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Zhang X, Zhang L, Liu Y, Liu L, Wang J, Wang C, Zhang S, Cheng G, Wang L. Predictive Roles of Basal Metabolic Rate and Muscle Mass in Lung Function among Patients with Obese Asthma: A Prospective Cohort Study. Nutrients 2024; 16:1809. [PMID: 38931162 PMCID: PMC11206345 DOI: 10.3390/nu16121809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND The metabolic-status-related mechanisms underlying the deterioration of the lung function in obese asthma have not been completely elucidated. OBJECTIVE This study aimed to investigate the basal metabolic rate (BMR) in patients with obese asthma, its association with the lung function, and its mediating role in the impact of obesity on the lung function. METHODS A 12-month prospective cohort study (n = 598) was conducted in a real-world setting, comparing clinical, body composition, BMR, and lung function data between patients with obese (n = 282) and non-obese (n = 316) asthma. Path model mediation analyses for the BMR and skeletal muscle mass (SMM) were conducted. We also explored the effects of the BMR on the long-term lung function in patients with asthma. RESULTS Patients with obese asthma exhibited greater airway obstruction, with lower FEV1 (1.99 vs. 2.29 L), FVC (3.02 vs. 3.33 L), and FEV1/FVC (65.5 vs. 68.2%) values compared to patients with non-obese asthma. The patients with obese asthma also had higher BMRs (1284.27 vs. 1210.08 kcal/d) and SMM (23.53 vs. 22.10 kg). Both the BMR and SMM mediated the relationship between obesity and the lung function spirometers (FEV1, %FEV1, FVC, %FVC, and FEV1/FVC). A higher BMR or SMM was associated with better long-term lung function. CONCLUSIONS Our study highlights the significance of the BMR and SMM in mediating the relationship between obesity and spirometry in patients with asthma, and in determining the long-term lung function. Interventions for obese asthma should focus not only on reducing adiposity but also on maintaining a high BMR.
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Affiliation(s)
- Xin Zhang
- Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; (X.Z.)
| | - Li Zhang
- Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; (X.Z.)
| | - Ying Liu
- Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; (X.Z.)
| | - Lei Liu
- Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; (X.Z.)
| | - Ji Wang
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Changyong Wang
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Shuwen Zhang
- Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; (X.Z.)
| | - Gaiping Cheng
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lei Wang
- Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; (X.Z.)
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Perdijk O, Azzoni R, Marsland BJ. The microbiome: an integral player in immune homeostasis and inflammation in the respiratory tract. Physiol Rev 2024; 104:835-879. [PMID: 38059886 DOI: 10.1152/physrev.00020.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/07/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023] Open
Abstract
The last decade of microbiome research has highlighted its fundamental role in systemic immune and metabolic homeostasis. The microbiome plays a prominent role during gestation and into early life, when maternal lifestyle factors shape immune development of the newborn. Breast milk further shapes gut colonization, supporting the development of tolerance to commensal bacteria and harmless antigens while preventing outgrowth of pathogens. Environmental microbial and lifestyle factors that disrupt this process can dysregulate immune homeostasis, predisposing infants to atopic disease and childhood asthma. In health, the low-biomass lung microbiome, together with inhaled environmental microbial constituents, establishes the immunological set point that is necessary to maintain pulmonary immune defense. However, in disease perturbations to immunological and physiological processes allow the upper respiratory tract to act as a reservoir of pathogenic bacteria, which can colonize the diseased lung and cause severe inflammation. Studying these host-microbe interactions in respiratory diseases holds great promise to stratify patients for suitable treatment regimens and biomarker discovery to predict disease progression. Preclinical studies show that commensal gut microbes are in a constant flux of cell division and death, releasing microbial constituents, metabolic by-products, and vesicles that shape the immune system and can protect against respiratory diseases. The next major advances may come from testing and utilizing these microbial factors for clinical benefit and exploiting the predictive power of the microbiome by employing multiomics analysis approaches.
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Affiliation(s)
- Olaf Perdijk
- Department of Immunology, School of Translational Science, Monash University, Melbourne, Victoria, Australia
| | - Rossana Azzoni
- Department of Immunology, School of Translational Science, Monash University, Melbourne, Victoria, Australia
| | - Benjamin J Marsland
- Department of Immunology, School of Translational Science, Monash University, Melbourne, Victoria, Australia
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Amegbletor DY, Goldberg D, Pope DA, Heckman BW. Food and Nutrition Security as Social Determinants of Health: Fostering Collective Impact to Build Equity. Prim Care 2023; 50:633-644. [PMID: 37866836 DOI: 10.1016/j.pop.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
An overview of the state of the American diet, how it relates to public health outcomes and the obesity epidemic, and how it arises from the policy and infrastructure that have been developed over the course of the 20th and 21st centuries. The article concludes by laying out concrete solutions for urban revitalization, providing people in underserved communities sovereignty over their food supply, and work with multi-stakeholder cooperatives to overcome the effects of food insecurity and poor diet quality.
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Affiliation(s)
- Duncan Y Amegbletor
- Department of Psychiatry & Behavioral Sciences, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Boulevard, Nashville, TN 37208, USA
| | - Danny Goldberg
- Grow2Learn Cooperative, 445 Kemper Drive, North, Madison, TN 37115, USA
| | - Derek A Pope
- Department of Psychiatry & Behavioral Sciences, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Boulevard, Nashville, TN 37208, USA
| | - Bryan W Heckman
- Department of Psychiatry & Behavioral Sciences, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Boulevard, Nashville, TN 37208, USA; Division of Public Health, School of Graduate Studies and Research, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Boulevard, Nashville, TN 37208, USA.
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Chan R, Lipworth B. Clinical impact of obesity on oscillometry lung mechanics in adults with asthma. Ann Allergy Asthma Immunol 2023; 131:338-342.e3. [PMID: 37209835 DOI: 10.1016/j.anai.2023.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/02/2023] [Accepted: 05/10/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND In the year 2035, projections have estimated that 5% of the Scottish population will be morbidly obese defined as a body mass index (BMI) greater than or equal to 40 kg/m2. Airway oscillometry is an effort-independent test akin to bronchial sonar which measures resistance and compliance. OBJECTIVE To evaluate the impact of obesity on lung mechanics using oscillometry. METHODS Clinical data for 188 patients with respiratory physician-diagnosed moderate-to-severe asthma were retrospectively collected and analyzed. RESULTS Obesity (BMI 30-39.9 kg/m2) and morbid obesity (BMI ≥ 40 kg/m2) were associated with a significantly worse heterogeneity of peripheral resistance between 5 Hz and 20 Hz and peripheral compliance as low-frequency reactance at 5 Hz and area under the reactance curve, as compared with normal weight (BMI 18.5-24.9 kg/m2). Cluster analysis incorporating oscillometry identified a patient cohort who was older, obese, and female with combined impairment of spirometry and oscillometry coupled with more frequent severe exacerbations. CONCLUSION Obesity is associated with worse peripheral airway dysfunction in moderate-to-severe asthma, including a patient cluster who was older, obese, and female with more frequent exacerbations.
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Affiliation(s)
- Rory Chan
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, United Kingdom.
| | - Brian Lipworth
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, United Kingdom
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Yang W, Yang Y, Guo Y, Guo J, Ma M, Han B. Obesity and risk for respiratory diseases: a Mendelian randomization study. Front Endocrinol (Lausanne) 2023; 14:1197730. [PMID: 37711902 PMCID: PMC10497775 DOI: 10.3389/fendo.2023.1197730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/31/2023] [Indexed: 09/16/2023] Open
Abstract
Background No existing comprehensive Mendelian randomization studies have focused on how obesity affects respiratory diseases. Methods BMI and waist circumference, mainly from the UK Biobank, and 35 respiratory diseases from the FinnGen Biobank were subjected to Mendelian randomization analyses. In this study, the inverse variance weighting method was used as the predominant analysis method and was complemented by MR-Egger and weighted median methods. Horizontal pleiotropy and potential outliers were detected by employing the MR-PRESSO method. Results This study indicated that obesity rises the possibility of acute upper respiratory infections (BMI: OR=1.131, p<0.0001; WC: OR=1.097, p=0.00406), acute sinusitis (BMI: OR=1.161, p=0.000262; WC: OR=1.209, p=0.000263), acute pharyngitis (WC: OR=1.238, p=0.0258), acute laryngitis and tracheitis (BMI: OR=1.202, p=0.0288; WC: OR=1.381, p=0.00192), all influenza (BMI: OR=1.243, p=0.000235; WC: OR=1.206, p=0.0119), viral pneumonia (WC: OR=1.446, p=0.000870), all pneumoniae (BMI: OR=1.174, p <0.0001; WC: OR=1.272, p <0.0001), bacterial pneumoniae (BMI: OR=1.183, p=0.000290; WC: OR=1.274, p<0.0001), acute bronchitis (BMI: OR=1.252, p <0.0001; WC: OR=1.237, p=0.000268), acute unspecified lower respiratory infection (BMI: OR=1.303, p=0.000403), chronic tonsils and adenoids diseases (BMI: OR=1.236, p <0.0001; WC: OR=1.178, p=0.000157), chronic laryngotracheitis and laryngitis (WC: OR=1.300, p=0.00785), COPD (BMI: OR=1.429, p <0.0001; WC: OR=1.591, p <0.0001), asthma (BMI: OR=1.358, p <0.0001; WC: OR=1.515, p <0.0001), necrotic and suppurative conditions of lower respiratory tract (WC: OR=1.405, p=0.0427), pleural effusion (BMI: OR=1.277, p=0.00225; WC: OR=1.561, p<0.0001), pleural plaque (BMI: OR=1.245, p=0.0312), other diseases of the respiratory system (BMI: OR=1.448, p <0.0001; WC: OR=1.590, p <0.0001), and non-small cell lung cancer (BMI: OR=1.262, p=0.00576; WC: OR=1.398, p=0.00181). This study also indicated that obesity decreases the possibility of bronchiectasis (BMI: OR=0.705; p=0.00200). Conclusion This study revealed that obesity increases the risk of the majority of respiratory diseases (including 20 of all 35 respiratory diseases) and that obesity decreases the risk of bronchiectasis.
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Affiliation(s)
- Wenwen Yang
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Yanjiang Yang
- The people’s Hospital of Qiandongnan Autonomous Prefecture, Kaili, Guizhou, China
| | - Yan Guo
- Dingxi City People’s Hospital, Dingxi, Gansu, China
| | - Jinde Guo
- Acupuncture and Massage, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Minjie Ma
- Department of Thoracic Surgery, the First Hospital of Lanzhou University, Lanzhou, Gansu, China
- Gansu Province International Cooperation Base for Research and Application of Key Technology of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Biao Han
- Department of Thoracic Surgery, the First Hospital of Lanzhou University, Lanzhou, Gansu, China
- Gansu Province International Cooperation Base for Research and Application of Key Technology of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
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Imperatore F, Gritti F, Esposito R, del Giudice C, Cafora C, Pennacchio F, Maglione F, Catauro A, Pace MC, Docimo L, Gambardella C. Non-Invasive Ventilation Reduces Postoperative Respiratory Failure in Patients Undergoing Bariatric Surgery: A Retrospective Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1457. [PMID: 37629747 PMCID: PMC10456476 DOI: 10.3390/medicina59081457] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Postoperative non-invasive ventilation (NIV) has been proposed as an attractive strategy to reduce morbidity in obese subjects undergoing general anaesthesia. The increased body mass index (BMI) correlates with loss of perioperative functional residual capacity, expiratory reserve volume, and total lung capacity. The aim of the current study is to evaluate the efficacy of NIV in a post-anaesthesia care unit (PACU) in reducing post-extubation acute respiratory failure (ARF) after biliointestinal bypass (BIBP) in obese patients. Materials and Methods: A retrospective analysis was conducted from January 2019 to December 2020 to compare acute respiratory failure within the first 72 postoperative hours and oximetry values of obese patients who underwent BIBP after postoperative NIV adoption or conventional Venturi mask. Results: In total, 50 patients who received NIV postoperative protocol and 57 patients who received conventional Venturi mask ventilation were included in the study. After 120 min in PACU pH, pCO2, pO2, and SpO2 were better in the NIV group vs. control group (p < 0.001). Seventy-two hours postoperatively, one patient (2%) in the NIV group vs. seven patients (12.2%) in the control group developed acute respiratory failure. Therefore, conventional Venturi mask ventilation resulted in being significantly associated (p < 0.05) with postoperative ARF with an RR of 0.51 (IC 0.27-0.96). Conclusions: After bariatric surgery, short-term NIV during PACU observation promotes a more rapid recovery of postoperative lung function and oxygenation in obese patients, reducing the necessity for critical care in the days following surgery. Therefore, as day-case surgery becomes more advocated even for morbid obesity, it might be considered a necessary procedure.
