Metabolic profile of clinically severe obese patients.

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Faria, Silvia Leite; Faria, Orlando Pereira; Menezes, Caroline Soares; de Gouvêa, Heloisa Rodrigues; de Almeida Cardeal, Mariane

2012-08-01

Since low basal metabolic rate (BMR) is a risk factor for weight regain, it is important to measure BMR before bariatric surgery. We aimed to evaluate the BMR among clinically severe obese patients preoperatively. We compared it with that of the control group, with predictive formulas and correlated it with body composition. We used indirect calorimetry (IC) to collect BMR data and multifrequency bioelectrical impedance to collect body composition data. Our sample population consisted of 193 patients of whom 130 were clinically severe obese and 63 were normal/overweight individuals. BMR results were compared with the following predictive formulas: Harris-Benedict (HBE), Bobbioni-Harsch (BH), Cunningham (CUN), Mifflin-St. Jeor (MSJE), and Horie-Waitzberg & Gonzalez (HW & G). This study was approved by the Ethics Committee for Research of the University of Brasilia. Statistical analysis was used to compare and correlate variables. Clinically severe obese patients had higher absolute BMR values and lower adjusted BMR values (p BMR were found in both groups. Among the clinically severe obese patients, the formulas of HW & G and HBE overestimated BMR values (p = 0.0002 and p = 0.0193, respectively), while the BH and CUN underestimated this value; only the MSJE formulas showed similar results to those of IC. The clinically severe obese patients showed low BMR levels when adjusted per kilogram per body weight. Body composition may influence BMR. The use of the MSJE formula may be helpful in those cases where it is impossible to use IC.

Difficult Tracheal Intubation in Obese Gastric Bypass patients

DEFF Research Database (Denmark)

Dohrn, Niclas; Sommer, Thorbjørn; Bisgaard, J.

2016-01-01

Endotracheal intubation is commonly perceived to be more difficult in obese patients than in lean patients. Primarily, we investigated the association between difficult tracheal intubation (DTI) and obesity, and secondarily, the association between DTI and validated scoring systems used to assess...... the airways, the association between DTI and quantities of anesthetics used to induce general anesthesia, and the association between DTI and difficulties with venous and arterial cannulation. This is a monocentric prospective observational clinical study of a consecutive series of 539 obese patients...... was 3.5 % and the patients with DTI were more frequently males, had higher CLC, higher American Society of Anesthesiologists physical status classification (ASA), and noticeably, a lower BMI compared to the patients with easy tracheal intubation. After adjustment with multivariable analyses body mass...

Psychiatric disorders of patients seeking obesity treatment

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Lin Hung-Yen

2013-01-01

Full Text Available Abstract Background Obese and overweight people have a higher risk of both chronic physical illness and mental illness. Obesity is reported to be positively associated with psychiatric disorders, especially in people who seek obesity treatment. At the same time, obesity treatment may be influenced by psychological factors or personality characteristics. This study aimed to understand the prevalence of mental disorders among ethnic Chinese who sought obesity treatment. Methods Subjects were retrospectively recruited from an obesity treatment center in Taiwan. The obesity treatments included bariatric surgery and non-surgery treatment. All subjects underwent a standardized clinical evaluation with two questionnaires and a psychiatric referral when needed. The psychiatric diagnosis was made thorough psychiatric clinic interviews using the SCID. A total of 841 patients were recruited. We compared the difference in psychiatric disorder prevalence between patients with surgical and non-surgical treatment. Results Of the 841 patients, 42% had at least one psychiatric disorder. Mood disorders, anxiety disorders and eating disorders were the most prevalent categories of psychiatric disorders. Females had more mood disorders and eating disorders than males. The surgical group had more binge-eating disorder, adjustment disorder, and sleep disorders than the non-surgical group. Conclusion A high prevalence of psychiatric disorders was found among ethnic Chinese seeking obesity treatment. This is consistent with study results in the US and Europe.

The obese patient undergoing nonbariatric surgery.

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Bluth, Thomas; Pelosi, Paolo; de Abreu, Marcelo Gama

2016-06-01

This article provides the reader with recent findings on the pathophysiology of comorbidities in the obese, as well as evidence-based treatment options to deal with perioperative respiratory challenges. Our understanding of obesity-associated asthma, obstructive sleep apnea, and obesity hypoventilation syndrome is still expanding. Routine screening for obstructive sleep apnea using the STOP-Bang score might identify high-risk patients that benefit from perioperative continuous positive airway pressure and close postoperative monitoring. Measures to most effectively support respiratory function during induction of and emergence from anesthesia include optimal patient positioning and use of noninvasive positive pressure ventilation. Appropriate mechanical ventilation settings are under investigation, so that only the use of protective low tidal volumes could be currently recommended. A multimodal approach consisting of adjuvants, as well as regional anesthesia/analgesia techniques reduces the need for systemic opioids and related respiratory complications. Anesthesia of obese patients for nonbariatric surgical procedures requires knowledge of typical comorbidities and their respective treatment options. Apart from cardiovascular diseases associated with the metabolic syndrome, awareness of any pulmonary dysfunction is of paramount. A multimodal analgesia approach may be useful to reduce postoperative pulmonary complications.

Population Pharmacokinetics and Pharmacodynamics of Meropenem in Nonobese, Obese, and Morbidly Obese Patients.

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Chung, Eun Kyoung; Cheatham, S Christian; Fleming, Megan R; Healy, Daniel P; Kays, Michael B

2017-03-01

The study objective was to evaluate meropenem population pharmacokinetics and pharmacodynamics in nonobese, obese, and morbidly obese patients. Forty adult patients-11 nonobese (body mass index [BMI] calculate probability of target attainment (PTA) for 5 dosing regimens, infused over 0.5 and 3 hours, using fT>MIC of 40%, 54%, and 100% of the dosing interval. A 2-compartment linear-elimination model best described the serum concentration-time data, and creatinine clearance was significantly associated with systemic clearance. Pharmacokinetic parameters were not significantly different among patient groups. In patients with creatinine clearances ≥50 mL/min, all simulated dosing regimens achieved >90% PTA at 40% fT>MIC in all patient groups at MICs ≤2 mg/L. Only 500 mg q8h, infused over 0.5 hour, did not achieve >90% PTA at 54% fT>MIC in nonobese and morbidly obese patients. At 100% fT>MIC, 1 g q6h and 2 g q8h, infused over 3 hours, reliably achieved >90% PTA in all patient groups. Meropenem pharmacokinetics are comparable among nonobese, obese, and morbidly obese patients. Standard dosing regimens provide adequate pharmacodynamic exposures for susceptible pathogens at 40% and 54% fT>MIC, but prolonged infusions of larger doses are needed for adequate exposures at 100% fT>MIC. Dosage adjustments based solely on body weight are unnecessary. © 2016, The American College of Clinical Pharmacology.

DOES PRESENTING PATIENT'S BMI INCREASE DOCUMENTATION OF OBESITY?

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Norm Clothier, MD, M. Kim Marvel, PhD, Courtney S. Cruickshank, MS

2002-09-01

Full Text Available Purpose: Despite the associated health consequences, obesity is infrequently documented as a problem in medical charts. The purpose of this study is to determine whether a simple intervention (routine listing of the BMI on the medical chart will increase physician documentation of obesity in the medical record. Methods: Participants were resident physicians in a family medicine residency program. Participants were randomly assigned to either an experimental group or a control group. For experimental group physicians, the Body Mass Index was listed alongside other vital signs of patients seen in an ambulatory setting. Physician documentation of patient obesity was assessed by chart review after patient visits. Documentation was defined as inclusion of obesity on the problem list or in the progress note. Results: The intervention did not significantly increase the rate of documentation of obesity in the medical chart. Several reasons for the lack of change are explored, including the difficulty of treating obesity successfully.

Perioperative lung protective ventilation in obese patients

OpenAIRE

Fernandez-Bustamante, Ana; Hashimoto, Soshi; Serpa Neto, Ary; Moine, Pierre; Vidal Melo, Marcos F; Repine, John E

2015-01-01

The perioperative use and relevance of protective ventilation in surgical patients is being increasingly recognized. Obesity poses particular challenges to adequate mechanical ventilation in addition to surgical constraints, primarily by restricted lung mechanics due to excessive adiposity, frequent respiratory comorbidities (i.e. sleep apnea, asthma), and concerns of postoperative respiratory depression and other pulmonary complications. The number of surgical patients with obesity is increa...

Iron deficiency anemia and megaloblastic anemia in obese patients.

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Arshad, Mahmoud; Jaberian, Sara; Pazouki, Abdolreza; Riazi, Sajedeh; Rangraz, Maryam Aghababa; Mokhber, Somayyeh

2017-03-01

The association between obesity and different types of anemia remained uncertain. The present study aimed to assess the relation between obesity parameters and the occurrence of iron deficiency anemia and also megaloblastic anemia among Iranian population. This cross-sectional study was performed on 1252 patients with morbid obesity that randomly selected from all patients referred to Clinic of obesity at Rasoul-e-Akram Hospital in 2014. The morbid obesity was defined according to the guideline as body mass index (BMI) equal to or higher than 40 kg/m2. Various laboratory parameters including serum levels of hemoglobin, iron, ferritin, folic acid, and vitamin B12 were assessed using the standard laboratory techniques. BMI was adversely associated with serum vitamin B12, but not associated with other hematologic parameters. The overall prevalence of iron deficiency anemia was 9.8%. The prevalence of iron deficiency anemia was independent to patients' age and also to body mass index. The prevalence of vitamin B12 deficiency was totally 20.9%. According to the multivariable logistic regression model, no association was revealed between BMI and the occurrence of iron deficiency anemia adjusting gender and age. A similar regression model showed that higher BMI could predict occurrence of vitamin B12 deficiency in morbid obese patients. Although iron deficiency is a common finding among obese patients, vitamin B12 deficiency is more frequent so about one-fifth of these patients suffer vitamin B12 deficiency. In fact, the exacerbation of obesity can result in exacerbation of vitamin B12 deficiency.

Controlled invasive mechanical ventilation strategies in obese patients undergoing surgery.

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Maia, Lígia de Albuquerque; Silva, Pedro Leme; Pelosi, Paolo; Rocco, Patricia Rieken Macedo

2017-06-01

The obesity prevalence is increasing in surgical population. As the number of obese surgical patients increases, so does the demand for mechanical ventilation. Nevertheless, ventilatory strategies in this population are challenging, since obesity results in pathophysiological changes in respiratory function. Areas covered: We reviewed the impact of obesity on respiratory system and the effects of controlled invasive mechanical ventilation strategies in obese patients undergoing surgery. To date, there is no consensus regarding the optimal invasive mechanical ventilation strategy for obese surgical patients, and no evidence that possible intraoperative beneficial effects on oxygenation and mechanics translate into better postoperative pulmonary function or improved outcomes. Expert commentary: Before determining the ideal intraoperative ventilation strategy, it is important to analyze the pathophysiology and comorbidities of each obese patient. Protective ventilation with low tidal volume, driving pressure, energy, and mechanical power should be employed during surgery; however, further studies are required to clarify the most effective ventilation strategies, such as the optimal positive end-expiratory pressure and whether recruitment maneuvers minimize lung injury. In this context, an ongoing trial of intraoperative ventilation in obese patients (PROBESE) should help determine the mechanical ventilation strategy that best improves clinical outcome in patients with body mass index≥35kg/m 2 .

Surgery for Gastroesophageal Reflux Disease in the Morbidly Obese Patient.

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Duke, Meredith C; Farrell, Timothy M

2017-01-01

The prevalence of gastroesophageal reflux disease (GERD) has mirrored the increase in obesity, and GERD is now recognized as an obesity-related comorbidity. There is growing evidence that obesity, specifically central obesity, is associated with the complications of chronic reflux, including erosive esophagitis, Barrett's esophagus, and esophageal adenocarcinoma. While fundoplication is effective in creating a competent gastroesophageal junction and controlling reflux in most patients, it is less effective in morbidly obese patients. In these patients a bariatric operation has the ability to correct both the obesity and the abnormal reflux. The Roux-en-Y gastric bypass is the preferred procedure.

Changes of serum leptin and their relationships with insulin resistance in patients with simple obesity and patients with type 2 diabetes mellitus complicated with obesity

International Nuclear Information System (INIS)

Zhang Lei; Changzhou Wujin People's Hospital of Jiangsu Province, Changzhou; Shi Linlin; Lu Dan; Zhang Lei; Wang Qing; Yao Wenhua

2005-01-01

Objective: To study the changes of serum leptin in patients with simple obesity and patients with type 2 diabetes mellitus complicated with obesity in order to explore the relationship of leptin and insulin resistance and the role of leptin in the occurrence of type 2 diabetes mellitus. Methods: 60 cases of simple obesity, 60 cases of type 2 diabetes mellitus and 30 cases of normal control were included according to the diagnostic criteria of obesity and type 2 diabetes mellitus. the levels of fasting serum leptin, fasting serum insulin, fasting glucose, fasting blood lipid were measured in all cases. The body mass index (BMI) and insulin action index were calculated. Results: The level of BMI, serum leptin, serum insulin, blood lipid were significantly higher in patients with simple obesity and with type 2 diabetes mellitus complicated with obesity than in normal control cases, while (IAI) was significantly lower. The levels of free serum leptin, serum insulin, free glucose, and blood lipid were significantly higher in patients with type 2 diabetes mellitus complicated with obesity than in patients with simple obesity, while IAI was significantly lower. The level of serum leptin was positively correlated with BMI (r=0.48, P<0.55) and fasting serum leptin (r=0.55, P<0.05) and negatively correlated with IAI (r=-0.47, P<0.05) in patients with type 2 diabetes complicated with obesity. Conclusion: The overexpression of serum leptin may play an important role in the occurrence of the insulin resistance and type 2 diabetes mellitus in obesity patients. (authors)

Obese patients: respiratory complications in the post-anesthesia care unit.

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Mendonça, J; Pereira, H; Xará, D; Santos, A; Abelha, F J

2014-01-01

Obesity has been associated with respiratory complications, and the majority of these complications occur in the Post-Anesthesia Care Unit (PACU). The aim of this study was to evaluate the outcome and incidence of adverse respiratory events (AREs) in obese patients during their stay in the PACU METHODS: We conducted a prospective control study that included 27 obese patients matched with an equal number of patients with body mass index (BMI)<30 (non-obese control group); the 2 groups of patients were similar in respect to gender distribution, age, and type of surgery and had been admitted into the PACU after elective surgery (May 2011). The AREs were identified during PACU stay. Descriptive analysis of variables was performed, and the Mann-Whitney U test, Chi-square test, or Fisher's exact test were used for comparisons. Associations with AREs were studied using univariate and multivariate logistic regression models. There was a higher frequency of STOP-BANG ≥3 (89% vs. 11%, P<.001) among obese patients and they were less frequently scheduled to undergo high-risk surgery (7% vs. 41%, P=.005) and major surgery (4% vs. 15%, P=.008). Obese patients had more frequent AREs in the PACU (33% vs. 7%, P<.018). Multivariate analysis identified obesity and residual neuromuscular blockade as independent risk factors for the occurrence of AREs. Stay in the PACU was longer for obese patients (120min vs. 84min, P<.01). Obesity was considered an independent risk factor for AREs in the PACU. Obese patients stayed longer in the PACU, but they did not stay longer in the hospital. Copyright © 2012 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

Assessing and counseling the obese patient: Improving resident obesity counseling competence.

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Iyer, Shwetha; Jay, Melanie; Southern, William; Schlair, Sheira

To evaluate obesity counseling competence among residents in a primary care training program METHODS: We delivered a 3h obesity curriculum to 28 Primary Care residents and administered a pre-curriculum and post curriculum survey looking specifically at self-assessed obesity counseling competence. Nineteen residents completed both the pre curriculum survey and the post curriculum survey. The curriculum had a positive impact on residents' ability to ascertain patient's stage of change, use different methods to obtain diet history (including 24h recall, food record or food frequency questionnaire), respond to patient's questions regarding treatment options, assist patients in setting realistic goals for weight loss based on making permanent lifestyle changes, and use of motivational interviewing to change behavior. When looking at the 5As domains, there was a significant improvement in the domains of Assess, Advise, and Assist. The proportion of residents with a lower level of self-assessed obesity counseling competence reduced from 75% before the curriculum to 37.5% (p=0.04) after the curriculum. Our curriculum addressing weight loss counseling using the 5As model increased obesity counseling competence among residents in a primary care internal medicine residency program. Copyright © 2018 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Gingival condition of patient with obesity

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Atikah Sabrina Alyani

2018-01-01

Full Text Available The prevalence of obesity has increased drastically in most developed countries. Many studies showed that obesity associated with oral diseases, especially periodontal disease. A recent study showed the relation between WC and periodontal disease counted by gingival index (GI. However, studies regarding the mechanism of the relationship between obesity and periodontal disease are still quite a few, whereas many studies conducted suggested that obesity was a medical problem. The study was aimed to know and assess the gingival condition of obese people who visited the Dental Polyclinic of Hasan Sadikin Hospital. The type of this study was descriptive with the survey technique. A total of 54 people consisted of 35 female and 19 male patients with the age range of 20-49 years old, and not using any dental prosthesis or orthodontic appliance. This study was using a questionnaire and clinical examination to assess the condition of the gingival using the Löe and Silness Gingival index (GI. Examination of obesity conducted by measuring the waist circumference with criteria from WHO. The average value of the gingival index was 1.22. Meanwhile, the average value of the waist circumference (WC was 95.89 cm and 107.74 cm consecutively for female and male. The majority of obese patients suffered moderate gingivitis.

Robotic surgery in supermorbidly obese patients with endometrial cancer.

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Stephan, Jean-Marie; Goodheart, Michael J; McDonald, Megan; Hansen, Jean; Reyes, Henry D; Button, Anna; Bender, David

2015-07-01

Morbid obesity is a known risk factor for the development of endometrial cancer. Several studies have demonstrated the overall feasibility of robotic-assisted surgical staging for endometrial cancer as well as the benefits of robotics compared with laparotomy. However, there have been few reports that have evaluated robotic surgery for endometrial cancer in the supermorbidly obese population (body mass index [BMI], ≥50 kg/m(2)). We sought to evaluate safety, feasibility, and outcomes for supermorbidly obese patients who undergo robotic surgery for endometrial cancer, compared with patients with lower body mass indices. We performed a retrospective chart review of 168 patients with suspected early-stage endometrial adenocarcinoma who underwent robotic surgery for the management of their disease. Analysis of variance and univariate logistic regression were used to compare patient characteristics and surgical variables across all body weights. Cox proportional hazard regression was used to determine the impact of body weight on recurrence-free and overall survival. The mean BMI of our cohort was 40.9 kg/m(2). Median follow up was 31 months. Fifty-six patients, 30% of which had grade 2 or 3 tumors, were supermorbidly obese with a BMI of ≥50 kg/m(2) (mean, 56.3 kg/m(2)). A comparison between the supermorbidly obese and lower-weight patients demonstrated no differences in terms of length of hospital stay, blood loss, complication rates, numbers of pelvic and paraaortic lymph nodes retrieved, or recurrence and survival. There was a correlation between BMI and conversion to an open procedure, in which the odds of conversion increased with increasing BMI (P = .02). Offering robotic surgery to supermorbidly obese patients with endometrial cancer is a safe and feasible surgical management option. When compared with patients with a lower BMI, the supermorbidly obese patient had a similar outcome, length of hospital stay, blood loss, complications, and numbers of lymph

Interconnection between metabolic syndrome components in obese patients

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E.G. Bayanova

2017-03-01

Full Text Available Background. The aim of our study is to deter­mine intercommunication between the indexes of insulin resistance, С-peptide, leptin, cortisol, thyroid hormones in obese patients. Materials and methods. The study involved 30 persons with the average body mass index (BMI 35.1 kg/м2. They were divided into three groups by this index depending on the obesity severity. Results. The indexes of insulin, С-peptide, HOMA index with the enhanced BMI had a tendency to the increase. Their average indexes were highest in patients with III stage obesity. An increased level of ТSH was determined for the 31 % patients of the first group, in 25 % patients of the second group and in 50 % patients of the third group. Free thyroxine (fТ4 level was highest in the patients of the second group, fТ4 indexes under 0.93 ng/dl were observed in 25 % patients of the first group and in 50 % patients of the third group. The cortisol level maximally rose in the patients of the second group and went down a little in the patients of the third group. The leptin indexes rose with the increase of BMI. Conclusions. Metabolic syndrome develops on a background of the decline of thyroid function and increase of insulin secretion.

Medical Student Bias and Care Recommendations for an Obese versus Non-Obese Virtual Patient

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Persky, Susan; Eccleston, Collette P.

2010-01-01

Objective This study examined the independent effect of a patient's weight on medical students' attitudes, beliefs, and interpersonal behavior toward the patient, in addition to the clinical recommendations they make for her care. Design Seventy-six clinical-level medical students were randomly assigned to interact with a digital, virtual female patient who was visibly either obese or non-obese. Methods Interactions with the patient took place in an immersive virtual clinical environment (i.e., virtual reality) which allowed standardization of all patient behaviors and characteristics except for weight. Visual contact behavior was automatically recorded during the interaction. Afterward, participants filled out a battery of self-report questionnaires. Results Analyses revealed more negative stereotyping, less anticipated patient adherence, worse perceived health, more responsibility attributed for potentially weight-related presenting complaints, and less visual contact directed toward the obese version of a virtual patient than the non-obese version of the patient. In contrast, there was no clear evidence of bias in clinical recommendations made for the patient's care. Conclusion Biases in attitudes, beliefs, and interpersonal behavior have important implications because they can influence the tone of clinical encounters and rapport in the patient-provider relationship, which can have important downstream consequences. Gaining a clear understanding of the nature and source of weight bias in the clinical encounter is an important first step toward development of strategies to address it. PMID:20820169

Metabolic syndrome and its characteristics among obese patients attending an obesity clinic.

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Termizy, H M; Mafauzy, M

2009-04-01

The increased prevalence of metabolic syndrome worldwide is closely related to the rising obesity epidemic. The objectives of the study were to determine the prevalence and identify the associated and prognostic factors that influence the risk of metabolic syndrome among obese patients attending the Obesity Clinic at Hospital Universiti Sains Malaysia. A study was conducted involving 102 obese persons who attended the Obesity Clinic from January 1 to December 31, 2005. Metabolic syndrome was defined according to the International Diabetes Federation criteria. The overall prevalence of metabolic syndrome among obese patients was 40.2 percent. The prevalence was higher in females (43.7 percent) than in males (32.3 percent). The prevalence of metabolic syndrome was noted to increase with increasing body mass index class, from class 1 to class 2. However, the prevalence was lower in obesity class 3. The prevalence of metabolic comorbidities of raised blood pressure, reduced high density lipoprotein, high triglyceride and raised fasting blood glucose was 42, 40, 36 and 17 percent, respectively. A quarter of obese patients in this study had no other comorbidity. Based on logistic regression multivariable analysis, age was the only significant associated factor that influenced the risk of having metabolic syndrome. The prevalence of metabolic syndrome was high and the highest comorbidity was high blood pressure. Age was the only significant risk factor of having this syndrome.

Mechanisms of lower maintenance dose of tacrolimus in obese patients.

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Sawamoto, Kazuki; Huong, Tran T; Sugimoto, Natsumi; Mizutani, Yuka; Sai, Yoshimichi; Miyamoto, Ken-ichi

2014-01-01

A retrospective analysis suggested that blood tacrolimus concentrations were consistent among patients with a body mass index (BMI) that was lean (maintenance dose of tacrolimus in patients with BMI ≥ 25 was significantly lower compared with that in patients with a BMI of less than 25. Lean and obese Zucker rats fed a normal diet were given tacrolimus intravenously or orally. The blood concentrations of tacrolimus in obese rats were significantly higher than those in lean rats after administration via both routes. The moment analysis has suggested that CLtot and Vdss of tacrolimus were not significantly different between lean and obese rats. The bioavailability was higher in obese rats, compared with that in lean rats. The protein expression of Cyp3a2 in the liver was significantly decreased in obese rats, compared with lean rats, while P-gp in the small intestine was also significantly decreased in obese rats. These results suggested that the steady-state trough concentration of tacrolimus in obese patients was well maintained by a relatively low dose compared with that in normal and lean patients, presumably due to increased bioavailability.

The prevalence of overweight and obesity among cardiac patients

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Hubert Wojarski

2017-11-01

Full Text Available Cardiovascular diseases, despite the increasing progress made in the field of cardiology, are still the most common cause of death for people over 60. Factors conducive to cardiovascular diseases include poor physical activity, high blood cholesterol, hypertension, diabetes, smoking, and obesity. The lifestyle, a determinant of health, is in more than 50% influenced by the diet, that is the type and amount of food consumed. The World Health Organization points to the growing problem of obesity in the world. Especially excess weight and obesity among children are of a great importance as these conditions can survive to the adulthood and lead to the development of cardiovascular diseases. This article aims to analyze the anthropometric data of cardiac patients in terms of excess weight and obesity. The study included 94 cardiac patients, including 35 women and 59 men aged between 40 and 88. The study used anthropometric data such as age, height, weight, body mass index, gender, and information on underlying illnesses and co-morbidities. The BMI helped to identify the overweight and the obese in the studied group. Out of the total number of patients aged between 40 and 88, 42% were overweight and 30% obese (grade 1, 11% (grade 2, 2% (grade 3. The overwhelming majority of patients diagnosed with obesity also have other risk factors for developing cardiovascular diseases such as hypertension, diabetes, and hypercholesterolemia. Excess weight and obesity are dangerous for cardiac patients. It is crucial to adapt meals to the needs and avoid generating excess energy and take into account the medicines. Preventing childhood obesity requires a high priority.

Insulin resistance and endocrine-metabolic abnormalities in polycystic ovarian syndrome: Comparison between obese and non-obese PCOS patients.

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Layegh, Parvin; Mousavi, Zohreh; Farrokh Tehrani, Donya; Parizadeh, Seyed Mohammad Reza; Khajedaluee, Mohammad

2016-04-01

Insulin resistance has an important role in pathophysiology of polycystic ovarian syndrome (PCOS). Yet there are certain controversies regarding the presence of insulin resistance in non-obese patients. The aim was to compare the insulin resistance and various endocrine and metabolic abnormalities in obese and non-obese PCOS women. In this cross-sectional study which was performed from 2007-2010, 115 PCOS patients, aged 16-45 years were enrolled. Seventy patients were obese (BMI ≥25) and 45 patients were non-obese (BMI 2.3) between two groups (p=0.357). Waist circumference (pPCOS patients. There was no significant difference in total testosterone (p=0.634) and androstenedione (p=0.736) between groups whereas Dehydroepiandrotendione sulfate (DHEAS) was significantly higher in non-obese PCOS women (p=0.018). There was no case of fatty liver and metabolic syndrome in non-obese patients, whereas they were seen in 31.3% and 39.4% of obese PCOS women, respectively. Our study showed that metabolic abnormalities are more prevalent in obese PCOS women, but adrenal axis activity that is reflected in higher levels of DHEAS was more commonly pronounced in our non-obese PCOS patients.

Changed adipocytokine concentrations in colorectal tumor patients and morbidly obese patients compared to healthy controls

International Nuclear Information System (INIS)

Hillenbrand, Andreas; Fassler, Juliane; Huber, Nadine; Xu, Pengfei; Henne-Bruns, Doris; Templin, Markus; Schrezenmeier, Hubert; Wolf, Anna Maria; Knippschild, Uwe

2012-01-01

Obesity has been associated with increased incidence of colorectal cancer. Adipose tissue dysfunction accompanied with alterations in the release of adipocytokines has been proposed to contribute to cancer pathogenesis and progression. The aim of this study was to analyze plasma concentrations of several adipose tissue expressed hormones in colorectal cancer patients (CRC) and morbidly obese (MO) patients and to compare these concentrations to clinicopathological parameters. Plasma concentrations of adiponectin, resistin, leptin, active plasminogen activator inhibitor (PAI)-1, monocyte chemotactic protein (MCP)-1, interleukin (IL)-1 alpha, and tumor necrosis factor (TNF)-alpha were determined in 67 patients operated on for CRC (31 rectal cancers, 36 colon cancers), 37 patients operated on for morbid obesity and 60 healthy blood donors (BD). Compared to BD, leptin concentrations were lowered in CRC patients whereas those of MO patients were elevated. Adiponectin concentrations were only lowered in MO patients. Concentrations of MCP-1, PAI-1, and IL-1 alpha were elevated in both CRC and MO patients, while resistin and TNF-alpha were similarly expressed in MO and CRC patients compared to BD. Resistin concentrations positively correlated with tumor staging (p<0.002) and grading (p=0.015) of rectal tumor patients. The results suggest that both MO and CRC have low-grade inflammation as part of their etiology

Dietary habits of obese patients qualified for bariatric procedures.

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Jastrzebska-Mierzyńska, Marta; Ostrowska, Lucyna; Hady, Hady Razak; Dadan, Jacek

2014-01-01

Patients with obesity, including morbid obesity, commit numerous dietary mistakes. They prefer high-energy diets, but of poor nutritional value. Patients qualified for bariatric procedures show deficiencies in vitamins and minerals due to insufficient intake of vegetables, fruit and whole grain products. Analysis of dietary habits in morbidly obese patients prepared for bariatric surgery, including assessment of eating style and frequency of consumption of certain products. The study group contained 39 people aged 18 - 65 years, who were surveyed with a questionnaire elaborated in the Department of Clinical Dietetics and Nutrition, Medical University of Bialystok. The following factors were assessed: number of meals, snacking between meals and eating at night, types of snacks eaten, and frequency of consumption of certain foods. Results were analyzed using Statistica 9.0. The majority of surveyed men (41.7%) ate three meals a day, whereas most women (40.7%) had at least 4 meals a day. Nearly 85% of the respondents admitted snacking between meals, mainly eating fruit, sweets and sandwiches. Whole grain cereal, milk and dairy products, fish, fruit, vegetables and pulses appeared in diet of patients qualified for treatment of obesity very rarely. Dietary habits of obese patients qualified for bariatric procedures are not consistent with recommendations. Therefore, these patients should receive nutritional education in order to foster proper eating habits that will help in the postoperative nutrition.

Improvement of type 2 diabetes mellitus in obese and non-obese patients after the duodenal switch operation.

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Frenken, M; Cho, E Y; Karcz, W K; Grueneberger, J; Kuesters, S

2011-01-01

Introduction. Type 2 diabetes mellitus (T2DM) is one of the most important obesity-related comorbidities. This study was undertaken to characterise the effect of the biliopancreatic diversion with duodenal switch (BPD-DS) in morbidly obese and nonmorbidly obese diabetic patients. Methods. Outcome of 74 obese diabetic patients after BPD-DS and 16 non-obese diabetic patients after BPD or gastric bypass surgery was evaluated. Insulin usage, HbA(1c)-levels, and index of HOMA-IR (homeostasis model assessment of insulin resistence) were measured. Results. A substantial fraction of patients is free of insulin and shows an improved insulin sensitivity early after the operation, another fraction gets free of insulin in a 12-month period after the operation and a small fraction of long-term insulin users will not get free of insulin but nevertheless shows an improved metabolic status (less insulin needed, normal HbA(1c)-levels). Conclusion. BPD-DS leads to an improvement of T2DM in obese and non-obese patients. Nevertheless, more data is needed to clarify indications and mechanisms of action and to adjust our operation techniques to the needs of non-obese diabetic patients.

Improvement of Type 2 Diabetes Mellitus in Obese and Non-Obese Patients after the Duodenal Switch Operation

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M. Frenken

2011-01-01

Full Text Available Introduction. Type 2 diabetes mellitus (T2DM is one of the most important obesity-related comorbidities. This study was undertaken to characterise the effect of the biliopancreatic diversion with duodenal switch (BPD-DS in morbidly obese and nonmorbidly obese diabetic patients. Methods. Outcome of 74 obese diabetic patients after BPD-DS and 16 non-obese diabetic patients after BPD or gastric bypass surgery was evaluated. Insulin usage, HbA1c-levels, and index of HOMA-IR (homeostasis model assessment of insulin resistence were measured. Results. A substantial fraction of patients is free of insulin and shows an improved insulin sensitivity early after the operation, another fraction gets free of insulin in a 12-month period after the operation and a small fraction of long-term insulin users will not get free of insulin but nevertheless shows an improved metabolic status (less insulin needed, normal HbA1c-levels. Conclusion. BPD-DS leads to an improvement of T2DM in obese and non-obese patients. Nevertheless, more data is needed to clarify indications and mechanisms of action and to adjust our operation techniques to the needs of non-obese diabetic patients.

Changed adipocytokine concentrations in colorectal tumor patients and morbidly obese patients compared to healthy controls

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Hillenbrand Andreas

2012-11-01

Full Text Available Abstract Background Obesity has been associated with increased incidence of colorectal cancer. Adipose tissue dysfunction accompanied with alterations in the release of adipocytokines has been proposed to contribute to cancer pathogenesis and progression. The aim of this study was to analyze plasma concentrations of several adipose tissue expressed hormones in colorectal cancer patients (CRC and morbidly obese (MO patients and to compare these concentrations to clinicopathological parameters. Methods Plasma concentrations of adiponectin, resistin, leptin, active plasminogen activator inhibitor (PAI-1, monocyte chemotactic protein (MCP-1, interleukin (IL-1 alpha, and tumor necrosis factor (TNF-alpha were determined in 67 patients operated on for CRC (31 rectal cancers, 36 colon cancers, 37 patients operated on for morbid obesity and 60 healthy blood donors (BD. Results Compared to BD, leptin concentrations were lowered in CRC patients whereas those of MO patients were elevated. Adiponectin concentrations were only lowered in MO patients. Concentrations of MCP-1, PAI-1, and IL-1 alpha were elevated in both CRC and MO patients, while resistin and TNF-alpha were similarly expressed in MO and CRC patients compared to BD. Resistin concentrations positively correlated with tumor staging (p Conclusions The results suggest that both MO and CRC have low-grade inflammation as part of their etiology.

Neural correlates of executive functions in patients with obesity.

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Ho, Ming-Chou; Chen, Vincent Chin-Hung; Chao, Seh-Huang; Fang, Ching-Tzu; Liu, Yi-Chun; Weng, Jun-Cheng

2018-01-01

Obesity is one of the most challenging problems in human health and is recognized as an important risk factor for many chronic diseases. It remains unclear how the neural systems (e.g., the mesolimbic "reward" and the prefrontal "control" neural systems) are correlated with patients' executive function (EF), conceptualized as the integration of "cool" EF and "hot" EF. "Cool" EF refers to relatively abstract, non-affective operations such as inhibitory control and mental flexibility. "Hot" EF refers to motivationally significant affective operations such as affective decision-making. We tried to find the correlation between structural and functional neuroimaging indices and EF in obese patients. The study population comprised seventeen patients with obesity (seven males and 10 females, BMI = 37.99 ± 5.40, age = 31.82 ± 8.75 year-old) preparing to undergo bariatric surgery. We used noninvasive diffusion tensor imaging, generalized q-sampling imaging, and resting-state functional magnetic resonance imaging to examine the neural correlations between structural and functional neuroimaging indices and EF performances in patients with obesity. We reported that many brain areas are correlated to the patients' EF performances. More interestingly, some correlations may implicate the possible associations of EF and the incentive motivational effects of food. The neural correlation between the left precuneus and middle occipital gyrus and inhibitory control may suggest that patients with a better ability to detect appetitive food may have worse inhibitory control. Also, the neural correlation between the superior frontal blade and affective decision-making may suggest that patients' affective decision-making may be associated with the incentive motivational effects of food. Our results provide evidence suggesting neural correlates of EF in patients with obesity.

SU-C-18C-04: Evaluation of Effective Dose During Ureteroscopy for Obese and Non-Obese Patients

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Wang, C; Nguyen, G; Chung, Y; Yoshizumi, T [Duke University, Durham, NC (United States); Cabrera, F; Lipkin, M [Duke University Medical Center, Durham, NC (United States); Shin, R [Duke University Medical Center, Durham, North Carolina (United States)

2014-06-01

Purpose: Ureteroscopy involves fluoroscopy which potentially results in considerable amount of radiation dose to the patient. Purpose of this study was two-fold: (a) to develop the effective dose computational model for obese and non-obese patients undergoing left and right ureteroscopy, and (b) to evaluate the utility of a commercial Monte Carlo software for dose assessment in ureteroscopy. Methods: Organ dose measurements were performed on an adult male anthropomorphic phantom, representing the non-obese patients, with 20 high-sensitivity MOSFET detectors and two 0.18cc ionization chambers placed in selected organs. Fat-equivalent paddings were placed around the abdominal region to simulate for obese patients. Effective dose (ED) was calculated using ICRP 103 tissue weighting factors and normalized to the effective dose rate in miliSivert per second (mSv/s). In addition, a commercial Monte Carlo (MC) dose estimation program was used to estimate ED for the non-obese model, with table attenuation correction applied to simulate clinical procedure. Results: For the equipment and protocols involved in this study, the MOSFETderived ED rates for the obese patient model (‘Left’: 0.0092±0.0004 mSv/s; ‘Right’: 0.0086±0.0004 mSv/s) was found to be more than twice as much as that to the non-obese patient model (‘Left’: 0.0041±0.0003 mSv/s; ‘Right’: 0.0036±0.0007 mSv/s). The MC-derived ED rates for the non-obese patient model (‘Left’: 0.0041 mSv/s; ‘Right’: 0.0036 mSv/s; with statistical uncertainty of 1%) showed a good agreement with the MOSFET method. Conclusion: The significant difference in ED rate between the obese and non-obese patient models shows the limitation of directly applying commercial softwares for obese patients and leading to considerable underestimation of ED. Although commercial softwares offer a convenient means of dose estimation, but the utility may be limited to standard-man geometry as the software does not account for

SU-C-18C-04: Evaluation of Effective Dose During Ureteroscopy for Obese and Non-Obese Patients

International Nuclear Information System (INIS)

Wang, C; Nguyen, G; Chung, Y; Yoshizumi, T; Cabrera, F; Lipkin, M; Shin, R

2014-01-01

Purpose: Ureteroscopy involves fluoroscopy which potentially results in considerable amount of radiation dose to the patient. Purpose of this study was two-fold: (a) to develop the effective dose computational model for obese and non-obese patients undergoing left and right ureteroscopy, and (b) to evaluate the utility of a commercial Monte Carlo software for dose assessment in ureteroscopy. Methods: Organ dose measurements were performed on an adult male anthropomorphic phantom, representing the non-obese patients, with 20 high-sensitivity MOSFET detectors and two 0.18cc ionization chambers placed in selected organs. Fat-equivalent paddings were placed around the abdominal region to simulate for obese patients. Effective dose (ED) was calculated using ICRP 103 tissue weighting factors and normalized to the effective dose rate in miliSivert per second (mSv/s). In addition, a commercial Monte Carlo (MC) dose estimation program was used to estimate ED for the non-obese model, with table attenuation correction applied to simulate clinical procedure. Results: For the equipment and protocols involved in this study, the MOSFETderived ED rates for the obese patient model (‘Left’: 0.0092±0.0004 mSv/s; ‘Right’: 0.0086±0.0004 mSv/s) was found to be more than twice as much as that to the non-obese patient model (‘Left’: 0.0041±0.0003 mSv/s; ‘Right’: 0.0036±0.0007 mSv/s). The MC-derived ED rates for the non-obese patient model (‘Left’: 0.0041 mSv/s; ‘Right’: 0.0036 mSv/s; with statistical uncertainty of 1%) showed a good agreement with the MOSFET method. Conclusion: The significant difference in ED rate between the obese and non-obese patient models shows the limitation of directly applying commercial softwares for obese patients and leading to considerable underestimation of ED. Although commercial softwares offer a convenient means of dose estimation, but the utility may be limited to standard-man geometry as the software does not account for

The obesity paradox in patients with peripheral arterial disease.

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Galal, Wael; van Gestel, Yvette R B M; Hoeks, Sanne E; Sin, Don D; Winkel, Tamara A; Bax, Jeroen J; Verhagen, Hence; Awara, Adel M M; Klein, Jan; van Domburg, Ron T; Poldermans, Don

2008-11-01

Cardiac events are the predominant cause of late mortality in patients with peripheral arterial disease (PAD). In these patients, mortality decreases with increasing body mass index (BMI). COPD is identified as a cardiac risk factor, which preferentially affects underweight individuals. Whether or not COPD explains the obesity paradox in PAD patients is unknown. We studied 2,392 patients who underwent major vascular surgery at one teaching institution. Patients were classified according to COPD status and BMIs (ie, underweight, normal, overweight, and obese), and the relationship between these variables and all-cause mortality was determined using a Cox regression analysis. The median follow-up period was 4.37 years (interquartile range, 1.98 to 8.47 years). The overall mortality rates among underweight, normal, overweight, and obese patients were 54%, 50%, 40%, and 31%, respectively (p < 0.001). The distribution of COPD severity classes showed an increased prevalence of moderate-to-severe COPD in underweight patients. In the entire population, BMI (continuous) was associated with increased mortality (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.94 to 0.98). In addition, patients who were classified as being underweight were at increased risk for mortality (HR, 1.42; 95% CI, 1.00 to 2.01). However, after adjusting for COPD severity the relationship was no longer significant (HR, 1.29; 95% CI, 0.91 to 1.93). The excess mortality among underweight patients was largely explained by the overrepresentation of individuals with moderate-to-severe COPD. COPD may in part explain the "obesity paradox" in the PAD population.

Comparison of Preprosthetic Implant Complications and Failures Between Obese and Nonobese Patients.

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Hazem, AbdelAzeem; Bissada, Nabil F; Demko, Catherine; Paes, Andre; Lang, Lisa A

2016-01-01

Obesity as a systemic risk factor associated with implant failure or other complications has not been studied. The aim of this study was to compare the frequency of implant failure and complications between obese and nonobese patients. Charts from 220 partially edentulous patients with 321 implants were examined for demographic information, medical health history, diabetes, smoking, patient-reported height and weight, periodontal status (no, mild, moderate, or severe periodontitis), tooth number, date of the implant and prosthesis placement, and treatment notes pertinent to the complications or failure. Subjects were classified according to their body mass index (BMI) as normal (18.5 to 24.5 kg/m(2)), overweight (25 to 29.9 kg/m(2)), or obese (≥ 30 kg/m(2)) based on self-reported height and weight. Variables including sex, smoking, diabetes, and periodontal condition were considered as confounders. Data were analyzed to examine differences in frequency of complications and occurrence of failures. Implant failure was low (2.1%) and did not differ by BMI category. Compared with normal BMI patients, obese patients had increased odds of experiencing an implant complication (OR = 4.9, 95% CI [1.4, 17.6]) after adjustment for other variables. Diabetes was not associated with an increased risk of complications; obese patients with diabetes had decreased odds of an implant complication compared with obese patients without diabetes. No association was observed between obesity and implant failures. BMI category was associated with implant complications; obese patients have greater odds of experiencing implant complications postsurgically. Treating obese patients with the existing protocol for diabetic patients (antibiotic regimens, more frequent follow-up, and maintenance appointments) may improve clinical outcomes.

Use of Sugammadex in Patients With Obesity: A Pooled Analysis.

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Monk, Terri G; Rietbergen, Henk; Woo, Tiffany; Fennema, Hein

A growing proportion of patients undergoing surgical procedures are obese, providing anesthesiologists with numerous challenges for patient management. The current pooled analysis evaluated recovery times following sugammadex reversal of neuromuscular blockade by body mass index (BMI) in general, and in particular, in patients with BMIs ≥30 kg/m (defined as obese) and sugammadex doses for reversal of moderate [reappearance of the second twitch of the train-of-four (TOF); sugammadex 2 mg/kg] or deep (1-2 post-tetanic counts or 15 minutes after rocuronium; sugammadex 4 mg/kg) rocuronium- or vecuronium-induced neuromuscular blockade. All doses of sugammadex were administered based on actual body weight. The recovery time from sugammadex administration to a TOF ratio ≥0.9 was the primary efficacy variable in all individual studies and in the pooled analysis. This analysis comprised a total of 1418 adult patients treated with sugammadex; 267 (18.8%) of these patients had a BMI ≥30 kg/m. The average time to recovery of the TOF ratio to 0.9 was 1.9 minutes for rocuronium-induced blockade and 3.0 minutes for vecuronium-induced blockade. No clinically relevant correlation was observed between BMI and recovery time. The recommended sugammadex doses based on actual body weight provide rapid recovery from neuromuscular blockade in both obese and non-obese patients; no dose adjustments are required in the obese patient.

BEHAVIORAL PECULIARITIES IN PATIENTS WITH SURPLUS BODY MASS AND OBESITY

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A. E. Bobrov

2014-01-01

Full Text Available Background: Eating in obesity represents behavioral systems more powerful than conscious self-control. Aim: To study the obese patients’ behavior with the help of clinical-psychopathological and personal style criteria. Materials and methods: A total of 149 patients (aged 19-69 years, who sought medical help due to obesity or overweight were examined. Their physical condition was satisfactory and concomitant somatic diseases were compensated. Patients’ behavior was assessed by diagnostic criteria ICD-10 as well as with a Minnesota Multiphasic Personality Inventory (psychological testing. Results: It was established that psychical impairments existed in 98 (65.8% patients. The anxiety disorders (in 65 patients, 43.6% and affective ones (in 41 patients, 31.5% were noted most frequently. Factor analysis of the psychological test data revealed 5 main styles of behavior in patients with overweight and obesity: borderline, hyperthymic, dysthymic, sensitive, and undifferentiated. Neither these behavioral styles nor the frequency of disorders corresponded to the degree of obesity. Conclusion: Disturbances of eating self-regulation in obesity are associated with different behavioral styles, which are not specific for mental disorders only. These behavioral styles are described in the study as well as corresponding psychological mechanisms of overeating.

Knee injury and obesity in patients undergoing total knee replacement: a retrospective study in 115 patients

DEFF Research Database (Denmark)

Jensen, Claus Hjorth; Rofail, S

1999-01-01

The prevalence of obesity and previous knee injury was assessed in a retrospective study of 115 patients under-going total knee replacement due to osteoarthritis. Obesity was considered a contributing factor in the development of osteoarthritis in 37% of the patients, and 33% of the patients had...... had an injury to the knee in question. Unilateral osteoarthritis was significantly more frequent than bilateral osteoarthritis among patients with a history of previous knee injury. The association of previous injury to the knee and unilateral osteoarthritis was stronger in men than women. Aggressive...... treatment of patients with knee injuries seems warranted....

Managing anesthesia  for cesarean section in obese patients: current perspectives

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Lamon AM

2016-08-01

Full Text Available Agnes M Lamon, Ashraf S Habib Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA Abstract: Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients. Neuraxial techniques are the preferred anesthetic techniques for cesarean delivery in obese parturients but can be technically challenging. An existing labor epidural catheter can be topped up for cesarean delivery. In patients who do not have a well-functioning labor epidural, a combined spinal epidural technique might be preferred over a single-shot spinal technique since it is technically easier in obese parturients and allows for extending the duration of the block as required. A continuous spinal technique can also be considered. Studies suggest that there is no need to reduce the dose of spinal bupivacaine in the obese parturient, but there is little data about spinal dosing in super obese parturients. Intraoperatively, patients should be placed in a ramped position, with close monitoring of ventilation and hemodynamic status. Adequate postoperative analgesia is crucial to allow for early mobilization. This can be achieved using a multimodal regimen incorporating neuraxial morphine (with appropriate observations with scheduled nonsteroidal anti-inflammatory drugs and acetaminophen. Thromboprophylaxis is also important in this patient population due to the increased risk of thromboembolic complications. These patients should be monitored carefully in the postoperative period, since there

Reactivation of adiponectin expression in obese patients after bariatric surgery.

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Hindle, A Katharine; Edwards, Claire; McCaffrey, Tim; Fu, Sidney W; Brody, Fred

2010-06-01

Bariatric surgery can resolve type 2 diabetes in morbidly obese patients. However, the underlying mechanism is unknown. This study aimed to identify potential biomarkers or molecular pathways that are altered after bariatric surgery in diabetic and nondiabetic patients. The study enrolled 17 morbidly obese patients undergoing bariatric surgery. Eight of the patients were diabetic, and nine were nondiabetic. In addition, a control group of four nonobese, nondiabetic volunteers was included. Patient blood samples were drawn before and after the operation. All blood samples were stabilized in Paxgene tubes (PreAnalytix). Total RNA was extracted and purified using the Paxgene Blood RNA Kit. For each sample, 100 ng of total RNA was amplified and labeled using the Ovation RNA Amplification System V2 with the Ovation Whole Blood reagent before hybridization to an Affymetrix Focus array containing more than 8,500 verified genes. Microarray results were analyzed with the GeneSpring GX 10.0 program, which uses an analysis of variance (ANOVA), and verified with real-time quantitative polymerase chain reaction (QPCR) using SYBR green (ABI). Microarray analysis showed that 167 genes were upregulated and 39 were downregulated in the obese diabetic patients. Preoperatively, adiponectin was downregulated 1.5-fold in diabetic versus nondiabetic patients. This was confirmed with quantitative PCR analysis. Preoperatively, morbidly obese patients showed a 3.12-fold downregulation of adiponectin expression versus the control group (p = 0.05). Interestingly, postoperative adiponectin levels were upregulated 2.79-fold (p = 0.02), which is close to the level of the normal control group. Adiponectin is dysregulated in obese patients and significantly dysregulated in obese diabetic patients. These findings correlate with the association between low levels of adiponectin and a predisposition to insulin resistance or diabetes. The data suggest that reactivation of adiponectin expression may

Impact of fibromyalgia on functioning in obese patients undergoing comprehensive rehabilitation.

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Arreghini, Marco; Manzoni, Gian Mauro; Castelnuovo, Gianluca; Santovito, Cristina; Capodaglio, Paolo

2014-01-01

A possible link between fibromyalgia (FM) and obesity has been recently suggested but very scanty data on the prevalence of FM in obese populations are available. The aims of the present cross-sectional study were: 1) to estimate the prevalence of FM in a population of obese patients undergoing rehabilitation and 2) to investigate the effect of FM on obese patients' functional capacities. One hundred and thirty Italian obese (Body Mass Index, BMI ≥ 30) patients admitted to hospital for 1-month rehabilitation treatment took part in the study. All participants were interviewed by a rheumatologist according to the 2010 American College of Rheumatology (ACR) diagnostic criteria for FM. At admission and discharge from hospital (on average, after 28 days), the following measures were compared between the group of patients with FM and the other patients: body weight, body mass index, functional independence (FIM), obesity-related disability (TSD-OC), self-reported functioning and the Timed-Up-Go (TUG) test. Thirty seven patients out of 130 fulfilled the diagnostic criteria for FM. The prevalence rate was 27.7% (95% CI: 20 to 35.4). Between-group comparisons showed that FM patients had higher disability level at the first assessment, had lower scores on the FIM at the final assessment, scored lower on self-reported functioning both at the first and the final assessments and had a lower body weight. The prevalence of FM in our study is much higher than the rates reported in the general normal-weight population (on average, 3.5%) and the 5.15% rate previously reported in a bariatric population. Functional data showed that the FM obese group yielded lower performance capacity and higher disability level as compared to the non-FM obese group. However, due to the relatively small sample size and the selected population, such results need to be confirmed in larger obese subpopulations.

Laparoscopic Sleeve Gastrectomy Improves Olfaction Sensitivity in Morbidly Obese Patients.

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Hancı, Deniz; Altun, Huseyin; Altun, Hasan; Batman, Burcin; Karip, Aziz Bora; Serin, Kursat Rahmi

2016-03-01

Olfactory abilities of the patients are known to be altered by eating and metabolic disorders, including obesity. There are only a number of studies investigating the effect of obesity on olfaction, and there is limited data on the changes in olfactory abilities of morbidly obese patients after surgical treatment. Here we investigated the changes in olfactory abilities of 54 morbidly obese patients (M/F, 22/32; age range 19-57 years; body mass index (BMI) range 30.5-63.0 kg/m(2)) after laparoscopic sleeve gastrectomy. A laparoscopic sleeve gastrectomy was performed by the same surgeon using five-port technique. Olfactory abilities were tested preoperatively and 1, 3, and 6 months after the surgery using a standardized Sniffin' Sticks Extended Test kit. Analyses of variance indicated statistically significant improvement in T, D, and I scores of morbidly obese patients within time factors (preoperative vs. 1, 3, and 6 months; 1 vs. 3 and 6 months; and 3 vs. 6 months; p < 0.001 for all). There was a statistically significant improvement in overall TDI scores with an increase from 25 to 41 during the 6 months follow-up period (p < 0.001 for all). Here, for the first time in literature, we were able to show the significant improvement in olfactory abilities of morbidly obese patients after laparoscopic sleeve gastrectomy.

Modifier 22 for acetabular fractures in morbidly obese patients: does it affect reimbursement?

