Adipose Tissue Inflammation and Pulmonary Dysfunction in Obesity

Chromium and formoterol therapy for obesity-induced asthma in rats

The development of asthma is impacted by fat. Asthma is more common in obese persons. The purpose of the experimental study is to determine how chromium, formoterol, and their combination can improve the quality of life for obese people with lung anomalies. Thirty-six male Wistar rats were divided into six groups: control (C), obesity (CO), obese-asthma (COA), and obese-asthma groups treated with formoterol (OAF), chromium (OACR), or both (OACRF). Except for group C, all groups received a high-fat diet for 4 weeks. Subsequently, ovalbumin (OVA) was administered subcutaneously (s.c.) to all groups except C and CO to induce sensitization. Asthma was triggered via 1% OVA aerosol challenges on days 26-28. Over 5 days, OAF and OACRF received daily formoterol inhalations (50 μg/kg), while OACR and OACRF were given chromium (400 μg/kg). Treatments were timed to align with asthma induction protocols. Lipid profile and inflammatory indicators were examined at the end of the trial-Immunohistochemical analysis of lung tissue, Histopathological and lung tissue stained with Hematoxylin and Eosin. The combination therapy (OACRF) significantly reduced body weight (p < 0.05), lowered LDL and triglycerides, increased HDL, and normalized lung tissue architecture compared to controls. Immunohistochemistry revealed reduced IL-1β and IL-17α expression. The (OACRF) group demonstrated superior asthma control by reducing body weight, improving inflammatory indicators, and restoring lung tissue to its normal state by administering chromium and formoterol therapy. The most effective strategy for treating both obesity and asthma is to address their two connected conditions. These findings demonstrate that combined chromium and formoterol therapy effectively addresses metabolic and inflammatory components of obesity-induced asthma, offering a promising dual-target therapeutic strategy.

Association Between Visceral Adipose Tissue and Chronic Respiratory Diseases: A Two-Sample Multivariable Mendelian Randomization Study in European Population

Background

The relationship between obesity and some respiratory diseases has been well documented. However there have been few studies on the association between visceral adipose tissue (VAT) and chronic respiratory diseases (CRDs), it remains unclear whether VAT is causally associated with CRDs.

Methods

We used two-sample Mendelian randomization (MR) to illuminate the effects of VAT on four CRDs: chronic obstructive pulmonary disease (COPD), allergic asthma, interstitial lung disease (ILD), and sarcoidosis. Inverse variance weighted (IVW) served as the primary assessment method. MR Egger, weighted median, Simple mode and Weighted mode were the supplementary methods for MR analysis. We used multivariate MR analysis to adjust for the effect of body mass index (BMI) on outcomes, Egger intercept, MR-pleiotropy residual sum and outlier, and leave-one-out analysis to confirm the MR results' consistency.

Results

Genetically-predicted VAT was associated with an increased risk of COPD (OR = 1.56; 95% CI: 1.34-1.82; P = 1.16×10-8), allergic asthma (OR = 1.44; 95% CI: 1.20-1.73; P = 8.63×10-5), and ILD (OR = 1.15; 95% CI: 1.04-1.26; P = 4.62×10-3). However, there was limited evidence to support an association between VAT and sarcoidosis. In multivariate MR analysis, VAT's associations with COPD, allergic asthma, and ILD persisted after adjusting for BMI.

Conclusion

This study provides evidence for a potential causal relationship between VAT and COPD, allergic asthma, and ILD; these relationships were independent of the effect of BMI.

Quantitative CT evaluation of extrapulmonary lesions in chronic obstructive pulmonary disease: a narrative review

Background and Objective

Chronic obstructive pulmonary disease (COPD) is a significant global health challenge characterized by persistent respiratory symptoms and airflow limitation. Recent advancements in computed tomography (CT) have enhanced our understanding of COPD, particularly in diagnosing extrapulmonary comorbidities. This review aims to summarize the current findings on extrapulmonary manifestations in COPD patients and the role of quantitative computed tomography (QCT) in evaluating these comorbidities.

Methods

A comprehensive literature search was conducted using PubMed and Web of Science databases, covering studies from January 1999 to May 2024. Keywords included "COPD", "chronic obstructive pulmonary disease", "muscle", "adipose tissue", "coronary artery calcification", "bone density", "extrapulmonary manifestations", and "Quantitative Computed Tomography". Inclusion criteria focused on studies involving COPD patients using QCT to identify extrapulmonary manifestations, published in peer-reviewed journals and available in English.

