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Xie L, Chandrasekhar A, DeSantis SM, Almandoz JP, de la Cruz-Muñoz N, Messiah SE. Discontinuation and reduction of asthma medications after metabolic and bariatric surgery: A systematic review and meta-analysis. Obes Rev 2023; 24:e13527. [PMID: 36345564 DOI: 10.1111/obr.13527] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/16/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
Obesity is a risk factor for asthma. Metabolic and bariatric surgery (MBS) is a safe and effective treatment option for obesity. Weight reduction via MBS, in turn, may improve asthma outcomes and decrease the need for asthma medications. The aim of the systematic review and meta-analysis is to explore the available evidence focused on the impact of MBS on the improvement of asthma outcomes via the discontinuation and reduction of asthma medications. After a comprehensive search in the PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases, 15 studies, including pre-post MBS data on asthma medication use among adults, were eligible for the systematic review. Thirteen studies reported the proportion of patient who discontinued asthma medication post-MBS and was meta-analyzed using random effects. Results showed 54% patients completely discontinued asthma medications (95% confidence interval 42%-67%, I2 = 86.2%, p < 0.001). The average number of asthma medications was also decreased by approximately 22%-46%. MBS provides strong therapeutic benefits for patients with asthma, as evidenced by the complete discontinuation of asthma medications in over 50% of MBS completers. The inference was limited by the small number, variations in follow-up time and rates, and heterogeneity of studies. Studies that include more ethnically diverse participant samples are needed to improve generalizability.
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Affiliation(s)
- Luyu Xie
- School of Public Health, University of Texas Health Science Center, Dallas Campus, Dallas, Texas, USA.,Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas, Dallas, Texas, USA
| | - Aparajita Chandrasekhar
- School of Public Health, University of Texas Health Science Center, Dallas Campus, Dallas, Texas, USA.,Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas, Dallas, Texas, USA
| | - Stacia M DeSantis
- School of Public Health, University of Texas Health Science Center, Houston Campus, Houston, Texas, USA
| | - Jaime P Almandoz
- Department of Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Sarah E Messiah
- School of Public Health, University of Texas Health Science Center, Dallas Campus, Dallas, Texas, USA.,Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas, Dallas, Texas, USA
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Abstract
Asthma is chronic eosinophilic bronchitis with the dominancy of T helper 2 (Th2) inflammation. However, patients with asthma and metabolic dysfunction have pathogenic and pathological differences from those with Th2 inflammation. Metabolic dysfunction, typically presented as metabolic syndrome, has several important clinical components including central obesity, insulin resistance or glucose intolerance, dyslipidemia, and vitamin D deficiency. Data from large epidemiological studies support the significance of these components in the control of asthma and their contribution to airway remodeling, suggesting the presence of an asthma phenotype with metabolic dysfunction. These components are quite interactive with each other, so it is difficult to reveal the individual role of each. It is well known that asthma is difficult to treat in patients with obesity, due in part to inadequate response to inhaled corticosteroids. Additionally, vitamin D deficiency and insulin resistance have been regarded as aggravating factors of asthma control and airway remodeling. Recent clinical and in vivo studies have revealed the specific mechanisms of these components, which may aggravate asthma control and airway remodeling. In this review article, I summarize the recent studies and unmet needs for patients with asthma and metabolic dysfunction.
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Affiliation(s)
- Jung-Won Park
- Institute for Allergy & Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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3
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Marouf A, Mortada H. Complications of Body Contouring Surgery in Postbariatric Patients: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2021; 45:2810-2820. [PMID: 34018015 DOI: 10.1007/s00266-021-02315-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/13/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Obesity is a major global health problem. With an increasing number of bariatric surgeries, the need for body-contouring procedures has grown. These procedures are associated with multiple complications because of various patient characteristics and risk factors. OBJECTIVES In this study, we performed a systematic literature review of all the complications of postbariatric body contouring surgeries, as well as a meta-analysis to estimate the effects of body mass index (BMI) and the weight of the tissue resected during body contouring on the development of complications. METHODS We conducted a literature search of the PubMed and Cochrane databases in September 2020, using the MeSH terms plastic surgery, weight loss, and complications. Studies were included if they involved more than 35 postbariatric patients and reported postoperative complication rates and types. RESULTS In total, 561 articles were initially identified, and 25 studies were included after the final review. The overall weighted rate of postbariatric body contouring surgical complications in all studies was 31.5%. The most frequent complication from all regions of body contouring was seroma (weighted rate 12.7-13.9%). Regarding risk factors, analysis indicated that a BMI < 30 kg/m2 and low mean weight of resected tissue were associated with fewer complications. CONCLUSION Body contouring procedures are relatively safe. Although complications after contouring are common, most either resolve spontaneously or require minimal intervention. In body contouring after bariatric surgery, there is a 37% increased risk of developing complications if the BMI is ≥ 30 kg/[Formula: see text] before body contouring. A higher weight of resected tissue appears to be linked to a greater risk of complications. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Azmi Marouf
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
- Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia.
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4
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Christopher AN, Morris MP, Patel V, Broach RB, Fischer JP. Abdominal Body Contouring: Does Body Mass Index Affect Clinical and Patient Reported Outcomes? J Surg Res 2021; 270:348-358. [PMID: 34731733 DOI: 10.1016/j.jss.2021.09.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 08/01/2021] [Accepted: 09/09/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obese individuals are thought to be higher risk for complications after excisional abdominal body contouring (EAC) due to co-morbidities and significant tissue resection. OBJECTIVES We comparatively analyzed EAC patients with Body Mass Index (BMI) ≥35 kg/m2 and BMI <35 kg/m2 to highlight key differences in clinical and patient-reported-outcomes (PROs). METHODS Patients ≥18 years-old undergoing EAC by a single surgeon from 01/2018-01/2020 were identified and separated into cohorts based on BMI (<35 and ≥35 kg/m2). Patients were excluded if they had a cosmetic abdominoplasty without history of bariatric surgery or massive weight loss, or if they had <1000 gs of tissue resected. Clinical outcomes and PROs using the BODY-Q were comparatively analyzed. RESULTS 70 total patients with median BMIs of 30[26-32] and 41[37-45] kg/m2 in each cohort, were identified. Patients with BMI ≥35 kg/m2 were more likely to have higher ASA (P<0.01) and use of incisional negative pressure wound devices (P = 0.042). Alternatively, they were less likely to have had concurrent liposuction (P = 0.05). There were no differences in development of an SSO, SSI or SSOpi (P>0.05) between cohorts. Multivariate logistic regression showed that BMI ≥35 kg/m2, iNPWD and liposuction were not associated with the development of complications. PROs demonstrated improvement in multiple domains despite BMI. CONCLUSION There was no association with BMI ≥35 kg/m2 and the development of complications within our cohort. We encourage preoperative weight loss when possible, however these procedures can be performed safely with acceptable outcomes even in individuals who are obese and/or require extensive tissue removal.
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Affiliation(s)
- Adrienne N Christopher
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania. Philadelphia, PA; Department of Surgery. Thomas Jefferson University. Philadelphia, PA.
| | - Martin P Morris
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania. Philadelphia, PA
| | - Viren Patel
- Perelman School of Medicine, University of Pennsylvania. Philadelphia, PA
| | - Robyn B Broach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania. Philadelphia, PA
| | - John P Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania. Philadelphia, PA.
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A Comparative Analysis of Fleur-de-Lis and Traditional Panniculectomy after Bariatric Surgery. Aesthetic Plast Surg 2021; 45:2208-2219. [PMID: 33544187 DOI: 10.1007/s00266-021-02149-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The Fleur-de-Lis panniculectomy (FdL) adds a vertical component to correct complex contour deformities after massive weight loss by addressing supra-umbilical horizontal skin excess which is not addressed with infra-umbilical transverse panniculectomy (TP). We aim to perform a head-to-head comparison of clinical outcomes and patient reported outcomes (PROs) between FdL and TP. METHODS A retrospective review of patients ≥18 with a history of bariatric surgery undergoing FdL or TP by a single plastic surgeon between 07/01/2015 and 05/31/2020 was conducted. Surgical site occurrences (SSOs) including surgical site infection (SSI), delayed healing, cellulitis, seroma, hematoma, surgical site occurrences requiring procedural intervention (SSOpi), and a composite of other postoperative outcomes were assessed. In addition, patient satisfaction was analyzed using the Body-Q questionnaire across 12 domains. RESULTS The analysis included 56 patients; 26 and 30 patients who were treated with FdL and TP, respectively. Cohorts were statistically similar in terms of age, gender, BMI, and co-morbid conditions. The overall complication rate was 50% (FdL n = 14 (53.9%), TP n = 14 (46.7%); p = 0.592). On multivariate analysis, pannus weight was associated with the development of SSO (p = 0.04). FdL incision, however, was not an independent risk factor for adverse outcomes. Absolute improvement in PROs was similar in both cohorts across multiple domains. CONCLUSION FdL showed a comparable safety and efficacy profile to TP when performed in post-bariatric surgery patients, with equivalent improvement in PROs across multiple domains. Preoperative weight loss should be encouraged in this population as pannus weight is an independent risk factor for complications. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Hossain N, Arhi C, Borg CM. Is Bariatric Surgery Better than Nonsurgical Weight Loss for Improving Asthma Control? A Systematic Review. Obes Surg 2021; 31:1810-1832. [PMID: 33590422 DOI: 10.1007/s11695-021-05255-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 01/01/2023]
Abstract
Obesity is associated with increased severity of asthma. Bariatric surgery can be effective in weight loss and improvement in asthma. Two reviewers conducted a systematic review using search terms: 'weight loss', 'bariatric surgery', and 'asthma'. Adult studies including all bariatric procedures and nonsurgical weight loss regimes were included. Thirty-nine studies, including twenty-six bariatric studies and thirteen nonsurgical studies, were found. No study directly compared bariatric surgery to nonsurgical techniques. Bariatric surgery offered greater weight loss (22-36%) than nonsurgical programmes (4.1-14.2%) and more consistently improved medication use, airway hyperresponsiveness, hospitalisation rate or ED attendance and lung function, while change in inflammatory markers were variable. Bariatric surgery appears to be superior in treating asthma; however, further study on surgery for both mild and severe asthma is required.
