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Molina-Gallardo R, Aurelien-Cabezas NS, Tiburcio-Jimenez D, Plata-Florenzano JE, Guzman-Esquivel J, Rodriguez-Sanchez IP, Martinez-Fierro ML, Molina-Osorio R, De-la-Madrid-Cernas AA, Barriguete-Melendez JA, Delgado-Enciso I. Traditional Cardiovascular Risk Factors Associated with Diagonal Earlobe Crease (Frank Sign) in Mexican Adults: Aging, Obesity, Arterial Hypertension, and Being Male Are the Most Important. Int J Hypertens 2024; 2024:5598134. [PMID: 38948003 PMCID: PMC11213639 DOI: 10.1155/2024/5598134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/29/2024] [Accepted: 06/10/2024] [Indexed: 07/02/2024] Open
Abstract
Introduction Cardiovascular risk factors such as obesity, type 2 diabetes, hypertension, smoking, and dyslipidemia enfold heart disease morbimortality. Diagonal earlobe crease has been proposed as a prognostic marker of extension and severity of illness in patients with acute coronary syndrome. But its usefulness remains unclear in patients with or without coronary disease. Methods A case-control study was carried out on a total of 805 patients with and without cardiovascular risk factors or acute coronary syndrome. Univariate and multivariate binary logistic regression analyses were used to determine the probability of having diagonal earlobe crease with the presence of cardiovascular risk factors and acute coronary syndrome. Data were summarized as odds ratio with 95% confidence intervals and P values. Results An unadjusted (univariate) analysis showed that being male, being older than 55 years, obesity, type 2 diabetes mellitus, arterial hypertension, smoking, and dyslipidemia, as well as having acute coronary syndrome, were associated with the presence of diagonal earlobe crease. The multivariate analysis showed that men (OR 1.6, 95% IC 1.1-2.4, P=0.007), being over 55 years old (OR 4.8, 95% IC 3.2-7.2, P < 0.001), being obese (OR 2.1, 95% IC 1.4-3.1, P < 0.001), having arterial hypertension (1.5, 95% IC 1.1-2.3, P=0.025), or suffering from acute coronary syndrome (OR 5.3, 95% IC 2.5-11.1, P < 0.001), were independent factors associated with diagonal earlobe crease. The rest of cardiovascular risk factors were not relevant in the multivariate model. Conclusions In Mexican adults, having an acute coronary syndrome is not the only factor associated with diagonal earlobe crease but also being a man, older than 55 years, having high blood pressure and obesity. Diagonal earlobe crease may simply be caused by changes in the skin and connective tissues of the ears because of the aging process, obesity, and/or being male. These factors, by themselves, enfold cardiovascular risk due to well-known pathophysiological causes.
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Affiliation(s)
- Rogelio Molina-Gallardo
- Facultad de Medicina, Universidad de Colima, Colima, 28040, Mexico
- Instituto Mexicano del Seguro Social, Delegación Colima, Villa de Álvarez, Colima, 28983, Mexico
| | | | | | | | - Jose Guzman-Esquivel
- Instituto Mexicano del Seguro Social, Delegación Colima, Villa de Álvarez, Colima, 28983, Mexico
| | - Iram P. Rodriguez-Sanchez
- Laboratorio de Fisiología Molecular y Estructural, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, San Nicolás de los Garza, 66455, Nuevo León, Mexico
| | | | - Roque Molina-Osorio
- Instituto Mexicano del Seguro Social, Delegación Colima, Villa de Álvarez, Colima, 28983, Mexico
| | | | | | - Ivan Delgado-Enciso
- Facultad de Medicina, Universidad de Colima, Colima, 28040, Mexico
- Instituto Estatal de Cancerología, IMSS-Bienestar Colima, Colima, 28085, Mexico
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Arora L, Sharma S, Carillo JF. Obesity and anesthesia. Curr Opin Anaesthesiol 2024; 37:299-307. [PMID: 38573180 DOI: 10.1097/aco.0000000000001377] [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: 04/05/2024]
Abstract
PURPOSE OF REVIEW Surgical procedures on obese patients are dramatically increasing worldwide over the past few years. In this review, we discuss the physiopathology of predominantly respiratory system in obese patients, the importance of preoperative evaluation, preoxygenation and intraoperative positive end expiratory pressure (PEEP) titration to prevent pulmonary complications and the optimization of airway management and oxygenation to reduce or prevent postoperative respiratory complications. RECENT FINDINGS Many patients are coming to preoperative clinic with medication history of glucagon-like-peptide 1 agonists ( GLP-1) agonists and it has raised many questions regarding Nil Per Os (NPO)/perioperative fasting guidelines due to delayed gastric emptying caused by these medications. American Society of Anesthesiologists (ASA) has come up with guiding document to help with such situations. Ambulatory surgery centers are doing more obesity cases in a safe manner which were deemed unsafe at one point . Quantitative train of four (TOF) monitoring, better neuromuscular reversal agents and gastric ultrasounds seemed to have made a significant impact in the care of obese patients in the perioperative period. SUMMARY Obese patients are at higher risk of perioperative complications, mainly associated with those related to the respiratory function. An appropriate preoperative evaluation, intraoperative management, and postoperative support and monitoring is essential to improve outcome and increase the safety of the surgical procedure.
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Affiliation(s)
- Lovkesh Arora
- Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Bines K, Strehlow E, Gray E, Nettnin E, Stoff L, Rafferty MR. Mobility and self-care outcomes in patients with a bariatric comorbidity during inpatient rehabilitation. PM R 2024; 16:426-433. [PMID: 37817058 DOI: 10.1002/pmrj.13079] [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: 12/22/2022] [Revised: 07/31/2023] [Accepted: 09/17/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVE First, we describe the characteristics and functional outcomes of obese and bariatric patients in an inpatient rehabilitation facility (IRF). Second, we assessed differences in functional outcomes for bariatric, obese, and standard weight body mass index (BMI) groups. Third, we explored whether these characteristics differ between time periods and diagnostic groups. DESIGN A retrospective study comparing electronic medical record data collected in 2016 and 2018, using a repeated cross-sectional cohort design. SETTING IRF. PARTICIPANTS Individuals ≥18 years of age diagnosed with brain injury, medical complexity, general neurology, orthopedic, spinal cord injury (SCI), and stroke. Participants grouped as standard (BMI <30 kg/m2), obese (BMI 30-39 kg/m2), and bariatric (BMI ≥40 kg/m2) weights. (N = 2015 in 2016, N = 2768 in 2018.) INTERVENTIONS: Patients received standard inpatient rehabilitation. In 2018, clinicians had access to new weight-appropriate equipment. MAIN OUTCOME MEASURES Discharge destination; length of stay (LOS) by BMI group and medical diagnoses; item-specific functional independence measure (FIM) change scores. RESULTS Sixty-four percent to 67% of all BMI groups achieved a home discharge. The bariatric BMI group had a longer LOS (21 days) than the standard or obese groups. There was a significant interaction in a linear regression analysis between diagnosis and LOS, where LOS was longer in medically complex patients with bariatric BMI (19.3 days compared to 16.1 days) but shorter in bariatric patients with SCI (20.6 days) compared to standard weight patients (26.2 days). In 2018, the bariatric BMI group had greater average FIM change scores for bathing, lower body dressing, toilet transfers, and bed transfers. CONCLUSIONS Patient BMI is associated with LOS in the IRF, although affected by diagnosis. Patients with higher BMIs can make changes in specific individual motor FIM items. For patients with bariatric BMIs, FIM change scores were higher in 2018, possibly due to the use of equipment and facilities designed for higher weight capacities.
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Affiliation(s)
- Kelcey Bines
- Shirley Ryan Ability Lab, Chicago, United States
| | | | - Elizabeth Gray
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Ella Nettnin
- Shirley Ryan Ability Lab, Chicago, United States
| | - Laura Stoff
- Shirley Ryan Ability Lab, Chicago, United States
| | - Miriam R Rafferty
- Shirley Ryan Ability Lab, Chicago, United States
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, United States
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, United States
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Shah SA, Khan NA, Qureshi FG. Metabolic and Bariatric Surgery in Children: Current Practices and Outcomes. Curr Obes Rep 2024; 13:77-86. [PMID: 38172474 DOI: 10.1007/s13679-023-00540-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW This review will examine the most current evidence for Metabolic and Bariatric Surgery (MBS) in the pediatric population, specifically in terms of weight loss outcomes and improvement in comorbid conditions and complications. Additionally, we compare surgical and non-surgical interventions, review current guidelines, and propose a stepwise evidence-based approach to the management of obesity in children. RECENT FINDINGS MBS is a safe option for appropriately selected pediatric patients which leads to significant and sustained weight loss. This weight loss is associated with improvement of related comorbid conditions. Laparoscopic sleeve gastrectomy (LSG) has emerged as the procedure of choice with a better safety profile. Despite the evidence, very few adolescents undergo MBS. New pharmacologic agents specifically the GLP-1/GIP agents have shown early promise especially in patients under body mass index 40, but the long-term effects are unknown. MBS is an effective tool in the management of pediatric obesity, and its use has been recommended by professional societies. Early referral to a multidisciplinary obesity team can help identify appropriate patients.
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Affiliation(s)
| | - Noor A Khan
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Mercy Hospital, Pittsburgh, PA, USA
| | - Faisal G Qureshi
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center and, Children's Medical Center Dallas, 1935 Medical District Drive, D2000, Dallas, TX, 75235, USA.
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Burnett AF, Pitman TC, Baekelandt JF. vNOTES (vaginal natural orifice transluminal surgery) gynecologic procedures in morbidly and super-morbidly obese women: five year experience. Arch Gynecol Obstet 2024; 309:565-570. [PMID: 37880384 DOI: 10.1007/s00404-023-07250-y] [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: 05/15/2023] [Accepted: 10/01/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE To analyze our experience with vNOTES gynecologic procedures in women with morbid and super morbid obesity to determine feasibility and compare outcomes with standard minimally invasive techniques. METHODS Gynecologic procedures performed by three surgeons on women with a body mass index (BMI) ≥ 40 kg/m2 from 2017 to 2023. A subset of women with a BMI ≥ 50 kg/m2 was also analyzed. RESULTS 103 women with a BMI ≥ 40 kg/m2 were identified (Class IV), 19 of whom had a BMI ≥ 50 kg/m2 (Class V). For the entire population the mean BMI was 45.7 kg/m2 (40-62). 29 women were nulliparous and 23 had at least one prior cesarean delivery. 51 had no prior abdominal surgery. The procedures performed were hysterectomy and removal of adnexae in 77 patients, hysterectomy alone in six, adnexal surgery alone in nine, and hysterectomy with adnexectomy and lymph nodes in five. Two surgeries were converted to laparoscopy and five to laparotomy. Average surgical time was 87 min (30-232). Average blood loss was 82 mL (10-400). Mean uterine weight was 206 g (29-2890). 53 procedures were performed as outpatient, 44 had overnight observation, four had a length of stay of 2 days, one each for 4 days and 5 days. The laparoscopies occurred in one patient with an obliterated cul-de-sac and in one patient for lymph node removal. The laparotomies occurred for adnexal adhesions in one, bleeding in two, a cystotomy in one requiring urology consultation, and an obliterated cul-de-sac One patient developed a postoperative vaginal cuff hematoma not requiring intervention. CONCLUSION vNOTES gynecologic procedures are feasible in this high-risk population and may result in shorter recovery times and fewer complications than standard laparoscopy or transvaginal surgery. What does this study add to the clinical work: VNOTES approach is feasible in morbidly obese women and may have distinct advantages over conventional laparoscopic, vaginal or open techniques.