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Bergin, Patrick F; Kneip, Christopher; Pierce, Christine; Hendrix, Stephen T; Porter, Scott E; Graves, Matthew L; Russell, George V

2014-11-01

Modifier 22 in the American Medical Association's Current Procedural Terminology (CPT®) book is a billing code for professional fees used to reflect an increased amount of skill, time, and work required to complete a procedure. There is little disagreement that using this code in the setting of surgery for acetabulum fractures in the obese patient is appropriate; however, to our knowledge, the degree to which payers value this additional level of complexity has not been determined. We asked whether (1) the use of Modifier 22 increased reimbursements in morbidly obese patients and (2) there was any difference between private insurance and governmental payer sources in treatment of Modifier 22. Over a 4-year period, we requested immediate adjudication with payers when using Modifier 22 for morbidly obese patients with acetabular fractures. We provided payers with evidence of the increased time and effort required in treating this population. Reimbursements were calculated for morbidly obese and nonmorbidly obese patients. Of the 346 patients we reviewed, 57 had additional CPT® codes or modifiers appended to their charges and were excluded, leaving 289 patients. Thirty (10%) were morbidly obese and were billed with Modifier 22. Fifty-three (18%) were insured by our largest private insurer and 69 (24%) by governmental programs (Medicare/Medicaid). Eight privately insured patients (15%) and seven governmentally insured patients (10%) were morbidly obese and were billed with Modifier 22. For our primary question, we compared reimbursement rates between patients with and without Modifier 22 for obesity within the 289 patients. We then performed the same comparison for the 53 privately insured patients and the 69 governmentally insured patients. Overall, there was no change in mean reimbursement when using Modifier 22 in morbidly obese patients, compared to nonmorbidly obese patients (USD 2126 versus USD 2149, p Level IV, economic and decision analyses. See Instructions

Evaluation of obesity in hemodialysis patients-relationship between visceral fat obesity and lipometabolism

International Nuclear Information System (INIS)

Tsushima, Megumi; Terayama, Yuriko; Fukuhara, Youko; Yamaya, Kanemitsu; Mizuno, Hiroshi; Saitoh, Hisao; Mikuni, Tsuneyasu; Momose, Akishi; Funyu, Tomihisa

2006-01-01

Due to various metabolic disorders, especially dyslipidemia, in patients undergoing dialysis, the prevailing reference values of indices for determining obesity may differ from those used in the general population. To clarify visceral fat levels indicating obesity in dialysis patients, we analyzed indices for determining obesity and lipid profiles, and compared the data between dialysis patients and control subjects with normal renal function. This study was conduced in 75 hemodialysis patients (HD group) aged 61.0 y on average and 58 control subjects (control group) aged 44.5 y on average. We calculated body mass index (BMI), waist circumference at the umbilical level (W), waist-height ratio (W/Ht) and evaluated visceral and subcutaneous fat areas using computed tomography (CT) at the level of the umbilicus. In addition, we measured postprandial total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) in the serum and calculated the ratios, (TC-HDL-C)/HDL-C and TG/TC. Visceral fat area, (TC-HDL-C)/HDL-C and TG/TC in HD group were 58.1 cm 2 , 2.31 and 0.74, which were significantly higher than those in the control group (37.4 cm 2 , 1.95 and 0.52), respectively. A significant positive correlation was found between visceral fat area and BMI, W, and W/Ht in both groups. In control subjects, visceral fat area was highly correlated with (TC-HDL-C)/HDL-C (r=0.532, p less than 0.0001), and with TG/TC (r=0.286, p=0.0296). In contrast, visceral fat area in hemodialysis patients was highly correlated with (TC-HDL-C)/HDL-C (r=0.397, p=0.0004), and with TG/TC (r=0.568, p less than 0.0001). Our study demonstrated that visceral fat accumulation in hemodialysis patients increased irrespective of BMI, and the standard criteria for obesity using BMI would be unsuitable. Furthermore, we identified a novel indicator, non-fasting TG/TC, which seems to indicate visceral fat obesity in hemodialysis patients. (author)

Evaluation of obesity in hemodialysis patients-relationship between visceral fat obesity and lipometabolism

Energy Technology Data Exchange (ETDEWEB)

Tsushima, Megumi; Terayama, Yuriko; Fukuhara, Youko; Yamaya, Kanemitsu; Mizuno, Hiroshi; Saitoh, Hisao; Mikuni, Tsuneyasu; Momose, Akishi; Funyu, Tomihisa [Oyokyo Kidney Research Inst., Hirosaki, Aomori (Japan)

2006-07-15

Due to various metabolic disorders, especially dyslipidemia, in patients undergoing dialysis, the prevailing reference values of indices for determining obesity may differ from those used in the general population. To clarify visceral fat levels indicating obesity in dialysis patients, we analyzed indices for determining obesity and lipid profiles, and compared the data between dialysis patients and control subjects with normal renal function. This study was conduced in 75 hemodialysis patients (HD group) aged 61.0 y on average and 58 control subjects (control group) aged 44.5 y on average. We calculated body mass index (BMI), waist circumference at the umbilical level (W), waist-height ratio (W/Ht) and evaluated visceral and subcutaneous fat areas using computed tomography (CT) at the level of the umbilicus. In addition, we measured postprandial total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) in the serum and calculated the ratios, (TC-HDL-C)/HDL-C and TG/TC. Visceral fat area, (TC-HDL-C)/HDL-C and TG/TC in HD group were 58.1 cm{sup 2}, 2.31 and 0.74, which were significantly higher than those in the control group (37.4 cm{sup 2}, 1.95 and 0.52), respectively. A significant positive correlation was found between visceral fat area and BMI, W, and W/Ht in both groups. In control subjects, visceral fat area was highly correlated with (TC-HDL-C)/HDL-C (r=0.532, p less than 0.0001), and with TG/TC (r=0.286, p=0.0296). In contrast, visceral fat area in hemodialysis patients was highly correlated with (TC-HDL-C)/HDL-C (r=0.397, p=0.0004), and with TG/TC (r=0.568, p less than 0.0001). Our study demonstrated that visceral fat accumulation in hemodialysis patients increased irrespective of BMI, and the standard criteria for obesity using BMI would be unsuitable. Furthermore, we identified a novel indicator, non-fasting TG/TC, which seems to indicate visceral fat obesity in hemodialysis patients. (author)

[Project to improve abdominal obesity in day care ward psychiatric patients].

Science.gov (United States)

Liu, Yu-Chieh; Wang, Hui-Yu; Huang, Hui-Ling; Chen, Min-Li

2011-06-01

Over half (57.14%) of patients in our ward suffer from abdominal obesity. This rate is on a continuing upward trend. Reasons for such obesity include lack of physical activity classes, inadequate physical activity, high calorie diets and unhealthy eating habits, chronic diseases and drug side effects, poor motivation to reduce weight, and lack of crisis awareness of abdominal obesity. This project was designed to lessen the problem of abdominal obesity among psychiatric day care inpatients. Resolution measures implemented included: (1) arranging aerobic exercise classes; (2) scheduling classes to teach patients healthy diet habits and knowledge regarding diseases and drugs; (3) holding a waistline reduction competition; (4) displaying health education bulletin boards; (5) holding a quiz contest with prizes for correct answers. The eight abdominally obese patients in the ward achieved an average waist circumference reduction of 2.9 cm and the overall abdominal obesity rate in the ward fell to 35.7%. BMI, eating habits, and awareness of weight loss importance and motivation all improved. The outcome achieved targeted project objectives. We recommend the integration of obesity prevention into routine ward activities and quality control indicators. Nurses should provide patients with weight loss concepts, regularly monitor risk factors, and encourage patient family cooperation to maintain medical care quality.

The prevalence, risk factors and clinical correlates of obesity in Chinese patients with schizophrenia.

Science.gov (United States)

Li, Qiongzhen; Du, Xiangdong; Zhang, Yingyang; Yin, Guangzhong; Zhang, Guangya; Walss-Bass, Consuelo; Quevedo, João; Soares, Jair C; Xia, Haishen; Li, Xiaosi; Zheng, Yingjun; Ning, Yuping; Zhang, Xiang Yang

2017-05-01

Obesity is a common comorbidity in schizophrenia. Few studies have addressed obesity in Chinese schizophrenia patients. The aims of this current study were to evaluate the prevalence, risk factors and clinical correlates of obesity in Chinese patients with schizophrenia. A total of 206 patients were recruited from a hospital in Beijing. Their clinical and anthropometric data together with plasma glucose and lipid parameters were collected. Positive and Negative Syndrome Scale (PANSS) was rated for all patients. Overall, 43 (20.9%) patients were obese and 67 (32.5%) were overweight. The obese patients had significantly higher glucose levels, triglyceride levels than non-obese patients. Females and patients with type 2 diabetes mellitus had increased risk for obesity. Correlation analysis showed that BMI was associated with sex, education levels, negative symptoms, total PANSS score, triglyceride levels and type 2 diabetes mellitus. Further stepwise regression analysis showed that sex, type 2 diabetes, education level, triglyceride and amount of smoking/day were significant predictors for obesity. Our study showed that the prevalence of obesity in Chinese patients with schizophrenia is higher than that in the general population. Some demographic and clinical variables are risk factors for obesity in schizophrenia. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Effect of Obesity on Motor Functional Outcome of Rehabilitating Traumatic Brain Injury Patients.

Science.gov (United States)

Le, David; Shafi, Shahid; Gwirtz, Patricia; Bennett, Monica; Reeves, Rustin; Callender, Librada; Dunklin, Cynthia; Cleveland, Samantha

2015-08-01

The aim of this study was to determine the association between obesity and functional motor outcome of patients undergoing inpatient rehabilitation after traumatic brain injury. This retrospective study at an urban acute inpatient rehabilitation center screened data from 761 subjects in the Traumatic Brain Injury Model System who were admitted from January 2010 to September 2013. Inclusion criteria consisted of age of 18 years or older and an abnormal Functional Independence Measure motor score. Body mass index was used to determine obesity in the study population. Patients with a body mass index of 30.0 kg/m or greater were considered obese. A total of 372 subjects met the criteria for inclusion in the study. Of these, 54 (13.2%) were obese. Both obese and nonobese patients showed similar improvement in Functional Independence Measure motor score (mean [SD], 30.4 [12.8] for the obese patients, P = 0.115, and 27.3 [13.1] for the nonobese patients). The mean (SD) Functional Independence Measure motor scores at discharge for the obese and nonobese patients were 63.0 (12.6) and 62.3 (10.1) (P = 0.6548), respectively. Obesity had no adverse impact on motor functional outcomes of the traumatic brain injury patients who underwent inpatient rehabilitation. Therefore, obesity should not be considered an obstacle in inpatient rehabilitation after traumatic brain injury, if patients are able to participate in necessary therapy.

Vancomycin Dosing in Obese Patients: Special Considerations and Novel Dosing Strategies.

Science.gov (United States)

Durand, Cheryl; Bylo, Mary; Howard, Brian; Belliveau, Paul

2018-06-01

To review the literature regarding vancomycin pharmacokinetics in obese patients and strategies used to improve dosing in this population. PubMed, EMBASE (1974 to November 2017), and Google Scholar searches were conducted using the search terms vancomycin, obese, obesity, pharmacokinetics, strategy, and dosing. Additional articles were selected from reference lists of selected studies. Included articles were those published in English with a primary focus on vancomycin pharmacokinetic parameters in obese patients and practical vancomycin dosing strategies, clinical experiences, or challenges of dosing vancomycin in this population. Volume of distribution and clearance are the pharmacokinetic parameters that most often affect vancomycin dosing in obese patients; both are increased in this population. Challenges with dosing in obese patients include inconsistent and inadequate dosing, observations that the obese population may not be homogeneous, and reports of an increased likelihood of supratherapeutic trough concentrations. Investigators have revised and developed dosing and monitoring protocols to address these challenges. These approaches improved target trough attainment to varying degrees. Some of the vancomycin dosing approaches provided promising results in obese patients, but there were notable differences in methods used to develop these approaches, and sample sizes were small. Although some approaches can be considered for validation in individual institutions, further research is warranted. This may include validating approaches in larger populations with narrower obesity severity ranges, investigating target attainment in indication-specific target ranges, and evaluating the impact of different dosing weights and methods of creatinine clearance calculation.

Perioperative management and monitoring of a super-obese patient.

Science.gov (United States)

Pellis, Tommaso; Leykin, Yigal; Albano, Giovanni; Zannier, Gianfederico; Di Capua, Gabriella; Marzano, Bernardo; Gullo, Antonino

2004-01-01

Anesthetic management of super-obese patients is inferred from evidence which has been based on obese or morbidly obese patients. We present the perioperative management and monitoring of a 44-year-old 232-kg patient (BMI 70) admitted for laparoscopic gastric bypass surgery. Awake fiberoptic endotracheal intubation preceded induction with propofol and rocuronium. Anesthesia was maintained with desflurane and remifentanil. Desflurane was titrated on BIS values, whereas remifentanil was based on hemodynamic monitoring (invasive arterial pressure and HemoSonic). Rocuronium was administered based on ideal body weight and recovery of twitch tension. Safe and rapid extubation in the operating theatre was made possible by the use of short-acting agents coupled with continuous intraoperative monitoring. Recovery in the post-anesthesia care unit was uneventful, pain was managed with meperidine, and after 5 hours the patient was discharged to the surgical ward. Oxygen therapy and SpO2 monitoring were continued overnight. No desaturation episodes were recorded. Pain was managed with I.V. drip of ketorolac and tramadole.

Assessment and treatment of binge eating in obese patients

OpenAIRE

Walmir Ferreira Coutinho

2006-01-01

Binge eating is a frequent disorder among obese patient, specialythose undergoing weight loss treatment. Binge eating disorder(BED) is a newly defined diagnostic category, usually associatedwith psychopathology and overweight. Several clinical trialsinvolving psychoterapeutical interventions have shown thatcognitive beahavior therapy and interpersonal therapy can beeffective for the treatment of obese patients with BED.Pharmacotherapy can be also an useful tool for the control ofbinge eating,...

Short Sleep Times Predict Obesity in Internal Medicine Clinic Patients

Science.gov (United States)

Buscemi, Dolores; Kumar, Ashwani; Nugent, Rebecca; Nugent, Kenneth

2007-01-01

Study Objectives: Epidemiological studies have demonstrated an association between short sleep times and obesity as defined by body mass index (BMI). We wanted to determine whether this association occurs in patients with chronic medical diagnoses since the number of confounding factors is likely higher in patients than the general population. Methods: Two hundred patients attending internal medicine clinics completed a survey regarding sleep habits, lifestyle characteristics, and medical diagnoses. An independent surveyor collected the information on the questionnaires and reviewed the medical records. Height and weight were measured by clinic personnel. Data were analyzed with multivariate logistic regression. Results: Subjects with short sleep times (< 7 hours) had an increased likelihood of obesity as defined by a BMI ≥ 30 kg/m2 when compared to the reference group of (8, 9] hours (odds ratio 2.93; 95% confidence interval, 1.06–8.09). There was a U-shaped relationship between obesity and sleep time in women but not in men. Young age (18 to 49 years), not smoking, drinking alcohol, hypertension, diabetes, and sleep apnea were also associated with obesity in the overall model. Conclusions: This study demonstrates an association between short sleep times and obesity in undifferentiated patients attending an internal medicine clinic using models adjusting for age, lifestyle characteristics, and some medical diagnoses. The U-shaped relationship in women suggests that sleep patterns may have gender specific associations. These observations provide the background for therapeutic trials in weight loss in patients with established medical problems. Citation: Buscemi D; Kumar A; Nugent R; Nugent K. Short sleep times predict obesity in internal medicine clinic patients. J Clin Sleep Med 2007;3(7):681–688. PMID:18198800

Impact of fibromyalgia on functioning in obese patients undergoing comprehensive rehabilitation.

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Marco Arreghini

Full Text Available A possible link between fibromyalgia (FM and obesity has been recently suggested but very scanty data on the prevalence of FM in obese populations are available. The aims of the present cross-sectional study were: 1 to estimate the prevalence of FM in a population of obese patients undergoing rehabilitation and 2 to investigate the effect of FM on obese patients' functional capacities. One hundred and thirty Italian obese (Body Mass Index, BMI ≥ 30 patients admitted to hospital for 1-month rehabilitation treatment took part in the study. All participants were interviewed by a rheumatologist according to the 2010 American College of Rheumatology (ACR diagnostic criteria for FM. At admission and discharge from hospital (on average, after 28 days, the following measures were compared between the group of patients with FM and the other patients: body weight, body mass index, functional independence (FIM, obesity-related disability (TSD-OC, self-reported functioning and the Timed-Up-Go (TUG test. Thirty seven patients out of 130 fulfilled the diagnostic criteria for FM. The prevalence rate was 27.7% (95% CI: 20 to 35.4. Between-group comparisons showed that FM patients had higher disability level at the first assessment, had lower scores on the FIM at the final assessment, scored lower on self-reported functioning both at the first and the final assessments and had a lower body weight. The prevalence of FM in our study is much higher than the rates reported in the general normal-weight population (on average, 3.5% and the 5.15% rate previously reported in a bariatric population. Functional data showed that the FM obese group yielded lower performance capacity and higher disability level as compared to the non-FM obese group. However, due to the relatively small sample size and the selected population, such results need to be confirmed in larger obese subpopulations.

Long-term cortisol levels measured in scalp hair of obese patients.

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Wester, Vincent L; Staufenbiel, Sabine M; Veldhorst, Margriet A B; Visser, Jenny A; Manenschijn, Laura; Koper, Jan W; Klessens-Godfroy, Francoise J M; van den Akker, Erica L T; van Rossum, Elisabeth F C

2014-09-01

In obese subjects a relatively high cortisol output in urine has been observed compared to nonobese individuals. However, cortisol levels in blood, saliva, and urine in association with obesity have been inconsistent across studies, possibly due to the high variability of systemic cortisol levels. Cortisol levels measured in scalp hair provide a marker for long-term cortisol exposure, and have been associated with cardiovascular disease in an elderly population and to disease course in Cushing's disease. We aimed to compare hair cortisol levels between obese patients and nonobese controls. Hair cortisol levels of 47 obese patients (median BMI 38.8, range 31.1-65.8), 41 overweight, and 87 normal-weight subjects using an enzyme-linked immunosorbent assay (ELISA) were measured. Obese patients had higher hair cortisol levels than overweight and normal weight subjects (respectively 30.8 vs 8.5 and 8.4 pg/mg hair, P cortisol levels was found between normal weight and overweight subjects. Our results suggest a higher long-term cortisol exposure in obese patients, which may contribute to cardiovascular disease risk. Future research will determine whether long-term cortisol levels provide a novel treatment target in the management of cardiovascular disease risk in obesity. © 2014 The Obesity Society.

The cost of obesity for nonbariatric inpatient operative procedures in the United States: national cost estimates obese versus nonobese patients.

Science.gov (United States)

Mason, Rodney J; Moroney, Jolene R; Berne, Thomas V

2013-10-01

To evaluate the economic impact of obesity on hospital costs associated with the commonest nonbariatric, nonobstetrical surgical procedures. Health care costs and obesity are both rising. Nonsurgical costs associated with obesity are well documented but surgical costs are not. National cost estimates were calculated from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) database, 2005-2009, for the highest volume nonbariatric nonobstetric procedures. Obesity was identified from the HCUP-NIS severity data file comorbidity index. Costs for obese patients were compared with those for nonobese patients. To control for medical complexity, each obese patient was matched one-to-one with a nonobese patient using age, sex, race, and 28 comorbid defined elements. Of 2,309,699 procedures, 439,8129 (19%) were successfully matched into 2 medically equal groups (obese vs nonobese). Adjusted total hospital costs incurred by obese patients were 3.7% higher with a significantly (P cost of $648 (95% confidence interval [CI]: $556-$736) compared with nonobese patients. Of the 2 major components of hospital costs, length of stay was significantly increased in obese patients (mean difference = 0.0253 days, 95% CI: 0.0225-0.0282) and resource utilization determined by costs per day were greater in obese patients due to an increased number of diagnostic and therapeutic procedures needed postoperatively (odds ratio [OR] = 0.94, 95% CI: 0.93-0.96). Postoperative complications were equivalent in both groups (OR = 0.97, 95% CI: 0.93-1.02). Annual national hospital expenditures for the largest volume surgical procedures is an estimated $160 million higher in obese than in a comparative group of nonobese patients.

Are natural killer cells protecting the metabolically healthy obese patient?

LENUS (Irish Health Repository)

Lynch, Lydia A

2012-02-01

With the emerging obesity pandemic, identifying those who appear to be protected from adverse consequences such as type 2 diabetes and certain malignancies will become important. We propose that the circulating immune system plays a role in the development of these comorbidities. Clinical data and blood samples were collected from 52 patients with severe obesity attending a hospital weight-management clinic and 11 lean healthy controls. Patients were classified into metabolically "healthy obese" (n = 26; mean age 42.6 years, mean BMI 46.8 kg\\/m(2)) or "unhealthy obese" (n = 26; mean age 45 years, mean BMI 47.5 kg\\/m(2)) groups, based upon standard cutoff points for blood pressure, lipid profile, and fasting glucose. Circulating lymphoid populations and phenotypes were assessed by flow cytometry. Obese patients had significantly less circulating natural killer (NK) and cytotoxic T lymphocytes (CTL) compared to lean controls. There were significantly higher levels of NK cells and CTLs in the healthy obese group compared to the unhealthy obese group (NK: 11.7% vs. 6.5%, P < 0.0001, CD8 13.4% vs. 9.3%, P = 0.04), independent of age and BMI and these NK cells were also less activated in the healthy compared to the unhealthy group (CD69, 4.1% vs. 11.8%, P = 0.03). This is the first time that quantitative differences in the circulating immune system of obese patients with similar BMI but different metabolic profiles have been described. The significantly higher levels of CTLs and NK cells, which express fewer inhibitory molecules, could protect against malignancy, infection, and metabolic disease seen in obesity.

[Eating habits of patients with severe obesity].

Science.gov (United States)

Reséndiz Barragán, Aída Monserrat; Hernández Altamirano, Sheila Viridiana; Sierra Murguía, Mariana Alejandra; Torres Tamayo, Margarita

2014-11-30

Severe obesity is a health problem that has medical, emotional and economic consequences. The etiology of severe obesity is multifactorial; however, it is known that the eating habits represent a major factor in the development of this disease. This study aimed to identify eating patterns and specific habits that need to be changed to achieve weight loss. An observational, descriptive, retrospective and cross-sectional study with 250 candidates for bariatric surgery, 79.2% women and 20.8% men aged 37.7 ± 10.2 years and 44.3 ± 7.7 kg/m2 BMI patients was performed. It was found that "drinking water", "eat faster than most people", "leave the plate empty", "have long fasts", "sweet cravings", and "drinking soda" were the most common habits in patients with severe obesity. The existence of significant differences between the habits of men and women and between BMI strata or groups are also discussed. "Snacking" and "eat until you feel uncomfortable" were significantly different between men and women and "eat by yourself because you feel ashamed of eating with others" was significant between BMI strata. It was concluded that it is important that the treatment of these patients includes assessment techniques and behavior modification aimed at these habits. It is recommended to include in future studies patients with normal weight and overweight as well as the use of instruments with adequate psychometric properties. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Dietary patterns are associated with obesity in Japanese patients with schizophrenia.

Science.gov (United States)

Sugawara, Norio; Yasui-Furukori, Norio; Sato, Yasushi; Saito, Manabu; Furukori, Hanako; Nakagami, Taku; Ishioka, Masamichi; Kaneko, Sunao

2014-06-20

Obesity among patients with schizophrenia is a growing concern because being overweight is widely regarded as a major risk factor for cardiovascular disease and premature death. Dietary patterns have been suggested as one modifiable factor that may play a role in development of obesity. The objective of this study was to examine the association between dietary patterns and obesity among patients with schizophrenia in Japan. We recruited patients (n = 338) aged 44.0 ± 13.2 (mean ± SD) years with a DSM-IV diagnosis of schizophrenia who were admitted to four psychiatric hospitals using a cross-sectional design. Diet was assessed with a validated brief-type self-administered diet history questionnaire (BDHQ). Dietary patterns from 52 predefined food groups were extracted by principal component analysis. A total of 61 subjects (18.0%) were classified as obese. Three dietary patterns were identified: the healthy dietary pattern, the processed food dietary pattern, and the alcohol and accompanying dietary patterns. After adjusting for age and gender, patients within the high tertile of each healthy dietary pattern (OR = 0.29, 95% CI = 0.13 to 0.62) and processed food dietary pattern (OR = 0.44, 95% CI = 0.22 to 0.89) had a significantly lower risk for obesity compared with low tertile of dietary pattern. Our findings suggest that dietary patterns, including higher intake of protein, fat, n-3 polyunsaturated fatty acids, n-6 polyunsaturated fatty acids, and vitamins, may be related to a decreased prevalence of obesity within patients with schizophrenia. Future longitudinal research exploring dietary patterns and obesity among patients with schizophrenia is warranted.

Clinical value of combined determining leptin, T and E2 in male teenager obesity patients

International Nuclear Information System (INIS)

Bai Zhenlian; Lv Tongqin; Wu Qiuhua

2006-01-01

To study clinical significance of combined detection of leptin, T and E 2 for teenager obesity patients, levels of leptin, T and E 2 in male teenagers obesity patients and male adult obesity patients were determined by RIA. The result showed that in all obesity patients, the levels of leptin and E 2 were much higher than those in normal controls and T was lower than that in normal controls. After treatment, leptin and E 2 were decreased and T was increased significantly in teenager obesity patients, but only leptin was decreased in adult obesity patients. All results indicate that combined detection of leptin, T and E 2 could find endocrine and metabolism disorder of obese teenagers at early stage, instituting prevention and treatment without delay.(authors)

Handling difficult anastomosis. Tips and tricks in obese patients and narrow pelvis

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Srinivas Samavedi

2014-01-01

Full Text Available Vesico-urethral anastomosis (VUA is a technically challenging step in robotic-assisted laparoscopic prostatectomy (RALP in obese individuals. We describe technical modifications to facilitate VUA encountered in obese individuals and in patients with a narrow pelvis. A Pubmed literature search was performed between 2000 and 2012 to review all articles related to RALP, obesity and VUA for evaluation of technique, complications and outcomes of VUA in obese individuals. In addition to the technical modifications described in the literature, we describe our own experience to encounter the technical challenges induced by obesity and narrow pelvis. In obese patients, technical modifications like use of air seal trocar technology, steep Trendlenburg positioning, bariatric trocars, alterations in trocar placement, barbed suture and use of modified posterior reconstruction facilitate VUA in robotic-assisted radical prostatectomy. The dexterity of the robot and the technical modifications help to perform the VUA in challenging patients with lesser difficulty. The experience of the surgeon is a critical factor in outcomes in these technically challenging patients, and obese individuals are best avoided during the initial phase of the learning curve.

Helping patients in Uganda overcome weight gain and obesity using ...

African Journals Online (AJOL)

in educational programmes, economic policy proposals and industry ... development and behaviours determine the expression of the obese phenotype. Obesity is ... MI is one possible solution that can help obese patients change their lifestyle ...

Cushing's Syndrome in a Morbidly Obese Patient Undergoing Evaluation before Bariatric Surgery

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Livia Borsoi

2014-06-01

Full Text Available Objective: Cushing's syndrome (CS is extremely rare in morbidly obese patients. To date, no occurrences in obese patients with BMI above 60 kg/m2 have been reported in the literature. Case Report: This case report describes a patient who was admitted to the ward of the Clinical Division of Endocrinology and Metabolism of the Medical University of Vienna in preparation for bariatric surgery. The patient was a 49-year-old female who showed morbid obesity (BMI 61.6 kg/m2, hypertension, and substituted hypothyroidism. Preoperative work-up revealed CS due to an adrenal adenoma. Therefore, the patient underwent unilateral adrenalectomy followed by bariatric surgery 6 months later. Conclusion: Since undiagnosed CS might result in severe perioperative complications in a population already at increased risk, this case report underlines the importance of careful endocrine evaluation of morbidly obese patients. After all, even rare endocrine causes should be excluded.

Metabolic profiles and lipoprotein lipid concentrations in non-obese and obese patients with polycystic ovarian disease.

Science.gov (United States)

Mahabeer, S; Naidoo, C; Norman, R J; Jialal, I; Reddi, K; Joubert, S M

1990-10-01

Clinical parameters, androgen status and lipoprotein lipid profiles were assessed in 10 non-obese and 10 obese patients with polycystic ovarian disease (PCOD) and reference subjects matched for age, height and weight. Both obese and non-obese women with PCOD had significantly higher androgen levels when compared to the reference groups. When comparison of lipoprotein lipid profiles were made between groups, non-obese women with PCOD had significantly higher total cholesterol, triglycerides and LDL-cholesterol levels than non-obese reference subjects. Obese PCOD women manifested significantly higher total cholesterol, LDL-cholesterol, cholesterol/HDL, and LDL/HDL values than did obese reference subjects. Correlations between serum androgens and lipoprotein lipid concentrations in PCOD and normal women were unhelpful. Both non-obese and obese patients with PCOD had significantly higher systolic and diastolic blood pressures (BPs) than the reference groups. Thus, both non-obese and obese women with PCOD manifest hyperandrogenaemia which may result in a male pattern of lipoprotein lipid concentrations.

Encounters for common illnesses in general practice increased in obese patients

NARCIS (Netherlands)

Wayenburg, van C.A.M.; Lerniengre, M.B.T.; Reenen-Schimmel, van A.H.; Bor, J.H.J.; Bakx, J.C.; Staveren, van W.A.; Weel, van C.; Binsbergen, van J.J.

2008-01-01

Background. Obese patients are known to have more chronic medical conditions. Objective. To compare the frequency of encounter for episodes of the 10 most common illnesses in general practice between obese and non-overweight patients. Methods. Data were derived from the Continuous Morbidity

Lifestyle intervention program in deprived obese adult patients and their non-deprived counterparts.

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Celine Loddo

Full Text Available Although it is known that the prevalence of obesity is high in deprived patients, the link between deprivation and obesity, and the impact of deprivation on compliance and efficacy of a lifestyle intervention program are not known.Deprivation was assessed in 40 patients (23 Females, mean±SD age: 49±17 years from the diabetology department and 140 patients (101 Females, age: 50±15 years from the nutrition department of Bordeaux University hospital. Eighty-seven patients suffering from obesity were evaluated before and after a tailored, multidisciplinary lifestyle intervention. Deprivation was assessed using EPICES scores. Deprivation was defined with an EPICES score > 30.Deprived patients suffering from obesity had significantly higher current (43.8 ±8.4 versus 40.9 ± 5.5 kg/m2, p = 0,02 and maximal BMI (46.1± 8.6 versus 42.3± 5.2 kg/m2, p = 0.002 compared to non-deprived obese. Percentage of body weight loss was not different according to deprivation (4.74 ± 0.75 versus 4.65 ± 1.04%, p = 0.9. EPICES scores were not different according to adherence to lifestyle intervention program (20.5 ± 8.5 versus 29.9 ± 3.9 versus 29.0 ±2.5, no follow up versus partial follow up versus total follow up, p = 0,58.Deprived patients suffering from obesity have a more serious disease than non-deprived patients. However, neither compliance to the lifestyle intervention program nor body weight loss differed between deprived patients with obesity and non-deprived ones. Deprivation should not be a limitation when enrolling patients with obesity in lifestyle intervention programs.

Lifestyle intervention program in deprived obese adult patients and their non-deprived counterparts.

Science.gov (United States)

Loddo, Celine; Pupier, Emilie; Amour, Rémy; Monsaingeon-Henry, Maud; Mohammedi, Kamel; Gatta-Cherifi, Blandine

2017-01-01

Although it is known that the prevalence of obesity is high in deprived patients, the link between deprivation and obesity, and the impact of deprivation on compliance and efficacy of a lifestyle intervention program are not known. Deprivation was assessed in 40 patients (23 Females, mean±SD age: 49±17 years) from the diabetology department and 140 patients (101 Females, age: 50±15 years) from the nutrition department of Bordeaux University hospital. Eighty-seven patients suffering from obesity were evaluated before and after a tailored, multidisciplinary lifestyle intervention. Deprivation was assessed using EPICES scores. Deprivation was defined with an EPICES score > 30. Deprived patients suffering from obesity had significantly higher current (43.8 ±8.4 versus 40.9 ± 5.5 kg/m2, p = 0,02) and maximal BMI (46.1± 8.6 versus 42.3± 5.2 kg/m2, p = 0.002) compared to non-deprived obese. Percentage of body weight loss was not different according to deprivation (4.74 ± 0.75 versus 4.65 ± 1.04%, p = 0.9). EPICES scores were not different according to adherence to lifestyle intervention program (20.5 ± 8.5 versus 29.9 ± 3.9 versus 29.0 ±2.5, no follow up versus partial follow up versus total follow up, p = 0,58). Deprived patients suffering from obesity have a more serious disease than non-deprived patients. However, neither compliance to the lifestyle intervention program nor body weight loss differed between deprived patients with obesity and non-deprived ones. Deprivation should not be a limitation when enrolling patients with obesity in lifestyle intervention programs.

Pharmacological management of obesity in pediatric patients.

Science.gov (United States)

Boland, Cassie L; Harris, John Brock; Harris, Kira B

2015-02-01

To review current evidence of pharmacological options for managing pediatric obesity and provide potential areas for future research. A MEDLINE search (1966 to October 2014) was conducted using the following keywords: exenatide, liraglutide, lorcaserin, metformin, obesity, orlistat, pediatric, phentermine, pramlintide, topiramate, weight loss, and zonisamide. Identified articles were evaluated for inclusion, with priority given to randomized controlled trials with orlistat, metformin, glucagon-like peptide-1 agonists, topiramate, and zonisamide in human subjects and articles written in English. References were also reviewed for additional trials. Whereas lifestyle modification is considered first-line therapy for obese pediatric patients, severe obesity may benefit from pharmacotherapy. Orlistat is the only Food and Drug Administration (FDA)-approved medication for pediatric obesity and reduced body mass index (BMI) by 0.5 to 4 kg/m(2), but gastrointestinal (GI) adverse effects may limit use. Metformin has demonstrated BMI reductions of 0.17 to 1.8 kg/m(2), with mild GI adverse effects usually managed with dose titration. Exenatide reduced BMI by 1.1 to 1.7 kg/m(2) and was well-tolerated with mostly transient or mild GI adverse effects. Topiramate and zonisamide reduced weight when used in the treatment of epilepsy. Future studies should examine efficacy and safety of pharmacological agents in addition to lifestyle modifications for pediatric obesity. Lifestyle interventions remain the treatment of choice in pediatric obesity, but concomitant pharmacotherapy may be beneficial in some patients. Orlistat should be considered as second-line therapy for pediatric obesity. Evidence suggests that other diabetes and antiepileptic medications may also provide weight-loss benefits, but safety should be further evaluated. © The Author(s) 2014.

KNEE ARTHROSCOPIC VISIBILITY ALTERATIONS IN OBESE AND NON-OBESE PATIENTS.

Science.gov (United States)

Zini, Cássio; Stieven-Filho, Edmar; Tabushi, Fernando Issamu; Ribas, Carmen Australia Paredes Marcondes; Ribas, Fernanda Marcondes; Opolski, Ana Cristina; Erbano, Bruna Olandoski

Obesity is a chronic disease and has become the most prevalent public health problem worldwide. The impact of obesity on knee is strong and the BMI is correlated with the different alterations. Compare surgical visualization of arthroscopic field in partial meniscectomy in obese and non-obese. Sixty patients were selected, 30 obese and 30 non-obese who underwent arthroscopic partial meniscectomy. The arthroscopic surgical procedures were recorded and analyzed. For the analysis of visualization was used the Johnson's classification (2000). Were analyzed 48 men and 12 women, the average age was 42.9 years with BMI between 21.56 to 40.14 kg/m2. The distribution of visibility of the surgical field according to the classification was: grade 1 - 38/60 (63.3%); grade 2 - 13/60 (21.6%); grade 3 - 6/60 (10%); grade 4 - 3/60 (5%). Knee arthroscopy did not show a significant difference in the visibility of arthroscopic field in obese and non-obese patients. Thus, it should not be indicated as the preferred method of diagnostic evaluation of joint changes in these patients. A obesidade é doença crônica e tem se tornado o problema de saúde pública mais prevalente em todo mundo. O impacto dela no joelho é grande e o IMC está correlacionado com as diferentes alterações existentes. Comparar a visualização do campo videoartroscópico na meniscectomia parcial de joelho em pacientes obesos e não obesos. Foram selecionados 60 pacientes, sendo 30 obesos e 30 não obesos que realizaram meniscectomia parcial videoartroscópica. Os procedimentos videoartroscópicos foram gravados e posteriormente analisados. Foi utilizada na análise a classificação de visibilidade do campo videoartroscópico de Johnson (2000). Foram analisados 48 homens e 12 mulheres com idade média de 42,9 anos e IMC de 21,56 a 40,14 kg/m2. A distribuição da visibilidade do campo cirúrgico foi: grau 1 - 38/60 (63,3%); grau 2 - 13/60 (21,6%); grau 3 - 6/60 (10%); grau 4 - 3/60 (5%). A artroscopia de

Does obesity hinder radiotherapy in endometrial cancer patients? The implementation of new techniques in adjuvant radiotherapy – focus on obese patients

Directory of Open Access Journals (Sweden)

Małgorzata Moszyńska-Zielińska

2014-05-01

Full Text Available The increasing incidence of obesity in Poland and its relation to endometrioid endometrial cancer (EEC is resulting in the increasing necessity of treating obese women. Treatment of an overweight patient with EEC may impede not only the surgical procedures but also radiotherapy, especially external beam radiotherapy (EBRT. The problems arise both during treatment planning and when delivering each fraction due to the difficulty of positioning such a patient – it implies the danger of underdosing targets and overdosing organs at risk. Willingness to use dynamic techniques in radiation oncology has increased for patients with EEC, even those who are obese. During EBRT careful daily verification is necessary for both safety and treatment accuracy. The most accurate method of verification is cone beam computed tomography (CBCT with soft tissue assessment, although it is time consuming and often requires a radiation oncologist. In order to improve the quality of such treatment, the authors present the practical aspects of planning and treatment itself by means of dynamic techniques in EBRT. The authors indicate the advantages and disadvantages of different types of on-board imaging (OBI verification images. Considering the scanty amount of literature in this field, it is necessary to conduct further research in order to highlight proper planning and treatment of obese endometrial cancer patients. The review of the literature shows that all centres that wish to use EBRT for gynaecological tumours should develop their own protocols on qualification, planning the treatment and methods of verifying the patients’ positioning.

Sarcopenia and sarcopenic obesity in patients with muscular dystrophy

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Luciano eMerlini

2014-10-01

Full Text Available Aging sarcopenia and muscular dystrophy are two conditions characterized by lower skeletal muscle quantity, lower muscle strength, and lower physical performance. Aging is associated with a peculiar alteration in body composition called sarcopenic obesity characterized by a decrease in lean body mass and increase in fat mass. To evaluate the presence of sarcopenia and obesity in a cohort of adult patients with muscular dystrophy we have used the measurement techniques considered golden standard for sarcopenia that is for muscle mass dual energy X-ray absorptiometry (DXA, for muscle strength hand held dynamometry, and for physical performance gait speed. The study involved 14 adult patients with different types of muscular dystrophy. We were able to demonstrate that all patient were sarcopenic-obese. We showed in fact that all were sarcopenic based on appendicular lean, fat & bone free, mass index (ALMI. In addition all resulted obese according to the % of body fat determined by DXA in contrast with their body mass index ranging from underweight to obese. Skeletal muscle mass determined by DXA was markedly reduced in all patients and correlated with residual muscle strength determined by hand held dynamometry, and physical performances determined by gait speed and respiratory function. Finally we showed that ALMI was the best linear explicator of muscle strength and physical function. Altogether, our study suggest the relevance of a proper evaluation of body composition in muscular dystrophy and we propose to use, both in research and practice, the measurement techniques that has already been demonstrated effective in aging sarcopenia.

The presence of obesity paradox in Greek patients with chronic heart failure.

Science.gov (United States)

Vlaras, Efstratios; Giakoumidakis, Konstantinos; Fotos, Nikolaos V; Chatziefstratiou, Anastasia A; Brokalaki, Hero

2017-01-01

To investigate the effect of body mass index (BMI) values on 1- and 2-year mortality rates in patients with chronic heart failure (HF). We conducted a retrospective cohort study of 112 patients with confirmed HF who visited the HF outpatient unit of a tertiary hospital of Athens, Greece, during a 5-month period (December 2012 - April 2013). These patients were assigned to four groups based on their BMI category. Data collection was carried out through a review of the medical patient records and the filling in of a structured questionnaire, including information on the demographic and clinical patient variables. Additionally, 1- and 2-year patient mortality was recorded. The statistical significance was two-tailed, and p -values of less than 0.05 were considered significant. The statistical analysis was performed with Mann-Whitney U test, χ 2 test, and Student's t -test using the SPSS software (IBM SPSS 21.0 for Windows). Obese patients had significantly lower 1-year (13% vs 34.6%, p =0.039) and 2-year (4% vs 21.4%, p =0.022) mortality rates compared with those with normal BMI values. Additionally, we found clinically and not statistically significant lower mortality in overweight and obese patients, when compared with normal BMI and overweight patients, respectively. Obesity paradox seems to be present in our study, translating to significantly lower long-term mortality rates of obese patients compared to those with normal BMI. The significantly higher left ventricular ejection fraction and hematocrit levels among obese HF patients could justify our study findings. Further research is needed due to the inherent weaknesses of BMI and the other study limitations.

The relationship between obesity and neurocognitive function in Chinese patients with schizophrenia.

Science.gov (United States)

Guo, Xiaofeng; Zhang, Zhanchou; Wei, Qinling; Lv, Hailong; Wu, Renrong; Zhao, Jingping

2013-04-09

Studies have reported that up to 60% of individuals with schizophrenia are overweight or obese. This study explored the relationship between obesity and cognitive performance in Chinese patients with schizophrenia. Outpatients with schizophrenia aged 18-50 years were recruited from 10 study sites across China. Demographic and clinical information was collected. A neuropsychological battery including tests of attention, processing speed, learning/memory, and executive functioning was used to assess cognitive function, and these 4 individual domains were transformed into a neurocognitive composite z score. In addition, height and weight were measured to calculate body mass index (BMI). Patients were categorized into 4 groups (underweight, normal weight, overweight and obese) based on BMI cutoff values for Asian populations recommended by the World Health Organization. A total number of 896 patients were enrolled into the study. Fifty-four percent of participants were overweight or obese. A higher BMI was significantly associated with lower scores on the Wechsler Memory Scale-Revised (WMS-R) Visual Reproduction subscale, the Wechsler Adult Intelligence Scale-Revised (WAIS-R) Digit Symbol subscale, and the composite z score (p's ≤ 0.024). Obese patients with schizophrenia had significantly lower scores than normal weight patients on the Trail Making Test B, the WMS-R Visual Reproduction subscale, the WAIS Digit Symbol subscale, and the composite z score (p's ≤ 0.004). Our study suggests that, in addition to its well established risk for various cardiometabolic conditions, obesity is also associated with decreased cognitive function in Chinese patients with schizophrenia. Future studies should explore if weight loss and management can improve cognitive function in obese patients who suffer from schizophrenia.

The impact of obesity and adiponectin signaling in patients with renal cell carcinoma: A potential mechanism for the "obesity paradox".

Science.gov (United States)

Ito, Ryuichi; Narita, Shintaro; Huang, Mingguo; Nara, Taketoshi; Numakura, Kazuyuki; Takayama, Koichiro; Tsuruta, Hiroshi; Maeno, Atsushi; Saito, Mitsuru; Inoue, Takamitsu; Tsuchiya, Norihiko; Satoh, Shigeru; Habuchi, Tomonori

2017-01-01

Although obesity increases the risk of renal cell carcinoma (RCC), obese patients with RCC experience longer survival than non-obese patients. However, the mechanism of this "obesity paradox" is unknown. We examined the impact of preoperative BMI, serum total adiponectin (sAd) level, total adiponectin secretion from perinephric adipose tissue, and intratumoral expression of adiponectin receptors on RCC aggressiveness and survival. We also investigated the mechanism underlying enhanced cancer aggressiveness in RCC cells stimulated with exogenous adiponectin. Overweight and obese patients had significantly lower grade cancers than normal patients in all patients and in those without metastasis (p = 0.003 and p = 0.027, respectively). Cancer-specific survival was significantly longer in overweight and obese patients than in normal patients in all patients (p = 0.035). There was a weak inverse correlation between sAd level and BMI in RCC patients (r = -0.344, p = 0.002). Tumor size was slightly correlated with sAd level, and high sAd was significantly associated with poor overall survival rates in patients with non-metastatic RCC (p = 0.035). Adiponectin levels in perinephric adipose tissue and intratumoral AdipoR1/R2 expression were not correlated with RCC aggressiveness or survival. Proliferation significantly increased in 786-O and Caki-2 cells exposed to exogenous adiponectin, whereas cell invasion and migration were unaffected. In addition, exogenous adiponectin significantly inhibited starvation- and metformin-induced apoptosis, and up-regulated p-AMPK and Bcl-xL levels. In summary, low BMI and high adiponectin levels are associated with aggressive cell behaviors and poor survival in surgically-treated RCC patients. The effects of adiponectin on proliferation and apoptosis might underlie the "obesity paradox" of RCC.

Monitoring bacterial community of human gut microbiota reveals an increase in Lactobacillus in obese patients and Methanogens in anorexic patients.

Directory of Open Access Journals (Sweden)

Fabrice Armougom

Full Text Available BACKGROUND: Studies of the bacterial communities of the gut microbiota have revealed a shift in the ratio of Firmicutes and Bacteroidetes in obese patients. Determining the variations of microbial communities in feces may be beneficial for the identification of specific profiles in patients with abnormal weights. The roles of the archaeon Methanobrevibacter smithii and Lactobacillus species have not been described in these studies. METHODS AND FINDINGS: We developed an efficient and robust real-time PCR tool that includes a plasmid-based internal control and allows for quantification of the bacterial divisions Bacteroidetes, Firmicutes, and Lactobacillus as well as the methanogen M. smithii. We applied this technique to the feces of 20 obese subjects, 9 patients with anorexia nervosa, and 20 normal-weight healthy controls. Our results confirmed a reduction in the Bacteroidetes community in obese patients (p<0.01. We found a significantly higher Lactobacillus species concentration in obese patients than in lean controls (p=0.0197 or anorexic patients (p=0.0332. The M. smithii concentration was much higher in anorexic patients than in the lean population (p=0.0171. CONCLUSIONS: Lactobacillus species are widely used as growth promoters in the farm industry and are now linked to obesity in humans. The study of the bacterial flora in anorexic patients revealed an increase in M. smithii. This increase might represent an adaptive use of nutrients in this population.

Pioglitazone metabolic effect in metformin-intolerant obese patients treated with sibutramine.

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Derosa, Giuseppe; Mereu, Roberto; Salvadeo, Sibilla A T; D'Angelo, Angela; Ciccarelli, Leonardina; Piccinni, Mario N; Ferrari, Ilaria; Gravina, Alessia; Maffioli, Pamela; Cicero, Arrigo F G

2009-01-01

Metformin is the drug of choice to treat obese type 2 diabetes patients because it reduces either insulin-resistance and body weight. We aimed to comparatively test the efficacy and tolerability of pioglitazone and sibutramine in metformin-intolerant obese type 2 diabetic patients treated with sibutramine. Five hundred and seventy-six consecutive Caucasian obese type 2 diabetic patients were evaluated during a 12-months period and fifty-two patients were resulted intolerant to metformin at maximum dosage (3,000 mg/day). All intolerant patients to metformin received a treatment with pioglitazone (45 mg/day) and sibutramine (10 mg/day) and they were compared with fifty-three patients treated with metformin (3,000 mg/day) and sibutramine (10 mg/day) for 6 months in a single-blind controlled trial. We assessed body mass index, waist circumference, glycated hemoglobin, Fasting Plasma glucose, postprandial plasma glucose, fasting plasma insulin, postprandial plasma insulin, lipid profile, systolic blood pressure, diastolic blood pressure and heart rate at baseline and after 3, and 6 months. No body mass index change was observed at 3, and 6 months in pioglitazone + sibutramine group, while a significant reduction of body mass index and waist circumference was observed after 6 months in metformin + sibutramine group (psibutramine combination appears to be a short-term equally efficacious and well-tolerated therapeutic alternative respect to metformin-intolerant obese type 2 diabetic patients treated with sibutramine.

Obese patients and radiography literature: what do we know about a big issue?

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Le, Nhat Tan Thanh; Robinson, John; Lewis, Sarah J, E-mail: sarah.lewis@sydney.edu.au [Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales (Australia)

2015-06-15

Obesity is a global health issue with obese patients requiring specialised diagnosis, treatment and care through the health service. The practical and social difficulties associated with medical imaging of obese patients are an increasingly common problem and it is currently unknown how student and qualified radiographers perceive and respond to these challenges. By better understanding challenges presented in providing quality imaging and care of imaging obese patients, education for both qualified and student radiographers can be enhanced. Radiographers are heavily reliant on visual and tactile senses to locate the position of anatomical structures for diagnostic imaging and determine radiation exposure through a delicate consideration of dose, image quality and anatomical attenuation. However, obese patients require modifications to routine radiographic practice in terms of movement/assisted positioning, equipment capabilities to take increased weight or coverage. These patients may also be subject to compromised radiological diagnosis through poor visualisation of structures. In this paper, the professional and educational literature was narratively reviewed to assess gaps in the evidence base related to the skill and care knowledge for obese patients. Literature was sourced relating to discrete radiographic considerations such as the technical factors of imaging obese patients, exposure and the impact of obesity on imaging departments’ service provisions. The recent literature (post-2000 to coincide with the sharp increase in global obesity) on the perceptions of health professionals and student health practitioners has also been explored because there are no specific radiographer studies to report. By understanding the research in similar fields, we may identify what common attitudes qualified and student radiographer's hold and what challenges, technical and care related, can be prepared for.

Obese patients and radiography literature: what do we know about a big issue?

International Nuclear Information System (INIS)

Le, Nhat Tan Thanh; Robinson, John; Lewis, Sarah J

2015-01-01

Obesity is a global health issue with obese patients requiring specialised diagnosis, treatment and care through the health service. The practical and social difficulties associated with medical imaging of obese patients are an increasingly common problem and it is currently unknown how student and qualified radiographers perceive and respond to these challenges. By better understanding challenges presented in providing quality imaging and care of imaging obese patients, education for both qualified and student radiographers can be enhanced. Radiographers are heavily reliant on visual and tactile senses to locate the position of anatomical structures for diagnostic imaging and determine radiation exposure through a delicate consideration of dose, image quality and anatomical attenuation. However, obese patients require modifications to routine radiographic practice in terms of movement/assisted positioning, equipment capabilities to take increased weight or coverage. These patients may also be subject to compromised radiological diagnosis through poor visualisation of structures. In this paper, the professional and educational literature was narratively reviewed to assess gaps in the evidence base related to the skill and care knowledge for obese patients. Literature was sourced relating to discrete radiographic considerations such as the technical factors of imaging obese patients, exposure and the impact of obesity on imaging departments’ service provisions. The recent literature (post-2000 to coincide with the sharp increase in global obesity) on the perceptions of health professionals and student health practitioners has also been explored because there are no specific radiographer studies to report. By understanding the research in similar fields, we may identify what common attitudes qualified and student radiographer's hold and what challenges, technical and care related, can be prepared for

Moderate overweight is beneficial and severe obesity detrimental for patients with documented atherosclerotic heart disease

DEFF Research Database (Denmark)

Azimi, Aziza; Charlot, Mette Gitz; Torp-Pedersen, Christian

2013-01-01

Obesity is paradoxically associated with enhanced survival in patients with established cardiovascular disease. We explored this paradox further by examining the influence of obesity on survival in patients with verified atherosclerotic heart disease.......Obesity is paradoxically associated with enhanced survival in patients with established cardiovascular disease. We explored this paradox further by examining the influence of obesity on survival in patients with verified atherosclerotic heart disease....

Obstructive sleep apnea and bone mineral density in obese patients

Directory of Open Access Journals (Sweden)

Mariani S

2012-11-01

Full Text Available Stefania Mariani,1 Daniela Fiore,1 Laura Varone,2 Sabrina Basciani,1 Agnese Persichetti,1 Mikiko Watanabe,1 Maurizio Saponara,3 Giovanni Spera,1 Costanzo Moretti,4 Lucio Gnessi11Department of Experimental Medicine, Section of Medical Physiopathology and Endocrinology, Sapienza University of Rome, Italy; 2Department of Environmental Biology, Sapienza University of Rome, Italy; 3Department of Otolaryngology, Audiology and Phonation, Sapienza University of Rome, Italy; 4Division of Endocrinology, Department of System Medicine, Section of Reproductive Endocrinology University of TorVergata, Fatebenefratelli Hospital "San Giovanni Calibita" Rome, ItalyContext: Obesity and its co-morbidities may adversely affect bone mineral density (BMD. Obstructive sleep apnea (OSA is a major complication of obesity. To date, the effects of OSA on BMD in obese patients have been poorly studied.Objective: To examine whether the severity of OSA independently correlates with BMD in obese patients.Methods: One hundred and fifteen obese subjects with OSA (Apnea/Hypopnea Index [AHI] ≥5 events per hour were included in the study. BMD was measured at lumbar spine, total hip, and femoral neck by dual energy X-ray absorptiometry. Body mass index, lean mass, and representative measures of metabolic syndrome (waist circumference, fasting plasma glucose, blood pressure, HDL-cholesterol, triglycerides and inflammation (ESR, CRP, fibrinogen were also evaluated.Results: BMD did not differ among obese individuals regardless of OSA severity. Correlation coefficient analysis for all the covariates showed a lack of association between AHI and BMD that was strongly influenced by age and weight.Conclusion: Our study does not support an independent association between AHI and BMD in obese patients. Controlled studies involving a greater number of patients are warranted.Keywords: obesity, polysomnography, metabolic syndrome

The impact of obesity and adiponectin signaling in patients with renal cell carcinoma: A potential mechanism for the "obesity paradox".

