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Phillips T, Mughrabi A, Garcia LJ, El Mouhayyar C, Hattar L, Tighiouart H, Moraco AH, Nader C, Jaber BL. Association of Body Mass Index with Multiple Organ Failure in Hospitalized Patients with COVID-19: A Multicenter Retrospective Cohort Study. J Intensive Care Med 2024; 39:768-777. [PMID: 38343031 DOI: 10.1177/08850666241232362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Purpose: This study examines whether excessive adipose tissue, as measured by the body mass index (BMI), is associated with higher systemic markers of inflammation and higher risk of severe acute organ failure among patients with coronavirus disease 2019 (COVID-19). Methods: This was a multicenter retrospective cohort study of 1370 hospitalized adults (18 years or older) with COVID-19 during the first wave of the pandemic. Patient-level variables were extracted from the electronic medical record. The primary predictor variable was the BMI at time of hospital admission, in accordance with the World Health Organization classification. Multivariable logistic regression analyses examined the association of BMI with the composite of acute respiratory distress syndrome (ARDS), as defined by the use of high-flow nasal canula, non-invasive ventilation, or mechanical ventilation, severe acute kidney injury (AKI), as defined by acute dialysis requirement, or in-hospital death. Results: After adjustment for important cofounders, the BMI stratum of > 40 kg/m2 (compared to the BMI < 25 kg/m2 reference group) was associated with higher odds for the composite of ARDS, severe AKI, or in-hospital death (adjusted odds ratio [ORadj] 1.69; 95% confidence interval [CI]1.03, 2.78). As a continuous variable, BMI (per 5-kg/m2 increase) remained independently associated with the composite outcome (ORadj 1.13; 95% CI 1.03, 1.23); patients in higher BMI categories exhibited significantly higher peak levels of C-reactive protein (CRP), a systemic marker of inflammation (P = .01). In a sub-cohort of 889 patients, the association of BMI with the composite outcome was no longer significant after adjustment for the peak level of CRP. Conclusions: Among hospitalized patients with COVID-19, a higher BMI is associated with higher risk of severe organ failure or in-hospital death, which dissipates after adjustment for CRP level. This supports the hypothesis that inflammation is a downstream mediator of adipose tissue on acute organ dysfunction.
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Affiliation(s)
- Timothy Phillips
- Department of Medicine, St. Elizabeth's Medical Center, Boston, MA, USA
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Abdallah Mughrabi
- Department of Medicine, St. Elizabeth's Medical Center, Boston, MA, USA
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Levindo J Garcia
- Department of Medicine, St. Elizabeth's Medical Center, Boston, MA, USA
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Christopher El Mouhayyar
- Department of Medicine, St. Elizabeth's Medical Center, Boston, MA, USA
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Laith Hattar
- Department of Medicine, St. Elizabeth's Medical Center, Boston, MA, USA
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Hocine Tighiouart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA
| | - Andrew H Moraco
- Department of Medicine, St. Elizabeth's Medical Center, Boston, MA, USA
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, St. Elizabeth's Medical Center, Boston, MA, USA
| | - Claudia Nader
- Department of Medicine, St. Elizabeth's Medical Center, Boston, MA, USA
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
- Division of Infectious Disease, St. Elizabeth's Medical Center, Boston, MA, USA
| | - Bertrand L Jaber
- Department of Medicine, St. Elizabeth's Medical Center, Boston, MA, USA
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
- Division of Nephrology, St. Elizabeth's Medical Center, Boston, MA, USA
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Hileman BA, Martucci G, Subramanian H. Metabolic support for patients on extra-corporeal membrane oxygenation. Curr Opin Crit Care 2024; 30:305-310. [PMID: 38841988 DOI: 10.1097/mcc.0000000000001162] [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: 06/07/2024]
Abstract
PURPOSE OF REVIEW The purpose of the review is to summarize recent research on metabolic support during extracorporeal membrane oxygenation. In this review, we cover the evidence on nutritional supplementation, both the route of supplementation, timing of initiation of supplementation as well as quantities of supplementation needed. In addition, we discuss the recent trend in awake extracorporeal membrane oxygenation (ECMO) and its benefits to patients. RECENT FINDINGS As ECMO use continues to increase over the last few years, for both cardiovascular as well as respiratory failure, the need to optimize the metabolic states of patients has arisen. Increasing evidence has pointed towards this hitherto unexplored domain of patient care having a large impact on outcomes. Additionally, strategies such as awake ECMO for select patients has allowed them to preserve muscle mass which could aid in a faster recovery. SUMMARY There is a role of optimal metabolic support in the early recovery of patients on ECMO that is currently under-recognized. Future directions of research that aim to improve post ECMO outcomes must focus on this area.
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Affiliation(s)
| | - Gennaro Martucci
- Department of Anesthesia and Intensive Care, ISMETT, Palermo, Italy
| | - Harikesh Subramanian
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Nemet M, Vukoja M. Obstructive Sleep Apnea and Acute Lower Respiratory Tract Infections: A Narrative Literature Review. Antibiotics (Basel) 2024; 13:532. [PMID: 38927198 PMCID: PMC11200551 DOI: 10.3390/antibiotics13060532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/27/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Both obstructive sleep apnea (OSA) and acute lower respiratory tract infections (LRTIs) are important global health issues. The pathophysiological links between OSA and LRTIs include altered immune responses due to chronic intermittent hypoxia and sleep fragmentation, increased aspiration risk, and a high burden of comorbidities. In this narrative review, we evaluated the current evidence on the association between OSA and the incidence and outcomes of acute LRTIs in adults, specifically community-acquired pneumonia and viral pneumonia caused by influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Studies have demonstrated that OSA patients are more likely to develop bacterial pneumonia and exhibit a higher risk of invasive pneumococcal disease. The risk intensifies with the severity of OSA, influencing hospitalization rates and the need for intensive care. OSA is also associated with an increased risk of contracting influenza and suffering more severe disease, potentially necessitating hospitalization. Similarly, OSA contributes to increased COVID-19 disease severity, reflected by higher rates of hospitalization, longer hospital stays, and a higher incidence of acute respiratory failure. The effect of OSA on mortality rates from these infections is, however, somewhat ambiguous. Finally, we explored antibiotic therapy for OSA patients with LRTIs, addressing care settings, empirical regimens, risks, and pharmacokinetic considerations. Given the substantial burden of OSA and its significant interplay with acute LRTIs, enhanced screening, targeted vaccinations, and optimized management strategies for OSA patients should be prioritized.
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Affiliation(s)
- Marko Nemet
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Marija Vukoja
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia;
- The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, 21204 Novi Sad, Serbia
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Ilyas A, Kharadi N, Shafique M, Mehreen T, Habib M, Khan J, Akhtar A, Kiran F, Mehmood F. Incidence of Weaning Failure in Obese Patients in Intensive Care Unit. Cureus 2024; 16:e55881. [PMID: 38595891 PMCID: PMC11002967 DOI: 10.7759/cureus.55881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/11/2024] Open
Abstract
Background The escalating prevalence of obesity worldwide presents unique challenges in critical care management, especially in the context of mechanical ventilation and weaning processes in intensive care units (ICUs). The present study aimed to determine the incidence of weaning failure in obese patients in an ICU. Methods A prospective observational study was carried out to gather data on patients in the ICU of Shifa International Hospital located in Islamabad, Pakistan. The target population consisted of adult patients who were both male and female, ages 18 years and above. These individuals required intubation procedures as well as mechanical ventilation during their hospitalization. The researchers followed these patients prospectively and observed their medical conditions closely to gather data about how obesity might impact critical care interventions and outcomes. Results The sample size was 288 bearing a median age of 61.0 with an interquartile range of 19 years. Older age manifested a significantly higher frequency of failed extubation (p=0.065). Higher body mass index (BMI) was significantly associated with failed extubation among the study population. It was found that a higher significant difference was associated with BMI > 30 kg/m2 (obese) in failed and successful extubation. One-half of the patients with failed extubation and only 16 (5.9%) patients with successful extubation had end-stage renal disease (p<0.001). It was found that patients who underwent failed extubation had notably increased ICU mortality (p=0.108), 28-day mortality (p=0.067), as well as mean ICU (p<0.001) and hospital stay (p=0.007). Conclusion Our study revealed some insightful correlations between obesity, age, comorbidities, length of hospitalization, ICU stay, and mortality rate in terms of weaning failure among the study population.
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Affiliation(s)
- Anum Ilyas
- Critical Care Department, Shifa International Hospital Islamabad, Islamabad, PAK
| | - Nusrat Kharadi
- Critical Care Department, Shifa International Hospital Islamabad, Islamabad, PAK
| | | | - Tooba Mehreen
- Critical Care Department, Shifa International Hospital Islamabad, Islamabad, PAK
| | - Maria Habib
- Critical Care Department, Shifa International Hospital Islamabad, Islamabad, PAK
| | - Jaffar Khan
- Critical Care Department, Shifa International Hospital Islamabad, Islamabad, PAK
| | - Aftab Akhtar
- Internal Medicine Department, Shifa International Hospital Islamabad, Islamabad, PAK
| | - Fnu Kiran
- Internal Medicine Department, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Farrukh Mehmood
- Internal Medicine Department, Liaquat National Hospital and Medical College, Karachi, PAK
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Martínez-Camacho MÁ, Jones-Baro RA, Gómez-González A, Morales-Hernández D, Lugo-García DS, Melo-Villalobos A, Navarrete-Rodríguez CA, Delgado-Camacho J. Physical and respiratory therapy in the critically ill patient with obesity: a narrative review. Front Med (Lausanne) 2024; 11:1321692. [PMID: 38455478 PMCID: PMC10918845 DOI: 10.3389/fmed.2024.1321692] [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] [Received: 10/24/2023] [Accepted: 01/22/2024] [Indexed: 03/09/2024] Open
Abstract
Obesity has become increasingly prevalent in the intensive care unit, presenting a significant challenge for healthcare systems and professionals, including rehabilitation teams. Caring for critically ill patients with obesity involves addressing complex issues. Despite the well-established and safe practice of early mobilization during critical illness, in rehabilitation matters, the diverse clinical disturbances and scenarios within the obese patient population necessitate a comprehensive understanding. This includes recognizing the importance of metabolic support, both non-invasive and invasive ventilatory support, and their weaning processes as essential prerequisites. Physiotherapists, working collaboratively with a multidisciplinary team, play a crucial role in ensuring proper assessment and functional rehabilitation in the critical care setting. This review aims to provide critical insights into the key management and rehabilitation principles for obese patients in the intensive care unit.
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Affiliation(s)
- Miguel Ángel Martínez-Camacho
- Critical Care Physical Therapy Department and Post-operative Recovery and Multi-Organ Support Unit, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
- Doctorate Programme in Health Sciences, Universidad Anahuac Norte, State of Mexico, Mexico
| | - Robert Alexander Jones-Baro
- Critical Care Physical Therapy Department and Post-operative Recovery and Multi-Organ Support Unit, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
- Master’s Programme in Health Sciences, Instituto Politecnico Nacional, Mexico City, Mexico
| | - Alberto Gómez-González
- Critical Care Physical Therapy Department and Post-operative Recovery and Multi-Organ Support Unit, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
| | - Diego Morales-Hernández
- Critical Care Physical Therapy Department and Post-operative Recovery and Multi-Organ Support Unit, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
| | - Dalia Sahian Lugo-García
- Critical Care Physical Therapy Department and Post-operative Recovery and Multi-Organ Support Unit, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
| | - Andrea Melo-Villalobos
- Critical Care Physical Therapy Department and Post-operative Recovery and Multi-Organ Support Unit, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
| | - Carlos Alberto Navarrete-Rodríguez
- Critical Care Physical Therapy Department and Post-operative Recovery and Multi-Organ Support Unit, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
| | - Josué Delgado-Camacho
- Critical Care Physical Therapy Department and Post-operative Recovery and Multi-Organ Support Unit, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
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Li S, Fu Z, Zhang W, Liu H. Impact of obesity on intensive care unit outcomes in older patients with critical illness: A cohort study. PLoS One 2024; 19:e0297635. [PMID: 38354125 PMCID: PMC10866459 DOI: 10.1371/journal.pone.0297635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Although the paradoxical association between obesity and improved survival has been reported in a variety of clinical settings, its applicability to intensive care unit (ICU) outcomes in older critically ill patients remains unclear. We sought to examine the association between obesity and 30-day mortality and other adverse outcomes in this population. METHODS We analyzed data of older patients (≥ 60 years) in the eICU Collaborative Research Database. Body mass index (BMI) was stratified according to the World Health Organization obesity classification. Logistic regression model was used to estimate adjusted odds ratios (ORs), and cubic spline curve was used to explore the nonlinear association between BMI and 30-day ICU outcomes. Stratified analysis and sensitivity analysis were also performed. RESULTS Compared with class I obesity, under- and normal-weight were associated with higher all-cause, cardiovascular and noncardiovascular mortality, and class III obesity was associated with greater all-cause and cardiovascular mortality (OR, 1.18 [95% CI, 1.06-1.32], 1.28 [1.08-1.51]). Obesity classes II and III were associated with higher composite all-cause mortality, mechanical ventilation, or vasoactive drug usage risks (OR, 1.12 [95% CI, 1.04-1.20], 1.33 [1.24-1.43]). Mechanical ventilation was strongly positively associated with BMI. A significant BMI-by-sex interaction was observed for cardiovascular mortality, such that the association between severe obesity and mortality was more pronounced among older men than older women. CONCLUSIONS The obesity paradox does not appear to apply to short-term ICU outcomes in older patients with critical illness, mainly due to increased all-cause and cardiovascular mortality in severely obese patients, particularly in men.
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Affiliation(s)
- Shan Li
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Zhiqing Fu
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Wei Zhang
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Hongbin Liu
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
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Achey RL, El-Abtah ME, Davison MA, Glauser G, Thiyagarajah N, Kashkoush A, Patterson TE, Kshettry VR, Rasmussen P, Bain M, Moore NZ. The obesity paradox and ventriculoperitoneal shunting in aneurysmal subarachnoid hemorrhage patients undergoing microsurgical clipping. J Clin Neurosci 2024; 120:42-47. [PMID: 38183771 DOI: 10.1016/j.jocn.2023.12.001] [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: 10/05/2023] [Revised: 11/19/2023] [Accepted: 12/06/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (aSAH) can be devastating. Identifying predisposing factors is paramount in reducing aSAH-related mortality. Obesity's negative impact on health is well-established. However, the controversial "obesity paradox" in neurosurgery suggests that obesity may confer a survival advantage in SAH. We hypothesized that obesity would have a negative impact on outcomes following surgical clipping in aSAH. METHODS A single-institution retrospective review was performed of aSAH patients undergoing surgical clipping from 2017 to 2021. Demographics and clinically relevant variables were collected. Obesity was defined as body mass index >30. Primary outcome was death or severe disability (mRS 4-6) at last follow-up. Secondary outcome was VPS placement. Multivariable Cox proportional-hazards model identified predictors of poor outcome. Kaplan-Meier curves identified survivorship differences between obese and non-obese patients. RESULTS Poor outcome occurred in 11 of 52 total patients (21.2 %). There were no differences in demographics or distribution of Hunt Hess (HH), modified Fisher Grade (mFG), or external ventricular drain (EVD) placement between obese and non-obese patients. On univariate analysis, hypertension, older age, and non-obesity were predictive of poor outcome. On multivariable analysis, only obesity remained significant, suggesting a protective effect from poor outcome (HR 0.45 [0.21-0.95], p = 0.037). VPS placement occurred in 6 (11.5 %) patients for which obesity was not a significant predictor. CONCLUSIONS Obesity may have a protective effect against poor outcome following surgical clipping in aSAH. Additionally, obesity does not appear to increase rate of EVD conversion to VPS. Thus, our study suggests that obesity should not preclude patients from open surgical intervention when clinically appropriate.
