The effect of obesity on lung function

Inpatient Hospitalizations for COVID-19 Among Patients With Prader-Willi Syndrome: A National Inpatient Sample Analysis

Prader-Willi syndrome (PWS) is a genetic disorder associated with baseline respiratory impairment caused by multiple contributing etiologies. While this may be expected to increase the risk of severe COVID-19 infections in PWS patients, survey studies have suggested paradoxically low disease severity. To better characterize the course of COVID-19 infection in patients with PWS, this study analyses the outcomes of hospitalizations for COVID-19 among patients with and without PWS. The National Inpatient Sample, an all-payors administrative claims database of hospitalizations in the United States, was queried for patients with a coded diagnosis COVID-19 in 2020 and 2021. Hospitalizations for patients with PWS compared to those for patients without PWS using Augmented Inverse Propensity Weighting (AIPW). There were 295 (95% CI: 228-362) COVID-19 hospitalizations for individuals with PWS and 4,112,400 (95% CI: 4,051,497-4,173,303) for individuals without PWS. PWS patients had a median age of 33 years compared to 63 for those without PWS. Individuals with PWS had higher baseline rates of obesity (47.5% vs. 28.4%). AIPW models show that PWS diagnosis is associated with increased hospital length of stay by 7.43 days, hospital charges by $80,126, and the odds of mechanical ventilation and in-hospital death (odds ratios of 1.79 and 1.67, respectively). PWS patients hospitalized with COVID-19 experienced longer hospital stays, higher charges, and increased risk of mechanical ventilation and death. These results suggest that PWS should be considered a risk factor for severe COVID-19, warranting continued protective measures and vaccination efforts. Further research is needed to validate coding for PWS and assess the impact of evolving COVID-19 variants and population immunity on this vulnerable population.

Obesity: pathophysiology and therapeutic interventions

Over the past few decades, obesity has transitioned from a localized health concern to a pressing global public health crisis affecting over 650 million adults globally, as documented by WHO epidemiological surveys. As a chronic metabolic disorder characterized by pathological adipose tissue expansion, chronic inflammation, and neuroendocrine dysregulation that disrupts systemic homeostasis and impairs physiological functions, obesity is rarely an isolated condition; rather, it is frequently complicated by severe comorbidities that collectively elevate mortality risks. Despite advances in nutritional science and public health initiatives, sustained weight management success rates and prevention in obesity remain limited, underscoring its recognition as a multifactorial disease influenced by genetic, environmental, and behavioral determinants. Notably, the escalating prevalence of obesity and its earlier onset in younger populations have intensified the urgency to develop novel therapeutic agents that simultaneously ensure efficacy and safety. This review aims to elucidate the pathophysiological mechanisms underlying obesity, analyze its major complications-including type 2 diabetes mellitus (T2DM), cardiovascular diseases (CVD), non-alcoholic fatty liver disease (NAFLD), obesity-related respiratory disorders, obesity-related nephropathy (ORN), musculoskeletal impairments, malignancies, and psychological comorbidities-and critically evaluate current anti-obesity strategies. Particular emphasis is placed on emerging pharmacological interventions, exemplified by plant-derived natural compounds such as berberine (BBR), with a focus on their molecular mechanisms, clinical efficacy, and therapeutic advantages. By integrating mechanistic insights with clinical evidence, this review seeks to provide innovative perspectives for developing safe, accessible, and effective obesity treatments.

The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and preserved ratio impaired spirometry: NHANES 2007-2012

BACKGROUND

Preserved ratio impaired spirometry (PRISm) refers to a form of lung function deterioration, and previous studies have established the association with Chronic Obstructive Pulmonary Disease (COPD). Research has also shown the association between COPD and lipid metabolism disturbances. Despite these findings, the association between lipid metabolism markers and PRISm remains poorly understood.

METHODS

This analysis was conducted on the 2007-2012 data from the National Health and Nutrition Examination Survey (NHANES), including a total of 9,431 participants. The Non-High-Density Lipoprotein Cholesterol to High-Density Lipoprotein Cholesterol Ratio (NHHR) was calculated based on lipid profiles, and PRISm patients were classified according to pulmonary function tests. To explore the association between NHHR and PRISm, multivariable logistic regression analysis was used.

RESULTS

A strong linear association was observed between NHHR and PRISm. In Adjusted Model 2, the weighted multivariable logistic regression analysis revealed that each unit increase in NHHR increased the chance of developing PRISm by 8% (OR:1.08, 95%CI:1.01-1.16, P = 0.039).Participants within the highest NHHR tertile demonstrated a 1.36-fold increased likelihood of presenting with PRISm compared to those in the lowest NHHR tertile (OR:1.36, 95% CI: 1.01-1.83, P = 0.048). Additionally, weighted Restricted Cubic Spline affirmed a linear association between NHHR and PRISm (P for non-linearity = 0.637), while clear non-linear associations were found between NHHR and FEV1% predicted (P for non-linearity = 0.010) and FEV1/FVC (P for non-linearity = 0.023). Subgroup analysis and interaction tests revealed a significant interaction effect among different waist circumference categories (P for interaction = 0.020). Notably, in individuals without abdominal obesity, NHHR showed a strong positive association with PRISm (OR = 1.23, 95% CI: 1.07-1.42, P = 0.01).

CONCLUSION

These results indicate that NHHR is positively associated with PRISm and is significantly associated with the decline in lung function. This study offers distinctive perspectives that may contribute to the avoidance and management of early-stage pulmonary dysfunction.

The WHO2SAFE Score: A Predictive Tool for Postoperative Oxygen Requirement After PACU Recovery

Background: This study aimed to develop a scoring system that predicts postoperative oxygen requirements, enhances clinical decision-making, reduces unnecessary oxygen use, and improves the efficiency of postoperative respiratory care. Methods: This retrospective study included patients who underwent elective non-cardiac surgery with general anesthesia between 1 January 2018 and 31 December 2022. The outcome of the study was the postoperative oxygen requirement at PACU discharge. Predictors with significance were used to create a scoring system. Results: Among the 42,378 cases, 14.9% required supplemental oxygen at PACU discharge. The WHO2SAFE score, which ranges from 0 to 15, incorporates eight independent risk factors, given in the mnemonic WHO2SAFE: intraoperative wheezing, intraoperative hypotension, obesity, operative time ≥ 180 min, sleep apnea, ASA classification ≥ 3, female, and elderly. Conclusions: The WHO2SAFE score provides a practical tool for predicting the need for supplemental oxygen at PACU discharge via the web, facilitating early intervention and efficient resource utilization. A cutoff score of 6 facilitates clinicians to identify high-risk patients who benefit from close observation while minimizing unnecessary oxygen use in low-risk individuals.

Association between milk consumption and migraines among American adults: national health and nutrition examination survey

BACKGROUND

Migraines have been associated with nutritional imbalances within the brain, sparking ongoing interest in the possible association between dietary elements, including milk intake, and the occurrence of migraines. Nevertheless, the exact nature of the connection between milk consumption and migraines remains unclear.

METHODS

This cross-sectional analysis sought to explore the association between milk intake and the prevalence of migraines. The study utilized data from individuals aged 20 and above who participated in the National Health and Nutrition Examination Survey from 1999 to 2004. In our study, we meticulously gathered comprehensive data on severe headaches or migraines, milk consumption, along with critical variables such as age, sex, marital status, and body mass index, among others. Milk consumption among participants was ascertained through a questionnaire. Logistic regression modeling and subgroup analyses were employed to evaluate the association between milk consumption and the incidence of severe headaches or migraines.

RESULTS

Among the 8850 participants, 19.98% (1768/8850) were identified as having migraines. Compared to individuals with only regular/whole milk consumption in the past 30 days, the adjusted OR values for only skim milk consumption in the past 30 days were 0.73 (95%CI: 0.60-0.89, p = 0.001), 0.78 (95%CI: 0.64-0.95, p = 0.014), and 0.77 (95%CI: 0.63-0.93, p = 0.009), respectively.

CONCLUSION

A notable association was detected between the type of milk intake and the occurrence of migraines. These results lay the groundwork for future investigations into the role of milk consumption in migraine management, potentially informing strategies for alleviating migraine symptoms.

Inhomogeneity of lung ventilation in children with obesity and its potential role in worsening asthma

Asthma is more frequent and severe in individuals with obesity compared to those with normal weight. While inhomogeneity of lung ventilation due to distal airway obstruction is a key feature in asthma, the effect of obesity on ventilation homogeneity is unclear. We conducted a cross-sectional study comparing lung clearance index (LCI) using multiple breath nitrogen washout technique between children with normal weight and asthma (n = 97), overweight/obesity and asthma (n = 100), overweight/obesity and no asthma (n = 100), and children with normal weight and no asthma (n = 67). Spirometry, lung volumes, and fractional exhaled nitric oxide (FeNO) were obtained for comparison. Results showed no significant difference in LCI between overweight/obesity groups and normal weight groups and no significant correlation between LCI and body mass index (BMI). However, LCI was higher in the asthma groups compared to non-asthma groups (p = 0.017, p = 0.003). There was a significant negative correlation between LCI and FEV1% predicted, FEV1/FVC, and FEF25-75% predicted (r = -0.24, p < 0.001; r = -0.26, p < 0.001; r = -0.23, p < 0.001), and a positive correlation with RV/TLC (r = 0.17, p = 0.003) and FeNO (r = 0.29, p < 0.001). These findings indicate that obesity does not affect the homogeneity of lung ventilation. Therefore, alternative mechanisms should be considered to explain the association between asthma and obesity.

Risk factors for extubation-related complications in morbidly obese patients undergoing bariatric surgery: a retrospective cohort study

BACKGROUND

One-third of major anesthesia-related airway complications occur during or shortly after tracheal extubation. Obesity significantly impacts respiratory function and is a key contributor to morbidity and mortality. Patients with morbid obesity often require bariatric surgery. However, extubation-related complications in this specific surgical population have not been previously studied. This study aimed to determine the rate and frequency of complications during tracheal extubation in patients undergoing bariatric surgery and the associated risk factors for these complications.

MATERIALS AND METHODS

This was a retrospective cohort study of adult patients above 18 years of age with a body mass index ≥ 40 kg/m2 who underwent bariatric surgery between June 2016 and June 2024. Extubation-related complications were defined as the occurrence of any of the following: vomiting, aspiration, laryngospasm, bronchospasm, cardiovascular instability, airway edema, desaturation (SpO2 < 90%), or the need for a rescue device or reintubation during or after tracheal extubation. Logistic regression analysis, adjusted for age and sex, was performed to evaluate the associations. The significance level was adjusted by applying the Bonferroni correction (0.05/16 = 0.0031), and a p-value < 0.0031 was interpreted as statistically significant.

RESULTS

Data from 1193 patients were analyzed. The overall complication rate was 4.4%, with the most frequent complication being desaturation, which occurred in 3.2% of patients. Logistic regression analysis showed that the odds of extubation-related complications increased twofold for obese patients with body mass index 50-59 kg/m2 (odds ratio [OR] 1.97, 95% confidence interval [95%CI] 0.99-3.94, p = 0.055) and threefold for patients with body mass index > 60 kg/m2 (OR 2.95, 95%CI 0.99-8.81, p = 0.05). The most commonly associated comorbidities were hypertension and obstructive sleep apnea, with an odds ratio of 2.98 for hypertension and 2.15 for obstructive sleep apnea (95%CI 1.40-6.33, p = 0.005; and 95%CI 1.08-4.29, p = 0.03; respectively). Despite these clinically important results, after applying the Bonferroni correction, none of these associations remain statistically significant, as the corrected p-values are above the threshold of p = 0.0031.