Key Content and Findings

The review highlights significant findings, such as the reduction in muscle mass and bone density and the increase in coronary artery calcification (CAC) in COPD patients, all closely associated with disease severity and prognosis. Key metrics evaluated include mid-thigh muscle cross-sectional area, pectoralis muscle area, erector spinae muscles, and bone density. Advanced CT analysis techniques, including artificial intelligence (AI) and machine learning, are emphasized as crucial for improving assessment accuracy and efficiency. Subcutaneous fat reduction and CAC are identified as critical indicators of mortality and disease progression.

Conclusions

Quantitative CT evaluation is vital for understanding and managing extrapulmonary lesions in COPD. Future research should focus on establishing suitable measurement tools and methods and defining critical thresholds for treatment efficacy. The integration of advanced CT techniques and interdisciplinary approaches is essential for enhancing diagnostic accuracy and developing personalized treatment strategies for COPD patients.

Association between body roundness index and weight-adjusted waist index with asthma prevalence among US adults: the NHANES cross-sectional study, 2005-2018

This study investigated the connection between asthma in US individuals and their body roundness index (BRI) and weight-adjusted waist index (WWI). According to data from the 2005-2018 National Health and Nutrition Examination Survey (NHANES), 3609 of the 25,578 persons in the survey who were 18 years of age or older reported having asthma. After adjusting for all confounders, the probability of asthma prevalence increased by 8% for every unit rise in BRI (OR = 1.08, 95% CI 1.06,1.11). The probability of asthma prevalence increased by 16% for every unit rise in WWI (OR = 1.16, 95% CI 1.08,1.25). The BRI and WWI indices were associated with prevalence and were nonlinearly correlated. The inflection points for threshold saturation effects were 4.36 and 10.69, respectively (log-likelihood ratio test, P < 0.05). Relationship subgroup analyses showed that the positive associations between BRI and WWI and asthma were generalized across populations and there was no significant interaction in most subgroups. In addition, sensitivity analyses verified the robustness of these results, further confirming the conclusion of BRI and WWI as independent risk factors for asthma. Finally, receiver operating characteristic (ROC) analysis showed that BRI outperformed WWI in predicting asthma, suggesting the potential of BRI in early asthma screening. Overall, BRI and WWI are independent risk factors for asthma with important clinical applications.

Correlation between abdominal visceral fat and laryngopharyngeal reflux in patients with obstructive sleep apnea

PURPOSE

To research the correlation between abdominal visceral fat and laryngopharyngeal reflux (LPR) in patients with obstructive sleep apnea (OSA).

METHODS

This study included 72 OSA patients, and the correlation between abdominal visceral fat and the severity of LPR was analyzed after abdominal visceral fat area (VFA) was measured according to body composition analysis and reflux symptom index (RSI) score was completed. Finally, in order to further clarify the effect of VFA on LPR, multiple linear regression analysis was performed on the collected related parameters.

RESULTS

Partial correlation analysis showed that the VFA was positively correlated with the RSI score (r = 0.502, p < 0.001) after controlling for apnea-hypopnea index (AHI), body mass index (BMI), lowest oxygen saturation (LSO₂), age, and sex. The multiple linear regression analysis indicated that VFA and AHI were the factors influencing LPR (t = 4.678, p < 0.001; t = 3.164, p = 0.002).

CONCLUSION

Our study found that VFA was associated with RSI score in OSA patients, but BMI didn't show an independent correlation with RSI score. This indicated that we should pay attention to the effect of abdominal visceral fat on LPR in OSA patients, and more experiments are needed in the future to clarify the relationship between the two.

