Pharmacologic Considerations for the Obese Patient

2020 ◽  
Author(s):  
Joy L. Chen ◽  
Taylor J. Pak ◽  
Tiffany S. Moon
Keyword(s):  
Body Mass ◽  
High Body Mass Index ◽  
Neuromuscular Blocking ◽  
Normal Weight ◽  
Lipid Solubility ◽  
Total Body Mass ◽  
Reversal Agents ◽  
Increased Risk ◽  
Total Body ◽  
Volumes Of Distribution

Obese patients gain lean and mass in different proportions to total body mass. This results in different volumes of distribution (Vd) for medications according to their lipid solubility compared to that of normal weight patients. High body mass index (BMI) patients are at increased risk of medical comorbidities that may affect drug metabolism and clearance. Anesthesiologists should factor in these differences in order to prevent erroneous medication dosing. This review contains 1 figure, 1 table, and 61 references. Keywords: obesity, induction agents, analgesics, inhaled anesthetics, neuromuscular blocking agents, reversal agents, local anesthetics, pharmacology, pharmacokinetics, pharmacodynamics

scholarly journals Comparison of methods to identify individuals with obesity at increased risk of functional impairment among a population of home-dwelling older adults

2021 ◽  
pp. 1-8
Author(s):  
Anne Lene Nordengen ◽  
Linn Kristin Lie Øyri ◽  
Stine Marie Ulven ◽  
Truls Raastad ◽  
Kirsten Bjørklund Holven ◽  
...  
Keyword(s):  
Older Adults ◽  
Muscle Strength ◽  
Muscle Mass ◽  
Body Mass ◽  
Functional Impairment ◽  
Muscle Quality ◽  
Obese Women ◽  
Total Body Mass ◽  
Increased Risk ◽  
Total Body

Abstract Obesity is associated with increased muscle mass and muscle strength. Methods taking into account the total body mass to reveal obese older individuals at increased risk of functional impairment are needed. Therefore, we aimed to detect methods to identify obese older adults at increased risk of functional impairment. Home-dwelling older adults (n 417, ≥ 70 years of age) were included in this cross-sectional study. Sex-specific cut-off points for two obesity phenotypes (waist circumference (WC) and body fat mass (FM %)) were used to divide women and men into obese and non-obese groups, and within-sex comparisons were performed. Obese women and men, classified by both phenotypes, had similar absolute handgrip strength (HGS) but lower relative HGS (HGS/total body mass) (P < 0·001) than non-obese women and men, respectively. Women with increased WC and FM %, and men with increased WC had higher appendicular skeletal muscle mass (P < 0·001), lower muscle quality (HGS/upper appendicular muscle mass) (P < 0·001), and spent longer time on the stair climb test and the repeated sit-to-stand test (P < 0·05) than non-obese women and men, respectively. Absolute muscle strength was not able to discriminate between obese and non-obese older adults. However, relative muscle strength in particular, but also muscle quality and physical performance tests, where the total body mass was taken into account or served as an extra load, identified obese older adults at increased risk of functional impairment. Prospective studies are needed to determine clinically relevant cut-off points for relative HGS in particular.

scholarly journals Effects of different circuit training protocols on body mass, fat mass and blood parameters in overweight adults

2017 ◽  
Vol 90 (1) ◽  
Author(s):  
Valentina Contrò ◽  
Antonino Bianco ◽  
Jill Cooper ◽  
Alessia Sacco ◽  
Alessandra Macchiarella ◽  
...  
Keyword(s):  
Lipid Profile ◽  
Body Mass ◽  
Body Fat ◽  
Significant Loss ◽  
Normal Weight ◽  
Control Group ◽  
Circuit Training ◽  
Total Body Mass ◽  
Total Body ◽  
Training Protocols

Benefits of exercise are known for a long time, but mechanisms underlying the exercise mode recommendations for specific chronic cardiovascular diseases remain unclear. The aim of this study was to compare the effects of different circuit training protocols in order to determine which is the best for weight loss and for specific overweight- related disorders. Forty-five female sedentary overweight participants from 20 to 50 years (average 31.8±11.2) were enrolled and assigned to three different groups; each group was compared with a control normal-weight group. Three different circuit protocols were randomly assigned to each overweight group: aerobictone- aerobic (ATA), aerobic-circuit-aerobic (ACA) and mini-trampoline circuit (MTC), while control group performed a classic circuit weight training (CWT). Every group trained three times per week, for 12 weeks. The results show that ATA group reduced body fat and total body mass more than other groups (P&lt;0.001; P=0.007). ACA group reduced total body mass in significant statistical way (P=0.032), as well as body fat (P&lt;0.001) and low-density lipoprotein cholesterol (P=0.013). In MTC group there was a significant reduction in every parameter we analyzed (total body mass, body fat and lipid profile: P&lt;0.001). CWT group has shown a significant loss only in body fat (P&lt;0.001). Every circuit protocol is optimal for reducing body fat and total body mass: however, MTC protocol has shown the best results on lipid profile.

