Association between obesity-related dyspnea in daily living, lung function and body composition analyzed by DXA: a prospective study of 130 patients

Time-Restricted Eating Benefits on Pulmonary Function and Postural Balance in Overweight or Obese Women

This study aimed to evaluate the impact of time-restricted eating (TRE) on neuro-physiological parameters, objective and subjective sleep, pulmonary capacity, and postural balance among women with excess body weight.

METHODS

Thirty-one participants were assigned to either a TRE group (n = 15, 28.74 ± 9.25 years, 88.32 ± 13.38 kg, and 32.71 ± 5.15 kg/m2), engaging in ad libitum 16 h fasting over a 12-week period, or a control group (CG, n = 16, 36.25 ± 11.52 years, 90.88 ± 19.01 kg, and 33.66 ± 6.18 kg/m2). The assessment of heart rate variability (HRV), spirometric parameters (forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/ FVC ratio, objective and subjective sleep assessments employing actigraphy and the Epworth Sleepiness Scale, and postural balance using the Y balance test (YBT) were conducted before and after the intervention.

RESULTS

No significant negative effects of TRE were observed for HRV and objective sleep parameters. Only the TRE group improved FEV1 in both sitting (p < 0.0005) and supine positions (p = 0.001). Furthermore, the TRE group showed improvement in postural balance performance compared to the CG in anterior (p = 0.03), postero-medial (p = 0.04), and postero-lateral directions (p = 0.003).

CONCLUSION

This study highlights TRE as a feasible and safe dietary intervention with significant improvements in postural balance and pulmonary function, without any negative impact on HRV or objective sleep assessments among overweight or obese women.

Preoperative Atelectasis in Patients with Obesity Undergoing Bariatric Surgery: A Cross-Sectional Study

BACKGROUND

Pulmonary atelectasis is present even before surgery in patients with obesity. We aimed to estimate the prevalence and extension of preoperative atelectasis in patients with obesity undergoing bariatric surgery and to determine if variation in preoperative Spo2 values in the seated position at room air is explained by the extent of atelectasis coverage in the supine position.

METHODS

This was a cross-sectional study in a single center specialized in laparoscopic bariatric surgery. Preoperative chest computed tomographies were reassessed by a senior radiologist to quantify the extent of atelectasis coverage as a percentage of total lung volume. Patients were classified as having atelectasis when the affection was ≥2.5%, to estimate the prevalence of atelectasis. Crude and adjusted prevalence ratios (aPRs) and odds ratios (aORs) were obtained to assess the relative prevalence of atelectasis and percentage coverage, respectively, with increasing obesity category. Inverse probability weighting was used to assess the total, direct (not mediated), and indirect (mediated through atelectasis) effects of body mass index (BMI) on preoperative Spo2, and to quantify the magnitude of mediation (proportion mediated). E-values were calculated, to represent the minimum magnitude of association that an unmeasured confounder with the same directionality of the effect should have to drive the observed point estimates or lower confidence intervals (CIs) to 1, respectively.

RESULTS

In 236 patients with a median BMI of 40.3 kg/m2 (interquartile range [IQR], 34.6-46.0, range: 30.0-77.3), the overall prevalence of atelectasis was 32.6% (95% CI, 27.0-38.9) and by BMI category: 30 to 35 kg/m2, 12.7% (95% CI, 6.1-24.4); 35 to 40 kg/m2, 28.3% (95% CI, 17.2-42.6); 40 to 45 kg/m2, 12.3% (95% CI, 5.5-24.3); 45 to 50 kg/m2, 48.4% (95% CI, 30.6-66.6); and ≥50 units, 100% (95% CI, 86.7-100). Compared to the 30 to 35 kg/m2 group, only the categories with BMI ≥45 kg/m2 had significantly higher relative prevalence of atelectasis-45 to 50 kg/m2, aPR = 3.52 (95% CI, 1.63-7.61, E-value lower bound: 2.64) and ≥50 kg/m2, aPR = 8.0 (95% CI, 4.22-15.2, E-value lower bound: 7.91)-and higher odds of greater atelectasis percentage coverage: 45-50 kg/m2, aOR = 7.5 (95% CI, 2.7-20.9) and ≥50 kg/m2, aOR = 91.5 (95% CI, 30.0-279.3). Atelectasis percent alone explained 70.2% of the variation in preoperative Spo2. The proportion of the effect of BMI on preoperative Spo2 values <96% mediated through atelectasis was 81.5% (95% CI, 56.0-100).

CONCLUSIONS

The prevalence and extension of atelectasis increased with higher BMI, being significantly higher at BMI ≥45 kg/m2. Preoperative atelectasis mediated the effect of BMI on Spo2 at room air in the seated position.