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Affiliation(s)
- Rebecca L Achey
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, United States
| | - Mohamed E El-Abtah
- Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Mark A Davison
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, United States
| | - Gregory Glauser
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, United States
| | | | - Ahmed Kashkoush
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, United States
| | | | - Varun R Kshettry
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, United States; Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, United States; Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, United States
| | - Peter Rasmussen
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, United States; Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, United States
| | - Mark Bain
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, United States; Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, United States
| | - Nina Z Moore
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, United States; Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, United States.
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Barbosa MG, Sganzerla D, Buttelli ACK, Teixeira C. Lower quality of life in obese ICU survivors: a multicenter cohort study. Qual Life Res 2024; 33:361-371. [PMID: 37906347 DOI: 10.1007/s11136-023-03523-w] [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] [Accepted: 09/20/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE To compare health-related quality of life (HRQoL) and functional status between obese, underweight, normal-weight, and overweight patients after three months post-intensive care unit (ICU) discharge. METHODS Multicenter cohort study (10 Brazilian ICUs). 1600 ICU survivors (≥ 72 h in the ICU) were included.The main outcomes were HRQoL and functional status assessed three months after the ICU discharge. The secondary outcomes were mortality, hospital readmission, and ICU readmission during the same period. RESULTS Obese patients (median 50.1; IQR 39.6-59.6) had lower HRQoL in the mental component than normal-weight patients (median 53; IQR 45.6-60.1) (p = 0.033). No differences were found between BMI categories regarding the physical component of HRQoL and the Barthel Index (p = 0.355 and 0.295, respectively). Regarding readmissions, 65.1 and 25.1% of patients were readmitted to the hospital and ICU, but there was no difference between the groups (p = 0.870 and 0.220, respectively). Obese patients died less frequently (11.8%) than underweight (30.9%) and normal-weight (19.3%) patients (p < 0.001). CONCLUSION After three months of post-ICU discharge, obese patients had lower HRQoL in the mental component than normal-weight patients. However, obese patients died less than underweight and normal-weight patients.
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Affiliation(s)
- Mirceli Goulart Barbosa
- Post-Graduation Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Sarmento Leite Street, 245, Porto Alegre, 90050-170, Brazil.
| | - Daniel Sganzerla
- UNIMED, Venancio Aires Street, 1040, Porto Alegre, 90040-191, Brazil
| | | | - Cassiano Teixeira
- Post-Graduation Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Sarmento Leite Street, 245, Porto Alegre, 90050-170, Brazil
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Alur P, Harvey K, Hart K, Yimer WK, Thekkeveedu RK. Association between Weight for Length and the Severity of Respiratory Morbidity in Preterm Infants. CHILDREN (BASEL, SWITZERLAND) 2024; 11:91. [PMID: 38255404 PMCID: PMC10814862 DOI: 10.3390/children11010091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024]
Abstract
Association Between Weight for Length and the Severity of Respiratory Morbidity in Preterm Infants. OBJECTIVE To determine whether higher weight-to-length z-scores after 32 weeks of gestation are associated with higher pulmonary scores (PSs) in preterm infants requiring respiratory support using a prospective observational study. METHODS Infants born at <30 weeks, with a post-menstrual age (PMA) of 30-33 weeks, were enrolled. The infant's weight, length, and head circumference were measured weekly. Data on calories/kg/d, protein g/kg/d, weight-for-length percentiles, z-scores, and BMI at 33 through 40 weeks PMA were collected. The PS was calculated. RESULTS We analyzed 91 infants. The mean gestational age was 26.9 ± 1.7 weeks. The mean birthweight was 0.898 ± 0.238 kgs. They were predominantly African American (81.3%) and girls (56%). Postnatal steroids were administered in 26.4% of the infants. The mean duration of invasive ventilation was 19.23 days ± 28.30 days. There was a significant association between the PS and W/L z-score (p < 0.0001). For every one-unit increase in W/L z-score, the PS increased by 0.063. There was a significant association between the PS and W/L percentile (p = 0.0017), as well as BMI (p ≤ 0.0001). For every unit increase in W/L percentile, the PS increased by 0.002, and for a unit increase in BMI, the PS increased by 0.04. The association remained significant after postnatal steroid use, sex, and corrected and birth gestational ages were included in the regression analysis. Nutrition did not affect the anthropometric measurements. CONCLUSIONS Our study is the first to demonstrate that a higher BMI and W/L may adversely affect the respiratory severity in preterm infants. Studies with larger sample sizes are needed to confirm our findings.
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Affiliation(s)
- Pradeep Alur
- Hampden Medical Center, Penn State Health, Harrisburg, PA 17025, USA
| | - Kristen Harvey
- School of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Kyle Hart
- School of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Wondwosen K. Yimer
- Department of Data Sciences, University of Mississippi Medical Center, Jackson, MS 39216, USA
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Slingerland-Boot R, Kummerow M, Arbous SM, van Zanten ARH. Association between first-week propofol administration and long-term outcomes of critically ill mechanically ventilated patients: A retrospective cohort study. Clin Nutr 2024; 43:42-51. [PMID: 38000194 DOI: 10.1016/j.clnu.2023.10.029] [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: 06/20/2023] [Revised: 09/21/2023] [Accepted: 10/29/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND & AIM Propofol is commonly used in ICUs, but its long-term effects have not been thoroughly studied. In vitro studies suggest it may harm mitochondrial function, potentially affecting clinical outcomes. This study aimed to investigate the association between substantial propofol sedation and clinical outcomes in critically ill patients. METHODS We conducted a single-centre cohort study of critically ill, mechanically ventilated (≥7 days) adults to compare patients who received a substantial dose of propofol (cumulative >500 mg) during the first week of ICU admission with those who did not. The primary outcome was the association between substantial propofol administration and 6-month mortality, adjusted for relevant covariates. Subanalyses were performed for administration in the early (day 1-3) and late (day 4-7) acute phases of critical illness due to the metabolic changes in this period. Secondary outcomes included tracheostomy need and duration, length of ICU and hospital stay (LOS), discharge destinations, ICU, hospital, and 3-month mortality. RESULTS A total of 839 patients were enrolled, with 73.7 % receiving substantial propofol administration (substantial propofol dose group). Six-month all-cause mortality was 32.4 %. After adjusting for relevant variables, we found no statistically significant difference in 6-month mortality between both groups. There were also no significant differences in secondary outcomes. CONCLUSION Our study suggests that substantial propofol administration during the first week of ICU stay in the least sick critically ill, mechanically ventilated adult patients is safe, with no significant associations found with 6-month mortality, ICU or hospital LOS, differences in discharge destinations or need for tracheostomy.
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Affiliation(s)
- Rianne Slingerland-Boot
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, the Netherlands; Wageningen University & Research, Division of Human Nutrition and Health, Wageningen, the Netherlands
| | - Maren Kummerow
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, the Netherlands
| | - Sesmu M Arbous
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Arthur R H van Zanten
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, the Netherlands; Wageningen University & Research, Division of Human Nutrition and Health, Wageningen, the Netherlands.
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Díaz Chavarro BC, Romero-Saldaña M, Assis Reveiz JK, Molina-Recio G. Nutritional State, Immunological and Biochemical Parameters, and Mortality in the ICU: An Analytical Study. J Clin Med 2023; 12:4177. [PMID: 37445212 DOI: 10.3390/jcm12134177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 07/15/2023] Open
Abstract
Intensive care unit (ICU) hospitalization involves critically ill patients with multiple diseases and possible complications, including malnutrition, which increases hospital stay and mortality. Therefore, identifying the patient's prior nutritional state, following up during hospitalization, and implementing early intervention positively affect patient's vital situations at discharge. The objective of this study is to determine the nutritional state of patients admitted to an ICU in Cali (Colombia) in 2019 and its association with immunological and biochemical parameters and mortality observed during hospitalization. This was an observational, analytical, and retrospective study of patients admitted to an ICU in a clinic in Cali (Colombia) from 1 January to 31 March 2019. The association between their nutritional state and outcome variables such as hospital stay, immunological and biochemical function, and mortality was analyzed. Logistic regression was used to predict patients' vital status at hospital discharge. In terms of the nutritional level, low weight was observed in 17.5% patients, and overweight/obesity was observed in 53.5% of the population. Nutritional state was associated with leukocytosis. The patients with lymphocytosis had longer hospital stays than those with normal lymphocyte ranges. Age, blood leukocytes, and creatinine and potassium levels increased the risk of mortality. Lymphocyte values have been used as predictors of severity and hospitalization time. The scientific literature has also evidenced a higher leukocyte count in people with obesity, and such leukocytosis is associated with the risk of mortality. The results of blood and laboratory tests determining kidney function and blood electrolytes allow for the prediction of mortality risk in critically ill patients.
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Affiliation(s)
- Blanca Cecilia Díaz Chavarro
- Nursing Program, School of Health, Institute of Biomedical Research (IIB), Universidad Santiago de Cali, Santiago de Cali 760001, Colombia
- Doctoral Program in Biosciences and Agricultural and Food Sciences, University of Córdoba, 14014 Cordoba, Spain
| | - Manuel Romero-Saldaña
- Nursing, Pharmacology and Physiotherapy Department, University of Córdoba, 14004 Cordoba, Spain
- Lifestyles, Innovation and Health (GA-16), Maimonides Biomedical Research Institute of Córdoba (IMIBIC), 14014 Cordoba, Spain
| | - Jorge Karim Assis Reveiz
- Department of Research and Education, Clínica de Occidente SA, Santiago de Cali 760001, Colombia
| | - Guillermo Molina-Recio
- Nursing, Pharmacology and Physiotherapy Department, University of Córdoba, 14004 Cordoba, Spain
- Lifestyles, Innovation and Health (GA-16), Maimonides Biomedical Research Institute of Córdoba (IMIBIC), 14014 Cordoba, Spain
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Baggerman MR, Dekker IM, Winkens B, Olde Damink SWM, Stapel SN, Weijs PJM, van de Poll MCG. Visceral obesity measured using computed tomography scans: No significant association with mortality in critically ill patients. J Crit Care 2023; 77:154316. [PMID: 37116438 DOI: 10.1016/j.jcrc.2023.154316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 04/30/2023]
Abstract
INTRODUCTION The association between obesity and outcome in critical illness is unclear. Since the amount of visceral adipose tissue(VAT) rather than BMI mediates the health effects of obesity we aimed to investigate the association between visceral obesity, BMI and 90-day mortality in critically ill patients. METHOD In 555 critically ill patients (68% male), the VAT Index(VATI) was measured using Computed Tomography scans on the level of vertebra L3. The association between visceral obesity, BMI and 90-day mortality was investigated using univariable and multivariable analyses, correcting for age, sex, APACHE II score, sarcopenia and muscle quality. RESULTS Visceral obesity was present in 48.1% of the patients and its prevalence was similar in males and females. Mortality was similar amongst patients with and without visceral obesity (27.7% vs 24.0%, p = 0.31). The corrected odds ratio of 90-day mortality for visceral obesity was 0.667 (95%CI 0.424-1.049, p = 0.080). Using normal BMI as reference, the corrected odds ratio for overweight was 0.721 (95%CI 0.447-1.164 p = 0.181) and for obesity 0.462 (95%CI 0.208-1.027, p = 0.058). CONCLUSION No significant association of visceral obesity and BMI with 90-day mortality was observed in critically ill patients, although obesity and visceral obesity tended to be associated with improved 90-day mortality.
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Affiliation(s)
- Michelle R Baggerman
- Maastricht University Medical Center+, Department of Intensive Care Medicine, P. Debyelaan 25, Maastricht, the Netherlands; Maastricht University, School for Nutrition and Translational Research in Metabolism (NUTRIM), Universiteitssingel 40, Maastricht, the Netherlands.; Erasmus University Medical Center, Department of Anesthesiology, Doctor Molewaterplein 40, Rotterdam, The Netherlands.
| | - Ingeborg M Dekker
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Nutrition and Dietetics, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Bjorn Winkens
- Maastricht University, Care and Public Health Research Institute (CAPHRI), Methodology and Statistics, P. Debeyeplein 1, Maastricht, the Netherlands
| | - Steven W M Olde Damink
- Maastricht University, School for Nutrition and Translational Research in Metabolism (NUTRIM), Universiteitssingel 40, Maastricht, the Netherlands.; Maastricht University Medical Center+, Department of Surgery, P. Debyelaan 25, Maastricht, the Netherlands; RWTH University Hospital Aachen, Department of General, Visceral and Transplantation Surgery, Pauwelsstraße 30, Aachen, Germany
| | - Sandra N Stapel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Intensive Care Medicine, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Peter J M Weijs
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Nutrition and Dietetics, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Intensive Care Medicine, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam University of Applied Sciences, Department of Nutrition and Dietetics, Dr. Meurerlaan 8, Amsterdam, the Netherlands
| | - Marcel C G van de Poll
- Maastricht University Medical Center+, Department of Intensive Care Medicine, P. Debyelaan 25, Maastricht, the Netherlands; Maastricht University, School for Nutrition and Translational Research in Metabolism (NUTRIM), Universiteitssingel 40, Maastricht, the Netherlands.; Maastricht University Medical Center+, Department of Surgery, P. Debyelaan 25, Maastricht, the Netherlands
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Fusco K, Sharma Y, Hakendorf P, Thompson C. The Impact of Weight Loss Prior to Hospital Readmission. J Clin Med 2023; 12:jcm12093074. [PMID: 37176515 PMCID: PMC10179303 DOI: 10.3390/jcm12093074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Hospital readmissions place a burden on hospitals. Reducing the readmission number and duration will help reduce the burden. Weight loss might affect readmission risk, especially the risk of an early (<30 days) readmission. This study sought to identify the predictors and the impact of weight loss prior to a delayed readmission (>30 days). Body mass index (BMI) was measured during the index admission and first readmission. Patients, after their readmission, were assessed retrospectively to identify the characteristics of those who had lost >5% weight prior to that readmission. Length of stay (LOS), time spent in the intensive care unit (ICU) and the one-year mortality of those patients who lost weight were compared to the outcomes of those who remained weight-stable using multilevel mixed-effects regression adjusting for BMI, Charlson comorbidity index (CCI), ICU hours and relative stay index (RSI). Those who were at risk of weight loss prior to readmission were identifiable based upon their age, BMI, CCI and LOS. Of 1297 patients, 671 (51.7%) remained weight-stable and 386 (29.7%) lost weight between admissions. During their readmission, those who had lost weight had a significantly higher LOS (IRR 1.17; 95% CI 1.12, 1.22: p < 0.001), RSI (IRR 2.37; 95% CI 2.27, 2.47: p < 0.001) and an increased ICU LOS (IRR 2.80; 95% CI 2.65, 2.96: p < 0.001). This study indicates that weight loss prior to a delayed readmission is predictable and leads to worse outcomes during that readmission.
