The Impact of Hypertension and Metabolic Syndrome on Nitrosative Stress and Glutathione Metabolism in Patients with Morbid Obesity

In this pathbreaking study, we evaluated nitrosative stress in morbidly obese patients with and without metabolic syndrome. 62 women with class 3 obesity (BMI>40 kg/m2) were divided into three subgroups: obese patients (OB), obese patients with hypertension (OB+HYP), and obese patients with metabolic syndrome (OB+MS). In comparison to the lean patients, OB had increased levels of serum myeloperoxidase (MPO), plasma nitric oxide (NO), S-nitrosothiols, and peroxynitrite (ONOO−), as well as nitrotyrosine, while oxidized glutathione (GSSG) rose only in OB+HYP group. Interestingly, ONOO− was significantly higher in OB+HYP and OB+MS as compared to OB group, while MPO only in OB+MS group. OB+MS had greater nitrotyrosine and S-nitrosothiol values than OB+HYP. Moreover, peroxynitrite could differentiate OB from OB+HYP and OB+MS (AUC 0.9292; p<0.0001; 87.5% sensitivity, 90% specificity) as well as between OB and OB+MS group (AUC 0.9125; p<0.0001; 81.25% sensitivity, 83.33%). In conclusion, we showed that MPO activity, NO formation, and nitrosative damage to proteins parallel the progression of metabolic disturbances of obesity. Evaluation of ONOO− concentrations may help predict the development of hypertension and metabolic syndrome in patients with morbid obesity; however, longer-term studies are required for larger numbers of patients.

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Towards Precision Health in Weight Reduction: Thematic Content Analysis of an Open-Ended Survey on Reasons Why Morbidly Obese Patients Want to Lose Weight.

10.21203/rs.3.rs-42745/v1 ◽

2020 ◽

Author(s):

Mazapuspavina Md-Ya ◽

Ilham Ameera Ismail ◽

Khasnur Abd Malek ◽

Khalid Yusoff ◽

Awang Bulgiba

Keyword(s):

Morbid Obesity ◽

Weight Loss ◽

Content Analysis ◽

Weight Reduction ◽

Extensive Study ◽

Morbidly Obese ◽

Obese Patients ◽

Thematic Content Analysis ◽

Thematic Content ◽

The Impact

Abstract Background: Addressing individuals’ motivation to lose weight among patients with morbid obesity is an essential entity in weight reduction. Failures to shift motivation into weight loss actions are common. These could be contributed by the inadequacy to identify and subsequently address the key reasons, that are of particular concern to the patient' individual needs. We aimed to understand the motivations better and identify the reasons why morbidly obese patients attending hospital-based weight management programmes (WMP) wanted to lose weight. Methods: The study used a qualitative approach to analyze part of a quantitative questionnaire of a more extensive study to understand factors influencing weight loss among morbidly obese patients. We used thematic content analysis to analyze responses from a self-administered open-ended question "What is the main factor why you want to lose your weight?”. A total of 225 new patients attending obesity clinics in two tertiary hospitals responded to the questionnaire. Results: Patients’ mean BMI was 45.6±8.05 kg/m2. Four themes emerged for the reasons why morbidly obese patients wanted to lose weight. Health was the most commonly inferred theme (84%). Patients were concerned about the impact obesity had on their health. Overcoming obesity was seen as a reward not just for physical health, but also for their psychological wellbeing. Patients regard being functional to care for themselves, their family members, as well as their religious and career needs as the next most crucial theme (25.8%). Patients raised the theme appearance (12.9%), especially with regards to wanting to look and feel beautiful. The last theme was perceived stigmatization for being morbidly obese as they were mocked and laughed at for their appearance (3.1%).Conclusion: Patients with morbid obesity in this study had expressed their main personal motivational reasons to lose weight. Concerns about the impact of morbid obesity on health, physical, social and obligatory function, appearance and perceived stigma warrant detailed exploration by the managing health professionals. Identifying and addressing these unique personal motivations in a focused approach is vital at the beginning and throughout a weight reduction program in this unique group.

