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Feng T, Hu S, Song C, Zhong M. Establishment of a novel weight reduction model after laparoscopic sleeve gastrectomy based on abdominal fat area. Front Surg 2024; 11:1390045. [PMID: 38826810 PMCID: PMC11140024 DOI: 10.3389/fsurg.2024.1390045] [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: 02/22/2024] [Accepted: 04/17/2024] [Indexed: 06/04/2024] Open
Abstract
In light of ongoing research elucidating the intricacies of obesity and metabolic syndrome, the role of abdominal fat (especially visceral fat) has been particularly prominent. Studies have revealed that visceral adipose tissue can accelerate the development of metabolic syndrome by releasing various bioactive compounds and hormones, such as lipocalin, leptin and interleukin. A retrospective analysis was performed on the clinical data of 167 patients with obesity. Among them, 105 patients who satisfied predefined inclusion and exclusion criteria were included. The parameters evaluated included total abdominal fat area (TAFA), laboratory indicators and anthropometric measurements. Weight reduction was quantified through percent total weight loss (%TWL) and percent excess weight loss (%EWL) postoperatively. Binary logistic regression analysis and receiver operating characteristic (ROC) curve analysis were employed to identify predictors of weight loss. Binary logistic regression analysis emphasized that total abdominal fat area was an independent predictor of %EWL ≥75% (p < 0.001). Total abdominal fat area (p = 0.033) and BMI (p = 0.003) were independent predictors of %TWL ≥30%. In our cohort, %TWL ≥30% at 1 year after surgery was closely related to the abdominal fat area and BMI. Based on these results, we formulated a novel model based on these factors, exhibiting superior predictive value for excellent weight loss.
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Affiliation(s)
- Tianyi Feng
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
| | - Sanyuan Hu
- Department of General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
| | - Changrong Song
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
| | - Mingwei Zhong
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
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Takenoshita M, Weir McCall JR, Barker AP, Suresh S, Celik H, Vuylsteke A. Association between body composition and mortality in patients requiring extracorporeal membrane oxygenation support. Clin Radiol 2024; 79:272-278. [PMID: 38278741 DOI: 10.1016/j.crad.2023.12.011] [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: 06/01/2023] [Revised: 11/16/2023] [Accepted: 12/14/2023] [Indexed: 01/28/2024]
Abstract
AIM To ascertain the association between body composition, including muscle mass and adiposity, and patient mortality in those requiring extracorporeal membrane oxygenation (ECMO) for acute respiratory failure. MATERIALS AND METHODS A retrospective study was undertaken of all patients with acute respiratory failure requiring veno-venous (VV) ECMO between January 2015 and December 2019. Automated image segmentation software was used to quantify the cross-sectional area and average radiodensity (in Hounsfield units) of different muscle and fat compartments at the L3 level of whole-body computed tomography (CT) images taken within 48 h of initiation of ECMO support. The primary endpoint was 30-day post-ECMO initiation all-cause mortality. Logistic regression was used to analyse the correlation between CT measurements, co-morbidities, and 30-day survival. RESULTS The study included 189 patients (age = 43.8 ± 14.6, sex = 42.3% female). There was no significant association between 30-day survival status and cross-sectional area of muscle or fat. Muscle attenuation (psoas, long spine, and abdominal muscles respectively) at the L3 level were significantly lower in those who died within 30 days of ECMO cannulation (p<0.05). On multivariable analysis including age, sex, and pre-existing respiratory comorbidities, psoas muscle attenuation was an independent predictor of survival at 30 days (OR 0.97; 95% CI 0.94 to 1.00; p=0.047). CONCLUSIONS Reduced psoas muscle attenuation is associated with poorer survival outcomes at 30 days post-ECMO cannulation in patients who received VV ECMO support for respiratory failure. Cross-sectional areas of muscle and fat compartments did not correlate with survival outcomes at 30 days even when corrected for height and sex.