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Affiliation(s)
- Francesco Imperatore
- Unit of Anaesthesia and Intensive Care, “San Giovanni di Dio Hospital” Frattamaggiore, 80020 Naples, Italy
| | - Fabrizio Gritti
- Unit of Intensive Care, Department of Emergency, “A. Cardarelli Hospital”, 80131 Naples, Italy; (F.G.); (R.E.); (C.C.)
- Unit of Anaesthesia and Intensive Care, University of Campania “L. Vanvitelli”, 80131 Naples, Italy;
| | - Rossella Esposito
- Unit of Intensive Care, Department of Emergency, “A. Cardarelli Hospital”, 80131 Naples, Italy; (F.G.); (R.E.); (C.C.)
- Unit of Anaesthesia and Intensive Care, University of Campania “L. Vanvitelli”, 80131 Naples, Italy;
| | - Claudia del Giudice
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (C.d.G.); (F.P.); (F.M.); (A.C.); (L.D.)
| | - Chiara Cafora
- Unit of Intensive Care, Department of Emergency, “A. Cardarelli Hospital”, 80131 Naples, Italy; (F.G.); (R.E.); (C.C.)
- Unit of Anaesthesia and Intensive Care, University of Campania “L. Vanvitelli”, 80131 Naples, Italy;
| | - Francesco Pennacchio
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (C.d.G.); (F.P.); (F.M.); (A.C.); (L.D.)
| | - Francesco Maglione
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (C.d.G.); (F.P.); (F.M.); (A.C.); (L.D.)
| | - Antonio Catauro
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (C.d.G.); (F.P.); (F.M.); (A.C.); (L.D.)
| | - Maria Caterina Pace
- Unit of Anaesthesia and Intensive Care, University of Campania “L. Vanvitelli”, 80131 Naples, Italy;
| | - Ludovico Docimo
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (C.d.G.); (F.P.); (F.M.); (A.C.); (L.D.)
| | - Claudio Gambardella
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (C.d.G.); (F.P.); (F.M.); (A.C.); (L.D.)
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Qayyum NT, Wallace CH, Khayat RN, Grosberg A. A mathematical model to serve as a clinical tool for assessing obstructive sleep apnea severity. Front Physiol 2023; 14:1198132. [PMID: 37601632 PMCID: PMC10434550 DOI: 10.3389/fphys.2023.1198132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/10/2023] [Indexed: 08/22/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a sleep disorder caused by periodic airway obstructions and has been associated with numerous health consequences, which are thought to result from tissue hypoxia. However, challenges in the direct measurement of tissue-level oxygenation make it difficult to analyze the hypoxia exposure pattern in patients. Furthermore, current clinical practice relies on the apnea-hypopnea index (AHI) and pulse oximetry to assess OSA severity, both of which have limitations. To overcome this, we developed a clinically deployable mathematical model, which outputs tissue-level oxygenation. The model incorporates spatial pulmonary oxygen uptake, considers dissolved oxygen, and can use time-dependent patient inputs. It was applied to explore a series of breathing patterns that are clinically differentiated. Supporting previous studies, the result of this analysis indicated that the AHI is an unreliable indicator of hypoxia burden. As a proof of principle, polysomnography data from two patients was analyzed with this model. The model showed greater sensitivity to breathing in comparison with pulse oximetry and provided systemic venous oxygenation, which is absent from clinical measurements. In addition, the dissolved oxygen output was used to calculate hypoxia burden scores for each patient and compared to the clinical assessment, highlighting the importance of event length and cumulative impact of obstructions. Furthermore, an intra-patient statistical analysis was used to underscore the significance of closely occurring obstructive events and to highlight the utility of the model for quantitative data processing. Looking ahead, our model can be used with polysomnography data to predict hypoxic burden on the tissues and help guide patient treatment decisions.
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Affiliation(s)
- Nida T. Qayyum
- Department of Chemical and Biomolecular Engineering, University of California, Irvine, Irvine, CA, United States
- UCI Edwards Lifesciences Foundation Cardiovascular Innovation and Research Center (CIRC), University of California, Irvine, Irvine, CA, United States
| | - C. Hunter Wallace
- UCI Edwards Lifesciences Foundation Cardiovascular Innovation and Research Center (CIRC), University of California, Irvine, Irvine, CA, United States
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, United States
| | - Rami N. Khayat
- The UCI Sleep Disorders Center, University of California, Irvine, Irvine, CA, United States
| | - Anna Grosberg
- Department of Chemical and Biomolecular Engineering, University of California, Irvine, Irvine, CA, United States
- UCI Edwards Lifesciences Foundation Cardiovascular Innovation and Research Center (CIRC), University of California, Irvine, Irvine, CA, United States
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, United States
- Center for Complex Biological Systems, University of California, Irvine, Irvine, CA, United States
- NSF-Simons Center for Multiscale Cell Fate Research, University of California, Irvine, Irvine, CA, United States
- Sue and Bill Gross Stem Cell Research, University of California, Irvine, Irvine, CA, United States
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Starr S, Wysocki M, DeLeon JD, Silverstein G, Arcoleo K, Rastogi D, Feldman JM. Obesity-related pediatric asthma: relationships between pulmonary function and clinical outcomes. J Asthma 2023; 60:1418-1427. [PMID: 36420526 PMCID: PMC10191971 DOI: 10.1080/02770903.2022.2152351] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/20/2022] [Accepted: 11/23/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We hypothesized that children with obesity-related asthma would have worse self-reported asthma control, report an increased number of asthma symptoms and have lower FEV1/FVC associated with worse clinical asthma outcomes compared to children with asthma only. METHODS Cross sectional analyses examined two hundred and eighteen (obesity-related asthma = 109, asthma only = 109) children, ages 7-15 that were recruited from clinics and hospitals within the Bronx, NY. Pulmonary function was assessed by forced expiratory volume in the first second (percent predicted FEV1) and the ratio of FEV1 to the forced vital capacity of the lungs (FEV1/FVC). Structural equation modeling examined if pulmonary function was associated with asthma control and clinical outcomes between groups. RESULTS Lower percent predicted FEV1 was associated with increased hospitalizations (p = 0.03) and oral steroid bursts in the past 12 months (p = 0.03) in the obesity-related asthma group but not in the asthma only group. FEV1/FVC was also associated with increased hospitalizations (p = 0.02) and oral steroid bursts (p = 0.008) in the obesity-related asthma group but not the asthma only group. Lower FEV1/FVC was associated with the number of asthma symptoms endorsed in the asthma only group but not in the obesity-related asthma group. Percent predicted FEV1 and FEV1/FVC was not associated with asthma control in either group. CONCLUSIONS Pulmonary function was associated with oral steroid bursts and hospitalizations but not self-reported asthma control, suggesting the importance of incorporating measures of pulmonary function into the treatment of pediatric obesity-related asthma.
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Affiliation(s)
- Sheena Starr
- Ferkauf Graduate School of Psychology, Yeshiva University, Rousso Building, 1165 Morris Park Ave., Bronx NY, 10467
| | - Matthew Wysocki
- Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Department of Pediatrics, Division of Academic General Pediatrics, Department of Psychiatry & Behavioral Sciences, 3415 Bainbridge Ave, Bronx, NY 10467
| | - Jesenya D. DeLeon
- Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Department of Pediatrics, Division of Academic General Pediatrics, Department of Psychiatry & Behavioral Sciences, 3415 Bainbridge Ave, Bronx, NY 10467
| | - Gabriella Silverstein
- Ferkauf Graduate School of Psychology, Yeshiva University, Rousso Building, 1165 Morris Park Ave., Bronx NY, 10467
| | - Kimberly Arcoleo
- University of Rhode Island, College of Nursing, 350 Eddy Street, Providence, RI 02903
| | - Deepa Rastogi
- Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Department of Pediatrics, Division of Academic General Pediatrics, Department of Psychiatry & Behavioral Sciences, 3415 Bainbridge Ave, Bronx, NY 10467
| | - Jonathan M. Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, Rousso Building, 1165 Morris Park Ave., Bronx NY, 10467
- Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Department of Pediatrics, Division of Academic General Pediatrics, Department of Psychiatry & Behavioral Sciences, 3415 Bainbridge Ave, Bronx, NY 10467
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Shaphe MA. The effects of a structured physiotherapy program on pulmonary function and walking capacity in obese and non-obese adults undergoing cardiac surgery. ISOKINET EXERC SCI 2023. [DOI: 10.3233/ies-220077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
BACKGROUND: Obesity is thought to be a risk factor for cardiopulmonary diseases due to changed pulmonary mechanics. It also drastically lowers functional capability in both males and females. A routine physiotherapy program has been shown to be effective in the prevention and treatment of cardiopulmonary diseases. It also significantly increases functional capacity following coronary artery bypass grafting. However, the effect of a structured physiotherapy program in obese and non-obese patients has not been well explored. As such, the objective of this study is to determine the effect of a standardized physiotherapy program on pulmonary function and walking capacity in obese and non-obese patients undergoing coronary artery bypass grafting. METHODS: A prospective study was conducted on 50 obese (age 57.2 ± 6.3 Y) and non-obese (age 56.6 ± 5.7 Y) adults who were schedule for coronary artery bypass grafting. Their body mass index was used to separate them into two groups. Both groups followed a structured physiotherapy program from day 1 to day 7 post cardiac surgery. Both groups underwent spirometry test at baseline (preoperatively) and after day 4 and day 7 postoperatively as well as a six-minute walk test at baseline and on day 7 postoperatively. RESULTS: At baseline, obese individuals had significantly lower pulmonary and physical functioning. On postoperative day 4, both groups deteriorated, although the obese group deterioration was worse, in most of the pulmonary parameters. On postoperative day 7, both groups improved, though the non-obese group improved at a faster rate. In contrary, it was observed that the obese group improved more rapidly in terms of functional capacity. CONCLUSIONS: The study indicated that the outcomes of a structured physiotherapy program following coronary artery bypass grafting were different for persons who were obese compared to those who were not. Adipose tissue variations surrounding the rib cage, diaphragm, and visceral cavity may account for the observed rate of change between the two groups. Therefore, it is apparent that a new strategy for managing obese individuals who have undergone CABG is required.