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Bariatric Surgery Normalizes Protein Glycoxidation and Nitrosative Stress in Morbidly Obese Patients

Antioxidants ◽

10.3390/antiox9111087 ◽

2020 ◽

Vol 9 (11) ◽

pp. 1087

Author(s):

Barbara Choromańska ◽

Piotr Myśliwiec ◽

Magdalena Łuba ◽

Piotr Wojskowicz ◽

Hanna Myśliwiec ◽

...

Keyword(s):

Bariatric Surgery ◽

Morbid Obesity ◽

Oxidative Damage ◽

Nitrosative Stress ◽

High Specificity ◽

Morbidly Obese ◽

Obese Patients ◽

Plasma Tryptophan ◽

Nitrative Stress ◽

Specificity And Sensitivity

The results of recent studies indicate the key role of nitrosative stress and protein oxidative damage in the development of morbid obesity. Nevertheless, the effect of bariatric surgery on protein oxidation/glycation and nitrosative/nitrative stress is not yet known. This is the first study evaluating protein glycoxidation and protein nitrosative damage in morbidly obese patients before and after (one, three, six and twelve months) laparoscopic sleeve gastrectomy. The study included 50 women with morbid obesity as well as 50 age- and gender-matched healthy controls. We demonstrated significant increases in serum myeloperoxidase, plasma glycooxidative products (dityrosine, kynurenine, N-formyl-kynurenine, amyloid, Amadori products, glycophore), protein oxidative damage (ischemia modified albumin) and nitrosative/nitrative stress (nitric oxide, peroxy-nitrite, S-nitrosothiols and nitro-tyrosine) in morbidly obese subjects as compared to lean controls, whereas plasma tryptophan and total thiols were statistically decreased. Bariatric surgery generally reduces the abnormalities in the glycoxidation of proteins and nitrosative/nitrative stress. Noteworthily, in the patients with metabolic syndrome (MS+), we showed no differences in most redox biomarkers, as compared to morbidly obese patients without MS (MS−). However, two markers: were able to differentiate MS+ and MS− with high specificity and sensitivity: peroxy-nitrite (>70%) and S-nitrosothiols (>60%). Further studies are required to confirm the diagnostic usefulness of such biomarkers.

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The Impact of Morbid Obesity on the Health Outcomes of Hospital Inpatients: An Observational Study

Journal of Clinical Medicine ◽

10.3390/jcm10194382 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4382

Author(s):

Kellie Fusco ◽

Campbell Thompson ◽

Richard Woodman ◽

Chris Horwood ◽

Paul Hakendorf ◽

...

Keyword(s):

Morbid Obesity ◽

Health Outcomes ◽

Clinical Outcomes ◽

Length Of Hospital Stay ◽

P Value ◽

Morbidly Obese ◽

Obese Patients ◽

Hospitalised Patients ◽

Nutritional Data ◽

The Impact

Morbid obesity poses a significant burden on the health-care system. This study determined whether morbid obesity leads to worse health-outcomes in hospitalised patients. This retrospective-study examined nutritional data of all inpatients aged 18–79 years, with a body-mass-index (BMI) ≥ 18.5 kg/m2 admitted over a period of 4 years at two major hospitals in Australia. Patients were divided into 3 groups for comparison: normal/overweight (BMI 18.5–29.9 kg/m2), obese (BMI 30–39.9 kg/m2) and morbidly-obese (BMI ≥ 40 kg/m2). Outcome measures included length-of-hospital-stay (LOS), in-hospital mortality, and 30-day readmissions. Multilevel-mixed-effects regression was used to compare clinical outcomes between the groups after adjustment for potential confounders. Of 16,579 patients, 1004 (6.1%) were classified as morbidly-obese. Morbidly-obese patients had a significantly longer median (IQR) LOS than normal/overweight patients (5 (2, 12) vs. 5 (2, 11) days, p value = 0.012) and obese-patients (5 (2, 12) vs. 5 (2, 10) days, p value = 0.036). After adjusted-analysis, morbidly-obese patients had a higher incidence of a longer LOS than normal/overweight patients (IRR 1.04; 95% CI 1.02–1.07; p value < 0.001) and obese-patients (IRR 1.13; 95% CI 1.11–1.16; p value < 0.001). Other clinical outcomes were similar between the different groups. Morbid obesity leads to a longer LOS in hospitalised patients but does not adversely affect other clinical outcomes.