CONCLUSION

This study identified desaturation as the most common complication post-extubation of morbidly obese patients who underwent bariatric surgery. Moreover, we found that the odds of extubation-related complications increased with increasing obesity classes, particularly in patients with body mass index 50-59 kg/m2 and > 60 kg/m2, as well as in patients with hypertension and obstructive sleep apnea. These findings suggest the importance of tailored extubation strategies and close perioperative monitoring in morbidly obese patients to mitigate extubation-related risks.

Associated Factors and Pulmonary Function Outcomes of Preserved Ratio Impaired Spirometry: A Scoping Review

Background

Preserved ratio impaired spirometry (PRISm) is a common but understudied abnormal pulmonary function state and is strongly associated with poor health outcomes. However, there is a lack of uniformity in defining the factors and pulmonary function outcomes associated with PRISm.

Objective

This scoping review aims to elucidate the associated factors and pulmonary function outcomes of PRISm, thereby enhancing healthcare professionals' understanding of PRISm and laying the groundwork for its prevention and treatment.

Methods

This scoping review follows the 5-step framework developed by Arksey and O'Malley. Literature on PRISm was systematically searched from databases including PubMed, Embase, CINAHL, the Cochrane Library, Web of Science, CNKI, and Wan Fang, spanning from inception to July 2024. Inclusion and exclusion criteria were applied to enroll relevant studies. Data were extracted, collected, summarized, and reported.

Results

A total of 38 studies were included. The analysis revealed that associated factors for PRISm encompass possible pathogenic factors (older age, female, lower education level, smoking, obesity, etc), comorbidity associations (asthma, diabetes, cardiovascular diseases, etc), and disease characteristic factors (disease burden, physical performance, radiological characteristics, etc). The pulmonary function status of the PRISm population is unstable, making progression to airflow obstruction (AFO) more likely than in the normal population. PRISm exhibits multiple subgroups (incident or stable PRISm, definite PRISm or PRISm with AFO, non-restrictive or restrictive PRISm, etc) and significant differences exist in pulmonary function outcomes among different subgroups.

Conclusion

This scoping review offers a more comprehensive understanding of PRISm. It is recommended that future research focus on a deeper investigation of the pulmonary function of PRISm, elucidating its pathophysiological characteristics, and proposing new strategies for its prevention and treatment. Furthermore, more research is needed in low-income and middle-income economies to understand PRISm comprehensively.

Visceral Fat, Metabolic Health, and Lifestyle Factors in Obstructive Bronchial Diseases: Insights from Bioelectrical Impedance Analysis

Background/Objectives: This study examines the relationship between visceral fat (VF), metabolic health, and dietary patterns in patients with obstructive bronchial diseases (OBDs) using bioelectrical impedance analysis (BIA). Methods: A total of 75 patients diagnosed with OBD, including chronic obstructive pulmonary disease (COPD) and/or asthma, were assessed for VF levels via BIA. Dietary habits were evaluated using a structured questionnaire to explore their correlation with VF accumulation. Results: The study cohort comprised predominantly male participants (66.7%), with the majority aged between 61 and 70 years (46.7%). Significant gender differences in VF distribution were observed, with 60% of females maintaining normal VF levels (1-9) compared to only 28% of males, while 38% of males exhibited very high VF levels (15-30; p = 0.003). Body mass index (BMI) showed a strong correlation with VF (p < 0.0001), as overweight and obese individuals predominantly displayed elevated VF levels (≥10). Moreover, metabolic syndrome (MS) was present in 66.7% of participants, with these individuals exhibiting significantly higher VF levels compared to those without MS (p = 0.001). Dietary analysis revealed that frequent consumption of fast food (r = 0.717, p < 0.001), carbonated drinks (r = 0.366, p = 0.001), and refined carbohydrates (r = 0.438, p < 0.001) was significantly associated with increased VF accumulation. Conversely, higher intake of water (r = -0.551, p < 0.001), fruits (r = -0.581, p < 0.001), and vegetables (r = -0.482, p < 0.001) correlated with lower VF levels. Lack of physical activity was also strongly linked to VF accumulation (r = 0.481, p < 0.001), further reinforcing the role of lifestyle factors in metabolic health. Conclusions: The findings underscore the significant impact of dietary habits and physical activity on VF accumulation in OBD patients. BMI and MS emerged as critical predictors of VF, while unhealthy dietary patterns and sedentary lifestyles further exacerbated VF deposition. Elevated VF levels were linked to adverse lipid profiles, reinforcing the need for dietary and lifestyle modifications in managing metabolic health among OBD patients. Although no direct association was identified between VF and forced expiratory volume in one second (FEV1), the results highlight the necessity of integrated nutritional and metabolic interventions in the management of chronic respiratory diseases.

Association between the weight-adjusted waist index and age-related macular degeneration in US adults aged≥40 years: the NHANES 2005-2008

Objective

The association between the weight-adjusted waist index (WWI) and age-related macular degeneration (AMD) in US adults aged 40 years and older is unknown. The goal of this study was to ascertain a possible association between the two.

Methods

Data were obtained from the National Health and Nutrition Examination Survey (NHANES) in the US from 2005 to 2008. The WWI was calculated by dividing waist circumference (WC) by the square root of body weight (kg). AMD was diagnosed based on distinctive features observed in the fundus, using a standard classification system. Weighted logistic regression analyses were conducted to investigate the association between the WWI and AMD. Spline smoothing and threshold effects were applied to explore non-linear correlations. Subgroup analyses were performed to identify underlying covariates affecting this relationship. In addition, receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive power of the WWI for AMD.

Results

A total of 5,132 participants were enrolled in this study. The results showed a significant positive association between the WWI and risk of AMD (OR = 1.76 (1.52, 2.04); p < 0.0001). When the WWI was categorized into tertiles, the highest group exhibited a stronger association compared to the lowest tertile (OR = 2.90 (2.18, 3.86); p < 0.0001) in model 1. The subgroup analyses and interaction tests indicated that the relationship between the WWI and AMD was stable across various populations. The spline smoothing and threshold effects showed a positive non-linear correlation between the WWI and AMD incidence. Furthermore, compared to body mass index (BMI), WC, and weight, the WWI showed better predictability for AMD, as shown by the ROC analysis.

Conclusion

There exists a positive non-linear association between the WWI and AMD in US adults aged 40 years and older. The WWI-related obesity management is necessary for the prevention and treatment of AMD.

Lifetime Body Mass Index Trajectories and Contrasting Lung Function Abnormalities in Mid-Adulthood: Data From the Tasmanian Longitudinal Health Study

BACKGROUND AND OBJECTIVE

The impact of lifetime body mass index (BMI) trajectories on adult lung function abnormalities has not been investigated previously. We investigated associations of BMI trajectories from childhood to mid-adulthood with lung function deficits and COPD in mid-adulthood.

METHODS

Five BMI trajectories (n = 4194) from age 5 to 43 were identified in the Tasmanian Longitudinal Health Study. Lung function outcomes were defined using spirometry at 45 and 53 years. Associations between these BMI trajectories and lung function outcomes were investigated using multivariable regression.

RESULTS

Compared to the average BMI trajectory, the child's average-increasing BMI trajectory was associated with greater FVC decline from 45 to 53 years (β = -178 mL; 95% CI -300.6, -55.4), lower FRC, ERV and higher TLco at 45 years, lower FVC (-227 mL; -345.3, -109.1) and higher TLco at 53 years. The High BMI trajectory was also associated with lower FRC, ERV and higher TLco at 45 years, while spirometric restriction (OR = 6.9; 2.3, 21.1) and higher TLco at 53 years. The low BMI trajectory was associated with an obstructive picture: lower FEV1 (-124 mL; -196.4, -51.4) and FVC (-91 mL; -173.4, -7.7), and FEV1/FVC (-1.2%; -2.2, -0.1) and higher ERV and lower TLco at 45 and 53 years. A similar pattern was found at 53 years. No associations were observed with spirometrically defined COPD.

CONCLUSION

Our findings revealed contrasting lung function abnormalities were associated with high, subsequently increasing, and low BMI trajectories. These results emphasise the importance of tracking changes in BMI over time and the need to maintain an average BMI trajectory (BMI-Z-score 0 at each time point) throughout life.

Definition and diagnostic criteria of clinical obesity

Current BMI-based measures of obesity can both underestimate and overestimate adiposity and provide inadequate information about health at the individual level, which undermines medically-sound approaches to health care and policy. This Commission sought to define clinical obesity as a condition of illness that, akin to the notion of chronic disease in other medical specialties, directly results from the effect of excess adiposity on the function of organs and tissues. The specific aim of the Commission was to establish objective criteria for disease diagnosis, aiding clinical decision making and prioritisation of therapeutic interventions and public health strategies. To this end, a group of 58 experts—representing multiple medical specialties and countries—discussed available evidence and participated in a consensus development process. Among these commissioners were people with lived experience of obesity to ensure consideration of patients’ perspectives. The Commission defines obesity as a condition characterised by excess adiposity, with or without abnormal distribution or function of adipose tissue, and with causes that are multifactorial and still incompletely understood. We define clinical obesity as a chronic, systemic illness characterised by alterations in the function of tissues, organs, the entire individual, or a combination thereof, due to excess adiposity. Clinical obesity can lead to severe end-organ damage, causing life-altering and potentially life-threatening complications (eg, heart attack, stroke, and renal failure). We define preclinical obesity as a state of excess adiposity with preserved function of other tissues and organs and a varying, but generally increased, risk of developing clinical obesity and several other non-communicable diseases (eg, type 2 diabetes, cardiovascular disease, certain types of cancer, and mental disorders). Although the risk of mortality and obesity-associated diseases can rise as a continuum across increasing levels of fat mass, we differentiate between preclinical and clinical obesity (ie, health vs illness) for clinical and policy-related purposes. We recommend that BMI should be used only as a surrogate measure of health risk at a population level, for epidemiological studies, or for screening purposes, rather than as an individual measure of health. Excess adiposity should be confirmed by either direct measurement of body fat, where available, or at least one anthropometric criterion (eg, waist circumference, waist-to-hip ratio, or waist-to-height ratio) in addition to BMI, using validated methods and cutoff points appropriate to age, gender, and ethnicity. In people with very high BMI (ie, >40 kg/m2), however, excess adiposity can pragmatically be assumed, and no further confirmation is required. We also recommend that people with confirmed obesity status (ie, excess adiposity with or without abnormal organ or tissue function) should be assessed for clinical obesity. The diagnosis of clinical obesity requires one or both of the following main criteria: evidence of reduced organ or tissue function due to obesity (ie, signs, symptoms, or diagnostic tests showing abnormalities in the function of one or more tissue or organ system); or substantial, age-adjusted limitations of daily activities reflecting the specific effect of obesity on mobility, other basic activities of daily living (eg, bathing, dressing, toileting, continence, and eating), or both. People with clinical obesity should receive timely, evidence-based treatment, with the aim to induce improvement (or remission, when possible) of clinical manifestations of obesity and prevent progression to end-organ damage. People with preclinical obesity should undergo evidence-based health counselling, monitoring of their health status over time, and, when applicable, appropriate intervention to reduce risk of developing clinical obesity and other obesity-related diseases, as appropriate for the level of individual health risk. Policy makers and health authorities should ensure adequate and equitable access to available evidence-based treatments for individuals with clinical obesity, as appropriate for people with a chronic and potentially life-threatening illness. Public health strategies to reduce the incidence and prevalence of obesity at population levels must be based on current scientific evidence, rather than unproven assumptions that blame individual responsibility for the development of obesity. Weight-based bias and stigma are major obstacles in efforts to effectively prevent and treat obesity; health-care professionals and policy makers should receive proper training to address this important issue of obesity. All recommendations presented in this Commission have been agreed with the highest level of consensus among the commissioners (grade of agreement 90–100%) and have been endorsed by 76 organisations worldwide, including scientific societies and patient advocacy groups.