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Affiliation(s)
- Alexander F Burnett
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 793, Little Rock, Arkansas, 72205, USA.
| | - Thomas C Pitman
- Baptist Medical Group Desoto Women's Consultants, Core Faculty, Baptist Memorial Hospital OB/GYN, Residency, Memphis, TN, USA
| | - Jan F Baekelandt
- Division of Gynecologic Oncology, Imelda Hospital, Bonheiden, Belgium
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Schulmeyer MCC, Lazo CP. Transthoracic Echocardiography Is Possible in Morbidly Obese Patients During Bariatric Surgery. Obes Surg 2024; 34:128-132. [PMID: 37999890 DOI: 10.1007/s11695-023-06941-4] [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: 07/10/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND To evaluate the feasibility of an abbreviated focus-assessed transthoracic echocardiography protocol in morbidly obese patients. The purpose of this study was to evaluate whether good images could be obtained from this particularly difficult group of patients for whom acoustic imaging is often poor. Heart imaging could be helpful for cardiopulmonary screening and real-time monitoring. METHODS The study included 186 morbidly obese patients, who underwent laparoscopic bariatric surgery. The mean patient age was 32 years (range 21-52), and there were 95 males. The parasternal long and short axes and apical 4 and 5 chambers were evaluated. RESULTS In 95% of the patients, at least one view was obtained. In 78%, two views were obtained, and in 31% of the patients, all views and measurements could be performed. CONCLUSION In obese patients, a modified focused echocardiography examination performed by anesthesiologists in the intraoperative period of morbid obese patients is feasible. The image quality was sufficient to undergo interpretation.
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Azizad O, Joshi GP. Day-surgery adult patients with obesity and obstructive sleep apnea: Current controversies and concerns. Best Pract Res Clin Anaesthesiol 2023; 37:317-330. [PMID: 37938079 DOI: 10.1016/j.bpa.2022.11.004] [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: 10/13/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022]
Abstract
Obesity and obstructive sleep apnea are considered independent risk factors that can adversely affect perioperative outcomes. A combination of these two conditions in the ambulatory surgery patient can pose significant challenges for the anesthesiologist. Nevertheless, these patients should not routinely be denied access to ambulatory surgery. Instead, patients should be appropriately optimized. Anesthesiologists and surgeons must work together to implement fast-track anesthetic and surgical techniques that will ensure successful ambulatory outcomes.
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Affiliation(s)
- Omaira Azizad
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Girish P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Moreira SMBP, Bachi ALL, Jirjos EI, Malheiros CA, Vencio S, Alves VLS, Sousa ART, Felipe LA, Perez EA, Lino MEM, Souza SKA, Santos JMB, Oliveira MC, Fonseca AL, Silva CHM, Vieira RP, Insalaco G, Freitas Júnior WR, Oliveira LVF. Roux-en-Y Gastric Bypass Improves Adiponectin to Leptin Ratio and Inflammatory Profile in Severely Obese Women with and without Metabolic Syndrome: A Randomized Controlled Trial. Nutrients 2023; 15:3312. [PMID: 37571250 PMCID: PMC10421521 DOI: 10.3390/nu15153312] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
Obesity is a troubling public health problem as it increases risks of sleep disorders, respiratory complications, systemic arterial hypertension, cardiovascular diseases, type 2 diabetes mellitus, and metabolic syndrome (MetS). As a measure to counteract comorbidities associated with severe obesity, bariatric surgery stands out. This study aimed to investigate the adiponectin/leptin ratio in women with severe obesity with and without MetS who had undergone Roux-en-Y gastric bypass (RYGB) and to characterize the biochemical, glucose, and inflammatory parameters of blood in women with severe obesity before and after RYGB. Were enrolled females with severe obesity undergoing RYGP with MetS (n = 11) and without (n = 39). Anthropometric data and circulating levels of glucose, total cholesterol, high-density lipoprotein (HDL), non-HDL total cholesterol, low-density lipoprotein (LDL), adiponectin, and leptin were assessed before and 6 months after RYGB. Significant reductions in weight, body mass index, and glucose, total cholesterol, LDL, and leptin were observed after surgery, with higher levels of HDL, adiponectin, and adiponectin/leptin ratio being observed after surgery compared to the preoperative values of those. This study demonstrated that weight loss induced by RYGB in patients with severe obesity with or without MetS improved biochemical and systemic inflammatory parameters, particularly the adiponectin/leptin ratio.
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Affiliation(s)
- Sandra M. B. P. Moreira
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
| | - André L. L. Bachi
- Post-Graduation Program in Health Sciences, Santo Amaro University (UNISA), São Paulo 04829-300, SP, Brazil;
| | - Elias I. Jirjos
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
| | - Carlos A. Malheiros
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
| | - Sergio Vencio
- Institute of Pharmaceutical Sciences, Goiania 74175-100, GO, Brazil;
| | - Vera L. S. Alves
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
| | - Alan R. T. Sousa
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
| | - Lucenda A. Felipe
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
| | - Eduardo A. Perez
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
| | - Maria E. M. Lino
- Scientific Initiation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis 75083-515, GO, Brazil; (M.E.M.L.); (S.K.A.S.)
| | - Shayra K. A. Souza
- Scientific Initiation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis 75083-515, GO, Brazil; (M.E.M.L.); (S.K.A.S.)
| | - Juliana M. B. Santos
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo 05360-000, SP, Brazil;
| | - Miriã C. Oliveira
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis 75083-515, GO, Brazil; (M.C.O.); (A.L.F.); (C.H.M.S.); (R.P.V.)
| | - Adriano L. Fonseca
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis 75083-515, GO, Brazil; (M.C.O.); (A.L.F.); (C.H.M.S.); (R.P.V.)
| | - Carlos H. M. Silva
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis 75083-515, GO, Brazil; (M.C.O.); (A.L.F.); (C.H.M.S.); (R.P.V.)
| | - Rodolfo P. Vieira
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis 75083-515, GO, Brazil; (M.C.O.); (A.L.F.); (C.H.M.S.); (R.P.V.)
| | - Giuseppe Insalaco
- Institute of Translational Pharmacology, National Research Council of Italy (CNR), 90146 Palermo, Italy;
| | - Wilson R. Freitas Júnior
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
| | - Luis V. F. Oliveira
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis 75083-515, GO, Brazil; (M.C.O.); (A.L.F.); (C.H.M.S.); (R.P.V.)
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Sobolewska-Nowak J, Wachowska K, Nowak A, Orzechowska A, Szulc A, Płaza O, Gałecki P. Exploring the Heart-Mind Connection: Unraveling the Shared Pathways between Depression and Cardiovascular Diseases. Biomedicines 2023; 11:1903. [PMID: 37509542 PMCID: PMC10377477 DOI: 10.3390/biomedicines11071903] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/11/2023] [Accepted: 06/15/2023] [Indexed: 07/30/2023] Open
Abstract
Civilization diseases are defined as non-communicable diseases that affect a large part of the population. Examples of such diseases are depression and cardiovascular disease. Importantly, the World Health Organization warns against an increase in both of these. This narrative review aims to summarize the available information on measurable risk factors for CVD and depression based on the existing literature. The paper reviews the epidemiology and main risk factors for the coexistence of depression and cardiovascular disease. The authors emphasize that there is evidence of a link between depression and cardiovascular disease. Here, we highlight common risk factors for depression and cardiovascular disease, including obesity, diabetes, and physical inactivity, as well as the importance of the prevention and treatment of CVD in preventing depression and other mental disorders. Conversely, effective treatment of CVD can also help prevent depression and improve mental health outcomes. It seems advisable to introduce screening tests for depression in patients treated for cardiac reasons. Importantly, in patients treated for mood disorders, it is worth controlling CVD risk factors, for example, by checking blood pressure and pulse during routine visits. It is also worth paying attention to the mental condition of patients with CVD. This study underlines the importance of interdisciplinary co-operation.
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Affiliation(s)
| | - Katarzyna Wachowska
- Department of Adult Psychiatry, Medical Univeristy of Lodz, 90-419 Lodz, Poland
| | - Artur Nowak
- Department of Immunopathology, Medical Univeristy of Lodz, 90-419 Lodz, Poland
| | - Agata Orzechowska
- Department of Adult Psychiatry, Medical Univeristy of Lodz, 90-419 Lodz, Poland
| | - Agata Szulc
- Psychiatric Clinic of the Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Olga Płaza
- Psychiatric Clinic of the Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Piotr Gałecki
- Department of Adult Psychiatry, Medical Univeristy of Lodz, 90-419 Lodz, Poland
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Waheed Z, Amatul-Hadi F, Kooner A, Afzal M, Ahmed R, Pande H, Alfaro M, Lee A, Bhatti J. General Anesthetic Care of Obese Patients Undergoing Surgery: A Review of Current Anesthetic Considerations and Recent Advances. Cureus 2023; 15:e41565. [PMID: 37554600 PMCID: PMC10405976 DOI: 10.7759/cureus.41565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2023] [Indexed: 08/10/2023] Open
Abstract
Obesity has long been linked to adverse health effects over time. As the prevalence of obesity continues to rise, it is important to anticipate and minimize the complications that obesity brings in the anesthesia setting during surgery. Anesthetic departments must recognize the innumerable risks when managing patients with obesity undergoing surgery, including anatomical and physiological changes as well as comorbidities such as diabetes, cardiovascular diseases, and malignancies. Therefore, the purpose of this review is to analyze the current literature and evaluate the current and recent advances in anesthetic care of obese patients undergoing surgery, to better understand the specific challenges this patient population faces. A greater understanding of the differences between anesthetic care for obese patients can help to improve patient care and the specificity of treatment. The examination of the literature will focus on differing patient outcomes and safety precautions in obese patients as compared to the general population. Specifically highlighting the differences in pre-operative, intra-operative, and post-operative care, with the aim to identify issues and present possible solutions.
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Affiliation(s)
- Zahra Waheed
- Anesthesia, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | | | - Amritpal Kooner
- Medical School, Midwestern University Chicago College of Osteopathic Medicine, Downers Grove, USA
| | - Muhammad Afzal
- Medical School, St. George's University School of Medicine, True Blue, GRD
| | - Rahma Ahmed
- Medical School, Kennesaw State University, Kennesaw, USA
| | | | - Moses Alfaro
- Medical School, Long School of Medicine at University of Texas Health Science Center San Antonio, San Antonio, USA
| | - Amber Lee
- Medical School, Arkansas College of Osteopathic Medicine, Fort Smith, USA
| | - Joravar Bhatti
- Medical School, Midwestern University Chicago College of Osteopathic Medicine, Downers Grove, USA
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Vibarel-Rebot N, Asselin M, Amiot V, Collomp K. Short-Term Effect of Bariatric Surgery on Cardiorespiratory Response at Submaximal, Ventilatory Threshold, and Maximal Exercise in Women with Severe Obesity. Obes Surg 2023; 33:1528-1535. [PMID: 36952099 DOI: 10.1007/s11695-023-06550-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE People with obesity have varying degrees of cardiovascular, pulmonary, and musculoskeletal dysfunction that affect aerobic exercise testing variables. Short time after bariatric surgery, these dysfunctions could affect both peak oxygen consumption ([Formula: see text] O2 peak), the gold standard for assessing cardiorespiratory fitness (CRF) and aerobic capacity evaluated with ventilatory threshold (VT1). The purpose of this study was to evaluate the short-term effect of bariatric surgery, i.e. before the resumption of physical activity, on submaximal, at VT1 and maximal cardiorespiratory responses in middle-aged women with severe obesity. MATERIALS AND METHODS Thirteen middle-aged women with severe obesity (age: 36.7 ± 2.3 years; weight: 110.5 ± 3.6 kg, BMI: 41.8 ± 1.1 kg/m2) awaiting bariatric surgery participated in the study. Four weeks before and 6 to 8 weeks after surgery, body composition was determined by bioelectrical impedance. The participants performed an incremental cycling test to [Formula: see text] O2 peak. RESULTS After bariatric surgery, all body composition parameters were reduced, absolute [Formula: see text] O2 peak and peak workload decline with a lower VT1. Relative [Formula: see text] O2 at peak and at VT1 (ml/min/kg or ml/min/kg of FFM) remained unchanged. Ventilation was lower after bariatric surgery during exercise with no change in cardiac response. CONCLUSION Our results showed that weight loss alone at short-term after bariatric surgery decreased CRF as seen by a decrease in absolute [Formula: see text] O2 peak, and peak workload with lower VT1, whereas relative [Formula: see text] O2 (ml/min/kg or ml/min/kg of FFM) during exercise remained unchanged in women with obesity. Rapid FFM loss affects cardiorespiratory responses at submaximal and maximal.
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Affiliation(s)
- Nancy Vibarel-Rebot
- CIAMS, EA 4532, Université Orléans, Orléans, France.
- CIAMS, EA 4532, Université Paris-Saclay, Orsay, France.