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Hameed M, Geerling E, Pinto AK, Miraj I, Weger-Lucarelli J. Immune response to arbovirus infection in obesity. Front Immunol 2022; 13:968582. [PMID: 36466818 PMCID: PMC9716109 DOI: 10.3389/fimmu.2022.968582] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/04/2022] [Indexed: 12/26/2023] Open
Abstract
Obesity is a global health problem that affects 650 million people worldwide and leads to diverse changes in host immunity. Individuals with obesity experience an increase in the size and the number of adipocytes, which function as an endocrine organ and release various adipocytokines such as leptin and adiponectin that exert wide ranging effects on other cells. In individuals with obesity, macrophages account for up to 40% of adipose tissue (AT) cells, three times more than in adipose tissue (10%) of healthy weight individuals and secrete several cytokines and chemokines such as interleukin (IL)-1β, chemokine C-C ligand (CCL)-2, IL-6, CCL5, and tumor necrosis factor (TNF)-α, leading to the development of inflammation. Overall, obesity-derived cytokines strongly affect immune responses and make patients with obesity more prone to severe symptoms than patients with a healthy weight. Several epidemiological studies reported a strong association between obesity and severe arthropod-borne virus (arbovirus) infections such as dengue virus (DENV), chikungunya virus (CHIKV), West Nile virus (WNV), and Sindbis virus (SINV). Recently, experimental investigations found that DENV, WNV, CHIKV and Mayaro virus (MAYV) infections cause worsened disease outcomes in infected diet induced obese (DIO) mice groups compared to infected healthy-weight animals. The mechanisms leading to higher susceptibility to severe infections in individuals with obesity remain unknown, though a better understanding of the causes will help scientists and clinicians develop host directed therapies to treat severe disease. In this review article, we summarize the effects of obesity on the host immune response in the context of arboviral infections. We have outlined that obesity makes the host more susceptible to infectious agents, likely by disrupting the functions of innate and adaptive immune cells. We have also discussed the immune response of DIO mouse models against some important arboviruses such as CHIKV, MAYV, DENV, and WNV. We can speculate that obesity-induced disruption of innate and adaptive immune cell function in arboviral infections ultimately affects the course of arboviral disease. Therefore, further studies are needed to explore the cellular and molecular aspects of immunity that are compromised in obesity during arboviral infections or vaccination, which will be helpful in developing specific therapeutic/prophylactic interventions to prevent immunopathology and disease progression in individuals with obesity.
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Affiliation(s)
- Muddassar Hameed
- Department of Biomedical Sciences and Pathobiology, VA-MD Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, United States
| | - Elizabeth Geerling
- Department of Molecular Microbiology and Immunology, Saint Louis University, St. Louis, MO, United States
| | - Amelia K. Pinto
- Department of Molecular Microbiology and Immunology, Saint Louis University, St. Louis, MO, United States
| | - Iqra Miraj
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, China
| | - James Weger-Lucarelli
- Department of Biomedical Sciences and Pathobiology, VA-MD Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, United States
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A. J. D, S. M. P, M. L. R. A comparative study of FVC, FEV1, FEV1/FVC ratio before and after cycling in young obese and non-obese women. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i5.1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction and Aim: Obesity is becoming a worldwide problem and women were more likely to be obese than men in all regions of world. Obesity affects multiple systems of the body including respiratory system. This study aimed at comparing the respiratory functions before and after cycling in obese and non obese young women.
Materials and Methods: One hundred healthy female in the age groups of 18-25 years were considered. Fifty subjects were obese [BMI>25 kg/m2] and 50 were age matched non obese [BMI=18 to 22.9 kg/m2]. Anthropometric measurements weight, height, waist circumference, hip circumference were measured. BMI and waist hip ratio were calculated. Spirometric parameters like FVC (Functional Vital Capacity), FEV1 (Forced expiratory volume 1 second), FEV1/FVC ratio were assessed before cycling. Cycling (a graded submaximal exercise) was performed using YMCA cycling protocol. Spirometric parameters were assessed within 5 minutes from termination of cycling. Data collected were statistically analyzed using paired ‘t’ test.
Results: Before cycling and after cycling values of FVC, FEV1/FVC in obese young women were lower (p<0.0001) compared to non obese young women but their values were within normal range of % prediction. On comparing the FVC, FEV1, FEV1/FVC values from before to after cycling there was statistically significant reduction in both the groups. On comparison of reduction in spirometric values from before to after cycling, among obese and non obese young women, it was not statistically significant.
Conclusion: Both in before and after cycling the obese young women had reduced pulmonary function test compared to non obese young women but values within the normal percentage of prediction.
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12
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Liver Fibrosis Indices Predict the Severity of SARS-CoV-2 Infection. J Clin Med 2022; 11:jcm11185369. [PMID: 36143014 PMCID: PMC9500647 DOI: 10.3390/jcm11185369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/11/2022] [Accepted: 09/08/2022] [Indexed: 12/03/2022] Open
Abstract
Discovering novel risk and prognostic factors for COVID-19 may help not only in reducing severity and mortality but also in creating targeted therapies considering patients’ individual features. Liver fibrosis is considered a complication in Non-alcoholic Fatty Liver Disease (NAFLD), it is a feature of steatohepatitis (NASH), and it has already been related to an increased risk for a wide range of diseases. Here, we aimed to define if any parameter assessing metabolic status has predictive power in identifying inpatients at risk for poorer prognosis and an increased mortality from COVID-19. This retrospective study was conducted at the Sub-Intensive Medicine Care Unit of the Presidio Maxi-Emergenze Fiera del Levante, Azienda Ospedaliero-Universitaria Policlinico di Bari, Italy. We evaluated 271 inpatients with moderate-to-severe SARS-CoV-2-related respiratory failure by comparing biochemical features and non-invasive liver fibrosis scores among discharged, transferred to Intensive Care Units (ICU) and non-survivor patients. Moreover, by performing ROC curves, we defined cut-off values to predict mortality and disease severity for each score. We found that non-invasive scores of liver fibrosis, obtained at day of admission, such as AAR (p < 0.001), FIB-4 and mFIB-4, FORNS, and AARPRI (p < 0.05) strongly predict not only in-hospital mortality but also the length of hospitalization and eventual admission to ICU. FIB-4 was the best score to identify non-survivor patients (sensitivity of 80% and specificity of 63%) and predict the need for ICU or mortality (71% of sensitivity and 65% of specificity), with a cut-off value of 1.94. Therefore, we present the predictive power and the cut-off values of several liver fibrosis scores here for disease severity and mortality in SARS-CoV-2 in-patients and we proposed the use of the present scores to identify ab initio the clinical therapeutic and diagnostic protocols for high-risk patients.
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Giri Ravindran S, Saha D, Iqbal I, Jhaveri S, Avanthika C, Naagendran MS, Bethineedi LD, Santhosh T. The Obesity Paradox in Chronic Heart Disease and Chronic Obstructive Pulmonary Disease. Cureus 2022; 14:e25674. [PMID: 35812616 PMCID: PMC9259072 DOI: 10.7759/cureus.25674] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2022] [Indexed: 11/05/2022] Open
Abstract
Obesity in recent years has become an epidemic. A high body mass index (BMI) is one of today's most crucial population health indicators. BMI does not directly quantify body fat but correlates well with easier body fat measurements. Like smoking, obesity impacts multiple organ systems and is a major modifiable risk factor for countless diseases. Despite this, reports have emerged that obesity positively impacts the prognosis of patients with chronic illnesses such as chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD), a phenomenon known as the Obesity Paradox. This article attempts to explain and summarize this phenomenon. As it stands, two theories explain this paradox. The muscle mass hypothesis states that obese patients are better adapted to tide through acute exacerbations due to increased reserve because of greater muscle mass. The other theory focuses on brown adipose tissue and its anti-inflammatory effects on the body. We performed a literature review on research articles published in English from 1983 to the present in the following databases - PubMed, Elsevier, and Google Scholar. The following search strings and Medical Subject Headings (MeSH) terms were used: "Obesity," "Heart Failure," "COPD," and "Cardio-Respiratory Fitness." In this review, we looked at the obesity paradox in Heart Failure and COPD. We summarized the current literature on the Obesity Paradox and reviewed its relationship with Cardio-Respiratory Fitness.
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Fitch AK, Bays HE. Obesity definition, diagnosis, bias, standard operating procedures (SOPs), and telehealth: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. OBESITY PILLARS (ONLINE) 2022; 1:100004. [PMID: 37990702 PMCID: PMC10661988 DOI: 10.1016/j.obpill.2021.100004] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2023]
Abstract
Background The Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) regarding definition, diagnosis, bias, standard operating procedures (SOPs) and telehealth is intended to provide clinicians an overview of obesity medicine and provide basic organizational tools towards establishing, directing, managing, and maintaining an obesity medical practice. Methods This CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by Obesity Medicine Association leadership. Results OMA has defined obesity as: "A chronic, progressive, relapsing, and treatable multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences." While body mass index may be sufficiently diagnostic for populations and many patients, accurate diagnosis of adiposity in an individual may require anthropometric assessments beyond body weight alone (e.g., waist circumference, percent body fat, and android/visceral fat). Obesity complications can be categorized as "sick fat disease" (adiposopathy) and/or "fat mass disease." Obesity complications predominantly of fat mass origins include sleep apnea and orthopedic conditions. Obesity complications due to adiposopathic endocrinopathies and/or immunopathies include cardiovascular disease, cancer, elevated blood sugar, elevated blood pressure, dyslipidemia, fatty liver, and alterations in sex hormones in both males (i.e., hypogonadism) and females (i.e., polycystic ovary syndrome). Obesity treatment begins with proactive steps to avoid weight bias, including patient-appropriate language, office equipment, and supplies. To help manage obesity and its complications, this CPS provides a practical template for an obesity medicine practice, creation of standard operating procedures, and incorporation of the OMA "ADAPT" method in telehealth (Assessment, Diagnosis, Advice, Prognosis, and Treatment). Conclusions The OMA CPS regarding "Obesity Definition, Diagnosis, Bias, Standard Operating Procedures (SOPs), and Telehealth" is one in a series of OMA CPSs designed to assist clinicians care for patients with the disease of obesity.
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Affiliation(s)
- Angela K. Fitch
- Massachusetts General Hospital Weight Center, Harvard Medical School, 50 Staniford Street Suite 430, Boston, MA, 02114, USA
| | - Harold E. Bays
- Louisville Metabolic and Atherosclerosis Research Center, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville, KY, 40213, USA
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Gao D, Sun L, Wang N, Shi Y, Song J, Liu X, Yang Q, Su Z. Impact of 30° Reserve Trendelenburg Position on Lung Function in Morbidly Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy. Front Surg 2022; 9:792697. [PMID: 35284476 PMCID: PMC8907616 DOI: 10.3389/fsurg.2022.792697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background This study aimed to evaluate the impact of patients' positioning before and after intubation with mechanical ventilation, and after extubation on the lung function and blood oxygenation of patients with morbid obesity, who had a laparoscopic sleeve gastrectomy. Methods Patients with morbid obesity (BMI ≥ 30 kg/m2, ASA I – II grade) who underwent laparoscopic sleeve gastrectomy at our hospital from June 2018 to January 2019 were enrolled in this prospective study. Before intubation, after intubation with mechanical ventilation, and after extubation, arterial blood was collected for blood oxygenation and gas analysis after posturing the patients at supine position or 30° reverse Trendelenburg position (30°-RTP). Results A total of 15 patients with morbid obesity were enrolled in this self-compared study. Pulmonary shunt (Qs/Qt) after extubation was significantly lower at 30°-RTP (18.82 ± 3.60%) compared to that at supine position (17.13 ± 3.10%, p < 0.01). Patients' static lung compliance (Cstat), during mechanical ventilation, was significantly improved at 30°-RTP (36.8 ± 6.7) compared to that of those in a supine position (33.8 ± 7.3, p < 0.05). The PaO2 and oxygen index (OI) before and after intubation with mechanical ventilation were significantly higher at 30°-RTP compared to that at supine position, and in contrast, the PA−aO2 before and after intubation with mechanical ventilation was significantly reduced at 30°-RTP compared to that at supine position. Conclusion During and after laparoscopic sleeve gastrectomy, patients with morbid obesity had improved lung function, reduced pulmonary shunt, reduced PA−aO2 difference, and increased PaO2 and oxygen index at 30°-RTP compared to that supine position.
