated with plasma aldosterone concentration (PAC) in treated essential hypertensive patients, and whether the relationship between BMI and high blood pressure (BP) can be partially mediated by PAC despite renin-angiotensin-aldosterone system blockade. This study used a cross-sectional design and included 295 consecutive essential hypertensive patients referred to our centre for uncontrolled BP despite stable antihypertensive treatment for at least 6 months. The main exclusion criteria were age >65 years; glomerular filtration rate <30 ml/min; and therapy with mineralocorticoid receptor antagonists, direct renin inhibitors, amiloride or oral contraceptives. Higher levels of obesity showed a significantly higher mean PAC with a steep nonlinear increase in patients with BMI ≥ 35 kg/m(2). Class 2 and 3 obese patients had a higher mean PAC than nonobese and class 1 obese patients, even in patients under stable treatment with either angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs). In a stepwise multiple linear regression model, only log of plasma renin activity (PRA), mean blood pressure (MBP), and class 2 and 3 obesity showed an independent correlation with PAC. In the same model applied to patients treated with ACEIs or ARBs, only logPRA and class 2 and 3 obesity showed a direct correlation with PAC. In treated essential hypertensive patients, a BMI ≥ 35 kg/m(2) is independently, albeit modestly, correlated with PAC. The correlation between BMI ≥ 35 kg/m(2) and PAC holds true even in ACEI/ARB-treated patients. Further study is required to determine whether the association of obesity with BP is mediated by PAC in hypertensive patients on stable therapy with ACEIs or ARBs.
Zozzaro-Smith, Paula; Gray, Lisa M; Bacak, Stephen J; Thornburg, Loralei L
Obesity is a worldwide epidemic and can have a profound effect on pregnancy risks. Obese patients tend to be older and are at increased risk for structural fetal anomalies and aneuploidy, making screening options critically important for these women. Failure rates for first-trimester nuchal translucency (NT) screening increase with obesity, while the ability to detect soft-markers declines, limiting ultrasound-based screening options. Obesity also decreases the chances of completing the anatomy survey and increases the residual risk of undetected anomalies. Additionally, non-invasive prenatal testing (NIPT) is less likely to provide an informative result in obese patients. Understanding the limitations and diagnostic accuracy of aneuploidy and anomaly screening in obese patients can help guide clinicians in counseling patients on the screening options.
Fernandes, Ricardo; Beserra, Bruna Teles Soares; Cunha, Raphael Salles Granato; Hillesheim, Elaine; Camargo, Carolina de Quadros; Pequito, Danielle Cristina Tonello; de Castro, Isabela Coelho; Fernandes, Luiz Cláudio; Nunes, Everson Araújo; Trindade, Erasmo Benício Santos de Moraes
Background. Obesity is considered a low-grade inflammatory state and has been associated with increased acute phase proteins as well as changes in serum fatty acids. Few studies have assessed associations between acute phase proteins and serum fatty acids in morbidly obese patients. Objective. To investigate the relationship between acute phase proteins (C-Reactive Protein, Orosomucoid, and Albumin) and serum fatty acids in morbidly obese patients. Methods. Twenty-two morbidly obese patients were enrolled in this study. Biochemical and clinical data were obtained before bariatric surgery, and fatty acids measured in preoperative serum. Results. Orosomucoid was negatively correlated with lauric acid (P = 0.027) and eicosapentaenoic acid (EPA) (P = 0.037) and positively with arachidonic acid (AA) (P = 0.035), AA/EPA ratio (P = 0.005), and n-6/n-3 polyunsaturated fatty acids ratio (P = 0.035). C-Reactive Protein (CRP) was negatively correlated with lauric acid (P = 0.048), and both CRP and CRP/Albumin ratio were negatively correlated with margaric acid (P = 0.010, P = 0.008, resp.). Albumin was positively correlated with EPA (P = 0.027) and margaric acid (P = 0.008). Other correlations were not statistically significant. Conclusion. Our findings suggest that serum fatty acids are linked to acute phase proteins in morbidly obese patients. PMID:24167354
Zini, Cássio; Stieven-Filho, Edmar; Tabushi, Fernando Issamu; Ribas, Carmen Australia Paredes Marcondes; Ribas, Fernanda Marcondes; Opolski, Ana Cristina; Erbano, Bruna Olandoski
Obesity is a chronic disease and has become the most prevalent public health problem worldwide. The impact of obesity on knee is strong and the BMI is correlated with the different alterations. Compare surgical visualization of arthroscopic field in partial meniscectomy in obese and non-obese. Sixty patients were selected, 30 obese and 30 non-obese who underwent arthroscopic partial meniscectomy. The arthroscopic surgical procedures were recorded and analyzed. For the analysis of visualization was used the Johnson's classification (2000). Were analyzed 48 men and 12 women, the average age was 42.9 years with BMI between 21.56 to 40.14 kg/m2. The distribution of visibility of the surgical field according to the classification was: grade 1 - 38/60 (63.3%); grade 2 - 13/60 (21.6%); grade 3 - 6/60 (10%); grade 4 - 3/60 (5%). Knee arthroscopy did not show a significant difference in the visibility of arthroscopic field in obese and non-obese patients. Thus, it should not be indicated as the preferred method of diagnostic evaluation of joint changes in these patients. A obesidade é doença crônica e tem se tornado o problema de saúde pública mais prevalente em todo mundo. O impacto dela no joelho é grande e o IMC está correlacionado com as diferentes alterações existentes. Comparar a visualização do campo videoartroscópico na meniscectomia parcial de joelho em pacientes obesos e não obesos. Foram selecionados 60 pacientes, sendo 30 obesos e 30 não obesos que realizaram meniscectomia parcial videoartroscópica. Os procedimentos videoartroscópicos foram gravados e posteriormente analisados. Foi utilizada na análise a classificação de visibilidade do campo videoartroscópico de Johnson (2000). Foram analisados 48 homens e 12 mulheres com idade média de 42,9 anos e IMC de 21,56 a 40,14 kg/m2. A distribuição da visibilidade do campo cirúrgico foi: grau 1 - 38/60 (63,3%); grau 2 - 13/60 (21,6%); grau 3 - 6/60 (10%); grau 4 - 3/60 (5%). A artroscopia de
Hodkinson, J P; Lucas, M; Lee, M; Harrison, M; Lunn, M P; Chapel, H
There are currently no data to support the suggestion that the dose of therapeutic immunoglobulin (Ig) should be capped in obese patients for pharmacokinetic (PK), safety and economic reasons. We compared IgG trough levels, increment and efficiency in matched pairs of obese and lean patients receiving either replacement or immunomodulatory immunoglobulin therapy. Thirty-one obese patients were matched with a clinically equivalent lean patient across a range of indications, including primary antibody deficiency or autoimmune peripheral neuropathy. Comprehensive matching was carried out using ongoing research databases at two centres in which the dose of Ig was based on clinical outcome, whether infection prevention or documented clinical neurological stability. The IgG trough or steady state levels, IgG increments and Ig efficiencies at times of clinical stability were compared between the obese and lean cohorts and within the matched pairs. This study shows that, at a population level, obese patients achieved a higher trough and increment (but not efficiency) for a given weight-adjusted dose compared with the lean patients. However at an individual patient level there were significant exceptions to this correlation, and upon sub-group analysis no significant difference was found between obese and lean patients receiving replacement therapy. Across all dose regimens a high body mass index (BMI) cannot be used to predict reliably the patients in whom dose restriction is clinically appropriate. © 2015 British Society for Immunology.
Hodkinson, J P; Lucas, M; Lee, M; Harrison, M; Lunn, M P; Chapel, H
There are currently no data to support the suggestion that the dose of therapeutic immunoglobulin (Ig) should be capped in obese patients for pharmacokinetic (PK), safety and economic reasons. We compared IgG trough levels, increment and efficiency in matched pairs of obese and lean patients receiving either replacement or immunomodulatory immunoglobulin therapy. Thirty-one obese patients were matched with a clinically equivalent lean patient across a range of indications, including primary antibody deficiency or autoimmune peripheral neuropathy. Comprehensive matching was carried out using ongoing research databases at two centres in which the dose of Ig was based on clinical outcome, whether infection prevention or documented clinical neurological stability. The IgG trough or steady state levels, IgG increments and Ig efficiencies at times of clinical stability were compared between the obese and lean cohorts and within the matched pairs. This study shows that, at a population level, obese patients achieved a higher trough and increment (but not efficiency) for a given weight-adjusted dose compared with the lean patients. However at an individual patient level there were significant exceptions to this correlation, and upon sub-group analysis no significant difference was found between obese and lean patients receiving replacement therapy. Across all dose regimens a high body mass index (BMI) cannot be used to predict reliably the patients in whom dose restriction is clinically appropriate. PMID:25731216
Lodewick, Toine M; van Nijnatten, Thiemo J A; van Dam, Ronald M; van Mierlo, Kim; Dello, Simon A W G; Neumann, Ulf P; Olde Damink, Steven W M; Dejong, Cornelis H C
The impact of body composition on outcomes after surgery for colorectal liver metastases (CRLM) remains unclear. The aim of the present study was to determine the influence of sarcopenia, obesity and sarcopenic obesity on morbidity, disease-free (DFS) and overall survival (OS). Between 2005 and 2012, all patients undergoing a partial liver resection for CRLM in the Maastricht University Medical Centre, and who underwent computed tomography (CT) imaging within 3 months before liver surgery, were included. Body composition was primarily based on pre-operative CT measurements. Sarcopenia was based on total muscle area at the level of the third lumbar vertebra and predefined body mass index (BMI)- and gender-specific cut-off values for sarcopenia were used. Body fat percentages were calculated and the top 40% for men and women were considered obese. Of the 171 included patients undergoing liver surgery for CRLM, 80 (46.8%) patients were sarcopenic, 69 (40.4%) obese and 49 (28.7%) sarcopenic obese. The presence of sarcopenia, obesity or sarcopenic obesity did not affect the complication rates. However, readmission rates were significantly increased in patients with (sarcopenic) obesity (P < 0.05). Surprisingly, obesity seemed to prolong OS (P = 0.021) and was identified as an independent predictor [hazard ratio (HR):0.58 and P = 0.046] for better OS. Sarcopenia and sarcopenic obesity did not affect DFS or OS. Sarcopenia, obesity and sarcopenic obesity did not worsen DFS, OS and complication rates after a partial liver resection for CRLM. © 2014 International Hepato-Pancreato-Biliary Association.
Odlaug, Brian L; Lust, Katherine; Wimmelmann, Cathrine L; Chamberlain, Samuel R; Mortensen, Erik L; Derbyshire, Katherine; Christenson, Gary; Grant, Jon E
Recent statistics indicate that over one-third of college students are currently overweight or obese, however, the impact of weight in this population from academic and psychiatric perspectives is not fully understood. This study sought to examine the prevalence of overweight and obesity in college students and its association with stress, mental health disorders and academic achievement. A total of 1765 students completed the College Student Computer User Survey (CSCUS) online at a large Midwestern United States University. Responders were classified by weight as normal, overweight or obese based on body mass index. Data were stratified by sex, with cross-tabulation and t-tests, one-way analysis of variance, and logistic regression for analysis. A total of 492 (27.9%) students were overweight (20.2%; range 25.01-29.98) or obese (7.7%; range 30.04-71.26). Overweight and obesity were associated with significantly lower overall academic achievement, more depressive symptoms, and using diet pills for weight loss. Obese males had significantly higher rates of lifetime trichotillomania while overweight and obese females reported higher rates of panic disorder. Higher educational institutions should be aware of the significant burden associated with overweight and obesity in students, and of the differing demographic and clinical associations between overweight or obesity in men and women.
Gul, Ozen Oz; Cander, Soner; Gul, Bulent; Açıkgoz, Ebru; Sarandol, Emre; Ersoy, Canan
This study was designed to evaluate insulin resistance and plasma levels of visfatin and resistin in obese and non-obese patients with polycystic ovary syndrome (PCOS). A total of 37 premenopausal PCOS patients with (n = 18, mean (SD) age: 27.5 (5.7 years) or without obesity (n = 19, mean (SD) age: 23.7 (3.1) years) and healthy volunteers (n = 18, mean (SD) age:29.8 (4.1) years) were included in this study. Data on clinical characteristics, glycemic parameters and lipid parameters were recorded for each subject as were plasma visfatin and resistin levels. Mean (SD) HOMA-IR values were significantly higher in obese PCOS patients (3.4 (1.7)) compared with non-obese PCOS patients (2.0 (1.2), p<0.01) and controls (1.6 (0.8), p<0.01). No significant difference was noted between study groups in terms of plasma resistin (ng/mL) or visfatin (ng/mL) levels. There was no correlation between serum plasma visfatin (r = 0.127, p = 0.407) and resistin (r = -0.096, p = 0.544) levels and HOMA-IR. In conclusion, our findings revealed increased likelihood of metabolic and dyslipidemic manifestations in obese compared to non-obese PCOS patients, while no significant difference was noted in visfatin and resistin levels among PCOS patients in terms of co-morbid obesity and in comparison to controls.
Despite countless diets, exercise regimens, drugs, and behavior modification strategies, the prevalence of obesity continues its relentless increase in both developed and developing nations. Although many necessary components to treat obesity have been identified, behavior modification remains the b...
Noli, G; Cornicelli, M; Marinari, G M; Carlini, F; Scopinaro, N; Adami, G F
Alexithymia is the inability to express feelings with words and comprises a psychological construct frequently found in obese individuals. In eating disordered patients who show a tendency to lose control over food intake, personality traits with alexithymic characteristics have been demonstrated. The present cross-sectional study investigated the relationships between alexithymia and eating behaviour in severely obese patients. This study analysed 150 obese patients undergoing bariatric surgery and 132 subjects at more than 1 year after biliopancreatic diversion (BPD), when body weight has steadily normalised and any preoccupation with weight, food and diet has been completely abandoned. Obese and operated subjects completed the Toronto Alexithymia Scale (TAS), and eating behaviour was assessed via a semi-structured interview exploring binge eating disorder (BED), night eating and emotional eating, as well as by utilisation of the Three Factor Eating Questionnaire (TFEQ). Although alexithymic patients showed deranged eating behaviour, as evaluated by the TFEQ scores, the frequency of BED, night eating and emotional eating was similar in alexithymic (TAS > 60) and non-alexithymic patients. However, the prevalence of alexithymia was similar in obese and BPD subjects, whereas, in the operated subjects, TFEQ scores were lower (P < 0.005) than those in obese patients. These data suggest that, in severely obese patients, alexithymia does not influence eating behaviour; in severely obese patients, the tendency to lose control over food intake apparently represents a psychological construct that is substantially independent from alexithymia.
Montoya-Morales, Danely Sabelia; de los Ángeles Tapia-González, María; Alamilla-Lugo, Lisndey; Sosa-Caballero, Alejandro; Muñoz-Solís, Andrés; Jiménez-Sánchez, Marisela
The morbid obesity (BMI greater than or equal to 40 kg/m2) is associated with dysfunction of the hypothalamus-pituitary-thyroid axis, showing high levels of thyrotropin (TSH), triiodothyronine (T3) total and free, suspecting a real thyroid condition. Our objetive was to describe the alterations in thyroid function in patients with morbid obesity, determining serum levels of TSH, total T3, free T4 and thyroid peroxidase antibodies (TPO). Prospective, descriptive, observational, cross-sectional study, we enrolled 52 patients with morbid obesity, at the obesity clinic, from department of Endocrinology, since January 2009 to July 2011. All patients signed a letter of informed consent. Patients with known thyroid disorders and/or under the use of levothyroxine or other medication that causes alteration in thyroid function were excluded. Statistical analysis was performed using measures of central tendency, simple frequencies, percentages and Spearman's correlation. The prevalence of primary hypothyroidism was 8%, 6% subclinical hypothyroidism and thyroid function alterations secondary to obesity of 23% (elevated TSH and/or free T4 Total T3 with normal and TPO antibody negative). Most morbidly obese patients haven't autoimmune thyroid dysfunction; the alterations in thyroid function are caused by an effect of homeostasis against obesity and can be corrected by reducing weight.
Bautista, Jennifer; Ehsan, Mohsin; Normandin, Edgar; Zuwallack, Richard; Lahiri, Bimalin
Although obesity is a common co-morbid condition in COPD, relatively little is known how it may affect functional exercise capacity. Accordingly, we compared physiologic responses during a 6 min walk test in 10 obese and 10 non-obese COPD patients matched by gender, age, and spirometric severity category. Patients first exercised on a treadmill to determine maximal exercise responses, then following a rest period they completed a 6 min walk test. Breath by-breath analyses of expired air via a facemask was obtained using a portable, battery operated device. Oxygen consumption (VO(2)), carbon dioxide production (VCO(2)), tidal volume (VT), respiratory rate (RR), minute ventilation (VE), and inspiratory capacity (IC) were compared. The mean FEV1 in the obese and non-obese groups was 52 ± 13 and 58 ± 18 percent of predicted, respectively, and the BMI of the obese patients was 37 ± 02 kg/m(2). Obese patients had shorter 6 min walk distances than non-obese patients (247 ± 73 vs 348 ± 51 m, respectively, p = 0.003), but walk-work, defined as 6 min walk distance × weight (in kg), was not different. There were no significant between-group differences in any exercise variable measured during the 6 min walk test. In both groups, VO(2) and VE increased linearly over the first 2-3 min, then plateaued at approximately 80% of maximum. Although 6 min walk distance is shorter in obese COPD patients, their physiologic responses are similar to those of non-obese patients.
Walid, M. Sami; Zaytseva, Nadezhda
Goal: To study the interaction of obesity and age in patients with multiple spine surgeries. Methods: Data on the body mass index (BMI) of 956 patients were collected and classified into four groups: non-obese (BMI <30 kg/m2), obese-class I (BMI ≥30 kg/m2), obese-class II (BMI ≥35 kg/m2) and obese-class III (BMI ≥40 kg/m2). Patients' age was categorized into the following age groups: ≤40, 41–65 and ≥66. T-test and Chi-square test were applied using SPSS v16. Results: In lumbar patients aged ≥66 years with previous spine surgery, the average number of previous spine surgeries significantly increased with increasing obesity from 1.4 in nonobese patients to 1.7, 2.5 and 3.5 in obese class I, II and III patients. In lumbar decompression and fusion patients aged ≥66 years with previous spine surgery, the average number of previous spine surgeries signifi-cantly increased with increasing obesity from 1.7 in nonobese patients to 1.6, 2.0 and 3.5 in obese class I, II and III patients. A similar trend was noted in lumbar microdiskectomy patients aged ≥66 years but it was statistically nonsignificant due probably to small numbers. Conclusion: Obesity is associated with an increased number of previous spine surgeries in patients over 65 years of age undergoing lumbar surgery. PMID:21468327
Valensi, P; Dabire, H; Brahimi, M; Paries, J; Platon, P; Attali, J R
Several studies have well demonstrated that obesity is associated with changes in cardiovascular vagosympathetic activity. The aim of the present work was to evaluate this activity in normotensive and in mildly hypertensive obese patients, and to correlate this activity with clinical and biological indexes of insulin resistance. Heart rate (HR) and systolic blood pressure (sBP) were examined by spectral analysis in 70 normotensive obese patients (group 1), 32 mildly hypertensive obese patients (group 2), and 21 controls. The high frequency peak of HR variations at a controlled breathing rate (vagal activity) was significantly reduced in both groups (p < 0.001). The mid frequency peak of sBP in the standing position (sympathetic activity) was similar in both groups and in the control group. In groups 1 and 2, the high frequency peak correlated negatively with age (p = 0.005 and 0.034 respectively). In group 1, the mid frequency peak correlated positively with fat mass, fasting plasma insulin and triglyceride levels, and insulin resistance index (p < or = 0.03). In group 2, the mid frequency peak correlated positively with fasting insulin and insulin resistance index (p = 0.006 and 0.007 respectively). This study shows that, in obese patients: 1. cardiac vagal activity is reduced in normotensive and mildly hypertensive subjects; 2. vascular sympathetic activity is unchanged in means but may be increased as a consequence of adiposity, hyperinsulinemia and insulin resistance, and this increase is likely to be involved in the increase of blood pressure.
MacLennan, Paul A.; Backstrom, Ian; Creek, Aaron; Sawyer, Jeffrey
Objective To determine whether there are differences in fracture patterns and femur fracture treatment choices in obese vs. non-obese pediatric trauma patients. Design Prognostic study, retrospective chart review. Setting Two level I pediatric trauma centers. Patients The trauma registries of two pediatric hospitals were queried for patients with lower extremity long bone fractures resulting from blunt trauma. 2858 alerts were examined and 397 patients had lower extremity fractures. 331 patients with a total of 394 femur or tibia fractures met inclusion criteria, and 70 patients (21%) were obese. Main Outcome Measurements Weight for age >95th percentile was defined as obese. Radiographs were reviewed and fractures were classified according the OTA/AO pediatric fracture classification system. Fracture patterns (OTA subsegment), severity, and choice of intervention for femur fractures were primary outcomes. Results Overall, obese patients were twice as likely (RR=2.20, 95% CI 1.25–3.89) to have fractures involving the physis. Physeal fracture risk was greater for femur fractures (RR=3.25, 95% CI 1.35–7.78) than tibia fractures (RR=1.58, 95% CI 0.76–3.26). Severity did not differ between groups. Obese patients with femur fractures were more likely to be treated with locked nails. Conclusion Obese pediatric trauma patients are more likely to sustain fractures involving the physis than non-obese patients. This could be related to intrinsic changes to the physis related to obesity, or altered biomechanical forces. This is consistent with the observed relationships between obesity and other conditions affecting the physis including Blount’s and slipped capital femoral epiphysis. PMID:24740109
Haley, Michael J
Obesity is a risk factor for stroke and is consequently one of the most common co-morbidities found in patients. There is therefore an identified need to model co-morbidities preclinically to allow better translation from bench to bedside. In preclinical studies, both diet-induced and genetically obese rodents have worse stroke outcome, characterised by increased ischaemic damage and an altered inflammatory response. However, clinical studies have reported an ‘obesity paradox’ in stroke, characterised by reduced mortality and morbidity in obese patients. We discuss the potential reasons why the preclinical and clinical studies may not agree, and review the mechanisms identified in preclinical studies through which obesity may affects stroke outcome. We suggest inflammation plays a central role in this relationship, as obesity features increases in inflammatory mediators such as C-reactive protein and interleukin-6, and chronic inflammation has been linked to worse stroke risk and outcome. PMID:27655337
Haley, Michael J; Lawrence, Catherine B
Obesity is a risk factor for stroke and is consequently one of the most common co-morbidities found in patients. There is therefore an identified need to model co-morbidities preclinically to allow better translation from bench to bedside. In preclinical studies, both diet-induced and genetically obese rodents have worse stroke outcome, characterised by increased ischaemic damage and an altered inflammatory response. However, clinical studies have reported an 'obesity paradox' in stroke, characterised by reduced mortality and morbidity in obese patients. We discuss the potential reasons why the preclinical and clinical studies may not agree, and review the mechanisms identified in preclinical studies through which obesity may affects stroke outcome. We suggest inflammation plays a central role in this relationship, as obesity features increases in inflammatory mediators such as C-reactive protein and interleukin-6, and chronic inflammation has been linked to worse stroke risk and outcome.
The gut microbiota has been linked with chronic diseases such as obesity in humans. However, the demonstration of causality between constituents of the microbiota and specific diseases remains an important challenge in the field. In this Opinion article, using Koch's postulates as a conceptual framework, I explore the chain of causation from alterations in the gut microbiota, particularly of the endotoxin-producing members, to the development of obesity in both rodents and humans. I then propose a strategy for identifying the causative agents of obesity in the human microbiota through a combination of microbiome-wide association studies, mechanistic analysis of host responses and the reproduction of diseases in gnotobiotic animals.
Brown, Ian; Thompson, Joanne; Tod, Angela; Jones, Georgina
Background Obesity has become a major public health issue and there is concern about the response of health services to patients who are obese. The perceptions of obese patients using primary care services have not been studied in depth. Aim To explore obese patients' experiences and perceptions of support in primary care. Design of study Qualitative study with semi-structured interviews conducted in participants' homes. Setting Five general practices contrasting in socioeconomic populations in Sheffield. Method Purposive sampling and semi-structured interviewing of 28 patients with a diverse range of ages, backgrounds, levels of obesity and experiences of primary care services. Results Participants typically felt reluctance when presenting with concerns about weight and ambivalence about the services received. They also perceived there to be ambivalence and a lack of resources on the part of the health services. Participants showed a strong sense of personal responsibility about their condition and stigma-related cognitions were common. These contributed to their ambivalence about using services and their sensitivity to its features. Good relationships with primary care professionals and more intensive support partly ameliorated these effects. Conclusion The challenges of improving access to and quality of primary care support in tackling obesity are made more complex by patients' ambivalence and other effects of the stigma associated with obesity. PMID:16953998
Gallo, Taryn; Kashani, Shabnam; Patel, Divya A.; Elsahwi, Karim; Silasi, Dan-Arin
Objective: To describe patient characteristics and perioperative outcomes among women undergoing robotic-assisted laparoscopic hysterectomy and to evaluate the characteristics of nonobese, obese, and morbidly obese patients. Methods: A retrospective review was conducted of 442 cases of women who underwent robotic-assisted laparoscopic hysterectomy for benign and malignant conditions over a 4-y period at an academic and community teaching hospital. Patient demographics, surgical indications, operative outcomes, and complications were evaluated for patients with a body mass index (BMI) <30 kg/m2, 30 kg/m2 to 39.9 kg/m2, and ≥40 kg/m2. Results: Of the 442 patients, 257 (58%) were obese or morbidly obese, with a BMI of ≥30 kg/m2. Overall, the median estimated blood loss was 100 mL (range, 10 to 800), the operative time was 135 min (range, 40 to 436), and the length of stay was 1 d (range, 0 to 22). These did not differ significantly by BMI group. Overall, 11.9% of patients experienced complications (7.9% minor, 4.1% major), and this did not differ significantly across BMI groups. Conclusion: Robotic hysterectomy can be performed safely in obese and morbidly obese patients, with surgical outcomes and complications similar to those in nonobese patients. PMID:23318068
Ito, Ryuichi; Narita, Shintaro; Huang, Mingguo; Nara, Taketoshi; Numakura, Kazuyuki; Takayama, Koichiro; Tsuruta, Hiroshi; Maeno, Atsushi; Saito, Mitsuru; Inoue, Takamitsu; Tsuchiya, Norihiko; Satoh, Shigeru; Habuchi, Tomonori
Although obesity increases the risk of renal cell carcinoma (RCC), obese patients with RCC experience longer survival than non-obese patients. However, the mechanism of this “obesity paradox” is unknown. We examined the impact of preoperative BMI, serum total adiponectin (sAd) level, total adiponectin secretion from perinephric adipose tissue, and intratumoral expression of adiponectin receptors on RCC aggressiveness and survival. We also investigated the mechanism underlying enhanced cancer aggressiveness in RCC cells stimulated with exogenous adiponectin. Overweight and obese patients had significantly lower grade cancers than normal patients in all patients and in those without metastasis (p = 0.003 and p = 0.027, respectively). Cancer-specific survival was significantly longer in overweight and obese patients than in normal patients in all patients (p = 0.035). There was a weak inverse correlation between sAd level and BMI in RCC patients (r = −0.344, p = 0.002). Tumor size was slightly correlated with sAd level, and high sAd was significantly associated with poor overall survival rates in patients with non-metastatic RCC (p = 0.035). Adiponectin levels in perinephric adipose tissue and intratumoral AdipoR1/R2 expression were not correlated with RCC aggressiveness or survival. Proliferation significantly increased in 786-O and Caki-2 cells exposed to exogenous adiponectin, whereas cell invasion and migration were unaffected. In addition, exogenous adiponectin significantly inhibited starvation- and metformin-induced apoptosis, and up-regulated p-AMPK and Bcl-xL levels. In summary, low BMI and high adiponectin levels are associated with aggressive cell behaviors and poor survival in surgically-treated RCC patients. The effects of adiponectin on proliferation and apoptosis might underlie the “obesity paradox” of RCC. PMID:28178338
Burke, Gregory L.; And Others
Contrasts body size and potential correlates of obesity in 1,481 African-American and 1,307 white 18- through 30-year-old women in the Coronary Artery Risk Development in Young Adults Study (CARDIA). The increased prevalence of obesity in African-American women could not be explained by racial differences in age or education. (SLD)
Burke, Gregory L.; And Others
Contrasts body size and potential correlates of obesity in 1,481 African-American and 1,307 white 18- through 30-year-old women in the Coronary Artery Risk Development in Young Adults Study (CARDIA). The increased prevalence of obesity in African-American women could not be explained by racial differences in age or education. (SLD)
Müller, Manfred James; Braun, Wiebke; Enderle, Janna; Bosy-Westphal, Anja
BMI is widely used as a measure of weight status and disease risks; it defines overweight and obesity based on statistical criteria. BMI is a score; neither is it biologically sound nor does it reflect a suitable phenotype worthwhile to study. Because of its limited value, BMI cannot provide profound insight into obesity biology and its co-morbidity. Alternative assessments of weight status include detailed phenotyping by body composition analysis (BCA). However, predicting disease risks, fat mass, and fat-free mass as assessed by validated techniques (i.e., densitometry, dual energy X ray absorptiometry, and bioelectrical impedance analysis) does not exceed the value of BMI. Going beyond BMI and descriptive BCA, the concept of functional body composition (FBC) integrates body components into regulatory systems. FBC refers to the masses of body components, organs, and tissues as well as to their inter-relationships within the context of endocrine, metabolic and immune functions. FBC can be used to define specific phenotypes of obesity, e.g. the sarcopenic-obese patient. Well-characterized obesity phenotypes are a precondition for targeted research (e.g., on the genomics of obesity) and patient-centered care (e.g., adequate treatment of individual obese phenotypes such as the sarcopenic-obese patient). FBC contributes to a future definition of overweight and obesity based on physiological criteria rather than on body weight alone. © 2016 The Author(s) Published by S. Karger GmbH, Freiburg.
Kumar, Gagan; Majumdar, Tilottama; Jacobs, Elizabeth R.; Danesh, Valerie; Dagar, Gaurav; Deshmukh, Abhishek; Taneja, Amit
Background: Critically ill, morbidly obese patients (BMI ≥ 40 kg/m2) are at high risk of respiratory failure requiring invasive mechanical ventilation (IMV). It is not clear if outcomes of critically ill, obese patients are affected by obesity. Due to limited cardiopulmonary reserve, they may have poor outcomes. However, literature to this effect is limited and conflicted. Methods: We used the Nationwide Inpatient Sample from 2004 to 2008 to examine the outcomes of morbidly obese people receiving IMV and compared them to nonobese people. We identified hospitalizations requiring IMV and morbid obesity using International Classification of Diseases, 9th Revision, Clinical Modification codes. Primary outcomes studied were inhospital mortality, rates of prolonged mechanical ventilation (≥ 96 h), and tracheostomy. Multivariable logistic regression was used to adjust for potential confounding variables. We also examined outcomes stratified by number of organs failing. Results: Of all hospitalized, morbidly obese people, 2.9% underwent IMV. Mean age, comorbidity score, and severity of illness were lower in morbidly obese people. The adjusted mortality was not significantly different in morbidly obese people (OR 0.89; 95% CI, 0.74-1.06). When stratified by severity of disease, there was a stepwise increase in risk for mortality among morbidly obese people relative to nonobese people (range: OR, 0.77; 95% CI, 0.58-1.01 for only respiratory failure, to OR, 4.14; 95% CI, 1.11-15.3 for four or more organs failing). Rates of prolonged mechanical ventilation were similar, but rate of tracheostomy (OR 2.19; 95% CI, 1.77-2.69) was significantly higher in patients who were morbidly obese. Conclusions: Morbidly obese people undergoing IMV have a similar risk for death as nonobese people if only respiratory failure is present. When more organs fail, morbidly obese people have increased risk for mortality compared with nonobese people. PMID:23349057
Martino, Jenny L.; Wang, Miao; Day, Andrew G.; Cahill, Naomi E.; Dixon, Anne E.; Suratt, Benjamin T.; Heyland, Daren K.
Background: Recent literature suggests that obese critically ill patients do not have worse outcomes than patients who are normal weight. However, outcomes in extreme obesity (BMI ≥ 40 kg/m2) are unclear. We sought to determine the association between extreme obesity and ICU outcomes. Methods: We analyzed data from a multicenter international observational study of ICU nutrition practices that occurred in 355 ICUs in 33 countries from 2007 to 2009. Included patients were mechanically ventilated adults ≥ 18 years old who remained in the ICU for > 72 h. Using generalized estimating equations and Cox proportional hazard modeling with clustering by ICU and adjusting for potential confounders, we compared extremely obese to normal-weight patients in terms of duration of mechanical ventilation (DMV), ICU length of stay (LOS), hospital LOS, and 60-day mortality. Results: Of the 8,813 patients included in this analysis, 3,490 were normal weight (BMI 18.5-24.9 kg/m2), 348 had BMI 40 to 49.9 kg/m2, 118 had BMI 50 to 59.9 kg/m2, and 58 had BMI ≥ 60 kg/m2. Unadjusted analyses suggested that extremely obese critically ill patients have improved mortality (OR for death, 0.77; 95% CI, 0.62-0.94), but this association was not significant after adjustment for confounders. However, an adjusted analysis of survivors found that extremely obese patients have a longer DMV and ICU LOS, with the most obese patients (BMI ≥ 60 kg/m2) also having longer hospital LOS. Conclusions: During critical illness, extreme obesity is not associated with a worse survival advantage compared with normal weight. However, among survivors, BMI ≥ 40 kg/m2 is associated with longer time on mechanical ventilation and in the ICU. These results may have prognostic implications for extremely obese critically ill patients. PMID:21816911
Moreland, Amber M; Santa Ana, Carol A; Asplin, John R; Kuhn, Joseph A; Holmes, Ross P; Cole, Jason A; Odstrcil, Elizabeth A; Van Dinter, Thomas G; Martinez, Juan G; Fordtran, John S
Hyperoxaluria after Roux-en-Y gastric bypass (RYGB) is generally attributed to fat malabsorption. If hyperoxaluria is indeed caused by fat malabsorption, magnitudes of hyperoxaluria and steatorrhea should correlate. Severely obese patients, prior to bypass, ingest excess dietary fat that can produce hyperphagic steatorrhea. The primary objective of the study was to determine whether urine oxalate excretion correlates with elements of fat balance in severely obese patients before and after RYGB. Fat balance and urine oxalate excretion were measured simultaneously in 26 severely obese patients before and 1 year after RYGB, while patients consumed their usual diet. At these time points, stool and urine samples were collected. Steatorrhea and hyperoxaluria were defined as fecal fat >7 g/day and urine oxalate >40 mg/day. Differences were evaluated using paired 2-tailed t tests. Prior to RYGB, 12 of 26 patients had mild to moderate steatorrhea. Average urine oxalate excretion was 61 mg/day; there was no correlation between fecal fat and urine oxalate excretion. After RYGB, 24 of 26 patients had steatorrhea and urine oxalate excretion averaged 69 mg/day, with a positive correlation between fecal fat and urine oxalate excretions (r = 0.71, P < .001). For each 10 g/day increase in fecal fat output, fecal water excretion increased only 46 mL/day. Steatorrhea and hyperoxaluria were common in obese patients before bypass, but hyperoxaluria was not caused by excess unabsorbed fatty acids. Hyperphagia, obesity, or metabolic syndrome could have produced this previously unrecognized hyperoxaluric state by stimulating absorption or endogenous synthesis of oxalate. Hyperoxaluria after RYGB correlated with steatorrhea and was presumably caused by excess fatty acids in the intestinal lumen. Because post-bypass steatorrhea caused little increase in fecal water excretion, most patients with steatorrhea did not consider themselves to have diarrhea. Before and after RYGB, high oxalate
Tanyolaç, Sinan; Sertkaya Cikim, Ayşe; Doğan Azezli, Adil; Orhan, Yusuf
The prevalence of obesity is rapidly increasing in Turkey as well as all over the world. Educational inequalities play an important role in the development of obesity. In this study, our aim is to evaluate how educational status affects obesity and cardiovascular risk factors in the overweight and obese Turkish female population. In this study, 3080 overweight (n=633) and obese (n=2447) Turkish women who applied to Istanbul Faculty of Medicine Obesity Outpatient Clinic were evaluated retrospectively. Educational status was classified according to the subjects' latest term of education. Subjects were evaluated in terms of anthropometric and biochemical parameters. The association of educational level with cardiovascular risk factors and metabolic syndrome were analyzed using logistic regression analysis. Educational levels after adjusted continuous variables (age and body mass index) showed significant correlation with waist circumference, total and high-density lipoprotein cholesterol, triglycerides, low-density lipoprotein cholesterol and glucose. Low educated class (LEC) had a 1.93 (95% CI--1.56-2.39, p=0.001) fold increased risk than high educated subjects for cardiovascular risk factors. Metabolic syndrome prevalence was more prevalent and significant risk increase was observed in LEC (OR=2.02, 95% CI--.53-2.67, p=0.001). Low educational status is a contributing factor for development of obesity and increased risk for obesity related disorders in the Turkish overweight and obese female population. Population based information and educational policies might prevent obesity related disorders and decrease cardiovascular mortality.
Macavei, Vladimir M.; Spurling, Kristofer J.; Loft, Janine; Makker, Himender K.
Introduction: Obesity-hypoventilation syndrome (OHS) is associated with significant morbidity and mortality and requires measurement of arterial pCO2 for diagnosis. Objective: To determine diagnostic predictors of OHS among obese patients with suspected obstructive sleep apnea/hypopnea syndrome (OSAHS). Methods: Retrospective analysis of data on 525 sleep clinic patients (mean age 51.4 ± 12.7 years; 65.7% males; mean BMI 34.5 ± 8.1). All patients had sleep studies, and arterialized capillary blood gases (CBG) were measured in obese subjects (BMI > 30 kg/m2). Results: Of 525 patients, 65.5% were obese, 37.2% were morbidly obese (BMI > 40 kg/m2); 52.3% had confirmed OSAHS. Hypercapnia (pCO2 > 6 kPa or 45 mm Hg) was present in 20.6% obese and 22.1% OSAHS patients. Analysis of OHS predictors showed significant correlations between pCO2 and BMI, FEV1, FVC, AHI, mean and minimum nocturnal SpO2, sleep time with SpO2 < 90%, pO2, and calculated HCO3 from the CBG. PO2 and HCO3 were independent predictors of OHS, explaining 27.7% of pCO2 variance (p < 0.0001). A calculated HCO3 cutoff > 27 mmol/L had 85.7% sensitivity and 89.5% specificity for diagnosis of OHS, with 68.1% positive and 95.9% negative predictive value. Conclusion: We confirmed a high prevalence of OHS in obese OSAHS patients (22.1%) and high calculated HCO3 level (> 27 mmol/L) to be a sensitive and specific predictor for the diagnosis of OHS. Citation: Macavei VM; Spurling KJ; Loft J; Makker HK. Diagnostic predictors of obesity-hypoventilation syndrome in patients suspected of having sleep disordered breathing. J Clin Sleep Med 2013;9(9):879-884. PMID:23997700
Moghanloo, Mehdi Niknam; Mohammadzadeh, Naser Aga; Lotfi, Hajie; Mahmoudi, Rasoul; Abbasi, Maryam; Alipour, Farzaneh Ghafarian; Shool, Fatemeh; Porfar, Sadegh; Zarghami, Nosratollah
Background Recent studies reported that Fat Mass and obesity-associated gene (FTO) single nucleotides polymorphisms (SNPs), especially rs9939609, have association with obesity and type 2 diabetes mellitus. On the other hand, many researches confirmed that leptin, an adipocytokine, is related to the obesity and body mass index (BMI) in patients who suffered from type 2 diabetes(T2DM). Objective In this study, the correlation of FTO rs9939609 polymorphism and leptin level was investigated in the obese women who suffered from T2DM. Methods In case-control study, metabolic and anthropometric parameters, and leptin level of 38 obese diabetic and 38 non-diabetic women were investigated. Genotyping of rs9939609 FTO gene was completed by sequencing of PCR amplicons for all cases. Results According to the results, FBS, age, HbA1c, insulin level, HOMA index and leptin level showed statistically significant difference between diabetic and non-diabetic women (P < 0.05). Based on the adjusting of FTO rs9939609 SNP with anthropometric and metabolic parameters, no significant difference was found between the three genotypes ( AA,TA and TT) in non-diabetic women (P > 0.05). But, in the diabetic group only TC had significant difference and mean of TC was higher in mutant genotypes (AA and TA) than wild genotype (TT). Also, BMI,insulin , LDL and HDL showed negative correlation with leptin level in both groups but these correlations were not staticallysignificant . Conclusion The results of our study (with little sample size) showed that the mean of leptin level in diabetic women was lower than non-diabetic women (significant difference). However, the level of leptin was not statistically significant between three genotypes, and odds ratio of rs9939609 was higher in diabetic women in comparison with non-diabetic women. Copyright© Bentham Science Publishers; For any queries, please email at email@example.com.
Liodaki, Eirini; Senyaman, Özge; Stollwerck, Peter Leonard; Möllmeier, Dirk; Mauss, Karl L; Mailänder, Peter; Stang, Felix
Obesity is an important predictor of mortality and morbidity during a hospital stay. There is very little data concerning the impact of the BMI on clinical outcomes in obese burn patients. The purpose of this study is to document the general epidemiological aspects of thermal injuries in an obese population and draw attention to topics relating to the management, rehabilitation and prognosis of burns in this emerging subpopulation of patients. All patients >16 years of age admitted to the burn unit between January 2008 and December 2012 and fulfilling the burn center referral criteria were enrolled in the study. SPSS version 20 (SPSS GmbH Software, Illinois, USA) was employed for data analysis. Eleven extreme obese patients (men:women, 6:5) had a mean BMI of 38kg/m(2). Their incidence in our study was 5.5%. The mean length of stay was 41.5 days, almost twice that of the non-obese. The presence of co-morbidities such as diabetes, hypertension, cardiac disease, or pulmonary disease, the problematic wound healing and the burn wound infection were significantly higher in the obese patients than in the non-obese. The mortality of obese burned patients was 36.4%. These facts indicate admission of these patients to a burn care unit for the best possible treatment although they might not always fulfill criteria for admission to burn intensive care unit. Burn centers must be also prepared in terms of special nursing equipment for obese patients. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.
Harbeck, Birgit; Danneberg, Sven; Rahvar, Amir-Hossein; Monig, Heiner; Haas, Christian S
Patients with hypothalamic-pituitary disorders (HPD) may be of increased risk to develop overweight and obesity, thereby fostering cardiovascular events. However, it remains unclear if patients with pituitary dysfunctions per se have an increased risk of becoming obese. The objective of this study was to evaluate prevalence and to identify possible predictors of overweight and obesity in patients with pituitary dysfunctions. A total of 121 out-patients having various causes for HPD were assessed for height and body weight; body mass index (BMI) was calculated and correlated with clinical features. Patients were divided into various subgroups depending on underlying conditions and therapeutic modalities. Most of the HPD patients were overweight or obese with males being significantly more affected. Of interest, patients with macroadenomas suffered significantly more often from overweight and obesity than individuals with microadenomas (73.4% vs. 43.5%, p= 0.006). Increased BMI (≥25 kg/m2) tended to be more common in patients with prolactinomas (70.0%), hormone deficiencies (76.1%) and hormone replacement therapies (76.6%) than in a healthy population. In conclusion, we showed that patients with HPD: (i) frequently suffer from overweight and obesity; (ii) prevalence of overweight and obesity however is comparable to that in the general population; (iii) only patients with macroadenomas seem to have a significantly higher risk; (iv) hormone deficiencies and hormonal replacement therapy may foster weight gain and (v) radiation and surgical tumour therapy per se do not seem to be additional risk factors for weight gain. Copyright© Bentham Science Publishers; For any queries, please email at firstname.lastname@example.org.
Lamon, Agnes M; Habib, Ashraf S
Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients. Neuraxial techniques are the preferred anesthetic techniques for cesarean delivery in obese parturients but can be technically challenging. An existing labor epidural catheter can be topped up for cesarean delivery. In patients who do not have a well-functioning labor epidural, a combined spinal epidural technique might be preferred over a single-shot spinal technique since it is technically easier in obese parturients and allows for extending the duration of the block as required. A continuous spinal technique can also be considered. Studies suggest that there is no need to reduce the dose of spinal bupivacaine in the obese parturient, but there is little data about spinal dosing in super obese parturients. Intraoperatively, patients should be placed in a ramped position, with close monitoring of ventilation and hemodynamic status. Adequate postoperative analgesia is crucial to allow for early mobilization. This can be achieved using a multimodal regimen incorporating neuraxial morphine (with appropriate observations) with scheduled nonsteroidal anti-inflammatory drugs and acetaminophen. Thromboprophylaxis is also important in this patient population due to the increased risk of thromboembolic complications. These patients should be monitored carefully in the postoperative period, since there is increased risk of postoperative complications in the morbidly obese parturients. PMID:27574464
Crujeiras, A. B.; Diaz-Lagares, A.; Sandoval, J.; Milagro, F. I.; Navas-Carretero, S.; Carreira, M. C.; Gomez, A.; Hervas, D.; Monteiro, M. P.; Casanueva, F. F.; Esteller, M.; Martinez, J. A.
The characterization of the epigenetic changes within the obesity-related adipose tissue will provide new insights to understand this metabolic disorder, but adipose tissue is not easy to sample in population-based studies. We aimed to evaluate the capacity of circulating leukocytes to reflect the adipose tissue-specific DNA methylation status of obesity susceptibility. DNA samples isolated from subcutaneous adipose tissue and circulating leukocytes were hybridized in the Infinium HumanMethylation 450 BeadChip. Data were compared between samples from obese (n = 45) and non-obese (n = 8–10) patients by Wilcoxon-rank test, unadjusted for cell type distributions. A global hypomethylation of the differentially methylated CpG sites (DMCpGs) was observed in the obese subcutaneous adipose tissue and leukocytes. The overlap analysis yielded a number of genes mapped by the common DMCpGs that were identified to reflect the obesity state in the leukocytes. Specifically, the methylation levels of FGFRL1, NCAPH2, PNKD and SMAD3 exhibited excellent and statistically significant efficiencies in the discrimination of obesity from non-obesity status (AUC > 0.80; p < 0.05) and a great correlation between both tissues. Therefore, the current study provided new and valuable DNA methylation biomarkers of obesity-related adipose tissue pathogenesis through peripheral blood analysis, an easily accessible and minimally invasive biological material instead of adipose tissue. PMID:28211912
Gilbert, Shawn R; MacLennan, Paul A; Backstrom, Ian; Creek, Aaron; Sawyer, Jeffrey
To determine whether there are differences in fracture patterns and femur fracture treatment choices in obese versus nonobese pediatric trauma patients. Prognostic study, retrospective chart review. Two level I pediatric trauma centers. The trauma registries of 2 pediatric hospitals were queried for patients with lower extremity long-bone fractures resulting from blunt trauma. 2858 alerts were examined, and 397 patients had lower extremity fractures. Three hundred thirty-one patients with a total of 394 femur or tibia fractures met the inclusion criteria, and 70 patients (21%) were obese. Weight for age >95th percentile was defined as obese. Radiographs were reviewed, and fractures were classified according the OTA/AO pediatric fracture classification system. Fracture patterns (OTA subsegment), severity, and choice of intervention for femur fractures were the primary outcomes. Overall, obese patients were twice as likely [risk ratio (RR), 2.20; 95% confidence interval (CI), 1.25-3.89] to have fractures involving the physis. Physeal fracture risk was greater for femur fractures (RR, 3.25; 95% CI, 1.35-7.78) than tibia fractures (RR, 1.58; 95% CI, 0.76-3.26). Severity did not differ between groups. Obese patients with femur fractures were more likely to be treated with locked nails. Obese pediatric trauma patients are more likely to sustain fractures involving the physis than nonobese patients. This could be related to intrinsic changes to the physis related to obesity or altered biomechanical forces. This is consistent with the observed relationships between obesity and other conditions affecting the physis including Blount disease and slipped capital femoral epiphysis. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Xu, Tianyuan; Wang, Xianjin; Xia, Leilei; Zhang, Xiaohua; Qin, Liang; Zhong, Shan; Shen, Zhoujun
To compare operative outcomes of robot-assisted radical prostatectomy (RARP) in obese and nonobese patients with prostate cancer. A literature search of MEDLINE, EMBASE, Google Scholar, and the Cochrane Library was performed up to March 2014. All studies that have assessed operative outcomes of RARP in obese and nonobese patients were included. Outcome measures were perioperative and functional results, including operating time, estimated blood loss (EBL), complications, length of hospital stay (LOS), positive surgical margins (PSMs), and recovery of continence and potency. Pooled odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using fixed-effect or random-effect model. Subgroup analysis was performed for institutions with greater experience of RARP in obese cases. Thirteen observational studies from 12 study population were included for 1821 obese patients compared with 4801 nonobese patients. Operating time (p=0.0001; WMD: 24.28; 95% CI, 11.93-36.64) and EBL (p=0.003; WMD: 38.28; 95% CI, 13.45-63.11) were significantly increased in obese patients compared with nonobese counterparts. There was no significant difference in complications, LOS, or PSM rates. Subgroup analysis for studies that have involved ≥100 obese cases showed consistent results, but the increases in operating time (9.8 minutes; 95% CI, 1.7-18 minutes) and EBL (14 mL; 95% CI, 5.0-23 mL) were much lower compared with the original analysis. As for functional outcomes, obese patients showed significantly higher probabilities of incontinence (p=0.003; OR: 1.41; 95% CI, 1.13-1.77) and impotency (p=0.02; OR: 1.29; 95% CI, 1.03-1.61) at 1 year. Perioperative outcomes of RARP in obese patients are comparable with those in nonobese patients, except for significant but small increases in operating time and EBL. Surgeons should initiate RARP procedures in obese cases after overcoming the learning curve. Further studies should be performed to
Dhakal, Binod; Eastwood, Daniel; Sukumaran, Sunitha; Hassler, George; Tisol, William; Gasparri, Mario; Choong, Nicholas; Santana-Davila, Rafael
Obesity is a risk factor for increased perioperative morbidity and mortality in surgical patients. There have been limited studies to correlate the morbidity of lung cancer resection with obesity. We performed a retrospective study of patients who underwent surgical resection for lung cancer at the Medical College of Wisconsin, Milwaukee, from 2006 to 2010. Data on patient demographics, weight, pathological findings, and hospital course were abstracted after appropriate institutional review board approval. Perioperative morbidity was defined as atrial fibrillation, heart failure, respiratory failure, pulmonary embolism, or any medical complications arising within 30 days after surgery. The Fisher exact test was used to test the association between body mass index (BMI) and perioperative morbidities. Between 2006 and 2010, 320 lung resections were performed for lung cancer. The median age was 67 (interquartile range, 59-75) years, and 185 (57.8%) were females. A total of 121 (37.8%) of patients had a BMI lower than 25, and 199 (62.18%) patients had a BMI of 25 or higher. The 30-day mortality rate was 1.8% (n = 6) in the whole group; only 2 of these patients had a BMI of 25 or higher. Perioperative morbidity occurred in 28 (23.14%) of patients with a normal BMI and in 47 (23.61%) of patients with a BMI of 25 or higher (P = .54). Specific morbidities encountered by patients with normal versus BMI of 25 or higher were as follows: atrial fibrillation, 11 (9.09%) versus 24 (12.06%) (P = .46); pulmonary embolism, 1 (0.83%) versus 3 (1.51%) (P = 1.0); congestive heart failure, 2 (1.65%) versus 2 (1.01%) (P = .63); renal failure, 4 (3.3%) versus 2 (1.0%) (P = .29); respiratory failure, 12 (9.92%) versus 17 (8.54%) (P = .69); and acute respiratory distress syndrome, 2 (1.65%) versus 1 (0.50%) (P = .55). The median hospital stay was 5 days in the lower BMI group and 4 days in the BMI of 25 or higher group (P = .52). Overweight and normal weight patients do not differ
Turner, R Brigg; Cumpston, Aaron; Sweet, Michael; Briggs, Frank; Slain, Douglas; Wen, Sijin; Craig, Michael; Hamadani, Mehdi; Petros, William
The current recommendations for intravenous (i.v.) acyclovir dosing in obese patients suggest using ideal body weight (IBW) rather than total body weight (TBW). To our knowledge, no pharmacokinetic analysis has validated this recommendation. This single-dose pharmacokinetic study was conducted in an inpatient oncology population. Enrollment was conducted by 1:1 matching of obese patients (>190% of IBW) to normal-weight patients (80 to 120% of IBW). All patients received a single dose of i.v. acyclovir, 5 mg/kg, infused over 60 min. Consistent with current recommendations, IBW was used for obese patients and TBW for normal-weight patients. Serial plasma concentrations were obtained and compared. Seven obese and seven normal-weight patients were enrolled, with mean body mass indexes of 45.0 and 22.5 kg/m(2), respectively. Systemic clearance was substantially higher in the obese than normal-weight patients (mean, 19.4 ± 5.3 versus 14.3 ± 5.4 liters/h; P = 0.047). Area under the concentration-time curve was lower in the obese patients (15.2 ± 2.9 versus 24.0 ± 9.4 mg · h/liter; P = 0.011), as was maximum concentration (5.8 ± 0.9 versus 8.2 ± 1.3 mg/liter; P = 0.031). Utilization of IBW for dose calculation of i.v. acyclovir in obese patients leads to lower systemic exposure than dosing by TBW in normal-weight patients. While not directly evaluated in this study, utilization of an adjusted body weight for dose determination appears to more closely approximate the exposure seen in normal-weight patients. (This study has been registered at ClinicalTrials.gov under registration no. NCT01714180.).