High body mass index before age 20 is associated with increased risk for multiple sclerosis in both men and women

2012 ◽  
Vol 18 (9) ◽  
pp. 1334-1336 ◽  
Author(s):  
Anna K Hedström ◽  
Tomas Olsson ◽  
Lars Alfredsson
Keyword(s):  
Multiple Sclerosis ◽  
Body Mass ◽  
High Body Mass Index ◽  
Population Based ◽  
Normal Weight ◽  
Preventive Strategy ◽  
Swedish Population ◽  
Obesity Epidemic ◽  
Increased Risk ◽  
Control Study

In a Swedish population-based case-control study (1571 cases, 3371 controls), subjects with different body mass indices (BMIs) were compared regarding multiple sclerosis (MS) risk, by calculating odds ratios (OR) with 95% confidence intervals (95% CI). Subjects whose BMI exceeded 27 kg/m2 at age 20 had a two-fold increased risk of developing MS compared with normal weight subjects. Speculatively, the obesity epidemic may explain part of the increasing MS incidence as recorded in some countries. Measures taken against adolescent obesity may thus be a preventive strategy against MS.

scholarly journals Resting IL-6 and TNF-α Level in Children of Different Weight and Fitness Status

2013 ◽  
Vol 25 (2) ◽  
pp. 238-247 ◽  
Author(s):  
Peter A. Hosick ◽  
Robert G. McMurray ◽  
A.C. Hackney ◽  
Claudio L. Battaglini ◽  
Terry P. Combs ◽  
...  
Keyword(s):  
Body Mass ◽  
Aerobic Power ◽  
Normal Weight ◽  
Fat Free Mass ◽  
Total Body Mass ◽  
Tnf Α ◽  
Total Body ◽  
Α Level ◽  
The Relationship ◽  
Overweight Subjects

Reports suggest children with high aerobic fitness (VO2max; mL/kg/min) have healthier profiles of TNF-α and IL-6; however, research has not accounted for differences in adiposity between high-fit and low-fit individuals. Thus, this study examined differences in inflammatory markers of obese and normal weight children of different fitness levels, using two different VO2max units: per unit of fat free mass (VO2FFM) or total body mass (VO2kg). Children (n = 124; ages 8–12) were divided into four matched groups; normal weight high-fit (NH), normal weight low-fit (NL), obese high-fit (OH), and obese low-fit (OL). Height, weight, skinfolds, body mass index (BMI), and predicted VO2max were measured and a morning, fasting blood sample taken. IL-6 was elevated in the NL and OL groups compared with the NH group, as well as the OL group compared with the OH group. No differences were found in TNF-α. The relationship between IL-6 or TNF-α and the two units of predicted VO2max did not differ suggesting that either VO2FFM or VO2kg can be used to describe aerobic power when studying inflammation and exercise in youth. The relationship between IL-6 or TNF-α and predicted VO2max, whether expressed per mass or per fat-free mass was similar, suggesting that both can be used to describe aerobic power when studying inflammation and exercise in youth. Given the polar design of this study, this relationship should be confirmed including overweight subjects.

scholarly journals Body mass index and clinical outcomes in patients with intracerebral haemorrhage: results from the China Stroke Center Alliance

2021 ◽  
pp. svn-2020-000534
Author(s):  
Zhentang Cao ◽  
Xinmin Liu ◽  
Zixiao Li ◽  
Hongqiu Gu ◽  
Yingyu Jiang ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Hospital Mortality ◽  
Body Mass ◽  
Intracerebral Haemorrhage ◽  
Final Analysis ◽  
Normal Weight ◽  
Discharge Disposition ◽  
Increased Risk ◽  
Significant Difference ◽  
Stroke Center