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Affiliation(s)
- Naveed Hossain
- Department of General Surgery, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, Lewisham High Street, London, SE13 6LH, UK. .,Department of General Surgery, Whittington Hospital, Whittington Health NHS Trust, Magdala Avenue, London, N19 5NF, UK.
| | - Chanpreet Arhi
- Department of General Surgery, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, Lewisham High Street, London, SE13 6LH, UK
| | - Cynthia-Michelle Borg
- Department of General Surgery, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, Lewisham High Street, London, SE13 6LH, UK
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Krauss S, Medesan R, Black J, Medved F, Schaefer R, Schaller HE, Daigeler A, Wahler T. Outcome of Body-Contouring Procedures After Massive Weight Loss. Obes Surg 2020; 29:1832-1840. [PMID: 30778847 DOI: 10.1007/s11695-019-03773-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND With the increased popularity of bariatric surgery, the demand for body-contouring procedures is growing. Associated with these procedures are a number of complications due to different risk factors and patients' characteristics. The aim of this study was to assess the outcome of body-contouring procedures and correlate it to possible risk factors. METHODS The study included a collective of 112 patients who underwent 157 body-contouring procedures. Patients' characteristics, risk factors, and complications have been recorded. Three groups were formed based on the type of surgical procedure to perform correlations of BMI, weight of resected tissue, and length of hospital stay using Spearman's rank test. Correlations between patients' risk factors and complication occurrence were analyzed with Fisher's exact test. RESULTS The most common procedure patients underwent was the classic abdominoplasty (n = 53). A significant correlation was found between preoperative BMI and weight of resected tissue in abdominoplasties (rho = 0.69), Fleur-de-Lis abdominoplasties (rho = 0.64), and body lifts (rho = 0.60). There was a significant correlation between weight of resected tissue and length of hospital stay (rho = 0.53) and preoperative BMI and length of hospital stay (rho = 0.4) as well. There was no significant correlation between patients' comorbidities or smoking status and the postoperative complication rate. The mean weight of resected tissue was higher in patients with than without complications requiring surgical revision. CONCLUSIONS The relevance of risk factors commonly believed to have an influence on postoperative complications should be revised. The weight of resected tissue has an influence on complication.
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Affiliation(s)
- Sabrina Krauss
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Raluca Medesan
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Jaantje Black
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Fabian Medved
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Ruth Schaefer
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Hans-Eberhard Schaller
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Adrien Daigeler
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Theodora Wahler
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
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8
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Villeneuve T, Guilleminault L. [Asthma and obesity in adults]. Rev Mal Respir 2019; 37:60-74. [PMID: 31866123 DOI: 10.1016/j.rmr.2019.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/06/2019] [Indexed: 12/31/2022]
Abstract
Asthma is a chronic inflammatory airway disorder characterized by a multitude of phenotypes. Epidemiological studies show an increase in asthma prevalence in obese patients regardless of age. The association of asthma and obesity is now considered as a phenotype with its own clinical, biological and functional characteristics. Regarding the pathophysiology of asthma and obesity, numerous factors such as nutrition, genetic predisposition, microbiome, ventilatory mechanics and the role of adipose tissue have been identified to explain the heterogeneous characteristics of patients with asthma and obesity. In adult patients with asthma and obesity, respiratory symptoms are particularly prominent and atopy and eosinophilic inflammation is uncommon compared to normal weight asthma patients. Obese asthma patients experience more hospitalizations and use more rescue medications than normal weight asthmatics. Management of asthma in obese patients is complex because these patients have less response to the usual anti-asthmatic treatments. Weight loss through caloric restriction combined with exercise is the main intervention to obtain improvement of asthma outcomes. Bariatric surgery is an invasive procedure with interesting results.
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Affiliation(s)
- T Villeneuve
- Pôles des voies respiratoires, hôpital Larrey, CHU de Toulouse, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France
| | - L Guilleminault
- Pôles des voies respiratoires, hôpital Larrey, CHU de Toulouse, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France; Centre de physiopathologie de Toulouse Purpan (CPTP-U1043, Inserm, équipe 12), UPS, Toulouse, France.
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9
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Chaaban TA. Bariatric surgery: a potential cure for asthma? Eur Respir Rev 2019; 28:28/152/190003. [PMID: 31285286 DOI: 10.1183/16000617.0003-2019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 06/04/2019] [Indexed: 12/19/2022] Open
Abstract
Asthma incidence and severity are increased in obese populations. Systematic reviews have shown benefit from weight-loss interventions on asthma outcomes, but the role of bariatric surgery is still unclear. In this review, cohorts of obese asthmatic patients undergoing bariatric surgery were examined regarding different asthma outcomes. The available data on patients who were followed up showed improvements in asthma control, exacerbation risk, asthma-related hospitalisation, medication use and airway hyperresponsiveness, with some patients not requiring further treatment for asthma. Follow-up duration was variable, being mostly of 1 year, with some studies reporting long-term outcomes after 5 years. The studies reviewed had many limitations, including small numbers of patients, lack of control arm in some studies and lack of standardisation of asthma diagnosis, classification and outcome measures, in addition to possible reporting bias. Data on small numbers of patients also show the possibility of benefit exclusively in nonallergic asthma. Larger, more stringent clinical trials are needed before recommending bariatric surgery for treatment of asthma.
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10
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Sadeghimakki R, McCarthy HD. Interactive effects of adiposity and insulin resistance on the impaired lung function in asthmatic adults: cross-sectional analysis of NHANES data. Ann Hum Biol 2019; 46:56-62. [PMID: 30712386 DOI: 10.1080/03014460.2019.1572223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Obesity is considered a risk factor for both asthma and insulin resistance in adults. Insulin resistance (IR) also influences pulmonary function in the non-obese population. AIM To investigate the modifying effect of insulin resistance on the predictive role of anthropometric measures in the estimation of impaired lung function among asthmatic adults. SUBJECTS AND METHODS A cross-sectional study of 1276 adults extracted from the NHANES 2009-2012 database was performed. Adjusted multiple linear regression was conducted to analyse the contributory role of obesity and IR in predicting lung function among asthmatic adults. RESULTS BMI, waist circumference (WC) and waist-to-height ratio (WHtR) showed significantly negative correlations with FVC (r=-0.24, -0.18, -0.39, respectively; p < 0.001), FEV1(r=-0.24, -0.21, -0.40, respectively; p < 0.001) and FEF 25-75% (r=-0.15, -0.18, -0.27, respectively; p < 0.001). Even after adjustment for the covariates (age, gender, smoking history and standing height), BMI and HOMA-IR had significant relationships with FVC (β= -10.3; p < 0.01 and β= -16.0; p < 0.05) and FEV1 (β= -8.7; p < 0.01 and β= -11.7; p < 0.05). BMI could significantly predict the decreased FVC (β= -13.7; p < 0.01) and FEV1 (β= -10.7; p < 0.01) only in the insulin resistant asthmatics. CONCLUSION WHtR and IR predict impaired lung function in overweight/obese asthmatic adults independently. IR also modifies the association between excessive adiposity and respiratory function in asthmatic adults.
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Affiliation(s)
- Roham Sadeghimakki
- a Public Health Nutrition Research Group, London Metropolitan University , London , UK
| | - Huw David McCarthy
- a Public Health Nutrition Research Group, London Metropolitan University , London , UK
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11
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McLaughlin MJ, Wagner J, Shakhnovich V, Carleton B, Leeder JS. Considerations for Implementing Precision Therapeutics for Children. Clin Transl Sci 2019; 12:140-150. [PMID: 30516322 PMCID: PMC6440566 DOI: 10.1111/cts.12607] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/13/2018] [Indexed: 12/12/2022] Open
Abstract
Improving the utilization of pharmacologic agents in the pediatric population yields significant, perhaps life‐long, benefits. Genetic factors related to the disposition of a medication or an alteration at the target receptor site contributes to the observed variability of exposure and response between individuals. An additional source of this variability specific to the pediatric population is ontogeny, where age‐specific changes during development may require dose adjustments to obtain the same levels of drug exposure and response. With significant improvements in characterizing both the ontogeny and genetic contributions of drug metabolizing enzymes, the time is right to begin placing more emphasis on response rather than only the dose‐exposure relationship. The amount of drug target receptors and the relative affinity for binding at that target site may require different levels of systemic exposure to achieve a desired response. Concentration‐controlled studies can identify the needed exposure for a response at the drug target, the level of expression of the target site in an individual patient, and the tools required to individualize response. Although pediatrics represents a large spectrum of growth and development, developing tools to improve drug delivery for each individual patient across the spectrum of the ages treated by clinicians remains valuable.