Using expanded diagnostic criteria mitigates gender disparities in diagnosis of sleep-disordered breathing

STUDY OBJECTIVES

Mitigating gender inequality in the diagnosis and management of sleep-disordered breathing (SDB) is of paramount importance. Historically, the diagnostic criteria for SDB were based on male physiology and did not account for variations in disease manifestation based on sex. Some payors use a definition of hypopnea that requires a 4% oxygen desaturation (AHI-4) to determine coverage for treatment, whereas the criteria recommended by the American Academy of Sleep Medicine require either a 3% oxygen desaturation or an arousal (AHI-3A). This study examined the diagnostic implications of these 2 definitions for men and women in a clinical setting.

METHODS

We reviewed polysomnography reports for all patients who completed a diagnostic polysomnography study at 1 sleep disorders center in 2019. Every polysomnography recording was scored using both sets of criteria to determine AHI-4 and AHI-3A.

RESULTS

Data from 279 women (64.7%) and 152 men (34.3%) were analyzed. Overall, the mean AHI-4 was 21.9 ± 27.3 and the mean AHI-3A was 34.7 ± 32.3 per hour of sleep. AHI-3A resulted in a diagnostic increase of 30.4% (P = .001) for women and 21.7% (P = .006) for men. Women saw a greater increase in diagnosis of mild and moderate SDB, and men saw a greater increase in severe SDB with the AHI-3A compared to the AHI-4 definition.

CONCLUSIONS

The definition of hypopnea used in the AHI-3A criteria is more consistent with the pathophysiology of SDB in women and results in higher rates of diagnosis. Use of the AHI-4 criteria may create a sex-based disparity in diagnosis, leading to symptomatic women remaining undiagnosed and untreated.

CITATION

Haile K, Mungarwadi M, Ibrahim NA, et al. Using expanded diagnostic criteria mitigates gender disparities in diagnosis of sleep-disordered breathing. J Clin Sleep Med. 2025;21(3):543-548.

The effect of total and partial meal replacements on obesity: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

The objective of this study was to conduct a comprehensive investigation into the effects of MRs on body weight, body mass index (BMI), fat mass, waist circumferences (WC), and leptin.

METHODS

A systematic search was conducted in five databases using established keywords. The random-effects model analysis was used to provide pooled weighted mean difference and 95% confidence intervals (CI).

RESULTS

Seventy studies were included in this article. The pooled findings showed that body weight (WMD: -3.35 kg, 95% CI: -4.28 to -2.42), BMI (WMD: -1.12 kg/m2, 95% CI: -1.51 to -0.72, p < 0.001), fat mass (WMD: -2.77 kg, 95% CI: -3.59 to -1.6), WC (WMD: -2.82 cm, 95% CI: -3.51 to -2.12) were significantly reduced after total and partial MRs compared to control group. However, no significant effect was observed on leptin (WMD: -3.37 ng/mL, 95% CI: -8.23 to 1.49) compared to the control group. Moreover, subgroup analyses indicated that impact of Total MRs on anthropometric factors was greater in comparison to Partial MRs.

CONCLUSIONS

Consequently, it appears that MRs, along with other lifestyle factors, can lead to significant weight loss.

Glucagon-Like Peptide 1 Receptor (Glp1r) Deficiency Does Not Appreciably Alter Airway Inflammation or Gut-Lung Microbiome Axis in a Mouse Model of Obese Allergic Airways Disease and Bariatric Surgery

Purpose

High body mass index (≥30 kg/m2) is associated with asthma severity, and nearly 40% of asthma patients exhibit obesity. Furthermore, over 40% of patients with obesity and asthma that receive bariatric surgery no longer require asthma medication. Increased levels of glucagon-like peptide 1 (GLP-1) occur after bariatric surgery, and recent studies suggest that GLP-1 receptor (GLP-1R) signaling may regulate the gut microbiome and have anti-inflammatory properties in the lung. Thus, we hypothesized that increased GLP-1R signaling following metabolic surgery in obese and allergen-challenged mice leads to gut/lung microbiome alterations, which together contribute to improved features of allergic airways disease.

Methods

Male and female Glp1r-deficient (Glp1r-/- ) and replete (Glp1r+/+) mice were administered high fat diet (HFD) to induce obesity with simultaneous intranasal challenge with house dust mite (HDM) allergen to model allergic airway disease with appropriate controls. Mice on HFD received either no surgery, sham surgery, or vertical sleeve gastrectomy (VSG) on week 10 and were sacrificed on week 13. Data were collected with regard to fecal and lung tissue microbiome, lung histology, metabolic markers, and respiratory inflammation.

Results

HFD led to metabolic imbalance characterized by lower GLP-1 and higher leptin levels, increased glucose intolerance, and alterations in gut microbiome composition. Prevalence of bacteria associated with short chain fatty acid (SCFA) production, namely Bifidobacterium, Lachnospiraceae UCG-001, and Parasutterella, was reduced in mice fed HFD and positively associated with serum GLP-1 levels. Intranasal HDM exposure induced airway inflammation. While Glp1r-/- genotype affected fecal microbiome beta diversity metrics, its effect was limited.

Conclusion

Herein, GLP-1R deficiency had surprisingly little effect on host gut and lung microbiomes and health, despite recent studies suggesting that GLP-1 receptor agonists are protective against lung inflammation.

Association of Abnormal Body Weight and Allergic Rhinitis-A Systematic Review and Meta-Analysis

OBJECTIVE

Allergic rhinitis (AR) is a prevalent inflammatory condition of the nasal mucosa, with significant burden worldwide. While studies have demonstrated a relationship between body mass index (BMI) and other atopic diseases, its association with AR is uncertain. This study aims to clarify the association between non-normal BMI and AR.

DESIGN

According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, independent authors screened studies for eligibility, extracted data and assessed bias of included studies using the Newcastle-Ottawa scale and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. A random-effects meta-analysis was used to pool maximally covariate-adjusted estimates. Additional subgroup and bias analyses were performed.

DATA SOURCES

PubMed, Embase, Cochrane Library, SCOPUS and CINAHL were searched from inception to 14 January, 2024.

ELIGIBILITY CRITERIA

Observational studies investigating the association between non-normal BMI and AR in both children and adults.

RESULTS

We included 32 articles comprising 2,008,835 participants. The risk of bias was low (N = 20) or moderate (N = 12) and GRADE certainty of evidence was very low to low. Pooled cross-sectional analyses indicated that obese children (OR = 0.99, 95% CI = 0.96-1.03, I2 = 0%), obese adults (OR = 1.11, 95% CI = 0.92-1.33, I2 = 73%), overweight children (OR = 1.02, 95% CI = 0.98-1.06, I2 = 35%), and overweight adults (OR = 1.13, 95% CI = 0.90-1.40, I2 = 0%) showed similar odds of AR compared to controls. Additionally, longitudinal analyses did not identify any evidence for an association between overweight (OR = 1.03, 95% CI = 0.85-1.24, I2 = 29%) or underweight (OR = 1.09, 95% CI = 0.77-1.54, I2 = 72%) children and AR risk. These results remained largely robust across various subgroups and sensitivity assessments.

CONCLUSION

Abnormal BMI may not be associated with AR. This study adds to the expanding literature on the association between non-normal BMI and atopic diseases. Further prospective studies are needed to explore the longitudinal relationship between BMI and AR and the effect of weight loss interventions on AR, given the limits of existing literature.

TRIAL REGISTRATION

PROSPERO CRD42024503589.

Muscle Mass Index Decline as a Predictor of Lung Function Reduction in the General Population

BACKGROUND

This study explores the link between muscle mass decline and lung function deterioration, which can worsen respiratory health by reducing exercise capacity and quality of life. The relationship between muscle mass index (MMI) changes and lung function in the general population remains unclear, especially as muscle mass fluctuates with aging. We aimed to clarify this dynamic relationship by examining how changes in muscle mass impact pulmonary function and the development of respiratory symptoms.

METHODS

We utilized the Ansan and Ansung Cohort Study of the Korean Genome and Epidemiology Study (KoGES) database, a large-scale prospective cohort, enrolling participants aged 40 to 69 years with lung function and body composition measurements. Over 12 years, data were collected biannually. The study assessed associations between changes in MMI and lung function trends, with cT1-T3 calculated using the linear regression coefficient and stratified by tertile. Survival analysis was then performed to examine differences in time to first airflow obstruction (AFO) and exacerbation among the tertiles.

RESULTS

A total of 2956 participants were enrolled in this study. At baseline, participants with higher MMI tended to be younger, had fewer co-morbidities and exhibited better lung function. Those with a steeper MMI decline rate exhibited a more rapid forced expiratory volume in 1 s (FEV1) decline over a 12-year follow-up (cT1: 43.3 mL/year, cT2: 38.4 mL/year, cT3: 33.2 mL/year, p < 0.001). Forced vital capacity (FVC) decline were more pronounced in groups with greater MMI decline rates (cT1: 38.5 mL/year, cT2: 32.8 mL/year, cT3: 26.0 mL/year, p < 0.001). Although, the time to first AFO did not differ significantly among T1-T3 groups, the time to first exacerbation related to wheezing event was significantly lower in cT3 group than in cT1 group (HR: 0.786, 95% CI: 0.629, 0.982).

CONCLUSIONS

A faster decline in MMI was associated with more rapid decline of both FEV1 and FVC and a higher risk of developing exacerbations of respiratory symptom. Although AFO was not associated with changes in MMI, further research is needed to explore the long-term relationships between muscle mass and the effects of preventive interventions aimed at maintaining muscle mass and respiratory health.

Evaluation of Pulmonary Function in Long-Term Follow-Up After Laparoscopic Sleeve Gastrectomy

BACKGROUND

Obesity is one of the most important health problems in the world. It affects all systems, especially the respiratory and cardiovascular systems. Laparoscopic sleeve gastrectomy is an effective method in the treatment of obesity and can improve respiratory functions. We aimed to evaluate the effects of surgery on pulmonary function in patients with obesity.

METHODS

A retrospective analysis was conducted on a group of patients who underwent sleeve gastrectomy. This study assessed pre-operative and long-term pulmonary function in patients who underwent laparoscopic sleeve gastrectomy between 2009 and 2015, with a minimum follow-up of 10 years. Patients were stratified based on smoking status and presence of comorbidities.