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Affiliation(s)
- M Takenoshita
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - J R Weir McCall
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK.
| | - A P Barker
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - S Suresh
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - H Celik
- University of Massachusetts Chan Medical School, Massachusetts, USA
| | - A Vuylsteke
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
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Miwa T, Hanai T, Nishimura K, Tajirika S, Nakahata Y, Imai K, Suetsugu A, Takai K, Yamamoto M, Shimizu M. Association between Body Composition and the Risk of Portopulmonary Hypertension Assessed by Computed Tomography in Patients with Liver Cirrhosis. J Clin Med 2023; 12:jcm12103351. [PMID: 37240457 DOI: 10.3390/jcm12103351] [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: 03/04/2023] [Revised: 04/24/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
The aim of this study is to investigate the impact of body composition on the risk of portopulmonary hypertension using computed tomography (CT) in patients with liver cirrhosis. We retrospectively included 148 patients with cirrhosis treated at our hospital between March 2012 and December 2020. POPH high-risk was defined as main pulmonary artery diameter (mPA-D) ≥ 29 mm or mPA-D to ascending aorta diameter ratio ≥ 1.0, based on chest CT. Body composition was assessed using CT images of the third lumbar vertebra. The factors associated with POPH high-risk were evaluated using logistic regression and decision tree analyses, respectively. Among the 148 patients, 50% were females, and 31% were found to be high-risk cases on evaluation of chest CT images. Patients with a body mass index (BMI) of ≥25 mg/m2 had a significantly higher prevalence of POPH high-risk than those with a BMI < 25 mg/m2 (47% vs. 25%, p = 0.019). After adjusting for confounding factors, BMI (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.10-1.33), subcutaneous adipose tissue index (OR, 1.02; 95% CI, 1.01-1.03), and visceral adipose tissue index (OR, 1.03; 95% CI, 1.01-1.04) were associated with POPH high-risk, respectively. In the decision tree analysis, the strongest classifier of POPH high-risk was BMI, followed by the skeletal muscle index. Body composition may affect the risk of POPH based on chest CT assessment in patients with cirrhosis. Since the present study lacked data on right heart catheterization, further studies are required to confirm the results of our study.
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Affiliation(s)
- Takao Miwa
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu 501-1194, Japan
- Health Administration Center, Gifu University, Gifu 501-1193, Japan
| | - Tatsunori Hanai
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu 501-1194, Japan
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu 501-1194, Japan
| | - Kayoko Nishimura
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu 501-1194, Japan
| | - Satoko Tajirika
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu 501-1194, Japan
- Health Administration Center, Gifu University, Gifu 501-1193, Japan
| | - Yuki Nakahata
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu 501-1194, Japan
- Department of Gastroenterology, Asahi University Hospital, Gifu 501-1194, Japan
| | - Kenji Imai
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu 501-1194, Japan
| | - Atsushi Suetsugu
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu 501-1194, Japan
| | - Koji Takai
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu 501-1194, Japan
- Division for Regional Cancer Control, Graduate School of Medicine, Gifu University, Gifu 501-1194, Japan
| | - Mayumi Yamamoto
- Health Administration Center, Gifu University, Gifu 501-1193, Japan
- United Graduate School of Drug Discovery and Medical Information Sciences, Gifu University, Gifu 501-1194, Japan
| | - Masahito Shimizu
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu 501-1194, Japan
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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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Puengel T, Weber B, Wirtz TH, Buendgens L, Loosen SH, Geisler L, Özdirik B, Karim H, Jhaisha SA, Brozat JF, Hohlstein P, Eisert A, Yagmur E, Trautwein C, Tacke F, Koch A. Low Serum Levels of Soluble Receptor Activator of Nuclear Factor κ B Ligand (sRANKL) Are Associated with Metabolic Dysregulation and Predict Long-Term Mortality in Critically Ill Patients. Diagnostics (Basel) 2021; 12:diagnostics12010062. [PMID: 35054232 PMCID: PMC8774641 DOI: 10.3390/diagnostics12010062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/18/2021] [Accepted: 12/23/2021] [Indexed: 01/23/2023] Open
Abstract
Soluble receptor activator of nuclear factor κ B ligand (sRANKL) is a member of the tumor necrosis factor receptor superfamily, and therefore, involved in various inflammatory processes. The role of sRANKL in the course of bone remodeling via activation of osteoclasts as well as chronic disease progression has been described extensively. However, the potential functional importance of sRANKL in critically ill or septic patients remained unknown. Therefore, we measured sRANKL serum concentrations in 303 critically ill patients, including 203 patients with sepsis and 100 with non-sepsis critical illness. Results were compared to 99 healthy controls. Strikingly, in critically ill patients sRANKL serum levels were significantly decreased at intensive care unit (ICU) admission (p = 0.011) without differences between sepsis and non-sepsis patients. Inline, sRANKL was correlated with markers of metabolic dysregulation, such as pre-existing diabetes and various adipokines (e.g., adiponectin, leptin receptor). Importantly, overall mortality of critically ill patients in a three-year follow-up was significantly associated with decreased sRANKL serum concentrations at ICU admission (p = 0.038). Therefore, our study suggests sRANKL as a biomarker in critically ill patients which is associated with poor prognosis and overall survival beyond ICU stay.