Liang, J.; Matheson, BE.; Kaye, WH.; Boutelle, KN.
Childhood obesity rates have risen dramatically over the past few decades. Although obesity has been linked to poorer neurocognitive functioning in adults, much less is known about this relationship in children and adolescents. Therefore, we conducted a systematic review to examine the relationship between obesity and obesity-related behaviors with neurocognitive functioning in youth. We reviewed articles from 1976 to 2013 using PsycInfo, PubMed, Medline and Google Scholar. Search terms included cognitive function, neurocognitive function/performance, executive function, impulsivity, self-regulation, effortful control, cognitive control, inhibition, delayed gratification, memory, attention, language, motor, visuo-spatial, academic achievement, obesity, overweight, body mass index, waist-hip ratio, adiposity and body fat. Articles were excluded if participants had health problems known to affect cognitive functioning, the study used imaging as the only outcome measure, they were non-peer-reviewed dissertations, theses, review papers, commentaries, or they were non-English articles. Sixty-seven studies met inclusion criteria for this review. Overall, we found data that support a negative relationship between obesity and various aspects of neurocognitive functioning, such as executive functioning, attention, visuo-spatial performance, and motor skill. The existing literature is mixed on the effects among obesity, general cognitive functioning, language, learning, memory, and academic achievement. Executive dysfunction is associated with obesity-related behaviors, such as increased intake, disinhibited eating, and less physical activity. Physical activity is positively linked with motor skill. More longitudinal research is needed to determine the directionality of such relationships, to point towards crucial intervention time periods in the development of children, and to inform effective treatment programs. PMID:23913029
Liang, J; Matheson, B E; Kaye, W H; Boutelle, K N
Childhood obesity rates have risen dramatically over the past few decades. Although obesity has been linked to poorer neurocognitive functioning in adults, much less is known about this relationship in children and adolescents. Therefore, we conducted a systematic review to examine the relationship between obesity and obesity-related behaviors with neurocognitive functioning in youth. We reviewed articles from 1976 to 2013 using PsycInfo, PubMed, Medline and Google Scholar. Search terms included cognitive function, neurocognitive function/performance, executive function, impulsivity, self-regulation, effortful control, cognitive control, inhibition, delayed gratification, memory, attention, language, motor, visuo-spatial, academic achievement, obesity, overweight, body mass index, waist-hip ratio, adiposity and body fat. Articles were excluded if participants had health problems known to affect cognitive functioning, the study used imaging as the only outcome measure, they were non-peer-reviewed dissertations, theses, review papers, commentaries, or they were non-English articles. Sixty-seven studies met inclusion criteria for this review. Overall, we found data that support a negative relationship between obesity and various aspects of neurocognitive functioning, such as executive functioning, attention, visuo-spatial performance, and motor skill. The existing literature is mixed on the effects among obesity, general cognitive functioning, language, learning, memory, and academic achievement. Executive dysfunction is associated with obesity-related behaviors, such as increased intake, disinhibited eating, and less physical activity. Physical activity is positively linked with motor skill. More longitudinal research is needed to determine the directionality of such relationships, to point towards crucial intervention time periods in the development of children, and to inform effective treatment programs.
Castillo-Hernandez, Jesus; Maldonado-Cervantes, Martha Imelda; Reyes, Juan Pablo; Patiño-Marin, Nuria; Maldonado-Cervantes, Enrique; Solorzano-Rodriguez, Claudia; de la Cruz Mendoza, Esperanza; Alvarado-Sanchez, Brenda
Systemic blockade of TNF-α in Rheumatoid arthritis with insulin resistance seems to produce more improvement in insulin sensitivity in normal weight patients with Rheumatoid arthritis than in obese patients with Rheumatoid arthritis, suggesting that systemic-inflammation and obesity are independent risk factors for insulin resistance in Rheumatoid arthritis patients. To evaluate the insulin resistance in: normal weight patients with Rheumatoid arthritis, overweight patients with Rheumatoid arthritis, obese Rheumatoid arthritis patients, and matched control subjects with normal weight and obesity; and its association with major cytokines involved in the pathogenesis of the disease. Assessments included: body mass index, insulin resistance by Homeostasis Model Assessment, ELISA method, and enzymatic colorimetric assay. Outstanding results from these studies include: (1) In Rheumatoid arthritis patients, insulin resistance was well correlated with body mass index, but not with levels of serum cytokines. In fact, levels of cytokines were similar in all Rheumatoid arthritis patients, regardless of being obese, overweight or normal weight (2) Insulin resistance was significantly higher in Rheumatoid arthritis with normal weight than in normal weight (3) No significant difference was observed between insulin resistances of Rheumatoid arthritis with obesity and obesity (4) As expected, levels of circulating cytokines were significantly higher in Rheumatoid arthritis patients than in obesity. Obesity appears to be a dominant condition above inflammation to produce IR in RA patients. The dissociation of the inflammation and obesity components to produce IR suggests the need of an independent therapeutic strategy in obese patients with RA. Copyright © 2017. Published by Elsevier Editora Ltda.
Bae, Jun Seok
Background Obese patients are at risk of complications such as slower wound healing and increased infection rates after spinal surgery. Transforaminal full-endoscopic lumbar discectomy (ELD) has advantages over conventional microdiscectomy because it decreases perioperative complications and increases favorable clinical outcomes. No clinical studies have reported ELD in obese patients. The purpose of this study is to evaluate the clinical outcomes of transforaminal ELD in obese patients Methods Obesity is defined as a body mass index (BMI) of more than 30 kg/m2. Our study included 21 obese patients and 27 normal BMI patients treated by posterolateral transforaminal ELD for radiating pain caused by a single-level lumbar disc herniation with more than 2 years of follow-up. Clinical chart reviews and telephone surveys were conducted. Clinical and functional outcomes using VAS and ODI, perioperative complications, and reherniation were evaluated. Results Overall clinical and functional outcomes were improved during postoperative follow-up evaluation. There were no immediate perioperative complications, such as infection or durotomy in both groups. In obese group, three patients had late reherniations. Of these, 2 patients had tolerable pain and showed good recovery with conservative treatment; 1 patient who had undergone ELD for recurrent disc herniation underwent open microdiscectomy. In control group, two patients had early reherniation and underwent open microdiscectomy and one patient with late reherniation showed good recovery with conservative treatment. Conclusion In select cases, ELD is an effective, safe, and minimally invasive technique for obese patients. It decreases perioperative morbidity and allows for both early mobilization and early return to work. Level of Evidence: level 3b. PMID:27441176
Naeem, Naveed; Petros, Firas; Sukumar, Shyam; Patel, Manish; Bhandari, Akshay; Kaul, Sanjeev; Menon, Mani; Rogers, Craig
To report our experience with robot-assisted partial nephrectomy (RAPN) in obese patients compared with a contemporary cohort of nonobese patients. We defined obesity as a body mass index (BMI) ≥ 30 kg/m(2). From June 2004 to September 2009, 97 patients underwent RAPN at our institution, of whom 49 were obese (group 1) and 48 were nonobese (group 2, BMI <30 kg/m(2)). We compared demographics, operative data, complications, and pathological outcomes between these two groups. The average BMI for the obese group was 36.2 kg/m(2) (range 30.3-49) compared with 25.7 kg/m(2) (range 20.5-29.7) for the nonobese group. Median tumor size was 2.5 versus 2.3 cm for obese and nonobese groups, respectively. Obese patients had a larger median estimated blood loss (150 vs.100 mL, p=0.027) and a trend toward a longer median operative time (265 vs. 242.5 minutes, p=0.085) and median warm ischemia time (26.5 vs. 22.5 minutes, p=0.074), but this did not achieve statistical significance. An intraoperative complication occurred in one patient in each group. The postoperative complication rate was not statistically significant between the two groups (8.3% vs. 4.3%, p=0.377). The median hospital stay was 2 days for both groups. RAPN is safe and feasible in obese patients. Obese patients had a higher estimated blood loss and a trend toward greater operative time and warm ischemia time, which did not achieve statistical significance.
Daubressse, J C; Cadière, G B; Sternon, J
Obesity is now one of the major health problems in industrial countries as well as in developing world. Excess caloric intake and reduction of the physical activity are the main causes of obesity. This epidemic precedes a tremendous increase of type 2 diabetes, which is generally linked to weight excess. Obesity and type 2 diabetes are associated with morbidity and mortality and are very expensive for the social security. The important point is to define the risks linked to obesity taking into account the Body Mass Index and the importance of visceral obesity evaluated by waist measurement. After medical check up, a strategy will be discussed with the patient, including moderate caloric restriction and increased physical activity. Our patients and also some doctors suggest "popular diets" whose efficacy has not been demonstrated as superior. On a short time basis, low carbohydrate and high protein diets have some advantages, which can help our obese subjects but on long term, only hypocaloric and equilibrated diets are advisable. Drugs that proved their efficacy and tolerance may be prescribed in case of failure. Three drugs are presented, orlistat, sibutramine and metformine: their efficacy, secondary effects, interactions and finally their positioning. Bariatric surgery will be proposed to highly selected patients presenting morbid obesity.
Demirpence, Mustafa; Yilmaz, Hamiyet; Colak, Ayfer; Yalcin, Hulya; Toprak, Burak; Turkon, Hakan; Ugurlu, Levent; Aydin, Cengiz
Irisin, a recently identified myokine, is associated with increased energy expenditure and has a potential role in obesity. Therefore, we investigated circulating irisin levels in morbidly obese patients undergoing sleeve gastrectomy (SG). Thirty morbidly obese patients undergoing SG and 30 healthy subjects were included. All participants were evaluated at baseline and again at three months post-SG. Body weight and height, the lipid profile, and plasma glucose, HbA1c, insulin, and irisin levels were measured at each visit. The two groups had similar mean age and sex distribution. Serum irisin was significantly lower in the morbidly obese subjects compared with the controls (p = 0.003) and negatively correlated with BMI, body weight, insulin levels, and HOMA-IR (p = 0.006, p = 0.011, p = 0.046, p = 0.048, respectively). When the morbidly obese patients were re-evaluated three months post-SG, their weight and BMI had significantly decreased (both p = 0.001). Similarly, the insulin, HbA1c, HDL-cholesterol, and HOMA-IR values significantly decreased (p = 0.001, p = 0.028, p = 0.006, and p = 0.001, respectively). However, irisin levels remained unchanged (p = 0,267). Although the irisin levels were significantly lower in the morbidly obese subjects, they did not change after SG-induced weight loss. (Endokrynol Pol 2016; 67 (5): 481-486).
Love, Lydia; Cline, Martha G
To review the available literature concerning the physiologic and pharmacologic alterations induced by obesity in canine and feline patients and their relevance to perioperative care. Literature review. PubMed, CAB, Web of Science. Obesity of cats and dogs is a chronic inflammatory condition that is increasingly prevalent. Similar to the situation in humans, small animal obesity may be associated with changes in endocrine, respiratory, and cardiovascular function. In addition, alteration of body composition in obesity can affect pharmacokinetic variables. Modifications in perioperative care may need to be made for obese dogs and cats, including attention to respiratory and cardiovascular supportive care and drug dose adjustments. © 2014 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.
Lynch, Lydia A; O'Connell, Jean M; Kwasnik, Anna K; Cawood, Thomas J; O'Farrelly, Cliona; O'Shea, Donal B
With the emerging obesity pandemic, identifying those who appear to be protected from adverse consequences such as type 2 diabetes and certain malignancies will become important. We propose that the circulating immune system plays a role in the development of these comorbidities. Clinical data and blood samples were collected from 52 patients with severe obesity attending a hospital weight-management clinic and 11 lean healthy controls. Patients were classified into metabolically "healthy obese" (n = 26; mean age 42.6 years, mean BMI 46.8 kg/m(2)) or "unhealthy obese" (n = 26; mean age 45 years, mean BMI 47.5 kg/m(2)) groups, based upon standard cutoff points for blood pressure, lipid profile, and fasting glucose. Circulating lymphoid populations and phenotypes were assessed by flow cytometry. Obese patients had significantly less circulating natural killer (NK) and cytotoxic T lymphocytes (CTL) compared to lean controls. There were significantly higher levels of NK cells and CTLs in the healthy obese group compared to the unhealthy obese group (NK: 11.7% vs. 6.5%, P < 0.0001, CD8 13.4% vs. 9.3%, P = 0.04), independent of age and BMI and these NK cells were also less activated in the healthy compared to the unhealthy group (CD69, 4.1% vs. 11.8%, P = 0.03). This is the first time that quantitative differences in the circulating immune system of obese patients with similar BMI but different metabolic profiles have been described. The significantly higher levels of CTLs and NK cells, which express fewer inhibitory molecules, could protect against malignancy, infection, and metabolic disease seen in obesity.
Durmus, U; Duran, C; Ecirli, S
Visceral adiposity index (VAI) is a proposed parameter to evaluate visceral obesity instead of waist circumference (WC) in patients with polycystic ovary syndrome (PCOS). We aimed to evaluate VAI levels in overweight and/or obese, and non-obese PCOS patients and investigate the association between metabolic and inflammatory parameters. Seventy-six PCOS patients between 18 and 40, and 38 age- and BMI-matched controls were enrolled into the study. Both PCOS groups and controls were classified into two subgroups according to body mass index (BMI) <25 and ≥25 kg/m(2). In PCOS patients, waist/hip ratio (WHR) (p = 0.023), diastolic blood pressure (DBP) (p = 0.001), insulin (p = 0.011), homeostasis of model assessment (HOMA-IR) (p = 0.006) and uric acid (UA) (p = 0.002) were higher than controls. In overweight and/or obese PCOS group, DBP (p < 0.001), insulin (p = 0.002), HOMA-IR (p = 0.001), triglyceride (p = 0.015) and VAI (p = 0.031) were higher than overweight and/or obese controls. In non-obese PCOS group, WHR (p = 0.016), WC (p = 0.030), DBP (p = 0.010) and UA (p < 0.001) were higher than non-obese controls. Similar VAI levels were found in all PCOS and non-obese PCOS subgroups than peer controls. Overweight and/or obese PCOS group had higher VAI levels than non-obese PCOS group (p < 0.001). VAI levels were positively correlated with WHR, glucose, HOMA-IR, high-sensitive CRP and UA in PCOS group. In controls, VAI levels were positively correlated with WHR, insulin and HOMA-IR. We found that VAI levels were higher in overweight and/or obese PCOS patients compared to peer controls and non-obese PCOS patients, and associated with some metabolic and inflammatory parameters.
Tinahones, Francisco José; Coín-Aragüez, Leticia; Mayas, Maria Dolores; Garcia-Fuentes, Eduardo; Hurtado-Del-Pozo, Carmen; Vendrell, Joan; Cardona, Fernando; Calvo, Rosa-Maria; Obregon, Maria-Jesus; El Bekay, Rajaa
The expansion of adipose tissue is linked to the development of its vasculature, which appears to have the potential to regulate the onset of obesity. However, at present, there are no studies highlighting the relationship between human adipose tissue angiogenesis and obesity-associated insulin resistance (IR). Our aim was to analyze and compare angiogenic factor expression levels in both subcutaneous (SC) and omentum (OM) adipose tissues from morbidly obese patients (n = 26) with low (OB/L-IR) (healthy obese) and high (OB/H-IR) degrees of IR, and lean controls (n = 17). Another objective was to examine angiogenic factor correlations with obesity and IR.Here we found that VEGF-A was the isoform with higher expression in both OM and SC adipose tissues, and was up-regulated 3-fold, together with MMP9 in OB/L-IR as compared to leans. This up-regulation decreased by 23% in OB/-H-IR compared to OB/L-IR. On the contrary, VEGF-B, VEGF-C and VEGF-D, together with MMP15 was down-regulated in both OB/H-IR and OB/L-IR compared to lean patients. Moreover, MMP9 correlated positively and VEGF-C, VEGF-D and MMP15 correlated negatively with HOMA-IR, in both SC and OM. We hereby propose that the alteration in MMP15, VEGF-B, VEGF-C and VEGF-D gene expression may be caused by one of the relevant adipose tissue processes related to the development of IR, and the up-regulation of VEGF-A in adipose tissue could have a relationship with the prevention of this pathology.
Background The expansion of adipose tissue is linked to the development of its vasculature, which appears to have the potential to regulate the onset of obesity. However, at present, there are no studies highlighting the relationship between human adipose tissue angiogenesis and obesity-associated insulin resistance (IR). Results Our aim was to analyze and compare angiogenic factor expression levels in both subcutaneous (SC) and omentum (OM) adipose tissues from morbidly obese patients (n = 26) with low (OB/L-IR) (healthy obese) and high (OB/H-IR) degrees of IR, and lean controls (n = 17). Another objective was to examine angiogenic factor correlations with obesity and IR. Here we found that VEGF-A was the isoform with higher expression in both OM and SC adipose tissues, and was up-regulated 3-fold, together with MMP9 in OB/L-IR as compared to leans. This up-regulation decreased by 23% in OB/-H-IR compared to OB/L-IR. On the contrary, VEGF-B, VEGF-C and VEGF-D, together with MMP15 was down-regulated in both OB/H-IR and OB/L-IR compared to lean patients. Moreover, MMP9 correlated positively and VEGF-C, VEGF-D and MMP15 correlated negatively with HOMA-IR, in both SC and OM. Conclusion We hereby propose that the alteration in MMP15, VEGF-B, VEGF-C and VEGF-D gene expression may be caused by one of the relevant adipose tissue processes related to the development of IR, and the up-regulation of VEGF-A in adipose tissue could have a relationship with the prevention of this pathology. PMID:22471305
Hancı, Deniz; Altun, Huseyin; Altun, Hasan; Batman, Burcin; Karip, Aziz Bora; Serin, Kursat Rahmi
Olfactory abilities of the patients are known to be altered by eating and metabolic disorders, including obesity. There are only a number of studies investigating the effect of obesity on olfaction, and there is limited data on the changes in olfactory abilities of morbidly obese patients after surgical treatment. Here we investigated the changes in olfactory abilities of 54 morbidly obese patients (M/F, 22/32; age range 19-57 years; body mass index (BMI) range 30.5-63.0 kg/m(2)) after laparoscopic sleeve gastrectomy. A laparoscopic sleeve gastrectomy was performed by the same surgeon using five-port technique. Olfactory abilities were tested preoperatively and 1, 3, and 6 months after the surgery using a standardized Sniffin' Sticks Extended Test kit. Analyses of variance indicated statistically significant improvement in T, D, and I scores of morbidly obese patients within time factors (preoperative vs. 1, 3, and 6 months; 1 vs. 3 and 6 months; and 3 vs. 6 months; p < 0.001 for all). There was a statistically significant improvement in overall TDI scores with an increase from 25 to 41 during the 6 months follow-up period (p < 0.001 for all). Here, for the first time in literature, we were able to show the significant improvement in olfactory abilities of morbidly obese patients after laparoscopic sleeve gastrectomy.
de Louw, Emma J; Sun, Pepijn O; Lee, Joon; Feng, Mengling; Mark, Roger G; Celi, Leo Anthony; Mukamal, Kenneth J; Danziger, John
Sodium retention occurs commonly in cardiac and liver disease, requiring the administration of diuretics to restore fluid balance. Whether obesity is associated with sodium retention has not been fully evaluated. In a large single-center cohort of critically ill patients, we evaluated whether admission body mass index was associated with the administration of either oral or intravenous diuretics during the intensive care unit (ICU) stay. Of 7724 critically ill patients, 3946 (51.1%) were prescribed diuretics during the ICU stay. Overweight, class I obesity, and class II/III obesity were associated with a 1.35 (95% confidence interval [CI], 1.20-1.53; P < .001), 1.56 (95% CI, 1.35-1.80; P < .001), and 1.91 (95% CI, 1.61-2.26; P < .001) adjusted risk of receiving diuretics within the ICU, respectively. In adjusted analysis, a 5-kg/m(2) increment of body mass index was associated with a 1.19 (95% CI, 1.14-1.23; P < .001) increased adjusted risk of within-ICU diuretics. Among those patients receiving loop diuretics, obese patients received significantly larger daily diuretic doses. Critically ill obese patients are more likely to receive diuretics during their stay in the ICU and to receive higher dosages of diuretics. Our data suggest that obesity is an independent risk factor for sodium retention. Copyright © 2015 Elsevier Inc. All rights reserved.
Arshad, Mahmoud; Jaberian, Sara; Pazouki, Abdolreza; Riazi, Sajedeh; Rangraz, Maryam Aghababa; Mokhber, Somayyeh
The association between obesity and different types of anemia remained uncertain. The present study aimed to assess the relation between obesity parameters and the occurrence of iron deficiency anemia and also megaloblastic anemia among Iranian population. This cross-sectional study was performed on 1252 patients with morbid obesity that randomly selected from all patients referred to Clinic of obesity at Rasoul-e-Akram Hospital in 2014. The morbid obesity was defined according to the guideline as body mass index (BMI) equal to or higher than 40 kg/m2. Various laboratory parameters including serum levels of hemoglobin, iron, ferritin, folic acid, and vitamin B12 were assessed using the standard laboratory techniques. BMI was adversely associated with serum vitamin B12, but not associated with other hematologic parameters. The overall prevalence of iron deficiency anemia was 9.8%. The prevalence of iron deficiency anemia was independent to patients' age and also to body mass index. The prevalence of vitamin B12 deficiency was totally 20.9%. According to the multivariable logistic regression model, no association was revealed between BMI and the occurrence of iron deficiency anemia adjusting gender and age. A similar regression model showed that higher BMI could predict occurrence of vitamin B12 deficiency in morbid obese patients. Although iron deficiency is a common finding among obese patients, vitamin B12 deficiency is more frequent so about one-fifth of these patients suffer vitamin B12 deficiency. In fact, the exacerbation of obesity can result in exacerbation of vitamin B12 deficiency.
Unger, Nathan R; Stein, Bradley J
Cefazolin remains the preferred preoperative antibiotic for the majority of surgical procedures. However, outcome evidence supporting current dosing recommendations for pre-operative prophylaxis is scarce, particularly for obese patients. With more than 33% of adults in the United States classified as obese, it is crucial that we determine the correct dosing regimen in order to maximize the potential to prevent surgical site infections (SSIs). The purpose of this study was to evaluate whether surgical prophylaxis with cefazolin 2 g, as recommended by practice guidelines, is as effective in preventing SSIs in obese as compared to non-obese patients. In retrospective fashion, data were collected from the electronic medical records of patients who received 2 g of cefazolin preoperatively during a 13-mo period. Patients who met the inclusion criteria were allocated to an obese (n=99) and non-obese (n=96) group according to body mass index (BMI). Charts were reviewed for identification of SSIs as defined by the U.S. Centers for Disease Control and Prevention. For the primary outcome, the numbers of SSIs in the two groups were compared using the Pearson χ(2) test. Patient characteristics were similar in the two groups with the expected exception of weight (mean 90 vs. 110 kg; p<0.001) and BMI (27 vs. 35 kg/m(2); p<0.001). The highest patient weight was 182 kg with a BMI of 55 kg/m(2). The most common surgical service was orthopedics/hand, accounting for 35% of patients. No significant difference was found in the number of SSIs in the two groups (7 vs. 5; p=0.56). No differences between weight and BMI were seen in patients with or without a SSI. Obese patients may continue to receive 2 g of cefazolin preoperatively until large-scale controlled trials show differently.
Alodhayani, Abdulaziz A.; Alshaikh, Omalkhaire M.; Ghomraoui, Firas Abdulsattar; AlShaibani, Tahani Jathab; Algadheeb, Abdulrahman Sulaiman; Bendahmash, Abdulrahman Waleed; Baqays, Abdullah Ali
[Purpose] The aim of the present study was to investigate the association between sleep duration, quality and obesity in the medical students of Saudi population. [Subjects and Methods] This is a cross-sectional study carried out in 408 medical students from King Khalid University Hospitals, Riyadh, Saudi Arabia, based on well-designed questionnaire study and consent form. [Results] The results of this study revealed 39.9% of subjects perform the exercise on regular basis and 61.5% of them reduced their weight, which may be due to diet plan (52.9%) also. Only 68.6% of the subjects were affected with the weight. The maximum number of subjects was lying down after the lunch (88.2%), sitting and reading (80.1%) are prone to develop obesity in future. [Conclusion] Our study confirms sleep disturbance has affected the weight gain and the maximum number of subjects was lying down after the lunch and sitting and reading will be prone to develop obesity in future. PMID:28265135
Alodhayani, Abdulaziz A; Alshaikh, Omalkhaire M; Ghomraoui, Firas Abdulsattar; AlShaibani, Tahani Jathab; Algadheeb, Abdulrahman Sulaiman; Bendahmash, Abdulrahman Waleed; Baqays, Abdullah Ali
[Purpose] The aim of the present study was to investigate the association between sleep duration, quality and obesity in the medical students of Saudi population. [Subjects and Methods] This is a cross-sectional study carried out in 408 medical students from King Khalid University Hospitals, Riyadh, Saudi Arabia, based on well-designed questionnaire study and consent form. [Results] The results of this study revealed 39.9% of subjects perform the exercise on regular basis and 61.5% of them reduced their weight, which may be due to diet plan (52.9%) also. Only 68.6% of the subjects were affected with the weight. The maximum number of subjects was lying down after the lunch (88.2%), sitting and reading (80.1%) are prone to develop obesity in future. [Conclusion] Our study confirms sleep disturbance has affected the weight gain and the maximum number of subjects was lying down after the lunch and sitting and reading will be prone to develop obesity in future.
BaHammam, Ahmed S; Pandi-Perumal, Seithikurippu R; Piper, Amanda; Bahammam, Salman A; Almeneessier, Aljohara S; Olaish, Awad H; Javaheri, Shahrokh
The role of gender and menopause in obstructive sleep apnoea is well known; however, no study has reported the impact of gender on the clinical presentation and the nocturnal respiratory events in patients with obesity hypoventilation syndrome. Therefore, this study prospectively evaluated differences in the clinical characteristics of women and men with obesity hypoventilation syndrome in a large cohort of patients with obstructive sleep apnoea. During the study period, a total of 1973 patients were referred to the sleep clinic with clinical suspicion of obstructive sleep apnoea. All patients underwent overnight polysomnography, during which time spirometry, arterial blood samples and thyroid tests were routinely obtained. Among 1973 consecutive patients, 1693 (617 women) were diagnosed with obstructive sleep apnoea, among whom 144 suffered from obesity hypoventilation syndrome (96 women). The prevalence of obesity hypoventilation syndrome among women and men was 15.6% and 4.5%, respectively (P < 0.001). Women with obesity hypoventilation syndrome were significantly older than men with obesity hypoventilation syndrome (61.5 ± 11.9 years versus 49.1 ± 12.5 years, P < 0.001). Although there were no significant differences between genders regarding symptoms, body mass index, spirometric data or daytime PaCO2 , women with obesity hypoventilation syndrome suffered significantly more from hypertension, diabetes and hypothyroidism. The prevalence of obesity hypoventilation syndrome was higher in post-menopausal (21%) compared with pre-menopausal (5.3%) women (P < 0001). HCO3 and duration of SpO2 <90% were the only independent predictors of obesity hypoventilation syndrome. In conclusion, this study reported that among subjects referred to the sleep disorders clinic for evaluation of obstructive sleep apnoea, obesity hypoventilation syndrome is more prevalent in women than men, and that women with obesity hypoventilation syndrome suffer from significantly
Nijhawan, Sheetal; Richards, William; O'Hea, Martha F; Audia, Jonathon P; Alvarez, Diego F
Obesity and its attendant comorbidities are an emerging epidemic. Chronic metabolic inflammation (metainflammation) is thought to precipitate obesity-associated morbidities; however, its mechanistic progression is poorly understood. Moreover, although interventions such as diet, exercise, and bariatric surgery can control body weight, their effects on metainflammation are also poorly understood. Recently, metainflammation and the pathobiology of obesity have been linked to mitochondrial dysfunction. Herein we examined the effects of bariatric surgery on mitochondrial respiration as an index of resolving metainflammation in morbidly obese patients. This institutional review board-approved study involved morbidly obese patients (body mass index > 35 kg/m(2)) undergoing sleeve gastrectomy or Roux-en-Y gastric bypass. Mitochondrial respiration was assessed in peripheral blood monocytes and in skeletal muscle samples before surgery and at 12 weeks after surgery. Patient biometrics, homeostasis model assessment-estimated insulin resistance (HOMA-IR) score, C-reactive protein, and lipid profile were analyzed. Twenty patients were enrolled and showed an average percent excess body weight loss of 30.3% weight loss at 12 weeks after surgery. Average HOMA-IR score decreased from 3.0 to 1.2 in insulin-resistant patients. C-reactive protein, an index of metainflammation, showed a modest decrease. Lipid profile remained stable. Intriguingly, mitochondrial basal and maximal respiration rates in peripheral blood monocytes increased after surgery. Basal rates of skeletal muscle mitochondrial respiration were unchanged, but the maximal respiration rate trended toward an increase after surgery. Cellular and tissue mitochondrial respiration increased in a morbidly obese patient cohort after laparoscopic bariatric surgery. These changes were consistent in patients with postsurgical weight loss. Importantly, no significant changes or improvements occurred in canonical indices used to
Macavei, Vladimir M; Spurling, Kristofer J; Loft, Janine; Makker, Himender K
Obesity-hypoventilation syndrome (OHS) is associated with significant morbidity and mortality and requires measurement of arterial pCO2 for diagnosis. To determine diagnostic predictors of OHS among obese patients with suspected obstructive sleep apnea/hypopnea syndrome (OSAHS). Retrospective analysis of data on 525 sleep clinic patients (mean age 51.4 ± 12.7 years; 65.7% males; mean BMI 34.5 ± 8.1). All patients had sleep studies, and arterialized capillary blood gases (CBG) were measured in obese subjects (BMI > 30 kg/m2). Of 525 patients, 65.5% were obese, 37.2% were morbidly obese (BMI > 40 kg/m2); 52.3% had confirmed OSAHS. Hypercapnia (pCO2 > 6 kPa or 45 mm Hg) was present in 20.6% obese and 22.1% OSAHS patients. Analysis of OHS predictors showed significant correlations between pCO2 and BMI, FEV1, FVC, AHI, mean and minimum nocturnal SpO2, sleep time with SpO2 < 90%, pO2, and calculated HCO3 from the CBG. PO2 and HCO3 were independent predictors of OHS, explaining 27.7% of pCO2 variance (p < 0.0001). A calculated HCO3 cutoff > 27 mmol/L had 85.7% sensitivity and 89.5% specificity for diagnosis of OHS, with 68.1% positive and 95.9% negative predictive value. We confirmed a high prevalence of OHS in obese OSAHS patients (22.1%) and high calculated HCO3 level (> 27 mmol/L) to be a sensitive and specific predictor for the diagnosis of OHS.
Mallamaci, Francesca; Ruggenenti, Piero; Perna, Annalisa; Leonardis, Daniela; Tripepi, Rocco; Tripepi, Giovanni; Remuzzi, Giuseppe
Obesity may increase the risk for progression of CKD, but the effect of established renoprotective treatments in overweight and obese patients with CKD is unknown. In this post hoc analysis of the Ramipril Efficacy In Nephropathy (REIN) trial, we evaluated whether being overweight or obese influences the incidence rate of renal events and affects the response to ramipril. Of the 337 trial participants with known body mass index (BMI), 105 (31.1%) were overweight and 49 (14.5%) were obese. Among placebo-treated patients, the incidence rate of ESRD was substantially higher in obese patients than overweight patients (24 versus 11 events/100 person-years) or than those with normal BMI (10 events/100 person-years); we observed a similar pattern for the combined endpoint of ESRD or doubling of serum creatinine. Ramipril reduced the rate of renal events in all BMI strata, but the effect was higher among the obese (incidence rate reduction of 86% for ESRD and 79% for the combined endpoint) than the overweight (incidence rate reduction of 45 and 48%, respectively) or those with normal BMI (incidence rate reduction of 42 and 45%, respectively). We confirmed this interaction between BMI and the efficacy of ramipril in analyses that adjusted for potential confounders, and we observed a similar effect modification for 24-hour protein excretion. In summary, obesity predicts a higher incidence of renal events, but treatment with ramipril can essentially abolish this risk excess. Furthermore, the reduction in risk conferred by ramipril is larger among obese than nonobese patients. PMID:21527660
Dupim Souza, Ana Carolina; Franco, Carolina F; Pataro, André L; Guerra, Tadeu; de Oliveira Costa, Fernando; da Costa, José Eustáquio
Patients undergoing bariatric surgery often complain of bad breath. However, the relationship between bariatric surgery and halitosis is relatively unknown. The purpose of the present study was to evaluate and compare the occurrence of halitosis among patients before and after a specific type of bariatric surgery, Roux-en-Y gastric bypass, and its relationship with the tongue coating index, plaque index, and salivary flow rate. A total of 62 patients with good oral health and in treatment for obesity at the walk-in clinic of Santa Casa Hospital, Belo Horizonte, Brazil, were selected. Of this sample, 31 were bariatric surgery candidates (control group) and 31 had already undergone Roux-en-Y gastric bypass surgery (case group). After completing a questionnaire, all patients underwent an oral clinical examination. Halitosis was measured using an organoleptic scale and a portable sulfide monitor. The Spearman correlation demonstrated a strong positive relation between the organoleptic rates and the concentration of volatile sulfur compounds determined using the sulfide monitor (rs = .58; P = .0001). No difference was found in the prevalence of halitosis between the 2 groups (P = .48). Only the salivary flow rate was significantly reduced in the control group compared with the case group (P = .02). In the case group, the concentration of volatile sulfur compounds correlated negatively with the salivary flow rate (P = .04) and positively with the tongue coating index (P = .005). The tongue coating index was significantly increased in those patients who did not brush the tongue (P < .04) and who had had episodes of vomiting (P = .02). These data suggest that no significant association exists between halitosis and Roux-en-Y gastric bypass. However, they do highlight the possible effect of this surgery on the oral cavity. Copyright © 2013 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
Celik, Fatih; Kose, Mesut; Yilmazer, Mehmet; Köken, Gülengül N; Arioz, Dagistan Tolga; Kanat Pektas, Mine
It is well-known that plasma L-carnitine concentrations are significantly decreased in obese individuals. A study showed that L-carnitine concentrations are significantly lower in lean PCOS patients than in lean healthy women. Thus, it has been suggested that lowered L-carnitine is associated with PCOS. This study also showed that the women with PCOS had significantly lower L-carnitine levels than those of the healthy controls. In addition, this study hypothesised that low L-carnitine levels in PCOS patients were associated with obesity and/or insulin resistance. Moreover, plasma L-carnitine concentrations were found to be statistically similar in PCOS patients and healthy controls, when controlled for obesity. This study implied that L-carnitine could be used as an adjunctive therapy in the management of insulin resistance or obesity in women who have PCOS. Further research might be planned to clarify the clinical effects of L-carnitine administration in PCOS patients with insulin resistance and/or obesity.
Feezor, Robert J
Obesity has reached an epidemic in the United States and, not surprisingly, there has been a dramatic increase in obesity-associated comorbidities, complete with a host of new, related surgical challenges. The creation and maintenance of permanent hemodialysis access, particularly autogenous access, is generally considered more difficult in the obese patient because of the increased risk of perioperative complications, as well as a decreased maturation rate. Most of the data documenting these adverse outcomes come from retrospective studies and, therefore, the reliability of the data is somewhat limited, given the inherent selection bias. In the United States, most obese patients dialyze through prosthetic access, despite the national initiatives targeted at maximizing autogenous access. However, it is possible to construct an autogenous access in most patients, including obese patients, presenting for permanent access using proper, diligent preoperative imaging and an aggressive postoperative surveillance protocol until access maturation. This is facilitated by careful preoperative planning and liberal use of multiple diagnostic and therapeutic maneuvers to improve overall access function. In this review, the outcomes associated with permanent hemodialysis access in the obese are discussed and helpful suggestions to facilitate a functional access provided.
Baugh, Nancy; Zuelzer, Helen; Meador, Jill; Blankenship, Jolie
The number of surgical patients who are obese in the United States is rising, a trend that's likely to continue. Such patients are at higher risk than nonobese patients are for surgical site infections and other complications such as dehiscence, pressure ulcers, deep tissue injury, and rhabdomyolysis. This article details the factors that can contribute to such complications, including a high number of comorbidities, and offers practical suggestions for preventing them. Nurses should understand that special equipment, precautions, and protocols may be needed at every stage of care, and that obese patients aren't anomalies but rather a part of a growing population with particular needs.
Brahimi, M; Dabire, H; Platon, P; Hadj-Brahim, F; Attali, J R; Valensi, P
An increase in arterial rigidity is associated with a poor cardiovascular prognosis. Several studies have suggested that an increase in sympathetic activity may be involved in essential hypertension. We have recently shown that vagal control of heart rate (HR) variations during standardised tests is altered in normotensive obese and diabetic patients. The aim of the present study was to compare cardiovascular vagosympathetic activity in obese and type 2 diabetic patients, either normotensive or hypertensive, and to investigate the relationship between pulse pressure (an index of arterial rigidity) and sympathetic activity in this population. Seventy normotensive obese and 32 mildly hypertensive obese patients, 18 normotensive type 2 diabetic patients and 14 mildly hypertensive type 2 diabetic patients were compared with 21 control subjects. Finapres studied HR and blood pressure variations. In the four groups, during a 6-min period at a controlled breathing rate, the high frequency peak of HR variations was significantly reduced (p < 0.001). The mid-frequency peak of systolic BP variations in the standing position, which depends on sympathetic activity, did not differ significantly between the four groups and control subjects. In obese and diabetic hypertensive patients, this peak correlated significantly with pulse pressure measured in the lying position (r = 0.379; p = 0.043 and r = 0.81; p < 0.0001, respectively). This study 1, confirms that vagal control of HR variations is reduced to a similar extent in obese and diabetic patients; and 2, suggests that cardiovascular sympathetic activity is relatively increased in these patients without significant difference between normotensive and hypertensive patients, but interestingly that the increase in arterial rigidity is associated with a higher sympathetic activity.
Deitel, M.; Thompson, D. A.; Saldanha, C. F.; Ramshaw, P. J.; Patterson, M. C.; Pritzker, K. P.
A pink coating on the inner surface of plastic urinary tubing, which gave the impression that the urine was pink, had frequently been noted 4 to 24 hours following gastric partitioning by means of a stapler in morbidly obese patients. A study was therefore done in 187 such patients as well as in 14 patients of normal weight who had undergone abdominal surgery of comparable magnitude. Postoperatively "pink urine" was observed in 32% of the obese patients but in none of the nonobese patients; however, a pink sediment remained following centrifugation of urine collected postoperatively from all the obese patients. Microscopy of this sediment showed crystals of uric acid dihydrate; these were infrequent in the preoperative specimens but present in high concentration in the postoperative specimens, particularly those of "pink urine". X-ray diffraction analysis confirmed the nature of the crystals. Preoperatively the obese patients had high-normal serum levels of uric acid. Postoperatively in all the groups of patients the serum levels of uric acid decreased while the urine levels and the urinary clearance of uric acid increased; the last two values, however, were significantly greater, both preoperatively and postoperatively, in those who were morbidly obese. Compared with the patients who did not have "pink urine" the patients with "pink urine" were significantly more obese and had a significantly lower postoperative urine pH. The latter also had a marked postoperative increase in urine osmolality and were the only patients to have a significant postoperative decrease in urine output. Thus, the pink colour of this group's urine was attributed to precipitation of uric acid crystals, fostered by a decrease in pH and an increase in concentration of the urine. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 PMID:6704846
Wansink, Brian; Hanks, Andrew S; Kaipainen, Kirsikka
Background The home is one place where people can control what foods are available and how the environment is arranged. Given the impact of environments on health, the objective of this study is to determine whether the presence of foods on a person's kitchen counter are associated with their body mass index (BMI). Method In Study 1, a nationwide sample of 500 households was asked to inventory their kitchen and provide their height and weight. In Study 2, researchers photographed and catalogued 210 households in Syracuse, New York, and measured the occupants' height and weight. Main outcome measures for the study were BMI differences between households that had various foods visible on the counter compared with those that did not. Findings The presence of fruit on the counter was associated with lower BMI in both studies, but the presence of foods such as candy, cereal, soft drinks, and dried fruit were associated with weight differences that ranged from 9.4 to 14.4 kg. Interpretations Although correlational, the findings from these two studies suggest that when counseling patients regarding their weight, physicians also suggest they clear their kitchen counter of all food except a fruit bowl.
Obese women are at an increased risk of antepartum pregnancy complications and are therefore more likely to require an induction of labor than normal weight women. They also have an increased rate of failing an induction of labor, a rate that rises significantly with increasing body mass index, and subsequent surgical and neonatal complications of an intrapartum cesarean delivery. This increase in induction failure may be due to differences in the myometrium of obese women resulting in decreased contraction strength. There have been only a few studies comparing the efficacy of the various cervical ripening agents in obese women and at this point no recommendation can be made as to what method may result in the greatest chance of a successful induction.
Park, Jongha; Ahmadi, Seyed-Foad; Streja, Elani; Molnar, Miklos Z; Flegal, Katherine M; Gillen, Daniel; Kovesdy, Csaba P; Kalantar-Zadeh, Kamyar
In the general population, obesity is associated with increased cardiovascular risk and decreased survival. In patients with end-stage renal disease (ESRD), however, an "obesity paradox" or "reverse epidemiology" (to include lipid and hypertension paradoxes) has been consistently reported, i.e. a higher body mass index (BMI) is paradoxically associated with better survival. This survival advantage of large body size is relatively consistent for hemodialysis patients across racial and regional differences, although published results are mixed for peritoneal dialysis patients. Recent data indicate that both higher skeletal muscle mass and increased total body fat are protective, although there are mixed data on visceral (intra-abdominal) fat. The obesity paradox in ESRD is unlikely to be due to residual confounding alone and has biologic plausibility. Possible causes of the obesity paradox include protein-energy wasting and inflammation, time discrepancy among competitive risk factors (undernutrition versus overnutrition), hemodynamic stability, alteration of circulatory cytokines, sequestration of uremic toxin in adipose tissue, and endotoxin-lipoprotein interaction. The obesity paradox may have significant clinical implications in the management of ESRD patients especially if obese dialysis patients are forced to lose weight upon transplant wait-listing. Well-designed studies exploring the causes and consequences of the reverse epidemiology of cardiovascular risk factors, including the obesity paradox, among ESRD patients could provide more information on mechanisms. These could include controlled trials of nutritional and pharmacologic interventions to examine whether gain in lean body mass or even body fat can improve survival and quality of life in these patients. © 2014.
Ferrante, Jeanne M.; Fyffe, Denise C.; Vega, Marielos L.; Piasecki, Alicja K.; Ohman-Strickland, Pamela A.; Crabtree, Benjamin F.
Extremely obese women are less likely than nonobese women to receive breast and cervical cancer screening examinations. Reasons for this disparity are unclear and may stem from patient and/or physician barriers. This sequential mixed-methods study used individual in-depth interviews of 15 family physicians followed by a mail survey of 255 family physicians (53% response rate) to understand the barriers they faced in performing cancer screening examinations in extremely obese women. Barriers fell into three main areas: (i) difficulty doing pelvic and breast exams; (ii) inadequate equipment; and (iii) challenges overcoming patient barriers and refusal. This led some physicians to avoid performing breast and pelvic examinations on extremely obese women. Having more knowledge about specific examination techniques was associated with less difficulty in palpating lumps on breast and pelvic examinations (P < 0.005). Physicians perceived that embarrassment, aversion to undressing, and avoidance of discussions related to their weight were the most frequent barriers extremely obese women had with getting physical examinations. Educating and/or motivating patients and addressing fears were strategies used most frequently when patients refused mammograms or Pap smears. Interventions focusing on physician barriers, such as educating them on specific examination techniques, obtaining adequate equipment and supplies, and providing resources to assist physicians in dealing with patient barriers and refusal, may be fruitful in increasing cancer screening rates in extremely obese patients. Future research studies testing the effectiveness of these strategies are needed to improve cancer outcomes in this high-risk population. PMID:20019676
Ferrante, Jeanne M; Fyffe, Denise C; Vega, Marielos L; Piasecki, Alicja K; Ohman-Strickland, Pamela A; Crabtree, Benjamin F
Extremely obese women are less likely than nonobese women to receive breast and cervical cancer screening examinations. Reasons for this disparity are unclear and may stem from patient and/or physician barriers. This sequential mixed-methods study used individual in-depth interviews of 15 family physicians followed by a mail survey of 255 family physicians (53% response rate) to understand the barriers they faced in performing cancer screening examinations in extremely obese women. Barriers fell into three main areas: (i) difficulty doing pelvic and breast exams; (ii) inadequate equipment; and (iii) challenges overcoming patient barriers and refusal. This led some physicians to avoid performing breast and pelvic examinations on extremely obese women. Having more knowledge about specific examination techniques was associated with less difficulty in palpating lumps on breast and pelvic examinations (P < 0.005). Physicians perceived that embarrassment, aversion to undressing, and avoidance of discussions related to their weight were the most frequent barriers extremely obese women had with getting physical examinations. Educating and/or motivating patients and addressing fears were strategies used most frequently when patients refused mammograms or Pap smears. Interventions focusing on physician barriers, such as educating them on specific examination techniques, obtaining adequate equipment and supplies, and providing resources to assist physicians in dealing with patient barriers and refusal, may be fruitful in increasing cancer screening rates in extremely obese patients. Future research studies testing the effectiveness of these strategies are needed to improve cancer outcomes in this high-risk population.
Jastrzebska-Mierzyńska, Marta; Ostrowska, Lucyna; Hady, Hady Razak; Dadan, Jacek
Patients with obesity, including morbid obesity, commit numerous dietary mistakes. They prefer high-energy diets, but of poor nutritional value. Patients qualified for bariatric procedures show deficiencies in vitamins and minerals due to insufficient intake of vegetables, fruit and whole grain products. Analysis of dietary habits in morbidly obese patients prepared for bariatric surgery, including assessment of eating style and frequency of consumption of certain products. The study group contained 39 people aged 18 - 65 years, who were surveyed with a questionnaire elaborated in the Department of Clinical Dietetics and Nutrition, Medical University of Bialystok. The following factors were assessed: number of meals, snacking between meals and eating at night, types of snacks eaten, and frequency of consumption of certain foods. Results were analyzed using Statistica 9.0. The majority of surveyed men (41.7%) ate three meals a day, whereas most women (40.7%) had at least 4 meals a day. Nearly 85% of the respondents admitted snacking between meals, mainly eating fruit, sweets and sandwiches. Whole grain cereal, milk and dairy products, fish, fruit, vegetables and pulses appeared in diet of patients qualified for treatment of obesity very rarely. Dietary habits of obese patients qualified for bariatric procedures are not consistent with recommendations. Therefore, these patients should receive nutritional education in order to foster proper eating habits that will help in the postoperative nutrition.
Koo, Hyeon-Kyoung; Park, Joo-Hyun; Park, Hye Kyeong; Jung, Hoon; Lee, Sung-Soon
To determine the impact of sarcopenia and obesity on pulmonary function and quality of life (QOL) in chronic obstructive pulmonary disease (COPD) patients. Data were obtained from the Korea National Health and Nutrition Examination Survey, including data from health interviews, health examinations, nutritional questionnaires, and laboratory findings. Laboratory data included pulmonary function assessment and dual energy X-ray absorptiometry results. Sarcopenia was measured by dual energy X-ray absorptiometry, and obesity was defined by body mass index. Male COPD patients were then classified into 4 groups according to the presence of sarcopenia and obesity. In male patients with COPD, the prevalence of sarcopenia was found to be 29.3%, and that of sarcopenic obesity was 14.2%. Furthermore, 22.5% of the patients observed in this study had impaired QOL. Following multivariable statistical analysis, both sarcopenia and obesity were independent risk factors for worsening lung function. Adjusted values of forced vital capacity and forced expiratory volume in 1 second were the lowest in the sarcopenic obesity group. Sarcopenia was also associated with more subjective activity limitation and poorer QOL; however obesity was related to less subjective limitation and better QOL after multivariable analysis. Adjusted value of QOL was the lowest in sarcopenic subjects without obesity, and the highest in obese subject without sarcopenia. Both sarcopenia and obesity were found to be associated with worsening lung function in male COPD patients. However, obesity was positively correlated with improved QOL while sarcopenia was negatively correlated with QQL.
Gómez-Zamudio, Jaime Héctor; Mendoza-Zubieta, Victoria; Ferreira-Hermosillo, Aldo; Molina-Ayala, Marío Antonio; Valladares-Sálgado, Adán; Suárez-Sánchez, Fernando; de Jesús Peralta-Romero, Jose; Cruz, Miguel
Obesity is an important health problem worldwide and many studies have suggested a relationship between obesity and thyroid function, with controversial results. Interestingly, high TSH levels have been involved with the presence of inflammatory state and risk for developing cardiovascular diseases in hypothyroid and obese patients. The aim in this work was to determine the prevalence of hypothyroidism in patients with extreme obesity and to determine whether their TSH levels were related to increased serum levels of inflammatory and cardiovascular markers. A cross-sectional study in 101 patients with extreme obesity (BMI ≥40) was performed. Anthropometric (weight, height and waist circumference) and biochemical (fasting glucose, glycosylated hemoglobin, triglycerides, total cholesterol, LDL-C, HDL-C and insulin) parameters were measured. TSH and FT4 levels as well as clinical exploration for diagnosis of hypothyroidism were carried out. Serum concentration of IL-10, IL-6, adiponectin, resistin, leptin, ICAM-1, VCAM-1 and E-selectin were determined. A high prevalence for diabetes (37.6%), prediabetes (50.5%), dyslipidemia (74.3%), hypertension (61.4%) and hypothyroidism (48.5%) was observed in patients with extreme obesity. The presence of hypothyroidism increased serum concentration of proinflammatory cytokines IL-6 and leptin and decreased the antiinflammatory cytokine adiponectin. In addition, serum TSH levels showed a correlation for waist circumference, weight, BMI, A1c, insulin, IL-6, leptin, ICAM-1 and E-selectin. There is a high prevalence for hypothyroidism in patients with extreme obesity. High levels of TSH contribute to elevate proinflammatory and cardiovascular risk markers, increasing the risk for development of cardiovascular diseases. Copyright © 2016 IMSS. Published by Elsevier Inc. All rights reserved.
Jastreboff, Ania M.; Sinha, Rajita; Lacadie, Cheryl; Small, Dana M.; Sherwin, Robert S.; Potenza, Marc N.
