scholarly journals Markers of adipose tissue hypoxia are elevated in subcutaneous adipose tissue of severely obese patients with obesity hypoventilation syndrome but not in the moderately obese

2021 ◽  
Author(s):  
Marijana Todorčević ◽  
Ari R. Manuel ◽  
Luke Austen ◽  
Zoi Michailidou ◽  
Jonathan M. Hazlehurst ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Hypoxia Inducible Factor ◽  
Class I ◽  
Protein Abundance ◽  
Metabolic Dysfunction ◽  
Class Iii ◽  
Class I Obesity ◽  
Obese Class ◽  
Class Iii Obesity ◽  
Hypoventilation Syndrome

AbstractIt has been suggested that metabolic dysfunction in obesity is at least in part driven by adipose tissue (AT) hypoxia. However, studies on AT hypoxia in humans have shown conflicting data. Therefore we aimed to investigate if markers of AT hypoxia were present in the subcutaneous AT of severly obese individuals (class III obesity) with and without hypoventilation syndrome (OHS) in comparison to moderately obese (class I obesity) and lean controls. To provide a proof-of-concept study, we quantified AT hypoxia by hypoxia inducible factor 1 A (HIF1A) protein abundance in human participants ranging from lean to severly obese (class III obesity). On top of that nightly arterial O2 saturation in individuals with obesity OHS was assessed. Subjects with class III obesity (BMI > 40 kg/m2) and OHS exhibited significantly higher adipose HIF1A protein levels versus those with class I obesity (BMI 30–34.9 kg/m2) and lean controls whereas those with class III obesity without OHS showed an intermediate response. HIF1A gene expression was not well correlated with protein abundance. Although these data demonstrate genuine AT hypoxia in the expected pathophysiological context of OHS, we did not observe a hypoxia signal in lesser degrees of obesity suggesting that adipose dysfunction may not be driven by hypoxia in moderate obesity.

scholarly journals Challenging the obesity paradox: extreme obesity and COPD mortality in the SUMMIT Trial

2021 ◽  
pp. 00902-2020
Author(s):  
Emily P. Brigham ◽  
Julie A. Anderson ◽  
Robert D. Brook ◽  
Peter M. A. Calverley ◽  
Bartolome R. Celli ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Proportional Hazards ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Class I ◽  
Class Iii ◽  
Obese Class ◽  
Class Iii Obesity ◽  
The Impact ◽  
The Relationship

Populations with COPD demonstrate higher survival in overweight and obese compared with normal weight; the “obesity paradox.” Relationships in less severe COPD are unclear, as is the impact of cardiovascular risk, and few studies include individuals at extremes of obesity.We examined the relationship between body mass index (BMI, defined as underweight: <20 kg·m−2, normal: 20–25 kg·m−2, overweight: 25-<30 kg·m−2, obese class I: 30-<35 kg·m−2, class II: 35-<40 kg·m−2, class III: ≥40 kg·m−2), morbidity, and mortality in the SUMMIT trial population (n=16 485), characterised by moderate COPD and heightened cardiovascular risk with a substantial proportion with class III obesity. The association between BMI category and time to event was modeled via proportional hazards (reference normal weight) adjusted for demographics and cardiorespiratory disease.Consistent with the paradox, underweight individuals demonstrated higher mortality (HR 1.31 (95%CI 1.04–1.64)), with lower mortality among overweight (HR 0.62 (95%CI 0.52–0.73)) and obese class I (HR 0.75 (95%CI 0.62–0.90)). However, mortality increased in obese class III (HR 1.36 (95%CI 1.00–1.86)). Death was primarily attributable to cardiovascular causes.Within a large, multinational cohort with moderate COPD and increased cardiovascular risk, the phenomenon of reduced mortality with obesity did not persist at BMI>40 kg·m−2, suggesting that obesity may not remain protective at the extremes in this population.

Body mass index and the visceral adipose tissue expression of IL-6 and TNF-alpha are associated with the morphological severity of non-alcoholic fatty liver disease in individuals with class III obesity

2018 ◽  
Vol 12 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Antônio Sérgio Barcala Jorge ◽  
João Marcus Oliveira Andrade ◽  
Alanna Fernandes Paraíso ◽  
Gislaine Candida Batista Jorge ◽  
Christine Mendes Silveira ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Adipose Tissue ◽  
Fatty Liver Disease ◽  
Tissue Expression ◽  
Tnf Alpha ◽  
Class Iii ◽  
Alcoholic Fatty Liver ◽  
Class Iii Obesity ◽  
Visceral Adipose ◽  
Alcoholic Fatty Liver Disease

Sex Differences in the Effect of Testosterone on Adipose Tissue Insulin Resistance from Overweight to Obese Adults