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Affiliation(s)
| | | | | | - Bruce Carleton
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
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12
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Shakhnovich V, Smith PB, Guptill JT, James LP, Collier DN, Wu H, Livingston CE, Zhao J, Kearns GL. Obese Children Require Lower Doses of Pantoprazole Than Nonobese Peers to Achieve Equal Systemic Drug Exposures. J Pediatr 2018; 193:102-108.e1. [PMID: 29389444 PMCID: PMC5806153 DOI: 10.1016/j.jpeds.2017.10.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 10/04/2017] [Accepted: 10/11/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess appropriate pantoprazole dosing for obese children, we conducted a prospective pharmacokinetics (PK) investigation of pantoprazole in obese children, a patient population that is traditionally excluded from clinical trials. STUDY DESIGN A total of 41 obese children (6-17 years of age), genotyped for CYP2C19 variants *2, *3, *4, and *17, received a single oral dose of pantoprazole, ~1.2 mg/kg lean body weight (LBW), with LBW calculated via a validated formula. Ten post-dose pantoprazole plasma concentrations were measured, and PK variables generated via noncompartmental methods (WinNonlin). Linear and nonlinear regression analyses and analyses of variance were used to explore obesity, age, and CYP2C19 genotype contribution to pantoprazole PK. PK variables of interest were compared with historic nonobese peers treated with pantoprazole. RESULTS Independent of genotype, when normalized to dose per kg total body weight, pantoprazole apparent clearance and apparent volume of distribution were significantly lower (P < .05) and systemic exposure significantly higher (P < .01) in obese vs nonobese children. When normalized per kg LBW, these differences were not evident in children ≥12 years of age and markedly reduced in children <12 years of age. CONCLUSIONS LBW dosing of pantoprazole led to pantoprazole PK similar to nonobese peers. Additional factors, other than body size (eg, age-related changes in CYP2C19 activity), appear to affect pantoprazole PK in children <12 years of age. TRIAL REGISTRATION ClinicalTrials.gov: NCT02186652.
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Affiliation(s)
- Valentina Shakhnovich
- Divisions of Gastroenterology & Clinical Pharmacology, Toxicology and Therapeutic Innovation, The Children's Mercy Hospital, Kansas City, MO.
| | - P Brian Smith
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Duke Clinical Research Institute, Durham, NC
| | - Jeffrey T Guptill
- Department of Neurology, Division of Neuromuscular Medicine, Duke Clinical Research Institute, Durham, NC
| | - Laura P James
- Department of Pediatrics, University of Arkansas for Medical Sciences Section of Clinical Pharmacology and Toxicology, Arkansas Children's Hospital, Little Rock, AR
| | - David N Collier
- Department of Pediatrics and Center for Health Disparities, Division of General Pediatrics, East Carolina University, Greenville, NC
| | - Huali Wu
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Duke Clinical Research Institute, Durham, NC
| | | | - Jian Zhao
- The Emmes Statistical Group, Rockville, MD
| | - Gregory L Kearns
- Department of Pediatrics, University of Arkansas for Medical Sciences Section of Clinical Pharmacology and Toxicology, Arkansas Children's Hospital, Little Rock, AR
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13
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Gallart-Aragón T, Fernández-Lao C, Galiano-Castillo N, Cantarero-Villanueva I, Lozano-Lozano M, Arroyo-Morales M. Improvements in Health-Related Quality of Life and Pain: A Cohort Study in Obese Patients After Laparoscopic Sleeve Gastrectomy. J Laparoendosc Adv Surg Tech A 2017; 28:53-57. [PMID: 28850292 DOI: 10.1089/lap.2017.0415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The principal aim of the study was to investigate the effect of the sleeve gastrectomy (SG) in the quality of life (QoL) and pain in a population of morbidly obese patients. METHODS Seventy-two SG patients were assessed in this descriptive observational study, before the surgery and 6 months after that. We evaluated health-related QoL (Gastrointestinal Quality of Life Index [GIQLI]) and pain (spontaneous low back pain by Numerical Point Rate Scale [NPRS] and pressure pain thresholds [PPTs]). RESULTS The results of the analysis of variance (ANOVA) revealed significant improvements in nearly all of the subscales of GIQLI questionnaire after 6 months: gastrointestinal symptoms (P = .01), physical well-being (P < .001), social well-being (P = .03), and total GIQLI score (P < .001), but not for the emotional condition (P = .20). Patients also had improvements in spontaneous low back pain (P = .002), but not in the PPTs in all the body areas explored, including the cervical area, low back, and hands (P > .05). CONCLUSION Patients receiving SG improved their health-related QoL and low back pain 6 months after the intervention, but this improvement was not so important for pressure pain thresholds in different body areas.
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Affiliation(s)
| | - Carolina Fernández-Lao
- 2 Department of Physical Therapy, Instituto Biosanitario Granada (IBS.Granada), Instituto Mixto Deporte y Salud (iMUDS), University of Granada , Granada, Spain
| | - Noelia Galiano-Castillo
- 2 Department of Physical Therapy, Instituto Biosanitario Granada (IBS.Granada), Instituto Mixto Deporte y Salud (iMUDS), University of Granada , Granada, Spain
| | - Irene Cantarero-Villanueva
- 2 Department of Physical Therapy, Instituto Biosanitario Granada (IBS.Granada), Instituto Mixto Deporte y Salud (iMUDS), University of Granada , Granada, Spain
| | | | - Manuel Arroyo-Morales
- 2 Department of Physical Therapy, Instituto Biosanitario Granada (IBS.Granada), Instituto Mixto Deporte y Salud (iMUDS), University of Granada , Granada, Spain
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14
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A new approach to the classification and management of airways diseases: identification of treatable traits. Clin Sci (Lond) 2017; 131:1027-1043. [PMID: 28487412 DOI: 10.1042/cs20160028] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/14/2016] [Accepted: 01/26/2017] [Indexed: 12/16/2022]
Abstract
This review outlines a new, personalized approach for the classification and management of airway diseases. The current approach to airways disease is, we believe, no longer fit for purpose. It is impractical, overgeneralizes complex and heterogeneous conditions and results in management that is imprecise and outcomes that are worse than they could be. Importantly, the assumptions we make when applying a diagnostic label have impeded new drug discovery and will continue to do so unless we change our approach. This review suggests a new mechanism-based approach where the emphasis is on identification of key causal mechanisms and targeted intervention with treatment based on possession of the relevant mechanism rather than an arbitrary label. We highlight several treatable traits and suggest how they can be identified and managed in different healthcare settings.
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Maniscalco M, Zamparelli AS, Vitale DF, Faraone S, Molino A, Zedda A, Motta A. Long-term effect of weight loss induced by bariatric surgery on asthma control and health related quality of life in asthmatic patients with severe obesity: A pilot study. Respir Med 2017; 130:69-74. [PMID: 29206636 DOI: 10.1016/j.rmed.2017.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/14/2017] [Accepted: 06/15/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND The weight loss induced by bariatric surgery (BS) improves asthma clinical control evaluated usually after a short time. The long-term effects of weight loss attained by BS on asthma control and health related-quality of life (HRQoL) in patients affected by asthma and obesity are not known. OBJECTIVE To investigate the five-year effect of weight reduction induced by BS on asthma control, quality of life and pulmonary functional parameters in severely obese intermittent or mild-to-moderate asthmatic patients. METHODS Twenty-six consecutive severe obese subjects with previous diagnosis of asthma with indication for laparoscopic adjustable gastric banding (LAGB) were enrolled into the study. Fifteen of them agreed to undertake the surgery (treatment group, TG) while the remaining eleven non-operated patients represented the control group (CG). Body mass index (BMI), Asthma Control Test (ACT), Mini Asthma Quality of Life Questionnaire (mini-AQLQ) and spirometric parameters were evaluated at baseline and after one and five years from surgery. RESULTS Mean BMI of TG significantly decreased at one and five years after the surgery, while it remained unchanged in CG. After surgery, both the overall ACT and the mini-AQLQ score significantly improved in TG after one year, persisting improved after 5-years (p < 0.001), while these outcomes remained unchanged in CG. As compared with the pre-surgery values, the percentage of predicted FEV1 and FVC significantly increased at five-year follow-up from surgery in TG, while it remained unchanged in CG. CONCLUSIONS In severe obese asthmatic patients, the significant improvement of asthma control test and HRQoL, observed one year after LAGB, persists five years after surgery.
