Adverse right ventricular remodelling, function, and stress responses in obesity: insights from cardiovascular magnetic resonance

Abstract Aims We aimed to determine the effect of increasing body weight upon right ventricular (RV) volumes, energetics, systolic function, and stress responses using cardiovascular magnetic resonance (CMR). Methods and results We first determined the effects of World Health Organization class III obesity [body mass index (BMI) > 40 kg/m2, n = 54] vs. healthy weight (BMI < 25 kg/m2, n = 49) upon RV volumes, energetics and systolic function using CMR. In less severe obesity (BMI 35 ± 5 kg/m2, n = 18) and healthy weight controls (BMI 21 ± 1 kg/m2, n = 9), we next performed CMR before and during dobutamine to evaluate RV stress response. A subgroup undergoing bariatric surgery (n = 37) were rescanned at median 1 year to determine the effects of weight loss. When compared with healthy weight, class III obesity was associated with adverse RV remodelling (17% RV end-diastolic volume increase, P < 0.0001), impaired cardiac energetics (19% phosphocreatine to adenosine triphosphate ratio reduction, P < 0.001), and reduction in RV ejection fraction (by 3%, P = 0.01), which was related to impaired energetics (R = 0.3, P = 0.04). Participants with less severe obesity had impaired RV diastolic filling at rest and blunted RV systolic and diastolic responses to dobutamine compared with healthy weight. Surgical weight loss (34 ± 15 kg weight loss) was associated with improvement in RV end-diastolic volume (by 8%, P = 0.006) and systolic function (by 2%, P = 0.03). Conclusion Increasing body weight is associated with significant alterations in RV volumes, energetic, systolic function, and stress responses. Adverse RV modelling is mitigated with weight loss. Randomized trials are needed to determine whether intentional weight loss improves symptoms and outcomes in patients with obesity and heart failure.

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Abstract 13594: Adverse Right Ventricular Remodelling, Function and Stress Responses in Obesity: Implications for Severe Acute Respiratory Illness

Circulation ◽

10.1161/circ.142.suppl_3.13594 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Andrew J Lewis ◽

William Watson ◽

Hani Mahmoud-Elsayed ◽

William Moody ◽

Ayisha M Khan-Kheil ◽

...

Keyword(s):

Weight Loss ◽

Right Ventricular ◽

Stress Responses ◽

Systolic Function ◽

Respiratory Illness ◽

Dobutamine Stress ◽

Adverse Outcomes ◽

Diastolic Filling ◽

Class Iii ◽

And Function

Introduction: The mechanisms linking obesity to increased mortality in patients with coronavirus-disease 2019 (COVID-19) are unclear. Hypothesis: We hypothesised that obesity would be associated with adverse right ventricular (RV) remodelling and function which might be further exacerbated by COVID-19 associated increases in RV afterload/demand. Methods: We used echocardiography and computed tomography to establish links between RV dimensions and function and bodyweight in patients with severe COVID-19. In obese and non-obese participants without COVID-19, we used cardiovascular magnetic resonance to define the effects of obesity upon RV volumes, energetics, systolic function and stress reserve. Results: In patients with severe COVID-19, increasing bodyweight was associated with disproportionate RV dilatation (n=26, echocardiography, R=0.42, P=0.03, CT n=34, R=0.23, P=0.004) and impairment of RV systolic function (fractional area change (FAC) R=-0.45, P=0.04); obesity (BMI >30kg/m2) was associated with a 32% reduction in RV FAC (P=0.03). Similar associations were seen in a validation cohort (n=91, all P<0.05). In participants without COVID-19, class III obesity (n=54, BMI 47±4 kg/m 2 ) was associated with RV remodelling, impaired cardiac energetics (PCr/ATP ratio 23% lower, P<0.001) and reduction in RV systolic function at rest (by 3±1%, P=0.01), which was related to reduced energetics (R=0.3, P=0.04). Participants with class I-II obesity (BMI 35±5 kg/m 2 , n=27) had impaired RV diastolic filling rate at rest (P<0.001) and blunted RV dobutamine stress systolic response (by 68%, P=0.03) and diastolic response (by 78%, P=0.008). Surgical weight loss in patients obesity (n=37, 34±15kg weight loss) was associated with improvement in RV volume (12±26 ml lower, P=0.006) and function (ejection fraction 2±5% higher, P=0.03). Conclusions: Increasing body weight is associated with both significant alterations in RV volumes, systolic function and stress responses which are mitigated with weight loss and also with disproportionate RV dilatation and dysfunction in severe COVID-19. RV dysfunction is a modifiable mechanism which might link obesity to adverse outcomes in patients with COVID-19 and other disorders stressing the right heart.

