scholarly journals How to Manage the Obese Patient With Cancer

2016 ◽  
Vol 34 (35) ◽  
pp. 4284-4294 ◽  
Author(s):  
Andrew G. Renehan ◽  
Michelle Harvie ◽  
Ramsey I. Cutress ◽  
Michael Leitzmann ◽  
Tobias Pischon ◽  
...  
Keyword(s):  
Obese Patient ◽  
Infectious Complications ◽  
Normal Weight ◽  
Supporting Evidence ◽  
Obese Patients ◽  
Effect Modifier ◽  
Treatment Effect Modifier ◽  
Asco 2012 ◽  
Secondary Analyses ◽  
Chemotherapy Dose

Purpose Obesity (body mass index [BMI] ≥ 30 kg/m2) is common among patients with cancer. We reviewed management issues in the obese patient with cancer, focusing on how obesity influences treatment selection (including chemotherapy dosing), affects chemotherapy toxicity and surgical complications, and might be a treatment effect modifier. Methods The majority of evidence is drawn from observational studies and secondary analyses of trial data, typically analyzed in N × 3 BMI categories (normal weight, overweight, and obese) matrix structures. We propose a methodological framework for interpretation focusing on sample size and composition, nonlinearity, and unmeasured confounding. Results There is a common perception that obesity is associated with increased treatment-related toxicity. Accordingly, cytotoxic chemotherapy dose reduction is common in patients with elevated BMI. Contrary to this, there is some evidence that full dosing in obese patients does not result in increased toxicity. However, these data are from a limited number of regimens, and fail to fully capture cytotoxic drug pharmacodynamics and pharmacokinetic variability in obese patients. Among patients undergoing surgery, there is evidence that elevated BMI is associated with increased perioperative mortality and increased rates of infectious complications. A novel finding is that these relationships hold after surgery for malignancy, but not for benign indications. There are biologic plausibilities that obesity might be an effect modifier of treatment, but supporting evidence from clinical studies is inconsistent. Conclusion In line with the ASCO 2012 guidelines, chemotherapy dosing is probably best performed using actual body weight in obese patients. However, specific regimens known to be associated with increased toxicity in this group should be used with caution. There is no guidance on dose for obese patients treated with biologic agents. Currently, there are no specific recommendations for the surgical management of the obese patient with cancer.

scholarly journals Higher body mass index is associated with larger postoperative improvement in patient-reported outcomes following total knee arthroplasty

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
K Giesinger ◽  
JM Giesinger ◽  
DF Hamilton ◽  
J Rechsteiner ◽  
A Ladurner
Keyword(s):  
Body Mass Index ◽  
Total Knee Arthroplasty ◽  
Pain Relief ◽  
Body Mass ◽  
Knee Arthroplasty ◽  
Normal Weight ◽  
World Health ◽  
Obese Patients ◽  
Total Knee ◽  
The Impact

Abstract Background Total knee arthroplasty is known to successfully alleviate pain and improve function in endstage knee osteoarthritis. However, there is some controversy with regard to the influence of obesity on clinical benefits after TKA. The aim of this study was to investigate the impact of body mass index (BMI) on improvement in pain, function and general health status following total knee arthroplasty (TKA). Methods A single-centre retrospective analysis of primary TKAs performed between 2006 and 2016 was performed. Data were collected preoperatively and 12-month postoperatively using WOMAC score and EQ-5D. Longitudinal score change was compared across the BMI categories identified by the World Health Organization. Results Data from 1565 patients [mean age 69.1, 62.2% women] were accessed. Weight distribution was: 21.2% BMI < 25.0 kg/m2, 36.9% BMI 25.0–29.9 kg/m2, 27.0% BMI 30.0–34.9 kg/m2, 10.2% BMI 35.0–39.9 kg/m2, and 4.6% BMI ≥ 40.0 kg/m2. All outcome measures improved between preoperative and 12-month follow-up (p < 0.001). In pairwise comparisons against normal weight patients, patients with class I-II obesity showed larger improvement on the WOMAC function and total score. For WOMAC pain improvements were larger for all three obesity classes. Conclusions Post-operative improvement in joint-specific outcomes was larger in obese patients compared to normal weight patients. These findings suggest that obese patients may have the greatest benefits from TKA with regard to function and pain relief one year post-op. Well balanced treatment decisions should fully account for both: Higher benefits in terms of pain relief and function as well as increased potential risks and complications. Trial registration This trial has been registered with the ethics committee of Eastern Switzerland (EKOS; Project-ID: EKOS 2020–00,879)

scholarly journals The Influence of Obesity on Treatment and Outcome of Severely Burned Patients