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Affiliation(s)
- Mauro Maniscalco
- Pulmonary Rehabilitation Unit, ICS Maugeri SpA SB, Institute of Telese Terme, Benevento, Italy.
| | | | - Dino Franco Vitale
- Clinical Epidemiology Section, ICS Maugeri SpA SB, Institute of Telese Terme, Benevento, Italy
| | - Stanislao Faraone
- Section of Respiratory Medicine, Hospital S. Maria della Pietà, Casoria, Naples, Italy
| | - Antonio Molino
- Department of Respiratory Medicine, A.O. dei Colli, University of Naples Federico II, Naples, Italy
| | - Anna Zedda
- Section of Respiratory Medicine, Hospital S. Maria della Pietà, Casoria, Naples, Italy
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, Pozzuoli, Naples, Italy
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16
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Chen Z, Salam MT, Alderete TL, Habre R, Bastain TM, Berhane K, Gilliland FD. Effects of Childhood Asthma on the Development of Obesity among School-aged Children. Am J Respir Crit Care Med 2017; 195:1181-1188. [PMID: 28103443 PMCID: PMC5439015 DOI: 10.1164/rccm.201608-1691oc] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/27/2016] [Indexed: 01/15/2023] Open
Abstract
RATIONALE Asthma and obesity often occur together in children. It is unknown whether asthma contributes to the childhood obesity epidemic. OBJECTIVES We aimed to investigate the effects of asthma and asthma medication use on the development of childhood obesity. METHODS The primary analysis was conducted among 2,171 nonobese children who were 5-8 years of age at study enrollment in the Southern California Children's Health Study (CHS) and were followed for up to 10 years. A replication analysis was performed in an independent sample of 2,684 CHS children followed from a mean age of 9.7 to 17.8 years. MEASUREMENTS AND MAIN RESULTS Height and weight were measured annually to classify children into normal, overweight, and obese categories. Asthma status was ascertained by parent- or self-reported physician-diagnosed asthma. Cox proportional hazards models were fitted to assess associations of asthma history with obesity incidence during follow-up. We found that children with a diagnosis of asthma at cohort entry were at 51% increased risk of developing obesity during childhood and adolescence compared with children without asthma at baseline (hazard ratio, 1.51; 95% confidence interval, 1.08-2.10) after adjusting for confounders. Use of asthma rescue medications at cohort entry reduced the risk of developing obesity (hazard ratio, 0.57; 95% confidence interval, 0.33-0.96). In addition, the significant association between a history of asthma and an increased risk of developing obesity was replicated in an independent CHS sample. CONCLUSIONS Children with asthma may be at higher risk of obesity. Asthma rescue medication use appeared to reduce obesity risk independent of physical activity.
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Affiliation(s)
- Zhanghua Chen
- Department of Preventive Medicine, Division of Environmental Health and
| | - Muhammad T. Salam
- Department of Preventive Medicine, Division of Environmental Health and
- Department of Psychiatry, Kern Medical Center, Bakersfield, California
| | - Tanya L. Alderete
- Department of Preventive Medicine, Division of Environmental Health and
| | - Rima Habre
- Department of Preventive Medicine, Division of Environmental Health and
| | | | - Kiros Berhane
- Department of Preventive Medicine, Division of Biostatistics, Keck School of Medicine of University of Southern California, Los Angeles, California; and
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Choi YB. Current Status of Bariatric and Metabolic Surgery in Korea. Endocrinol Metab (Seoul) 2016; 31:525-532. [PMID: 27834081 PMCID: PMC5195828 DOI: 10.3803/enm.2016.31.4.525] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 08/31/2016] [Accepted: 09/07/2016] [Indexed: 01/27/2023] Open
Abstract
Bariatric surgery is considered to be the most effective treatment modality in maintaining long-term weight reduction and improving obesity-related conditions in morbidly obese patients. In Korea, surgery for morbid obesity was laparoscopic sleeve gastrectomy first performed in 2003. Since 2003, the annual number of bariatric surgeries has markedly increased, including adjustable gastric banding (AGB), Roux-en-Y gastric bypass, sleeve gastrectomy, mini-gastric bypass, and others. In Korea, AGB is much more common than in others countries. A large proportion of doctors, the public, and government misunderstand the necessity and effectiveness of bariatric surgery, believing that bariatric surgery has an unacceptably high morbidity, and that it is not superior to non-surgical treatments to improve obesity and obesity-related diseases. The effectiveness, safety, and cost-effectiveness of bariatric surgery have been well demonstrated. The Korean Society of Metabolic and Bariatric Surgery recommend bariatric surgery confining to morbidly obese patients (body mass index ≥40 or >35 in the presence of significant comorbidities).
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Affiliation(s)
- Youn Baik Choi
- Department of Surgery, Chung Hospital, Seoul, Korea.
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction in Patients With Previous Bariatric Surgery: Is It Safe and Feasible? Ann Plast Surg 2016; 76:216-20. [PMID: 26756599 DOI: 10.1097/sap.0000000000000526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Obesity is widely recognized as a major health concern and a leading cause of preventable death. The correlation between obesity and breast cancer has been thoroughly described by several authors. Bariatric surgery is often associated with redundant abdominal tissue, often leading patients to consider body-contouring procedures. Autologous tissue breast reconstruction using the deep inferior epigastric artery perforator (DIEP) flap has advantages because it is tissue that is normally discarded during postbariatric body contouring. METHODS We conducted a retrospective chart review of 18 DIEP flaps performed by the senior author in 9 patients for breast reconstruction between February 2008 and May 2013. All patients underwent mastectomies. All patients underwent bariatric surgery preceding breast reconstruction. Breast reconstruction was performed immediately in 13 cases and delayed in 5 cases. RESULTS Mean age of the study population was 44.6 years (range, 41-57 years). The mean maximum body mass index of the patients was 44 (range, 37.6-52.1), and the mean current body mass index at the time of the reconstruction was 30.7 (range, 24.3-38.1). No intraoperative complications were reported. No fascia or muscle was taken during flap dissection. Mean operative time was 632 minutes (range, from 480 to 750 minutes). Average hospital stay was 4 days. No partial or total flap loss was reported. There were no postoperative hernias or bulges at the abdominal donor site. CONCLUSIONS This series represents the largest group of patients undergoing DIEP flap breast reconstruction after bariatric surgery. In the hands of experienced microsurgeons, breast reconstruction with the DIEP flap in postbariatric patients represents a low-risk option with high satisfaction.
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De Luca M, Angrisani L, Himpens J, Busetto L, Scopinaro N, Weiner R, Sartori A, Stier C, Lakdawala M, Bhasker AG, Buchwald H, Dixon J, Chiappetta S, Kolberg HC, Frühbeck G, Sarwer DB, Suter M, Soricelli E, Blüher M, Vilallonga R, Sharma A, Shikora S. Indications for Surgery for Obesity and Weight-Related Diseases: Position Statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg 2016; 26:1659-96. [PMID: 27412673 PMCID: PMC6037181 DOI: 10.1007/s11695-016-2271-4] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Maurizio De Luca
- Director Department of Surgery, Montebelluna Treviso Hospital, Montebelluna, Treviso, Italy.
| | | | - Jacques Himpens
- The European School of Laparoscopic Surgery, Brussels, Belgium
| | | | | | | | - Alberto Sartori
- Director Department of Surgery, Montebelluna Treviso Hospital, Montebelluna, Treviso, Italy
| | | | | | | | | | - John Dixon
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | | | | | | | - Michel Suter
- University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Mattias Blüher
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | | | - Arya Sharma
- Obesity Research Management, University of Alberta, Edmonton, Canada
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Abstract
Obesity as a risk factor for asthma has been identified in previous studies. Additionally, a disproportionate number of patients with severe or difficult-to-control asthma are obese. Patients with obesity-related asthma tend to have worse asthma control and quality of life disproportionate to their pulmonary function tests, are less responsive to corticosteroid therapy, and are more likely to have obesity-related comorbidities such as obstructive sleep apnea and gastroesophageal disease that complicate asthma treatment. With the increasing prevalence of obesity, the prevalence of asthma is anticipated to grow proportionally. Addressing weight loss and encouraging activity is essential in the management of obesity-related asthma. This article briefly overviews the epidemiology, unique distinguishing features, potential mechanisms, and approach to management of patients with obesity-related asthma in adults.
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Affiliation(s)
- Nikunj A Bhatt
- a Department of Pulmonary Medicine , Walter Reed National Military Medical Center , Bethesda , MD , USA
| | - Angeline Lazarus
- a Department of Pulmonary Medicine , Walter Reed National Military Medical Center , Bethesda , MD , USA
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Peters U, Hernandez P, Dechman G, Ellsmere J, Maksym G. Early detection of changes in lung mechanics with oscillometry following bariatric surgery in severe obesity. Appl Physiol Nutr Metab 2016; 41:538-47. [PMID: 27109263 DOI: 10.1139/apnm-2015-0473] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Obesity is associated with respiratory symptoms that are reported to improve with weight loss, but this is poorly reflected in spirometry, and few studies have measured respiratory mechanics with oscillometry. We investigated whether early changes in lung mechanics following weight loss are detectable with oscillometry. Furthermore, we investigated whether the changes in lung mechanics measured in the supine position following weight loss are associated with changes in sleep quality. Nineteen severely obese female subjects (mean body mass index, 47.2 ± 6.6 kg/m(2)) were evaluated using spirometry, oscillometry, plethysmography, and the Pittsburgh Sleep Quality Index before and 5 weeks after bariatric surgery. These tests were conducted in both the upright and the supine position, and pre- and postbronchodilation with 200 μg of salbutamol. Five weeks after surgery, weight loss of 11.5 ± 2.5 kg was not associated with changes in spirometry and plethysmography, with the exception of functional residual capacity. There were also no changes in upright respiratory system resistance (Rrs) or reactance following weight loss. Importantly, however, in the supine position, weight loss caused a substantial reduction in Rrs. In addition, sleep quality improved significantly and was highly correlated with the reduction in supine Rrs. Prior to weight loss, subjects did not respond to the bronchodilator when assessed in the upright position with either spirometry or oscillometry; however, with modest weight loss, bronchodilator responsiveness returned to the normal range. Improvements in lung mechanics occur very early after weight loss, mostly in the supine position, resulting in improved sleep quality. These improvements are detectable with oscillometry but not with spirometry.