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Affiliation(s)
- Kellie Fusco
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Yogesh Sharma
- Department of General Medicine, Division of Medicine, Cardiac & Critical Care, Flinders Medical Centre, Bedford Park, SA 5042, Australia
| | - Paul Hakendorf
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5001, Australia
| | - Campbell Thompson
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
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14
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Královcová M, Karvunidis T, Matějovič M. Critical care for multimorbid patients. VNITRNI LEKARSTVI 2023; 69:166-172. [PMID: 37468311 DOI: 10.36290/vnl.2023.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Multimorbidity - the simultaneous presence of several chronic diseases - is very common in the critically ill patients. Its prevalence is roughly 40-85 % and continues to increase further. Certain chronic diseases such as diabetes, obesity, chronic heart, pulmonary, liver or kidney disease and malignancy are associated with higher risk of developing serious acute complications and therefore the possible need for intensive care. This review summarizes and discusses selected specifics of critical care for multimorbid patients.
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Bhaskar S, Jovanovic S, Katyal A, Namboodiri NK, Chatzis D, Banach M. Is COVID-19 another case of the obesity paradox? Results from an international ecological study on behalf of the REPROGRAM Consortium Obesity study group. Arch Med Sci 2023; 19:25-34. [PMID: 36817671 PMCID: PMC9897093 DOI: 10.5114/aoms/136447] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 05/06/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Obesity has emerged as one of the major risk factors of severe morbidity and cause-specific mortality among severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infected individuals. Patients with obesity also have overlapping cardiovascular diseases and diabetes, which make them increasingly vulnerable. This novel ecological study examines the impact of obesity and/or body mass index (BMI) on rates of population-adjusted cases and deaths due to coronavirus disease 2019 (COVID-19). MATERIAL AND METHODS Publicly available datasets were used to obtain relevant data on COVID-19, obesity and ecological variables. Group-wise comparisons and multivariate logistic regression analyses were performed. The receiver operating characteristic curve (ROC) was plotted to compute the area under the curve. RESULTS We found that male BMI is an independent predictor of cause-specific (COVID-19) mortality, and not of the caseload per million population. Countries with obesity rates of 20-30% had a significantly higher (approximately double) number of deaths per million population to both those in < 20% and > 30% slabs. We postulate that there may be a U-shaped paradoxical relationship between obesity and COVID-19 with the cause-specific mortality burden more pronounced in the countries with 20-30% obesity rates. These findings are novel along with the methodological approach of doing ecological analyses on country-wide data from publicly available sources. CONCLUSIONS We anticipate, in light of our findings, that appropriate targeted public health approaches or campaigns could be developed to minimize the risk and cause-specific morbidity burden due to COVID-19 in countries with nationwide obesity rates of 20-30%.
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Affiliation(s)
- Sonu Bhaskar
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Global Consortium, Obesity REPROGRAM Study Group, Sydney, Australia
- Department of Neurology & Neurophysiology, Liverpool Hospital & South West Sydney Local Health District (SWSLHD), Liverpool, Australia
- NSW Brain Clot Bank, NSW Health Pathology and Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Sanja Jovanovic
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Global Consortium, Obesity REPROGRAM Study Group, Sydney, Australia
- Kwantlen Polytechnic University, Office of Research Services, Surrey, British Columbia, Canada
| | - Anubhav Katyal
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Global Consortium, Obesity REPROGRAM Study Group, Sydney, Australia
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia
- University of New South Wales (UNSW), South Western Sydney Clinical School, Sydney, Australia
| | - Narayanan K. Namboodiri
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Global Consortium, Obesity REPROGRAM Study Group, Sydney, Australia
- Sree Chitra Institute for Medical Sciences and Technology (SCTIMST), Department of Cardiology, Trivandrum, Kerala, India
| | - Dimitrios Chatzis
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Global Consortium, Obesity REPROGRAM Study Group, Sydney, Australia
- Medical School, European University Cyprus, Nicosia, Cyprus
| | - Maciej Banach
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Global Consortium, Obesity REPROGRAM Study Group, Sydney, Australia
- Polish Mother’s Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
- Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
- Department of Hypertension, Medical University of Lodz, Lodz, Poland
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Body Mass Index and Clinical Outcomes in Adult COVID-19 Patients of Diverse Ethnicities. Healthcare (Basel) 2022; 10:healthcare10122575. [PMID: 36554099 PMCID: PMC9778867 DOI: 10.3390/healthcare10122575] [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] [Received: 11/10/2022] [Revised: 12/04/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
(1) Background: Body mass index (BMI) was observed to affect COVID-19 outcomes; however, the complete spectrum of clinical outcomes concerning BMI remains unexplored. The current study aimed to investigate the correlation between BMI and the severity and mortality of COVID-19, as well as ICU admission, radiological findings, clinical presentation, and time to viral clearance. (2) Methods: This retrospective study included 1796 multiethnic patients with COVID-19 treated at NMC Royal Hospital, Abu Dhabi, UAE. (3) Results: COVID-19’s adjusted odds of severity increased by 3.7- and 21.5-fold in classes I and III, respectively (p = 0.001). The odds of mortality were not significantly different after adjustment for age, sex, and race. The adjusted odds of ICU admission increased significantly by 3-fold and non-significantly by 4-fold in obesity classes I and II, respectively. Pneumonia was significantly higher in patients who were overweight and class I, II, and III obese. Furthermore, class III obese patients had a greater risk of presenting with combined respiratory and gastrointestinal manifestations (p < 0.001). The median time to viral clearance with a BMI > 40 kg/m2 was moderately higher than that with a BMI < 40 kg/m2. (4) Conclusions: High BMI was associated with pneumonia, ICU admission, severity, and mortality due to COVID-19.
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Dickerson RN, Andromalos L, Brown JC, Correia MITD, Pritts W, Ridley EJ, Robinson KN, Rosenthal MD, van Zanten ARH. Obesity and critical care nutrition: current practice gaps and directions for future research. Crit Care 2022; 26:283. [PMID: 36127715 PMCID: PMC9486775 DOI: 10.1186/s13054-022-04148-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/25/2022] [Indexed: 11/25/2022] Open
Abstract
Background This review has been developed following a panel discussion with an international group of experts in the care of patients with obesity in the critical care setting and focuses on current best practices in malnutrition screening and assessment, estimation of energy needs for patients with obesity, the risks and management of sarcopenic obesity, the value of tailored nutrition recommendations, and the emerging role of immunonutrition. Patients admitted to the intensive care unit (ICU) increasingly present with overweight and obesity that require individualized nutrition considerations due to underlying comorbidities, immunological factors such as inflammation, and changes in energy expenditure and other aspects of metabolism. While research continues to accumulate, important knowledge gaps persist in recognizing and managing the complex nutritional needs in ICU patients with obesity. Available malnutrition screening and assessment tools are limited in patients with obesity due to a lack of validation and heterogeneous factors impacting nutrition status in this population. Estimations of energy and protein demands are also complex in patients with obesity and may include estimations based upon ideal, actual, or adjusted body weight. Evidence is still sparse on the role of immunonutrition in patients with obesity, but the presence of inflammation that impacts immune function may suggest a role for these nutrients in hemodynamically stable ICU patients. Educational efforts are needed for all clinicians who care for complex cases of critically ill patients with obesity, with a focus on strategies for optimal nutrition and the consideration of issues such as weight stigma and bias impacting the delivery of care. Conclusions Current nutritional strategies for these patients should be undertaken with a focus on individualized care that considers the whole person, including the possibility of preexisting comorbidities, altered metabolism, and chronic stigma, which may impact the provision of nutritional care. Additional research should focus on the applicability of current guidelines and evidence for nutrition therapy in populations with obesity, especially in the setting of critical illness.
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Chen Y, Luo M, Cheng Y, Huang Y, He Q. A nomogram to predict prolonged stay of obesity patients with sepsis in ICU: Relevancy for predictive, personalized, preventive, and participatory healthcare strategies. Front Public Health 2022; 10:944790. [PMID: 36033731 PMCID: PMC9403617 DOI: 10.3389/fpubh.2022.944790] [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: 05/15/2022] [Accepted: 07/18/2022] [Indexed: 01/21/2023] Open
Abstract
Objective In an era of increasingly expensive intensive care costs, it is essential to evaluate early whether the length of stay (LOS) in the intensive care unit (ICU) of obesity patients with sepsis will be prolonged. On the one hand, it can reduce costs; on the other hand, it can reduce nosocomial infection. Therefore, this study aimed to verify whether ICU prolonged LOS was significantly associated with poor prognosis poor in obesity patients with sepsis and develop a simple prediction model to personalize the risk of ICU prolonged LOS for obesity patients with sepsis. Method In total, 14,483 patients from the eICU Collaborative Research Database were randomized to the training set (3,606 patients) and validation set (1,600 patients). The potential predictors of ICU prolonged LOS among various factors were identified using logistic regression analysis. For internal and external validation, a nomogram was developed and performed. Results ICU prolonged LOS was defined as the third quartile of ICU LOS or more for all sepsis patients and demonstrated to be significantly associated with the mortality in ICU by logistic regression analysis. When entering the ICU, seven independent risk factors were identified: maximum white blood cell, minimum white blood cell, use of ventilation, Glasgow Coma Scale, minimum albumin, maximum respiratory rate, and minimum red blood cell distribution width. In the internal validation set, the area under the curve was 0.73, while in the external validation set, it was 0.78. The calibration curves showed that this model predicted probability due to actually observed probability. Furthermore, the decision curve analysis and clinical impact curve showed that the nomogram had a high clinical net benefit. Conclusion In obesity patients with sepsis, we created a novel nomogram to predict the risk of ICU prolonged LOS. This prediction model is accurate and reliable, and it can assist patients and clinicians in determining prognosis and making clinical decisions.
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Singh R, Rathore SS, Khan H, Karale S, Chawla Y, Iqbal K, Bhurwal A, Tekin A, Jain N, Mehra I, Anand S, Reddy S, Sharma N, Sidhu GS, Panagopoulos A, Pattan V, Kashyap R, Bansal V. Association of Obesity With COVID-19 Severity and Mortality: An Updated Systemic Review, Meta-Analysis, and Meta-Regression. Front Endocrinol (Lausanne) 2022; 13:780872. [PMID: 35721716 PMCID: PMC9205425 DOI: 10.3389/fendo.2022.780872] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/10/2022] [Indexed: 12/11/2022] Open
Abstract
Background Obesity affects the course of critical illnesses. We aimed to estimate the association of obesity with the severity and mortality in coronavirus disease 2019 (COVID-19) patients. Data Sources A systematic search was conducted from the inception of the COVID-19 pandemic through to 13 October 2021, on databases including Medline (PubMed), Embase, Science Web, and Cochrane Central Controlled Trials Registry. Preprint servers such as BioRxiv, MedRxiv, ChemRxiv, and SSRN were also scanned. Study Selection and Data Extraction Full-length articles focusing on the association of obesity and outcome in COVID-19 patients were included. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used for study selection and data extraction. Our Population of interest were COVID-19 positive patients, obesity is our Intervention/Exposure point, Comparators are Non-obese vs obese patients The chief outcome of the study was the severity of the confirmed COVID-19 positive hospitalized patients in terms of admission to the intensive care unit (ICU) or the requirement of invasive mechanical ventilation/intubation with obesity. All-cause mortality in COVID-19 positive hospitalized patients with obesity was the secondary outcome of the study. Results In total, 3,140,413 patients from 167 studies were included in the study. Obesity was associated with an increased risk of severe disease (RR=1.52, 95% CI 1.41-1.63, p<0.001, I2 = 97%). Similarly, high mortality was observed in obese patients (RR=1.09, 95% CI 1.02-1.16, p=0.006, I2 = 97%). In multivariate meta-regression on severity, the covariate of the female gender, pulmonary disease, diabetes, older age, cardiovascular diseases, and hypertension was found to be significant and explained R2 = 40% of the between-study heterogeneity for severity. The aforementioned covariates were found to be significant for mortality as well, and these covariates collectively explained R2 = 50% of the between-study variability for mortality. Conclusions Our findings suggest that obesity is significantly associated with increased severity and higher mortality among COVID-19 patients. Therefore, the inclusion of obesity or its surrogate body mass index in prognostic scores and improvement of guidelines for patient care management is recommended.
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Affiliation(s)
- Romil Singh
- Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA, United States
| | - Sawai Singh Rathore
- Department of Internal Medicine, Dr. Sampurnanand Medical College, Jodhpur, India
| | - Hira Khan
- Department of Neurology, Allegheny General Hospital, Pittsburgh, PA, United States
| | - Smruti Karale
- Department of Internal Medicine, Government Medical College-Kolhapur, Kolhapur, India
| | - Yogesh Chawla
- Department of Immunology, Mayo Clinic, Rochester, MN, United States
| | - Kinza Iqbal
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Abhishek Bhurwal
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, United States
| | - Aysun Tekin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, MN, United States
| | - Nirpeksh Jain
- Department of Emergency Medicine, Marshfield Clinic, Marshfield, WI, United States
| | - Ishita Mehra
- Department of Internal Medicine, North Alabama Medical Center, Florence, AL, United States
| | - Sohini Anand
- Department of Internal Medicine, Patliputra Medical College and Hospital, Dhanbad, India
| | - Sanjana Reddy
- Department of Internal Medicine, Gandhi Medical College, Secunderabad, India
| | - Nikhil Sharma
- Department of Nephrology, Mayo Clinic, Rochester, MI, United States
| | - Guneet Singh Sidhu
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MI, United States
| | | | - Vishwanath Pattan
- Department of Medicine, Division of Endocrinology and Metabolism, State University of New York (SUNY) Upstate Medical University, Syracuse, NY, United States
| | - Rahul Kashyap
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, MN, United States
| | - Vikas Bansal
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MI, United States
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Yaseri M, Alipoor E, Seifollahi A, Rouhifard M, Salehi S, Hosseinzadeh-Attar MJ. Association of obesity with mortality and clinical outcomes in children and adolescents with transplantation: A systematic review and meta-analysis. Rev Endocr Metab Disord 2021; 22:847-858. [PMID: 33730228 DOI: 10.1007/s11154-021-09641-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
Obesity might be associated with mortality and clinical outcomes following transplantation; however, the direction of this relationship has not been well-recognized in youth. The aim of this systematic review and meta-analysis was to investigate the association of obesity with post-transplant mortality and clinical outcomes in children and adolescents. Following a systematic search of observational studies published by December 2018 in PubMed, Scopus, Embase, and Cochrane library, 15 articles with total sample size of 50,498 patients were included in the meta-analysis. The main outcome was mortality and secondary outcomes included acute graft versus host disease (GVHD), acute rejection, and overall graft loss. The pooled data analyses showed significantly higher odds of long term mortality (OR 1.30, 95% CI 1.15-1.48, P < 0.001, I2 = 50.3%), short term mortality (OR 1.79, 95% CI 1.19-2.70, P = 0.005, I2 = 59.6%), and acute GVHD (OR 2.13, 95% CI 1.5-3.02, P < 0.001, I2 = 1.7%) in children with obesity. There were no significant differences between patients with and without obesity in terms of acute rejection (OR 1.07, 95% CI 0.98-1.16, P = 0.132, I2 = 7.5%) or overall graft loss (OR 1.04, 95% CI 0.84-1.28, P = 0.740, I2 = 51.6%). This systematic review and meta-analysis has stated higher post-transplant risk of short and long term mortality and higher risk of acute GVHD in children with obesity compared to those without obesity. Future clinical trials are required to investigate the effect of pre-transplant weight management on post-transplant outcomes to provide insights into the clinical application of these findings. This may in turn lead to establish guidelines for the management of childhood obesity in transplantations.