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Affiliation(s)
- Dengyu Gao
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Lu Sun
- Department of Anesthesiology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Ning Wang
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yubo Shi
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jianli Song
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xiaoying Liu
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qiyao Yang
- Education Centre, China Medical Tribun, Beijing, China
| | - Zhenbo Su
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Zhenbo Su
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Pulmonary Complications Are a Strong Independent Predictor of 30-Day Mortality Following Elective Bariatric Surgery. Obes Surg 2022; 32:696-703. [PMID: 35072915 DOI: 10.1007/s11695-021-05882-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Pulmonary complications in patients with obesity carry a high morbidity and mortality. An analysis of the MBSAQIP database was performed to determine the effect of post-operative pulmonary complications on patients undergoing elective bariatric surgery, with the primary outcome of 30-day mortality. METHODS We extracted data from the MBSAQIP database from 2015 to 2019 on patients who underwent elective Roux-en-Y gastric bypass or sleeve gastrectomy. Pulmonary complications were defined as prolonged ventilation, pneumonia, unplanned intubation, pulmonary embolism, and coma past 24 h (with the assumption of this being due to hypercapnia). Data on post-operative complications and 30-day mortality was extracted. To determine the effect of pulmonary complications on 30-day mortality, a multivariable logistic regression model was developed. RESULTS Pulmonary complications were associated with a near 50-fold increased odds of 30-day mortality (OR 47.1; 95%, 38.6-57.5; p < 0.0001). Pulmonary complications were also associated with higher rates of anastomotic leaks (9.5% vs. 0.3%; p < 0.0001), post-operative bleeding (13.7% vs. 0.9%; p < 0.0001), cardiac complications (6.6% vs. 0.0%; p < 0.0001), post-operative AKIs (9.6% vs. 0.1%; p < 0.0001), incidence of deep SSI (9.4% vs. 0.2%; p < 0.0001), incidence of post-operative sepsis (6.2% vs. 0.1%; p < 0.0001), and incidence of Clostridioides difficile (2.0% vs. 0.1%; p < 0.0001). CONCLUSION Pulmonary complications after elective bariatric surgery are a strong predictor of 30-day mortality. Patients who experience pulmonary complications have a higher incidence of co-morbidities and unfavorable baseline patient characteristics, and thus, likely form a unique subset of the bariatric patient population.
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Narasimhan M, Raji G, Kumar K, Ganga N. Analysis of peak expiratory flow rate and spirometry in obese and nonobese schoolchildren. INDIAN JOURNAL OF RESPIRATORY CARE 2022. [DOI: 10.4103/ijrc.ijrc_67_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Jaleel I, Ahamed H. Analysis of spirometric variables with increasing body mass index in normal and overweight healthy individuals. JOURNAL OF CLINICAL SCIENCES 2022. [DOI: 10.4103/jcls.jcls_41_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Lauria MJ, Root CW, Gottula AL, Braude DA. Management of Respiratory Distress and Failure in Morbidly and Super Obese Patients During Critical Care Transport. Air Med J 2022; 41:133-140. [PMID: 35248332 DOI: 10.1016/j.amj.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/24/2021] [Accepted: 09/21/2021] [Indexed: 06/14/2023]
Abstract
Morbidly and super obese patients are a unique patient population that presents critical care transport providers with unique clinical and logistical challenges in the setting of respiratory distress and failure. These patients are more likely to have chronic respiratory issues at baseline, unique anatomic and physiologic abnormalities, and other comorbidities that leave them poorly able to tolerate respiratory illness or injury. This requires specialized understanding of their respiratory mechanics as well as how to tailor standard treatment modalities, such as noninvasive ventilation, to meet their needs. Also, careful and deliberate planning is required to address the specific anatomic and physiologic characteristics of this population if intubation and mechanical ventilation are needed. Finally, their dimensions and weight also have distinct consequences on transport vehicle considerations. This article reviews the pathophysiology, management, and critical care transport considerations for this unique patient population in respiratory distress and failure.
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Affiliation(s)
- Michael J Lauria
- Lifeguard Air Emergency Services, Albuquerque, NM; Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM.
| | - Christopher W Root
- Lifeguard Air Emergency Services, Albuquerque, NM; Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Adam L Gottula
- Department of Anesthesiology, Division of Critical Care Medicine, University of Michigan, Ann Arbor, MI
| | - Darren A Braude
- Lifeguard Air Emergency Services, Albuquerque, NM; Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM; Department of Emergency Medicine, University of New Mexico, Albuquerque, NM
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Shehata I, Diab S, Kweon J, Farrag O. The role of ultrasonography in anesthesia for bariatric surgery. Saudi J Anaesth 2022; 16:347-354. [PMID: 35898531 PMCID: PMC9311175 DOI: 10.4103/sja.sja_80_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 11/30/2022] Open
Abstract
Bariatric surgeries are effective long-term management for morbid obesity with its adverse sequelae. Anesthesia of bariatric surgeries poses unique challenges for the anesthesiologist in every step starting with vascular access till tracheal extubation. The usage of ultrasound in anesthesia is becoming more prevalent with a variety of benefits, especially in the obese population. Ultrasound is successfully used for obtaining vascular access, with more than 15 million catheters placed in the United States alone. Ultrasound can also be used to predict difficult intubation, as it can confirm the tracheal intubation and assess the gastric content to prevent pulmonary aspiration. Ultrasound is also used in the management of mechanically ventilated patients to monitor lung aeration and to identify respiratory complications during positive pressure ventilation. Moreover, intraoperative echocardiography helps to discover the pulmonary embolism and guides the fluid therapy. Finally, ultrasound can be used to perform neuraxial and fascial plane block with a less overall time of the procedures and minimal complications. The wide use of ultrasound in bariatric anesthesia reflects the learning curve of the anesthesiologists and their mounting efforts to provide safe anesthesia utilizing the updated technology. In this review, we highlight the role of ultrasonography in anesthesia of bariatric surgery and discuss the recent guidelines.
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Verdú E, Homs J, Boadas-Vaello P. Physiological Changes and Pathological Pain Associated with Sedentary Lifestyle-Induced Body Systems Fat Accumulation and Their Modulation by Physical Exercise. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413333. [PMID: 34948944 PMCID: PMC8705491 DOI: 10.3390/ijerph182413333] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/02/2021] [Accepted: 12/10/2021] [Indexed: 12/11/2022]
Abstract
A sedentary lifestyle is associated with overweight/obesity, which involves excessive fat body accumulation, triggering structural and functional changes in tissues, organs, and body systems. Research shows that this fat accumulation is responsible for several comorbidities, including cardiovascular, gastrointestinal, and metabolic dysfunctions, as well as pathological pain behaviors. These health concerns are related to the crosstalk between adipose tissue and body systems, leading to pathophysiological changes to the latter. To deal with these health issues, it has been suggested that physical exercise may reverse part of these obesity-related pathologies by modulating the cross talk between the adipose tissue and body systems. In this context, this review was carried out to provide knowledge about (i) the structural and functional changes in tissues, organs, and body systems from accumulation of fat in obesity, emphasizing the crosstalk between fat and body tissues; (ii) the crosstalk between fat and body tissues triggering pain; and (iii) the effects of physical exercise on body tissues and organs in obese and non-obese subjects, and their impact on pathological pain. This information may help one to better understand this crosstalk and the factors involved, and it could be useful in designing more specific training interventions (according to the nature of the comorbidity).
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Affiliation(s)
- Enrique Verdú
- Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, University of Girona, 17003 Girona, Spain;
- Correspondence: (E.V.); (P.B.-V.)
| | - Judit Homs
- Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, University of Girona, 17003 Girona, Spain;
- Department of Physical Therapy, EUSES-University of Girona, 17190 Salt, Spain
| | - Pere Boadas-Vaello
- Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, University of Girona, 17003 Girona, Spain;
- Correspondence: (E.V.); (P.B.-V.)
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22
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Ghavipanje V, Rahimi NM, Akhlaghi F. Six Weeks Effects of Dynamic Neuromuscular Stabilization (DNS) Training in Obese Postpartum Women With Low Back Pain: A Randomized Controlled Trial. Biol Res Nurs 2021; 24:106-114. [PMID: 34555964 DOI: 10.1177/10998004211044828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The worldwide prevalence of obesity and low back pain (LBP) has recently dramatically increased and is mainly indicated among postpartum women, leading to a range of adverse health consequences. OBJECTIVE This study aimed to investigate the effects of 6 weeks of Dynamic Neuromuscular Stabilization training (DNS) in obese postpartum women with LBP. METHOD This was a pretest-posttest study design. The study was conducted with 40 obese postpartum women with LBP randomized to receive DNS (n = 20) or General Exercise (GE, n = 20) 6 times a week for 6 weeks. The data were gathered before and after the 6-week intervention. RESULTS Forty participants completed the study (mean ± SD, age 29.30 ± 3.77 years; weight 88.10 ± 6.09 kg; height 165.40 ± 6.31 cm; and BMI, 32.19 ± 1.07 kg/m2). The overall group-by-time interaction was significant for Numeric Pain-Rating Scale, Modified Oswestry Disability Questionnaire, Fear-Avoidance Beliefs Questionnaire, Inspiration and Expiration Breath Hold Time, and Respiratory Rate outcomes. The global rating of change was significantly different between groups (p < .05). The rate of improvement was higher in the DNS group compared to the GE group in all 6 tests. CONCLUSION The present study confirms that DNS is applicable in obese postpartum women with LBP and effectively improved NPRS, MODQ, FABQ, BHT, and RR. It is clinically suggested that DNS is imperative based on ideal ontogenetic patterns to attain optimal results for obese postpartum women with LBP.
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Affiliation(s)
- Vajihe Ghavipanje
- Department of Sports Sciences, Imam Reza International University, Mashhad, Iran
| | | | - Farideh Akhlaghi
- Obstetrics & Gynecology, Neonatal Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Chang JE, Seol T, Hwang JY. Body position and the effectiveness of mask ventilation in anaesthetised paralysed obese patients: A randomised cross-over study. Eur J Anaesthesiol 2021; 38:825-830. [PMID: 33600105 DOI: 10.1097/eja.0000000000001473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Airway management is more challenging in the obese. Compared with the supine position, the sitting position can decrease the collapsibility of the upper airway and improve respiratory mechanics. OBJECTIVE The aim of this study was to evaluate the 25° semisitting position on the effectiveness of mask ventilation in anaesthetised paralysed obese patients. DESIGN A randomised, cross-over study. SETTING Medical centre managed by a university tertiary hospital. PATIENTS Thirty-eight obese adults scheduled for general anaesthesia. METHODS After anaesthesia and paralysis, two-handed mask ventilation was performed in the supine and 25° semi-sitting positions with a cross-over, in a randomised order. During mask ventilation, mechanical ventilation was delivered with a pressure-controlled mode with a peak inspiratory pressure of 15 cmH2O, a respiratory rate of 15 bpm, and no positive end-expiratory pressure. Ventilatory outcomes were based upon lean body weight. MAIN OUTCOMES Exhaled tidal volume (ml kg-1), respiratory minute volume (ml kg-1 min-1), and the occurrence of inadequate ventilation, defined as an exhaled tidal volume less than 4 ml kg-1, or absence of end-tidal CO2 recording. RESULTS Exhaled tidal volume (mean ± SD) in the 25° semi-sitting position was higher than in the supine position, 9.3 ± 2.7 vs. 7.6 ± 2.4 ml kg-1; P less than 0.001. Respiratory minute volume was improved in the 25° semisitting position compared with that in the supine position, 139.6 ± 40.7 vs. 113.4 ± 35.7 ml kg-1 min-1; P less than 0.001. CONCLUSION The 25° semisitting position improved mask ventilation compared with the supine position in anaesthetised paralysed obese patients. TRIAL REGISTRY NUMBER ClinicalTrials.gov (NCT03996161).