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Affiliation(s)
- Ubong Peters
- a School of Biomedical Engineering, Dalhousie University, 5981 University Avenue, Halifax, NS B3H 4R2, Canada
| | - Paul Hernandez
- b Department of Medicine, Dalhousie University, and Division of Respirology, Queen Elizabeth II Health Sciences Centre, Halifax, NS B3H 3A7, Canada
| | - Gail Dechman
- c School of Physiotherapy, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - James Ellsmere
- d School of Biomedical Engineering, Department of Surgery, Dalhousie University, and Division of General Surgery, Queen Elizabeth II Health Sciences Centre, Halifax, NS B3H 2Y9, Canada
| | - Geoffrey Maksym
- a School of Biomedical Engineering, Dalhousie University, 5981 University Avenue, Halifax, NS B3H 4R2, Canada
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22
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Weight Loss After Laparoscopic Band-to-Bypass Revision Compared With Primary Gastric Bypass. Surg Laparosc Endosc Percutan Tech 2015; 25:258-61. [DOI: 10.1097/sle.0000000000000156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Renard Y, Diaz Cives A, Veyrie N, Bouillot JL, Bertin E, Labrousse M, Kianmanesh R, Avisse C. Anatomical and CT approach of the adipose tissue: application in morbid obesity. Surg Radiol Anat 2015; 37:1035-42. [PMID: 25944254 DOI: 10.1007/s00276-015-1484-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 04/28/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE The importance and proportion of visceral adipose tissue (VAT) represent the best criterion to define obesity. Because VAT value is difficult to obtain in clinical practice, the indication for bariatric surgery is still based at present on Body Mass index (BMI), even though BMI is a poor predictor of obesity-related morbid complications. This correlation study aimed at determining a simple and accurate computed tomography (CT) anatomic marker, which can be easily used clinically, well correlated with the volume of VAT and consequently with morbid complications. METHODS We studied 108 CT scans of patients presenting with morbid obesity. Several simplified measures (external and internal abdominal diameters and circumferences) were conducted on CT scan view, going through the fourth lumbar vertebra (L4), in addition to various vertebral measurements (area of the vertebra, sagittal and transversal diameters), VAT and subcutaneous adipose tissue (SAT). Then, we reported the simplified measures values on the vertebral areas, and we calculated the Bertin index. Finally, we conducted a correlation study between all variables to obtain accurate VAT measurements. RESULTS The internal abdominal circumference and the Bertin index showed the best correlations with VAT in morbidly obese patients (r = 0.84 and 0.85, respectively). BMI and anthropometric measures were not correlated with VAT. CONCLUSION CT scan study allows to simply approximate VAT value in morbidly obese patients. An abdominal CT scan could be part of the tests used in the evaluation of obese patients to base therapeutic strategies on VAT values and not on BMI as it is the case today.
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Affiliation(s)
- Yohann Renard
- Department of Anatomy, Faculté de Médecine de Reims, Université de Reims Champagne-Ardenne, 51, rue Cognacq-Jay, 51095, Reims, France. .,Department of Digestive and Endocrine Surgery, Robert-Debré University Hospital, Université de Reims Champagne-Ardenne, 51, rue Cognacq-Jay, 51095, Reims, France.
| | - Anna Diaz Cives
- Department of Digestive and Endocrine Surgery, Robert-Debré University Hospital, Université de Reims Champagne-Ardenne, 51, rue Cognacq-Jay, 51095, Reims, France
| | - Nicolas Veyrie
- Department of General, Digestive and Metabolic Surgery, Ambroise Pare University Hospital, Université Versailles Saint-Quentin, Assistance Publique-Hôpitaux de Paris, 9, Avenue Charles de Gaulle, 92100, Boulogne, France
| | - Jean Luc Bouillot
- Department of General, Digestive and Metabolic Surgery, Ambroise Pare University Hospital, Université Versailles Saint-Quentin, Assistance Publique-Hôpitaux de Paris, 9, Avenue Charles de Gaulle, 92100, Boulogne, France
| | - Eric Bertin
- Department of Diabetology, Nutrition, and Metabolism, Robert-Debré University Hospital, Université de Reims Champagne-Ardenne, 51, rue Cognacq-Jay, 51095, Reims, France
| | - Marc Labrousse
- Department of Anatomy, Faculté de Médecine de Reims, Université de Reims Champagne-Ardenne, 51, rue Cognacq-Jay, 51095, Reims, France
| | - Reza Kianmanesh
- Department of Digestive and Endocrine Surgery, Robert-Debré University Hospital, Université de Reims Champagne-Ardenne, 51, rue Cognacq-Jay, 51095, Reims, France
| | - Claude Avisse
- Department of Anatomy, Faculté de Médecine de Reims, Université de Reims Champagne-Ardenne, 51, rue Cognacq-Jay, 51095, Reims, France.,Department of Digestive and Endocrine Surgery, Robert-Debré University Hospital, Université de Reims Champagne-Ardenne, 51, rue Cognacq-Jay, 51095, Reims, France
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Abstract
GERD is a significant comorbidity in bariatric patients preoperatively and postoperatively. Surgeons should be aware of appropriate evaluation, procedures choices, and management options. Revision surgery for reflux symptoms is common and appropriate anatomy and outcomes should be considered when offering these interventions to our patients. Patient selection is important to ensure avoiding postoperative development or worsening of GERD.
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Piché MÈ, Auclair A, Harvey J, Marceau S, Poirier P. How to choose and use bariatric surgery in 2015. Can J Cardiol 2014; 31:153-66. [PMID: 25661550 DOI: 10.1016/j.cjca.2014.12.014] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/03/2014] [Accepted: 12/03/2014] [Indexed: 01/01/2023] Open
Abstract
Severe obesity is associated with increased morbidity and mortality and represents a major health care problem with increasing incidence worldwide. Bariatric surgery, through its efficacy and improved safety, is emerging as an important available treatment for patients with severe obesity. Classically, bariatric surgery has been described as either a restrictive or a hybrid surgery, which is a combination of restriction and malabsorption. For most severely obese patients, bariatric surgery results in the remission of major obesity-related comorbidities including type 2 diabetes mellitus, sleep apnea, hypertension, and dyslipidemia. Thus, bariatric surgery reduces cardiovascular risk burden, and overall mortality risk. Early complications (< 30 days) after bariatric surgery were reported to be < 10% and tend to be lower in restrictive surgeries compared with hybrid surgeries. Most common early complications reported are gastric and anastomosis leak (1.6%-5.1%), bleeding (0.5%-3.5%), and pulmonary embolism (0.2%-1%). Long-term complications (> 30 days) might differ depending on the type of bariatric surgery. According to the type of surgery and the type of study, the 30-day operative mortality rates differ from 0.1% to 1.2%. Studies on postoperative outcomes, investigations on weight loss physiology, and mechanism of action after bariatric surgery provide a better understanding of the bariatric surgery metabolic benefits. In this article, we present an overview of bariatric procedures with their effects, including risks and benefits, on the severely obese patients' health. It provides evidence to support surgical treatment of severe obesity to achieve cardiovascular disease risk reduction in severely obese patients.
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Affiliation(s)
- Marie-Ève Piché
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Audrey Auclair
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada; Faculty of Pharmacy, Laval University, Québec, Québec, Canada
| | - Jany Harvey
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada; Faculty of Pharmacy, Laval University, Québec, Québec, Canada
| | - Simon Marceau
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Paul Poirier
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada; Faculty of Pharmacy, Laval University, Québec, Québec, Canada.
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Mohanan S, Tapp H, McWilliams A, Dulin M. Obesity and asthma: pathophysiology and implications for diagnosis and management in primary care. Exp Biol Med (Maywood) 2014; 239:1531-40. [PMID: 24719380 PMCID: PMC4230977 DOI: 10.1177/1535370214525302] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The effects of obesity on asthma diagnosis, control, and exacerbation severity are increasingly recognized; however, the underlying pathophysiology of this association is poorly understood. Mainstream clinical practice has yet to adopt aggressive management of obesity as a modifiable risk factor in asthma care, as is the case with a risk factor like tobacco or allergen exposure. This review summarizes existing data that support the pathophysiologic mechanisms underlying the association between obesity and asthma, as well as the current and future state of treatment for the obese patient with asthma. Our review suggests that evidence of chronic inflammatory response linking obesity and asthma indicates a need to address obesity during asthma management, possibly using patient-centered approaches such as shared decision making. There is a need for research to better understand the mechanisms of asthma in the obese patient and to develop new therapies specifically targeted to this unique patient population.