Amelioration of obesity-associated disorders using solanesol with the mitigation of NLRP3 inflammasome activation and macrophage inflammation in adipose tissue

Obesity and obesity-related metabolic diseases are causally linked to inflammatory activation. Proinflammatory macrophage infiltration and NOD-like receptor pyrin domain containing 3 (NLRP3) inflammasome activation contribute to chronic inflammation and insulin resistance. Alleviating inflammatory responses is a reliable method to restore insulin sensitivity and reduce the severity of metabolic syndrome. Solanesol, rich in anti-inflammatory foods (potato, tomato, eggplant, chili peppers), has demonstrated anti-inflammatory properties, but whether it plays a beneficial role in obesity-induced chronic inflammation remains poorly understood. In this study, we investigated the effects of solanesol on the NLRP3 inflammasome and inflammatory responses both in vitro and in high-fat diet (HFD)-fed mice. We found that oral administration of solanesol reduced weight gain, insulin resistance, and inflammation in epididymal white adipose tissue (eWAT) in both HFD-fed obese mice and mice concurrently treated with a HFD. This effect was involved with reducing macrophage inflammation and inactivating the NLRP3 inflammasome by reducing the K+ efflux and reactive oxygen species (ROS) production in macrophages. Solanesol also reprogrammed the phenotype of inflammatory macrophages. Taken together, our study suggests that solanesol may be a promising candidate for treating obesity and obesity-related metabolic diseases.

Prognostic value of glycolipid metabolism index on complications and mechanical ventilation in intensive care unit patients with intracerebral hemorrhage: a retrospective cohort study using the MIMIC-IV database

Objective

This study aimed to evaluate the predictive capability of glycolipid metabolism index (triglyceride-glucose index, TyG; atherogenic index of plasma, AIP; triglyceride to high-density lipoprotein cholesterol ratio, TG/HDL-C; and non-HDL-C to HDL-C ratio, NHHR) for complications and ventilator use in patients with intracerebral hemorrhage (ICH) admitted to the intensive care unit (ICU).

Methods

Patients with ICH requiring ICU admission were selected from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Outcomes assessed included incidence of complications and use of ventilator support. Multivariate logistic regression, receiver operating characteristic (ROC) analysis, and restricted cubic spline were employed to investigate the relationship between glycolipid metabolism index and clinical outcomes in ICH patients.

Results

A total of 733 patients were included. Multivariate logistic regression analysis revealed that elevated TyG, AIP, and TG/HDL-C levels were associated with increased incidence of complications and prolonged ventilator use. ROC curve analysis demonstrated that TyG (AUC 0.646) exhibited the strongest predictive ability for multiple complications in ICH patients. Further multiple regression analysis identified TG/HDL-C as an independent predictor of deep vein thrombosis, while TyG, AIP, and TG/HDL-C independently predicted pulmonary embolism, and TyG, AIP, NHHR, and TG/HDL-C independently predicted acute kidney injury. Moreover, ventilator use further heightened the risk of multiple complications in ICU patients with elevated glycolipid metabolism index.

Conclusion

Glycolipid metabolism index represent promising and readily accessible biomarkers for predicting multiple complications and ventilator use in ICU patients with ICH.

Association of lung health and cardiovascular health (Life's Essential 8)

Background

Cardiorespiratory health issues often intersect. This study explored the relationship between lung health and the recently updated Cardiovascular Health Measure (Life's Essential 8).

Methods

Data from the 2007-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed. Three cohorts were included: lung disease in the Main cohort (N = 9,772), lung function in the Spirometry sub-cohort (N = 3,896), and respiratory symptoms in the Respiratory Symptoms sub-cohort (Age > 40) (N = 3,449). LE8 scores were used as both continuous and categorical variables (0-49, 50-79, 80-100). Weighted multivariate regression analyses examined the correlations between LE8 and lung health, and weighted restricted cubic spline (RCS) regression analyzed potential non-linear relationships. Subgroup analysis was conducted to verify stability.

Results

Overall lung health was better in the high LE8 group than in the low LE8 group. In the fully adjusted model, the high LE8 group had significantly lower odds of asthma (OR = 0.42; 95% CI = 0.29, 0.59) and chronic bronchitis (OR = 0.27; 95% CI = 0.15, 0.49) compared to the low LE8 group. Regarding lung function, each 10-point increase in LE8 was associated with an increase of 50 ml in FEV1 (Beta = 50; 95% CI = 32, 67) and 56 ml in FVC (Beta = 56; 95% CI = 32, 79). Among middle-aged and older adults (age > 40), the high LE8 group had significantly lower odds of respiratory symptoms, including cough (OR = 0.23; 95% CI = 0.12, 0.46), phlegm (OR = 0.42; 95% CI = 0.19, 0.90), and wheezing (OR = 0.29; 95% CI = 0.15, 0.54). RCS analyses demonstrated a non-linear negative correlation between LE8 and cough, sputum, and wheeze. Subgroup and sensitivity analysis suggested stability.