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Morbid Obesity Is Associated With Worse Outcomes and Increased Inpatient Mortality in Patients With Alcohol Induced Acute Pancreatitis

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.042 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A22-A22

Author(s):

Hafeez Shaka ◽

Essam Rashad ◽

Ikechukwu Achebe ◽

Jennifer Chiagoziem Asotibe ◽

Emmanuel Palomera ◽

...

Keyword(s):

Morbid Obesity ◽

Acute Pancreatitis ◽

Negative Impact ◽

The United States ◽

Hospital Charges ◽

Morbidly Obese ◽

Obese Patients ◽

Inpatient Mortality ◽

Nationwide Inpatient Sample Database ◽

The Impact

Abstract Introduction: The prevalence of obesity in the United States is rising. Obesity is a known comorbidity with various health impacts. Alcohol is a common etiology for acute pancreatitis. Obesity is known to be associated with liver dysfunction. It is unclear to what extent the degree of obesity affects patients with alcohol induced acute pancreatitis (AAP), as nationally representative data are lacking. This study aimed to ascertain the impact of morbid obesity on outcomes of patients with alcohol induced pancreatitis. Methods: Data was obtained from the Nationwide Inpatient Sample database for 2016 and 2017. Hospital discharges of patients 18 years and over with a principal diagnosis of AAP were included. This cohort was divided based on presence of comorbid obesity into nonobese patients, mild-moderately obese patients (MMO) (BMI: 30.0 - 39.9) and morbidly obese patients (MO) (BMI >/=40.0). Primary outcome was inpatient mortality. Secondary outcomes included length of hospital stay (LOS), total hospital charges (THC), discharge diagnoses of hypocalcemia, sepsis, acute renal failure (AKI) and acute respiratory failure (ARF). Multivariate regression analysis was used to adjust for patients’ sociodemographic factors, Charlson comorbidity index as well as hospital characteristics as confounders. Results: A total of 143650 hospitalizations were principally for AAP, with 5.5% and 2.7% of these patients classified as having MMO and MO, respectively. In MO patients, there was increased odds of mortality (aOR=2.99, 95% CI: 1.509 - 5.917, p=0.002) when compared with patients who were nonobese. There was no difference in mortality in patients with MMO (aOR 0.88 95% CI: 0.383 - 2.026, p=0.765) when compared with the nonobese group. MO patients had increased mean LOS of 1.1 days (95% CI: 0.7 - 1.6, p<0.001) as well as THC of $14481 (95% CI: 7894 - 21068, p<0.001), increased odds of hypocalcemia (aOR=1.77, 95% CI: 1.302 - 2.392, p<0.001), sepsis (aOR=1.84, 95% CI: 1.183 - 2.873, p=0.007), AKI (aOR=1.55, 95% CI: 1.257 - 1.912, p<0.001). Conclusion: Morbid obesity has a negative impact on outcomes of patients with AAP. Efforts should be channeled towards promoting alcohol cessation in at-risk patients as a preventative measure, as well as closer monitoring of hospitalized patients with morbid obesity to mitigated these adverse events.

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Health-related quality of life in morbid obesity: the impact of laparoscopic sleeve gastrectomy

Open Medicine ◽

10.2478/s11536-013-0294-y ◽

2014 ◽

Vol 9 (3) ◽

pp. 374-381 ◽

Cited By ~ 1

Author(s):

