Influence of Neck Circumference on Respiratory Endurance and Muscle Strength in the Morbidly Obese

Perceptual, Aerodynamic and Acoustic Evaluation of Vocal Characteristics in Subjects With Obesity

INTRODUCTION

Obesity has tripled since 1975 and affects health across many domains. Increasing body mass index increases the risk to the obese subject of many non-communicable diseases. The study evaluated the perceptive, aerodynamic, and acoustic parameters that characterize the voice of the obese population.

METHODOLOGY

Eighty adult subjects (40 participants in each obese and control group) aged 18-50 years were enrolled. The perceptual voice analysis was performed using the Consensus Auditory Perceptual Evaluation of Voice. The aerodynamic and acoustic voice analyses were performed using the MIR Spiro lab instrument and Doctor's Speech software. A digital stopwatch was also used to measure maximum phonation time.

RESULTS

Statistical analysis revealed a significant difference (P-value <0.05 and t value >2) between two groups on acoustic parameters, specifically Normalized noise energy and fundamental frequency tremor (F0 tremor). Normalized noise energy and fundamental frequency tremor were greater in the obese group. Moreover, maximum phonation time and expiratory reserve volume were significantly reduced in the obese group.

DISCUSSION AND CONCLUSION

Results of the present study showed poor voice quality and reduced expiratory reserve volume in obese individuals. This could be credited to the adverse effects of accrued adipose on the functioning of the laryngeal and respiratory systems. Increasing body mass index escalates the risk to the obese subjects of many non-communicable diseases.

Inverse Association between Omega-3 Index and Severity of COVID-19: A Case-Control Study

Background: Omega-3 fatty acids enhance immune response and modulate inflammation. This study aimed to determine the relationship between omega-3 fatty acid status and the severity of SARS-CoV-2 infection. Methods: Using a case−control design, we compared hospitalized patients with severe SARS-CoV-2 infection (cases, n = 73) with a group of ambulatory patients with mild SARS-CoV-2 infection (controls, n = 71). No patients were vaccinated against SARS-CoV-2. Results: The cases were older (p = 0.003), less educated (p = 0.001), had larger neck and smaller waist circumferences (p = 0.035 and p = 0.003, respectively), more frequently had diabetes (p < 0.001), consumed less fish (p < 0.001), consumed higher proportions of fried fish (p = 0.001), and had lower Omega-3 Index (O3I) values (p = 0.001) than controls. Cases had significantly lower rates of upper airway symptoms than controls. Lower O3I was associated with an increased likelihood of developing severe COVID-19 after adjusting for potential confounders (OR: 0.52; CI 0.32−0.86). Diabetes (OR: 4.41; CI 1.60−12.12), neck circumference (OR: 1.12; CI 1.03−1.21), and older age (OR: 1.03; CI 1.002−1.062) were also linked to COVID-19 severity. Fried fish consumption and low educational level were independent risk factors for severe COVID-19. Conclusions: This study suggests incorporating nutritional interventions to improve omega-3 status within nonpharmacological measures may help to reduce the severity of COVID-19.

Assessment of Cardiorespiratory and Metabolic Responses in Women with Obesity After Surgically Induced Weight Loss: Results from a Pilot Study

PURPOSE

Bariatric surgery is effective in controlling severe obesity. However, studies investigating the impact of surgically induced weight loss on cardiorespiratory and metabolic responses during maximal effort are controversial. The aim of this study was to assess cardiorespiratory and metabolic responses in women with obesity after bariatric surgery.

MATERIALS AND METHODS

We performed a secondary analysis on data from a pilot study with women with obesity submitted to bariatric surgery and who did not participate in a controlled physical training program. Anthropometry, pulmonary function (spirometry), and cardiorespiratory fitness (cardiopulmonary exercise testing [CPX]) were assessed before and after bariatric surgery.

RESULTS

Thirty-four women were included (38.7 ± 9.6 years, body mass index = 44.1 ± 6.3 kg/m²). Postoperative assessment was conducted 9.4 ± 2.7 months after surgery. After surgery, we observed a reduction in all anthropometric measurements (mean loss of 28.6 kg, p < 0.001), and improvement in spirometry values (p < 0.001). Relative VO_2peak (mL/kg/min) increased slightly (Δ = 1.7; p = 0.06); however, absolute VO_2peak (L/min) reduced significantly (Δ =  - 0.398; p < 0.001). We also observed an increase of 1.3 min (p < 0.001) in CPX duration, a reduction of 11.3 bpm (p < 0.001) in resting heart rate, and a decrease of systolic (p = 0.02) and diastolic (p < 0.001) blood pressures at peak effort.

CONCLUSION

Surgically induced weight loss without exercise training improved cardiac reserve, ventilatory response, blood pressure, and resting heart rate. Cardiorespiratory fitness reflected by relative VO_2peak increased slightly, despite increased tolerance to CPX.