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Affiliation(s)
- Tobias Puengel
- Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum (CVK) and Campus Charité Mitte (CCM), Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (L.G.); (B.Ö.); (F.T.)
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
- Correspondence:
| | - Beate Weber
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
| | - Theresa H. Wirtz
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
| | - Lukas Buendgens
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
| | - Sven H. Loosen
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany;
| | - Lukas Geisler
- Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum (CVK) and Campus Charité Mitte (CCM), Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (L.G.); (B.Ö.); (F.T.)
| | - Burcin Özdirik
- Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum (CVK) and Campus Charité Mitte (CCM), Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (L.G.); (B.Ö.); (F.T.)
| | - Hamesch Karim
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
| | - Samira Abu Jhaisha
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
| | - Jonathan F. Brozat
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
| | - Philipp Hohlstein
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
| | - Albrecht Eisert
- Hospital Pharmacy, RWTH-University Hospital Aachen, 52074 Aachen, Germany;
- Institute of Clinical Pharmacology, RWTH-University Hospital Aachen, 52074 Aachen, Germany
| | - Eray Yagmur
- Institute of Laboratory Medicine, Western Palatinate Hospital, 67655 Kaiserslautern, Germany;
| | - Christian Trautwein
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum (CVK) and Campus Charité Mitte (CCM), Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (L.G.); (B.Ö.); (F.T.)
| | - Alexander Koch
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
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Serum Perilipin 2 (PLIN2) Predicts Multiple Organ Dysfunction in Critically Ill Patients. Biomedicines 2021; 9:biomedicines9091210. [PMID: 34572396 PMCID: PMC8468514 DOI: 10.3390/biomedicines9091210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 12/24/2022] Open
Abstract
Perilipin 2 (PLIN2) is a lipid droplet protein with various metabolic functions. However, studies investigating PLIN2 in the context of inflammation, especially in systemic and acute inflammation, are lacking. Hence, we assessed the relevance of serum PLIN2 in critically ill patients. We measured serum PLIN2 serum in 259 critically ill patients (166 with sepsis) upon admission to a medical intensive care unit (ICU) compared to 12 healthy controls. A subset of 36 patients underwent computed tomography to quantify body composition. Compared to controls, serum PLIN2 concentrations were elevated in critically ill patients at ICU admission. Interestingly, PLIN2 independently indicated multiple organ dysfunction (MOD), defined as a SOFA score > 9 points, at ICU admission, and was also able to independently predict MOD after 48 h. Moreover, serum PLIN2 levels were associated with severe respiratory failure potentially reflecting a moribund state. However, PLIN2 was neither a predictor of ICU mortality nor did it reflect metabolic dysregulation. Conclusively, the first study assessing serum PLIN2 in critical illness proved that it may assist in risk stratification because it is capable of independently indicating MOD at admission and predicting MOD 48 h after PLIN2 measurement. Further evaluation regarding the underlying mechanisms is warranted.
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