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Affiliation(s)
- Jee-Eun Chang
- From the Department of Anaesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul (J-EC, J-YH), College of Medicine, Kangwon University, Chuncheon, Republic of Korea (J-EC), Department of Anaesthesiology & Pain Medicine, Sheikh Khalifa Specialty Hospital, RAK, United Arab Emirates (TS) and College of Medicine, Seoul National University, Seoul, Republic of Korea (TS, J-YH)
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Kuiper-Makris C, Selle J, Nüsken E, Dötsch J, Alejandre Alcazar MA. Perinatal Nutritional and Metabolic Pathways: Early Origins of Chronic Lung Diseases. Front Med (Lausanne) 2021; 8:667315. [PMID: 34211985 PMCID: PMC8239134 DOI: 10.3389/fmed.2021.667315] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
Lung development is not completed at birth, but expands beyond infancy, rendering the lung highly susceptible to injury. Exposure to various influences during a critical window of organ growth can interfere with the finely-tuned process of development and induce pathological processes with aberrant alveolarization and long-term structural and functional sequelae. This concept of developmental origins of chronic disease has been coined as perinatal programming. Some adverse perinatal factors, including prematurity along with respiratory support, are well-recognized to induce bronchopulmonary dysplasia (BPD), a neonatal chronic lung disease that is characterized by arrest of alveolar and microvascular formation as well as lung matrix remodeling. While the pathogenesis of various experimental models focus on oxygen toxicity, mechanical ventilation and inflammation, the role of nutrition before and after birth remain poorly investigated. There is accumulating clinical and experimental evidence that intrauterine growth restriction (IUGR) as a consequence of limited nutritive supply due to placental insufficiency or maternal malnutrition is a major risk factor for BPD and impaired lung function later in life. In contrast, a surplus of nutrition with perinatal maternal obesity, accelerated postnatal weight gain and early childhood obesity is associated with wheezing and adverse clinical course of chronic lung diseases, such as asthma. While the link between perinatal nutrition and lung health has been described, the underlying mechanisms remain poorly understood. There are initial data showing that inflammatory and nutrient sensing processes are involved in programming of alveolarization, pulmonary angiogenesis, and composition of extracellular matrix. Here, we provide a comprehensive overview of the current knowledge regarding the impact of perinatal metabolism and nutrition on the lung and beyond the cardiopulmonary system as well as possible mechanisms determining the individual susceptibility to CLD early in life. We aim to emphasize the importance of unraveling the mechanisms of perinatal metabolic programming to develop novel preventive and therapeutic avenues.
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Affiliation(s)
- Celien Kuiper-Makris
- Department of Pediatric and Adolescent Medicine, Translational Experimental Pediatrics-Experimental Pulmonology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jaco Selle
- Department of Pediatric and Adolescent Medicine, Translational Experimental Pediatrics-Experimental Pulmonology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Eva Nüsken
- Department of Pediatric and Adolescent Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jörg Dötsch
- Department of Pediatric and Adolescent Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Miguel A Alejandre Alcazar
- Department of Pediatric and Adolescent Medicine, Translational Experimental Pediatrics-Experimental Pulmonology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Excellence Cluster on Stress Responses in Aging-associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Member of the German Centre for Lung Research (DZL), Institute for Lung Health, University of Giessen and Marburg Lung Centre (UGMLC), Gießen, Germany
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25
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Marjani A, Khatami A, Saadati H, Asghari M, Razizadeh MH, Abbasi A, Zarei M, Beikzadeh L, Soleimani A. Association of adenovirus 36 infection and obesity; An updated meta-analysis of community-based studies. Rev Med Virol 2021; 32:e2255. [PMID: 34028108 DOI: 10.1002/rmv.2255] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 12/11/2022]
Abstract
As a health problem, obesity has several risk factors; it has been suggested that human adenovirus type 36 (HAdV-36) infections may possibly be associated with obesity. This updated meta-analysis was designed and conducted with an emphasis on articles published from 2015 to 2020. The PubMed, Web of Science, and Scopus databases were searched up to 1 December 2020. Overall, pooled prevalence and odds ratio of antibodies against HAdV-36 in people with obesity and controls was assessed among different ages. Case-control and cohort studies were included in the analysis. The overall prevalence of HAdV-36 infection in obese population was 31% (CI: 0.24%-0.38%) which was 32% in cases and 27% in controls, respectively; a significant association was found between the cases and the controls (OR, 1.84; 95% CI, 1.39-2.43), especially in children younger than 18 years of age (OR, 2.44; 95% CI, 1.85-3.22). A significant association between adenovirus infection and obesity was found, especially in adolescents.
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Affiliation(s)
- Arezoo Marjani
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Khatami
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran.,Department of Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Saadati
- Department of Epidemiology and Biostatistics, School of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Milad Asghari
- Department of Microbiology, Faculty of Basic Science, Tabriz Branch, Islamic Azad University, Tabriz, Iran
| | | | - Aida Abbasi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Zarei
- John B. Little Center for Radiation Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Leila Beikzadeh
- Department of Medical Laboratory Sciences, Faculty of Para-Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Alireza Soleimani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
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26
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Mettelman RC, Thomas PG. Human Susceptibility to Influenza Infection and Severe Disease. Cold Spring Harb Perspect Med 2021; 11:cshperspect.a038711. [PMID: 31964647 PMCID: PMC8091954 DOI: 10.1101/cshperspect.a038711] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Influenza viruses are a persistent threat to global human health. Increased susceptibility to infection and the risk factors associated with progression to severe influenza-related disease are determined by a multitude of viral, host, and environmental conditions. Decades of epidemiologic research have broadly defined high-risk groups, while new genomic association studies have identified specific host factors impacting an individual's response to influenza. Here, we review and highlight both human susceptibility to influenza infection and the conditions that lead to severe influenza disease.
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Affiliation(s)
- Robert C Mettelman
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
| | - Paul G Thomas
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
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27
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Heubel AD, Kabbach EZ, Schafauser NS, Phillips SA, Pires Di Lorenzo VA, Borghi Silva A, Mendes RG. Noninvasive ventilation acutely improves endothelial function in exacerbated COPD patients. Respir Med 2021; 181:106389. [PMID: 33831730 DOI: 10.1016/j.rmed.2021.106389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/11/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is associated with an elevated risk of cardiovascular events, which can be linked to endothelial dysfunction. In this study, we aimed to investigate whether noninvasive ventilation (NIV) acutely changes endothelial function in hospitalized AECOPD patients. METHODS Twenty-one AECOPD patients were assessed in a hospital ward setting from 24 to 48 h after admission. NIV was applied using a ventilator with bilevel pressure support. Before and after NIV protocol, patients were evaluated regarding (1) endothelium-dependent function, assessed non-invasively using the flow-mediated dilation (FMD) method; (2) arterial blood gas analysis. Other baseline evaluations included clinical and anthropometric data, and laboratory tests. RESULTS The total group showed a significant improvement in FMD as a result of NIV effect (P = 0.010). While arterial carbon dioxide and oxygen were not altered, oxygen saturation increased after NIV (P = 0.045). The subgroup comparison of responders (FMD ≥ 1%) and non-responders (FMD < 1%) showed significant baseline differences in body mass index (BMI) (P = 0.019) and predicted forced expiratory volume in one second (FEV1) (P = 0.007). In univariate and multivariate analyses, both BMI and FEV1 were determinant for endothelial response to NIV. CONCLUSION NIV acutely improves endothelial function in hospitalized AECOPD patients. Overweight and COPD severity may represent important characteristics for the magnitude of peripheral vascular response.
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Affiliation(s)
- Alessandro Domingues Heubel
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
| | - Erika Zavaglia Kabbach
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
| | - Nathany Souza Schafauser
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
| | - Shane Aaron Phillips
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois, United States of America.
| | - Valéria Amorim Pires Di Lorenzo
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
| | - Audrey Borghi Silva
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
| | - Renata Gonçalves Mendes
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
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28
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The Inflammatory Profile of Obesity and the Role on Pulmonary Bacterial and Viral Infections. Int J Mol Sci 2021; 22:ijms22073456. [PMID: 33810619 PMCID: PMC8037155 DOI: 10.3390/ijms22073456] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 12/16/2022] Open
Abstract
Obesity is a globally increasing health problem, entailing diverse comorbidities such as infectious diseases. An obese weight status has marked effects on lung function that can be attributed to mechanical dysfunctions. Moreover, the alterations of adipocyte-derived signal mediators strongly influence the regulation of inflammation, resulting in chronic low-grade inflammation. Our review summarizes the known effects regarding pulmonary bacterial and viral infections. For this, we discuss model systems that allow mechanistic investigation of the interplay between obesity and lung infections. Overall, obesity gives rise to a higher susceptibility to infectious pathogens, but the pathogenetic process is not clearly defined. Whereas, viral infections often show a more severe course in obese patients, the same patients seem to have a survival benefit during bacterial infections. In particular, we summarize the main mechanical impairments in the pulmonary tract caused by obesity. Moreover, we outline the main secretory changes within the expanded adipose tissue mass, resulting in chronic low-grade inflammation. Finally, we connect these altered host factors to the influence of obesity on the development of lung infection by summarizing observations from clinical and experimental data.
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29
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Mihmanlı A, Bozkurt E. Effects of Laparoscopic Sleeve Gastrectomy on Respiratory Functions. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Aydanur Mihmanlı
- Department of Pneumology, Beykent University Medical Faculty, Istanbul, Turkey
| | - Emre Bozkurt
- Department of General Surgery, University of Health Sciences Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
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30
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Moon TS, Van de Putte P, De Baerdemaeker L, Schumann R. The Obese Patient: Facts, Fables, and Best Practices. Anesth Analg 2021; 132:53-64. [PMID: 32282384 DOI: 10.1213/ane.0000000000004772] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The prevalence of obesity continues to rise worldwide, and anesthesiologists must be aware of current best practices in the perioperative management of the patient with obesity. Obesity alters anatomy and physiology, which complicates the evaluation and management of obese patients in the perioperative setting. Gastric point-of-care ultrasound (PoCUS) is a noninvasive tool that can be used to assess aspiration risk in the obese patient by evaluating the quantity and quality of gastric contents. An important perioperative goal is adequate end-organ perfusion. Standard noninvasive blood pressure (NIBP) is our best available routine surrogate measurement, but is vulnerable to greater inaccuracy in patients with obesity compared to the nonobese population. Current NIBP methodologies are discussed. Obese patients are at risk for wound and surgical site infections, but few studies conclusively guide the exact dosing of intraoperative prophylactic antibiotics for them. We review evidence for low-molecular-weight heparins and weight-based versus nonweight-based administration of vasoactive medications. Finally, intubation and extubation of the patient with obesity can be complicated, and evidence-based strategies are discussed to mitigate danger during intubation and extubation.