OBJECTIVE Obesity is associated with alterations in corticolimbic-striatal brain regions involved in food motivation and reward. Stress and the presence of food cues may each motivate eating and engage corticolimibic-striatal neurocircuitry. It is unknown how these factors interact to influence brain responses and whether these interactions are influenced by obesity, insulin levels, and insulin sensitivity. We hypothesized that obese individuals would show greater responses in corticolimbic-striatal neurocircuitry after exposure to stress and food cues and that brain activations would correlate with subjective food craving, insulin levels, and HOMA-IR. RESEARCH DESIGN AND METHODS Fasting insulin levels were assessed in obese and lean subjects who were exposed to individualized stress and favorite-food cues during functional MRI. RESULTS Obese, but not lean, individuals exhibited increased activation in striatal, insular, and hypothalamic regions during exposure to favorite-food and stress cues. In obese but not lean individuals, food craving, insulin, and HOMA-IR levels correlated positively with neural activity in corticolimbic-striatal brain regions during favorite-food and stress cues. The relationship between insulin resistance and food craving in obese individuals was mediated by activity in motivation-reward regions including the striatum, insula, and thalamus. CONCLUSIONS These findings demonstrate that obese, but not lean, individuals exhibit increased corticolimbic-striatal activation in response to favorite-food and stress cues and that these brain responses mediate the relationship between HOMA-IR and food craving. Improving insulin sensitivity and in turn reducing corticolimbic-striatal reactivity to food cues and stress may diminish food craving and affect eating behavior in obesity. PMID:23069840
Manthous, Constantine A; Mokhlesi, Babak
The prevalence of obesity hypoventilation syndrome and obstructive sleep apnea are increasing rapidly in the United States in parallel with the obesity epidemic. As the pathogenesis of this chronic illness is better understood, effective evidence-based therapies are being deployed to reduce morbidity and mortality. Nevertheless, patients with obesity hypoventilation still fall prey to at least four avoidable types of therapeutic errors, especially at the time of hospitalization for respiratory or cardiovascular decompensation: (1) patients with obesity hypoventilation syndrome may develop acute hypercapnia in response to administration of excessive supplemental oxygen; (2) excessive diuresis for peripheral edema using a loop diuretic such as furosemide exacerbates metabolic alkalosis, thereby worsening daytime hypoventilation and hypoxemia; (3) excessive or premature pharmacological treatment of psychiatric illnesses can exacerbate sleep-disordered breathing and worsen hypercapnia, thereby exacerbating psychiatric symptoms; and (4) clinicians often erroneously diagnose obstructive lung disease in patients with obesity hypoventilation, thereby exposing them to unnecessary and potentially harmful medications, including β-agonists and corticosteroids. Just as literary descriptions of pickwickian syndrome have given way to greater understanding of the pathophysiology of obesity hypoventilation, clinicians might exercise caution to consider these potential pitfalls and thus avoid inflicting unintended and avoidable complications.
Rossi-Izquierdo, Marcos; Santos-Pérez, Sofía; Faraldo-García, Ana; Vaamonde-Sánchez-Andrade, Isabel; Gayoso-Diz, Pilar; Del-Río-Valeiras, María; Lirola-Delgado, Antonio; Soto-Varela, Andrés
The aim of the study is to assess whether obesity affects balance in elderly patients with postural instability. It is a case-control study, with cases defined by BMI ≥30 kg/m(2), and developed in a third level university hospital. We included 135 patients aged 65 years old or more who presented postural instability. Balance assessment was through the sensory organisation test (SOT), limits of stability (LOS) and rhythmic weight shift (RWS) of computerised dynamic posturography (CDP) and the modified timed up-and-go (TUG) test. The patients also completed the Dizziness Handicap Inventory and short Falls Efficacy Scale-International questionnaire. Patients with obesity took longer to perform the modified TUG and required more steps. Also these patients had poorer scores in the subjective tests. In the CDP there were no significant differences in the SOT nor the LOS, and only there was a statistical significant difference in the anterior-posterior directional control of the RWS. Obese patients have a higher risk of fallings compared to non-obese patients. In essence, our results indicate that obesity interferes in the balance of elderly patients with postural instability, putting them at a greater risk of fallings, performing worse dynamic tasks and feeling more disabled. Although continued education on training balance may be useful in older population, since the obese group shows more rate of fallers, rehabilitation programmes focus on dynamic tasks in these patients could be useful to reduce their fall risk and improve their quality of life.
Ho, Alan; Kennedy, James; Dimitropoulos, Anastasia
Two thirds of US adults are either obese or overweight and this rate is rising. Although the etiology of obesity is not yet fully understood, neuroimaging studies have demonstrated that the central nervous system has a principal role in regulating eating behavior. In this study, functional magnetic resonance imaging and survey data were evaluated for correlations between food-related problem behaviors and the neural regions underlying responses to visual food cues before and after eating in normal-weight individuals and overweight/obese individuals. In normal-weight individuals, activity in the left amygdala in response to high-calorie food vs. nonfood object cues was positively correlated with impaired satiety scores during fasting, suggesting that those with impaired satiety scores may have an abnormal anticipatory reward response. In overweight/obese individuals, activity in the dorsolateral prefrontal cortex (DLPFC) in response to low-calorie food cues was negatively correlated with impaired satiety during fasting, suggesting that individuals scoring lower in satiety impairment were more likely to activate the DLPFC inhibitory system. After eating, activity in both the putamen and the amygdala was positively correlated with impaired satiety scores among obese/overweight participants. While these individuals may volitionally suggest they are full, their functional response to food cues suggests food continues to be salient. These findings suggest brain regions involved in the evaluation of visual food cues may be mediated by satiety-related problems, dependent on calorie content, state of satiation, and body mass index. PMID:23028988
Hodgson, Luke E.; Murphy, Patrick B.
As a reflection of the increasing global incidence of obesity, there has been a corresponding rise in the proportion of obese patients undergoing major surgery. This review reports the physiological effect of these changes in body composition on the respiratory system and discusses the clinical approach required to maximize safety and minimize the risk to the patient. The changes in respiratory system compliance and lung volumes, which can adversely affect pulmonary gas exchange, combined with upper airways obstruction and sleep-disordered breathing need to be considered carefully in the peri-operative period. Indeed, these challenges in the obese patient have led to a clear focus on the clinical management strategy and development of peri-operative pathways, including pre-operative risk assessment, patient positioning at induction and under anesthesia, modified approach to intraoperative ventilation and the peri-operative use of non-invasive ventilation (NIV) and continuous positive airways pressure. PMID:26101653
Porter, Scott E; Russell, George V; Dews, Robert C; Qin, Zhen; Woodall, James; Graves, Matthew L
To compare the early complications with operative treatment of acetabular fractures in morbidly obese (body mass index >or=40) patients when compared with all other patients. Retrospective review. University medical center. Four hundred thirty-five consecutive patients with acetabular fractures operatively treated by a single surgeon. Forty-one of these patients were morbidly obese (group 1) and were compared with the remaining patients (group 2). Group 2, therefore, included patients who were clinically overweight and obese. Operative repair of acetabular fracture. Outcome variables included patient positioning time, total operative time, estimated intraoperative blood loss, length of hospital stay, perioperative complications, and late complications. The average total operative time was 293 minutes for group 1 and 250 minutes (P = 0.008) for group 2. The hospital stay for group 1 averaged 26 days versus 15 days in group 2 (P < 0.01). There were 19 (46%) wound complications in group 1 compared with 49 (12%) in group 2 (P < 0.0001). Overall, there were complications in 26 of the 41 patients (63%) in group 1 and in 96 of the 394 patients (24%) in group 2. Group 1's relative risk of having a complication was 2.6 (95% confidence interval = 2.4-2.8) when compared with group 2. Our morbidly obese population had a statistically higher complication rate, longer operative times, and greater estimated intraoperative blood loss. The majority of complications were related primarily to wound healing problems and successfully controlled with aggressive approach to surgical debridement.
GROSSI, João Vicente Machado; NICOLA, Felipe Fernandes; ZEPEDA, Ivan Alberto; BECKER, Martina; TRINDADE, Eduardo Neubarth; DIEMEN, Vinicius Von; CAVAZZOLA, Leandro Totti; TRINDADE, Manoel Roberto Maciel
ABSTRACT Background: The evaluation of collagen in the abdominal wall has been increasingly studied because of the relevance on collagen in the healing process after laparotomy. Aim: To evaluate the amount of collagen in the linea alba of patients undergoing laparotomic bariatric surgery and comparing with non-obese cadavers. Methods: Were evaluated 88 samples of aponeurosis from abdominal linea alba of 44 obese patients (obesity group) and 44 non-obese cadavers (control group). The samples were collected in 2013 and 2104, and were sorted according to age (18-30, 31-45 and 46-60), gender, BMI, waist and cervical circumference, and subcutaneous tissue thickness. Material for biopsy was collected from the supraumbilical region of the linea alba for immunohistochemical analysis differentiating collagen type 1 and type 3 and the 1/3 ratio. Image-Pro Plus pixel counting software was used to measure the amount of collagen. Results: The obesity group evidenced mean age 44.11±9.90 years; 18-30 age group had three (6.8%) obese individuals; 31-45 had 22 (50%) and 46-60 had 19 (43.1%). Females were present in 81.8% (n=36); BMI (kg/m²) was 48.81±6.5; waist circumference (cm) was 136.761±13.55; subcutaneous tissue thickness (cm) 4.873±0.916. Considering age groups, gender and BMI, there were statistical differences in all tests when compared with the cadavers. Conclusion: The amount of collagen in the linea alba above the umbilical region in the morbidly obese patients was smaller than in the non-obese cadavers in the same age group. PMID:27683766
Mohammedi, Kamel; Compaoré, Aminata; Potier, Louis; Belhatem, Narimène; Feron, Marilyne; Matallah, Nadia; Travert, Florence; Hansel, Boris; Velho, Gilberto; Roussel, Ronan; Hallab, Magid; Marre, Michel
Pulse wave velocity (PWV) is a marker of arterial stiffness. The aim of the present study was to compare PWV in patients with type 2 diabetes mellitus (T2DM) or obesity and healthy subjects in an outpatient setting. A cross-sectional study was conducted in patients with obesity without T2DM (n = 37), T2DM without obesity (n = 40), T2DM plus obesity (n = 43), and healthy controls (n = 114). Outpatient measurements of the finger-toe PWV (ftPWV) were made. Mean (± SD) ftPWV was higher in men than in women (10.57 ± 5.02 vs 9.14 ± 3.68 m/s, respectively P = 0.006) and was positively correlated with age (r(2) = 0.31, P < 0.0001), body mass index (r(2) = 0.03, P = 0.01), systolic blood pressure (SBP; r(2) = 0.06, P < 0.0001), and right (r(2) = 0.03, P = 0.01) and left (r(2) = 0.03, P = 0.01) ankle-brachial index (ABI). Age, SBP and ABI remained significantly correlated with ftPWV in the stepwise regression analysis. Mean ftPWV in controls and in patients with obesity, T2DM, and T2DM plus obesity was 8.32 ± 2.68, 9.50 ± 3.38, 11.29 ± 4.34, and 12.36 ± 6.67 m/s, respectively (P < 0.0001). These differences remained significant after adjustments for sex, age, SBP, and ABI (P = 0.008). Although ftPWV was higher in patients with than without macrovascular complications (13.11 ± 6.25 vs 10.40 ± 4.54 m/s, respectively; P = 0.006) in univariate analysis, this was not so in the multivariate-adjusted model. Outpatient-measured ftPWV was correlated with age, SBP, and ABI. It was higher in patients with T2DM and obesity compared with healthy controls. The highest ftPWV was observed in patients with both T2DM and obesity. © 2016 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.
Buscemi, Dolores; Kumar, Ashwani; Nugent, Rebecca; Nugent, Kenneth
Epidemiological studies have demonstrated an association between short sleep times and obesity as defined by body mass index (BMI). We wanted to determine whether this association occurs in patients with chronic medical diagnoses since the number of confounding factors is likely higher in patients than the general population. Two hundred patients attending internal medicine clinics completed a survey regarding sleep habits, lifestyle characteristics, and medical diagnoses. An independent surveyor collected the information on the questionnaires and reviewed the medical records. Height and weight were measured by clinic personnel. Data were analyzed with multivariate logistic regression. Subjects with short sleep times (< 7 hours) had an increased likelihood of obesity as defined by a BMI > or = 30 kg/m2 when compared to the reference group of (8, 9] hours (odds ratio 2.93; 95% confidence interval, 1.06-8.09). There was a U-shaped relationship between obesity and sleep time in women but not in men. Young age (18 to 49 years), not smoking, drinking alcohol, hypertension, diabetes, and sleep apnea were also associated with obesity in the overall model. This study demonstrates an association between short sleep times and obesity in undifferentiated patients attending an internal medicine clinic using models adjusting for age, lifestyle characteristics, and some medical diagnoses. The U-shaped relationship in women suggests that sleep patterns may have gender specific associations. These observations provide the background for therapeutic trials in weight loss in patients with established medical problems.
Changchien, Te-Chang; Tai, Chi-Ming; Huang, Chih-Kun; Chien, Chia-Chang; Yen, Yung-Chieh
Objective There is a significant relationship between obesity and common mental symptoms (depression and anxiety symptoms). But the association between depression (or anxiety symptoms) and serum leptin is still unclear and controversial, despite the growing body of evidence supporting the existence of “leptin resistance” in obese persons. So we investigated whether common mental symptoms, obesity, and the interactive effect of these two factors have a relationship with leptin in obese patients who were candidates for bariatric surgery. Methods In all, 139 participants (mean age: 31.4 years, standard deviation: 9.3 years, 73.4% female) were enrolled at an obesity treatment center in southern Taiwan. Serum leptin levels and body mass index (BMI) were measured. The Chinese Health Questionnaire and Taiwanese Depression Questionnaire were administered. Results The mean BMI of our participants was 39.4 kg/m2 (±6.8), and the mean leptin level was 24.5 ng/mL (±9.4). In the multivariate regression models, Chinese Health Questionnaire-by-BMI and Taiwanese Depression Questionnaire-by-BMI interaction terms remained significant predictors of leptin level (β=0.16, P<0.0001; β=0.04, P<0.0001, respectively), after adjustment for age, sex, and history of hypertension, diabetes, and hyperlipidemia, despite the inverse correlation between Chinese Health Questionnaire (or Taiwanese Depression Questionnaire) and leptin. In addition, female patients had significantly higher leptin levels than male patients. Conclusion The present findings confirmed that the relationship between common mental symptoms and leptin is modulated by obesity in severely obese patients. Future studies should focus on further measures of leptin receptors or signaling on the basis of these interactive effects in psychiatry. PMID:26316761
Ali, Masood; Smith, Ian E; Gulati, Atul; Shneerson, John M
Reduced atmospheric pressure during air travel can cause significant hypoxaemia in some patients with respiratory disease. Our aims were to investigate the degree of hypoxaemia in patients with obesity hypoventilation syndrome (OHS) during hypoxic challenge test (HCT), and to identify any predictors of a positive HCT. Thirteen patients underwent assessment, including HCT, lung function and incremental shuttle walk test. All had OHS well controlled with long-term nocturnal non-invasive ventilation (NIV). Patients with chronic obstructive pulmonary disease were excluded. A positive HCT was defined according to the British Thoracic Society (BTS) recommendation as arterial oxygen tension (PaO₂) <6.6 kPa and/or oxygen saturation <85%. Mean age was 57 (± 11) years. Mean body mass index was 51.7 (± 12) kg/m(2) . Mean baseline PaO₂ and arterial carbon dioxide tension (PaCO₂) were 10.2 (9.5-11.3) kPa and 5.2 (3.7-6.8) kPa, respectively. Seven patients (54%) had a positive HCT. The correlation between baseline PaO₂ and PaO₂ at the end of the HCT was not statistically significant (r = 0.433, P = 0.184). A negative correlation was observed between baseline PaCO₂ and PaO₂ at the end of the HCT (r = -0.793, P = 0.004). A positive correlation was observed between the distance walked and the PaO₂ at the end of the HCT (r = 0.608, P = 0.047). OHS is a risk factor for severe hypoxaemia during air travel even if the ventilatory failure is well controlled. An HCT before air travel is advisable in all OHS patients. Those with positive HCT may use NIV or have oxygen on-board as per BTS recommendation. © 2014 Asian Pacific Society of Respirology.
Garber, A J
An estimated 72.5 million American adults are obese, and the growing US obesity epidemic is responsible for substantial increase in morbidity and mortality, as well as increased health care costs. Obesity results from a combination of personal and societal factors, but is often viewed as a character flaw rather than a medical condition. This leads to stigma and discrimination towards obese individuals and decreases the likelihood of effective intervention. Conditions related to obesity are increasingly common, such as metabolic syndrome, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), all of which indicate high risk for type 2 diabetes (T2DM). This paper reviews the progression from obesity to diabetes, identifying physiological changes that occur along this path as well as opportunities for patient identification and disease prevention. Patients with prediabetes (defined as having IFG, IGT or both) and/or metabolic syndrome require interventions designed to preserve insulin sensitivity and β-cell function, both of which start to deteriorate prior to T2DM diagnosis. Lifestyle modification, including both healthy eating choices and increased physical activity, is essential for weight management and diabetes prevention. Although sustained weight loss is often considered by patients and physicians as being impossible to achieve, effective interventions do exist. Specifically, the Diabetes Prevention Program (DPP) and programs modelled along its parameters have shown repeated successes, even with long-term maintenance. Recent setbacks in the development of medications for weight loss further stress the importance of lifestyle management. By viewing obesity as a metabolic disorder rather than a personal weakness, we can work with patients to address this increasingly prevalent condition and improve long-term health outcomes. © 2011 Blackwell Publishing Ltd.
de Luis, D A; Terroba, M C; Cuellar, L; Conde, R; Primo, D; Aller, R; Sagrado, M G; Izaola, O
Previous studies addressing the changes of resistin concentrations in morbidly obese patients after bariatric surgery have yielded conflicting results. The purpose of the present study was to investigate the changes in serum resistin levels 1 year after biliopancreatic diversion in morbidly obese patients without diabetes mellitus. A cohort of 39 morbidly obese patients without diabetes mellitus was operated. Biochemical and anthropometric evaluation were realized at basal visit and at each visit. The frequency of patients with hypertension and hyperlipidemia was recorded at each visit. Overall the mean patient age was 44.8 ± 14.1, and the mean preoperative BMI was 47.3 ± 6.5 kg/m². After one year of surgery, a significant decrease was observed in BMI, weight, waist circumference, fat mass, blood pressure, total cholesterol, LDL cholesterol, and triglyceride levels. Resistin levels did not change after surgery (5.61 ± 1.93 ng/ml vs. 6.41 ± 3.58 ng/ml; ns). Correlation analysis showed a positive association between basal resistin and weight (r = 0.68, p < 0.01) and fat mass (r = 0.65, p < 0.05). Resistin concentrations did not change after massive weight loss with biliopancreatic diversion in morbid obese patients without diabetes mellitus.
Stroescu, Ramona; Bizerea, Teofana; Doroş, Gabriela; Marazan, Monica; Lesovici, Maria; Mãrginean, Otilia
To investigate the relationship between markers of adiposity and common carotid artery (CIMT) in obese children born small for gestational age (SGA) versus appropriate for gestational age (AGA), to establish cut-off values for CIMT in obese pediatric populations. A cross-sectional study was carried out over a 1-year period (Jul 2013 - June 2014). We analyzed 122 obese patients aged 4-20 (mean age 14.9 ± 2.28). Twenty-six patients were born SGA. CIMT was measured in all the patients. Using ROC curve, cut-off values were obtained for both groups. We demonstrated a correlation between CIMT and adiponectin, leptin and high sensitivity C-reactive protein (hsCRP) (r = -0.25, r = 0.279, r = 0.498) in obese children. CIMT in obese children born SGA were significantly increased as compared with obese children born AGA of similar age, sex and body mass index (BMI) (p = 0.0035). A CIMT cut off value of 0.049 cm has been obtained with a high sensitivity and specificity. CIMT is a well-known marker of subclinical atherosclerosis and its measurement is a noninvasive and inexpensive method of detecting subclinical atherosclerosis. Being born SGA increases the atherogenic risk. Obese children with CIMT above 0.049 cm should be screened for metabolic syndrome (MetS).
Deakin, Angela H; Iyayi-Igbinovia, Aghimien; Love, Gavin J
Obesity is a growing public health issue with the prevalence of morbid obesity, (Body Mass Index (BMI) ≥ 40 kg/m(2)) increasing. There is some evidence these patients have more peri- and post-operative complications and poorer outcomes when undergoing arthroplasty procedures. This audit aimed to determine and compare the outcomes of non-obese, obese and morbidly obese patients undergoing arthroplasty at our institution. This was a retrospective audit of patients from our institution who had undergone total knee (TKA) or total hip arthroplasty (THA) in 2009. Data collected were: age, gender, BMI, length of stay (LOS), Oxford knee or hip score (OKS/OHS), satisfaction and complications up to two years post operation. Patients were divided into three groups: BMI < 30, BMI 30-40 and BMI > 40. Outcomes for each BMI group were compared. 1014 TKA and 906 THA operations were included. When compared to obese and non-obese patients, morbidly obese patients undergoing TKA had a mean LOS one day longer, a mean OKS four points lower and higher rates of postoperative problems, 37% vs. 21%. For THA patients there was no difference in LOS, OHS score was two points lower for each increasing BMI category and postoperative problems increase from 25% for non-obese to 31% for obese and 38% for morbidly obese patients. These results will be useful in informing obese patients of their potential outcomes following TKA or THA. These patients can then make a more informed choice before proceeding with arthroplasty. Copyright © 2016 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.
Casas-Vara, Antonio; Santolaria, Francisco; Fernández-Bereciartúa, Ainhoa; González-Reimers, Emilio; García-Ochoa, Alfonso; Martínez-Riera, Antonio
The obesity paradox refers to the improved survival of obese compared with non-obese elderly or diseased patients for reasons that are not clear. To assess the relative roles of fat and other factors in this improved survival, we analyzed the prognostic value of overweight and obesity elderly patients with heart failure (HF), controlling for other nutritional data such as midarm anthropometrics, serum proteins, and muscle strength. Two hundred forty-four patients (83.2 ± 0.5 y old) hospitalized for HF were included. A nutritional survey was performed in all patients. After discharge, the patients were followed up by telephone. Fourteen patients (5.7%) died during hospitalization. The median survival was 984 d. Patients with better nutritional status as assessed by the body mass index (BMI), subjective score, midarm muscle area, triceps skinfold thickness, handgrip, lymphocyte count, and serum albumin, prealbumin, and cholesterol levels showed better short- and long-term prognoses. Obese patients with a BMI above 30 kg/m(2) showed a better long-term prognosis than those with a BMI from 25 to 30 kg/m(2), those with a BMI from 20 to 25 kg/m(2), and those with a BMI lower than 20 kg/m(2). However, survival was not significantly related to a triceps skinfold thickness above the 95th percentile. Obese and overweight patients were younger and had better a nutritional status than those with a normal or decreased BMI as shown by the anthropometrics, subjective score, handgrip, lymphocyte count, hemoglobin, and serum albumin, prealbumin, and cholesterol levels. All the nutritional data correlated closely with each other. New York Heart Association class also correlated with nutrition-derived data: as the HF class increased, the nutritional status deteriorated. On multivariate analysis, to predict long-term survival, neither BMI nor triceps skinfold thickness showed an independent predictive value, whereas a larger midarm muscle area did. The obesity paradox was confirmed in
Côté-Daigneault, Justin; Poitras, Pierre; Rabasa-Lhoret, Rémi; Bouin, Mickael
BACKGROUND: Although esophageal hypomotility is prevalent in obese patients, its cause remains unknown. Leptin, a hormone derived from adipose tissue, may be involved in this phenomenon because it has been shown to decrease gastric and intestinal motility in animals. It has been hypothesized that elevated plasma leptin concentration is a risk factor for esophageal dysmotility in obese patients. OBJECTIVE: To determine whether plasma leptin concentrations are higher in obese patients with esophageal hypomotility than in obese patients with a normal motility profile. METHOD: Fasting plasma leptin concentration (assessed by radioimmuoassay) was measured in all patients who were included in a study protocol investigating esophageal manometry before bariatric surgery. The patients completed standardized surveys regarding epidemiological data, upper gastrointestinal symptoms, medical history and medication(s). Basal levels of leptin, as well as corrected leptin scores adjusted for sex and body mass index, were compared in patients with and without esophageal dysmotility. RESULTS: Nine patients without dysmotility and eight with dysmotility were included. Both groups were comparable with regard to age (42±9 versus 38±9 years), sex (78% versus 75% women) and body mass index (49±10 kg/m2 versus 42±7 kg/m2). There were no significant differences regarding medication(s) and comorbidities between the two groups. When compared with normal predicted values, the corrected leptin scores were 30% higher in patients with dysmotility than in the control group with normal motility (P≤0.05). CONCLUSION: Obese patients with esophageal dysmotility exhibited elevated plasma leptin concentrations, suggesting a role for leptin in promoting esophageal hypomotility. PMID:25706575
Rodriguez, John; El-Hayek, Kevin; Brethauer, Stacy; Schauer, Philip; Zelisko, Andrea; Chand, Bipan; O'Rourke, Colin; Kroh, Matthew
Background and Objectives: Treatment of gastroesophageal reflux disease (GERD) with hiatal hernia in obese patients has proven difficult, as studies demonstrate poor symptom control and high failure rates in this patient population. Recent data have shown that incorporating weight loss procedures into the treatment of reflux may improve overall outcomes. Methods: We retrospectively reviewed 28 obese and morbidly obese patients who presented from December 2007 through July 2013 with large or recurrent type 3 or 4 paraesophageal hernia. All of the patients underwent combined paraesophageal hernia repair and partial longitudinal gastrectomy. Charts were retrospectively reviewed, and the patients were contacted to determine symptomatic relief. Results: Mean preoperative body mass index was 38.1 ± 4.9 kg/m2. Anatomic failure of prior fundoplication occurred in 7 patients (25%). The remaining 21 had primary paraesophageal hernia, 3 of which were type 4. Postoperative complications included pulmonary embolism (n = 1), pulmonary decompensation (n = 2), and wound infection (n = 1). Mean hospital stay was 5 ± 3 days. Upper gastrointestinal esophagogram was performed in 21 patients with no immediate recurrence or staple line dehiscence. Mean excess weight loss was 44 ± 25%. All of the patients surveyed experienced near to total resolution of their preoperative symptoms within the first month. At 1 year, symptom scores decreased significantly. At 27 months, however, there was a mild increase in the scores. Return of severe symptoms occurred in 2 patients, both of whom underwent conversion to gastric bypass. Conclusions: Combined laparoscopic paraesophageal hernia repair with longitudinal partial gastrectomy offers a safe, feasible approach to the management of large or recurrent paraesophageal hernia in well-selected obese and morbidly obese patients. Short-term results were promising; however, intermediate results showed increasing rates of reflux symptoms that required
Pires, Juliana Rico; dos Santos, Isac Pinheiro; de Camargo, Lilian Flosi; Zuza, Elizangela Partata; de Toledo, Benedicto Egbert Corrêa; Monteiro, Sally Cristina Moutinho
Background: Obesity is a chronic inflammatory condition that has been associated to a risk factor for the development of periodontitis and cardiovascular disease; however, the relationship still needs to be clarified. The objective of this study was to evaluate the cardiovascular risk in obese patients with chronic periodontitis. Materials and Methods: A total of 87 obese patients were evaluated for anthropometric data (body mass index [BMI], waist circumference, body fat), systolic blood pressure (SBP) and diastolic blood pressure (DBP), cholesterol, high-density lipoprotein (HDL) and low-density lipoprotein (LDL), triglycerides, glycemia and periodontal parameters (visible plaque index (VPI), gingival bleeding index (GBI), bleeding on probing (BOP), periodontal probing depth (PPD) and clinical attachment level (CAL)). Results: Patients were divided into two groups according to the periodontal characteristics found: Group O-PD: Obese patients with chronic periodontitis (n = 45), 22 men and 23 women; and Group O-sPD: Obese patients without chronic periodontitis (n = 42), 17 men and 25 women. Patients had a BMI mean of 35.2 (±5.1) kg/m2 . Group O-PD showed a similarity between the genders regarding age, SBP, DBP, cholesterol, HDL, GBI, VPI, PPD ≥4 mm and CAL ≥4 mm. O-PD women showed greater glycemia level and smoking occurrence, but O-PD men presented a 13% - risk over of developing coronary artery disease in 10 years than O-PD women, 9% - risk over than O-sPD men and 15% - risk over than O-sPD women, by the Framingham Score. Conclusions: It was concluded that obesity and periodontal disease are cardiovascular risk factors and that the two associated inflammatory conditions potentially increases the risk for heart diseases. PMID:24744538
Yang, Hai-Yan; Ma, Yan; Lu, Xin-Hong; Liang, Xing-Huan; Suo, Ying-Jun; Huang, Zhen-Xing; Lu, De-Cheng; Qin, Ying-Fen; Luo, Zuo-Jie
Aberrant circulating adipokines are considered to be related to the pathological mechanism of polycystic ovary syndrome (PCOS). This study aims to evaluate the relationship between plasma omentin-1 levels, metabolic and hormonal parameters in the setting of non-obese Chinese women with PCOS. This was a case-controlled, cross-sectional study of 153 non-obese (BMI<25kg/m(2)) PCOS and 114 age-matched healthy non-obese control individuals. Levels of plasma omentin-1, fasting blood glucose, insulin and sexual hormones and ovary volume were analyzed in all subjects. Plasma omentin-1 levels of non-obese PCOS individuals were significantly lower than in healthy non-obese controls. Body Mass Index (BMI), homeostasis model of assessment for insulin resistance index (HOMA-IR), levels of testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), LH/FSH ratio and ovary volume (OV) were significantly higher in subjects with PCOS than controls. In the HOMA-IR stratified subgroups, PCOS individuals with insulin resistance had lower omentin-1 than those without insulin resistance after BMI adjustment. Omentin-1 was negatively correlated with BMI, HOMA-IR and fasting insulin. Multiple linear regressions revealed that BMI contributed to omentin-1 levels. Ovary volume was negatively correlated to HOMA-IR but had no correlation with omentin-1. Plasma omentin-1 concentrations were decreased in the non-obese PCOS group. Insulin resistance could further decrease plasma omentin-1 in non-obese individuals with PCOS independent of BMI status. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
de Luis, Daniel A; Ballesteros, María; Ruiz, Enrique; Muñoz, Carmen; Penacho, Angeles; Iglesias, Pedro; Guzmán, Antonio López; Abreu, Cristina; Maldonado, Alfonso; Delgado, Manuel; Martín, Lucía San; Puigdevall, Victor; Romero, Enrique; Sagrado, Manuel González; Izaola, Olatz; Conde, Rosa
Obesity and insulin resistance are associated with cardiovascular risk factors. The aim of the present study was to explore the relation of visfatin with insulin resistance, cardiovascular risk factors and anthropometry in obese patients without comorbidities. A population of 270 obese patients was analyzed in a prospective way. In all patients we performed a biochemical analysis (lipid profile, insulin, HOMA and visfatina), and a nutritional evaluation (dietary intake, conventional anthropometry and bioimpedance). Patients were divided in two groups by median visfatin value (8,32 ng/ml), group I (patients with the low values, average value 7,11 (0,7) ng/ml) and group II (patients with the high values, average value 13,5 (10,1) ng/ml). Patients in the group I had higher weight, body mass index, waist circumference, and waist to hip ratio than patients in group II. Patients in group I had lower LDL-cholesterol and C reactive protein than patients in group II. Correlation analysis showed a positive correlation between visfatin levels and LDL cholesterol (r=0.194; p<0.05) and C reactive protein (r=0.266; p<0.05) and a negative corelation with weight (r=-0.162; p<0.05). In the logistic analysis with age-, sex- and dietary intake- adjusted basal visfatin concentration as a dependent variable, the next variables remained in the model; weight with an odds ratio (OR) 0,97 (IC95% 0,95-0,99), LDL cholesterol 1,012(1,010-1.023) and C reactive protein 1,15 (1.03-1.3). LDL cholesterol and c reactive protein levels are positively correlated with visfatin levels. Weight is negatively correlated with visfatin levels, in an independent way and adjusted by age, sex and dietary intake. Copyright © 2010 Elsevier España, S.L. All rights reserved.
Majdi, Maryam Abbasi; Mohammadzadeh, Naser Aga; Lotfi, Hajie; Mahmoudi, Rasoul; Alipour, Farzaneh Ghafarian; Shool, Fatemeh; Moghanloo, Mehdi Niknam; Porfaraj, Sadeg; Zarghami, Nosratollah
The aim of this study was to detect any association of fat mass and obesity-associated (FTO) rs9939609 variant to metabolic and anthropometric parameters and resistin level as adipokines in Iranian obese women with type 2 diabetes mellitus. Totally, 42 diabetic and 36 non-diabetic women were selected. The PCR amplicons of FTO gene were sequenced and metabolic, anthropometric parameters and resistin level were measured. Serum resistin concentrations were not different between diabetic and non-diabetic subjects (p>0.05), while resistin level in diabetic group with AA genotype was lower than that with other genotypes in the same group. In rs9939609 SNP adjusted analysis, insulin and HOMA levels were high in AA genotype. While levels of FBS and HbA1c were higher in AA and AT genotypes. In diabetic group, only TG showed significant difference among three genotypes and mean of TG was higher in TA genotype. No significant correlation between resistin and anthropometric and metabolic parameters was found except for DBP in diabetic patients. There was no significant association between rs9939609 and resistin serum level in type 2 obese diabetic women while percentile ranges (25(th), 50(th) and 75(th)) of resistin concentrations was high in diabetic group. Copyright © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.
Turner, Robert M.; Gusenoff, Jeffrey A.; Correa, Andres F.; Jacobs, Bruce L.; Davies, Benjamin J.
The obese patient undergoing radical cystectomy faces a unique set of challenges. We present the case of a 68-year-old gentleman who presented to our institution with Bacillus Calmette-Guerin refractory disease, a body mass index of 38.5, and a large pannus. The present paper describes our technique for performing radical cystectomy with ileal conduit urinary diversion and concomitant panniculectomy. We discuss the impact of obesity on patients undergoing radical cystectomy and how this may be mitigated by panniculectomy. PMID:27195168
Barros, Raffaelle K; Cotrim, Helma P; Daltro, Carla; Alves, Erivaldo; de Freitas, Luiz A R; Daltro, Claudia; Oliveira, Yanaihara
Obesity correlates with nonalcoholic fatty liver disease (NAFLD) and occurs in 90 to 100% of severely obese individuals (body mass index [BMI] > 35 kg/m2). Coffee consumption (CC) has been associated with reduced progression of fibrosis in both hepatitis C infection and NAFLD; however, this topic is still under discussion when this liver disease affects severely obese individuals. To assess the association between CC, insulin resistance (IR) and histological NAFLD morbid obese patients. Cross-sectional study, including obese individuals undergoing bariatric surgery, liver biopsy and histological diagnosis between September 2013 and August 2014. The patients were classified into 3 groups according to their weekly CC: 0- 239.9 mL; 240-2099.9 mL and ≥ 2100 mL. A total of 112 obese individuals were included (BMI = 41.9 ± 4.3 kg/m2), with a mean age of 34.7 ± 7.4 years; 68.6% were women. CC was reported by 72.3% of patients. There were no statistical significant differences between groups regarding the presence of IR (84.8% vs. 74.2% vs. 75.9%; p = 0.536). Progressively higher percentages of individuals with normal liver histology were observed (14.7% vs. 21.9% vs. 24.3%). NASH (65.7% vs. 70.3% vs. 57.5%) were observed among those who consumed greater coffee volumes (p = 0.812). In conclusion, obese individuals with elevated CC exhibited lower frequencies of NASH, although with no statistical significance in this sample.
Rojano-Rodriguez, Martin Edgardo; Beristain-Hernandez, Jose Luis; Zavaleta-Villa, Beatriz; Maravilla, Pablo; Romero-Valdovinos, Mirza; Olivo-Diaz, Angelica
Human obesity is due to a complex interaction among environmental, behavioral, developmental and genetic factors, including the interaction of leptin (LEP) and leptin receptor (LEPR). Several LEPR mutations and polymorphisms have been described in patients with early onset severe obesity and hyperphagic eating behavior; however, some contradictory findings have also been reported. In the present study we explored the association of six LEPR gene polymorphisms in patients with morbid obesity. Twenty eight patients with morbid obesity and 56 non-obese Mexican Mestizo individuals were included. Typing of rs1137100, rs1137101, rs1805134, Ser492Thr, rs1805094 and rs1805096 LEPR polymorphisms was performed by PCR and allele specific hybridization. The LEPR Ser492Thr polymorphism was monomorphic with the presence of only the Ser492Thr-G allele. Allele C and genotype T/C for rs1805134 polymorphism were associated with susceptibility to morbid obesity (p = 0.02 and p = 0.03, respectively). No association was observed with any haplotype. Linkage disequilibrium (LD) showed that five polymorphisms (rs1137100, rs1137101, rs1805134, rs1805094 and rs1805096) were in absolute (D' = 1) but none in perfect (r(2) = 1) LD. Our results suggest that rs1805134 polymorphism could be involved in the development of morbid obesity, whilst none of the alleles of the LEPR gene, rs1137100, rs1137101, rs1805094 and rs1805096 were associated as risk factors. However, more studies are necessary to confirm or reject this hypothesis.
Aboueldahab, Abdelmohsen Khalaf
Introduction: The abdomen, thighs and buttocks are often the areas of greatest concern to patients following massive weight loss due to bariatric surgery. The typical appearance of the patient who has lost a massive amount of weight derives from a combination of factors, including gender-dependent body morphology and a change in body mass index, which lead to skin and soft-tissue excess and poor skin tone. Thigh laxity and redundancy represents a great challenge to both patients and surgeons. Not only because of the difficulty to satisfy the patients, but also due to the higher incidence of complications especially, with those obese patients who have not undergone bariatric surgery before. The problems with such patients are due to the heavy thighs that require both debulking and tight anchorage to prevent scar migration or labial distortion. Aim of the Work: The aim of the present study is to improve the aesthetic outcome and avoid the complications of medial thigh lifting with simultaneous liposuction in obese and non-obese. Patients and Methods: A total of 25 female patients presented during the period from January 2007 to July 2011 complaining of moderate to severe thigh laxity with or without lipodystrophy. In 20 patients medial transverse thigh lift was performed, to treat medial thigh friction and laxity particularly in the upper half. Whereas, in the other five patients were suffering from upper and lower medial thigh bulkiness, vertical thigh lift was performed. Results: All patients recovered well in 2 weeks and showed improvement of thigh contour. Scar downward displacement in one patient. No skin necrosis or seroma. No labial distortion or separation encountered. Conclusion: Simultaneous liposuction and thigh lift gave good results provided proper patients selection, appropriate technique to each patient, meticulous, cautious liposuction and handling of the tissues and most importantly is the deep tight anchorage sutures to guard against the effect of
Keskin, O; Aksoy, S; Babacan, T; Sarici, F; Kertmen, N; Solak, M; Turkoz, F P; Arik, Z; Esin, E; Petekkaya, I; Altundag, K
Although many studies have shown association of obesity and tumor size, the association with the lymph node status is not clear. We examined the relationship of the lymph node status and obesity and other possible factors in early breast cancer patients. In this retrospective cohort study, 1295 breast cancer patients who had axillary dissection were included. Patients were grouped according to their body mass index (BMI) values at the time of diagnosis. We analyzed the relationship between BMI and patient and tumor characteristics, especially lymph node status. The median patient age was 48 years (range 20- 84). Of the patients 69.6% had modified radical mastectomy and the remaining 30.4% had breast-conserving surgery and axillary dissection. Median BMI of the patients was 27.2 kg/m(2) and 33.1% (N-429) of them had normal BMI, 36% (N-471) were overweight and 30.5% (N=395) were obese at the time of the diagnosis. Of the patients, 44.2% had N0 disease, and 55.8% had lymph node metastasis. N1 disease had 28.3% (N=367), 13.8% (N=179) had N2 and 13.7% (N=177) had N3 disease. When patients were classified as normal (≤24.9 kg/m(2)) and obese (>24.9 kg/m(2)) group, the total number of lymph nodes removed was higher in the obese group and this difference was statistically significant (18.12±10.48 and 20.36±11.37, respectively, p= 0.001). There was strong correlation between the number of the dissected lymph nodes and BMI (r=0.11; p<0.001). However, there was no statistically significant correlation between the number of metastatic lymph nodes and BMI. The mean number of the dissected and involved lymph nodes was higher in the HER2 positive group compared to the negative ones (21 vs 19, p=0.008; 6 vs 3, p<0.001; respectively) The number of the dissected lymph nodes was slightly higher in obese patients but there was no correlation between metastatic lymph node number and BMI. The number of the dissected and involved lymph nodes was higher in the HER2 positive group.
Norlelawati, A T; Kartini, A; Ramli, M; Norsidah, K; Wan Azizi, W S; Tariq, A R
OBJECTIVES. Obesity is an issue of concern among patients with schizophrenia as it is a co-morbid condition that is closely related to metabolic syndrome. The present study assessed the correlation of body mass index with antipsychotic use among multiracial schizophrenia outpatients. The study also compared the patients' body mass index with Malaysian Adult Nutrition Survey (MANS) data. METHODS. A total of 216 participants were recruited into a cross-sectional study conducted over 5 months, from December 2010 to April 2011. Body weight and height were measured using the standard methods. Demographic data and treatment variables were gathered through interview or review of the medical records. RESULTS. There were differences in mean body mass index between men and women (p = 0.02) and between Malay, Chinese and Indian races (p = 0.04). Stratified by sex, age, and race, the body mass index distributions of the patients were significantly different to those of the reference MANS population. The prevalence of obesity among patients was more than 2-fold greater than among the reference population in all variables. Although body mass index distribution was related to antipsychotic drugs (χ(2) = 33.42; p = 0.04), obesity could not be attributed to any specific drug. CONCLUSION. The prevalence of obesity among patients with schizophrenia was significantly greater than that in the healthy Malaysian population, and affects the 3 main races in Malaysia.
Stengel, Andreas; Goebel-Stengel, Miriam; Teuffel, Pauline; Hofmann, Tobias; Buße, Petra; Kobelt, Peter; Rose, Matthias; Klapp, Burghard F
Dipeptidyl peptidase IV (DPPIV) is a protease with broad distribution involved in various homeostatic processes such as immune defense, psychoneuroendocrine functions and nutrition. While DPPIV protein levels were investigated in patients with hyporectic disorders, less is known under conditions of obesity. Therefore, we investigated DPPIV across a broad range of body mass index (BMI). Blood samples from hospitalized patients with normal weight (BMI 18.5-25 kg/m(2)), anorexia nervosa (BMI <17.5 kg/m(2)) and obesity (BMI 30-40, 40-50 and >50 kg/m(2), n = 15/group) were tested cross-sectionally and DPPIV concentration and total enzyme activity and the DPPIV targets, pancreatic polypeptide (PP) and glucagon-like peptide (GLP-1) were measured. DPPIV protein expression was detected in human plasma indicated by a strong band at the expected size of 110 kDa and another major band at 50 kDa, likely representing a fragment comprised of two heavy chains. Obese patients had higher DPPIV protein levels compared to normal weight and anorexics (+50%, p<0.05) resulting in a positive correlation with BMI (r = 0.34, p = 0.004). DPPIV serum activity was similar in all groups (p>0.05), while the concentration/activity ratio was higher in obese patients (p<0.05). Plasma PP levels were highest in anorexic patients (∼ 2-fold increase compared to other groups, p<0.05), whereas GLP-1 did not differ among groups (p<0.05). Taken together, circulating DPPIV protein levels depend on body weight with increased levels in obese resulting in an increased concentration/activity ratio. Since DPPIV deactivates food intake-inhibitory hormones like PP, an increased DPPIV concentration/activity ratio might contribute to reduced food intake-inhibitory signaling under conditions of obesity.
Park, Chan Yong; Kim, Jung Chul; Kim, Shin Kon
Purpose To describe the clinical characteristics and outcomes after inguinal hernia repair in overweight and obese patients. Methods We retrospectively reviewed the medical records of 636 adult patients who underwent mesh plug inguinal hernia repair performed by one surgeon from November 2001 to January 2009.The clinical characteristics and surgical outcomes of the patients were analyzed. According to the body mass index, patients higher than 23 were defined as overweight and obese patient group (O group) and patients between 18.5 and 23 were defined as normal weight patient group (N group). Seventeen underweight patients were excluded in this study. Results Of 619 cases, the number for O group was 344 (55.6%) and for N group was 275 (44.4%). The mean age was significantly higher in N group (62.2 ± 12.6 vs. 64.4 ± 14.8, P = 0.048). Underlying diseases were present in 226 (65.7%) of the O group and 191 (69.5%) of the N group (P = 0.322). Anesthesia method, operative time and postoperative hospital stay had no significant difference between the two groups. Postoperative complications developed in 41 (11.9%) of the O group and in 28 (10.2%) of the N group, respectively, and no major complications developed in either group. Conclusion Adult inguinal hernias developed at a relatively younger age in overweight and obese patients than in normal weight patients. There were no specific differences in other clinical characteristics and outcomes between the two groups. Therefore inguinal hernia repair in overweight and obese patients is a safe procedure as in normal weight patients. PMID:22066122
Al-Basti, Habib B; El-Khatib, Hamdy A; Taha, Ahmed; Sattar, Hisham Abdul; Bener, Abdulbari
This study measured intraabdominal pressure in morbidly obese and multiparous patients who underwent abdominoplasty with musculoaponeurotic plication. The purpose of this study was to evaluate any potential adverse effect on pulmonary function by virtue of pulmonary function tests and measurement of peak airway pressure. The study included 43 multiparous, morbidly obese women (mean body mass index, 35.8 kg/m2) with a mean age (+/- SD) of 38.6 +/- 7 years. All had full abdominoplasty and repair of the musculoaponeurotic system during the period from June of 1999 to May of 2002. Forty-three morbidly obese multiparous patients were seen over a period of 24 months. Their intraabdominal pressure was estimated by measuring the intravesical pressure before and after repair of severe diastases (divarication) of the rectus abdominis muscles with severely flaccid myofascial component before using a hydrometer connected to a Foley catheter both before and after repair. All patients had pulmonary function checked before and 2 months after the repair. The study confirmed that there are minimal changes on the intraabdominal pressure parameters compared with measurement before and after full abdominoplasty with plication of the rectus muscles, with minimal to negligible changes in the intrathoracic pressure. These changes are clinically and statistically significant (p < 0.0001). The study also recommended the safety of full abdominoplasty and repair of the musculoaponeurotic system in multiparous and morbidly obese patients. Furthermore, no statistically significant difference was found in pulmonary function parameters before and after surgery in patients with a history of bronchial asthma.
Tewari, N; Awad, S; Macdonald, I A; Lobo, D N
In healthy surgical patients, preoperative fasting and major surgery induce development of insulin resistance (IR). IR can be present in up to 41% of obese patients without diabetes and this can rise in the postoperative period, leading to an increased risk of postoperative complications. Inflammation is implicated in the aetiology of IR. This review examines obesity-associated IR and its implications for the surgical patient. Searches of the Medline and Science Citation Index databases were performed using various key words in combinations with the Boolean operators AND, OR and NOT. Key journals, nutrition and metabolism textbooks and the reference lists of key articles were also hand searched. Adipose tissue has been identified as an active endocrine organ and the chemokines secreted as a result of macrophage infiltration have a role in the pathogenesis of IR. Visceral adipose tissue appears to be the most metabolically active, although results across studies are not consistent. Results from animal and human studies often provide conflicting results, which has rendered the pursuit of a common mechanistic pathway challenging. Obesity-associated IR appears, in part, to be related to inflammatory changes associated with increased adiposity. Postoperatively, the surgical patient is in a proinflammatory state, so this finding has important implications for the obese surgical patient.
Holzer, Jessica; Canavan, Maureen; Bradley, Elizabeth
Investigators of previous studies regarding the correlation between area-level health care resources and obesity have not examined the association between the prevalence of dentists and rates of adult obesity. The authors conducted a study to address that knowledge gap. Using data compiled in the Robert Wood Johnson County Health Rankings and Roadmaps database, the authors conducted multivariable analyses of the relationship between the prevalence of dentists (from the 2011 Health Resources and Services Administration Area Resource File) and rates of obesity within counties. The authors controlled for prevalence of primary care providers, measures of the built environment (for example, number of recreational facilities per 10,000 population, the percentage of restaurants serving fast food) and county-level sociodemographic and economic factors. When the authors conducted a multivariable analysis adjusted for state-level fixed effects, they found that having one additional dentist per 10,000 population was associated significantly with a 1-percentage point reduction in the rate of obesity (P < .001). This effect was significantly larger in counties in which 25 percent of children or more (versus less than 25 percent of children) lived in poverty and in counties that had more primary care physicians per 10,000 population (P ≤ .009). The association between the prevalence of dentists and obesity, even after adjusting for primary care resources and sociodemographic factors, was evident. Although these data could not be used to assess causality, given the strength of the ecological, cross-sectional association, additional research involving person-level, longitudinal data is warranted. The correlation between the prevalence of dentists and obesity rates highlights the potential for dental professionals, as well as other primary care providers, to provide meaningful health education and support for improved nutritional behaviors, although the increased obesity rates in
Quero Alfonso, Angel I; Fernández Gallegos, Ruth; Fernández Castillo, Rafael; Gomez Jimenez, Francisco Javier; García Rios, María Del Carmen; García García, Inmaculada
The metabolic syndrome (MS) consists of a set of clinical and biochemical changes. It is very common among chronic hemodialysis patients, being the leading cause of death in these patients, 44% of all patients undergoing this therapy. The aim of this study was to investigate the prevalence of MS and risk factors associated with its development, as well as the prevalence of obesity in HD patients. This study has followed 90 patients of both sexes with chronic renal failure (CRF) who were treated with hemodialysis periodically in our unit for ten years. All patients were performed quarterly measurements of plasma albumin (A1b) and other biochemical analysis; besides, they underwent some anthropometric measurements like weight, height and body mass index (BMI). This was calculated using weight / size2 formula and grouped in BMI values according to WHO criteria. The data concerning hypertension and glucose were also considered. The prevalence of MS was 25% and obesity was presented as follows: 45% with type I overweight; 30.8% with type II overweight and 12 patients (2%) were obese. Being statistically significant as risk factors, BMI, overweight, triglycerides, total cholesterol, HDL cholesterol as well as hypertension and elevated glucose levels were obtained. The metabolic syndrome compromises the patient survival causing a high prevalence in these patients. The principal risk factors in MS are monitoring weight, BMI, triglycerides, HDL cholesterol, hypertension and diabetes. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.
Mason, Rodney J; Moroney, Jolene R; Berne, Thomas V
To evaluate the economic impact of obesity on hospital costs associated with the commonest nonbariatric, nonobstetrical surgical procedures. Health care costs and obesity are both rising. Nonsurgical costs associated with obesity are well documented but surgical costs are not. National cost estimates were calculated from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) database, 2005-2009, for the highest volume nonbariatric nonobstetric procedures. Obesity was identified from the HCUP-NIS severity data file comorbidity index. Costs for obese patients were compared with those for nonobese patients. To control for medical complexity, each obese patient was matched one-to-one with a nonobese patient using age, sex, race, and 28 comorbid defined elements. Of 2,309,699 procedures, 439,8129 (19%) were successfully matched into 2 medically equal groups (obese vs nonobese). Adjusted total hospital costs incurred by obese patients were 3.7% higher with a significantly (P < 0.0001) higher per capita cost of $648 (95% confidence interval [CI]: $556-$736) compared with nonobese patients. Of the 2 major components of hospital costs, length of stay was significantly increased in obese patients (mean difference = 0.0253 days, 95% CI: 0.0225-0.0282) and resource utilization determined by costs per day were greater in obese patients due to an increased number of diagnostic and therapeutic procedures needed postoperatively (odds ratio [OR] = 0.94, 95% CI: 0.93-0.96). Postoperative complications were equivalent in both groups (OR = 0.97, 95% CI: 0.93-1.02). Annual national hospital expenditures for the largest volume surgical procedures is an estimated $160 million higher in obese than in a comparative group of nonobese patients.