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Lifestyle modification for weight loss: effects on cardiorespiratory capacity in Patients with Class II and Class III Obesity

Obesity Science & Practice ◽

10.1002/osp4.544 ◽

2021 ◽

Author(s):

Finn Wammer ◽

Andrea Haberberger ◽

Anita Dyb Linge ◽

Tor Åge Myklebust ◽

Sveinung Vemøy ◽

...

Keyword(s):

Weight Loss ◽

Lifestyle Modification ◽

Class Ii ◽

Class Iii ◽

Class Iii Obesity

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Effect of Mixed Nuts on Body Weight and Composition, and Gut Microbiome (P08-054-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz044.p08-054-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Shih Lung Woo ◽

Dina Ben-Nissan ◽

Zahra Ezzat-Zadeh ◽

Jieping Yang ◽

Lijun Zhang ◽

...

Keyword(s):

Weight Loss ◽

Body Composition ◽

Body Weight ◽

Gut Microbiome ◽

Plasma Lipids ◽

Plasma Lipid ◽

Healthy Weight ◽

Weight Changes ◽

Fecal Microbiome ◽

Tree Nuts

Abstract Objectives This study was designed to assess the effects of mixed nut consumption on body weight and composition, and gut microbiome in obese individuals. Primary outcome was change in body weight and composition. Secondary outcomes include gut microbiome composition, inflammatory markers, and plasma lipids. Methods The reported results are from an interim analysis (n = 50) of a randomized, placebo controlled, parallel study. Total enrollment target is 154 overweight/obese subjects (BMI 27–35 kg/m2). Participants were randomly assigned to consume either 1.5oz mixed tree nuts or pretzels with equal calorie content daily for 24 weeks. The study included a 12-week weight loss phase (500 kcal per day less than total daily energy expenditure), followed by a 12-week weight maintenance phase. Body composition, fasting blood, and stool samples were collected at baseline, week 12 and 24. Body composition, and vitals were analyzed, whereas plasma lipid profile, fecal microbiome, and microbiome metabolites analysis is still pending. Results At week 12, subjects from both the pretzel (n = 15, 10 dropouts; P = 0.009) and nut group (n = 22, 3 dropouts; P = 0.038) lost significant amount of weight. The trend of weight changes did not differ between groups (P = 0.530). Subjects from both groups were able to sustain weight loss through 24 weeks (pretzel: 81.43 ± 3.85 kg at baseline vs. 79.43 ± 4.08 kg at week 24, P = 0.028; nut: 84.26 ± 3.78 kg at baseline vs. 82.38 ± 3.72 kg at week 24, P = 0.026). At week 12, fat mass in both groups was significantly decreased (pretzel: P = 0.002; nut: P = 0.012). The trend of fat changes did not differ between groups (P = 0.547). Subjects from both groups were able to sustain fat loss through 24 weeks (pretzel: 30.84 ± 1.75 kg at baseline vs. 29.25 ± 2.12 kg at week 24, P = 0.024; nut: 31.51 ± 1.56 kg vs 30.21 ± 1.81 kg at week 24, P = 0.04). Muscle mass, and blood pressure were not significantly different between both groups. Conclusions Our data suggested that tree nuts could be consumed as part of a healthy weight loss meal plan without concern of causing weight gain. Further analysis of the remaining samples is needed to confirm results. Due to higher dropouts in the pretzel group, future intention-to-treat analysis is also needed to eliminate bias. Funding Sources This study is supported by the International Tree Nut Council.

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Vancomycin volume of distribution estimation in adults with class III obesity

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxz241 ◽

2019 ◽

Cited By ~ 1

Author(s):

Ryan D Dunn ◽

Ryan L Crass ◽

Joseph Hong ◽

Manjunath P Pai ◽

Lynne C Krop

Keyword(s):

Body Weight ◽

Total Body Weight ◽

Volume Of Distribution ◽

Patient Specific ◽

Pharmacokinetic Analysis ◽

Pharmacokinetic Parameters ◽

Parameter Estimates ◽

Class Iii ◽

Class Iii Obesity ◽

Total Body

Abstract Purpose To compare methods of estimating vancomycin volume of distribution (V) in adults with class III obesity. Methods A retrospective, multicenter pharmacokinetic analysis of adults treated with vancomycin and monitored through measurement of peak and trough concentrations was performed. Individual pharmacokinetic parameter estimates were obtained via maximum a posteriori Bayesian analysis. The relationship between V and body weight was assessed using linear regression. Mean bias and root-mean-square error (RMSE) were calculated to assess the precision of multiple methods of estimating V. Results Of 241 patients included in the study sample, 159 (66.0%) had a BMI of 40.0–49.9 kg/m2, and 82 (34.0%) had a BMI of ≥50.0 kg/m2. The median (5th, 95th percentile) weight of patients was 136 (103, 204) kg, and baseline characteristics were similar between BMI groups. The mean ± S.D. V was lower in patients with a BMI of 40.0–49.9 kg/m2 than in those with a BMI of ≥50.0 kg/m2 (72.4 ± 19.6 L versus 79.3 ± 20.6 L, p = 0.009); however, body size poorly predicted V in regression analyses (R2 < 0.20). A fixed estimate of V (75 L) or use of 0.52 L/kg by total body weight yielded similar bias and error in this population. Conclusion Results of the largest analysis of vancomycin V in class III obesity to date indicated that use of a fixed V value (75 L) and use of a TBW-based estimate (0.52 L/kg) for estimation of vancomycin V in patients with a BMI of ≥40.0 kg/m2 have similar bias. Two postdistribution vancomycin concentrations are needed to accurately determine patient-specific pharmacokinetic parameters, estimate AUC, and improve the precision of vancomycin dosing in this patient population.