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Affiliation(s)
- Tiffany S Moon
- From the Department of Anesthesiology and Pain, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Roman Schumann
- Department of Anesthesiology and Perioperative Medicine, Tufts University School of Medicine, Boston, Massachusetts
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31
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Fedele D, De Francesco A, Riso S, Collo A. Obesity, malnutrition, and trace element deficiency in the coronavirus disease (COVID-19) pandemic: An overview. Nutrition 2021; 81:111016. [PMID: 33059127 PMCID: PMC7832575 DOI: 10.1016/j.nut.2020.111016] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/24/2020] [Accepted: 08/29/2020] [Indexed: 02/06/2023]
Abstract
The world is currently facing the coronavirus disease (COVID-19) pandemic which places great pressure on health care systems and workers, often presents with severe clinical features, and sometimes requires admission into intensive care units. Derangements in nutritional status, both for obesity and malnutrition, are relevant for the clinical outcome in acute illness. Systemic inflammation, immune system impairment, sarcopenia, and preexisting associated conditions, such as respiratory, cardiovascular, and metabolic diseases related to obesity, could act as crucial factors linking nutritional status and the course and outcome of COVID-19. Nevertheless, vitamins and trace elements play an essential role in modulating immune response and inflammatory status. Overall, evaluation of the patient's nutritional status is not negligible for its implications on susceptibility, course, severity, and responsiveness to therapies, in order to perform a tailored nutritional intervention as an integral part of the treatment of patients with COVID-19. The aim of this study was to review the current data on the relevance of nutritional status, including trace elements and vitamin status, in influencing the course and outcome of the disease 3 mo after the World Health Organization's declaration of COVID-19 as a pandemic.
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Affiliation(s)
- Debora Fedele
- Dietetic and Clinical Nutrition Unit, San Giovanni Battista Hospital, Città della Salute e della Scienza, Turin, Italy.
| | - Antonella De Francesco
- Dietetic and Clinical Nutrition Unit, San Giovanni Battista Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Sergio Riso
- Dietetic and Clinical Nutrition Unit, Maggiore della Carità Hospital, Novara, Italy
| | - Alessandro Collo
- Dietetic and Clinical Nutrition Unit, Maggiore della Carità Hospital, Novara, Italy
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32
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Itagi AH, Kalaskar A, Dukpa P, Chandi D, Yunus GY. Association of basal metabolic rate with respiratory function among middle-aged obese and nonobese subjects. MGM JOURNAL OF MEDICAL SCIENCES 2021. [DOI: 10.4103/mgmj.mgmj_68_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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33
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Irandoust K, Taheri M, H'mida C, Neto GR, Trabelsi K, Ammar A, Souissi N, Chtourou H, Nikolaidis PT, Rosemann T, Knechtle B. Exergaming and Aquatic Exercises Affect Lung Function and Weight Loss in Obese Children. Int J Sports Med 2020; 42:566-572. [PMID: 33176381 DOI: 10.1055/a-1289-9307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We investigated the effect of exergames and aquatic exercises on lung function and weight loss in obese children. Sixty-one obese male primary-school children were randomly allocated to video game, aquatic exercise, and control groups. Lung functions and anthropometric variables were measured before and after the intervention and after one month (follow-up). In the video game group, an Xbox Kinect game was played for 60 min during three sessions a week. The aquatic aerobic exercise was performed three times per week and consisted of a warm-up, main exercises, and a cool down phase. For the video game group, there was a significant reduction in body weight between (i) pre- and (ii) post-intervention and follow-up. In the aquatic exercise group, there was a significant reduction in body weight between pre- and post-intervention and between pre-intervention and follow-up. Both exercise groups improved the waist/hip ratio index compared to the control group. Forced vital capacity was significantly improved in the follow-up of the video game group and the aquatic exercise group compared to the control group. A significant improvement was found in forced expiratory volume in the first second at post-intervention and follow-up in the video game and the aquatic exercise groups. Exergames and aquatic exercises improved weight loss and lung function in obese children.
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Affiliation(s)
- Khadijeh Irandoust
- Faculty of Social Sciences, Imam Khomeini International University, Qazvin, Iran
| | - Morteza Taheri
- Faculty of Social Sciences, Imam Khomeini International University, Qazvin, Iran
| | - Cyrine H'mida
- Education, Motricity, Sport and Health (EM2S), High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia.,Institut Supérieur du Sport et de l'Education Physique de Sfax, Université de Sfax, Sfax, Tunisie
| | - Gabriel Rodrigues Neto
- Center for Higher Education and Development (CESED - UNIFACISA / FCM / ESAC), Campina Grande, Paraíba, Brazil
| | - Khaled Trabelsi
- Education, Motricity, Sport and Health (EM2S), High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia.,Institut Supérieur du Sport et de l'Education Physique de Sfax, Université de Sfax, Sfax, Tunisie
| | - Achraf Ammar
- Institute of Sport Science, Otto-von-Guericke-University, Magdeburg, Germany
| | - Nizar Souissi
- Activité Physique, Sport et Santé, UR18JS01, Observatoire National du Sport, Tunis, Tunisie
| | - Hamdi Chtourou
- Institut Supérieur du Sport et de l'Education Physique de Sfax, Université de Sfax, Sfax, Tunisie.,Activité Physique, Sport et Santé, UR18JS01, Observatoire National du Sport, Tunis, Tunisie
| | | | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland.,Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland
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34
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Quality of life in children and adolescents with overweight or obesity: Impact of obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2020; 138:110320. [PMID: 32889438 DOI: 10.1016/j.ijporl.2020.110320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To investigate the association between obstructive sleep apnea (OSA) and health related quality of life (HRQOL) in children and adolescents referred to an obesity treatment clinic. In addition, we examined the association between body mass index standard deviation score (BMI SDS) and HRQOL comparing children and adolescents with overweight or obesity without OSA with a control group of children and adolescents with normal weight without OSA. METHODS This cross-sectional study included 130 children and adolescents with overweight or obesity (BMI SDS > 1.28) aged 7-18 years recruited from an obesity treatment clinic. The control group consisted of 28 children and adolescents with normal weight (BMI SDS ≤ 1.28) aged 7-18 years recruited from schools. Sleep examinations were performed using a type 3 portable sleep monitor, Nox T3. OSA was defined as apnea-hypopnea index (AHI) ≥ 2. HRQOL was measured by the Pediatric Quality of Life Inventory (PedsQL) 4.0 generic core scale. RESULTS A total of 56 children and adolescents with overweight or obesity were diagnosed with OSA (43%). The children and adolescents with OSA were older (p = 0.01) and had higher BMI SDS (p = 0.04) than children and adolescents without OSA. In generalized linear regression analyses adjusted for age, sex, BMI SDS and pubertal development stage there was no association between OSA or AHI and HRQOL in children and adolescents with overweight or obesity. In the analysis, including children and adolescents without OSA and the normal-weight control group, the generalized linear regression adjusted for age, sex and AHI revealed an association between BMI SDS and HRQOL (p < 0.001). CONCLUSION We found no association between AHI or OSA and HRQOL in children and adolescents with overweight or obesity. However, we found an association between BMI SDS and HRQOL in children and adolescents without OSA.
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35
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Acute respiratory muscle unloading improves time-to-exhaustion during moderate- and heavy-intensity cycling in obese adolescent males. Sci Rep 2020; 10:17036. [PMID: 33046823 PMCID: PMC7550339 DOI: 10.1038/s41598-020-74240-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 09/23/2020] [Indexed: 11/08/2022] Open
Abstract
Obesity significantly impairs breathing during exercise. The aim was to determine, in male obese adolescents (OB), the effects of acute respiratory muscle unloading, obtained by switching the inspired gas from ambient air (AIR) to a normoxic helium + oxygen gas mixture (HeO2) (AIR → HeO2) during moderate [below gas exchange threshold (GET)] and heavy [above GET] constant work rate cycling. Ten OB [age 16.0 ± 2.0 years (mean ± SD); body mass index (BMI) 38.9 ± 6.1 kg/m2] and ten normal-weight age-matched controls (CTRL) inspired AIR for the entire exercise task, or underwent AIR → HeO2 when they were approaching volitional exhaustion. In OB time to exhaustion (TTE) significantly increased in AIR → HeO2 vs. AIR during moderate [1524 ± 480 s vs. 1308 ± 408 (P = 0.024)] and during heavy [570 ± 306 s vs. 408 ± 150 (P = 0.0154)] exercise. During moderate exercise all CTRL completed the 40-min task. During heavy exercise no significant differences were observed in CTRL for TTE (582 ± 348 s [AIR → HeO2] vs. 588 ± 252 [AIR]). In OB, but not in CTRL, acute unloading of respiratory muscles increased TTE during both moderate- and heavy-exercise. In OB, but not in CTRL, respiratory factors limit exercise tolerance during both moderate and heavy exercise.
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36
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Cornelius T, Schwartz JE, Balte P, Bhatt SP, Cassano PA, Currow D, Jacobs DR, Johnson M, Kalhan R, Kronmal R, Loehr L, O'Connor GT, Smith B, White WB, Yende S, Oelsner EC. A Dyadic Growth Modeling Approach for Examining Associations Between Weight Gain and Lung Function Decline. Am J Epidemiol 2020; 189:1173-1184. [PMID: 32286615 DOI: 10.1093/aje/kwaa059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 04/07/2020] [Accepted: 04/10/2020] [Indexed: 12/30/2022] Open
Abstract
The relationship between body weight and lung function is complex. Using a dyadic multilevel linear modeling approach, treating body mass index (BMI; weight (kg)/height (m)2) and lung function as paired, within-person outcomes, we tested the hypothesis that persons with more rapid increase in BMI exhibit more rapid decline in lung function, as measured by forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and their ratio (FEV1:FVC). Models included random intercepts and slopes and adjusted for sociodemographic and smoking-related factors. A sample of 9,115 adults with paired measurements of BMI and lung function taken at ≥3 visits were selected from a pooled set of 5 US population-based cohort studies (1983-2018; mean age at baseline = 46 years; median follow-up, 19 years). At age 46 years, average annual rates of change in BMI, FEV1, FVC, and FEV1:FVC ratio were 0.22 kg/m2/year, -25.50 mL/year, -21.99 mL/year, and -0.24%/year, respectively. Persons with steeper BMI increases had faster declines in FEV1 (r = -0.16) and FVC (r = -0.26) and slower declines in FEV1:FVC ratio (r = 0.11) (all P values < 0.0001). Results were similar in subgroup analyses. Residual correlations were negative (P < 0.0001), suggesting additional interdependence between BMI and lung function. Results show that greater rates of weight gain are associated with greater rates of lung function loss.