Brill, Margreke J E; Houwink, Aletta P I; Schmidt, Stephan; Van Dongen, Eric P A; Hazebroek, Eric J; van Ramshorst, Bert; Deneer, Vera H; Mouton, Johan W; Knibbe, Catherijne A J
As morbidly obese patients are prone to surgical site infections, adequate blood and subcutaneous tissue concentrations of prophylactic antibiotic agents during surgery are imperative. In this study we evaluated cefazolin subcutaneous adipose tissue distribution in morbidly obese and non-obese patients, thereby quantifying the influence of morbid obesity on cefazolin pharmacokinetics and enabling Monte Carlo simulations for subsequent dose adjustments. Nine morbidly obese patients [body mass index (BMI) 47 ± 6 kg/m(2)], of whom eight were evaluable, and seven non-obese patients (BMI 28 ± 3 kg/m(2)) received cefazolin 2 g intravenously before surgery (NCT01309152). Using microdialysis, interstitial space fluid (ISF) samples of subcutaneous adipose tissue were collected together with total and unbound plasma cefazolin samples until 240 min after dosing. Using NONMEM, population pharmacokinetic modelling, covariate analysis and Monte Carlo simulations were performed. The unbound (free) cefazolin ISF penetration ratio (fAUC(tissue)/fAUC(plasma)) was 0.70 (range 0.68-0.83) in morbidly obese patients versus 1.02 (range 0.85-1.41) in non-obese patients (P < 0.05). A two-compartment model with saturable protein binding was identified in which the central volume of distribution and cefazolin distribution from the central compartment to the ISF compartment proved dependent on body weight (P < 0.001 and P < 0.01, respectively). Monte Carlo simulations showed reduced probability of target attainment for morbidly obese versus non-obese patients for MIC values of 2 and 4 mg/L. This study shows that cefazolin tissue distribution is lower in morbidly obese patients and reduces with increasing body weight, and that dose adjustments are required in this patient group.
De Jong, Audrey; Deras, Pauline; Martinez, Orianne; Latry, Pascal; Jaber, Samir; Capdevila, Xavier; Charbit, Jonathan
Background Prediction of massive transfusion (MT) is challenging in management of trauma patients. However, MT and its prediction were poorly studied in obese patients. The main objective was to assess the relationship between obesity and MT needs in trauma patients. The secondary objectives were to validate the Trauma Associated Severe Hemorrhage (TASH) score in predicting MT in obese patients and to use a grey zone approach to optimize its ability to predict MT. Methods and Findings An observational retrospective study was conducted in a Level I Regional Trauma Center Trauma in obese and non-obese patients. MT was defined as ≥10U of packed red blood cells in the first 24h and obesity as a BMI≥30kg/m². Between January 2008 and December 2012, 119 obese and 791 non-obese trauma patients were included. The rate of MT was 10% (94/910) in the whole population. The MT rate tended to be higher in obese patients than in non-obese patients: 15% (18/119, 95%CI 9‒23%) versus 10% (76/791, 95%CI 8‒12%), OR, 1.68 [95%CI 0.97‒2.92], p = 0.07. After adjusting for Injury Severity Score (ISS), obesity was significantly associated with MT rate (OR, 1.79[95%CI 1.00‒3.21], p = 0.049). The TASH score was higher in the obese group than in the non-obese group: 7(4–11) versus 5(2–10)(p<0.001). The area under the ROC curves of the TASH score in predicting MT was very high and comparable between the obese and non-obese groups: 0.93 (95%CI, 0.89‒0.98) and 0.94 (95%CI, 0.92‒0.96), respectively (p = 0.80). The grey zone ranged respectively from 10 to 13 and from 9 to 12 in obese and non obese patients, and allowed separating patients at low, intermediate or high risk of MT using the TASH score. Conclusions Obesity was associated with a higher rate of MT in trauma patients. The predictive performance of the TASH score and the grey zones were robust and comparable between obese and non-obese patients. PMID:27010445
Shimada, Shino; Maegaki, Yoshihiro; Osawa, Makiko; Yamamoto, Toshiyuki
We identified mosaic 1p36 deletions in two patients with developmental delay, distinctive features, and obesity, who can walk alone and communicate with others. Thus, their neurological defects are milder than those in typical patients with 1p36 deletion syndrome because most patients with 1p36 deletion cannot acquire expressive language. Chromosomal microarray testing revealed 3.0 and 4.5 Mb aberrations in the subtelomeric region of the short arm of chromosome 1. Mean signal ratios of the identified aberrations were -0.4 and -0.5, indicating mosaicism, which was confirmed by fluorescence in situ hybridization analysis with a mosaic ratio of 70% and 77%, respectively. Previous studies demonstrated that deletion of the distal 2-3 Mb region would be responsible for hyperphagia and obesity seen in patients. On the other hand, the severity of the neurological defect often correlates with the size of the terminal deletion of 1p36, and patients with larger deletions of 1p36 would usually show severely impaired developmental milestones and be immobile and aphasic. In such cases, hyperphagia and obesity could be clinically masked. In this study, two patients with mosaic deletions of 1p36 showed obesity as a consequence of hyperphagia. This study suggests that patients with 1p36 deletion would be at risk for hyperphagia and obesity when they have both risk factors, that is, (1) deletions including the 2-3 Mb critical region and (2) milder phenotypes that allow them to reach food on their own and to overeat.
Iavazzo, Christos; Gkegkes, Ioannis D
Robotic hysterectomy is an alternative approach to the management of female genital tract pathology. A systematic literature review was performed to evaluate the till now available literature evidence on robotic assisted hysterectomy in obese and morbidly obese patients. In total, robotic assisted hysterectomy was performed on 2769 patients. The most frequent indication for robotic hysterectomy was endometrial carcinoma (1832 out of 2769 patients, 66.2 %). Hypertension, diabetes mellitus, obstructive sleep apnea, chronic obstructive pulmonary disease and venous thromboembolism were the most common comorbidities reported. The conversion rate to laparotomy was 92 out of 2226 patients (4.1 %). The most frequent intraoperative complications for robotic hysterectomy were gastrointestinal injury (17 out of 2769 patients, 0.6 %), haemorrhage (five out of 2769 patients, 0.2 %) and bladder injury (five out of 2769 patients, 0.2 %). Wound infections/dehiscence (66 out of 2769 patients, 2.4 %), fever (56 out of 2769 patients, 2 %), pulmonary complications (55 out of 2769 patients, 1.9 %), urogenital complications (36 out of 2769 patients, 1.3 %) and postoperative ileus (28 out of 2769 patients, 1 %) were the most common postoperative complications. Death was reported in three out of 2769 patients (0.1 %). The ICU admitted patients were eight of 2226 patients (0.4 %). The robotic technique, especially in obese, can optimize the surgical approach and recovery of such patients with equally if not better outcomes compared to open and/or laparoscopic techniques.
Leiter, Amanda; Doucette, John; Krege, Susan; Lin, Chia-Chia; Hahn, Noah; Ecke, Thorsten; Sonpavde, Guru; Bamias, Aristotle; Oh, William K; Galsky, Matthew D
Background: Obesity has been associated with worse outcomes in patients with clinically localized urothelial cancer. However, this impact has not been evaluated in metastatic disease. Objective: To assess the impact of obesity on outcomes of patients with metastatic urothelial cancer. Methods: Data from 537 patients were aggregated from eight phase II and phase III clinical trials investigating first-line cisplatin-based combination therapy in metastatic urothelial cancer. Chemotherapy regimen, adverse events, treatment response, and survival outcomes were compared across body mass index (BMI) and body surface area (BSA) categories. Results: BMI was classified according to WHO criteria (<18.5 underweight, 18.5-24.99 normal weight, 25-29.99 overweight, >30 obese). BSA was classified as either below or greater than or equal to (average for this cohort (1.87 m(2) for males and 1.66 m(2) for females). There was no significant difference in number of chemotherapy cycles, adverse events, and response rate or survival outcomes (overall and progression-free) across BMI and BSA categories. There was no significant difference in adverse events across BMI categories, but the incidences of embolic events and renal failure were higher in patients with an average or higher BSA than those with a lower than average BSA (6.6% vs. 3.1% for renal failure p = 0.06; 5.9% vs. 2.7% for renal failure, p = 0.07). There was no significant difference in response rate or survival outcomes (overall and progression-free) amongst BMI and BSA categories. Conclusions: Obese patients with metastatic urothelial cancer on cisplatin-based therapies have similar response rates, survival outcomes, and tolerability of cisplatin-based therapy to non-obese patients.
Móczár, Csaba; Borda, Ferenc; Faragó, Katalin; Borgulya, Gábor; Braunitzer, Ferencné; Vörös, Vera
Obesity is an important risk factor for cardiovascular diseases. Change of life style plays very important role for the management of overweight and obesity and related cardiovascular risk factors. Patients need to acquire and adopt these changes. The aim of this study was to screen practices for overweight and obese patients, to decrease their cardiovascular risk and prevent development of cardiovascular diseases. 2489 overweight patients were screened from 29 general practices since April of 2001. The authors surveyed their characteristics of life style: eating and exercise habits, body mass index, waist line, resting blood pressure, heart rate and plasma glucose, total cholesterin, triglyceride, HDL after a 12-hour fasting. A team, which consisted of an internist, a dietician and a physical instructor dealt with the patients. After ruling out secondary obesity the team tailored an individual life-style which focused on dietary interventions (low calorie diet) and increased physical activity. 12 months later the body mass index decreased significantly by 0.56 kg/m 2 on average and further 0.088 kg/m 2 by the end of the second year, the waist line first did not change significantly then decreased 0.04 cm. The rest systolic blood pressure cut down significantly on average 5.9 Hg mm in the first year, and more 0.11 Hg mm by the end of second year. The metabolic parameters also decreased significantly: total cholesterin 0.23 mmol/l in the first year, 0.07 mmol/l in the second year, triglyceride: 0.18 mmol/l; 0.08 mmol/l, blood glucose: 0.15 mmol/l; 0.19 mmol/l. The level of HDL did not change. It is very important for management of overweight and obesity that patients adopt changes of life style. The authors' results show that these patients must be followed very strictly.
Lichwala-Zyla, Christine; Price, James H.; Dake, Joseph A.; Jordan, Timothy; Price, Joy Ann
Objective: This study identified psychiatrists' perceptions and practices regarding advising and treating obese patients. Methods: Questionnaires were mailed to a national random sample of 500 members of APA. A three-wave mailing was used to maximize the return rate. The questionnaire contained items on weight control based on the Stages of Change…
Lichwala-Zyla, Christine; Price, James H.; Dake, Joseph A.; Jordan, Timothy; Price, Joy Ann
Objective: This study identified psychiatrists' perceptions and practices regarding advising and treating obese patients. Methods: Questionnaires were mailed to a national random sample of 500 members of APA. A three-wave mailing was used to maximize the return rate. The questionnaire contained items on weight control based on the Stages of Change…
Peart, Tasha; de Leon Siantz, MaryLou
Though many studies have examined the level of physician obesity prevention counseling among the general population, little is known about how homeless patients are advised about healthy eating and physical activity by their health care provider. The homeless are an at-risk population with whom physicians and other health professionals can play a…
Mokhlesi, Babak; Kryger, Meir H.; Grunstein, Ronald R.
Obesity hypoventilation syndrome (OHS) is characterized by obesity, daytime hypercapnia, and sleep-disordered breathing in the absence of significant lung or respiratory muscle disease. Compared with eucapnic morbidly obese patients and eucapnic patients with sleep-disordered breathing, patients with OHS have increased health care expenses and are at higher risk of developing serious cardiovascular disease leading to early mortality. Despite the significant morbidity and mortality associated with this syndrome, diagnosis and institution of effective treatment occur late in the course of the syndrome. Given that the prevalence of extreme obesity has increased considerably, it is likely that clinicians will encounter patients with OHS in their clinical practice. Therefore maintaining a high index of suspicion can lead to early recognition and treatment reducing the high burden of morbidity and mortality and related health care expenditure associated with undiagnosed and untreated OHS. In this review we define the clinical characteristics of the syndrome and review the pathophysiology, morbidity, and mortality associated with it. Last, we discuss currently available treatment modalities. PMID:18250215
Simmons, Jon D; Duchesne, Juan C; Ahmed, Naveed; Schmieg, Robert E; Rushton, Fred W; Porter, John M; Mitchell, Marc E
Clinical obesity is an epidemic problem in the United States. The impact of this disease upon traumatic lower extremity vascular injuries (LEVI) is as yet undefined. We hypothesized that clinical obesity adversely affects outcome in patients with traumatic LEVI. All adult patients admitted over a 5-year period with a traumatic LEVI were identified. Clinical obesity was defined as body mass index (BMI)>30. Obese and non-obese patient groups were compared for surgical management and outcome. A total of 145 patients were identified. BMI data were available for 115 (79.3%) of these patients (obese n=47; non-obese n=68). Obese and non-obese groups were similar. Obese patients underwent more vascular repairs but the amputation rate and mortality were not significantly different. While obese body habitus can increase the complexity of evaluation and management of patients with LEVI, we have demonstrated that equivalent outcomes to the non-obese population can be achieved for the clinically obese patient with a BMI>30. However, patients with a BMI>40 did reveal a significantly higher chance of amputation and death after LEVI. Due to the small number of patients in this subset, one should use caution when interpreting this data. Copyright © 2010 Elsevier Ltd. All rights reserved.
Chen, Ke; Pan, Yu; Zhai, Shu-Ting; Cai, Jia-Qin; Chen, Qi-Long; Chen, Ding-Wei; Zhu, Yi-Ping; Zhang, Yu; Zhang, Ya-Ping; Maher, Hendi; Wang, Xian-Fa
Obesity is a growing epidemic around the world, and obese patients are generally regarded as high risk for surgery compared with normal weight patients. The purpose of this study was to evaluate the influence of obesity on the surgical outcomes of laparoscopic gastrectomy (LG) for gastric cancer. We reviewed data for all patients undergoing LG for gastric cancer at our institute between October 2004 and December 2016. Patients were divided into non-obese and obese groups and the perioperative outcomes were compared. Furthermore, a subgroup analysis was conducted to evaluate which of the two commonly used methods of LG, laparoscopic-assisted gastrectomy (LAG) and totally laparoscopic gastrectomy (TLG), is more suitable for obese patients. A total of 1691 patients, 1255 non-obese and 436 obese or overweight patients, underwent LG during the study period. The mean operation time was significantly longer in the obese group than in the non-obese group (209.9 ± 29.7 vs. 227.2 ± 25.7 min, P < 0.01), and intraoperative blood loss was significantly lower in the non-obese group (113.4 ± 34.1 vs. 136.9 ± 36.7 ml, P < 0.01). Time to first flatus, time to oral intake, and postoperative hospital stay were significantly shorter in the non-obese group than in the obese group (3.3 ± 0.8 vs. 3.6 ± 0.9 days; 4.3 ± 1.0 vs. 4.6 ± 1.0 days; and 9.0 ± 2.2 vs. 9.6 ± 2.2 days, respectively; P < 0.01). 119 (9.5%) of the non-obese patients had postoperative complications as compared to 44 (10.1%) of the obese patients (P = 0.71). In the subgroup analysis of all patients, TLG showed improved results for early surgical outcomes compared to LAG, mainly due to its advantages in obese patients. Obesity is associated with long operation time, increased blood loss, and slow recovery after laparoscopic gastric resection but does not affect intraoperative security or effectiveness. TLG may have less negative results in obese patients than LAG due to a
Koerner, John D; Patel, Neeraj M; Yoon, Richard S; Gage, Mark J; Donegan, Derek J; Liporace, Frank A
Intramedullary nailing (IMN) of obese patients with femoral fractures can be difficult due to soft tissue considerations and overall body habitus. Complications including malrotation can occur and have significant impact on postoperative function. The purpose of this study was to evaluate femoral rotation after intramedullary nailing of obese and non-obese patients to see if there was a difference in rotation, complications and any risk factors for malrotation. Between 2000 and 2009, 417 consecutive patients with femur fractures treated with IM nail at Level I trauma and tertiary referral center. Of these, 335 with postoperative computed tomography (CT) scanogram of the bilateral lower extremities were included in this study. Baseline demographic, perioperative and postoperative femoral version calculations were included in the dataset. Statistical analysis included chi-squared test for categorical data, t-test for continuous data, and univariate and multivariate regression analysis. Significance was set at p<0.05. Of the 417 patients with femur fractures between 2000 and 2009, 335 met criteria for this study. There were 111 patients with a BMI <25, 129 with BMI 25-29.9, and 95 patients with a BMI >30. When BMI was categorised into 3 groups (<25, 25-29.9, or 30+), none of these groups were predictive of version in univariate or multivariate regressions. Among only obese patients (BMI 30+), BMI of 35+ was not a significant predictor of version when compared to BMI 30-34.9. There were no significant differences in femoral version based on entry point (antegrade vs. retrograde) in any BMI category. There were also no significant difference between groups of patients with a DFV of >15̊ (p=0.212). Based on this study, BMI did not have an effect on postoperative difference in femoral version. In fact, in our multivariate regression analysis, BMI of over 30 was actually predictive of significantly lower difference in femoral version. While other studies have documented
Nesbit, K C; Kolobe, T H; Sisson, S B; Ghement, I R
The relationships between environmental correlates of adolescent obesity are complex and not yet well defined by current research, especially when considering age and gender. The purpose of this study was to test a model of proximal (home) and distal (neighbourhood) environmental correlates of obesity for adolescent age and gender groups. This was a descriptive, cross-sectional study, using the 2007 National Survey of Children's Health of 39 542 children ages 11-17 years. The model fit the data well for early adolescents (ages 11-14 years) (root mean square standard error of approximation [RMSEA] 0.040, 90% confidence interval [CI]: 0.039-0.041; comparative fit index [CFI] 0.947; Tucker-Lewis index [TLI] 0.929) and middle adolescents (ages 15-17 years) (RMSEA 0.037, 90% CI: 0.036-0.038; CFI 0.052; TLI 0.937). The model also fit the data well for boy adolescents (RMSEA 0.038, 90% CI: 0.037-0.039; CFI 0.951; TLI 0.935) and girl adolescents (RMSEA 0.038, 90% CI: 0.037-0.040; CFI 0.949; TLI 0.932). All models provide loadings of the environmental correlates of adolescent obesity for specific age and gender groups that can be used for early identification of risks and targeted interventions. © 2014 World Obesity.
Layegh, Parvin; Mousavi, Zohreh; Farrokh Tehrani, Donya; Parizadeh, Seyed Mohammad Reza; Khajedaluee, Mohammad
Background: Insulin resistance has an important role in pathophysiology of polycystic ovarian syndrome (PCOS). Yet there are certain controversies regarding the presence of insulin resistance in non-obese patients. Objective: The aim was to compare the insulin resistance and various endocrine and metabolic abnormalities in obese and non-obese PCOS women. Materials and Methods: In this cross-sectional study which was performed from 2007-2010, 115 PCOS patients, aged 16-45 years were enrolled. Seventy patients were obese (BMI ≥25) and 45 patients were non-obese (BMI <25). Presence of insulin resistance and endocrine-metabolic abnormalities were compared between two groups. Collected data were analyzed with SPSS version 16.0 and p<0.05 was considered as statistically significant. Results: There was no significant difference in presence of insulin resistance (HOMA-IR >2.3) between two groups (p=0.357). Waist circumference (p<0.001), waist/hip ratio (p<0.001), systolic (p<0.001) and diastolic (p<0.001) blood pressures, fasting blood sugar (p=0.003) and insulin (p=0.011), HOMA-IR (p=0.004), total cholesterol (p=0.001) and triglyceride (p<0.001) were all significantly higher in obese PCOS patients. There was no significant difference in total testosterone (p=0.634) and androstenedione (p=0.736) between groups whereas Dehydroepiandrotendione sulfate (DHEAS) was significantly higher in non-obese PCOS women (p=0.018). There was no case of fatty liver and metabolic syndrome in non-obese patients, whereas they were seen in 31.3% and 39.4% of obese PCOS women, respectively. Conclusion: Our study showed that metabolic abnormalities are more prevalent in obese PCOS women, but adrenal axis activity that is reflected in higher levels of DHEAS was more commonly pronounced in our non-obese PCOS patients. PMID:27351028
Layegh, Parvin; Mousavi, Zohreh; Farrokh Tehrani, Donya; Parizadeh, Seyed Mohammad Reza; Khajedaluee, Mohammad
Insulin resistance has an important role in pathophysiology of polycystic ovarian syndrome (PCOS). Yet there are certain controversies regarding the presence of insulin resistance in non-obese patients. The aim was to compare the insulin resistance and various endocrine and metabolic abnormalities in obese and non-obese PCOS women. In this cross-sectional study which was performed from 2007-2010, 115 PCOS patients, aged 16-45 years were enrolled. Seventy patients were obese (BMI ≥25) and 45 patients were non-obese (BMI <25). Presence of insulin resistance and endocrine-metabolic abnormalities were compared between two groups. Collected data were analyzed with SPSS version 16.0 and p<0.05 was considered as statistically significant. There was no significant difference in presence of insulin resistance (HOMA-IR >2.3) between two groups (p=0.357). Waist circumference (p<0.001), waist/hip ratio (p<0.001), systolic (p<0.001) and diastolic (p<0.001) blood pressures, fasting blood sugar (p=0.003) and insulin (p=0.011), HOMA-IR (p=0.004), total cholesterol (p=0.001) and triglyceride (p<0.001) were all significantly higher in obese PCOS patients. There was no significant difference in total testosterone (p=0.634) and androstenedione (p=0.736) between groups whereas Dehydroepiandrotendione sulfate (DHEAS) was significantly higher in non-obese PCOS women (p=0.018). There was no case of fatty liver and metabolic syndrome in non-obese patients, whereas they were seen in 31.3% and 39.4% of obese PCOS women, respectively. Our study showed that metabolic abnormalities are more prevalent in obese PCOS women, but adrenal axis activity that is reflected in higher levels of DHEAS was more commonly pronounced in our non-obese PCOS patients.
Noureldein, Mohamed H; Abd El-Razek, Rania S; El-Hefnawy, Mohamed H; El-Mesallamy, Hala O
The aim of the current study is to investigate the effect of fenofibrate alone and in combination with pioglitazone on serum sirtuin 1 and fetuin A of obese patients with Type 2 Diabetes Mellitus (T2DM). Intervention effect on inflammatory parameters was assessed before and after treatment. The study was conducted on 60 postmenopausal females of whom, only 44 patients completed the study. They were distributed as follows; obese patients without T2DM (n=15) who administered fenofibrate (160 mg/day) once for 8 weeks, obese patients with T2DM (n=15) who administered fenofibrate (160 mg/day) once for 8 weeks, obese patients with T2DM (n=14) who administered fenofibrate (160 mg/day) and pioglitazone (15 mg/day) combination once for 8 weeks. We measured fasting plasma glucose, glycated hemoglobin (HbA1c), serum lipids. Inflammatory markers (high sensitivity C-reactive protein "hs-CRP", interleukin-6 "IL-6", fetuin A, and sirtuin 1) of patients were measured in serum using enzyme-linked immunoassay (ELISA) kits. Sirtuin 1 levels in obese patients with T2DM were significantly lower than its levels in obese patients while fetuin A levels were significantly higher (P<0.001). Fenofibrate, alone and in combination with pioglitazone, significantly decreased triacylglycerol, hs-CRP, IL-6, fetuin A and increased sirtuin 1 levels (P<0.001) which suggests that it can be used to delay the complications of obesity and T2DM. There is a strong correlation between fetuin A, sirtuin 1, IL-6 and hs-CRP levels suggesting a shared common pathway. Fenofibrate was shown to increase serum sirtuin 1 and decrease serum fetuin A levels in obese patients. PACTR201407000856135. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Popovic, Miroslav D.; Banicevic, Arnela Ceric; Popovic, Biljana; Ceric, Amela; Banicevic, Andrija; Popadic, Danijela
ABSTRACT Our 60-year-old patient menarche in 13-year, two delivery, last menstruation in 53-year, without uterine bleeding or any kind of symptomatology. The gynecological transvaginal ultrasound examination showed hyperplasio endometrii (20mm). After curettage, pathological examination was diagnostic polypus carcinomatoides. The patient with HTA and obesity was admitted to and operated on at the Gynecological Department due to endometrial carcinoma (FIGO stage IA1). Because of her giant obesity, BMI – 71.50 kg/m2, weight 219 kg and height 175cm, surgery by the abdominal approach was very difficult to perform, so vaginal hysterectomy was carried out. The procedure was completed within 127 minutes without any intraoperative complications. Blood loss was less than 100ml. The patient was discharged on postoperative day 7. The patient was followed up for 6 months after surgery. No complications or recurrence were reported during the 6-month follow up. PMID:24783920
Popovic, Miroslav D; Banicevic, Arnela Ceric; Popovic, Biljana; Ceric, Amela; Banicevic, Andrija; Popadic, Danijela
Our 60-year-old patient menarche in 13-year, two delivery, last menstruation in 53-year, without uterine bleeding or any kind of symptomatology. The gynecological transvaginal ultrasound examination showed hyperplasio endometrii (20 mm). After curettage, pathological examination was diagnostic polypus carcinomatoides. The patient with HTA and obesity was admitted to and operated on at the Gynecological Department due to endometrial carcinoma (FIGO stage IA1). Because of her giant obesity, BMI - 71.50 kg/m2, weight 219 kg and height 175 cm, surgery by the abdominal approach was very difficult to perform, so vaginal hysterectomy was carried out. The procedure was completed within 127 minutes without any intraoperative complications. Blood loss was less than 100 ml. The patient was discharged on postoperative day 7. The patient was followed up for 6 months after surgery. No complications or recurrence were reported during the 6-month follow up.
Li, Qiongzhen; Chen, Dachuan; Liu, Tiebang; Walss-Bass, Consuelo; de Quevedo, Joao L; Soares, Jair C; Zhao, Jingping; Zhang, Xiang Yang
Sex differences in schizophrenia have been well recognized. However, sex differences in obesity associated with antipsychotics have received little systematic study. This study was conducted to compare sex difference effects of antipsychotics and related risk factors on obesity and body mass index (BMI) in Chinese patients with schizophrenia. A total of 204 inpatients with chronic schizophrenia (males/females = 140/66) were recruited. Demographic and clinical data were collected, and serum glucose and lipid levels were measured. The Positive and Negative Syndrome Scale (PANSS) was used to assess patients' psychopathology. The prevalence of obesity in female patients (21/66, 31.82%) was approximately 2 times that of male patients (22/140, 15.83%; P < 0.001) and women also had higher BMI than men (25.49 ± 4.42 kg/m versus 23.95 ± 3.67 kg/m; P < 0.005). Regression analyses showed that obesity was associated with type 2 diabetes (P < 0.05) and triglycerides (P < 0.05) in women, and limited to triglyceride in men (P < 0.01). Further correlation analysis showed that BMI was associated with the PANSS negative symptom subscore (P < 0.001) and the PANSS total score (P < 0.01) in men. In addition, women had higher low-density lipoprotein plasma levels than men. Our findings suggest that there are significant sex differences in bodyweight and obesity in chronic medicated patients with schizophrenia, with worse lipid metabolic dysfunction in female patients.
Gylen, Elena; Anttalainen, Ulla; Saaresranta, Tarja
Short sleep duration has been linked with obesity in general population, but this issue has not been addressed in patients with obstructive sleep apnoea syndrome (OSAS) separately. Depressive symptoms are frequent in OSAS and may affect sleep and energy balance. Our purpose was to assess the association of habitual sleep duration, psychological distress, depressive symptoms, and excessive daytime sleepiness with measures of obesity in patients with OSAS. 210 middle aged consecutive patients (111 men and 99 women) referred for evaluation of suspected OSAS were divided into subgroups based on apnoea-hypopnoea index (AHI) and treatment suggested by a sleep physician. OSAS (AHI>5/h plus symptoms) was diagnosed in 75.7% of the patients. Their sleep duration correlated negatively with psychological distress (r=-0.22, p=0.043) and depressive symptoms (r=-0.27, p=0.013) in men. No association was found between self-reported habitual sleep duration and measures of obesity or subjective sleepiness. In patients considered for CPAP therapy, sleep duration associated inversely with depressive symptoms both in men (r=-0.28, p=0.024) and women (r=-0.33, p=0.037). After adjusting for age and Epworth Sleepiness Score, the results remained essentially similar. Our results suggest that self-reported habitual sleep duration does not associate with obesity in patients with OSAS. Shorter habitual sleep duration seems to associate with higher scores of depressive symptoms and psychological distress. Copyright © 2013 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.
Pakradouni, Jihane; Le Goff, Wilfried; Calmel, Claire; Antoine, Bénédicte; Villard, Elise; Frisdal, Eric; Abifadel, Marianne; Tordjman, Joan; Poitou, Christine; Bonnefont-Rousselot, Dominique; Bittar, Randa; Bruckert, Eric; Clément, Karine; Fève, Bruno; Martinerie, Cécile; Guérin, Maryse
Objective Evidence points to a founder of the multifunctional CCN family, NOV/CCN3, as a circulating molecule involved in cardiac development, vascular homeostasis and inflammation. No data are available on the relationship between plasma NOV/CCN3 levels and cardiovascular risk factors in humans. This study investigated the possible relationship between plasma NOV levels and cardiovascular risk factors in humans. Methods NOV levels were measured in the plasma from 594 adults with a hyperlipidemia history and/or with lipid-lowering therapy and/or a body mass index (BMI) >30 kg/m2. Correlations were measured between NOV plasma levels and various parameters, including BMI, fat mass, and plasma triglycerides, cholesterol, glucose, and C-reactive protein. NOV expression was also evaluated in adipose tissue from obese patients and rodents and in primary cultures of adipocytes and macrophages. Results After full multivariate adjustment, we detected a strong positive correlation between plasma NOV and BMI (r = 0.36 p<0.0001) and fat mass (r = 0.33 p<0.0005). According to quintiles, this relationship appeared to be linear. NOV levels were also positively correlated with C-reactive protein but not with total cholesterol, LDL-C or blood glucose. In patients with drastic weight loss induced by Roux-en-Y bariatric surgery, circulating NOV levels decreased by 28% (p<0.02) and 48% (p<0.0001) after 3 and 6 months, respectively, following surgery. In adipose tissue from obese patients, and in human primary cultures NOV protein was detected in adipocytes and macrophages. In mice fed a high fat diet NOV plasma levels and its expression in adipose tissue were also significantly increased compared to controls fed a standard diet. Conclusion Our results strongly suggest that in obese humans and mice plasma NOV levels positively correlated with NOV expression in adipose tissue, and support a possible contribution of NOV to obesity-related inflammation. PMID:23785511
Li, Jiayu; Zhou, Changyu; Li, Jiarui; Su, Ziyuan; Sang, Haiyan; Jia, Erna; Si, Daoyuan
Obesity is an increasing health problem associated with major adverse consequences for human health. MicroRNAs (miRNAs), small endogenous non-coding RNAs, regulate the expression of genes that play roles in human body via posttranscriptional inhibition. To identify the miRNAs and their target genes involved in obesity, we downloaded the miRNA and gene expression profiles from gene expression omnibus (GEO) database and analyzed the differentially expressed miRNAs (DEMs) and differentially expressed genes (DEGs) in adipose tissues from obese subjects compared to those from non-obese subjects. Then, we constructed the miRNA-target interaction network and conducted functional enrichment analysis of DEGs, and the targets negatively correlated with DEMs. We identified a total of 16 miRNAs and 192 genes that showed a significantly different expression and 3002 miRNA-target interaction pairs, including 182 regulatory pairs in obesity. Target genes of DEMs were found mainly enriched in several functions, such as collagen fibril organization, extracellular matrix part, and extracellular matrix structural constituent. Moreover, hsa-miR-425 and hsa-miR-126 had a significant number of target genes and hsa-miR-16/COL12A1 and hsa-miR-634/SLC4A4 interaction pairs are significantly co-expressed, suggesting that they might play important roles in the pathogenesis of obesity. Our study provides a bioinformatic basis for further research of molecular mechanism in obesity. Copyright © 2014 Elsevier GmbH. All rights reserved.
Castillo-Hernandez, Jesus; Maldonado-Cervantes, Martha Imelda; Reyes, Juan Pablo; Patiño-Marin, Nuria; Maldonado-Cervantes, Enrique; Solorzano-Rodriguez, Claudia; de la Cruz Mendoza, Esperanza; Alvarado-Sanchez, Brenda
Systemic blockade of TNF-α in Rheumatoid arthritis (RA) with insulin resistance (IR) seems to produce more improvement in insulin sensitivity in normal weight patients with RA than in obese patients with RA, suggesting that systemic-inflammation and obesity are independent risk factors for IR in RA patients. To evaluate the insulin resistance in: normal weight patients with RA (RA NW), overweight patients with RA (RA OW), obese RA patients (RA OB), and matched control subjects with normal weight (NW) and obesity (OB); and its association with major cytokines involved in the pathogenesis of the disease. Assessments included: body mass index (BMI), insulin resistance by HOMA-IR, ELISA method, and enzymatic colorimetric assay. Outstanding results from these studies include: (1) In RA patients, IR was well correlated with Body Mass Index (the higher the BMI, the higher IR), but not with levels of serum cytokines. In fact, levels of cytokines were similar in all RA patients, regardless of being obese, overweight or normal weight (2) IR was significantly higher in RA NW than in NW (3) No significant difference was observed between IRs of RA OB and OB (4) As expected, levels of circulating cytokines were significantly higher in RA patients than in OB. Obesity appears to be a dominant condition above inflammation to produce IR in RA patients. The dissociation of the inflammation and obesity components to produce IR suggests the need of an independent therapeutic strategy in obese patients with RA. Copyright © 2016. Published by Elsevier Editora Ltda.
Gardner, Lea Anne
The Pennsylvania Patient Safety Reporting System is a confidential, statewide Internet reporting system to which all Pennsylvania hospitals, outpatient-surgery facilities, and birthing centers, as well as some abortion facilities, must file information on medical errors.Safety Monitor is a column from Pennsylvania's Patient Safety Authority, the authority that informs nurses on issues that can affect patient safety and presents strategies they can easily integrate into practice. For more information on the authority, visit www.patientsafetyauthority.org. For the original article discussed in this column or for other articles on patient safety, click on "Patient Safety Advisories" and then "Advisory Library" in the left-hand navigation menu.
Scheen, A J; Rorive, M; Letiexhe, M; Devoitille, L; Jandrain, B
Obesity is a mulfactorial disease whose prevalence is progressively increasing. Ideally, it requires a multidisciplinary management by medical doctors, dieticians, psychologists and kinetherapists. The new "Centre de l'Obésité" at the University of Liège aims at fulfilling such objectives with: 1) a first outpatient visit including the simultaneous participation of an endocrinologist, a dietician and a psychologist; 2) a structured and individualized programme of physical rehabilitation; 3) an individualized management of obese subjects as in-(hospital) and/or outpatients, using medical and/or surgical approaches; and 4) an opportunity to benefit of other specialized medical advices, if necessary, in order to increase both the efficacy and safety of the treatment. Owing to the increasing importance of obesity and the well-known difficulties to succeed in treating it, general practitioners should consider this new centre as a valuable help rather than a competitive structure for the management of their patients, especially those with severe or morbid obesity.
Sert, Ahmet; Aslan, Eyup; Buyukınan, Muammer; Pirgon, Ozgur
P-wave dispersion is a new and simple electrocardiographic marker that has been reported to be associated with inhomogeneous and discontinuous propagation of sinus impulses. In the present study, we evaluated P-wave dispersion in obese adolescents and investigated the relationship between P-wave dispersion, cardiovascular risk factors, and echocardiographic parameters. We carried out a case-control study comparing 150 obese adolescents and 50 healthy controls. Maximum and minimum P-wave durations were measured using a 12-lead surface electrocardiogram, and P-wave dispersion was calculated as the difference between these two measures. Echocardiographic examination was also performed for each subject. Multivariate linear regression analysis with stepwise variable selection was used to evaluate parameters associated with increased P-wave dispersion in obese subjects. Maximum P-wave duration and P-wave dispersion were significantly higher in obese adolescents than control subjects (143±19 ms versus 117±20 ms and 49±15 ms versus 29±9 ms, p<0.0001 for both). P-wave dispersion was positively correlated with body mass index, waist and hip circumferences, systolic and diastolic blood pressures, total cholesterol, serum levels of low-density lipoprotein cholesterol, triglycerides, glucose, and insulin, homoeostasis model assessment for insulin resistance score, left ventricular mass, and left atrial dimension. P-wave dispersion was negatively correlated with high-density lipoprotein cholesterol levels. By multiple stepwise regression analysis, left atrial dimension (β: 0.252, p=0.008) and homoeostasis model assessment for insulin resistance (β: 0.205; p=0.009) were independently associated with increased P-wave dispersion in obese adolescents. Insulin resistance is a significant, independent predictor of P-wave dispersion in obese adolescents.
Westling, Agneta; Bergqvist, David; Boström, Annika; Karacagil, Sadettin; Gustavsson, Sven
The aim of this study was to investigate prospectively the incidence of deep venous thrombosis (DVT) after surgery for morbid obesity. The series comprised 116 consecutive patients undergoing Roux-en-Y gastric bypass. The median age and body mass index were 35 years (range 19-59 years) and 42 kg/m2 (range 32-68 kg/m2), respectively. The patients were examined with duplex ultrasonography pre- and postoperatively. No patient had any symptoms or signs of DVT postoperatively, and ultrasonography showed no signs of thrombosis in iliac, femoral, and popliteal veins in any of the patients. Two patients (1.7%) had a thrombus in the peroneal vein of one leg. Repeated ultrasonographic investigation after 1 week showed complete resolution of both. One patient with a previously unknown activated protein C resistance had an angiographically confirmed minor pulmonary embolus. The incidence of venous thromboembolism after obesity surgery seems to be low, and obesity as a risk factor for thromboembolic disease might have been overestimated in the past.
Galvão, Roberto; Plavnik, Frida Liane; Ribeiro, Fernando Flexa; Ajzen, Sérgio Aron; Christofalo, Dejaldo M de J; Kohlmann, Osvaldo
Obesity derived from intra-abdominal fat deposition tends to increase hormonal and cytokine production, thus worsening insulin sensitivity and leading to endothelial dysfunction. Hyperinsulinemia is considered an independent risk factor for ischemic heart disease and cause of endothelial dysfunction in healthy individuals. To assess the impact of different degrees of insulin resistance, measured by HOMA-IR (Homeostasis Model Assessment of Insulin Resistance), on endothelial function in obese, non-diabetic patients without prior history of cardiovascular events and different metabolic syndrome components. Forty obese individuals were submitted to anthropometric measurements, BP measurements at office and ABPM and laboratory tests, in addition to non-invasive ultrasound assessment of endothelial function. Patients were divided into 3 groups according to the level of insulin resistance: patients with HOMA-IR values from 0.590 to 1.082 were assigned to Group 1 (n=13), from 1.083 to 1.410 to Group 2 (n=14) and from 1.610 to 2.510 to Group 3 (n=13). We found a significant difference in flow-mediated dilation in group 3 compared to group 1 (9.2 ± 7.0 vs 18.0 ± 7.5 %, p=0.006). There was a negative correlation between endothelial function and insulin, HOMA-IR and triglycerides. Our data suggest that mild changes in insulin resistance levels assessed by HOMA-IR may have an impact on vasodilatatory endothelial function in uncomplicated obese individuals with different cardiovascular risk factors.
Miyahara, T; Mochinaga, S; Kimura, S; Aragane, N; Yakabe, T; Morita, S; Okudaira, K; Fujito, H
The American Society of Clinical Oncology recently published a Clinical Practice Guideline entitled "Appropriate Chemotherapy Dosing for Obesity Adult Patients with Cancer." The panel recommended that full weight (actual weight)-based cytotoxic chemotherapy doses are used to treat obese patients with cancer, particularly when the goal of treatment is cure. However, no study has examined dosage calculation methods used for obese cancer patients in Japan. Here, we retrospectively studied the relationships between chemotherapy dose intensity, the occurrence of adverse events, and treatment outcomes in obese patients undergoing chemotherapy. Patients were divided into two groups: the actual BW group (BWg) was composed of patients receiving dosage amounts calculated using their actual BW (n = 64), and the ideal BWg was composed of patients receiving dosage amounts calculated using their ideal BW (n = 41). There were significant differences in the incidence of Grade 3/4 hematological toxicity in the actual and ideal BWg in solid tumor patients, but not in patients with hematological malignancies. In solid tumor patients with ≥30 body mass index (BMI), the incidence of Grade 3/4 hematological toxicity was significantly lower in the ideal BWg than in the actual BWg. Particularly, in patients with complications, incidence of Grade 4 hematological toxicity was significantly higher in the actual BWg than in the ideal BWg. These results suggest that the tumor type, degree of obesity, complications, and choice of chemotherapy regimen should be considered when determining chemotherapy dosage for obese patients.
Sundaram, V; Kaung, A; Rajaram, A; Lu, S C; Tran, T T; Nissen, N N; Klein, A S; Jalan, R; Charlton, M R; Jeon, C Y
Infection is the most common cause of mortality in end-stage liver disease (ESLD). The impact of obesity on infection risk in ESLD is not established. To characterise the impact of obesity on infection risk in ESLD. We evaluated the association between infection and obesity in patients with ESLD. Patients grouped as non-obese, obesity class I-II and obesity class III were studied using the Nationwide Inpatient Sample. Validated diagnostic code based algorithms were utilised to determine weight category and infections, including bacteraemia, skin/soft tissue infection, urinary tract infection (UTI), pneumonia/respiratory infection, Clostridium difficile infection (CDI) and spontaneous bacterial peritonitis (SBP). Risk factors for infection and mortality were assessed using multivariable logistic regression analysis. Of 115 465 patients identified, 100 957 (87.5%) were non-obese and 14 508 (12.5%) were obese, with 9489 (8.2%) as obesity class I-II and 5019 (4.3%) as obesity class III. 37 117 patients (32.1%) had an infection diagnosis. Infection was most prevalent among obesity class III (44.0%), followed by obesity class I-II (38.9%) and then non-obese (31.9%). In multivariable modelling, class III obesity (OR = 1.41; 95% CI 1.32-1.51; P < 0.001), and class I-II obesity (OR = 1.08; 95% CI 1.01-1.15; P = 0.026) were associated with infection. Compared to non-obese patients, obese individuals had greater prevalence of bacteraemia, UTI, and skin/soft tissue infection as compared to non-obese patients. Obesity is newly identified to be independently associated with infection in end-stage liver disease. The distribution of infection sites varies based on weight category. © 2015 John Wiley & Sons Ltd.
Nascimento, Henrique; Rocha, Susana; Rego, Carla; Mansilha, Helena Ferreira; Quintanilha, Alexandre; Santos-Silva, Alice; Belo, Luís
Objectives: to evaluate whether total and differential WBC counts are altered in young obese patients (aged 6-12 years) and if a relationship exists between WBC counts and the severity of obesity as well as with CRP level. Materials and Methods: a group of 77 obese patients [32 males and 45 females] and 19 controls [7 males and 12 females] were studied. Total WBC count was performed by using an automatic blood cell counter. Blood cell morphology and WBC differential count were evaluated in Wright stained blood films. The plasma levels of CRP were evaluated by immunoturbidimetry. Results: obese participants presented with a statistically significant higher neutrophil percentage and CRP levels when compared to controls; the median CRP value was about 5 times higher than that observed in controls. Absolute neutrophil count and neutrophil/lymphocyte ratio were also higher in patients, though without statistical significance. The parameters that were statistically significant related with adiposity markers were neutrophil count and CRP levels. The neutrophil count was positively and statistically correlated with body mass index (BMI), BMI z-score, waist circumference and waist/height ratio, and also with CRP levels. In multiple regression analysis, the only variable that remained statistically associated with neutrophil count was CRP (neutrophil count = 2.612 + 0.439lnCRP; standardised coefficient/beta: 0.384, P=0.001). When performing multiple regression without CRP, the only variable that remained statistically associated with neutrophil count was BMI. Conclusions: our results demonstrated in obese patients aged 6-12 years, a significant change in the differential leukocyte count towards neutrophilia, together with a significant higher CRP concentration, and that absolute neutrophil count correlates with obesity markers and with CRP levels. Our data also indicate that neutrophil count, a current clinically used low-cost parameter, may be used as an obesity
Chacko, Sara A.; Chiodi, Sarah N.; Wee, Christina C.
Objective In clinical practice, behavioral approaches to obesity treatment focus heavily on diet and exercise recommendations. However, these approaches may not be effective for patients with disordered eating behaviors. Little is known about the prevalence of disordered eating behaviors in primary care patients with obesity or whether they affect difficulty making dietary changes. Methods We conducted a telephone interview of 337 primary care patients aged 18–65 years with BMI≥35kg/m2 in Greater-Boston, 2009–2011 (58% response rate, 69% women). We administered the Three-Factor Eating Questionnaire R-18 (Scores 0–100) and the Impact of Weight on Quality of Life-Lite (IWQOL-lite) (Scores 0–100). We measured difficulty making dietary changes using four questions regarding perceived difficulty changing diet (Scores 0–10). Results 50% of patients reported high emotional eating (score>50) and 28% reported high uncontrolled eating (score>50). Women were more likely to report emotional [OR=4.14 (2.90, 5.92)] and uncontrolled eating [OR=2.11 (1.44, 3.08)] than men. African Americans were less likely than Caucasians to report emotional [OR=0.29 (95% CI: 0.19, 0.44)] and uncontrolled eating [OR=0.11 (0.07, 0.19)]. For every 10-point reduction in QOL score (IWQOL-lite), emotional and uncontrolled eating scores rose significantly by 7.82 and 5.48, respectively. Furthermore, participants who reported emotional and uncontrolled eating reported greater difficulty making dietary changes. Conclusions Disordered eating behaviors are prevalent among obese primary care patients and disproportionately affect women, Caucasians, and patients with poor QOL. These eating behaviors may impair patients' ability to make clinically recommended dietary changes. Clinicians should consider screening for disordered eating behaviors and tailoring obesity treatment accordingly. PMID:25572624
Obesity means having too much body fat. It is different from being overweight, which means weighing too ... what's considered healthy for his or her height. Obesity occurs over time when you eat more calories ...
Nino, Gustavo; Gutierrez, Maria J.; Ravindra, Anjani; Nino, Cesar L.; Rodriguez-Martinez, Carlos E.
Background. Obese adolescents with Obstructive Sleep Apnea (OSA) have a unique pathophysiology that combines adenotonsillar hypertrophy and increased visceral fat distribution. We hypothesized that in this population waist circumference (WC), as a clinical marker of abdominal fat distribution, correlates with the likelihood of response to AT. Methods. We conducted a retrospective cohort study of obese adolescents (BMI ≥ 97th percentile) that underwent AT for therapy of severe OSA (n = 21). We contrasted WC and covariates in a group of subjects that had complete resolution of severe OSA after AT (n = 7) with those obtained in subjects with residual OSA after AT (n = 14). Multivariate linear and logistic models were built to control possible confounders. Results. WC correlated negatively with a positive AT response in young adolescents and the percentage of improvement in obstructive apnea-hypopnea index (OAHI) after AT (P ≤ 0.01). Extended multivariate analysis demonstrated that the link between WC and AT response was independent of demographic variables, OSA severity, clinical upper airway assessment, obesity severity (BMI), and neck circumference (NC). Conclusion. The results suggest that in obese adolescents, abdominal fat distribution determined by WC may be a useful clinical predictor for residual OSA after AT. PMID:23251797
Ruiz de Angulo, David; Munitiz, Vicente; Ortiz, M Ángeles; Martínez de Haro, Luisa F; Frutos, M Dolores; Hernández, Antonio; Parrilla, Pascual
Communication between the bariatric surgeon and the obese patient is very important as it influences the expectations of patients with regard to surgery, aim of the surgery and the understanding of the mechanisms of failure of surgery. Furthermore, the incidence of certain psychopathology in these patients makes it necessary for the surgeon to have the ability to communicate to the patient the need for motivation and the maintenance of healthy life habits. Although the topic is subjective, in this article we review several useful recommendations to optimize communication before and after surgery. Finally, we emphasize the need to create workshops to train the bariatric surgeon in these issues that we consider so important.
Vanguri, Poornima; Brengman, Matthew; Oiticica, Claudio; Wickham, Edmond; Bean, Melanie; Lanning, David
Childhood obesity is a significant problem. Due in part to suboptimal weight loss with lifestyle intervention alone, bariatric surgery, combined with ongoing lifestyle changes, has become a favorable approach in adolescents with severe obesity and weight-related comorbidities and is associated with effective weight loss and reducing weight-related comorbidities. Laparoscopic greater curvature plication is a promising new bariatric surgical procedure that has been shown to be effective in adults with severe obesity but has not been evaluated in the adolescent population. Gastric plication may be a particularly attractive approach for the adolescent patient as it is potentially reversible, does not involve the surgical removal of tissue and is without a significant malabsorptive component. Our team has obtained approval from our Institutional Review Board to perform a laparoscopic greater curvature plication on 30 adolescent patients with severe obesity and study its effect on weight loss, metabolic effects, and psychological functioning in the setting of a multidisciplinary program. Results of this study, including comprehensive clinical and psychological data collected over a three and a half year span, will inform larger prospective investigations comparing the laparoscopic greater curvature plication and other bariatric operations in the adolescent population. PMID:24491365
Koutsoukou, A; Koulouris, N; Bekos, B; Sotiropoulou, C; Kosmas, E; Papadima, K; Roussos, C
Although obesity promotes tidal expiratory flow limitation (EFL), with concurrent dynamic hyperinflation (DH), intrinsic PEEP (PEEPi) and risk of low lung volume injury, the prevalence and magnitude of EFL, DH and PEEPi have not yet been studied in mechanically ventilated morbidly obese subjects. In 15 postoperative mechanically ventilated morbidly obese subjects, we assessed the prevalence of EFL [using the negative expiratory pressure (NEP) technique], PEEPi, DH, respiratory mechanics, arterial oxygenation and PEEPi inequality index as well as the levels of PEEP required to abolish EFL. In supine position at zero PEEP, 10 patients exhibited EFL with a significantly higher PEEPi and DH and a significantly lower PEEPi inequality index than found in the five non-EFL (NEFL) subjects. Impaired gas exchange was found in all cases without significant differences between the EFL and NEFL subjects. Application of 7.5 +/- 2.5 cm H2O of PEEP (range: 4-16) abolished EFL with a reduction of PEEPi and DH and an increase in FRC and the PEEPi inequality index but no significant effect on gas exchange. The present study indicates that: (a) on zero PEEP, EFL is present in most postoperative mechanically ventilated morbidly obese subjects; (b) EFL (and concurrent risk of low lung volume injury) is abolished with appropriate levels of PEEP; and (c) impaired gas exchange is common in these patients, probably mainly due to atelectasis.
Wardell, Stephan; Wall, Alastair; Bryce, Rhonda; Gjevre, John A; Laframboise, Karen; Reid, John Kilpatrick
Obesity rates are increasing worldwide, particularly in North America. The impact of obesity on the outcome of critically ill patients is unclear. A prospective observational cohort study of consecutive patients admitted to a tertiary critical care unit in Canada between January 10, 2008 and March 31, 2009 was conducted. Exclusion criteria were age <18 years, admission <24 h, planned cardiac surgery, pregnancy, significant ascites, unclosed surgical abdomen and brain death on admission. Height, weight and abdominal circumference were measured at the time of intensive care unit (ICU) admission. Coprimary end points were ICU mortality and a composite of ICU mortality, reintubation, ventilator-associated pneumonia, line sepsis and ICU readmission. Subjects were stratified as obese or nonobese, using two separate metrics: body mass index (BMI) ≥ 30 kg/m(2) and a novel measurement of 75th percentile for waist-to-height ratio (WHR). Among 449 subjects with a BMI ≥ 18.5 kg/m(2), both BMI and WHR were available for comparative analysis in 348 (77.5%). Neither measure of obesity was associated with the primary end points. BMI ≥ 3 0 kg/m(2) was associated with a lower odds of six-month mortality than the BMI <30 kg/m(2) group (adjusted OR 0.59 [95% CI 0.36 to 0.97]; P=0.04) but longer intubation times (adjusted RR 1.56 [95% CI 1.17 to 2.07]; P=0.003) and longer ICU length of stay (adjusted RR 1.67 [95% CI 1.21 to 2.31]; P=0.002). Conversely, measurement of 75th percentile for WHR was associated only with decreased ICU readmission (OR 0.23 [95% CI 0.07 to 0.79]; P=0.02). Obesity was not necessarily associated with worse outcomes in critically ill patients.