- Research Group Sport, Physical Activity, Rehabilitation and Movement for Performance and Health, University of Orleans, Orléans, France.
| | - Marine Asselin
- CIAMS, EA 4532, Université Orléans, Orléans, France
- CIAMS, EA 4532, Université Paris-Saclay, Orsay, France
| | - Virgile Amiot
- Research Group Sport, Physical Activity, Rehabilitation and Movement for Performance and Health, University of Orleans, Orléans, France
- Service de Médecine du Sport, CHR Orléans, 45067, Orléans, France
| | - Katia Collomp
- CIAMS, EA 4532, Université Orléans, Orléans, France
- CIAMS, EA 4532, Université Paris-Saclay, Orsay, France
- Research Group Sport, Physical Activity, Rehabilitation and Movement for Performance and Health, University of Orleans, Orléans, France
- Laboratoire AntiDopage Français, LADF, Université Paris-Saclay, Chatenay-Malabry, France
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12
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Huh Y, Kim SH, Nam GE, Park HS. Weight Gain, Comorbidities, and Its Associated Factors Among Korean Adults. J Korean Med Sci 2023; 38:e90. [PMID: 36974399 PMCID: PMC10042724 DOI: 10.3346/jkms.2023.38.e90] [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] [Received: 08/16/2022] [Accepted: 12/21/2022] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Weight gain in adults is associated with an increased risk of obesity-related diseases and high healthcare costs. However, there have been limited studies on weight gain in Asians. This study investigated the prevalence, comorbidities, and associated factors of weight gain in the Korean population. METHODS This is a cross-sectional study of Korean adults aged 19-64 years who participated in the Korea National Health and Nutritional Examination Survey 2016-2019. We used data from 15,514 adults (subjects 1) to analyze the prevalence of weight gain. Finally, after excluding adults with suspicious debilitating conditions among them, 11,477 adults (subjects 2) were used to analyze comorbidities and associated factors. Weight changes and lifestyle factors were assessed using a self-report questionnaire. We analyzed odds ratios and 95% confidence intervals using multivariable logistic regression analysis to examine factors associated with weight gain. RESULTS The overall prevalence of weight gain was 25.7% in men and 31.3% in women and decreased significantly with age in both sexes. Weight gain of ≥ 6 kg was evident in 10.5% of men and 9.8% of women and was more pronounced with a higher baseline body mass index (BMI). Most metabolic comorbidities worsened the greater the weight gain. Young age was the strongest associated factor for weight gain. Other factors associated with weight gain were being unmarried, blue-collar job, lower income, and alcohol consumption in men; being married in women; smoking and skipping breakfast in both sexes. CONCLUSION Weight gain was much more pronounced in younger adults and at a higher baseline BMI in both sexes. Public education and health policies to prevent unnecessary weight gain should be strengthened by considering the associated harmful factors in Korean adults.
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Affiliation(s)
- Youn Huh
- Department of Family Medicine, Uijeongbu Eulji Medical Center, Eulji Unversity, Uijeongbu, Korea
| | - Seung Hee Kim
- Department of Family Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea
- Department of Medicine, University of Ulsan College of Medicine, Ulsan, Korea
| | - Ga Eun Nam
- Department of Family Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hye Soon Park
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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13
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Deficiency of Adipose Triglyceride Lipase Induces Metabolic Syndrome and Cardiomyopathy in Zebrafish. Int J Mol Sci 2022; 24:ijms24010117. [PMID: 36613558 PMCID: PMC9820674 DOI: 10.3390/ijms24010117] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Lipid metabolism dysfunction is related to clinical disorders including obesity, cancer, liver steatosis, and cardiomyopathy. Impaired lipolytic enzymes result in altered release of free fatty acids. The dramatic change in dyslipidemia is important in lipotoxic cardiomyopathy. Adipose triglyceride lipase (ATGL) catalyzes the lipolysis of triacylglycerol to reduce intramyocardial triglyceride levels in the heart and improve myocardial function. We examined the role of ATGL in metabolic cardiomyopathy by developing an Atgl knockout (ALKO) zebrafish model of metabolic cardiomyopathy disease by continuously expressing CRISPR/Cas9 protein and atgl gene guide RNAs (gRNAs). The expressed Cas9 protein bound to four gRNAs targeting the atgl gene locus, facilitating systemic gene KO. Ablation of Atgl interfered with lipid metabolism, which induced hyperlipidemia and hyperglycemia. ALKO adults and embryos displayed hypertrophic hearts. ALKO presented a typical dilated cardiomyopathy profile with a remarkable reduction in four sarcomere genes (myosin heavy chain 7-like, actin alpha cardiac muscle 1b, myosin binding protein C3, and troponin T type 2a) and two Ca2+ handling regulator genes (tropomyosin 4b and ATPase sarcoplasmic/endoplasmic reticulum Ca2+ transporting 2b). Immune cell infiltration in cardiac tissue of ALKO provided direct evidence of advanced metabolic cardiomyopathy. The presently described model could become a powerful tool to clarify the underlying mechanism between metabolic disorders and cardiomyopathies.
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14
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Efficacy of Bariatric Surgery in COVID-19 Patients: An Updated Systematic Review and Meta-Analysis. SURGERY IN PRACTICE AND SCIENCE 2022; 11:100140. [PMID: 36337713 PMCID: PMC9616481 DOI: 10.1016/j.sipas.2022.100140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Obesity is linked with poor prognostic outcomes in patients with SARS-CoV-2 infection. In patients with BMI>35 kg/m2, increased rates of hospital and subsequently ICU admissions have been noted. Bariatric surgery resulting in sustained weight loss is hypothesized to decrease the morbid outcomes associated with COVID. In this review, we planned to update the evidence on the topic presented by Aminian et al. Methods An extensive literature search was conducted of the electronic databases. Screening of the articles based on the eligibility criteria was followed by relevant data extraction. Other than the articles used in the previous meta-analysis, relevant databases were searched to filter for any new articles. Initially, two independent reviewers screened Pubmed and Cochrane database followed by a thorough search of additional databases such as Google scholar and Medrxiv. The articles were first screened using title and abstract, followed by a full text read. Duplicates, meta-analysis, letter to the editors, and commentaries were excluded. No language restrictions were placed. Results A total of nine articles with a population of 1,130,341 were entered into the RevMan. Patients with bariatric surgery were significantly associated with decreased hospitalizations (OR: 0.52, 95% CI [0.45, 0.61]), less likely to be admitted to the ICU (OR: 0.44, 95% CI [0.29,0.67]), and reported reduced overall mortality (OR: 0.42, 95% CI [0.25, 0.70]). Conclusion Surgically induced weight loss is more beneficial in reducing the morbidity and mortality burden of COVID-19. More studies are needed to stratify the effect of demographics and metabolic profiles on disease progression.
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15
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Pan X, Xing Z, Yang G, Ding N, Zhou Y, Chai X. Obesity Increases In-Hospital Mortality of Acute Type A Aortic Dissection Patients Undergoing Open Surgical Repair: A Retrospective Study in the Chinese Population. Front Cardiovasc Med 2022; 9:899050. [PMID: 35903673 PMCID: PMC9315262 DOI: 10.3389/fcvm.2022.899050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The prevalence of obesity is increasing worldwide, and the role of the obesity paradox in cardiovascular surgery remains controversial. In this study, we redefined obesity according to the Chinese criteria and examined the relationship between obesity and in-hospital mortality in patients with acute type A aortic dissection (AAD) undergoing open surgical repair. Materials and Methods A total of 289 patients with AAD (between 2014 and 2016) were divided into the non-obese group and obese group for correlation analysis, general information, demographic factors, blood biochemistry, surgical details, and complications, which were used as covariates. Survival was estimated by the Kaplan–Meier method, and any differences in survival were evaluated with a stratified log-rank test. Least Absolute Shrinkage and Selection Operator (LASSO) regression and logistic regression were used to evaluate the effect and interaction of obesity on surgical mortality. Results All the 289 patients had a mean age of 48.64 (IQR 44.00–55.00) and 74.39% were men. Of the 289 patients, 228 were non-obese (78.89%) and 61 were obese (21.11%). Patients with obesity were younger and more prone to unstable blood pressure [systolic blood pressure (SBP) and diastolic blood pressure (DBP)], preoperative hypoxemia and delirium, prolonged operative time, and surgical wound deep infection (p < 0.05). In the fully adjusted model, we observed an increased risk of in-hospital mortality in patients with obesity after fine-tuning other covariates including age and sex (HR = 2.65; 95% CI = 1.03 to 6.80; p = 0.042). The interaction suggested that obesity was more likely to cause death in elderly patients (age ≥ 60), although it was more common in younger patients (test for interaction, p = 0.012). Conclusion Obesity, interacting with age, increases the risk of in-hospital mortality in patients with AAD undergoing open surgical repair. Although more verification is needed, we believe these findings provide further evidence for the treatment of AAD.
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Affiliation(s)
- Xiaogao Pan
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhenhua Xing
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Guifang Yang
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Ning Ding
- Emergency Department, Changsha Central Hospital, University of South China, Changsha, China
| | - Yang Zhou
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiangping Chai
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Xiangping Chai,
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16
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Seyni-Boureima R, Zhang Z, Antoine MMLK, Antoine-Frank CD. A review on the anesthetic management of obese patients undergoing surgery. BMC Anesthesiol 2022; 22:98. [PMID: 35382771 PMCID: PMC8985303 DOI: 10.1186/s12871-022-01579-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 01/27/2022] [Indexed: 12/01/2022] Open
Abstract
There has been an observed increase in theprevalence of obesity over the past few decades. The prevalence of anesthesiology related complications is also observed more frequently in obese patients as compared to patients that are not obese. Due to the increased complications that accompany obesity, obese patients are now more often requiring surgical interventions. Therefore, it is important that anesthesiologists be aware of this development and is equipped to manage these patients effectively and appropriately. As a result, this review highlights the effective management of obese patients undergoing surgery focusing on the preoperative, perioperative and postoperative care of these patients.
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Affiliation(s)
- Rimanatou Seyni-Boureima
- Department of Anaesthesiology, Zhongnan Hospital, Wuhan University, East Lake Road, 430071, Wuhan, Hubei, China
| | - Zongze Zhang
- Department of Anaesthesiology, Zhongnan Hospital, Wuhan University, East Lake Road, 430071, Wuhan, Hubei, China.
| | - Malyn M L K Antoine
- Department of Endocrinology, Zhongnan Hospital, Wuhan University, East Lake Road, 430071, Wuhan, Hubei, China
| | - Chrystal D Antoine-Frank
- Department of Anatomical Sciences, St. George's University, True Blue,Grand Anse, West Indies, St. George, Grenada
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17
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Mir IA, Soni R, Srivastav SK, Bhavya I, Dar WQ, Farooq MD, Chawla V, Nadeem M. Obesity as an Important Marker of the COVID-19 Pandemic. Cureus 2022; 14:e21403. [PMID: 35198310 PMCID: PMC8856632 DOI: 10.7759/cureus.21403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 01/15/2023] Open
Abstract
Introduction: In December 2019, the emergence of the new coronavirus disease 2019 (COVID-19) began in Wuhan, China. Thereafter, the disease has been spreading rapidly across the world, with about 300 million registered cases worldwide, and the numbers are also exponentially increasing in India, with about 34 million registered cases by the end of 2021. Among the comorbidities, obesity may increase the risk of hospitalization due to COVID-19 infection as it is related to immune system dysfunction. Since the epidemiological picture of COVID-19 is changing very rapidly. Therefore, it is very important to discuss the pattern of clinical manifestation and association with comorbidities. Hence, we have conducted this observational study in one of the tertiary care centers in North India. Methods and Materials: We conducted a hospital-based prospective observational study in dedicated COVID-19 wards and ICU of a tertiary care center in North India with a sample size of 400 positive patients (males: 260, females: 140). We divided the patients in this study into three different age groups (less than 40 years, 40-60 years, and more than 60 years). The patients with age ≤ 18 years and BMI 18.5 kg/m2 were excluded from the study. Results: Out of these 400 patients, 55 (13.8%) developed severe COVID-19. There was a fewer number of patients who developed severe COVID-19 in the normal and over-weight group. Moreover, obese patients progressed to more severe cases (34.5%). This also shows that after adjusting for age, compared to the normal-weight group, those who were overweight had a 1.48-fold chance of developing severe COVID-19 (OR 1.48, P 0.0455), while those who were obese had a 1.73-fold chance of developing the disease (ORs 1.73, P 5 0.0652). Regarding gender distribution, the association appeared to be stronger in men than in women. After similar adjustment, the ORs for overweight and obese patients compared to normal-weight patients were 1.39 (p 0.5870) and 3.55 (p 0.0113) in females and 1.36 (0.5115) and 6.19 (0.0001) in males, respectively. Conclusion: Our study shows that obese patients with a BMI of greater than or equal to 27.5 are at higher risk of developing COVID-19 severity, especially in the male population. Moreover, severity may be related to other comorbid conditions. However, in our study, patients with chronic obstructive pulmonary disease (COPD) and GI/liver diseases were less obese, and severity was relatively low. So, the conclusion is that obese male patients with comorbidities are more likely to develop severe COVID-19 infection.