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Affiliation(s)
- Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Alipoor
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Atefeh Seifollahi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahtab Rouhifard
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Shiva Salehi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Hosseinzadeh-Attar
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Mitsuda S, Uzawa K, Sawa M, Ando T, Yoshikawa T, Miyao H, Yorozu T, Ushiyama A. Vascular Endothelial Glycocalyx Plays a Role in the Obesity Paradox According to Intravital Observation. Front Cardiovasc Med 2021; 8:727888. [PMID: 34796208 PMCID: PMC8593246 DOI: 10.3389/fcvm.2021.727888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
According to the “obesity paradox,” for severe conditions, individuals with obesity may be associated with a higher survival rate than those who are lean. However, the physiological basis underlying the mechanism of the obesity paradox remains unknown. We hypothesize that the glycocalyx in obese mice is thicker and more resistant to inflammatory stress than that in non-obese mice. In this study, we employed intravital microscopy to elucidate the differences in the vascular endothelial glycocalyx among three groups of mice fed diets with different fat concentrations. Male C57BL/6N mice were divided into three diet groups: low-fat (fat: 10% kcal), medium-fat (fat: 45% kcal), and high-fat (fat: 60% kcal) diet groups. Mice were fed the respective diet from 3 weeks of age, and a chronic cranial window was installed at 8 weeks of age. At 9 weeks of age, fluorescein isothiocyanate-labeled wheat germ agglutinin was injected to identify the glycocalyx layer, and brain pial microcirculation was observed within the cranial windows. We randomly selected arterioles of diameter 15–45 μm and captured images. The mean index of the endothelial glycocalyx was calculated using image analysis and defined as the glycocalyx index. The glycocalyx indexes of the high-fat and medium-fat diet groups were significantly higher than those of the low-fat diet group (p < 0.05). There was a stronger positive correlation between vessel diameter and glycocalyx indexes in the high-fat and medium-fat diet groups than in the low-fat diet group. The glycocalyx indexes of the non-sepsis model in the obese groups were higher than those in the control group for all vessel diameters, and the positive correlation was also stronger. These findings indicate that the index of the original glycocalyx may play an important role in the obesity paradox.
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Affiliation(s)
- Shingo Mitsuda
- Department of Anesthesiology, National Disaster Medical Center, Tokyo, Japan
| | - Kohji Uzawa
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Marie Sawa
- Meiji Pharmaceutical University Graduate School of Pharmaceutical Sciences, Tokyo, Japan
| | - Tadao Ando
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Takahiro Yoshikawa
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Hideki Miyao
- Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Saitama-Ken, Japan
| | - Tomoko Yorozu
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Akira Ushiyama
- Department of Environmental Health, National Institute of Public Health, Saitama, Japan
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22
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Gao Q, Cheng Y, Li Z, Tang Q, Qiu R, Cai S, Xu X, Peng J, Xie H. Association Between Nutritional Risk Screening Score and Prognosis of Patients with Sepsis. Infect Drug Resist 2021; 14:3817-3825. [PMID: 34557005 PMCID: PMC8455294 DOI: 10.2147/idr.s321385] [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: 05/27/2021] [Accepted: 08/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background Malnutrition is one of the most critical factors affecting patients’ risk of infection and length of stay, and it may affect the prognosis of patients with sepsis. There have been no studies that have applied nutritional risk screening tools to stratify patients with sepsis according to prognosis. Methods We retrospectively analyzed the clinical data of 425 adult sepsis inpatients who were grouped based on nutritional risk screening (NRS) score, including a nutrition score, disease severity score, and age score. Prognostic factors were analyzed using univariate and multivariate regression analyses. Results Of the enrolled patients, 174 had an NRS score of ≥3; these patients were older and had a longer hospitalization time but lower body mass index (BMI), albumin (ALB) than others. Univariate Cox regression analysis showed that age, ALB, C-reactive protein (CRP), and NRS score were significantly (P<0.05) associated with in-hospital mortality. Multivariate analysis showed that age (hazard ratio [HR]=1.020, 95% confidence interval [CI]: 1.005–1.036; P=0.008) and ALB (HR=0.924, 95% CI: 0.885–0.966; P<0.001) were independent risk factors for sepsis-related mortality. The Kaplan–Meier analysis revealed that the cumulative in-hospital mortality of sepsis patients with an NRS score of ≥3 was significantly higher than that of patients with an NRS score of <3 (P=0.022). Conclusion NRS scores can effectively risk stratify sepsis patients. Patients with high NRS scores should be monitored more closely to halt further disease progression.
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Affiliation(s)
- Qiqing Gao
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Yao Cheng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Zhuohong Li
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Qingyun Tang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Rong Qiu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Shaohang Cai
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Xuwen Xu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Jie Peng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Hongyan Xie
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
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23
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Wu SW, Peng CK, Wu SY, Wang Y, Yang SS, Tang SE, Huang KL. Obesity Attenuates Ventilator-Induced Lung Injury by Modulating the STAT3-SOCS3 Pathway. Front Immunol 2021; 12:720844. [PMID: 34489970 PMCID: PMC8417798 DOI: 10.3389/fimmu.2021.720844] [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: 06/05/2021] [Accepted: 08/09/2021] [Indexed: 12/12/2022] Open
Abstract
Background Ventilator-induced lung injury (VILI) is characterized by vascular barrier dysfunction and suppression of alveolar fluid clearance (AFC). Obesity itself leads to chronic inflammation, which may initiate an injurious cascade to the lungs and simultaneously induce a protective feedback. In this study, we investigated the protective mechanism of obesity on VILI in a mouse model. Methods The VILI model was set up via 6-h mechanical ventilation with a high tidal volume. Parameters including lung injury score, STAT3/NFκB pathway, and AFC were assessed. Mice with diet-induced obesity were obtained by allowing free access to a high-fat diet since the age of 3 weeks. After a 9-week diet intervention, these mice were sacrificed at the age of 12 weeks. The manipulation of SOCS3 protein was achieved by siRNA knockdown and pharmaceutical stimulation using hesperetin. WNK4 knockin and knockout obese mice were used to clarify the pathway of AFC modulation. Results Obesity itself attenuated VILI. Knockdown of SOCS3 in obese mice offset the protection against VILI afforded by obesity. Hesperetin stimulated SOCS3 upregulation in nonobese mice and provided protection against VILI. In obese mice, the WNK4 axis was upregulated at the baseline, but was significantly attenuated after VILI compared with nonobese mice. At the baseline, the manipulation of SOCS3 by siRNA and hesperetin also led to the corresponding alteration of WNK4, albeit to a lesser extent. After VILI, WNK4 expression correlated with STAT3/NFκB activation, regardless of SOCS3 status. Obese mice carrying WNK4 knockout had VILI with a severity similar to that of wild-type obese mice. The severity of VILI in WNK4-knockin obese mice was counteracted by obesity, similar to that of wild-type nonobese mice only. Conclusions Obesity protects lungs from VILI by upregulating SOCS3, thus suppressing the STAT3/NFκB inflammatory pathway and enhancing WNK4-related AFC. However, WNK4 activation is mainly from direct NFκB downstreaming, and less from SOCS3 upregulation. Moreover, JAK2–STAT3/NFκB signaling predominates the pathogenesis of VILI. Nevertheless, the interaction between SOCS3 and WNK4 in modulating VILI in obesity warrants further investigation.
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Affiliation(s)
- Shih-Wei Wu
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chung-Kan Peng
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan.,Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Shu-Yu Wu
- Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Yu Wang
- Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Sung-Sen Yang
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,Division of Nephrology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-En Tang
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan.,Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Kun-Lun Huang
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
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24
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Dalamaga M, Christodoulatos GS, Karampela I, Vallianou N, Apovian CM. Understanding the Co-Epidemic of Obesity and COVID-19: Current Evidence, Comparison with Previous Epidemics, Mechanisms, and Preventive and Therapeutic Perspectives. Curr Obes Rep 2021; 10:214-243. [PMID: 33909265 PMCID: PMC8080486 DOI: 10.1007/s13679-021-00436-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW A growing body of evidence suggests that obesity and increased visceral adiposity are strongly and independently linked to adverse outcomes and death due to COVID-19. This review summarizes current epidemiologic data, highlights pathogenetic mechanisms on the association between excess body weight and COVID-19, compares data from previous pandemics, discusses why COVID-19 challenges the "obesity paradox," and presents implications in prevention and treatment as well as future perspectives. RECENT FINDINGS Data from meta-analyses based on recent observational studies have indicated that obesity increases the risks of infection from SARS-CoV-2, severe infection and hospitalization, admission to the ICU and need of invasive mechanical ventilation (IMV), and the risk of mortality, particularly in severe obesity. The risks of IMV and mortality associated with obesity are accentuated in younger individuals (age ≤ 50 years old). The meta-inflammation in obesity intersects with and exacerbates underlying pathogenetic mechanisms in COVID-19 through the following mechanisms and factors: (i) impaired innate and adaptive immune responses; (ii) chronic inflammation and oxidative stress; (iii) endothelial dysfunction, hypercoagulability, and aberrant activation of the complement; (iv) overactivation of the renin-angiotensin-aldosterone system; (v) overexpression of the angiotensin-converting enzyme 2 receptor in the adipose tissue; (vi) associated cardiometabolic comorbidities; (vii) vitamin D deficiency; (viii) gut dysbiosis; and (ix) mechanical and psychological issues. Mechanistic and large epidemiologic studies using big data sources with omics data exploring genetic determinants of risk and disease severity as well as large randomized controlled trials (RCTs) are necessary to shed light on the pathways connecting chronic subclinical inflammation/meta-inflammation with adverse COVID-19 outcomes and establish the ideal preventive and therapeutic approaches for patients with obesity.
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Affiliation(s)
- Maria Dalamaga
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Goudi, 11527 Athens, Greece
| | - Gerasimos Socrates Christodoulatos
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Goudi, 11527 Athens, Greece
| | - Irene Karampela
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Goudi, 11527 Athens, Greece
- Second Department of Critical Care, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini St, Haidari, 12462 Athens, Greece
| | - Natalia Vallianou
- Department of Internal Medicine and Endocrinology, Evangelismos General Hospital of Athens, 45-47 Ypsilantou street, 10676 Athens, Greece
| | - Caroline M. Apovian
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Doctor’s Office Building, 720 Harrison Avenue, Suite, Boston, MA 8100 USA
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25
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Fujinaga J, Suzuki E, Irie H, Onodera M. Body Mass Index and Ventilator Dependence in Critically Ill Subjects in Japan: A Cohort Study Using a Nationwide Database. Respir Care 2021; 66:1433-1439. [PMID: 33688093 PMCID: PMC9993876 DOI: 10.4187/respcare.08660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Body mass index (BMI) can be an important indicator for health outcomes among critically ill patients. However, the association between BMI and ventilator dependence at ICU discharge among these patients remains unknown. We aimed to evaluate the association between BMI at ICU admission and ventilator dependence at the time of ICU discharge. As secondary outcomes, we used ICU mortality, hospital mortality, and implementation of tracheostomy during ICU stay. METHODS This is a retrospective cohort study. The data were derived from The Japanese Intensive Care Patient Database, a nationwide ICU database in Japan. We included all patients in the registry who were ≥ 16 y old, received mechanical ventilation, and were admitted to an ICU between April 2018 and March 2019. On the basis of their BMI at ICU admission, subjects were classified as underweight (< 18.5 kg/m2); normal weight (≥ 18.5 kg/m2 to < 23 kg/m2); overweight (≥ 23 kg/m2 to < 27.5 kg/m2); or obese (≥ 27.5 kg/m2). RESULTS Among 11,801 analyzed subjects, 388 (3.3%) subjects were ventilator-dependent at ICU discharge. Compared with normal-weight subjects, the risk for ventilator dependence at ICU discharge increased among underweight subjects even after adjusting for potential confounders and inter-ICU variance in 2-level multivariable logistic regression analysis (odds ratio 1.46 [95% CI 1.18-1.79]). Although obesity was also associated with a higher risk of ventilator dependence, the association was less clear (odds ratio 1.10 [95% CI 0.99-1.22]). The risk of ICU mortality, hospital mortality, and implementation of tracheostomy also increased in underweight subjects. CONCLUSIONS Critically ill underweight subjects had a higher risk of ventilator dependence at ICU discharge compared to normal-weight subjects, even after adjusting for potential confounders and inter-ICU variance. The association between BMI and ventilator dependence should be examined using information on subjects' nutritional status and frailty in further studies.