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Effect of weight loss via bariatric surgery for class III obesity on exertional breathlessness

Respiratory Physiology & Neurobiology ◽

10.1016/j.resp.2019.05.007 ◽

2019 ◽

Vol 266 ◽

pp. 130-137 ◽

Cited By ~ 1

Author(s):

Amar Mainra ◽

Sara J. Abdallah ◽

Ryan E.R. Reid ◽

Ross E. Andersen ◽

Dennis Jensen

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Class Iii ◽

Class Iii Obesity

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Effect of different transportation period on body weight loss, hematological and biochemical stress responses of sheep

Journal of the Indonesian Tropical Animal Agriculture ◽

10.14710/jitaa.45.2.115-123 ◽

2020 ◽

Vol 45 (2) ◽

pp. 115-123

Author(s):

L. Lendrawati ◽

R. Priyanto ◽

A. Jayanegara ◽

W. Manalu ◽

D. Desrial

Keyword(s):

Weight Loss ◽

Body Weight ◽

Stress Responses ◽

Good Condition ◽

Body Weight Loss ◽

Well Being ◽

Water Access ◽

Road Transportation ◽

Normal Range ◽

Blood Profiles

The study was conducted to evaluate the duration of road transportation during 4, 8 and 12 hours on body weight loss, hematological and biochemical responses of sheep. Twenty-four male Javanese thin tailed sheep were separated into transported group (T4, T8 and T12) and non-transported group (NT4, NT8 and NT12). Transportation (T) groups were transported for 4, 8 and 12 h in the same open pick up with 0.28 m2/head of loading density. Body weight, haematological and biochemical blood profiles were determined. The results showed that increasing of transportation duration significantly increased (P<0.05) body weight loss and decreased (P<0.05) hematocrit, cortisol and glucose values in the blood. However, these values were in the normal range of sheep well-being. In conclusion, transported healthy Javanese thin tailed sheep under good condition without feed and water access up to 12 h can tolerate to adverse effect of transportation without disturbing their welfare.

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Persistently High Hip Circumference after Bariatric Surgery Is a Major Hurdle to Successful Hip Replacement

Case Reports in Medicine ◽

10.1155/2014/786474 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Menachem M. Meller ◽

Amber B. Courville ◽

Anne E. Sumner

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Gastric Bypass ◽

Black Women ◽

Soft Tissue ◽

Hip Replacement ◽

Functional Independence ◽

Class Iii ◽

Hip Circumference ◽

Class Iii Obesity

The prevalence of class III obesity (BMI≥40 kg/m2) in black women is 18%. As class III obesity leads to hip joint deterioration, black women frequently present for orthopedic care. Weight loss associated with bariatric surgery should lead to enhanced success of hip replacements. However, we present a case of a black woman who underwent Roux-en-Y gastric bypass with the expectation that weight loss would make her a better surgical candidate for hip replacement. Her gastric bypass was successful as her BMI declined from 52.0 kg/m2to 33.7 kg/m2. However, her hip circumference after weight loss remained persistently high. Therefore, at surgery the soft tissue tunnel geometry presented major challenges. Tunnel depth and immobility of the soft tissue interfered with retractor placement, tissue reflection, and surgical access to the acetabulum. Therefore a traditional cup placement could not be achieved. Instead, a hemiarthroplasty was performed. After surgery her pain and reliance on external support decreased. But her functional independence never improved. This case demonstrates that a lower BMI after bariatric surgery may improve the metabolic profile and decrease anesthesia risk, but the success of total hip arthroplasties remains problematic if fat mass in the operative field (i.e., high hip circumference) remains high.