Directory of Open Access Journals (Sweden)

Ryuichi Ito

Full Text Available Although obesity increases the risk of renal cell carcinoma (RCC, obese patients with RCC experience longer survival than non-obese patients. However, the mechanism of this "obesity paradox" is unknown. We examined the impact of preoperative BMI, serum total adiponectin (sAd level, total adiponectin secretion from perinephric adipose tissue, and intratumoral expression of adiponectin receptors on RCC aggressiveness and survival. We also investigated the mechanism underlying enhanced cancer aggressiveness in RCC cells stimulated with exogenous adiponectin. Overweight and obese patients had significantly lower grade cancers than normal patients in all patients and in those without metastasis (p = 0.003 and p = 0.027, respectively. Cancer-specific survival was significantly longer in overweight and obese patients than in normal patients in all patients (p = 0.035. There was a weak inverse correlation between sAd level and BMI in RCC patients (r = -0.344, p = 0.002. Tumor size was slightly correlated with sAd level, and high sAd was significantly associated with poor overall survival rates in patients with non-metastatic RCC (p = 0.035. Adiponectin levels in perinephric adipose tissue and intratumoral AdipoR1/R2 expression were not correlated with RCC aggressiveness or survival. Proliferation significantly increased in 786-O and Caki-2 cells exposed to exogenous adiponectin, whereas cell invasion and migration were unaffected. In addition, exogenous adiponectin significantly inhibited starvation- and metformin-induced apoptosis, and up-regulated p-AMPK and Bcl-xL levels. In summary, low BMI and high adiponectin levels are associated with aggressive cell behaviors and poor survival in surgically-treated RCC patients. The effects of adiponectin on proliferation and apoptosis might underlie the "obesity paradox" of RCC.

Severity of coronary artery disease in obese patients undergoing coronary angiography

International Nuclear Information System (INIS)

Javed, A.; Ali, J.; Kayani, A.M.

2012-01-01

Objective: To assess the relationship of severity of coronary artery disease with obesity in patients undergoing coronary angiography. Design: Cross sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology - National Institute of Heart Diseases (AFIC-NIHD), 1st February 2010 to 31st August 2010 Patients and Methods: The study population included 468 patients undergoing coronary angiography. Obesity was classified according to the BMI using the National Institutes of Health (NIH) criteria as normal (BMI 21-24 kg/m2), overweight (BMI 25-29 kg/m2), obesity class I (BMI 30-34 kg/m2), obesity class II (BMI 35 to 39 kg/m2 and obesity class III (BMI 40 or above kg/m2). Coronary angiography data were obtained from the Siemens Queries software system, which maintains the database including detailed angiographic findings of all patients at this institution. Significant lesions were defined as those with >70% diameter narrowing of coronary arteries (>50% for the left main coronary artery). We attempted to quantify the 'severity of CAD' by ascertaining the prevalence of High-Risk Coronary Anatomy (HRCA). Results: Insignificant difference was observed in traditional risk factors i.e. age, diabetes mellitus and smoking except hypertension and gender. Statistically significantly low prevalence of HRCA was encountered in the obese group (57.7%) as compared to normal/overweight group (75.8%) (p < 0.05). Conclusion: We conclude that obesity is associated with less severe coronary artery disease. (author)

Association of obesity with patient-reported outcomes in patients with axial spondyloarthritis: a cross-sectional study in an urban Asian population.

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Lee, Yi Xuan; Kwan, Yu Heng; Png, Wan Yu; Lim, Ka Keat; Tan, Chuen Seng; Lui, Nai Lee; Chew, Eng Hui; Thumboo, Julian; Østbye, Truls; Fong, Warren

2017-10-01

To determine if obesity is associated with poorer patient-reported outcomes (PROs) in patients with axial spondyloarthritis (axSpA), we conducted a cross-sectional study using data of the PRESPOND registry from a tertiary referral center in Singapore between 2011 and 2015. Demographics, clinical, and PRO variables were collected. Patients were divided into three categories: normal (BMI < 23 kg/m 2 ), overweight (23 kg/m 2  ≤ BMI < 27.5 kg/m 2 ) and obese (BMI ≥ 27.5 kg/m 2 ), using Asian BMI classification. The dependent variables are Pain score, Bath Ankylosing Spondylitis Patient Global Score (BAS-G), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Health Assessment Questionnaire (HAQ), and Medical Outcomes Study Short Form 36 version 2 (SF-36). Multivariate regression analyses were performed with these dependent variables and obesity categories, adjusting for confounders. Among 194 patients with axSpA, 32% are overweight while 22% are obese. We found that obese patients had significant poorer pain (β: 11.87, 95%CI 2.13, 21.60) and BAS-G scores (β: 10.18, 95%CI 1.59, 18.76) when compared to normal BMI patients. However, obesity was not associated with BASDAI (β 0.50, 95%CI -0.22, 1.22), BASFI (β 0.08, 95%CI -0.66, 0.81), HAQ (β -0.07, 95%CI -0.21, 0.06), physical component summary (β -0.02, 95%CI -4.47, 4.44), and mental component summary (β -2.85, 95%CI -7.57, 1.88) of SF-36. Obesity was associated with pain score and BAS-G but not with BASDAI, BASFI, HAQ, and SF-36. Further study is needed to examine the causal relationship between obesity and poorer PROs.

Lipid discordance and carotid plaque in obese patients in primary prevention.

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Masson, Walter; Siniawski, Daniel; Lobo, Martín; Molinero, Graciela

2018-01-01

Obese patients with lipid discordance (non-HDL cholesterol levels 30mg/dL above the LDL-c value) may have a greater prevalence of carotid atherosclerotic plaque (CAP). Our study objectives were: 1) To assess the prevalence of lipid discordance in a primary prevention population of obese patients; 2) To investigate the association between lipid discordance and presence of CAP. Obese subjects aged >18 years (BMI ≥30kg/m 2 ) with no cardiovascular disease, diabetes, or lipid-lowering treatment from six cardiology centers were included. Lipid discordance was defined when, regardless of the LDL-c level, the non-HDL cholesterol value exceeded the LDL-c value by 30mg/dL. Presence of CAP was identified by ultrasonography. Univariate and multivariate analyses were performed to explore the association between lipid discordance and presence of CAP. The study simple consisted of 325 obese patients (57.2% men; mean age, 52.3 years). Prevalence of lipid discordance was 57.9%. CAP was found in 38.6% of patients, but the proportion was higher in subjects with lipid discordance as compared to those without this lipid pattern (44.4% vs. 30.7%, P=.01). In both the univariate (OR: 1.80; 95% CI: 1.14-2.87; P=.01) and the multivariate analysis (OR: 2.07; 95% CI: 1.22-3.54; P=.007), presence of lipid discordance was associated to an increased probability of CAP. In these obese patients, lipid discordance was associated to greater prevalence of CAP. Evaluation of obese patients with this strategy could help identify subjects with higher residual cardiovascular risk. Copyright © 2017 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

Skin disorders in overweight and obese patients and their relationship with insulin.

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Plascencia Gómez, A; Vega Memije, M E; Torres Tamayo, M; Rodríguez Carreón, A A

2014-03-01

The prevalence of obesity has increased worldwide in recent years. Some authors have described skin conditions associated with obesity, but there is little evidence on the association between insulin levels and such disorders. To describe the skin disorders present in overweight and obese patients and analyze their association with insulin levels. The study included nondiabetic male and female patients over 6 years of age who were seen at our hospital between January and April 2011. All the patients were evaluated by a dermatologist, who performed a physical examination, including anthropometry, and reviewed their medical history and medication record; fasting blood glucose and insulin were also measured. The patients were grouped according to degree of overweight or obesity and the data were compared using analysis of variance or the χ(2) test depending on the type of variable. The independence of the associations was assessed using regression analysis. In total, 109 patients (95 adults and 13 children, 83.5% female) were studied. The mean (SD) age was 38 (14) years and the mean body mass index was 39.6±8 kg/m(2). The skin conditions observed were acanthosis nigricans (AN) (in 97% of patients), skin tags (77%), keratosis pilaris (42%), and plantar hyperkeratosis (38%). Statistically significant associations were found between degree of obesity and AN (P=.003), skin tags (P=.001), and plantar hyperkeratosis. Number of skin tags, AN neck severity score, and AN distribution were significantly and independently associated with insulin levels. AN and skin tags should be considered clinical markers of hyperinsulinemia in nondiabetic, obese patients. Copyright © 2013 Elsevier España, S.L. and AEDV. All rights reserved.

Nonalcoholic fatty liver disease in Japanese patients with severe obesity who received laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) in comparison to non-Japanese patients

International Nuclear Information System (INIS)

Kakizaki, Satoru; Takizawa, Daichi; Yamazaki, Yuichi; Nakajima, Yuka; Ichikawa, Takeshi; Sato, Ken; Takagi, Hitoshi; Mori, Masatomo; Kasama, Kazunori

2008-01-01

The number of patients with morbid obesity is increasing worldwide. However, the prevalence of morbid obesity is still low in Japan, and therefore few systematic investigations of liver dysfunction in this population have so far been carried out. This study aimed to investigate the clinical characteristics in severe obese Japanese patients undergoing laparoscopic Roux-en-Y gastric bypass surgery (LRYGB). Eighty-four patients with severe obesity, including 61 Japanese and 23 non-Japanese patients, were analyzed. The mean body mass index (BMI) was 43.7±7.8 kg/m 2 , and there was no difference between Japanese and non-Japanese patients. Nonalcoholic fatty liver disease (NAFLD) was observed in 45/59 (76.2%) of the Japanese patients. Although there were no differences in the BMI and body weight, serum alanine aminotransferase (ALT) was higher in Japanese patients in comparison to non-Japanese patients (P<0.05). The indices for insulin resistance were significantly higher in the Japanese patients in comparison to non-Japanese patients (P<0.01). The liver/spleen computed tomography (CT) ratios were lower in Japanese patients (P<0.05). The laboratory data and BMI significantly improved at 1 year after LRYGB in both groups. Racial difference may exist difference may exist in NAFLD in patients with severe obesity. When the BMI is similar, liver dysfunction among Japanese patients with severe obesity tends to be higher than in non-Japanese patients. Japanese patients with severe obesity must therefore reduce their body weight to a greater degree in comparison to non-Japanese patients with the same BMI. LRYGB can achieve effective weight control and lower ALT levels in Japanese patients with severe obesity. (author)

Resistin expression correlates with steatohepatitis in morbidly obese patients.

Science.gov (United States)

Edwards, Claire R; Hindle, A Katharine; Latham, Patricia S; Fu, Sidney W; Brody, Fred J

2013-04-01

Morbidly obese patients are at risk for nonalcoholic steatohepatitis (NASH) even in the absence of risk factors for liver disease. Unfortunately, NASH is usually not clinically evident, and a definitive, noninvasive test for NASH does not exist. Resistin, a cytokine originating from adipose tissue, is involved in insulin resistance and also initiates proinflammatory signaling from hepatic stellate cells. This study explores the relationship between resistin expression and liver pathology in bariatric surgery patients. Blood samples from 30 patients undergoing bariatric surgery were collected. Total RNA was extracted and cDNA was synthesized. Quantitative RT-PCR was used to quantify relative gene expression using 18s rRNA gene as an internal control. Wedge liver biopsies from these patients were sectioned and stained. Based on a previously published scoring method, biopsies were assigned an overall NASH severity score and subscores for steatosis, inflammation, and fibrosis. Results were analyzed by using Student's t test. Resistin mRNA levels ranged from 0.5 to 9.7. A group of five patients with very high resistin expression (>4) was identified. These patients had a significantly higher average NASH score compared with the rest of the group (7.9 vs. 4.48, p = 0.019). Steatosis and inflammation scores were significantly higher in the high-resistin group (p < 0.05 for both comparisons). There also was a trend toward higher fibrosis score in this group, which approached statistical significance (p = 0.051). In morbidly obese patients, high resistin expression in serum is associated with hepatic steatosis, inflammation, and fibrosis. The development of elevated resistin expression may represent a link between obesity and the onset of steatohepatitis.

Evaluation of cardiac risk marker levels in obese and non-obese patients with polycystic ovaries.

Science.gov (United States)

Elci, Erkan; Kaya, Cihan; Cim, Numan; Yildizhan, Recep; Elci, Gulhan Gunes

2017-01-01

To compare cardiac risk markers such as asymmetric dimethyl arginine (ADMA), C-reactive protein (CRP), homocystein (Hcy), plasminogen activator inhibitor-1 (PAI-1), vascular endothelial growth factor (VEGF), angiopoietin-related growth factor 6 (ANGPTL6) in obese and non-obese patients with polycystic ovary syndrome (PCOS). Thirty obese (BMI >30 kg/m 2 ) and 30 non-obese (BMI < 30 kg/m 2 ) patients diagnosed with PCOS and 30 age-matched healthy controls were included in the study. The ages of subjects were varying between 18 and 30 years. Serum ADMA, CRP, Hcy, PAI-1, VEGF and ANGPTL6 levels were analyzed for each subject. Serum ADMA, CRP, Hcy, PAI-1, VEGF and ANGPTL6 levels were significantly elevated in obese and non-obese women with PCOS in comparison to control subjects (p < 0.05). This elevation was more obvious in the obese PCOS group than in the other group. Cardiovascular risk markers such as ADMA, CRP, Hcy, PAI-1, VEGF and ANGPTL6 levels are elevated in women with PCOS.

Management of the Open Abdomen in Obese Trauma Patients.

Science.gov (United States)

Johnston, Matthew; Safcsak, Karen; Cheatham, Michael L; Smith, Chadwick P

2015-11-01

Obesity incidence in the trauma population is increasing. Abdominal compartment syndrome has poor outcomes when left untreated. Surgeons may treat obese patients differently because of concern for increased morbidity and mortality. We studied the effects of body mass index (BMI) on resource utilization and outcome. An Institutional Review Board-approved retrospective review of trauma patients requiring temporary abdominal closure (TAC) was performed. Patients were stratified as follows: Group 1-BMI = 18.5 to 24.9 kg/m(2), Group 2-BMI = 25 to 29.9 kg/m(2), Group 3-BMI = 30 to 39.9 kg/m(2), Group 4-BMI ≥ 40 kg/m(2). Demographic data, illness severity as defined by Injury Severity Score, Acute Physiology and Chronic Health Evaluation Score Version II and Simplified Acute Physiology Score Version II scores, resource utilization, fascial closure rate, and survival were collected. About 380 patients required TAC. Median age of Group 1 was significantly lower than Groups 2 and 3 (P = 0.001). Severity of illness did not differ. Group 4 had a longer intensive care unit stay compared with Groups 1 and 2 (P = 0.005). Group 4 required mechanical ventilation longer than Group 1 (P = 0.027). Hospital stay, fascial closure, and survival were equivalent. Obese trauma patients with TAC have a longer intensive care unit stay and more ventilator days, but there is no difference in survival or type of closure. TAC can be used safely in trauma patients with a BMI ≥ 30 kg/m(2).

Perioperative lung protective ventilation in obese patients

NARCIS (Netherlands)

Fernandez-Bustamante, Ana; Hashimoto, Soshi; Serpa Neto, Ary; Moine, Pierre; Vidal Melo, Marcos F.; Repine, John E.

2015-01-01

The perioperative use and relevance of protective ventilation in surgical patients is being increasingly recognized. Obesity poses particular challenges to adequate mechanical ventilation in addition to surgical constraints, primarily by restricted lung mechanics due to excessive adiposity, frequent

Decreased circulating T regulatory lymphocytes in obese patients undergoing bariatric surgery.

Science.gov (United States)

Agabiti-Rosei, Claudia; Trapletti, Valentina; Piantoni, Silvia; Airò, Paolo; Tincani, Angela; De Ciuceis, Carolina; Rossini, Claudia; Mittempergher, Francesco; Titi, Amin; Portolani, Nazario; Caletti, Stefano; Coschignano, Maria Antonietta; Porteri, Enzo; Tiberio, Guido A M; Pileri, Paola; Solaini, Leonardo; Kumar, Rajesh; Ministrini, Silvia; Agabiti Rosei, Enrico; Rizzoni, Damiano

2018-01-01

It has been previously demonstrated that T lymphocytes may be involved in the development of hypertension and microvascular remodeling, and that circulating T effector lymphocytes may be increased in hypertension. In particular, Th1 and Th 17 lymphocytes may contribute to the progression of hypertension and microvascular damage while T-regulatory (Treg) lymphocytes seem to be protective in this regard. However, no data is available about patients with severe obesity, in which pronounced microvascular alterations were observed. We have investigated 32 severely obese patients undergoing bariatric surgery, as well as 24 normotensive lean subjects and 12 hypertensive lean subjects undergoing an elective surgical intervention. A peripheral blood sample was obtained before surgery for assessment of CD4+ T lymphocyte subpopulations. Lymphocyte phenotype was evaluated by flow cytometry in order to assess T-effector and Treg lymphocytes. A marked reduction of several Treg subpopulations was observed in obese patients compared with controls, together with an increased in CD4+ effector memory T-effector cells. In severely obese patients, Treg lymphocytes are clearly reduced and CD4+ effector memory cells are increased. It may be hypothesized that they might contribute to the development of marked microvascular alterations previously observed in these patients.

Impact of obesity on health-related quality of life in patients with chronic illness.

Science.gov (United States)

Katz, D A; McHorney, C A; Atkinson, R L

2000-11-01

To determine the association between overweight and obesity and health-related quality of life (HRQOL) in patients with chronic conditions typical of those seen in general medical practice, after accounting for the effects of depression and medical comorbidities. Cross-sectional analysis of data from the Medical Outcomes Study. Offices of physicians practicing family medicine, internal medicine, endocrinology, cardiology, and psychiatry in three U.S. cities. We surveyed 2,931 patients with chronic medical and psychiatric conditions. The patients completed a self-administered questionnaire at enrollment and had complete data on height and weight. Body mass index (BMI), chronic medical conditions, and depression were obtained by structured interview. Health-related quality of life was measured by the SF-36 Health Survey. Patients who were overweight (BMI 25.0-29.9 kg/m2), patients with class I obesity (BMI 30.0-34.9 kg/m2), and patients with class II-III obesity (BMI > or = 35 kg/m2) had significantly lower adjusted physical function scores (by 3.4, 7.8, and 13.8 points, respectively) compared with nonoverweight patients. Patients with class I and class II-III obesity also had significantly lower adjusted general health perceptions scores (by 2.8 and 4.4 points, respectively) and lower adjusted vitality scores (by 4.0 and 7.1 points, respectively), compared with nonoverweight patients. No significant differences between nonoverweight, overweight, and obese patients were observed for the mental health scale. Women with elevated BMI had significantly lower HRQOL scores compared with the scores of obese men in several domains. Additionally, blacks with elevated BMI had significantly lower scores than whites in several domains of HRQOL. Overweight and obesity have the largest association with physical function measures. Recent national standards, which have lowered the threshold for defining overweight, identify patients who are more likely to have clinically significant

Are English CT departments and radiographers prepared for the morbidly obese patient?

International Nuclear Information System (INIS)

Wiles, R.; Meredith, S.M.; Mullany, J.P.; Wiles, T.

2017-01-01

Introduction: Morbid obesity is increasing in England, as is the use of CT scanning. All CT scanners have weight and body width limits. It is imperative that the radiographer performing the scan is aware of these limits, particularly in an emergency. This study aim was to determine whether radiographers are aware of their scanner limits, where they may be able to send a patient who exceeds these limits and whether a formal protocol exists. The secondary aim of the study was to determine capacities of scanners in acute trusts throughout England. Methods: CT radiographers from 86 English Hospital Trusts with Emergency Departments were contacted and asked questions regarding their CT scanners and their practice of CT scanning morbidly obese patients. Results: 21% of CT radiographers did not know the maximum width capacity of their scanner. Only 24% knew where a nearby larger capacity scanner was located and only 3% had a formal protocol for scanning obese patients. Weight capacities ranged from 147 to 305 kg. Width capacities ranged from 55 to 100 cm. 70% had weight capacity 226 kg or less and 70% had size capacity of 78 cm or less. Conclusion: Patients over 226 kg or 78 cm may not be accommodated in most (70%) trusts in England. Lack of knowledge of scanner capacities and alternative scanners for morbidly obese patients could have consequences for these patients, particularly in an emergency. The authors advise that all acute trusts have a protocol regarding CT scanning morbidly obese to prevent delays in accessing imaging. - Highlights: • Radiographer knowledge about CT scan capacity is somewhat lacking, potentially delaying emergency management. • Most CT scanners in England will not accommodate patients over 226 kg or 78 cm. • Most centres do not have a formal protocol for CT scanning obese patients. • Animal CT scanners are not likely to be useful alternatives for most patients.

Childhood Obesity: Dental hygienists' beliefs attitudes and barriers to patient education.

Science.gov (United States)

Cole, Doreen Dawn M; Boyd, Linda D; Vineyard, Jared; Giblin-Scanlon, Lori J

2018-04-01

Purpose: Increasing childhood obesity rates present a significant threat to public health. The purpose of this study was to explore dental hygienists' (DH) beliefs, attitudes, knowledge, current practices, and barriers for assessing and educating patients about childhood obesity. Methods: A random sample of DHs (n=13,357) was selected and emailed a link to the validated survey. Of the 1046 respondents who accessed the survey, 919 completed the survey for a completion rate of 89%. Results: A majority of the respondents understood the risk of chronic disease and obesity (99%), role sugar-sweetened beverages (SSBs) play as added sugar content in the diet (76%), and the amount of SSBs consumed by youth (91%). Participants felt current research showed an association between obesity and periodontal disease (62%), but were unsure of the association between obesity and dental caries (51%). Most respondents never measure height and weight (91%) or plot BMI (94%). Fifty-one percent always provide nutritional counseling to reduce consumption of SSBs, but only sometimes provide nutritional counseling for healthy eating (61%). Respondents had a slightly positive attitude (mean score=4.15, SD=14.58) about assessing and educating for childhood obesity. Major barriers reported were time constraints (63%), and fear of offending the patient or parent (47%). Regression showed attitudes towards patient's nutrition, exercise, and weight predicted the dental hygienist behavior. Conclusion: DHs have some understanding of the risks of obesity and general/oral health, but lack adequate training, knowledge, and confidence to provide obesity counseling in clinical practice settings. There is a need for further education to address the lack of knowledge about nutritional guidelines and practitioners' beliefs regarding addressing childhood obesity without offending the patient or parent. Copyright © 2018 The American Dental Hygienists’ Association.

Assessment and treatment of binge eating in obese patients

Directory of Open Access Journals (Sweden)

Walmir Ferreira Coutinho

2006-03-01

Full Text Available Binge eating is a frequent disorder among obese patient, specialythose undergoing weight loss treatment. Binge eating disorder(BED is a newly defined diagnostic category, usually associatedwith psychopathology and overweight. Several clinical trialsinvolving psychoterapeutical interventions have shown thatcognitive beahavior therapy and interpersonal therapy can beeffective for the treatment of obese patients with BED.Pharmacotherapy can be also an useful tool for the control ofbinge eating, as part of a multidimensional therapeutic approach,associated to psychotherapy and eating behavior modification.Although the investigation of pharmacological agents for thetreatment of BED is still in its preliminary stages, somemedications have shown promising results in randomized clinicaltrials. Currently, three main classes of drugs have been evaluatedin randomized controlled trials: antidepressants, anti-obesityagents and anticonvulsants. The most studied drugs were theserotonina selective reuptake inhibitors (SSRIs. Fluoxetine,fluvoxamine, sertralina and citalopram have been shown to causemodest, but significant reduction in the frequency of bingeepisodes and body weight over the short term of the trials. Morerecently, sibutramina and topiramate have been shown tosignificantly reduce the binge eating behavior and the body weightin patients with obesity and binge eating.

Totally tubeless percutaneous nephrolithotomy is feasible in morbidly obese patients.

Science.gov (United States)

Aghamir, Seyed Mohammad Kazem; Mohseni, Mohammad Ghasem; Hosseini, Seyed Reza; Salavati, Alborz; Ganjali, Hossein; Fallah, Mohammad Ali; Rezaei, Hamed; Modaresi, Seyed Saeed

2017-06-01

Regarding technical difficulties that obese body habitus might impose to percutaneous nephrolithotomy (PNL) success and higher risk of peri-operative complications in this group of patients, we decided to retrospectively gather data from our patients during past 8 years to determine the stone free and complication rates. Between January 2007-December 2015, seventy-eight obese patients with body mass index over 35 who had indication for PNL including stones larger than 2 cm in pelvi-calyceal system or smaller extracorporeal shock wave lithotripsy (ESWL) resistant stones or who were not a fit candidate for ESWL due to increased skin to target distance, with no contraindication of PNL (including bleeding diathesis, inability to be positioned in prone) were enrolled. They were randomly assigned to group 1 (standard PNL with nephrostomy and ureteral stent) or group 2 (totally tubeless PNL with no ureteral stent and no nephrostomy). The outcomes were compared. The transfusion rate, operation time, and the hemoglobin drop were same across the groups (p>0.05). Total analgesic use was equivalent of 33.8 vs. 14.7 mgs of morphine sulfate (18-77 mg) and was significantly lower in total tubeless group (p=0.001). Return to normal activity was described as total number of in-patient and outpatient days from time of admission to the point which the patients returns to normal life activity such as going to job or school and was 19.4 vs. 9.3 days (6-30 days, p=0.001). Totally tubeless PNL in obese subjects would have lower analgesic use and return to normal activity versus standard PNL. Totally tubeless PNL is recommended for obese patients.

Patient obesity and the practical experience of the plain radiography professional: On everyday ethics, patient positioning and infelicitous equipment

International Nuclear Information System (INIS)

Woods, A.L.; Miller, P.K.; Sloane, C.

2016-01-01

Patient obesity is increasingly placing significant and multifaceted strain upon medical imaging departments, and professionals, in (particularly Western) healthcare systems. The majority of obesity-related studies in radiology are, however, primarily focused only upon the technical business of collecting diagnostically-efficacious images. This study, using Interpretative Phenomenological Analysis (IPA), qualitatively explores the everyday clinical experiences of eight expert UK diagnosticians working in plain radiography. Focus herein falls particularly upon (a) problems with patient positioning during examination, and (b) challenges arising around available equipment. In line with extant research, participants reported that difficulties with positioning obese patients could have negative impacts on image quality, and that insufficient table weight limits and widths, and inadequate detector sizes, can adversely affect examination. They also raised some more novel issues, such as how the impact of available gown sizes upon a patient's sense of dignity can cause practical and ethical dilemmas for a clinician in situ. The issue of how one might ‘train’ experience in positioning patients without bony landmarks as a reference point was also made salient, with strong implications for undergraduate radiography curricula. It is finally highlighted how the participating radiographers themselves seldom conceptualised any given problem as a purely ‘technical’ one, instead recurrently recognising the interlinking of material, socio-economic and moral matters in real healthcare contexts. By better understanding such nuance and complexity as lived by real radiographers, it is contended, a more context-sensitive and flexible path to effective training and guideline-production can be mapped. - Highlights: • Difficulties with positioning obese patients can have negative impacts on image quality. • Positioning patients without bony landmarks as a reference point is

The Metabolic Syndrome and Behavioral Correlates in Obese Patients With Binge Eating Disorder

OpenAIRE

Roehrig, Megan; Masheb, Robin M.; White, Marney A.; Grilo, Carlos M.

2008-01-01

This study examined the frequency of the metabolic syndrome (MetSyn) and explored behavioral eating- and weight-related correlates in obese patients with binge eating disorder (BED). Ninety-three treatment-seeking obese BED patients (22 men and 71 women) with and without the MetSyn were compared on demographic features and a number of current and historical eating and weight variables. Sixty percent of the obese patients with BED met criteria for the MetSyn, with men and whites having signifi...

[Pathological gastroesophageal reflux in patients with severe, morbid and hyper obesity].

Science.gov (United States)

Csendes, A; Burdiles, P; Rojas, J; Burgos, A; Henríquez, A

2001-09-01

Overweight can be a risk factor for pathological gastroesophageal reflux or hiatal hernia. To study the prevalence of gastroesophageal reflux in patients with severe obesity. Sixty seven patients, 51 female, aged 17 to 56 years old with a body mass index over 35 kg/m2, were studied. An upper gastrointestinal endoscopy was performed in all, esophageal manometry was done in 32 and 24 h pH monitoring was done in 32 patients. Seventy nine percent of patients complained of heartburn and 66% of regurgitation. In 16 patients, endoscopy was normal. An erosive esophagitis was found in 33 patients, a short columnar epithelium in 12 and a Barret esophagus with intestinal metaplasia in six. Normal endoscopic findings and erosive esophagitis were present with a higher frequency in women. No association between the degree of obesity and esophageal lesions was observed. Lower esophageal sphincter pressure and abdominal length were significantly higher in subjects with a body mass index over 50 compared to those with a body mass index between 35 and 39.9 kg/m2. No differences were observed in 24 h pH monitoring. A high proportion of severely obese patients had symptoms and endoscopical findings of pathological gastroesophageal reflux.

Triglycerides and glycated hemoglobin for screening insulin resistance in obese patients.

Science.gov (United States)

Boursier, Guilaine; Sultan, Ariane; Molinari, Nicolas; Maimoun, Laurent; Boegner, Catherine; Picandet, Marion; Kuster, Nils; Bargnoux, Anne-Sophie; Badiou, Stéphanie; Dupuy, Anne-Marie; Cristol, Jean-Paul; Avignon, Antoine

2018-03-01

Assessment of insulin resistance (IR) is essential in non-diabetic patients with obesity. Thus study aims to identify the best determinants of IR and to propose an original approach for routine assessment of IR in obesity. All adult with obesity defined by a body mass index ≥30kg/m 2 , evaluated in the Nutrition Department between January 2010 and January 2015 were included in this cross-sectional study. Patients with diabetes were excluded. IR was diagnosed according to the HOMA-IR. Based on a logistic regression, we determined a composite score of IR. We then tested the variables with a principal component analysis and a hierarchical clustering analysis. A total of 498 patients with obesity were included. IR was associated with grade III obesity (OR=2.6[1.6-4.4], p1.7mmol/l (OR=3.0[2.0-4.5], p<0.001) and age (OR=0.98[0.96-0.99], p=0.002). Exploratory visual analysis using factor map and clustering analysis revealed that lipid and carbohydrates metabolism abnormalities were correlated with insulin resistance but not with excessive fat accumulation and low-grade inflammation. Our results highlight the interest of simple blood tests such as HbA1c and triglyceride determination, which associated with BMI, may be widely available tools for screening IR in obese patients. Copyright © 2017 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Association of obesity with cognitive function and brain structure in patients with major depressive disorder.

Science.gov (United States)

Hidese, Shinsuke; Ota, Miho; Matsuo, Junko; Ishida, Ikki; Hiraishi, Moeko; Yoshida, Sumiko; Noda, Takamasa; Sato, Noriko; Teraishi, Toshiya; Hattori, Kotaro; Kunugi, Hiroshi

2018-01-01

Obesity has been implicated in the pathophysiology of major depressive disorder (MDD), which prompted us to examine the possible association of obesity with cognitive function and brain structure in patients with MDD. Three hundred and seven patients with MDD and 294 healthy participants, matched for age, sex, ethnicity (Japanese), and handedness (right) were recruited for the study. Cognitive function was assessed using the Brief Assessment of Cognition in Schizophrenia (BACS). Gray and white matter structures were analyzed using voxel-based morphometry and diffusion tensor imaging in a subsample of patients (n = 114) whose magnetic resonance imaging (MRI) data were obtained using a 1.5 T MRI system. Verbal memory, working memory, motor speed, attention, executive function, and BACS composite scores were lower for the MDD patients than for the healthy participants (p function, and BACS composite scores were lower in obese patients (body mass index ≥ 30, n = 17) than in non-obese patients (n = 290, p left optic radiation were reduced in obese patients (n = 7) compared with non-obese patients (n = 107, p function, reduced gray matter volume, and impaired white matter integrity in cognition-related brain areas in patients with MDD. Copyright © 2017 Elsevier B.V. All rights reserved.

Depth of anaesthesia monitoring in obese patients: a randomized study of propofol-remifentanil

DEFF Research Database (Denmark)

Meyhoff, C S; Henneberg, S W; Jørgensen, B G

2009-01-01

BACKGROUND: In obese patients, depth of anaesthesia monitoring could be useful in titrating intravenous anaesthetics. We hypothesized that depth of anaesthesia monitoring would reduce recovery time and use of anaesthetics in obese patients receiving propofol and remifentanil. METHODS: We investig......BACKGROUND: In obese patients, depth of anaesthesia monitoring could be useful in titrating intravenous anaesthetics. We hypothesized that depth of anaesthesia monitoring would reduce recovery time and use of anaesthetics in obese patients receiving propofol and remifentanil. METHODS: We...... investigated 38 patients with a body mass index >or=30 kg/m(2) scheduled for an abdominal hysterectomy. Patients were randomized to either titration of propofol and remifentanil according to a cerebral state monitor (CSM group) or according to usual clinical criteria (control group). The primary end point.......04). During surgery, when the cerebral state index was continuously between 40 and 60, the corresponding optimal propofol infusion rate was 10 mg/kg/h based on ideal body weight. CONCLUSION: No significant reduction in time to eye opening could be demonstrated when a CSM was used to titrate propofol...

Proliferation and differentiation of adipose tissue in prolonged lean and obese critically ill patients.

Science.gov (United States)

Goossens, Chloë; Vander Perre, Sarah; Van den Berghe, Greet; Langouche, Lies

2017-12-01

In prolonged non-obese critically ill patients, preservation of adipose tissue is prioritized over that of the skeletal muscle and coincides with increased adipogenesis. However, we recently demonstrated that in obese critically ill mice, this priority was switched. In the obese, the use of abundantly available adipose tissue-derived energy substrates was preferred and counteracted muscle wasting. These observations suggest that different processes are ongoing in adipose tissue of lean vs. overweight/obese critically ill patients. We hypothesize that to preserve adipose tissue mass during critical illness, adipogenesis is increased in prolonged lean critically ill patients, but not in overweight/obese critically ill patients, who enter the ICU with excess adipose tissue. To test this, we studied markers of adipogenesis in subcutaneous and visceral biopsies of matched lean (n = 24) and overweight/obese (n = 24) prolonged critically ill patients. Secondly, to further unravel the underlying mechanism of critical illness-induced adipogenesis, local production of eicosanoid PPARγ agonists was explored, as well as the adipogenic potential of serum from matched lean (n = 20) and overweight/obese (n = 20) critically ill patients. The number of small adipocytes, PPARγ protein, and CEBPB expression were equally upregulated (p ≤ 0.05) in subcutaneous and visceral adipose tissue biopsies of lean and overweight/obese prolonged critically ill patients. Gene expression of key enzymes involved in eicosanoid production was reduced (COX1, HPGDS, LPGDS, ALOX15, all p ≤ 0.05) or unaltered (COX2, ALOX5) during critical illness, irrespective of obesity. Gene expression of PLA2G2A and ALOX15B was upregulated in lean and overweight/obese patients (p ≤ 0.05), whereas their end products, the PPARγ-activating metabolites 15s-HETE and 9-HODE, were not increased in the adipose tissue. In vitro, serum of lean and overweight/obese prolonged critically ill

FREQUENCY RATE OF OBESITY AND LOW MOBILITY IN NORTH AMERICAN AND IRANIAN STROKE PATIENTS

Directory of Open Access Journals (Sweden)

Kavian Ghandehari

2010-12-01

Full Text Available Abstract   INTRODUCTION: Obesity and low mobility are among the risk factors of stroke and cardiovascular diseases. A pilot double-center study evaluated frequency rate of obesity and low mobility in patients with ischemic stroke.   METHODS: This prospective clinical study was conducted on 100 consecutive stroke patients in Mackenzie hospital, Canada and 100 consecutive stroke patients in Ghaem hospital, Iran in 2007. The patients were age- and sex- matched. Diagnosis of ischemic stroke was made by stroke neurologists. Obesity and low mobility was detected based on the standard method in the two studied groups. Chi-Square and Fisher tests served for statistical analysis and P < 0.05 was declared as significant.   RESULTS: 92 males and 108 females with ischemic stroke were investigated. Obesity was present in 26% of the Canadians and 21% of Iranian stroke patients, df = 1, P = 0.403. Low mobility was reported in 29% of Canadian and 5% of Iranian stroke patients, df = 1, P < 0.0001. The frequency rate of obesity was not significantly different in the two groups and in each gender separately (P > 0.05, while the difference was significant for low mobility, P < 0.05.   CONCLUSIONS: There is no significant difference in frequency rate of obesity between Canadian and Iranian stroke patients. However, low mobility is significantly more frequent in the old Canadian individuals with stroke. Keywords: Obesity, Stroke, Race.

Intravenous Vancomycin Associated With the Development of Nephrotoxicity in Patients With Class III Obesity.

Science.gov (United States)

Choi, Yookyung Christy; Saw, Stephen; Soliman, Daniel; Bingham, Angela L; Pontiggia, Laura; Hunter, Krystal; Chuang, Linda; Siemianowski, Laura A; Ereshefsky, Benjamin; Hollands, James M

2017-11-01

A consensus statement recommends initial intravenous (IV) vancomycin dosing of 15-20 mg/kg every 8- 24 hours, with an optional 25- to 30-mg/kg loading dose. Although some studies have shown an association between weight and the development of vancomycin-associated nephrotoxicity, results have been inconsistent. To evaluate the correlation between incidence of nephrotoxicity associated with weight-based IV vancomycin dosing strategies in nonobese and obese patients. This retrospective cohort study evaluated hospitalized adult patients admitted who received IV vancomycin. Patients were stratified into nonobese (body mass index [BMI] obesity class I and II (BMI 30-39.9kg/m 2 ), and obesity class III (BMI≥40 kg/m 2 ) groups; patients who were overweight but not obese were excluded. Incidence of nephrotoxicity and serum vancomycin trough concentrations were evaluated. Of a total of 62 documented cases of nephrotoxicity (15.1%), 13 (8.7%), 23 (14.3%), and 26 (26.3%) cases were observed in nonobese, obesity class I and II, and obesity class III groups, respectively ( P=0.002). Longer durations of therapy ( P20 mg/L ( Pobesity were 3-times as likely to develop nephrotoxicity when compared with nonobese patients (odds ratio [OR]=2.99; CI=1.12-7.94) and obesity class I and II patients (OR=3.14; CI=1.27-7.75). Obesity and other factors are associated with a higher risk of vancomycin-associated nephrotoxicity.

Occurrence and significance of Mallory bodies in morbidly obese patients. An immunohistochemical study

DEFF Research Database (Denmark)

Gluud, C; Christoffersen, Pernille Yde; Andersen, T

1984-01-01

Liver biopsies from 61 consecutive patients with morbid obesity (less than 60% overweight) and from 48 patients with alcoholic liver disease were examined for the presence of Mallory bodies. For the detection both routine haematoxylin and eosin stained sections and sections exposed to an immunohi......Liver biopsies from 61 consecutive patients with morbid obesity (less than 60% overweight) and from 48 patients with alcoholic liver disease were examined for the presence of Mallory bodies. For the detection both routine haematoxylin and eosin stained sections and sections exposed...... to an immunohistochemical technique were employed. The latter uses an antiserum which recognizes antigenic determinants in Mallory bodies. Using haematoxylin and eosin staining. Mallory bodies were not detected in any of the biopsies from the obese patients, but found to be present in 63% of the patients with alcoholic...

The meaning of providing caring to obese patients to a group of nurses

Directory of Open Access Journals (Sweden)

Emilly Souza Marques

2014-03-01

Full Text Available This qualitative study was performed with six nurses of a public hospital, with the objective to describe their view of the meaning of providing care to obese patients. Interviews were conducted using a semi-structured script. The data were organized under themes extracted from the subjects’ statements, after being thoroughly read. Symbolic Interactionism was adopted to interpret the findings. The results from the analysis were organized under the following themes: Being obese is excessive, it is not healthy; Providing care to the obese is a structural issue; Obese patients are troublesome, they require care, no big deal; Providing care to the obese requires teamwork. The grasped meanings can interfere in the care provided. The nurses, however, recognize the need to work as a team to deliver comprehensive care. Making positive changes to the meanings found in this study is possible, thus, contributing to providing prejudice-free nursing care to obese patients. Descriptors: Obesity; Nursing Care; Hospital Care.

Intentional Weight Loss Improved Performance in Obese Ischaemic Heart Patient

DEFF Research Database (Denmark)

Geiker, Nina; Myint, Khin Swe; Heck, Patrick

2014-01-01

Aims: The risk of heart failure (HF) increases with BMI, but paradoxically obesity has been associated with reduced mortality in patients with HF. The effect of intentional or therapeutic weight loss on HF is not well known. We examined the effect of weight loss induced by low energy diet (LED......) on physical performance and cardiovascular risk factors in obese patients with moderate-to-severe HF and/or ischaemic heart disease (IHD). Methods and Results: Results from two weight loss interventions at two centres, one in Denmark (DK - 12 week intervention in 21 subjects (14 LED, 7 controls)) and one.......1 in the intervention group versus -22.1% ± 25.6 in the control group (P=0.000). Treatment also improved triglycerides (P=0.000), very low lipoprotein (P=0.001) and C-reactive protein (P=0.010). Conclusion: Weight loss induced by LED in obese patients with moderate-to-severe HF or IHD resulted in clinically significant...

post-operative morbidity of the obese patient undergoing posterior

African Journals Online (AJOL)

urinary tract infection, neurological injury and dural tears. Methods: One hundred consecutive patients undergoing ... muscle mass in the human body, in which weight in kilograms is divided by height in meters2). The current .... complications with the exception of one dural tear occurred in the obese patient group. Table 3.

The obesity paradox in elderly patients with heart failure: analysis of nutritional status.

Science.gov (United States)

Casas-Vara, Antonio; Santolaria, Francisco; Fernández-Bereciartúa, Ainhoa; González-Reimers, Emilio; García-Ochoa, Alfonso; Martínez-Riera, Antonio

2012-06-01

The obesity paradox refers to the improved survival of obese compared with non-obese elderly or diseased patients for reasons that are not clear. To assess the relative roles of fat and other factors in this improved survival, we analyzed the prognostic value of overweight and obesity elderly patients with heart failure (HF), controlling for other nutritional data such as midarm anthropometrics, serum proteins, and muscle strength. Two hundred forty-four patients (83.2 ± 0.5 y old) hospitalized for HF were included. A nutritional survey was performed in all patients. After discharge, the patients were followed up by telephone. Fourteen patients (5.7%) died during hospitalization. The median survival was 984 d. Patients with better nutritional status as assessed by the body mass index (BMI), subjective score, midarm muscle area, triceps skinfold thickness, handgrip, lymphocyte count, and serum albumin, prealbumin, and cholesterol levels showed better short- and long-term prognoses. Obese patients with a BMI above 30 kg/m(2) showed a better long-term prognosis than those with a BMI from 25 to 30 kg/m(2), those with a BMI from 20 to 25 kg/m(2), and those with a BMI lower than 20 kg/m(2). However, survival was not significantly related to a triceps skinfold thickness above the 95th percentile. Obese and overweight patients were younger and had better a nutritional status than those with a normal or decreased BMI as shown by the anthropometrics, subjective score, handgrip, lymphocyte count, hemoglobin, and serum albumin, prealbumin, and cholesterol levels. All the nutritional data correlated closely with each other. New York Heart Association class also correlated with nutrition-derived data: as the HF class increased, the nutritional status deteriorated. On multivariate analysis, to predict long-term survival, neither BMI nor triceps skinfold thickness showed an independent predictive value, whereas a larger midarm muscle area did. The obesity paradox was confirmed in

[Perception of obesity in university students and in patients with eating disorders].

Science.gov (United States)

Jáuregui Lobera, I; Polo, I M López; González, M T Montaña; Millán, M T Morales

2008-01-01

In order to approach in a multidisciplinary way obesity and eating disorders it is necessary to know the implicit theories of personality, the stereotypes, and the current stigmatization of overweight, as well as making the obese individual guilty by attributing his/her state to a "way of being". The objective was to know the perception that students and patients with eating disorders may have about obese people and analyze the differences that might exist between both groups. Setting, population, and interventions: we selected 138 students and 50 patients with anorexia or bulimia that assigned qualifying adjectives to obese people from a given list. We analyzed the most used adjectives and the corresponding personality scales by using the c2 test to determine the differences between the adjectives used and the scales in both samples. A p value childish", or "impulsive". To know the perception of obesity is essential for the psycho-educative work and prevention of associated psychopathological impairments. In eating disorders obesity represents "the most feared" condition so knowing the underlying theories about obesity and overweight in these patients is essential for their management.

Impact of Physician Training on Diagnosis and Counseling of Overweight and Obese Asian Patients.

Science.gov (United States)

Vasudevan, Deepa A; Northrup, Thomas F; Mandayam, Sreedhar; Bamidele, Oluwatosin O; Stotts, Angela L

2017-06-01

Obesity is widely underdiagnosed among Asians, due in part to a lack of physician awareness of the modified diagnostic criteria for Asians. This study investigated the effect of a physician training on accurately diagnosing obesity among and providing weight counseling to overweight and obese Asian patients. Physicians (N = 16) from five primary care practices received 1 h of face-to-face training and other reminder resources (e.g., wallet card) describing the guidelines for the diagnosis of overweight/obesity among Asians, as well as weight counseling instruction. Chart reviews of overweight/obese Asian patients were conducted for the 12 months before the training (n = 198) and 3 months following the training (n = 163). Physician race (Asian/non-Asian) and clinic setting (private/academic) were included as outcome moderators. Patients were predominantly male (63.1 %), with a mean age of 46.0 years (SD = 14.9) and an average BMI of 28.2 (SD = 3.8). Across all physicians, 26.8 and 45.1 % of patients were accurately diagnosed as overweight or obese before and after the training, respectively (p Asian patients as overweight or obese were 102 % higher at post-training after accounting for nesting of patients within physicians. Similarly, weight counseling was higher (65.0 %) following training compared to pre-training levels (43.9 %) but failed to reach significance (p = 0.06). Accurate identification and counseling of overweight/obese Asian patients can be improved by education and training. Universal adoption of race-specific guidelines will ensure more successful weight management and reduced morbidity in a rapidly growing Asian population.

Anatomical measurements of the gastric cardia in obese patients.

Science.gov (United States)

Hindle, A Katherine; Gonzalez, Florencia; Brody, Fred

2009-11-01

Currently, surgeons implant a variety of laparoscopic adjustable gastric bands. However, there is little data to guide the selection process. This study aims to determine the relationship between a patient's body mass index (BMI), height, and weight and the anatomical measurements of the gastric cardia in morbidly obese patients undergoing laparoscopic adjustable gastric band (LAGB) surgery. A total of 67 morbidly obese patients undergoing LAGB surgery were studied. Intraoperative measurements of the gastric cardia were obtained. The relative circumference and posterior diameter of the gastric cardia were measured along with the patient's height, weight, and BMI. Pearson's correlation coefficient was used to measure the relationship between the circumference and posterior diameter of the gastric cardia and the BMI, height, and weight. A p < 0.05 was considered significant. No correlation exists between a patient's BMI or weight and the circumference or diameter of the gastric cardia. A correlation exists between a patient's height and the posterior diameter of the gastric cardia (p = 0.02). Of note, there is a correlation between the relative circumference and the posterior diameter of the gastric cardia for each patient (p = 0.05). Our unique data show no significant correlation between a patient's BMI and weight and the measurements of the gastric cardia. There was a correlation between a patient's height and the posterior diameter of the gastric cardia. These intraoperative measurements may help surgeons objectively select the appropriate band for each respective patient undergoing LAGB surgery. This may potentially decrease postoperative dysphagia.

Obesity, hyperlipidemia, and hyperuraecemia in young and old hypertensive patients

International Nuclear Information System (INIS)

Ahmed, N.; Waqas, H.; Anwar, W.

2009-01-01

There is strong correlation among hypertension, obesity, hyperlipidemia and hyperuricemia which are important risk factor for the cardiovascular disease. Objective of this study was to assess and compare the prevalence of obesity, hyperlipidemia and hyperuricemia among young and old hypertensive patients in the local setting. This cross-sectional study was conducted at medical Out-patient Department at Shahina Jamil Teaching Hospital, Abbottabad, from September 2007 to February 2008. Eighty-six patients seen in the medical outpatient department were enrolled in the study. Patients with age 15 years or above and diagnosed as case of systemic hypertension were included. Patients with endocrine disease, pregnancy, coarctation of aorta, and renal disease leading to hypertension were excluded from the study. Total eighty-six patients with mean age of 53.7+- 12.9 years were included in the study. Patients were divided into younger age group (age <46 years) and older age group (age greater or equal to 46 years). Mean Body Mass Index (BMI) was 29.7 +- 5.2 in the younger age group and 26.9 +- 4.7 in the older age group, mean serum cholesterol level was 192.2 +- 14.2 mg/dL in younger age group and 190.9 +- 18.3 mg/dL in the older age group, mean serum triglyceride level was 170.5 +- 13.7 mg/dL in younger age group and 166.6 +-21.4 mg/dL in the older age group and mean serum uric acid levels were 5.6 +- 0.7 mg/dL in younger age group and 5.7 +- 1.2 mg/dL in the older age group. Overweight and obese patients were 70.9% with its higher prevalence in younger (86.2%) as compared to older patients (63.2%). Hypercholesterolemia was found in 27.9% of the patients, with a frequency of 24.1% in younger patients and 29.8% in the older patients. Hypertriglyceridemia was seen in 66.3% of the patients, with a frequency of 69.0% in younger patients and 64.9% in the older patients. Hyperuricemia was present in 37.2% of the hypertensive patients with a frequency of 34.5% in the younger

Panniculectomy and Cystectomy: An Approach to the Morbidly Obese Patient

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Lee A. Hugar

2016-01-01

Full Text Available The obese patient undergoing radical cystectomy faces a unique set of challenges. We present the case of a 68-year-old gentleman who presented to our institution with Bacillus Calmette-Guerin refractory disease, a body mass index of 38.5, and a large pannus. The present paper describes our technique for performing radical cystectomy with ileal conduit urinary diversion and concomitant panniculectomy. We discuss the impact of obesity on patients undergoing radical cystectomy and how this may be mitigated by panniculectomy.

Moderate overweight is beneficial and severe obesity detrimental for patients with documented atherosclerotic heart disease.

Science.gov (United States)

Azimi, Aziza; Charlot, Mette Gitz; Torp-Pedersen, Christian; Gislason, Gunnar H; Køber, Lars; Jensen, Lisette Okkels; Thayssen, Per; Ravkilde, Jan; Tilsted, Hans-Henrik; Lassen, Jens Flensted; Thuesen, Leif

2013-05-01

Obesity is paradoxically associated with enhanced survival in patients with established cardiovascular disease. We explored this paradox further by examining the influence of obesity on survival in patients with verified atherosclerotic heart disease. This retrospective registry based cohort study included all patients from the Western Denmark Heart Registry with coronary atherosclerosis confirmed by coronary angiography from January 2000 to December 2010. Patients were divided into eight groups according to body mass index (BMI) based on WHO BMI classification. Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark. The study included 37 573 patients (70.7% men) with a mean age of (66.3 ± 11.1) years. During the 11 years of follow-up, 5866 (15.6%) patients died. Multivariable analysis confirmed that the risk of death was the lowest among the preobese patients (27.5 ≤ BMIObese classes I and II did not differ from the reference group (23 ≤ BMIheart disease patients have improved survival compared with normal weight patients. Underweight and severely obese patients have increased mortality. Our results lean more towards an overweight paradox than an obesity paradox.

The Impact of Obesity on Patients Bridged to Transplantation with Continuous-Flow Left Ventricular Assist Devices

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Clerkin, Kevin J.; Naka, Yoshifumi; Mancini, Donna M.; Colombo, Paolo C.; Topkara, Veli K.

2017-01-01

Objectives This study sought to determine if obese patients had worse post-LVAD implantation outcomes and if the implantation of an LVAD allowed for weight loss. Background Obesity is a risk factor for cardiovascular disease including heart failure. Obese heart failure patients have better outcomes than those with normal weight; however obese patients have worse outcomes following heart transplantation. Methods Patients were identified in the UNOS database that underwent LVAD implantation as bridge to transplantation from May 2004 and April 2014, with follow-up through June 2014. Patients were grouped according to BMI based on the WHO classification Results Among 3,856 patients the risk of death or delisting was not significantly different between BMI groups (p=0.347). There was no increased risk of death (p=0.234) or delisting (p=0.918). The risk of complication requiring UNOS status upgrade was increased for those with Class II obesity or greater (HR 1.48, 95% CI 1.14–1.93, p=0.004), driven by increased infection and thromboembolism. Obese patients had worse post-transplant outcomes. Weight loss substantial enough to decrease BMI group was achieved by a small proportion of patients listed with Class I obesity or greater (9.6–15.5%). Conclusions Patients with obesity had similar freedom from death or delisting while on LVAD support. However, Class II obese or greater patients had an increased risk of complications requiring UNOS status upgrade compared with those with normal BMI during LVAD support and decreased post-transplant survival. Weight loss on device therapy was possible, but uncommon. Careful consideration is needed when a bridge to weight loss strategy is proposed. PMID:27614942

The Effect of Weight Loss in Obese Patients with Chronic Stable Plaque-Type Psoriasis

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Wanjarus Roongpisuthipong

2013-01-01

Full Text Available Background. Chronic plaque psoriasis is frequently associated with obesity. The effect of a low-calorie diet on psoriasis has not been investigated. Objective. The objective was to investigate whether moderate weight loss increases the therapeutic response to topical treatment in obese patients with chronic stable plaque-type psoriasis. Material and Method. A 24-week clinical trial was conducted in 10 patients. The efficacy of a low-calorie diet with topical treatment was compared with baseline in obese patients with chronic stable plaque-type psoriasis. The primary measure of clinical response was the Psoriasis Area and Severity Index at weeks 12 and 24. Results. At week 12, the mean reduction in body weight was 9.6 percent. There was an improvement from baseline of 50 percent or more in the Psoriasis Area and Severity Index in 50 percent of the patients. The responses as measured by improvements in the Psoriasis Area and Severity Index were paralleled by improvements in global assessments by the physician and the patients and in the Dermatology Life Quality Index. Conclusion. Obese patients with chronic stable plaque-type psoriasis increase their response to a low-calorie diet. Lifestyle modifications, including a low-calorie diet, may supplement the pharmacologic treatment of obese psoriasis patients.