Background and aimObesity paradox has aroused increasing concern in recent years. However, impact of obesity on outcomes in intracerebral haemorrhage (ICH) remains unclear. This study aimed to evaluate association of body mass index (BMI) with in-hospital mortality, complications and discharge disposition in ICH.MethodsData were from 85 705 ICH enrolled in the China Stroke Center Alliance study. Patients were divided into four groups: underweight, normal weight, overweight and obese according to Asian-Pacific criteria. The primary outcome was in-hospital mortality. The secondary outcomes included non-routine discharge disposition and in-hospital complications. Discharge to graded II or III hospital, community hospital or rehabilitation facilities was considered non-routine disposition. Multivariable logistic regression analysed association of BMI with outcomes.Results82 789 patients with ICH were included in the final analysis. Underweight (OR=2.057, 95% CI 1.193 to 3.550) patients had higher odds of in-hospital mortality than those with normal weight after adjusting for covariates, but no significant difference was observed for patients who were overweight or obese. No significant association was found between BMI and non-disposition. Underweight was associated with increased odds of several complications, including pneumonia (OR 1.343, 95% CI 1.138 to 1.584), poor swallow function (OR 1.351, 95% CI 1.122 to 1.628) and urinary tract infection (OR 1.532, 95% CI 1.064 to 2.204). Moreover, obese patients had higher odds of haematoma expansion (OR 1.326, 95% CI 1.168 to 1.504), deep vein thrombosis (OR 1.506, 95% CI 1.165 to 1.947) and gastrointestinal bleeding (OR 1.257, 95% CI 1.027 to 1.539).ConclusionsIn patients with ICH, being underweight was associated with increased in-hospital mortality. Being underweight and obese can both increased risk of in-hospital complications compared with having normal weight.

On the Nature of Hereditary Size Limitation

1929 ◽  
Vol 6 (4) ◽  
pp. 311-324
Author(s):  
R. CUMMING ROBB
Keyword(s):  
Body Weight ◽  
Body Mass ◽  
Physical Significance ◽  
Body Parts ◽  
Total Body Mass ◽  
Organ Growth ◽  
Submaxillary Glands ◽  
Size Limitation ◽  
Similar Association ◽  
Total Body

1. Throughout post-natal life the relative weights of the pituitary body, thyroid, thymus and adrenals in the rabbit may be expressed by the equation y = axk + c. 2. A similar association is indicated in the rat for the weights of eyeballs, liver, pancreas, hypophysis, thyroid, adrenals, submaxillary glands, kidney and fresh skeleton (data from Donaldson, 1924). 3. In giant and pigmy rabbits, the ultimate proportions of body parts are not the same, but (for any given body weight) corresponding tissues in the two groups tend to exhibit an identical relation to total body mass. 4. The adrenals and testes of the Polish rabbits are relatively much larger than those of the Flemish. But in each case the growth of the adrenal approximates to a constant power function of body weight. Moreover, in these two groups and in their hybrids, the growth of the testes adheres to a simple association with adrenal weight identical for each. 5. These data suggest the generalisation that in a growing organism the magnitude of any part tends to be a specific function of the total body mass or of some portion so related to the whole. 6. These associations may be explained by surmising that each tissue is in equilibrium with the internal milieu with regard to the distribution of nutrient growth essentials; that in each case the equilibrium point would be determined by the nature of the cell and after differentiation would tend to remain constant; and that the relative enlargement of each tissue is limited by the excess of the equilibrium value over the katabolic expenditure. 7. According to the above hypothesis of organ growth, the equation y = axk + c may possess a physical significance. Eight types of growth relationships may thus exist, differing because of the apparent inactivity of one or more constants in this equation.

scholarly journals The Future Excess Fraction of Cancer Attributable to High Body Mass Index in Australia

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 194s-194s ◽  
Author(s):  
R. Carey ◽  
R. Norman ◽  
D. Whiteman ◽  
A. Reid ◽  
R. Neale ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Adult Population ◽  
Significant Proportion ◽  
High Body Mass Index ◽  
Overweight And Obesity ◽  
High Body ◽  
Increased Risk ◽  
The Future ◽  
Future Burden

Background: High body mass index (BMI > 25 kg/m2) has been found to be associated with an increased risk of many cancers, including cancers of the colon and rectum, liver, and pancreas. Aim: This study aimed to estimate the future burden of cancer resulting from current levels of overweight and obesity in Australia. Methods: The future excess fraction method was used to estimate the future burden of cancer among the proportion of the Australian adult population who were overweight or obese in 2016. Calculations were conducted for 13 cancer types, including cancers of the colon, rectum, kidney, and liver. Results: The cohort of 18.7 million adult Australians in 2016 will develop ∼7.6 million cancers over their lifetime. Of these, ∼402,500 cancers (5.3%) will be attributable to current levels of overweight and obese. The majority of these will be postmenopausal breast cancers (n = 72,300), kidney cancers (n = 59,200), and colon cancers (n = 55,100). More than a quarter of future endometrial cancers (30.3%) and esophageal adenocarcinomas (35.8%) will be attributable to high body mass index. Conclusion: A significant proportion of future cancers will result from current levels of high body mass index. Our estimates are not directly comparable to past estimates of the burden from overweight and obesity because they describe different quantities - future cancers in currently exposed vs current cancers due to past exposures. The results of this study provide us with relevant up-to-date information about how many cancers in Australia could be prevented.