Obesity Impact on Dyspnea in COPD Patients

Background

The role of obesity on dyspnea in chronic obstructive pulmonary disease (COPD) patients remains unclear. We aimed to provide an assessment of dyspnea in COPD patients according to their Body Mass Index (BMI) and to investigate the impact of obesity on dyspnea according to COPD severity.

Methods

One hundred and twenty seven COPD patients with BMI ≥ 18.5 kg/m² (63% male, median (interquartile range) post bronchodilator forced expiratory volume of 1 second (post BD FEV1) at 51 (34-66) % pred) were consecutively included. Dyspnea was assessed by mMRC (Modified medical research council) scale. Lung function tests were recorded, and emphysema was quantified on CT-scan (computed tomography-scan).

Results

Twenty-five percent of the patients were obese (BMI ≥ 30kg/m²), 66% of patients experienced disabling dyspnea (mMRC ≥ 2). mMRC scores did not differ depending on BMI categories (2 (1-3) for normal weight, 2 (1-3) 1 for overweight and 2 (1-3) for obese patients; p = 0.71). Increased mMRC scores (0-1 versus 2-3 versus 4) were associated with decreased post BD-FEV1 (p < 0.01), higher static lung hyperinflation (inspiratory capacity/total lung capacity (IC/TLC), p < 0.01), reduced DLCO (p < 0.01) and higher emphysema scores (p < 0.01). Obese patients had reduced static lung hyperinflation (IC/TLC p < 0.01) and lower emphysema scores (p < 0.01) than non-obese patients. mMRC score increased with GOLD grades (1-2 versus 3-4) in non-obese patients but not in obese patients, in association with a trend towards reduced static lung hyperinflation and lower emphysema scores.

Conclusion

By contrast with non-obese patients, dyspnea did not increase with spirometric GOLD grades in obese patients. This might be explained by a reduced lung hyperinflation related to the mechanical effects of obesity and a less severe emphysema in severe COPD patients with obesity.

Beyond Weight Loss: the Emerging Role of Incretin-Based Treatments in Cardiometabolic HFpEF

PURPOSE OF REVIEW

Incretin-based drugs are potent weight-lowering agents, emerging as potential breakthrough therapy for the treatment of obesity-related phenotype of heart failure with preserved ejection fraction (HFpEF). In this review article, we will discuss the contribution of weight loss as part of the benefits of incretin-based medications in obese patients with HFpEF. Furthermore, we will describe the potential effects of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonists on the heart, particularly in relation to HFpEF pathophysiology.

RECENT FINDINGS

In the STEP-HFpEF trial, the GLP-1 receptor agonist semaglutide significantly improved quality of life outcomes in obese HFpEF patients. Whether the beneficial effects of semaglutide in obese patients with HFpEF are merely a consequence of body weight reduction is unclear. Considering the availability of other weight loss strategies (e.g., caloric restriction, exercise training, bariatric surgery) to be used in obese HFpEF patients, answering this question is crucial to provide tailored therapeutic options in these subjects.

SUMMARY

Incretin-based drugs may represent a milestone in the treatment of obesity in HFpEF. Elucidating the contribution of weight loss in the overall benefit observed with these drugs is critical in the management of obese HFpEF patients, considering that other weight-lowering strategies are available and might represent potential alternative options for these patients.

Association between healthy lifestyles and post-COVID-19 syndrome among college students

BACKGROUND

Post-COVID-19 syndrome still occurs in some populations. A healthy lifestyle is widely recognized as a first-line treatment to increase the body's antiviral resistance and tissue repair, but it is unclear whether a healthy lifestyle can promote or alleviate the symptoms of post-COVID-19 syndrome.

METHODS

A stratified random sampling method was used to select 498 participants from three universities in Fujian as the target of the questionnaire survey. The survey focused on students' healthy lifestyles and the symptoms of fatigue, anxiety, dyspnea, and depression that are common in post-COVID-19 syndrome.

RESULTS

Two months after developing COVID-19, some students continued to experience fatigue, anxiety, dyspnea, and depression, with fatigue being the most prominent symptom. The results of the study showed that there was a significant negative correlation (P < 0.01) between a healthy lifestyle and fatigue, anxiety, dyspnea, and depression among university students. Furthermore, when analyzing the different subdimensions of healthy lifestyles among university students, it was found that all dimensions showed varying degrees of negative correlation with fatigue, anxiety, dyspnea, and depression, except for health-related behaviors and interpersonal behaviors, which showed no relationship with fatigue (P < 0.01).