2021 ◽  
Author(s):  
Xiaohui Li ◽  
Jia Liu ◽  
Biao Zhou ◽  
Yinhui Li ◽  
Zhengyu Wu ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Sex Differences ◽  
Adipose Tissue ◽  
Protective Factor ◽  
Class Iii ◽  
Obese Adults ◽  
Testosterone Levels ◽  
Class Iii Obesity ◽  
Males And Females ◽  
Potential Factors

Abstract Objective Adipose tissue distribution and glucose metabolism differ between men and women. Few studies have investigated sex differences in adipose tissue insulin resistance (adipose-IR). Herein, we investigated sex differences in adipose-IR in adults ranging from overweight to obese and the potential factors associated with sex differences in adipose-IR. Methods A total of 424 adults had their BMI, adipose-IR, and sex hormones evaluated. Based on BMI, males and females were assigned to four groups. Results In total, males (n=156) had higher adipose-IR than females with similar BMIs (n=268) (p&lt;0.05). Adipose-IR progressively increased from overweight to class III obesity in both males and females (all p&lt;0.0001); however, only in the class III obesity group was the adipose-IR significantly higher in males than in females (p=0.025). There were significant differences in testosterone between males and females (all p&lt;0.01); testosterone levels were negatively correlated with adipose-IR (r=-0.333, p&lt;0.001) in males but positively correlated with adipose-IR (r=0.216, p&lt;0.001) in females. For the logistic regression analysis, testosterone was an independent protective factor against adipose-IR in males, with an odds ratio of 0.858 (B= -0.153 [95% CI 0.743-0.991], p=0.037). Conclusions Adipose-IR reflects the progressive deterioration in adipose tissue insulin sensitivity from overweight to obesity in both males and females. Males with class III obesity have more severe adipose-IR than similarly obese females. The sex difference is associated with testosterone, and low testosterone levels may contribute to more severe adipose-IR in obese males.

The Effect of Maternal Obesity on Oxytocin Requirements to Achieve Vaginal Delivery

2019 ◽  
Vol 37 (04) ◽  
pp. 349-356
Author(s):  
April D. Adams ◽  
Elizabeth M. Coviello ◽  
Daphnie Drassinower
Keyword(s):  
Vaginal Delivery ◽  
Maternal Obesity ◽  
Normal Weight ◽  
University Hospital ◽  
Obese Women ◽  
Class Iii ◽  
Class I Obesity ◽  
Class Iii Obesity ◽  
Higher Doses ◽  
Hospital Center

Abstract Objective Our objective was to determine if obese women are more likely to require oxytocin rates > 20 mU/min to achieve vaginal delivery, compared with normal weight women. Study Design This is a retrospective cohort study of deliveries at the MedStar Washington Hospital Center and MedStar Georgetown University Hospital. Results There were 4,284 births included in the analysis. Thirty-three per cent of deliveries were among women classified as overweight (body mass index [BMI] 25–29.9 kg/m2) and 58% were among women classified as obese (BMI >30.0 kg/m2), 12% were classified as class III obesity (BMI >40 kg/m2). Overall 110 (2.6%) women required an oxytocin rate of >20 mU/min. Doses of oxytocin >20 mU/min for women in the overweight, class I obesity, and class II obesity groups were 2.6, 1.9, and 1.6%, respectively. Deliveries among women with class III obesity had a significantly longer duration of oxytocin exposure (10.7 hours) compared with the normal weight group (8.2 hours, p < 0.001), and had a higher maximum rate of oxytocin compared (10 mU/min) to normal weight women (8 mU/min, p < 0.001). Conclusion Obese women are more likely to require oxytocin rates more than 20 mU/min, higher doses of oxytocin, and greater duration of oxytocin exposure to achieve a vaginal delivery.

Mild and Severe Obesity Reduce the Effectiveness of Lumbar Fusions: 1-Year Patient-Reported Outcomes in 8171 Patients

Neurosurgery ◽  
2020 ◽  
Author(s):  
Graham Mulvaney ◽  
Olivia M Rice ◽  
Vincent Rossi ◽  
David Peters ◽  
Mark Smith ◽  
...  
Keyword(s):  
Risk Factor ◽  
Surgical Complications ◽  
Surgical Complication ◽  
Lumbar Fusion ◽  
Class Ii ◽  
Class I ◽  
Class Iii ◽  
Class I Obesity ◽  
Patient Reported ◽  
One Year