Aghamir, Seyed Mohammad Kazem; Mohseni, Mohammad Ghasem; Hosseini, Seyed Reza; Salavati, Alborz; Ganjali, Hossein; Fallah, Mohammad Ali; Rezaei, Hamed; Modaresi, Seyed Saeed
Regarding technical difficulties that obese body habitus might impose to percutaneous nephrolithotomy (PNL) success and higher risk of peri-operative complications in this group of patients, we decided to retrospectively gather data from our patients during past 8 years to determine the stone free and complication rates. Between January 2007-December 2015, seventy-eight obese patients with body mass index over 35 who had indication for PNL including stones larger than 2 cm in pelvi-calyceal system or smaller extracorporeal shock wave lithotripsy (ESWL) resistant stones or who were not a fit candidate for ESWL due to increased skin to target distance, with no contraindication of PNL (including bleeding diathesis, inability to be positioned in prone) were enrolled. They were randomly assigned to group 1 (standard PNL with nephrostomy and ureteral stent) or group 2 (totally tubeless PNL with no ureteral stent and no nephrostomy). The outcomes were compared. The transfusion rate, operation time, and the hemoglobin drop were same across the groups (p>0.05). Total analgesic use was equivalent of 33.8 vs. 14.7 mgs of morphine sulfate (18-77 mg) and was significantly lower in total tubeless group (p=0.001). Return to normal activity was described as total number of in-patient and outpatient days from time of admission to the point which the patients returns to normal life activity such as going to job or school and was 19.4 vs. 9.3 days (6-30 days, p=0.001). Totally tubeless PNL in obese subjects would have lower analgesic use and return to normal activity versus standard PNL. Totally tubeless PNL is recommended for obese patients.
Mohammed, Nadeem; Tang, Lihua; Jahangiri, Anisa; de Villiers, Willem; Eckhardt, Erik
OBJECTIVE High fat diets increase the risk for insulin resistance by promoting inflammation. The cause of inflammation is unclear, but germfree mouse studies have implicated commensal gut bacteria. We tested whether diet-induced obesity, diabetes, and inflammation are associated with anti-bacterial IgG. MATERIALS/METHODS Blood from lean and obese healthy volunteers or obese patients with diabetes were analyzed by ELISA for IgG against extracts of potentially pathogenic and pro-biotic strains of Escherichia coli (LF-82 and Nissle), Bacteroides thetaiotaomicron, and Lactobacillus acidophilus, and for circulating Tumor Necrosis Factor α (TNFα). C57Bl/6 mice were fed low- or high- fat diets (10 or 60% kcal from fat) for 10 weeks and tested for anti-bacterial IgG, bodyweight, fasting glucose, and inflammation. RESULTS Obese diabetic patients had significantly more IgG against extracts of E. coli LF-82 compared with lean controls, whereas IgG against extracts of the other bacteria was unchanged. Circulating TNFα was elevated and correlated with IgG against the LF-82 extract. Mice fed high-fat diets had increased fasting glucose levels, elevated TNFα and neutrophils, and significantly more IgG against the LF-82 extracts. CONCLUSIONS Diabetes in obesity is characterized by increased IgG against specific bacterial antigens. Specific commensal bacteria may mediate inflammatory effects of high-fat diets. PMID:22424821
Rotkegel, Sylwia; Chudek, Jerzy; Spiechowicz-Zaton, Urszula; Ficek, Rafal; Adamczak, Marcin; Wiecek, Andrzej
Experimental and clinical studies revealed contradictory data concerning the influence of renin-angiotensin-aldosterone (RAA) system activation on visfatin release. The aim of the present study was the assessment of the effect of dietary sodium restriction with RAA system activation on visfatin level in hypertensive and normotensive patients with visceral obesity. The study included 24 hypertensive patients with visceral obesity (12 women) and 22 normotensive subjects with visceral obesity (11 women) constituting the control group. Plasma renin activity, plasma insulin, aldosterone and visfatin levels were determined twice, on normal-salt diet after 6-8 h in recumbent position and the second time after 3 days of dietary sodium restriction and upright position for 2 h. Dietary compliance was controlled by 24 h natriuresis measurement. Hypertensive patients had significantly higher plasma visfatin level than the control group [11.0 (8.5-13.5) vs. 6.8 (6.0-7.6) ng/ml, p=0.003]. Dietary sodium restriction and upright position caused significant increase in PRA and plasma aldosterone level in both groups. While, plasma visfatin level remained unaffected. In the combined group plasma visfatin levels correlated with BMI (r=0.398), waist circumference (r=0.391), glucose (r=0.328), insulin (r=0.663), HOMA-IR (r=0.698), triglycerides (r=0.500) and CRP (r=0.546) but not with percentage of fat mass, percentage of trunk fat, and blood pressure values. 1) Increased plasma visfatin concentration may play a significant role in the pathogenesis of hypertension in patients with visceral obesity. 2) RAA system activation by dietary sodium restriction and upright position has no effect on plasma visfatin levels in subjects with visceral obesity. Copyright © 2013 S. Karger AG, Basel.
Rosen, L W; Aniskiewicz, A S
Fourteen morbidly obese women who were candidates for intestinal bypass surgery were compared in terms of psychosocial functioning and dietary behavior to 14 morbidly obese women who elected not to undergo the bypass procedure. Each patient underwent a psychiatric evaluation which included a developmental and dietary history, a mental status exam, and the administration of the MMPI. Diagnoses were based on the DSM-III multi-axial system. There was no difference between the bypass group and the non-bypass group on the Axis I diagnoses, however the bypass group did have a significantly higher frequency of Axis II diagnoses. The bypass group demonstrated significantly higher levels of psychosocial stressors (Axis IV) and lower levels of adaptive functioning (Axis V) when compared to the non-bypass group. The bypass patients also had a significantly higher frequency of past suicide attempts. On the MMPI, the bypass group had significantly higher elevations on scales 2 (depression), 4 (psychopathic deviate), 6 (paranoia), and 0 (social introversion). There were no significant differences between the groups in terms of dietary history and behavior, except that significantly fewer bypass patients could place a numerical estimate on their daily energy intake. These results were discussed in terms of their implications for the assessment and treatment of morbidly obese patients.
Lydecker, Janet A; Grilo, Carlos M
This study addressed gaps in the existing literature about correlates of parental perception of child weight using a community sample. This study evaluated how weight-status and its perception related to parents' personal and parenting attitudes/behaviors. Participants were parents (N = 1,007; 65.3% mothers, 34.4% fathers) of children 5 to 15 years old. Parents completed online measures of personal eating attitudes/behaviors, attitudes/behaviors about their children's eating and weight, and parental practices related to weight-related attitudes. Parents frequently underestimated children's overweight/obesity, even more frequently than their own overweight/obesity (P < 0.001). Parents' personal eating attitudes/behaviors were related to their own weight-status (P < 0.001) and perceived child weight-status (P < 0.001) but not actual child weight-status. Parents' child-focused eating attitudes/behaviors were related to actual (P < 0.001) and perceived child weight-status (P < 0.001), but not parent weight-status. In general, parents' personal attitudes/behaviors did not extend into their perceptions of their children's weight or their response to it. Results suggest a dual need to improve parent accuracy perceiving children's overweight/obesity and to guide parent responses to perceived overweight/obesity. Given the high prevalence of childhood obesity, and the serious consequences during childhood and into adulthood, further research is needed to enhance understanding of parents' specific needs to engage in prevention and treatment programs. © 2016 The Obesity Society.
Udo, Tomoko; White, Marney A; Lydecker, Janet L; Barnes, Rachel D; Genao, Inginia; Garcia, Rina; Masheb, Robin M; Grilo, Carlos M
This study examined racial differences in eating-disorder psychopathology, eating/weight-related histories, and biopsychosocial correlates in women (n = 53 Caucasian and n = 56 African American) with comorbid binge eating disorder (BED) and obesity seeking treatment in primary care settings. Caucasians reported significantly earlier onset of binge eating, dieting, and overweight, and greater number of times dieting than African American. The rate of metabolic syndrome did not differ by race. Caucasians had significantly elevated triglycerides whereas African Americans showed poorer glycaemic control (higher glycated haemoglobin A1c [HbA1c]), and significantly higher diastolic blood pressure. There were no significant racial differences in features of eating disorders, depressive symptoms, or mental and physical health functioning. The clinical presentation of eating-disorder psychopathology and associated psychosocial functioning differed little by race among obese women with BED seeking treatment in primary care settings. Clinicians should assess for and institute appropriate interventions for comorbid BED and obesity in both African American and Caucasian patients. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.
Ezri, T.; Gewürtz, G.; Sessler, D.I.; Medalion, B.; Szmuk, P.; Hagberg, C.; Susmallian, S.
Prediction of difficult laryngoscopy in obese patients is challenging. In 50 morbidly obese patients, we quantified the neck soft tissue from skin to anterior aspect of trachea at the vocal cords using ultrasound. Thyromental distance <6 cm, mouth opening <4 cm, limited neck mobility, Mallampati score >2, abnormal upper teeth, neck circumference >45 cm, and sleep apnoea were considered predictors of difficult laryngoscopy. Of the nine (18%) difficult laryngoscopy cases, seven had obstructive sleep apnoea history; whereas, only 2 of the 41 easy laryngoscopy patients did (P<0.001). Difficult laryngoscopy patients had larger neck circumference [50 (3.8) vs. 43.5 (2.2) cm; P<0.001] and more pre-tracheal soft tissue [28 (2.7) mm vs. 17.5 (1.8) mm; P<0.001] [mean (SD)]. Soft tissue values completely separated difficult and easy laryngoscopies. None of the other predictors correlated with difficult laryngoscopy. Thus, an abundance of pretracheal soft tissue at the level of vocal cords is a good predictor of difficult laryngoscopy in obese patients. PMID:14616599
Bulut, Cengiz; Helvaci, Aysen; Adas, Mine; Ozsoy, Neslihan; Bayyigit, Akif
In this study, we investigated the relationship between left ventricular mass and insulin resistance in obese patients. A total of 90 subjects, 66 women, and 24 men, with an age range from 24 to 56 years, were enrolled in the study. Forty-nine patients were in the obesity group whose body mass index (BMI) was >29.9kg/m(2) and 41 subjects were in the control group with a BMI <25kg/m(2). All of them were normotensive, nondiabetic, and did not have any cardiovascular disease. They were not taking any medication. Weight, height, and waist circumference were measured and BMI was calculated. Plasma glucose, insulin, serum total, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, and triglyceride levels were measured, and insulin resistance was calculated via homeostasis model of assessment-estimated insulin resistance (HOMA-IR). Subjects were examined by echocardiography and left ventricular mass (LVM) and index (LVMI) were calculated with Devereux formula. Insulin levels, HOMA-IR, LVM, and LVMI were significantly higher in obesity group (p<0.01). Fasting glucose, triglyceride, fasting insulin levels, and waist circumference did not correlate with LVMI. In conclusion, though findings of the present study suggest increased left ventricular hypertrophy (LVH) in obese subjects compared to controls, it appears that the increased LVM or LVH is not linked to BMI and insulin resistance in this study population. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.
Rodrigues, A M dos S; Martins, L B; Franklin, A M T; Candido, A L; dos Santos, L C; Ferreira, A V M
The high rates of overweight status observed in women with polycystic ovary syndrome (PCOS) may reflect dietary intake, and so it is important to investigate diet quality and its relationship with the rates of overweight status and obesity among these patients. A cross-sectional study was conducted in which 100 women with PCOS (Rotterdam criteria) were evaluated considering anthropometric and dietary data. The anthropometric evaluation included the measurement of weight, height, body mass index (BMI), waist circumference (WC), hip circumference and waist-hip ratio. Food intake data were collected from two 24-h dietary recalls to assess dietary patterns using the Brazilian Healthy Eating Index - Revised (BHEI-R). The anthropometric analysis indicated a high prevalence of overweight status, obesity and increased visceral fat (30.0%, 60.0% and 90.0%, respectively). The mean BHEI-R score was 56.1 ± 12.0 points (range 34.5-77.5 points). Diet quality was negatively correlated with obesity, which was evaluated by BMI (r = -0.248; P = 0.013) and WC (r = -0.278; P = 0.005). Dietary interventions focused on improvement of diet quality should be targeted to treat patients with PCOS because obesity in these women is associated with worsening endocrine, metabolic and reproductive functions. © 2014 The British Dietetic Association Ltd.
Sfasciotti, Gian Luca; Marini, Roberta; Pacifici, Andrea; Ierardo, Gaetano; Pacifici, Luciano; Polimeni, Antonella
Summary Objective The association between obesity and periodontitis has been extensively investigated in adults but not in young people. The aim of this study was to examine the association between overweight-obesity and periodontal disease in pediatric subjects. Methods Controlled cross-sectional study involving 100 school children of both gender (50 M and 50 F) between 7 and 12 years of age (mean age 9,19±1,57). Two groups were formed based on Body Mass Index value: test group with BMI ≥ 25 Kg/m2 and control group with BMI ≤ 24 Kg/m2. Diet intake and oral hygiene habits were recorded by a specific questionnaire and the periodontal clinical parameters were evaluated. Results The periodontal examination in the control group revealed a full-mouth plaque score (FMPS) value equal to 21.86% against 50.08% in the group of patients overweight/obese; the full-mouth bleeding score (FMBS) in the control group amounted to 12.7% against 26.24% of test group. No patient in either group included in the study presented a probing pocket depth (PPD) ≥3, so a significant difference regarding this value was not found. Regarding the frequency and quantity of food consumption, the number of obese patients who did not follow a balanced diet largely exceeded the number of normal-weight patients (70 versus 20%). Conclusions These results focus the attention on the negative impact of obesity on gingival health in young subjects, probably due to a combination of metabolic and inflammatory profiles and the result of a careless attitude towards prevention diseases of the oral cavity. PMID:28149453
Hanafy, Sherif; Pinsk, Maury; Jamali, Fakhreddin
Obesity is associated with an increased concentration of inflammatory mediators, which in turn, in adults, reduces the response to calcium channel blockers (CCBs). We reviewed the medical charts of 263 pediatric nephrology patients with renal conditions, with the aim of studying the effect of obesity on the response to L-type CCBs, angiotensin interrupting agents (ANGIs), or a combination of the two. Forty-eight patients were ultimately enrolled in the study: 25 obese and 23 non-obese patients. The effect of the treatments on lowering the blood pressure was compared in obese versus non-obese patients. The systolic response to CCBs, measured as at least a 10% reduction from the baseline, was significantly lower in the obese (12.5%) patients than in the non-obese (52.9%) ones. The differences in diastolic response (58.8 and 25% for non-obese and obese patients, respectively) did not reach significance. The percentage response to CCBs, however, was significantly less in the obese patients than in the non-obese patients for both systolic and diastolic blood pressure. Corticosteroids also significantly influenced the response to CCBs in terms of diastolic pressure (62.9 and 25% for non-obese and obese patients, respectively). None of the tested covariates, including obesity, was found to significantly influence the response to ANGIs alone or in various combinations with CCBs. In conclusion, obesity and corticosteroid therapy should be considered when initiating antihypertensive drug treatment in children with kidney disease as both may contribute to a reduced efficacy of the antihypertensive therapy.
Nesbit, Kathryn C; Kolobe, Thubi H; Sisson, Susan B; Ghement, Isabella R
The purpose of this study was to test a conceptual model of proximal (home) and distal (neighborhood) environmental correlates of adolescent obesity. This was a descriptive, cross-sectional study, using the 2007 National Survey of Children's Health, of 39,542 children aged 11-17 years. Structural equation modeling was used to test the fit of the model, identify direct and indirect effects of the proximal and distal environmental correlates, and determine reliabilities for latent constructs (Access to Physical Activity, Neighborhood Conditions, Social Capital Home Sedentary Behavior, and Physical Activity). The model fitted the data well (Root Mean Square Standard Error of Approximation: .038 (90% confidence interval .038-.039), Comparative Fit Index: .950, and Tucker-Lewis Index: .934). Access to Physical Activity, Social Capital, Home Sedentary Behavior, and Physical Activity had direct effects on obesity (-.026, p = .001; .061, p < .001; .110, p < .001; and -.119, p < .001, respectively). Neighborhood Condition had indirect effects on obesity through Access to Physical Activity, Social Capital, and Home Sedentary Behavior (-.001, p = .009; .032, p < .001; and .044, p < .001, respectively). Access to Physical Activity had indirect effects on obesity through Physical Activity, Social Capital, and Home Sedentary Behavior (-.013, p < .001; -.005, p < .001; and -.005, p = .003, respectively). Home Sedentary Behavior had indirect effect on obesity through Physical Activity (.052, p <.001). Results of this model fit to the U. S. population-based data suggest that interventions should target not only sedentary behavior and physical activity but also parent perceptions of safety, access to physical activity, and the neighborhood condition. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Cohen, Ricardo V.; Pinheiro, Jose C.; Schiavon, Carlos A.; Salles, João E.; Wajchenberg, Bernardo L.; Cummings, David E.
OBJECTIVE Roux-en-Y gastric bypass (RYGB) ameliorates type 2 diabetes in severely obese patients through mechanisms beyond just weight loss, and it may benefit less obese diabetic patients. We determined the long-term impact of RYGB on patients with diabetes and only class I obesity. RESEARCH DESIGN AND METHODS Sixty-six consecutively selected diabetic patients with BMI 30–35 kg/m2 underwent RYGB in a tertiary-care hospital and were prospectively studied for up to 6 years (median 5 years [range 1–6]), with 100% follow-up. Main outcome measures were safety and the percentage of patients experiencing diabetes remission (HbA1c <6.5% without diabetes medication). RESULTS Participants had severe, longstanding diabetes, with disease duration 12.5 ± 7.4 years and HbA1c 9.7 ± 1.5%, despite insulin and/or oral diabetes medication usage in everyone. For up to 6 years following RYGB, durable diabetes remission occurred in 88% of cases, with glycemic improvement in 11%. Mean HbA1c fell from 9.7 ± 1.5 to 5.9 ± 0.1% (P < 0.001), despite diabetes medication cessation in the majority. Weight loss failed to correlate with several measures of improved glucose homeostasis, consistent with weight-independent antidiabetes mechanisms of RYGB. C-peptide responses to glucose increased substantially, suggesting improved β-cell function. There was no mortality, major surgical morbidity, or excessive weight loss. Hypertension and dyslipidemia also improved, yielding 50–84% reductions in predicted 10-year cardiovascular disease risks of fatal and nonfatal coronary heart disease and stroke. CONCLUSIONS This is the largest, longest-term study examining RYGB for diabetic patients without severe obesity. RYGB safely and effectively ameliorated diabetes and associated comorbidities, reducing cardiovascular risk, in patients with a BMI of only 30–35 kg/m2. PMID:22723580
Usenko, O Yu; Gomolyako, I V; Kondratenko, B M; Moskalenko, V V
Results of morphological investigation of musculo-aponeurotic structures of anterior abdominal wall were presented in the morbid obesity patients. The role of obesity as a primary cause for morphofunctional insufficience of musculo-aponeurotic structures was established.
Bogdanov, A R; Derbeneva, S A; Strokova, T V; Surkov, A G; Kaganov, B S
Was investigated 471 patients with obesity and cardiovascular diseases. Direct dependence between degree of expressiveness of obesity and the clinical status, severity of infringement of a functional condition of cardiovascular system, frequency of development of complications is revealed.
Müller, Astrid; Claes, Laurence; Mitchell, James E; Fischer, Julia; Horbach, Thomas; de Zwaan, Martina
The objective of this study was to investigate the relationship between binge eating and temperament variables, controlling for depression and adult attention deficit/hyperactivity disorder (ADHD), in 90 extremely obese individuals. The participants completed questionnaires assessing eating pathology, reactive temperament, effortful control, depression and ADHD and were grouped based on the presence of regular binge eating. Patients reporting regular binge eating did not differ from patients not reporting regular binge eating with respect to BMI, age, gender, the occurrence of adult ADHD and reactive temperament. However, individuals with binge eating exhibited more pathological scores with regard to eating pathology, depression and effortful control. A logistic regression analysis revealed that only eating concerns and reduced effortful control remained significantly associated with regular binge eating. Binge eating in morbidly obese individuals appears to be associated with a lack of effortful control.
Masheb, Robin M; Roberto, Christina A; White, Marney A
The goal of this study was to examine the clinical utility of nibbling behavior, defined as eating in an unplanned and repetitious manner between meals and snacks without a sense of loss of control, in obese patients with Binge Eating Disorder (BED). Two-hundred seventeen (N = 217) consecutive, treatment-seeking, obese patients with BED were assessed with the Eating Disorder Examination (EDE). Nibbling frequency was examined in relation to current weight, eating disorder psychopathology and eating patterns. Results found that nibbling/picking was not related to body mass index, objective bulimic, subjective bulimic, or overeating episodes, food avoidance, sensitivity to weight gain, or any subscales of the EDE. However, nibbling/picking was significantly related to frequency of morning and afternoon snacking (r = .21, p = .002; r = .27, p < .001). The assessment of nibbling/picking behaviors among individuals with BED might not provide clinically significant information. © 2013.
Secombe, Paul; Harley, Simon; Chapman, Marianne; Aromataris, Edoardo
The objective of this review is to identify effective enteral nutritional regimens targeting protein and calorie delivery for the critically ill obese patient on morbidity and mortality.More specifically, the review question is:In the critically ill obese patient, what is the optimal enteral protein and calorie target that improves mortality and morbidity? The World Health Organization (WHO) defines obesity as abnormal or excessive fat accumulation that may impair health, or, empirically, as a body mass index (BMI) ≥ 30 kg/m. Twenty-eight percent of the Australian population is obese with the prevalence rising to 44% in rural areas, and there is evidence that rates of obesity are increasing. The prevalence of obese patients in intensive care largely mirrors that of the general population. There is concern, however, that this may also be rising. A recently published multi-center nutritional study of critically ill patients reported a mean BMI of 29 in their sample, suggesting that just under 50% of their intensive care population is obese. It is inevitable, therefore, that the intensivist will care for the critically ill obese patient.Managing the critically ill obese patient is challenging, not least due to the co-morbid diseases frequently associated with obesity, including diabetes mellitus, cardiovascular disease, dyslipidaemia, sleep disordered breathing and respiratory insufficiency, hepatic steatohepatitis, chronic kidney disease and hypertension. There is also evidence that metabolic processes differ in the obese patient, particularly those with underlying insulin resistance, itself a marker of the metabolic syndrome, which may predispose to futile cycling, altered fuel utilization and protein catabolism. These issues are compounded by altered drug pharmacokinetics, and the additional logistical issues associated with prophylactic, therapeutic and diagnostic interventions.It is entirely plausible that the altered metabolic processes observed in the obese
Barboza, Isabela Corrêa; Depes, Daniella de Batista; Vianna, Ilzo; Patriarca, Marisa Teresinha; Arruda, Raquel Martins; Martins, João Alfredo; Lopes, Reginaldo Guedes Coelho
ABSTRACT Objective To compare the endometrial echo values obtained by transvaginal ultrasonography with the body mass index of postmenopausal patients; to verify if there is higher prevalence of endometrial thickening in women with body mass index ≥30. Methods This is an analytical and cross-sectional study that evaluated 294 patients. Postmenopausal women were included, and those on hormone therapy were excluded. The variables evaluated were body mass index (considering obesity if >30), number of pregnancies, years since menopause, and age. These variables were correlated with endometrial echography. Results There was a statistically significant correlation between overweight and obese patients and increased endometrial thickness (p=0.0236). The correlation between age and endometrial echo was negative and statistically significant, that is, the older the woman, the lower the endometrial thickness (p=0.0478). Pregnancies and years since menopause showed no statistical significance in relation to endometrial echo, with p=0.0614 and p=0.115, respectively. Conclusion There was positive and significant correlation between body mass index ≥30 and endometrial thickeness. PMID:25003920
Pagotto, Uberto; Gambineri, Alessandra; Vicennati, Valentina; Heiman, Mark L; Tschöp, Matthias; Pasquali, Renato
In addition to its orexigenic properties, ghrelin has been shown to modulate the secretory pattern of pituitary hormones, and it may exert direct effects on peripheral organs such as the gonads and endocrine pancreas. To study possible interactions among ghrelin, glucose homeostasis, and the reproductive system, we investigated 10 obese women with polycystic ovary syndrome (OB-PCOS) in comparison with 10 age- and body mass index-matched obese subjects (OB). Plasma levels of insulin, glucose, androgens, and ghrelin were measured at baseline condition and after 7 months of therapy (hypocaloric diet + metformin or placebo). Plasma ghrelin levels were lower in OB-PCOS than in OB (P < 0.05). A strong negative correlation between ghrelin and androstenedione levels was found in both populations at baseline (OB-PCOS: P < 0.01; OB: P < 0.001) and after therapy (OB-PCOS: P < 0.01; OB: P < 0.05), whereas no correlation was found between ghrelin and other androgens. In both groups, the markers of insulin resistance in fasting and stimulated conditions (glucose/insulin ratio, homeostasis model insulin resistance index, homeostasis model applied to the oral glucose tolerance test) demonstrated decreased insulin sensitivity. However, a negative correlation between plasma ghrelin and all these markers was observed only in the OB-PCOS group (P < 0.05). Accordingly, a negative correlation between ghrelin variation and treatment-induced changes of the glucose/insulin ratio, HOMA-R, and HOMA(OGTT) was observed only in the OB-PCOS group (P < 0.05). In conclusion, OB-PCOS women have lower ghrelin levels than those expected based on the presence of obesity. Only in OB-PCOS, ghrelin negatively correlates with insulin sensitivity. In addition, regardless of the presence of PCOS, a marked negative correlation exists between ghrelin and androstenedione levels, suggestive of an interaction between ghrelin and steroid synthesis or action.
Agacayak, Elif; Tunc, Senem Yaman; Sak, Sibel; Basaranoglu, Serdar; Yüksel, Hatice; Turgut, Abdulkadir; Gul, Talip
We aimed to measure the levels of inflammatory markers and neopterin in obese and non-obese patients with PCOS by using 2 separate control groups with matching body mass index (BMI). A total of 60 women of reproductive age with (n=30) and without (n=30) PCOS were included in this study. Based on their BMI, patients with PCOS were divided into 2 groups as obese (n=15) and non-obese (n=15) PCOS groups. In addition, 2 BMI-matched control groups were formed. Neopterin, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (N/L ratio), and vitamin B12 were assessed by complete blood count. No significant difference was found between patients with PCOS and control subjects in neopterin, IL-6, TNF-α, and CRP levels. However, N/L ratio levels were significantly higher (p 0.045) and vitamin B12 levels were significantly lower (p 0.033) in patients with PCOS compared to control subjects. No statistically significant difference was found between obese and non-obese patients with PCOS and control subjects in neopterin, IL-6, TNF-α, and N/L ratio levels. However, CRP levels were significantly higher in obese patients with PCOS compared to obese control subjects (p 0.007). It can be concluded that inflammatory activity is increased in patients with PCOS, can lead to an increased risk for atherosclerosis, and this increase is not caused by obesity but rather by the polycystic ovary syndrome itself. However, studies with larger sample sizes are needed in this area.
Agacayak, Elif; Tunc, Senem Yaman; Sak, Sibel; Basaranoglu, Serdar; Yüksel, Hatice; Turgut, Abdulkadir; Gul, Talip
Background We aimed to measure the levels of inflammatory markers and neopterin in obese and non-obese patients with PCOS by using 2 separate control groups with matching body mass index (BMI). Material/Methods A total of 60 women of reproductive age with (n=30) and without (n=30) PCOS were included in this study. Based on their BMI, patients with PCOS were divided into 2 groups as obese (n=15) and non-obese (n=15) PCOS groups. In addition, 2 BMI-matched control groups were formed. Neopterin, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (N/L ratio), and vitamin B12 were assessed by complete blood count. Results No significant difference was found between patients with PCOS and control subjects in neopterin, IL-6, TNF-α, and CRP levels. However, N/L ratio levels were significantly higher (p 0.045) and vitamin B12 levels were significantly lower (p 0.033) in patients with PCOS compared to control subjects. No statistically significant difference was found between obese and non-obese patients with PCOS and control subjects in neopterin, IL-6, TNF-α, and N/L ratio levels. However, CRP levels were significantly higher in obese patients with PCOS compared to obese control subjects (p 0.007). Conclusions It can be concluded that inflammatory activity is increased in patients with PCOS, can lead to an increased risk for atherosclerosis, and this increase is not caused by obesity but rather by the polycystic ovary syndrome itself. However, studies with larger sample sizes are needed in this area. PMID:26292090
Crandall, Cameron S; Gardner, Stephanie; Braude, Darren A
Knowledge of accurate patient weight is vital to safe air medical transport and critical care. Patient weight is often unknown in emergency settings, and visual estimations have been shown to be inaccurate, especially in obese patients. We hypothesized that a simple formula based on anthropometric measurements could accurately predict patient weight for obese adult men and women. Data from cross-sectional anthropometric measurements from the National Health and Nutrition Examination Survey (NHANES) III (1988-1994)-height, leg length, thigh circumference, and mid-arm circumference-were used to estimate patient weight among adult (18 years and older) men and nonpregnant women who weighed at least 100 kg (N = 1,471). Linear modeling was used to develop simple sex-specific linear models to estimate patient weight. Models were derived on a random 67% subset of the original sample and then validated against the remaining 33% to assess the model's predictive capacity. The combination of arm circumference and height yielded the best model: Women: weight (WT) = -64.6 + 2.15 x arm circumference (ARM) + 0.54 x height (HT) (adjusted R(2): 0.55); men: WT = -93.2 + 3.29 x ARM + 0.43 x HT (adjusted R(2): 0.59). Approximately 90% of patient weights were accurately estimated within a 15% error tolerance. We have derived and validated simple equations with easy-to-use tables to accurately predict total body weight of obese men and women using only height and arm circumference. These tables may assist air medical transport pilots and medical crews make decisions about which patients may be safely transported, how far they may be transported, how much fuel is required, and how many crewmembers and family members may accompany them.
Jon, Ali F.; Cheema, Ahmad R.; Khan, Atif N.; Raptopoulos, V.; Hauser, T.; Nasser, I.; Welty, F.K.; Karellas, A.; Clouse, Melvin E.
Objective To develop a simplified method to quantify liver fat using CT fat % index (CTFPI) compared to liver spleen method (CTL/S, CTL-S) Methods Non-contrast CT of the liver was performed in 89 patients (overweight, obese, severely obese) to quantify fat, using: CTFPI= [(65-patient HU)/65] ×100, normal liver =65 HU. Results There was strong linear correlation between CTFPI and the standard method of assessing liver fat using CTL/S (r = −0.901), CTL-S (r = −0.911). Hepatic HU and CTFPI were significantly different in the severely obese group compared to other two groups(p<0.05). Conclusion Significant correlation indicates equal diagnostic accuracy of the two methods in appropriately calibrated scanners. PMID:24559751
Wang, C; Nguyen, G; Chung, Y; Yoshizumi, T; Cabrera, F; Lipkin, M; Shin, R
Purpose: Ureteroscopy involves fluoroscopy which potentially results in considerable amount of radiation dose to the patient. Purpose of this study was two-fold: (a) to develop the effective dose computational model for obese and non-obese patients undergoing left and right ureteroscopy, and (b) to evaluate the utility of a commercial Monte Carlo software for dose assessment in ureteroscopy. Methods: Organ dose measurements were performed on an adult male anthropomorphic phantom, representing the non-obese patients, with 20 high-sensitivity MOSFET detectors and two 0.18cc ionization chambers placed in selected organs. Fat-equivalent paddings were placed around the abdominal region to simulate for obese patients. Effective dose (ED) was calculated using ICRP 103 tissue weighting factors and normalized to the effective dose rate in miliSivert per second (mSv/s). In addition, a commercial Monte Carlo (MC) dose estimation program was used to estimate ED for the non-obese model, with table attenuation correction applied to simulate clinical procedure. Results: For the equipment and protocols involved in this study, the MOSFETderived ED rates for the obese patient model (‘Left’: 0.0092±0.0004 mSv/s; ‘Right’: 0.0086±0.0004 mSv/s) was found to be more than twice as much as that to the non-obese patient model (‘Left’: 0.0041±0.0003 mSv/s; ‘Right’: 0.0036±0.0007 mSv/s). The MC-derived ED rates for the non-obese patient model (‘Left’: 0.0041 mSv/s; ‘Right’: 0.0036 mSv/s; with statistical uncertainty of 1%) showed a good agreement with the MOSFET method. Conclusion: The significant difference in ED rate between the obese and non-obese patient models shows the limitation of directly applying commercial softwares for obese patients and leading to considerable underestimation of ED. Although commercial softwares offer a convenient means of dose estimation, but the utility may be limited to standard-man geometry as the software does not account for
Maffiuletti, Nicola A; Malatesta, Davide; Agosti, Fiorenza; Sartorio, Alessandro
Ergonomic unstable shoes, which are widely available to the general population, could increase daily non-exercise activity thermogenesis as the result of increased muscular involvement. We compared the energy expenditure of obese patients during standing and walking with conventional flat-bottomed shoes versus unstable shoes. Twenty-nine obese patients were asked to stand quietly and to walk at their preferred walking speed while wearing unstable or conventional shoes. The main outcome measures were metabolic rate of standing and gross and net energy cost of walking, as assessed with indirect calorimetry. Metabolic rate of standing was higher while wearing unstable shoes compared with conventional shoes (1.11 ± 0.20 W/kg(-1) vs 1.06 ± 0.23 W/kg(-1), P=.0098). Gross and net energy cost of walking were higher while wearing unstable shoes compared with conventional shoes (gross: 4.20 ± 0.42 J/kg(-1)/m(-1)vs 4.01 ± 0.39 J/kg(-1)/m(-1), P=.0035; net: 3.37 ± 0.41 J/kg(-1)/m(-1) vs 3.21 ± 0.37 J/kg(-1)/m(-1); P=.032). In obese patients, it is possible to increase energy expenditure of standing and walking by means of ergonomic unstable footwear. Long-term use of unstable shoes may eventually prevent a positive energy balance. Copyright © 2012 Elsevier Inc. All rights reserved.
Wu, Victor J; Pang, Darren; Tang, Wendell W; Zhang, Xin; Li, Li; You, Zongbing
Approximately 36.5% of the U.S. adults (≥ 20 years old) are obese. Obesity has been associated with type 2 diabetes mellitus, cardiovascular disease, stroke, and several types of cancer. The present study included 1788 prostate cancer patients who were treated with radical prostatectomy at the Ochsner Health System, New Orleans, Louisiana, from January, 2001 to March, 2016. The patient’s medical records were retrospectively reviewed. Body mass index (BMI), age, ethnicity (Caucasians versus African Americans), clinical stage, Gleason score, and prostate-specific antigen (PSA) levels were retrieved. The relative risk of the patients was stratified into low risk and high risk groups. Associative analyses found that BMI was associated with age, clinical stage, Gleason score, but not ethnicity, PSA levels, or the relative risk in this cohort. Age was associated with ethnicity, clinical stage, Gleason score, and PSA levels, as well as the relative risk. Ethnicity was associated with Gleason score and PSA levels as well as the relative risk, but not clinical stage. These findings suggest that obesity is associated with advanced prostate cancer with stage T3 or Gleason score ≥ 7 diseases, and age and ethnicity are important factors that are associated with the clinical features of prostate cancer patients. PMID:28337464
Rovner, D R; Rothert, M L; Holmes, M M; Ravitch, M M; Holzman, G B; Elstein, A S
Health care costs are an increasing burden upon American society. Referral of patients to a specialist generates additional cost. We studied the reasons behind decisions to refer patients with uncomplicated obesity to endocrinologists. Obesity may be viewed as a paradigm of diseases with relatively well-known etiology, low morbidity and mortality, chronicity, and poor outcome from standard therapy. In addition, it is a disease that is rarely curable by medical intervention, requiring behavioral change. Physicians have little direct experience in the differential diagnosis of endocrine disease, because of its low prevalence. We studied the referral decisions of 45 physicians in three medical specialties. Clinical decision making was studied using a standard set of 24 carefully structured case reports of obese women, all without obvious endocrine disease cues on history or physical. In these cases the patients' desire to be seen by endocrinologists was the major factor in the decision to refer. Referrals were not made primarily to rule out suspected endocrine disorder or because of concern for increased risk of morbidity.
Dreyer Gillette, Meredith L; Borner, Kelsey B; Nadler, Cy B; Poppert, Katrina M; Odar Stough, Cathleen; Swinburne Romine, Rebecca; Davis, Ann M
Children with autism spectrum disorder (ASD) may be at increased risk for overweight and obesity, but little information is known about correlates of overweight and obesity in this population. This study compared prevalence rates of parent-reported overweight and obesity and specific health behaviors (i.e., parent report of child sleep, family meal patterns, child screen time, and child physical activity) among children with ASD (N = more than 900 [weighted to represent 690,000; age 10-17]) compared with children without ASD using data from a nationally representative sample. Additionally, the relationship between specific health behaviors (i.e., child sleep, family meals, screen time, and physical activity) and weight status was examined in the ASD population. Data were from the National Survey of Children's Health 2011-2012. Results indicate that children with ASD were more likely to be obese but not more likely to be overweight than non-ASD youth. Children with ASD engaged in physical activity less than children without ASD, but no differences were found on sleep, most measures of screen time, and mealtimes. However, parent perceived poorer sleep was associated with increased weight status, and fewer family meals were associated with normal weight status among children with ASD.
Ebert, Thomas J; Shankar, Hariharan; Haake, Rachel M
The anesthetic management of the MO patient requires an important focus on a number of issues beginning with a careful preoperative evaluation and synthesizing pre-existing disease processes with the anesthetic management plan. The common misperception that all MO patients are "full stomach" has been challenged and may be a nonissue. New approaches to pre-oxygenation to lessen the likelihood of desaturation during apnea may be a valuable tool if difficulty is encountered in tracheal intubation. In addition, promising results have been demonstrated with the use of the ILMA for ventilation and for blindly establishing tracheal tube placement. Proper patient positioning is essential to aid in successful intubation when a laryngoscope is employed. Intraoperative anesthetic management can be guided with a processed electroencephalogram monitor to help improve emergence and to enhance wakefulness in the PACU. Careful consideration must be given to postoperative analgesic needs by minimizing the use of opioids and employing nonopioid analgesics including NSAIDs, alpha2-adrenergic agonists, and low doses of ketamine.
Alawami, M; Mustafa, A; Whyte, K; Alkhater, M; Bhikoo, Z; Pemberton, J
Obesity is a risk factor for both sleep-related breathing disorders (SRBD), including obesity hypoventilation syndrome (OHS) and cardiovascular diseases (CVD). The development of CVD in patients with SRBD is usually attributed to the fact that most patients are obese in addition to conventional cardiovascular risk factors. This study aims to measure the prevalence of certain CVD in patients with OHS in the Auckland region and highlight the importance of the effects of SRBD on the heart. A dataset of all patients with a formal diagnosis of OHS that were under active follow up was compiled from Auckland District Health Board Sleep Disordered Breathing Service. Clinical notes were retrospectively reviewed for echocardiogram reports, blood pressure measurements and electrocardiograms. Forty-seven patients were included in the present study. The median age was 60 years, 24 were female (51%), 20 (42.5%) had diabetes, mean HbA1C was 53.5 mmol/mol, mean systolic blood pressure was 127 mmHg, mean body mass index was 49 kg/m(2) , mean forced expiratory volume in 1 s was 1.7 L, mean estimated glomerular filtration was 71 mL/min/1.73 m(2) and there was anti-hypertensive use in 31 (65.9%) patients. Thirty-three patients had poor quality echocardiography views (70.2%). Left ventricular systolic and diastolic function was impaired in 8 (25%) and 18 (60%) respectively. Right ventricular dysfunction and pulmonary hypertension was present in 19 (63.3%) and 13 (52%) respectively. Sixteen patients (34%) had recurrent atrial or ventricular arrhythmias. There appears to be a high prevalence of right ventricular impairment, pulmonary hypertension, left ventricle hypertrophy, diastolic dysfunction and arrhythmias in patients with OHS. These findings would appear to be higher than expected in obese patients without OHS. A larger prospective matched cohort study would be needed to confirm the clinical significance of these findings. © 2014 Royal Australasian College of
Dohrn, Niclas; Sommer, Thorbjørn; Bisgaard, Jannie; Rønholm, Ebbe; Larsen, Jens Fromholt
Endotracheal intubation is commonly perceived to be more difficult in obese patients than in lean patients. Primarily, we investigated the association between difficult tracheal intubation (DTI) and obesity, and secondarily, the association between DTI and validated scoring systems used to assess the airways, the association between DTI and quantities of anesthetics used to induce general anesthesia, and the association between DTI and difficulties with venous and arterial cannulation. This is a monocentric prospective observational clinical study of a consecutive series of 539 obese patients undergoing gastric bypass. Tracheal intubation was done preoperatively together with scoring of Intubation Score (IS), Mallampati (MLP), and Cormack-Lehane classification (CLC) and registration of the quantities of anesthetics and total attempts on cannulation. The overall proportion of patients with DTI was 3.5 % and the patients with DTI were more frequently males, had higher CLC, higher American Society of Anesthesiologists physical status classification (ASA), and noticeably, a lower BMI compared to the patients with easy tracheal intubation. After adjustment with multivariable analyses body mass index (BMI) <40, CLC >2, ASA scores >2, and male gender were risk factors of DTI. Males generally had higher CLC, MLP, and ASA scores compared to females, but no difference in BMI. There was no difference in quantities of anesthetics used between the two groups with or without DTI. Intra-venous and intra-arterial cannulation was succeeded in first attempt in 85 and 86 % of the patients, respectively, and there were no association between BMI and difficult vascular access. We found no association between increasing BMI and DTI.
Lelouvier, Benjamin; Servant, Florence; Païssé, Sandrine; Brunet, Anne-Claire; Benyahya, Salah; Serino, Matteo; Valle, Carine; Ortiz, Maria Rosa; Puig, Josep; Courtney, Michael; Federici, Massimo; Fernández-Real, José-Manuel; Burcelin, Rémy; Amar, Jacques
The early detection of liver fibrosis among patients with nonalcoholic fatty liver disease (NAFLD) is an important clinical need. In view of the suggested role played by bacterial translocation in liver disease and obesity, we sought to investigate the relationship between blood microbiota and liver fibrosis (LF) in European cohorts of patients with severe obesity. We carried out a cross-sectional study of obese patients, well characterized with respect to the severity of the NAFLD, in the cohort FLORINASH. This cohort has been divided into a discovery cohort comprising 50 Spanish patients and then in a validation cohort of 71 Italian patients. Blood bacterial DNA was analyzed both quantitatively by 16S ribosomal DNA (rDNA) quantitative polymerase chain reaction and qualitatively by 16S rDNA targeted metagenomic sequencing and functional metagenome prediction. Spanish plasma bile acid contents were analyzed by liquid chromatography/mass spectrometry. The 16S rDNA concentration was significantly higher in patients of the discovery cohort with LF. By 16S sequencing, we found specific differences in the proportion of several bacterial taxa in both blood and feces that correlate with the presence of LF, thus defining a specific signature of the liver disease. Several secondary/primary bile acid ratios were also decreased with LF in the discovery cohort. We confirmed, in the validation cohort, the correlation between blood 16S rDNA concentration and LF, whereas we did not confirm the specific bacterial taxa signature, despite a similar trend in patients with more-severe fibrosis.
Ekart, Robert; Hojs, Radovan
Obesity is a chronic disease that is increasingly prevalent around the world and is a well-recognized risk factor for type 2 diabetes and hypertension, leading causes of end-stage renal disease (ESRD). The obese diabetic patient with ESRD is a challenge for the nephrologist with regard to the type of renal replacement therapy that should be suggested and offered to the patient. There is no evidence that either peritoneal dialysis or hemodialysis is contraindicated in obese ESRD patients. In the literature, we can find a discrepancy in the impact of obesity on mortality among hemodialysis vs. peritoneal dialysis patients. Several studies in hemodialysis patients suggest that a higher BMI confers a survival advantage - the so-called "reverse epidemiology". In contrast, the literature among obese peritoneal dialysis patients is inconsistent, with various studies reporting an increased risk of death, no difference, or a decreased risk of death. Many of these studies only spanned across a few years, and this is probably too short of a time frame for a realistic assessment of obesity's impact on mortality in ESRD patients. The decision for dialysis modality in an obese diabetic patient with ESRD should be individualized. According to the results of published studies, we cannot suggest PD or HD as a better solution for all obese diabetic patients. The obese patient should be educated about all their dialysis options, including home dialysis therapies. In this review, the available literature related to the dialysis modality in obese patients with diabetes and ESRD was reviewed.
Lou, Baohui; Chen, Min; Luo, Xiaojie; Dai, Yongming
To investigate the underlying physiological mechanisms of the structural differences in gray matter (GM) and white matter (WM) associated with obesity in young Chinese adults. A total of 49 right-handed obese or overweight (n = 22, mean age 31.72±8.04 years) and normal weight (n = 27, mean age 29.04±7.32 years) Han Chinese individuals were recruited. All participants underwent voxel-based morphometry analysis of T1-weighted MRI and tract-based spatial statistics analysis of diffusion tensor imaging. Partial correlation analysis was performed between the physiological data obtained and the abnormal structural alterations. In the OO group, GM atrophy occurred in the left prefrontal cortex, bilateral cingulate gyrus, and the right temporal lobe, while enlargement was observed in the bilateral putamen. WM atrophy was observed predominantly in the regions that regulate food intake, such as the bilateral basal ganglia, the right amygdala, and the left insula. The OO group exhibited lower fractional anisotropy (FA) in bilateral frontal corticospinal tracts and the right brainstem. Significant negative correlations were observed between FA values of those three clusters and BMI, and waist circumference, while the volume of bilateral putamen positively correlated with both BMI and waist circumference. High plasma LDL levels were correlated with low FA values in the right frontal corticospinal tract. Interestingly, the negative correlation was limited to male participants. Obesity-related alterations of GM and WM volumes were observed predominantly in food reward circuit, which may motivate abnormal dietary intake. Further, early elevated plasma LDL might contribute to low right frontal FA values of male adults, which requires further demonstration by larger-scale and longitudinal studies.
Lou, Baohui; Chen, Min; Luo, Xiaojie; Dai, Yongming
Objective To investigate the underlying physiological mechanisms of the structural differences in gray matter (GM) and white matter (WM) associated with obesity in young Chinese adults. Materials and Methods A total of 49 right-handed obese or overweight (n = 22, mean age 31.72±8.04 years) and normal weight (n = 27, mean age 29.04±7.32 years) Han Chinese individuals were recruited. All participants underwent voxel-based morphometry analysis of T1-weighted MRI and tract-based spatial statistics analysis of diffusion tensor imaging. Partial correlation analysis was performed between the physiological data obtained and the abnormal structural alterations. Results In the OO group, GM atrophy occurred in the left prefrontal cortex, bilateral cingulate gyrus, and the right temporal lobe, while enlargement was observed in the bilateral putamen. WM atrophy was observed predominantly in the regions that regulate food intake, such as the bilateral basal ganglia, the right amygdala, and the left insula. The OO group exhibited lower fractional anisotropy (FA) in bilateral frontal corticospinal tracts and the right brainstem. Significant negative correlations were observed between FA values of those three clusters and BMI, and waist circumference, while the volume of bilateral putamen positively correlated with both BMI and waist circumference. High plasma LDL levels were correlated with low FA values in the right frontal corticospinal tract. Interestingly, the negative correlation was limited to male participants. Conclusions Obesity-related alterations of GM and WM volumes were observed predominantly in food reward circuit, which may motivate abnormal dietary intake. Further, early elevated plasma LDL might contribute to low right frontal FA values of male adults, which requires further demonstration by larger-scale and longitudinal studies. PMID:25279729
Kasi, Pashtoon Murtaza; Zafar, S Yousuf; Grothey, Axel
Obesity/higher BMI appears to be important determinants in the development of colon cancer as well as in predicting outcomes in the adjuvant setting in these patients. These associations seem to be stronger for men and tend to be 'J-shaped', with worse outcomes in both lower and upper BMI categories than in the middle categories. How this factors in the metastatic setting is less clear. A recent pooled analysis of patients with metastatic colorectal cancer receiving bevacizumab in the first-line setting observed that patients with the lowest BMI had the lowest median overall survival. An incremental BMI increase of 5 kg/m(2) led to actually a decrease in the risk of death (hazard ratio, 0.911 [95% CI, 0.879-0.944]). The observed association does not necessarily mean that obesity is an advantage for patients with metastatic colorectal cancer. More likely, it is conceivable that, in patients with metastatic colorectal cancer with a lower BMI, the effects of cancer-related cachexia may be more deleterious than the potential adverse events related to a higher BMI. In patients already diagnosed with metastatic disease, studying how body weight affects tumor biology and treatment-related decisions are important considerations.
Churin, B V; Trunova, V A; Sidorina, A V; Zvereva, V V; Starkova, E V
Using a high-fat diet in experiment on rats received model alimentary obesity (AO). Adding zinc to the diet did not affect the severity of the AO. The concentration of K, Ca, Mn, Fe, Cu, Zn, Se, Br, Rb, Sr in the liver and lungs of rats with obesity in both groups did not differ from that of healthy animals. As in the liver and lungs in rats of both groups with obesity has been a redistribution of interelement correlation (COP) and during physiological hunger and soon after consumption of pork fat. Redistribution of interelement COP in a state of physiological hunger reflects the strong changes of metabolic processes of the body. The nature of rearrangements of the COP in the liver and lungs were significantly different in each group of rats. Soon after intake of fatty foods in control rats and rats AO not receiving zinc, found an increase in the total number interelement COP in the lungs and major decline in the liver, which indirectly indicates the active participation of the lungs in the metabolism of dietary fat, over-expressed in control animals. In rats receiving more zinc, the increase in the total number of correlations after eating found in both bodies.
Vila, Greisa; Riedl, Michaela; Anderwald, Christian; Resl, Michael; Handisurya, Ammon; Clodi, Martin; Prager, Gerhard; Ludvik, Bernhard; Krebs, Michael; Luger, Anton
Growth differentiation factor-15 (GDF-15) is a stress-responsive cytokine linked to obesity comorbidities such as cardiovascular disease, inflammation, and cancer. GDF-15 also has adipokine properties and recently emerged as a prognostic biomarker for cardiovascular events. We evaluated the relationship of plasma GDF-15 concentrations with parameters of obesity, inflammation, and glucose and lipid metabolism in a cohort of 118 morbidly obese patients [mean (SD) age 37.2 (12) years, 89 females, 29 males] and 30 age- and sex-matched healthy lean individuals. All study participants underwent a 75-g oral glucose tolerance test; 28 patients were studied before and 1 year after Roux-en-Y gastric bypass surgery. Obese individuals displayed increased plasma GDF-15 concentrations (P < 0.001), with highest concentrations observed in patients with type 2 diabetes. GDF-15 was positively correlated with age, waist-to-height ratio, mean arterial blood pressure, triglycerides, creatinine, glucose, insulin, C-peptide, hemoglobin A(1c), and homeostatic model assessment insulin resistance index and negatively correlated with oral glucose insulin sensitivity. Age, homeostatic model assessment index, oral glucose insulin sensitivity, and creatinine were independent predictors of GDF-15 concentrations. Roux-en-Y gastric bypass led to a significant reduction in weight, leptin, insulin, and insulin resistance, but further increased GDF-15 concentrations (P < 0.001). The associations between circulating GDF-15 concentrations and age, insulin resistance, and creatinine might account for the additional cardiovascular predictive information of GDF-15 compared to traditional risk factors. Nevertheless, GDF-15 changes following bariatric surgery suggest an indirect relationship between GDF-15 and insulin resistance. The clinical utility of GDF-15 as a biomarker might be limited until the pathways directly controlling GDF-15 concentrations are better understood.