Conclusion

Life's Essential 8 (LE8) scores are positively associated with lung health in the US population. These findings provide a valuable reference for maintaining overall cardiorespiratory health.

Pharmacogenetics of childhood uncontrolled asthma

INTRODUCTION

Asthma is a heterogeneous, multifactorial disease with multiple genetic and environmental risk factors playing a role in pathogenesis and therapeutic response. Understanding of pharmacogenetics can help with matching individualized treatments to specific genotypes of asthma to improve therapeutic outcomes especially in uncontrolled or severe asthma.

AREAS COVERED

In this review, we outline novel information about biology, pathways, and mechanisms related to interindividual variability in drug response (corticosteroids, bronchodilators, leukotriene modifiers, and biologics) for childhood asthma. We discuss candidate gene, genome-wide association studies and newer omics studies including epigenomics, transcriptomics, proteomics, and metabolomics as well as integrative genomics and systems biology methods related to childhood asthma. The articles were obtained after a series of searches, last updated November 2022, using database PubMed/CINAHL DB.

EXPERT OPINION

Implementation of pharmacogenetic algorithms can improve therapeutic targeting in children with asthma, particularly with severe or uncontrolled asthma who typically have challenges in clinical management and carry considerable financial burden. Future studies focusing on potential biomarkers both clinical and pharmacogenetic can help formulate a prognostic test for asthma treatment response that would represent true bench to bedside clinical implementation.

NLRP3 is a BMI-independent mediator of stable COPD

PURPOSE

The inflammatory response in animal models of chronic obstructive pulmonary disease (COPD) is activated by the NLR-family-pyrin-domain-containing-3 (NLRP3) inflammasome pathway, which is also known to play a role in obesity-related inflammation. The NLRP3/caspase-1/interleukin (IL)-1β pathway might be involved in the progression of COPD with increasing body mass index. To our knowledge, no previous studies have explored the role of NLRP3 inflammasome markers in linking COPD and obesity. Here, we aim to investigate this potential connection by examining levels of NLRP3, caspase-1, IL-1β, and IL-17A and to provide additional data on the expression of these molecules in relation to smoking status and COPD severity.

METHODS

A case‒control study was conducted between July 2020 and March 2023. Peripheral blood mononuclear cells were isolated, and total RNA was extracted for real-time quantitative polymerase chain reaction (qPCR) analysis to measure the expression levels of inflammasome molecules.

RESULTS

29 subjects who were diagnosed with stable COPD and 32 controls were included in the data analysis. NLRP3 and IL-17A but not caspase-1 or IL-1β expression was significantly greater in the COPD group than in the control group. We detected a significant increase in NLRP3 levels in the smoker COPD group (p = 0.009) and nonsmoker COPD group (p = 0.045) compared with those in the nonsmoker control group. There was no significant correlation between BMI and the inflammasome markers.

CONCLUSION

As proinflammatory biomarkers, NLRP3 and IL-17A are prominent in stable COPD patients. Smoking may trigger NLRP3-mediated inflammation in stable COPD patients. The expression levels of NLRP3 inflammasome molecules did not differ in terms of disease severity or BMI.

The influencing of obesity on lung ventilation function among middle-aged and elderly people

This study examined the effect of obesity on lung ventilation function in middle-aged and older adults using data from the China Health and Retirement Longitudinal Study. Lung function was measured using peak expiratory flow, and obesity was assessed using waist circumference and body mass index (BMI). Logistic regression and the bivariate logit model were applied to analyze the data. Among the 5631 participants, 727 were obese, 1,801 had central obesity, and 2,859 had poor pulmonary function. Individuals with obesity had a higher risk of poor pulmonary ventilation (OR = 1.869, p < 0.001) and a 12.3% decrease in the probability of good lung function (dy/dx = -0.123, p < 0.001). Moreover, individuals with a higher abdominal circumference had an increased risk of poor pulmonary ventilation (OR = 1.842, p < 0.001) and a 12.1% decrease in the probability of good lung function (dy/dx = -0.121, p < 0.001). This study indicates a negative association between obesity and lung ventilation function.