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37
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Rodrigues GC, Rocha NN, Maia LDA, Melo I, Simões AC, Antunes MA, Bloise FF, Woyames J, da Silva WS, Capelozzi VL, Abela GP, Ball L, Pelosi P, Rocco PRM, Silva PL. Impact of experimental obesity on diaphragm structure, function, and bioenergetics. J Appl Physiol (1985) 2020; 129:1062-1074. [PMID: 32909923 DOI: 10.1152/japplphysiol.00262.2020] [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: 02/08/2023] Open
Abstract
Obesity is associated with bioenergetic dysfunction of peripheral muscles; however, little is known regarding the impact of obesity on the diaphragm. We hypothesized that obesity would be associated with diaphragm dysfunction attributable to mitochondrial oxygen consumption and structural and ultrastructural changes. Wistar rat litters were culled to 3 pups to induce early postnatal overfeeding and consequent obesity. Control animals were obtained from unculled litters. From postnatal day 150, diaphragm ultrasound, computed tomography, high-resolution respirometry, immunohistochemical, biomolecular, and ultrastructural histological analyses were performed. The diaphragms of obese animals, compared with those of controls, presented changes in morphology as increased thickening fraction, diaphragm excursion, and diaphragm dome height, as well as increased mitochondrial respiratory capacity coupled to ATP synthesis and maximal respiratory capacity. Fatty acid synthase gene expression was also higher in obese animals, suggesting a source of energy for the respiratory chain. Myosin heavy chain-IIA was increased, indicating shift from glycolytic toward oxidative muscle fiber profile. Diaphragm tissue also exhibited ultrastructural changes, such as compact, round, and swollen mitochondria with fainter cristae and more lysosomal bodies. Dynamin-1 expression in the diaphragm was reduced in obese rats, suggesting decreased mitochondrial fission. Furthermore, gene expressions of peroxisome γ proliferator-activated receptor coactivator-1α and superoxide dismutase-2 were lower in obese animals than in controls, which may indicate a predisposition to oxidative injury. In conclusion, in the obesity model used herein, muscle fiber phenotype was altered in a manner likely associated with increased mitochondrial respiratory capability, suggesting respiratory adaptation to increased metabolic demand.NEW & NOTEWORTHY Obesity has been associated with peripheral muscle dysfunction; however, little is known about its impact on the diaphragm. In the current study, we found high oxygen consumption in diaphragm tissue and changes in muscle fiber phenotypes toward a more oxidative profile in experimental obesity.
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Affiliation(s)
- Gisele C Rodrigues
- Laboratory of Pulmonary Investigation, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nazareth N Rocha
- Laboratory of Pulmonary Investigation, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Fluminense Federal University, Niteroi, Brazil
| | - Ligia de A Maia
- Laboratory of Pulmonary Investigation, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Isabella Melo
- Laboratory of Pulmonary Investigation, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Carolina Simões
- Laboratory of Pulmonary Investigation, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mariana A Antunes
- Laboratory of Pulmonary Investigation, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flavia F Bloise
- Laboratory of Translational Endocrinology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Juliana Woyames
- Laboratory of Molecular Endocrinology, Institute of Biophysics Carlos Chagas Filho, Rio de Janeiro, Brazil
| | - Wagner S da Silva
- Laboratory of Metabolic Adaptations, Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vera L Capelozzi
- Laboratory of Pulmonary Genomics, Department of Pathology, University of São Paulo, São Paulo, Brazil
| | - Glenn Paul Abela
- Anesthesiology and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Lorenzo Ball
- Anesthesiology and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Paolo Pelosi
- Anesthesiology and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Patricia R M Rocco
- Laboratory of Pulmonary Investigation, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro L Silva
- Laboratory of Pulmonary Investigation, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Moazzami M, Bijeh N, Farahati S. Comparing the effects of six-months aerobic training on pulmonary function tests in obese and nonobese women. J Sports Med Phys Fitness 2020; 61:96-101. [PMID: 32878423 DOI: 10.23736/s0022-4707.20.11058-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Obesity is becoming a serious public health issue in the world and is associated with a wide range of health conditions, including respiratory diseases. Prolonged aerobic exercises are thought to improve aerobic capacity and to have a favorable effect on lung function. Thus, the purpose of this study was to determine the comparison the effects of six months of aerobic training on pulmonary function tests in obese and nonobese women. METHODS The subjects of this study were nineteen healthy and inactive females assigned into the obese (N.=10) and nonobese (N.=9) groups. The exercise protocol included aerobic exercise training lasted for 6 months and 3 sessions per week and every session lasted for 60 minutes and with intensity of 55-65 percent of maximum heart rate reserve. Before starting program, the anthropometric measurements of subjects such as weight, percent body fat and body mass Index was measured by body composition analyzer and lung function tests were carried out by using a spirometer. RESULTS Obese women have lower values of FEV1, FVC, FEV1/FVC, PEF, Vt and MVV when compared with nonobese group but the difference did not reach significant level. Also, the results of this study showed that there are significant differences in FVE1 Index and MVV tests in obese and nonobese groups in pretest and post-test, but FVC Index increased significantly just in obese group. CONCLUSIONS It seems that if the training program is done in appropriate time and intensity, which leads to weight loss in obese people, it can lead to improve all Index of pulmonary function.
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Affiliation(s)
- Mahtab Moazzami
- Department of Exercise Physiology, Faculty of Sport Sciences, Ferdowsi University of Mashhad, Mashhad, Iran - .,-
| | - Nahid Bijeh
- Department of Exercise Physiology, Faculty of Sport Sciences, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Samaneh Farahati
- Department of Sport Sciences, Faculty of Humanities, Sadjad University, Mashhad, Iran
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Prevention of Oxygen Desaturation in Morbidly Obese Patients During Electroconvulsive Therapy: A Narrative Review. J ECT 2020; 36:161-167. [PMID: 32040021 DOI: 10.1097/yct.0000000000000664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In general, preoxygenation is performed using a face mask with oxygen in a supine position, and oxygenation is maintained with manual mask ventilation during electroconvulsive therapy (ECT). However, hypoxic episodes during ECT are not uncommon with this conventional method, especially in morbidly obese patients. The most important property of ventilatory mechanics in patients with obesity is reduced functional residual capacity (FRC). Thus, increasing FRC and oxygen reserves is an important step to improve oxygenation and prevent oxygen desaturation in these individuals. Head-up position, use of apneic oxygenation, noninvasive positive pressure ventilation, and high-flow nasal cannula help increase FRC and oxygen reserves, resulting in improved oxygenation and prolonged safe apnea period. Furthermore, significantly higher incidence of difficult mask ventilation is common in morbidly obese individuals. Supraglottic airway devices establish effective ventilation in patients with difficult airways. Thus, the use of supraglottic airway devices is strongly recommended in these patients. Conversely, because muscle fasciculation induced by depolarizing neuromuscular blocking agents markedly increases oxygen consumption, especially in individuals with obesity, the use of nondepolarizing neuromuscular blocking agents may contribute to better oxygenation in morbidly obese patients during ECT.
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Mohd Nasir AAB, Ban AYL, Syed Zakaria SZ, Nik Mahmood NRK, Abdul Hamid MF. A single tertiary centre outlook on the short-term outcome of bariatric surgery in improving pulmonary parameters and sleep apnoea. PROCEEDINGS OF SINGAPORE HEALTHCARE 2020. [DOI: 10.1177/2010105820948533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Obesity is associated with obstructive sleep apnoea (OSA). Weight loss is an effective treatment. Bariatric surgery for obese, symptomatic OSA patients results in weight loss and improvement in lung function and sleep apnoea. This study aimed to determine the effectiveness of bariatric surgery in improving the respiratory mechanics and sleep apnoea using a lung function test and sleep study. Methods: A prospective study was conducted at the Pusat Perubatan Universiti Kebangsaan Malaysia Medical Centre involving adults undergoing bariatric work-up, attending respiratory clinic or admitted for bariatric work-up. We included subjects with a body mass index (BMI) >35 kg/m2 and Apnoea–Hypopnoea Index (AHI) of >5 events/hour. Subjects were assessed at baseline and at 12±2 weeks post bariatric surgery using the following methods: a partial sleep study, lung function test, six-minute walk test (6MWT) and Epworth Sleepiness Scale (ESS) score. Results: Twelve subjects were analysed. Their mean age was 36±5.7 years, and eight (67%) were female. The baseline mean AHI was 24.75±9.51 events/hour, the nadir mean oxygen saturation during sleep (SpO2) was 83.6±3.8%, the mean ESS score was 16±4, the mean forced expiratory volume in one second (FEV1) was 2.66±0.35 L, the mean forced vital capacity (FVC) was 3.23±0.45 L, the mean total lung capacity (TLC) was 4.97±1.19 L, the mean expiratory reserve volume (ERV) was 0.5±0.46 L, the mean residual volume (RV) was 1.46±0.91 L, the mean adjusted diffusing lung capacity for carbon monoxide (DLCO Adj) was 22.71±5.22 mL/mmHg/min, the mean adjusted diffusing lung capacity corrected for alveolar volume (DLVA Adj) was 5.61±0.90 mL/mmHg/min and the mean 6MWT was 293±49 m. Post surgery (12±2 weeks), the mean BMI decreased from 45.5 kg/m2 to 39.7 kg/m2, with a clinically significant improvement in AHI, ESS score, nadir SpO2, FEV1, FVC, TLC, ERV, RV, DLCO Adj, DLVA Adj and 6MWT ( p<0.05). Conclusion: Bariatric surgery improves sleep apnoea and lung function and reduces daytime somnolence.
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Affiliation(s)
| | - Andrea Yu-Lin Ban
- Respiratory Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Malaysia
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Song H, Zuo Z, Yang Z, Gao C, Chen K, Fang J, Cui H, Ouyang P, Deng J, Geng Y, Guo H. Hepatic histopathology and apoptosis in diet-induced-obese mice under Escherichia coli pneumonia. Aging (Albany NY) 2020; 11:2836-2851. [PMID: 31085802 PMCID: PMC6535052 DOI: 10.18632/aging.101956] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 05/03/2019] [Indexed: 12/30/2022]
Abstract
This research was to investigate the difference of hepatic histopathology and apoptosis between the diet-induced obesity (DIO) and normal (lean) mice after Escherichia coli (E. coli) pneumonia. A total of 128 ICR mice were selected to be challenged intranasally with phosphate-buffered saline (PBS) or 4×109CFUs/mL of E. coli, and the liver histopathology and apoptosis were examined pre- and post-infection. Results showed that the liver index, levels of lipid droplets, cytokines, adipocytokines, oxidative stress, apoptotic percentage, and apoptotic related factors in the E. coli-infected mice were generally higher than those in the uninfected mice, whereas the hepatic glycogen and Bcl-2 were the opposite. Interestingly, after E. coli infection, the DIO-E. coli mice exhibited decreased liver index and apoptotic percentages, and reduced levels of TNF-α, IL-6, resistin, MDA, GSH, CAT, Caspase-3, Caspase-9, Bax as well as Bax/Bcl-2 ratio in comparison to the lean-E. coli mice. Our results indicated that E. coli-induced pneumonia caused hepatic histopathological damage, increased hepatic apoptosis, oxidative damages, and higher levels of cytokines and adipocytokines. However, such changes showed less severely in the DIO mice than in the lean mice following E. coli pneumonia.
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Affiliation(s)
- Hetao Song
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan 611130, PR China
| | - Zhicai Zuo
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan 611130, PR China
| | - Zhuangzhi Yang
- Chengdu Academy of Agriculture and Forestry Sciences, Chengdu, Sichuan 611130, PR China
| | - Caixia Gao
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan 611130, PR China
| | - Kejie Chen
- School of Public Health, Chengdu Medical College, Chengdu, Sichuan 610500 PR China
| | - Jing Fang
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan 611130, PR China
| | - Hengmin Cui
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan 611130, PR China
| | - Ping Ouyang
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan 611130, PR China
| | - Junliang Deng
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan 611130, PR China
| | - Yi Geng
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan 611130, PR China
| | - Hongrui Guo
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan 611130, PR China
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Kanney ML, Harford KL, Raol N, Leu RM. Obstructive sleep apnea in pediatric obesity and the effects of sleeve gastrectomy. Semin Pediatr Surg 2020; 29:150887. [PMID: 32238281 DOI: 10.1016/j.sempedsurg.2020.150887] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The prevalence of severe pediatric obesity is rising and poses many adverse health risks. Children with obesity are at increased risk of several cardiovascular and metabolic diseases. They are also more likely to have obstructive sleep apnea (OSA), which increases the risk of cardiovascular and metabolic problems. In this review, we examine the relationship between OSA and obesity, improvements in OSA after non-surgical and surgical weight loss, and explore potential directions for future research.