Radka Bužgová ◽

Marek Bužga ◽

Pavol Holéczy

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Morbid Obesity ◽

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

World Health ◽

Morbidly Obese ◽

Obese Patients ◽

The Impact

AbstractOur aim in this prospective study was to determine the impact of laparoscopic sleeve gastrectomy on the quality of life of patients with morbid obesity in comparison with population standards. The study evaluated 76 morbidly obese patients who underwent laparoscopic sleeve gastrectomy. The short version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) was used to evaluate quality of life in the following four areas: physical health, mental health, social relations, and environment. Patients completed the questionnaire before their planned operation and again 3 and 6 months after surgery. Compared with the population standard, patients with morbid obesity had significantly lower quality of life scores in the physical and mental health domains, including on independent questions related to of overall health and quality of life (p<0.001). Women scored lower on indicators of mental health than men. Three and 6 months following surgery a significant trend of body mass index (BMI) reduction was seen, as well as increased quality of life in all indicated areas (p<0.001). Laparoscopic sleeve gastrectomy treatment in morbidly obese patients reduced BMI on a long-term basis, a change seen as early as 3 months after surgery. By 6 months after surgery, patients had the same quality of life scores as the reference population.

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Understanding the Impact of Obesity on Short-term Outcomes and In-hospital Costs After Instrumented Spinal Fusion

Neurosurgery ◽

10.1227/neu.0000000000001018 ◽

2015 ◽

Vol 78 (1) ◽

pp. 127-132 ◽

Cited By ~ 28

Author(s):

Dominique M. Higgins ◽

Grant W. Mallory ◽

Ryan F. Planchard ◽

Ross C. Puffer ◽

Mohamed Ali ◽

...

Keyword(s):

Morbid Obesity ◽

Spinal Fusion ◽

Cost Of Care ◽

Wound Complications ◽

Morbidly Obese ◽

Obese Patients ◽

Degenerative Spine ◽

Degenerative Spine Disease ◽

The Impact ◽

Spine Disease

Abstract BACKGROUND: Obesity rates continue to rise along with the number of obese patients undergoing elective spinal fusion. OBJECTIVE: To evaluate the impact of obesity on resource utilization and early complications in patients undergoing surgery for degenerative spine disease. METHODS: A single-institution retrospective analysis was conducted on patients with degenerative spine disease requiring instrumentation between 2008 and 2012. The 801 identified patients were grouped based on a body mass index (BMI) of <30 (nonobese, n = 478), ≥30 and <40 (obese, n = 283), and alternatively BMIs of ≥40 (morbidly obese, n = 40). Baseline characteristics, surgical outcomes and requirements, complications, and cost were compared. Logistic and linear regression analyses were used to determine the strength of association between obesity and outcomes for categorical and continuous data, respectively. RESULTS: Significant differences were found in comorbidities between cohorts. Multivariate analysis revealed significant associations between obesity and longer anesthesia times (30 minutes, P = .008), and surgical times (24 minutes, P = .02). Additionally, there was a 2.8 times higher rate of wound complications in obese patients (4.2% vs 1.5, P = .03), and 2.5 times higher rate of major medical complications (7.8% vs 3.1, P = .01). Morbid obesity resulted in a 10 times higher rate of wound complications (P < .001). Morbid obesity resulted in a $9078 (P = .005) increase in overall cost of care. CONCLUSION: Increased BMI is associated with longer operative times, increased complication rates, and increased cost independent of comorbidities. These effects are more pronounced with morbidly obese patients, further supporting a role for preoperative weight loss.

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Is ICD-9 Coding of Morbid Obesity Reliable in Patients Undergoing Total Knee Arthroplasty?

The Journal of Knee Surgery ◽

10.1055/s-0038-1668567 ◽

2018 ◽

Vol 31 (10) ◽

pp. 934-939 ◽

Cited By ~ 1

Author(s):

Jaiben George ◽

Nipun Sodhi ◽

Hiba Anis ◽

Anton Khlopas ◽

Joseph Moskal ◽

...