RESULTS

The study included 51 patients (82.4% female) with a mean age of 51.90 ± 11.57 years. Significant weight loss and reductions in BMI were observed postoperatively. Mean pre-operative BMI was 47.53 ± 6.95 and significantly decreased to 37.75 ± 6.02 post-operatively, BMI reduction rate was %22 (p < 0.001). Pulmonary function tests demonstrated significant improvements in FEV1 (2.65 ± 0.69 to 2.76 ± 0.67, p = 0.044), FEV1% (92.07 ± 15.31 to 97.98 ± 14.45, p = 0.001), PEF (74.01 ± 18.12 to 91.53 ± 24.16, p < 0.001), and MEF25-75 (77.17 ± 22.07 to 108.57 ± 28.11 p < 0.001) after surgery. These improvements were consistent across different subgroups, including smokers, non-smokers, and patients with and without comorbidities. Non-smokers exhibited a greater percentage increase in FEV1 compared to smokers. While there was an increase in FEV1 among patients with comorbidities, this difference was not statistically significant. Conversely, patients without comorbidities demonstrated a significant improvement in FEV1.

CONCLUSION

Bariatric surgery is associated with significant improvements in pulmonary function in obese patients, regardless of smoking status or comorbidities.

Physical Activity before and After Bariatric Surgery

Lifestyle changes including reduced calorie intake and increased physical activity (PA) improve the prognosis associated with bariatric surgery (BS) and metabolic indices. Early implementation of exercise leads to improved physical performance, better glycemic control and lipid profile, reduces the risks associated with anesthesia, and accelerates recovery from surgery. Undertaking systematic exercise after BS is associated with a better quality of life, improves insulin sensitivity, results in additional weight loss, reduces adverse effects on bone mass, and results in better body composition. The aim of this review was to summarize recommendations for physical activity in patients undergoing BS and to highlight the key role of physical activity in this patient group.

Adolescent Obesity and Charlson Comorbidity Index in Young Adults

Background: There is insufficient evidence regarding the independent risk of childhood/adolescent obesity for morbidity and mortality in adulthood. The objective of the present study was to evaluate the association of weight categories during adolescence with high-risk diseases determined by the Charlson Comorbidity Index in young adulthood. We also analyzed the association of weight categories with cumulative mortality at the age of 30. Methods: A retrospective cohort study, based on the central computerized database of a major health service organization, was conducted. The study population consisted of 80,853 adolescents. The study period was from 1 January 2007 to 31 December 2022 and was divided into the exposure period from 1 January 2007 to 31 December 2011 (ages 17-19) and the follow-up period from 1 January 2007 to 31 December 2022 (from the date of the defining BMI measurement up to the age of 30 years). Results: The five diseases with the highest cumulative incidence were chronic pulmonary disease (8.2%), mild liver disease (3.7%), cerebrovascular disease (2.8%), diabetes without end-organ damage (2.0%), and peptic disease (1.6%). When adjusted for socio-demographic variables and adult BMI, the relative risks with 95% confidence intervals for the increase in the Charlson Comorbidity Index were 1.11 (1.05-1.17), 1.17 (1.11-1.24), and 1.22 (1.09-1.35) for the "overweight", "obesity", and "class 2 obesity" categories, respectively, while the mortality for these categories were 1.60 (1.11-2.27), 1.71 (1.12-2.57), and 3.18 (1.48-6.35), respectively. Conclusions: Adolescent obesity is an independent risk factor for high-risk diseases and mortality in young adulthood. Interventions aimed at reducing the rate of adolescent overweight and obesity should be implemented as early as possible.

Association between World Trade Center disaster exposures and body mass index in community members enrolled at World Trade Center Environmental Health Center

Studies suggest that environmental disasters have a big impact on population health conditions including metabolic risk factors, such as obesity and hypertension. The World Trade Center (WTC) destruction from the 9/11 terrorist attack resulted in environmental exposures to community members (Survivors) with potential for metabolic effects. We now examine the impact of WTC exposure on Body Mass Index (BMI) using the data from 7136 adult participants enrolled in the WTC Environmental Health Center (EHC) from August 1, 2005, to December 31, 2022. We characterized WTC-related exposures by multiple approaches including acute dust-cloud exposure, occupational or residential exposures, and latent exposure patterns identified by synthesizing multiplex exposure questions using latent class analysis. Employing multivariable linear and quantile regressions for continuous BMI and ordered logistic regression for BMI categories, we found significant associations of BMI with WTC exposure categories or latent exposure patterns. For example, using exposure categories, compared to the group of local residents, local workers exhibited an average BMI increase of 1.71 kg/m2 with 95% confidence intervals (CI) of (1.33, 2.09), the rescue/recovery group had an increase of 3.13 kg/m2 (95% CI: 2.18, 4.08), the clean-up worker group had an increase of 0.75 kg/m2 (95% CI: 0.09, 1.40), and the other mixer group had an increase of 1.01 kg/m2 (95% CI: 0.43, 1.58). Furthermore, quantile regression analysis demonstrated that WTC exposures adversely affected the entire distribution of BMI in the WTC EHC Survivors, not merely the average. Our analysis also extended to blood pressure and hypertension, demonstrating statistically significant associations with WTC exposures. These outcomes highlight the intricate connection between WTC exposures and metabolic risk factors including BMI and blood pressure in the WTC Survivor population.

Association between lipid accumulation product and chronic obstructive pulmonary disease: a cross-sectional study based on U.S. adults

Background

Lipid Accumulation Product (LAP), which is derived from measurements of waist circumference and triglyceride (TG) levels, serves as a comprehensive indicator of lipid accumulation. Emerging research indicates that lipid accumulation dysfunction might significantly contribute to the pathogenesis of Chronic Obstructive Pulmonary Disease (COPD). Nevertheless, the investigation into the association between LAP and COPD risk is still insufficient, particularly in population-based research. This research intends to examine the possible correlation between LAP and the likelihood of developing COPD.

Methods

This study, designed as a cross-sectional analysis, made use of data gathered from the National Health and Nutrition Examination Survey (NHANES) spanning the years 2017 to 2020, encompassing a total of 7,113 eligible participants. LAP, the exposure variable, was calculated using waist circumference and triglyceride concentration. COPD diagnosis was determined using participants' self-reported information. To explore the association between LAP and COPD, multivariate logistic regression models were applied, and smoothing curve fitting was employed to examine any potential nonlinear patterns. Further analysis included stratified subgroup evaluations to assess how variables such as sex, smoking habits, and alcohol intake might impact the relationship between LAP and COPD.

Results

The findings indicated a significant increase in COPD risk with each one-unit rise in ln LAP, as evidenced by an Odds Ratio (OR) of 1.16 [95% Confidence Interval (CI): 1.04-1.30, p < 0.01]. Furthermore, a quartile-based analysis revealed that individuals in the highest ln LAP category had a considerably higher likelihood of developing COPD compared to those in the lowest category, with an OR of 1.35 (95% CI: 1.04-1.75, P for trend <0.01). Furthermore, the smoothing curve fitting identified a nonlinear and positive association between ln LAP and COPD, suggesting a steeper increase in risk as ln LAP values rise. Subgroup analysis suggested that this association remained fairly consistent across various demographic groups.

Conclusion

This study found a significant link between higher LAP levels and an elevated risk of COPD, with the association displaying a nonlinear pattern. As a marker of lipid accumulation abnormalities, LAP may serve as a valuable tool for assessing COPD risk and could inform strategies for early identification and targeted clinical management.

Association between body mass index and chronic obstructive pulmonary disease in young individuals: a nationwide population‑based cohort study

Body mass index (BMI) is associated with chronic obstructive pulmonary disease (COPD) risk. We investigated the association between BMI and the risk of COPD among young individuals. Using the Korean National Health Information Database, we screened individuals aged 20-39 years who participated in the national health examination between 2009 and 2012. We identified 6,304,769 eligible individuals, and 13,784 had newly developed COPD. BMI was categorized according to the Asian BMI criteria. We performed multivariate Cox proportional hazards models to estimate the adjusted hazard ratio (aHR) of risk factors for COPD development. Their mean age was 30.8 ± 5.0 years, and 3,732,656 (59.2%) were men. The incidence rate for developing COPD was 0.22/1,000 person-years. Compared to individuals with normal BMI (18.5-22.9 kg/m2), those who were underweight (< 18.5 kg/m2) had higher risks of COPD development (aHR: 1.37, 95% confidence interval [CI]: 1.29-1.46). Meanwhile, overweight or obese individuals (23-24.9 or 25-29.9 kg/m2) had lower risks for COPD development (aHR 0.90, 95% CI 0.86-0.95, and aHR 0.90, 95% CI 0.85-0.94, respectively). Although males showed tendencies similar to those of the total population, the risk was increased with increasing BMI among females. In the subgroup analysis, the risk reduction was not observed among non-smokers as BMI increased. In young individuals, being underweight was associated with an increased risk for COPD development, whereas being overweight and obese were associated with a decreased risk for COPD.

Association Between Visceral Fat and Lung Function Impairment in Overweight and Grade I Obese Women: A Cross-Sectional Study

Beyond the common comorbidities related to obesity, such as type 2 diabetes and cardiovascular diseases, impaired lung function is already known, but whether the fat distribution (sub-cutaneous, visceral) affects the lung function and pulmonary immune response are poorly known. Few evidence has shown that visceral fat is associated with insulin resistance, low-grade inflammation, and reduced lung function. In the present study, the body composition and fat distribution were evaluated by multi-frequency octopolar bioimpedance. This study demonstrated a possible association of increased visceral fat with impaired lung function in obesity grade I (n = 28; 45.46 ± 10.38 years old) women that was not observed in normal weight (n = 20; 43.20 ± 10.78 years old) and in overweight women (n = 30; 47.27 ± 10.25 years old). We also identified a negative correlation in FVC% (R2 = 0.9129; p < 0.0236), FEV1% (R2 = 0.1079; p < 0.0134), PEF% (R2 = 0.1673; p < 0.0018), and VC IN% (R2 = 0.1330; p < 0.0057) in the obesity grade I group, clearly demonstrating that higher levels of visceral fat correlate with reduced lung function, but not with sub-cutaneous fat. In addition, for the first time, a negative correlation among anti-fibrotic protein klotho (R2 = 0.09298; p < 0.0897) and anti-inflammatory IL-10 (R2 = 0.1653; p < 0.0487) in plasma was observed, in contrast to increased visceral fat. On the contrary, in breath condensate, a positive correlation for adiponectin (R2 = 0.5665; p < 0.0120), IL1-Ra (R2 = 0.2121; p < 0.0544), and IL1-Beta (R2 = 0.3270; p < 0.0084) was found. Thus, increased visceral fat directly influences the impairment of lung function and the systemic and pulmonary immune response of women with obesity grade I.