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Affiliation(s)
- Jun Fujinaga
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki City, Japan.
| | - Etsuji Suzuki
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Kita-ku, Japan
| | - Hiromasa Irie
- Department of Anesthesiology, Kurashiki Central Hospital, Kurashiki City, Japan
| | - Mutsuo Onodera
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki City, Japan
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26
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Anderson MR, Shashaty MGS. The Impact of Obesity in Critical Illness. Chest 2021; 160:2135-2145. [PMID: 34364868 PMCID: PMC8340548 DOI: 10.1016/j.chest.2021.08.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/19/2021] [Accepted: 08/01/2021] [Indexed: 12/16/2022] Open
Abstract
The prevalence of obesity is rising worldwide. Adipose tissue exerts anatomic and physiological effects with significant implications for critical illness. Changes in respiratory mechanics cause expiratory flow limitation, atelectasis, and V̇/Q̇ mismatch with resultant hypoxemia. Altered work of breathing and obesity hypoventilation syndrome may cause hypercapnia. Challenging mask ventilation and peri-intubation hypoxemia may complicate intubation. Patients with obesity are at increased risk of ARDS and should receive lung-protective ventilation based on predicted body weight. Increased positive end expiratory pressure (PEEP), coupled with appropriate patient positioning, may overcome the alveolar decruitment and intrinsic PEEP caused by elevated baseline pleural pressure; however, evidence is insufficient regarding the impact of high PEEP strategies on outcomes. Venovenous extracorporeal membrane oxygenation may be safely performed in patients with obesity. Fluid management should account for increased prevalence of chronic heart and kidney disease, expanded blood volume, and elevated acute kidney injury risk. Medication pharmacodynamics and pharmacokinetics may be altered by hydrophobic drug distribution to adipose depots and comorbid liver or kidney disease. Obesity is associated with increased risk of VTE and infection; appropriate dosing of prophylactic anticoagulation and early removal of indwelling catheters may decrease these risks. Obesity is associated with improved critical illness survival in some studies. It is unclear whether this reflects a protective effect or limitations inherent to observational research. Obesity is associated with increased risk of intubation and death in SARS-CoV-2 infection. Ongoing molecular studies of adipose tissue may deepen our understanding of how obesity impacts critical illness pathophysiology.
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Affiliation(s)
- Michaela R Anderson
- Division of Pulmonary Disease and Critical Care Medicine, Columbia University
| | - Michael G S Shashaty
- Pulmonary, Allergy, and Critical Care Division and the Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania.
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27
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Iannotta D, Yang M, Celia C, Di Marzio L, Wolfram J. Extracellular vesicle therapeutics from plasma and adipose tissue. NANO TODAY 2021; 39:101159. [PMID: 33968157 PMCID: PMC8104307 DOI: 10.1016/j.nantod.2021.101159] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Extracellular vesicles (EVs) are cell-released lipid-bilayer nanoparticles that contain biologically active cargo involved in physiological and pathological intercellular communication. In recent years, the therapeutic potential of EVs has been explored in various disease models. In particular, mesenchymal stromal cell-derived EVs have been shown to exert anti-inflammatory, anti-oxidant, anti-apoptotic, and pro-angiogenic properties in cardiovascular, metabolic and orthopedic conditions. However, a major drawback of EV-based therapeutics is scale-up issues due to extensive cell culture requirements and inefficient isolation protocols. An emerging alternative approach to time-consuming and costly cell culture expansion is to obtain therapeutic EVs directly from the body, for example, from plasma and adipose tissue. This review discusses isolation methods and therapeutic applications of plasma and adipose tissue-derived EVs, highlighting advantages and disadvantages compared to cell culture-derived ones.
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Affiliation(s)
- Dalila Iannotta
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Jacksonville, FL, USA
- Department of Pharmacy, University of Chieti – Pescara “G d’Annunzio”, Chieti, Italy
| | - Man Yang
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Jacksonville, FL, USA
| | - Christian Celia
- Department of Pharmacy, University of Chieti – Pescara “G d’Annunzio”, Chieti, Italy
| | - Luisa Di Marzio
- Department of Pharmacy, University of Chieti – Pescara “G d’Annunzio”, Chieti, Italy
| | - Joy Wolfram
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Jacksonville, FL, USA
- Department of Nanomedicine, Houston Methodist Research Institute, Houston TX, USA
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28
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Mamandipoor B, Frutos-Vivar F, Peñuelas O, Rezar R, Raymondos K, Muriel A, Du B, Thille AW, Ríos F, González M, del-Sorbo L, del Carmen Marín M, Pinheiro BV, Soares MA, Nin N, Maggiore SM, Bersten A, Kelm M, Bruno RR, Amin P, Cakar N, Suh GY, Abroug F, Jibaja M, Matamis D, Zeggwagh AA, Sutherasan Y, Anzueto A, Wernly B, Esteban A, Jung C, Osmani V. Machine learning predicts mortality based on analysis of ventilation parameters of critically ill patients: multi-centre validation. BMC Med Inform Decis Mak 2021; 21:152. [PMID: 33962603 PMCID: PMC8102841 DOI: 10.1186/s12911-021-01506-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Mechanical Ventilation (MV) is a complex and central treatment process in the care of critically ill patients. It influences acid-base balance and can also cause prognostically relevant biotrauma by generating forces and liberating reactive oxygen species, negatively affecting outcomes. In this work we evaluate the use of a Recurrent Neural Network (RNN) modelling to predict outcomes of mechanically ventilated patients, using standard mechanical ventilation parameters. METHODS We performed our analysis on VENTILA dataset, an observational, prospective, international, multi-centre study, performed to investigate the effect of baseline characteristics and management changes over time on the all-cause mortality rate in mechanically ventilated patients in ICU. Our cohort includes 12,596 adult patients older than 18, associated with 12,755 distinct admissions in ICUs across 37 countries and receiving invasive and non-invasive mechanical ventilation. We carry out four different analysis. Initially we select typical mechanical ventilation parameters and evaluate the machine learning model on both, the overall cohort and a subgroup of patients admitted with respiratory disorders. Furthermore, we carry out sensitivity analysis to evaluate whether inclusion of variables related to the function of other organs, improve the predictive performance of the model for both the overall cohort as well as the subgroup of patients with respiratory disorders. RESULTS Predictive performance of RNN-based model was higher with Area Under the Receiver Operating Characteristic (ROC) Curve (AUC) of 0.72 (± 0.01) and Average Precision (AP) of 0.57 (± 0.01) in comparison to RF and LR for the overall patient dataset. Higher predictive performance was recorded in the subgroup of patients admitted with respiratory disorders with AUC of 0.75 (± 0.02) and AP of 0.65 (± 0.03). Inclusion of function of other organs further improved the performance to AUC of 0.79 (± 0.01) and AP 0.68 (± 0.02) for the overall patient dataset and AUC of 0.79 (± 0.01) and AP 0.72 (± 0.02) for the subgroup with respiratory disorders. CONCLUSION The RNN-based model demonstrated better performance than RF and LR in patients in mechanical ventilation and its subgroup admitted with respiratory disorders. Clinical studies are needed to evaluate whether it impacts decision-making and patient outcomes. TRIAL REGISTRATION NCT02731898 ( https://clinicaltrials.gov/ct2/show/NCT02731898 ), prospectively registered on April 8, 2016.
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Affiliation(s)
| | - Fernando Frutos-Vivar
- Hospital Universitario de Getafe & Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Oscar Peñuelas
- Hospital Universitario de Getafe & Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Richard Rezar
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | | | - Alfonso Muriel
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
- Unidad de Bioestadística Clinica Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS) & Centro de Investigación en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Bin Du
- Peking Union Medical College Hospital, Beijing, People’s Republic of China
| | | | - Fernando Ríos
- Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
| | - Marco González
- Clínica Medellín & Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Lorenzo del-Sorbo
- Interdepartmental Division of Critical Care Medicine, Toronto, ON Canada
| | - Maria del Carmen Marín
- Hospital Regional 1° de Octubre, Instituto de Seguridad Y Servicios Sociales de Los Trabajadores del Estado (ISSSTE), México, DF México
| | - Bruno Valle Pinheiro
- Pulmonary Research Laboratory, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | | | | | | | - Andrew Bersten
- Department of Critical Care Medicine, Flinders University, Adelaide, South Australia Australia
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Raphael Romano Bruno
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Pravin Amin
- Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - Nahit Cakar
- Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - Manuel Jibaja
- Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | | | - Amine Ali Zeggwagh
- Centre Hospitalier Universitarie Ibn Sina - Mohammed V University, Rabat, Morocco
| | - Yuda Sutherasan
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Antonio Anzueto
- South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, TX USA
| | - Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Andrés Esteban
- Hospital Universitario de Getafe & Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Venet Osmani
- Fondazione Bruno Kessler Research Institute, Trento, Italy
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Patient-Level Barriers and Facilitators to Early Mobilization and the Relationship With Physical Disability Post-Intensive Care: Part 2 of an Integrative Review Through the Lens of the World Health Organization International Classification of Functioning, Disability, and Health. Dimens Crit Care Nurs 2021; 40:164-173. [PMID: 33792276 DOI: 10.1097/dcc.0000000000000470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Early mobilization (EM) is associated with reduced physical disability post-intensive care (PD PIC). Yet, contextual factors facilitate or impede delivery of EM in the intensive care unit (ICU). Only 45% of ICUs in the United States routinely practice EM despite its recognized benefits. OBJECTIVES To analyze the evidence on the relationship between critical care EM, PD PIC, and personal (patient-level) factors, using the theoretical lens of the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). METHOD The Whittemore and Knafl methodology for integrative reviews and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) reporting guidelines were followed. Qualitative, quantitative, and mixed-methods studies (n = 38) that evaluated EM and 1 or more domains of the World Health Organization ICF were included. Quality was appraised using the Mixed-Methods Appraisal Tool. Study characteristics were evaluated for common themes and relationships. The ICF domains and subdomains pertaining to each study were synthesized. RESULTS Early mobilization delivery was influenced by personal factors. Deeper sedation level, the presence of delirium, higher patient acuity, the presence of medical devices, and patient weight were identified barriers to EM delivery. Patient engagement in EM was associated with improved delivery. Patients who enjoyed rehabilitation were more likely to demonstrate improvement in functional impairment than those who did not enjoy rehabilitation. DISCUSSION Early mobilization is associated with reduced PD PIC, yet numerous contextual factors affect the delivery of EM in the ICU. Further study of patient-level factors and EM must explore the relationship between patient engagement, baseline demographics, and functional status at ICU admission, patient-level considerations for decisions to mobilize, and EM in the ICU. This research is critical to improving the delivery of EM in the ICU and reducing PD PIC.
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Wirtz TH, Loosen SH, Schulze-Hagen M, Weiskirchen R, Buendgens L, Abu Jhaisha S, Brozat JF, Puengel T, Vucur M, Paffenholz P, Kuhl C, Tacke F, Trautwein C, Luedde T, Roderburg C, Koch A. CT-based determination of excessive visceral adipose tissue is associated with an impaired survival in critically ill patients. PLoS One 2021; 16:e0250321. [PMID: 33861804 PMCID: PMC8051769 DOI: 10.1371/journal.pone.0250321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/05/2021] [Indexed: 12/14/2022] Open
Abstract
Objective Obesity is a negative prognostic factor for various clinical conditions. In this observational cohort study, we evaluated a CT-based assessment of the adipose tissue distribution as a potential non-invasive prognostic parameter in critical illness. Methods Routine CT-scans upon admission to the intensive care unit (ICU) were used to analyze the visceral and subcutaneous adipose tissue areas at the 3rd lumbar vertebra in 155 patients. Results were correlated with various prognostic markers and both short-term- and overall survival. Multiple statistical tools were used for data analysis. Results We observed a significantly larger visceral adipose tissue area in septic patients compared to non-sepsis patients. Interestingly, patients requiring mechanical ventilation had a significantly higher amount of visceral adipose tissue correlating with the duration of mechanical ventilation. Moreover, both visceral and subcutaneous adipose tissue area significantly correlated with several laboratory markers. While neither the visceral nor the subcutaneous adipose tissue area was predictive for short-term ICU survival, patients with a visceral adipose tissue area above the optimal cut-off (241.4 cm2) had a significantly impaired overall survival compared to patients with a lower visceral adipose tissue area. Conclusions Our study supports a prognostic role of the individual adipose tissue distribution in critically ill patients. However, additional investigations need to confirm our suggestion that routine CT-based assessment of adipose tissue distribution can be used to yield further information on the patients’ clinical course. Moreover, future studies should address functional and metabolic analysis of different adipose tissue compartments in critical illness.
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Affiliation(s)
- Theresa H. Wirtz
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
- * E-mail:
| | - Sven H. Loosen
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Maximilian Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Ralf Weiskirchen
- Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry, University Hospital RWTH Aachen, Aachen, Germany
| | - Lukas Buendgens
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Samira Abu Jhaisha
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Jonathan F. Brozat
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Tobias Puengel
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
- Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany
| | - Mihael Vucur
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Pia Paffenholz
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany
| | - Christian Trautwein
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Tom Luedde
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christoph Roderburg
- Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany
| | - Alexander Koch
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
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Schavemaker R, Schultz MJ, Lagrand WK, van Slobbe-Bijlsma ER, Serpa Neto A, Paulus F. Associations of Body Mass Index with Ventilation Management and Clinical Outcomes in Invasively Ventilated Patients with ARDS Related to COVID-19-Insights from the PRoVENT-COVID Study. J Clin Med 2021; 10:jcm10061176. [PMID: 33799735 PMCID: PMC8000207 DOI: 10.3390/jcm10061176] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 12/16/2022] Open
Abstract
We describe the practice of ventilation and mortality rates in invasively ventilated normal-weight (18.5 ≤ BMI ≤ 24.9 kg/m2), overweight (25.0 ≤ BMI ≤ 29.9 kg/m2), and obese (BMI > 30 kg/m2) COVID-19 ARDS patients in a national, multicenter observational study, performed at 22 intensive care units in the Netherlands. The primary outcome was a combination of ventilation variables and parameters over the first four calendar days of ventilation, including tidal volume, positive end–expiratory pressure (PEEP), respiratory system compliance, and driving pressure in normal–weight, overweight, and obese patients. Secondary outcomes included the use of adjunctive treatments for refractory hypoxaemia and mortality rates. Between 1 March 2020 and 1 June 2020, 1122 patients were included in the study: 244 (21.3%) normal-weight patients, 531 (47.3%) overweight patients, and 324 (28.8%) obese patients. Most patients received a tidal volume < 8 mL/kg PBW; only on the first day was the tidal volume higher in obese patients. PEEP and driving pressure were higher, and compliance of the respiratory system was lower in obese patients on all four days. Adjunctive therapies for refractory hypoxemia were used equally in the three BMI groups. Adjusted mortality rates were not different between BMI categories. The findings of this study suggest that lung-protective ventilation with a lower tidal volume and prone positioning is similarly feasible in normal-weight, overweight, and obese patients with ARDS related to COVID-19. A patient’s BMI should not be used in decisions to forgo or proceed with invasive ventilation.
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Affiliation(s)
- Renée Schavemaker
- Department of Intensive Care, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands; (R.S.); (M.J.S.); (W.K.L.); (A.S.N.)
| | - Marcus J. Schultz
- Department of Intensive Care, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands; (R.S.); (M.J.S.); (W.K.L.); (A.S.N.)
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
| | - Wim K. Lagrand
- Department of Intensive Care, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands; (R.S.); (M.J.S.); (W.K.L.); (A.S.N.)
| | | | - Ary Serpa Neto
- Department of Intensive Care, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands; (R.S.); (M.J.S.); (W.K.L.); (A.S.N.)
- Department of Critical Care Medicine, Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, VIC 3004, Australia
| | - Frederique Paulus
- Department of Intensive Care, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands; (R.S.); (M.J.S.); (W.K.L.); (A.S.N.)
- ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, 1105 AZ Amsterdam, The Netherlands
- Correspondence:
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Wiebe N, Ye F, Crumley ET, Bello A, Stenvinkel P, Tonelli M. Temporal Associations Among Body Mass Index, Fasting Insulin, and Systemic Inflammation: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e211263. [PMID: 33710289 PMCID: PMC7955272 DOI: 10.1001/jamanetworkopen.2021.1263] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE Obesity is associated with a number of noncommunicable chronic diseases and is purported to cause premature death. OBJECTIVE To summarize evidence on the temporality of the association between higher body mass index (BMI) and 2 potential mediators: chronic inflammation and hyperinsulinemia. DATA SOURCES MEDLINE (1946 to August 20, 2019) and Embase (from 1974 to August 19, 2019) were searched, although only studies published in 2018 were included because of a high volume of results. The data analysis was conducted between January 2020 and October 2020. STUDY SELECTION AND MEASURES Longitudinal studies and randomized clinical trials that measured fasting insulin level and/or an inflammation marker and BMI with at least 3 commensurate time points were selected. DATA EXTRACTION AND SYNTHESIS Slopes of these markers were calculated between time points and standardized. Standardized slopes were meta-regressed in later periods (period 2) with standardized slopes in earlier periods (period 1). Evidence-based items potentially indicating risk of bias were assessed. RESULTS Of 1865 records, 60 eligible studies with 112 cohorts of 5603 participants were identified. Most standardized slopes were negative, meaning that participants in most studies experienced decreases in BMI, fasting insulin level, and C-reactive protein level. The association between period 1 fasting insulin level and period 2 BMI was positive and significant (β = 0.26; 95% CI, 0.13-0.38; I2 = 79%): for every unit of SD change in period 1 insulin level, there was an ensuing associated change in 0.26 units of SD in period 2 BMI. The association of period 1 fasting insulin level with period 2 BMI remained significant when period 1 C-reactive protein level was added to the model (β = 0.57; 95% CI, 0.27-0.86). In this bivariable model, period 1 C-reactive protein level was not significantly associated with period 2 BMI (β = -0.07; 95% CI, -0.42 to 0.29; I2 = 81%). CONCLUSIONS AND RELEVANCE In this meta-analysis, the finding of temporal sequencing (in which changes in fasting insulin level precede changes in weight) is not consistent with the assertion that obesity causes noncommunicable chronic diseases and premature death by increasing levels of fasting insulin.
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Affiliation(s)
- Natasha Wiebe
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Feng Ye
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ellen T. Crumley
- Department of Health, St Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Aminu Bello
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Stenvinkel
- Department of Renal Medicine M99, Karolinska University Hospital, Stockholm, Sweden
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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More is not better: the complicated relationship between obesity, critical illness, and infection. Intensive Care Med 2021; 47:467-469. [PMID: 33638648 DOI: 10.1007/s00134-021-06371-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
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Krishnamoorthy G, Arsene C, Jena N, Mogulla SM, Coakley R, Khine J, Khosrodad N, Klein A, Sule AA. Racial disparities in COVID-19 hospitalizations do not lead to disparities in outcomes. Public Health 2021; 190:93-98. [PMID: 33385640 PMCID: PMC7698674 DOI: 10.1016/j.puhe.2020.11.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/09/2020] [Accepted: 11/22/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The objective of the study is the identification of racial differences in characteristics and comorbidities in patients hospitalized for COVID-19 and the impact on outcomes. STUDY DESIGN The study design is a retrospective observational study. METHODS Data for all patients admitted to seven community hospitals in Michigan, United States, with polymerase chain reaction confirmed diagnosis of COVID-19 from March 10 to April 15, 2020 were analyzed. The primary outcomes of racial disparity in inpatient mortality and intubation were analyzed using descriptive statistics and multivariate regression models. RESULTS The study included 336 Black and 408 White patients. Black patients were younger (62.9 ± 15.0 years vs 71.8 ± 16.4, P < .001), had a higher mean body mass index (32.4 ± 8.6 kg/m2 vs 28.8 ± 7.5, P < .001), had higher prevalence of diabetes (136/336 vs 130/408, P = .02), and presented later (6.6 ± 5.3 days after symptom onset vs. 5.4 ± 5.4, P = .006) compared with White patients. Younger Black patients had a higher prevalence of obesity (age <65 years, 69.9%) than older Black patients (age >65 years, 39.2%) and younger White patients (age < 65, 55.1%). Intubation did not reach statistical significance for racial difference (Black patients 61/335 vs. 54/406, P = .08). Mortality was not higher in Black patients (65/335 vs. 142/406 in White patients, odds ratio 0.61, 95% confidence interval: 0.37 to 0.99, 2-sided P = .05) in multivariate analysis, accounting for other risk factors associated with mortality. CONCLUSIONS Higher prevalence of obesity and diabetes in young Black populations may be the critical factor driving disproportionate COVID-19 hospitalizations in Black populations. Hospitalized Black patients do not have worse outcomes compared with White patients.
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Affiliation(s)
| | - C Arsene
- ProMedica Health System, Toledo, OH, United States
| | - N Jena
- St Joseph Mercy Oakland Hospital, Pontiac, MI, United States
| | - S M Mogulla
- St Joseph Mercy Oakland Hospital, Pontiac, MI, United States
| | - R Coakley
- Ross University School of Medicine, United States
| | - J Khine
- St Joseph Mercy Oakland Hospital, Pontiac, MI, United States
| | - N Khosrodad
- St Joseph Mercy Oakland Hospital, Pontiac, MI, United States
| | - A Klein
- Ross University School of Medicine, United States
| | - A A Sule
- St Joseph Mercy Oakland Hospital, Pontiac, MI, United States.
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Khatua B, El-Kurdi B, Patel K, Rood C, Noel P, Crowell M, Yaron JR, Kostenko S, Guerra A, Faigel DO, Lowe M, Singh VP. Adipose saturation reduces lipotoxic systemic inflammation and explains the obesity paradox. SCIENCE ADVANCES 2021; 7:7/5/eabd6449. [PMID: 33514548 PMCID: PMC7846167 DOI: 10.1126/sciadv.abd6449] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/11/2020] [Indexed: 05/10/2023]
Abstract
Obesity sometimes seems protective in disease. This obesity paradox is predominantly described in reports from the Western Hemisphere during acute illnesses. Since adipose triglyceride composition corresponds to long-term dietary patterns, we performed a meta-analysis modeling the effect of obesity on severity of acute pancreatitis, in the context of dietary patterns of the countries from which the studies originated. Increased severity was noted in leaner populations with a higher proportion of unsaturated fat intake. In mice, greater hydrolysis of unsaturated visceral triglyceride caused worse organ failure during pancreatitis, even when the mice were leaner than those having saturated triglyceride. Saturation interfered with triglyceride's interaction and lipolysis by pancreatic triglyceride lipase, which mediates organ failure. Unsaturation increased fatty acid monomers in vivo and aqueous media, resulting in greater lipotoxic cellular responses and organ failure. Therefore, visceral triglyceride saturation reduces the ensuing lipotoxicity despite higher adiposity, thus explaining the obesity paradox.
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Affiliation(s)
| | - Bara El-Kurdi
- Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Krutika Patel
- Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Pawan Noel
- Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Jordan R Yaron
- Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Andre Guerra
- Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Mark Lowe
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO, USA
| | - Vijay P Singh
- Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA.
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Abstract
Obesity is an important risk factor for major complications, morbidity and mortality related to intubation procedures and ventilation in the intensive care unit (ICU). The fall in functional residual capacity promotes airway closure and atelectasis formation. This narrative review presents the impact of obesity on the respiratory system and the key points to optimize airway management, noninvasive and invasive mechanical ventilation in ICU patients with obesity. Non-invasive strategies should first optimize body position with reverse Trendelenburg position or sitting position. Noninvasive ventilation (NIV) is considered as the first-line therapy in patients with obesity having a postoperative acute respiratory failure. Positive pressure pre-oxygenation before the intubation procedure is the method of reference. The use of videolaryngoscopy has to be considered by adequately trained intensivists, especially in patients with several risk factors. Regarding mechanical ventilation in patients with and without acute respiratory distress syndrome (ARDS), low tidal volume (6 ml/kg of predicted body weight) and moderate to high positive end-expiratory pressure (PEEP), with careful recruitment maneuver in selected patients, are advised. Prone positioning is a therapeutic choice in severe ARDS patients with obesity. Prophylactic NIV should be considered after extubation to prevent re-intubation. If obesity increases mortality and risk of ICU admission in the overall population, the impact of obesity on ICU mortality is less clear and several confounding factors have to be taken into account regarding the “obesity ICU paradox”.
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Association between Body Mass Index and Short-Term Clinical Outcomes in Critically Ill Patients with Sepsis: A Real-World Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5781913. [PMID: 33123579 PMCID: PMC7584974 DOI: 10.1155/2020/5781913] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/02/2020] [Accepted: 09/24/2020] [Indexed: 02/06/2023]
Abstract
Background Obesity is now recognized as one of the major public health threats, especially for patients with a critical illness. However, studies regarding whether and how body mass index (BMI) affects clinical outcomes in patients with sepsis are still scarce and controversial. The aim of our study was to determine the effect of BMI on critically ill patients with sepsis. Materials and Methods We performed this study using data from the Medical Information Center for Intensive Care III database. A multivariate Cox regression model was used to assess the independent association of BMI with the primary outcome. Results A total of 7,967 patients were enrolled in this study. Firstly, we found that the 28-day mortality was reduced by 22% (HR = 0.78, 95% CI 0.69–0.88) and 13% (HR = 0.87, 95% CI 0.78–0.98) for obese and overweight compared to normal weight, respectively. Subsequently, a U-shaped association of BMI with 28-day mortality was observed in sepsis patients, with the lowest 28-day mortality at the BMI range of 30–40 kg/m2. Finally, significant interactions were observed only for sex (P = 0.0071). Male patients with a BMI of 25-30 kg/m2 (HR = 0.74, 95% CI 0.63–0.86) and 30-40 kg/m2 (HR = 0.63, 95% CI 0.53–0.76) had a significantly lower risk of 28-day mortality. Conclusions A U-shaped association of BMI with 28-day mortality in critically ill sepsis patients was found, with the lowest 28-day mortality at a BMI range of 30–40 kg/m2. Notably, male patients were protected by a higher BMI more effectively than female patients as males had a significantly lower mortality risk.
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Karampela I, Chrysanthopoulou E, Christodoulatos GS, Dalamaga M. Is There an Obesity Paradox in Critical Illness? Epidemiologic and Metabolic Considerations. Curr Obes Rep 2020; 9:231-244. [PMID: 32564203 DOI: 10.1007/s13679-020-00394-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Obesity represents a global epidemic with serious implications in public health due to its increasing prevalence and its known association with a high morbidity and mortality burden. However, a growing number of data support a survival benefit of obesity in critical illness. This review summarizes current evidence regarding the obesity paradox in critical illness, discusses methodological issues and metabolic implications, and presents potential pathophysiologic mechanisms. RECENT FINDINGS Data from meta-analyses and recent studies corroborate the obesity-related survival benefit in critically ill patients as well as in selected populations such as patients with sepsis and acute respiratory distress syndrome, but not trauma. However, this finding warrants a cautious interpretation due to certain methodological limitations of these studies, such as the retrospective design, possible selection bias, the use of BMI as an obesity index, and inadequate adjustment for confounding variables. Main pathophysiologic mechanisms related to obesity that could explain this phenomenon include higher energy reserves, inflammatory preconditioning, anti-inflammatory immune profile, endotoxin neutralization, adrenal steroid synthesis, renin-angiotensin system activation, cardioprotective metabolic effects, and prevention of muscle wasting. The survival benefit of obesity in critical illness is supported from large meta-analyses and recent studies. Due to important methodological limitations, more prospective studies are needed to further elucidate this finding, while future research should focus on the pathophysiologic role of adipose tissue in critical illness.
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Affiliation(s)
- Irene Karampela
- Second Department of Critical Care, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini St, Haidari, 12462, Athens, Greece.
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Goudi, 11527, Athens, Greece.
| | - Evangelia Chrysanthopoulou
- Second Department of Critical Care, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini St, Haidari, 12462, Athens, Greece
| | - Gerasimos Socrates Christodoulatos
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Goudi, 11527, Athens, Greece
| | - Maria Dalamaga
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Goudi, 11527, Athens, Greece
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Smulders L, van der Aalst A, Neuhaus EDET, Polman S, Franssen FME, van Vliet M, de Kruif MD. Decreased Risk of COPD Exacerbations in Obese Patients. COPD 2020; 17:485-491. [DOI: 10.1080/15412555.2020.1799963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Lian Smulders
- Department of Pulmonary Medicine, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Anniek van der Aalst
- Department of Pulmonary Medicine, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Erik D. E. T. Neuhaus
- Department of Pulmonary Medicine, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Sharona Polman
- Department of Pulmonary Medicine, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | - M. van Vliet
- Department of Pulmonary Medicine, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Martijn D. de Kruif
- Department of Pulmonary Medicine, Zuyderland Medical Center, Heerlen, The Netherlands
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Decruyenaere A, Steen J, Colpaert K, Benoit DD, Decruyenaere J, Vansteelandt S. The obesity paradox in critically ill patients: a causal learning approach to a casual finding. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:485. [PMID: 32758295 PMCID: PMC7405433 DOI: 10.1186/s13054-020-03199-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/23/2020] [Indexed: 01/06/2023]
Abstract
Background While obesity confers an increased risk of death in the general population, numerous studies have reported an association between obesity and improved survival among critically ill patients. This contrary finding has been referred to as the obesity paradox. In this retrospective study, two causal inference approaches were used to address whether the survival of non-obese critically ill patients would have been improved if they had been obese. Methods The study cohort comprised 6557 adult critically ill patients hospitalized at the Intensive Care Unit of the Ghent University Hospital between 2015 and 2017. Obesity was defined as a body mass index of ≥ 30 kg/m2. Two causal inference approaches were used to estimate the average effect of obesity in the non-obese (AON): a traditional approach that used regression adjustment for confounding and that assumed missingness completely at random and a robust approach that used machine learning within the targeted maximum likelihood estimation framework along with multiple imputation of missing values under the assumption of missingness at random. 1754 (26.8%) patients were discarded in the traditional approach because of at least one missing value for obesity status or confounders. Results Obesity was present in 18.9% of patients. The in-hospital mortality was 14.6% in non-obese patients and 13.5% in obese patients. The raw marginal risk difference for in-hospital mortality between obese and non-obese patients was − 1.06% (95% confidence interval (CI) − 3.23 to 1.11%, P = 0.337). The traditional approach resulted in an AON of − 2.48% (95% CI − 4.80 to − 0.15%, P = 0.037), whereas the robust approach yielded an AON of − 0.59% (95% CI − 2.77 to 1.60%, P = 0.599). Conclusions A causal inference approach that is robust to residual confounding bias due to model misspecification and selection bias due to missing (at random) data mitigates the obesity paradox observed in critically ill patients, whereas a traditional approach results in even more paradoxical findings. The robust approach does not provide evidence that the survival of non-obese critically ill patients would have been improved if they had been obese.