Obesity and Outcome of Assisted Reproduction in Patients With Polycystic Ovary Syndrome.

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Tziomalos, Konstantinos; Dinas, Konstantinos

2018-01-01

Assisted reproduction, including in vitro fertilization and intracytoplasmic sperm injection, is increasingly being used for the management of infertility in patients with polycystic ovary syndrome (PCOS). However, there are limited data regarding the association between obesity and the outcome of assisted reproduction in this specific population as well as on the effects of weight loss. The aim of the present review is to summarize the existing evidence on the association between obesity and the outcome of assisted reproduction in patients with PCOS. Accumulating data suggest that obesity is associated with lower pregnancy and live birth rates in patients with PCOS who are undergoing assisted reproduction therapy. However, it remains unclear whether weight loss improves the outcome of this therapy. Notably, recent guidelines state that the health benefits of postponing pregnancy to achieve weight loss must be balanced against the risk of declining fertility with advancing age. Therefore, if weight loss is not achieved within a reasonable time period, assisted reproduction therapy should be offered in adequately selected patients with PCOS, regardless of the presence of obesity.

Obesity and Outcome of Assisted Reproduction in Patients With Polycystic Ovary Syndrome

Science.gov (United States)

Tziomalos, Konstantinos; Dinas, Konstantinos

2018-01-01

Assisted reproduction, including in vitro fertilization and intracytoplasmic sperm injection, is increasingly being used for the management of infertility in patients with polycystic ovary syndrome (PCOS). However, there are limited data regarding the association between obesity and the outcome of assisted reproduction in this specific population as well as on the effects of weight loss. The aim of the present review is to summarize the existing evidence on the association between obesity and the outcome of assisted reproduction in patients with PCOS. Accumulating data suggest that obesity is associated with lower pregnancy and live birth rates in patients with PCOS who are undergoing assisted reproduction therapy. However, it remains unclear whether weight loss improves the outcome of this therapy. Notably, recent guidelines state that the health benefits of postponing pregnancy to achieve weight loss must be balanced against the risk of declining fertility with advancing age. Therefore, if weight loss is not achieved within a reasonable time period, assisted reproduction therapy should be offered in adequately selected patients with PCOS, regardless of the presence of obesity. PMID:29670581

Obesity and Outcome of Assisted Reproduction in Patients With Polycystic Ovary Syndrome

Directory of Open Access Journals (Sweden)

Konstantinos Tziomalos

2018-04-01

Full Text Available Assisted reproduction, including in vitro fertilization and intracytoplasmic sperm injection, is increasingly being used for the management of infertility in patients with polycystic ovary syndrome (PCOS. However, there are limited data regarding the association between obesity and the outcome of assisted reproduction in this specific population as well as on the effects of weight loss. The aim of the present review is to summarize the existing evidence on the association between obesity and the outcome of assisted reproduction in patients with PCOS. Accumulating data suggest that obesity is associated with lower pregnancy and live birth rates in patients with PCOS who are undergoing assisted reproduction therapy. However, it remains unclear whether weight loss improves the outcome of this therapy. Notably, recent guidelines state that the health benefits of postponing pregnancy to achieve weight loss must be balanced against the risk of declining fertility with advancing age. Therefore, if weight loss is not achieved within a reasonable time period, assisted reproduction therapy should be offered in adequately selected patients with PCOS, regardless of the presence of obesity.

Obesity is associated with increased health care charges in patients undergoing outpatient plastic surgery.

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Sieffert, Michelle R; Fox, Justin P; Abbott, Lindsay E; Johnson, R Michael

2015-05-01

Obesity is associated with greater rates of surgical complications. To address these complications after outpatient plastic surgery, obese patients may seek care in the emergency department and potentially require admission to the hospital, which could result in greater health care charges. The purpose of this study was to determine the relationship of obesity, postdischarge hospital-based acute care, and hospital charges within 30 days of outpatient plastic surgery. From state ambulatory surgery center databases in four states, all discharges for adult patients who underwent liposuction, abdominoplasty, breast reduction, and blepharoplasty were identified. Patients were grouped by the presence or absence of obesity. Multivariable regression models were used to compare the frequency of hospital-based acute care, serious adverse events, and hospital charges within 30 days between groups while controlling for confounding variables. The final sample included 47,741 discharges, with 2052 of these discharges (4.3 percent) being obese. Obese patients more frequently had a hospital-based acute care encounter [7.3 percent versus 3.9 percent; adjusted OR, 1.35 (95% CI,1.13 to 1.61)] or serious adverse event [3.2 percent versus 0.9 percent; adjusted OR, 1.73 (95% CI, 1.30 to 2.29)] within 30 days of surgery. Obese patients had adjusted hospital charges that were, on average, $3917, $7412, and $7059 greater (p Obese patients who undergo common outpatient plastic surgery procedures incur substantially greater health care charges, in part attributable to more frequent adverse events and hospital-based health care within 30 days of surgery. Risk, II.

Reality of obesity paradox: Results of percutaneous coronary intervention in Middle Eastern patients.

Science.gov (United States)

Jarrah, Mohamad; Hammoudeh, Ayman J; Khader, Yousef; Tabbalat, Ramzi; Al-Mousa, Eyas; Okkeh, Osama; Alhaddad, Imad A; Tawalbeh, Loai Issa; Hweidi, Issa M

2018-04-01

Objective The aim of this study was to assess the baseline clinical characteristics, coronary angiographic features, and adverse cardiovascular events during hospitalization and at 1 year of follow-up in obese patients compared with overweight and normal/underweight patients. Methods A prospective, multicenter study of consecutive patients undergoing percutaneous coronary intervention was performed. Results Of 2425 enrolled patients, 699 (28.8%) were obese, 1178 (48.6%) were overweight, and 548 (22.6%) were normal/underweight. Obese patients were more likely to be female and to have a higher prevalence of diabetes, hypertension, hypercholesterolemia, or previous percutaneous coronary intervention. Acute coronary syndrome was the indication for percutaneous coronary intervention in 77.0% of obese, 76.4% of overweight, and 77.4% of normal/underweight patients. No significant differences in the prevalence of multi-vessel coronary artery disease or multi-vessel percutaneous coronary intervention were found among the three groups. Additionally, no significant differences were found in stent thrombosis, readmission bleeding rates, or cardiac mortality among the three groups during hospitalization, at 1 month, and at 1 year. Conclusion The major adverse cardiovascular event rate was the same among the three groups throughout the study period. Accordingly, body mass index is considered a weak risk factor for cardiovascular comorbidities in Arab Jordanian patients.

Observations on obesity patterns in tetralogy of Fallot patients from childhood to adulthood.

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Briston, David A; Sabanayagam, Aarthi; Zaidi, Ali N

2017-07-01

Obesity is increasingly prevalent, and abnormal body mass index is a risk factor for cardiovascular disease. There are limited data published regarding body mass index and CHD. We tested the hypothesis that body mass index and obesity prevalence are increasing in patients with tetralogy of Fallot over time by analysing time since surgery, age, height, weight, and body mass index among tetralogy of Fallot patients and demographic data from age-matched controls. NYHA class and left ventricular ejection fraction were analysed in adults. Body mass index was categorised into normal, overweight, and obese in this single-centre, retrospective chart review. Data were collected from 137 tetralogy of Fallot patients (71 men:66 women), of whom 40 had body mass index >25 kg/m2. Tetralogy of Fallot patients aged tetralogy of Fallot patients, the mean body mass index was 26.5 but not statistically significantly different from the control cohort. Obese adult patients had significantly higher average NYHA class compared with those of normal weight (p=0.03), but no differences in left ventricular ejection fraction by echocardiography (p=0.55) or cardiac MRI (p=0.26) were noted. Lower body mass index was observed initially in tetralogy of Fallot patients, but by late adolescence no significant difference was observed. As adults, tetralogy of Fallot patients with higher body mass index had increased NYHA class but similar left ventricular ejection fraction.

Argyrophil cell density in the oxyntic mucosa is higher in female than in male morbidly obese patients

International Nuclear Information System (INIS)

Maksud, F.A.N.; Kakehasi, A.M.; Barbosa, A.J.A.

2013-01-01

Obesity is a multifactorial disorder often associated with many important diseases such as diabetes, hypertension and other metabolic syndrome conditions. Argyrophil cells represent almost the total population of endocrine cells of the human gastric mucosa and some reports have described changes of specific types of these cells in patients with obesity and metabolic syndrome. The present study was designed to evaluate the global population of argyrophil cells of the gastric mucosa of morbidly obese and dyspeptic non-obese patients. Gastric biopsies of antropyloric and oxyntic mucosa were obtained from 50 morbidly obese patients (BMI >40) and 50 non-obese patients (17 dyspeptic overweight and 33 lean individuals) and processed for histology and Grimelius staining for argyrophil cell demonstration. Argyrophil cell density in the oxyntic mucosa of morbidly obese patients was higher in female (238.68 ± 83.71 cells/mm 2 ) than in male patients (179.31 ± 85.96 cells/mm 2 ) and also higher in female (214.20 ± 50.38 cells/mm 2 ) than in male (141.90 ± 61.22 cells/mm 2 ) morbidly obese patients with metabolic syndrome (P = 0.01 and P = 0.02, respectively). In antropyloric mucosa, the main difference in argyrophil cell density was observed between female morbidly obese patients with (167.00 ± 69.30 cells/mm 2 ) and without (234.00 ± 69.54 cells/mm 2 ) metabolic syndrome (P = 0.001). In conclusion, the present results show that the number of gastric argyrophil cells could be under gender influence in patients with morbid obesity. In addition, gastric argyrophil cells seem to behave differently among female morbidly obese patients with and without metabolic syndrome

Impact of spinal anaesthesia on peri-operative lung volumes in obese and morbidly obese female patients.

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Regli, A; von Ungern-Sternberg, B S; Reber, A; Schneider, M C

2006-03-01

Although obesity predisposes to postoperative pulmonary complications, data on the relationship between body mass index (BMI) and peri-operative respiratory performance are limited. We prospectively studied the impact of spinal anaesthesia, obesity and vaginal surgery on lung volumes measured by spirometry in 28 patients with BMI 30-40 kg.m(-2) and in 13 patients with BMI > or = 40 kg.m(-2). Vital capacity, forced vital capacity, forced expiratory volume in 1 s, mid-expiratory and peak expiratory flows were measured during the pre-operative visit (baseline), after effective spinal anaesthesia with premedication, and after the operation at 20 min, 1 h, 2 h, and 3 h (after mobilisation). Spinal anaesthesia and premedication were associated with a significant decrease in spirometric parameters. Spinal anaesthesia and premedication were associated with a significant decrease in spirometric parameters; mean (SD) vital capacities were - 19% (6.4) in patients with BMI 30-40 kg.m(-2) and - 33% (9.0) in patients with BMI > 40 kg.m(-2). The decrease of lung volumes remained constant for 2 h, whereas 3 h after the operation and after mobilisation, spirometric parameters significantly improved in all patients. This study showed that both spinal anaesthesia and obesity significantly impaired peri-operative respiratory function.

Effect of CPAP on arterial stiffness in severely obese patients with obstructive sleep apnoea.

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Seetho, Ian W; Asher, Rebecca; Parker, Robert J; Craig, Sonya; Duffy, Nick; Hardy, Kevin J; Wilding, John P H

2015-12-01

Obstructive sleep apnoea (OSA) may independently increase cardiovascular risk in obesity. Although there is evidence that arterial stiffness is altered in OSA, knowledge of these effects with continuous positive airway pressure (CPAP) in severe obesity (body mass index (BMI) ≥ 35 kg/m(2)) is limited. This study aimed to explore how arterial stiffness, as measured by the augmentation index (Aix), changed in severely obese patients with OSA who were treated with CPAP and in patients without OSA. Forty-two patients with severe obesity-22 with OSA, 20 without OSA-were recruited at baseline and followed-up after a median of 13.5 months. Pulse wave analysis (PWA) was performed using applanation tonometry at the radial artery to measure augmentation index (Aix), augmentation pressure (AP) and subendocardial viability ratio (SEVR). Cardiovascular parameters and body composition were also measured. There were significant improvements in Aix, AP (both P CPAP compared with subjects without OSA. Epworth scores (P CPAP. Regression showed that CPAP was significantly associated with change in arterial stiffness from baseline. However, patients with OSA on CPAP continued to have increased arterial stiffness (Aix) (P CPAP in severe obesity, CPAP alone is not sufficient to modify PWA measures to levels comparable with non-OSA patients. This supports a need for a multifaceted approach when managing cardiovascular risk in patients with severe obesity and obstructive sleep apnoea receiving CPAP therapy.

Microvascular Blood Flow Improvement in Hyperglycemic Obese Adult Patients by Hypocaloric Diet.

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Mastantuono, T; Di Maro, M; Chiurazzi, M; Battiloro, L; Starita, N; Nasti, G; Lapi, D; Iuppariello, L; Cesarelli, M; D'Addio, G; Colantuoni, A

2016-11-01

The present study was aimed to assess the changes in skin microvascular blood flow (SBF) in newly diagnosed hyperglycemic obese subjects, administered with hypocaloric diet. Adult patients were recruited and divided in three groups: NW group (n=54), NG (n=54) and HG (n=54) groups were constituted by normal weight, normoglycemic and hyperglycemic obese subjects, respectively. SBF was measured by laser Doppler perfusion monitoring technique and oscillations in blood flow were analyzed by spectral methods under baseline conditions, at 3 and 6 months of dietary treatment. Under resting conditions, SBF was lower in HG group than in NG and NW ones. Moreover, all subjects showed blood flow oscillations with several frequency components. In particular, hyperglycemic obese patients revealed lower spectral density in myogenic-related component than normoglycemic obese and normal weight ones. Moreover, post-occlusive reactive hyperemia (PORH) was impaired in hyperglycemic obese compared to normoglycemic and normal weigh subjects. After hypocaloric diet, in hyperglycemic obese patients there was an improvement in SBF accompanied by recovery in myogenic-related oscillations and arteriolar responses during PORH. In conclusion, hyperglycemia markedly affected peripheral microvascular function; hypocaloric diet ameliorated tissue blood flow.

Resting metabolic rate of obese patients under very low calorie ketogenic diet

OpenAIRE

Gomez-Arbelaez, Diego; Crujeiras, Ana B.; Castro, Ana I.; Martinez-Olmos, Miguel A.; Canton, Ana; Ordoñez-Mayan, Lucia; Sajoux, Ignacio; Galban, Cristobal; Bellido, Diego; Casanueva, Felipe F.

2018-01-01

Background The resting metabolic rate (RMR) decrease, observed after an obesity reduction therapy is a determinant of a short-time weight regain. Thus, the objective of this study was to evaluate changes in RMR, and the associated hormonal alterations in obese patients with a very low-calorie ketogenic (VLCK)-diet induced severe body weight (BW) loss. Method From 20 obese patients who lost 20.2 kg of BW after a 4-months VLCK-diet, blood samples and body composition analysis, determined by DXA...

The Cardiovascular Effects of Obesity on Ventricular Function and Mass in Patients after Tetralogy of Fallot Repair.

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Fogel, Mark A; Pawlowski, Thomas; Keller, Marc S; Cohen, Meryl S; Goldmuntz, Elizabeth; Diaz, Laura; Li, Christine; Whitehead, Kevin K; Harris, Matthew A

2015-08-01

To determine the cardiovascular effects of obesity on patients with tetralogy of Fallot (TOF) repair. Ventricular performance measures were compared between obese (body mass index [BMI] ≥95%), overweight (85% ≤BMI <95%), and normal weight subjects (BMI <85%) in a retrospective review of patients with TOF who underwent cardiac magnetic resonance from 2005-2010. Significance was P < .05. Of 260 consecutive patients with TOF, 32 were obese (12.3%), 48 were overweight (18.5%), and 180 were normal weight (69.2%). Biventricular mass was increased in obese compared with normal weight patients with right ventricular mass more affected than left ventricular mass. Obese patients demonstrated decreased biventricular end-diastolic volume (EDV) and stroke volume (SV) when indexed to body surface area (BSA) with an increased heart rate when compared with normal weight patients; cardiac index, ejection fraction, and pulmonary regurgitation fraction were similar. When indexed to ideal BSA, biventricular EDV and SV were similar. EDV and SV for overweight patients were nearly identical to normal weight patients with ventricular mass in between the other 2 groups. Approximately 12% of patients after TOF repair referred for cardiac magnetic resonance in a tertiary referral center are obese with increased biventricular mass. Obese patients and normal weight patients have similar cardiac indices, however, when indexed to actual BSA, obese patients demonstrate decreased EDV and SV with increased heart rate and similar cardiac indices. When indexed to ideal BSA, no differences in biventricular volumes were noted. Copyright © 2015. Published by Elsevier Inc.

The influence of high versus low sodium intake on blood pressure and haemodynamics in patients with morbid obesity

DEFF Research Database (Denmark)

Bonfils, Peter K; Taskiran, Mustafa; Damgaard, Morten

2013-01-01

fluid compartments and haemodynamic responses (at rest and during exercise) after 5 days of a low-sodium diet (90 mmol/day) and 5 days of a high-sodium diet (250 mmol/day) in 12 morbidly obese, hypertensive patients; 12 morbidly obese, normotensive patients and 12 nonobese controls. RESULTS: High sodium......BACKGROUND: Many patients with morbid obesity (BMI > 40 kg/m) have hypertension. The complex pathophysiological abnormalities linking hypertension to obesity have not been fully clarified, but abnormal sodium handling could be an important mechanism. METHOD: Therefore, we examined changes in body...... intake as compared to low sodium intake was associated with an increase in plasma volume (obese, hypertensive patients: 5 ± 4%; obese, normotensive patients: 10 ± 11%; nonobese controls: 7 ± 6%), cardiac output (CO) (obese, hypertensive patients: 17 ± 12%; obese, normotensive patients: 20 ± 16%; nonobese...

Needle Decompression in Appalachia Do Obese Patients Need Longer Needles?

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Carter, Thomas Edward

2013-11-01

Full Text Available Introduction: Needle decompression of a tension pneumothorax can be a lifesaving procedure. It requires an adequate needle length to reach the chest wall to rapidly remove air. With adult obesity exceeding one third of the United States population in 2010, we sought to evaluate the proper catheter length that may result in a successful needle decompression procedure. Advance Trauma Life Support (ATLS currently recommends a 51 millimeter (mm needle, while the needles stocked in our emergency department are 46 mm. Given the obesity rates of our patient population, we hypothesize these needles would not have a tolerable success rate of 90%. Methods: We retrospectively reviewed 91 patient records that had computed tomography of the chest and measured the chest wall depth at the second intercostal space bilaterally. Results: We found that 46 mm needles would only be successful in 52.7% of our patient population, yet the ATLS recommended length of 51 mm has a success rate of 64.8%. Therefore, using a 64 mm needle would be successful in 79% percent of our patient population. Conclusion: Use of longer length needles for needle thoracostomy is essential given the extent of the nation’s adult obesity population. [West J Emerg Med. 2013;14(6:650-652.

Extracorporeal shock wave lithotripsy in the treatment of renal pelvicalyceal stones in morbidly obese patients

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V. A. Mezentsev

2005-04-01

Full Text Available INTRODUCTION: Management of urolithiasis in morbidly obese patients is usually associated with higher morbidity and mortality compared to non-obese patients. In morbidly obese patients, since the kidney and stone are at a considerable distance from the skin (compared to non-obese patients difficulty may be found in positioning the patient so that the stone is situated at the focal point of the lithotripter. OBJECTIVE: To evaluate the outcomes and cost-efficiency of extracorporeal shock wave lithotripsy (ESWL in the treatment of renal pelvicalyceal stones sized between 6 and 20 mm in morbidly obese patients. MATERIALS AND METHODS: Using various aids, such as mobile overtable module, extended shock pathway and abdominal compression 37 patients with body mass index more than 40 kg/m2 were treated using the Siemens Lithostar-plus third generation lithotripter. The size of renal pelvicalyceal stones was between 6 and 20 mm. Treatment costs for shock wave lithotripsy were calculated. RESULTS: The overall stone free rate at 3 months of 73% was achieved. The mean number of treatments per patient was 2.1. The post-lithotripsy secondary procedures rate was 5.4%. No complications, such as subcapsular haematoma or acute pyelonephritis were recorded. The most effective (87% success rate and cost-efficient treatment was in the patients with pelvic stones. The treatment of the patients with low caliceal stones was effective in 60% only. The cost of the treatment of the patients with low calyceal stones was in 1.8 times higher than in the patients with pelvic stones. CONCLUSION: We conclude that ESWL with the Siemens Lithostar-plus is the most effective and cost-efficient in morbidly obese patients with pelvic stones sized between 6 and 20 mm. 87% success rate was achieved. The increased distance from the skin surface to the stone in those patients does not decrease the success rate provided the stone is positioned in the focal point or within 3 cm of it on the

Argyrophil cell density in the oxyntic mucosa is higher in female than in male morbidly obese patients

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Maksud, F.A.N. [Laboratório de Patologia Digestiva e Neuroendócrina, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG (Brazil); Faculdade de Medicina, Universidade Federal de Ouro Preto, Ouro Preto, MG (Brazil); Kakehasi, A.M. [Laboratório de Patologia Digestiva e Neuroendócrina, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG (Brazil); Barbosa, A.J.A. [Laboratório de Patologia Digestiva e Neuroendócrina, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG (Brazil); Instituto Alfa de Gastroenterologia, Belo Horizonte, MG (Brazil)

2013-04-05

Obesity is a multifactorial disorder often associated with many important diseases such as diabetes, hypertension and other metabolic syndrome conditions. Argyrophil cells represent almost the total population of endocrine cells of the human gastric mucosa and some reports have described changes of specific types of these cells in patients with obesity and metabolic syndrome. The present study was designed to evaluate the global population of argyrophil cells of the gastric mucosa of morbidly obese and dyspeptic non-obese patients. Gastric biopsies of antropyloric and oxyntic mucosa were obtained from 50 morbidly obese patients (BMI >40) and 50 non-obese patients (17 dyspeptic overweight and 33 lean individuals) and processed for histology and Grimelius staining for argyrophil cell demonstration. Argyrophil cell density in the oxyntic mucosa of morbidly obese patients was higher in female (238.68 ± 83.71 cells/mm{sup 2}) than in male patients (179.31 ± 85.96 cells/mm{sup 2}) and also higher in female (214.20 ± 50.38 cells/mm{sup 2}) than in male (141.90 ± 61.22 cells/mm{sup 2}) morbidly obese patients with metabolic syndrome (P = 0.01 and P = 0.02, respectively). In antropyloric mucosa, the main difference in argyrophil cell density was observed between female morbidly obese patients with (167.00 ± 69.30 cells/mm{sup 2}) and without (234.00 ± 69.54 cells/mm{sup 2}) metabolic syndrome (P = 0.001). In conclusion, the present results show that the number of gastric argyrophil cells could be under gender influence in patients with morbid obesity. In addition, gastric argyrophil cells seem to behave differently among female morbidly obese patients with and without metabolic syndrome.

Hormonal status and the orexin system in obese patients with obstructive sleep apnea syndrome

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Natalya Viktorovna Strueva

2015-05-01

Full Text Available The aim of research was to estimate the influence of hormone metabolism and sleep apnea on patients with obesity. 76 patients (37 males and 39 females with obesity were included in this study. After night polysomnography all patients were divided in two groups comparableby age, sex ratio and BMI. The first group consisted of 41 patients with obstructive sleep apnea syndrome (OSAS, the second (controls – 35 patients without breath disorders during sleep. OSAS is accompanied by the increase in urinary cortisol during the night, high levels ofbasal insulin, disturbances of hepatic production of IGF-1, dysfunction of the pituitary-gonadal axis. Our results show that sleep-related breathing disorders render markedly and negatively affect on hormonal parameters of patients with obesity. As a reliable difference of basalsecretion of orexin A in obese patients with and without OSAS was not revealed (42,0 [14; 99,5] vs. 18,0 [14,5; 124,5] pg/ml; р=0,9, we were not able to show the existence that the existence of OSAS is followed by any special changes of activity of the orexin system.

Physicians' perspectives and practices regarding the fertility management of obese patients.

Science.gov (United States)

Harris, Isiah D; Python, Johanne; Roth, Lauren; Alvero, Ruben; Murray, Shona; Schlaff, William D

2011-10-01

To assess the practice patterns and personal beliefs of fertility physicians who care for obese patients seeking assisted reproduction, we conducted a national survey of fertility program directors from both private and academic practices and discovered that although few practices have firm guidelines regarding the management of obese patients, the overwhelming majority of providers believe that body mass index guidelines or cutoffs should exist. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Dyspnea descriptors developed in Brazil: application in obese patients and in patients with cardiorespiratory diseases.

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Teixeira, Christiane Aires; Rodrigues Júnior, Antonio Luiz; Straccia, Luciana Cristina; Vianna, Elcio Dos Santos Oliveira; Silva, Geruza Alves da; Martinez, José Antônio Baddini

2011-01-01

To develop a set of descriptive terms applied to the sensation of dyspnea (dyspnea descriptors) for use in Brazil and to investigate the usefulness of these descriptors in four distinct clinical conditions that can be accompanied by dyspnea. We collected 111 dyspnea descriptors from 67 patients and 10 health professionals. These descriptors were analyzed and reduced to 15 based on their frequency of use, similarity of meaning, and potential pathophysiological value. Those 15 descriptors were applied in 50 asthma patients, 50 COPD patients, 30 patients with heart failure, and 50 patients with class II or III obesity. The three best descriptors, as selected by the patients, were studied by cluster analysis. Potential associations between the identified clusters and the four clinical conditions were also investigated. The use of this set of descriptors led to a solution with seven clusters, designated sufoco (suffocating), aperto (tight), rápido (rapid), fadiga (fatigue), abafado (stuffy), trabalho/inspiração (work/inhalation), and falta de ar (shortness of breath). Overlapping of descriptors was quite common among the patients, regardless of their clinical condition. Asthma was significantly associated with the sufoco and trabalho/inspiração clusters, whereas COPD and heart failure were associated with the sufoco, trabalho/inspiração, and falta de ar clusters. Obesity was associated only with the falta de ar cluster. In Brazil, patients who are accustomed to perceiving dyspnea employ various descriptors in order to describe the symptom, and these descriptors can be grouped into similar clusters. In our study sample, such clusters showed no usefulness in differentiating among the four clinical conditions evaluated.

Neuroendocrine Alterations in Obese Patients with Sleep Apnea Syndrome

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Fabio Lanfranco

2010-01-01

Full Text Available Obstructive sleep apnea syndrome (OSAS is a serious, prevalent condition that has significant morbidity and mortality when untreated. It is strongly associated with obesity and is characterized by changes in the serum levels or secretory patterns of several hormones. Obese patients with OSAS show a reduction of both spontaneous and stimulated growth hormone (GH secretion coupled to reduced insulin-like growth factor-I (IGF-I concentrations and impaired peripheral sensitivity to GH. Hypoxemia and chronic sleep fragmentation could affect the sleep-entrained prolactin (PRL rhythm. A disrupted Hypothalamus-Pituitary-Adrenal (HPA axis activity has been described in OSAS. Some derangement in Thyroid-Stimulating Hormone (TSH secretion has been demonstrated by some authors, whereas a normal thyroid activity has been described by others. Changes of gonadal axis are common in patients with OSAS, who frequently show a hypogonadotropic hypogonadism. Altogether, hormonal abnormalities may be considered as adaptive changes which indicate how a local upper airway dysfunction induces systemic consequences. The understanding of the complex interactions between hormones and OSAS may allow a multi-disciplinary approach to obese patients with this disturbance and lead to an effective management that improves quality of life and prevents associated morbidity or death.

Imaging body composition in cancer patients: visceral obesity, sarcopenia and sarcopenic obesity may impact on clinical outcome

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Yip, Connie; Dinkel, Charlotte; Mahajan, Abhishek; Siddique, Musib; Cook, Gary J. R.; Goh, Vicky

2015-01-01

Abstract In recent years, there has been increasing interest in the influence of body composition on oncological patient outcomes. Visceral obesity, sarcopenia and sarcopenic obesity have been identified as adverse factors in cancer patients. Imaging quantification of body composition such as lean muscle mass and fat distribution is a potentially valuable tool. This review describes the following imaging techniques that may be used to assess body composition: dual-energy X-ray absorptiometry ...

Weight loss and skin manifestations in obese patients with psoriasis

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Geiker, Nina Rica Wium; Jensen, Peter; Kirchner Larsson, Lena

Objective To examine if psoriatic patients can achieve a weight loss to the same extent as non-psoriatic patients To describe the effect of weight loss on the cutaneous manifestations. Conclusion Patients with psoriasis achieved a weight loss, similar to non-psoriatic patients, of 12...... % of their body weight following calorie restriction for 12 weeks. Taken together with recent literature the findings suggest that weight loss has a potential to reduce skin manifestations. Weight loss might also attenuate the increased cardiovascular and diabetes risks posed by obese psoriatric patients....

Calcium and vitamin D status in morbidly obese patients and in patients after biliopancretic diversion/duodenal switch

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Natalya Mazurina

2016-10-01

Full Text Available Objective: The objective was to estimate the prevalence of inadequate vitamin D status and secondary hyperparathyroidism (SHPT in morbidly obese patients and in patients who underwent biliopancreatic diversion/duodenal switch surgery (BPD/DS Design: 3 groups were included in the cross-sectional comparative study: group 1 - morbidly obese (MO patients with BMI > 40 and without type 2 diabetes mellitus (n=22, group 2 – patients in the long-term period after BPD/DS (n=23; group 3 – healthy normal weight controls (n=22. Results: 25(OHD levels were significantly different in the controls (21.8 ng/dl, in the MO (8.8 ng/dl and in the BPD/DS patients (8.6 ng/dl. Parathyroid hormone (PTH elevation was found in 4 (18% MO patients, in 12 (52 % patients after BPD/DS, and was not detected in the control group. The frequency of SHPT was significantly higher in the operated group (52 % in comparison with the MO group (18 % (р=0.029. Conclusions: Vitamin D deficiency and secondary hyperparathyroidism are significantly more prevalent in MO patients than in normal weight subjects. In the long-term period after BPD secondary hyperthyroidism is more frequent than in MO and is not always accompanied by vitamin D depletion. Special attention should be paid for adequate control of calcium metabolism and supplementation by calcium and vitamin D.

Managing social awkwardness when caring for morbidly obese patients in intensive care: A focused ethnography.

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Hales, Caz; de Vries, Kay; Coombs, Maureen

2016-06-01

Critically ill morbidly obese patients pose considerable healthcare delivery and resource utilisation challenges in the intensive care setting. These are resultant from specific physiological responses to critical illness in this population and the nature of the interventional therapies used in the intensive care environment. An additional challenge arises for this population when considering the social stigma that is attached to being obese. Intensive care staff therefore not only attend to the physical and care needs of the critically ill morbidly obese patient but also navigate, both personally and professionally, the social terrain of stigma when providing care. To explore the culture and influences on doctors and nurses within the intensive care setting when caring for critically ill morbidly obese patients. A focused ethnographic approach was adopted to elicit the 'situated' experiences of caring for critically ill morbidly obese patients from the perspectives of intensive care staff. Participant observation of care practices and interviews with intensive care staff were undertaken over a four month period. Analysis was conducted using constant comparison technique to compare incidents applicable to each theme. An 18 bedded tertiary intensive care unit in New Zealand. Sixty-seven intensive care nurses and 13 intensive care doctors involved with the care and management of seven critically ill patients with a body mass index ≥40kg/m(2). Interactions between intensive care staff and morbidly obese patients were challenging due to the social stigma surrounding obesity. Social awkwardness and managing socially awkward moments were evident when caring for morbidly obese patients. Intensive care staff used strategies of face-work and mutual pretence to alleviate feelings of discomfort when engaged in aspects of care and caring. This was a strategy used to prevent embarrassment and distress for both the patients and staff. This study has brought new understandings

Targeting hyperglycaemia with either metformin or repaglinide in non-obese patients with type 2 diabetes

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Lund, S S; Tarnow, L; Stehouwer, C D A

2007-01-01

-initiated trial, we evaluated the effect of metformin vs. an insulin secretagogue, repaglinide on glycaemic regulation and markers of inflammation and insulin sensitivity in non-obese patients with T2DM. METHODS: A single-centre, double-masked, double-dummy, crossover study during 2 x 4 months involved 96 non......AIM: Metformin is the 'drug-of-first-choice' in obese patients with type 2 diabetes mellitus (T2DM) due to its antihyperglycaemic and cardiovascular protective potentials. In non-obese patients with T2DM, insulin secretagogues are empirically used as first choice. In this investigator......-obese (body mass index T2DM. At enrolment, previous oral hypoglycaemic agents (OHA) were stopped and patients entered a 1-month run-in on diet-only treatment. Hereafter, patients were randomized to either repaglinide 2 mg thrice daily followed by metformin 1 g...

Adiponectin but not leptin is involved in early hepatic disease in morbidly obese patients.

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Hindle, Anna Katharine; Edwards, Claire; Mendonsa, Alisha; Rojkind, Marcos; McCaffrey, Tim; Fu, Sidney; Brody, Fred

2010-07-01

Pathologic changes in the liver are common in morbidly obese patients, and insulin resistance may potentiate the progression of nonalcoholic steatohepatitis to fibrosis and cirrhosis. This study investigates the impact of leptin and adiponectin in morbidly obese diabetic and nondiabetic patients with regard to histopathologic changes in the liver. Thirty-seven morbidly obese patients who underwent bariatric surgery with liver biopsies were enrolled in the study. Fourteen were diabetic and 23 were nondiabetic. Intraoperative liver tissue was sent for histopathologic analysis and extraneous intraoperative tissue was snap-frozen in liquid nitrogen. Total RNA was extracted and RNA was reverse transcribed to cDNA. Real-time quantitative PCR was performed to determine relative gene expression levels. The data were analyzed using a logarithmic transformation and normalized by 18S ribosome expression. Student's t test was used for statistical analysis with p < or = 0.05 as significant. Adiponectin expression was downregulated 4.4-fold (p < or = 0.05) in liver samples with evidence of inflammation on pathology. When hepatic inflammation was evaluated separately, there were no statistically significant differences in adiponectin levels between the diabetic and nondiabetic patients. However, overall adiponectin levels in hepatic samples of diabetic patients were 3.8-fold higher than those of nondiabetic patients (p < or = 0.05). There were no significant differences in leptin levels regardless of hepatic pathology or diabetic status. This study illustrates that there is a downregulation of adiponectin in morbidly obese patients with inflammatory infiltrates in the liver. Variations in adiponectin levels could be an indicator of disease progression since inflammatory infiltrates are commonly associated with nonalcoholic steatohepatitis (NASH) in morbidly obese patients. Currently, we are using human myofibroblasts derived from livers of morbidly obese people to further

A "Family-Based" Approach to the Treatment of Obese Type II Diabetic Patients.

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Wing, Rena R.; And Others

1991-01-01

Assigned 49 obese diabetic patients with obese spouses (diabetic or nondiabetic) to an alone or together (with spouses) treatment condition of behavioral weight control program. Found no significant differences in weight losses of patients at posttreatment or one-year followup, but did find that women did better when treated with their spouses,…

Management of obesity in patients with type 2 diabetes mellitus in primary care.

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Mohammad, Shoaib; Ahmad, Jamal

2016-01-01

Obesity and being overweight is the most powerful risk factor accounting for 80-90% of patients with type 2 diabetes mellitus (T2DM). The epidemic of obesity is driving the diabetes epidemic to alarming levels and primary care is becoming an important setting for obesity management in T2DM in India. Yet many primary care providers feel ill-equipped or inadequately supported to address obesity in patients with diabetes. This article reviews the most recent and strongest evidence-based strategies that may aid physicians in management of obesity in patients with T2DM in primary care. A systematic literature search of MEDLINE using the search terms Obesity, Obesity in T2DM, weight loss and Primary Care was conducted. The American Diabetes Association, National Institute for Health, National Institute of Health and Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN) and World Health Organization websites were also searched. Most studies in this area are observational in design with few randomized controlled trials (RCTs). Articles and studies involving meta-analysis or RCTs were preferred over other types. Effective weight management treatment in T2DM patient can be implemented in the primary care setting. Evidence based individualized lifestyle and pharmacologic measures supported by behavioral intervention and counseling with appropriate and informed surgical referrals has the potential to improve the success of weight management within primary care. Copyright © 2016 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Does morbid obesity negatively affect the hospital course of patients undergoing treatment of closed, lower-extremity diaphyseal long-bone fractures?

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Baldwin, Keith D; Matuszewski, Paul E; Namdari, Surena; Esterhai, John L; Mehta, Samir

2011-01-03

Obesity is prevalent in the developed world and is associated with significant costs to the health care system. The effect of morbid obesity in patients operatively treated for long-bone fractures of the lower extremity is largely unknown. The National Trauma Data Bank was accessed to determine if morbidly obese patients (body mass index >40) with lower extremity fractures have longer length of hospital stay, higher cost, greater rehabilitation admission rates, and more complications than nonobese patients. We identified patients with operatively treated diaphyseal femur (6920) and tibia (5190) fractures. Polytrauma patients and patients younger than 16 years were excluded. Morbidly obese patients were identified by ICD-9 and database comorbidity designation (femur, 131 morbidly obese; tibia, 75 morbidly obese). Patients meeting these criteria who were not morbidly obese were used as controls. Sensitivity analyses were performed to analyze patients with isolated trauma to the tibia or femur. Morbidly obese patients were more likely to be admitted to a subacute facility. Length of stay trended higher in morbidly obese patients. There was no significant relationship between obesity and inpatient mortality or inpatient complications. These trends held true when considering patients with multiple injuries and patients who had isolated long-bone injuries. Our study showed that morbidly obese patients may have greater rehabilitation needs following long-bone fractures in the lower extremity. Our study showed no difference in mortality or complications, although further studies are needed to confirm these findings. Copyright 2011, SLACK Incorporated.

FUNCTIONAL ASSESSMENT OF OLDER OBESE PATIENTS CANDIDATES FOR BARIATRIC SURGERY

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Denis PAJECKI

2014-03-01

Full Text Available Context Obesity in the elderly is associated with exacerbation of functional decline (dependency, that occurs with aging, because of decreased muscle mass and strength, and increased joint dysfunction. Consequently, there is progressive loss of independence, autonomy, chronic pain and impaired quality of life. The weight loss can bring benefits in all these aspects, especially when accompanied by exercises. Elderly patients with morbid obesity may be submitted to surgical treatment, taking into account that the massive weight loss, eventually caused by bariatric surgery, may exacerbate the loss of muscle mass and nutritional complications that may bring harm to the overall health and quality of life of these patients. The functional assessment of elderly patients, candidates for bariatric surgery and the extent to which surgery can bring benefits to the patients, in the field of functionality, has still to be determined. Objective To describe profile functionality in obese elderly referred to a bariatric surgery program. Methods Patients with age ≥60 and BMI ≥35 underwent comprehensive geriatric assessment that evaluates co morbidities, medication use, ability to perform basic activities of daily living and instrumental activities of daily living, and the “Timedupandgo” test to evaluate mobility, whose cut-off point was ≤10 seconds. Statistical analysis was performed in order to see if there is a positive correlation of dependency with BMI and age (over or under 65 years. Results Forty subjects have completed evaluation. The mean age was 64.1 years (60-72 and 75% were women. They had an average weight of 121.1 kg (72.7-204 and a mean BMI of 47.2 kg/m2 (35.8-68.9. 16 patients (40% have shown dependency for activities of daily living, 19 (47,5% for instrumental activities of daily living and 20 patients (50% had a “Timedupandgo” test over 10 seconds. Statistical analysis (t-Student, Mann-Whitney, Binary Logistic Regression has shown

VGF Peptide Profiles in Type 2 Diabetic Patients' Plasma and in Obese Mice.

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Filomena D'Amato

Full Text Available To address the possible involvement of VGF peptides in obesity and diabetes, we studied type 2 diabetes (T2D and obese patients, and high-fat diet induced obese mice. Two VGF peptides (NAPP-19 and QQET-30 were identified in human plasma by HPLC-ESI-MS. The VGF C-terminus, the above two cleaved peptides, and the TLQP-21 related peptide/s were studied using ELISA and immunohistochemistry. In euglycemic patients, plasma NAPPE and TLQP like peptides were significantly reduced with obesity (74±10 vs. 167±28, and 92±10 vs. 191±19 pmol/ml, mean+SEM, n = 10 and 6, obese vs. normal BMI, respectively, p<0.03. Upon a standard glucose load, a distinct response was shown for VGF C-terminus, TLQP and QQET-like (ERVW immunoreactive peptides in euglycemic normal BMI patients, but was virtually abolished in euglycemic obese, and in T2D patients independently of BMI. High-fat diet induced obese mice showed reduced plasma VGF C-terminus, NAPPE and QQET-like (ERVW peptide/s (3±0.2 vs. 4.6±0.3, 22±3.5 vs. 34±1.3, and 48±7 vs. 100±7 pmol/ml, mean+SEM, n = 8/group, obese vs. slim, respectively, p<0.03, with a loss of the response to glucose for all VGF peptides studied. In immunohistochemistry, TLQP and/or VGF C-terminus antibodies labelled VGF containing perikarya in mouse celiac ganglia, pancreatic islet cells and thin beaded nerve fibres in brown adipose tissues, with fewer in white adipose tissue. Upon the glucose load, tyrosine hydroxylase and VGF C-terminus immunoreactive axons became apparent in pancreatic islets of slim animals, but not in obese animals. Alltogether, a significant loss of VGF peptide immunoreactivity and/or their response to glucose was demonstrated in obese patients, with or without T2D, in parallel with a similar loss in high-fat diet induced obese mice. An involvement of VGF in metabolic regulations, including those of brown and/or white adipose tissues is underlined, and may point out specific VGF peptides as potential targets

Physicians' use of the 5As in counseling obese patients: is the quality of counseling associated with patients' motivation and intention to lose weight?

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Sherman Scott

2010-06-01

Full Text Available Abstract Background Physicians are encouraged to counsel obese patients to lose weight, but studies measuring the quality of physicians' counseling are rare. We sought to describe the quality of physicians' obesity counseling and to determine associations between the quality of counseling and obese patients' motivation and intentions to lose weight, key predictors of behavior change. Methods We conducted post-visit surveys with obese patients to assess physician's use of 5As counseling techniques and the overall patient-centeredness of the physician.. Patients also reported on their motivation to lose weight and their intentions to eat healthier and exercise. One-way ANOVAs were used to describe mean differences in number of counseling practices across levels of self-rated intention and motivation. Logistic regression analyses were conducted to assess associations between number of 5As counseling practices used and patient intention and motivation. Results 137 patients of 23 physicians were included in the analysis. While 85% of the patients were counseled about obesity, physicians used only a mean of 5.3 (SD = 4.6 of 18 possible 5As counseling practices. Patients with higher levels of motivation and intentions reported receiving more 5As counseling techniques than those with lower levels. Each additional counseling practice was associated with higher odds of being motivated to lose weight (OR 1.31, CI 1.11-1.55, intending to eat better (OR 1.23, CI 1.06-1.44, and intending to exercise regularly (OR 1.14, CI 1.00-1.31. Patient centeredness of the physician was also positively associated with intentions to eat better (OR 2.96, CI 1.03-8.47 and exercise (OR 26.07, CI 3.70-83.93. Conclusions Quality of physician counseling (as measured using the 5As counseling framework and patient-centeredness scales was associated with motivation to lose weight and intentions to change behavior. Future studies should determine whether higher quality obesity

Cytokine Profile in Chronic Periodontitis Patients with and without Obesity: A Systematic Review and Meta-Analysis

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Zohaib Akram

2016-01-01

Full Text Available To investigate the cytokine profile as biomarkers in the gingival crevicular fluid (GCF of chronic periodontitis (CP patients with and without obesity, MEDLINE/PubMed, EMBASE, ScienceDirect, and SCOPUS databases were combined with handsearching of articles published from 1977 up to May 2016 using relevant MeSH terms. Meta-analyses were conducted separately for each of the cytokines: resistin, adiponectin, TNF-α, leptin, IL-6, IL-8, and IL-1β. Forest plots were produced reporting standardized mean difference of outcomes and 95% confidence intervals. Eleven studies were included. Three studies showed comparable levels of leptin among obese and nonobese patients with CP. Four studies reported comparable levels of interleukin- (IL- 6 and resistin whereas five studies reported comparable levels of adiponectin. Two studies reported similar levels of CRP in patients with periodontitis with and without obesity. One study showed higher levels of tumor necrosis factor-alpha in obese patients with CP. One study showed higher levels of IL-1β and IL-8 in obese patients with CP. The level of localized periodontal inflammation may have a greater influence on the GCF proinflammatory biomarker levels as compared to systemic obesity. Whether patients having chronic periodontitis with obesity have elevated proinflammatory GCF biomarkers levels compared to nonobese individuals remains debatable.

The impact of body weight management in chronic kidney disease patients with obesity.

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Wang, Ya-Ling; Shu, Kuo-Hsiung; Yang, Mei-Fang; Yang, Wen-Ching; Wu, Ming-Ju; Lin, Tzu-Mei; Chen, Cheng-Hsu

2013-09-01

Chronic kidney disease (CKD) and obesity are important public health concerns. Because obesity may initiate and/or accelerate kidney damage, weight control may benefit CKD patients. We examined the influence of dietary management and physical exercise in 38 obese CKD patients with or without target reduction of body weight 3% or more from baseline. After a 2-month lifestyle intervention program, those with target body weight control had significant improvement of blood pressure control, as well as reduced lipid profiles, serum creatinine level (1.1 ± 0.3 vs. 0.8 ± 0.3; P management and exercise were associated with improvements in health-related physical fitness, cardiovascular risk factors (blood pressure and lipid control), and renal profiles in obese CKD patients. Supportive individualized programs for lifestyle change could exert beneficial effects, but long-term research with a larger patient population is needed to elucidate the optimal effective combination of dietary management and exercise. Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

The relationship between various measures of obesity and arterial stiffness in morbidly obese patients

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Røislien J

2011-02-01

Full Text Available Abstract Background Obesity is associated with increased risk of cardiovascular disease. Arterial stiffness assessed by carotid femoral pulse wave velocity (PWV is an independent predictor of cardiovascular morbidity and mortality. We aimed to investigate how various measures of body composition affect arterial stiffness. Methods This is an analysis of cross-sectional baseline data from a controlled clinical trial addressing changes in arterial stiffness after either surgery or lifestyle intervention in a population of morbidly obese patients. High-fidelity applanation tonometry (Millar®, Sphygmocor® was used to measure pulse wave velocity (PWV. Carotid femoral PWV is a direct measure of arterial stiffness and is considered to be the gold standard method. The Inbody 720 Body Composition Analyzer was used for bioelectrical impedance analysis (BIA. Spearman's correlation, independent samples t-test, chi-square tests, Fisher's exact test and multiple linear regression analyses were used as statistical methods. Results A total of 133 patients (79 women, with a mean (SD age of 43 (11 years were included in the study. Men had a significantly higher prevalence of obesity related comorbidities and significantly higher PWV, 9.1 (2.0 m/s vs. 8.1 (1.8 m/s, p = 0.003, than women. In the female group, PWV was positively correlated with WC, WHtR, BMI and visceral fat area. In the male group, PWV was negatively correlated with BMI. Multiple linear regression analysis showed that increasing BMI, WC, WHtR, visceral fat area and fat mass were independently associated with higher PWV in women, but not in men, after adjustment for age, hypertension and type 2 diabetes. Conclusion Most measures of general and abdominal obesity were predictors of arterial stiffness in female morbidly obese patients. Trial registration ClinicalTrials.gov Identifier NCT00626964

Features of eating behavior, emotional state and metabolic parameters in obese patients with insomnia

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2014-06-01

Full Text Available Aim. The aim of this study was to investigate the influence of insomnia on eating behavior, anxiety, depression, metabolic and hormonal parameters in obese patients. Materials and Methods. The study involved 104 patients with primary obesity from 20 to 55 years old: 47 men and 57 women, mean age 39 years, mean body weight 118 kg, BMI 39.6. Patients were divided into 2 groups: the first group consisted of patients with complaints of insomnia (n=45, the second (control group (n=59 were patients without sleep disorders. Results. Mean levels of anxiety and depression were significantly higher in the first group. The results of research showed a statistically significant association emotional eating and insomnia. Patients with chronic insomnia without obstructive sleep apnea had low levels of free cortisol in 24-hour urinary compared with patients without sleep disorders (169 [145, 194] vs. 324 [244, 330], respectively, p=0.001, positive correlation with total sleep time, sleep efficiency, and negative with wake time during sleep period time. Conclusions. Sleep disorders in obese patients are one of the factors contributing to the increase in food intake in response to changes in emotional state on the background of "hidden" anxiety and depressive disorders. It is possible that the data eating disorders and psychological status may have a negative impact on the dynamics of weight during the treatment of obesity.

Superstorm Sandy's forgotten patient: a lesson in emergency preparedness in severe obesity.

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Ramme, Austin J; Vira, Shaleen; McLaurin, Toni M

2015-02-01

Superstorm Sandy gained national attention in late 2012 after its impact on the Northeastern US. In New York City, thousands of residents lost power, and multiple hospitals were forced to evacuate. Bellevue Hospital Center (BHC), the nation's oldest public hospital, was forced to close for the first time in over 275 years. Two patients remained in BHC three days after the primary evacuation without water service and minimal power. Herein, we describe the challenges associated with evacuating a severely obese patient. Obesity management is challenging and at an institutional level must be addressed in emergency preparedness plans. © 2014 The Obesity Society.

Impact of obesity on left ventricular geometry and function in pediatric patients after successful aortic coarctation repair.

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Di Salvo, Giovanni; Gala, Simona; Castaldi, Biagio; Baldini, Luca; Limongelli, Giuseppe; D'Andrea, Antonello; Scognamiglio, Giancarlo; Sarubbi, Berardo; Caso, Pio; Pacileo, Giuseppe; Giovanna Russo, Maria; Calabrò, Raffaele

2011-09-01

To evaluate if obesity has an additional negative impact on left ventricular (LV) geometry and function in normotensive pediatric patients >12 months after successful treatment of aortic coarctation (CoA). We studied 40 CoA patients (mean age 14 ± 3 years, and male sex 70%), of them 10 were obese and 30 lean. Both groups were age and sex comparable. The entire studied sample underwent 24-ambulatory blood pressure (BP) monitoring, standard echocardiographic evaluation, and speckle tracking study. Both office and 24-hour diastolic BP were significantly increased in obese patients. Obese CoA patients showed increased LV mass (52 ± 13 g/m(2.7) vs. 43 ± 9 g/m(2.7) , P = 0.02), and significant reduction in E/A compared with lean CoA patients. Myocardial deformation properties were significantly reduced in obese CoA patients in all the three studied planes (longitudinal, radial, and circumferential) compared with CoA lean patients. LV twist values showed a significant reduction in the obese CoA group (9.9° ± 2.2° vs. 14.5° ± 2.3°, P < 0.0001). Our study shows that obesity in successfully treated CoA children, has an additional negative effect on BP, LV mass, and cardiac function. These findings are of particular concern, since life expectancy in CoA patients is limited mainly by atherosclerosis, and all the obesity-associated abnormalities found are harbingers of higher cardiovascular risk. © 2011, Wiley Periodicals, Inc.

Nurses' attitudes towards adult patients who are obese: literature review.

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Brown, Ian

2006-01-01

This paper presents a review of all empirical studies focusing on nurses' attitudes towards adult overweight or obese patients, with the aim of clarifying the dimensions and patterns of these attitudes and the methods by which they have been studied. Obesity has become a common condition and a major public health concern, but it is often associated with negative attitudes and discrimination. Nurses play a key role in providing support and care to patients who are obese. Electronic searches were carried out on seven databases from inception to December 2004, along with hand-searching of references in relevant studies. The search terms were built around obesity (and related terms), nursing (and its branches) and attitudes (and related terms). Eleven studies met the inclusion criteria. Data were extracted and summarized in tabular form and analysed in relation to the aims of this review during January 2005. There is relatively little research about nurses' attitudes towards obese patients, and the studies reviewed mostly have weaknesses of sampling and measurement. However, they do consistently suggest that a proportion of nurses have negative attitudes and beliefs, reflecting wider stereotypes within Western cultures. There is also a hint of a more complex mix of attitudes among nurses, some of which may counter the consequences of negative attitudes, but these have not been adequately investigated. A number of variables that influence attitudes of nurses can be identified, including age, gender, experience and the weight/body mass index of the nurse. Further research (both qualitative and quantitative) is needed with more rigorous sampling and, where appropriate, more consistency of measurement. A shift in focus towards the sets of attitudes (positive as well as negative) and behaviours that influence health service quality and outcomes for obese persons would be useful.