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Affiliation(s)
- Sveta Mohanan
- Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC 28207, USA
| | - Hazel Tapp
- Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC 28207, USA
| | - Andrew McWilliams
- Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC 28207, USA
| | - Michael Dulin
- Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC 28207, USA
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Abstract
Obesity and asthma have increasingly been linked with an increased risk of developing asthma associated with increasing body mass index. Overweight/obese patients with asthma have more symptoms, poor asthma control, and decreased response to conventional asthma therapies. Weight loss may be associated with improvements in asthma control, response to medications, and overall asthma-related quality of life. This article discusses the effect of weight loss via dietary modifications and surgical interventions on asthma symptoms and control. Weight loss should be encouraged as a means of improving asthma control but there are insufficient data to recommend surgical interventions solely for this purpose.
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Expert Panel Report: Guidelines (2013) for the management of overweight and obesity in adults. Obesity (Silver Spring) 2014; 22 Suppl 2:S41-410. [PMID: 24227637 DOI: 10.1002/oby.20660] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Bruno A, Pace E, Cibella F, Chanez P. Body mass index and comorbidities in adult severe asthmatics. BIOMED RESEARCH INTERNATIONAL 2014; 2014:607192. [PMID: 24987694 PMCID: PMC4058470 DOI: 10.1155/2014/607192] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/05/2014] [Accepted: 05/14/2014] [Indexed: 02/07/2023]
Abstract
Both severe asthma and obesity are growing health problems. Severe asthma leads to a poor quality of life. The relationship among BMI, comorbidities, and severe asthma control in adults is still unclear. The aim of the study is to better understand the effect of the comorbidities as atopy, type II diabetes, OSAS, gastroesophageal reflux, hypertension, cardiovascular diseases, osteoporosis, infections, and psychological factors with BMI on asthma control in a cohort of adult severe asthmatics. One hundred and two patients were enrolled in a cross-sectional study assessing asthma control, treatments, pulmonary function, inflammatory markers, and comorbidities. Patients were divided into 3 classes according to BMI: normal weight, overweight, and obese. We found that the optimal state of asthma control is lower. whereas the score of Asthma Control Questionnaire, the number of asthma exacerbations during last year, the oral corticosteroids requirement during the previous year, and the LABA treatments are higher in obese than in overweight and normal weight severe asthmatics. The number of subjects with type II diabetes and OSAS are higher among obese and overweight patients than in normal weight asthmatics. In conclusion, BMI represents per se a factor for the deterioration in disease control in severe asthma.
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Affiliation(s)
- Andreina Bruno
- Istituto di Biomedicina e Immunologia Molecolare (IBIM), Consiglio Nazionale delle Ricerche (CNR), Via Ugo La Malfa 153, 90146 Palermo, Italy
| | - Elisabetta Pace
- Istituto di Biomedicina e Immunologia Molecolare (IBIM), Consiglio Nazionale delle Ricerche (CNR), Via Ugo La Malfa 153, 90146 Palermo, Italy
| | - Fabio Cibella
- Istituto di Biomedicina e Immunologia Molecolare (IBIM), Consiglio Nazionale delle Ricerche (CNR), Via Ugo La Malfa 153, 90146 Palermo, Italy
| | - Pascal Chanez
- Département de Pneumoallergology, AP-HM, Laboratoire d'Immunologie, Inserm CNRS U 1067, UMR7333, Aix Marseille Université, 13009 Marseille, France
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Fusco M, James S, Cornell C, Okerson T. Weight loss through adjustable gastric banding and improvement in daytime sleepiness: 2 year interim results of APEX study. Curr Med Res Opin 2014; 30:849-55. [PMID: 24328387 DOI: 10.1185/03007995.2013.874991] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Obesity is one factor associated with an increased risk of obstructive sleep apnea (OSA). This study reports the investigator-reported resolution or improvement of OSA and improvements in sleep-related quality of life (QOL) 2 years after surgical placement of the LAP-BAND AP * (LBAP) system. RESEARCH DESIGN AND METHODS The LBAP Experience (APEX) study is an ongoing 5 year, prospective, observational study assessing change in weight, comorbidities, and QOL after LBAP implantation. This is an interim analysis of patients with evaluable data at 24 months who had OSA at baseline. CLINICAL TRIAL REGISTRATION NCT00501085. RESULTS At baseline, 117 of 395 patients (29.6%; mean body mass index [BMI], 45.0 kg/m2) reported OSA; of these, 57 had evaluable patient-reported outcome data at 2 years. Investigator-reported resolution or improvement of OSA was 69% and 86% at post-operative years 1 and 2, respectively. Patients reporting resolution, improvement, or no change in OSA experienced mean changes in BMI and percentage of weight loss of -9.7 kg/m(2)/-21.7%, -8.3 kg/m(2)/-18.7%, and -5.7 kg/m(2)/-13.2%, respectively (n = 54). Mean 2 year BMI was not statistically different between the groups (p = not significant). Mean scores for all Epworth Sleepiness Scale responses for the OSA population improved by -0.43 from baseline (p < 0.0001; n = 78) compared with -0.29 for patients without OSA at baseline (n = 177; p = 0.037 between groups). In addition, the overall study population experienced resolution and/or improvement in other obesity-related comorbidities, such as type 2 diabetes (96%) and hypertension (91%). CONCLUSIONS These data support that surgically facilitated weight loss can improve sleep-related QOL and may result in resolution or improvement of OSA; the degree of weight loss may be related to these changes.
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Affiliation(s)
- Mark Fusco
- Health First Medical Group , Melbourne, FL , USA
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31
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Vanhecke TE, Franklin BA, Ajluni SC, Sangal RB, McCullough PA. Cardiorespiratory fitness and sleep-related breathing disorders. Expert Rev Cardiovasc Ther 2014; 6:745-58. [DOI: 10.1586/14779072.6.5.745] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sarkhosh K, Switzer NJ, El-Hadi M, Birch DW, Shi X, Karmali S. The impact of bariatric surgery on obstructive sleep apnea: a systematic review. Obes Surg 2013; 23:414-23. [PMID: 23299507 DOI: 10.1007/s11695-012-0862-2] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
There is a strong relationship between obesity and the development of obstructive sleep apnea (OSA). Respectively, bariatric surgery is often touted as the most effective option for treating obesity and its comorbidities, including OSA. Nevertheless, there remains paucity of data in the literature of the comparison of all the specific types of bariatric surgery themselves. In an effort to answer this question, a systematic review was performed, to determine, of the available bariatric procedures [Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, or biliopancreatic diversion (BPD)], which procedures were the most efficacious in the treatment of OSA. A total of 69 studies with 13,900 patients were included. All the procedures achieved profound effects on OSA, as over 75 % of patients saw at least an improvement in their sleep apnea. BPD was the most successful procedure in improving or resolving OSA, with laparoscopic adjustable gastric banding being the least. In conclusion, bariatric surgery is a definitive treatment for obstructive sleep apnea, regardless of the specific type.
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Affiliation(s)
- Kourosh Sarkhosh
- Center for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, 10240 Kingsway, Edmonton, AB, T5H 3V9, Canada
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Obesity and asthma: physiological perspective. J Allergy (Cairo) 2013; 2013:198068. [PMID: 23970905 PMCID: PMC3732624 DOI: 10.1155/2013/198068] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 05/27/2013] [Accepted: 07/03/2013] [Indexed: 12/19/2022] Open
Abstract
Obesity induces some pertinent physiological changes which are conducive to either development of asthma or cause of poorly controlled asthma state. Obesity related mechanical stress forces induced by abdominal and thoracic fat generate stiffening of the lungs and diaphragmatic movements to result in reduction of resting lung volumes such as functional residual capacity (FRC). Reduced FRC is primarily an outcome of decreased expiratory reserve volume, which pushes the tidal breathing more towards smaller high resistance airways, and consequentially results in expiratory flow limitation during normal breathing in obesity. Reduced FRC also induces plastic alteration in the small collapsible airways, which may generate smooth muscle contraction resulting in increased small airway resistance, which, however, is not picked up by spirometric lung volumes. There is also a possibility that chronically reduced FRC may generate permanent adaptation in the very small airways; therefore, the airway calibres may not change despite weight reduction. Obesity may also induce bronchodilator reversibility and diurnal lung functional variability. Obesity is also associated with airway hyperresponsiveness; however, the mechanism of this is not clear. Thus, obesity has effects on lung function that can generate respiratory distress similar to asthma and may also exaggerate the effects of preexisting asthma.