scholarly journals Physical activity modifies the risk of atrial fibrillation in obese individuals: The HUNT3 study

2018 ◽  
Vol 25 (15) ◽  
pp. 1646-1652 ◽  
Author(s):  
Lars E Garnvik ◽  
Vegard Malmo ◽  
Imre Janszky ◽  
Ulrik Wisløff ◽  
Jan P Loennechen ◽  
...  
Keyword(s):  
Physical Activity ◽  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Confidence Interval ◽  
Body Mass ◽  
High Body Mass Index ◽  
Overweight And Obesity ◽  
Hazard Ratio ◽  
Increased Risk

Background Atrial fibrillation is the most common heart rhythm disorder, and high body mass index is a well-established risk factor for atrial fibrillation. The objective of this study was to examine the associations of physical activity and body mass index and risk of atrial fibrillation, and the modifying role of physical activity on the association between body mass index and atrial fibrillation. Design The design was a prospective cohort study. Methods This study followed 43,602 men and women from the HUNT3 study in 2006–2008 until first atrial fibrillation diagnosis or end of follow-up in 2015. Atrial fibrillation diagnoses were collected from hospital registers and validated by medical doctors. Cox proportional hazard regression analysis was performed to assess the association between physical activity, body mass index and atrial fibrillation. Results During a mean follow-up of 8.1 years (352,770 person-years), 1459 cases of atrial fibrillation were detected (4.1 events per 1000 person-years). Increasing levels of physical activity were associated with gradually lower risk of atrial fibrillation ( p trend 0.069). Overweight and obesity were associated with an 18% (hazard ratio 1.18, 95% confidence interval 1.03–1.35) and 59% (hazard ratio 1.59, 95% confidence interval 1.37–1.84) increased risk of atrial fibrillation, respectively. High levels of physical activity attenuated some of the higher atrial fibrillation risk in obese individuals (hazard ratio 1.53, 95% confidence interval 1.03–2.28 in active and 1.96, 95% confidence interval 1.44–2.67 in inactive) compared to normal weight active individuals. Conclusion Overweight and obesity were associated with increased risk of atrial fibrillation. Physical activity offsets some, but not all, atrial fibrillation risk associated with obesity.

scholarly journals Maternal Body Mass Index and Breastfeeding Non-Initiation and Cessation: A Quantitative Review of the Literature

Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2684
Author(s):  
Kyoko Nomura ◽  
Sachiko Minamizono ◽  
Kengo Nagashima ◽  
Mariko Ono ◽  
Naomi Kitano
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Normal Weight ◽  
Maternal Body Mass Index ◽  
Review Of The Literature ◽  
Maternal Body ◽  
Cross Sectional ◽  
Quantitative Review ◽  
Increased Risk ◽  
Meta Analyses

This study aims to investigate which maternal body mass index (BMI) categories are associated with the non-initiation or cessation of breastfeeding (BF) based on a quantitative review of the literature. We searched Ovid MEDLINE and EBSCO CINAHL for peer-reviewed articles published between 1946 (MEDLINE) or 1981 (CINAHL), and 2019. Selected studies were either cross-sectional or cohort studies, of healthy mothers and infants, that reported nutrition method (exclusive/full or any) and period (initiation/duration/cessation) of breastfeeding according to maternal BMI levels. Pairwise meta-analyses of 57 studies demonstrated that the pooled odds risks (OR) of not initiating BF among overweight and obese mothers compared to normal weight mothers were significant across 29 (OR 1.33, 95% confidence interval (CI), 1.15–1.54, I2 = 98%) and 26 studies (OR 1.61, 95% CI, 1.33–1.95, I2 = 99%), respectively; the pooled risks for BF cessation were inconsistent in overweight and obese mothers with substantial heterogeneity. However, we found that overweight mothers (n = 10, hazard ratio (HR) 1.16, 95% CI, 1.07–1.25; I2 = 23%) and obese mothers (n = 7, HR 1.45, 95% CI: 1.27–1.65; I2 = 44%) were both associated with an increased risk of not continuing any BF and exclusive BF, respectively. Overweight and obese mothers may be at increased risk of not initiating or the cessation of breastfeeding.

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