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18
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Ayubcha D, Grosh T, Fleisher LA. Perioperative Cardiac Risk Assessment in Noncardiac Surgery. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00005-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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19
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Tabatabai S, Do Q, Min J, Tang CJ, Pleasants D, Sands LP, Du P, Leung JM. Obesity and perioperative outcomes in older surgical patients undergoing elective spine and major arthroplasty surgery. J Clin Anesth 2021; 75:110475. [PMID: 34352602 PMCID: PMC11046412 DOI: 10.1016/j.jclinane.2021.110475] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 11/27/2022]
Abstract
STUDY OBJECTIVE To determine whether obesity status is associated with perioperative complications, discharge outcomes and hospital length of stay in older surgical patients. DESIGN Secondary analysis of five independent study cohorts (N = 1262). SETTING An academic medical center between 2001 and 2017 in the United States. PATIENTS Patients aged 65 years or older who were scheduled to undergo elective spine, knee, or hip surgery with an expected hospital stay of at least 2 days. MEASUREMENTS Body mass index (BMI) was stratified as nonobese (BMI ≤ 30 kg/m2), obesity class 1 (30 kg/m2 ≤ BMI < 35 kg/m2) or obesity class 2-3 (BMI ≥ 35 kg/m2). Primary outcomes included predefined intraoperative and postoperative complications, hospital length of stay (LOS), and discharge location. Univariate and multivariate logistic regression was performed. MAIN RESULTS Obesity status was not associated with intraoperative adverse events. However, obesity class 2-3 significantly increased the risk for postoperative complications (IRR 1.43, 95% CI 1.03-1.95, P = 0.03), hospital LOS (IRR 1.13, 95% CI 1.02-1.25, P = 0.02) and non-home discharge destination (OR 1.95, 95% CI 1.35-2.81, P < 0.001) after accounting for patient related factors and surgery type. CONCLUSIONS Obesity class 2-3 status has prognostic value in predicting an increased incidence of postoperative complications, increased hospital LOS, and non-home discharge location. These results have important clinical implications for preoperative informed consent and provide areas to target for care improvement for the older obese individual.
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Affiliation(s)
- Sanam Tabatabai
- University of California, Department of Anesthesia & Perioperative Care, San Francisco, CA, United States of America
| | - Quyen Do
- Virginia Tech, Center for Gerontology and Department of Statistics, Blacksburg, VA, United States of America
| | - Jie Min
- Virginia Tech, Center for Gerontology and Department of Statistics, Blacksburg, VA, United States of America
| | - Christopher J Tang
- University of California, Department of Anesthesia & Perioperative Care, San Francisco, CA, United States of America
| | - Devon Pleasants
- University of California, Department of Anesthesia & Perioperative Care, San Francisco, CA, United States of America
| | - Laura P Sands
- Virginia Tech, Center for Gerontology and Department of Statistics, Blacksburg, VA, United States of America
| | - Pang Du
- Virginia Tech, Center for Gerontology and Department of Statistics, Blacksburg, VA, United States of America
| | - Jacqueline M Leung
- University of California, Department of Anesthesia & Perioperative Care, San Francisco, CA, United States of America.
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20
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Longhi R, Santos ASEADC, López-Yerena A, Rodrigues APS, de Oliveira C, Silveira EA. The Effectiveness of Extra Virgin Olive Oil and the Traditional Brazilian Diet in Reducing the Inflammatory Profile of Individuals with Severe Obesity: A Randomized Clinical Trial. Nutrients 2021; 13:4139. [PMID: 34836393 PMCID: PMC8624522 DOI: 10.3390/nu13114139] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 12/26/2022] Open
Abstract
We analyzed the effectiveness of two nutritional interventions alone and together, EVOO and the DieTBra, on the inflammatory profile of severely obese individuals. This study was an RCT with 149 individuals aged from 18 to 65 years, with a body mass index ≥ 35 kg/m2, randomized into three intervention groups: (1) 52 mL/day of EVOO (n = 50); (2) DieTBra (n = 49); and (3) DieTBra plus 52 mL/day of EVOO (DieTBra + EVOO, n = 50). The primary outcomes we measured were the-neutrophil-to-lymphocyte ratio (NLR) and the secondary outcomes we measured were the lymphocyte-to-monocyte ratio (LMR); leukocytes; and C reactive protein (CRP). After 12 weeks of intervention, DieTBra + EVOO significantly reduced the total leucocytes (p = 0.037) and LMR (p = 0.008). No statistically significant differences were found for the NLR in neither the intra-group and inter-group analyses, although a slight reduction was found in the DieTBra group (-0.22 ± 1.87). We observed reductions in the total leukocytes and LMR in the three groups, though without statistical difference between groups. In conclusion, nutritional intervention with DietBra + EVOO promotes a significant reduction in inflammatory biomarkers, namely leukocytes and LMR. CRP was reduced in EVOO and DieTBra groups and NLR reduced in the DieTBra group. This study was registered at ClinicalTrials.gov under NCT02463435.
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Affiliation(s)
- Rafael Longhi
- Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte 30130-100, Brazil;
| | - Annelisa Silva e Alves de Carvalho Santos
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiânia, Rua 235 c/1ª s/n, Setor Universitário, Goiânia 74650-050, Brazil; (A.S.e.A.d.C.S.); (A.P.S.R.)
| | - Anallely López-Yerena
- Department of Nutrition, Food Science and Gastronomy, XIA, Faculty of Pharmacy and Food Sciences, Institute of Nutrition and Food Safety (INSA-UB), University of Barcelona, 08028 Barcelona, Spain;
| | - Ana Paula Santos Rodrigues
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiânia, Rua 235 c/1ª s/n, Setor Universitário, Goiânia 74650-050, Brazil; (A.S.e.A.d.C.S.); (A.P.S.R.)
| | - Cesar de Oliveira
- Department of Epidemiology & Public Health, Institute of Epidemiology & Health Care, London University College, London WC1E 6BT, UK;
| | - Erika Aparecida Silveira
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiânia, Rua 235 c/1ª s/n, Setor Universitário, Goiânia 74650-050, Brazil; (A.S.e.A.d.C.S.); (A.P.S.R.)
- Department of Epidemiology & Public Health, Institute of Epidemiology & Health Care, London University College, London WC1E 6BT, UK;
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21
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Wood S, Harrison SE, Judd N, Bellis MA, Hughes K, Jones A. The impact of behavioural risk factors on communicable diseases: a systematic review of reviews. BMC Public Health 2021; 21:2110. [PMID: 34789209 PMCID: PMC8596356 DOI: 10.1186/s12889-021-12148-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/22/2021] [Indexed: 12/24/2022] Open
Abstract
Background The coronavirus (COVID-19) pandemic has highlighted that individuals with behavioural risk factors commonly associated with non-communicable diseases (NCDs), such as smoking, harmful alcohol use, obesity, and physical inactivity, are more likely to experience severe symptoms from COVID-19. These risk factors have been shown to increase the risk of NCDs, but less is known about their broader influence on communicable diseases. Taking a wide focus on a range of common communicable diseases, this review aimed to synthesise research examining the impact of behavioural risk factors commonly associated with NCDs on risks of contracting, or having more severe outcomes from, communicable diseases. Methods Literature searches identified systematic reviews and meta-analyses that examined the association between behavioural risk factors (alcohol, smoking, illicit drug use, physical inactivity, obesity and poor diet) and the contraction/severity of common communicable diseases, including infection or associated pathogens. An a priori, prospectively registered protocol was followed (PROSPERO; registration number CRD42020223890). Results Fifty-three systematic reviews were included, of which 36 were also meta-analyses. Reviews focused on: tuberculosis, human immunodeficiency virus, hepatitis C virus, hepatitis B virus, invasive bacterial diseases, pneumonia, influenza, and COVID-19. Twenty-one reviews examined the association between behavioural risk factors and communicable disease contraction and 35 examined their association with communicable disease outcomes (three examined their association with both contraction and outcomes). Fifty out of 53 reviews (94%) concluded that at least one of the behavioural risk factors studied increased the risk of contracting or experiencing worse health outcomes from a communicable disease. Across all reviews, effect sizes, where calculated, ranged from 0.83 to 8.22. Conclusions Behavioural risk factors play a significant role in the risk of contracting and experiencing more severe outcomes from communicable diseases. Prevention of communicable diseases is likely to be most successful if it involves the prevention of behavioural risk factors commonly associated with NCDs. These findings are important for understanding risks associated with communicable disease, and timely, given the COVID-19 pandemic and the need for improvements in future pandemic preparedness. Addressing behavioural risk factors should be an important part of work to build resilience against any emerging and future epidemics and pandemics. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12148-y.
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Affiliation(s)
- Sara Wood
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Wrexham, UK
| | - Sophie E Harrison
- Public Health Collaborating Unit, School of Medical and Health Sciences, Bangor University, Wrexham, UK.,Institute for Applied Human Physiology, School of Human and Behavioural Sciences, Bangor University, Bangor, UK
| | - Natasha Judd
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Wrexham, UK.,Public Health Collaborating Unit, School of Medical and Health Sciences, Bangor University, Wrexham, UK
| | - Mark A Bellis
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Wrexham, UK. .,Public Health Collaborating Unit, School of Medical and Health Sciences, Bangor University, Wrexham, UK.
| | - Karen Hughes
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Wrexham, UK.,Public Health Collaborating Unit, School of Medical and Health Sciences, Bangor University, Wrexham, UK
| | - Andrew Jones
- Health Protection and Screening Services, Public Health Wales, Cardiff, UK
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22
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The Influence of Obesity on Care of Adults with Cardiovascular Disease. Nurs Clin North Am 2021; 56:511-525. [PMID: 34749891 DOI: 10.1016/j.cnur.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Obesity is a strong independent predictor of cardiovascular disease. In this article, we briefly review the physiologic effects of obesity on the cardiovascular system, discuss how obesity influences history taking, physical assessment, diagnostic testing, and treatment of patients with common cardiovascular conditions such as hypertension, coronary heart disease, and chronic heart failure. Implications for nursing practice will be shared with a focus on lifestyle modifications to be included in patient education.
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Berti S, Bartorelli AL, Koni E, Giordano A, Petronio AS, Iadanza A, Bedogni F, Reimers B, Spaccarotella C, Trani C, Attisano T, Sardella G, Bonmassari R, Medda M, Sherwood MW, Tomai F, Navarese EP. Impact of High Body Mass Index on Vascular and Bleeding Complications After Transcatheter Aortic Valve Implantation. Am J Cardiol 2021; 155:86-95. [PMID: 34284861 DOI: 10.1016/j.amjcard.2021.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 12/20/2022]
Abstract
Increased body mass index (BMI) is an established cardiovascular risk factor. The impact of high BMI on vascular and bleeding complications in patients undergoing transcatheter aortic valve implantation (TAVI) is not clarified. RISPEVA, a multicenter prospective database of patients undergoing TAVI stratified by BMI was used for this analysis. Patients were classified as normal or high BMI (obese and overweight) according to the World Health Organization criteria. A comparison of 30-day vascular and bleeding outcomes between groups was performed using propensity scores methods. A total of 3776 matched subjects for their baseline characteristics were included. Compared with normal BMI, high BMI patients had significantly 30-day greater risk of the composite of vascular or bleeding complications (11.1% vs 8.8%, OR: 1.28, 95% CI [1.02 to 1.61]; p = 0.03). Complications rates were higher in both obese (11.3%) and overweight (10.5%), as compared with normal weight patients (8.8%). By a landmark event analysis, the effect of high versus normal BMI on these complications appeared more pronounced within 7 days after the TAVI procedure. A significant linear association between increased BMI and vascular complications was observed at this time frame (p = 0.03). In conclusion, compared with normal BMI, both obese and overweight patients undergoing TAVI, experience increased rates of 30-day vascular and bleeding complications. These findings indicate that high BMI is an independent risk predictor of vascular and bleeding complications after TAVI.