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Affiliation(s)
- Alexander Decruyenaere
- Department of Internal Medicine and Pediatrics, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium. .,Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium.
| | - Johan Steen
- Department of Internal Medicine and Pediatrics, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium.,Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.,Department of Nephrology, Ghent University Hospital, Ghent, Belgium.,Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | - Kirsten Colpaert
- Department of Internal Medicine and Pediatrics, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium.,Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Dominique D Benoit
- Department of Internal Medicine and Pediatrics, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium.,Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Johan Decruyenaere
- Department of Internal Medicine and Pediatrics, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium.,Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Stijn Vansteelandt
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium.,Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
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Bouzas C, Bibiloni MDM, Julibert A, Ruiz-Canela M, Salas-Salvadó J, Corella D, Zomeño MD, Romaguera D, Vioque J, Alonso-Gómez ÁM, Wärnberg J, Martínez JA, Serra-Majem L, Estruch R, Tinahones FJ, Lapetra J, Pintó X, García Ríos A, Bueno-Cavanillas A, Gaforio JJ, Matía-Martín P, Daimiel L, Martín-Sánchez V, Vidal J, Vázquez C, Ros E, Fernandez-Lázaro CI, Becerra-Tomás N, Gimenez-Alba IM, Muñoz J, Morey M, Oncina-Canovas A, Tojal-Sierra L, Pérez-López J, Abete I, Casañas-Quintana T, Castro-Barquero S, Bernal-López MR, Santos-Lozano JM, Galera A, Angullo-Martinez E, Basterra-Gortari FJ, Basora J, Saiz C, Castañer O, Martín M, Notario-Barandiarán L, Belló-Mora MC, Sayón-Orea C, García-Gavilán J, Goday A, Tur JA. Adherence to the Mediterranean Lifestyle and Desired Body Weight Loss in a Mediterranean Adult Population with Overweight: A PREDIMED-Plus Study. Nutrients 2020; 12:nu12072114. [PMID: 32708828 PMCID: PMC7400596 DOI: 10.3390/nu12072114] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/03/2020] [Accepted: 07/09/2020] [Indexed: 01/02/2023] Open
Abstract
Background. Body weight dissatisfaction is a hindrance to following a healthy lifestyle and it has been associated with weight concerns. Objectives. The aim of this study was to assess the association between the adherence to the Mediterranean lifestyle (diet and exercise) and the desired body weight loss in an adult Mediterranean population with overweight. Methods. Cross-sectional analysis in 6355 participants (3268 men; 3087 women) with metabolic syndrome and BMI (Body mass index) between 27.0 and 40.0 kg/m2 (55–75 years old) from the PREDIMED-Plus trial. Desired weight loss was the percentage of weight that participants wished to lose. It was categorized into four cut-offs of this percentage (Q1: <10%, n = 1495; Q2: 10–15%, n = 1804; Q3: <15–20%, n = 1470; Q4: ≥20%, n = 1589). Diet was assessed using a validated food frequency questionnaire and a 17-item Mediterranean diet questionnaire. Physical activity was assessed by the validated Minnesota-REGICOR and the validated Spanish version of the Nurses’ Health Study questionnaire. Results. Participants reporting higher percentages of desired weight loss (Q3 and Q4) were younger, had higher real and perceived BMI and were more likely to have abdominal obesity. Desired weight loss correlated inversely to physical activity (Q1: 2106 MET min/week; Q4: 1585 MET min/week. p < 0.001) and adherence to Mediterranean diet (Q1: 8.7; Q4: 8.3. p < 0.001). Conclusions. In older Mediterranean individuals with weight excess, desired weight loss was inversely associated with Mediterranean lifestyle adherence. Deeply rooted aspects of the MedDiet remained similar across groups. Longitudinal research is advised to be able to establish causality.
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Affiliation(s)
- Cristina Bouzas
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Research Group on Community Nutrition & Oxidative Stress, University of Balearic Islands, Guillem Colom Bldg, Campus, 07122 Palma de Mallorca, Spain;
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain
| | - Maria del Mar Bibiloni
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Research Group on Community Nutrition & Oxidative Stress, University of Balearic Islands, Guillem Colom Bldg, Campus, 07122 Palma de Mallorca, Spain;
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain
| | - Alicia Julibert
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Research Group on Community Nutrition & Oxidative Stress, University of Balearic Islands, Guillem Colom Bldg, Campus, 07122 Palma de Mallorca, Spain;
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain
| | - Miguel Ruiz-Canela
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Department of Preventive Medicine and Public Health, IdISNA, University of Navarra, 31008 Pamplona, Spain
| | - Jordi Salas-Salvadó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Universitat Rovira i Virgili, Department of Biochemistry and Biotechnology, Human Nutrition Unit, 43201 Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), 43201 Reus, Spain
| | - Dolores Corella
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Department of Preventive Medicine, University of Valencia, 46100 Valencia, Spain
| | - Maria Dolors Zomeño
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d’Investigació Mèdica (IMIM), 08003 Barcelona, Spain
- Blanquerna School of Health Sciences, Universitat Ramon Llull, 08022 Barcelona, Spain
| | - Dora Romaguera
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain
| | - Jesús Vioque
- Unit of Nutritional Epidemiology, Miguel Hernández University, ISABIAL-UMH, 46020 Alicante, Spain; (J.V.); (A.O.-C.); (L.N.-B.)
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (A.B.-C.); (J.J.G.)
| | - Ángel M. Alonso-Gómez
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, 48013 Vitoria-Gasteiz, Spain
| | - Julia Wärnberg
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Department of Nursing, School of Health Sciences, University of Málaga-IBIMA, 29071 Málaga, Spain
| | - J. Alfredo Martínez
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Precision Nutrition Program, IMDEA Food, CEI UAM + CSIC, 28049 Madrid, Spain
- Department of Nutrition, Food Sciences, and Physiology, Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain
| | - Luís Serra-Majem
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Institute for Biomedical Research, University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Ramon Estruch
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Department of Internal Medicine, IDIBAPS, Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain
| | - Francisco J. Tinahones
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Virgen de la Victoria Hospital, Department of Endocrinology, Biomedical Research Institute of Málaga (IBIMA), University of Málaga, 29010 Málaga, Spain
| | - José Lapetra
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, 41013 Sevilla, Spain
| | - Xavier Pintó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Antonio García Ríos
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Cordoba, Spain
| | - Aurora Bueno-Cavanillas
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (A.B.-C.); (J.J.G.)
- Department of Preventive Medicine, University of Granada, 18071 Granada, Spain
| | - José J. Gaforio
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (A.B.-C.); (J.J.G.)
- Department of Health Sciences, Centro de Estudios Avanzados en Olivar y Aceites de Oliva, University of Jaen, 23071 Jaen, Spain
| | - Pilar Matía-Martín
- Department of Endocrinology and Nutrition, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain;
| | - Lidia Daimiel
- Nutritional Genomics and Epigenomics Group, IMDEA Food, CEI UAM + CSIC, 28049 Madrid, Spain;
| | - Vicente Martín-Sánchez
- CIBER Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain;
- Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain
| | - Josep Vidal
- Department of Endocrinology, IDIBAPS, Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain;
| | - Clotilde Vázquez
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Department of Endocrinology, Fundación Jiménez-Díaz, 28040 Madrid, Spain
| | - Emilio Ros
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Lipid Clinic, Department of Endocrinology and Nutrition, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, 08036 Barcelona, Spain
| | - Cesar Ignacio Fernandez-Lázaro
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Department of Preventive Medicine and Public Health, IdISNA, University of Navarra, 31008 Pamplona, Spain
| | - Nerea Becerra-Tomás
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Universitat Rovira i Virgili, Department of Biochemistry and Biotechnology, Human Nutrition Unit, 43201 Reus, Spain
| | - Ignacio Manuel Gimenez-Alba
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Department of Preventive Medicine, University of Valencia, 46100 Valencia, Spain
| | - Julia Muñoz
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d’Investigació Mèdica (IMIM), 08003 Barcelona, Spain
| | - Marga Morey
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain
| | - Alejandro Oncina-Canovas
- Unit of Nutritional Epidemiology, Miguel Hernández University, ISABIAL-UMH, 46020 Alicante, Spain; (J.V.); (A.O.-C.); (L.N.-B.)
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (A.B.-C.); (J.J.G.)
| | - Lucas Tojal-Sierra
- Research Group on Community Nutrition & Oxidative Stress, University of Balearic Islands, Guillem Colom Bldg, Campus, 07122 Palma de Mallorca, Spain;
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, 48013 Vitoria-Gasteiz, Spain
| | - Jéssica Pérez-López
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Department of Nursing, School of Health Sciences, University of Málaga-IBIMA, 29071 Málaga, Spain
| | - Itziar Abete
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Department of Nutrition, Food Sciences, and Physiology, Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain
| | - Tamara Casañas-Quintana
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Institute for Biomedical Research, University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Sara Castro-Barquero
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Department of Internal Medicine, IDIBAPS, Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain
| | - M. Rosa Bernal-López
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Virgen de la Victoria Hospital, Department of Endocrinology, Biomedical Research Institute of Málaga (IBIMA), University of Málaga, 29010 Málaga, Spain
| | - José Manuel Santos-Lozano
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, 41013 Sevilla, Spain
| | - Ana Galera
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Escarlata Angullo-Martinez
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Research Group on Community Nutrition & Oxidative Stress, University of Balearic Islands, Guillem Colom Bldg, Campus, 07122 Palma de Mallorca, Spain;
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain
- Escola Graduada Primary Health Care Center, IBSalut, 07002 Palma de Mallorca, Spain
| | - F. Javier Basterra-Gortari
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Department of Preventive Medicine and Public Health, IdISNA, University of Navarra, 31008 Pamplona, Spain
- Servicio Navarro de Salud, Osasunbidea, 31071 Pamplona, Spain
| | - Josep Basora
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Universitat Rovira i Virgili, Department of Biochemistry and Biotechnology, Human Nutrition Unit, 43201 Reus, Spain
| | - Carmen Saiz
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Department of Preventive Medicine, University of Valencia, 46100 Valencia, Spain
| | - Olga Castañer
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d’Investigació Mèdica (IMIM), 08003 Barcelona, Spain
| | - Marian Martín
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain
| | - Leyre Notario-Barandiarán
- Unit of Nutritional Epidemiology, Miguel Hernández University, ISABIAL-UMH, 46020 Alicante, Spain; (J.V.); (A.O.-C.); (L.N.-B.)
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (A.B.-C.); (J.J.G.)
| | - María C. Belló-Mora
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, 48013 Vitoria-Gasteiz, Spain
| | - Carmen Sayón-Orea
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Department of Preventive Medicine and Public Health, IdISNA, University of Navarra, 31008 Pamplona, Spain
- Servicio Navarro de Salud, Osasunbidea, 31071 Pamplona, Spain
| | - Jesús García-Gavilán
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Universitat Rovira i Virgili, Department of Biochemistry and Biotechnology, Human Nutrition Unit, 43201 Reus, Spain
| | - Albert Goday
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d’Investigació Mèdica (IMIM), 08003 Barcelona, Spain
| | - Josep A. Tur
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (C.B.); (M.d.M.B.); (A.J.); (M.R.-C.); (J.S.-S.); (D.C.); (M.D.Z.); (D.R.); (Á.M.A.-G.); (J.W.); (J.A.M.); (L.S.-M.); (R.E.); (F.J.T.); (J.L.); (X.P.); (A.G.R.); (C.V.); (E.R.); (C.I.F.-L.); (N.B.-T.); (I.M.G.-A.); (J.M.); (M.M.); (J.P.-L.); (I.A.); (T.C.-Q.); (S.C.-B.); (M.R.B.-L.); (J.M.S.-L.); (A.G.); (E.A.-M.); (F.J.B.-G.); (J.B.); (C.S.); (O.C.); (M.M.); (M.C.B.-M.); (C.S.-O.); (J.G.-G.); (A.G.)
- Research Group on Community Nutrition & Oxidative Stress, University of Balearic Islands, Guillem Colom Bldg, Campus, 07122 Palma de Mallorca, Spain;
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain
- Correspondence: ; Tel.: +34-971-1731; Fax: +34-971-173184
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Barrera SC, Sanford EJ, Ammerman SB, Ferrell JK, Simpson CB, Dominguez LM. Postoperative Complications in Obese Patients After Tracheostomy. OTO Open 2020; 4:2473974X20953090. [PMID: 32923919 PMCID: PMC7453467 DOI: 10.1177/2473974x20953090] [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: 02/20/2020] [Accepted: 07/07/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the prevalence of varying classes of obesity in patients undergoing tracheostomy and the associated complication rates as compared with nonobese patients. STUDY DESIGN A retrospective chart review was performed from 2012 to 2018 on all patients who underwent open tracheostomy by the Department of Otolaryngology-Head and Neck Surgery. SETTING All tracheostomies were performed at a single tertiary care center. METHODS Patients were classified by body mass index (BMI) according to the World Health Organization classification system: underweight (<18.5), normal-overweight (18.5-29.9), class I (30-34.9), class II (35-39.9), and class III (>40). Charts were reviewed for patient demographic information, Charlson Comorbidity Index score, surgical indication, operative time, tracheostomy tube type, and postoperative complications. RESULTS A total of 387 patients (mean ± SD BMI, 31.3 ± 14.2) were identified per the inclusion/exclusion criteria. Of patients with BMI >30 (n=153), 34.6% were categorized as obesity class I, 29.4% as class II, and 35.9% as class III. The most common indication for tracheostomy was malignancy in nonobese patients (41.5%) and respiratory failure for obese patients (58.2%). Operative time was significantly longer in obese patients, and most of these patients required an extended-length tracheostomy tube. Patients with a BMI >40 had higher rates of multiple postoperative complications or death (P = .009). Underweight patients also had a higher rate of complication than normal-overweight patients (P = .016). CONCLUSION Class III and underweight patients had higher rates of postoperative complications, which should be taken into consideration during perioperative counseling.