Abstract BACKGROUND Elevated body mass index (BMI) is a well-known risk factor for surgical complications in lumbar surgery. However, its effect on surgical effectiveness independent of surgical complications is unclear. OBJECTIVE To determine increasing BMI’s effect on functional outcomes following lumbar fusion surgery, independent of surgical complications. METHODS We retrospectively analyzed a prospectively built, patient-reported, quality of life registry representing 75 hospital systems. We evaluated 1- to 3-level elective lumbar fusions. Patients who experienced surgical complications were excluded. A stepwise multivariate regression model assessed factors independently associated with 1-yr Oswestry Disability Index (ODI), preop to 1-yr ODI change, and achievement of minimal clinically important difference (MCID). RESULTS A total of 8171 patients met inclusion criteria: 2435 with class I obesity (BMI 30-35 kg/m2), 1328 with class II (35-40 kg/m2), and 760 with class III (≥40 kg/m2). Increasing BMI was independently associated with worse 12-mo ODI (t = 8.005, P &lt; .001) and decreased likelihood of achieving MCID (odds ratio [OR] = 0.977, P &lt; .001). One year after surgery, mean ODI, ODI change, and percentage achieving MCID worsened with class I, class II, and class III vs nonobese cohorts (P &lt; .001) in stepwise fashion. CONCLUSION Increasing BMI is associated with decreased effectiveness of 1- to 3-level elective lumbar fusion, despite absence of surgical complications. BMI ≥ 30 kg/m2 is, therefore, a risk factor for both surgical complication and reduced benefit from lumbar fusion.

Impact of maternal body mass index on the cesarean delivery rate in Germany from 1990 to 2012

2015 ◽  
Vol 43 (4) ◽  
Author(s):  
Ioannis Kyvernitakis ◽  
Christine Köhler ◽  
Stephan Schmidt ◽  
Björn Misselwitz ◽  
Jasmin Großmann ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Cesarean Delivery ◽  
Body Mass ◽  
Early Pregnancy ◽  
Normal Weight ◽  
Class I ◽  
Class Iii ◽  
The Past ◽  
Obese Class ◽  
Maternal Bmi

AbstractMaternal obesity is a risk factor for cesarean delivery (CD). The aim of this analysis was to determine the association between early-pregnancy body mass index (BMI) and the rate of CD over the past two decades.We retrospectively analyzed data from the perinatal quality registry of singleton deliveries in the state of Hesse in Germany from 1990 to 2012. We divided the patients into groups according to the WHO criteria for BMI: underweight (<18.5), normal weight (18.5–<25), overweight (25–<30), obese class I (30–<35), obese class II (35–<40), and obese class III (≥40).The analysis included 1,092,311 patients with available data regarding maternal BMI and mode of delivery. The CD rates for underweight (<18.5), normal weight (18.5–<25), overweight (25–<30), obese class I (30–<35), obese class II (35–<40), and obese class III (≥40) women increased from 14.4%, 16.1%, 19.5%, 22.3%, 25%, and 26.9% in the year 1990 to 27.9%, 31.4%, 38.8%, 45.1%, 50.2%, and 55.2% in the year 2012, respectively (P<0.001).Maternal BMI in early pregnancy is linearly associated with the incidence of CD. We found a disproportionate increase of CD in morbidly obese women compared with the CD incidence in the reference BMI population over the past two decades.

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

2017 ◽  
Vol 51 (11) ◽  
pp. 937-944 ◽  
Author(s):  
Yookyung Christy Choi ◽  
Stephen Saw ◽  
Daniel Soliman ◽  
Angela L. Bingham ◽  
Laura Pontiggia ◽  
...  
Keyword(s):  
Concomitant Administration ◽  
Class I ◽  
Class Iii ◽  
Obesity Class ◽  
Class Iii Obesity ◽  
Dosing Strategies ◽  
Vancomycin Trough ◽  
Trough Concentrations ◽  
Serum Vancomycin ◽  
Nonobese Patients

Background: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. Objective: To evaluate the correlation between incidence of nephrotoxicity associated with weight-based IV vancomycin dosing strategies in nonobese and obese patients. Methods: This retrospective cohort study evaluated hospitalized adult patients admitted who received IV vancomycin. Patients were stratified into nonobese (body mass index [BMI] <25 kg/m2), obesity class I and II (BMI 30-39.9kg/m2), and obesity class III (BMI≥40 kg/m2) groups; patients who were overweight but not obese were excluded. Incidence of nephrotoxicity and serum vancomycin trough concentrations were evaluated. Results: 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 ( P<0.0001), higher initial maintenance doses in both total milligrams/day ( P=0.0137) and milligrams/kilogram ( P=0.0307), and any trough level >20 mg/L ( P<0.0001) were identified as predictors of development of nephrotoxicity. Concomitant administration of piperacillin/tazobactam, diuretics, and IV contrast were associated with development of nephrotoxicity ( P<0.005, all). Patients with class III obesity 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). Conclusions: Obesity and other factors are associated with a higher risk of vancomycin-associated nephrotoxicity.