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The asthma phenotype in the obese: distinct or otherwise? J Allergy (Cairo) 2013; 2013:602908. [PMID: 23878548 PMCID: PMC3708411 DOI: 10.1155/2013/602908] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 05/09/2013] [Indexed: 11/17/2022] Open
Abstract
Asthma is a heterogenous disorder that can be classified into several different phenotypes. Recent cluster analyses have identified an “obese-asthma” phenotype which is characterized by late onset, female predominance and lack of atopy. In addition, obesity among early-onset asthmatics clearly exists and heightens the clinical presentation. Observational studies have demonstrated that asthma among the obese has a clinical presentation that is more severe, harder to control, and is not as responsive to standard controller therapies. While weight loss studies have demonstrated improvement in asthma outcomes, further studies need to be performed. The current knowledge of the existence of two obesity-asthma phenotypes (early- versus late-onset asthma) should encourage investigators to study these entities separately since just as they have distinct presentations, their course, response to therapies, and weight loss strategies may be different as well.
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Ali Z, Ulrik CS. Obesity and asthma: a coincidence or a causal relationship? A systematic review. Respir Med 2013; 107:1287-300. [PMID: 23642708 DOI: 10.1016/j.rmed.2013.03.019] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 02/19/2013] [Accepted: 03/26/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Epidemiological data has established increasing adiposity as a risk factor for incident asthma. However, the mechanisms underlying the association between obesity and asthma are incompletely understood. In the present paper, we review current knowledge of possible mechanisms mediating the observed association between obesity and asthma. METHODS Systematic literature review. RESULTS Obesity and asthma share some etiological factors, such as a common genetic predisposition and effects of in utero conditions, and may also have common predisposing factors such as physical activity and diet. Obesity results in important changes in the mechanical properties of the respiratory system which could explain the occurrence of asthma. However, there are also plausible biological mechanisms whereby obesity could be expected to either cause or worsen asthma. These include co-morbidities such as gastro-oesophageal reflux, complications from sleep-disordered breathing, breathing at low lung volumes, chronic systemic inflammation, and endocrine factors, including adipokines and reproductive hormones. Obesity related asthma is in general not associated with eosinophilic airway inflammation, and adipokines are likely to play important roles in the inflammatory pathogenesis of asthma in obese individuals. CONCLUSION The association between obesity and asthma is not straightforward, and further knowledge is clearly needed, as understanding the underlying mechanisms may lead to new therapeutic options for this high-risk part of the asthma population.
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Affiliation(s)
- Zarqa Ali
- Department of Pulmonary Medicine, Hvidovre Hospital and University of Copenhagen, Denmark
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Velsor-Friedrich B, Militello LK, Kouba J, Harrison PR, Manion A, Doumit R. Pediatric obesity and asthma quality of life. Nurs Clin North Am 2013; 48:259-70. [PMID: 23659812 DOI: 10.1016/j.cnur.2013.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Widely researched as separate entities, our understanding of the comorbid effects of childhood obesity and asthma on quality of life is limited. This article discusses the effects of childhood obesity and asthma on self-reported quality of life in low-income African American teens with asthma. When controlling for the influence of symptom frequency, asthma classification, asthma self-efficacy, and asthma self-care levels, body mass index remains a most important factor in determining self-reported quality of life among teens with asthma. Although overweight and obesity did not change the effectiveness of the asthma intervention program, obesity did affect participants quality of life scores.
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Rieger UM, Djedovic G, Bauer T, Pierer G. Approach to the lower body after massive weight loss: the Innsbruck experience with abdomino-torso and thigh-contouring after massive weight loss. Eur Surg 2013. [DOI: 10.1007/s10353-012-0171-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Asthma is one of the most common chronic illnesses in the world, affecting an estimated 300 million people. Globally, the prevalence of asthma has continued to spread as economic improvements in developing countries create a population trend toward urbanization and adoption of a western lifestyle. Research supports an association between obesity and asthma. Only by making weight management a priority in the treatment of asthma can the rising prevalence of both diseases be hindered and global health improved.
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Affiliation(s)
- Amy B Manion
- Northwestern Children's Practice, Chicago, IL, USA.
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Goktas Z, Moustaid-Moussa N, Shen CL, Boylan M, Mo H, Wang S. Effects of bariatric surgery on adipokine-induced inflammation and insulin resistance. Front Endocrinol (Lausanne) 2013; 4:69. [PMID: 23772224 PMCID: PMC3677351 DOI: 10.3389/fendo.2013.00069] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 05/23/2013] [Indexed: 12/31/2022] Open
Abstract
Over a third of the US population is obese and at high risk for developing type 2 diabetes, insulin resistance, and other metabolic disorders. Obesity is considered a chronic low-grade inflammatory condition that is primarily attributed to expansion and inflammation of adipose tissues. Indeed, adipocytes produce and secrete numerous proinflammatory and anti-inflammatory cytokines known as adipokines. When the balance of these adipokines is shifted toward higher production of proinflammatory factors, local inflammation within adipose tissues and subsequently systemic inflammation occur. These adipokines including leptin, visfatin, resistin, apelin, vaspin, and retinol binding protein-4 can regulate inflammatory responses and contribute to the pathogenesis of diabetes. These effects are mediated by key inflammatory signaling molecules including activated serine kinases such as c-Jun N-terminal kinase and serine kinases inhibitor κB kinase and insulin signaling molecules including insulin receptor substrates, protein kinase B (PKB, also known as Akt), and nuclear factor kappa B. Bariatric surgery can decrease body weight and improve insulin resistance in morbidly obese subjects. However, despite reports suggesting reduced inflammation and weight-independent effects of bariatric surgery on glucose metabolism, mechanisms behind such improvements are not yet well understood. This review article focuses on some of these novel adipokines and discusses their changes after bariatric surgery and their relationship to insulin resistance, fat mass, inflammation, and glucose homeostasis.
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Affiliation(s)
- Zeynep Goktas
- Nutritional Sciences Program, College of Human Science, Texas Tech University, Lubbock, TX, USA
| | - Naima Moustaid-Moussa
- Nutritional Sciences Program, College of Human Science, Texas Tech University, Lubbock, TX, USA
| | - Chwan-Li Shen
- Department of Pathology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Mallory Boylan
- Nutritional Sciences Program, College of Human Science, Texas Tech University, Lubbock, TX, USA
| | - Huanbiao Mo
- Department of Nutrition and Food Sciences, Texas Woman’s University, Denton, TX, USA
| | - Shu Wang
- Nutritional Sciences Program, College of Human Science, Texas Tech University, Lubbock, TX, USA
- *Correspondence: Shu Wang, Nutritional Science Program, College of Human Science, Texas Tech University, P.O. Box: 41240, Lubbock, TX 79409-1240, USA e-mail:
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Abstract
The world is facing an unprecedented epidemic of obesity. This epidemic has led to major changes in the epidemiology of common diseases such as asthma. Obesity is a major risk factor for new-onset asthma. This article will discuss the role of mechanical and metabolic factors, as well as obesity-related comorbidities, in both causing airway disease and also affecting response to therapy in obese asthmatics. Asthma in obese individuals probably includes a spectrum of disease with at least two distinct phenotypes: early-onset allergic disease complicated by obesity and late-onset disease developing in the setting of obesity. Both phenotypes are distinct from asthma in lean individuals. Treatment of asthma in obesity needs to consider altered response to controller therapy, and the fact that mechanical factors, metabolic inflammation and other comorbidities are probably contributing to airway disease. Future studies should focus on the development of therapies specifically tailored towards the treatment of asthma in obesity.
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Affiliation(s)
- Anne Dixon
- Pulmonary and Critical Care Medicine, Given D209, University of Vermont College of Medicine, 89 Beaumont Avenue, Burlington, VT 05405, USA.
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Cywes R, Bhoyrul S, Billy H, Ponce J, Okerson T, Oefelein MG. Interim results at 48 weeks of LAP-BAND AP experience (APEX) study: prospective, multicenter, open-label longitudinal patient observational study. Surg Obes Relat Dis 2012; 8:741-6. [DOI: 10.1016/j.soard.2011.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 08/18/2011] [Accepted: 09/07/2011] [Indexed: 02/05/2023]
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Metabolic changes one year after laparoscopic adjustable gastric banding operation in morbidly obese subjects. Wideochir Inne Tech Maloinwazyjne 2012; 8:13-21. [PMID: 23630549 PMCID: PMC3627148 DOI: 10.5114/wiitm.2011.30828] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 07/24/2012] [Accepted: 08/28/2012] [Indexed: 01/14/2023] Open
Abstract
Introduction Laparoscopic adjustable gastric banding (LAGB) is effective for weight reduction in severely obese patients. However, the data about its effect on metabolic syndrome (MS) are limited. Aim To assess weight loss and changes of metabolic parameters 1 year after LAGB in a prospective, nonrandomized single center cohort study in morbidly obese subjects. Material and methods Physical examination, body weight (BW) parameters and metabolic profile were assessed at baseline and 1 year after LAGB in morbidly obese subjects. The incidence of MS was evaluated according to National Cholesterol Education Program Adult Treatment Panel III criteria. Results One year after the operation data from 90 patients out of 103 were available. Mean excess weight (EW) loss of 33.1% was associated with a significant improvement in all metabolic parameters: decrease of hypertension by 15.8%, hypertriglyceridemia by 42.6%, and hyperglycemia by 46.3%; and increase in high density lipoprotein cholesterol by 48.3%. This resulted in the resolution of MS in 44.2% of subjects. The significant change in the distribution of MS components was observed with the highest frequency of 4 components before and 2 components after surgery. Patients with MS at baseline lost 29.9% of EW compared to 44.3% in those without MS (p = 0.009). Conclusions The LAGB resulted in effective reduction of BW parameters in morbidly obese subjects 1 year after the operation. Along with the weight loss, resolution of MS and a significant shift towards decrease in the number of MS components was observed. Patients with MS were more resistant to the weight loss.