Metabolic Health, Overweight or Obesity, and Lung Function in Older Australian Adults

Background: Few studies have explored the links between adiposity, metabolic health, and lung function. This study examined the cross-sectional association between spirometric lung function and overweight/obesity, with and without metabolic abnormalities, in older adults. Methods: The research involved 3,318 older adults from the Hunter Community Study Cohort who had a BMI of 18.5 kg/m2 or higher. Participants were grouped based on BMI and metabolic health risk. Obesity was defined as a BMI of 30 kg/m2 or more, while metabolic health was determined by the absence of risk factors according to the International Diabetes Federation criteria. Lung function was assessed via spirometry, measuring FEV1, FVC, predicted FEV1, predicted FVC, and FEV1/FVC ratio. Lung dysfunction was classified into restrictive, obstructive, mixed patterns, and deviations from predicted FEV1 and FVC. Results: The mean lung function measurements were as follows: FEV1 2.4 L (0.7), FVC 2.9 L (0.8), predicted FEV1% 88.7% (17.6), predicted FVC% 85.6% (15.7), and FEV1/FVC 82.5% (8.5). Compared to the metabolically healthy normal weight (MHNW) group, the odds of lung dysfunction were as follows. For the restrictive pattern, the MHOW group had an odds ratio (OR) of 1.00 (95% CI: 0.70-1.47, p = 0.959) and the MHO group had an OR of 1.67 (95% CI: 1.13-2.49, p = 0.011). For the obstructive pattern, the MHOW group had an OR of 0.39 (95% CI: 0.20-0.77, p = 0.007) and the MHO group had an OR of 0.36 (95% CI: 0.12-1.05, p = 0.061). For the mixed pattern, the MHOW group had an OR of 0.39 (95% CI: 0.18-0.87, p = 0.021) and the MHO group had an OR of 0.29 (95% CI: 0.10-0.87, p = 0.027). Conclusions: A higher BMI and variations in metabolic health are associated with an increased likelihood of restrictive lung function patterns. Conversely, obesity is inversely related to obstructive lung function patterns.

Effect of Pilates exercises on pulmonary function, respiratory muscle strength, and functional capacity in patients with inhalation injury after flame thermal burn: A prospective randomized controlled trial

BACKGROUND

Inhalation injury is an acute respiratory tract injury that occurrs by inhalation of smoke, toxic gases, or steam. Early management is needed to reduce its mortality and morbidity. The purpose of this study was to ascertain whether Pilates training could help burn patients with inhalation injury after flame thermal burn in increasing pulmonary function, respiratory muscle strength, and functional ability.

METHODS

In this prospective, randomized, controlled trial, sixty participants (26 males and 34 females) with inhalation injury and deep partial-thickness flame burns of 30-40 % total body surface area (TBSA) were randomized in blocks of four, with a 1:1 allocation ratio into two groups: Group A (Pilates Group); received Pilates training plus conventional physical therapy program, and Group B (Control Group); received conventional physical therapy program only. This study was conducted at the Faculty of Physical Therapy's outpatient clinic, Cairo University, 3 sessions/week for 12 weeks. The primary outcome measure was the forced vital capacity (FVC) measured by a spirometer, while the secondary outcome measures were peak expiratory flow rate (PEFR), forced expiratory volume in 1 s (FEV1), FEV1/FVC% assessed by a spirometer, strength of respiratory muscles (maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) assessed by the digital manovacuometer, and the functional capacity evaluated by 6-Minute Walk Test (6-MWT).

RESULTS

A two-way mixed-design MANOVA was used to analyze the results within and between groups. There were no significant differences in demographic data between groups (P > 0.05). There were significant differences in all variables after treatment in group A compared with group B; FVC (95 % CI: 0.38, 1.13) (P = 0.001), FEV1 (95 % CI: 0.39, 0.97) (P = 0.001), FEV1/FVC % (95 % CI: 1.90, 17.19) (P = 0.02), PEFR (95 % CI: 0.47, 0.99) (P = 0.001), MIP (95 % CI: 5.12, 11.44) (P = 0.001), MEP (95 % CI: 2.57, 8.24) (P = 0.001), 6-MWT (95 % CI: 27.22, 54.96) (P = 0.001), FVC (% predicted) (95 % CI: 3.58, 12.58) (P = 0.001), FEV1 (% predicted) (95 % CI: 1.21, 11.11) (P = 0.02), PEFR (% predicted) (95 % CI: 1.33, 10.83) (P = 0.01), MIP (% predicted) (95 % CI: 2.26, 11.72) (P = 0.001) and MEP (% predicted) (95 % CI: 1.33, 10.37) (P = 0.01).

CONCLUSION

The current study demonstrated that a Pilates exercise program in addition to a traditional physical therapy program for 12 weeks significantly improved the pulmonary function (FVC, FEV1, PEFR and FEV1/FEV), strength of respiratory muscles (MIP and MEP), and functional capacity (6-MWT) in patients with inhalation injury after flame burns. These results underscore the importance of including Pilates exercises in the rehabilitation plan for burn patients with inhalation injury. Future studies are needed to evaluate the effect of Pilates exercises on other degrees and TBSA of burn, long-term follow up, and to measure cardiopulmonary parameters.

Opioid-Free Anesthesia for Upper Limb Surgery in Obese Patients as a Day Case Surgery: A Prospective Observational Study

Background

Opioid-free anesthesia (OFA) is a relatively new approach, and many studies are still needed to assess its effectiveness and compare it to opioid-based anesthesia (OBA).

Objectives

This study investigated the use of OFA in obese patients undergoing upper limb surgery and compares its outcomes with those of OBA.Methods:This prospective randomized clinical study included 76 obese patients with a Body Mass Index (BMI) ≥ 30 kg/m² who were scheduled for upper limb surgery. Patients were randomly assigned to receive either OFA (group A, n = 38) or OBA (group B, n = 38). The OBA group was administered propofol, fentanyl, and atracurium, while the OFA group received lidocaine, propofol, atracurium, and dexmedetomidine. All patients were mechanically ventilated, and anesthesia was maintained with isoflurane and atracurium. Primary outcomes monitored included postoperative pain [Visual Analog Scale (VAS) ≥ 4] and the number of rescue doses of tramadol. Secondary outcomes included extubation time, any cardiac events, hypoxia, postoperative nausea and vomiting (PONV), intensive care unit (ICU) admission rates, and duration of hospital stay.

Results

The OFA group had significantly lower extubation time, mean arterial pressure (MAP), and heart rate (HR) compared to the OBA group. Additionally, VAS scores were significantly lower at the 30-minute and 2-hour marks after extubation (P < 0.001 and P < 0.001, respectively) in patients receiving OFA. The OFA group also experienced fewer adverse effects, required fewer rescue doses of tramadol, and had shorter hospital stays.

Conclusions

Opioid-free anesthesia may result in better and safer outcomes for obese patients undergoing upper limb surgeries, with fewer postoperative complications and shorter hospital stays. However, further research is needed to fully understand the potential benefits of OFA compared to OBA.

Prospective association between social isolation, loneliness and lung function among Chinese middle-aged and older adults

OBJECTIVE

Previous research has highlighted a heightened occurrence of social isolation and loneliness in older adults diagnosed with chronic lung diseases. Nevertheless, there exists a dearth of studies that have explored the influence of impoverished social relationships on lung function. This study aimed to examine the longitudinal association between social isolation, loneliness and lung function over 4 years among middle-aged and older Chinese adults.

METHODS

This study employed two waves (2011 and 2015) of data from the China Health and Retirement Longitudinal Study (CHARLS). The analysis was limited to participants aged 45 years and above and stratified based on gender (3325 men and 3794 women). The measurement of peak expiratory flow (PEF) served as an indicator for assessing lung function. Lagged dependent variable regression models, accounting for covariates, were employed to explore the relationship between baseline social isolation and loneliness and the subsequent PEF.

RESULTS

For women, social isolation was significantly associated with the decline in PEF at follow-up (β = -.06, p < .001) even after adjusting for all covariates; no significant correlation was observed between loneliness and PEF. Among men, there was no significant association found between either social isolation or loneliness and PEF.

CONCLUSIONS

Social isolation is prospectively associated with worse lung function in middle-aged and older Chinese women but not men. The results highlight the importance of promoting social relationships in public health initiatives, especially in groups that are more vulnerable.

Impact of Preliminary Bronchodilator Dose in Chronic Obstructive Pulmonary Disease Patients With Suboptimal Peak Inspiratory Flow

PURPOSE

Suboptimal peak inspiratory flow rate (PIFR) is highly prevalent in patients with chronic obstructive pulmonary disease (COPD) owing to the mismatch of their PIFR with the corresponding inhaler-device resistance. This study aimed to investigate the impact of a preliminary dose of pressurized metered dose inhalers (pMDIs) on patients with COPD with suboptimal PIFR using Diskus dry powder inhalers (DPIs).

METHODS

A prospective, randomized, case-control study included 24 patients with COPD. PIFR was measured using the In-Check Dial G16 with low-to-medium resistance. Spirodoc was used to measure baseline spirometric data and compare it before and 30 minutes after the administration of Diskus DPI. On a different day, the study dose was given to each suboptimal patient by the same aerosol generator with preceded 2 puffs of salbutamol pMDI and re-evaluated for spirometric parameters 30 minutes after the study dose.

FINDINGS

There was a significant difference between the optimal and suboptimal groups in peak expiratory flow (2.38 ± 1.20 vs 1.49 ± 1.06 L/s, P = 0.050). PIFR showed a statistically significant difference between the optimal and suboptimal groups (71.66 ± 6.15 vs 41.25 ± 9.79 L/min, P < 0.0001). There was a significant difference in forced vital capacity (ΔFVC) between optimal and suboptimal groups without a preliminary dose (0.42 ± 0.21 vs 0.16 ± 0.11 L, P = 0.002), forced expiratory volume in 6 seconds (ΔFEV6) (0.53 ± 0.49 vs 0.17 ± 0.11 L, P = 0.022), forced expiratory volume in 3 seconds (ΔFEV3) (0.41 ± 0.38 vs 0.1 ± 0.16 L, P = 0.013), forced expiratory volume in 1 second (ΔFEV1)/FVC (-2.38 ± 8.41 vs 2.96% ± 2.95%, P = 0.033), and ΔFEV1/FEV6 (-4.32 ± 11.23 vs 2.91% ± 4.35%, P = 0.015). There was a significant difference in ΔFVC between optimal and suboptimal groups with a preliminary dose (0.42 ± 0.21 vs 0.23 ± 0.18 L, P = 0.046), ΔFEV1/FVC (-2.38 ± 8.41 vs 5.67% ± 6.53%, P = 0.009), ΔFEV1/FEV6 (-4.32 ± 11.23 vs 5.16% ± 4.99%, P = 0.008), and forced expiratory time (ΔFET) (0.28 ± 0.45 vs -0.31 ± 0.70 seconds, P = 0.022). The only parameter that showed a significant difference between suboptimal groups without and with a preliminary dose is Δ peak expiratory flow (0.24 ± 0.59 vs 0.65 ± 0.68 L/s, P = 0.004).

IMPLICATIONS

Administering a preliminary dose of pMDI can minimally enhance the effectiveness of DPIs in patients with COPD with suboptimal PIFR and health outcomes.

Associations between metabolic score for visceral fat and adult lung functions from NHANES 2007-2012

Background

Obesity is a significant part of the factors affecting lung function, and the assessment of obesity using the Metabolic Score for Visceral Fat (METS-VF) is more precise than other indicators like waist circumference and body mass index. This study investigated the relationship between lung function and METS-VF in The National Health and Nutrition Examination Survey (NHANES) database from 2007 to 2012.

Method

The data utilized in this study was obtained from National Health and Nutrition Examination Survey spanning the years 2007 to 2012. A multivariate linear regression analysis was employed to investigate the association between METS-VF and lung function, followed by subgroup analysis to identify populations that may exhibit heightened sensitivity. Nonlinear correlations were assessed by fitting a restricted cubic spline, with validation of results conducted via threshold effect analysis.