2019 ◽  
Vol 40 (6) ◽  
pp. 996-1008 ◽  
Author(s):  
Christian Tapking ◽  
Khosrow S Houschyar ◽  
Victoria G Rontoyanni ◽  
Gabriel Hundeshagen ◽  
Karl-Friedrich Kowalewski ◽  
...  
Keyword(s):  
Fluid Resuscitation ◽  
Chronic Conditions ◽  
Perioperative Management ◽  
Normal Weight ◽  
Burn Patients ◽  
Obese Patients ◽  
Nonalcoholic Fatty Liver ◽  
Wound Coverage ◽  
Severe Burns ◽  
Early Wound

Abstract Obesity and the related medical, social, and economic impacts are relevant multifactorial and chronic conditions that also have a meaningful impact on outcomes following a severe injury, including burns. In addition to burn-specific difficulties, such as adequate hypermetabolic response, fluid resuscitation, and early wound coverage, obese patients also present with common comorbidities, such as arterial hypertension, diabetes mellitus, or nonalcoholic fatty liver disease. In addition, the pathophysiologic response to severe burns can be enhanced. Besides the increased morbidity and mortality compared to burn patients with normal weight, obese patients present a challenge in fluid resuscitation, perioperative management, and difficulties in wound healing. The present work is an in-depth review of the current understanding of the influence of obesity on the management and outcome of severe burns.

scholarly journals POS0358 EVALUATION OF THE EFFECT OF mTOR EXPRESSION ON THE CLINICAL MANIFESTATIONS OF KNEE OSTEOARTHRITIS IN OBESE AND NORMAL WEIGHT PATIENTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 409.2-409
Author(s):  
E. Strebkova ◽  
E. Tchetina ◽  
L. Alekseeva
Keyword(s):  
Body Weight ◽  
Knee Pain ◽  
Mammalian Target Of Rapamycin ◽  
Clinical Manifestations ◽  
Normal Weight ◽  
Womac Pain ◽  
Obese Patients ◽  
Normal Body ◽  
Knee Oa ◽  
Normal Body Weight

Background:Currently, a large number of molecular biological and genetic markers are known to be involved in the development of osteoarthritis (OA). The mammalian target of rapamycin (mTOR) signaling pathway is responsible for chondrocyte proliferation, cartilage matrix production, and cell growth. OA is characterized by increased mTOR synthesis, which is accompanied by an increase in proliferative activity and destruction of chondrocytes. Obesity is an important factor in the progression of knee OA. The study of mTOR expression in patients with OA and obesity is an urgent task in the development of personalized OA therapy.Objectives:To determine the expression of mTOR in patients with knee OA in combination with obesity and normal body weight. To evaluate the effect of mTOR on the clinical manifestations of OA in patients with different body mass index (BMI).Methods:The study included 73 female patients aged 45-65 y.o. with Kellgren-Lawrence stage II-III knee OA. The patients were divided into 2 groups: group 1 (n=50) with obesity (BMI > 30 kg / cm2) and group 2 (n=23) with normal or increased body weight (BMI < 30 kg/cm2). The average age of patients with obesity is 56.5 ± 5.87 years, without obesity - 58.7 ± 5.43 years. Clinical manifestations were evaluated by a WOMAС. RNA was isolated from the patients ‘ blood samples, which was used to determine the expression of mTOR.Results:Patients with knee OA with and without obesity did not differ in age. OA develops at an earlier age in obese patients, than in non-obese patients (p < 0.001). Patients from 1 group had a high BMI > 30 kg/m2 at the onset of OA. Obese patients had more severe knee OA is significantly more often detected: Kellgren-Lawrence stage III was determined in 10% of obese patients and in 4.35% - without obesity (p < 0.001). Significantly higher values of the WOMAC index pain, stiffness, joint functional failure, and total WOMAC were observed in obese patients (p = 0.006, p = 0.039, p = 0.037, and p = 0.014, respectively). Obese patients had higher VAS pain scores (p < 0.05) compared to patients with a lower BMI. Obese patients had a higher mTOR expression (p < 0.05) of 8.02±8.62, compared to non-obese patients. High mTOR expression was associated with VAS knee pain (r=0.78; p < 0.05) and WOMAC pain (r=0.89; p<0.05) in obese patients (Table 1).Table 1.Correlation of m-TORParametersmTOR (1 group, n=50)mTOR (2 group, n=23)Body weightр > 0,05р > 0,05Pain (VAS)r=0,78; р<0,05p = 0,07; r = 0,45Pain (WOMAC)r=0,89; р<0,05р > 0,05Total WOMACр > 0,05р > 0,05Conclusion:Our study showed that patients with obesity and knee OA have higher rates of mTOR expression, compared to patients with normal body weight. High mTOR expression correlates with the severity of knee pain in obese patients. Thus, the evaluation of mTOR expression in obese patients and knee OA plays an important role in predicting the severity of clinical manifestations of OA, and may influence the choice of personalized therapy tactics for such patients.Disclosure of Interests:None declared