Fournier’s Gangrene in  a Patient with Obesity and B-lymphoma

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Christos Komninos

2013-01-01

Full Text Available We present a  case of Fournier’s gangrene disease in  a young obese patient with coexistent B-lymphoma. It remains controversial if obesity constitutes a  predisposing factor for an individual to develop necrotizing fasciitis. On the other hand, only few cases of patients with coexistence of B-lymphoma and Fournier’s gangrene disease have been reported.  A 30-years-old obese man was admitted to emergency department with fever (38.7 °C, pain, erythema and swelling extended from the left scrotum to the left lower abdominal quadrant. He was confused, with low urinary excretion and septic shock’s signs. The clinical findings were characteristics of Fournier’s gangrene disease. Furthermore during physical examination a  massive, painless and motionless mass in  the left breast was revealed. The patient required urgent surgical debridement of the affected area and pus drainage. Biopsies of the breast mass were received by excision. Pus and blood cultures yielded Staphylococci coagulase(–, Klebsiella and Proteus sp. Intravenous antibiotic treatment with Meropeneme and Clindamycine started immediately. Repeated debridement was often performed. Pathology examination of the massive tissue revealed a  diffuse B-lymphoma of large cells (Germinal center B-cell like-GCB. The patient was discharged from the hospital 35 days later.  Afterwards, he was treated with chemotherapeutic agents for malignant lymphoma at the oncological department. The aim of this case’s presentation is to mention that young obese patients with Fournier’s gangrene disease should be particularly investigated due to the possible occurrence of another not obvious predisposing factor, such as a  malignant disease.

Obesity in primary care: a qualitative synthesis of patient and practitioner perspectives on roles and responsibilities.

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Henderson, Emily

2015-04-01

Obesity is a top-priority global health issue; however, a clear way to address obesity in primary care is not yet in view. To conduct a meta-ethnography of patient and primary care practitioner perspectives of roles and responsibilities in how to address obesity in the UK, to inform evidence-based services that are acceptable to, and appropriate for, patients and practitioners. Qualitative synthesis applying meta-ethnographic methods according to the Noblit and Hare monograph. Database searches in MEDLINE(®), Social Sciences Citation Index(®), CINAHL, and Health Management Information Consortium were limited to 1997-2012 to examine recent perspectives. Full articles of practitioner and/or patient perspectives on obesity services in primary care were reviewed, and included semi-structured or unstructured interviews and focus groups, and participant observations. Nine studies were synthesised with perspectives from patients (n = 105) and practitioners (n = 144). Practitioners believe that patients are responsible for obesity, and that primary care should not help, or is poorly equipped to do so. Patients 'take responsibility' by 'blaming' themselves, but feel that practitioners should demonstrate more leadership. The empowerment of patients to access health services is reliant on the empowerment of practitioners to take an unambiguous position. Primary care has the potential either to perpetuate or counter obesity-related stigma. There needs to be a firm decision as to what role primary care will take in the prevention and treatment of obesity. To remain ambiguous runs the risk of losing patients' confidence and adding to a growing sense of futility. © British Journal of General Practice 2015.

Association of anemia with the risk of cardiovascular adverse events in overweight/obese patients

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Winther, S. A.; Finer, N.; Sharma, A. M.

2014-01-01

Objective:Anemia is associated with increased cardiovascular risks. Obesity may cause anemia in several ways, for example, by low-grade inflammation and relative iron deficit. The outcomes associated with anemia in overweight/obese patients at high cardiovascular risk are however not known....... Therefore, we investigated the cardiovascular prognosis in overweight/obese subjects with anemia.Methods:A total of 9 687 overweight/obese cardiovascular high-risk patients from the Sibutramine Cardiovascular OUTcomes trial were studied. Patients were stratified after baseline hemoglobin level and followed...... for the risks of primary event (comprising nonfatal myocardial infarction, nonfatal stroke, resuscitated cardiac arrest or cardiovascular death) and all-cause mortality. Risk estimates (hazard ratios (HR) with 95% confidence intervals (CI)) were calculated using Cox regression models.Results:Anemia...

An Underreported Consequence of Obesity in Pregnancy: Patient-Prosthesis Mismatch

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Hartman, William R.; Arendt, Katherine W.; Rehfeldt, Kent H.

2012-01-01

As the rate of obesity increases in childbearing-aged women, so too will the complications of obesity in pregnancy. An uncommon and likely underreported complication occurs in obese women who have received prepregnancy cardiac valve replacement with a prosthesis that is inadequately sized for body habitus, a condition referred to as patient-prosthesis mismatch (PPM). The physiologic changes of pregnancy as well as the increased weight gain combine to exacerbate PPM. We report a case of PPM th...

Mid-term shoulder functional and quality of life outcomes after shoulder replacement in obese patients.

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Vincent, Heather K; Struk, Aimee M; Reed, Austin; Wright, Thomas W

2016-01-01

Shoulder pain and loss of function are directly associated with obesity. We hypothesized that significant interactions would exist between total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RSA) and obesity status on functional and quality of life (QOL) outcomes over the long term. Clinical and QOL outcomes (American Shoulder and Elbow Surgeons Evaluation form, Shoulder Pain and Disability Index, University of California at Los Angeles Shoulder Rating scale, Medical Outcomes Short Form 12 (SF-12), range of motion (ROM), and strength) were longitudinally compared in patients with low and high body mass index (BMI) after a TSA or a RSA. Prospectively collected data of patients with a TSA or RSA were reviewed (N = 310). Preoperative, 2-year, and final follow-up visits were included (range 3-17 years; mean 5.0 ± 2.5 years). Patient data were stratified for analysis using BMI. Morbidly obese patients had worse preoperative functional scores and QOL compared to the other groups. There were no significant interactions of BMI group by surgery type for any of the outcome variables except for active external rotation ROM. Morbidly obese patients attained lower SF-12 scores compared to the remaining groups at each time point. Both TSA and RSA can be expected to impart positive functional outcomes in patients irrespective of BMI. Morbidly obese patients do not attain the same gains in Medical Outcomes SF-12 scores as the non-morbidly obese patients. The lower improvements in active external ROM may be due to morphological limitations of excessive adiposity. This is a level II study.

Alpha-lipoic acid reduces body weight and regulates triglycerides in obese patients with diabetes mellitus.

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Okanović, Azra; Prnjavorac, Besim; Jusufović, Edin; Sejdinović, Rifat

2015-08-01

To determine an influence of alpha-lipoic acid to reduction of body weight and regulation of total cholesterol concentration, triglycerides and glucose serum levels in obese patients with diabetes mellitus type 2. A prospective study includes two groups of obese patients with diabetes mellitus and signs of peripheral polyneuropathia: examined group (30 patients; 15 females and 15 males), and control group (30 patients; 12 females and 18 males). All were treated with metformin (850-1700 mg/day). Examined patients were additionally treated with alpha-lipoic acid 600 mg/day during 20 weeks. Body mass index and concentrations of total cholesterol, triglycerides and glucose in serum were compared before and after the treatment. The group treated with 600 mg alpha-lipoic acid lost significantly more weight, and had lower triglyceride level than the control group. There were no significant differences in total cholesterol and glucose serum levels between the groups. Alpha-lipoic acid of 600 mg/day treatment have influenced weight and triglycerides loss in obese patients with diabetes mellitus type 2. It should be considered as an important additive therapy in obese patients with diabetes mellitus type 2. Copyright© by the Medical Assotiation of Zenica-Doboj Canton.

Heartburn during sleep: a clinical marker of gastro-oesophageal reflux disease in morbidly obese patients.

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Fornari, F; Madalosso, C A S; Callegari-Jacques, S M; Gurski, R R

2009-02-01

Gastro-oesophageal reflux disease (GORD) and morbid obesity are entities with increasing prevalence. New clinical strategies are cornerstones for their management. The aim of this study was to assess the prevalence of heartburn during sleep (HDS) and whether this symptom predicts the presence of objective GORD parameters and increased heartburn perception in morbidly obese patients. Ninety-one consecutive morbidly obese patients underwent clinical evaluation, upper gastrointestinal endoscopy and oesophageal pH monitoring. HDS was characterized when patients replied positively to the question, 'Does heartburn wake you from sleep?'. A General Score for Heartburn (GSH) ranging between 0 and 5 was assessed with the question 'How bad is your heartburn?'. HDS was reported by 33 patients (36%). More patients with HDS had abnormal acid contact time or reflux oesophagitis than patients without HDS (94%vs 57%, P heartburn preceded by acid reflux in diurnal (39%vs 9%; P heartburn. HDS occurs in a significant minority of patients with morbid obesity and has high positive predictive value for GORD. Symptomatic reflux during the sleep seems to be a marker of increased heartburn perception in this population.

Complex correction of erectile and copulative violations at patients with obesity and reproductive function violation

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Kotenko K.V.

2013-12-01

Full Text Available The study aimed the development and assessment of features of corrective action of a medical complex on a lipid imbalance at patients with obesity. Material and methods. For an assessment of features of corrective action of a medical complex on a lipid imbalance at patients with obesity in research I was 50 male patients with obesity and frustration of the reproductive sphere aged from 24 to 68 years are included, middle age was 38,5±6,1 years and 7 healthy persons, men of comparable age without any pathological states, results of which all researches were accepted to values of norm. To all patients included in research, except all-clinical inspection calculation of an index of body weight and the relation of a circle of a waist to a circle of hips, measurement of arterial pressure were applied questioning concerning food and food behavior, anthropometry (growth the body weight, a circle of a waist and hips. Besides all patients conducted laboratory methods the researches including definition of atherogenic fractions of lipids (the general cholesterol, triglycerides, LPNP and LPVP. Researches were conducted before treatment and after a course of treatment. Results. The effective complex program for restoration of reproductive function at patients with obesity is developed. Conclusion. Application of the developed complex program more than its separate components caused the expressed reduction of body weight, mainly due to reduction of fatty tissue and manifestations of visceral obesity in patients with obesity and violation of reproductive function, including due to elimination of a metabolic imbalance.

Surgical treatment of nonalcoholic fatty liver disease in severely obese patients

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Vander Naalt SJ

2014-10-01

Full Text Available Steven J Vander Naalt, Juan P Gurria, AiXuan L HoltermanUniversity of Illinois College of Medicine at Peoria, Children's Hospital of Illinois, Department of Surgery/Pediatric Surgery, Peoria, IL, USAAbstract: Obesity is a multi-organ system disease with underlying metabolic abnormalities and chronic systemic inflammation. Nonalcoholic fatty liver disease (NAFLD is a hepatic manifestation of obesity metabolic dysfunction and its associated cardiovascular- and liver-related morbidities and mortality. Our current understanding of NAFLD pathogenesis, disease characteristics, the role of insulin resistance, chronic inflammation, gut–liver and gut–brain crosstalk and the effectiveness of pharmacotherapy is still evolving. Bariatric surgery significantly improves metabolic and NAFLD histology in severely obese patients, although its positive effects on fibrosis are not universal. Bariatric surgery benefits NAFLD through its metabolic effect on insulin resistance, inflammation, and insulinotropic and anorexinogenic gastrointestinal hormones. Further studies are needed to understand the natural course of NAFLD in severely obese patients and the role of weight loss surgery as a primary treatment for NAFLD.Keywords: NAFLD, severe obesity, bariatric surgery

[Effect of Acupuncture Therapy on Body Compositions in Patients with Obesity].

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Zhang, Hui-Min; Wu, Xue-Liang; Jiang, Chao; Shi, Rong-Xing

2017-04-25

To observe the clinical effectiveness of acupuncture intervention in weight reduction by modulating body compositions in obesity patients. A total of 71 obesity patients during weight-loss procedure were allocated to acupuncture+nutrition-consultation group ( n =40) and simple nutrition-consultation group ( n =31). The patients of the acupuncture +nutrition-consultation group were treated by acupuncture stimulation of Zhongwan (CV 12), Xiawan (CV 10), Tianshu (ST 25), Wailing (ST 26), Qihai (CV 6), Guanyuan (CV 4), etc. for 30 min, once every other day, 3 times per week, 12 times altogether, and also given with weekly nutrition consultation (including subjective query, objective measurement, analysis, program for nutrition support) at the same time. The patients of the simple nutrition-consultation group were treated by only weekly nutrition consultation for 4 weeks. Before and after the treatment, the patients' body weight, body mass index (BMI), fat mass, percentage of body fat, muscle mass, protein quality, water quality and bone mass were measured by using a composition analyzer. After 4 weeks' treatment, the body mass, BMI, fat mass and fat percentage in both acupuncture+nutrition-consultation and simple nutrition-consultation groups were significantly decreased ( P 0.05). The therapeutic effect of acupuncture+nutrition-consultation group was markedly superior to that of the simple nutrition-consultation group in increasing the improved degrees of body weight, BMI, fat mass and fat percentage ( P Acupuncture plus nutrition consultation is effective in reducing body mass, fat mass and percentage of body fat in obesity patients.

Obese patients: Respiratory complications in the post-anesthesia care unit

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J. Mendonça

2014-01-01

Full Text Available Introduction: Obesity has been associated with respiratory complications, and the majority of these complications occur in the Post-Anesthesia Care Unit (PACU. The aim of this study was to evaluate the outcome and incidence of adverse respiratory events (AREs in obese patients during their stay in the PACU. Methods: We conducted a prospective control study that included 27 obese patients matched with an equal number of patients with body mass index (BMI  0,025. A análise multivariada identificou a obesidade e o bloqueio neuromuscular residual como fatores de risco independentes para a ocorrência de eventos respiratórios. A duração da estadia na UPA foi superior nos doentes obesos (120 min vs 84 min, p > 0,01. Conclusões: A incapacidade de respirar profundamente foi o ARE mais frequente no período pós-operatório imediato nos doentes obesos. A obesidade foi considerada um fator de risco independente para ocorrência de ARE na UPA. Os doentes obesos tiveram maior tempo de estadia na UPA mas não tiveram maior tempo de internamento hospitalar. Keywords: Obesity, Body mass index, Respiratory events, Postoperative outcome, Palavras chave: Obesidade, Índice de massa corporal, Eventos respiratórios, Resultados pós-operatórios

Psychological characterisation of severely obese patients: pre- and post-bariatric surgery

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André Ferreira

2013-06-01

Full Text Available Although psychological disorders are more prevalent among candidates for bariatric surgery than among non-obese populations, there is limited knowledge about the impact of this type of surgery on psychopathology. The main goal of this study was to characterize the evolution of psychopathological morbidity among obese patients after surgery. This was an observational longitudinal study. All patients submitted to bariatric surgery between March 2008 and June 2010, in a general hospital located in the south of Portugal were invited to participate. Psychological assessment was done through structured clinical interviews and administration of MCMI-III. Participants were assessed with the same protocol before and after surgery (minimum, 12 months after surgery. Overall, 20 patients (19 women were assessed. The most prevalent clinical syndromes (axis I before surgery were: anxiety (40%, dysthymia disorder (20%, somatoform disorder and delusional disorder (both 15%. After surgery, the most prevalent clinical syndromes were: anxiety (40%, bipolar disorder, dysthymia disorder, and delusional disorder (all with 15%. Before surgery, compulsive personality was the most prevalent personality disorder (15%. After surgery, the most prevalent ones were: histrionic personality, compulsive personality disorder, and paranoia (all with 10%. These findings may suggest that bariatric surgery per se is not enough as treatment for the remission of psychopathology among severe obese patients.

Comparison of neostigmine induced reversal of vecuronium in normal weight, overweight and obese female patients

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Shilpa Bhimasen Joshi

2015-01-01

Full Text Available Background and Aims: Obese patients are more vulnerable to residual neuromuscular block (NMB and its associated complications in the post-operative period. This study was carried out to compare neostigmine induced reversal of vecuronium in normal weight, overweight and obese female patients, objectively using neuromuscular (NM monitoring. Methods: Twenty female patients each belonging to normal weight, overweight and obese, based on body mass index, requiring general anaesthesia were recruited for this prospective cross sectional study. NMB was induced with vecuronium (0.1 mg/kg dose based on patient′s real body weight (RBW and monitored using acceleromyographic train of four (TOF. All patients received neostigmine 40 μg/kg and glycopyrrolate 10 μg/kg at 25% of spontaneous recovery of first twitch height (T1 of TOF (DUR 25% and were allowed to recover to TOF ratio of 0.9. Statistical analysis was done using analysis of variance test. Results: Recovery of TOF ratio to 0.5 was comparable in all three groups. Recovery of TOF ratio to 0.7 was delayed in obese (9.82 ± 3.21 min compared with normal weight group (7.50 ± 2.52 min. Recovery of TOF to 0.9 was significantly delayed in both overweight (12.18 ± 4.29 min and obese patients (13.78 ± 4.30 min. DUR 25% was significantly longer in overweight (mean, standard deviation [range]; 30.10 [19-40 min] and obese (28.8 [12-45 min] compared with normal weight patients (22.75 [16-30 min]. Conclusion: In overweight and obese patients, when vecuronium induction dose is based on RBW, neostigmine induced recovery of NMB is delayed in late phases (TOF 0.7-0.9, which may result in vulnerability for associated complications of incomplete recovery. Ensuring safe recovery thus requires objective NM monitoring.

Appearance vs. health reasons for seeking treatment among obese patients with binge eating disorder.

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Reas, Deborah L; Masheb, Robin M; Grilo, Carlos M

2004-05-01

This study examined reasons for seeking treatment reported by obese patients diagnosed with binge eating disorder (BED). Participants were 248 adults (58 men and 190 women) who met DSM criteria for BED. Participants were recruited through advertisements for treatment studies looking for persons who wanted to "stop binge eating and lose weight." Patients' reasons for seeking treatment were examined with respect to demography (gender and age), obesity (BMI and age of onset), features of eating disorders, and associated psychological functioning (depression and self-esteem). Of the 248 participants, 64% reported health concerns and 36% reported appearance concerns as their primary reason for seeking treatment. Reasons for seeking treatment did not differ significantly by gender. Patients seeking treatment because of appearance-related reasons had lower BMIs than those reporting health-related reasons (34.8 vs. 38.5, respectively), but they reported greater body dissatisfaction, more features of eating disorders, and lower self-esteem. Reasons that prompt treatment seeking among obese individuals with BED reflect meaningful patient characteristics and, therefore, warrant assessment and consideration during treatment planning. Further research is needed to determine whether reasons for treatment seeking among different obese patient groups affect treatment outcomes. Copyright 2004 NAASO

DIABETES ASSOCIATED OXIDATIVE STRESS AND INFLAMMATION ALTERS THE PROTECTIVE EFFECT OF OBESITY ON SURVIVAL IN CHD PATIENTS

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Serpil M. Deger

2012-06-01

Full Text Available In contrast to the adverse outcomes of obesity in general population, increased body mass index (BMI is associated with improved survival in hemodialysis (CHD patients. The aim of this retrospective study was to evaluate the association between obesity and mortality by diabetic status among 98 maintenance CHD patients. The median follow up was 33 (19, 56 months. Mean age was 49±13 years, 66% were male and 48 % had obesity. 45% of obese subjects were diabetic. Among the subgroups of study population, survival of diabetic obese patients was significantly lower compared to non-diabetic obese subjects (p=0.007 (Figure 1. The subgroup comparisons showed that diabetic obese patients tend to have higher truncal fat percentage (p<0.001 and lower lean body mass standardized by body surface area compared to nondiabetic counterparts although difference was not statistically significance. Diabetic obese patients had higher leptin (p=0.001 and high sensitivity C-reactive protein levels (0.005. Additionally, protein thiols (P-SH were significantly decreased in diabetic obese participants (p=0.03. Although, elevated body fatness appears to be protective for CHD population, presence of overt diabetes alters this advantage by increasing inflammation and oxidative stress.fx1

Australian diagnostic radiographers' attitudes and perceptions of imaging obese patients: A study of self, peers and students

International Nuclear Information System (INIS)

Aweidah, L.; Robinson, J.; Cumming, S.; Lewis, S.

2016-01-01

Introduction and Objective: Imaging obese patients poses a number of challenges for diagnostic radiographers through positioning, radiation exposure, communication and care. Furthermore, the increasing prevalence of obesity in Australian society ensures these imaging challenges are more frequent however little is known about this area. This study aims to explore the attitudes and perceptions of diagnostic radiographers toward imaging obese patients through a mixed methods study. Methods: Ethics approval was granted to interview and survey diagnostic radiographers about their attitudes and perceptions of imaging obese patients. Twelve diagnostic radiographers who are designated clinical educators (DR CEs) took part in a 30–45 min semi-structured interview as well as a 20 min computer-based Weight Implicit Association Test (Weight-IAT) and self-report questionnaire of explicit attitudes. An additional 25 experienced Diagnostic Radiographers who were associate supervisors completed the Weight-IAT/explicit questionnaire only. Results: Thematic analysis of the interviews revealed that DR CEs adopted an image-focussed or patient-focussed approach to obese patients. Key themes with a negative bias included blame, tolerance and insecurity of skill. Positively associated key themes were empathy and experience in radiography. The sample overall showed a significant negative implicit weight bias (P = 0.016) as measured by the Weight-IAT and there was no evidence of negative explicit attitudes. Conclusion: Australian diagnostic radiographers in this study exhibited significant negative implicit weight bias, with interview results highlighting attitudes of blame and frustration towards obese patients. DR CEs were more likely to be focussed on image acquisition rather than patient considerations, with fewer responses related to empathy and equity. - Highlights: • Mixed-methods study combining qualitative interviews and implicit–explicit bias towards imaging obese

Obesity is the main determinant of insulin resistance more than the circulating pro-inflammatory cytokines levels in rheumatoid arthritis patients.

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Castillo-Hernandez, Jesus; Maldonado-Cervantes, Martha Imelda; Reyes, Juan Pablo; Patiño-Marin, Nuria; Maldonado-Cervantes, Enrique; Solorzano-Rodriguez, Claudia; de la Cruz Mendoza, Esperanza; Alvarado-Sanchez, Brenda

Systemic blockade of TNF-α in Rheumatoid arthritis with insulin resistance seems to produce more improvement in insulin sensitivity in normal weight patients with Rheumatoid arthritis than in obese patients with Rheumatoid arthritis, suggesting that systemic-inflammation and obesity are independent risk factors for insulin resistance in Rheumatoid arthritis patients. To evaluate the insulin resistance in: normal weight patients with Rheumatoid arthritis, overweight patients with Rheumatoid arthritis, obese Rheumatoid arthritis patients, and matched control subjects with normal weight and obesity; and its association with major cytokines involved in the pathogenesis of the disease. Assessments included: body mass index, insulin resistance by Homeostasis Model Assessment, ELISA method, and enzymatic colorimetric assay. Outstanding results from these studies include: (1) In Rheumatoid arthritis patients, insulin resistance was well correlated with body mass index, but not with levels of serum cytokines. In fact, levels of cytokines were similar in all Rheumatoid arthritis patients, regardless of being obese, overweight or normal weight (2) Insulin resistance was significantly higher in Rheumatoid arthritis with normal weight than in normal weight (3) No significant difference was observed between insulin resistances of Rheumatoid arthritis with obesity and obesity (4) As expected, levels of circulating cytokines were significantly higher in Rheumatoid arthritis patients than in obesity. Obesity appears to be a dominant condition above inflammation to produce IR in RA patients. The dissociation of the inflammation and obesity components to produce IR suggests the need of an independent therapeutic strategy in obese patients with RA. Copyright © 2017. Published by Elsevier Editora Ltda.

Impact of weight bias and stigma on quality of care and outcomes for patients with obesity.

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Phelan, S M; Burgess, D J; Yeazel, M W; Hellerstedt, W L; Griffin, J M; van Ryn, M

2015-04-01

The objective of this study was to critically review the empirical evidence from all relevant disciplines regarding obesity stigma in order to (i) determine the implications of obesity stigma for healthcare providers and their patients with obesity and (ii) identify strategies to improve care for patients with obesity. We conducted a search of Medline and PsychInfo for all peer-reviewed papers presenting original empirical data relevant to stigma, bias, discrimination, prejudice and medical care. We then performed a narrative review of the existing empirical evidence regarding the impact of obesity stigma and weight bias for healthcare quality and outcomes. Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making. These attitudes may impact the care they provide. Experiences of or expectations for poor treatment may cause stress and avoidance of care, mistrust of doctors and poor adherence among patients with obesity. Stigma can reduce the quality of care for patients with obesity despite the best intentions of healthcare providers to provide high-quality care. There are several potential intervention strategies that may reduce the impact of obesity stigma on quality of care. © 2015 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of International Association for the Study of Obesity (IASO).

The Influence of Obesity on Patient Reported Outcomes following Total Knee Replacement

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Vandana Ayyar

2012-01-01

Full Text Available This study retrospectively analysed the effects of obesity as described by Body Mass Index (BMI on patient reported outcomes following total knee replacement. Participants (105 females and 66 males who had undergone surgery under the care of a single surgeon were included in the review and were grouped according to their preoperative BMI into nonobese ( kg/m2, ( obese ( kg/m2 (. Oxford Knee Score (OKS and Short Form 12 scores (SF12 were taken preoperatively and 6 and 12 months after surgery to analyse differences between groups in the absolute scores as well as changes from before to after surgery. Preoperatively, the obese group had a significantly poorer OKS compared to non obese (44.7 versus 41.2, . There were no statistically significant group effects on follow-up or change scores of the OKS and SF12. Correlations coefficients between BMI and follow-up and change scores were low (. There were no significant differences in the number of complications and revisions (local wound infection, 6.7% non obese, 11% obese, postoperative systemic complication, 8% non obese, 12% obese, revision, 4% nonobese, 3% obese. In conclusion, our findings indicate similar degrees of benefits from the surgery irrespective of patient BMI.

Hypovitaminosis D is independently associated with metabolic syndrome in obese patients.

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Ilaria Barchetta

Full Text Available BACKGROUND: Metabolic syndrome (MS and hypovitaminosis D represent two of the most diffuse condition worldwide, reaching pandemic proportions in industrialized countries, and are both strongly associated with obesity. This study set out to evaluate the presence of an independent association between hypovitaminosis D and MS in an adult population of obese subjects with/without MS. METHODS: We recruited 107 consecutive obese subjects, 61 with MS (age(mean±SD 45.3±13.3 years, BMI(mean±SD: 43.1±8.3 kg/m(2 and 46 without MS (age: 41.8±11.5, p = n.s., BMI:41.6±6.5 kg/m(2, p = n.s. comparable for sex, BMI, waist circumference and body fat mass, evaluated by bioimpedentiometry. 25(OH vitamin D3 levels were measured by colorimetric method. Insulin resistance was estimated by fasting blood insulin, HOMA-IR and ISI. RESULTS: Serum 25(OHD3 levels were significantly lower in MS obese patients than in obese subjects without MS (median(range 13.5(3.3-32 vs 17.4(5.1-37.4, p<0.007. Low 25(OHD3 levels correlated with glycaemia (p<0.007, phosphate (p<0.03, PTH (p<0.003 and the MS (p<0.001. Multivariate model confirmed that low 25(OHD3 levels were associated with the diagnosis of MS in obese patients independently from gender, age, serum PTH and body fat mass. After stratifying the study population according to 25(OHD3 concentrations, patients in the lowest quartile showed a markedly increased prevalence of MS compared to those in the highest quartile (OR = 4.1, CI 1.2-13.7, p = 0.02. CONCLUSIONS: A powerful association exists between hypovitaminosis D and MS in obese patients independently from body fat mass and its clinical correlates. This indicates that the association between low 25(OH D3 levels and MS is not merely induced by vitamin D deposition in fat tissue and reinforces the hypothesis that hypovitaminosis D represent a crucial independent determinant of MS.

Social phobia and quality of life in morbidly obese patients before and after bariatric surgery.

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Mirijello, Antonio; D'Angelo, Cristina; Iaconelli, Amerigo; Capristo, Esmeralda; Ferrulli, Anna; Leccesi, Laura; Cossari, Anthony; Landolfi, Raffaele; Addolorato, Giovanni

2015-07-01

Morbidly obesity is characterized by physical and psychological comorbidities which are associated with reduced quality of life. Bariatric surgery has been linked to a reduction of psychopathology other than to a reduction of weight and improvement in physical functioning. Aim of the present study was to compare psychological features of two groups of morbidly obese patients, before and after bariatric surgery, assessing social phobia and quality of life. A total of 46 morbidly obese patients were enrolled in the study. Of them, 20 were waiting for bilio-pancreatic diversion (group A), while 26 had already undergone surgical procedure (group B). Psychometric evaluation assessed social phobia, fear for the body-shape and quality of life, using appropriate psychometric tests. The percentage of patients showing social phobia was significantly higher compared to a sample of healthy controls (p=0.004), both in group A (p=0.003) and in group B (p=0.029). No differences in percentage of patients affected by social phobia were found between groups. A significantly higher percentage of patients affected by distress about the body (psocial phobia in a population of morbidly obese patients, both before and after surgery. A general reduction of quality of life was also observed, with a partial improvement after surgery. Future studies are needed to clarify the relationship between social phobia and quality of life in surgically-treated morbidly obese patients. Copyright © 2015 Elsevier B.V. All rights reserved.

Hypoxia induced VEGF synthesis in visceral adipose depots of obese diabetic patients.

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Fusaru, Ana Marina; Pisoschi, Cătălina Gabriela; Bold, Adriana; Taisescu, C; Stănescu, R; Hîncu, Mihaela; Crăiţoiu, Stefania; Baniţă, Ileana Monica

2012-01-01

VEGF is one the pro-inflammatory adipokines synthesized by the "adipose secretoma" of obese subjects as a response to hypoxic conditions; but the main function of VEGF is angiogenesis, being recognized as the most important factor increasing blood capillaries in the adipose tissue by stimulating endothelial cell growth. In this paper, we propose a comparative study of the vascular response to VEGF synthesis in the subcutaneous and central-peritoneal adipose depots in lean, obese and obese diabetic patients. We used CD31 to label the endothelial cells in order to evaluate the response of the vascular network to VEGF synthesis. Our results showed an increase of VEGF protein synthesis in obese and obese-diabetic patients compared to lean subjects where the protein was absent. The positivity for VEGF in obese diabetic samples was observed in numerous structures from the adipose depots, both in the stromal vascular fraction--blood vessels and stromal cells--as well as in the cytoplasm of adipocytes. Positivity in the vascular wall was observed more frequently in areas of perivascular and intralobular fibrosis. Obese and diabetic patients showed similar incidence of CD31 immunoreactivity with lean subjects in both subcutaneous and peritoneal depots. In conclusion, human adipose depots show a different incidence of VEGF positive cells in relation with their disposal and the metabolic status. VEGF synthesis in visceral adipose tissue is inefficient being not followed by angiogenesis to counterbalance tissue hypoxia. We suggest that may be a pathogenic link between the degrees of intralobular fibrosis in adipose depots and VEGF expression.

Salivary cortisol levels are associated with outcomes of weight reduction therapy in obese Japanese patients.

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Himeno, Akihiro; Satoh-Asahara, Noriko; Usui, Takeshi; Wada, Hiromichi; Tochiya, Mayu; Kono, Shigeo; Yamada-Goto, Nobuko; Katsuura, Goro; Hasegawa, Koji; Nakao, Kazuwa; Shimatsu, Akira

2012-02-01

Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis can increase the risk of cardiovascular disease (CVD). However, the detailed relationships of HPA axis activity with weight reduction and CVD risk factors in obese patients have not been examined. This study was designed to elucidate the associations of salivary cortisol levels with weight reduction and CVD risk factors in obese patients. As a marker of HPA axis activity, we measured the morning salivary cortisol levels of 83 obese Japanese outpatients. We also examined metabolic parameters, inflammatory markers, and indicators of arterial stiffness, that is, the pulse wave velocity and cardio-ankle vascular index. All 83 obese patients underwent 3-month weight reduction therapy with lifestyle modification. At the baseline, multivariate regression analysis revealed that only logarithmic transformation of C-reactive protein (β = 0.258, P cortisol levels. However, other metabolic parameters were not significantly associated with the salivary cortisol levels. In addition, lower salivary cortisol levels and higher body weight at the baseline were the only independent determinants of successful weight loss through the weight reduction therapy (P cortisol levels are significantly associated with the levels of an inflammatory marker, arterial stiffness, and successful weight reduction in obese patients. Therefore, salivary cortisol could be a useful marker for assessing and managing body weight and CVD risk factors in obese patients. Copyright © 2012 Elsevier Inc. All rights reserved.

Obese Patients With a Binge Eating Disorder Have an Unfavorable Metabolic and Inflammatory Profile.

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Succurro, Elena; Segura-Garcia, Cristina; Ruffo, Mariafrancesca; Caroleo, Mariarita; Rania, Marianna; Aloi, Matteo; De Fazio, Pasquale; Sesti, Giorgio; Arturi, Franco

2015-12-01

To evaluate whether obese patients with a binge eating disorder (BED) have an altered metabolic and inflammatory profile related to their eating behaviors compared with non-BED obese.A total of 115 White obese patients consecutively recruited underwent biochemical, anthropometrical evaluation, and a 75-g oral glucose tolerance test. Patients answered the Binge Eating Scale and were interviewed by a psychiatrist. The patients were subsequently divided into 2 groups according to diagnosis: non-BED obese (n = 85) and BED obese (n = 30). Structural equation modeling analysis was performed to elucidate the relation between eating behaviors and metabolic and inflammatory profile.BED obese exhibited significantly higher percentages of altered eating behaviors, body mass index (P < 0.001), waist circumference (P < 0.01), fat mass (P < 0.001), and a lower lean mass (P < 0.001) when compared with non-BED obese. Binge eating disorder obese also had a worse metabolic and inflammatory profile, exhibiting significantly lower high-density lipoprotein cholesterol levels (P < 0.05), and higher levels of glycated hemoglobin (P < 0.01), uric acid (P < 0.05), erythrocyte sedimentation rate (P < 0.001), high-sensitive C-reactive protein (P < 0.01), and white blood cell counts (P < 0.01). Higher fasting insulin (P < 0.01) and higher insulin resistance (P < 0.01), assessed by homeostasis model assessment index and visceral adiposity index (P < 0.001), were observed among BED obese. All differences remained significant after adjusting for body mass index. No significant differences in fasting plasma glucose or 2-hour postchallenge plasma glucose were found. Structural equation modeling analysis confirmed the relation between the altered eating behaviors of BED and the metabolic and inflammatory profile.Binge eating disorder obese exhibited an unfavorable metabolic and inflammatory profile, which is related to their characteristic

Obesity and chronic kidney disease in patients with chronic heart failure: an insight from the China Heart Survey.

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Liu, Hao; Shi, Hong; Yu, Jinming; Chen, Fang; Jiang, Qingwu; Hu, Dayi

2011-08-01

Obesity and decreased kidney function have been shown to be prevalent in Western patients with heart failure; however, whether this phenomenon exists in Chinese patients with chronic heart failure (CHF) is not known. One thousand and nine patients with CHF from the China Heart Survey were assessed. The prevalence of chronic kidney disease (CKD) was 34.2%, and there was a stepwise increase in the prevalence of CKD with New York Heart Association (NYHA) classes (P obesity and central obesity was 35.7% and 62.5%, respectively. Notably, there was a downward trend in the prevalence of obesity with advanced NYHA classes (trend test, P = 0.003). Multivariate analysis further supported the finding that obesity, but not central obesity, was inversely associated with the extent of CHF (OR = 0.72, 95% CI: 0.55-0.94, P = 0.017). Renal dysfunction is common in Chinese patients with CHF and is independently associated with advanced NYHA classes. Obesity was inversely associated with the extent of CHF, which further supports the notion that obesity confers improved prognosis in patients with heart failure.

Risk perception of obesity and bariatric surgery in patients seeking treatment for obesity.

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Prasad, Chaithra; Batsis, John A; Lopez-Jimenez, Francisco; Clark, Matthew M; Somers, Virend K; Sarr, Michael G; Collazo-Clavell, Maria L

2014-06-01

Bariatric surgery (BSx) produces clinically relevant weight loss that translates into improved quality of life, decreased mortality, and reduction in medical comorbidities, including cardiovascular (CV) risk. Little is known about patients' decision-making process to undergo BSx, but risk perception is known to influence medical decision-making. This study examined CV and BSx risk perception in obese subjects undergoing BSx (n = 268) versus those managed medically (MM) (n = 273). This retrospective population-based survey of subjects evaluated for BSx had 148 (55%) and 88 (32%) responders in the BSx and MM groups, respectively. Survey questions assessed risk perceptions and habits prior to weight loss intervention. CV risk was calculated using the Framingham Risk Score (FRS). At baseline, BSx subjects had a greater body mass index and greater prevalence of diabetes and depression. Follow-up mean weight loss was greater in the BSx group. BSx subjects perceived obesity as a greater risk to their overall health than the surgical risk. FRS declined in the BSx group (10 to 5%; p risk had a greater tendency to perceive the risk of BSx as greater than that of obesity. Obese subjects undergoing BSx are more likely than MM subjects to perceive obesity as a greater risk to their health than BSx. MM subjects generally underestimate their CV risk and overestimate the risk of BSx. Active discussion of CV risk using the FRS and the perception of risk associated with bariatric surgery can enhance patients' ability to make an informed decision regarding their management. © The European Society of Cardiology 2012 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Role of routine pre-operative screening venous duplex ultrasound in morbidly obese patients undergoing bariatric surgery

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P Praveen Raj

2017-01-01

Full Text Available Background/Aims: It is well established that obesity is a strongly associated risk factor for post-operative deep vein thrombosis (DVT. Physical effects and pro-thrombotic, pro-inflammatory and hypofibrinolytic effects of severe obesity may predispose to idiopathic DVT (pre-operatively because of which bariatric patients are routinely screened before surgery. The aim of this study was to audit the use of routine screening venous duplex ultrasound in morbidly obese patients before undergoing bariatric surgery. Methods: We retrospectively reviewed 180 patients who underwent bariatric surgery from August 2013 to August 2014 who had undergone pre-operative screening bilateral lower-extremity venous duplex ultrasound for DVT. Data were collected on patient's demographics, history of venous thromboembolism, prior surgeries and duplex ultrasound details of the status of the deep veins and superficial veins of the lower limbs. Results: No patients had symptoms or signs of DVT pre-operatively. No patient gave history of DVT. No patient was found to have iliac, femoral or popliteal vein thrombosis. Superficial venous disease was found in 17 (8%. One patient had a right lower limb venous ulcer. Conclusion: Thromboembolic problems in the morbidly obese before bariatric surgery are infrequent, and screening venous duplex ultrasound can be done in high-risk patients only.

Postoperative Complications of Total Joint Arthroplasty in Obese Patients Stratified by BMI.

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Zusmanovich, Mikhail; Kester, Benjamin S; Schwarzkopf, Ran

2018-03-01

High body mass index (BMI) is associated with significant complications in patients undergoing total joint arthroplasty. Many studies have evaluated this trend, but few have looked at the rates of complications based on BMI as a continuous variable. The purpose of this study was to stratify obese patients into 3 BMI categories and evaluate their rates of complications and gauge whether transitioning from higher to lower BMI category lowers complication. Patients undergoing primary total joint arthroplasty were selected from the National Surgical Quality Improvement Program database from 2008-2015 and arranged into 3 groups based on BMI: O1 (BMI 30-34.9 kg/m 2 ), O2 (BMI 35-39.9 kg/m 2 ), and O3 (BMI >40 kg/m 2 ). Thirty-day complications were recorded and evaluated utilizing univariate and multivariate analyses stratified by BMI. A total of 268,663 patients were identified. Patients with a BMI >30 kg/m 2 had more infectious and medical complications compared with nonobese patients. Furthermore, there were increased complications as the BMI categories increased. Patients with a BMI >40 kg/m 2 (O3) had longer operating times, length of stay, higher rates of readmissions, reoperations, deep venous thrombosis, renal insufficiency, superficial infections, deep infections, and wound dehiscence. These trends were present when comparing the O2 with O1 category as well. We have demonstrated increased rates of medical and surgical complications in obese patients. Furthermore, we demonstrated a stepwise increase in complication rates when transitioning to higher BMI groups. Based on our data, we believe that preoperative counseling and interventions to decrease BMI should be explored before offering elective surgery to obese patients. Copyright © 2017 Elsevier Inc. All rights reserved.

The Effect of Peptide YY3-36 in Body Mass Regulation in Patients with Exogenous Constitutional Obesity

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Alexander S. Ametov PhD, ScD³

2012-03-01

Full Text Available The article deals with PYY3-36 level in the blood serum of patients suffering from exogenous constitutional obesity and overweight, as well as its role in the process of the body mass growth. Among the 327 patients diagnosed with obesity and overweight, particularly those with Class I and II degrees of obesity (p<0.05 showed a significantly increased level of PYY 3 -36. The highest PYY3-36 level was observed in those with the Class II or second degree of obesity (p<0.05. Exogenous Constitutional Obesity is accompanied by a significant increase in PYY3-36 in patients with Class I and II degrees of obesity.

Hypothalamic Obesity in Craniopharyngioma Patients: Disturbed Energy Homeostasis Related to Extent of Hypothalamic Damage and Its Implication for Obesity Intervention

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Christian L. Roth

2015-09-01

Full Text Available Hypothalamic obesity (HO occurs in patients with tumors and lesions in the medial hypothalamic region. Hypothalamic dysfunction can lead to hyperinsulinemia and leptin resistance. This review is focused on HO caused by craniopharyngiomas (CP, which are the most common childhood brain tumors of nonglial origin. Despite excellent overall survival rates, CP patients have substantially reduced quality of life because of significant long-term sequelae, notably severe obesity in about 50% of patients, leading to a high rate of cardiovascular mortality. Recent studies reported that both hyperphagia and decreased energy expenditure can contribute to severe obesity in HO patients. Recognized risk factors for severe obesity include large hypothalamic tumors or lesions affecting several medial and posterior hypothalamic nuclei that impact satiety signaling pathways. Structural damage in these nuclei often lead to hyperphagia, rapid weight gain, central insulin and leptin resistance, decreased sympathetic activity, low energy expenditure, and increased energy storage in adipose tissue. To date, most efforts to treat HO have shown disappointing long-term success rates. However, treatments based on the distinct pathophysiology of disturbed energy homeostasis related to CP may offer options for successful interventions in the future.

Pharmacological Treatment of Obesity in Patients with Polycystic Ovary Syndrome

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Hassan Kahal

2011-01-01

Full Text Available Polycystic ovary syndrome (PCOS is a common disorder affecting women of reproductive age and it is associated with increased cardiovascular risk. Obesity plays an important role in the pathogenesis of PCOS, and the majority of patients with PCOS are obese. Over the last 20 years, the prevalence of obesity has dramatically increased, with probable associated increase in PCOS. Weight reduction plays an integral part in the management of women with PCOS. In this paper, current available weight reduction therapies in the management of PCOS are discussed.

Relationship between Acute Phase Proteins and Serum Fatty Acid Composition in Morbidly Obese Patients

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Fernandes, Ricardo; Beserra, Bruna Teles Soares; Cunha, Raphael Salles Granato; Hillesheim, Elaine; Camargo, Carolina de Quadros; Pequito, Danielle Cristina Tonello; de Castro, Isabela Coelho; Fernandes, Luiz Cláudio; Nunes, Everson Araújo; Trindade, Erasmo Benício Santos de Moraes

2013-01-01

Background. Obesity is considered a low-grade inflammatory state and has been associated with increased acute phase proteins as well as changes in serum fatty acids. Few studies have assessed associations between acute phase proteins and serum fatty acids in morbidly obese patients. Objective. To investigate the relationship between acute phase proteins (C-Reactive Protein, Orosomucoid, and Albumin) and serum fatty acids in morbidly obese patients. Methods. Twenty-two morbidly obese patients were enrolled in this study. Biochemical and clinical data were obtained before bariatric surgery, and fatty acids measured in preoperative serum. Results. Orosomucoid was negatively correlated with lauric acid (P = 0.027) and eicosapentaenoic acid (EPA) (P = 0.037) and positively with arachidonic acid (AA) (P = 0.035), AA/EPA ratio (P = 0.005), and n-6/n-3 polyunsaturated fatty acids ratio (P = 0.035). C-Reactive Protein (CRP) was negatively correlated with lauric acid (P = 0.048), and both CRP and CRP/Albumin ratio were negatively correlated with margaric acid (P = 0.010, P = 0.008, resp.). Albumin was positively correlated with EPA (P = 0.027) and margaric acid (P = 0.008). Other correlations were not statistically significant. Conclusion. Our findings suggest that serum fatty acids are linked to acute phase proteins in morbidly obese patients. PMID:24167354

Predictors of Quality of Life in Portuguese Obese Patients: A Structural Equation Modeling Application

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Estela Vilhena

2014-01-01

Full Text Available Living with obesity is an experience that may affect multiple aspects of an individual’s life. Obesity is considered a relevant public health problem in modern societies. To determine the comparative efficacy of different treatments and to assess their impact on patients’ everyday life, it is important to identify factors that are relevant to the quality of life of obese patients. The present study aims to evaluate, in Portuguese obese patients, the simultaneous impact of several psychosocial factors on quality of life. This study also explores the mediating role of stigma in the relationship between positive/negative affect and quality of life. A sample of 215 obese patients selected from the main hospitals in Portugal completed self-report questionnaires to assess sociodemographic, clinical, psychosocial, and quality of life variables. Data were analysed using structural equation modeling. The model fitted the data reasonably well, CFI = 0.9, RMSEA = 0.06. More enthusiastic and more active patients had a better quality of life. Those who reflect lower perception of stigma had a better physical and mental health. Partial mediation effects of stigma between positive affect and mental health and between negative affect and physical health were found. The stigma is pervasive and causes consequences for psychological and physical health.

Saliva of obese patients – is it different?

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Katarzyna Choromańska

2015-01-01

Full Text Available Obesity is a major public health concern that increases the risk of cardiovascular disease, type 2 diabetes and cancer. The incidence of obesity has increased significantly in recent years, not only in adults, but also in adolescents and children. This is evidenced by rapidly developing bariatric surgery, the most effective method of treating morbid obesity. Obesity is a multifactorial disease, and its pathogenesis is not completely understood. Numerous studies have been performed to clarify pathogenetic mechanisms, based mostly on blood and sometimes urine samples. Saliva is easily accessible and can be obtained non-invasively. Our aim was to review studies performed on saliva obtained from obese subjects in order to answer the title question.Obese people have different composition of salivary bacteria. Changes in the concentration of sialic acid, phosphorus and peroxidase activity as well as a lower flow rate of stimulated whole saliva promote dental caries and periodontal disease. Concentrations of salivary uric acid, endocannabinoids and CRP are increased in obesity and may provide a useful index of cardiometabolic risk. Assessment of fasting salivary ghrelin might facilitate choosing the best type of bariatric surgery for a specific patient. A significant decrease in salivary cortisol in women with morbid obesity also seems interesting.There is sufficient evidence to state that the saliva of obese and lean subjects is different. Saliva as an easily accessible research material seems promising, as shown by the few studies performed so far.

Ultrasound Accuracy in Diagnosing Appendicitis in Obese Pediatric Patients.

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Love, Bryan E; Camelo, Monica; Nouri, Sarvenaz; Kriger, Diego; Ludi, Daniel; Nguyen, Henry

2017-10-01

The use of ultrasound to diagnose appendicitis in pediatric patients has been growing with the improvement of ultrasound technology and operator skills, but its utility in the increasingly obese pediatric population has not been thoroughly investigated. A retrospective review of all pediatric (≤18 years old) patients with appendicitis who were admitted at a single hospital from 2014 to 2016 was conducted. Patients were stratified into body mass index (BMI) percentile categories based on the centers for disease control guidelines. Comparisons were then made. There were 231 patients with an average BMI percentile of 72.6; 99 (42.9%) who had an ultrasound, of which 54 (54.5%) were positive for acute appendicitis, whereas 43 (43.4%) were nondiagnostic. In patients who had a nondiagnostic ultrasound, 37 had a CT demonstrating acute appendicitis. These were compared with 123 patients who had CT alone demonstrating acute appendicitis. The CT-only group was older (12 vs 9, P appendicitis.

Gastric emptying and intragastric balloon in obese patients.

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Bonazzi, P; Petrelli, M D; Lorenzini, I; Peruzzi, E; Nicolai, A; Galeazzi, R

2005-01-01

Intragastric balloons have been proposed to induce weight loss in obese subjects. The consequences of the balloon on gastric physiology remain poorly studied. We studied the influence of an intragastric balloon on gastric emptying in obese patients. 12 patients were included in the study, with BMI (mean +/- SD) of 38.51 +/- 4.32 kg/m2. The balloon was inserted under light anaesthesia and endoscopic control, inflated with 700 ml saline, and removed 6 months later. Body weight and gastric emptying (T1/2 and T lag) using 13C-octanoic acid breath test were monitored before balloon placement, during its permanence and 2 months after removal. Mean weight loss was: 6.2 +/- 2.3 kg after one month; 12.4 +/- 5.8 kg after 3 months; 14.4 +/- 6.6 kg after 6 months and 10.1 +/- 4.3 kg two months after BIB removal. Gastric emptying rates were significantly decreased in the first periods with balloon in place, and returned to pre-implantation values after balloon removal. T1/2 was: 87 +/- 32 min before BIB positioning, 181 +/- 91 min after 1 month, 145 +/- 99 min after 3 months, 104 +/- 50 min after 6 months and 90 +/- 43 min 2 months after removal. T lag was 36 +/- 18 min before BIB positioning, 102 +/- 82 min after 1 month, 77 +/- 53 min after 3 months, 59 +/- 28 min after 6 months and 40 +/- 21 min. 2 months after removal. BIB in obese patients seems to be a good help in following the hypo caloric diet, especially during the first three months when the gastric emptying is slower and the sense of repletion is higher. After this period gastric emptying starts to return to normal and the stomach adapts to BIB loosing efficacy in weight loss.

Relationship between Body Image and Psychological Well-being in Patients with Morbid Obesity

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Negar Yazdani

2018-04-01

Full Text Available Background: Morbid obesity is rising around the world. It can cause unpleasant appearance and body image. Most of the studies have aimed to evaluate the psychopathology of overweight and obesity and paying attention to mental well-being in morbid obese individuals is rare. Therefore, this study aimed to assess the relationship between body image and psychological well-being in morbid obese patients. Methods: This cross-sectional study, using simple random sampling method, was done on 124 morbid obese patients who referred to obesity clinic in Shiraz from 2016 to 2017. The data were collected by body image index and psychological well-being questionnaire. Results were analyzed using descriptive statistics, Pearson correlation coefficient test, ANOVA, and Regression analysis. Results: The results showed a significant relationship between body image and psychological well-being (r=0.43 (P0.05. Conclusion: Final results indicated that body image defects caused by obesity could lie in negative psychological well-being in all aspects. This study can promote health clinicians’ knowledge in supporting of mental status of obese individuals. It is suggested that preventing and supporting intervention should be performed as effective methods for encountering and coping with psychological effects of obesity.

Decreased serum glicentin concentration in patients with severe and morbid obesity.

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Raffort, Juliette; Panaïa-Ferrari, Patricia; Lareyre, Fabien; Blois, Mathilde; Bayer, Pascale; Staccini, Pascal; Fénichel, Patrick; Chinetti, Giulia

2018-03-01

Background Proglucagon-derived hormones represent a family of peptides mainly produced in the pancreas and the intestine. While several proglucagon-derived peptides play key roles in metabolic diseases, little is known about glicentin. The aim of the present study was to investigate serum glicentin concentrations in individuals with adult obesity and to study its potential link with various metabolic parameters. Methods Fifty-two individuals with normal body mass index (BMI  35 kg/m 2 ) were prospectively included at the University Hospital of Nice between January 2014 and April 2016. Clinical data were recorded, and a fasting blood sample was collected to measure glicentin, glucose, insulin, C-peptide, total cholesterol, triglyceride, LDL and HDL-cholesterol. In addition, a homeostasis model assessment for insulin resistance (HOMA2-IR) was also calculated. Results Patients with severe and morbid obesity had significantly higher plasma glucose, together with higher serum concentrations of insulin, C-peptide, HOMA2-IR, triglyceride, LDL-cholesterol and lower serum concentrations of HDL-cholesterol compared with individuals with a normal body mass index. The obese patients displayed significantly lower fasting serum concentrations of glicentin compared with subjects with a normal body mass index (12 pmol/L vs. 24 pmol/L, P < 0.0001). In the total population, fasting glicentin concentrations did not correlate with BMI, glycaemic parameters (glucose, insulin, C-peptide, HOMA-IR) or lipid parameters (total cholesterol, triglyceride, LDL and HDL-cholesterol). Conclusion To the best of our knowledge, this is the first study reporting serum glicentin concentrations in healthy lean and obese adult subjects. We found that fasting serum glicentin concentrations are decreased in patients with severe or morbid obesity suggesting the potential interest of this peptide in obesity and metabolic-related disorders.

Liver and Cardiovascular Damage in Patients With Lean Nonalcoholic Fatty Liver Disease, and Association With Visceral Obesity.