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Affiliation(s)
- Sergio Berti
- Department of Diagnostic and Interventional Cardiology, Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Antonio L Bartorelli
- Centro Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Endrin Koni
- Department of Diagnostic and Interventional Cardiology, Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart Hospital, Massa, Italy; Department of Interventional Cardiology, Santa Corona Hospital, Pietra Ligure, Italy
| | - Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| | - Anna S Petronio
- Department of Cardiology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Francesco Bedogni
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Bernard Reimers
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Carmen Spaccarotella
- Division of Cardiology, CCU and Interventional, Cardiology, Cardiovascular Research Center, University Magna Graecia, Catanzaro, Italy
| | - Carlo Trani
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tiziana Attisano
- Department of Cardiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Gennaro Sardella
- Department of Cardiology, Policlinico "Umberto I," Sapienza University of Rome, Rome, Italy
| | | | - Massimo Medda
- Istituto Clinico Sant'Ambrogio, Gruppo San Donato, Milano, Italy
| | | | | | - Eliano P Navarese
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland; Faculty of Medicine, University of Alberta, Edmonton, Canada.
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Guerrera F, Lyberis P, Lausi PO, Cristofori RC, Giobbe R, Molinatti M, Filosso PL, Curcio C, Crisci R, Ruffini E. Does morbid obesity influence perioperative outcomes after video-assisted thoracic surgery (VATS) lobectomy for non-small cell lung cancer? Analysis of the Italian VATS group registry. Surg Endosc 2021; 36:3567-3573. [PMID: 34398283 PMCID: PMC9001530 DOI: 10.1007/s00464-021-08680-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/07/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Obesity in Europe, and worldwide, has been an increasing epidemic during the past decades. Moreover, obesity has important implications regarding technical issues and the risks associated with surgical interventions. Nevertheless, there is a lack of evidence assessing the influence of obesity on video-assisted thoracic surgery (VATS) lobectomy results. Our study aimed to assess the impact of morbid obesity on perioperative clinical and oncological outcomes after VATS lobectomy using a prospectively maintained nationwide registry. METHODS The Italian VATS lobectomy Registry was used to collect all consecutive cases from 55 Institutions. Explored outcome parameters were conversion to thoracotomy rates, complication rates, intra-operative blood loss, surgical time, hospital postoperative length of stay, chest tube duration, number of harvested lymph-node, and surgical margin positivity. RESULTS From 2016 to 2019, a total of 4412 patients were collected. 74 patients present morbid obesity (1.7%). Multivariable-adjusted analysis showed that morbid obesity was associated with a higher rate of complications (32.8% vs 20.3%), but it was not associated with a higher rate of conversion, and surgical margin positivity rates. Moreover, morbid obesity patients benefit from an equivalent surgical time, lymph-node retrieval, intraoperative blood loss, hospital postoperative length of stay, and chest tube duration than non-morbid obese patients. The most frequent postoperative complications in morbidly obese patients were pulmonary-related (35%). CONCLUSION Our results showed that VATS lobectomy could be safely and satisfactorily conducted even in morbidly obese patients, without an increase in conversion rate, blood loss, surgical time, hospital postoperative length of stay, and chest tube duration. Moreover, short-term oncological outcomes were preserved.
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Affiliation(s)
- Francesco Guerrera
- Department of Surgical Science, University of Torino, Torino, Italy.
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.
- , Corso Dogliotti, 14, 10126, Torino, Italy.
| | - Paraskevas Lyberis
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Paolo Olivo Lausi
- Department of Surgical Science, University of Torino, Torino, Italy
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Riccardo Carlo Cristofori
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Roberto Giobbe
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Massimo Molinatti
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Pier Luigi Filosso
- Department of Surgical Science, University of Torino, Torino, Italy
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Carlo Curcio
- Department of Thoracic Surgery, Monaldi Hospital, Napoli, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, University of L'Aquila, L'Aquila, Italy
- Thoracic Surgery Unit, "G. Mazzini" Hospital, Teramo, Italy
| | - Enrico Ruffini
- Department of Surgical Science, University of Torino, Torino, Italy
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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Okauchi Y, Matsuno K, Nishida T, Sawada K, Kawasaki A, Ito N, Morimura O, Otani Y, Yokoe M, Abe K, Iwahashi H. Obesity, glucose intolerance, advanced age, and lymphocytopenia are independent risk factors for oxygen requirement in Japanese patients with Coronavirus disease 2019 (COVID-19). Endocr J 2021; 68:849-856. [PMID: 33762519 DOI: 10.1507/endocrj.ej20-0784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
At the current time of rising demand for hospital beds, it is important to triage COVID-19 patients according to the treatment needed during hospitalization. The need for oxygen therapy is an important factor determining hospital admission of these patients. Our retrospective study was designed to identify risk factors associated with the progression to oxygen requirement in COVID-19 patients. A total of 133 patients with laboratory-confirmed COVID-19 were admitted to our hospital from February 22, 2020, to August 23. After excluding asymptomatic, non-Japanese, pediatric, pregnant patients and also those who needed oxygen immediately at admission, data of the remaining 84 patients were analyzed. The patients were separated into those who required oxygen after admission and those who did not, and their characteristics were compared. Age, body mass index (BMI), lymphocyte count, C-reactive protein (CRP), lactate dehydrogenase, estimated glomerular filtration rate, glucose intolerance, hypertension, and dyslipidemia were significantly different between the two groups. Multivariate analysis identified four significant and independent risk factors of oxygen requirement, including advanced age, obesity, glucose intolerance and lymphocytopenia. Dividing the patients into subgroups according to the number of these risk factors found in each patient indicated that the need for oxygen increased with higher number of these risk factors in the same individual. Our results suggest that the presence of higher number of these risk factors in COVID-19 patients is associated with future oxygen requirement and that this index can be potentially useful in triaging COVID-19 patients staying home in the context of need for hospitalization.
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Affiliation(s)
- Yukiyoshi Okauchi
- Departments of Diabetes Center, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
- Internal Medicine, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
| | - Kanae Matsuno
- Departments of Diabetes Center, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
- Internal Medicine, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
| | - Tsutomu Nishida
- Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
| | - Koichi Sawada
- Departments of Diabetes Center, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
- Internal Medicine, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
| | - Akiko Kawasaki
- Departments of Diabetes Center, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
- Internal Medicine, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
| | - Naohiko Ito
- Departments of Diabetes Center, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
- Internal Medicine, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
| | - Osamu Morimura
- Internal Medicine, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
| | - Yasushi Otani
- Internal Medicine, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
| | - Masaru Yokoe
- Neurology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
| | - Kinya Abe
- Internal Medicine, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
| | - Hiromi Iwahashi
- Departments of Diabetes Center, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
- Internal Medicine, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
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Huh Y, Nam GE. Overcoming Increasing Morbid Obesity in Korea. J Obes Metab Syndr 2021; 30:77-80. [PMID: 34187966 PMCID: PMC8277585 DOI: 10.7570/jomes21052] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/12/2021] [Accepted: 06/13/2021] [Indexed: 02/02/2023] Open
Affiliation(s)
- Youn Huh
- Department of Family Medicine, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Korea.,Committee of the Health Insurance and Legislation, the Korean Society for the Study of Obesity, Seoul, Korea
| | - Ga Eun Nam
- Committee of the Health Insurance and Legislation, the Korean Society for the Study of Obesity, Seoul, Korea.,Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
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D’silva WW, Biradar PR, Patil A. Luffa cylindrica: a promising herbal treatment in progesterone induced obesity in mice. J Diabetes Metab Disord 2021; 20:329-340. [PMID: 34178841 PMCID: PMC8212254 DOI: 10.1007/s40200-021-00749-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/20/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The present study investigates the anti-obesity activity of Luffa cylindrica in progesterone induced obesity model. METHOD Swiss albino mice were grouped into 7 (n = 6). Obesity was induced by administration of progesterone (10 mg/kg s.c.) for 28 days. Normal group received ad libitum and water. Disease control, positive control and treatment groups received progesterone (10 mg/kg s.c.). Further positive control group received Orlistat (10 mg/kg p.o). Treatment groups received hydro-alcoholic and fractionation extract of Luffa cylindrica at doses 400, 200, 100 mg/kg b.w. Food and water intake were recorded daily, Body weight, BMI and blood glucose were checked weekly. On completion of the study, animals were sacrificed and blood serum being utilized to accesses in vitro to estimate the various biochemical parameters. Serotonin levels and antioxidant biomarkers were also estimated. Histopathology of liver and adipose tissue was studied. RESULT After the 28 days of treatment with plant extract and fraction, it was observed to improve the progestrogen-induced obesity by improving BMI, body weight, brain serotionin, locomotor activity, blood glucose level, anti-oxidant biomarkers, and lipid profile. CONCLUSION After assimilating the In vivo and in vitro studies Luffa cylindrical extract highlighted the antilipidemic, anti-hyperglycaemic, antioxidant potential in hormone-induced obesity.
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Affiliation(s)
- Wilnoska Wilnellia D’silva
- Department of Pharmacology and Toxicology, KLE College of Pharmacy Belagavi, KLE Academy of Higher Education and Research (KAHER), Belagavi, 590010 India
| | - Prakash Rajshekhar Biradar
- Department of Pharmacology and Toxicology, KLE College of Pharmacy Belagavi, KLE Academy of Higher Education and Research (KAHER), Belagavi, 590010 India
| | - Ashwini Patil
- Department of Pharmacology and Toxicology, KLE College of Pharmacy Belagavi, KLE Academy of Higher Education and Research (KAHER), Belagavi, 590010 India
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Abstract
PURPOSE OF REVIEW Obesity is a major health epidemic, with the prevalence reaching ∼40% in the United States in recent years. It is associated with increased risk of hypertension, diabetes, heart disease, stroke, obstructive sleep apnea (OSA), and gynecologic conditions requiring surgery. Those comorbidities, in addition to the physiologic changes associated with obesity, lead to increased risk of perioperative complications. The purpose of this review is to highlight the anesthetic considerations for robotic assisted hysterectomy in obese patients. RECENT FINDINGS In the general gynecologic population, minimally invasive surgery is associated with less postoperative fever, pain, hospital length of stay, total cost of care and an earlier return to normal function. This also applies to robotic surgery in obese patients, which is on the rise. The physiologic changes of obesity bring different anesthetic challenges, including airway management and intraoperative ventilation. Vascular access and intraoperative blood pressure monitoring can also be challenging and require modifications. Optimizing analgesia with a focus on opioid-sparing strategies is crucial due to the increased prevalence of OSA in this patient population. SUMMARY Anesthesia for obese patients undergoing robotic hysterectomy is challenging and must take into consideration the anatomic and physiologic changes associated with obesity.
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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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Nascimento C, Peixoto MS, Fonte Boa LF, de Faria CC, Costa TSF, Matta L, Ferreira ACF, Fortunato RS. The Effects of Combined Physical Exercise on Serum Redox Biomarkers and Leukocyte DNA Damage of Obese Women. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:6638420. [PMID: 33868573 PMCID: PMC8032510 DOI: 10.1155/2021/6638420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/25/2021] [Accepted: 03/17/2021] [Indexed: 11/22/2022]
Abstract
Obesity is usually linked to oxidative stress, which can lead to damage to biomolecules. The combination of aerobic and strength exercises seems to induce health benefits in obese individuals, but little is known about the effects of combined physical exercise on redox homeostasis and DNA damage in this population. Thus, the aim of the current study was to determine the effects of 16 weeks of combined physical exercise on biomarkers of oxidative stress and DNA damage in obese women. 17 obese women underwent 16 weeks of a combined physical training program, 3 times per week. Anthropometric and biochemical parameters, serum superoxide dismutase (SOD) and glutathione peroxidase activity, plasma 8-isoprostane levels, and DNA and chromosomal damage were evaluated before and after physical training. Combined physical exercise training decreased body weight (83.2 ± 9.6 vs. 80.2 ± 9.6 kg), body mass index (33.8 ± 3.6 vs. 32.6 ± 3.7 kg·m-2), body fat (40.2 ± 2.6 vs. 39.0 ± 3.2%), and waist circumference (99.3 ± 9.4 vs. 94.1 ± 8.8 cm), while the fat-free mass was augmented (59.9 ± 2.9 vs. 60.7 ± 3.1 kg). Moreover, blood glucose reduced (113.5 ± 29.6 vs. 107.3 ± 28.9 mg/dL) along with high-density lipoprotein (54.6 ± 18.1 vs. 59.0 ± 18.8 mg/dL), TSH (2.1 ± 1.1 vs. 2.6 ± 1.2 mIU/mL), and free T4 (0.9 ± 0.1 vs. 1.12 ± 0.2 ng/dL) increase after physical exercise training. Plasma 8-isoprostane levels (17.24 ± 7.9 vs. 29.11 ± 17.44 pg/mL) and DNA damage (34.16 ± 7.1 vs. 45.96 ± 5.8% DNA in tail) were also higher after physical training. No changes were observed in chromosomal damage levels. These results suggest that 16 weeks of combined exercise training 3 times per week is effective in reducing body fat but also increases oxidative stress and DNA damage in obese women.