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Low VHS, Tan J, Lu J. Complications of laparoscopic adjustable gastric banding: our local experience. J Med Imaging Radiat Oncol 2012; 56:432-41. [PMID: 22883651 DOI: 10.1111/j.1754-9485.2012.02406.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Obesity is a major medical problem both within Australia as well as throughout the developed world. Achievement of weight loss for any individual patient brings an additional desirable benefit of improvement or resolution of a wide range of comorbid conditions. Bariatrics is the branch of medicine that deals with the causes, prevention and treatment of obesity and allied diseases. The term bariatrics was created around 1965, from the Greek root baro ('weight' as in barometer), suffix-iatr (relating to medical treatment) and suffix -ic ('pertaining to'). Besides the pharmacotherapy of obesity, it is concerned with obesity surgery. Bariatric surgery refers to surgical procedures of the gastrointestinal tract that are designed to induce weight loss. The treatment of obesity traditionally relied on non-surgical techniques to modify behaviour in regard to diet and exercise. This has variable and limited success. More recently, bariatric surgery has become the most rapidly growing form of treatment for obesity in recent years. In fact, it is the only current therapy that has been shown to achieve major and durable weight loss. It is important for the radiologist to be familiar with the normal anatomical appearance of the more common bariatric operations and to be able to recognise their potential complications on imaging. The aim of this pictorial essay is to give an insight into some of the more common complications of laparoscopic adjustable gastric banding surgery encountered in our centre during the period of 2001-2007.
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Juel CTB, Ali Z, Nilas L, Ulrik CS. Asthma and obesity: does weight loss improve asthma control? a systematic review. J Asthma Allergy 2012; 5:21-6. [PMID: 22791994 PMCID: PMC3392696 DOI: 10.2147/jaa.s32232] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Aim and methods Obesity is a major health problem, and obesity is associated with a high incidence of asthma and poor asthma control. The aim of the present paper is to systematically review the current knowledge of the effect on overall asthma control of weight reduction in overweight and obese adults with asthma. Results Weight loss in obese individuals with doctor-diagnosed asthma is associated with a 48%–100% remission of asthma symptoms and use of asthma medication. Published studies, furthermore, reveal that weight loss in obese asthmatics improves asthma control, and that especially surgically induced weight loss results in significant improvements in asthma severity, use of asthma medication, dyspnoea, exercise tolerance, and acute exacerbations, including hospitalizations due to asthma. Furthermore, weight loss in obese asthmatics is associated with improvements in level of lung function and airway responsiveness to inhaled methacholine, whereas no significant improvements have been observed in exhaled nitric oxide or other markers of eosinophilic airway inflammation. Conclusion Overweight and obese adults with asthma experience a high symptomatic remission rate and significant improvements in asthma control, including objective measures of disease activity, after weight loss. Although these positive effects of weight loss on asthma-related health outcomes seem not to be accompanied by remission or improvements in markers of eosinophilic airway inflammation, it has potentially important implications for the future burden of asthma.
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Affiliation(s)
- Caroline Trunk-Black Juel
- Respiratory Section, Internal Medicine Unit, Hvidovre Hospital and University of Copenhagen, Hvidovre, Denmark
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Prospective, multicenter, 3-year trial of laparoscopic adjustable gastric banding with the MIDBAND™. Obes Surg 2012; 22:572-81. [PMID: 21870049 DOI: 10.1007/s11695-011-0508-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although laparoscopic adjustable gastric banding (LAGB) is a popular metabolic/bariatric procedure, few prospective studies have assessed its outcomes. This study aimed to prospectively assess LAGB safety and effectiveness outcomes using the MIDBAND™ (MID, Dardilly, France). METHODS Between May 2005 and September 2006, 262 morbidly obese patients underwent primary gastric banding with pars flaccida technique in 13 French medical centers. Excess weight loss and change in body mass index (BMI, kilogram per square meter), percentage of patients with comorbidities, and obesity-related complications were recorded. Patients were followed at 6-month intervals for 3 years. A multivariable individual growth model was used to analyze weight change over time and determine potential predictors of weight loss. RESULTS The majority of patients were female (n = 233, 89%), with mean age of 36.4 ± 9.7 years. At 3 years, LAGB with MIDBAND resulted in significant decrease in mean BMI from 41.8 ± 4.2 to 30.7 ± 5.8 (p < 0.0001). Median excess weight loss and excess BMI loss were 61% and 68%, respectively. The prevalence of obesity-related comorbidities had significantly decreased from 71% to 15% (p < 0.0001). Complications were observed in 26 patients (10%); device-related complications occurred in 20 patients (8.2%), requiring band removal in 8 (3.3%), and port revision in 8 (3.3%). Individual growth analysis identified significant predictors of weight loss including the number of follow-up visits. CONCLUSION Prospective outcomes demonstrate the safety and efficacy of gastric banding over time using the MIDBAND. Individual growth modeling demonstrated that postoperative weight loss is strongly related to the frequency and consistency of follow-up visits.
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100 obese patients after laparoscopic adjustable gastric banding - the influence on BMI, gherlin and insulin concentration, parameters of lipid balance and co-morbidities. Adv Med Sci 2012; 57:58-64. [PMID: 22440938 DOI: 10.2478/v10039-012-0008-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Obesity is a widespread health issue caused by chronic impaired balance between energy supply and its expenditure. It leads to gathering of excessive fat tissue and numerous co-morbidities.The aim of this study is to present the influence of laparoscopic adjustable gastric banding (LAGB) on plasma ghrelin, insulin, glucose, triglycerides, total, HDL- and LDL-cholesterol concentration as well as on alanine and aspartate aminotransferase in obese patients and influence on co-morbidities such as type 2 diabetes mellitus, dislipidemy, hypertension and sleep apnea. MATERIALS AND METHODS 100 obese patients underwent LAGB: 34 men - average age 39.18 ± 12.17 years old and 66 women - average age 37.0 ± 12.6 years old. During 6 months follow-up, particular measurements have been conducted in different time points. Evaluation of body mass loss (%EWL, %EBL) and the homeostatic model assessment insulin resistance (HOMA IR) was conducted. In the same time ghrelin, insulin, glucose, triglycerides, total cholesterol, HDL- and LDL-cholesterol concentration was determined after 7 days, 1, 3 and 6 months after the surgery. RESULTS Significant decrease in BMI and HOMA IR was observed as well as in insulin and glucose concentration. Increase in ghrelin concentration in comparison to preoperative values was also stated. CONCLUSIONS LAGB leads to significant body mass loss, improvement in patients' general health state and to normalization of metabolic parameters. Improvement or total resolution of type 2 diabetes (T2DM), hypertension and sleep apnea was also noticed.
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Lang JE. Obesity, Nutrition, and Asthma in Children. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2012; 25:64-75. [PMID: 22768385 DOI: 10.1089/ped.2011.0137] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 01/15/2012] [Indexed: 02/06/2023]
Abstract
Obesity rates have increased dramatically among children in many parts of the world, especially in North America and several other English-speaking countries. The impact of obesity on pediatric health has become a major prevention initiative by the Obama administration and several public health organizations. Children with obesity are at increased risk for developing asthma, which is already one of the most common chronic diseases among children. The cause underlying obesity's impact on asthma risk is unknown. Commonly cited potential etiologies include airway smooth muscle dysfunction from thoracic restriction, obesity-related circulating inflammation priming the lung, and obesity-related comorbidities mediating asthma symptom development. Each of these theories does not fit precisely with all of the data that have accumulated over the last decade. In this review, I will explore other possible causes including: (1) dietary characteristics common in Westernized countries that might lead to both obesity and asthma; (2) reductions in physical activity; and (3) genetic alterations that increase the propensity to both obesity and asthma together. Next, I will review the current data on how obesity affects common characteristics of asthma such as airway inflammation, lung function, risk of exacerbation, atopy, and response to treatment. Obesity in children with asthma appears to be associated with greater airflow obstruction and a mildly diminished response to inhaled corticosteroids. Little objective evidence in children suggests that obesity significantly heightens the risk of exacerbation or worsens disease stability in children. Lastly, I will discuss the current literature that suggests that obese children with asthma generally should receive the same guidelines-based management as lean children. However, interventions that encourage daily physical activity, weight-loss, normalization of nutrient levels, and monitoring of common obesity-related sequelae should be considered by healthcare providers managing obese children with difficult-to-control asthma.
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Asthma and Association With Obesity and Weight Loss. TOP CLIN NUTR 2012. [DOI: 10.1097/tin.0b013e3182542459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Comprehensive Nutrition and Lifestyle Education Improves Weight Loss and Physical Activity in Hispanic Americans Following Gastric Bypass Surgery: A Randomized Controlled Trial. J Acad Nutr Diet 2012; 112:382-90. [DOI: 10.1016/j.jada.2011.10.023] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 10/27/2011] [Indexed: 12/31/2022]
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