Result

In a study involving 4,356 participants, a weighted multiple linear regression model revealed a significant negative association between the METS-VF and forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, and forced expiratory flow between 25 and 75% of FVC (FEF25-75%). However, no association was observed with peak expiratory flow rate (PEF). When dividing the METS-VF into thirds, participants in the highest third exhibited significantly decreased levels of FEV1 (β: -342, 95%CI: -440, -245, p < 0.001), FVC (β: -312, 95%CI: -431, -192, p < 0.001), FEV1/FVC (β: -0.020, 95%CI: -0.030, -0.010, p < 0.001), and FEF25-75% (β: -424, 95%CI: -562, -285, p < 0.001). However, there was no significant relationship with PEF (β: -89, 95%CI: -325, 147, p = 0.446). RCS curve indicated a nonlinear negative correlation between METS-VF and FEV1, FVC, and FEV1/FVC. For FEV1, a significant negative correlation was found when the METS-VF < 6.426 (β = -158.595, 95%CI: -228.183, -89.007). This negative association became more pronounced when the METS-VF > 6.426 (β = -314.548, 95%CI: -387.326, -241.770). For FVC, a negative association was observed when the METS-VF < 6.401, (β = -5.477, 95%CI: -91.655, 80.702), but it did not reach statistical significance. However, METS-VF > 6.401, METS VF and lung function show a significant negative correlation (β = -399.288, 95%CI: -486.187, -312.388). FEV1/FVC showed a negative correlation only before the inflection point (METS-VF < 6.263) (β = -0.040, 95%CI: -0.047, -0.032), after the inflection point (METS-VF > 6.263), no correlation was found, but there was no statistical significance (β = 0.000; 95%CI: -0.006, 0.007), and METS-VF had a linear negative correlation with FEF25-75%. Subgroup analysis showed that the association was consistent across a variety of demographic factors, including age, sex, race, hypertension, and coronary heart disease. In addition, we found a stronger association between men under 40 and lung function.

Conclusion

METS-VF showed a linear negative correlation with FEF25-75%, and a nonlinear negative correlation with FEV1, FVC, FEV1/FVC, and FEF25-75%, but was not associated with PEF, particularly among males under the age of 40. These findings offer valuable insights into managing lung function by controlling visceral fat.

Correlation between weight-adjusted-waist index and hypertension in the US population: based on data from NHANES 2005-2018

Objectives

This study aimed to investigate the association between the weight-adjusted waist index (WWI) and the prevalence of hypertension in U.S. adults.

Methods

Data were sourced from the National Health and Nutrition Examination Survey (NHANES) spanning 2005-2018. In our cross-sectional study, we focused on the non-institutional U.S. population over the age of 18 from various communities in the United States. WWI is derived by dividing waist circumference by the square root of body weight. The definition of hypertension was based on self-reported history of hypertension, antihypertensive drug use, and blood pressure measurements. Participants without complete information on WWI and hypertension were excluded. The independent relationship and consistency between WWI and hypertension were assessed through weighted multivariate regression. The Pearson correlation test was used to detect the association between WWI and BMI. Subgroup analyses were used to verify the stability of the relationship between WWI and the prevalence of hypertension, and interaction tests were also conducted by gender, age, smoking, and triglycerides.

Results

Among the 37,299 participants included, the hypertension prevalence was 33.9%. After adjusting for confounding variables, WWI demonstrated a significant association with hypertension. Individuals in the top quarter of WWI had a 2.27fold higher chance of hypertension prevalence compared with the bottom quarter (OR = 2.27, 95% CI 1.97-2.61; P < 0.0001). Subgroup analysis highlighted that this association was particularly pronounced in males aged ≤60 years.

Conclusion

The findings underscore a robust correlation between elevated WWI and a heightened risk of hypertension, especially in males aged ≤60 years.

Weight-adjusted waist index is an independent predictor of all-cause and cause-specific mortality in patients with asthma

BACKGROUND

There is a close relationship between obesity and the occurrence of asthma.The weight-adjusted waist index (WWI) is a relatively novel anthropometric parameter that reflects obesity.

OBJECTIVE

We aimed to explore the association between WWI and mortality in the asthma population.

METHODS

We included adult with asthma from NHANES 1999-2018. WWI = Waist circumference (cm)/square root of body weight (kg). Current asthma was determined by the participant's responses in standardized questionnaires. All-cause, cardiovascular disease (CVD), cancer, and respiratory disease mortality information was obtained by prospectively matching these data to the National Death Index. Multivariate-adjusted Cox proportional hazards regression analyses, Kaplan Meier survival analyses, restricted cubic spline (RCS) analyses, stratified analyses, and sensitivity analyses were used to clarify these associations.

RESULTS

A total of 101,316 participants were included in the study, and 3223 were diagnosed with asthma.WWI was independently and positively associated with all-cause and all factor-specific mortality in asthma. In fully adjusted models, each unit increase in WWI was associated with 43 % (hazard ratio [HR] and 95 % confidence interval [CI] = 1.43 [1.25,1.64], p < 0.0001), 58 % (1.58 [1.25, 1.99], p < 0.001), 50 % (1.50 [1.19, 1.90], p < 0.001), and 79 % (1.79 [1.34, 2.39], p < 0.0001) increased all-cause, CVD, cancer, and respiratory disease mortality, respectively. RCS analyses showed largely linear associations between WWI and all mortality risks. Stratified analyses indicated that these associations were influenced by multiple factors, and that age was consistently the effect modifier across all associations.

CONCLUSIONS

WWI is an independent predictor of all-cause, CVD, cancer, and respiratory-related mortality in the adult asthma population. These findings highlight that WWI may have novel prognostic value as a simple and easily accessible obesity parameter in asthma patients.

Prevalence of Obesity and Its Associated Comorbidities in Adults with Asthma: A Single-Center Study in Saudi Arabia

Background and Objectives: Asthma is associated with several comorbidities, one of which is obesity. The worldwide increase in obesity has been accompanied by a parallel rise in asthma prevalence, with obesity recognized as a significant risk factor for both the development and severity of asthma. Obesity is often linked to various comorbidities, which can complicate asthma management and lead to poorer clinical outcomes. This study aims to investigate the prevalence of obesity and its comorbidities in adults with asthma in a single center in Saudi Arabia, providing an overview of the associated health implications. Materials and Methods: This single-center, retrospective study aimed to assess the prevalence of obesity and other comorbidities in asthma patients. Data were collected from King Khalid University Hospital in Saudi Arabia between July 2023 and December 2023. Results: This study revealed that 72.1% of asthma patients were either obese or overweight. Female patients had significantly higher BMI values compared to males. Our study revealed that 38.21% of female asthma patients (mean age = 57 ± 13.85 years) had comorbidities compared to 24.14% of male asthma patients (mean age = 59 ± 14.02 years). Furthermore, the proportion of obese asthmatic patients with comorbidities was significantly greater than those without comorbidities. Conclusions: This study investigates obesity prevalence and associated comorbidities in adult asthmatics in a single center in Saudi Arabia. The findings reveal a 72.1% rate of obesity and overweight among asthmatic patients, with higher BMI and comorbidity prevalence in females. These results underscore the need for targeted interventions addressing obesity and comorbidities, especially in female asthmatics.

The Impact of Pneumoperitoneum on Mean Expiratory Flow Rate: Observational Insights from Patients with Healthy Lungs

BACKGROUND/OBJECTIVES

Surgical pneumoperitoneum (PP) significantly impacts volume-controlled ventilation, characterized by reduced respiratory compliance, elevated peak inspiratory pressure, and an accelerated expiratory phase due to an earlier onset of the airway pressure gradient. We hypothesized that this would shorten expiratory time, potentially increasing expiratory flow rate compared to pneumoperitoneum conditions. Calculations were performed to establish correlations between respiratory parameters and the mean increase in expiratory flow rate relative to baseline.

METHODS

Mechanical ventilation parameters were recorded for 67 patients both pre- and post-PP. Ventilator settings were standardized with a tidal volume of 6 mL/kg, a respiratory rate of 12 breaths per minute, a PEEP of 3 cmH2O, an inspiratory time of 2 s, and an inspiratory-to-expiratory ratio of 1:1.5 (I:E).

RESULTS

The application of PP increased both peak inspiratory pressure and mean expiratory flow rate by 28% compared to baseline levels. The elevated intra-abdominal pressure of 20 cmH2O resulted in a 34% reduction in dynamic chest compliance, a 50% increase in elastance, and a 20% increase in airway resistance. The mean expiratory flow rate increments relative to baseline showed a significant negative correlation with elastance (p = 0.0119) and a positive correlation with dynamic compliance (p = 0.0028) and resistance (p = 0.0240).

CONCLUSIONS

A PP of 20 cmH2O resulted in an increase in the mean expiratory flow rate in the conventional I:E ratio in the volume-ventilated mode. PP reduces lung and chest wall compliance by elevating the diaphragm, compressing the thoracic cavity, and increasing airway pressures. Consequently, the lungs and chest wall stiffen, requiring greater ventilatory effort and accelerating expiratory flow due to increased airway resistance and altered pulmonary mechanics. Prolonging the inspiratory phase through I:E ratio adjustment helps maintain peak inspiratory pressures closer to baseline levels, and this method enhances the safety and efficacy of mechanical ventilation in maintaining optimal respiratory function during laparoscopic surgery.

The negative association between weight-adjusted-waist index and lung functions: NHANES 2007-2012

Obesity is a common public health issue worldwide, and its negative impact on lung function has garnered widespread attention. This study sought to investigate the possible association between a new obesity metric, the weight-adjusted waist index (WWI), and lung functions, providing a basis for the monitoring and protection of lung functions. We conducted a cross-sectional evaluation, analyzing data from adults in the U.S. gathered through the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2012. To explore the correlation between WWIs and lung functions, we utilized a multivariate logistic regression model with appropriate weighting to ensure accuracy. Smooth curve fitting also helped to confirm the linear nature of this relationship. Subgroup analyses were conducted to confirm the uniformity and dependability of the results. Our study included data from 13,805 adults in the United States. Multivariate linear regression analysis revealed that, in the fully adjusted model, higher WWIs were negatively correlated with forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC, peak expiratory flow rate (PEF), and forced expiratory flow rate (FEF) 25%-75% (β = -0.63; 95% confidence interval [CI] [-0.71, -0.55]; β = -0.55; 95% CI [-0.62, -0.48]; β = -0.02; 95% CI [-0.03, -0.01]; β = -1.44; 95% CI [-1.65, -1.23]; β = -0.52; 95% CI [-0.65, -0.39], respectively). Additionally, when analyzing the WWI as a categorical variable, a significant downward trend in the FVC, FEV1, PEF, and FEF 25%-75% was observed from Q2 to Q4 as the WWI increased (trend P < 0.05). Subgroup analysis showed stronger associations between WWI and lung functions, particularly among younger, non-Hispanic white, male participants, and current smokers. Our results indicate that elevated WWI is strongly associated with declining lung functions, demonstrating the importance of long-term monitoring and tracking of WWIs.

Targeting Lipid Metabolism in Obese Asthma: Perspectives and Therapeutic Opportunities

BACKGROUND

Obese asthma represents a unique phenotype of asthma characterized by severe symptoms, poor medication controls, increased frequency of exacerbations, and an overall diminished quality of life. Numerous factors, including the complex interactions between environment, mechanical processes, inflammatory responses, and metabolites disturbance, contribute to the onset of obese asthma.