Keyword(s):

Morbid Obesity ◽

Total Knee Arthroplasty ◽

Sensitivity And Specificity ◽

Knee Arthroplasty ◽

International Classification Of Diseases ◽

Morbidly Obese ◽

Obese Patients ◽

Primary Tkas ◽

Total Knee ◽

The Impact

AbstractMorbid obesity is considered to have a stronger association with complications after total knee arthroplasty (TKA). Although the impact of obesity coding errors has been previously reported, the extent of coding inaccuracies with respect to morbid obesity is unclear. Therefore, the purpose of this study was to assess (1) the utility of coding in identifying morbid obesity and (2) the effects of morbid obesity on 90-day complications after TKA when morbid obesity was defined by both body mass index (BMI) and International Classification of Diseases 9th edition (ICD-9) coding. A total of 18,030 primary TKAs performed at a single institution from 2004 to 2014 were identified. Patients were defined as morbidly obese based on ICD-9 codes or by BMI recorded in the electronic medical record (EMR). Patients were defined as obese (ICD-9 codes 278.0, 278.00, 278.01, 278.03, 649.10–14, 793.91, V85.30–39, V85.41–45, V85.54) or morbidly obese (278.01, V85.41–45) by ICD-9 codes. Patient EMRs were also reviewed to identify obese and morbidly obese patients (BMI cutoffs of 30 and 40 kg/m2, respectively). Complications between the cohorts were compared. Sensitivity and specificity were also calculated. Among the 2,880 surgeries performed in morbidly obese patients, a code for obesity was present in 1,618 (56.2%) surgeries, but only 57.9% (937) of these patients had a code specific for morbid obesity, with the rest having a code not specifying morbid obesity. The sensitivity and specificity of obesity coding were 34.5 and 96.0%, while that of morbid obesity were 32.5 and 96.7%, respectively (area under curve: 0.65 vs. 0.65, p = 0.214). A higher rate of complications was noted when patients were defined as morbidly obese by ICD-9 as when defined by EMR-reported BMI. Although morbidly obese patients are more likely to have a code for obesity compared with obese patients, these patients may not be correctly identified as morbidly obese due to a lack of specificity in the codes. These errors may lead to inadequate reimbursements, and may also overestimate the effect of morbid obesity on complications.

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Serum Retinol and β-carotene Levels and Risk Factors for Cardiovascular Disease in Morbid Obesity

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000018 ◽

2010 ◽

Vol 80 (3) ◽

pp. 159-167 ◽

Cited By ~ 7

Author(s):

Gabriela Villaça Chaves ◽

Gisele Gonçalves de Souza ◽

Andréa Cardoso de Matos ◽

Dra. Wilza Abrantes Peres ◽

Silvia Elaine Pereira ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Metabolic Syndrome ◽

Morbid Obesity ◽

Serum Levels ◽

World Health ◽

Morbidly Obese ◽

Serum Retinol ◽

Significant Difference ◽

Β Carotene

Objective: To evaluate retinol and β-carotene serum levels and their relationship with risk factors for cardiovascular disease in individuals with morbid obesity, resident in Rio de Janeiro. Methodology: Blood serum concentrations of retinol and β-carotene of 189 morbidly obese individuals were assessed. The metabolic syndrome was identified according to the criteria of the National Cholesterol Education Program (NCEP) and World Health Organization (WHO). Lipid profile, insulin resistance, basal insulin, glycemia, blood pressure, and anthropometry and their correlation with retinol and β-carotene serum levels were evaluated. Results: Metabolic syndrome diagnosis was observed in 49.0% of the sample. Within this percentage the levels of β-carotene were significantly lower when body mass index increased. Serum retinol didn't show this behavior. Serum retinol inadequacy in patients with metabolic syndrome (61.3%), according to WHO criterion, was higher (15.8%) than when the whole sample was considered (12.7%). When metabolic syndrome was diagnosed by NCEP criterion, β-carotene inadequacy was higher (42.8%) when compared to the total sample (37.5%). There was a significant difference between average β-carotene values of patients with and without metabolic syndrome (p=0.048) according to the classification of the NCEP. Lower values were found in patients with metabolic syndrome. Conclusion: Considering the vitamin A contribution in antioxidant protection, especially when risk factors for cardiovascular disease are present, it is suggested that great attention be given to morbidly obese. This could aid in prevention and treatment of cardiovascular disease, which affects a significant part of the population.

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