Heidari, Zahra; Hosseinpanah, Farhad; Barzin, Maryam; Safarkhani, Maryam; Azizi, Fereidoun
This study aimed to investigate the mother-daughter correlation for central obesity and other noncommunicable disease risk factors. The authors used metabolic and anthropometric data from the Tehran Lipid and Glucose Study, enrolling 1041 mother-daughter pairs for the current study. Three age strata were defined: 3 to 9 years for childhood (146 mother-daughter pairs), 10 to 17 years for adolescence (395 mother-daughter pairs), and 18 to 25 years for early adulthood (500 mother-daughter pairs). Familial associations for central obesity and other noncommunicable disease risk factors were assessed. The prevalence of central obesity was 44.7% in mothers and 11.2% in daughters (6.2% in the 3-9, 19.2% in the 10-17, and 6.4% in the 18-25 years groups). Mothers with central obesity were more likely than nonobese mothers to have daughters with central obesity (10.5% and 1.7%, respectively; P = .0001). Central obesity indices among daughters were positively correlated with those of their mothers in all 3 age strata. Correlations for other noncommunicable disease risk factors were analyzed before and after adjusting the risk factor levels for mothers' and daughters' waist circumferences (WCs) within each group to determine whether risk factor correlations were, in part, a result of the central obesity correlations. After the non-communicable disease risk factor levels of participants were adjusted for their WCs, the mother-daughter correlations remained significant. The consistent association of central obesity between mothers and daughters may indicate the key role that could be played by the mother in the primary prevention of central obesity, particularly in high-risk families.
Objective To evaluate the effects of cardiac rehabilitation (CR) on functional capacity in obese and non-obese patients who have suffered acute myocardial infarction (AMI). Methods Overall, 359 patients who have suffered AMI, and were referred for CR after percutaneous coronary intervention from 2010 to 2015 and underwent an exercise tolerance test before and after phase II CR were included in this study. The patients were divided into two groups: obese group with body mass index (BMI) ≥25 kg/m2 (n=170; age, 54.32±9.98 years; BMI, 27.52±2.92 kg/m2) and non-obese group with BMI <25 kg/m2 (n=189; age, 59.12±11.50 years; BMI 22.86±2.01 kg/m2). The demographic characteristics and cardiopulmonary exercise capacity of all patients were analyzed before and after CR. Results There were significant changes in resting heart rate (HRrest) before and after CR between the obese and non-obese groups (before CR, p=0.028; after CR, p=0.046), but other cardiopulmonary exercise capacity before and after CR was not different between the groups. HRrest (p<0.001), maximal metabolic equivalents (METs, p<0.001), total exercise duration (TED, p<0.001), and maximal oxygen consumption (VO2max, p<0.001) improved significantly in the obese and non-obese groups after CR. No difference in the change in the cardiopulmonary exercise capacity rate was detected between the groups. Conclusion CR may improve functional capacity in patients who suffered AMI regardless of their obesity. PMID:27847723
Bahadır, Anzel; Baltacı, Davut; Türker, Yasemin; Türker, Yasin; Iliev, Darkov; Öztürk, Serkan; Deler, Mehmet Harun; Sarıgüzel, Yunus Cem
Objective: Obesity causes subclinical inflammation. Leukocyte count and high-sensitivity C-reactive protein (hs-CRP) are used to indicate inflammation in clinical practice. Also, inflammatory markers are evaluated as important indicators of cardiovascular risk in patients with obesity and metabolic syndrome (MetS). We aimed to investigate the usage of the neutrophil-lymphocyte ratio (NLR) as an inflammatory marker in obese patients with and without MetS. Methods: The study included a total of 1267 patients. The patients were assigned groups according to degree of obesity and status of MetS. Metabolic and inflammatory markers were compared between groups, and correlation analysis was performed. Results: Leukocyte count and hs-CRP were significantly different (p<0.001), but NLR was not different between body mass index (BMI) groups (p=0.168). Both lymphocyte and neutrophil counts were significantly increased with increased degree of obesity (p<0.001, p=0.028, respectively). Leukocyte, neutrophil, and lymphocyte counts and hs-CRP level showed a significant correlation with BMI (r=0.198, p<0.001; r=0.163, p<0.001; r=0.167, p<0.001; r=0.445, p<0.001, respectively), whereas NLR was not correlated with BMI (r=0.017, p=0.737). Only a significant association between a MetS severity of 5 and 4 with hs-CRP level was observed (p=0.028), whereas there was no statistically significant association for leukocyte count and NLR (p=0.246; p=0.643, respectively). Conclusion: NLR was not a good indicator of inflammation, while leukocyte and hs-CRP were more useful biomarkers to indicate inflammation in non-diabetic patients with obesity and MetS. PMID:25592102
Bahadır, Anzel; Baltacı, Davut; Türker, Yasemin; Türker, Yasin; Iliev, Darkov; Öztürk, Serkan; Deler, Mehmet Harun; Sarıgüzel, Yunus Cem
Obesity causes subclinical inflammation. Leukocyte count and high-sensitivity C-reactive protein (hs-CRP) are used to indicate inflammation in clinical practice. Also, inflammatory markers are evaluated as important indicators of cardiovascular risk in patients with obesity and metabolic syndrome (MetS). We aimed to investigate the usage of the neutrophil-lymphocyte ratio (NLR) as an inflammatory marker in obese patients with and without MetS. The study included a total of 1267 patients. The patients were assigned groups according to degree of obesity and status of MetS. Metabolic and inflammatory markers were compared between groups, and correlation analysis was performed. Leukocyte count and hs-CRP were significantly different (p<0.001), but NLR was not different between body mass index (BMI) groups (p=0.168). Both lymphocyte and neutrophil counts were significantly increased with increased degree of obesity (p<0.001, p=0.028, respectively). Leukocyte, neutrophil, and lymphocyte counts and hs-CRP level showed a significant correlation with BMI (r=0.198, p<0.001; r=0.163, p<0.001; r=0.167, p<0.001; r=0.445, p<0.001, respectively), whereas NLR was not correlated with BMI (r=0.017, p=0.737). Only a significant association between a MetS severity of 5 and 4 with hs-CRP level was observed (p=0.028), whereas there was no statistically significant association for leukocyte count and NLR (p=0.246; p=0.643, respectively). NLR was not a good indicator of inflammation, while leukocyte and hs-CRP were more useful biomarkers to indicate inflammation in non-diabetic patients with obesity and MetS.
Chang, Jee-Eun; Kim, Hyerim; Ryu, Jung-Hee; Lee, Jung-Man; Hwang, Jin-Young
Central obesity may be related to the spread of spinal anesthesia in female patients. Fifty-seven female patients undergoing spinal anesthesia were allocated to either the central obesity or noncentral obesity group. After induction of spinal anesthesia, maximal sensory blockade (primary outcome), time for maximal sensory block, maximum motor block, time to maximum motor block, time to L2 regression, and time to Bromage scale 0 were evaluated. Multiple linear regression analyses showed that maximal sensory blockade was related to central obesity (P = .004). Central obesity is related to a more extensive spread of spinal anesthesia in female patients.
Lydecker, Janet; Grilo, Carlos
Objective This study addressed gaps in the existing literature about correlates of parental perception of child weight using a community sample. We evaluated how weight-status and its perception related to parents’ personal and parenting attitudes/behaviors. Methods Participants were parents (N=1007; 65.3% mothers, 34.4% fathers) of children 5–15 years old. Parents completed online measures of personal eating attitudes/behaviors, attitudes/behaviors about their children’s eating and weight, and parental practices related to weight-related attitudes. Results Parents frequently underestimated children’s overweight/obesity, even more frequently than their own overweight/obesity (p<.001). Parents’ personal eating attitudes/behaviors were related to their own weight-status (p<.001) and perceived child weight-status (p<.001) but not actual child weight-status. Parents’ child-focused eating attitudes/behaviors were related to actual (p<.001) and perceived child weight-status (p<.001), but not parent weight-status. Conclusions In general, parents’ personal attitudes/behaviors did not extend into their perceptions of their child’s weight or their response to it. Results suggest a dual need to improve parent accuracy perceiving children’s overweight/obesity, and to guide parent responses to perceived overweight/obesity. Given the high prevalence of childhood obesity, and the serious consequences during childhood and into adulthood, further research is needed to enhance understanding of parents’ specific needs to engage in prevention and treatment programs. PMID:26916369
Stenkamp-Strahm, Chloe M; Kappmeyer, Adam J; Schmalz, Joe T; Gericke, Martin; Balemba, Onesmo
Obesity and type 2 diabetes are increasing in prevalence at an alarming rate in developed and developing nations and over 50% of patients with prolonged stages of disease experience forms of autonomic neuropathy. These patients have symptoms indicating disrupted enteric nervous system function including gastric discomfort, gastroparesis and intestinal dysmotility. Previous assessments have examined enteric neuronal injury within either type 1 diabetic or transgenic type 2 diabetic context. This study aims to assess damage to myenteric neurons within the duodenum of high-fat diet ingesting mice experiencing symptoms of type 2 diabetes, as this disease context is most parallel to the human condition and disrupted duodenal motility underlies negative gastrointestinal symptoms. Mice fed a high-fat diet developed symptoms of obesity and diabetes by 4 weeks. After 8 weeks, the total number of duodenal myenteric neurons and the synaptophysin density index were reduced and transmission electron microscopy showed axonal swelling and loss of neurofilaments and microtubules, suggesting compromised neuronal health. High-fat diet ingestion correlated with a loss of neurons expressing VIP and nNOS but did not affect the expression of ChAT, substance P, calbindin and CGRP. These results correlate high-fat diet ingestion, obesity and type 2 diabetes symptoms with a loss of duodenal neurons, biasing towards those with inhibitory nature. This pathology may underlie dysmotility and other negative GI symptoms experienced by human type 2 diabetic and obese patients.
Tran, Albert; Gual, Philippe
The hepatic complications of morbid obesity range from steatosis to steatohepatitis (Non-alcoholic steatohepatitis [NASH]), fibrosis, cirrhosis and finally hepatocellular carcinoma. The pathophysiological mechanisms of the progression of a normal liver to a liver showing steatosis and then steatohepatitis are complex, including, per se, insulin-resistance, iron accumulation, oxidative stress and hepatocyte death. An imbalance in anti- and pro-inflammatory factors may be the trigger. These factors can originate from intra- or extrahepatic sites, particularly the adipose tissue and the gut. This review will provide insight into the current diagnosis and understanding of hepatic inflammation including non-invasive markers of NASH (markers of hepatocyte death), intrahepatic mechanisms (regulation of the immune and inflammatory response, hepatocellular iron deposition, hepatocyte death) and extrahepatic factors (from adipose tissue and gut) in morbidly obese patients. Copyright © 2012 Elsevier Masson SAS. All rights reserved.
Liu, Jia; Hu, Yanjin; Zhang, Heng; Xu, Yuan; Wang, Guang
Irisin is a myokine secreted by skeletal muscle during exercise. Abnormal serum irisin levels are associated with obesity and type 2 diabetes (T2D). This study investigated the changes in serum irisin in the obese patients with newly diagnosed T2D following glucagon-like peptide-1 (GLP-1) receptor agonist (exenatide) treatment. Fifty-four obese patients with T2D were treated with exenatide for 12weeks. The control group included 54 age-, sex-, and body mass index (BMI)-matched subjects with normal glucose tolerance. Patients with T2D had lower irisin than the control group (38.06 [29.29-53.79] vs. 58.01 [43.07-87.79] ng/mL, P<0.01]. Serum irisin was negatively associated with BMI (r=-0.178, P<0.05), fasting blood glucose (FBG; r=-0.170, P<0.05), and glycosylated hemoglobin (HbA1c; r=-0.189, P<0.01) in patients with T2D. Exenatide treatment markedly increased serum irisin by 19.28ng/mL (12.59-25.98) compared to baseline (P<0.01). Increased irisin was significantly correlated with decreased FBG and HbA1c after exenatide treatment (FBG: r=-0.35; HbA1c: r=-0.37; both P<0.05). Exenatide treatment significantly increased irisin in patients with T2D. Post-treatment changes in irisin were correlated with decreases in FBG and HbA1c. The upregulation of irisin might be a novel mechanism for the beneficial effects of exenatide in type 2 diabetic patients. Copyright © 2016 Elsevier Inc. All rights reserved.
Fukushima, Yaeko; Kurose, Satoshi; Shinno, Hiromi; Cao Thi Thu, Ha; Tamanoi, Atsuko; Tsutsumi, Hiromi; Hasegawa, Takaaki; Nakajima, Toshiaki; Kimura, Yutaka
Irisin is a skeletal muscle myokine that causes the brown coloration of white fat, promotes fat burning, inhibits weight gain and may be useful for treatment of obesity. Irisin is also related to glucose/lipid metabolism and may prevent onset of diabetes, but a consensus on irisin secretion has not been reached. The purpose of this study was to determine the relationships between serum irisin levels and physical factors in untreated Japanese men and women with obesity. The subjects were 66 untreated patients with obesity (body mass index ≥30 kg m(-2)) who visited our obesity clinic. The subjects included 19 men and 47 women with a mean age of 45.7 ± 13.4 years, mean body weight of 93.8 ± 17.6 kg, and mean body mass index of 36.5 ± 4.7 kg m(-2). At the initial visit, blood sampling was performed, body composition was evaluated using dual energy X-ray absorptiometry, and exercise tolerance was determined in a cardiopulmonary exercise test. Homeostasis model of assessment - insulin resistance (HOMA-IR), an index of insulin resistance, and the serum level of irisin were measured. In men, serum irisin was positively correlated with fasting blood glucose (r = 0.491, P < 0.05), immunoreactive insulin (r = 0.536, P < 0.05), HOMA-IR (r = 0.635, P < 0.01), body weight (r = 0.491, P < 0.05), lean body mass of the trunk (r = 0.579, P < 0.05) and whole lean body mass (r = 0.489, P < 0.05). In women, serum irisin was positively correlated with immunoreactive insulin (r = 0.502, P < 0.01) and HOMA-IR (r = 0.385, P < 0.01). In both sexes, HOMA-IR was an independent variable associated with obesity (men: β = 0.635, R(2) = 0.369, P < 0.01; women: β = 0.385, R(2) = 0.129, P < 0.01). The serum level of irisin was positively correlated with HOMA-IR in Japanese patients with obesity of both sexes. This suggests that compensatory enhancement of irisin secretion may
Sharma, Sunil; Mather, Paul J.; Efird, Jimmy T.; Kahn, Daron; Shiue, Kristin Y.; Cheema, Mohammed; Malloy, Raymond; Quan, Stuart F.
Study Objectives: Obstructive sleep apnea (OSA) is an important health problem associated with significant morbidity and mortality. This condition often is underrecognized in hospitalized patients. The aim of this study was to conduct a clinical pathway evaluation (CPE) among obese patients admitted to a tertiary care hospital. We also assessed oxygen desaturation index (ODI, measured by overnight pulse oximetry) as a potential low-cost screening tool for identifying OSA. Methods: This was a prospective study of 754 patients admitted to an academic medical center between February 2013 and February 2014. Consecutive obese patients (body mass index ≥ 30) admitted to the hospital (medical services) were screened and evaluated for OSA with the snoring, tiredness during daytime, observed apnea, high blood pressure (STOP) questionnaire. The admitting team was advised to perform follow-up evaluation, including polysomnography, if the test was positive. Results: A total of 636 patients were classified as high risk and 118 as low risk for OSA. Within 4 w of discharge, 149 patients underwent polysomnography, and of these, 87% (129) were shown to have OSA. An optimal screening cutoff point for OSA (apnea-hypopnea index ≥ 10/h) was determined to be ODI ≥ 10/h [Matthews correlation coefficient = 0.36, 95% confidence interval = 0.24–0.47]. Significantly more hospitalized patients were identified and underwent polysomnography compared with the year prior to introduction of the CPE. Conclusions: Our results indicate that the CPE increased the identification of OSA in this population. Furthermore, ODI derived from overnight pulse oximetry may be a cost-effective strategy to screen for OSA in hospitalized patients. Citation: Sharma S, Mather PJ, Efird JT, Kahn D, Shiue KY, Cheema M, Malloy R, Quan SF. Obstructive sleep apnea in obese hospitalized patients: a single center experience. J Clin Sleep Med 2015;11(7):717–723. PMID:25766715
Koo, Hyeon-Kyoung; Park, Joo-Hyun; Park, Hye Kyeong; Jung, Hoon; Lee, Sung-Soon
Objective To determine the impact of sarcopenia and obesity on pulmonary function and quality of life (QOL) in chronic obstructive pulmonary disease (COPD) patients. Research Design and Methods Data were obtained from the Korea National Health and Nutrition Examination Survey, including data from health interviews, health examinations, nutritional questionnaires, and laboratory findings. Laboratory data included pulmonary function assessment and dual energy X-ray absorptiometry results. Sarcopenia was measured by dual energy X-ray absorptiometry, and obesity was defined by body mass index. Male COPD patients were then classified into 4 groups according to the presence of sarcopenia and obesity. Results In male patients with COPD, the prevalence of sarcopenia was found to be 29.3%, and that of sarcopenic obesity was 14.2%. Furthermore, 22.5% of the patients observed in this study had impaired QOL. Following multivariable statistical analysis, both sarcopenia and obesity were independent risk factors for worsening lung function. Adjusted values of forced vital capacity and forced expiratory volume in 1 second were the lowest in the sarcopenic obesity group. Sarcopenia was also associated with more subjective activity limitation and poorer QOL; however obesity was related to less subjective limitation and better QOL after multivariable analysis. Adjusted value of QOL was the lowest in sarcopenic subjects without obesity, and the highest in obese subject without sarcopenia. Conclusions Both sarcopenia and obesity were found to be associated with worsening lung function in male COPD patients. However, obesity was positively correlated with improved QOL while sarcopenia was negatively correlated with QQL. PMID:25353344
Leoni, A; Arlati, S; Ghisi, D; Verwej, M; Lugani, D; Ghisi, P; Cappelleri, G; Cedrati, V; El Tantawi Ali Alsheraei, A; Pocar, M; Ceriani, V; Aldegheri, G
This study aimed to determine the accuracy of commonly used preoperative difficult airway indices as predictors of difficult mask ventilation (DMV) in obese patients (BMI >30 kg/m2). In 309 consecutive obese patients undergoing general surgery, the modified Mallampati test, patient's Height/Thyromental distance ratio, Inter-Incisor Distance, Protruding Mandible (PM), history of Obstructive Sleep Apnea and Neck Circumference (NC) were recorded preoperatively. DMV was defined as Grade 3 mask ventilation (MV) by the Han's scale (MV inadequate, unstable or requiring two practitioners). Data are shown as means±SD or number and proportions. Independent DMV predictors were identified by multivariate analysis. The discriminating capacity of the model (ROC curve area) and adjusted weights for the risk factors (odds ratios) were also determined. BMI averaged 42.5±8.3 kg/m2. DMV was reported in 27 out of 309 patients (8.8%; 95%CI 5.6-11.9%). The multivariate analysis retained NC (OR 1.17; P<0.0001), limited PM (1.99; P=0.046) and Mallampati test (OR 2.12; P=0.009) as risk predictors for DMV. Male gender was also included in the final model (OR 1.87; P=0.06) as biologically important variable albeit the borderline statistical significance. The model yielded a good discriminating capacity (ROC curve 0.85). The four parameters were used to create an unweighted prediction score (ROC curve 0.84) with >2 associated factors as the best discriminating point for DMV. Obese patients show increased incidence of DMV with respect to the undifferentiated surgical population. Limited PM, Mallampati test and NC are important DMV predictors.
Ji, Hyung-Min; Han, Jun; Jin, Dong San; Suh, Hyunseok; Chung, Yoon-Sok; Won, Ye-Yeon
The purpose of this retrospective study was to determine the prevalence of sarcopenia and sarcopenic obesity among patients who underwent orthopedic surgery (OS). A total of 222 patients were reviewed immediately after or prior to OS. In the control group, 364 patients from outpatient departments (OPDs) who did not have any OS were enrolled. Whole-body dual-energy X-ray absorptiometry was used to analyze body composition. Skeletal muscle mass was adjusted for height squared, total body weight, and height and fat mass (residuals). Obesity was defined as body mass index (BMI) > 25.0 kg/m(2). The prevalence of sarcopenia in the OS group was 25.7%, 44.1%, and 26.6%, respectively, according to the 3 different criteria. The prevalence was significantly lower in the OPD group (6.0%, 33.1%, and 14.8%, respectively). The highest rates of sarcopenia with height-adjusted definition were seen in patients with a femoral neck fracture. In the multivariate analysis, factors associated with sarcopenia were male gender, older age, and lower BMI (odds ratio [OR]: 28.38, 1.03, and 1.83, respectively) when muscle mass was adjusted for height, whereas male gender, older age, and higher BMI were associated with sarcopenia (OR: 1.04, 2.57, and 1.83, respectively) when adjusted for weight. When residuals were used as a cutoff, decreased BMI and total hip bone mineral density (0.1 g/cm(2)) were independent risk factors associated with sarcopenia (OR: 1.09 and 1.05). The prevalence of sarcopenic obesity ranged from 1.8% to 21.2%. Our study demonstrated a high prevalence of sarcopenia among OS patients.
Guadalajara, Héctor; Sanz Baro, Raquel; Pascual, Isabel; Blesa, Isabel; Rotundo, Grevelyn Sosa; López, Jose María Gil; Corripio, Ramón; Vesperinas, Gregorio; Sancho, Luis García; Montes, Jose Antonio Rodríguez
Obesity constitutes a clear risk factor for cholelithiasis, especially if it is associated with a rapid weight loss, as is the case of patients following bariatric surgery. Prophylactic cholecystectomy is indicated in biliopancreatic diversions due to the high incidence of postoperative cholelithiasis. However, there is no agreement on gastric bypass. This study was conducted to establish the incidence of cholecystopathy demonstrated by histology and to assess the indication for prophylactic cholecystectomy in a systematic way on patients undergoing gastric bypass. The evaluation is based on 100 consecutive morbidly obese patients undergoing open gastric bypass surgery with concomitant prophylactic cholecystectomy. Variables studied were: age, gender, body mass index, preoperative ultrasound and the anatomopathologic analysis of the gallbladder that was removed. Of the 100 patients who took part in the trial, 11 had had a previous cholecystectomy. Among the 89 patients remaining, preoperative ultrasound diagnosis of cholelithiasis was 16.8%, and the actual postoperative incidence was 24.7%. Other histologic alterations were: cholesterolosis 46.1%, chronic unspecified cholecystitis 22.5%, and granulomatous cholecystitis 1.1%. The total incidence of cholecystopathy was 93.3%. The morbi-mortality related to cholecystectomy was 0%. Based on these results and given the absence of morbidity, we believe that prophylactic cholecystectomy is suitable during open gastric bypass.
Cierniak, Marcin; Sobczak, Renata; Timler, Dariusz; Wieczorek, Andrzej; Borkowski, Bartosz; Gaszyński, Tomasz
Abstract The intubation difficulties in obese patients are not a new problem. They may result from an accumulation of fat in the oral cavity and cheeks. A thick tongue is also a significant factor. The literature reports that some tests to determine the intubation difficulties in obese people may be unreliable. The observed predictors of difficult intubation were the thyromental and sternomental distance and the intubation difficulty scale: FRONT score. The aim of this study was to assess the degree of difficult intubation in obese patients by the parameters such as the thyromental and sternomental distance. The authors also tried to evaluate the frequency of the guidewire usage and the number of intubation attempts in obese patients in the research sample. The study included the group of 153 patients intubated in prehospital conditions. The research was conducted in 3 clinical centers receiving patients from prehospital care. Among the members of the research sample, obese patients with body mass index >35 were selected and evaluated for various predictors of intubation difficulties. Quantitative analysis of differences in the incidence of the variables was assessed using the chi-squared test for P < 0.05. Analyses were performed in STATISTICA.Complications such as postintubation hematomas were more frequent in obese patients of the research sample. The frequency of the guidewire usage observed in that group was also higher. As anticipated by the adopted predictors, most of the obese patients were classified as difficult to intubate. There is a correlation between the occurrence of injuries and the prevalence of obesity in the research sample and the same dependency has been demonstrated in the issue concerning the use of the guidewire. Although the majority of predictors indicated patients with intubation difficulties, many predictors could show falsely positive results. The greater amount of intubation attempts was observed in obese patients. Further studies
Cierniak, Marcin; Sobczak, Renata; Timler, Dariusz; Wieczorek, Andrzej; Borkowski, Bartosz; Gaszyński, Tomasz
The intubation difficulties in obese patients are not a new problem. They may result from an accumulation of fat in the oral cavity and cheeks. A thick tongue is also a significant factor. The literature reports that some tests to determine the intubation difficulties in obese people may be unreliable. The observed predictors of difficult intubation were the thyromental and sternomental distance and the intubation difficulty scale: FRONT score.The aim of this study was to assess the degree of difficult intubation in obese patients by the parameters such as the thyromental and sternomental distance. The authors also tried to evaluate the frequency of the guidewire usage and the number of intubation attempts in obese patients in the research sample.The study included the group of 153 patients intubated in prehospital conditions. The research was conducted in 3 clinical centers receiving patients from prehospital care. Among the members of the research sample, obese patients with body mass index >35 were selected and evaluated for various predictors of intubation difficulties. Quantitative analysis of differences in the incidence of the variables was assessed using the chi-squared test for P < 0.05. Analyses were performed in STATISTICA.Complications such as postintubation hematomas were more frequent in obese patients of the research sample. The frequency of the guidewire usage observed in that group was also higher. As anticipated by the adopted predictors, most of the obese patients were classified as difficult to intubate.There is a correlation between the occurrence of injuries and the prevalence of obesity in the research sample and the same dependency has been demonstrated in the issue concerning the use of the guidewire. Although the majority of predictors indicated patients with intubation difficulties, many predictors could show falsely positive results. The greater amount of intubation attempts was observed in obese patients. Further studies devoted to
Anari, Razieh; Amani, Reza; Veissi, Masoud
Sugar sweetened beverages (SSBs) are any beverages containing added-sugar and supposed to increase body lipogenesis and fat accumulation in healthy subjects. This study was performed to assess the possible association between SSBs consumption and obesity in type 2 diabetes (T2DM) patients. T2DM adults with no insulin treatment entered the study. Abdominal obesity and general adiposity were determined using waist circumference (WC) and body mass index (BMI), respectively. SSBs intake was extracted from a validated food frequency questionnaire. Mean SSBs intake was 0.6 serving/d (145.6mL/d). There was no considerable association between SSBs intake and gender. About 46% of patients consumed at least one serving of SSBs per week. SSBs consumption was correlated neither to WC nor to BMI. After adjustment for confounding factors, abdominal obesity was associated with drinking SSBs ≥1 serving/week (OR=4.93, 95% CI: 1.35-18.03), and SSB ≥3 serving/week (OR=5.07, 95% CI: 1.22-21.15) compared to those consumed <1 serving/week. This association was not found for general obesity (OR=0.88, 95% CI: 0.60-1.23). Ex-smokers had higher SSBs intake compared to those never smoked (OR=3.94, 95% CI=1.06-14.71). Energy intake and macronutrients were similar in both SSBs sub-groups. Mean daily energy supplied by SSBs was 120kcal in participants having ≥1 serving of SSBs/week and 2.7kcal in <1 serving SSBs/week (OR=1.14, 95% CI: 1.09-1.20). Lower SSBs drinkers had 17% higher fiber intake (OR=0.83, 95% CI=0.73-0.96). SSBs intake might increase abdominal obesity in diabetic population and therefore should be considered in diabetes control procedure. Copyright © 2017. Published by Elsevier Ltd.
González-Muniesa, Pedro; Mártinez-González, Miguel-Angel; Hu, Frank B; Després, Jean-Pierre; Matsuzawa, Yuji; Loos, Ruth J F; Moreno, Luis A; Bray, George A; Martinez, J Alfredo
Excessive fat deposition in obesity has a multifactorial aetiology, but is widely considered the result of disequilibrium between energy intake and expenditure. Despite specific public health policies and individual treatment efforts to combat the obesity epidemic, >2 billion people worldwide are overweight or obese. The central nervous system circuitry, fuel turnover and metabolism as well as adipose tissue homeostasis are important to comprehend excessive weight gain and associated comorbidities. Obesity has a profound impact on quality of life, even in seemingly healthy individuals. Diet, physical activity or exercise and lifestyle changes are the cornerstones of obesity treatment, but medical treatment and bariatric surgery are becoming important. Family history, food environment, cultural preferences, adverse reactions to food, perinatal nutrition, previous or current diseases and physical activity patterns are relevant aspects for the health care professional to consider when treating the individual with obesity. Clinicians and other health care professionals are often ill-equipped to address the important environmental and socioeconomic drivers of the current obesity epidemic. Finally, understanding the epigenetic and genetic factors as well as metabolic pathways that take advantage of 'omics' technologies could play a very relevant part in combating obesity within a precision approach.
Ely, Andrea Charbonneau; Greiner, K. Allen; Born, Wendi; Hall, Sandra; Rhode, Paula C.; James, Aimee S.; Nollen, Nicole; Ahluwalia, Jasjit S.
Context: Although clinical guidelines recommend routine screening and treatment for obesity in primary care, lack of agreement between physicians and patients about the need for obesity treatment in the primary care setting may be an unexplored factor contributing to the obesity epidemic. Purpose and Methods: To better understand this dynamic, we…
Ely, Andrea Charbonneau; Greiner, K. Allen; Born, Wendi; Hall, Sandra; Rhode, Paula C.; James, Aimee S.; Nollen, Nicole; Ahluwalia, Jasjit S.
Context: Although clinical guidelines recommend routine screening and treatment for obesity in primary care, lack of agreement between physicians and patients about the need for obesity treatment in the primary care setting may be an unexplored factor contributing to the obesity epidemic. Purpose and Methods: To better understand this dynamic, we…
Bukavneva, N S; Pozdniakov, A L; Nikitiuk, D B
In the article there are presented major anthropometric parameters of patients (male and female) with obesity, combined with cardiovascular pathology, before and after treatment. Constitutional predisposition to obesity is defined. Efficacy of dietary therapy is estimated and with obesity are defined on the basil of associated cardio-vascular pathology.
Sebo, Paul; Herrmann, François R; Haller, Dagmar M
We recently showed that abdominal obesity measurements (waist and hip circumference, waist-to-hip ratio) were inaccurate when performed by general practitioners (GPs). We hypothesise that measurement error could be even higher in overweight and obese patients due to difficulty in locating anatomical landmarks. We aimed to estimate GPs' measurement error of general (weight, height and body mass index (BMI)) and abdominal obesity measurements across BMI subgroups. This cross-sectional study involved 26 GPs in Geneva, Switzerland. They were asked to take measurements on 20 volunteers within their practice. Two trained research assistants repeated the measures after the GPs ("gold standard"). The proportion of measurement error was computed by comparing the GPs' values (N = 509) to the average value of two measurements taken in turn by the research assistants and stratified by BMI subgroup (normal/underweight: <25 kg/m(2), overweight: 25 ≤ BMI < 30 kg/m(2), obese: ≥30 kg/m(2)). General obesity measurements were less prone to measurement error than abdominal obesity measurements, regardless of the BMI subgroup. The proportions of error increased across BMI subgroups (except for height), and were particularly high for abdominal obesity measurements in obese patients. Abdominal obesity measurements are particularly inaccurate when GPs use these measurements to assess overweight and obese patients. These findings add further strength to recommendations for GPs to favour use of general obesity measurements in daily practice, particularly when assessing overweight or obese patients.
Dacal Quintas, Raquel; Tumbeiro Novoa, Manuel; Alves Pérez, María Teresa; Santalla Martínez, Mari Luz; Acuña Fernández, Adela; Marcos Velázquez, Pedro
To determine the frequency of obstructive sleep apnoea (OSA) and metabolic syndrome (MS) in normal weight patients and their characteristics, and to compare these with overweight and obese patients. We studied all patients with suspected OSA referred to the sleep laboratory from January to December 2009. OSA was diagnosed when the apnoea-hypopnoea index (AHI) was >5 and symptoms were present. MS was diagnosed according to International Diabetes Federation (IDF) criteria. The patients were distributed into 3 groups according to body mass index (BMI): normal weight (<25kg/m(2)), overweight (25-29.9kg/m(2)) and obese (≥30kg/m(2)). We studied 475 patients: 7.60% normal weight and 56.4% obese. Most patients in the normal weight group were women, snorers, non-smokers, non-drinkers and were significantly younger and with a smaller neck and waist circumference than obese and overweight patients. OSA was diagnosed in 90.10%: 77.70% normal weight. OSA in these patients was mostly mild, and there were differences between the diagnosis of OSA and the BMI classified. MS was diagnosed in 64.40%: 33.33% normal weight. There was a higher probability of MS as the BMI increased. OSA and MS frequency in normal weight patients was 22% and in obese patients was 70.52%. OSA in normal weight patients was related with gender and age. There was no relationship between OSA and MS, or between otorhinolaryngological malformations and OSA in normal weight patients. Eight normal weight patients with OSA were treated with continuous positive airway pressure (CPAP) therapy. The frequency of OSA in normal weight patients was lower than in overweight and obese patients. The frequency of concomitant OSA and MS was lower in normal weight patients than in obese subjects. Normal weight patients were mostly women, younger and had no toxic habits. In normal weight patients, age and gender were predictive factors for OSA, but OSA and MS were not related. Copyright © 2013 SEPAR. Published by Elsevier
Picu, Ariana; Petcu, Laura; Ştefan, Simona; Mitu, Manuela; Lixandru, Daniela; Ionescu-Tîrgovişte, Constantin; Pîrcălăbioru, Grațiela Grădișteanu; Ciulu-Costinescu, Felicia; Bubulica, Maria-Viorica; Chifiriuc, Mariana Carmen
Type 2 diabetes mellitus (T2DM) is strongly associated with obesity. The adipose tissue secretes bioactive adipokines leading to low grade inflammation, amplified by oxidative stress, which promotes the formation of advanced glycation end products and eventually leads to dyslipidemia and vascular complications. The aim of this study was to correlate anthropometric, biochemical and oxidative stress parameters in newly diagnosed (ND) T2DM patients and to investigate the role of oxidative stress in T2DM associated with obesity. A group of 115 ND- T2DM patients was compared to a group of 32 healthy subjects in terms of clinical, anthropometric, biochemical and oxidative stress parameters. ND-T2DM patients had significantly lower adiponectin, glutathione (GSH) and gluthatione peroxidase (GPx) and elevated insulin, proinsulin, HOMA-IR index, proinsulin/insulin (P/I) and proinsulin/adiponectin (P/A) ratio, fructosamine, and total oxidant status (TOS). The total body fat mass was positively correlated with total oxidant status (TOS). Positive correlations were found between TOS and glycated hemoglobin (HbA1c), and between TOS and glycaemia. Negative correlations were identified between: GPx and glycaemia, GPx and HbA1c, and also between GSH and fructosamine. The total antioxidant status was negatively correlated with the respiratory burst. The identified correlations suggest the existence of a complex interplay between diabetes, obesity and oxidative stress.
Yao, Hong; Chen, Jian-Xiong; Zhang, Zi-Qian; Pan, Yu; Zheng, Jie; Tong, Juan
To observe the effect of acupuncture intervention on the appetite of obesity patients. A total of 118 obesity patients were randomized into acupuncture group (76 cases, treated by true acupuncture needles) and placebo group (42 cases, treated by placebo acupuncture needles) using single-blind method. All the patients of the two groups were ordered to control their diet during the treatment. The acupoints around the umbilicus [Zhongwan (CV 12), Zhongji (CV 3), Daheng (SP 15), Xiawan (CV 10), Shimen (CV 5) and Tianshu (ST 25), etc.] and Liangqiu (ST 34), Zusanli (ST 36), and Yin-lingquan (SP 9) were punctured with filiform needles which were manipulated with uniform reducing and reinforcing method for a while tijl "Deqi" and retained for 30 min. The treatment was conducted once every other day, 12 times altogether. Body mass index (BMI), and visual analogue scale (VAS) scores of eating-desire and hunger feeling and prospective food consumption were measured before and after the treatment. The gastric fluid survival rate (GFSR) was evaluated by using ultrasound scanning. The BMI in the acupuncture group was obviously declined after the treatment in comparison with the placebo group (P < 0.01). Compared to the placebo group, the VAS scores of eating-desire, hunger feeling and prospective food consumption were significantly decreased in the acupuncture group ( P < 0.05), but there are no significant difference between two groups in the VAS score of gastric fullness feeling (P > 0.05). The GFSR was obviously increased in the acupuncture group compared to the placebo group (P < 0.05). Acupuncture therapy can significantly decrease BMI and delay the digesting time and control the appetite in obesity patients, which may contribute to its effect in body weight reduction.
Chiba, K; Tsuchiya, M; Kato, J; Ochi, K; Kawa, Z; Ishizaki, T
Markedly obese athletes like Japanese sumo wrestlers may frequently suffer various traumas which result in the prophylaxis or treatment of posttraumatic infection with antibiotics. However, appropriate dosage regimens in this group of patients have not been fully known for many antibiotics. Therefore, we studied the kinetic disposition of cefotiam, a parenteral, broad-spectrum cephalosporin with activity against gram-positive and -negative bacteria, after an intravenous dose (2 g) infused over 30 min into 15 sumo wrestler patients with an excess body weight (130 to 220% of ideal body weight) and 10 control patients with a normal weight (90 to 102% of ideal body weight). Mean (+/- standard deviation) clearance and steady-state volume of distribution were significantly greater in the sumo wrestler than in the control group (38.3 +/- 9.4 versus 23.5 +/- 6.0 liters/h, P less than 0.001, and 30.2 +/- 8.0 versus 17.9 +/- 6.1 liters, P less than 0.001). Mean elimination half-life was slightly but significantly longer in the sumo wrestler than in the control group (0.91 +/- 0.14 versus 0.74 +/- 0.20 h, P less than 0.05). However, mean residence time did not differ between the two groups (0.79 +/- 0.10 versus 0.75 +/- 0.14 h). The statistical differences in clearance and volume of distribution between the two groups disappeared when these kinetic parameters were corrected for body surface area, but not for total body weight or ideal body weight. The results suggest that the dosage calculation of cefotiam, a hydrophilic antibiotic, should be made on the basis of body surface area in morbidly obese athlete or sumo wrestler patients. However, whether this recommendation should extend to other nonathlete obese subjects remains to be determined. PMID:2802548
Tinahones, Francisco J; Garrido-Sánchez, Lourdes; Murri, Mora; García-Fuentes, Eduardo; Cardona, Fernando
Criteria for the diagnosis of the metabolic syndrome are currently being reconsidered, as their usefulness is not the same for all phenotypes in relation to the risk of cardiovascular disease. We analyzed the changes in metabolic parameters after a fat overload in different groups of patients. The study included 20 healthy persons, 30 metabolic syndrome patients without morbid obesity, 80 metabolic syndrome patients with morbid obesity and 16 patients with morbid obesity without the metabolic syndrome. All the participants received a fat overload of 60g. Measurements were made before the overload and 3h afterwards of triglycerides, free fatty acids, insulin and uric acid. Metabolic syndrome patients with morbid obesity had a lower waist-to-hip ratio, and lower plasma free fatty acid and triglycerides levels at baseline and after the overload than patients without morbid obesity. Plasma uric acid levels rose after the fat overload in the metabolic syndrome patients who had morbid obesity but not in the patients without morbid obesity. A positive relation was found between plasma triglycerides and free fatty acid levels in all the patients but not in the controls after the fat overload. A positive relation was also found between uric acid and insulin levels in the metabolic syndrome patients with morbid obesity. Metabolic syndrome patients with and without morbid obesity presented different metabolic characteristics. This suggests that there are 2 different clinical phenotypes, both grouped under the metabolic syndrome umbrella. Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.
SABAU, DANIEL; STAMATIN, MARIA; STOICESCU, SILVIA; FILIP, VALERIA; CUCEREA, MANUELA; OGNEAN, LIVIA; BLAGA, LIGIA; AVASILOAIEI, ANDREEA; SIMIONESCU, BIANCA; MIU, NICOLAE
Background and aims Infant and adult obesity is becoming a real public health concern in Romania, similar to other countries of the European Union. Maternal obesity and excessive weight gain during pregnancy are proven risk factors for the obesity of the child. The protective role of the breastfeeding against obesity has also been demonstrated. The most important issue is whether the choice of a milk formula with the right protein composition could or not protect the newborn from becoming a future obese infant and child. Our study aims to describe the characteristics of a group of macrosomic newborns, in relation to the mothers’ weight gain during pregnancy, mode of delivery, birth weight, complications at birth, time of first feeding and type of feeding during maternity stay. Patients and methods We conducted a retrospective study on 179 newborns with birth weights >4000 grams, born over a period of three months (March–May) in 6 large maternity hospitals in Romania. Results the newborns had a mean gestational age of 39.5 weeks and a mean birth weight of 4195 grams. Male newborns were prevalent (74%). More than half were born by Cesarian section and had Apgar scores with a median of 9. Macrosomes are prone to complications at birth and in our study those were mainly hypoglycemia and birth trauma. Time at first feeding was 95 minutes (mean), with a high percentage of formula/mixed feeding (68%). Conclusion Macrosomia itself attracts the risk of birth by cesarean section (54% of study group), birth trauma and a low rate of exclusive breast milk feeding (32% of study group) at discharge. PMID:26528018
Garrido-Sánchez, Lourdes; García-Almeida, Jose M.; García-Serrano, Sara; Cardona, Isabel; García-Arnes, Juan; Soriguer, Federico; Tinahones, Francisco J.; García-Fuentes, Eduardo
OBJECTIVE—Antioxidized LDL (anti-oxLDL) antibodies have recently been suggested to be protective against the development of diabetes. We measured the changes in anti-oxLDL antibody levels in the inverse situation of improvement in carbohydrate metabolism. RESEARCH DESIGN AND METHODS—The study was undertaken in 73 morbidly obese individuals, 21 of whom had type 2 diabetes, before and 7 months after they underwent bariatric surgery and in 11 healthy, nonobese individuals. Measurements were made of the area under the curve of glucose (AUCGlu) by an intravenous glucose tolerance test and of oxidized LDL (oxLDL) and IgG and IgM anti-oxLDL antibodies. RESULTS—The morbidly obese patients with diabetes had significantly higher levels of oxLDL compared with the morbidly obese patients with normal fasting glucose and the control subjects and significantly lower levels of IgM anti-oxLDL antibodies. An inverse correlation was found between the levels of oxLDL and IgM anti-oxLDL antibodies (r = −0.352, P = 0.012). Although the levels of IgG and IgM anti-oxLDL antibodies rose after surgery, this increase was only significant in the diabetic patients, who experienced an improvement in their metabolic profile. Different multiple linear regression models showed that the AUCGlu was the main factor explaining the behavior of the levels of oxLDL and anti-oxLDL antibodies. CONCLUSIONS—We found a close association between carbohydrate metabolism and IgM anti-oxLDL antibodies, which were significantly reduced in the morbidly obese patients with diabetes. The improvement in carbohydrate metabolism after bariatric surgery led to a significant increase in the levels of IgG and IgM anti-oxLDL antibodies. PMID:18835956
Garrido-Sánchez, Lourdes; García-Almeida, Jose M; García-Serrano, Sara; Cardona, Isabel; García-Arnes, Juan; Soriguer, Federico; Tinahones, Francisco J; García-Fuentes, Eduardo
Antioxidized LDL (anti-oxLDL) antibodies have recently been suggested to be protective against the development of diabetes. We measured the changes in anti-oxLDL antibody levels in the inverse situation of improvement in carbohydrate metabolism. The study was undertaken in 73 morbidly obese individuals, 21 of whom had type 2 diabetes, before and 7 months after they underwent bariatric surgery and in 11 healthy, nonobese individuals. Measurements were made of the area under the curve of glucose (AUC(Glu)) by an intravenous glucose tolerance test and of oxidized LDL (oxLDL) and IgG and IgM anti-oxLDL antibodies. The morbidly obese patients with diabetes had significantly higher levels of oxLDL compared with the morbidly obese patients with normal fasting glucose and the control subjects and significantly lower levels of IgM anti-oxLDL antibodies. An inverse correlation was found between the levels of oxLDL and IgM anti-oxLDL antibodies (r = -0.352, P = 0.012). Although the levels of IgG and IgM anti-oxLDL antibodies rose after surgery, this increase was only significant in the diabetic patients, who experienced an improvement in their metabolic profile. Different multiple linear regression models showed that the AUC(Glu) was the main factor explaining the behavior of the levels of oxLDL and anti-oxLDL antibodies. We found a close association between carbohydrate metabolism and IgM anti-oxLDL antibodies, which were significantly reduced in the morbidly obese patients with diabetes. The improvement in carbohydrate metabolism after bariatric surgery led to a significant increase in the levels of IgG and IgM anti-oxLDL antibodies.
Bodunova, N A; Askerkhanov, R G; Khatkov, I E; Sabelnikova, E A; Parfenov, A I; Tkachenko, E V; Varvanina, G G; Feydorov, I Yu
To investigate the impact of bariatric surgery (BS) on the level of vitamins in obese patients. One hundred obese patients (78 women and 22 men) aged 19 to 61 years were examined. Controlled gastric banding (CGB) was carried out in 20 patients (mean body mass index (BMI), 41.3 ± 8.2 kg/m2); gastric sleeve resection (GSR) in 40 patients, and gastric shunting (GS) in 40 (the mean BMI in these groups were 41.1 ± 17.8 and 45.9 ± 6.2 kg/m2, respectively). A control group consisted of 10 apparently healthy individuals (BMI, 24.9 ± 3.2 kg/m2). An enzyme immunoassay was used to determine the serum concentrations of vitamins B1, B2, B5, B6, B9, B12, C, and D, niacin, biotin, and retinol-binding protein (RBP) before and 1 year after surgery. All the three groups showed a considerable decrease in the levels of vitamins C, B5, B6, and D, and RBP both prior to and following BS. More than 50% of the patients who had undergone GSR had also a lower baseline niacin level. A year after CGB, GSR, and GS, the number of patents with deficiency of these vitamins remained the same or increased. The majority of patients with the same level of vitamin B2, niacin, and folic acid (FA) were observed to have its decrease a year postsurgery. The concentration of the other test vitamins was also reduced a year after all operations; however, it remained within the normal range. GS had no substantial impact on the concentrations of FA, vitamins B2, B12, B1, and biotin. The lower serum vitamin levels were not accompanied by clinical symptoms in most patients following BS. In 80% of the patients with obesity, the levels of vitamins C, B6, and D were decreased to a variable degree. After BS, there was a rise in the number of patients with low serum vitamin C, D, B6, B5, niacin, FA, and RBP concentrations, at the same time the number of patients with FA deficiency increased by more than twice. BS did not significantly affect the metabolism of vitamins B1 B2 B12, and biotin.
Boros, Szilvia; Halmy, Laszlo
Study aim: To assess the physical self-concept, trait depression and readiness for physical activity in relation to the degree of obesity. Material and methods: Obese (Grade I and II; n = 59) and morbidly obese (Grade III; n = 42) patients aged 30-66 years, as well as 83 non-obese college students aged 30 [plus or minus] 7.3 years were studied.…
Vo, Hanh D; Goli, Sridhar; Gill, Rupinder; Anderson, Virginia; Stefanov, Dimitre G; Xu, Jiliu; Kulsum-Mecci, Nazia; Schwarz, Steven M; Rabinowitz, Simon S
Recently, publications in adults and children have documented a potential role of Helicobacter pylori (H. pylori) in decreasing the likelihood of obesity. The present study compares the prevalence of H. pylori colonization between obese (body mass index [BMI] ≥ 95th percentile) and healthy weight (BMI ≥ 5th to <85th percentiles) children seen at an inner city medical center in the United States. This retrospective study reviewed clinical features, BMI, and gastric histology of consecutive children aged 1-18 years undergoing an esophagogastroduodenoscopy. BMI percentile was calculated for age and gender. Helicobacter pylori colonization was determined by histopathologic identification of the organism. Multiple logistic regression was employed to measure the association between BMI and H. pylori colonization, controlling for baseline age, gender, and presenting symptoms. Among 340 patients (51.5% female, mean age of 10.5 ± 4.7 years), 98 (29%) were obese and 173 (51%) were healthy weight. The H. pylori colonization rate of the entire cohort was 18.5% (95% CI = 14.7-23.0%). Among obese children, 10% had H. pylori colonization compared to 21% of the healthy weight children (RR = 2.1, 95% CI = 1.1-4.0). Conversely, 39% of noncolonized children, but only 21% of the infected children, were obese (RR = 1.8, 95% CI = 1.1-3.3). Multivariate analysis revealed that being colonized with H. pylori is associated with a 50% reduction in the odds of being obese (adjusted OR = 0.5, 95% CI = 0.2-1.0). Our findings in a North American cohort are in agreement with studies from Asia and Europe suggesting that H. pylori infection decreases the prevalence of obesity in children. Further work to characterize the extent and nature of this relationship is warranted. © 2014 John Wiley & Sons Ltd.
Feitosa, Alina C R; Mancini, Márcio C; Cercato, Cíntia; Villares, Sandra M; Halpern, Alfredo
Increased body mass index and waist circumference are related to cardiovascular risk factors. Leptin is an adipocyte-produced hormone and regulates body weight. Leptin is directly related to body fat. To evaluate the relationship between leptin and metabolic profile in obese subjects, we studied 119 patients. Anthropometric, laboratory, body composition (by bioelectrical impedance) and co-morbidity data were collected. The analysis was performed in the female population (86.6%): average age: 42 +/- 13 years; hypertension, type 2 diabetes and grade III obesity were present in 61.9%, 20.2% and 58.3%, respectively. Leptin levels were positively related to insulin resistance (IR). HOMA-IR was related to metabolic abnormalities of IR. No differences were demonstrated between lipid profile, glycemia, body composition and tertiles of leptin corrected by fat weight. A significant difference in HOMA-IR was present when the 2nd and 3rd tertiles of leptin corrected by fat weight [3.4 (2.8-4.1) vs. 5.3 (4.1-6.5), p=0.011] were compared. In conclusion, leptin corrected by fat weight did not influence lipid profile and glycemia in moderate to severe obese women with similar percent body fat. Leptin should not be considered an independent factor affecting lipid metabolism.
Bittner, Nathan; Merrick, Gregory S; Stewart, Renee; Andreini, Hugo; Taubenslag, Walter; Curtis, Rodney; Butler, Wayne M; Wallner, Kent E
Obesity has correlated with adverse pathologic features on prostate biopsy and may predispose to a higher rate of prostate cancer-related death after radical prostatectomy. In this study, we examine the potential relationship between body mass index (BMI) and histopathologic findings on transperineal template-guided mapping biopsy of the prostate (TTMB). From January 2005 to January 2008, 244 consecutive patients underwent TTMB using an anatomic-based technique. The criteria for TTMB included previously negative transrectal ultrasound (TRUS) biopsy with persistently elevated PSA and/or diagnosis of ASAP, or HG-PIN. The study population was divided into 4 different BMI cohorts (BMI < 25, BMI 25-29.9, BMI 30-34.9, and BMI ≥ 35 kg/m(2)). Biopsy findings were compared between the various BMI cohorts using one-way analysis of variance (ANOVA) and the χ(2) test. Pre-TTMB clinical parameters, including PSA and prostate volume, were not significantly different between the various BMI cohorts. On average, the study population had undergone 1.7 TRUS biopsies before TTMB. Of the 244 study patients, 112 (45.9%), were diagnosed with prostate adenocarcinoma on TTMB. There was no difference in the rate of cancer detection between the different BMI cohorts. Among patients diagnosed with prostate cancer, BMI did not correlate with Gleason score or percent of positive biopsy cores. When the geography of biopsy-positive cores was analyzed, there were no statistically significant differences in cancer location among the different BMI groups. In this study, obesity did not predispose toward higher Gleason score, larger cancer volume, or geographic cancer distribution on repeat biopsy with TTMB. Copyright © 2011 Elsevier Inc. All rights reserved.