SUMMARY

Notably, multiple metabolomics studies in the last several years have revealed the significant abnormalities in lipid metabolism among obese asthmatic patients. Several bioactive lipid messengers participate in the development of obese asthma has also been observed. Here, we present and discuss the latest advances regarding how bioactive lipid molecules contribute to the pathogenic process and mechanisms underlying obese asthma. The key roles of potentially significant effector cells and the pathways by which they respond to diverse lipid metabolites are also described. We finally summarize current lipid-related therapeutic options for the treatment of obese asthma and discuss their application prospects.

KEY MESSAGES

This review underscores the impacts of abnormal lipid metabolism in the etiopathogenesis of obese asthma and asks for further investigation to elucidate the intricate correlations among lipids, obesity, and asthma.

Inhibition of angiogenesis and regenerative lung growth in Lepob/ob mice through adiponectin-VEGF/VEGFR2 signaling

Introduction

Obesity is associated with impairment of wound healing and tissue regeneration. Angiogenesis, the formation of new blood capillaries, plays a key role in regenerative lung growth after unilateral pneumonectomy (PNX). We have reported that obesity inhibits angiogenesis. The effects of obesity on post-PNX lung vascular and alveolar regeneration remain unclear.

Methods

Unilateral PNX is performed on Lep o b / o b obese mice to examine vascular and alveolar regeneration.

Results

Regenerative lung growth and expression of vascular endothelial growth factor (VEGF) and its receptor VEGFR2 induced after PNX are inhibited in Lep o b / o b obese mice. The levels of adiponectin that exhibits pro-angiogenic and vascular protective properties increase after unilateral PNX, while the effects are attenuated in Lep o b / o b obese mice. Post-PNX regenerative lung growth and increases in the levels of VEGF and VEGFR2 are inhibited in adiponectin knockout mice. Adiponectin stimulates angiogenic activities in human lung endothelial cells (ECs), which is inhibited by decreasing the levels of transcription factor Twist1. Adiponectin agonist, AdipoRon restores post-PNX lung growth and vascular and alveolar regeneration in Lep o b / o b obese mice.

Discussion

These findings suggest that obesity impairs lung vascular and alveolar regeneration and adiponectin is one of the key factors to improve lung regeneration in obese people.

Childhood Air Pollution Exposure Associated with Self-reported Bronchitic Symptoms in Adulthood

Rationale: Few studies have examined the effects of long-term childhood air pollution exposure on adult respiratory health, including whether childhood respiratory effects underlie this relation. Objectives: To evaluate associations between childhood air pollution exposure and self-reported adult bronchitic symptoms while considering child respiratory health in the Southern California Children's Health Study. Methods: Exposures to nitrogen dioxide (NO2), ozone, and particulate matter <2.5 μm and <10 μm in diameter (PM10) assessed using inverse-distance-squared spatial interpolation based on childhood (birth to age 17 yr) residential histories. Bronchitic symptoms (bronchitis, cough, or phlegm in the past 12 mo) were ascertained via a questionnaire in adulthood. Associations between mean air pollution exposure across childhood and self-reported adult bronchitic symptoms were estimated using logistic regression. We further adjusted for childhood bronchitic symptoms and asthma to understand whether associations operated beyond childhood respiratory health impacts. Effect modification was assessed for family history of asthma, childhood asthma, and adult allergies. Measurements and Main Results: A total of 1,308 participants were included (mostly non-Hispanic White [56%] or Hispanic [32%]). At adult assessment (mean age, 32.0 yr; standard deviation [SD], 4.7), 25% reported bronchitic symptoms. Adult bronchitic symptoms were associated with NO2 and PM10 childhood exposures. Odds ratios per 1-SD increase were 1.69 (95% confidence interval, 1.14-2.49) for NO2 (SD, 11.1 ppb) and 1.51 (95% confidence interval, 1.00-2.27) for PM10 (SD, 14.2 μg/m3). Adjusting for childhood bronchitic symptoms or asthma produced similar results. NO2 and PM10 associations were modified by childhood asthma, with greater associations among asthmatic individuals. Conclusions: Childhood NO2 and PM10 exposures were associated with adult bronchitic symptoms. Associations were not explained by childhood respiratory health impacts; however, participants with childhood asthma had stronger associations.

Obesity, Inflammation, and Clinical Outcomes in COVID-19: A Multicenter Prospective Cohort Study

CONTEXT

Obesity is a risk factor for coronavirus disease 2019 (COVID-19)-related outcomes; however, the mechanism remains unclear.

OBJECTIVE

The objective of this analysis was to determine whether inflammation mediates the association between obesity and COVID-19 outcomes.

METHODS

The International Study of Inflammation in COVID-19 (ISIC): A Prospective Multi-Center Observational Study Examining the Role of Biomarkers of Inflammation in Predicting Covid-19 Related Outcomes in Hospitalized Patients, was conducted at 10 hospitals in the United States and Europe. Participants were adults hospitalized specifically for COVID-19 between February 1, 2020, through October 19, 2022. Inflammatory biomarkers, including soluble urokinase plasminogen activator receptor (suPAR), were measured at admission. Associations were examined between body mass index (BMI, kg/m2) and a composite of death, need for mechanical ventilation, and renal replacement therapy, stratified by pre- and post-Omicron variants. The contribution of inflammation to the relationship between obesity and outcomes was assessed.

RESULTS

Among 4644 participants (mean age 59.3, 45.6% male, 21.8% BMI ≥ 35), those with BMI > 40 (n = 485) had 55% higher odds of the composite outcome (95% CI, 1.21-1.98) compared with nonobese individuals (BMI < 30, n = 2358) in multivariable analysis. In multiple mediation analysis, only suPAR remained a significant mediator between BMI and composite outcome. Associations were amplified for participants younger than 65 years and with pre-Omicron variants.

CONCLUSION

Obesity is associated with worse outcomes in COVID-19, notably in younger participants and in the pre-Omicron era. Inflammation, as measured by suPAR, is a significant mediator of the association between obesity and COVID-19 outcomes.

Clinical Impact of Obesity on Postoperative Outcomes of Patients With Thyroid Cancer Undergoing Thyroidectomy: A 5-Year Retrospective Analysis From the US National Inpatient Sample

BACKGROUND

The clinical impact of obesity on postoperative outcomes of patients undergoing thyroidectomy remains controversial.

METHODS

Patients aged ≥ 18 years who were diagnosed with thyroid malignancy and underwent thyroidectomy between 2016 and 2020 were included, and divided into two groups: patients with body mass index (BMI) < 30 kg/m2 and those with BMI ≥ 30 kg/m2. Patients in the obese group were then subdivided into four groups: Group 1 (BMI 30.0-34.9 kg/m2), Group 2 (BMI 35.0-39.9 kg/m2), Group 3 (BMI 40.0-44.9 kg/m2), and Group 4 (BMI ≥ 45.0 kg/m2) to evaluate the association between degree of obesity and clinical outcomes. We performed propensity score matching, compared outcome variables between the groups, and conducted adjusted multivariate logistic regression analyses of postoperative outcomes.

RESULTS

A total of 6778 patients diagnosed with thyroid cancer who underwent thyroidectomy were screened, of whom 1299 (19.2%) patients were obese. Patients in the obese group had higher total hospital charges (p < 0.001) and an increased risk of overall postoperative complications (34.7% vs. 30.5%, p = 0.023). Specifically, patients in the obese group had increased odds of respiratory complication (adjusted odds ratio (aOR) 1.66, 95% confidence interval (CI) [1.26-2.19]), acute renal failure (aOR 1.87, 95% CI [1.13-3.09]), and wound complication (aOR 2.77, 95% CI [1.21-6.37]) than those in the non-obese group. Moreover, trend tests showed that the risks of unfavorable discharge, infection, acute renal failure, and respiratory complication all exhibited an upward trend with increased BMI.

CONCLUSION

Obesity is associated with an increased risk of postoperative complications in patients with thyroid cancer undergoing thyroidectomy. This finding suggests that obese patients should be treated with more caution during postoperative recovery.

Investigating Predictors of Decannulation Through Endoscopic Approach in Patients With Tracheostomy and Peristomal Subglottic Stenosis

Objective

Peristomal subglottic stenosis (SGS) is a common sequela after tracheostomy, with severe cases precluding decannulation. Predictors of decannulation success in these patients following endoscopic intervention are not well studied. The aim of this study is to investigate predictors of successful decannulation and inform treatment decisions.

Study Design

This study is a retrospective case series of 22 adult patients presenting to the senior author with a tracheostomy and peristomal SGS precluding decannulation between 2018 and 2023.

Setting

Department of Otolaryngology-Head & Neck Surgery, University of Arizona College of Medicine-Tucson.

Methods

Patient demographics, relevant clinical factors, stenosis characteristics, and the number of endoscopic procedures performed were analyzed to identify predictors of successful decannulation. Endoscopic interventions were generally performed 3 months apart with CO2 laser debridement, balloon dilation, and intralesional injection of steroid, all done with a laser-safe endotracheal tube in place through the stoma.

Results

Out of the 22 patients in the study, 9 (40.9%) achieved decannulation, all through an endoscopic approach. Body mass index (BMI) and age were identified as significant negative predictors of decannulation success (P = .02; P = .05, respectively). Stenosis characteristics, such as the presence of tracheomalacia, excessive dynamic airway collapse, multilevel stenosis, posterior glottic stenosis, and anterior granulation tissue shelf did not significantly impact decannulation success.

Conclusion

A 40.9% decannulation rate was achieved in our cohort. BMI and age were identified as negative predictors of decannulation success. Stenosis characteristics did not significantly affect decannulation outcomes. Further investigation is warranted to establish reliable predictors of decannulation.

A clinician's guide to effects of obesity on childhood asthma and into adulthood

INTRODUCTION

Obesity, one of the most common chronic conditions affecting the human race globally, affects several organ systems, including the respiratory system, where it contributes to onset and high burden of asthma. Childhood onset of obesity-related asthma is associated with high persistent morbidity into adulthood.

AREAS COVERED

In this review, we discuss the disease burden in children and adults to highlight the overlap between symptoms and pulmonary function deficits associated with obesity-related asthma in both age ranges, and then discuss the potential role of three distinct mechanisms, that of mechanical fat load, immune perturbations, and of metabolic perturbations on the disease burden. We also discuss interventions, including medical interventions for weight loss such as diet modification, that of antibiotics and anti-inflammatory therapies, as well as that of surgical intervention on amelioration of burden of obesity-related asthma.

EXPERT OPINION

With increase in obesity-related asthma due to increasing burden of obesity, it is evident that it is a disease entity distinct from asthma among lean individuals. The time is ripe to investigate the underlying mechanisms, focusing on identifying novel therapeutic targets as well as consideration to repurpose medications effective for other obesity-mediated complications, such as insulin resistance, dyslipidemia and systemic inflammation.

Vaping causes an acute BMI-dependent change in pulmonary blood flow

Vaping use has skyrocketed especially among young adults, however there is no consensus on how vaping impacts the lungs. We aimed to determine whether there were changes in lung function acutely after a standard vaping session or if there were differences in lung function metrics between a healthy never-vaping cohort (N = 6; 27.3 ± 3.0 years) and a young asymptomatic vaping cohort (N = 14; 26.4 ± 8.0 years) indicating chronic changes. Pulmonary function measurements and impulse oscillometry were obtained on all participants. Oxygen-enhanced and Arterial Spin Labelling MRI were used to measure specific ventilation and perfusion, respectively, before and after vaping, and in the control cohort at baseline. MRI metrics did not show any significant differences in specific ventilation or perfusion after vaping. Heart rate increased post-vaping (68.1 ± 10.5 to 71.3 ± 8.7, p = 0.020); however, this and other metrics did not show a nicotine dose-dependent effect. There was a significant negative correlation between BMI and change in mean perfusion post-vaping (p = 0.003); those with normal/low BMI showing an increase in perfusion and vice versa for high BMI. This may be due to subjects lying supine during vaping inhalation. Pulmonary function metrics indicative of airways resistance showed significant differences between the vaping and control cohorts indicating early airway changes.