Effects of different masks on diaphragm motion in OSAS patients undergoing CPAP: results from an ultrasound-based proof of concept study

PURPOSE

Obstructive sleep apnea (OSA) is characterized by recurrent upper airway narrowing or collapse during sleep. Continuous positive airway pressure (CPAP) remains the preferred treatment in selected patients and masks' choice plays an important role for subsequent respiratory events' reduction. It is known that oronasal masks are not as effective at opening the upper airway compared to nasal ones. Thus, the objective of this study was to investigate differences in US-assessed diaphragmatic excursion (DE) using oronasal vs. nasal CPAP masks.

METHODS

This observational study included 50 OSA patients presenting a moderate to severe apnea-hypopnea index and requiring CPAP treatment. All participants received US evaluations on diaphragm motion during their oronasal and nasal CPAP trial at equal positive end-expiratory pressure level.

RESULTS

The difference of DE switching mask during CPAP was assessed by using the non-parametric Wilcoxon signed-rank test. A statistically significant increase in US- assessed DE was found when shifting from oronasal to nasal mask (p-value < 0.01). Linear regression models revealed that increased neck circumference and more severe AHI were associated with decreased DE when shifting to an oronasal mask.

CONCLUSION

This study evaluated the acute impact on US-assessed DE after changing CPAP route from oronasal to nasal mask. Our results suggest that the nasal type should be the more suitable option for most patients with OSA, especially those with higher nasal circumference. Diaphragmatic motion throughout US may become a practical tool to help in the choice of the fittest mask in patients undergoing CPAP.

Association Between Weight-Adjusted Waist Index and Emphysema in Adults in the United States: A Cross-Sectional Study Involving 44,949 Participants

Background: The relationship between obesity and respiratory diseases has been widely explored. In this context, the Weight-Adjusted Waist Index (WWI) has emerged as a novel metric for assessing visceral fat. This study aims to evaluate the association between WWI and the risk of emphysema in the U.S. population, by utilizing data from the 2001-2018 National Health and Nutrition Examination Survey (NHANES). Methods: A cross-sectional study was conducted using NHANES data from 2001 to 2018. Logistic regression models were applied to assess the relationship between WWI and emphysema risk. Interaction and subgroup analyses were performed to explore effect modifiers. Results: Our study included a total of 44,949 American adults. The results of the multivariable logistic regression analysis revealed an association between WWI and the incidence of emphysema. In the fully adjusted model, the probability of developing emphysema was 1.5 times higher in the group with WWI > 10.46 compared to those with WWI ≤ 10.46, with an odds ratio of [1.5 (1.1, 1.9), p = 0.003]. Subgroup analysis showed stronger associations among males, non-Hispanic Whites, and individuals with hypertension. Furthermore, we used a two-piece linear regression model and found a nonlinear association between WWI and emphysema, with a breakpoint at 12.5. Conclusions: Our findings indicate a significant association between WWI levels and emphysema. Larger-scale prospective studies are needed to further explore the role of WWI in emphysema.

Obesity and Asthma: Implementing a Treatable Trait Care Model

Recognition of obesity as a treatable trait of asthma, impacting its development, clinical presentation and management, is gaining widespread acceptance. Obesity is a significant risk factor and disease modifier for asthma, complicating treatment. Epidemiological evidence highlights that obese asthma correlates with poorer disease control, increased severity and persistence, compromised lung function and reduced quality of life. Various mechanisms contribute to the physiological and clinical complexities observed in individuals with obesity and asthma. These encompass different immune responses, including Type IVb, where T helper 2 cells are pivotal and driven by cytokines like interleukins 4, 5, 9 and 13, and Type IVc, characterised by T helper 17 cells and Type 3 innate lymphoid cells producing interleukin 17, which recruits neutrophils. Additionally, Type V involves immune response dysregulation with significant activation of T helper 1, 2 and 17 responses. Finally, Type VI is recognised as metabolic-induced immune dysregulation associated with obesity. Body mass index (BMI) stands out as a biomarker of a treatable trait in asthma, readily identifiable and targetable, with significant implications for disease management. There exists a notable gap in treatment options for individuals with obese asthma, where asthma management guidelines lack specificity. For example, there is currently no evidence supporting the use of incretin mimetics to improve asthma outcomes in asthmatic individuals without Type 2 diabetes mellitus (T2DM). In this review, we advocate for integrating BMI into asthma care models by establishing clear target BMI goals, promoting sustainable weight loss via healthy dietary choices and physical activity and implementing regular reassessment and referral as necessary.