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Fracanzani, Anna Ludovica; Petta, Salvatore; Lombardi, Rosa; Pisano, Giuseppina; Russello, Maurizio; Consonni, Dario; Di Marco, Vito; Cammà, Calogero; Mensi, Laura; Dongiovanni, Paola; Valenti, Luca; Craxì, Antonio; Fargion, Silvia

2017-10-01

Lean nonalcoholic fatty liver disease (NAFLD) is defined as NAFLD that develops in patients with a body mass index (BMI) less than 25 kg/m 2 . We investigated the differences between lean NAFLD and NAFLD in overweight and obese persons, factors associated with the severity of liver and cardiovascular disease, and the effects of visceral obesity. We performed a retrospective cohort study of 669 consecutive patients with biopsy-proven NAFLD seen at 3 liver centers in Italy. We collected anthropometric, clinical, and biochemical data, as well as information on carotid atherosclerosis (artery intima-media thickness and plaque), liver histology (nonalcoholic steatohepatitis [NASH] and fibrosis), insulin resistance, and diabetes. Overweight was defined as a BMI of 25 to 29.9 kg/m 2 , and obese was defined as a BMI of 30 kg/m 2 or greater. Patients were assigned to groups based on waist circumference, a marker of visceral obesity (low: men, 102 cm, women >88 cm). DNA samples were analyzed for the rs738409 C>G (I148M in PNPLA3), the rs58542926 C>T (E167K in TM6SF2), and single-nucleotide polymorphisms. Variables in men and women were analyzed using chi-squared analysis and the Mann-Whitney or Kruskal-Wallis tests. Multiple linear or logistic regression analyses were adjusted for all the variables of clinical relevance or statistically significant at univariate analyses. The primary outcome was the difference in liver and cardiovascular disease between lean NAFLD and NAFLD in overweight and obese persons. Secondary outcomes were effects of visceral obesity, based on waist circumference, on hepatic, vascular, and metabolic features. Significantly lower proportions of patients with lean NAFLD (143 patients; 43 women; mean age, 46 ± 13 y) had hypertension (P = .001), diabetes (P = .0001), and metabolic syndrome (P = .0001) than overweight or obese patients with NAFLD (526 patients; 149 women; mean age, 49 ± 12 y). Significantly lower proportions of patients with lean

Effect of aquatic interval training with Mediterranean diet counseling in obese patients: results of a preliminary study.

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Boidin, Maxime; Lapierre, Gabriel; Paquette Tanir, Laurie; Nigam, Anil; Juneau, Martin; Guilbeault, Valérie; Latour, Elise; Gayda, Mathieu

2015-10-01

No previous studies have investigated a high-intensity interval training program (HIIT) with an immersed ergocycle and Mediterranean diet counseling (Med) in obese patients. We aimed to compare the effects of an intensive lifestyle intervention, Med and HIIT with a water-immersed versus dryland ergocycle, on cardiometabolic and exercise parameters in obese patients. We retrospectively identified 95 obese patients at their entry into a 9-month Med and HIIT program: 21 were trained on a water-immersed ergocycle and 74 on a standard dryland ergocycle. Body composition, cardiometabolic and exercise parameters were measured before and after the program. For obese patients performing water- and dryland-exercise (mean age 58±9 years versus 55±7 years), BMI was higher for the water- than dryland-exercise group (39.4±8.3kg/m(2) versus 34.7±5.1kg/m(2), Pendurance were similarly improved (PHIIT program with water-cycling is as effective as a dryland program in improving body composition, fasting glucose, triglycerides level, blood pressure and fitness in obese patients. A Mediterranean diet combined with water-cycling HIIT may be efficient for severely obese patients at high risk of musculoskeletal conditions. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Physical Self-Concept, Trait Depression and Readiness for Physical Activity of Obese Patients

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Boros, Szilvia; Halmy, Laszlo

2009-01-01

Study aim: To assess the physical self-concept, trait depression and readiness for physical activity in relation to the degree of obesity. Material and methods: Obese (Grade I and II; n = 59) and morbidly obese (Grade III; n = 42) patients aged 30-66 years, as well as 83 non-obese college students aged 30 [plus or minus] 7.3 years were studied.…

An obesity drug sibutramine reduces brain natriuretic peptide (BNP) levels in severely obese patients.

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Taner Ertugrul, D; Yavuz, B; Okhan Akin, K; Arif Yalcin, A; Ata, N; Kucukazman, M; Algul, B; Dal, K; Sinan Deveci, O; Tutal, E

2010-03-01

Sibutramine is a selective inhibitor of the reuptake of monoamines. Plasma levels of brain natriuretic peptide (BNP) appear to be inversely associated with body mass index (BMI) in subjects with and without heart failure for reasons that remain unexplained. The aim of this study was to investigate the possible influence of sibutramine treatment on BNP levels in severely obese patients. Fifty-two severely obese female patients with BMI > 40 kg/m(2) were included to this study. The women were recommended to follow a weight-reducing daily diet of 25 kcal/kg of ideal body weight. During the treatment period, all patients were to receive 15 mg of sibutramine once a day. Blood chemistry tests were performed before the onset of the medication and after 12 weeks of treatment. None of the subjects was withdrawn from the study because of the adverse effects of sibutramine. Body weight (108.8 +/- 13.3 kg vs. 101.7 +/- 15.6 kg, p sibutramine treatment. Total cholesterol (5.19 +/- 0.90 mmol/l vs. 4.82 +/- 1.05 mmol/l respectively; p sibutramine treatment. Further randomised studies are needed to be conducted to clarify the relationship between sibutramine and BNP.

Initiation of nutritional support is delayed in critically ill obese patients: a multicenter cohort study.

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Borel, Anne-Laure; Schwebel, Carole; Planquette, Benjamin; Vésin, Aurélien; Garrouste-Orgeas, Maité; Adrie, Christophe; Clec'h, Christophe; Azoulay, Elie; Souweine, Bertrand; Allaouchiche, Bernard; Goldgran-Toledano, Dany; Jamali, Samir; Darmon, Michael; Timsit, Jean-François

2014-09-01

A high catabolic rate characterizes the acute phase of critical illness. Guidelines recommend an early nutritional support, regardless of the previous nutritional status. We aimed to assess whether the nutritional status of patients, which was defined by the body mass index (BMI) at admission in an intensive care unit (ICU), affected the time of nutritional support initiation. We conducted a cohort study that reported a retrospective analysis of a multicenter ICU database (OUTCOMEREA) by using data prospectively entered from January 1997 to October 2012. Patients who needed orotracheal intubation within the first 72 h and >3 d were included. Data from 3257 ICU stays were analyzed. The delay before feeding was different according to BMI groups (P = 0.035). The delay was longer in obese patients [BMI (in kg/m²) ≥30; n = 663] than in other patients with either low weight (BMI nutritional status and a delay in nutrition initiation was independent of potential confounding factors such as age, sex, and diabetes or other chronic diseases. In comparison with normal weight, the adjusted RR (95% CI) associated with a delayed nutrition initiation was 0.92 (0.86, 0.98) for patients with low weight, 1.00 (0.94, 1.05) for overweight patients, and 1.06 (1.00, 1.12) for obese patients (P = 0.004). The initiation of nutritional support was delayed in obese ICU patients. Randomized controlled trials that address consequences of early compared with delayed beginnings of nutritional support in critically ill obese patients are needed. © 2014 American Society for Nutrition.

Hypocoagulability does not protect against atherosclerosis in hemophilia A patients with obesity

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Biere-Rafi, S.; Tuinenburg, A.; Haak, B.; Peters, M.; De Groot, E.; Verhamme, P.; Peerlinck, K.; Visseren, F.; Kruip, M.; Gorkom, B.L.-V.; Buller, H.; Gerdes, V.; Schutgens, R.; Kamphuisen, P.

Introduction: Hemophilia A patients have a 50% lower cardiovascular mortality than the general population. Whether this is caused by less atherosclerosis due to hypocoagulability is unclear. We assessed whether hemophilia A patients with obesity, a major atherosclerotic risk factor, have a lower

Barriers to exercise in obese patients with type 2 diabetes.

LENUS (Irish Health Repository)

Egan, A M

2013-07-01

Although regular exercise is a critical component of the management of type 2 diabetes, many patients do not meet their exercise targets. Lack of exercise is associated with obesity and adverse cardiovascular outcomes.

Comparison of Survival Rates, Tumor Stages, and Localization in between Obese and Nonobese Patients with Gastric Cancer

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Hakan Kocoglu

2016-01-01

Full Text Available Purpose. In this study we tried to determine the association between body-mass index (BMI, survival rate, and the stage of tumor at the time of diagnosis in patients with gastric cancer. Methods. A total of 270 gastric cancer patients’ hospital records were retrospectively evaluated. Patients were grouped according to their BMI at the time of tumor diagnosis. Tumor stages at admission were compared according to their BMI values. Results. There were no differences in OS among BMI subgroups (p=0.230. The percent of patients with stage III tumor was significantly higher in nonobese while the percent of stage IV tumor was surprisingly higher in obese patients (p was 0.011 and 0.004, resp.. Percent of patients who did not have any surgical intervention was significantly lower in overweight and obese patients than normal and/or underweight patients. Conclusions. At the time of diagnosis, obese patients had significantly higher percent of stage IV tumor than nonobese patients. Despite of that, there were no differences in survival rates among BMI subgroups. Our study results are consistent with “obesity paradox” in gastric cancer patients. We also did not find any relationship between BMI and localization of gastric tumor.

[Metabolic profile in obese patients with obstructive sleep apnea. A comparison between patients with insulin resistance and with insulin sensitivity].

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Dumitrache-Rujinski, Stefan; Dinu, Ioana; Călcăianu, George; Erhan, Ionela; Cocieru, Alexandru; Zaharia, Dragoş; Toma, Claudia Lucia; Bogdan, Miron Alexandru

2014-01-01

Obstructive sleep apnea syndrome (OSAS) may induce metabolic abnormalities through intermittent hypoxemia and simpathetic activation. It is difficult to demonstrate an independent role of OSAS in the occurrence of metabolic abnormalities, as obesity represents an important risk factor for both OSAS and metabolic abnormalities. to assess the relations between insulin resistance (IR), insulin sensitivity (IS), OSAS severity and nocturnal oxyhaemoglobin levels in obese, nondiabetic patients with daytime sleepiness. We evaluated 99 consecutive, obese, nondiabetic patients (fasting glycemia 5/hour and daytime sleepiness) by an ambulatory six channel cardio-respiratory polygraphy. Hight, weight serum triglycerides (TG), high density lipoprotein-cholesterol (HDL-C) levels were evaluated. Correlations between Apneea Hypopnea Index (AHI), Oxygen Desaturation Index (ODI), average and lowest oxyhaemoglobin saturation (SaO), body mass index (BMI) and insulin resistance or sensitivity were assesed. IR was defined as a TG/ HDL-Cratio > 3, and insulin sensitivity (IS) as a TG/HDL-C ratio obese nondiabetic patients. Preserving insulin sensitivity is more likely when oxyhaemoglobin levels are higher and ODI is lower. Mean lowest nocturnal SaO2 levels seems to be independently involved in the development of insulin resistance as no statistically significant differences were found for BMI between the two groups.

Walking and neighborhood environments for obese and overweight patients: perspectives from family physicians.

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Hong, Yan; Ory, Marcia G; Lee, Chanam; Wang, Suojin; Pulczinksi, Jairus; Forjuoh, Samuel N

2012-05-01

Primary care practitioners can play a significant role in helping patients adopt healthy behaviors such as physical activity (PA). The aim of this qualitative study was to assess family physicians' understanding and perception of the personal and environmental factors influencing PA, especially walking, and factors affecting their counseling of obese patients about environmental motivators and barriers to PA. We conducted five focus groups with 35 family physicians and 14 family medicine residents in four clinics and a residency program affiliated with CenTexNet, a primary care practice-based research network in central Texas. Data were transcribed and analyzed using thematic content analysis. Physicians were aware of the PA guidelines, but not many actually brought up PA during their counseling of patients. Physicians agreed that neighborhood environments are important for walking and reported that their patients often brought up environmental barriers. Physicians recommended walking as an ideal type of PA for obese patients and sidewalks, parks, and trails/tracks with smooth and soft surfaces as ideal places to engage in walking. However, they rarely talked about these factors with their patients due to a perceived ineffectiveness in counseling, an inability to address environmental factors, and time constraints in the medical encounter. While physicians believe neighborhood environments often present many barriers to PA, they still believe that environmental factors are secondary to personal motivation in promoting PA among obese patients. Physicians, if better informed of the growing evidence on the environment-PA links, may be able to facilitate patients' behavior change more effectively.

The Impact of Obesity on Patients Bridged to Transplantation With Continuous-Flow Left Ventricular Assist Devices.

Science.gov (United States)

Clerkin, Kevin J; Naka, Yoshifumi; Mancini, Donna M; Colombo, Paolo C; Topkara, Veli K

2016-10-01

This study sought to determine if obese patients had worse post-left ventricular assist device (LVAD) implantation outcomes and if the implantation of an LVAD allowed for weight loss. Obesity is a risk factor for cardiovascular disease including heart failure. Obese heart failure patients have better outcomes than those with normal weight; however, obese patients have worse outcomes after heart transplantation. Patients were identified in the United Network for Organ Sharing (UNOS) database that underwent LVAD implantation as bridge to transplantation from May 2004 and April 2014, with follow-up through June 2014. Patients were grouped according to body mass index (BMI) based on the World Health Organization classification. Among 3,856 patients, the risk of death or delisting was not significantly different between BMI groups (p = 0.347). There was no increased risk of death (p = 0.234) or delisting (p = 0.918). The risk of complication requiring UNOS status upgrade was increased for those with class II obesity or greater (hazard ratio: 1.48; p = 0.004), driven by increased infection and thromboembolism. Obese patients had worse post-transplantation outcomes. Weight loss substantial enough to decrease BMI group was achieved by a small proportion of patients listed with class I obesity or greater (9.6% to 15.5%). Patients with obesity had similar freedom from death or delisting while on LVAD support. However, class II obese or greater patients had an increased risk of complications requiring UNOS status upgrade compared with those with normal BMI during LVAD support and decreased post-transplantation survival. Weight loss on device therapy was possible, but uncommon. Careful consideration is needed when a bridge to weight loss strategy is proposed. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

GH and cortisol responses following an acute session of respiratory muscle endurance training in severely obese patients.

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Sartorio, A; Agosti, F; Patrizi, A; Gattico, A; Tringali, G; Giunta, M; Muller, E E; Rigamonti, A E

2013-03-01

It is well established that obese patients are hypo-responsive to classical GH-releasing stimuli, including aerobic exercise. Recently, we have demonstrated that whole body vibration was able to markedly stimulate GH secretion in obese patients, thus suggesting that this refractoriness is not absolute but dependent on the GH-releasing stimulus. Furthermore, we have shown the ability of a respiratory muscle endurance training (RMET) to stimulate GH and cortisol secretion in healthy subjects. The objective of this study was to evaluate the effects of RMET on GH and cortisol responses in severely obese patients. Eight severely obese patients (4 M/4 F, mean age±SEM: 22.8±1.6 years, body mass index, BMI: 39.9±1.1 kg/m2) underwent an incremental progressive RMET protocol of 11 daily sessions, obtained through the use of a specifically designed respiratory device (Spiro Tiger®). The 12th session of RMET (15 min duration: 1 min at a respiration rate of 28 acts/min, 5 min at 32 acts/min, 5 min at 34 acts/min, 4 min at 36 acts/min) was associated with blood samplings for determination of GH, cortisol, and lactate (LA) levels. An age- and sex-matched normal-weighted control group (n=7, 4 M/3 F, age: 26.1±3.1 years, BMI: 22.4±0.6 kg/m2) was also recruited. In both normal-weighted subjects and obese patients, GH secretion significantly increased after a 15-min RMET session. Although serum GH levels at 30 min were higher in normal-weighted subjects than in obese patients, there was no statistically significant difference in either GH peaks or net GH areas under the curve between the 2 groups. RMET significantly increased serum cortisol levels in normal-weighted subjects, but was associated to a progressive cortisol decline in obese patients. RMET stimulated LA production, with no significant differences in normal-weighted subjects and in obese patients. A 15-min RMET session was capable to induce a GH response in severely obese patients, which was comparable to that

Frequency of metabolic syndrome and its components in 300 Pakistani obese patients

International Nuclear Information System (INIS)

Khattak, I.; Ishaq, T.; Fida, Z.; Rehman, F.U.

2017-01-01

To assess the frequency of metabolic syndrome (MS) and its constituents in a sample of Pakistani obese patients. Methodology: In this descriptive and cross-sectional study, we used a sample of 300 patients from Khyber Teaching Hospital, Peshawar, Pakistan from April 2016 to November 2016. They were randomly selected and their mean age was between 15 and 25 years. The variables obtained included BMI, both systolic and diastolic blood pressure, cholesterol, fasting blood glucose, triglyceride levels, LDL- cholesterol, HDL-cholesterol, waist to hip ratio, waist circumference and insulin resistance. Results: Of the 300 patients, the frequency of MS was 20%. There were no significant differences in the frequency of developing MS between the genders. The order of frequency of the components as observed was as follows; abdominal obesity was 88%, high triglyceride level was 85%, males were 40%, 40% of the sampled population resided in the urban area. Meanwhile, 35% of the patients had hypertension while only 5% had hyperglycemia. The frequency of developing MS was 70 times higher in patients with high triglyceride levels in their when compared to those with normal levels. Conclusion: The frequency of MS and its components in Pakistani adolescent patients is high. The high levels of triglyceride and a sedentary lifestyle profoundly contributed to MS. Moreover, the findings signify the importance of early treatment and prevention of obesity in working toward reducing the rate of diabetes mellitus type 2; as glucose intolerance had a strong relationship with the components of MS, and cardiovascular diseases such coronary artery disease. (author)

Beneficial Effects of Apelin on Vascular Function in Patients With Central Obesity.

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Schinzari, Francesca; Veneziani, Augusto; Mores, Nadia; Barini, Angela; Di Daniele, Nicola; Cardillo, Carmine; Tesauro, Manfredi

2017-05-01

Patients with central obesity have impaired insulin-stimulated vasodilation and increased ET-1 (endothelin 1) vasoconstriction, which may contribute to insulin resistance and vascular damage. Apelin enhances insulin sensitivity and glucose disposal but also acts as a nitric oxide (NO)-dependent vasodilator and a counter-regulator of AT 1 (angiotensin [Ang] II type 1) receptor-induced vasoconstriction. We, therefore, examined the effects of exogenous (Pyr 1 )apelin on NO-mediated vasodilation and Ang II- or ET-1-dependent vasoconstrictor tone in obese patients. In the absence of hyperinsulinemia, forearm blood flow responses to graded doses of acetylcholine and sodium nitroprusside were not different during saline or apelin administration (both P >0.05). During intra-arterial infusion of regular insulin, however, apelin enhanced the vasodilation induced by both acetylcholine and nitroprusside (both P 0.05). In conclusion, in patients with central obesity, apelin has favorable effects not only to improve insulin-stimulated endothelium-dependent and endothelium-independent vasodilator responses but also to blunt Ang II- and ET-1-dependent vasoconstriction by a mechanism not involving NO. Taken together, our results suggest that targeting the apelin system might favorably impact some hemodynamic abnormalities of insulin-resistant states like obesity. © 2017 American Heart Association, Inc.

Diabetic and Obese Patient Clinical Outcomes Improve During a Care Management Implementation in Primary Care.

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Holtrop, Jodi Summers; Luo, Zhehui; Piatt, Gretchen; Green, Lee A; Chen, Qiaoling; Piette, John

2017-10-01

To address the increasing burden of chronic disease, many primary care practices are turning to care management and the hiring of care managers to help patients coordinate their care and self-manage their conditions. Care management is often, but not always, proving effective at improving patient outcomes, but more evidence is needed. In this pair-matched cluster randomized trial, 5 practices implemented care management and were compared with 5 comparison practices within the same practice organization. Targeted patients included diabetic patients with a hemoglobin A1c >9% and nondiabetic obese patients. Clinical values tracked were A1c, blood pressure, low-density lipoprotein, microalbumin, and weight. Clinically important improvements were demonstrated in the intervention versus comparison practices, with diabetic patients improving A1c control and obese patients experiencing weight loss. There was a 12% relative increase in the proportion of patients meeting the clinical target of A1c management practices lost 5% or more of their body weight as compared with 10% of comparison patients (adjusted relative improvement, 15%; CI, 2%-28%). These findings add to the growing evidence-base for the effectiveness of care management as an effective clinical practice with regard to improving diabetes- and obesity-related outcomes.

The development of hypothalamic obesity in craniopharyngioma patients: A risk factor analysis in a well-defined cohort.

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van Iersel, Laura; Meijneke, Ruud W H; Schouten-van Meeteren, Antoinette Y N; Reneman, Liesbeth; de Win, Maartje M; van Trotsenburg, A S Paul; Bisschop, Peter H; Finken, Martijn J J; Vandertop, W Peter; van Furth, Wouter R; van Santen, Hanneke M

2018-05-01

Hypothalamic obesity (HO) is a major concern in patients treated for craniopharyngioma (CP). The influence of degree of resection on development of HO, event-free survival (EFS), and neuroendocrine sequelae is an issue of debate. A retrospective cohort consisting of all CP patients treated between 2002 and 2012 in two university hospitals was identified. Multivariable logistic regression was used to study the associations between preoperative BMI, age at diagnosis, tumor volume, performed surgical resection, and presence of HO at follow-up. Thirty-five patients (21 children and 14 adults) were included. Median follow-up time was 35.6 months (4.1-114.7). Four patients were obese at diagnosis. HO was present in 19 (54.3%) patients at last follow-up of whom eight were morbidly obese. Thirteen (37.1%) patients underwent partial resection (PR) and 22 (62.9%) gross total resection (GTR). GTR was related to HO (OR 9.19, 95% CI 1.43-59.01), but for morbid HO, obesity at diagnosis was the only risk factor (OR 12.92, 95% CI 1.05-158.73). EFS in patients after GTR was 86%, compared to 42% after PR (log-rank 9.2, P = 0.003). Adjuvant radiotherapy after PR improved EFS (log-rank 8.2, P = 0.004). Panhypopituitarism, present in 15 patients, was mainly seen after GTR. HO is less frequent after PR than after GTR, but PR cannot always prevent the development of morbid obesity in patients with obesity at diagnosis. PR reduces the occurrence of panhypopituitarism. When developing a treatment algorithm, all these factors should be considered. © 2018 Wiley Periodicals, Inc.

in the assessment of the rate of disability in patients with morbid obesity – pilot study

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Krystyn Sosada

2017-06-01

Full Text Available Background. Due to the constant increase in the number of morbidly obese patients, an adequate tool for assessing the functioning and disability of these patients is being sought. The International Classification of Functioning, Disability and Health (IC F could be that tool. Objectives. The aim of this study is to examine the usefulness of the IC F scale in assessing the functioning of morbidly obese patients in two selected areas in reference to recognized scales. Material and methods . The study group included 76 patients with morbid obesity qualified for bariatric treatment. The ICF was applied to assess the function and limitations of each individual. Two domains of the IC F were selected: Body Functions and Structures and Activities and Participation. The usefulness of the IC F was compared to that of the Barthel and EPQ-R scales. Results . In morbidly obese patients, a correlation between motor functions and IC F and BMI, as well as age, was observed. A significant correlation was observed between BMI and psychomotor control, appropriateness and range of emotions experienced, age and amount of sleep, quality of sleep, memory retrieval and psychomotor functions. Women’s mental functions were significantly worse than those of men. In terms of interpersonal relations, a correlation between BMI and regulating behavior within interactions was observed. Conclusions . The IC F is a useful tool for the study and description of the functioning of patients with morbid obesity. The selected domains are described better than by the previously used Barthel scale. Women with morbid obesity tend to have more impaired mental functioning than morbidly obese men.

Obesity and dyslipidemia in patients with psoriasis treated at a dermatologic clinic in Manaus*

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Santos, Mônica; Fonseca, Hannah Monteiro; Jalkh, Alex Panizza; Gomes, Gabriela Piraice; Cavalcante, Andrea de Souza

2013-01-01

BACKGROUND Psoriasis is a chronic inflammatory disease of multifactorial etiology, with participation of genetic, autoimmune and environmental factors. Recent studies have demonstrated the role of inflammatory cells and mediators in the pathogenesis of psoriasis, which is now defined as a systemic and autoimmune inflammatory disease that may be associated with other diseases of inflammatory nature. OBJECTIVES To evaluate the occurrence of obesity and dyslipidemia in patients with psoriasis treated at a dermatology clinic in Manaus. METHODS We performed a prospective descriptive study to assess the prevalence of obesity and dyslipidemia in patients with psoriasis. Besides the recommended dermatological care, a physical examination was performed to measure weight, height and waist circumference. RESULTS We included 72 patients, 44 (61.1%) female and 28 (38.9%) male, with a mean age of 51.0 years ± 15.9 years. As for body mass index (BMI), 16 (22.2%) were overweight and 20 (27.8%) were obese. In the analysis of waist circumference in relation to gender, we found that 79.5% of women surveyed had central obesity, a percentage statistically higher than that observed among men (42.9%) at the 5% level of significance (p = 0.001). Regarding the diagnosis of dyslipidemia, 29 (65.9%) females and 22 (78.6%) males showed alterations in lipid profile. CONCLUSIONS The occurrence of dyslipidemia and obesity in patients with psoriasis can affect life quality and expectancy, increasing the risk of systemic and metabolic diseases, which makes periodic investigation of these comorbidities in patients with psoriasis mandatory. PMID:24474099

The changes of serum leptin and insulin contents in elderly male patients with obesity-related hypertension

International Nuclear Information System (INIS)

Zhan Hao; Huang Daijuan; Yuan Bin; He Yong; Zhang Yongxue

2004-01-01

To study the contents of serum leptin and insulin in elderly male patients with obesity-related hypertension, the levels of serum leptin and insulin in 21 normotensive cases and 41 hypertensive cases of them were determined by RIA. The results showed that the levels of serum leptin and insulin between hypertensives and normotensives in the non-obese groups were not significantly different (P>0.05). Compared with normotensives, the levels of serum leptin and insulin of hypertensives in the obese groups remarkably increased 1.8μg/L and 2.7 mIU/L respectively (P<0.01). The levels of serum leptin and insulin in the patients with obesity - related hypertension were markedly higher than those in the patients with non-obesity-related hypertension and elevated 2.7μg/L and 4.7mIU/L (P<0.01) respectively. Insulin-sensitivity index (ISI) successively decreased in the groups of HBPOb, NBPOb, HBPNOb and NBPNOb (relative ISI 0.50, 0.68, 0.92, 1 respectively). It is concluded that leptin-resistance and insulin-resistance exist in male elderly patients with obesity-related hypertension

Possibly preventable cardiac arrest in a morbidly obese patient - a comment on the 2015 ERC guidelines.

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Hans, Felix Patricius; Hoeren, Claudia Johanna Maria; Kellmeyer, Phillipp; Hohloch, Lisa; Busch, Hans-Jörg; Bayer, Jörg

2016-10-04

The incidence of overweight and obesity has been steadily on the rise and has reached epidemic proportions in various countries and this represents a well-known major health problem. Nevertheless, current guidelines for resuscitation do not include special sequences of action in this subset of patients. The aim of this letter is to bring this controversy into focus and to suggest alterations of the known standard cardiopulmonary resuscitation in the obese. An obese patient weighing 272 kg fell to the floor, afterwards being unable to get up again. Thus, emergency services were called for assistance. There were no signs or symptoms signifying that the person had been harmed in consequence of the fall. Only when brought into a supine position the patient suffered an immediate cardiac arrest. Cardiopulmonary resuscitation was performed but there was no return of a stable spontaneous circulation until the patient was brought into a full lateral position. In spite of immediate emergency care the patient ultimately suffered a lethal hypoxic brain damage. A full lateral position should be considered in obese patients having a cardiac arrest as it might help to re-establish stable circulatory conditions.

Consumption of Two Healthy Dietary Patterns Restored Microbiota Dysbiosis in Obese Patients with Metabolic Dysfunction.

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Haro, Carmen; García-Carpintero, Sonia; Rangel-Zúñiga, Oriol A; Alcalá-Díaz, Juan F; Landa, Blanca B; Clemente, José C; Pérez-Martínez, Pablo; López-Miranda, José; Pérez-Jiménez, Francisco; Camargo, Antonio

2017-12-01

The consumption of two healthy diets (Mediterranean (MED) and low-fat (LF) diets) may restore the gut microbiome dysbiosis in obese patients depending on the degree of metabolic dysfunction. The differences in bacterial community at baseline and after 2 years of dietary intervention of 106 subjects from the CORDIOPREV study were analyzed, 33 of whom were obese patients with severe metabolic disease (5 criteria for metabolic syndrome) (MetS-OB), 32 obese patients without metabolic dysfunction (2 or less criteria for metabolic syndrome) (NonMetS-OB) and 41 non-obese subjects (NonMetS-NonOB). Our study showed a marked dysbiosis in people with severe metabolic disease (Met-OB), compared with obese people without MetS (NonMetS-OB) and non-obese people (NonMetS-NonOB). This disbiotic pattern was reversed by consumption of both MED (35% of calories as fat (22% MUFA fat, 6% PUFA fat and <10% saturated fat) or LF (<30% total fat (<10% saturated fat, 12%-14% MUFA fat and 6-8% PUFA fat) diets, whereas no significant microbiota changes were observed in NonMetS-NonOB and NonMetS-OB groups. Our results suggest that the chronic intake of two healthy dietary patterns partially restores the gut microbiome dysbiosis in obese patients with coronary heart disease, depending on the degree of metabolic dysfunction. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Predictors of psychological symptoms in morbidly obese patients after gastric bypass surgery.

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Ortega, Joaquin; Fernandez-Canet, Regina; Alvarez-Valdeita, Sagrario; Cassinello, Norberto; Baguena-Puigcerver, Maria Jose

2012-01-01

Morbid obesity is associated with debilitating psychosocial consequences, such as depression, anxiety, and low self-esteem. One of the main goals of bariatric surgery should not only be reducing weight and counteracting co-morbid conditions, but also improving postoperative psychosocial functioning. The objective of our study was to determine the preoperative variables that could predict the psychological symptoms 6 and 12 months after surgery to improve the clinical outcome of morbidly obese patients undergoing bariatric surgery. The setting was a university hospital in Spain. The study group consisted of 60 morbidly obese patients (46 women and 14 men) who had undergone gastric bypass surgery for weight reduction and had ≥ 1 year of follow-up. The patients were evaluated using different questionnaires (Symptom Checklist-90-Revised, Body Shape Questionnaire, Rosenberg Self-Esteem Questionnaire, COPE, Medical Outcomes Study Social Support Survey) at 3 points: before surgery, at 6 months postoperatively, and at 1 year postoperatively. To determine the influence of preoperative variables on long-term psychological status, a step-by-step multivariate linear regression analysis was performed, taking P self-esteem, instrumental support, and coping focused in the emotions were the main preoperative predictors for psychological symptoms 6 months after surgery. Preoperative drug abuse as a strategy of problem solving and mainly body image significantly predicted most of the psychological disorders 1 year after surgery. The study of different psychosocial variables in patients before bariatric surgery is an important aid to predict postoperative psychological functioning. Self-esteem and body image were the most influential factors in the postoperative psychological outcome of morbidly obese patients in our study. Copyright © 2012 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Evaluation of effective dose from CT scans for overweight and obese adult patients using the VirtualDose software

International Nuclear Information System (INIS)

Liang, Baohui; Gao, Yiming; Chen, Zhi; Xu, X. George

2017-01-01

This paper evaluates effective dose (ED) of overweight and obese patients who undergo body computed tomography (CT) examinations. ED calculations were based on tissue weight factors in the International Commission on Radiological Protection Publication 103 (ICRP 103). ED per unit dose length product (DLP) are reported as a function of the tube voltage, body mass index (BMI) of patient. The VirtualDose software was used to calculate ED for male and female obese phantoms representing normal weight, overweight, obese 1, obese 2 and obese 3 patients. Five anatomic regions (chest, abdomen, pelvis, abdomen/pelvis and chest/abdomen/pelvis) were investigated for each phantom. The conversion factors were computed from the DLP, and then compared with data previously reported by other groups. It was observed that tube voltage and BMI are the major factors that influence conversion factors of obese patients, and that ED computed using ICRP 103 tissue weight factors were 24% higher for a CT chest examination and 21% lower for a CT pelvis examination than the ED using ICRP 60 factors. For body CT scans, increasing the tube voltage from 80 to 140 kVp would increase the conversion factors by as much as 19-54% depending on the patient's BMI. Conversion factor of female patients was ∼7% higher than the factors of male patients. DLP and conversion factors were used to estimate ED, where conversion factors depended on tube voltage, sex, BMI and tissue weight factors. With increasing number of obese individuals, using size-dependence conversion factors will improve accuracy, in estimating patient radiation dose. (authors)

Clinical experience with a C-section surgical technique in patients with morbid obesity: a case series

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Mayra Elena Hernández Carrazco

2014-07-01

Full Text Available Obesity is a public health challenge that has crossed into the area of reproductive health. An obese pregnant woman has multiple complications before, during, and after pregnancy. Likewise, cesarean section is more difficult and has slower recovery times in this group of patients. This paper proposes a surgical technique adapted to the morbidly obese pregnant patient that aims to reduce cesarean section complications

Combined Oocyte Retrieval and Robot-assisted Hysterectomy in a Super Morbidly Obese Patient with Endometrial Carcinoma.

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Chung, Esther H; Brady, Paula C; Smith, Kimberly Keefe; Davis, Michelle R; Muto, Michael G; Ashby, Rachel K; Ginsburg, Elizabeth S

2018-03-01

To report on the unique, innovative management of a super morbidly obese patient presenting for fertility preservation in the setting of Grade 2 endometrioid endometrial adenocarcinoma. A back-to-back oocyte retrieval and robot-assisted total laparoscopic hysterectomy (RA-TLH) with bilateral salpingo-oophorectomy (BSO) was performed in a 37-year-old nulligravid woman with super morbid obesity (BMI 63 kg/m 2 ) with endometrial cancer. the successful retrieval of oocytes for fertility preservation and oncologic intervention via RA-TLH with BSO in the same operative and anesthetic episode. This combined procedure strategy was successful in our case and is a feasible option for similar high-risk patients in the future. Identifying safe and effective approaches for oocyte retrieval in morbidly obese patients represents a pressing need as obesity rates rise among reproductive-aged women. Back-to-back oocyte retrieval and RA-TLH with BSO are not only feasible, but could also decrease significant anesthetic risks for morbidly obese patients. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

ACE Gene I/D Polymorphism and Obesity in 1,574 Patients with Type 2 Diabetes Mellitus.

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Pan, Yan-Hong; Wang, Min; Huang, Yan-Mei; Wang, Ying-Hui; Chen, Yin-Ling; Geng, Li-Jun; Zhang, Xiao-Xi; Zhao, Hai-Lu

2016-01-01

Association between ACE gene I/D polymorphism and the risk of overweight/obesity remains controversial. We investigated the possible relationship between ACE gene I/D polymorphism and obesity in Chinese type 2 diabetes mellitus (T2DM) patients. In this study, obesity was defined as a body mass index (BMI) value ≥ 25 kg/m 2 and subjects were classified into 4 groups (lean, normal, overweight, and obese). PCR (polymerase chain reaction) was used to detect the ACE gene I/D polymorphism in T2DM patients. Metabolic measurements including blood glucose, lipid profile, and blood pressure were obtained. Frequencies of the ACE genotypes (DD, ID, and II) were not significant among the 4 groups of BMI-defined patients ( P = 0.679) while ACE II carriers showed higher systolic blood pressure (SBP) and pulse pressure (PP) (all P ACE gene I/D polymorphism with obesity is insignificant in Chinese patients with T2DM. SBP and PP might be higher in the ACE II carriers than in the DD and ID carriers.

The impact of obesity on clinical, metabolic and hormonal features in patients with polycystic ovary syndrome

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Serap Baydur Şahin

2014-12-01

Full Text Available Objectives: Our aim was to compare the clinical, hormonal and metabolic features between overweight and obese patients with PCOS and normal weight women with polycystic ovary syndrome (PCOS. Methods: 119 patients with PCOS (15-39 years were included in the study. We evaluated anthropometric, hormonal and metabolic parameters in all patients. Results: Ferriman- Gallwey hirsutism score was similar in overweight or obese patients with PCOS (n=78 and normal weight patients with PCOS (n=41 (p=0.373. While 71.8% of the obese group had irregular menses, this ratio was 60.9% in normal weight group (p=0.160. HOMA-IR values were higher in the obese group (1.7±0.7 vs 3.3±1.7, p<0.001. Serum triglyceride (87.2±49.8 vs. 123.4±65.3 mg/dl and LDL-cholesterol levels (104.5±29.4 vs 121.7±32.9 mg/dl were higher in obese group than the normal weight group (p=0.002, p=0.006. HDL-cholesterol levels were lower in obese group (46.5±11 vs 56.7±11.7 mg/dl, p<0.001. Free testosterone levels were 3.54±2.5 pg/ml in overweight and obese group and 2.36 ± 1.2 pg/ml in normal weight group (p = 0.016. While BMI was positively correlated with age (r=0.210, waist circumference (r=0.916, systolic (r=0.238 and diastolic blood pressure (r=0.181, insulin (r=0.635, HOMA-IR (r=0.650, total-C ( r=0.242, LDL-C (r=0.295, triglyceride (r=0.424 and total testosterone (r=0.230, it was negatively correlated with HDL-C (r=-0.476. Conclusion: Obesity did not influence hirsutism and menstruel regularity in patients with PCOS in this study, however obesity deteriorated insulin sensitivity and lipid profile. J Clin Exp Invest 2014; 5 (4: 567-571

Clinical implications of gait analysis in the rehabilitation of adult patients with "Prader-Willi" Syndrome: a cross-sectional comparative study ("Prader-Willi" Syndrome vs matched obese patients and healthy subjects

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Baccalaro Gabriele

2007-05-01

Full Text Available Abstract Background Being severely overweight is a distinctive clinical feature of Prader-Willi Syndrome (PWS. PWS is a complex multisystem disorder, representing the most common form of genetic obesity. The aim of this study was the analysis of the gait pattern of adult subjects with PWS by using three-Dimensional Gait Analysis. The results were compared with those obtained in a group of obese patients and in a group of healthy subjects. Methods Cross-sectional, comparative study: 19 patients with PWS (11 males and 8 females, age: 18–40 years, BMI: 29.3–50.3 kg/m2; 14 obese matched patients (5 males and 9 females, age: 18–40 years, BMI: 34.3–45.2 kg/m2; 20 healthy subjects (10 males and 10 females, age: 21–41 years, BMI: 19.3–25.4 kg/m2. Kinematic and kinetic parameters during walking were assessed by an optoelectronic system and two force platforms. Results PWS adult patients walked slower, had a shorter stride length, a lower cadence and a longer stance phase compared with both matched obese, and healthy subjects. Obese matched patients showed spatio-temporal parameters significantly different from healthy subjects. Furthermore, Range Of Motion (ROM at knee and ankle, and plantaflexor activity of PWS patients were significantly different between obese and healthy subjects. Obese subjects revealed kinematic and kinetic data similar to healthy subjects. Conclusion PWS subjects had a gait pattern significantly different from obese patients. Despite that, both groups had a similar BMI. We suggest that PWS gait abnormalities may be related to abnormalities in the development of motor skills in childhood, due to precocious obesity. A tailored rehabilitation program in early childhood of PWS patients could prevent gait pattern changes.

The Effect of Peptide YY3-36 in Body Mass Regulation in Patients with Exogenous Constitutional Obesity

OpenAIRE

Alexander S. Ametov PhD, ScD³; Yuliya Y. Vlasova, PhD¹²

2012-01-01

The article deals with PYY3-36 level in the blood serum of patients suffering from exogenous constitutional obesity and overweight, as well as its role in the process of the body mass growth. Among the 327 patients diagnosed with obesity and overweight, particularly those with Class I and II degrees of obesity (p

Procedural Complications of Spinal Anaesthesia in the Obese Patient

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Manuel Wenk

2012-01-01

Full Text Available Background. Complications of spinal anaesthesia (SpA range between 1 and 17%. Habitus and operator experience may play a pivotal role, but only sparse data is available to substantiate this claim. Methods. 161 patients were prospectively enrolled. Data such as spread of block, duration of puncture, number of trials, any complication, operator experience, haemodynamic parameters, was recorded and anatomical patient habitus assessed. Results. Data from 154 patients were analyzed. Success rate of SpA in the group of young trainees was 72% versus 100% in the group of consultants. Trainees succeeded in patients with a normal habitus in 83.3% of cases versus 41.3% when patients had a difficult anatomy (P=0.02. SpA in obese patients (BMI ≥ 32 was associated with a significantly longer duration of puncture, an increased failure ratio when performed by trainees (almost 50%, and an increased number of bloody punctures. Discussion. Habitus plays a pivotal role for SpA efficiency. In patients with obscured landmarks, failure ratio in unexperienced operators is high. Hence, patient prescreening as well as adequate choice of operators may be beneficial for the success rate of SpA and contribute to less complications and better patient and trainee satisfaction.

Effect of overweight and obesity on weight loss and length of stay in patients with walled-off pancreatic necrosis

DEFF Research Database (Denmark)

Rysgaard, Sisse; Rasmussen, Ditlev; Novovic, Srdan

2017-01-01

as overweight, and ≥30 kg/m2 as obesity. The Nutritional Risk Screening score-2002 was calculated to identify patients at risk for undernutrition. Results We included 38 patients (61% men, 68% with infected necrosis; 40% normal weight; 60% overweight/obesity). Four patients (11%) required treatment at the semi......-intensive care unit, 11 (29%) developed pneumonia, and 10 (26%) developed septicemia. One patient died due to respiratory failure and hemorrhage. The remaining patients were discharged after a median of 49 d (36–64 d). During admission, 14 patients (38%) achieved an energy–protein intake of at least 75% and 17...... (46%) achieved ≥70% coverage. The percentage weight loss was different (P obesity (14%). There was no difference between groups regarding percentage of energy or protein coverage. Patients with overweight/obesity had a longer hospital...

Skin tags associated with obesity and diabetes mellitus in patients with chronic kidney disease

OpenAIRE

Sari Funda; Inci Ayca; Dolu Suleyman; Sari Ramazan

2017-01-01

Introduction/Objective. Both chronic kidney disease and skin tags are associated with similar cardiovascular risk factors such as obesity, diabetes mellitus, dyslipidemia, hypertension, etc. The aim of this study was to determine the prevalence of skin tags in patients with chronic kidney disease, and to assess the relationship between skin tags and cardiovascular risk factors such as diabetes, hypertension, dyslipidemia, obesity, and metabolic syndrome. Methods. We evaluated 358 patients [14...

Aspirin responsiveness changes in obese patients following bariatric surgery.

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Norgard, Nicholas B; Monte, Scott V; Fernandez, Stanley F; Ma, Qing

2017-08-01

Bariatric surgery has emerged as a promising treatment option for weight loss and to counter the metabolic consequences of obesity. Obesity has been linked to a hyperaggregable state, as well as a blunted response to aspirin. This pilot study assessed the hypothesis that bariatric surgery would lead to an improvement in aspirin-induced platelet inhibition and a reduction in platelet aggregability. Fifteen patients scheduled to undergo bariatric surgery were administered two 7-day courses of aspirin 81 mg: the first course administered before surgery and the second was 3 months following surgery. Platelet aggregation was measured before and after each aspirin course using VerifyNow-Aspirin. The primary endpoint was the change in on-treatment aspirin reactive units (ARU) pre- and postsurgery. Data from bariatric surgery study patients were compared to data of normal weighted subjects gathered in a previous study. Roux-en-Y gastric bypass was performed in 80%, and 20% underwent sleeve gastrectomy. The mean starting body mass index (BMI) was 46.9 kg/m 2 . Patients lost on average 24.5 kg, resulting in a postsurgical BMI of 38.5 kg/m 2 . Postbariatric surgery, off-treatment ARU was significantly reduced from presurgery levels (602±59 vs 531±78; P=.035). On-aspirin platelet reactivity was also significantly reduced following surgery (469±60 vs 432±143, P=.03). There was a significant correlation between the extent of weight loss and the degree of improvement in on-aspirin platelet reactivity (r 2 =.49, P=.024). Presurgery on-aspirin platelet reactivity was significantly higher in obese patients compared to normal weighted subjects (469±60 vs 419±52; P=.016) and reduced to the baseline after the surgery (432±63 vs 419±52; P=.54). Aspirin-induced platelet inhibition may be more potent following bariatric surgery. The mechanisms behind this improvement require further investigation. © 2017 John Wiley & Sons Ltd.

Associated cutaneous diseases in obese adult patients: a prospective study from a skin referral care center.

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Al-Mutairi, Nawaf

2011-01-01

The aim of the present study was to determine the spectrum of skin diseases seen among adult obese patients referred to Farwaniya Hospital. A total of 437 overweight/obese subjects (200 men and 237 women) aged 18-74 years were enrolled in the study, which was conducted from October 2008 to November 2009. Demographic details such as age, sex, occupation, personal and family history of diabetes mellitus, hypertension, and obesity were recorded. A thorough examination was performed by an experienced dermatologist (N.A.M.). Blood investigations such as complete blood count, fasting and postprandial blood sugar levels, liver function tests, kidney function tests, lipid profile, and thyroid function tests were done for all patients in addition to hormonal assay and abdominal sonar to exclude polycystic ovary disease for indicated patients. Common skin diseases found among these patients were plantar hyperkeratosis: n = 197; acanthosis nigricans: n = 144; skin tags: n = 131; striae cutis distensae: n = 102; intertrigo: n = 97; acne vulgaris: n = 94. Diabetes mellitus was diagnosed in 87 patients, polycystic ovary syndrome/hyperandrogenism in 74 female patients, and hyperlipidemia in 209 patients. This study shows that certain dermatoses such as plantar hyperkeratosis, acanthosis nigricans, skin tags, striae cutis distensae, and intertrigo are more common among obese persons. Some, such as plantar hyperkeratosis, could serve as markers of obesity and its severity, while the presence of acanthosis nigricans and skin tags may point to underlying internal disease such as diabetes and polycystic ovary syndrome. Copyright © 2011 S. Karger AG, Basel.

Performance in neurocognitive tasks in obese patients. Does somatic comorbidity matter?

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Wibke eKiunke

2013-08-01

Full Text Available The aim of the present study was to examine if obese individuals with obesity-related somatic comorbidity (i.e., hypertension, diabetes, sleep apnea, dyslipidemia, pain disorder perform worse in neurocognitive tasks compared to obese individuals without any somatic disorder. Neurocognitive functioning was measured by a computerized test battery that consisted of the following tasks: Corsi Block Tapping Test, Auditory Word Learning Task, Trail Making Test-Part B, Stroop Test, Labyrinth Test, and a 4-disk version of the Tower of Hanoi. The total sample consisted of 146 patients, the majority (N=113 suffered from obesity grade 3, 26 individuals had obesity grade 2, and only 7 individuals obesity grade 1. Ninety-eight participants (67.1% reported at least one somatic disorder (Soma+-group. Hypertension was present in 75 individuals (51.4%, type 2 diabetes in 34 participants (23.3%, 38 individuals had sleep apnea (26.0%, 16 suffered from dyslipidemia (11.0%, and 14 individuals reported having a chronic pain disorder (9.6%. Participants without a coexisting somatic disorder were younger (MSoma-=33.7, SD=9.8 vs. MSoma+=42.7, SD=11.0, F(1,144=23.01, p<0.001 and more often female (89.6% and 62.2%, χ2(1= 11.751, p=0.001 but did not differ with respect to education, regular binge eating or depressive symptoms from those in the Soma+-group. The Soma--group performed better on cognitive tasks related to memory and mental flexibility. However, the group differences disappeared completely after controlling for age. The findings indicate that in some obese patients increasing age may not only be accompanied by an increase of obesity severity and by more obesity-related somatic disorders but also by poorer cognitive functioning.

Growth hormone and insulin-like growth factor-1 in prognosis coronary artery disease in patients with obesity

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Olga Viktorovna Shpagina

2014-10-01

Conclusion: 1. IGF-1 may be a useful indicator to assess the prognosis of CAD and CHF in patients with obesity. 2. Relative GH deficiency was more often associated with severe CAD in patients with obesity.

Treatment of obese patients with binge eating disorder using topiramate: a review

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Paolo Leombruni

2009-07-01

Full Text Available Paolo Leombruni, Luca Lavagnino, Secondo FassinoDepartment of Neurosciences, Psychiatry Section, University of Torino, Centre for Eating Disorders and Obesity, Torino, ItalyAbstract: Topiramate is an anticonvulsant drug used for the treatment of epilepsy and prophylaxis of migraine. Some authors have proposed its use as a mood stabilizer and have reported its efficacy in reducing impulsiveness and improving mood regulation, possibly via its antagonism to glutamatergic transmission in the lateral hypothalamus, although this indication is still controversial. Weight loss is a side effect consistently reported in the medical literature in patients treated with topiramate. Given its potential role in stabilizing mood and reducing impulse control problems and weight, topiramate has been proposed as a treatment for obese patients with binge eating disorder (BED. The aim of this paper is to review published data on the efficacy and safety of topiramate for the treatment of obese subjects with BED. Although the evidence is preliminary, topiramate appears to be a relatively safe and effective treatment for obese subjects with BED. Limitations of the studies and future directions for research are discussed.Keywords: topiramate, binge eating disorder, obesity

Better prognosis in overweight/obese coronary heart disease patients with high plasma levels of leptin.

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Simiti, Luminita Animarie Vida; Todor, Irina; Stoia, Mirela Anca; Goidescu, Cerasela Mihaela; Anton, Florin Petru; Farcas, Anca Daniela

2016-01-01

The involvement of leptin in atherosclerosis is very complex, including inflammation, the oxidative stress and thrombosis. Leptin has atherogenic and also antiatherogenic actions. In obesity elevated leptin levels are not sufficient to prevent disturbances of energy balance, suggesting that obese people are leptin resistant. The aim of the study was to investigate the relationship between baseline plasma levels of leptin and the incidence of new ischemic events in patients with CHD. Plasma levels of leptin in fifty nine consecutive patients (29 men and 30 women) with CHD hospitalized in the County Emergency Clinical Hospital of Cluj-Napoca were measured using commercially available ELISA at admission. Patients with active infectious disease, neoplasia, acute coronary syndrome, stroke, hepatic or renal failure and severe heart failure were excluded The relationship between leptin levels and incident cardiovascular events (angina, nonfatal myocardial infarction or heart failure) over two years follow-up was studied using MEDCALC version 9.6. 73.6% patients with CHD were overweight or suffered of obesity. There were no significant differences between women and men regarding the plasma levels of leptin, the body mass index (BMI), the number of rehospitalizations, rehospitalizations/patient, diabetes mellitus, hypertension or dyslipidemia. Only in women plasma levels of leptin are correlated with BMI. As compared with men with overweight and obesity (BMI≥25kg/m(2)), plasma levels of leptin were significantly higher in women with overweight and obesity (3905.97±463.91 pg/ml vs 1835.17±533.9 pg/ml) (p2000 pg/ml and BMI >28kg/m(2) had a better prognosis, suggesting a protective role of leptin in overweight/mild obesity.

Increased relative risk of subsequent affective disorders in patients with a hospital diagnosis of obesity

DEFF Research Database (Denmark)

Thomsen, A F; Kvist, T K; Andersen, P K

2006-01-01

OBJECTIVE: To investigate the risk of clinical affective disorders of patients who were hospitalized because of obesity in the study period 1 January 1977 to 31 December 1999. METHOD: Using data from Danish hospital registers, three study cohorts were identified by their diagnoses at discharge from...... discharged with an index diagnosis was identified. In total, 1081 events occurred in the observation period. An index diagnosis of obesity was associated with an increased risk of affective-disorders hospitalization when compared with patients with osteoarthritis (Rate ratio: 1.35 (95% CI: 1.......09-1.67)) and tended to be associated with an increased risk when compared to patients with non-toxic goiter (Rate ratio: 1.23 (95% CI: 0.99-1.53)). Patients with obesity diagnoses who did not have additional hospital diagnoses of substance- or alcohol abuse had a risk of affective disorders that was 1.55 (95% CI: 1...

Should dosing of rocuronium in obese patients be based on ideal or corrected body weight?

DEFF Research Database (Denmark)

Meyhoff, Christian S; Lund, Jørgen; Jenstrup, Morten T

2009-01-01

BACKGROUND: Pharmacokinetic studies in obese patients suggest that dosing of rocuronium should be based on ideal body weight (IBW). This may, however, result in a prolonged onset time or compromised conditions for tracheal intubation. In this study, we compared onset time, conditions for tracheal...... intubation, and duration of action in obese patients when the intubation dose of rocuronium was based on three different weight corrections. METHODS: Fifty-one obese patients, with a median (range) body mass index of 44 (34-72) kg/m2, scheduled for laparoscopic gastric banding or gastric bypass under...... propofol-remifentanil anesthesia were randomized into three groups. The patients received rocuronium (0.6 mg/kg) based on IBW (IBW group, n = 17), IBW plus 20% of excess weight (corrected body weight [CBW]20% group, n = 17), or IBW plus 40% of excess weight (CBW40% group, n = 17). Propofol was administered...

Gender differences in respiratory disturbance, sleep and daytime sleepiness in hypertensive patients with different degrees of obesity.