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Affiliation(s)
- Carla Nascimento
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Milena Simões Peixoto
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luiz Fernando Fonte Boa
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Caroline Coelho de Faria
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tulio Senna Fonseca Costa
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo Matta
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andrea Claudia Freitas Ferreira
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- NUMPEX, Campus Duque de Caxias, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rodrigo Soares Fortunato
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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AlRahimi J, Aboud A, AlQuhaibi AS, Almaghrabi Y, Alghamdi YS, Mufti HN. Effect of Isolated Obesity on Left Ventricular Function and Structure: A Single-Center Experience. Cureus 2021; 13:e13988. [PMID: 33880308 PMCID: PMC8053228 DOI: 10.7759/cureus.13988] [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] [Indexed: 11/29/2022] Open
Abstract
Background and objectives Obesity can increase cardiac mass and affect cardiac performance independently from other risk factors. Several studies have identified an association in patients who already have comorbidities, however, few studies focused on obesity as an isolated risk factor. This study aimed to assess the associations between isolated obesity and heart morphological and functional characteristics. Methods This was a cross-sectional study that recruited 114 patients referred for echocardiographic study in King Faisal Cardiac Center. Adult patients who had a body mass index (BMI) above 25 kg/m2 were included, while patients with comorbidities such as hypertension, diabetes mellitus, dyslipidemia, or those who use medications for chronic diseases were excluded from this study. Variables of interest that we collected were age, gender, weight, BMI, and those related to morphological and functional changes in the heart including left ventricular mass index (LVMI), LV end-diastolic volume, and left ventricular ejection fraction (LVEF). Results Most of the study participants (63.8%) were class II or class III obesity and about 80% were males. The mean ± SD of LVEF was 55.7% ± 2.8%, while the mean of the left ventricular mass index was 28.5±5.84. The mean of LV end-diastolic volume index (LVEDVI) was slightly higher among males than females (48.8±11.6 versus 46.4±11.7 ml/m2), however, this difference was not statistically significant (p-value= 0.395). There was no correlation between BMI and LVMI in females (R - 0.226, R2 0.05, P-value 0.37), while the LVMI was found to have a negative correlation between BMI and male gender that was significant (R - 0.292, R2 0.09, P-value 0.0052). It was found that there is no correlation between LVEF and BMI for males and females (male= R 0.093, R2 0.032, P-value 0.093; female= R 0.172, R2 0.029, P-value 0.434). With regards to the LVEDVI, there was a negative correlation between higher BMI and male gender that was significant (male= R - 0.396, R2 0.157, P-value 0.0001) while it was not significant in females (R -0.0298, R2 0.0009, P-value 0.893). Conclusions We have found that cardiac function is not affected by isolated obesity. However, indexed cardiac parameters like LVM and LV end diastolic volume were negatively correlated with higher BMI and positively correlated with relative wall thickness (RWT) only in males. This negative correlation might be one of the triggers to the development of obesity-induced cardiomyopathy.
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Affiliation(s)
- Jamilah AlRahimi
- Cardiology, King Faisal Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Science, Jeddah, SAU
| | - Abdulbari Aboud
- College of Medicine, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Science, Jeddah, SAU
| | - Abdullah S AlQuhaibi
- Pediatrics, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Science, Jeddah, SAU
| | - Yazan Almaghrabi
- College of Medicine, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Science, Jeddah, SAU
| | - Yousef S Alghamdi
- College of Medicine, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Science, Jeddah, SAU
| | - Hani N Mufti
- Cardiac Surgery, King Faisal Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Science, Jeddah, SAU
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Preoperative Cardiac Diagnostics in Bariatric Patients with Diabetes and Perioperative Morbidity: Results of a Cohort of 258 Patients. Obes Surg 2021; 31:2607-2613. [PMID: 33660152 PMCID: PMC8113137 DOI: 10.1007/s11695-021-05300-5] [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: 10/23/2020] [Revised: 02/12/2021] [Accepted: 02/12/2021] [Indexed: 11/18/2022]
Abstract
Purpose The combination of obesity and diabetes mellitus are well-known risk factors for cardiovascular complications and perioperative morbidity in metabolic surgery. The aim of this study was to evaluate effectivity and reliability of the cardiac assessment in patients with diabetes prior to bariatric surgery. Setting Private, university-affiliated teaching hospital, Switzerland Material and Methods Retrospective analysis of prospectively collected data on results and consequences of cardiac assessments in 258 patients with obesity and diabetes scheduled for primary bariatric surgery at our institution between January 2010 and December 2018. Results Out of 258 patients, 246 (95.3%) received cardiac diagnostics: 173 (67.1%) underwent stress-rest myocardial perfusion scintigraphy (MPS), 15 (5.8%) patients had other cardiac imaging including cardiac catheterization, 58 (22.5%) patients had echocardiography and/or stress electrocardiography, and 12 (4.7%) patients received no cardiac evaluation. Subsequently, cardiac catheterization was performed in 28 patients (10.9%), and coronary heart disease was detected and treated in 15 subjects (5.8%). Of these 15 individuals, 5 (33.3%) patients had diffuse vascular sclerosis, 8 (53.3%) patients underwent coronary angioplasty and stenting, and 2 (13.3%) patients coronary artery bypass surgery. Bariatric surgery was performed without perioperative cardiovascular events in all 258 patients. Conclusion Our data suggest that a detailed cardiac assessment is mandatory in bariatric patients with diabetes to identify those with yet unknown cardiovascular disease before performing bariatric surgery. We recommend carrying out myocardial perfusion scintigraphy as a reliable diagnostic tool in this vulnerable population. If not viable, stress echocardiography should be performed as a minimum.
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Lawrence S, Malacova E, Reutens D, Sturgess DJ. Increased maternal body mass index is associated with prolonged anaesthetic and surgical times for caesarean delivery but is partially offset by clinician seniority and established epidural analgesia. Aust N Z J Obstet Gynaecol 2020; 61:394-402. [PMID: 33249566 PMCID: PMC8247043 DOI: 10.1111/ajo.13277] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obesity is associated with higher surgical and anaesthetic morbidity and difficulties. AIMS We aimed to investigate associations between maternal body mass index (BMI) and the in-theatre time taken to produce an anaesthetised state or to perform surgery for caesarean delivery. MATERIALS AND METHODS Using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines, we identified all women who underwent caesarean section at a single institution (2009-2015). The prospectively collected data arising from antenatal and peripartum care were analysed. Generalised linear regression was used to examine associations between maternal BMI and the time taken to anaesthetise the mother and the duration of surgery. RESULTS Of a total of 24 761 caesarean deliveries, 5607 (22.7%) women were obese at antenatal registration. In-theatre anaesthetic preparation (18 vs 32 min, P < 0.001) and surgical duration (38 vs 52 min, P < 0.001) were longer in women with BMI ≥50 kg/m2 (BMI-50) than those with normal BMI (BMI-N). This difference remained significant after controlling for antenatal, intra-operative and immediate postoperative variables. Modifiable variables were identified that may mitigate the effects of severe obesity. Senior obstetric and anaesthetic care were both independently associated with a significant reduction in mean in-theatre anaesthetic preparation time and surgical duration, by 11 and three minutes respectively (P < 0.001), while epidural top-up significantly lessened mean anaesthetic in-theatre preparation duration by seven minutes (P < 0.001). CONCLUSIONS Obese women had greater anaesthesia and surgery time, but the effect may potentially be mitigated by provision of care by experienced staff and prior establishment of epidural analgesia.
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Affiliation(s)
- Sue Lawrence
- The Centre for Advanced Imaging, University of Queensland, Brisbane, Queensland, Australia.,Mater Research Institute (MRI-UQ), Mater Hospital Brisbane, The University of Queensland, Brisbane, Queensland, Australia
| | - Eva Malacova
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - David Reutens
- The Centre for Advanced Imaging, University of Queensland, Brisbane, Queensland, Australia
| | - David J Sturgess
- Mater Research Institute (MRI-UQ), Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia
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Cornejo-Pareja IM, Gómez-Pérez AM, Fernández-García JC, Barahona San Millan R, Aguilera Luque A, de Hollanda A, Jiménez A, Jimenez-Murcia S, Munguia L, Ortega E, Fernandez-Aranda F, Fernández Real JM, Tinahones F. Coronavirus disease 2019 (COVID-19) and obesity. Impact of obesity and its main comorbidities in the evolution of the disease. EUROPEAN EATING DISORDERS REVIEW 2020; 28:799-815. [PMID: 32974994 DOI: 10.1002/erv.2770] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/22/2020] [Accepted: 06/29/2020] [Indexed: 01/08/2023]
Abstract
The COVID-19 pandemic is posing a great challenge worldwide. Its rapid progression has caused thousands of deaths worldwide. Although multiple aspects remain to be clarified, some risk factors associated with a worse prognosis have been identified. These include obesity and some of its main complications, such as diabetes and high blood pressure. Furthermore, although the possible long-term complications and psychological effects that may appear in survivors of COVID-19 are not well known yet, there is a concern that those complications may be greater in obese patients. In this manuscript, we review some of the data published so far and the main points that remain to be elucidated are emphasized.
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Affiliation(s)
- Isabel M Cornejo-Pareja
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, Málaga, Spain
| | - Ana M Gómez-Pérez
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, Málaga, Spain
| | - José C Fernández-García
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, Málaga, Spain
| | - Rebeca Barahona San Millan
- Unit of Diabetes, Endocrinology and Nutrition, Hospital de Girona Dr. Josep Trueta, 17007, Institut d'Investigació Biomèdica de Girona (IDIBGI) Girona, and Department of Medical Sciences, University of Girona, Girona, Spain
| | - Alexandre Aguilera Luque
- Unit of Diabetes, Endocrinology and Nutrition, Hospital de Girona Dr. Josep Trueta, 17007, Institut d'Investigació Biomèdica de Girona (IDIBGI) Girona, and Department of Medical Sciences, University of Girona, Girona, Spain
| | - Ana de Hollanda
- Department of Endocrinology and Nutrition, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Hospital Clínic of Barcelona, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Madrid, Spain
| | - Amanda Jiménez
- Department of Endocrinology and Nutrition, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Hospital Clínic of Barcelona, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Madrid, Spain
| | - Susana Jimenez-Murcia
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Madrid, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and Department of Clinical Sciences, School of Medicine and Health Sciences. University of Barcelona, Barcelona, Spain
| | - Lucero Munguia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and Department of Clinical Sciences, School of Medicine and Health Sciences. University of Barcelona, Barcelona, Spain
| | - Emilio Ortega
- Department of Endocrinology and Nutrition, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Hospital Clínic of Barcelona, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Madrid, Spain
| | - Fernando Fernandez-Aranda
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Madrid, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and Department of Clinical Sciences, School of Medicine and Health Sciences. University of Barcelona, Barcelona, Spain
| | - José M Fernández Real
- Unit of Diabetes, Endocrinology and Nutrition, Hospital de Girona Dr. Josep Trueta, 17007, Institut d'Investigació Biomèdica de Girona (IDIBGI) Girona, and Department of Medical Sciences, University of Girona, Girona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Madrid, Spain
| | - Francisco Tinahones
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, Málaga, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Madrid, Spain
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Auclair A, Harvey J, Leclerc J, Piché ME, O'Connor K, Nadreau É, Pettigrew M, Haykowsky MJ, Marceau S, Biertho L, Hould FS, Lebel S, Biron S, Julien F, Bouvet L, Lescelleur O, Poirier P. Determinants of Cardiorespiratory Fitness After Bariatric Surgery: Insights From a Randomised Controlled Trial of a Supervised Training Program. Can J Cardiol 2020; 37:251-259. [PMID: 32738206 DOI: 10.1016/j.cjca.2020.03.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Severely obese patients have decreased cardiorespiratory fitness (CRF) and poor functional capacity. Bariatric surgery-induced weight loss improves CRF, but the determinants of this improvement are not well known. We aimed to assess the determinants of CRF before and after bariatric surgery and the impact of an exercise training program on CRF after bariatric surgery. METHODS Fifty-eight severely obese patients (46.1 ± 6.1 kg/m2, 78% women) were randomly assigned to either an exercise group (n = 39) or usual care (n = 19). Exercise training was conducted from the 3rd to the 6th months after surgery. Anthropometric measurements, abdominal and mid-thigh computed tomographic scans, resting echocardiography, and maximal cardiopulmonary exercise testing was performed before bariatric surgery and 3 and 6 months after surgery. RESULTS Weight, fat mass, and fat-free mass were reduced significantly at 3 and 6 months, without any additive impact of exercise training in the exercise group. From 3 to 6 months, peak aerobic power (V̇O2peak) increased significantly (P < 0.0001) in both groups but more importantly in the exercise group (exercise group: from 18.6 ± 4.2 to 23.2 ± 5.7 mL/kg/min; control group: from 17.4 ± 2.3 to 19.7 ± 2.4 mL/kg/min; P value, group × time = 0.01). In the exercise group, determinants of absolute V̇O2peak (L/min) were peak exercise ventilation, oxygen pulse, and heart rate reserve (r2 = 0.92; P < 0.0001), whereas determinants of V̇O2peak indexed to body mass (mL/kg/min) were peak exercise ventilation and early-to-late filling velocity ratio (r2 = 0.70; P < 0.0001). CONCLUSIONS A 12-week supervised training program has an additive benefit on cardiorespiratory fitness for patients who undergo bariatric surgery.