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.

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.

Malnutrition and Obesity in Patients with COPD Exacerbation, Insights from the National Inpatient Sample

Background

The obesity paradox suggests that obese patients with Chronic Obstructive Pulmonary Disease Exacerbation (COPDE) may have better outcomes. COPD patients are at a higher risk of becoming malnourished, which has been linked to poor outcomes.

Objective

This paper aims to study the impact of malnutrition in patients with and without obesity hospitalized with COPDE.

Methods

Our retrospective study analyzed data from the National Inpatient Sample dataset between 2017 and 2020 to observe patients who were hospitalized with COPDE. The patients were divided into two groups: with and without malnutrition. The outcomes included all-cause mortality, invasive mechanical ventilation, length of stay, and total charge. We adjusted for confounders using multivariate regression model analysis.

Results

The study involved 392,920 patients with COPDE, out of which 5720 (1.45%) were diagnosed with malnutrition. Most of the patients in both groups were female, white, and under Medicare coverage. The mean age was higher in patients with malnutrition (67.6 vs. 64 years). In both groups, the rates of admissions were lowest in 2020 compared to three years prior. The rates and adjusted odds ratios of all-cause mortality were higher in patients with malnutrition (3.59% vs. 0.61%, P <0.01; adjusted odds ratio (aOR) 2.36, P<0.01, CI 1.8-3.7). We observed comparable findings when using invasive mechanical ventilation (13.2% vs. 2.82%, P<0.01, aOR 4.9, P<0.01, 3.9-6). Malnourished patients had a lengthier hospital stay and a greater total charge.

Conclusion

Malnutrition was identified as an independent risk factor associated with worse outcomes in obese patients admitted with COPD exacerbation.

Recent advances in the effect of adipose tissue inflammation on insulin resistance

Obesity is one of the major risk factors for diabetes. Excessive accumulation of fat leads to inflammation of adipose tissue, which can increase the risk of developing diabetes. Obesity-related chronic inflammation can result in anomalies in glucose-lipid metabolism and insulin resistance, and it is a major cause of β-cell dysfunction in diabetes mellitus. Thus, a long-term tissue inflammatory response is crucial for metabolic diseases, particularly type 2 diabetes. Chronic inflammation associated with obesity increases oxidative stress, secretes inflammatory factors, modifies endocrine variables, and interferes with insulin signalling pathways, all of which contribute to insulin resistance and glucose tolerance. Insulin resistance and diabetes are ultimately caused by chronic inflammation in the stomach, pancreas, liver, muscle, and fat tissues. In this article, we systematically summarize the latest research progress on the mechanisms of adipose tissue inflammation and insulin resistance, as well as the mechanisms of cross-talk between adipose tissue inflammation and insulin resistance, with a view to providing some meaningful therapeutic strategies for the treatment of insulin resistance by controlling adipose tissue inflammation.

Eosinophil biology from the standpoint of metabolism: implications for metabolic disorders and asthma

Eosinophils, recognized for their immune and remodeling functions and participation in allergic inflammation, have recently garnered attention due to their impact on host metabolism, especially in the regulation of adipose tissue. Eosinophils are now known for their role in adipocyte beiging, adipokine secretion, and adipose tissue inflammation. This intricate interaction involves complex immune and metabolic processes, carrying significant implications for systemic metabolic health. Importantly, the interplay between eosinophils and adipocytes is bidirectional, revealing the dynamic nature of the immune-metabolic axis in adipose tissue. While the homeostatic regulatory role of eosinophils in adipose tissue is appreciated, this relationship in the context of obesity or allergic inflammation is much less understood. Mechanistic details of eosinophil-adipose interactions, especially the direct regulation of adipocytes by eosinophils, are also lacking. Another poorly understood aspect is the metabolism of the eosinophils themselves, encompassing metabolic shifts during eosinophil subset transitions in different tissue microenvironments, along with potential effects of host metabolism on the programming of eosinophil hematopoiesis and the resulting plasticity. This review consolidates recent research in this emerging and fascinating frontier of eosinophil investigation, identifying unexplored areas and presenting innovative perspectives on eosinophil biology in the context of metabolic disorders and associated health conditions, including asthma.