Del Re, Mariana Pantaleão; Melo, Camila Maria de; Santos, Marcus Vinicius Dos; Tufik, Sergio; Mello, Marco Túlio de
To investigate the applicability of predictive equations for resting energy expenditure (REE) in obese individuals with obstructive sleep apnea (OSA) and the effects of OSA severity on REE. Twenty-nine obese men, 41.5 ± 7 years old, with moderate and severe OSA were recruited. All subjects were submitted to a clinical polysomnography, body composition, and indirect calorimetry measurements. REE was also predicted by three different equations: Harris and Benedict (1919), Cunningham (1990), and DRI (2002). No effects of OSA severity on REE were found. The measured REE (2416.0 ± 447.1 kcal/day) and the REE predicted by equations were different from each other (F = 2713.88; p < 0.05): Harris and Benedict (2128.0 ± 245.8 kcal/day), Cunningham (1789.1 ± 167.8 kcal/day) and DRI (2011.1 ± 181.4 kcal/day). Pearson correlations showed a moderate positive correlation between the REE measured and predicted by all equations. Our findings suggest that predictive equations for REE underestimate the energy expenditure in obese patients with sleep apnea. Also, no effects of OSA severity on REE were found.
Hofmann, Tobias; Stengel, Andreas; Ahnis, Anne; Buße, Petra; Elbelt, Ulf; Klapp, Burghard F
Nesfatin-1 is derived from nucleobindin2 (NUCB2) and implicated in the regulation of food intake and body weight. Plasma levels are altered under conditions of chronically altered body weight such as obesity. Nesfatin-1 was also shown to be involved in the modulation of emotion. Since obesity is often associated with anxiety and depression we investigated plasma NUCB2/nesfatin-1 levels in obese women (n=77) over a broad range of body mass index (BMI, 32-67 kg/m(2)) with different levels of anxiety assessed by the generalized anxiety disorder questionnaire (GAD-7). Stress was assessed using the perceived stress questionnaire (PSQ-20) and depression using the patient health questionnaire (PHQ-9). The study population was divided in patients with low anxiety (n=40, GAD scores, mean ± SD, 5.0 ± 2.7) and high anxiety (n=37, 14.2 ± 3.3, p<0.001). Patients with high anxiety showed higher levels of NUCB2/nesfatin-1 (+33%), perceived stress (+60%) and depression (+98%) compared to the low anxiety group (p<0.001). NUCB2/nesfatin-1 levels positively correlated with GAD-7 (r=0.68, p<0.001), total PSQ-20 (r=0.57, p<0.001) and PHQ-9 scores (r=0.45, p<0.001), while no significant correlation was observed with BMI (r=-0.21, p=0.09). Also the subscales of the PSQ-20, "worries", "tension" and "demands" were higher in the high anxiety group and correlated positively with NUCB2/nesfatin-1 (p<0.001), whereas "joy" was lower and correlated negatively with NUCB2/nesfatin-1 (p=0.015). Summarized, plasma NUCB2/nesfatin-1 levels were altered under conditions of perceived anxiety, stress and depression in obese women. No correlation was observed with BMI. These data point toward an involvement of NUCB2/nesfatin-1 in the regulation of emotion in addition to its impact on body weight.
Brochu, M; Starling, R D; Tchernof, A; Matthews, D E; Garcia-Rubi, E; Poehlman, E T
Older obese postmenopausal women have an increased risk for type 2 diabetes and cardiovascular disease. Increased abdominal obesity may contribute to these comorbidities. There is considerable controversy, however, regarding the effects of visceral adipose tissue as a singular predictor of insulin resistance compared to the other constituents of adiposity. To address this issue, we examined the independent association of regional adiposity and total fat mass with glucose disposal in obese older postmenopausal women. A secondary objective examined the association between glucose disposal with markers of skeletal muscle fat content (muscle attenuation) and physical activity levels. We studied 44 healthy obese postmenopausal women between 50 and 71 yr of age (mean +/- SD, 56.5 +/- 5.3 yr). The rate of glucose disposal was measured using the euglycemic/hyperinsulinemic clamp technique. Visceral and sc adipose tissue areas and midthigh muscle attenuation were measured from computed tomography. Fat mass and lean body mass were estimated from dual energy x-ray absorptiometry. Peak VO2 was measured from a treadmill test to volitional fatigue. Physical activity energy expenditure was measured from indirect calorimetry and doubly labeled water. Pearson correlations indicated that glucose disposal was inversely related to visceral adipose tissue area (r = -0.40; P < 0.01), but not to sc adipose tissue area (r = 0.17), total fat mass (r = 0.05), midthigh muscle attenuation (r = 0.01), peak VO2 (r = -0.22), or physical activity energy expenditure (r = -0.01). The significant association persisted after adjusting visceral adipose tissue for fat mass and abdominal sc adipose tissue levels (r = -0.45; P < 0.005; in both cases). Additional analyses matched two groups of women for fat mass, but with different visceral adipose tissue levels. Results showed that obese women with high visceral adipose tissue levels (283 +/- 59 vs. 137 +/- 24 cm2; P < 0.0001) had a lower glucose
Zanato, Veronica; Lombardi, Anna Maria; Busetto, Luca; Prà, Chiara Dal; Foletto, Mirto; Prevedello, Luca; De Marinis, Giulia Berti; Fabris, Fabrizio; Vettor, Roberto; Fabris, Roberto
Obese patients have been described at increased risk of thrombotic thrombocytopenic purpura, a disease caused by anti-ADAMTS13 autoantibodies. ADAMTS13 has a structure homology with the adipokine thrombospondin-1. We previously demonstrated an increased presence of anti-ADAMTS13 antibodies in obese patients. We aimed to study the changes induced by weight loss after bariatric surgery on some inflammatory and coagulative parameters and their link with anti-ADAMTS13 autoantibodies. We studied 100 obese patients before and after weight loss induced by bariatric surgery and 79 lean volunteers as controls. We measured anthropometric, metabolic and inflammatory parameters, thrombospondin-1, ADAMTS13 activity, anti-ADAMTS13 autoantibodies, Von Willebrand factor. At baseline, 13 % of patients was positive for anti-ADAMTS13 autoantibodies, while all controls were negative. Thrombospondin-1 levels were higher in obese subjects with than without antibodies, with a positive correlation between the two parameters. In multiple logistic regression analysis only thrombospondin-1 levels predicted positivity for anti-ADAMTS13 antibodies. After weight loss both anti-ADAMTS13 antibodies and thrombospondin-1 reduced significantly. Weight loss in obesity improves the inflammatory and coagulative profile, and in particular anti-ADAMTS13 autoantibodies, ADAMTS13 activity and thrombospondin-1.
Huo, Jinhai; Smith, Benjamin D; Giordano, Sharon H; Reece, Gregory P; Tina Shih, Ya-Chen
The objectives of this study were to compare, by patient obesity status, the contemporary utilization patterns of different reconstruction surgery types, understand postoperative complication profiles in the community setting, and analyze the financial impact on health care payers and patients. Using data from the MarketScan Health Risk Assessment Database and Commercial Claims and Encounters Database, we identified breast cancer patients who received breast reconstruction surgery following mastectomy between 2009 and 2012. The Cochran-Armitage test was used to evaluate the utilization pattern of breast reconstruction surgery. Multivariable logistic regressions were used to estimate the association between obesity status and infectious, wound, and perfusion complications within one year of surgery. A generalized linear model was used to compare total, complication-related, and out-of-pocket costs. The rate of TE/implant-based reconstruction increased significantly for non-obese patients but not for obese patients during the years analyzed, whereas autologous reconstruction decreased for both patient groups. Obesity was associated with higher odds of infectious, wound, and perfusion complications after TE/implant-based reconstruction, and higher odds of perfusion complications after autologous reconstruction. The adjusted total healthcare costs and out-of-pocket costs were similar for obese and non-obese patients for either type of breast reconstruction surgery. A greater likelihood of one-year complications arose from TE/implant-based vs autologous reconstruction surgery in obese patients. Given that out-of-pocket costs were independent of the type of reconstruction, greater emphasis should be placed on conveying the surgery-related complications to obese patients to aid in patient-based decision making with their plastic surgeons and oncologists. Copyright © 2016 Elsevier Ltd. All rights reserved.
Kaufman, K R; Thurber, K M; O'Meara, J G; Langworthy, D R; Kashiwagi, D T
Identification of adequate antimicrobial dosing regimens for morbidly obese patients is essential given the simultaneous increase in morbid obesity and cellulitis prevalence in recent years. Insufficient data currently exist to describe the effectiveness of extrapolating traditional antibiotic dosing strategies to morbidly obese patients with cellulitis. The primary objective of this study was to compare therapeutic failure rates in non-obese and morbidly obese patients with cellulitis when treated with cephalexin at standard dosing. This was a single-centre, retrospective cohort analysis. Adult patients hospitalized or under inpatient observation at a 1265-bed academic medical centre who received cephalexin monotherapy for non-purulent cellulitis from 2005 to 2015 were evaluated for inclusion. Patients were divided into two cohorts based on body mass index (BMI), where BMI <30 kg/m(2) was defined as non-obese and BMI ≥40 kg/m(2) as morbidly obese. Patients with critical risk factors for purulent or polymicrobial cellulitis were excluded. The primary outcome, therapeutic failure, was defined as a need for extended or additional antimicrobial therapy, surgical intervention, emergency department visit, or re-hospitalization within two to thirty days after cephalexin initiation. A total of 94 patients (69 non-obese and 25 morbidly obese) met inclusion and exclusion criteria, which was below the estimated sample size needed to reach desired power. The rate of therapeutic failure in the morbidly obese group was similar to the non-obese group (20% vs. 14·5%, P = 0·53). Patients most commonly had extended or additional antibiotics prescribed in response to therapeutic failure with cephalexin. Cephalexin failure rates for cellulitis did not differ statistically between morbidly obese and non-obese patients. The underpowered nature of this study is a limitation. Until further study with a larger sample size is completed, empiric adjustment of cephalexin dosing based
Heitlage, Viviene; Borgstadt, Mary Beth; Carlson, Lisa
A case highlighting challenges with enoxaparin dosage and monitoring in obese patients is presented. A morbidly obese 22-year-old Caucasian female (height, 168 cm; weight, 322 kg; body mass index [BMI], 114 kg/m(2)) who presented to the emergency department with acute-onset dyspnea and hypoxia was empirically initiated on enoxaparin for suspected pulmonary embolism at the institution's standard maximum dosage (160 mg subcutaneously every 12 hours). On hospital day 2, a peak anti-factor Xa (anti-Xa) level of 0.4 IU/mL was documented about 4 hours after the fourth enoxaparin dose. On hospital day 3, the enoxaparin dose was increased to 200 mg, a dose equivalent to 0.62 mg per kilogram of actual body weight (ABW), much lower than the guideline-recommended dose for venous thromboembolism prophylaxis (1 mg/kg). Four hours after her third 200-mg dose of enoxaparin, the patient had an anti-Xa value of 0.64 IU/mL (goal range, 0.5-1.1 IU/mL), with no evidence of bleeding or other adverse drug events. Follow-up anti-Xa testing on hospital day 4 yielded a value of 0.78 IU/mL. The case highlights the need for research to better delineate strategies for enoxaparin dosage and monitoring in the context of extreme obesity. A female patient with a BMI of 114 kg/m(2) was safely and effectively treated using an initial twice-daily dose of enoxaparin less than the recommended 1-mg/kg dose based on ABW. Dosage adjustments were made according to anti-Xa levels, and no adverse drug reactions were noted. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.
Capitanio, Umberto; Suardi, Nazareno; Briganti, Alberto; Gallina, Andrea; Abdollah, Firas; Lughezzani, Giovanni; Salonia, Andrea; Freschi, Massimo; Montorsi, Francesco
• To investigate the association between body mass index and tumour volume at radical prostatectomy in a large European population. • Recent data support the hypothesis that the hormonal environment in overweight and obese men may alter androgen-dependent prostate growth. Body mass index (BMI) has been implicated in prostate cancer pathophysiology. • We analysed 1275 patients with prostate cancer who underwent radical prostatectomy at a single tertiary care institution. Mean tumour volume (TV) was evaluated according to BMI WHO categories (normal <25 kg/m(2) vs overweight 25-30 kg/m(2) vs obese 30-35 kg/m(2) vs severely obese >35 kg/m(2)). • Univariable linear regression analyses targeted the association between BMI and TV at radical prostatectomy. Multivariable analyses were adjusted for age, prostate-specific antigen value, biopsy Gleason sum, clinical stage and prostate volume. • Mean BMI was 26.3 kg/m(2) (median 26; range 16.7-42.0). Mean TV was 5.6 mL (median 3.3; range 0.1-61.2). The mean prostate-specific antigen value was 10.3 ng/dL (median 6.6; range 0.3-327). • The mean TV was 5.0, 5.8, 6.3 and 9.2 mL in normal, overweight, obese and severely obese patients, respectively (P= 0.03). TVs in men with a normal BMI were 84% smaller than in severely obese men (5.0 vs 9.2 mL). • On univariable analysis, BMI was correlated with TV at radical prostatectomy (P < 0.001). On multivariable analysis, BMI reached the independent predictor status after adjustment for age, prostate-specific antigen value, biopsy Gleason score, clinical stage and prostate volume (P= 0.03). • We showed that BMI is independently associated with prostate cancer volume at radical prostatectomy. The present results confirm that obesity may play a key role in prostate cancer pathophysiology. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.
Qu, Yuan-Yuan; Dai, Bo; Kong, Yun-Yi; Chang, Kun; Ye, Ding-Wei; Yao, Xu-Dong; Zhang, Shi-Lin; Zhang, Hai-Liang; Yang, Wei-Yi
This study aimed to investigate the association between different anthropometric measures of obesity and clinicopathological characteristics in Chinese patients with clinically localized prostate cancer (PCa). A total of 734 patients with clinically localized PCa who underwent radical prostatectomy (RP) were included in this study. Clinical and pathological data from each patient were collected. Anthropometric measures of abdominal adiposity were measured from T2-weighted sagittal localisation images from magnetic resonance imaging (MRI) for 413 (56.3%) patients. Patient clinical and pathological characteristics were compared across body mass index (BMI) groups. Univariable and multivariable logistic regression models were used to address the influence of the preoperative total testosterone level and anthropometric measures of obesity on pathological outcomes. In the multivariate analysis, BMI was not significantly associated with any pathological outcomes. However, the percentage of visceral adipose tissue (VAT%) was an independent predictor of a pathological Gleason score ≥8 (P<0.001), extracapsular extension (ECE; P=0.002) and seminal vesicle invasion (SVI; P=0.007). More importantly, we found that the preoperative total testosterone level was significantly correlated with the VAT% (Pearson's correlation coefficient: -0.485, P<0.001) and subcutaneous adipose tissue (SAT; Pearson's correlation coefficient: 0.413, P<0.001). In conclusion, the results of this study suggest that abdominal fat distribution, and particularly VAT%, is associated with a risk of advanced PCa. Moreover, our present study confirms a significant inverse correlation between visceral adiposity and testosterone. Further studies are warranted to elucidate the biological mechanisms underlying the relationship between abdominal adiposity and the aggressiveness of PCa.
Qu, Yuan-Yuan; Dai, Bo; Kong, Yun-Yi; Chang, Kun; Ye, Ding-Wei; Yao, Xu-Dong; Zhang, Shi-Lin; Zhang, Hai-Liang; Yang, Wei-Yi
This study aimed to investigate the association between different anthropometric measures of obesity and clinicopathological characteristics in Chinese patients with clinically localized prostate cancer (PCa). A total of 734 patients with clinically localized PCa who underwent radical prostatectomy (RP) were included in this study. Clinical and pathological data from each patient were collected. Anthropometric measures of abdominal adiposity were measured from T2-weighted sagittal localisation images from magnetic resonance imaging (MRI) for 413 (56.3%) patients. Patient clinical and pathological characteristics were compared across body mass index (BMI) groups. Univariable and multivariable logistic regression models were used to address the influence of the preoperative total testosterone level and anthropometric measures of obesity on pathological outcomes. In the multivariate analysis, BMI was not significantly associated with any pathological outcomes. However, the percentage of visceral adipose tissue (VAT%) was an independent predictor of a pathological Gleason score ≥8 (P<0.001), extracapsular extension (ECE; P=0.002) and seminal vesicle invasion (SVI; P=0.007). More importantly, we found that the preoperative total testosterone level was significantly correlated with the VAT% (Pearson's correlation coefficient: −0.485, P<0.001) and subcutaneous adipose tissue (SAT; Pearson's correlation coefficient: 0.413, P<0.001). In conclusion, the results of this study suggest that abdominal fat distribution, and particularly VAT%, is associated with a risk of advanced PCa. Moreover, our present study confirms a significant inverse correlation between visceral adiposity and testosterone. Further studies are warranted to elucidate the biological mechanisms underlying the relationship between abdominal adiposity and the aggressiveness of PCa. PMID:24036920
Pujante, Pedro; Hellín, María D; Fornovi, Aisa; Martínez Camblor, Pablo; Ferrer, Mercedes; García-Zafra, Victoria; Hernández, Antonio M; Frutos, María D; Luján-Monpeán, Juan; Tébar, Javier
Bariatric surgery is a valuable tool for metabolic control in obese diabetic patients. The aim of this study was to determine changes in weight and carbohydrate and lipid metabolism in obese diabetic patients during the first 4 years after bariatric surgery. A retrospective study was performed in 104 patients (71 women; mean age, 53.0 [0.9] years; mean body mass index, 46.8 [0.7]) with type 2 diabetes mellitus (median duration, 3 years) who underwent laparoscopic proximal gastric bypass. Blood glucose levels and glycated hemoglobin concentrations decreased during the first 1-3 postoperative months. Values stabilized for the rest of the study period, allowing hypoglycemic treatment to be discontinued in 80% of the patients. No significant differences were observed as a function of the body mass index, diabetes mellitus duration, or previous antidiabetic treatment. Weight decreased during the first 15-24 months and slightly increased afterward. Levels of total cholesterol, triglycerides, and low-density lipoprotein significantly decreased, and target values were reached after 12 months in 80% of the patients. No correlation was found between these reductions and weight loss. Similarly, high-density lipoprotein concentrations decreased until 12 months after surgery. Although concentrations showed a subsequent slight increase, target or lower high-density lipoprotein values were achieved at 24 months postintervention in 85% of the patients. Bariatric surgery is effective for the treatment of obese diabetic patients, contributing to their metabolic control and reducing their cardiovascular risk. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.
Brodsky, Sergey V; Barth, Rolf F; Mo, Xiaokui; Yildiz, Vedat; Allenby, Patricia; Ivanov, Iouri; Moore, Stephen; Hitchcock, Charles L; Smith, Stephen; Sachak, Taha; Yao, Keluo; Ball, Matthew; Rosborough, Kelly; Olson, Zachary; Kiehl, Micah; Muni, Navin; Virmani, Renu
correlated with the severity of atherosclerosis (P=.014 and 0.028, respectively), and the inverse relationship between BMI and atherosclerosis remained (adjusted relative risk of BMI≥40 vs. <40=0.64, 95% confidence interval: 0.4-1; P=.03). Our data extend the previously described obesity paradox to another disease entity, atherosclerosis of the aorta. Morbid obesity appeared to have a protective effect for developing severe aortic atherosclerosis, for the reasons for which are yet to be determined. However, the mean age at death of decedents with BMIs≥40 was younger than those with BMIs in the 20-30 range (55.9 vs. 63.2 years, P=.001), confirming that morbid obesity was not associated with increased longevity. Copyright © 2016 Elsevier Inc. All rights reserved.
Umemura, Akira; Sasaki, Akira; Nitta, Hiroyuki; Baba, Shigeaki; Ando, Taro; Kajiwara, Takashi; Ishigaki, Yasushi
This study aimed to assess the relationship between the metabolic effect after laparoscopic sleeve gastrectomy (LSG) in morbidly obese Japanese patients, with or without type 2 diabetes mellitus (T2DM), and improved pancreatic steatosis (PS). The study enrolled 27 morbidly obese Japanese patients who were undergoing LSG. Their clinical and metabolic effects were evaluated at baseline and six months after LSG. Pancreas volume (PV), pancreatic attenuation (PA), and splenic attenuation (SA) were measured using a 64-row computed tomography (CT). Changes in PV, PA-SA, and PA/SA were evaluated. The mean body-weight loss, body mass index loss, and percentage of excess weight loss (%EWL) were -34.4 kg (p < 0.001), -11.0 kg/m(2) (p < 0.001), and 43.7%, respectively. The mean PV was 96.7 mL at baseline, and it decreased six months after LSG (-16.3mL, p < 0.001). The mean PA significantly increased six months after LSG (9.5 HU, p < 0.001). PA-SA (-23.2 HU vs. -13.3 HU, p = 0.003), and PA/SA (0.54 vs. 0.73, p < 0.001) also significantly increased six months after LSG. In T2DM patients, decreased PV correlated with decreased fasting blood sugar, decreased insulin, and reduced liver volume. In conclusion, PV significantly decreased after LSG in morbidly obese Japanese patients, and that decrease correlated with improvements in PS. In addition, PS plays an important role of development and progression of insulin resistance and T2DM.
Abdelaal, Ashraf Abdelaal Mohamed; Mohamad, Mohamad Ali
Obesity, diabetes and hypertension are major worldwide interconnected problems. The aim of this study was to investigate body mass index (BMI), waist circumference (WC), systolic and diastolic blood pressure (SBP and DPB) responses to circuit weight training (CWT) or aerobic exercise training (AET) in obese diabetic hypertensive patients (ODHP). Fifty-nine ODHP were randomly assigned into CWT, AET and control groups. Either CWT or AET was performed thrice weekly for 12 weeks. Variables were evaluated pre-training (evaluation-1), after 3 months (evaluation-2) and 1 month post-training cessation (evaluation-3). At evaluation-2, BMI, WC, SBP, DBP mean values and percentages of decrease were 31.56±1.48 (9.23%), 104±5.97 (6.2%), 141±2.2 (3.09%), 91.2±1.24 (2.98%) and 32.09±1.21 (7.11%), 107.66±3.92 (3.07%), 138.3±1.17 (4.79%), 88.05±1.05 (6.02%) for CWT and AET groups respectively (P<0.05). At evaluation-3, mean values and percentage of decrease in BMI, WC, SBP, DBP were 31.88±1.54 (8.29%), 105±5.28 (5.26), 142.6±2.21 (1.99%), 92.7±0.86 (1.38%) and 33.26±1.22 (3.72%), 109.1±4.15 (1.77%), 140.35±1.23 (3.38%), 89.5±0.61 (4.47%) for CWT and AET groups respectively (P<0.05). There were also significant differences in BMI, WC, SBP, and DBP between groups at evaluation-2 and 3 (P<0.05). While CWT is the intervention of choice to control obesity indices, AET is still the best intervention to lower blood pressure in ODHP, for a more extended period of time. Copyright © 2014 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.
Kamińska, Anna; Kopczyńska, Ewa; Bieliński, Maciej; Borkowska, Alina; Junik, Roman
Visfatin, protein secreted by visceral adipose tissue, exerts insulin-mimetic actions. Visfatin concentration increases in patients with longer-standing diabetes type 2 with progressive b-cell dysfunction. Data about the role of visfatin in newly diagnosed glucose metabolism abnormalities are limited. Evaluation of visfatin concentration in patients with obesity, in relation to the presence of newly diagnosed glucose metabolism disorders. The study included 68 subjects with obesity, without a previous diagnosis of abnormal glucose metabolism. In all subjects we performed an oral glucose tolerance test, and according to the results the group was divided into the subgroups: A (n = 31), with glucose metabolism disorders (impaired fasting glucose, impaired glucose tolerance and type 2 diabetes); and B (n = 37), without abnormalities. In all subjects serum lipids, uric acid, C-peptide, glycated haemoglobin (HbA1c), creatinine, and serum visfatin concentrations were measured. The control group comprised 30 lean, healthy individuals with normal glucose tolerance. We found elevated visfatin levels in obese individuals versus the control group (50.0 ± 48 vs. 26.7 ± 22.1 ng/mL; p = 0.01). Visfatin concentrations in both subgroups, A and B, did not differ (40.86 ± 27.84 vs. 57.7 ± 59.79 ng/mL; p = 0.19). In subgroup A visfatin concentration correlated significantly with triglycerides (r = 0.37, p = 0.038), HbA1c (r = -0.43, p = 0.02), C-peptide (r = -0.38,p = 0.048), and waist-hip ratio (r = -0.41, p = 0.036). The presence of newly diagnosed glucose metabolism abnormalities in obese subjects had no influence on the visfatin level, probably due to preserved endogenous insulin secretion and relatively short exposure to hyperglycaemia in patients with prediabetes or at early stage of type 2 diabetes.
Abrão, Maria Angélica; Ferreira, Renata Gomes; Germano Filho, Paulo Alípio; Lerner, Luiz Cláudio
Rhabdomyolysis is a syndrome caused by skeletal muscle injury. Its etiology is broad with special interest when it is manifested as intra or post-anesthetic complication. This report aimed at describing two cases of rhabdomyolysis in the postoperative period of long procedures in morbidly obese and trauma injury patients, emphasizing its correlation with anesthesia. The first case is a 39-year old, morbidly obese patient, BMI 62, submitted to laparoscopic gastric bypass under general anesthesia. In the postoperative period patient presented upper and lower limbs muscle weakness and changes in sensitivity evolving with muscle pain and reddish urine. Increased creatinokinase (CK) plasma levels confirmed the diagnosis of rhabdomyolysis. Patient was treated with forced and diuretic hydration, has not evolved with renal failure, but was discharged with muscular and neurological sequelae. The second case is a 7-year old child victim of accident with a glass door, who was submitted to emergency procedure for left upper limb revascularization. During anesthesia urine color has changed becoming reddish. Intravenous sodium bicarbonate and mannitol were administered to alkalinize the urine and increase urinary output. Patient was referred to the ICU where rhabdomyolysis was confirmed by increased CK enzyme and myoglobinuria. Patient was discharged 10 days later without sequelae. Cases have shown risk factors for rhabdomyolysis and their relationship with anesthesia and surgery. Early diagnosis is critical for a fast and aggressive treatment to prevent more severe complications.
Prat-Larquemin, Lydie; Oppert, Jean-Michel; Clément, Karine; Hainault, Isabelle; Basdevant, Arnaud; Guy-Grand, Bernard; Quignard-Boulangé, Annie
To investigate AGT secretion in cultured adipocytes from obese patients and its relationship with obesity-related phenotypes, blood pressure, and the M235T polymorphism in the AGT gene. Measurements, including anthropometry, body composition (DXA), and blood pressure, were performed in 61 overweight or obese women (BMI: 28 to 68 kg/m(2)). A subcutaneous abdominal adipose tissue biopsy was used for adipocyte size determination and quantification of AGT secretion in the medium of cultured adipocytes. AGT M235T genotype was determined using polymerase chain reaction-restriction fragment length polymorphism. Adipose secretion of the AGT protein (range, 140 to 2575 ng/10(6) cells/24 h) was not significantly correlated with BMI, body fat, or blood pressure and did not vary according to the M235T polymorphism in the AGT gene. However, the AGT M235T polymorphism was associated with adipocyte size (111.6 +/- 2.8, 108.8 +/- 1.9, 118.2 +/- 2.6 micro m in MM, MT, and TT genotypes, respectively; p < 0.01) after adjustment for age and fat mass. An association between the AGT M235T polymorphism and adipocyte size (p < 0.02 adjusted for sex, age, and BMI) was found in another independent sample of 106 obese subjects (sex ratio, M/F 16/90; BMI, 29 to 70 kg/m(2)). In cultured adipocytes from obese subjects, AGT secretion was not associated with body fat phenotypes, blood pressure, or fat cell size. However, results from two independent studies suggest an association between the AGT M235T polymorphism and adipocyte size.
Adams, Ted D.; Pendleton, Robert C.; Strong, Michael B.; Kolotkin, Ronette L.; Walker, James M.; Litwin, Sheldon E.; Berjaoui, Wael K.; LaMonte, Michael J.; Cloward, Tom V.; Avelar, Erick; Owan, Theophilus E.; Nuttall, Robert T.; Gress, Richard E.; Crosby, Ross D.; Hopkins, Paul N.; Brinton, Eliot A.; Rosamond, Wayne D.; Wiebke, Gail A.; Yanowitz, Frank G.; Farney, Robert J.; Halverson, R. Chad; Simper, Steven C.; Smith, Sherman C.; Hunt, Steven C.
Favorable health outcomes at 2 years postbariatric surgery have been reported. With exception of the Swedish Obesity Subjects (SOS) study, these studies have been surgical case series, comparison of surgery types, or surgery patients compared to subjects enrolled in planned nonsurgical intervention. This study measured gastric bypass effectiveness when compared to two separate severely obese groups not participating in designed weight-loss intervention. Three groups of severely obese subjects (N = 1,156, BMI ≥ 35 kg/m2) were studied: gastric bypass subjects (n = 420), subjects seeking gastric bypass but did not have surgery (n = 415), and population-based subjects not seeking surgery (n = 321). Participants were studied at baseline and 2 years. Quantitative outcome measures as well as prevalence, incidence, and resolution rates of categorical health outcome variables were determined. All quantitative variables (BMI, blood pressure, lipids, diabetes-related variables, resting metabolic rate (RMR), sleep apnea, and health-related quality of life) improved significantly in the gastric bypass group compared with each comparative group (all P < 0.0001, except for diastolic blood pressure and the short form (SF-36) health survey mental component score at P < 0.01). Diabetes, dyslipidemia, and hypertension resolved much more frequently in the gastric bypass group than in the comparative groups (all P < 0.001). In the surgical group, beneficial changes of almost all quantitative variables correlated significantly with the decrease in BMI. We conclude that Roux-en-Y gastric bypass surgery when compared to severely obese groups not enrolled in planned weight-loss intervention was highly effective for weight loss, improved health-related quality of life, and resolution of major obesity-associated complications measured at 2 years. PMID:19498344
Nagamine, Y; Nishiyama, T; Hanaoka, K
A forty-six year old woman (136 cm, 115 kg), with body mass index (BMI) of 62.2, was scheduled for osteotomy because of postoperative infection and pseudoarthrosis of the right lower leg. During the post two years, the patient had received several orthopedic surgeries under spina anesthesia, which repeatedly accompanied intraoperative respiratory difficulties. At the age of thirty one, she weighted more than 100 kg and needed cardiopulmonary resuscitation during cesarean section under general anesthesia. Considering the past history of anesthesic complications, we decided to perform epidural anesthesia with a written informed consent from the patient. Due to technical difficulties, the operative procedures took six hours and forty-five minutes without complications related to anesthesia. This case demonstrates the necessity of safe and comfortable anesthesia for morbidly obese patients.
Pardina, E; López-Tejero, M D; Llamas, R; Catalán, R; Galard, R; Allende, H; Vargas, V; Lecube, A; Fort, J M; Baena-Fustegueras, J A; Peinado-Onsurbe, J
Although bariatric surgery is the most common procedure used to induce weight loss in morbidly obese patients, its effect on plasma satiety factors (leptin, ghrelin, and apolipoprotein (apo)-AIV) is controversial. The aim of this work was to analyze these parameters before and at different times after surgery. Plasma was obtained from 34 patients before undergoing Roux-en-Y gastric bypass and during weight loss in the 12 months following surgery. Morbidly obese patients had significantly higher values (147%) of leptin than normal-weight (NW) persons, while their ghrelin levels were 46% less than NW. Apo-AIV levels had approximately the same value in both groups (obese and NW). During weight loss, leptin decreased by 75% and ghrelin increased by 78%. Both parameters reached values less than or near NW, respectively, at 1 year after surgery. During the first month after surgery, apo-AIV plasma levels decreased (47%) but later increased and finally returned to preoperative values. Apo-AIV levels were correlated negatively with leptin and positively with ghrelin. High-density lipoprotein (HDL) levels were positively correlated with those of ghrelin and apo-AIV. During weight loss, plasma leptin and ghrelin could be good markers of total fat decrease. Ghrelin could also indicate gastric mucous improvement, whereas apo-AIV could indicate the recovery of intestinal function. Changes produced in the HDL levels of morbidly obese patients during weight loss suggest a decreased risk of coronary disease.
Gallart-Aragón, Tania; Fernández-Lao, Carolina; Castro-Martín, Eduardo; Cantarero-Villanueva, Irene; Cózar-Ibáñez, Antonio; Arroyo-Morales, Manuel
Laparoscopic sleeve gastrectomy (LSG) has demonstrated high long-term effectiveness and major advantages over other techniques. The objective of this study was to analyze changes in physical fitness parameters in morbidly obese patients during 6 months after LSG. We conducted a descriptive observational study with 6-month follow-up in 72 LSG patients, evaluating changes in body mass index (BMI), functional capacity (6-min walking test), hand grip strength (manual dynamometry), flexibility (fingertip-to-floor test), balance (Flamingo test), physical activity level (International Physical Activity Questionnaire, IPAQ), and perception of general physical fitness (International Fitness Scale [IFIS] questionnaire). The ANOVA revealed significant improvements in BMI, functional capacity, flexibility, balance, and physical activity level (P < 0.001) at 6 months, with an improvement in the perception of physical fitness in most cases. No significant changes were found in dominant hand (P = 0.676) or non-dominant hand (P = 0.222) dynamometry. General physical fitness was positively correlated with BMI and distance in the 6-min test, and was negatively correlated with fingertip-to-floor distance. Morbidly obese patients showed major improvements at 6 months after LSG in functional capacity, balance, mobility, and physical activity, with no change in grip strength. These improvements were related to a better self-perception of general physical fitness.
Palomo Atance, Enrique; Ballester Herrera, M José; Giralt Muiña, Patricio; Ruiz Cano, Rafael; León Martín, Alberto; Giralt Muiña, Juan
To assess the estimated glucose disposal rate (eGDR), insulin dose, and lipoprotein profile in children with type 1 diabetes mellitus (T1DM) and overweight or obesity as compared to children with T1DM and normal weight. A total of 115 patients (aged 5-16 years) with T1DM on intensive insulin therapy were recruited. The following parameters were measured: weight, height, body mass index, waist and hip circumference, insulin dose, eGDR, glycosylated hemoglobin, blood pressure, and lipoprotein profile. Results were stratified by sex and age. No significant differences were found in eGDR between children with normal weight, overweight, and obesity. However, obese children older than 11 years had lower eGDR values (9.3±1.3 vs 10.1±0.8 mg kg(-1)min(-1); p<0.01). Insulin dose was higher in overweight and obese children, especially in IU/m2/day (37.7 vs 36.1 vs. 29.4 respectively; p<0.01). Obese children had higher low-density lipoprotein cholesterol levels than children with overweight and normal weight (106.5 vs 91.7 vs 91.5mg/dL respectively; p<0.01). No correlation was found between waist circumference and the different markers of insulin resistance. Values of eGDR values were lower in obese children with T1DM older than 11 years, and this may therefore be considered a marker of insulin resistance. Insulin dose was higher in diabetic patients with overweight or obesity, specially in IU/m2/day. Obese children with T1DM had a lipoprotein profile of cardiovascular risk. Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.
Elder, John P; Arredondo, Elva M; Campbell, Nadia; Baquero, Barbara; Duerksen, Susan; Ayala, Guadalupe; Crespo, Noe C; Crespo, Noc C; Slymen, Donald; McKenzie, Thomas
The prevalence of overweight children has reached epidemic proportions, and affects Latinos youth more than other subgroups in the United States. Given the prevalence of obesity and its economic consequences, community health initiatives have shifted toward primary prevention at younger ages. Data representing all levels of the ecological systems theory were collected using diverse methods. Participants were children enrolled in K-2nd grade and their parents. Overweight children were less active compared to normal weight children. The parents of overweight children provided less instrumental support to engage in activity and set fewer limits on their child's activities. Similarly, parents of overweight children were less likely to control, but more likely to set limits on their child's diet compared to parents of normal weight children. Parents who rated their health more positively and were less acculturated were more likely to have children who were overweight. School and community level variables were not significantly correlated with children's weight. Adjusting for the aforementioned variables, parents' weight status was positively associated with children's weight. Social and structural environments in which Hispanic children are reared may play an important role in determining their risk for obesity and related behaviors. Parents' weight was among the strongest correlate of child weight; however, the extent to which this influence functions primarily through biological or social/structural influences is not entirely clear. The role of school and community factors on child's health practices and body mass index needs to be further examined.
Carver, Tamara E; Court, Olivier; Christou, Nicolas V; Reid, Ryan E R; Andersen, Ross E
A new measurement tool, the automated software CoreScan, for the GE Lunar iDXA, has been validated for measuring visceral adipose tissue (VAT) against computed tomography in normal-weight populations. However, no study has evaluated the precision of CoreScan in measuring VAT among severely obese patients. The purpose of the study was to evaluate the precision of CoreScan for VAT measurements in severely obese adults (body mass index > 40 kg·m(-2)). A total of 55 obese participants with a mean age of 46 ± 11 yr, body mass index of 49 ± 6 kg·m(-2), and body mass of 137.3 ± 21.3 kg took part in this study. Two consecutive iDXA scans with repositioning of the total body were conducted for each participant. The coefficient of variation, the root-mean-square averages of SD of repeated measurements, the corresponding 95% least significant change, and intraclass correlations were calculated. Precision error was 8.77% (percent coefficient of variation), with a root-mean-square SD of 0.294 kg and an intraclass correlation of 0.96. Bland-Altman plots demonstrated a mean precision bias of -0.08 ± 0.41 kg, giving a coefficient of repeatability of 0.82 kg and a bias range of -0.890 to 0.725 kg. When interpreting VAT results with the iDXA in severely obese populations, clinicians should be aware of the precision error for this important clinical parameter.
Foster, Gary D.; Sanders, Mark H.; Millman, Richard; Zammit, Gary; Borradaile, Kelley E.; Newman, Anne B.; Wadden, Thomas A.; Kelley, David; Wing, Rena R.; Pi Sunyer, F. Xavier; Darcey, Valerie; Kuna, Samuel T.
OBJECTIVE To assess the risk factors for the presence and severity of obstructive sleep apnea (OSA) among obese patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Unattended polysomnography was performed in 306 participants. RESULTS Over 86% of participants had OSA with an apnea-hypopnea index (AHI) ≥5 events/h. The mean AHI was 20.5 ± 16.8 events/h. A total of 30.5% of the participants had moderate OSA (15 ≤ AHI <30), and 22.6% had severe OSA (AHI ≥30). Waist circumference (odds ratio 1.1; 95% CI 1.0–1.1; P = 0.03) was significantly related to the presence of OSA. Severe OSA was most likely in individuals with a higher BMI (odds ratio 1.1; 95% CI 1.0–1.2; P = 0.03). CONCLUSIONS Physicians should be particularly cognizant of the likelihood of OSA in obese patients with type 2 diabetes, especially among individuals with higher waist circumference and BMI. PMID:19279303
Knutsen, Ingrid Ruud; Terragni, Laura; Foss, Christina
Morbidly obese patients and lifestyle change: constructing ethical selves In contemporary societies, bodily size is an important part of individuals' self-representation. As the number of persons clinically diagnosed as morbidly obese increases, programmes are developed to make people reduce weight by changing their lifestyle, and for some, by bariatric surgery. This article presents findings from interviews with 12 participants undergoing a prerequisite course prior to bariatric surgery that is intended both as a preparation for further (surgical) treatment and as a tool to empower individuals regarding lifestyle changes. In this study, we investigate how power operates by looking at how the participants position themselves throughout the course. Findings reveal how participants construct their ability to act in line with norms of lifestyle change. They do this by positioning themselves as both included group members and as 'morally' acceptable individuals. Despite some resistance, the participants tend to glide into the role of 'good patients' acting in compliance with the aims of the course in their hope and striving for new positions as 'normal-sized'. The intention in the course is to empower individuals towards lifestyle changes. The findings provide a basis to question whether these kinds of courses create new forms of compliance and dependency. © 2011 Blackwell Publishing Ltd.
Tanaka, Shogo; Iimuro, Yuji; Hirano, Tadamichi; Hai, Seikan; Suzumura, Kazuhiro; Nakamura, Ikuo; Kondo, Yuichi; Fujimoto, Jiro
This study aimed at investigating the safety of hepatic resection for hepatocellular carcinoma (HCC) in obese patients with cirrhosis in Japan. We reviewed the clinical records of 202 patients with liver cirrhosis, who underwent hepatic resection for HCC between January, 2001 and August, 2011. The patients were divided into three groups according to their body mass index (BMI): the normal body weight (BMI < 24.9 kg/m(2)), obese class I (BMI 25.0-29.9 kg/m(2)), and obese class II (BMI ≥ 30 kg/m(2)) groups. We compared the patient backgrounds, intraoperative factors, and postoperative complications among the three groups. The normal body weight, obese class I, and obese class II groups comprised 138 (68.3 %), 55 (27.2 %), and 9 (4.5 %) patients, respectively. The incidence of non-B non-C cirrhosis was higher in the obese class II group (22 %) than in the normal body weight group (14 %, p = 0.034). Intraoperative blood loss tended to be higher in the obese class II patients than in the other two groups. Postoperative complications and mortality did not differ significantly among the three groups. According to multivariate analysis, obesity was not a risk factor for postoperative complications (Clavien-Dindo classification Grade III or higher) or mortality. Hepatic resection for HCC can be performed safely in obese patients with cirrhosis.
Lagger, Grégoire; Pataky, Zoltan; Golay, Alain
To evaluate the clinical, methodological and reporting aspects of systematic reviews and meta-analyses in order to determine the efficacy of therapeutic patient education (TPE). A thorough search of the medical and nursing literature recorded in MedLine database from 1999 to August 2009 was conducted using the keywords: patient education, efficacy, diabetes, asthma, COPD, hypertension, cardiology, obesity, rheumatology, and oncology. Thirty five relevant meta-analyses were identified and initially selected for critical analyses (598 studies concerning approximately 61,000 patients). The detailed description of the educative intervention was present in 4% of articles whereas in 23% the interventions were briefly described. In the majority of studies, the educative interventions were only named (49%) or totally absent (24%). The majority of studies reported improvement of patient outcomes due to the TPE (64%), 30% of studies reported no effect of TPE and 6% of the analysed reviews and meta-analyses reported worsening of measured outcomes. Patient education could improve patient outcomes. The high benefit from TPE was shown by articles with detailed description of educational intervention as well as by those who report multidimensional and multidisciplinary educational intervention. The impact of therapeutic patient education on health outcomes is 50-80%. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.
Walden, Christine M; Bankard, Scott B; Cayer, Bradford; Floyd, William B; Garrison, Herbert G; Hickey, Todd; Holfer, Linda D; Rotondo, Michael F; Pories, Walter J
Obese patients are difficult to transport between emergency departments, imaging facilities, operating rooms, intensive care units, acute care units, and rehabilitation facilities. Each move, along with turning, bathing, and access to bathrooms, poses risks of injury to patients and personnel. Similarly, inadequate mobilization raises the risk of pressure ulcers. The costs can be prohibitive. On 6 pilot units, mobilization of patients was delegated to trained lift team technicians who covered the units in pairs, 24 hours per day, 7 days per week, to assist with moving and lifting of patients weighing 200 pounds or more, with a Braden Scale score of 18 or less and/or the presence of pressure ulcers. In fiscal year 2012, hospital-acquired pressure ulcers on pilot units decreased by 43% (from 61 to 35). Patient handling-related employee injuries on pilot units decreased by 38.5% (from 13 to 8). Employee satisfaction related to organizational commitment to employee safety and impact on job satisfaction was positively impacted by implementation of the lift team. With the reduction in employee injuries and the fall in the prevalence of pressure ulcers, the adoption of the lift team program decreased costs by $493,293.00. Implementation of lift teams on pilot nursing units decreased patient handling-related employee injuries, resulting in sharp improvements in quality patient care and reduced costs.
Goldin, R H; McAdam, L; Louie, J S; Gold, R; Bluestone, R
Twenty-five grossly obese males were investigated for evidence of osteoarthrosis. A roentgenological survey of multiple joints obtained from 22 of these patients showed few significant degenerative changes. 6 patients (20%) had previously incurred traumatic rents in their menisci necessitating meniscectomy. Our results refute previous claims that obesity is a factor in the genesis of osteoarthrosis but do indicate that obese individuals are more predisposed to traumatic injury of the knee. PMID:970992
Werner, Brian C; Evans, Cody L; Carothers, Joshua T; Browne, James A
This study utilized a national database to evaluate 90 day postoperative complication rates after total knee arthroplasty (TKA) in super obese (BMI > 50 kg/m(2)) patients (n = 7666) compared to non-obese patients (n = 1,212,793), obese patients (n = 291,914), morbidly obese patients (n = 169,308) and revision TKA patients (n = 28,812). Super obese patients had significantly higher rates of local and systemic complications compared to all other BMI groups as well as those undergoing revision TKA with higher rates of venous thromboembolism (VTE), infection, and medical complications. Super obesity is associated with dramatically increased rates of postoperative complications after TKA compared to non-obese, obese, and morbidly obese patients as well as those undergoing revision TKA.
Bertola, Adeline; Bonnafous, Stéphanie; Anty, Rodolphe; Patouraux, Stéphanie; Saint-Paul, Marie-Christine; Iannelli, Antonio; Gugenheim, Jean; Barr, Jonathan; Mato, José M; Le Marchand-Brustel, Yannick; Tran, Albert; Gual, Philippe
Obesity modulates inflammation and activation of immune pathways which can lead to liver complications. We aimed at identifying expression patterns of inflammatory and immune response genes specifically associated with obesity and NASH in the liver of morbidly obese patients. Expression of 222 genes was evaluated by quantitative RT-PCR in the liver of morbidly obese patients with histologically normal liver (n = 6), or with severe steatosis without (n = 6) or with NASH (n = 6), and in lean controls (n = 5). Hepatic expression of 58 out of 222 inflammatory and immune response genes was upregulated in NASH patients. The most notable changes occurred in genes encoding chemokines and chemokine receptors involved in leukocyte recruitment, CD and cytokines involved in the T cell activation towards a Th1 phenotype, and immune semaphorins. This regulation seems to be specific for the liver since visceral adipose tissue expression and serum levels of MCP1, IP10, TNFα and IL6 were not modified. Importantly, 47 other genes were already upregulated in histologically normal liver (e.g. CRP, Toll-like receptor (TLR) pathway). Interestingly, serum palmitate, known to activate the TLR pathway, was increased with steatosis. The liver of obese patients without histological abnormalities already displayed a low-grade inflammation and could be more responsive to activators of the TLR pathway. NASH was then characterized by a specific gene signature. These findings help to identify new potential actors of the pathogenesis of NAFLD.
FERNANDEZ, Mônica; TOIMIL, Rosana Farah; RASSLAN, Zied; ILIAS, Elias Jirjoss; GRADINAR, Ana Lúcia Torloni; MALHEIROS, Carlos Alberto
ABSTRACT Background: The study of body composition in patient candidates for bariatric surgery is directly related to the increase and distribution of body fat in the development of cardiovascular disease. Aim: To correlate anthropometric indicators and bioelectrical impedance in the assessment of body fat in female candidates for bariatric surgery. Methods: Cross-sectional, observational study of 88 women. The weight, height, body mass index and waist circumference data were evaluated in the anthropometric analysis. The body fat was determinate by bioelectrical impedance conducted according to the manufacturer´s recommended technique with a specific severe obesity formula. The patients were divided into two subgroups according to the average waist circumference and body mass index for better analysis of the results. Results: The group had a mean age of 39.7 years (±7.2), average weight of 125.6 kg (±16.2), mean body mass index of 48.7 kg/m2 (±6.4) and the mean waist circumference 137.6 cm (±12.4). Negative and significant relationship between BMI values waist circumference and resistance obtained by bioelectrical impedance were found. By analyzing the two groups the mean BMI and waist circumference, a significant relationship was observed, ie, the higher the degree of obesity less resistance was obtained by bioelectrical impedance. The higher is the obesity the lower is value found for resistance. Conclusion: The increase of anthropometric indicators (BMI and waist circumference) determined reduction in resistance and reactance obtained by bioelectrical impedance analysis in obese women candidates to bariatric surgery. PMID:27683778
Acevedo, A; León, J
Ambulatory hernia surgery under local anesthesia is becoming more widely used worldwide. Although many reports include obese patients, there are no studies that report specifically on the feasibility and safety of ambulatory hernia surgery in this category of patients. This paper documents our experience in this respect. The present investigation is an observational study performed at the CRS Hernia Center, Santiago, Chile, on 510 obese and 1,521 non-obese patients with all kinds of hernias susceptible to ambulatory hernia repair under local anesthesia. Both tissue and mesh repairs were performed. Obesity was defined as a body mass index (BMI) greater than 30. Patients with a BMI greater than 45 were excluded from this study. Operative time and pain experienced during the intervention were recorded. During the controls performed by a staff member at the 7th postoperative day, a questionnaire was answered by each patient regarding satisfaction, complaints, and postoperative pain. A second questionnaire was completed on the 30th postoperative day. Satisfaction and pain were both measured by means of a 10-point visual analog scale (VAS). The mean age was similar in both groups (51 years for non-obese and 52 years for obese patients). Obesity was present in 38.3% of women and in 17.5% of men (P < 0.002). Diabetes and hypertension were observed in a significantly (P < 0.004 and P < 0.02, respectively) higher proportion of obese patients. The duration of the operation on obese patients was 78 min compared with 62 min in non-obese patients (P < 0.001). Pain experienced during the intervention was significantly higher in obese patients with a VAS of 2.4 vs. in lean patients with a VAS of 2.0 (P < 0.01). At 24 h, pain was significantly higher and satisfaction significantly lower in obese patients (P < 0.007 and P < 0.0001, respectively). All other parameters were similar in both groups. At 30 days, infection was present in 0.7% of lean patients and in 2.1% of obese patients
Zhao, Y; Lv, G
This meta-analysis evaluated the correlations between C-reactive protein (CRP) and obesity in Chinese adults and children. We searched three Chinese databases [Wanfang, WEIPU, and Chinese National Knowledge Infrastructure (CNKI)] in addition to PubMed. The search was restricted to only Chinese studies published online before January 9, 2013. Data from 28 articles were independently abstracted by two reviewers. The articles' characteristics were abstracted as follows: 1) first author name; 2) year of publication; 3) study population; 4) sample size; 5) sex, age, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and CRP level of the study population; 6) Pearson correlation coefficients, Spearman correlation coefficients, or odds ratios between CRP level and obesity. The metaanalysis was conducted to pool the Pearson correlation coefficients using a random-effects model. The pooled Pearson correlation coefficient between CRP and BMI was 0.45 [95% confidence interval (CI): 0.33-0.56] in Chinese adults and 0.46 (95% CI: 0.31-0.62) in Chinese children, and the pooled Pearson correlation coefficient was 0.32 (95% CI: 0.24-0.40) in the general Chinese population and 0.53 (95% CI: 0.42-0.64) in the obese Chinese population. Significant correlation was thus found between CRP and obesity in Chinese adults and children.
Jastreboff, Ania M; Sinha, Rajita; Lacadie, Cheryl; Small, Dana M; Sherwin, Robert S; Potenza, Marc N
Obesity is associated with alterations in corticolimbic-striatal brain regions involved in food motivation and reward. Stress and the presence of food cues may each motivate eating and engage corticolimibic-striatal neurocircuitry. It is unknown how these factors interact to influence brain responses and whether these interactions are influenced by obesity, insulin levels, and insulin sensitivity. We hypothesized that obese individuals would show greater responses in corticolimbic-striatal neurocircuitry after exposure to stress and food cues and that brain activations would correlate with subjective food craving, insulin levels, and HOMA-IR. Fasting insulin levels were assessed in obese and lean subjects who were exposed to individualized stress and favorite-food cues during functional MRI. Obese, but not lean, individuals exhibited increased activation in striatal, insular, and hypothalamic regions during exposure to favorite-food and stress cues. In obese but not lean individuals, food craving, insulin, and HOMA-IR levels correlated positively with neural activity in corticolimbic-striatal brain regions during favorite-food and stress cues. The relationship between insulin resistance and food craving in obese individuals was mediated by activity in motivation-reward regions including the striatum, insula, and thalamus. These findings demonstrate that obese, but not lean, individuals exhibit increased corticolimbic-striatal activation in response to favorite-food and stress cues and that these brain responses mediate the relationship between HOMA-IR and food craving. Improving insulin sensitivity and in turn reducing corticolimbic-striatal reactivity to food cues and stress may diminish food craving and affect eating behavior in obesity.