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Affiliation(s)
- Audrey Auclair
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada
| | - Jany Harvey
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Pharmacy, Laval University, Québec, Québec, Canada
| | - Jacinthe Leclerc
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Pharmacy, Laval University, Québec, Québec, Canada; Nursing Department, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Marie-Eve Piché
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Kim O'Connor
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Éric Nadreau
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada
| | - Myriam Pettigrew
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Pharmacy, Laval University, Québec, Québec, Canada
| | - Mark J Haykowsky
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Simon Marceau
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Laurent Biertho
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Frédéric-Simon Hould
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Stéfane Lebel
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Simon Biron
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - François Julien
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Léonie Bouvet
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Odette Lescelleur
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Paul Poirier
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Pharmacy, Laval University, Québec, Québec, Canada.
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Cai Q, Chen F, Wang T, Luo F, Liu X, Wu Q, He Q, Wang Z, Liu Y, Liu L, Chen J, Xu L. Obesity and COVID-19 Severity in a Designated Hospital in Shenzhen, China. Diabetes Care 2020; 43:1392-1398. [PMID: 32409502 DOI: 10.2337/dc20-0576] [Citation(s) in RCA: 391] [Impact Index Per Article: 97.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/19/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Patients with obesity are at increased risk of exacerbations from viral respiratory infections. However, the association of obesity with the severity of coronavirus disease 2019 (COVID-19) is unclear. We examined this association using data from the only referral hospital in Shenzhen, China. RESEARCH DESIGN AND METHODS A total of 383 consecutively hospitalized patients with COVID-19 admitted from 11 January 2020 to 16 February 2020 and followed until 26 March 2020 at the Third People's Hospital of Shenzhen were included. Underweight was defined as a BMI <18.5 kg/m2, normal weight as 18.5-23.9 kg/m2, overweight as 24.0-27.9 kg/m2, and obesity as ≥28 kg/m2. RESULTS Of the 383 patients, 53.1% were normal weight, 4.2% were underweight, 32.0% were overweight, and 10.7% were obese at admission. Obese patients tended to have symptoms of cough (P = 0.03) and fever (P = 0.06) compared with patients who were not obese. Compared with normal weight patients, those who were overweight had 1.84-fold odds of developing severe COVID-19 (odds ratio [OR] 1.84, 95% CI 0.99-3.43, P = 0.05), while those who were obese were at 3.40-fold odds of developing severe disease (OR 3.40, 95% CI 1.40-2.86, P = 0.007), after adjusting for age, sex, epidemiological characteristics, days from disease onset to hospitalization, presence of hypertension, diabetes, cardiovascular disease, chronic obstructive pulmonary disease, liver disease, and cancer, and drug used for treatment. Additionally, after similar adjustment, men who were obese versus those who were normal weight were at increased odds of developing severe COVID-19 (OR 5.66, 95% CI 1.80-17.75, P = 0.003). CONCLUSIONS In this study, obese patients had increased odds of progressing to severe COVID-19. As the severe acute respiratory syndrome coronavirus 2 may continue to spread worldwide, clinicians should pay close attention to obese patients, who should be carefully managed with prompt and aggressive treatment.
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Affiliation(s)
- Qingxian Cai
- National Clinical Research Center for Infectious Diseases, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Fengjuan Chen
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Tao Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Fang Luo
- National Clinical Research Center for Infectious Diseases, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Xiaohui Liu
- National Clinical Research Center for Infectious Diseases, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Qikai Wu
- National Clinical Research Center for Infectious Diseases, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Qing He
- National Clinical Research Center for Infectious Diseases, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Zhaoqin Wang
- National Clinical Research Center for Infectious Diseases, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Yingxia Liu
- National Clinical Research Center for Infectious Diseases, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Lei Liu
- National Clinical Research Center for Infectious Diseases, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Jun Chen
- National Clinical Research Center for Infectious Diseases, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Lin Xu
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
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Kohlman-Trigoboff D, Rich K, Foley A, Fitzgerald K, Arizmendi D, Robinson C, Brown R, Treat-Jacobson D. Society for Vascular Nursing endovascular repair of abdominal aortic aneurysm updated nursing clinical practice guideline. JOURNAL OF VASCULAR NURSING 2020; 38:36-65. [PMID: 32534654 PMCID: PMC7707638 DOI: 10.1016/j.jvn.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/26/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Debra Kohlman-Trigoboff
- Duke University Medical Center, Division of Cardiology, Duke Heart and Vascular, Durham, North Carolina.
| | - Kathleen Rich
- Critical Care Administration, Franciscan Health-Michigan City, Michigan City, Indiana
| | - Anne Foley
- Department of Vascular Surgery, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karen Fitzgerald
- The Vascular Group, PLLC, Albany Medical Center Hospital, Albany, New York
| | - Dianne Arizmendi
- Corporal Michael Crescenz VA Hospital, Philadelphia, Pennsylvania
| | | | - Rebecca Brown
- National Institutes of Health's National Center for Advancing Translational Sciences, University of Minnesota School of Nursing, Minneapolis, Minnesota
| | - Diane Treat-Jacobson
- Nursing Research for Improved Care, University of Minnesota School of Nursing, Minneapolis, Minnesota
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Abstract
This review addresses the interplay between obesity, type 2 diabetes mellitus, and cardiovascular diseases. It is proposed that obesity, generally defined by an excess of body fat causing prejudice to health, can no longer be evaluated solely by the body mass index (expressed in kg/m2) because it represents a heterogeneous entity. For instance, several cardiometabolic imaging studies have shown that some individuals who have a normal weight or who are overweight are at high risk if they have an excess of visceral adipose tissue-a condition often accompanied by accumulation of fat in normally lean tissues (ectopic fat deposition in liver, heart, skeletal muscle, etc). On the other hand, individuals who are overweight or obese can nevertheless be at much lower risk than expected when faced with excess energy intake if they have the ability to expand their subcutaneous adipose tissue mass, particularly in the gluteal-femoral area. Hence, excessive amounts of visceral adipose tissue and of ectopic fat largely define the cardiovascular disease risk of overweight and moderate obesity. There is also a rapidly expanding subgroup of patients characterized by a high accumulation of body fat (severe obesity). Severe obesity is characterized by specific additional cardiovascular health issues that should receive attention. Because of the difficulties of normalizing body fat content in patients with severe obesity, more aggressive treatments have been studied in this subgroup of individuals such as obesity surgery, also referred to as metabolic surgery. On the basis of the above, we propose that we should refer to obesities rather than obesity.
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Affiliation(s)
- Marie-Eve Piché
- From the Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval (M.-E.P., A.T., J.-P.D.), Université Laval, Québec, QC, Canada.,Department of Medicine, Faculty of Medicine (M.-E.P.), Université Laval, Québec, QC, Canada
| | - André Tchernof
- From the Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval (M.-E.P., A.T., J.-P.D.), Université Laval, Québec, QC, Canada.,School of Nutrition (A.T.), Université Laval, Québec, QC, Canada
| | - Jean-Pierre Després
- From the Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval (M.-E.P., A.T., J.-P.D.), Université Laval, Québec, QC, Canada.,Vitam - Centre de recherche en santé durable, CIUSSS - Capitale-Nationale (J.-P.D.), Université Laval, Québec, QC, Canada.,Department of Kinesiology, Faculty of Medicine (J.-P.D.), Université Laval, Québec, QC, Canada
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Cífková R, Bruthans J, Wohlfahrt P, Krajčoviechová A, Šulc P, Jozífová M, Eremiášová L, Pudil J, Linhart A, Widimský J, Filipovský J, Mayer O, Škodová Z, Poledne R, Stávek P, Lánská V. 30-year trends in major cardiovascular risk factors in the Czech population, Czech MONICA and Czech post-MONICA, 1985 - 2016/17. PLoS One 2020; 15:e0232845. [PMID: 32392239 PMCID: PMC7213700 DOI: 10.1371/journal.pone.0232845] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/22/2020] [Indexed: 12/27/2022] Open
Abstract
Background Compared with Western Europe, the decline in cardiovascular (CV) mortality has been delayed in former communist countries in Europe, including the Czech Republic. We have assessed longitudinal trends in major CV risk factors in the Czech Republic from 1985 to 2016/17, covering the transition from the totalitarian regime to democracy. Methods There were 7 independent cross-sectional surveys for major CV risk factors conducted in the Czech Republic in the same 6 country districts within the WHO MONICA Project (1985, 1988, 1992) and the Czech post-MONICA study (1997/98, 2000/01, 2007/08 and 2016/2017), including a total of 7,606 males and 8,050 females. The population samples were randomly selected (1%, aged 25–64 years). Results Over the period of 31/32 years, there was a significant decrease in the prevalence of smoking in males (from 45.0% to 23.9%; p < 0.001) and no change in females. BMI increased only in males. Systolic and diastolic blood pressure decreased significantly in both genders, while the prevalence of hypertension declined only in females. Awareness of hypertension, the proportion of individuals treated by antihypertensive drugs and consequently hypertension control improved in both genders. A substantial decrease in total cholesterol was seen in both sexes (males: from 6.21 ± 1.29 to 5.30 ± 1.05 mmol/L; p < 0.001; females: from 6.18 ± 1.26 to 5.31 ± 1.00 mmol/L; p < 0.001). Conclusions The significant improvement in most CV risk factors between 1985 and 2016/17 substantially contributed to the remarkable decrease in CV mortality in the Czech Republic.