Evaluation of demographic and clinical characteristics of 728 patients with mycosis fungoides and their relationship with systemic comorbidities: multicenter, registry-based (MF-TR) study from Türkiye

BACKGROUND

Mycosis fungoides (MF) is the most common cutaneous lymphoma with a chronic disease course. MF patients may also suffer from systemic comorbidities such as cardiovascular and metabolic diseases.

METHODS

In this study, we aimed to evaluate the demographic and clinical features of MF patients registered in the MF-TR registry system and to examine the relationship of these features with systemic comorbidities. We collected the data from the medical files of the patients via the MF-TR registry system.

RESULTS

Our study included 728 patients with MF, of which 396 (54.40%) were male and 332 (45.60%) were female. The most common additional systemic disease observed was hypertension, affecting 124 (17.03%) patients. This was followed by multinodular goiter in 66 (9.06%) patients, and diabetes mellitus type 2 in 61 (8.37%) patients. Twenty-two (3.02%) patients had a history of another secondary malignancy, with lung cancer being the most common type, affecting 5 (0.68%) patients. Female gender and high BMI were statistically higher in MF patients with asthma (P=0.019 and P=0.031, respectively). In patients with hypertension and hypercholesterolemia, the duration of diagnosis was significantly longer (P=0.013 and P=0.047, respectively).

CONCLUSIONS

Dermatologists should be aware of these accompanying comorbidities in patients with MF. Multidisciplinary evaluation should be performed in the follow-up, if necessary.

Inter-cohort shifts in chronic disease, dementia, and mortality

Previous work using U.S. data has identified generational shifts, reflected in inter-cohort changes, in the incidence and prevalence of diseases in older ages. This study extends previous findings to England by examining similar results in memory complaints, heart conditions, stroke, diabetes, lung disease, and cancer using data from the English Longitudinal Study of Ageing (ELSA). We fit Cox proportional hazard models to the first eight waves (2002-2016) of the ELSA sample (n = 18,528). In addition to exploring shifts in disease incidence we also examine shifts in disease mortality. Both general and sex-related differences are examined. Disease incidence has increased for later-born cohorts in England, replicating similar trends in the U.S. Not all diseases showed differences between men and women, but when differences were identified, women had lower risks for disease. In comparison to the U.S. sample, disease trends in England are more negative (i.e. accelerated failure times) for more recently born cohorts. These results showing increasing incidence of disease among the later-born cohorts suggest the possibility of increased disease burden in coming years.

The Impact of Intermittent Hypoxia-Hyperoxia Therapy on Metabolism and Respiratory System in Obese Patients as Part of Comprehensive Medical Rehabilitation

Introduction Obesity is a complex condition characterized by excessive accumulation of body fat, which can have multiple causes, including genetic factors, inadequate diet, lack of physical exercise, and socioeconomic factors. Obesity can cause significant respiratory changes, so obese patients present pulmonary complications more frequently than individuals with normal weight. Improving respiratory function is an important aspect of obesity management, as it can reduce the risk of pulmonary complications and improve patients' quality of life. Material and method We conducted a randomized controlled, single-center study that included 70 obese patients, aiming to evaluate the effectiveness of intermittent hypoxia-hyperoxia therapy (IHHT) on metabolic and respiratory effects. Patients were randomly allocated into two equivalent groups: an intervention group, consisting of 35 patients who received IHHT, and a control group, consisting of 35 patients who did not receive this therapy. Results Patients in the intervention group showed a significant increase in exercise tolerance (p < 0.001), improvement in renal function parameters (p = 0.047 for uric acid; p = 0.006 for creatinine), and liver function (p = 0.001 AST; p = 0.030 ALT), compared to the control group. An improvement in the Tiffeneau index was also observed in the intervention group (p < 0.001), indicating an improvement in respiratory function and lung capacity. Conclusions The approach to obesity requires a holistic perspective that takes into account the physical, psychological, and social aspects of this condition. IHHT represents an integrative therapeutic approach that addresses both the metabolic and respiratory aspects of obesity and metabolic syndrome, offering promising prospects for improving patients' health and quality of life. The study results suggest that IHHT may be effective in improving physical performance, renal and hepatic function, as well as respiratory function, with the potential to provide significant benefits in the management and treatment of obese and/or metabolic syndrome patients.

Perioperative Care for Bariatric Surgery

This review will start with a brief pathophysiology of obesity and the requirement for bariatric surgery, and it continues with a preoperative assessment, which includes a surgical mortality risk assessment, respiratory and cardiovascular assessments, and a psychological assessment. In-hospital postoperative care will be discussed, including which patients need a surgical intensive care unit and the monitoring tools required. The need for postoperative medications, postoperative complications, strategies for management, and a follow-up plan are also reviewed. This manuscript is written in a narrative review form with a chance of bias as a possible limitation.

The Mediating Roles of Lung Function Traits and Inflammatory Factors on the Associations between Measures of Obesity and Risk of Lower Respiratory Tract Infections: A Mendelian Randomization Study

BACKGROUND

Identifying mediators between obesity-related traits and lower respiratory tract infections (LRTIs) would inform preventive and therapeutic strategies to reduce the burden of LRITs. We aimed to recognize whether lung function and inflammatory factors mediate their associations.

METHODS

We conducted a two-step, two-sample Mendelian randomization (MR) analysis. Two-sample MR was performed on (1) obesity-related traits (i.e., body mass index [BMI], waist circumference [WC], and waist-to-hip ratio [WHR]) and LRTIs (i.e., acute bronchitis, acute bronchiolitis, bronchiectasis, influenza, and pneumonia), (2) obesity-related traits and potential mediators, and (3) potential mediators and LRTIs. Next, two-step MR was applied to infer whether the mediation effects exist.

RESULTS

We found that C-reactive protein (CRP), interleukin-6 (IL-6), and forced expiratory volume in the first second (FEV1) mediated 32.59% (95% CI: 17.90%, 47.27%), 7.96% (95% CI: 1.79%, 14.14%), and 4.04% (95% CI: 0.34%, 7.74%) of the effect of BMI on pneumonia, and they mediated 26.90% (95% CI: 13.98%, 39.83%), 10.23% (95% CI: 2.72%, 17.73%), and 4.67% (95% CI: 0.25%, 9.09%) of the effect of WC on pneumonia, respectively. Additionally, CRP, forced vital capacity (FVC), and FEV1 mediated 18.66% (95% CI: 8.70%, 28.62%), 8.72% (95% CI: 1.86%, 15.58%), and 8.41% (95% CI: 2.77%, 14.06%) of the effect of BMI on acute bronchitis, and they mediated 19.96% (95% CI: 7.44%, 32.48%), 12.19% (95% CI: 2.00%, 22.39%), and 12.61% (95% CI: 2.94%, 22.29%) of the effect of WC on acute bronchitis, respectively.

CONCLUSIONS

Health interventions linked to reducing inflammation and maintaining normal lung function could help mitigate the risk of obesity-related LRTIs.

Longitudinal effects of obesity on pulmonary function in obese children and adolescents

BACKGROUND

To investigate the longitudinal effects of obesity on change in lung function after 1 year of follow-up in obese children and adolescents.

METHODS

Obese children/adolescents aged 8-15 years with pulmonary function test (PFT) results and recorded anthropometric obesity indices from 1 year earlier for comparison were recruited. Multiple linear regression of change in each lung function parameter was applied to determine the effect of sex, change in body mass index (ΔBMI), change in chest circumference (ΔCC), change in waist circumference (ΔWC), and change in waist circumference-to-height ratio (ΔWC/Ht).

RESULTS

Sixty-six children/adolescents (mean age: 12.5 ± 2.6 years) were recruited. Multiple linear regression analysis showed that ΔWC negatively affects the ratio of the forced expiratory volume in the first 1 s to the forced vital capacity of the lungs Δ(FEV1/FVC) (b = -0.3, p = 0.002), forced expiratory flow rate within 25-75% of vital capacity (ΔFEF25-75%) (b = -0.92, p = 0.006), and Δ(FEF25-75%/FVC) (b = -0.99, p = 0.003). When replacing ΔWC with Δ(WC/Ht) as the independent variable, Δ(WC/Ht) also negatively affects Δ(FEV1/FVC) (b = -33.71, p = 0.02), ΔFEF25-75% (b = -102.9, p = 0.03) and Δ(FEF25-75%/FVC) (b = -102.7, p = 0.03).

CONCLUSION

After 1 year of follow-up, change in abdominal adiposity determined by WC and WC/Ht exerted significant negative effect on lung function change specific to FEV1/FVC, FEF25-75% /FVC, and FEF25-75%.

IMPACT

Longitudinal effects of change in obesity on lung function in obese children and adolescents are evidenced. Change in waist circumference or waist-to-height ratio, which indicates abdominal adiposity, was inversely correlated with a change in FEV1/FVC, FEF25-75% /FVC, and FEF25-75% in children and adolescents with obesity after 1 year of follow-up. Our results suggest using waist circumference and/or waist-to-height ratio in addition to BW and/or BMI for monitoring obesity. Fat loss programs, especially those focused on reducing abdominal adiposity should be encouraged to prevent late lung function impairment.

Inpatient Hospitalizations for COVID-19 Among Patients with Prader-Willi Syndrome: a National Inpatient Sample Analysis

Background

Prader-Willi syndrome (PWS) is a genetic disorder associated with baseline respiratory impairment caused by multiple contributing etiologies. While this may be expected to increase the risk of severe COVID-19 infections in PWS patients, survey studies have suggested paradoxically low disease severity. To better characterize the course of COVID-19 infection in patients with PWS, this study analyzes the outcomes of hospitalizations for COVID-19 among patients with and without PWS.

Methods

The National Inpatient Sample, an all-payors administrative claims database of hospitalizations in the United States, was queried for patients with a coded diagnosis COVID-19 in 2020 and 2021. Hospitalizations for patients with PWS compared to those for patients without PWS using Augmented Inverse Propensity Weighting (AIPW).

Results

There were 295 (95% CI: 228 to 362) COVID-19 hospitalizations for individuals with PWS and 4,112,400 (95% CI: 4,051,497 to 4,173,303) for individuals without PWS. PWS patients had a median age of 33 years compared to 63 for those without PWS. Individuals with PWS had higher baseline rates of obesity (47.5% vs. 28.4%). AIPW models show that PWS diagnosis is associated with increased hospital length of stay by 7.43 days, hospital charges by $80,126, and the odds of mechanical ventilation and in-hospital death (odds ratios of 1.79 and 1.67, respectively).

Conclusions

PWS patients hospitalized with COVID-19 experienced longer hospital stays, higher charges, and increased risk of mechanical ventilation and death. PWS should be considered a risk factor for severe COVID-19, warranting continued protective measures and vaccination efforts. Further research is needed to validate coding for PWS and assess the impact of evolving COVID-19 variants and population immunity on this vulnerable population.