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Broström, Anders; Sunnergren, Ola; Nilsen, Per; Fridlund, Bengt; Ulander, Martin; Svanborg, Eva

2013-04-01

Hypertension (HT) and obesity have both been linked to obstructive sleep apnoea (OSA). Difficulties have been described in identifying patients with OSA in primary care, causing low referral rates to sleep clinics. Increased knowledge about gender-specific characteristics and symptoms may help to identify patients. The aim was to describe gender differences regarding undiagnosed OSA, self-rated sleep, insomnia and daytime sleepiness in middle-aged primary care patients with HT and different degrees of obesity. A cross-sectional design was used and 394 patients (52.5% women), mean age 57.8 years (SD 6.7 years), with HT (BP >140/90 mmHg) were included. Clinical examinations, respiratory recordings and self-rated scales regarding OSA symptoms, sleep, insomnia and daytime sleepiness were used. Body mass index (BMI) was classified according to the criteria from the National Institutes of Health. Pre-obesity and obesity classes I and II were seen among 53%, 26% and 8% of the men and 37%, 19% and 14% of the women, respectively. Occurrence of mild, moderate and severe OSA increased significantly across the BMI classes for both genders (pobesity class II had OSA. Insomnia was prevalent in obese patients. Other clinical variables did not differ between BMI classes or genders. The occurrence of overweight/obesity and OSA was high among both genders. A high BMI might be a convenient clinical marker for healthcare personnel to identify hypertensive patients with possible OSA in need of further evaluation and treatment.

Effect of weight maintenance on symptoms of knee osteoarthritis in obese patients

DEFF Research Database (Denmark)

Christensen, Robin; Henriksen, Marius; Leeds, Anthony R

2015-01-01

Objective To compare results of obese patients with knee osteoarthritis (OA) who, after an intensive weight loss regimen, received 1 year of either Dietary support (D), knee-Exercise program (E), or Control (C) "no attention". Methods Randomized, two-phase, parallel-group trial. 192 obese...... of maintenance program. © 2014 American College of Rheumatology....

Obesity in Ireland in 2008: what radiological equipment is available to image the obese patient?

LENUS (Irish Health Repository)

Campbell, N

2009-04-01

Obesity is a global epidemic, responsible for 2000 premature deaths in Ireland each year. The extent of this epidemic was quantified by the National Taskforce on Obesity (IOTF), whose report, published in 2005, found that 39% of adults in Ireland were overweight and 18% obese with obesity in adults predicted to increase by 1% per year. In light of the clear evidence that we, as a nation, are quite literally expanding, how well equipped are Irish hospitals and, in particular, radiology departments, to deal with patients of increasing size and weight? The purpose of this study was to quantify the weight limits and girth restrictions of the radiology equipment, in particular CT, MRI and fluoroscopy, in hospitals, both public and private, in Ireland in an attempt to answer this question.

Lipogenic potential of liver from morbidly obese patients with and without non-insulin-dependent diabetes

International Nuclear Information System (INIS)

Barakat, H.A.; McLendon, V.D.; Carpenter, J.W.; Marks, R.H.; Legett, N.; O'Brien, K.; Caro, J.F.

1991-01-01

Intra-abdominal liver biopsies were obtained during surgery from fasted obese patients with non-insulin-dependent diabetes mellitus (NIDDM), obese normoglycemic controls, and lean controls. Lipid synthesis was studied in freshly isolated hepatocytes and liver homogenates from the three groups of subjects. Incorporation of 3H2O into the lipids of hepatocytes was determined in the absence and presence of insulin (0.1 mumol/L). The activities of five enzymes involved in fatty acid synthesis, and the incorporation of 14C-glycerol-3-phosphate into lipids were determined in liver homogenates. Basal lipid synthesis by hepatocytes was not different in the three groups of patients. Insulin stimulated lipogenesis by 8% +/- 30% in the lean controls, 33% +/- 8% in the obese controls and 17% +/- 6% in the NIDDM patients. No significant differences in the activities of the five enzymes that are involved in de novo fatty acid synthesis among the three groups of patients were observed. Similarly, incorporation of 14C-glycerol-3-phosphate by liver homogenates, in the presence of saturating or submaximal concentrations of fatty acids, did not differ among the three groups. These results show that under the experimental conditions of this study, including the fasted state of the patients, the basal capacity of liver of NIDDM patients to synthesize fatty acids or glycerides is the same as that of liver from obese and lean controls. Thus, it is likely that an increase in fatty acid flux into a liver with normal lipogenic potential may contribute to the increased synthesis of triglycerides by the liver of these patients in vivo

Work-related musculoskeletal risks associated with nurses and nursing assistants handling overweight and obese patients: A literature review.

Science.gov (United States)

Choi, Sang D; Brings, Kathryn

2015-01-01

Nurses and nursing assistants are susceptible to work-related musculoskeletal disorders and injuries (WMSDs) due to the increase in overweight and obese patients they are handling on a daily basis. This study aimed to review work-related musculoskeletal hazards and risks associated with handling overweight and obese patients, and summarize the recommended interventions to mitigate musculoskeletal concerns among nurses and nursing assistants. Approximately 350 publications were initially screened and 22 refereed articles were used to synthesize for this study on the bases of inclusion/exclusion relevance and strength of evidence on overweight or obese patient handling. Evidence suggested that the work-related musculoskeletal risks among nurses and nursing assistants included sprains/strains, low back pain, wrist, knee and shoulder injuries. The findings indicated that the WMSD risks increased when nurses and nursing assistants were manually moving or lifting patients, especially when the patients were overweight or obese. The recommended solutions included the lifting/transfer equipment and devices, ergonomic assessments and controls, no-lift policies, and training and education. To alleviate the risk of musculoskeletal disorders and injuries among nurses and nursing assistants handling overweight or obese patients, additional research and development into what safe patient handling interventions suit this growing population needs to be addressed.

Relationship between Body Image and Psychological Well-being in Patients with Morbid Obesity.

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Yazdani, Negar; Hosseini, Sayed Vahid; Amini, Masood; Sobhani, Zahra; Sharif, Farkhondeh; Khazraei, Hajar

2018-04-01

Morbid obesity is rising around the world. It can cause unpleasant appearance and body image. Most of the studies have aimed to evaluate the psychopathology of overweight and obesity and paying attention to mental well-being in morbid obese individuals is rare. Therefore, this study aimed to assess the relationship between body image and psychological well-being in morbid obese patients. This cross-sectional study, using simple random sampling method, was done on 124 morbid obese patients who referred to obesity clinic in Shiraz from 2016 to 2017. The data were collected by body image index and psychological well-being questionnaire. Results were analyzed using descriptive statistics, Pearson correlation coefficient test, ANOVA, and Regression analysis. The results showed a significant relationship between body image and psychological well-being (r=0.43) (Pimage and all the subscales of psychological well-being except autonomy and purpose in life (Pimage (Pimage and those of psychological well-being in different categories of body mass index (BMI) (P>0.05). Final results indicated that body image defects caused by obesity could lie in negative psychological well-being in all aspects. This study can promote health clinicians' knowledge in supporting of mental status of obese individuals. It is suggested that preventing and supporting intervention should be performed as effective methods for encountering and coping with psychological effects of obesity.

[General anesthesia for a patient with pulmonary hypertension, bronchial asthma and obesity].

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Nakamura, Shinji; Nishiyama, Tomoki; Hanaoka, Kazuo

2005-10-01

The management of the patient with pulmonary hypertension is a challenge for the anesthesiologists because the risk of right-sided heart failure is markedly increased. We experienced a case of general anesthesia for a patient with pulmonary hypertension (mean pulmonary arterial pressure 39 mmHg), bronchial asthma and obesity. A 31-year-old woman was scheduled for arytenoid rotation for left recurrent nerve palsy. We applied routine monitors (noninvasive blood-pressure, five-lead electrocardiogram, pulse oximeter), and direct blood pressure monitoring through the radial artery. Anesthesia was induced with midazolam 4 mg, fentanyl 100 microg and sevoflurane 5%, and maintained with sevoflurane (1-2%) and nitrous oxide in oxygen. Surgery was completed in 100 minutes without any complications. We could successfully perform general anesthesia in a patient complicated by pulmonary hypertension, bronchial asthma and obesity, without invasive right-sided heart catheterization.

Significantly reduced hypoxemic events in morbidly obese patients undergoing gastrointestinal endoscopy: Predictors and practice effect

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Basavana Gouda Goudra

2014-01-01

Full Text Available Background: Providing anesthesia for gastrointestinal (GI endoscopy procedures in morbidly obese patients is a challenge for a variety of reasons. The negative impact of obesity on the respiratory system combined with a need to share the upper airway and necessity to preserve the spontaneous ventilation, together add to difficulties. Materials and Methods: This retrospective cohort study included patients with a body mass index (BMI >40 kg/m 2 that underwent out-patient GI endoscopy between September 2010 and February 2011. Patient data was analyzed for procedure, airway management technique as well as hypoxemic and cardiovascular events. Results: A total of 119 patients met the inclusion criteria. Our innovative airway management technique resulted in a lower rate of intraoperative hypoxemic events compared with any published data available. Frequency of desaturation episodes showed statistically significant relation to previous history of obstructive sleep apnea (OSA. These desaturation episodes were found to be statistically independent of increasing BMI of patients. Conclusion: Pre-operative history of OSA irrespective of associated BMI values can be potentially used as a predictor of intra-procedural desaturation. With suitable modification of anesthesia technique, it is possible to reduce the incidence of adverse respiratory events in morbidly obese patients undergoing GI endoscopy procedures, thereby avoiding the need for endotracheal intubation.

Significantly reduced hypoxemic events in morbidly obese patients undergoing gastrointestinal endoscopy: Predictors and practice effect.

Science.gov (United States)

Goudra, Basavana Gouda; Singh, Preet Mohinder; Penugonda, Lakshmi C; Speck, Rebecca M; Sinha, Ashish C

2014-01-01

Providing anesthesia for gastrointestinal (GI) endoscopy procedures in morbidly obese patients is a challenge for a variety of reasons. The negative impact of obesity on the respiratory system combined with a need to share the upper airway and necessity to preserve the spontaneous ventilation, together add to difficulties. This retrospective cohort study included patients with a body mass index (BMI) >40 kg/m(2) that underwent out-patient GI endoscopy between September 2010 and February 2011. Patient data was analyzed for procedure, airway management technique as well as hypoxemic and cardiovascular events. A total of 119 patients met the inclusion criteria. Our innovative airway management technique resulted in a lower rate of intraoperative hypoxemic events compared with any published data available. Frequency of desaturation episodes showed statistically significant relation to previous history of obstructive sleep apnea (OSA). These desaturation episodes were found to be statistically independent of increasing BMI of patients. Pre-operative history of OSA irrespective of associated BMI values can be potentially used as a predictor of intra-procedural desaturation. With suitable modification of anesthesia technique, it is possible to reduce the incidence of adverse respiratory events in morbidly obese patients undergoing GI endoscopy procedures, thereby avoiding the need for endotracheal intubation.

Higher plasma motilin levels in obese patients decrease after Roux-en-Y gastric bypass surgery and regulate hunger.

Science.gov (United States)

Deloose, E; Janssen, P; Lannoo, M; Van der Schueren, B; Depoortere, I; Tack, J

2016-07-01

Motilin-induced phase III contractions of the migrating motor complex (MMC) signal hunger in healthy volunteers. The current aim was to study the role of motilin as a hunger-inducing factor in obese patients and to evaluate the effect of Roux-en-Y gastric bypass (RYGB) surgery on plasma motilin levels and hunger scores. Motilin and ghrelin plasma levels were determined during a complete MMC cycle in controls and obese patients selected for RYGB before, 6 months and 1 year after surgery. 20 min after the end of the second phase III, obese patients received an intravenous infusion of 40 mg erythromycin. Hunger was scored every 5 min. Hedonic hunger was assessed in obese patients with the Power of Food Scale questionnaire. Obesity caused a switch in the origin of phase III from antrum to duodenum. Obese patients had significantly higher motilin levels compared with controls during the MMC but tended to lack the motilin peak prior to phase III necessary to trigger hunger. Hunger scores during phase III were significantly lower in obese patients, but could be restored to control levels through the administration of a low dose of the motilin agonist, erythromycin. After RYGB surgery motilin, but not ghrelin, levels decreased in parallel with hedonic hunger scores. Motilin may be an important regulator involved in the pathogenesis of obesity. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Determinants of noninvasive ventilation success or failure in morbidly obese patients in acute respiratory failure.

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Lemyze, Malcolm; Taufour, Pauline; Duhamel, Alain; Temime, Johanna; Nigeon, Olivier; Vangrunderbeeck, Nicolas; Barrailler, Stéphanie; Gasan, Gaëlle; Pepy, Florent; Thevenin, Didier; Mallat, Jihad

2014-01-01

Acute respiratory failure (ARF) is a common life-threatening complication in morbidly obese patients with obesity hypoventilation syndrome (OHS). We aimed to identify the determinants of noninvasive ventilation (NIV) success or failure for this indication. We prospectively included 76 consecutive patients with BMI>40 kg/m2 diagnosed with OHS and treated by NIV for ARF in a 15-bed ICU of a tertiary hospital. NIV failed to reverse ARF in only 13 patients. Factors associated with NIV failure included pneumonia (n = 12/13, 92% vs n = 9/63, 14%; psuccessful response to NIV was idiopathic decompensation of OHS (n = 30, 48% vs n = 0, 0%; p = 0.001). In the NIV success group (n = 63), 33 patients (53%) experienced a delayed response to NIV (with persistent hypercapnic acidosis during the first 6 hours). Multiple organ failure and pneumonia were the main factors associated with NIV failure and death in morbidly obese patients in hypoxemic ARF. On the opposite, NIV was constantly successful and could be safely pushed further in case of severe hypercapnic acute respiratory decompensation of OHS.

Diabetes screening: a pending issue in hypertense/obese patients.

Science.gov (United States)

Sepehri, Armina; Palazón-Bru, Antonio; Gil-Guillén, Vicente Francisco; Ramírez-Prado, Dolores; Navarro-Cremades, Felipe; Cortés, Ernesto; Rizo-Baeza, María Mercedes

2015-01-01

The literature about possible cardiovascular consequences of diagnostic inertia in diabetes is scarce. We examined the influence of undetected high fasting blood glucose (FBG) levels on the cardiovascular risk and poor control of cardiovascular risk factors in hypertensive or obese patients, with no previous diagnosis of diabetes mellitus (i.e., diagnostic inertia). A cross-sectional study during a preventive program in a Spanish region was performed in 2003-2004. The participants were aged ≥40 years and did not have diabetes but were hypertensive (n = 5, 347) or obese (n = 7, 833). The outcomes were high cardiovascular risk (SCORE ≥5%), poor control of the blood pressure (≥140/90 mmHg) and class II obesity. The relationship was examined between FBG and the main parameters, calculating the adjusted odd ratios with multivariate models. Higher values of FBG were associated with all the outcomes. A more proactive attitude towards the diagnosis of diabetes mellitus in the hypertensive and obese population should be adopted.

Obesity and smoking are factors associated with poor prognosis in patients with bacteraemia

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Vuento Risto

2007-03-01

Full Text Available Abstract Background Bacteraemia is still a major cause of case fatality in all age groups. Our aim was to identify the major underlying conditions constituting risk factors for case fatality in bacteraemia patients. Methods The study involved 149 patients (79 male and 70 female with bacteraemia caused by Staphylococcus aureus (S. aureus (41 patients, Streptococcus pneumoniae (Str. pneumoniae (42 patients, β-hemolytic streptococcae (β-hml str. (23 patients and Eschericia coli (E. coli (43 patients. Underlying diseases, alcohol and tobacco consumption and body mass index (BMI were registered. Laboratory findings and clinical data were registered on admission and 6 consecutive days and on day 10–14. Case fatality was studied within 30 days after positive blood culture. Associations between underlying conditions and case fatality were studied in univariate analysis and in a multivariate model. Results Nineteen patients (12.8% died of bacteraemia. We found obesity (p = 0.002, RR 9.8; 95% CI 2.3 to 41.3, smoking (p Conclusion Our results indicate that obesity and smoking are prominent risk factors for case fatality in bacteraemic patients. Identification of risk factors underlying fatal outcome in bacteraemia may allow targeting of preventive efforts to individuals likely to derive greatest potential benefit.

General practitioners' and district nurses' conceptions of the encounter with obese patients in primary health care

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Rasmussen Finn

2011-02-01

Full Text Available Abstract Background Primary health care specialists have a key role in the management of obesity. Through understanding how they conceive the encounter with patients with obesity, treatment may be improved. The aim of this study was thus to explore general practitioners' and district nurses' conceptions of encountering patients with obesity in primary health care. Method Data were collected through semi-structured interviews, and analysed using a phenomenographic approach. The participants were 10 general practitioners (6 women, 4 men and 10 district nurses (7 women, 3 men from 19 primary health care centres within a well-defined area of Sweden. Results Five descriptive categories were identified: Adequate primary health care, Promoting lifestyle change, Need for competency, Adherence to new habits and Understanding patient attitudes. All participants, independent of gender and profession, were represented in the descriptive categories. Some profession and gender differences were, however, found in the underlying conceptions. The general staff view was that obesity had to be prioritised. However, there was also the contradictory view that obesity is not a disease and therefore not the responsibility of primary health care. Despite this, staff conceived it as important that patients were met with respect and that individual solutions were provided which could be adhered to step-by-step by the patient. Patient attitudes, such as motivation to change, evasive behaviour, too much trust in care and lack of self-confidence, were, however, conceived as major barriers to a fruitful encounter. Conclusions Findings from this study indicate that there is a need for development and organisation of weight management in primary health care. Raising awareness of staff's negative views of patient attitudes is important since it is likely that it affects the patient-staff relationship and staff's treatment efforts. More research is also needed on gender and

Binge eating disorder, anxiety, depression and body image in grade III obesity patients

OpenAIRE

Matos,Maria Isabel R; Aranha,Luciana S; Faria,Alessandra N; Ferreira,Sandra R G; Bacaltchuck,Josué; Zanella,Maria Teresa

2002-01-01

INTRODUCTION: The objective of this study was to assess the frequency of Binge Eating Disorder (BED) or Binge Eating episodes (BINGE), anxiety, depression and body image disturbances in severely obese patients seeking treatment for obesity. METHOD: We assessed 50 patients (10M and 40F) with Body Mass Index (BMI) between 40 and 81.7 Kg/m² (mean 52.2±9.2 Kg/m²) and aging from 18 to 56 years (mean 38.5±9.7). Used instruments: Questionnaire on Eating and Weight Patterns ¾ Rev...

THE IMPACT OF BODY WEIGHT MANAGEMENT IN CHRONIC KIDNEY DISEASE PATIENTS WITH OBESITY

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Ya-Ling Wang

2012-06-01

Full Text Available Chronic kidney disease (CKD and obesity are important public health concerns. We examined the influence of dietary management and physical exercises on renal function, lipid profiles and exercise tolerance of a group of CKD patients. We enrolled 45 obese patients with CKD from stage 1 to 3b with tailored by regular dietitian consultation, recommendations of adequate daily protein and caloric intake, and physical exercises for body weight (BW reduction. The target was BW reduction ≥ 3%. Thirty eight obese CKD patients completed the study and 24 patients reached the target. Patients who reached the target was significant larger in total body fat decrement than those who failed (3.0% vs 0.5%, p = 0.003. In addition, total muscle mass, especially on trunk and lower limbs (1.2% vs 0%, P = 0.026 was significant decreased in patients who reached the target compared to those who failed. The laboratory data disclosed the significant reduction of Chol (0.7% vs. -19.3%; P = 0.007, LDL-C ( 3.7% vs. -37.6%; P < 0.001, and UA (0% vs. -0.8%; P = 0.025 between the two groups. The cardiorespiratory endurance to complete 800 meters run (375.1 ± 64.7 sec vs. 327.1 ± 84.0 sec; P = 0.001, abdominal muscle strength and endurance by times of sit-ups (13.6 ± 9.1 number/min vs. 19.9 ± 9.2; P = 0.005, and flexibility of the lower back by sit and reach (18.8 ± 10.8 cm vs. 27.8 ± 10.9 cm; P< 0.001 of the patients who reached the target were improved significantly after 2-months of physical exercise training and education.We conclude that combination of dietary management and exercises are effective in improving health-related physical fitness, blood pressure control, dyslipidemia and renal function in overweight or obese CKD patients. Supportive individualized programs for lifestyle change could exert beneficial effects. A longitudinal study with larger sample size is warranted to elucidate the efficacy of combination of dietary management and exercises.

analyzers in overweight/obese renal patients

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Mariusz Kusztal

2015-05-01

Full Text Available Bioelectrical impedance analysis (BIA is an affordable, non-invasive and fast alternative method to assess body composition. The purpose of this study was to compare two different tetrapolar BIA devices for estimating body fluid volumes and body cell mass (BCM in a clinical setting among patients with kidney failure.All double measurements were performed by multi-frequency (MF and single-frequency (SF BIA analyzers: a Body Composition Monitor (Fresenius Medical Care, Germany and BIA-101 (Akern, Italy, respectively. All procedures were conducted according to the manufacturers’ instructions (dedicated electrodes, measurement sites, positions, etc. Total body water (TBW, extracellular water (ECW, intracellular water (ICW and BCM were compared. The study included 39 chronic kidney disease patients (stage III-V with a mean age of 45.8 ± 8 years (21 men and 18 women who had a wide range of BMI [17-34 kg/m2 (mean 26.6 ±5].A comparison of results from patients with BMI <25 vs ≥25 revealed a significant discrepancy in measurements between the two BIA devices. Namely, in the group with BMI <25 (n=16 acceptable correlations were obtained in TBW (r 0.99; p<0.01, ICW (0.92; p<0.01, BCM (0.68; p<0.01, and ECW (0.96 p<0.05, but those with BMI ≥25 (n=23 showed a discrepancy (lower correlations in TBW (r 0.82; p<0.05, ICW (0.78; p<0.05, BCM (0.52; p<0.05, and ECW (0.76; p<0.01.Since estimates of TBW, ICW and BCM by the present BIA devices do not differ in patients with BMI <25, they might be interchangeable. This does not hold true for overweight/obese renal patients.

Adipokines, Oxidized Low-Density Lipoprotein, and C-Reactive Protein Levels in Lean, Overweight, and Obese Portuguese Patients with Type 2 Diabetes

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Neuparth, Maria João; Proença, Jorge Brandão; Santos-Silva, Alice; Coimbra, Susana

2013-01-01

Aim. Our aim was to study how different BMI scores may influence the levels of inflammation, oxidative stress, adipogenesis, glucose, and lipid metabolism, in lean, overweight, and obese Portuguese patients with type 2 diabetes mellitus (T2DM). Methods. We studied 28 lean, 38 overweight, and 17 obese patients with T2DM and 20 controls (gender and age matched). The circulating levels of oxLDL, CRP, and some adipokines—adiponectin, leptin, and chemerin—and the lipid profile were evaluated. Results. Obese patients presented significantly lower levels of adiponectin and higher leptin, oxLDL, and chemerin levels, as compared to the overweight, lean, and control groups. Overweight, compared to lean and control, subjects showed significantly lower adiponectin and higher leptin and chemerin levels; oxLDL values were significantly higher in overweight than in lean patients. Lean patients presented significantly higher chemerin values than the control. Obese patients presented significantly higher CRP values, as compared to lean patients and the control group. Obese and overweight patients presented significantly higher triglycerides values than lean patients. Except for CRP, all the observed significant changes between control and patients remained significant after statistical adjustment for the body mass index (BMI). Conclusion. The levels of leptin, adiponectin, oxLDL, CRP, and triglycerides in patients with T2DM seem to be more associated with obesity and less with diabetes. Chemerin levels were raised in lean, overweight, and obese patients, suggesting that, independently of BMI, an adipocyte dysfunction occurs. Moreover, chemerin may provide an important early biomarker of adipocyte dysfunction and a link between obesity and type 2 diabetes mellitus. PMID:24634792

Association of energy intake and expenditure with obesity: A cross-sectional study of 150 pediatric patients following treatment for leukemia.

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Srivastava, Richa; Batra, Atul; Dhawan, Deepa; Bakhshi, Sameer

2017-02-01

Increased obesity in leukemia survivors has been attributed to chemotherapy and radiation. Data on total energy intake (TEI) and total energy expenditure (TEE) are lacking in obese childhood leukemia patients after completion of therapy from India. We conducted a cross-sectional study in pediatric acute leukemia patients after completion of therapy wherein energy intake was assessed by 24-hour recall method. TEE was calculated using Harris-Benedict equation, by assessing the physical activity level using Physical Activity Questionnaire for children and basal metabolic rate by World Health Organization equation. Indian Academy of Pediatrics 2015 guidelines for BMI were used for defining overweight and obesity. Nutritional status was assessed in 150 leukemia patients after completion of therapy. Twenty-five percent of leukemia patients after completion of therapy were overweight and obese versus 11% of healthy controls (p = 0.042). The mean ratio of TEI/required energy intake (REI), TEE/required energy expenditure (REE), and (TEI:REI)/(TEE:REE) were significantly higher in overweight and obese group versus nonobese survivors (p obesity. Obesity in leukemia patients after completion of therapy is associated with increased energy intake, causing imbalance between energy intake and TEE in these patients.

The investigation of the some body parameters of obese and (obese+diabetes) patients with using bioelectrical impedance analysis techniques

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Yerlikaya, Emrah; Karageçili, Hasan; Aydin, Ruken Zeynep

2016-04-01

Obesity is a key risk for the development of hyperglycemia, hypertension, hyperlipidemia, insulin resistance and is totally referred to as the metabolic disorders. Diabetes mellitus, a metabolic disorder, is related with hyperglycemia, altered metabolism of lipids, carbohydrates and proteins. The minimum defining characteristic feature to identify diabetes mellitus is chronic and substantiated elevation of circulating glucose concentration. In this study, it is aimed to determine the body composition analyze of obese and (obese+diabetes) patients.We studied the datas taken from three independent groups with the body composition analyzer instrument. The body composition analyzer calculates body parameters, such as body fat ratio, body fat mass, fat free mass, estimated muscle mass, and base metabolic rate on the basis of data obtained by Dual Energy X-ray Absorptiometry using Bioelectrical Impedance Analysis. All patients and healthy subjects applied to Siirt University Medico and their datas were taken. The Statistical Package for Social Sciences version 21 was used for descriptive data analysis. When we compared and analyzed three groups datas, we found statistically significant difference between obese, (obese+diabetes) and control groups values. Anova test and tukey test are used to analyze the difference between groups and to do multiple comparisons. T test is also used to analyze the difference between genders. We observed the statistically significant difference in age and mineral amount p<0.00 between (diabetes+obese) and obese groups. Besides, when these patient groups and control group were analyzed, there were significant difference between most parameters. In terms of education level among the illiterate and university graduates; fat mass kg, fat percentage, internal lubrication, body mass index, water percentage, protein mass percentage, mineral percentage p<0.05, significant statistically difference were observed. This difference especially may result

Obesity and Prognostic Variables in Colombian Breast Cancer Patients: A Cross-Sectional Study.

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Cuello-López, Javier; Fidalgo-Zapata, Ana; Vásquez-Trespalacios, Elsa

2017-01-01

Obesity is an established risk factor for cancer and cancer-related deaths, including that of the breast. While the prevalence of female obesity has accelerated over the past decade in many developing countries, such as Colombia, the prevalence of overweight and obesity specifically in breast cancer populations has not been fully described. A cross-sectional study including 849 women diagnosed with breast cancer between 2009 and 2014. Based on body mass index, prevalence of overweight (BMI ≥ 25 Colombian breast cancer patients had a prevalence of overweight of 34.28% and obesity of 28.15%. Mean BMI was comparable between premenopausal and postmenopausal women (27.2 versus 27.7, resp.). Among premenopausal women, higher BMI was significantly positively associated with hormone receptor negative tumors, as well as with greater lymphovascular invasion. Colombian breast cancer patients exhibit a significant prevalence of overweight and obesity. Associations of high BMI and poor prognosis variables in the premenopausal population suggest risk of aggressive disease in this population. Future studies to further validate our observations are warranted in order to implement multidisciplinary clinical guidelines.

Effectiveness of a Low-Calorie Weight Loss Program in Moderately and Severely Obese Patients

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Julia K. Winkler

2013-10-01

Full Text Available Aims: To compare effectiveness of a 1-year weight loss program in moderately and severely obese patients. Methods: The study sample included 311 obese patients participating in a weight loss program, which comprised a 12-week weight reduction phase (low-calorie formula diet and a 40-week weight maintenance phase. Body weight and glucose and lipid values were determined at the beginning of the program as well as after the weight reduction and the weight maintenance phase. Participants were analyzed according to their BMI class at baseline (30-34.9 kg/m2; 35-39.9 kg/m2; 40-44.9 kg/m2; 45-49.9 kg/m2; ≥50 kg/m2. Furthermore, moderately obese patients (BMI 2 were compared to severely obese participants (BMI ≥ 40 kg/m2. Results: Out of 311 participants, 217 individuals completed the program. Their mean baseline BMI was 41.8 ± 0.5 kg/m2. Average weight loss was 17.9 ± 0.6%, resulting in a BMI of 34.3 ± 0.4 kg/m2 after 1 year (p Conclusion: 1-year weight loss intervention improves body weight as well as lipid and glucose metabolism not only in moderately, but also in severely obese individuals.

The activity of gastric ghrelin positive cells in obese patients treated surgically.

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Artur Bossowski

2009-12-01

Full Text Available Ghrelin is a 28 amino acid peptide hormone regulating food intake and stimulating releasement of growth hormone. It is produced in a distinct endocrine call known as X/A - like cells. The most abundant source of this very important factor in energy homeostasis is gastric fundus. Regulatory mechanisms of ghrelin synthesis and secretion in physiological and pathological states are not discovered completely. The aim of our study was evaluation of the activity of gastric X/A-like cells in obese patients before and after the most popular surgical bariatric procedures - Roux - Y Gastric Bypass (RYGB and Laparoscopic Adjustable Gastric Banding (LAGB. Obese patients in number 18 took part in the study. LAGB was performed in 7 patients and RYGB in 11 patients. Peripheral blood was taken from each patient before operation and first day, seventh day, one month and three months after surgery. Ghrelin level was determined by RIA technique. The specimen of stomach was taken from circular stapler after gastrojejunostomy during RYGB and immunohistochemical study of gastric mucosa, using the EnVision method and specific monoclonal antybodies against ghrelin was performed. The intensity of ghrelin-immunoreactivity in X/A-like cells was analyzed using Olympus Cell D image analysis system. Efficiency of bariatric procedures was estimated by EWL- excess weight loss. We observed very strong immunohistochemical reactions of gastric X/A-like cells, accompanied by lower ghrelin plasma concentration, in comparison to the control group. LAGB procedure induced increase of ghrelin plasma level while RYGB procedure induced decrease of this hormone. The main finding of the present study is the hypoactivity of gastric X/A-like cells in obese patients in comparison to the control group.

Nibbling and picking in obese patients with Binge Eating Disorder.

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Masheb, Robin M; Roberto, Christina A; White, Marney A

2013-12-01

The goal of this study was to examine the clinical utility of nibbling behavior, defined as eating in an unplanned and repetitious manner between meals and snacks without a sense of loss of control, in obese patients with Binge Eating Disorder (BED). Two-hundred seventeen (N = 217) consecutive, treatment-seeking, obese patients with BED were assessed with the Eating Disorder Examination (EDE). Nibbling frequency was examined in relation to current weight, eating disorder psychopathology and eating patterns. Results found that nibbling/picking was not related to body mass index, objective bulimic, subjective bulimic, or overeating episodes, food avoidance, sensitivity to weight gain, or any subscales of the EDE. However, nibbling/picking was significantly related to frequency of morning and afternoon snacking (r = .21, p = .002; r = .27, p < .001). The assessment of nibbling/picking behaviors among individuals with BED might not provide clinically significant information. © 2013.

Overweight and obesity in patients with atrial fibrillation: Sex differences in 1-year outcomes in the EORP-AF General Pilot Registry.

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Boriani, Giuseppe; Laroche, Cécile; Diemberger, Igor; Fantecchi, Elisa; Meeder, Joan; Kurpesa, Malgorzata; Baluta, Monica Mariana; Proietti, Marco; Tavazzi, Luigi; Maggioni, Aldo P; Lip, Gregory Y H

2018-04-01

The impact of overweight and obesity on outcomes in "real world" patients with atrial fibrillation (AF) is not fully defined. Second, sex differences in AF outcomes may also exist. The aim was to investigate outcomes at 1 year follow-up for AF patients enrolled in the EORP-AF Registry, according to BMI (kg/m 2 ), comparing patients with normal BMI (18.5 to obesity (≥ 30 kg/m 2 ), in relation to sex differences. Among 2,540 EORP AF patients (38.9% female; median age 69) with 1 year follow-up data available, 720 (28.3%) had a normal BMI, 1,084 (42.7%) were overweight, and 736 (29.0%) were obese. Obese patients were younger and with more prevalent diabetes mellitus and hypertension (P different according to BMI among female patients (9.3% normal BMI, 5.3% overweight, and 4.3 % obese, P = 0.023), but not among male patients (P = 0.748). The composite outcome of thromboembolic events and death was also significantly different, being lower in obese females (P = 0.035). Among male patients, bleeding events were significantly more frequent in obese subjects (P = 0.035). On multivariable Cox analysis, BMI was not independently associated with all-cause mortality. Among AF patients, overweight and obesity are common and associated with better outcomes in females (a finding previously reported as "obesity paradox"), while no significant differences in outcomes are detected among male patients. Final multivariable model found that increasing BMI was not associated with increased risk of all-cause death; conversely, age and comorbidities persisted as major determinants. © 2018 Wiley Periodicals, Inc.

Obesity in multiracial schizophrenia patients receiving outpatient treatment in a regional tertiary hospital in malaysia.

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Norlelawati, A T; Kartini, A; Ramli, M; Norsidah, K; Wan Azizi, W S; Tariq, A R

2012-06-01

OBJECTIVES. Obesity is an issue of concern among patients with schizophrenia as it is a co-morbid condition that is closely related to metabolic syndrome. The present study assessed the correlation of body mass index with antipsychotic use among multiracial schizophrenia outpatients. The study also compared the patients' body mass index with Malaysian Adult Nutrition Survey (MANS) data. METHODS. A total of 216 participants were recruited into a cross-sectional study conducted over 5 months, from December 2010 to April 2011. Body weight and height were measured using the standard methods. Demographic data and treatment variables were gathered through interview or review of the medical records. RESULTS. There were differences in mean body mass index between men and women (p = 0.02) and between Malay, Chinese and Indian races (p = 0.04). Stratified by sex, age, and race, the body mass index distributions of the patients were significantly different to those of the reference MANS population. The prevalence of obesity among patients was more than 2-fold greater than among the reference population in all variables. Although body mass index distribution was related to antipsychotic drugs (χ(2) = 33.42; p = 0.04), obesity could not be attributed to any specific drug. CONCLUSION. The prevalence of obesity among patients with schizophrenia was significantly greater than that in the healthy Malaysian population, and affects the 3 main races in Malaysia.

Obese patients in an open MRI at 1.0 Tesla: image quality, diagnostic impact and feasibility

International Nuclear Information System (INIS)

Bucourt, Maximilian de; Streitparth, Florian; Wonneberger, Uta; Rump, Jens; Teichgraeber, Ulf

2011-01-01

To investigate the performance of an open MRI system at its conceptual limits by examining excessively obese patients who otherwise could not receive adequate imaging examinations. Twenty-six excessively obese patients (BMI ≥ 35, average age 46) where CT, standard MR or ultrasound examinations were not possible or not conclusive were referred to an open MRI system at 1.0 Tesla. Image quality was measured by SNR and CNR with the integrated body coil for obese patients and optimal body coils for a regular weight control group (average BMI 23, average age 30). MRI findings were evaluated by a diagnostic impact matrix. SNR and CNR were generally lower in obese patients when the integrated body coil was used compared to the normal weight group with ideal body coils e.g.: For cerebral imaging T2W TSE (<5% for white matter, ca. 30% for grey matter) and T1W SE (ca. 15% for white matter, <5% for grey matter), for spinal imaging T2W TSE (ca. 35% for disc and vertebral body) and T1W SE (about 2% for disc, ca. 10% for vertebral body). Relevant new diagnoses impacting patient's therapy were identified in 30% (8/26), the particular medical question of the referring physician could be ruled out as possible reason for the medical condition in 53% (14/26). In excessively obese patients where CT, standard MR or ultrasound examination is not possible or not conclusive open MRI system have great potential in diagnostic evaluation, offering lower but sufficient image quality to impact therapy. (orig.)

Challenging Obesity: Patient, Provider, and Expert Perspectives on the Roles of Available and Emerging Nonsurgical Therapies

Science.gov (United States)

Apovian, Caroline M.; Garvey, W. Timothy; Ryan, Donna H.

2015-01-01

Objective Adult obesity is recognized as a chronic disease. According to principles of chronic disease management, healthcare professionals should work collaboratively with patients to determine appropriate therapeutic strategies that address overweight and obesity, specifically considering a patient’s disease status in addition to their individual needs, preferences, and attitudes regarding treatment. A central role and responsibility of healthcare professionals in this process is to inform and educate patients about their treatment options. Although current recommendations for the management of adult obesity provide general guidance regarding safe and proper implementation of lifestyle, pharmacological, and surgical interventions, healthcare professionals need awareness of specific evidence-based information that supports individualized clinical application of these therapies. More specifically, healthcare professionals should be up-to-date on approaches that promote successful lifestyle management and be knowledgeable about newer weight loss pharmacotherapies, so they can offer patients with obesity a wide range of options to personalize their treatment. Accordingly, this educational activity has been developed to provide participants with the latest information on treatment recommendations and therapeutic advances in lifestyle intervention and pharmacotherapy for adult obesity management. Design and Methods This supplement is based on the content presented at a live CME symposium held in conjunction with ObesityWeek 2014. Results This supplement provides an expert summary of current treatment recommendations and recent advances in nonsurgical therapies for the management of adult obesity. Patient and provider perspectives on obesity management are highlighted in embedded video clips available via QR codes, and new evidence will be applied using clinically relevant case studies. Conclusions This supplement provides a topical update of obesity management

Treatment Failure of TNF-α Inhibitors in Obese Patients With Inflammatory Bowel Disease-A Cohort Study

DEFF Research Database (Denmark)

Madsen, Kenneth Grønkjær; Pottegård, Anton; Hallas, Jesper

2018-01-01

Background: In treatment of inflammatory bowel disease (IBD) with anti-tumor necrosis factor-α agents (anti-TNF-α), obesity has been suspected as a cause of accelerated loss of response (LOR). We sought to determine whether overweight IBD patients have accelerated LOR when treated with anti......, and 45 (21%) were obese. Regression analysis produced the following adjusted HRs, compared with the normal weight group: overweight 0.89 (95% confidence interval [CI], 0.51-1.56) and obese 1.31 (95% CI, 0.76-2.24), thus showing no statistically significant association between BMI and time to LOR....... Subgroup analyses produced similar results, except for obese ulcerative colitis patients having an adjusted HR of 2.42 (95% CI, 1.03-5.70). Conclusions: In IBD patients treated with anti-TNF-α agents, we found no overall association between increased BMI and accelerated LOR....

Laparoscopic versus open inguinal hernia repair in patients with obesity: an American College of Surgeons NSQIP clinical outcomes analysis.

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Froylich, Dvir; Haskins, Ivy N; Aminian, Ali; O'Rourke, Colin P; Khorgami, Zhamak; Boules, Mena; Sharma, Gautam; Brethauer, Stacy A; Schauer, Phillip R; Rosen, Michael J

2017-03-01

The laparoscopic approach to inguinal hernia repair (IHR) has proven beneficial in reducing postoperative pain and facilitating earlier return to normal activity. Except for indications such as recurrent or bilateral inguinal hernias, there remains a paucity of data that specifically identities patient populations that would benefit most from the laparoscopic approach to IHR. Nevertheless, previous experience has shown that obese patients have increased wound morbidity following open surgical procedures. The aim of this study was to investigate the effect of a laparoscopic versus open surgical approach to IHR on early postoperative morbidity and mortality in the obese population using the National Surgical Quality Improvement Program (NSQIP) database. All IHRs were identified within the NSQIP database from 2005 to 2013. Obesity was defined as a body mass index ≥30 kg/m 2 . A propensity score matching technique between the laparoscopic and open approaches was used. Association of obesity with postoperative outcomes was investigated using an adjusted and unadjusted model based on clinically important preoperative variables identified by the propensity scoring system. A total of 7346 patients met inclusion criteria; 5573 patients underwent laparoscopic IHR, while 1773 patients underwent open IHR. On univariate analysis, obese patients who underwent laparoscopic IHR were less likely to experience a deep surgical site infection, wound dehiscence, or return to the operating room compared with those who underwent an open IHR. In both the adjusted and unadjusted propensity score models, there was no difference in outcomes between those who underwent laparoscopic versus open IHR. The laparoscopic approach to IHR in obese patients has similar outcomes as an open approach with regard to 30-day wound events. Preoperative risk stratification of obese patients is important to determining the appropriate surgical approach to IHR. Further studies are needed to investigate the

Effect of overweight and obesity on weight loss and length of stay in patients with walled-off pancreatic necrosis.

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Rysgaard, Sisse; Rasmussen, Ditlev; Novovic, Srdan; Schmidt, Palle N; Gluud, Lise L

2017-06-01

The aim of this study was to assess the association between admission weight, weight loss, and length of stay (LOS) in patients with walled-off pancreatic necrosis. We classified the admission body mass index (BMI) of 18.5 to overweight, and ≥30 kg/m 2 as obesity. The Nutritional Risk Screening score-2002 was calculated to identify patients at risk for undernutrition. We included 38 patients (61% men, 68% with infected necrosis; 40% normal weight; 60% overweight/obesity). Four patients (11%) required treatment at the semi-intensive care unit, 11 (29%) developed pneumonia, and 10 (26%) developed septicemia. One patient died due to respiratory failure and hemorrhage. The remaining patients were discharged after a median of 49 d (36-64 d). During admission, 14 patients (38%) achieved an energy-protein intake of at least 75% and 17 (46%) achieved ≥70% coverage. The percentage weight loss was different (P overweight (9%), and obesity (14%). There was no difference between groups regarding percentage of energy or protein coverage. Patients with overweight/obesity had a longer hospital LOS (P = 0.016). In univariable regression analysis, overweight, obesity, energy, and protein coverage predicted weight loss. LOS did not predict weight loss. In multivariable regression analysis, overweight and obesity were the only remaining significant predictors of weight loss. Patients with walled-off pancreatic necrosis are at considerable risk for undernutrition. A BMI >25 kg/m 2 predicts greater weight loss and longer LOS. Copyright © 2017 Elsevier Inc. All rights reserved.

Analysis of Proteolytic and Fibrinolytic Activity of the Blood Plasma in Patients with Bronchial Asthma Combined with Obesity

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Fediv A.I. Fediv A.I.

2016-09-01

Full Text Available Aim of the study — to conduct the analysis of the performance of proteolytic and fibrinolytic activity of the blood plasma in patients with bronchial asthma (BA combined with obesity. Materials and methods. The study included 40 patients divided into groups. The basic group consisted of 20 patients with BA associated with obesity (ІI group, two comparison groups — of 10 patients with BA and normal body weight (I group and 10 patients with obesity and without pathology of the bronchopulmonary system (ІІІ group. Control group included 10 apparently healthy persons. In patients with BA, there were investigated the indexes of proteolytic and fibrinolytic activity of the blood plasma. Results. Analysis of the obtained data in patients with BA showed an increase of activity of plasma coagulation factors: total fibrinolytic activity increased in comparison to the control group, and in patients with BA it was 1.46 ± 0.13 Е440/ml/h, while in apparently healthy persons — 1.23 ± 0.16 Е440/ml/h (р < 0.05. In addition, an increase was marked and in the group of patients with the isolated obesity (by 38.5 % as compared to the group of apparently healthy persons, that can be explained by the growth of activity of inflammatory process due to the immune changes related to biological activity of fatty tissue as an additional source of proinflammatory cytokines. Conclusions. In combination of bronchial asthma and obesity, there is an activation of fibrinolytic and proteolytic systems of the blood that leads to microcirculatory and hemostatic disorders, enhancement of inflammatory process. In obesity as the state of systemic inflammatory response, the activation of fibrinolytic and proteolytic blood systems is more significant, than in bronchial asthma.

Effect of physical activities and obesity on Ramadan fasting among hypertensive patients

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Nazeer Khan

2016-12-01

Full Text Available Objective: To find out the effect of physical activities and obesity among Ramadan fasting hypertensive patients of Karachi. Methods: 117 hypertensive patients were selected conveniently from the staff and faculty members of Dow University and other locations of Karachi. The inclusion criterion was the hypertensive patients with at least 20 days of fasting. The investigators visited three times (last ten days of Shaban, Ramadan and Shawwal for collection of data. A questionnaire was completed before clinical examination. Blood pressures were   measured 3 times in sitting position. 103 patients fasted at least 20 days. Results: The mean age of the 103 patients was 53.7±11.0 years. 11% participants could be considered as active using MET value of 600 and above. Mean sleeping hours decreased from 6.9 hours in Shaban to 6.3 hours in Ramadan. Mean systolic and diastolic blood pressures decreased from Shaban to Ramadan and bounced back in Shawwal for both ‘active’ and ‘inactive’ patients. However, it was statistically significant for ‘inactive’ patients only. Only mean SBP decreased significantly from Shaban to Ramadan for normal and overweight patients. Combined effect of physical activity, obesity, sleeping pattern and number of fasting days with repeated measure ANOVA showed that only number of fasting days was statistically significant. Conclusions: The study concludes that fasting does not harm anyway to the hypertensive patients. Nevertheless, it significantly reduces the systolic and diastolic blood pressures. Changes in physical activities, sleeping patterns, and weight reduction, except number days of fasting, do not affect on the fasting hypertensive patients.

Hypertension and obesity among HIV patients in a care programme ...

African Journals Online (AJOL)

Objective: To determine the prevalence of hypertension and obesity among HIV patients enrolled in the Sex Worker Outreach Programme (SWOP), Nairobi, Kenya. Design: A retrospective a study. Setting: SWOP managed by the University of Manitoba, Nairobi team. Subjects: We selected clinic visit records from HIV ...

Anaesthesia for a morbidly obese patient with schizophrenia and ...

African Journals Online (AJOL)

We report the case of a morbidly obese woman with schizophrenia and intellectual disability who underwent dental treatment using general anaesthesia. The 38-year-old patient was 156 cm tall and weighed 140 kg, with a body mass index of 57.5 kg.m-2. Her developmental age was less than five or six years. She had ...

[Assessment of external breathing parameters and cardiovascular function in patients with constitutive exogenous obesity and reduced body weight].

Science.gov (United States)

Merzlikina, N L; Romantsova, T I; Roik, O V; Lobanova, N A; Drapkina, O M; Ivashkin, V T

2009-01-01

The study was designed to evaluate external respiratory function (ERF) and cardiovascular function based on AP measurements, results of 24 hour AP monitoring, treadmill test, and ECG during weight loss therapy in patients with excess body mass. A total of 93 patients with grade 2-3 obesity were examined including 41 (39.8%) with type 2 diabetes mellitus (DM). Group 1 consisted of patients with constitutive exogenous obesity, group 2 of patients with constitutive exogenous obesity and DM, group 3 was used as control. Follow-up studies were conducted after 6 and 12 months. Patients of groups 1 and 2 showed positive dynamics of hemodynamic characteristics related to the loss of weight including significant reduction of heart rate, systolic and diastolic indices of hypertonic loading, specific peripheral vascular resistance, and left ventricular mass. Simultaneously, cardiac index and ERF increased while vital lung capacity, forced vital capacity, and forced respiratory volume in the first second returned to normal values. It is concluded that reduction of body weight has positive effect on ERF dynamics and hemodynamic characteristics in patients with constitutive exogenous obesity.

Sarcopenic obesity: A probable risk factor for dose limiting toxicity during neo-adjuvant chemotherapy in oesophageal cancer patients.

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Anandavadivelan, Poorna; Brismar, Torkel B; Nilsson, Magnus; Johar, Asif M; Martin, Lena

2016-06-01

Profound weight loss and malnutrition subsequent to severe dysphagia and cancer cachexia are cardinal symptoms in oesophageal cancer (OC). Low muscle mass/sarcopenia has been linked to toxicity during neo-adjuvant therapy in other cancers, with worser effects in sarcopenic obesity. In this study the association between sarcopenia and/or sarcopenic obesity and dose limiting toxicity (DLT) during cycle one chemotherapy in resectable OC patients was evaluated. Body composition was assessed from computed tomography scans of 72 consecutively diagnosed OC patients. Lean body mass and body fat mass were estimated. Patients were grouped as sarcopenic or non-sarcopenic based on pre-defined gender-specific cut-offs for sarcopenia, and as underweight/normal (BMI sarcopenia combined with overweight and obesity. DLT was defined as temporary reduction/delay or permanent discontinuation of drugs due to adverse effects. Odds ratios for developing toxicity were ascertained using multiple logistic regression. Of 72 patients, 85% (n = 61) were males. Sarcopenia and sarcopenic obesity were present in 31 (43%) and 10 (14%), respectively, prior to chemotherapy. Sarcopenic patients had significantly lower adipose tissue index (p = 0.02) compared to non-sarcopenic patients. Patients with DLT (n = 24) had lower skeletal muscle mass (p = 0.04) than those without DLT. Sarcopenic patients (OR = 2.47; 95% CI: 0.88-6.93) showed a trend towards increased DLT risk (p < 0.10). Logistic regression with BMI as an interaction term indicated higher DLT risk in sarcopenic patients with normal BMI (OR = 1.60; 95% CI 0.30-8.40), but was non-significant. In the sarcopenic obese, risk of DLT increased significantly (OR = 5.54; 95% CI 1.12-27.44). Sarcopenic and sarcopenic obese OC patients may be at a higher risk for developing DLT during chemotherapy compared to non-sarcopenic OC patients. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All

Similarities and differences between eating disorders and obese patients in a virtual environment for normalizing eating patterns.

Science.gov (United States)

Perpiñá, Conxa; Roncero, María

2016-05-01

Virtual reality has demonstrated promising results in the treatment of eating disorders (ED); however, few studies have examined its usefulness in treating obesity. The aim of this study was to compare ED and obese patients on their reality judgment of a virtual environment (VE) designed to normalize their eating pattern. A second objective was to study which variables predicted the reality of the experience of eating a virtual forbidden-fattening food. ED patients, obese patients, and a non-clinical group (N=62) experienced a non-immersive VE, and then completed reality judgment and presence measures. All participants rated the VE with similar scores for quality, interaction, engagement, and ecological validity; however, ED patients obtained the highest scores on emotional involvement, attention, reality judgment/presence, and negative effects. The obese group gave the lowest scores to reality judgment/presence, satisfaction and sense of physical space, and they held an intermediate position in the attribution of reality to virtually eating a "fattening" food. The palatability of a virtual food was predicted by attention capturing and belonging to the obese group, while the attribution of reality to the virtual eating was predicted by engagement and belonging to the ED group. This study offers preliminary results about the differential impact on ED and obese patients of the exposure to virtual food, and about the need to implement a VE that can be useful as a virtual lab for studying eating behavior and treating obesity. Copyright © 2016 Elsevier Inc. All rights reserved.

Interest, views and perceived barriers to bariatric surgery in patients with morbid obesity.

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Wharton, S; Serodio, K J; Kuk, J L; Sivapalan, N; Craik, A; Aarts, M-A

2016-04-01

The objective of the study was to assess the interest, views and patient-perceived barriers to bariatric surgery among surgery-eligible patients. Surveys were completed at a weight management clinic and local hospital in Ontario, Canada. Patients were ≥18 years of age with a body mass index (BMI) >40 kg m(-2) or BMI > 35 kg m(-2) with ≥1 comorbidity. The sample included 105 participants, 73.3% female, with a mean BMI of 46.6 ± 7.1 kg m(-2) . Only 33.3% of participants were interested in surgery; 50.5% of participants were not interested and 16.2% had mixed feelings. Participants identified risks (69.5%) and side effects (57.1%) as significant surgical barriers. Interested participants were more likely to perceive themselves as obese, were unhappy with their current weight loss method and were less likely to fear surgery (P bariatric surgery, the majority of qualified patients are not interested in surgery mainly due to the perceived risk of surgery in general and satisfaction with current non-surgical weight loss efforts. The self-perception of obesity, as opposed to medical comorbidities, may be a stronger driver of the decision to have bariatric surgery. It is unclear if patients are aware of the effectiveness of bariatric surgery to help improve comorbidities or if bariatric surgery is perceived as being more cosmetic in nature. © 2016 World Obesity.

Assessment of anti-factor Xa activity of enoxaparin for venous thromboembolism prophylaxis in morbidly obese surgical patients

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Nouf Al Otaib

2017-01-01

Conclusions: Weight-based enoxaparin dose led to the anticipated peak anti-Xa levels (0.2–0.6 IU/mL in most of the morbidly obese study patients undergoing surgery without any evidence of major side effects. The weight-based dosing of enoxaparin was also effective in preventing VTE in all patients. Although these results are promising, further comparative trials are needed in the setting of morbidly obese surgical patients.