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Affiliation(s)
- Michelle L Kanney
- Division of Pulmonology, Allergy, Cystic Fibrosis and Sleep Medicine, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Kelli-Lee Harford
- Division of Pulmonology, Allergy, Cystic Fibrosis and Sleep Medicine, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Nikhila Raol
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Roberta M Leu
- Division of Pulmonology, Allergy, Cystic Fibrosis and Sleep Medicine, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.
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Hatem AM, Ismail MS, El-Hinnawy YH. Effect of different classes of obesity on the pulmonary functions among adult Egyptians: a cross-sectional study. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_21_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bhatti U, Laghari ZA, Syed BM. Effect of Body Mass Index on respiratory parameters: A cross-sectional analytical Study. Pak J Med Sci 2019; 35:1724-1729. [PMID: 31777523 PMCID: PMC6861468 DOI: 10.12669/pjms.35.6.746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/23/2019] [Accepted: 08/07/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess association of Body mass index (BMI) on respiratory parameters by performing spirometry in apparently healthy adults living in the district Jamshoro and Hyderabad, Sindh, Pakistan. METHODS A cross sectional study was conducted at Department of Physiology, Liaquat University of Medical and Health Sciences Jamshoro, Pakistan from January to September 2015. A total of 180 underweight, normal, overweight and obese participants, aged between 18 to 40 years were included in the study. BMI was calculated by measuring weight and height by BMI scale (RGZ-160) in standing position. Pulmonary parameters were determined by spirometry on Power lab (AD instruments). Pulmonary parameters were compared between subjects in different categories of BMI. RESULTS Mean age of participants was 21.83±5.88 years and the mean BMI was 25.10±6.55 kg/m2. The study results revealed that except for FVC, which was not statistically significant (p=0.45) all other respiratory parameters were significantly different (p≤0.05) in all BMI categories. Mean FEV1/FVC ratio (93.1 vs. 90.3, 86.4 and 86.6 respectively) was highest among underweight as compared to overweight, obese and normal weight individuals. The mean VT was 1.22 vs. 0.90, 1.01 and 0.84 respectively, IRV was 1.04 vs. 1.18, 1.23 and 1.20 respectively, IC was 2.26 vs. 2.08, 2.25 and 2.05 respectively, VC was 2.63 vs. 2.42, 2.54 and 2.54 respectively, TLC was 2.98 vs. 3.03 vs. 3.18 and 3.17 respectively among underweight, overweight, obese and normal weight participants. CONCLUSION We found a significant association between body mass index and pulmonary function parameters. Obesity causes detrimental effects on respiratory system.
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Affiliation(s)
- Urooj Bhatti
- Dr. Urooj Bhatti, Lecturer, Department of Physiology, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, Sindh, Pakistan
| | - Zulfiqar Ali Laghari
- Prof. Dr. Zulfiqar Ali Laghari, PhD. Professor of Physiology, University of Sindh, Jamshoro, Pakistan. Lecturer, Department of Physiology, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, Sindh, Pakistan
| | - Binafsha Manzoor Syed
- Dr. Binafsha Manzoor Syed, MBBS, PhD. Director ORIC Medical Research Centre, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, Sindh, Pakistan
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Applying Positive End-Expiratory Pressure During Mechanical Ventilation Causes Pulmonary Redox Imbalance and Inflammation in Rats. Shock 2019; 50:572-578. [PMID: 29194341 DOI: 10.1097/shk.0000000000001072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Mechanical ventilation (MV) may induce or aggravate lung injury through the production of cytokines, inflammatory infiltration of neutrophils, and changes in the permeability of the alveolar-capillary barrier. The use of positive end-expiratory pressure (PEEP) helps improve gas exchanges avoiding alveolar collapse at the end of expiration. The present study aimed to analyze inflammatory response and redox imbalance in lungs of rats submitted to MV with and without PEEP. METHODS Eighteen Wistar rats were divided into three groups: control (CG), PEEP group (PG), and zero PEEP (ZEEP) group (ZG). PG and ZG were submitted to MV for 60 min with or without PEEP, respectively. Subsequently, the animals were euthanized, and blood, bronchoalveolar lavage fluid, and lungs were collected for analyses. RESULTS The number of neutrophils was higher in PG compared with CG. Leucocyte and neutrophil influx in bronchoalveolar lavage fluid was higher in PG compared with CG. PG showed an increase in alveolar area compared with the other groups. There were increases in the levels of chemokines, CCL3 and CCL5, in PG compared with CG. There were increases in oxidation of lipids and proteins in PG compared with other groups. There were increases in the activity of superoxide dismutase and catalase in PG compared with CG and ZG. However, there was a decrease in the ratio of glutathione to glutathione disulfide in PG compared with other groups. CONCLUSIONS MV with PEEP caused redox imbalance and inflammation in lungs of healthy rats.
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Andersen IG, Holm JC, Homøe P. Impact of weight-loss management on children and adolescents with obesity and obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2019; 123:57-62. [PMID: 31075707 DOI: 10.1016/j.ijporl.2019.04.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 04/17/2019] [Accepted: 04/19/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To evaluate the impact of weight-loss management on obstructive sleep apnea (OSA) in children and adolescents with obesity. We hypothesized that a reduction in the degree of obesity was associated with a reduction in the apnea-hypopnea index (AHI). METHODS OSA (AHI ≥2) was investigated using a type 3 portable sleep device (Nox T3) in children and adolescents aged 7-18 years with overweight or obesity (body mass index standard deviation score (BMI SDS) > 1.28) at enrollment in a chronic care multidisciplinary overweight- and obesity treatment clinic. Individuals with OSA were included prospectively and longitudinally. A follow-up sleep examination was performed after 6 and 12 months from baseline accompanied by anthropometric measurements. RESULTS At baseline, 62 children with OSA were included (median age = 13.4 years, median BMI SDS = 3.16). A total of 55 out of 62 children (89%) attended the first follow-up, and 29 out of 34 children (85%) with residual OSA attended the second follow-up. By the end of the study, the AHI was normalized in 27 out of 62 children (44%). In a multiple linear regression analysis, the decrease in BMI SDS was associated with the decrease in AHI upon the first follow-up (p = 0.02) independently of sex; age; baseline puberty stage; baseline tonsillar hypertrophy; baseline AHI; baseline BMI SDS; and time to follow-up. There was no association between change in BMI SDS and change in AHI from the first to the second follow-up (p = 0.81). CONCLUSIONS OSA improved during obesity treatment, and the reduction in BMI SDS was significantly associated with the reduction in AHI after approximately six months of treatment. This indicates that obesity treatment should be considered among the first-line treatments of OSA in children and adolescents affected by overweight or obesity.
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Affiliation(s)
- Ida Gillberg Andersen
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Lykkebækvej 1, 4600, Køge, Denmark; The Children's Obesity Clinic, Department of Pediatrics, Holbæk University Hospital, Smedelundsgade 60, 4300, Holbæk, Denmark.
| | - Jens-Christian Holm
- The Children's Obesity Clinic, Department of Pediatrics, Holbæk University Hospital, Smedelundsgade 60, 4300, Holbæk, Denmark; The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Blegdamsvej 3A, 2200, Copenhagen, Denmark.
| | - Preben Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Lykkebækvej 1, 4600, Køge, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.
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Huang L, Ye Z, Lu J, Kong C, Zhu Q, Huang B, Wang Z, Xu L, Deng Q, Gong J, Liu P. Effects of fat distribution on lung function in young adults. J Physiol Anthropol 2019; 38:7. [PMID: 31234934 PMCID: PMC6591837 DOI: 10.1186/s40101-019-0198-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 05/23/2019] [Indexed: 02/08/2023] Open
Abstract
Aims To study the associations between fat distribution and lung functions in healthy subjects of young adults and to explore potential gender difference in these correlations. Methods A total of 2101 adult participants were recruited. Height, weight, and vital capacity index (VCI) were measured and recorded according to the national physical fitness test standard. Body compositions, including body mass index (BMI), body fat percentage (BFP), waist-to-hip ratio (WHR), fat-free mass (FFM), trunk muscle mass (TMM), fat mass (FM), visceral fat area (VFA), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT), were conducted using body composition analyzer. Data were analyzed by SPSS 20.0 software. Results We found that male participants showed significantly higher BMI, WHR, FFM, TMM, VFA, and VCI, but lower FM, BFP, and SAT in comparison with women. However, there was no significant difference in VAT between the male and female. Lung functions represented by VCI were negatively correlated with FM, VAT, SAT, and VFA for both men and women (r < 0; P < 0.05). Among these negative correlations, VCI was more inversely correlated with VFA for men but with SAT for women, respectively. After dividing the whole populations by BMI, BFP, and WHR, further correlation analysis showed VCI was still more negatively correlated with VFA for all male subgroups (r < 0; P < 0.05). On the contrary, VCI was more negatively correlated with SAT in BMI-underweight, BMI-normal, BFP-low fat, BFP-normal fat, WHR-normal, and WHR-obese subgroups (r < 0; P < 0.05), while VFA and VAT was more inversely correlated with VCI in BMI- and BFP-overweight+obese subgroups (r < 0; P < 0.05). Conclusions Fat accumulation is highly associated with the vital capacity index in young adults. In general, VCI was more negatively correlated with VFA for men but with SAT for women, respectively, in comparison with other tested indices.
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Affiliation(s)
- Liqian Huang
- Department of Anatomy, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Ziliang Ye
- Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Jingjing Lu
- Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Cunqing Kong
- Department of Anatomy, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Qingqing Zhu
- Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Binbin Huang
- Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Zerong Wang
- Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Lin Xu
- Department of Anatomy, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Qiongying Deng
- Department of Anatomy, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Jiangu Gong
- Department of Anatomy, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Peng Liu
- Department of Anatomy, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China.
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Abstract
PURPOSE OF REVIEW Sarcoidosis is a multisystem disease of unknown cause. Obesity can affect many physiological factors. The relationship between obesity and sarcoidosis is unclear, and can been described as posing a 'chicken and egg' scenario for the patient as it is not always clear whether it is a consequence of, or a risk factor for any disease. The purpose of this review is to examine the dual roles of obesity on sarcoidosis morbidity and the incidence. RECENT FINDINGS Obesity magnifies the symptoms of sarcoidosis and corticosteroid therapy increases BMI. Prospective epidemiologic studies started to explore the role of obesity as a potential risk factor for sarcoidosis. Three studies in the United States, and one study in Denmark, have demonstrated significantly increased risks of sarcoidosis among obese compared with nonobese patients; risk estimates ranged from 1.42 [95% confidence interval (CI), 1.07-1.89] to 3.59 (95% CI, 2.31-5.57). SUMMARY Obesity can be both a consequence of sarcoidosis treatment, and a contributor to disease risk likely through the pro-inflammatory environment of obesity. Prospective epidemiologic cohort studies are needed to explore the cause of sarcoidosis and insight into possible avenues of treatment development and prevention.
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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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