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Affiliation(s)
- Shelby C. Barrera
- Department of Otolaryngology–Head and Neck Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | - Evan J. Sanford
- Department of Otolaryngology–Head and Neck Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | - Sarah B. Ammerman
- Department of Deaf Education and Hearing Science, UT Health San Antonio, San Antonio, Texas, USA
| | - Jay K. Ferrell
- Department of Otolaryngology–Head and Neck Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | - C. Blake Simpson
- Department of Otolaryngology–Head and Neck Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | - Laura M. Dominguez
- Department of Otolaryngology–Head and Neck Surgery, UT Health San Antonio, San Antonio, Texas, USA
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Christian-Miller N, Hadaya J, Nakhla M, Sanaiha Y, Madrigal J, Emami S, Cale M, Sareh S, Benharash P. The impact of obesity on outcomes in patients receiving extracorporeal life support. Artif Organs 2020; 44:1184-1191. [PMID: 32530120 DOI: 10.1111/aor.13752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/25/2020] [Accepted: 06/02/2020] [Indexed: 12/16/2022]
Abstract
Extracorporeal life support (ECLS) has been increasingly utilized to manage cardiac and pulmonary dysfunction. The impact of obesity on outcomes of ECLS is poorly defined. The purpose of the study was to compare in-hospital mortality, resource use, complications, and readmissions in obese versus non-obese patients receiving ECLS. We performed a retrospective cohort study of all adult ECLS patients with and without an obesity diagnosis using the 2010-2016 Nationwide Readmissions Database (NRD). Mortality, length of stay (LOS), hospital charges, complications, and readmissions were evaluated using multivariable logistic and linear regression. Of 23 876, patients who received ECLS, 1924 (8.1%) were obese. Obese patients received ECLS more frequently for respiratory failure (29.5% vs. 23.7%, P = .001). After adjustment for patient and hospital factors, obesity was not associated with increased odds of mortality (AOR = 1.06, P = .44) and was associated with decreased LOS (13.7 vs. 21.2 days, P < .001), hospital charges ($171 866 vs. $211 445, P < .001), and 30-day readmission (AOR = 0.71, P = .03). Obesity was also associated with reduced odds of hemorrhage (AOR = 0.43, P < .001), neurologic complications (AOR = 0.55, P = .004), and acute kidney injury (AOR=0.83, P = .04). After stratification by ECLS indication, obesity remained predictive of shorter LOS (AOR range: 0.53-0.78, all P < .05 ) and did not impact mortality (all P > .05). Respiratory support remains the most common indication for ECLS among obese patients. Among all patients, as well as by individual ECLS indication, obesity was not associated with increased odds of mortality. These findings suggest that obesity should not be considered a high-risk contraindication to ECLS.
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Affiliation(s)
- Nathaniel Christian-Miller
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Morcos Nakhla
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Josef Madrigal
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Sara Emami
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Mario Cale
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Sohail Sareh
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Zeuschner P, Sester U, Stöckle M, Saar M, Zompolas I, El-Bandar N, Liefeldt L, Budde K, Öllinger R, Ritschl P, Schlomm T, Mihm J, Friedersdorff F. Should We Perform Old-for-Old Kidney Transplantation during the COVID-19 Pandemic? The Risk for Post-Operative Intensive Stay. J Clin Med 2020; 9:E1835. [PMID: 32545566 PMCID: PMC7356807 DOI: 10.3390/jcm9061835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022] Open
Abstract
Health care systems worldwide have been facing major challenges since the outbreak of the SARS-CoV-2 pandemic. Kidney transplantation (KT) has been tremendously affected due to limited personal protective equipment (PPE) and intensive care unit (ICU) capacities. To provide valid information on risk factors for ICU admission in a high-risk cohort of old kidney recipients from old donors in the Eurotransplant Senior Program (ESP), we retrospectively conducted a bi-centric analysis. Overall, 17 (16.2%) patients out of 105 KTs were admitted to the ICU. They had a lower BMI, and both coronary artery disease (CAD) and hypertensive nephropathy were more frequent. A risk model combining BMI, CAD and hypertensive nephropathy gained a sensitivity of 94.1% and a negative predictive value of 97.8%, rendering it a valuable search test, but with low specificity (51.1%). ICU admission also proved to be an excellent parameter identifying patients at risk for short patient and graft survivals. Patients admitted to the ICU had shorter patient (1-year 57% vs. 90%) and graft (5-year 49% vs. 77%) survival. To conclude, potential kidney recipients with a low BMI, CAD and hypertensive nephropathy should only be transplanted in the ESP in times of SARS-CoV-2 pandemic if the local health situation can provide sufficient ICU capacities.
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Affiliation(s)
- Philip Zeuschner
- Department of Urology and Pediatric Urology, Saarland University, Kirrberger Street 100, 66421 Homburg/Saar, Germany; (P.Z.); (M.S.); (M.S.)
| | - Urban Sester
- Department of Nephrology and Hypertension, Internal Medicine IV, Saarland University, Kirrberger Street 100, 66421 Homburg/Saar, Germany; (U.S.); (J.M.)
| | - Michael Stöckle
- Department of Urology and Pediatric Urology, Saarland University, Kirrberger Street 100, 66421 Homburg/Saar, Germany; (P.Z.); (M.S.); (M.S.)
| | - Matthias Saar
- Department of Urology and Pediatric Urology, Saarland University, Kirrberger Street 100, 66421 Homburg/Saar, Germany; (P.Z.); (M.S.); (M.S.)
| | - Ilias Zompolas
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (I.Z.); (N.E.-B.); (T.S.)
| | - Nasrin El-Bandar
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (I.Z.); (N.E.-B.); (T.S.)
| | - Lutz Liefeldt
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (L.L.); (K.B.)
| | - Klemens Budde
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (L.L.); (K.B.)
| | - Robert Öllinger
- Department of Surgery, Campus Charité Mitte/Campus Virchow-Klinikum CCM/CVK, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (R.Ö.); (P.R.)
| | - Paul Ritschl
- Department of Surgery, Campus Charité Mitte/Campus Virchow-Klinikum CCM/CVK, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (R.Ö.); (P.R.)
| | - Thorsten Schlomm
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (I.Z.); (N.E.-B.); (T.S.)
| | - Janine Mihm
- Department of Nephrology and Hypertension, Internal Medicine IV, Saarland University, Kirrberger Street 100, 66421 Homburg/Saar, Germany; (U.S.); (J.M.)
| | - Frank Friedersdorff
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (I.Z.); (N.E.-B.); (T.S.)
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Nurkkala JP, Kaakinen TI, Vakkala MA, Ala-Kokko TI, Liisanantti JH. Nutrition deficit during intensive care stay: incidence, predisposing factors and outcomes. Minerva Anestesiol 2020; 86:527-536. [DOI: 10.23736/s0375-9393.20.14068-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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46
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Yu Q, Wang D, Wen X, Tang X, Qi D, He J, Zhao Y, Deng W, Zhu T. Adipose-derived exosomes protect the pulmonary endothelial barrier in ventilator-induced lung injury by inhibiting the TRPV4/Ca 2+ signaling pathway. Am J Physiol Lung Cell Mol Physiol 2020; 318:L723-L741. [PMID: 32073873 PMCID: PMC7191475 DOI: 10.1152/ajplung.00255.2019] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Mechanical ventilation (MV) is the main supportive treatment of acute respiratory distress syndrome (ARDS), but it may lead to ventilator-induced lung injury (VILI). Large epidemiological studies have found that obesity was associated with lower mortality in mechanically ventilated patients with acute lung injury, which is known as “obesity paradox.” However, the effects of obesity on VILI are unknown. In the present study, wild-type mice were fed a high-fat diet (HFD) and ventilated with high tidal volume to investigate the effects of obesity on VILI in vivo, and pulmonary microvascular endothelial cells (PMVECs) were subjected to 18% cyclic stretching (CS) to further investigate its underlying mechanism in vitro. We found that HFD protects mice from VILI by alleviating the pulmonary endothelial barrier injury and inflammatory responses in mice. Adipose-derived exosomes can regulate distant tissues as novel adipokines, providing a new mechanism for cell-cell interactions. We extracted three adipose-derived exosomes, including HFD mouse serum exosome (S-Exo), adipose tissue exosome (AT-Exo), and adipose-derived stem cell exosome (ADSC-Exo), and further explored their effects on MV or 18% CS-induced VILI in vivo and in vitro. Administration of three exosomes protected against VILI by suppressing pulmonary endothelial barrier hyperpermeability, repairing the expression of adherens junctions, and alleviating inflammatory response in vivo and in vitro, accompanied by transient receptor potential vanilloid 4 (TRPV4)/Ca2+ pathway inhibition. Collectively, these data indicated that HFD-induced obesity plays a protective role in VILI by alleviating the pulmonary endothelial barrier injury and inflammatory response via adipose-derived exosomes, at least partially, through inhibiting the TRPV4/Ca2+ pathway.
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Affiliation(s)
- Qian Yu
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daoxin Wang
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoting Wen
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xumao Tang
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Di Qi
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing He
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yan Zhao
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wang Deng
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tao Zhu
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Schiffl H. Obesity and the Survival of Critically Ill Patients with Acute Kidney Injury: A Paradox within the Paradox? KIDNEY DISEASES (BASEL, SWITZERLAND) 2020; 6:13-21. [PMID: 32021870 PMCID: PMC6995946 DOI: 10.1159/000502209] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/17/2019] [Indexed: 12/30/2022]
Abstract
The obesity epidemic is reflected by the rising number of obese patients requiring intensive care. Obesity is a recognized risk factor for the development of acute kidney injury (AKI) in critically ill patients. Both acute critical illness and AKI are associated with higher in-hospital mortality rates, and intensive care unit (ICU) patients suffering from AKI have an elevated risk of death. The relationships between obesity and mortality in critically ill paediatric and adult patients with or without AKI are less clear. Conflicting evidence exists regarding the potential impact of body mass index on the mortality of ICU patients with AKI. Some studies looking at the ICU outcomes of critically ill obese patients with AKI show reduced mortality and others show either no association or elevated mortality. Despite a high biologic plausibility of the proposed causal mechanisms, such as a greater haemodynamic stability and the protective cytokine, adipokine, and lipoprotein defence profiles associated with obesity, the inconsistency of the data suggests that the obesity paradox is a statistical fallacy and the result of chance, bias, and residual confounding variables in retrospective cohort analyses. Further prospective randomized trials are essential to elucidate the role of obesity and the mechanisms underlying a potential survival benefit of obesity in critically ill patients with AKI.
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Affiliation(s)
- Helmut Schiffl
- Department of Internal Medicine IV, University of Munich, Munich, Germany
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48
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Zhang W, Wang Y, Li W, Wang J. Association Between Obesity and Short-And Long-Term Mortality in Patients With Acute Respiratory Distress Syndrome Based on the Berlin Definition. Front Endocrinol (Lausanne) 2020; 11:611435. [PMID: 33643222 PMCID: PMC7907504 DOI: 10.3389/fendo.2020.611435] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/21/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Acute respiratory distress syndrome (ARDS) is one of the most common causes of death in intensive care units (ICU). Previous studies have reported the potential protective effect of obesity on ARDS patients. However, these findings are inconsistent, in which less was reported on long-term prognosis and diagnosed ARDS by Berlin definition. This study aimed to investigate the relationship between obesity and short-term and long-term mortality in patients with ARDS based on the Berlin Definition. METHODS This is a retrospective cohort study from the Medical Information Mart for Intensive Care III (MIMIC-III) database, in which all the patients were diagnosed with ARDS according to the Berlin definition. The patients were divided into four groups according to the WHO body mass index (BMI) categories. The multivariable logistic regression and Cox regression analysis were used to investigate the relationship between BMI and short-term and long-term mortality. RESULT A total of 2,378 patients with ARDS were enrolled in our study. In-hospital mortality was 27.92%, and 1,036 (43.57%) patients had died after 1-year follow-up. After adjusting for confounders, the in-hospital and 1-year mortality risks of obese patients were significantly lower than those of normal weight (OR 0.72, 95%CI 0.55-0.94, P=0.0168; HR 0.80, 95%CI 0.68-0.94 P=0.0084; respectively), while those mortality risks of underweight patients were higher than normal weight patients (P=0.0102, P=0.0184; respectively). The smooth curve showed that BMI, which was used as a continuous variable, was negatively correlated with in-hospital and 1-year mortality. The results were consistent after being stratified by age, gender, race, type of admission, severity of organ dysfunction, and severity of ARDS. The Kaplan-Meier survival curves showed that obese patients had significant lower 1-year mortality than normal weight patients. CONCLUSION We found that obesity was associated with decreased risk of short-term and long-term mortality in patients with ARDS.
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Affiliation(s)
- Wei Zhang
- Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People’s Hospital, Xi’an, China
- *Correspondence: Wei Zhang,
| | - Yadan Wang
- Medical Department, Ruibiao (Wuhan) Biotechnology Co. Ltd, Wuhan, China
| | - Weijie Li
- Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Jun Wang
- Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People’s Hospital, Xi’an, China
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49
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Favorable 90-Day Mortality in Obese Caucasian Patients with Septic Shock According to the Sepsis-3 Definition. J Clin Med 2019; 9:jcm9010046. [PMID: 31878238 PMCID: PMC7019854 DOI: 10.3390/jcm9010046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 12/04/2019] [Accepted: 12/20/2019] [Indexed: 02/07/2023] Open
Abstract
Septic shock is a frequent life-threatening condition and a leading cause of mortality in intensive care units (ICUs). Previous investigations have reported a potentially protective effect of obesity in septic shock patients. However, prior results have been inconsistent, focused on short-term in-hospital mortality and inadequately adjusted for confounders, and they have rarely applied the currently valid Sepsis-3 definition criteria for septic shock. This investigation examined the effect of obesity on 90-day mortality in patients with septic shock selected from a prospectively enrolled cohort of septic patients. A total of 352 patients who met the Sepsis-3 criteria for septic shock were enrolled in this study. Body-mass index (BMI) was used to divide the cohort into 24% obese (BMI ≥ 30 kg/m2) and 76% non-obese (BMI < 30 kg/m2) patients. Kaplan-Meier survival analysis revealed a significantly lower 90-day mortality (31% vs. 43%; p = 0.0436) in obese patients compared to non-obese patients. Additional analyses of baseline characteristics, disease severity, and microbiological findings outlined further statistically significant differences among the groups. Multivariate Cox regression analysis estimated a significant protective effect of obesity on 90-day mortality after adjustment for confounders. An understanding of the underlying physiologic mechanisms may improve therapeutic strategies and patient prognosis.
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50
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Khayat J, Champely S, Diab A, Rifai Sarraj A, Fargier P. Effect of mental calculus on the performance of complex movements. Hum Mov Sci 2019; 66:347-354. [PMID: 31146193 DOI: 10.1016/j.humov.2019.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Joy Khayat
- Lebanese University, Rafic Hariri Campus, Faculty of Public Health, Lebanon
| | - Stéphane Champely
- Université de Lyon, Université Lyon 1, LVIS - EA 7428, SFR CRIS - FED 4272, 69 622 Villeurbanne Cedex, France
| | - Ahmad Diab
- Lebanese University, Rafic Hariri Campus, Faculty of Public Health, Lebanon
| | - Ahmad Rifai Sarraj
- Lebanese University, Rafic Hariri Campus, Faculty of Public Health, Lebanon
| | - Patrick Fargier
- Université de Lyon, Université Lyon 1, LIBM - EA 7424, SFR CRIS - FED 4272, 69 622 Villeurbanne Cedex, France.
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