The impact of EndoBarrier gastrointestinal liner in obese patients with normal glucose tolerance and in patients with type 2 diabetes

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Rohde, Ulrich; Federspiel, Cecilie A; Vilmann, Peter

2017-01-01

metabolism, gut hormone secretion, gallbladder emptying, appetite and food intake in patients undergoing DJBS treatment. MATERIAL AND METHODS: Ten normal glucose tolerant (NGT) obese subjects and nine age, body weight and body mass index-matched metformin-treated T2D patients underwent a liquid mixed meal...... intake was reduced at 1w in NGT subjects; no changes in appetite measures or food intake were observed in the T2D group. No effect of DJBS on postprandial gallbladder emptying was observed, and gastric emptying was not delayed. CONCLUSIONS: DJBS-induced weight loss was associated with only marginal......AIMS: The duodenal-jejunal bypass sleeve ((DJBS) or EndoBarrier Gastrointestinal Liner) induces weight loss in obese subjects and may improve glucose homeostasis in patients with type 2 diabetes (T2D). To explore the underlying mechanisms, we evaluated postprandial physiology including glucose...

The challenge of diet, exercise and lifestyle modification in the management of the obese diabetic patient.

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Foreyt, J P; Poston, W S

1999-06-01

Type 2 diabetes is associated with many comorbid medical conditions including obesity, neuropathy, microvascular pathology and atherosclerotic arterial disease. Due to its complications and chronicity, reducing risk factors such as obesity and sedentary lifestyle through lifestyle modification is crucial to the long-term health of patients with type 2 diabetes. Patients must learn how to adopt lifelong, low-fat eating habits and regular activity patterns, with formal treatments focusing on weight loss, increased physical activity and low-fat, low-saturated fat diets. In this article we review the efficacy of lifestyle modification programmes for obese diabetic patients. In addition, we discuss barriers to lifestyle changes and methods for improving long-term adherence. Finally, we present information on how this approach has been adapted to a group of Mexican Americans in the USA, a population at high risk for type 2 diabetes, obesity and sedentary lifestyle.

Metabolic observations during the treatment of obese patients by periods of total starvation

NARCIS (Netherlands)

Riet, H.G. van; Schwarz, F.; Kinderen, P.J. der; Veeman, W.

Ten very obese female patients were treated by periods of total starvation lasting 10 days each. In the interval between these starvation periods, a diet of 600 calories was given. Twenty-one periods were completed, 6 patients went through 3 periods each. The fasting was generally well tolerated;

Tranexamic acid reduces intraoperative occult blood loss and tourniquet time in obese knee osteoarthritis patients undergoing total knee arthroplasty: a prospective cohort study.

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Meng, Yutong; Li, Zhirui; Gong, Ke; An, Xiao; Dong, Jiyuan; Tang, Peifu

2018-01-01

Obesity can result in increased blood loss, which is correlated with poor prognosis in total knee arthroplasty (TKA). Clinical application of tranexamic acid is effective in reducing blood loss in TKA. However, most previous studies focused on the effect of tranexamic acid in the whole population, neglecting patients with specific health conditions, such as obesity. We hypothesized that tranexamic acid would reduce blood loss to a greater extent in obese patients than in those of normal weight. A total of 304 patients with knee osteoarthritis treated with TKA from October 2013 to March 2015 were separated into tranexamic, non-tranexamic, obese, and non-obese groups. The demographic characteristics, surgical indices, and hematological indices were all recorded. We first investigated the ability of intravenous tranexamic acid to reduce intraoperative blood loss in knee osteoarthritis patients undergoing unilateral TKA. Second, we performed subgroup analysis to compare the effects of tranexamic acid between obese and non-obese patients separately. Of the 304 patients, 146 (52.0%) received tranexamic acid and 130 (42.8%) were obese. In the analysis of the whole group, both the actual and occult blood loss volume were lower in the tranexamic acid group (both P tranexamic acid group ( P tranexamic acid was shown to reduce theoretical and actual blood loss in both the obese and non-obese groups ( P Tranexamic acid reduced occult blood loss and tourniquet time in the obese group ( P 0.05). Tranexamic acid can reduce occult blood loss and tourniquet time in obese patients to a greater extent than in patients of normal weight. Therefore, obese knee osteoarthritis patients undergoing TKA can benefit more from tranexamic acid.

Sacral colpopexy versus transvaginal mesh colpopexy in obese patients.

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McDermott, Colleen D; Park, Jean; Terry, Colin L; Woodman, Patrick J; Hale, Douglass S

2013-05-01

Obesity can predispose women to pelvic organ prolapse and can also affect the success of pelvic organ prolapse surgery. The purpose of this study was to compare the postoperative anatomical outcomes following sacral colpopexy (SC) and transvaginal mesh colpopexy in a group of obese women with pelvic organ prolapse. We conducted a retrospective cohort study of obese women who underwent SC (n = 56) or transvaginal mesh colpopexy (n = 35). Follow-up ranged from 6 to 12 months. Preoperative, perioperative, and postoperative variables were compared using Student t, Mann-Whitney U, and Fisher exact tests, and by analysis of covariance. The women in the SC group had significantly higher mean apical vaginal measurements (P transvaginal mesh colpopexy group. There were no significant differences between the groups for other postoperative outcomes, including mesh erosion, recurrent prolapse symptoms, dyspareunia, and surgical satisfaction (P > 0.05). In these 91 obese patients with pelvic organ prolapse, SC resulted in better anatomical outcomes than transvaginal mesh colpopexy. However, the two procedures had similar outcomes with regard to recurrent symptoms and surgical satisfaction.

Effect of interval training on cognitive functioning and cerebral oxygenation in obese patients: a pilot study.

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Drigny, Joffrey; Gremeaux, Vincent; Dupuy, Olivier; Gayda, Mathieu; Bherer, Louis; Juneau, Martin; Nigam, Anil

2014-11-01

To assess the effect of a 4-month high-intensity interval training programme on cognitive functioning, cerebral oxygenation, central haemodynamic and cardiometabolic parameters and aerobic capacity in obese patients. Cognitive functioning, cerebral oxygenation, central haemodynamic, cardiometabolic and exercise para-meters were measured before and after a 4-month high-intensity interval training programme in 6 obese patients (mean age 49 years (standard deviation 8), fat mass percentage 31 ± 7%). Body composition (body mass, total and trunk fat mass, waist circumference) and fasting insulin were improved after the programme (p attention and processing speed, was significantly improved after training (p training (p training programme in obese patients improved both cognitive functioning and cere-bral oxygen extraction, in association with improved exercise capacity and body composition.

The influence of body mass index on outcomes in patients undergoing cardiac surgery: does the obesity paradox really exist?

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Juan Carlos Lopez-Delgado

Full Text Available Obesity influences risk stratification in cardiac surgery in everyday practice. However, some studies have reported better outcomes in patients with a high body mass index (BMI: this is known as the obesity paradox. The aim of this study was to quantify the effect of diverse degrees of high BMI on clinical outcomes after cardiac surgery, and to assess the existence of an obesity paradox in our patients.A total of 2,499 consecutive patients requiring all types of cardiac surgery with cardiopulmonary bypass between January 2004 and February 2009 were prospectively studied at our institution. Patients were divided into four groups based on BMI: normal weight (18.5-24.9 kg∙m-2; n = 523; 21.4%, overweight (25-29.9 kg∙m-2; n = 1150; 47%, obese (≥ 30-≤ 34.9 kg∙m-2; n = 624; 25.5% and morbidly obese (≥ 35kg∙m-2; n = 152; 6.2%. Follow-up was performed in 2,379 patients during the first year.After adjusting for confounding factors, patients with higher BMI presented worse oxygenation and better nutritional status, reflected by lower PaO2/FiO2 at 24h and higher albumin levels 48 h after admission respectively. Obese patients showed a higher risk for Perioperative Myocardial Infarction (OR: 1.768; 95% CI: 1.035-3.022; p = 0.037 and septicaemia (OR: 1.489; 95% CI: 1.282-1.997; p = 0.005. In-hospital mortality was 4.8% (n = 118 and 1-year mortality was 10.1% (n = 252. No differences were found regarding in-hospital mortality between BMI groups. The overweight group showed better 1-year survival than normal weight patients (91.2% vs. 87.6%; Log Rank: p = 0.029. HR: 1.496; 95% CI: 1.062-2.108; p = 0.021.In our population, obesity increases Perioperative Myocardial Infarction and septicaemia after cardiac surgery, but does not influence in-hospital mortality. Although we found better 1-year survival in overweight patients, our results do not support any protective effect of obesity in patients undergoing cardiac surgery.

A real world study on the genetic, cognitive and psychopathological differences of obese patients clustered according to eating behaviours.

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Caroleo, Mariarita; Primerano, Amedeo; Rania, Marianna; Aloi, Matteo; Pugliese, Valentina; Magliocco, Fabio; Fazia, Gilda; Filippo, Andrea; Sinopoli, Flora; Ricchio, Marco; Arturi, Franco; Jimenez-Murcia, Susana; Fernandez-Aranda, Fernando; De Fazio, Pasquale; Segura-Garcia, Cristina

2018-02-01

Considering that specific genetic profiles, psychopathological conditions and neurobiological systems underlie human behaviours, the phenotypic differentiation of obese patients according to eating behaviours should be investigated. The aim of this study was to classify obese patients according to their eating behaviours and to compare these clusters in regard to psychopathology, personality traits, neurocognitive patterns and genetic profiles. A total of 201 obese outpatients seeking weight reduction treatment underwent a dietetic visit, psychological and psychiatric assessment and genotyping for SCL6A2 polymorphisms. Eating behaviours were clustered through two-step cluster analysis, and these clusters were subsequently compared. Two groups emerged: cluster 1 contained patients with predominantly prandial hyperphagia, social eating, an increased frequency of the long allele of the 5-HTTLPR and low scores in all tests; and cluster 2 included patients with more emotionally related eating behaviours (emotional eating, grazing, binge eating, night eating, post-dinner eating, craving for carbohydrates), dysfunctional personality traits, neurocognitive impairment, affective disorders and increased frequencies of the short (S) allele and the S/S genotype. Aside from binge eating, dysfunctional eating behaviours were useful symptoms to identify two different phenotypes of obese patients from a comprehensive set of parameters (genetic, clinical, personality and neuropsychology) in this sample. Grazing and emotional eating were the most important predictors for classifying obese patients, followed by binge eating. This clustering overcomes the idea that 'binging' is the predominant altered eating behaviour, and could help physicians other than psychiatrists to identify whether an obese patient has an eating disorder. Finally, recognising different types of obesity may not only allow a more comprehensive understanding of this illness, but also make it possible to tailor

Providing prenatal care to pregnant women with overweight or obesity: Differences in provider communication and ratings of the patient-provider relationship by patient body weight.

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Washington Cole, Katie O; Gudzune, Kimberly A; Bleich, Sara N; Cheskin, Lawrence J; Bennett, Wendy L; Cooper, Lisa A; Roter, Debra L

2017-06-01

To examine the association of women's body weight with provider communication during prenatal care. We coded audio recordings of prenatal visits between 22 providers and 117 of their patients using the Roter Interaction Analysis System. Multivariate, multilevel Poisson models were used to examine the relationship between patient pre-pregnancy body mass index and provider communication. Compared to women with normal weight, providers asked fewer lifestyle questions (IRR 0.66, 95% CI 0.44-0.99, p=0.04) and gave less lifestyle information (IRR 0.51, 95% CI 0.32-0.82, p=0.01) to women with overweight and obesity, respectively. Providers used fewer approval (IRR 0.68, 95% CI 0.51-0.91, p=0.01) and concern statements (IRR 0.68, 95% CI 0.53-0.86, p=0.002) when caring for women with overweight and fewer self-disclosure statements caring for women with obesity (IRR 0.40, 95% CI 0.19-0.84 p=0.02). Less lifestyle and rapport building communication for women with obesity may weaken patient-provider relationship during routine prenatal care. Interventions to increase use of patient-centered communication - especially for women with overweight and obesity - may improve prenatal care quality. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Determination of pump flow rate during cardiopulmonary bypass in obese patients avoiding hemodilution.

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Santambrogio, Luisa; Leva, Cristian; Musazzi, Giorgio; Bruno, Piergiorgio; Vailati, Andrea; Zecchillo, Franco; Di Credico, Germano

2009-01-01

During cardiopulmonary bypass the pump flow is usually set on 2.4 L/min/m(2) of body surface area (BSA) to guarantee adequate tissue perfusion without differences for patient constitutional type. The present study attempts to evaluate the adequacy of pump flow rate in obese patients, considering the ideal weight instead of the real one, avoiding the overflow side effects and hemodilution. Obese patients with body mass index (BMI) > 30 presented for cardiac surgery were randomized in two groups: in one the cardiopulmonary bypass was led traditionally, in the other, pump flow rate was calculated on ideal BMI of 25. Demographics, preoperative tests, and monitoring data were registered. Mortality at hospital discharge and 30 days after were analyzed. The pump flow rate between the groups was different (4.46 vs. 4.87; p = 0.004); there were no differences in organ perfusion (SvO(2); diuresis) and mortality, but the study group presented fewer complications and blood transfusions. The BSA is widely used as the biometric unit to normalize physiologic parameters included pump flow rate, but it is disputable if this practice is correct also in obese patients. The study group, in which pump flow rate was set on ideal BSA, presented no difference in diuresis and mixed venous saturation but fewer complications and fewer perioperative blood transfusions.

Analyzing the some biochemical parameters of diabetes mellitus and obese patients who applied to Siirt State Hospital endocrine polyclinic and their prevalence

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Karageçili, Hasan; Yerlikaya, Emrah; Aydin, Ruken Zeynep

2016-04-01

Obesity and diabetes are major public health problems throughout the World. Obese individuals body mass index (BMI) is >30 kg/m2. Obesity is characterized by increased waist circumference, total body fat and hyperglycemia. The increased triglyceride and cholesterol level is also shown in obese individuals. The development of obesity is largely due to the consumption of high energy food and sedentary lifestyle. This study was held with the participation of patients applied to Siirt State Hospital endocrine policlinic for treatment. Our aim is to try to determine the biochemical relation and border line of obese and obese+diabetes mellitus patients. Patients and control group lipid profiles were studied in the hospital biochemisty laboratory. Laboratory results of diabetes+obese, obese and control groups were evaluated. Patients and control samples blood serum levels were compared according to their lipid profiles. In 2015, 735 diabetes mellitus type 2 patients applied to Endocrine polyclinic. Some of these patient's serum levels were evaluated. Difference between diabetes+obese and diabetes groups were near critical level for LDL and trigliserid. There were not observed statistically significant difference between groups in terms of HDL and cholesterol. There were found significant difference between groups for blood glucose p<0.003, age p<0.001. According to gender between women and men serum levels, ALT and AST levels; p<0.006 and cholesterol; p<0.04 were detected. According to participants education level blood biochemistry levels were observed statisticaly different p<0.001 with non-literacy group. In conclusion, obese and obese+diabetes patients blood serum values nearly close to each other. Obese subjects were been diabetic obese with age. In women obesity and diabetes mellitus prevalence were seen too much.

Hypothalamic obesity in patients with craniopharyngioma: Profound changes of several weight regulatory circuits

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Christian eRoth

2011-10-01

Full Text Available One of the most striking examples of dysfunctional hypothalamic signaling of energy homeostasis is observed in patients with hypothalamic lesions leading to hypothalamic obesity (HO. This drastic condition is frequently seen in patients with craniopharyngioma (CP, an embryological tumor located in the hypothalamic and/or pituitary region, frequently causing not only hypopituitarism, but also leading to damage of medial hypothalamic nuclei due to the tumor and its treatment. HO syndrome in CP patients is characterized by fatigue, decreased physical activity, uncontrolled appetite, and morbid obesity, and is associated with insulin and leptin resistance. Mechanisms leading to the profoundly disturbed energy homeostasis are complex. This review summarizes different aspects of important clinical studies as well as data obtained in rodent studies. In addition a model is provided describing how medial hypothalamic lesion can interact simultaneously with several weight regulating circuitries.

Impact of weight loss achieved through a multidisciplinary intervention on appetite in patients with severe obesity

DEFF Research Database (Denmark)

Coutinho, Silvia R; Rehfeld, Jens F; Holst, Jens J

2018-01-01

The impact of lifestyle-induced weight loss (WL) on appetite in patients with obesity remains controversial. This study aimed was to assess the short- and long-term impact of WL achieved by diet and exercise, on appetite in patients with obesity. Thirty-five (22 females) adults with severe obesity......), in the fasting and postprandial states, were measured at baseline (B), week 4 (W4), 1 and 2-years (and average values for all fasting and postprandial time points computed). BW was significantly reduced and VO2max (ml/kg/min) increased at all time points compared with B (3.5, 8.1 and 8.4 % WL and 7, 11 and 8...... compared with B. Average GLP-1 was reduced at W4 and CCK increased at 2y. After lifestyle-induced WL, patients with severe obesity will, therefore, have to deal with increased hunger in the long-term. In conclusion, sustained WL at 2y achieved with diet and exercise is associated with increased hunger...

The effect of obesity on inflammatory markers in patients with PCOS: a BMI-matched case-control study.

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Keskin Kurt, Raziye; Okyay, Ayşe Güler; Hakverdi, Ali Ulvi; Gungoren, Arif; Dolapcioglu, Kenan Serdar; Karateke, Atilla; Dogan, Mustafa Ozcil

2014-08-01

Previous studies have shown increased inflammatory activity in patients with polycystic ovary syndrome (PCOS); however, it remains uncertain whether this increased inflammatory activity is a consequence of the disorder itself or of the accompanying obesity. We therefore aimed to test the inflammatory marker levels in obese and lean patients with PCOS by using two separate control groups with matching body mass index (BMI). A total of 120 women in reproductive age with (n = 62) and without (n = 60) PCOS were recruited for the study. Patients with PCOS were divided into two groups as obese (n = 32) and lean (n = 30) PCOS groups according to BMI. Two BMI-matched control groups were created. Furthermore, high sensitive CRP protein (hsCRP), neutrophils, lymphocytes, white blood cell count (WBC) and neutrophil to lymphocyte ratio (NLR) were evaluated with complete blood count. The hsCRP (5.5 ± 0.8 vs. 3.1 ± 0.7, p PCOS compared to the control group while lymphocyte count was lower (1.71 ± 0.65 vs. 1.98 ± 0.39, p = 0.008). Similarly, both obese and lean patients with PCOS had higher levels of hsCRP, neutrophils, leukocytes and NLR ratios compared to BMI-matched controls. The correlation analysis revealed a moderate correlation between NLR and hsCRP (r 0.459, p lean and obese patients with PCOS have increased inflammatory markers compared to BMI-matched control groups indicating that the inflammation seen in PCOS might be related with the presence of the disorder rather than with obesity.

The Effect of Agave tequilana Weber Inulin on Postprandial Ghrelin Concentration in Obese Patients.

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Contreras-Haro, Betsabe; Robles-Cervantes, Jose A; Gonzalez-Ortiz, Manuel; Martinez-Abundis, Esperanza; Espinel-Bermudez, Claudia; Gallegos-Arreola, Martha P; Morgado-Castillo, Karina C

2017-02-01

This study was performed to investigate the effect of Agave tequilana Weber inulin on postprandial ghrelin levels in obese patients. A randomized, double-blind, cross-over design was performed. A total of 14 patients were allocated into two groups: one group received a drink that contained 500 mL lemon water, 24 g of A. tequilana Weber inulin, and 75 g glucose and the other group received a placebo drink with 500 mL lemon drink and 75 g of glucose. After a 7-day washout period, the groups were crossed. The primary outcome measure was postprandial ghrelin levels between minute 240 and minute 270. A. tequilana Weber inulin did not change postprandial ghrelin concentration in obese patients.

Level of knowledge about the effect of obesity on hypertension among the patients of Isfahan Oil Company Polyclinic, Iran

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Zamane Vafaei

2012-12-01

Full Text Available BACKGROUND: Hypertension is a chronic disease and is one of the complications of Obesity. Based on this serious complication and the importance of preventing hypertension, we decided to study the level of public knowledge about the effect of obesity on hypertension.    METHODS: The present study was conducted through simple random sampling (SRS on 262 patients of Isfahan Oil Company Polyclinic, Iran. In order to collect the required data, we provided special questionnaires which were completed by the patients.    RESULTS: Most of the patients participating in our study were over 40 years of age (50%. The next largest age group consisted of 40‐45 year olds (14%. The lowest educational status was high school diploma (41.3%, and 75.7% were married. 60.7% of the participants mentioned hypertension as a complication of obesity. 21.1% stated that hypertension is not a complication of obesity and18.2% did not know.    CONCLUSION: Since public knowledge about the effect of obesity on hypertension is rather moderate, efforts to increase public knowledge and treat obesity are important in reducing the rate of patients with hypertension.       Keywords: Knowledge, Obesity, Hypertension

Sleep duration in elderly obese patients correlated negatively with intake fatty

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Santana Aline

2012-08-01

Full Text Available Abstract Study objectives The purpose of the present study was to evaluate the relationship between sleep duration and dietary habits in elderly obese patients treated at an institute of cardiology. Methods The fifty-eight volunteers were elderly patients with obesity (classified as obese according to BMI of both genders, between 60 and 80 years of age. All participants were subjected to assessments of food intake, anthropometry, level of physical activity, and duration of sleep. Results The men had significantly greater weight, height, and waist circumference than women. Sleep durations were correlated with dietary nutrient compositions only in men. We found a negative association between short sleep and protein intake (r = -0.43; p = 0.02, short sleep and monounsaturated fatty acids intake (r = -0.40; p = 0.03, and short sleep and cholesterol dietary intake (r = -0.50; p = 0.01. Conclusions We conclude that mainly in men, volunteers that had short sleep duration showed a preference for high energy-density as fatty food, at least in part, may explain the relationship between short sleep duration and the development of metabolic abnormalities.

Effects of obesity on weight-bearing versus weight-supported exercise testing in patients with COPD.

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Maatman, Robbert C; Spruit, Martijn A; van Melick, Paula P; Peeters, Jos P I; Rutten, Erica P A; Vanfleteren, Lowie E G W; Wouters, Emiel F M; Franssen, Frits M E

2016-04-01

Obesity is associated with increased dyspnoea and reduced health status in patients with chronic obstructive pulmonary disease (COPD). Studies on the effects of obesity on exercise capacity showed divergent results. The objective of this study is to investigate the impact of obesity on weight-bearing versus weight-supported exercise tolerance in obese and normal weight patients, matched for age, gender and degree of airflow limitation. Retrospective analyses of data obtained during pre-pulmonary rehabilitation assessment in 108 obese COPD patients (OB) (age: 61.2 ± 5.3y, FEV1 : 43.2 ± 7.4%, BMI: 34.1 ± 3.9 kg/m(2) ,) and 108 age and FEV1 -matched normal weight COPD patients (NW) (age: 61.7 ± 3.6y, FEV1 : 41.5 ± 8.4%, BMI: 22.9 ± 1.2 kg/m(2) ,). Cardiopulmonary exercise test (CPET) and 6 min walk test (6MWT) were performed, Borg scores for dyspnoea and leg fatigue were recorded, before and after the tests. Six-minute walk distance differed between OB (398 ± 107 m) and NW patients (446 ± 109 m, P exercise load was comparable (OB: 75 ± 29 W, NW: 70 ± 25 W, ns). Dyspnoea (OB 3.2 ± 2.0 vs NW 3.1 ± 1.7, ns) and leg fatigue (OB 2.4 ± 2.3 vs NW 1.9 ± 1.7, ns) were not significantly different in OB compared with NW after 6MWT, or after CPET (dyspnoea: OB 5.1 ± 2.4 vs NW 5.4 ± 2.2, ns; leg fatigue: OB 4.0 ± 2.3 vs NW 4.0 ± 2.7, ns). In contrast to weight-supported exercise, obesity has a negative impact on weight-bearing exercise capacity, despite comparable exercise-related symptoms. The results of this study enhance the understanding of the impact of obesity on physical performance in COPD. © 2015 Asian Pacific Society of Respirology.

Impact of vitamin D status and obesity on C-reactive protein in kidney-transplant patients

DEFF Research Database (Denmark)

Ewers, B.; Gasbjerg, A.; Zerahn, B.

2008-01-01

and Patients: Data were collected between December 2005 and April 2006 from 161 adult (aged >18 years) kidney-transplant patients (mean age, 53.1 years; SD, 11.5 years; females/males, 78/83), with a median kidney-graft age of 7.0 years and serum CRP levels :... was found. Fat mass correlated positively with CRP, suggesting that obesity may increase the risk of cardiovascular disease and chronic allograft rejection in kidney-transplant patients. (C) 2008 by the National Kidney Foundation, Inc Udgivelsesdato: 2008/5......Objective: We examined whether vitamin D status and obesity are associated with low-grade systemic inflammation, as assessed by serum concentrations of C-reactive protein (CRP) in an adult population of kidney-transplant patients. Design: This was a single-center, cross-sectional study. Setting...

[Survival of Overweight Patients After Coronary Artery Bypass Surgery. Does the Obesity Paradox Play a Role?

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Efros, L A; Samorodskaya, I V

2015-07-01

Although excessive body mass and obesity are considered risk factors of a number of diseases and conditions numerous results of studies evidence for the existence of the "obesity paradox" - higher long-term survival of overweight and obese patients. Aim of this study was to elucidate impact of body mass index (BMI) on postoperative mortality and long-term survival of patients after coronary artery bypass grafting (CABG). The study was conducted on the basis of register of patients with ischemic heart disease who had undergone CABG with or without correction of valvular defects and/or resection of left ventricular (LV) aneurism during the period from 2000 to 2009 in the Chelyabinsk Interregional Cardiosurgical Center. Duration of follow-up was 1 to 10 years (mean - 2.3+/-2.4 years). The patients were divided into groups in dependence on BMI. Multifactorial logistic regression analysis of association of BMI and hospital mortality was carried out with adjustment for age, sex, arterial pressure, presence of diabetes mellitus (DM), chronic obstructive pulmonary disease, LV aneurism, LV ejection fraction, and character of involvement of vessels. Long term survival was studied using Coxs regression model. Compared with group of patients with normal BMI DM and arterial hypertension were more often registered among patients with excessive body mass and obesity. Elevated body mass was not an independent factor of risk of postoperative and lower long-term survival. There was a tendency to lower survival among patients with BMI >35 rg/m2. Results of this study evidence for the absence of proof of negative impact of excessive BMI on hospital mortality and long term survival.

[Survival of Overweight Patients After Coronary Artery Bypass Surgery. Does the "Obesity Paradox" Play a Role?].

Science.gov (United States)

Efros, L A; Samorodskaya, I V

2015-01-01

Although excessive body mass and obesity are considered risk factors of a number of diseases and conditions numerous results of studies evidence for the existence of the "obesity paradox"--higher long-term survival of overweight and obese patients. Aim of this study was to elucidate impact of body mass index (BMI) on postoperative mortality and long-term survival of patients after coronary artery bypass grafting (CABG). The study was conducted on the basis of register of patients with ischemic heart disease who had undergone CABG with or without correction of valvular defects and/or resection of left ventricular (LV) aneurism during the period from 2000 to 2009 in the Chelyabinsk Interregional Cardiosurgical Center. Duration of follow-up was 1 to 10 years (mean--2.3 ± 2.4 years). The patients were divided into groups in dependence on BMI. Multifactorial logistic regression analysis of association of BMI and hospital mortality was carried out with adjustment for age, sex, arterial pressure, presence of diabetes mellitus (DM), chronic obstructive pulmonary disease, LV aneurism, LV ejection fraction, and character of involvement of vessels. Long term survival was studied using Cox's regression model. Compared with group of patients with normal BMI DM and arterial hypertension were more often registered among patients with excessive body mass and obesity. Elevated body mass was not an independent factor of risk of postoperative and lower long-term survival. There was a tendency to lower survival among patients with BMI > 35 rg/m2. Results of this study evidence for the absence of proof of negative impact of excessive BMI on hospital mortality and long term survival.

Quality of Life, Disability, and Body Mass Index Are Related in Obese Patients

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Sirtori, Anna; Brunani, Amelia; Liuzzi, Antonio; Pasqualinotto, Lucia; Villa, Valentina; Leonardi, Matilde; Raggi, Alberto

2011-01-01

The aim of this study is to analyze the relationship between health-related quality of life (QoL), disability, and degree of obesity. Adult obese patients (BMI greater than 30) were consecutively enrolled in this cross-sectional observational study. The WHO Disability Assessment Schedule (WHO-DAS II) and the short version of the impact of weight…

Health-Related Quality of Life in Obese Presurgery Patients with and without Binge Eating Disorder, and Subdiagnostic Binge Eating Disorders

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Rita Marie Sandberg

2013-01-01

Full Text Available Objective. To study health-related quality of life (HRQoL in obese presurgery patients with binge eating disorder (BED and with subdiagnostic binge eating disorder (SBED compared to patients without eating disorders or SBED. Method. Participants were patients referred to St. Olavs University Hospital, Norway, for bariatric surgery. Eating Disorders in Obesity (EDO questionnaire was used to diagnose BED and SBED. Short-Form Health Survey (SF-12 assessed health-related quality of life. Questionnaires were returned by 160 of 209 patients. The present study sample consisted of 143 patients (103 women and 40 men as 17 patients did not complete the SF-12. Results. Patients with BED and patients with SBED both had significantly lower mental HRQoL, but not physical HRQoL, compared to patients without eating disorders. Discussion. The findings indicate that obese presurgery patients with BED, and also SBED, may have special treatment needs in regard to their mental health.

Weight loss as treatment for knee osteoarthritis symptoms in obese patients

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Bliddal, Henning; Leeds, Anthony; Stigsgaard, Lise

2011-01-01

OBJECTIVE: To evaluate 1-year symptomatic improvement in obese patients with knee osteoarthritis (OA) on an intensive low-energy diet (LED) maintained by frequent consultations with a dietician compared to minimal attention. METHODS: The LED programme consisted of group therapy with dietary...

Percutaneous ultrasound-guided renal biopsy in supine antero-lateral position: a new approach for obese and non-obese patients.

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Gesualdo, Loreto; Cormio, Luigi; Stallone, Giovanni; Infante, Barbara; Di Palma, Anna Maria; Delli Carri, Paolo; Cignarelli, Mauro; Lamacchia, Olga; Iannaccone, Salvatore; Di Paolo, Salvatore; Morrone, Luigi; Aucella, Filippo; Carrieri, Giuseppe

2008-03-01

Percutaneous ultrasound (US)-guided renal biopsy is the gold standard in the evaluation of renal diseases, but some patients, such as the obese, may not be eligible for this procedure. Aim of this study was to determine the feasibility, efficacy and safety of US-guided percutaneous renal biopsy in supine antero-lateral position (SALP) in high-risk patients (BMI > 30 and/or respiratory difficulty), as well as to compare the overall outcome of SALP with that of traditional prone position (PP) in low-risk patients (BMI SALP (Group 2), whereas 20 high-risk patients received US-guided renal biopsy in SALP (Group 3) and were our observational cohort study. Comfort compliance and breathing difficulty in each group were evaluated by the Visual Analogue Scale (VAS). Bleeding complications were evaluated through US renal scanning. Mean operating time was 7 min. Comfort compliance and breathing difficulty were significantly better for SALP in both low- and high-risk patients; there were no significant differences in pain after biopsy among the three groups. Bleeding complications were slightly higher in Group 1. Diagnostic yield was similar in all groups. SALP is reliable, minimally invasive, easy, highly successful, timesaving and almost free from severe side-effects. A better VAS score for breathing difficulty and comfort compliance characterizes this procedure, making it particularly suitable for obese patients.

Percutaneous endovascular aneurysm repair in morbidly obese patients.

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Chin, Jason A; Skrip, Laura; Sumpio, Bauer E; Cardella, Jonathan A; Indes, Jeffrey E; Sarac, Timur P; Dardik, Alan; Ochoa Chaar, Cassius I

2017-03-01

Endovascular aneurysm repair (EVAR) with percutaneous femoral access (PEVAR) has several potential advantages. Morbidly obese (MO) patients present unique anatomical challenges and have not been specifically studied. This study examines the trends in the use of PEVAR and its surgical outcomes compared with open femoral cutdown (CEVAR) in MO patients. The American College of Surgeons National Surgical Quality Improvement Program files for the years 2005 to 2013 were reviewed. The study included all MO patients (body mass index [BMI] ≥40 kg/m 2 ) undergoing EVAR. Patients were categorized as having CEVAR if they had any one of 11 selected Current Procedural Terminology (American Medical Association, Chicago, Ill) codes describing an open femoral procedure. The PEVAR group included any remaining patients who had only codes for EVAR and endovascular procedures. Linear correlation was used to evaluate temporal trends in the use of PEVAR among MO patients. Baseline comorbidities and surgical outcomes were compared between the PEVAR and CEVAR groups using χ 2 tests or t-tests. There were 833 MO patients (470 CEVAR and 363 PEVAR) constituting 3.0% of all patients undergoing EVAR. The use of PEVAR in MO patients significantly increased from 27.3% of total EVARs in the years 2005 to 2006 to 48.6% in 2013 (P = .039). The two groups had similar baseline characteristics, including age, BMI, comorbidities, and emergency procedures, except for history of severe chronic obstructive pulmonary disease (29.6% CEVAR vs 22.6% PEVAR; P = .024). PEVAR patients had shorter duration of anesthesia (244 vs 260 minutes; P = .048) and shorter total operation time (158 vs 174 minutes; P = .002). PEVAR patients had significantly decreased wound complications (5.5% vs 9.4%; P = .039). There was a trend towards PEVAR patients being more likely to be discharged home than to a facility (93.6% vs 87.8%; P = .060). There was no difference in any other complication or mortality. A subgroup

Orlistat for Six Months in Overweight and Obese Patients

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Alfredo Halpern

2010-01-01

Full Text Available Objective. To assess the efficacy and tolerability of the association sibutramine (10–20 mg/day and orlistat (120 mg 2-3 times a day in the treatment of obesity in a six-month open trial. Methods. 446 overweight and obese patients who sought treatment for obesity in a private clinic were assessed every 2 weeks during a period of 3 and 6 months. Results. After 3 months, the mean weight loss was 10.5 kg (−9.8% of the initial weight, =263, and after 6 months, the mean weight loss was 13.9 kg (−12.8% of the initial weight, =97. The tolerability of such association was quite acceptable and coherent with the action mechanism of each component. Conclusions. The association of orlistat and sibutramine is quite efficient and it seems to promote a higher rate of weight loss than that reported in clinical studies performed with each drug separately.

SLEEVE GASTRECTOMY IN PATIENTS WITH MORBID OBESITY AND HIV.

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Pinto, José Máximo Costa; Lima, Marianna Gomes Cavalcanti Leite de; Almeida, Ana Luiza Melo Cavalcanti de; Sousa, Marcelo Gonçalves

It is estimated that there are nearly 40 million people with the human immunodeficiency virus (HIV) worldwide. Due to the advent of antiretroviral drugs, it has been observed increasing in obesity and metabolic rates among patients undergoing treatment. Thus, numerous surgical therapies for weight loss are proposed for continuous improvement in health of patients with HIV, being the vertical gastrectomy an option for intact intestinal transit. To evaluate the applicability of the vertical gastrectomy in patients with morbid obesity and HIV. Was conducted a systematic review of the literature, in the electronic databases Scopus, Pubmed, Cinahl, Scielo, Cochrane and Lilacs, from 1998 to 2015. MeSH headings used in data collection were "Gastrectomy" and "Morbid obesity" being combined with the descriptor "HIV". Were found 2148 articles in Scopus, 1234 in PubMed and 784 in Cinahl. The articles were analyzed by the Jadad Quality Scale, being reduced to 40 articles, subsequently reassessed using an elaborated form by the Critical Appraisal Skills Programme (CASP), reaching 12 articles in the end. It was found that vertical gastrectomy constitutes a safe and effective method, with low mortality and low rate of postoperative complications, being recommended as surgical technique in patients with obesity, HIV and comorbidities. Estima-se que haja quase 40 milhões de pessoas com o vírus da imunodeficiência adquirida (HIV) no mundo. Com o advento dos antirretrovirais, observou-se aumento da obesidade e de taxas metabólicas nos pacientes em tratamento. Assim, inúmeras terapias cirúrgicas para a perda de peso estão sendo estudadas para a melhoria contínua da saúde dos pacientes com HIV, sendo a gastrectomia vertical uma opção de trânsito íntegro. Avaliar a aplicabilidade da gastrectomia vertical em pacientes com obesidade mórbida e HIV. Foi realizada revisão sistemática de literatura, de artigos publicados nas bases eletrônicas de dados Scopus, Pubmed, Cinahl

Ilioinguinal Nerve Block in Obese Patients: Description of New Technique

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Jonathan Mathers

2015-12-01

Full Text Available Ilioinguinal nerve blockade is an effective technique for both perioperative and chronic pain conditions in adult and pediatric practice. Ultrasound guidance can increase the success rate and reduce the complications associated with performing ilioinguinal nerve blockade. Obese patients present a particular challenge with ilioinguinal block as the overlying abdominal pannus impedes the ultrasound view by increasing the depth to target and necessitating an out-of-plane approach. We demonstrate that modification of the technique by placing the patient into the lateral decubitus position reduces the depth to target and allows an in-plane approach to be utilized.

Patients' and professionals' experiences and perspectives of obesity in health-care settings: a synthesis of current research.

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Mold, Freda; Forbes, Angus

2013-06-01

Obesity-related stigma likely influences how obese people interact with health-care professionals and access health care. To undertake a synthesis of studies examining the views and experiences of both obese people in relation to their health-care provision and health-care professionals in providing care to obese patients. A systematic search of key electronic databases relating to professional or patient experiences of, or perspectives on, obesity was performed in 2008 and updated in 2010. Reference lists of article bibliographies were searched, along with hand searches of relevant journals.   Studies were screened against explicit inclusion criteria and published between 1990 and 2010. Findings were examined and organized thematically.   Data were extracted focusing on obesity, stigma and access to health-care services. All included studies were subject to critical appraisal to assess the quality of the research. Thirty studies were identified. All the studies reported obesity impacting on health-care interactions. Key themes identified were experiences of stigma and feelings of powerlessness, treatment avoidance, psycho-emotional functioning, professional attitudes, confidence and training, variations in health contact time and finally, differences in treatment options and preventative measures. Obesity is a stigmatized condition that impacts negatively on the relationship between patients and health-care providers. Given the increasing prevalence of obesity and the range of therapeutic options available, further work is necessary to understand how the presence of obesity affects health-care interactions and decision making. © 2011 John Wiley & Sons Ltd.

Underweight, overweight and obesity in paediatric dialysis and renal transplant patients.

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Bonthuis, Marjolein; van Stralen, Karlijn J; Verrina, Enrico; Groothoff, Jaap W; Alonso Melgar, Ángel; Edefonti, Alberto; Fischbach, Michel; Mendes, Patricia; Molchanova, Elena A; Paripović, Dušan; Peco-Antic, Amira; Printza, Nikoleta; Rees, Lesley; Rubik, Jacek; Stefanidis, Constantinos J; Sinha, Manish D; Zagożdżon, Ilona; Jager, Kitty J; Schaefer, Franz

2013-11-01

The prevalence of childhood overweight is rising worldwide, but in children on renal replacement therapy (RRT) a poor nutritional status is still the primary concern. We aimed to study the prevalence of, and factors associated with, underweight and overweight/obesity in the European paediatric RRT population. Moreover, we assessed the evolution of body mass index (BMI) after the start of RRT. We included 4474 patients younger than 16 years from 25 countries of whom BMI data, obtained between 1995 and 2010, were available within the European Society for Paediatric Nephrology/European Renal Association-European Dialysis and Transplant Association Registry. Prevalence estimates for under- and overweight/obesity were calculated using age and sex-specific criteria of the World Health Organization (WHO, 0-1 year olds) and the International Obesity Task Force cut-offs (2-15 year olds). The prevalence of underweight was 3.5%, whereas 20.8% of the patients were overweight and 12.5% obese. Factors associated with being underweight were receiving dialysis treatment and infant age. Among transplanted recipients, a very short stature (OR: 1.64, 95% CI: 1.40-1.92) and glucocorticoid treatment (OR: 1.23, 95% CI: 1.03-1.47) were associated with a higher risk of being overweight/obese. BMI increased post-transplant, and a lower BMI and a higher age at the start of RRT were associated with greater BMI changes during RRT treatment. Overweight and obesity, rather than underweight, are highly prevalent in European children on RRT. Short stature among graft recipients had a strong association with overweight, while underweight appears to be only a problem in infants. Our findings suggest that nutritional management in children receiving RRT should focus as much on the prevention and treatment of overweight as on preventing malnutrition.

Preoperative weight loss in super-obese patients: study of the rate of weight loss and its effects on surgical morbidity

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Marco Aurelio Santo

2014-01-01

Full Text Available OBJECTIVES: The incidence of obesity and particularly super obesity, has increased tremendously. At our institution, super obesity represents 30.1% of all severely obese individuals in the bariatric surgery program. In super obesity, surgical morbidity is higher and the results are worse compared with morbid obesity, independent of the surgical technique. The primary strategy for minimizing complications in these patients is to decrease the body mass index before surgery. Preoperative weight reduction can be achieved by a hypocaloric diet, drug therapy, an intragastric balloon, or hospitalization. The objective of this study was to analyze the results of a period of hospitalization for preoperative weight loss in a group of super-obese patients. METHODS: Twenty super-obese patients were submitted to a weight loss program between 2006 and 2010. The mean patient age was 46 years (range 21-59. The mean BMI was 66 kg/m2 (range 51-98 and 12 were women. The average hospital stay was 19.9 weeks and the average weight loss was 19% of the initial weight (7-37%. The average caloric intake was 5 kcal/kg/day. After the weight loss program, the patients underwent gastric bypass surgery. RESULTS: The statistical analysis revealed that after 14 weeks of treatment (15% loss of initial weight, the weight loss was not significant. All patients had satisfactory surgical recovery and were discharged after an average of 4.6 days. CONCLUSION: In super obesity, preoperative weight loss is an important method for reducing surgical risks. Hospitalization and a hypocaloric diet are safe and effective. After 14 weeks, the weight loss rate stabilized, signaling the time of surgical intervention in our study.

Obesity paradox in heart failure patients – Female gender characteristics-KAMC-single center experience

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Sheeren Khaled

2017-09-01

Conclusion: Our findings showed that heart failure patients with low BMI had poor adverse clinical outcome measures (poor EF, recurrent readmission, mortality and composite rates of CVA, TIA and unexplained syncope which reflect the effect of obesity paradox in those patients with HFrEF. Female patient subgroup showed similar characteristic findings which also might reflect the value of gender-specific BMI related clinical outcomes.

Effect of Avocado Soybean Unsaponifiables on Insulin Secretion and Insulin Sensitivity in Patients with Obesity

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Esperanza Martínez-Abundis

2013-10-01

Full Text Available Aim: To evaluate the effect of avocado soybean unsaponifiables (ASU on insulin secretion and insulin sensitivity in patients with obesity. Methods: A randomized, double-blind, placebo-controlled, clinical trial was carried out in 14 obese adult volunteers. After random allocation of the intervention, 7 patients received 300 mg of ASU or placebo during a fasting state for 3 months. A metabolic profile including IL-6 and high-sensitivity C-reactive protein (hs-CRP levels was carried out prior to the intervention. A hyperglycemic-hyperinsulinemic clamp technique was used to assess insulin secretion and insulin sensitivity phases. Mann-Whitney U test and Wilcoxon test were performed for statistical analyses. The study was approved by the local ethics committee of our institution. Results: At baseline, both groups were similar according to clinical and laboratory characteristics. There was no significant difference in insulin secretion and insulin sensitivity with ASU. Conclusions: ASU administration for 3 months did not modify insulin secretion and insulin sensitivity in patients with obesity.

[Effect of Acupuncture Therapy on Visceral Fat Thickness in Simple Central Obesity Patients].

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Zhang, Cui-yan; Yang, Li

2015-12-01

To evaluate the efficacy of acupuncture therapy in decreasing visceral fat thickness(VFT) in patients with simple central obesity. Sixty patients with simple central obesity (syndrome of stomach and intestinal excessive heat) were randomly divided into control and acupuncture groups. Patients of the control group were treated with diet control and physical exercise procedure (basic treatment) for 6 months, and those of the acupuncture group treated with basic treatment combined with acupuncture stimulation of main acupoints Shuifen (CV 9), Yinjiao (CV 7), and bilateral Tianshu (ST 25), Huaroumen (ST 24) and bilateral Wailing (ST 26), etc., in combination with electroacupuncture (EA, 50- 100 Hz, 1- 5 mA) of bilateral ST 25, CV 9 and CV 7 for 30 min, once every other day for 3 months. The VFT (1 cm above the umbilicus) was detected by using an ultrasonic diagnosis instrument, and the body mass index (BMI, body weight/height(2)), and waist circumfe-rence (WC) were measured before treatment, 3 and 6 months after the treatment, respectively. Following 3 and 6 months' treatment, the VFT, BMI and WC of both groups were significantly decreased (Pacupuncture group were significantly superior to those of the control group in lowering VFT [(51.5 ± 6.5) mm vs (48.3 ± 4.7) mm)] and WC [(88.2 ± 3.6)cm vs (85.9 ± 4.3)cm] 6 months' after the treatment (Pacupuncture groups in BMI fowllowing 6 months' treatment [(31.0 ± 4.3) vs (30.1 ± 3.2), P>0.05]. Acupuncture intervention combined with diet control and physical exercise can effectively decrease VFT and WC in simple central obesity patients. VFT is a sensitive and better parameter for evaluating the effect of obesity treatment.

Modification of cardiometabolic profile in obese diabetic patients after bariatric surgery: changes in cardiovascular risk.

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Pujante, Pedro; Hellín, María D; Fornovi, Aisa; Martínez Camblor, Pablo; Ferrer, Mercedes; García-Zafra, Victoria; Hernández, Antonio M; Frutos, María D; Luján-Monpeán, Juan; Tébar, Javier

2013-10-01

Bariatric surgery is a valuable tool for metabolic control in obese diabetic patients. The aim of this study was to determine changes in weight and carbohydrate and lipid metabolism in obese diabetic patients during the first 4 years after bariatric surgery. A retrospective study was performed in 104 patients (71 women; mean age, 53.0 [0.9] years; mean body mass index, 46.8 [0.7]) with type 2 diabetes mellitus (median duration, 3 years) who underwent laparoscopic proximal gastric bypass. Blood glucose levels and glycated hemoglobin concentrations decreased during the first 1-3 postoperative months. Values stabilized for the rest of the study period, allowing hypoglycemic treatment to be discontinued in 80% of the patients. No significant differences were observed as a function of the body mass index, diabetes mellitus duration, or previous antidiabetic treatment. Weight decreased during the first 15-24 months and slightly increased afterward. Levels of total cholesterol, triglycerides, and low-density lipoprotein significantly decreased, and target values were reached after 12 months in 80% of the patients. No correlation was found between these reductions and weight loss. Similarly, high-density lipoprotein concentrations decreased until 12 months after surgery. Although concentrations showed a subsequent slight increase, target or lower high-density lipoprotein values were achieved at 24 months postintervention in 85% of the patients. Bariatric surgery is effective for the treatment of obese diabetic patients, contributing to their metabolic control and reducing their cardiovascular risk. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

Prevalence of obesity and systemic hypertension among diabetes mellitus patients attending an out-patient diabetes clinic in a Ghanaian Teaching Hospital.

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Mogre, Victor; Abedandi, Robert; Salifu, Zenabankara S

2014-01-01

Diabetes Mellitus is now a prevalent disease in both developed and developing countries. Overweight/obesity and hypertension are potential modifiable risk factors for diabetes mellitus and persist during the course of the disease. This study was aimed at reporting the prevalence of overweight/obesity and systemic hypertension and their association to blood glucose levels in persons with diabetes mellitus attending a diabetic clinic in Ghanaian Teaching Hospital. This cross-sectional study was conducted among 100 previously diagnosed diabetes mellitus patients attending a diabetic clinic at the Tamale Teaching Hospital, Ghana. Anthropometric variables of age, weight and height were measured with appropriate instruments, computed into BMI and classified according to WHO classifications. Systolic and diastolic blood pressures were measured by an appropriate instrument and classified by WHO standards. Fasting plasma glucose levels of the study participants were recorded from their personal health folder. All data was analysed by GraphPad prism version 5. In general, 7.0% of the participants were underweight and 32.0% were overweight or obese. The mean±SD weight, height and BMI of the participants were 67.53±13.32, 1.68±0.12 and 24.18±5.32. Twenty-one percent of the studied participants were hypertensive. Mean±SD fasting plasma glucose of 7.94±2.82 was observed among the diabetic patients. As the prevalence of hyperglycaemia was higher among patients aged ≤40 years (88.9% vs. 75.8%), normoglycaemia (11.1% vs. 24.2%) was higher among those over 40 years. The differences were not significant. The prevalence of hyperglycaemia was significantly higher in participants with overweight/obese (0.0% vs. 41.6%, phypertension was found. Hyperglycaemia was more prevalent among overweight/obese participants. Copyright © 2014 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Prevalence of obesity among patients with congenital and acquired heart disease.

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Shustak, Rachel J; McGuire, Sharda B; October, Tessie W; Phoon, Colin K L; Chun, Anne J L

2012-01-01

Overweight and obesity rates have risen dramatically in the United States, with subsequent detrimental comorbidity risks. The rates for obesity among children with congenital and acquired heart disease have rarely been reported. A retrospective cross-sectional study was conducted to determine the prevalence of overweight and obesity in children with heart disease and to identify subgroups at increased risk. A total of 795 cases were identified from a chart review of patients presenting to an urban center's Pediatric Cardiology Program between 1 January and 31 December 2006. A body mass index (BMI) at the 85th percentile or higher was defined as overweight, and a BMI at the 95th percentile or higher was defined as obese. Subjects with comorbidities affecting body habitus were excluded from the study. Overall, overweight and obesity rates were similar to national data. No significant differences in overweight or obesity rates were detected between heart disease and non-heart disease groups (P = 0.50). According to multivariate analysis, Hispanic ethnicity and male gender were the only predictors of obesity. This study shows that children with heart disease are not immune to the common predictors of obesity such as gender and ethnicity and that the future care of children with heart disease should include general discussions about the risks for obesity.

Impact of bariatric surgery on life expectancy in severely obese patients with diabetes: A Decision analysis

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Schauer, Daniel P.; Arterburn, David E.; Livingston, Edward H.; Coleman, Karen J.; Sidney, Steve; Fisher, David; O'Connor, Patrick; Fischer, David; Eckman, Mark H.

2014-01-01

Objective To create a decision analytic model to estimate the balance between treatment risks and benefits for severely obese patients with diabetes. Summary Background Data Bariatric surgery leads to many desirable metabolic changes, but long-term impact of bariatric surgery on life expectancy in patients with diabetes has not yet been quantified. Methods We developed a Markov state transition model with multiple Cox proportional hazards models and logistic regression models as inputs to compare bariatric surgery versus no surgical treatment for severely obese diabetic patients. The model is informed by data from three large cohorts: 1) 159,000 severely obese diabetic patients (4,185 had bariatric surgery) from 3 HMO Research Network sites, 2) 23,000 subjects from the Nationwide Inpatient Sample (NIS), and 3) 18,000 subjects from the National Health Interview Survey linked to the National Death Index. Results In our main analyses, we found that a 45 year-old female with diabetes and a BMI of 45 kg/m2 gained an additional 6.7 years of life expectancy with bariatric surgery (38.4 years with surgery vs. 31.7 without). Sensitivity analyses revealed that the gain in life expectancy decreased with increasing BMI, until a BMI of 62 kg/m2 is reached, at which point nonsurgical treatment was associated with greater life expectancy. Similar results were seen for both men and women in all age groups. Conclusions For most severely obese patients with diabetes, bariatric surgery appears to improve life expectancy; however, surgery may reduce life expectancy for the super obese with BMIs over 62 kg/m2. PMID:25844968

Effectiveness of a motivational intervention on overweight/obese patients in the primary healthcare: a cluster randomized trial.

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Rodriguez-Cristobal, Juan Jose; Alonso-Villaverde, Carlos; Panisello, Jose Ma; Travé-Mercade, Pere; Rodriguez-Cortés, Francisca; Marsal, Josep Ramon; Peña, Esther

2017-06-20

Overweight and obesity are common health problems which increase the risk of developing several serious health conditions. The main difficulty in the management of weight-loss lies in its maintenance, once it is achieved. The aim of this study was to investigate whether a motivational intervention, together with current clinical practice, was more efficient than a traditional intervention, in the treatment of overweight and obesity and whether this intervention reduces cardiovascular risk factors associated with overweight and obesity. Multi-centre cluster randomized trial with a 24-month follow-up included 864 overweight/obese patients randomly assigned. Motivational intervention group (400 patients), delivered by a nurse trained by an expert psychologist, in 32 sessions, 1 to 12 fortnightly, and 13 to 32, monthly, on top of their standard programmed diet and exercise. The control group (446 patients), received the usual follow-up. Weight reduction was statistically significant in the second year with a mean reduction of 1.0 Kg in the control group and 2.5 Kg in the intervention group (p = 0. 02). While 18.1% of patients in the control group reduced their weight by more than 5%, this percentage rose to 26.9% in the intervention group, which is statistically significant (p = 0.04). Patients in the motivational intervention group had significantly greater improvements in triglycerides and APOB/APOA1ratio. The results highlight the importance of the group motivational interview in the treatment of overweight /obese patients in primary care, and in the improvement of their associated cardiovascular risks factors. ClinicalTrials.gov Identifier: NCT01006213 October 30, 2009.

Altered DNA methylation of glycolytic and lipogenic genes in liver from obese and type 2 diabetic patients

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Kirchner, Henriette; Sinha, Indranil; Gao, Hui

2016-01-01