Prevalence of class-I, class-II and class-III obesity in Australian adults between 1995 and 2011–12

2015 ◽  
Vol 9 (6) ◽  
pp. 553-562 ◽  
Author(s):  
Catherine Keating ◽  
Kathryn Backholer ◽  
Emma Gearon ◽  
Christopher Stevenson ◽  
Boyd Swinburn ◽  
...  
Keyword(s):  
Class Ii ◽  
Class I ◽  
Class Iii ◽  
Class Iii Obesity

scholarly journals Gait and Function in Class III Obesity

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Catherine Ling ◽  
Teresa Kelechi ◽  
Martina Mueller ◽  
Sandra Brotherton ◽  
Sheila Smith
Keyword(s):  
Health Condition ◽  
Gait Velocity ◽  
Class Iii ◽  
Hip Circumference ◽  
Timed Up And Go ◽  
Physical Activity Guidelines ◽  
Class I Obesity ◽  
Class Iii Obesity ◽  
And Function ◽  
Guidelines And Recommendations

Walking, more specifically gait, is an essential component of daily living. Walking is a very different activity for individuals with a Body Mass Index (BMI) of 40 or more (Class III obesity) compared with those who are overweight or obese with a BMI between 26–35. Yet all obesity weight classes receive the same physical activity guidelines and recommendations. This observational study examined the components of function and disability in a group with Class III obesity and a group that is overweight or has Class I obesity. Significant differences were found between the groups in the areas of gait, body size, health condition, and activity capacity and participation. The Timed Up and Go test, gait velocity, hip circumference, and stance width appear to be most predictive of activity capacity as observed during gait assessment. The findings indicate that Class III-related gait is pathologic and not a normal adaptation.

scholarly journals Maternal Obesity and Its Associated Factors and Outcomes in Klang Valley, Malaysia: Finding from National Obstetric Registry

2021 ◽  
Vol 16 (3) ◽  
pp. 56-67
Author(s):  
Nurul Farehah Shahrir ◽  
Rohana Abdul Jalil ◽  
J Ravichandran R Jeganathan ◽  
Shamala Devi Karalasingam ◽  
Noraihan Mohd Nordin ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Associated Factors ◽  
Maternal Obesity ◽  
Multiple Logistic Regression Analysis ◽  
Class I ◽  
Hypertensive Disorder ◽  
Class Iii ◽  
Cross Sectional ◽  
Obese Class ◽  
Klang Valley

Introduction: Maternal obesity presents significant health risks to mothers and their fetuses. This study aimed to determine the proportion, associated factors and outcomes of maternal obesity among pregnant women in Klang Valley, Malaysia. Methods: A retrospective cross-sectional study was conducted between January 2018 and March 2018 using secondary data from the Malaysian National Obstetric Registry (NOR) for the year 2015. All pregnant women with first-trimester booking at 12 weeks and below that were registered with the NOR and met the inclusion and exclusion criteria were included in the study. Descriptive statistics and multiple logistic regression analysis were used. Data were analysed using SPSS version 22.0. A total of 2113 respondents were included in this study to determine the proportion, associated factors and outcomes of maternal obesity. Regarding the univariate and multivariate analyses, respondents were classified into two groups: normal and obese. The obese group comprised overweight and obese mothers. The underweight group was excluded in the subsequent analysis. Results: Out of the 2113 respondents, 7.1% were underweight, 41.7% were of normal weight, 28.6% were overweight, 15.9% were in obese class I, 4.6% were in obese class II, and 2.1% were in obese class III according to the WHO (1995) reference. However, when the MOH (2003) cutoff point was used, there was a marked increase in the proportion of respondents in the overweight categories by 2.7% and obesity class I by 12.8%. The Indian (AdjOR 2.06, 95% CI: 1.11, 3.83, p=0.021) and Malay (AdjOR 1.75, 95% CI: 1.02, 3.00, p=0.040) ethnicities, as well as both multiparity (AdjOR 1.46, 95% CI: 1.23, 1.73, p <0.001) and grand multiparity (AdjOR 2.41, 95% CI: 1.78, 3.26, p <0.001), were significantly associated with maternal obesity. There were significant association between maternal obesity with hypertensive disorder in pregnancy (p=0.025), caesarean section delivery (p=0.002) and macrosomic infant (p <0.001). Conclusion: The identification of risk factors for maternal obesity is important to facilitate intervention programmes focused on improving the pregnancy outcomes for a high-risk group of women.

Sign in / Sign up

Export Citation Format

Share Document