Pérez-Segura, P; Palacio, J E; Vázquez, L; Monereo, S; de Las Peñas, R; de Icaya, P Martínez; Grávalos, C; Lecube, A; Blasco, A; García-Almeida, J M; Barneto, I; Goday, A
The relationship between obesity and cancer is clear and is present at all times during course of the disease. The importance of obesity in increasing the risk of developing cancer is well known, and some of the most prevalent tumours (breast, colorectal, and prostate) are directly related to this risk increase. However, there is less information available on the role that obesity plays when the patient has already been diagnosed with cancer. Certain data demonstrate that in some types of cancer, obese patients tolerate the treatments more poorly. Obesity is also known to have an impact on the prognosis, favouring lower survival rates or the appearance of secondary tumours. In this consensus statement, we will analyse the scientific evidence on the role that obesity plays in patients already diagnosed with cancer, and the available data on how obesity control can improve the quality of daily life for the cancer patient.
Ather, Jennifer L; Poynter, Matthew E; Dixon, Anne E
Obesity is associated with severe, poorly controlled asthma that does not respond as well to therapy as asthma in leaner asthmatics. Important insights gained from animal models of obesity and asthma suggests that different forms of obesity may lead to different manifestations of airway disease: obesity is associated with both innate increased airway reactivity and altered responses to aeroallergen and pollutant challenges. In humans, at least two broad groups of obese asthmatics have been recognized: one that is likely unique to obesity and another that is likely lean allergic asthma much complicated by obesity. This article will discuss what we have learned about the immunological and pathophysiological basis of asthma in obesity from animal and human studies, and how this might guide therapy. PMID:25914932
Shailaja, S.; Nichelle, S. M.; Shetty, A. Kishan; Hegde, B. Radhesh
Background: Difficult tracheal intubation contributes to significant morbidity and mortality during induction of anesthesia. There are divided opinions regarding ease of intubation in obese patients. Moreover, the definition of difficult intubation is not uniform; hence we have use the Intubation Difficulty Scale (IDS) to find the incidence of difficult intubation in obese patients. Aims: The primary aim of the following study is to find out the incidence of difficult intubation in obese and lean patients using IDS and secondary aim is to assess the performance of bedside screening tests to predict difficult intubation, mask ventilation and laryngoscopy in obese and lean patients. Materials and Methods: A prospective, observational cohort study of 200 patients requiring general anesthesia were categorized into 100 each based on body mass index (BMI) into lean (BMI <25 kg/m2) and obese (BMI ≥25 kg/m2) groups. IDS score ≥5 was termed as difficult intubation. Pre-operative airway assessment included Mallampati score, mouth opening, neck circumference (NC), upper lip bite test, thyromental distance, sternomental distance (SMD) and head neck mobility. Patients having difficulty in mask ventilation and laryngoscopy was recorded. Results: Over all in 200 patients the incidence of difficult intubation was 9%. Obese patients were slightly more difficult to intubate than lean (11% vs. 7%, P = 0.049). Age >40 years, NC >35 cm, SMD <12.5 cm and restricted head neck mobility were factors which were associated with IDS ≥5. Multivariate analysis revealed SMD <12.5 cm to predict difficult intubation in obese patients. Obese patients were difficult to mask ventilate (6% vs. 1%, P = 0.043). There was no difference regarding grading of laryngoscopy between the two groups. Conclusion: Obese patients are difficult to mask ventilate and intubate. During intubation of obese patients who is more than 40 years age and SMD <12.5 cm, it is preferable to have a second skilled
Wing, Rena R.; And Others
Assigned 49 obese diabetic patients with obese spouses (diabetic or nondiabetic) to an alone or together (with spouses) treatment condition of behavioral weight control program. Found no significant differences in weight losses of patients at posttreatment or one-year followup, but did find that women did better when treated with their spouses,…
Lim, Junghyun; Davison, Kirsten K; Jurkowski, Janine M; Horan, Christine M; Orav, E John; Kamdar, Neil; Fiechtner, Lauren G; Taveras, Elsie M
Few studies have examined correlates of resource empowerment among parents of children with overweight or obesity. We studied baseline data of 721 parent-child pairs participating in the Connect for Health randomized trial being conducted at six pediatric practices in Massachusetts. Parents completed the child weight management subscale (n = 5 items; 4-point response scale) of the Parent Resource Empowerment Scale; items were averaged to create a summary empowerment score. We used linear regression to examine the independent effects of child (age, sex, and race/ethnicity), parent/household characteristics (age, education, annual household income, BMI category, perceived stress, and their ratings of their healthcare quality), and neighborhood median household income, on parental resource empowerment. Mean (SD) child age was 7.7 years (2.9) and mean (SD) BMI z-score was 1.9 (0.5); 34% of children were white, 32% black, 22% Hispanic, 5% Asian, and 6% multiracial/other. The mean parental empowerment score was 2.95 (SD = 0.56; range = 1-4). In adjusted models, parents of older children [β -0.03 (95% CI: -0.04, -0.01)], Hispanic children [-0.14 (-0.26, -0.03)], those with annual household income less than $20,000 [-0.16 (-0.29, -0.02)], those with BMI ≥30.0 kg/m(2) [-0.17 (-0.28, -0.07)], and those who reported receiving lower quality of obesity-related care [-0.05 (-0.07, -0.03)] felt less empowered about resources to support their child's healthy body weight. Parental resource empowerment is influenced by parent and child characteristics as well as the quality of their obesity-related care. These findings could help inform equitable, family-centered approaches to improve parental resource empowerment.
Yerlikaya, Emrah; Karageçili, Hasan; Aydin, Ruken Zeynep
Obesity is a key risk for the development of hyperglycemia, hypertension, hyperlipidemia, insulin resistance and is totally referred to as the metabolic disorders. Diabetes mellitus, a metabolic disorder, is related with hyperglycemia, altered metabolism of lipids, carbohydrates and proteins. The minimum defining characteristic feature to identify diabetes mellitus is chronic and substantiated elevation of circulating glucose concentration. In this study, it is aimed to determine the body composition analyze of obese and (obese+diabetes) patients.We studied the datas taken from three independent groups with the body composition analyzer instrument. The body composition analyzer calculates body parameters, such as body fat ratio, body fat mass, fat free mass, estimated muscle mass, and base metabolic rate on the basis of data obtained by Dual Energy X-ray Absorptiometry using Bioelectrical Impedance Analysis. All patients and healthy subjects applied to Siirt University Medico and their datas were taken. The Statistical Package for Social Sciences version 21 was used for descriptive data analysis. When we compared and analyzed three groups datas, we found statistically significant difference between obese, (obese+diabetes) and control groups values. Anova test and tukey test are used to analyze the difference between groups and to do multiple comparisons. T test is also used to analyze the difference between genders. We observed the statistically significant difference in age and mineral amount p<0.00 between (diabetes+obese) and obese groups. Besides, when these patient groups and control group were analyzed, there were significant difference between most parameters. In terms of education level among the illiterate and university graduates; fat mass kg, fat percentage, internal lubrication, body mass index, water percentage, protein mass percentage, mineral percentage p<0.05, significant statistically difference were observed. This difference especially may result
Tamada, Daisuke; Otsuki, Michio; Kashine, Susumu; Hirata, Ayumu; Onodera, Toshiharu; Kitamura, Tetsuhiro; Shimomura, Iichiro
Activation of the hypothalamic-pituitary-adrenal axis has been reported in some patients with the obstructive sleep apnea syndrome (OSAS). In current study, we investigated whether OSAS affect the screening test for subclinical Cushing's disease using 0.5 mg overnight dexamethasone suppression test (DST) in Japanese obese diabetic patients with OSAS. Among Japanese obese patients with type 2 diabetes mellitus who had been hospitalized in our department, we selected 20 patients with moderate to severe untreated OSAS (apnea-hypoxia index, AHI, of ≥15 events/hour). All patients underwent 0.5 mg DST. The same test was repeated in patients with positive response of it within a few days after continuous positive airway pressure (CPAP) therapy. We found that five patients showed positive response of DST (25%). Three of these patients continued to use CPAP, and they showed normal response of DST after CPAP therapy. Serum cortisol after 0.5 mg DST measured before CPAP therapy correlated significantly with fasting serum cortisol level (r=0.764, p<0.0001), but not with various clinical parameters, including AHI (p=0.784), body mass index (p=0.984), waist circumference (p=0.957), HbA1c (p=0.261), fasting plasma glucose (p=0.420) and HOMA-IR (p=0.500). Our study show that OSAS causes a pseudo-Cushing's syndrome in obese patients with type 2 diabetes mellitus, which phenomena can be reversed by CPAP therapy.
Dudchenko, I A; Pristupa, L N; Ataman, A V; Garbuzova, V Iu
The aim of the study was to determine the effect of gene polymorphisms Arg389Gly ADRβ1 gene and T393C gene GNAS1 on the level of heart rate (HR), systolic and diastolic blood pressure (SBP and DBP) in hypertensive patients according to body mass index (BMI). The study involved 166 patients with hypertension and 90 healthy individuals. Patients of the main group was divided according to BMI into three subgroups: I subgroup--with normal body weight, II subgroup--overweight, II subgroup--obesity. Gene polymorphism is determined using polymerase chain reaction and subsequent analysis of restriction fragments. Patients from subgroups II and III, who had presence of genotypes Arg389Arg, Arg389Gly, had higher HR, SBP than in patients with genotype Gly389Gly (p = 0.010 and p = 0.001; p = 0.010 and p = 0.001, respectively). In the analysis of DBP, the dependence of its level of polymorphism Arg389Gly of ADRβ1 gene was found only in I subgroup (p < 0.001). During the analysis of polymorphism T393C of GNAS1 gene only in patients from III subgroup was found a higher heart rate in patients with T393T genotype relatively to C393C genotype, but this difference was not statistically significant (p = 0.191). There is a direct correlation between HR and SBP in hypertensive patients with overweight and obesity from polymorphism Arg389Gly of ADRβ1 gene, in hypertensive patients with normal body weight from this polymorphism depends DBP. Clinical manifestations of hypertension do not depend on polymorphism T393C of GNAS1 gene.
Pires, António; Martins, Paula; Pereira, Ana Margarida; Marinho, Joana; Vaz Silva, Patrícia; Marques, Margarida; Castela, Eduardo; Sena, Cristina; Seiça, Raquel
Pediatric obesity is increasingly prevalent in the Portuguese population. Adipocyte dysfunction results in the expression of pro-inflammatory mediators that are responsible for the low-grade inflammatory process that characterizes obesity. The aim of this study was to investigate the relationship between markers of adiposity, inflammation and adipokines in a Portuguese obese pediatric population. One hundred and twenty children of both sexes, aged 6-17 years, were included in this study. The control group consisted of 41 healthy normal-weight children. The variables analyzed were age, gender, body mass index, waist circumference, fat mass percentage, high-sensitivity C-reactive protein (hs-CRP), leptin and adiponectin. There were significant differences between controls and obese children for all parameters analyzed. In the obese group, after controlling for age and gender, hs-CRP (p=0.041), adiponectin (p=0.019) and leptin (p<0.001) still showed significant statistical differences. A direct correlation was found between hs-CRP, leptin, body mass index and waist circumference, the strongest being with leptin (r=0.568; p<0.001). This trend remained statistically significant, regardless of gender or pubertal age. Considering the role of leptin, adiponectin and hs-CRP in the genesis of endothelial dysfunction, they may be used in clinical practice for risk stratification, as well as in the assessment of weight control programs. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.
Venkatasubramanian, Palamadai N; Brendler, Charles B; Plunkett, Beth A; Crawford, Susan E; Fitchev, Philip S; Morgan, Gina; Cornwell, Mona L; McGuire, Michael S; Wyrwicz, Alice M; Doll, Jennifer A
Obesity, particularly visceral adiposity, confers a worse prognosis for prostate cancer (PCa) patients, and increasing periprostatic adipose (PPA) tissue thickness or density is positively associated with more aggressive disease. However, the cellular mechanism of this activity remains unclear. Therefore, in this pilot study, we assessed the functional activity of PPA tissue secretions and established a biochemical profile of PPA as compared to subcutaneous adipose (SQA) tissues from lean, overweight and obese PCa patients. Adipose tissues were collected from PCa patients undergoing surgical prostate removal. Tissues were analyzed by histologic and magnetic resonance (MR) techniques. Explant tissue culture secretions were used in proliferation assays on PCa and endothelial cells. PPA secretions obtained from obese patients were significantly more pro-proliferative in both PCa and endothelial cells as compared to PPA obtained from lean or overweight men and SQA tissues. Consistent with this, PPA microvessel density was increased, and the T2 relaxation time was decreased, compared to SQA tissues, and we observed a modest, inverse correlation between the T2 and tumor stage. Moreover, the ratio of unsaturated to saturated fatty acids, obtained using MR spectroscopy, showed a modest, inverse correlation with Gleason score. These pilot data show that PPA stimulates PCa cell proliferation and angiogenesis and that obesity intensifies this activity, thus generating a mechanistic hypothesis to explain the worse prognosis observed in obese PCa patients. Our pilot study also shows that MR technology may be useful in further elucidating the relationship between obesity and PCa progression.
Wang, Cuizhe; Ha, Xiaodan; Li, Wei; Xu, Peng; Gu, Yajuan; Wang, Tingting; Wang, Yan; Xie, Jianxin; Zhang, Jun
Objective Recent studies have revealed a link between toll-like receptors (TLRs), Kruppel-like factors (KLFs), and the adipose tissue inflammation associated with obesity. TLR4 is associated with chronic inflammation in obesity. KLF7 is known to play an important role in the differentiation of adipocytes, but its role in visceral adipose tissue inflammation has not yet been investigated. Thus, the objective of this study was to determine the correlation of TLR4 and KLF7 in inflammation induced by obesity. Methods A total of 32 Wistar male rat subjects were fed in the center for experimental animals of Shihezi University. The rats were divided into normal control (NC) and high-fat diet (HFD) group. Surgical instruments were used to collect rats' visceral adipose tissue samples in the 10th week after HFD feeding. Ninety-five Uygur subjects between 20 and 90 years old were enrolled in the present study. The subjects were divided into two groups: the normal control group (NC, 18.0 kg/m(2) ≤ BMI ≤ 23.9 kg/m(2), n = 50) and the obesity group (OB, BMI ≥ 28 kg/m(2), n = 45), and visceral adipose tissue was collected from the subjects. Anthropometric and clinical parameters were measured using standard procedures; biochemical indices were detected using the glucose oxidase-peroxidase method and a standardized automatic biochemistry analyzer; the plasma levels of inflammatory factors and adipocytokines were measured by enzyme-linked immunosorbent assay (ELISA); the mRNA and protein expression levels of key genes involved in the inflammatory signaling pathway were measured by real-time PCR and Western blot. Results In rats, compared with the NC group, the weight, Lee's index, waist circumference, visceral fat mass, and the plasma level of Glu, TG, FFA, and TNF-α were higher in the HFD group, while the plasma levels of LPT and APN were significantly lower in the HFD group in the 10th week. Furthermore, compared with the NC group, visceral adipose
Wiewiora, Maciej; Piecuch, Jerzy; Glűck, Marek; Slowinska-Lozynska, Ludmila; Sosada, Krystyn
The effects of dieting on blood rheology in obese individuals suggest that improving the rheologic profiles depends on the amount of weight lost and its long-term maintenance. The aim of this study was to evaluate the effects of weight loss after surgery on blood rheology at 12-month follow-up. We studied 38 obese patients who underwent laparoscopic weight loss surgery, 22 of whom had sleeve gastrectomy (SG) and 16 of whom had gastric banding (LAGB). We evaluated rheologic parameters such as blood viscosity, plasma viscosity, and erythrocyte deformability (as measured by elongation index [EI]) preoperatively and 12 months after surgery. Whole blood viscosity at 150 s(-1) shear rate (P<.01) and 300 s(-1) shear rate (P<.05), blood viscosity corrected to a standard hematocrit at both shear rates (P<.0005 and P<.005, respectively), and plasma viscosity (P<.005) were significantly reduced after surgery. EI evaluated at different shear stresses (18.49-60.03 Pa) decreased (P<.005) 12 months after surgery. There were significantly decreased EI and blood viscosity corrected to a standard hematocrit after SG (P<.005 and P<.05) and LAGB (P = .0621 and P<.05), but plasma viscosity significantly decreased only after SG (P<.005). Blood viscosity at both shear rates correlated with plasma viscosity (r = .51, P<.005 and r = .5, P<.005). Plasma viscosity correlated positively with body mass index (r = .57; P<.0005) and negatively with percentage of excess weight lost (r = -.56; P< .005). This study found that weight loss after bariatric surgery induced improvement in blood rheology in obese patients at 12 months after surgery. The increased red blood cell rigidity after surgery requires further study because the physiologic importance of this change has not yet been established. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
Cyr, Robyn; Feng, Li Rebekah; Bae, Edward; Danner, Malika T; Ayoob, Marilyn; Yung, Thomas M; Lei, Siyuan; Collins, Brian T; Saligan, Leorey; Simeng, Suy; Kumar, Deepak; Collins, Sean P
Objectives The relationship between obesity (Body Mass Index >30 kg/m2) and quality of life (QoL) following prostate cancer (PCa) radiation therapy (RT) is unknown. Excess abdominal fat may compromise the precise delivery of radiation, putting surrounding organs at risk for greater radiation exposure. Stereotactic body radiation therapy (SBRT) utilizes a real-time tracking system that provides updated prostate position information and allows for correction of the therapeutic beam during treatment with high accuracy. In this study, we evaluate the impact of obesity on patient reported outcomes following SBRT for prostate cancer. Materials and methods Between February 2008 and April 2012, 88 obese and 178 non-obese patients with PCa were treated with SBRT at Georgetown University Hospital, Washington, DC. Health-related quality of life (HRQol) was assessed via the expanded prostate cancer index composite (EPIC)-26 at baseline, 6, 12, 18, and 24 months after 5-fraction delivery of 35-36.25 Gy with the CyberKnife. Patients who received androgen deprivation therapy (ADT) were excluded from this analysis due to its known negative impact on HRQoL. Results Pretreatment characteristics of obese and non-obese patient groups were similar except that obese patients had lower total testosterone levels. Urinary and bowel function and bother scores between the two patient cohorts were comparable at baseline and subsequent follow-ups. Sexual function and bother were also similar at baseline between both groups. Bother was defined by displeasure patients may experience from functional decline. At 24 months post-SBRT, obese men experienced borderline clinically significant decrease in sexual function and greater sexual bother compared to non-obese patients. Fatigue was significantly higher in obese patients compared to non-obese patients at 18 months post-SBRT. Conclusions Prostate SBRT affects obese and non-obese patients similarly in total HRQoL scores and majority of its
Koneru, Harsha; Cyr, Robyn; Feng, Li Rebekah; Bae, Edward; Danner, Malika T; Ayoob, Marilyn; Yung, Thomas M; Lei, Siyuan; Collins, Brian T; Saligan, Leorey; Simeng, Suy; Kumar, Deepak; Collins, Sean P
The relationship between obesity (Body Mass Index ->30 kg/m(2)) and quality of life (QoL) following prostate cancer (PCa) radiation therapy (RT) is unknown. Excess abdominal fat may compromise the precise delivery of radiation, putting surrounding organs at risk for greater radiation exposure. Stereotactic body radiation therapy (SBRT) utilizes a real-time tracking system that provides updated prostate position information and allows for correction of the therapeutic beam during treatment with high accuracy. In this study, we evaluate the impact of obesity on patient reported outcomes following SBRT for prostate cancer. Between February 2008 and April 2012, 88 obese and 178 non-obese patients with PCa were treated with SBRT at Georgetown University Hospital, Washington, DC. Health-related quality of life (HRQol) was assessed via the expanded prostate cancer index composite (EPIC)-26 at baseline, 6, 12, 18, and 24 months after 5-fraction delivery of 35-36.25 Gy with the CyberKnife. Patients who received androgen deprivation therapy (ADT) were excluded from this analysis due to its known negative impact on HRQoL. Pretreatment characteristics of obese and non-obese patient groups were similar except that obese patients had lower total testosterone levels. Urinary and bowel function and bother scores between the two patient cohorts were comparable at baseline and subsequent follow-ups. Sexual function and bother were also similar at baseline between both groups. Bother was defined by displeasure patients may experience from functional decline. At 24 months post-SBRT, obese men experienced borderline clinically significant decrease in sexual function and greater sexual bother compared to non-obese patients. Fatigue was significantly higher in obese patients compared to non-obese patients at 18 months post-SBRT. Prostate SBRT affects obese and non-obese patients similarly in total HRQoL scores and majority of its domains. Obesity has been associated with cancer
Bao, Jean J; Desai, Vikas; Christoffel, Katherine Kaufer; Smith-Ray, Patrick; Nagle, Alex P
Clinical experience suggests that some adults who undergo bariatric surgery have children who are obese. Childhood obesity is associated with increased morbidity and mortality in later life. This study examined the prevalence of obesity among children and grandchildren (< or =12 years of age) of adult bariatric surgery patients. Patients in a prospective database of morbidly obese patients who underwent bariatric surgery between January 2004 and May 2007 were recruited by phone and in clinic. Patient demographics, body mass index (BMI) at surgery, and survey data were collected. The survey included questions regarding their child/grandchild's body habitus, weight, and height. Child obesity was defined as BMI percentile > or =95. Statistical significance was set at p < 0.05. One hundred twenty-two patients were enrolled in this study (77% women, mean BMI 49 kg/m(2)). One hundred thirty-four out of 233 children/grandchildren identified had complete data; 41% had a BMI percentile > or =95. Only 29% of these obese children were so identified by the adult respondents. Significantly more biological children/grandchildren were obese than nonbiological (p = 0.013), and significantly more biological children were obese than biological grandchildren (p = 0.027). This sample of bariatric surgery patients had a high proportion of obese preteen children/grandchildren. Obesity was most prevalent among biological children (vs. biological grandchildren and nonbiological children). Patients often did not recognize the degree of overweight in their children/grandchildren. Because families of bariatric surgery patients often include obese children, interventions aimed at all family members merit consideration.
De Lorenzo, Andrea; Peclat, Thais; Amaral, Ana Carolina; Lima, Ronaldo S L
The purpose of this study is to evaluate the prognostic value of myocardial perfusion SPECT obtained in CZT cameras (CZT-SPECT) with multipinhole collimation in obese patients. CZT-SPECT may be technically challenging in the obese, and its prognostic value remains largely unknown. Patients underwent single-day, rest/stress (supine and prone) imaging. Images were visually inspected and graded as poor, fair or good/excellent. Summed stress and difference scores (SSS and SDS, respectively) were converted into percentages of total perfusion defect and of ischemic defect by division by the maximum possible score. Obesity was defined as a body mass index (BMI) ≥ 30 kg/m(2) and classified as class I (BMI 30-34.9 kg/m(2)), II (BMI 35-39.9 kg/m(2)), or III (BMI ≥ 40 kg/m(2)). Patients were followed-up by telephone interview for the occurrence of all-cause death, myocardial infarction or revascularization. A Cox proportional hazards analysis was used to assess the independent predictors of death. Among 1396 patients, 365 (26.1 %) were obese (mean BMI 33.9 ± 3.6; 17.5 % class I, 3.4 % class II, and 3.4 % class III). Image quality was good/excellent in 94.5 % of the obese patients. The annualized mortality rates were not significantly different among obese and non-obese patients, being <1 % with normal CZT-SPECT, and increased with the degree of scan abnormality in both obese and non-obese patients. Age, the use of pharmacologic stress and an abnormal CZT-SPECT, but not obesity, were independent predictors of death. In obese patients, single-day rest/stress CZT-SPECT with a multipinhole camera provides prognostic discrimination with high image quality.
Ardeshiri, Maryam; Faritous, Zahra; Ojaghi Haghighi, Zahra; Hosseini, Shirin; Baghaei, Ramin
Background: Recent years have witnessed the emergence of obesity as a major public health concern. The drastic rise in obesity and its concomitant co-morbidities is a reflection of the recent changes in dietary habits in Iran and many other developing countries. A recent large population study in Tehran reported that 58% and 75% of middle-aged Iranian men and women, respectively, were either overweight or obese. Objectives: Considering the impact of obesity on mortality and morbidity after coronary artery bypass graft surgery (CABG), we sought to investigate the association between central obesity and the body mass index (BMI) and the post-CABG mortality and morbidity in Iranian patients. Patients and Methods: This prospective study was on 235 adult patients scheduled for isolated CABG in a university hospital. The patients were divided in two groups according to BMI ≥ 30 (obese; n = 60) and BMI < 30 (non-obese; n = 175). In-hospital and late (after 3 months) morbidity and mortality rates were compared between obese and non-obese patients. Results: A total of 235 patients (135 women) with a mean age of 59 ± 9.2 years (range = 29 to 79 years), mean BMI of 27.3 ± 4.2 (range = 17 to 40), and mean waist circumference of 101.2 ± 14.7 cm (range = 55 to 145 cm) were included. By the third postoperative month, wound infection had significantly increased in patients with BMI ≥ 30 (P = 0.022). In-hospital and late morbidity and mortality rates were comparable between the two groups (P > 0.05). Conclusions: In our patients obesity was a risk factor for wound infection but not atelectasis or the need for intra-aortic balloon pump or re-exploration. Obesity was not associated with increased in-hospital or 3 months mortality rates after CABG. PMID:24977121
de Moraes, Leonardo Iezzi; Nicola, Thaís Coutinho; de Jesus, Julyanna Silva Araújo; Alves, Eduardo Roberty Badiani; Giovaninni, Nayara Paula Bernurdes; Marcato, Daniele Gasparini; Sampaio, Jéssica Dutra; Fuly, Jeanne Teixeira Bessa; Costalonga, Everlayny Fiorot
Background Several authors have correlated the increase of cardiovascular risk with the nutritional status, however there are different criteria for the classification of overweight and obesity in children. Objectives To evaluate the performance of three nutritional classification criteria in children, as definers of the presence of obesity and predictors of high blood pressure in schoolchildren. Methods Eight hundred and seventeen children ranging 6 to 13 years old, enrolled in public schools in the municipality of Vila Velha (ES) were submitted to anthropometric evaluation and blood pressure measurement. The classification of the nutritional status was established by two international criteria (CDC/NCHS 2000 and IOTF 2000) and one Brazilian criterion (Conde e Monteiro 2006). Results The prevalence of overweight was higher when the criterion of Conde e Monteiro (27%) was used, and inferior by the IOTF (15%) criteria. High blood pressure was observed in 7.3% of children. It was identified a strong association between the presence of overweight and the occurrence of high blood pressure, regardless of the test used (p < 0.001). The test showing the highest sensitivity in predicting elevated BP was the Conde e Monteiro (44%), while the highest specificity (94%) and greater overall accuracy (63%), was the CDC criterion. Conclusions The prevalence of overweight in Brazilian children is higher when using the classification criterion of Conde e Monteiro, and lower when the criterion used is IOTF. The Brazilian classification criterion proved to be the most sensitive predictor of high BP risk in this sample. PMID:24676372
Moraes, Leonardo Iezzi de; Nicola, Thaís Coutinho; Jesus, Julyanna Silva Araújo de; Alves, Eduardo Roberty Badiani; Giovaninni, Nayara Paula Bernurdes; Marcato, Daniele Gasparini; Sampaio, Jéssica Dutra; Fuly, Jeanne Teixeira Bessa; Costalonga, Everlayny Fiorot
Several authors have correlated the increase of cardiovascular risk with the nutritional status, however there are different criteria for the classification of overweight and obesity in children. To evaluate the performance of three nutritional classification criteria in children, as definers of the presence of obesity and predictors of high blood pressure in schoolchildren. Eight hundred and seventeen children ranging 6 to 13 years old, enrolled in public schools in the municipality of Vila Velha (ES) were submitted to anthropometric evaluation and blood pressure measurement. The classification of the nutritional status was established by two international criteria (CDC/NCHS 2000 and IOTF 2000) and one Brazilian criterion (Conde e Monteiro 2006). The prevalence of overweight was higher when the criterion of Conde e Monteiro (27%) was used, and inferior by the IOTF (15%) criteria. High blood pressure was observed in 7.3% of children. It was identified a strong association between the presence of overweight and the occurrence of high blood pressure, regardless of the test used (p<0.001). The test showing the highest sensitivity in predicting elevated BP was the Conde e Monteiro (44%), while the highest specificity (94%) and greater overall accuracy (63%), was the CDC criterion. The prevalence of overweight in Brazilian children is higher when using the classification criterion of Conde e Monteiro, and lower when the criterion used is IOTF. The Brazilian classification criterion proved to be the most sensitive predictor of high BP risk in this sample.
Fernandes, Meenakshi; Sturm, Roland
Objectives The objectives were to: (1) document correlations among facility provision (availability and adequacy) in elementary schools, child sociodemographic factors, and school characteristics nationwide; and (2) investigate whether facility provision is associated with physical education (PE) time, recess time, and obesity trajectory. Methods The analytic sample included 8935 fifth graders from the Early Childhood Longitudinal Survey Kindergarten Cohort. School teachers and administrators were surveyed about facility provision, PE, and recess time in April 2004. Multivariate linear and logistic regressions that accounted for the nesting of children within schools were used. Results Children from disadvantaged backgrounds were more likely to attend a school with worse gymnasium and playground provision. Gymnasium availability was associated with an additional 8.3 min overall and at least an additional 25 min of PE per week for schools in humid climate zones. These figures represent 10.8 and 32.5%, respectively, of the average time spent in PE. No significant findings were obtained for gymnasium and playground adequacy in relation to PE and recess time, and facility provision in relation to obesity trajectory. Conclusions Poor facility provision is a potential barrier for school physical activity programs and facility provision is lower in schools that most need them: urban, high minority, and high enrollment schools. PMID:19850074
Valentini, Diletta; Alisi, Anna; di Camillo, Chiara; Sartorelli, Maria Rita; Crudele, Annalisa; Bartuli, Andrea; Nobili, Valerio; Villani, Alberto
To assess the prevalence of overweight/obesity in a cohort of Italian children with Down syndrome (DS) and to investigate the correlation of both obesity and DS with nonalcoholic fatty liver disease (NAFLD). We enrolled 280 children with DS (age range 5-18 years), who were referred to the DS outpatient clinic of the Bambino Gesù Children's Hospital in Rome. For all children, we collected the clinical history and measured anthropometric variables. Eighty-four of 280 children with DS were selected to undergo liver ultrasound scanning to evaluate the presence of NAFLD. Italian children with DS exhibited a prevalence of 19.64% for overweight and 12.14% for obesity. The prevalence of NAFLD in nonobese (45%) and overweight/obese (82%) children with DS is greater than in the European pediatric nonobese (5.7%) or obese population (33%). Moreover, the severity of liver brightness on ultrasound scan correlated positively with body mass index, triglycerides, low-density lipoprotein-cholesterol, and leptin levels and negatively with adiponectin. We demonstrated that, independently from the obese phenotype, children with DS display a greater risk to develop NAFLD than the general pediatric population. Copyright © 2017 Elsevier Inc. All rights reserved.
Grossi, João Vicente Machado; Nicola, Felipe Fernandes; Zepeda, Ivan Alberto; Becker, Martina; Trindade, Eduardo Neubarth; Diemen, Vinicius Von; Cavazzola, Leandro Totti; Trindade, Manoel Roberto Maciel
The evaluation of collagen in the abdominal wall has been increasingly studied because of the relevance on collagen in the healing process after laparotomy. To evaluate the amount of collagen in the linea alba of patients undergoing laparotomic bariatric surgery and comparing with non-obese cadavers. Were evaluated 88 samples of aponeurosis from abdominal linea alba of 44 obese patients (obesity group) and 44 non-obese cadavers (control group). The samples were collected in 2013 and 2104, and were sorted according to age (18-30, 31-45 and 46-60), gender, BMI, waist and cervical circumference, and subcutaneous tissue thickness. Material for biopsy was collected from the supraumbilical region of the linea alba for immunohistochemical analysis differentiating collagen type 1 and type 3 and the 1/3 ratio. Image-Pro Plus pixel counting software was used to measure the amount of collagen. The obesity group evidenced mean age 44.11±9.90 years; 18-30 age group had three (6.8%) obese individuals; 31-45 had 22 (50%) and 46-60 had 19 (43.1%). Females were present in 81.8% (n=36); BMI (kg/m²) was 48.81±6.5; waist circumference (cm) was 136.761±13.55; subcutaneous tissue thickness (cm) 4.873±0.916. Considering age groups, gender and BMI, there were statistical differences in all tests when compared with the cadavers. The amount of collagen in the linea alba above the umbilical region in the morbidly obese patients was smaller than in the non-obese cadavers in the same age group. A avaliação do colágeno na parede abdominal é cada vez mais estudada, em virtude da relevância dele no processo cicatricial após laparotomia. Avaliar a quantidade de colágeno na linha alba de pacientes submetidos à cirurgia bariátrica e compará-la com a de cadáveres não-obesos. Foram avaliados dois grupos com total de 88 amostras da aponeurose da linha alba abdominal, divididas em 44 de pacientes obesos (grupo obesidade) com indicação de cirurgia bariátrica e 44 de cadáveres n
Pucher, Philip H; Tanno, Lulu; Hewage, Kalon; Bagnall, N Mark
The growing incidence of obesity in Western populations continues to place new stressors on health systems. Obese trauma patients present particular challenges across the entirety of the patient care pathway, and are at risk of higher lengths of stay, morbidity, and mortality. This study sought to assess a national group of trauma experts' opinions and knowledge regarding the management of obese trauma. A questionnaire was circulated to a trauma training providers and national steering committee members at a UK national Advance Trauma Life Support meeting. Demographic, knowledge, and opinion data was collected and collated for analysis. 109 questionnaires were returned (73% response rate). Broad agreement was reached that obese trauma patients were more challenging to manage (96.2% agreement) and suffered worse outcomes (89.9%). Only 22.2% felt their hospitals possessed appropriate resources to facilitate management. Up to a third of respondents had personally witnesses errors in care due to patient obesity. 90% believed specialist training for obese trauma could improve care. There is broad consensus amongst UK trauma providers that obese trauma patients are at risk of poorer outcomes and errors in care. Knowledge and preparedness of centres to manage these patients is variable. There was broad consensus that specialist training for the management of obese trauma patients may improve outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.
Osorio-Conles, O; Guitart, M; Chacón, M R; Maymo-Masip, E; Moreno-Navarrete, J M; Montori-Grau, M; Näf, S; Fernandez-Real, J M; Vendrell, J; Gómez-Foix, A M
Plasma acutephase protein pentraxin 3 (PTX3) concentration is dysregulated in human obesity and metabolic syndrome. Here, we explore its relationship with insulin secretion and sensitivity, obesity markers, and adipose tissue PTX3 gene expression. Plasma PTX3 protein levels were analyzed in a cohort composed of 27 lean [body mass index (BMI) ≤ 25 kg/m(2)] and 48 overweight (BMI 25-30 kg/m(2)) men (cohort 1). In this cohort, plasma PTX3 was negatively correlated with fasting triglyceride levels and insulin secretion after intravenous and oral glucose administration. Plasma PTX3 protein and PTX3 gene expression in visceral (VAT) and subcutaneous (SAT) whole adipose tissue and adipocyte and stromovascular fractions were analyzed in cohort 2, which was composed of 19 lean, 28 overweight, and 15 obese subjects (BMI >30 kg/m(2)). An inverse association with body weight and waist/hip ratio was observed in cohort 2. In VAT depots, PTX3 mRNA levels were higher in subjects with BMI >25 kg/m(2) than in lean subjects, positively correlated with IL-1β mRNA levels, and higher in the adipocyte than stromovascular fraction. Human preadipocyte SGBS cell line was used to study PTX3 production in response to factors that obesity entails. In SGBS adipocytes, PTX3 gene expression was enhanced by IL-1β and TNFα but not IL-6 or insulin. In conclusion, the negative correlation between PTX3 and glucose-stimulated insulin secretion suggests a role for PTX3 in metabolic control. PTX3 gene expression is upregulated in VAT depots in obesity, despite lower plasma PTX3 protein, and by some proinflammatory cytokines in cultured adipocytes.
Richter, Magdalena; Trzeciak, Tomasz; Rybka, Jakub Dalibor; Suchorska, Wiktoria; Augustyniak, Ewelina; Lach, Michał; Kaczmarek, Małgorzata; Kaczmarczyk, Jacek
The study was designed to investigate whether serum concentrations of leptin, resistin and adiponectin in obese and normal-weight patients with primary knee osteoarthritis (OA) correlate with clinical and radiological stages of the disease and percentage of total body fat. Seventy-three patients with knee OA, divided into obese and normal-weight groups, were clinically evaluated according to the Knee Society Score (KSS), and radiologically assessed using Kellgren and Lawrence scale. The percentage of total body fat and some anthropometric data were also given. Serum leptin, resistin and adiponectin concentrations were measured by Elisa and were correlated with the clinical, radiological and anthropometric parameters. Leptin concentrations were significantly higher (p = 0.001) in the obese patients and positively correlated (R = 0.63) with radiologically assessed OA grade, but only in the normal-weight group. Resistin and adiponectin concentrations were identical in obese and normal-weight patients and negatively correlated (R = -0.41) with the clinical status of obese patients. In both groups, percentage of total body fat positively correlated (R = 0.29 and R = 0.53 for obese and normal-weight respectively) with radiologically assessed OA grade. However, no correlations were found with clinical status of the patients. It was found that in the obese patients with knee OA, increased percentage of total body fat and elevated serum leptin concentration might favour the advancement of clinical but not radiologically assessed changes in the joint structures, while in normal-weight patients it correlates only with radiologically assessed changes but does not affect to an appreciable extent the clinical status of the patients.
Silveira, Leonardo E; Kozicky, Jan-Marie; Muralidharan, Kesavan; Bücker, Joana; Torres, Ivan J; Bond, David J; Kapczinski, Flavio; Kauer-Sant’Anna, Marcia; Lam, Raymond W; Yatham, Lakshmi N
Objective Obesity is frequent in people with bipolar I disorder (BD I) and has a major impact on the course of the illness. Although obesity negatively influences cognitive function in patients with BD, its impact in the early phase of the disorder is unknown. We investigated the impact of overweight and obesity on cognitive functioning in clinically stable patients with BD recently recovered from their first manic episode. Method: Sixty-five patients with BD (25 overweight or obese and 40 normal weight) recently remitted from a first episode of mania and 37 age- and sex-matched healthy control subjects (9 overweight or obese and 28 normal weight) were included in this analysis from the Systematic Treatment Optimization Program for Early Mania (commonly referred to as STOP-EM). All subjects had their cognitive function assessed using a standard neurocognitive battery. We compared cognitive function between normal weight patients, overweight–obese patients, and normal weight healthy control subjects. Results: There was a negative affect of BD diagnosis on the domains of attention, verbal memory, nonverbal memory, working memory, and executive function, but we were unable to find an additional effect of weight on cognitive functioning in patients. There was a trend for a negative correlation between body mass index and nonverbal memory in the patient group. Conclusions: These data suggest that overweight–obesity does not negatively influence cognitive function early in the course of BD. Given that there is evidence for a negative impact of obesity later in the course of illness, there may be an opportunity to address obesity early in the course of BD. PMID:25702364
Nishioka, Shinta; Wakabayashi, Hidetaka; Yoshida, Tomomi; Mori, Natsumi; Watanabe, Riko; Nishioka, Emi
A protective effect of excessive body mass index (BMI) on mortality or functional outcome in patients with stroke is not well established in the Asian population. This study aimed to explore whether obese patients with stroke have advantages for functional improvement in Japanese rehabilitation wards. This retrospective cohort study included consecutive patients with stroke admitted and discharged from convalescent rehabilitation wards between 2011 and 2015. Demographic data, BMI, Functional Independence Measure (FIM) score, and nutritional status were analyzed. Participants were classified into 4 groups according to BMI (underweight <18.5 kg/m(2), standard 18.5-<23 kg/m(2), overweight 23-<27.5 kg/m(2), obese ≥27.5 kg/m(2)). The primary outcome was the FIM gain, and the secondary outcome was the FIM score at discharge. Multiple regression analysis was performed to analyze the relationship between BMI and functional recovery. In total, 897 participants (males 484, females 413; mean age 71.6 years) were analyzed and classified as underweight (134), standard (432), overweight (277), and obese (54). The median FIM gain and the FIM score at discharge were 30 and 114, respectively. The FIM gain in the obese group was significantly higher than those in the other groups. Multiple regression analysis revealed that obesity was independently correlated with the FIM gain, and those at discharge after adjusting for confounders such as age, gender, and FIM score on admission. Obese Japanese convalescent patients with stroke may have some advantages for functional recovery in rehabilitation wards. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.
Li, Shi-kuan; Zhou, Yan-bing; Zhou, Cheng-fu; Wang, Pei-ge; Wang, Hai-bo; Mao, Wei-zheng; Wang, Zhen-guang
To explore the influence of obesity on surgical procedure and short-term surgical outcome in patients with gastric carcinoma. A total of 426 patients with gastric carcinoma underwent laparotomy in our hospital during January 2006 and June 2008. All the patients were divided into obesity group and non-obesity group according to body mass index (BMI). The thickness of subcutaneous fat (SCF), abdominal anterior-posterior diameter (APD) and transverse diameter (TD) at the umbilicus level were measured by abdominal CT. Furthermore, the surgical data and postoperative conditions including short-term outcome were reviewed and compared between two groups. The incidence of obesity was 29.8% in gastric carcinoma patients. Mean values of SCF thickness, APD and TD in obesity group and non-obesity group were (21.8+/-7.1) mm vs (14.4+/-7.5) mm, (223.2+/-24.6) mm vs (181.8+/-23.5) mm and (323.6+/-23.8) mm vs (285.8+/-24.4) mm (P=0.000). Longer operative time (P=0.007) and less amount of dissected lymph nodes were found in obesity group as compared to non-obesity group (P=0.000). Also, obesity group lasted a longer postoperative period of fever (P=0.000) and experienced more post-operative complications (P=0.005) than non-obesity group did. Abdominal CT scan may display the abdominal shape of gastric carcinoma patients, hence, it is useful to evaluate the difficulty of surgical procedure. These patients may involve in complicated surgical procedure and worse short-term outcome due to obese abdominal shape. Therefore, perioperative management should be emphasized for these patients.
Eisenstein, Amy R; Prohaska, Thomas R; Kruger, Judy; Satariano, William A; Hooker, Steven; Buchner, David; Kealey, Melissa; Hunter, Rebecca H
This study examines the role of environmental correlates of overweight and obesity among older adults independent of walking activity and lower body function. In-person interviews were conducted with 789 adults aged 65 and older, residing in four areas in the U.S. Demographic information, general health, lower body function, walking behavior, and awareness of environmental infrastructure features using the modified Neighborhood Environment Walking Survey (NEWS) were obtained. Regression analyses examined the association between Body Mass Index (BMI) and environmental infrastructure features, adjusting for demographics and lower body function. Older adults who perceived their neighborhood as less safe from crime and had reduced access to services were more likely to have higher BMI. Controlling for demographic and functional characteristics, access to services remained significant. This association remained significant for those with lower functional status. This research suggests that neighborhood environment may have an influence on BMI above and beyond walking activity.
Pinto, José Máximo Costa; Lima, Marianna Gomes Cavalcanti Leite de; Almeida, Ana Luiza Melo Cavalcanti de; Sousa, Marcelo Gonçalves
It is estimated that there are nearly 40 million people with the human immunodeficiency virus (HIV) worldwide. Due to the advent of antiretroviral drugs, it has been observed increasing in obesity and metabolic rates among patients undergoing treatment. Thus, numerous surgical therapies for weight loss are proposed for continuous improvement in health of patients with HIV, being the vertical gastrectomy an option for intact intestinal transit. To evaluate the applicability of the vertical gastrectomy in patients with morbid obesity and HIV. Was conducted a systematic review of the literature, in the electronic databases Scopus, Pubmed, Cinahl, Scielo, Cochrane and Lilacs, from 1998 to 2015. MeSH headings used in data collection were "Gastrectomy" and "Morbid obesity" being combined with the descriptor "HIV". Were found 2148 articles in Scopus, 1234 in PubMed and 784 in Cinahl. The articles were analyzed by the Jadad Quality Scale, being reduced to 40 articles, subsequently reassessed using an elaborated form by the Critical Appraisal Skills Programme (CASP), reaching 12 articles in the end. It was found that vertical gastrectomy constitutes a safe and effective method, with low mortality and low rate of postoperative complications, being recommended as surgical technique in patients with obesity, HIV and comorbidities. Estima-se que haja quase 40 milhões de pessoas com o vírus da imunodeficiência adquirida (HIV) no mundo. Com o advento dos antirretrovirais, observou-se aumento da obesidade e de taxas metabólicas nos pacientes em tratamento. Assim, inúmeras terapias cirúrgicas para a perda de peso estão sendo estudadas para a melhoria contínua da saúde dos pacientes com HIV, sendo a gastrectomia vertical uma opção de trânsito íntegro. Avaliar a aplicabilidade da gastrectomia vertical em pacientes com obesidade mórbida e HIV. Foi realizada revisão sistemática de literatura, de artigos publicados nas bases eletrônicas de dados Scopus, Pubmed, Cinahl
Phelan, S M; Burgess, D J; Yeazel, M W; Hellerstedt, W L; Griffin, J M; van Ryn, M
The objective of this study was to critically review the empirical evidence from all relevant disciplines regarding obesity stigma in order to (i) determine the implications of obesity stigma for healthcare providers and their patients with obesity and (ii) identify strategies to improve care for patients with obesity. We conducted a search of Medline and PsychInfo for all peer-reviewed papers presenting original empirical data relevant to stigma, bias, discrimination, prejudice and medical care. We then performed a narrative review of the existing empirical evidence regarding the impact of obesity stigma and weight bias for healthcare quality and outcomes. Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making. These attitudes may impact the care they provide. Experiences of or expectations for poor treatment may cause stress and avoidance of care, mistrust of doctors and poor adherence among patients with obesity. Stigma can reduce the quality of care for patients with obesity despite the best intentions of healthcare providers to provide high-quality care. There are several potential intervention strategies that may reduce the impact of obesity stigma on quality of care.
Phelan, SM; Burgess, DJ; Yeazel, MW; Hellerstedt, WL; Griffin, JM; van Ryn, M
The objective of this study was to critically review the empirical evidence from all relevant disciplines regarding obesity stigma in order to (i) determine the implications of obesity stigma for healthcare providers and their patients with obesity and (ii) identify strategies to improve care for patients with obesity. We conducted a search of Medline and PsychInfo for all peer-reviewed papers presenting original empirical data relevant to stigma, bias, discrimination, prejudice and medical care. We then performed a narrative review of the existing empirical evidence regarding the impact of obesity stigma and weight bias for healthcare quality and outcomes. Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making. These attitudes may impact the care they provide. Experiences of or expectations for poor treatment may cause stress and avoidance of care, mistrust of doctors and poor adherence among patients with obesity. Stigma can reduce the quality of care for patients with obesity despite the best intentions of healthcare providers to provide high-quality care. There are several potential intervention strategies that may reduce the impact of obesity stigma on quality of care. PMID:25752756
Rinaldi, John M; Geletzke, Abby K; Phillips, Brett E; Miller, Jamie; Dykes, Thomas M; Soybel, David I
Chronic muscle wasting, or sarcopenia, has been associated with poor-health outcomes after major surgical procedures. Here, we explore the utility of CT-generated determinations of sarcopenia as markers of risk in patients undergoing evaluation for complex ventral hernia repair. In 148 successive patients being evaluated for complex ventral hernia repair, CT scans were analyzed retrospectively for attributes of the hernia and indices of core-muscle mass, correlating them with preoperative clinical/laboratory profiles and outcomes in 82 patients who had undergone surgery. Prevalence of sarcopenia, and sarcopenia corrected for obesity, was 26% and 20% respectively. Sarcopenia was associated with age, some laboratory indicators, and increased hospital length of stay but not with a higher likelihood of surgical site occurrence. Obesity may obscure the value of sarcopenia as a marker of metabolic disturbance and postoperative outcome. Image-based measurements of core-muscle mass should be used with caution as predictors of risk in similar surgical populations. Copyright © 2016 Elsevier Inc. All rights reserved.
Baptista, T; López, M E; Teneud, L; Contreras, Q; Alastre, T; de Quijada, M; Araujo de Baptista, E; Alternus, M; Weiss, S R; Musseo, E; Páez, X; Hernández, L
The efficacy of the antiviral agent Amantadine (AM, 5-100 mg/kg/sc, ip or intrahypothalamically, 12.5-100 micrograms bilaterally) in influencing body weight and food intake in drug-free rats, and in preventing neuroleptic-induced weight gain, was assessed in adult female rats. In drug-free rats, acute administration of systemic AM or directly injected in the lateral hypothalamus (LH) displayed a significant dose-dependent anorectic effect (p < 0.001). This effect could be mediated by the brain monoaminergic system, because systemic or local injections of AM increased dopamine and serotonin overflow in the nucleus accumbens and in the LH. Chronic administration of AM significantly decreased body weight gain in drug-free rats only at the dose of 100 mg/kg/sc. Similarly, obesity induced by the neuroleptic drug sulpiride (SUL, 20 mg/kg/ip for 21 days) was prevented by AM only at the dose of 100 mg/kg. AM did not prevent SUL-induced hyperprolactinemia, disruption of the vaginal cycle and a decrement in the weight of the uterus and ovaries at any dosage. This lack of efficacy of AM contrasts with that of bromocriptine, which completely prevented SUL-induced weight gain and hyperprolactinemia. The results show that despite a potent acute anorectic effect, AM displays a weak antagonistic action on SUL-induced obesity in rats, in contrast to the preliminary results obtained in humans. As AM metabolism differs in humans and rats, additional research is needed before its systematic testing in counteracting neuroleptic-induced obesity in patients with mental disorders.
Struzzo, Pierluigi; Fumato, Raffaella; Tillati, Silvia; Cacitti, Anita; Gangi, Fabrizio; Stefani, Alessia; Torcutti, Alessia; Crapesi, Lucia; Tubaro, Gianni; Balestrieri, Matteo
Introduction Obesity is a growing health problem in Europe and it causes many diseases. Many weight-reducing methods are reported in medical literature, but none of them proved to be effective in maintaining the results achieved over time. Self-empowerment can be an important innovative method, but an effectiveness study is necessary. In order to standardise the procedures for a randomised controlled study, a pilot study will be run to observe, measure and evaluate the effects of a period of self-empowerment group treatment on overweight/obese patients. Methods and analysis Non-controlled, experimental, pilot study. A selected group of patients with body mass index >25, with no severe psychiatric disorders, with no aesthetic or therapeutic motivation will be included in the study. A set of quantitative and qualitative measures will be utilised to evaluate the effects of a self-empowerment course in a 12 month time. Group therapy and medical examinations will also complete this observational phase. At the end of this pilot study, a set of appropriate measures and procedures to determine the effectiveness of individual empowerment will be identified and agreed among the different professional figures. Results will be recorded and analysed to start a randomised controlled trial to evaluate the effectiveness of the proposed methodology. Ethics and dissemination This protocol was approved by the local Ethics Committee of Udine in March 2012. The findings of the trial will be disseminated through peer-reviewed journals, national and international conference presentations and public events involving the local administrations of the towns where the trial participants are resident. Trial Registration http://www.clinicalstrials.gov identifier NCT01644708. PMID:23676799
Elder, John P.; Arredondo, Elva M.; Campbell, Nadia; Baquero, Barbara; Duerksen, Susan; Ayala, Guadalupe; Crespo, Noc C.; Slymen, Donald; McKenzie, Thomas
BACKGROUND The prevalence of overweight children has reached epidemic proportions, and affects Latinos youth more than other subgroups in the United States. Given the prevalence of obesity and its economic consequences, community health initiatives have shifted toward primary prevention at younger ages. METHODS Data representing all levels of the ecological systems theory were collected using diverse methods. Participants were children enrolled in K-2nd grade and their parents. RESULTS Overweight children were less active compared to norma