Obesity and the Latissimus Dorsi Flap: A Radiologic Study

2021 ◽  
pp. 229255032110319
Author(s):  
Joshua H. Choo ◽  
Bradley J. Vivace ◽  
Luke T. Meredith ◽  
Swapnil Kachare ◽  
Thomas J. Lee ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Latissimus Dorsi ◽  
Normal Weight ◽  
Latissimus Dorsi Flap ◽  
Class I ◽  
Autologous Reconstruction ◽  
Complication Rates ◽  
Obese Patients ◽  
Weight Category ◽  
Flap Thickness

Introduction: The increasing prevalence of obesity in patients with breast cancer has prompted a reappraisal of the role of the latissimus dorsi flap (LDF) in breast reconstruction. Although the reliability of this flap in obese patients is well-documented, it is unclear whether sufficient volume can be achieved through a purely autologous reconstruction (eg, extended harvest of the subfascial fat layer). Additionally, the traditional combined autologous and prosthetic approach (LDF + expander/implant) is subject to increased implant-related complication rates related to flap thickness in obese patients. The purpose of this study is to provide data on the thicknesses of the various components of the latissimus flap and discuss the implications for breast reconstruction in patients with increasing body mass index (BMI). Methods: Measurements of back thickness in the usual donor site area of an LDF were obtained in 518 patients undergoing prone computed tomography–guided lung biopsies. Thicknesses of the soft tissue overall and of individual layers (e.g., muscle, subfascial fat) were obtained. Patient, demographics including age, gender, and BMI were obtained. Results: A range of BMI from 15.7 to 65.7 was observed. In females, total back thickness (skin, fat, muscle) ranged from 0.6 to 9.4 cm. Every 1-point increase in BMI resulted in an increase of flap thickness by 1.11 mm (adjusted R 2 of 0.682, P < .001) and an increase in the thickness of the subfascial fat layer by 0.513 mm (adjusted R 2 of 0.553, P < .001). Mean total thicknesses for each weight category were 1.0, 1.7, 2.4, 3.0, 3.6, and 4.5 cm in underweight, normal weight, overweight, and class I, II, III obese individuals, respectively. The average contribution of the subfascial fat layer to flap thickness was 8.2 mm (32%) overall and 3.4 mm (21%), 6.7 mm (29%), 9.0 mm (30%), 11.1 mm (32%), and 15.6 mm (35%) in normal weight, overweight, class I, II, III obese individuals, respectively. Conclusion: The above findings demonstrate that the thickness of the LDF overall and of the subfascial layer closely correlated with BMI. The contribution of the subfascial layer to overall flap thickness tends to increase as a percentage of overall flap thickness with increasing BMI, which is favourable for extended LDF harvests. Because this layer cannot be separated from overall thickness on examination, these results are useful in estimating the amount of additional volume obtained from an extended latissimus harvest technique.

scholarly journals Facilitating Airway Surgery in a Morbidly Obese Patient Using Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE)

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Si-Jia Lee ◽  
Kelvin Howyow Quek
Keyword(s):  
Obese Patient ◽  
Normal Weight ◽  
Morbidly Obese ◽  
Airway Surgery ◽  
Laryngeal Surgery ◽  
Morbidly Obese Patient ◽  
Obese Population ◽  
Obese Subjects ◽  
Difficult Airways ◽  
Surgical Field

Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) is a relatively new noninvasive oxygenation technique with a broad range of applications. It is used in the treatment of type one respiratory failure, as a preoxygenation tool, as a rescue and temporising measure in difficult airways, and as step-down oxygen therapy in patients after extubation. Its use has also been described in laryngeal surgeries, but they mainly involved normal-weight subjects or were used as a bridging oxygenation therapy before definitive airway is secured. The major benefits of using THRIVE in obese subjects undergoing laryngeal surgery include a tubeless and uninterrupted surgical field. This advantage is especially crucial in obese patients as they tend to have limited oropharyngeal space, rendering a shared airway technically challenging for surgeons. However, concerns of potential difficult airway and shorter safe apnoeic time in the obese population limit its use. In this case, we report its use as the sole oxygenation strategy in a morbidly obese patient undergoing airway surgery. Our experience suggests that THRIVE can provide a conducive operating field and adequate oxygenation in short apnoeic laryngeal procedures in the obese population, without causing excessive hypercarbia.

scholarly journals The association between obesity and hematologic inflammatory markers in the first trimester pregnancies

2021 ◽  
Vol 28 (1) ◽  
pp. 17-22
Author(s):  
Feyza Nur İncesu Çintesun
Keyword(s):  
Blood Cell ◽  
White Blood Cell ◽  
Inflammatory Markers ◽  
Demographic Data ◽  
First Trimester ◽  
Normal Weight ◽  
Obese Patients ◽  
Distribution Width ◽  
Lymphocyte Ratio ◽  
Significant Difference

Objective Obesity is the defined as the abnormal or excessive accumulation of the fat which is harmful for the health, and its prevalence has been increasing. Many studies have shown that obesity alone leads to inflammation and causes poor gestational outcomes. In our study, we aimed to investigate the association between basic hematologic markers and obesity in the first trimester pregnancies. Methods A total of 321 pregnant women who admitted to the clinic of gynecology and obstetrics in a tertiary state hospital were included in the study. The patients were separated into three groups, which were normal weight (BMI: 18–24.9 kg/m2), overweight (BMI: 25–29.9 kg/m2), and obese (BMI>30 kg/m2). Of the patients, the demographic data (age, gravida, and parity) and the parameters of hemoglobin, hematocrit, white blood cell, neutrophil, lymphocyte, platelet (PLT), eosinophil, basophil, mean platelet volume (MPV), platelet distribution width (PDW), neutrophil/lymphocyte ratio (NLR), red blood cell distribution width (RDW), plateletcrit (PCT) and platelet/lymphocyte ratio (PLR) measured in the complete blood count which was checked in the first trimester routinely during the pregnancy follow-up were analyzed. The three groups were compared in terms of inflammatory markers. Results The patients were evaluated in three groups: 108 patients with normal weight (Group 1), 109 overweight patients (Group 2) and 104 obese patients (Group 3). No significant difference was found in terms of age, parity and gravida when the demographic data were analyzed among the groups (p>0.05). When the groups were compared in terms of hematologic markers, similar values were found in the markers other than white blood cell, neutrophil, lymphocyte, PLT and PCT values. The difference among white blood cell, neutrophil, lymphocyte, PLT and PCT values were between the patients with normal weight and obese patients, and the values of these markers were found higher in overweight / normal weight patient groups than the normal group (p<0.05). Conclusion The values of white blood cell, neutrophil, lymphocyte, PLT and PCT which were shown to be associated with inflammation were higher in the obese patients.

scholarly journals The value of blood serotonin for effective weight loss in obese women

2015 ◽  
Vol 12 (3) ◽  
pp. 31-35
Author(s):  
Natal'ya Vadimovna Anikina ◽  
Elena Nikolaevna Smirnova
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Clinical Laboratory ◽  
Normal Weight ◽  
Obese Patients ◽  
Obese Women ◽  
Endothelin 1 ◽  
Excessive Accumulation ◽  
Made In

Introduction. Obesity is a disorder of energy balance, which leads to excessive accumulation of fat. In recent years, many important discoveries were made in this field, including the discovery of hormones produced by adipose tissue and the identification of many of the central and peripheral pathways of energy balance.Objective. To study the levels of hormones that affect appetite and metabolism in women with obesity baseline and after weight loss while taking sibutramine.Materials and methods. The study included 56 women aged 42,9±9,5 years, with a BMI of 34,6±6,1 kg/m2. All patients underwent clinical, laboratory and instrumental examination. Hormonal study included determination of serotonin, leptin, ghrelin, endothelin-1, adiponectin.Results: In women with obesity we identified hyperleptinemia and increased serotonin levels. The decrease in body weight in patients receiving sibutramine was accompanied by lower levels of serotonin, leptin, ghrelin, endothelin-1, and increase of adiponectin.Conclusions: Obese patients have significantly elevated levels of leptin, serotonin, ghrelin compared to women of normal weight. Sibutramine treatment leads to a decrease in serotonin, leptin, ghrelin and is more effective in women with a BMI less than 36,5 kg/m2.