Vocal Characteristics of Patients With Morbid Obesity

INTRODUCTION

Obesity modifies vocal characteristics, causing abnormal fat deposition in the abdominal region and upper airways. For some authors the voice of the obese is not different from nonobese and the vocal symptoms are scarce; for others dysphonia in obese is reported by 70% of them and the voice becomes hoarse, breathy, and unstable.

OBJECTIVE

To characterize the voice of patients with morbid obesity.

METHODS

Two groups were included: Obese (n-27), aged between 26 and 59 years, selected for bariatric surgery; Control (n-27), matched in age, with ideal weight for height.

PARAMETERS

Vocal self-assessment (Vocal Disadvantage Index-IDV and Quality of Life and Voice-QVV); Perceptual-auditory vocal evaluation (GRBASI scale), maximum phonation time; Acoustic vocal analysis and Videolaryngoscopic exams.

RESULTS

In obese, the most frequent symptoms were gastroesophageal and hoarseness. The vocal self-evaluation did not record any relevant complaints in both groups. In obese, the perceptual-auditory voice evaluations indicated significant changes in R (roughness), B (breathiness), I (instability), and S (tension) parameters. Acoustic vocal analysis recorded changes in the noise-harmonic ratio (NHR) and soft phonation index (SPI) parameters. The videolaryngoscopy examinations showed, in control and obese groups, respectively: normal: 92.5% and 55.5%; posterior pachydermia: 11.1% and 33.3%; mid-posterior bowing: 0% and 7.4%; edema/congestion: 0% and 7.40%.

CONCLUSION

The voice of the obese becomes discreetly hoarse, breathless, and unstable. The most frequent videolaryngoscopic findings in obese patients are hyperemia and edema of vocal folds and posterior pachydermia, related to acid laryngitis, secondary to gastroesophageal reflux.

Improvement in lung function and functional capacity in morbidly obese women subjected to bariatric surgery

OBJECTIVE

To determine whether weight loss in women with morbid obesity subjected to bariatric surgery alters lung function, respiratory muscle strength, functional capacity and the level of habitual physical activity and to investigate the relationship between these variables and changes in both body composition and anthropometrics.

METHODS

Twenty-four women with morbid obesity were evaluated with regard to lung function, respiratory muscle strength, functional capacity, body composition, anthropometrics and the level of habitual physical activity two weeks prior to and six months after bariatric surgery.

RESULTS

Regarding lung function, mean increases of 160 mL in slow vital capacity, 550 mL in expiratory reserve volume, 290 mL in forced vital capacity and 250 mL in forced expiratory volume in the first second as well as a mean reduction of 490 mL in inspiratory capacity were found. Respiratory muscle strength increased by a mean of 10 cmH2O of maximum inspiratory pressure, and a 72-meter longer distance on the Incremental Shuttle Walk Test demonstrated that functional capacity also improved. Significant changes also occurred in anthropometric variables and body composition but not in the level of physical activity detected using the Baecke questionnaire, indicating that the participants remained sedentary. Moreover, correlations were found between the percentages of lean and fat mass and both inspiratory and expiratory reserve volumes.

CONCLUSION

The present data suggest that changes in body composition and anthropometric variables exerted a direct influence on functional capacity and lung function in the women analyzed but exerted no influence on sedentarism, even after accentuated weight loss following bariatric surgery.

Association of neck circumference and pulmonary function in children

BACKGROUND

Childhood obesity leads to many complications including impaired respiratory function. There are various anthropometric parameters related to obesity.

OBJECTIVE

To investigate the correlation between anthropometric indices and pulmonary function test results in children without asthma.

METHODS

Children without any respiratory disorders were enrolled in this study. Anthropometric measurements, such as height, weight, neck circumference (NC), and waist circumference, were obtained from the enrollees and body mass index was calculated. Afterward, pulmonary function tests were performed using spirometry.

RESULTS

A total of 178 children (106 boys, 59.5%) with a mean age of 9.7 years were included the study. NC was above the 90th percentile in 65 children. Importantly, pulmonary parameters, such as forced expiratory volume during the first second (FEV₁) and the ratio of FEV₁ to forced vital capacity (FVC), were lower in subjects with a large NC. Similarly, waist circumference was above the 90th percentile in 67 children, and FEV₁/FVC was significantly lower in children with a large waist circumference. Moreover, there was a statistically significant negative correlation among FEV₁, FEV₁/FVC, and body mass index SD score. Also, multivariable linear regression analysis showed that an NC above the 90th percentile was associated with lower FEV₁ and FEV₁/FVC values.

CONCLUSION

We identified NC as a novel anthropometric index that is strongly correlated with respiratory functions in children. Therefore, close monitoring of respiratory symptoms, particularly in children with obesity and a large NC, could help with early and prompt determination of respiratory complications of obesity.