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Changes in Theory-Based Psychological Factors Predict Weight Loss in Women with Class III Obesity Initiating Supported Exercise

Journal of Obesity ◽

10.1155/2010/171957 ◽

2010 ◽

Vol 2010 ◽

pp. 1-4 ◽

Cited By ~ 12

Author(s):

James J. Annesi ◽

Srinivasa Gorjala

Keyword(s):

Weight Loss ◽

Psychological Factors ◽

Behavioral Treatment ◽

Severe Obesity ◽

Exercise Program ◽

Behavioral Model ◽

Exercise Session ◽

Class Iii ◽

Predict Weight Loss ◽

Severely Obese

Background. Psychological factors' effect on weight loss is poorly understood, in general, and specifically in the severely obese.Objective. To examine whether a behavioral model based on tenets of social cognitive and self-efficacy theory will increase understanding of the relationship between exercise and weight loss.Methods. Fifty-one women with severe obesity participated in a 24-week exercise and nutrition information treatment and were measured on changes in psychological factors and exercise attendance.Results. A significant portion of the variance in BMI change (adjusted for number of predictors) was accounted for by the behavioral model . Entry of exercise session attendance only marginally improved the prediction to 0.27. Only 19% of the weight lost was directly attributable to caloric expenditure from exercise.Conclusions. Findings suggest that participation in an exercise program affects weight loss through psychological pathways and, thus, may be important in the behavioral treatment of severe obesity.

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A sympathetic gut connection drives the metabolic benefits of Roux-en-Y gastric bypass

Cell Stress ◽

10.15698/cst2020.12.236 ◽

2020 ◽

Vol 4 (12) ◽

pp. 265-269

Author(s):

Mohammed K. Hankir

Keyword(s):

Weight Loss ◽

Gastric Bypass ◽

Body Weight ◽

Sleeve Gastrectomy ◽

Severe Obesity ◽

Resting Metabolic Rate ◽

Splanchnic Nerve ◽

Negative Energy ◽

Recent Issue ◽

White Fat

Surgery is regarded by many as the go-to treatment option for severe obesity; yet how physically altering the gastrointestinal tract produces such striking results on body weight and overall metabolic health is poorly understood. In a recent issue of Cell Reports Ye et al. (2020) compare mouse models of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), the two most commonly performed weight loss surgeries in the clinic today, to show that the former reconfiguring procedure selectively increases resting metabolic rate through splanchnic nerve-mediated browning of mesenteric white fat. More significantly, they demonstrate that this effect for RYGB is required for the maintained negative energy balance and improved glycemic control that it confers.

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Impact of a hospital-wide computerised approach to optimise the quality of antimicrobial prescriptions in patients with severe obesity: a quasi-experimental study

BMC Infectious Diseases ◽

10.1186/s12879-021-06682-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Stéphanie Sirard ◽

Vincent Nault ◽

Marie-France Langlois ◽

Julie Perron ◽

Louis Valiquette

Keyword(s):

Surveillance System ◽

Severe Obesity ◽

Interrupted Time Series ◽

Antimicrobial Consumption ◽

Class Iii ◽

Days Of Therapy ◽

Class Iii Obesity ◽

Quasi Experimental ◽

The Impact ◽

Antimicrobial Prescription

Abstract Background Rates of adherence to available recommendations for dose adjustments in patients with severe obesity are generally low. Hence, antimicrobials are often underdosed in these patients. Antimicrobial stewardship programmes can improve the use of antimicrobials in hospitalised patients. The aim of the study was to analyse the impact of an antimicrobial stewardship programme based on a computerised clinical decision support system for optimal dosing and antimicrobial use in inpatients with severe obesity. Methods This quasi-experimental retrospective study using interrupted time series was conducted in an academic centre in Canada from August 2008 to June 2018. The Antimicrobial Prescription Surveillance System was implemented in August 2010 (intervention 1) and specific rules targeting patients with class III obesity (body mass index ≥ 40 kg/m2) were added in June 2014 (intervention 2). Data were collected from all hospitalised adults receiving antimicrobials which required dose adjustment for severe obesity and were stratified by body mass index. Segmented regression analysis of interrupted time series was used to evaluate the impact of the Antimicrobial Prescription Surveillance System on the proportion of inappropriate days of therapy according to posology and on antimicrobial consumption. Results Overall, 65 205 antimicrobial prescriptions (68% non-obese, 25% class I-II obesity, and 7% class III obesity) were analysed. In patients with class III obesity, the intervention was associated with a decrease in the proportion of inappropriate days of therapy (trend after the first intervention, −0.8% per 2-month period [95% CI −1.1 to −0.5], p < 0.001; intercept, 11.3% [95% CI 8.2 to 14.5], p < 0.001), which led to a reduction of 35% over an eight-year period (from pre-intervention level of 19.1%). Intervention 1 resulted in a downward trend in antimicrobial consumption, followed by an increasing trend after intervention 2. In these patients, the most frequent interventions made by pharmacists targeted posology (46%). Conclusions Antimicrobial Prescription Surveillance System had a positive impact on dosing optimisation and antimicrobial consumption in patients with class III obesity. Improving antimicrobial prescriptions in these patients is important because suboptimal dosing could be associated with unfavourable outcomes.

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