scholarly journals MON-161 Body Weight Reduction Not Always Reduced Adrenal Gland Volume in Obese Patients

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Tao Chen
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Sleeve Gastrectomy ◽  
Adrenal Gland ◽  
Morphological Changes ◽  
Normal Weight ◽  
Obese Patients ◽  
Gland Volume ◽  
Significant Difference ◽  
Adrenal Gland Volume

Abstract Recent studies have shown that obesity is a major risk factor for idiopathic hyperaldosteronism (IHA). IHA patients have greater AGV than normal controls. However, it is unclear whether such changes are caused by obesity and whether losing weight could reverse the morphological and functional abnormalities of the adrenal gland. This study was to investigate the association of obesity with adrenal gland volume (AGV) and the effects of weight loss on AGV. This study recruited obese patients (N=25) who underwent sleeve gastrectomy and age- and sex-matched normal-weight (N=25) and overweight healthy volunteers (HV) (N=21). Thin-slice computed tomography was used to evaluate adrenal morphological changes. AGV was measured semiautomatically based on the digital imaging and communications in medicine (DICOM) image. The effects of weight loss on AGV were evaluated in patients for one year or more after sleeve gastrectomy. The results showed that left, right and total AGV were larger in obese patients than those in overweight and normal- weight HVs (6.77±0.36, 5.76±0.31, and 12.53±0.64 cm3 vs. 3.88±0.14, 3.09± 0.13 and 6.97± 0.24 cm3 vs. 3.38±0.23, 2.67±0.15 and 6.04±0.36 cm3). No statistically significant difference was identified between overweight and normal-weight HVs. Sleeve gastrectomy significantly reduced body weight (-27.1±2.5 kg), left AGV (-0.80±0.26 cm3), and right AGV (-0.88±0.20 cm2). However, the adrenal volume in five patients was not reduced, despite significant weight loss postsurgery. In brief, obesity leads to increased AGV, and in some cases, this effect seems to be irreversible. We speculate that obesity causes permanently adrenal morphological changes (increased volume or hyperplasia), and under certain circumstances, it results in excessive aldosterone secretion via altered adipokines (leptin, CTRP1, etc.).

Plasma Nesfatin-1 Level in Obese Patients after Acupuncture: A Randomised Controlled Trial

2014 ◽  
Vol 32 (4) ◽  
pp. 313-317 ◽  
Author(s):  
Yongfang Guo ◽  
Mingqing Xing ◽  
Wenjuan Sun ◽  
Xiaoyan Yuan ◽  
Hongyan Dai ◽  
...  
Keyword(s):  
Weight Control ◽  
Serum Insulin ◽  
Controlled Trial ◽  
Diet Group ◽  
Normal Weight ◽  
Obese Patients ◽  
Obese Adults ◽  
The Difference ◽  
Randomised Controlled ◽  
The Relationship

Background Nesfatin-1 is an anorexigenic hormone suggested to regulate obesity. Objective To investigate the relationship between nesfatin-1 level and anthropometric and metabolic parameters in obese patients, and examine the change in plasma nesfatin-1 level after acupuncture treatment. Methods 64 obese adult patients without diabetes and 58 normal weight control subjects were enrolled in this study. The obese patients were randomly divided into an acupuncture plus diet group (n=32) and a diet only group (n=32). Measurements were repeated after 45 days. Results Body mass index (BMI), waist and hip circumferences, serum insulin, lipoprotein and insulin resistance measures were significantly higher, and plasma nesfatin-1 level was significantly lower, in obese patients than in normal weight controls. In addition, negative correlations were found between plasma nesfatin-1 level and BMI, waist and hip circumferences. Weight reduction in participants after acupuncture and diet restriction was 7.0% and 4.3%, respectively. Plasma nesfatin-1 level increased from 2.75±1.16 to 3.44±1.28 ng/mL and from 2.86±1.07 to 3.23±1.06 ng/mL in acupuncture and diet groups, respectively; the difference was significant, p<0.05. Conclusions Plasma nesfatin-1 level is reduced in obese adults, and is increased after acupuncture. The beneficial effect of acupuncture on obesity is associated with increased plasma nesfatin-1 level.

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