Characterization of Executive Functioning in a Portuguese Sample of Candidates for Bariatric Surgery

Aim

The prevalence of obesity has been steadily increasing and is a major worldwide public health problem. It is associated with multiple medical and psychological conditions and recent research supports a link to several cognitive deficit domains, including executive functioning. The aim of this article is to describe socio-demographic, clinical and neuropsychological characteristics of a sample of candidates for bariatric surgery (BS) and to compare their performance with normative values.

Method

Between May 2012 and May 2013 we evaluated the neuropsychological performance of 42 patient candidates for BS at the Morbid Obesity Consultation at Centro Hospitalar Lisboa Norte (CHLN).

Results

The population was predominantly female and education was equally distributed between basic, secondary and tertiary levels. The neuropsychological results showed a significant decrease on Recall (p < .01), Learning (p < .10), Nonverbal Memory (p < .001), Cognitive Flexibility (p < .01) and Resistance to Interference (p < .05).

Conclusion

Despite the limitations inherent to a small sample, the results obtained in the Portuguese population coincide with those of earlier studies; namely that obesity differentially effects instrumental functions.

Reproducibility of the incremental shuttle walk test for women with morbid obesity

OBJECTIVE

The incremental shuttle walk test (ISWT) is a valuable tool for the assessment of functional capacity. However, few studies have used the ISWT in individuals with obesity or have determined its reproducibility in this population.

PURPOSE

The aim of the present study was to evaluate the reproducibility of the ISWT in women with morbid obesity.

METHODS

Twenty-three women with a body mass index >40 kg/m(2) (mean age: 39.1 ± 7.7) performed the ISWT twice on the same day.

RESULTS

The mean distance traveled was 313.3 ± 100.2 m on the first test and 322.5 ± 98.9 on the second test, with no significant difference between tests. The intraclass correlation coefficient (0.91) indicated excellent reproducibility. Reliability determined through Bland-Altman analysis revealed a small mean difference between tests (-9.2 m).

CONCLUSION

The practice of repeating the ISWT appears to be unnecessary for women with morbid obesity, as demonstrated by the excellent reproducibility of the test.

VOCAL COMPLAINT, AUDITORY-PERCEPTUAL ASSESSMENT OF VOICE AND VOCAL SELF-ASSESSMENT IN WOMEN WITH MORBID OBESITY

BACKGROUND

Obese people often have altered breathing patterns and therefore may experience difficulties in voice production.

AIM

To verify the presence of vocal complaints and the correlation between the auditory-perceptual analysis of voice and vocal self-assessment of a group of women with morbid obesity before and after bariatric surgery.

METHODS

A longitudinal, exploratory, descriptive study of 21 morbidly obese women aged between 28 and 68 years, assessed before and after bariatric surgery, was performed. The women filled out a form containing identification data and type of vocal complaint. Perceptual evaluation of voice and vocal self-assessment were performed using a visual analog scale. For perceptual assessment of voice the women were asked to say three sentences from the Consensus Auditory-Perceptual Evaluation of Voice.

RESULTS

Of the 21 patients, 14 (66.6%) reported vocal complaints, of which 10 (71%) vocal fatigue, eight (57.14%) voice failures and seven (50%) vocal effort. All participants reported improvements in the voice after surgery, irrespective of having reported vocal complaints before surgery. There was no correlation between vocal self-assessment and auditory-perceptual assessment of the voice before or after the procedure. There was no correlation between vocal self-assessment and perceptual evaluation of the voice before surgery.

CONCLUSION

Obesity interfered with voice production and influenced negative perception and therefore vocal complaints. Complaints about vocal production cannot be perceived by a speech therapist with the same impact as by patients, as both employ different criteria for vocal evaluation. Vocal self-assessment is an important tool in voice evaluation.

Fundamental frequency, phonation maximum time and vocal complaints in morbidly obese women

BACKGROUND

Obese people have abnormal deposition of fat in the vocal tract that can interfere with the acoustic voice. Aim : To relate the fundamental frequency, the maximum phonation time and voice complaints from a group of morbidly obese women.

METHODS

Observational, cross-sectional and descriptive study that included 44 morbidly obese women, mean age of 42.45 (± 10.31) years old, observational group and 30 women without obesity, control group, with 33.79 (± 4.51)years old. The voice recording was done in a quiet environment, on a laptop using the program ANAGRAF acoustic analysis of speech sounds. To extract the values ​​of fundamental frequency the subjects were asked to produce vowel [a] at usual intensity for a period in average of three seconds. After the voice recording, participants were prompted to produce sustained vowel [ a] , [ i] and [ u] at usual intensity and height, using a stopwatch to measure the time that each participant could hold each vowel.

RESULTS

The majority, 31(70.5%), had vocal complaints, with a higher percentage for complaints of vocal fatigue 20(64.51%) and voice failures 19(61.29%) followed by dryness of the throat in 15 (48.38%) and effort to speak 13(41.93%). There was no statistically significant difference regarding the mean fundamental frequency of the voice in both groups, but there was significance between the two groups regarding maximum phonation.

CONCLUSION

Increased adipose tissue in the vocal tract interfered in the vocal parameters.