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Affiliation(s)
- Renata Cífková
- Center for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Charles University in Prague, Prague, Czech Republic.,Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
| | - Jan Bruthans
- Center for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Charles University in Prague, Prague, Czech Republic
| | - Peter Wohlfahrt
- Center for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Charles University in Prague, Prague, Czech Republic
| | - Alena Krajčoviechová
- Center for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Charles University in Prague, Prague, Czech Republic
| | - Pavel Šulc
- Center for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Charles University in Prague, Prague, Czech Republic
| | - Marie Jozífová
- Center for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Charles University in Prague, Prague, Czech Republic
| | - Lenka Eremiášová
- Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
| | - Jan Pudil
- Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
| | - Aleš Linhart
- Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
| | - Jiří Widimský
- Department of Medicine III, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
| | - Jan Filipovský
- Department of Medicine II, Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Otto Mayer
- Department of Medicine II, Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Zdenka Škodová
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Rudolf Poledne
- Atherosclerosis Research Laboratory, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Stávek
- Atherosclerosis Research Laboratory, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Věra Lánská
- Medical Statistics Unit, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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41
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Bierle DM, Raslau D, Regan DW, Sundsted KK, Mauck KF. Preoperative Evaluation Before Noncardiac Surgery. Mayo Clin Proc 2020; 95:807-822. [PMID: 31753535 DOI: 10.1016/j.mayocp.2019.04.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/23/2019] [Accepted: 04/30/2019] [Indexed: 01/19/2023]
Abstract
The medical complexity of surgical patients is increasing and medical specialties are frequently asked to assist with the perioperative management surgical patients. Effective pre-anesthetic medical evaluations are a valuable tool in providing high-value, patient-centered surgical care and should systematically address risk assessment and identify areas for risk modification. This review outlines a structured approach to the pre-anesthetic medical evaluation, focusing on the asymptomatic patient. It discusses the evidence supporting the use of perioperative risk calculation tools and focused preoperative testing. We also introduce important key topics that will be explored in greater detail in upcoming reviews in this series.
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Affiliation(s)
- Dennis M Bierle
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN.
| | - David Raslau
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN
| | - Dennis W Regan
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN
| | - Karna K Sundsted
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN
| | - Karen F Mauck
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN
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Abstract
Obesity is considered a major comorbidity, and it is imperative for an anesthesiologist to put increased emphasis on preoperative evaluation and perioperative management. A multidisciplinary team approach is the key for a successful outcome. This article encompasses basic tenets like pathophysiology and pharmacology pertaining to obesity. The authors also talk about important aspects of anesthesia care starting from preoperative assessment and optimization, intraoperative challenges and care, to recovery and discharge of these patients.
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Affiliation(s)
- Surangama Sharma
- Department of Anesthesia, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 6417-JCP, Iowa City, IA 52242, USA.
| | - Lovkesh Arora
- Department of Anesthesia, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 6413-JCP, Iowa City, IA 52242, USA
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43
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Butsch S, Cetin D. Medical Management Before Bariatric Surgery. CURRENT CARDIOVASCULAR RISK REPORTS 2020. [DOI: 10.1007/s12170-019-0636-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Pirlet C, Biertho L, Poirier P, Marceau S, Marceau P, Biron S, Hould FS, Lebel S, Lescelleur O, Julien F, Lafortune-Payette A, Bertrand OF. Comparison of Short and Long Term Cardiovascular Outcomes After Bariatric Surgery in Patients With vs Without Coronary Artery Disease. Am J Cardiol 2020; 125:40-47. [PMID: 31694775 DOI: 10.1016/j.amjcard.2019.09.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 12/12/2022]
Abstract
There is little data regarding the risks and benefits of bariatric surgery in patients with coronary artery disease (CAD). We aimed to assess the short- and long-term cardiovascular outcomes of patients with CAD undergoing bariatric surgery. Patients with a history of CAD were identified from a dedicated database with prospectively collected outcomes, comprising all 6795 patients who underwent bariatric surgery between January 1992 and October 2017. Patients were matched with patients who did not have CAD before the bariatric surgery procedure. The primary endpoints were mortality (cardiac and noncardiac) and major adverse cardiocerebral events (MACCE), including all-cause death, myocardial infarction, stroke, and myocardial revascularization at 30 days after bariatric surgery and throughout follow-up. After propensity score matching, 249 patients with chronic CAD were matched with 249 patients without CAD. Throughout follow-up (7.4 years; interquartile range 4.1 to 11.5, maximum 22 years), mortality (mainly cardiac mortality) remained significantly higher in the CAD compared with the non-CAD group (18% vs 10%, hazard ratio [HR] 1.70, 95% confidence interval [CI]: 1.03 to 2.79, p = 0.037). At 30 days, MACCE rate was significantly higher in the CAD compared with the non-CAD group (3.6% vs 0.4%, p = 0.011), essentially driven by non-ST elevation myocardial infarctions. After 30 days, MACCE rates remained significantly higher in the CAD group (30% vs 14%, HR 2.18, 95% CI: 1.45-3.28, p = 0.0002). In conclusion, patients with severe obesity and CAD referred to bariatric surgery were at a higher risk of early and late MACCE compared with non-CAD severely obese patients. Further study is required to define how this cardiovascular risk compares with nonoperated patients.
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Wilms B, Ernst B, Schmid SM, Thurnheer M, Weisser B, Schultes B. Spiroergometric assessment of cardiorespiratory fitness in subjects with severe obesity: A challenge of reference. Nutr Metab Cardiovasc Dis 2019; 29:1382-1389. [PMID: 31558415 DOI: 10.1016/j.numecd.2019.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/10/2019] [Accepted: 07/18/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Severe obesity is associated with poor physical performance but objective data are scarce. METHODS AND RESULTS Bicycle spiroergometry data with focus on peak oxygen uptake (V˙O2,peak) and workload (Wpeak) from 476 subjects with severe obesity (BMI ≥ 35.0 kg/m2; 70% women) were analysed. In a first step, V˙O2,peak values were compared with reference values calculated upon different formulas (Wassermann; Riddle). Thereafter, multivariate regression analyses were performed to identify determinants of cardiorespiratory fitness. Cardiorespiratory fitness reference classes for V˙O2,peak and Wpeak were established by stratifying the sample upon identified determinants. Absolute V˙O2,peak (1.87 ± 0.47 vs. 2.40 ± 0.59 l/min) and Wpeak (131 ± 26 vs. 168 ± 44 W) were lower in women than men (both p<0.001). Same pattern was found for relative V˙O2,peak and Wpeak, respectively (both p < 0.05). In women, measured V˙O2,peak was lower than predicted by Wasserman (p < 0.001) but not by Riddle (p = 0.961). In men, V˙O2,peak was lower than calculated by both Wasserman and Riddle formulas (both p ≤ 0.003). Multivariate analyses revealed height and age to be the main determinants of cardiorespiratory fitness in both sexes. Subsequent statistical analyses of calculated reference fitness classes revealed that V˙O2,peak and Wpeak differed between the age- and height-defined groups in both sexes (all p < 0.001). CONCLUSION Data indicate that the evaluation of cardiorespiratory fitness in subjects with severe obesity is largely biased by selected references values for comparison. Our newly established reference fitness classes upon height and age might be helpful in the clinical context when dealing with obese patients.
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Affiliation(s)
- Britta Wilms
- Medizinische Klinik 1, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany.
| | - Barbara Ernst
- Metabolic Center St. Gallen, friendlyDocs Ltd., St. Gallen, Switzerland
| | - Sebastian M Schmid
- Medizinische Klinik 1, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany
| | | | | | - Bernd Schultes
- Metabolic Center St. Gallen, friendlyDocs Ltd., St. Gallen, Switzerland
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Rodriguez LV. Anesthesia for Ambulatory and Office-Based Ear, Nose, and Throat Surgery. Otolaryngol Clin North Am 2019; 52:1157-1167. [PMID: 31551126 DOI: 10.1016/j.otc.2019.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
With today's technological advances in outpatient surgery, anesthetic technique does not differ significantly between inpatient and outpatient settings. It is important to decide which setting is most appropriate for the patient based on the surgeon's ability, the patient's comorbidities, the facility resources, and the staff who will provide care for the patient. Matching all of the above can lead to good outcomes, less complications, and a good patient experience.
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Affiliation(s)
- Leopoldo V Rodriguez
- Society for Ambulatory Anesthesiology (SAMBA); ASA Committee on Ambulatory Surgical Care; Surgery Center of Aventura, Aventura, FL, USA; Envision Physician Services, 7700 West Sunrise Boulevard, Plantation, FL 33322, USA.
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De Jong A, Verzilli D, Chanques G, Futier E, Jaber S. [Preoperative risk and perioperative management of obese patients]. Rev Mal Respir 2019; 36:985-1001. [PMID: 31521434 DOI: 10.1016/j.rmr.2019.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/07/2019] [Indexed: 12/18/2022]
Abstract
The obese patient is at an increased risk of perioperative complications. Most importantly, these include difficult access to the airways (intubation, difficult or impossible ventilation), and post-extubation respiratory distress secondary to the development of atelectasis or obstruction of the airways, sometimes associated with the use of morphine derivatives. The association of obstructive sleep apnea syndrome (OSA) with obesity is very common, and induces a high risk of peri- and postoperative complications. Preoperative OSA screening is crucial in the obese patient, as well as its specific management: use of continuous positive pre, per and postoperative pressure. For any obese patient, the implementation of protocols for mask ventilation and/or difficult intubation and the use of protective ventilation, morphine-sparing strategies and a semi-seated positioning throughout the care, is recommended, combined with close monitoring postoperatively. The dosage of anesthetic drugs should be based on the theoretical ideal weight and then titrated, rather than dosed to the total weight. Monitoring of neuromuscular blocking should be used where appropriate, as well as monitoring of the depth of anesthesia. The occurrence of intraoperative recall is indeed more frequent in the obese patient than in the non-obese patient. Appropriate prophylaxis against venous thromboembolic disease and early mobilization are recommended, as thromboembolic disease is increased in the obese patient. The use of non-invasive ventilation to prevent the occurrence of acute post-operative respiratory failure and for its treatment is particularly effective in obese patients. In case of admission to ICU, an individualized ventilatory management based on pathophysiology and careful monitoring should be initiated.
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Affiliation(s)
- A De Jong
- PhyMedExp, University of Montpellier, Inserm, CNRS, CHU Montpellier, 371 avenue du doyen Gaston Giraud, 34080 Montpellier, France; Département d'Anesthésie-Réanimation, hôpital Saint-Éloi, 80, avenue Augustin-Fliche, 34295 Montpellier cedex, France
| | - D Verzilli
- Département d'Anesthésie-Réanimation, hôpital Saint-Éloi, 80, avenue Augustin-Fliche, 34295 Montpellier cedex, France
| | - G Chanques
- PhyMedExp, University of Montpellier, Inserm, CNRS, CHU Montpellier, 371 avenue du doyen Gaston Giraud, 34080 Montpellier, France; Département d'Anesthésie-Réanimation, hôpital Saint-Éloi, 80, avenue Augustin-Fliche, 34295 Montpellier cedex, France
| | - E Futier
- CHU de Clermont-Ferrand, Department of Perioperative Medicine, GReD, UMR/CNRS6293, University, Clermont Auvergne, Inserm, U1103, Clermont-Ferrand, France
| | - S Jaber
- PhyMedExp, University of Montpellier, Inserm, CNRS, CHU Montpellier, 371 avenue du doyen Gaston Giraud, 34080 Montpellier, France; Département d'Anesthésie-Réanimation, hôpital Saint-Éloi, 80, avenue Augustin-Fliche, 34295 Montpellier cedex, France.
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Challenges of Robotic Gynecologic Surgery in Morbidly Obese Patients and How to Optimize Success. Curr Pain Headache Rep 2019; 23:51. [DOI: 10.1007/s11916-019-0788-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
Obesity and obstructive sleep apnea (OSA) are often associated with increased perioperative risks and challenges for the anesthesiologist. This article addresses the current controversies surrounding perioperative care of morbidly obese patients with or without OSA scheduled for ambulatory surgery, particularly in a free-standing ambulatory center. Topics discussed include preoperative selection of obese and OSA patients for ambulatory surgeries, intraoperative methods to reduce perioperative risk, and appropriate postoperative care.
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Affiliation(s)
- Gaganpreet Grewal
- University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9068, USA.
| | - Girish P Joshi
- University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-7208, USA
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Abstract
The preanesthesia evaluation is an opportunity to elucidate a patient's underlying medical disease, determine if the patient is optimized, treat modifiable conditions, screen for potentially unrecognized disorders, and present the clear picture of the patient's overall risk for perioperative complications. This article presents the preoperative assessment of pulmonary patients in 2 sections. First, the components of a thorough assessment of patients presenting for preanesthesia evaluation, which should occur for all patients, regardless of the presence of pulmonary pathology, are discussed. Then, the considerations unique to patients with pulmonary diseases commonly encountered are described.
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Affiliation(s)
- Angela Selzer
- Department of Anesthesiology, University of Colorado, 12401 East 17th Avenue, 7th floor, Aurora, CO 80045, USA
| | - Mona Sarkiss
- Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 409, Houston, TX 77030, USA.
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