CONCLUSIONS

By improving healthy lifestyles, long-term COVID-19 symptoms can be reduced and improved and contribute positively to patient recovery, providing a viable rehabilitation option for long-term COVID-19 patients.

[Relationship between body composition and the risk of non-communicable chronic diseases in active older women from Chillán (Chile).]

OBJECTIVE

In Chile, the elderly represent 18% of the population. In women, the aging process impacts body composition, in addition to the coexistence of other pathologies such as chronic noncommunicable diseases (NCDs). The aim of the study was to relate body composition to the presence of chronic noncommunicable diseases in active older women in the city of Chillán.

METHODS

The sample consisted of 284 women belonging to senior centers in Chillán. Body composition was determined by bioimpedanciometry. Sociodemographic information, prevalent pathologies, geriatric syndromes and physical activity were determined by means of a validated questionnaire. Data were analyzed with descriptive and inferential statistics in STATA 15.0 software with an α<0.05.

RESULTS

Of the sample, 63% were under seventy-five years of age, 77.5% had less than twelve years of schooling, the predominant socioeconomic level was low, and the poor perception of health was mainly referred to as well as the use of regular medication. Arterial hypertension (AHT) and hypercholesterolemia were prevalent with 70.4% and 48.2% respectively. Body mass index (BMI) was 29.7±4.8 and 71.8% had excess malnutrition. The group older than seventy-five years presented more body fat (BMF) and extracellular water (ECW). AHT was related to higher BMI, TGM, MBC (Mean Arm Circumference), PC (Calf Circumference) and ECW (p<0.05), while Diabetes mellitus was related to BMI and MBC.

CONCLUSIONS

Hypertension is the most frequent pathology and is related to higher BMI, MGT, CMB, CP and ECW, followed by DM2 which is related to BMI and CMB.

Management of obesity across women's life course: FIGO Best Practice Advice

Obesity is a chronic, progressive, relapsing, and treatable multifactorial, neurobehavioral disease. According to the World Health Organization, obesity affects 15% of women and has long-term effects on women's health. The focus of care in patients with obesity should be on optimizing health outcomes rather than on weight loss. Appropriate and common language, considering cultural sensitivity and trauma-informed care, is needed to discuss obesity. Pregnancy is a time of significant physiological change. Pre-, ante-, and postpartum clinical encounters provide opportunities for health optimization for parents with obesity in terms of, but not limited to, fertility and breastfeeding. Pre-existing conditions may also be identified and managed. Beyond pregnancy, women with obesity are at an increased risk for gastrointestinal and liver diseases, impaired kidney function, obstructive sleep apnea, and venous thromboembolism. Gynecological and reproductive health of women living with obesity cannot be dismissed, with accommodations needed for preventive health screenings and consideration of increased risk for gynecologic malignancies. Mental wellness, specifically depression, should be screened and managed appropriately. Obesity is a complex condition and is increasing in prevalence with failure of public health interventions to achieve significant decrease. Future research efforts should focus on interprofessional care and discovering effective interventions for health optimization.

Contribution of obesity to breathlessness in a large nationally representative sample of Australian adults

BACKGROUND AND OBJECTIVE

Breathlessness is prevalent and associated with medical consequences. Obesity is related to breathlessness. However, the magnitude of its contribution has not been clearly documented. This investigation aimed to determine the contribution of obesity to breathlessness by estimating the population attributable fraction (PAF) in a representative sample of Australian adults.

METHODS

A cross-sectional, nationally representative survey of Australian residents aged ≥18 years was conducted in October 2019. Breathlessness was defined as modified Medical Research Council (mMRC) dyspnoea scale grade ≥2. BMI was calculated from self-reported height and weight. Adjusted relative risks (aRRs) were estimated using a generalized linear model with Poisson distribution, adjusted for age group and/or participant-reported diagnosed illnesses. Adjusted PAFs were estimated using aRR and obesity prevalence in Australian adults.

RESULTS

Among those who completed the National Breathlessness Survey, 9769 participants (51.4% female) were included in the analysis; 28.1% of participants were obese. The prevalence of breathlessness was 9.54%. The aRR of obesity for breathlessness was 2.04, adjusted for age. Adjusting for various co-morbid conditions, the aRR was slightly attenuated to around 1.85-1.98. The PAF, adjusted only for age, was 24.6% (95% CI 20.1-29.1) and after further adjustment for co-morbid conditions, the PAF ranged from 21.1% to 23.6%. Obesity accounted for a higher proportion of breathlessness in women than in men.

CONCLUSION

Our results demonstrate that obesity accounts for around a quarter of breathlessness symptoms in Australian adults. This has important implications for health policy in light of the global trend in increasing obesity.