Immune cells crosstalk Pathways, and metabolic alterations in Idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) presents a challenging progression characterized by lung tissue scarring and abnormal extracellular matrix deposition. This review examines the influence of immune responses, emphasizing their complex role in initiating and perpetuating fibrosis. It highlights how metabolic pathways modulate immune cell function during IPF. Immune cell modulation holds promise in managing pulmonary fibrosis (PF). Inhibiting neutrophil recruitment and monitoring mast cell levels offer insights into PF progression. Low-dose IL-2 therapy and regulation of fibroblast recruitment present potential therapeutic avenues, while the role of innate lymphoid cells (ILC2s) in allergic lung inflammation sheds light on disease mechanisms. The review focuses on metabolic reprogramming's role in shaping immune cell function during IPF progression. While some immune cells use glycolysis for pro-inflammatory responses, others favor fatty acid oxidation for regulatory functions. Targeting specialized pro-resolving lipid mediators (SPMs) presents significant potential for managing fibrotic disorders. Additionally, it highlights the pivotal role of amino acid metabolism in synthesizing serine and glycine as crucial regulators of collagen production and exploring the interconnectedness of lipid metabolism, mitochondrial dysfunction, and adipokines in driving fibrotic processes. Moreover, the review discusses the impact of metabolic disorders such as obesity and diabetes on lung fibrosis. Advocating for a holistic approach, it emphasizes the importance of considering this interplay between immune cell function and metabolic pathways in developing effective and personalized treatments for IPF.

Euiin-Tang Attenuates Obesity-Induced Asthma by Resolving Metaflammation

Euiin-tang reduces obesity and hypertension. Patients with obesity may develop obesity-induced asthma (OIA) owing to phlegm dampness. This study aimed to determine whether euiin-tang alleviates high-fat diet (HFD)-induced OIA in C57BL/6 mice. OIA was developed by HFD feeding for 15 weeks in C57BL/6 mice, and euiin-tang (5 mg/10 g/day) was orally administered for the last five weeks. Oral administration of euiin-tang suppressed HFD-induced changes in body weight, liver weight, airway hypersensitivity (AHR), and immune cell infiltration in bronchoalveolar lavage fluid. Histological analysis revealed that euiin-tang treatment suppressed HFD-induced mucosal inflammation, hypersecretion, and fibrosis. The lungs and gonadal white adipose tissue showed increased expression of inflammatory cytokines (IL-1β, IL-17A, TNF-α, IL-6, IL-13, IFN-γ, MPO, and CCL2) following HFD, whereas euiin-tang inhibited this increase. HFD also increased the number of pro-inflammatory CD86+ M1 macrophages and decreased the number of anti-inflammatory CD206+ M2 macrophages in the lungs, whereas euiin-tang treatment reversed these effects. HFD induced a decrease in adiponectin and an increase in leptin, which was reversed by euiin-tang. Therefore, euiin-tang may be a potential therapeutic agent for OIA because it suppresses metaflammation as demonstrated in the present study.

Association between waist circumference and lung function in American middle-aged and older adults: findings from NHANES 2007-2012

PURPOSE

There is a major epidemic of obesity, and many obese patients suffer from respiratory symptoms and disease. However, limited research explores the associations between abdominal obesity and lung function indices, yielding mixed results. This study aims to analyze the association between waist circumference (WC), an easily measurable marker of abdominal obesity, and lung function parameters in middle-aged and older adults using the National Health and Nutrition Examination Survey (NHANES).

METHODS

This study utilized data obtained from the National Health and Nutrition Examination Survey (NHANES) spanning 2007 to 2012, with a total sample size of 6089 individuals. A weighted multiple regression analysis was conducted to assess the relationship between WC and three pulmonary function parameters. Additionally, a weighted generalized additive model and smooth curve fitting were applied to capture any potential nonlinear relationship within this association.

RESULTS

After considering all confounding variables, it was observed that for each unit increase in WC, in males, Forced Vital Capacity (FVC) increased by 23.687 ml, Forced Expiratory Volume in one second (FEV1) increased by 12.029 ml, and the FEV1/FVC ratio decreased by 0.140%. In females, an increase in waist circumference by one unit resulted in an FVC increase of 6.583 ml and an FEV1 increase of 4.453 ml. In the overall population, each unit increase in waist circumference led to a FVC increase of 12.014 ml, an FEV1 increase of 6.557 ml, and a decrease in the FEV1/FVC ratio by 0.076%. By constructing a smooth curve, we identified a positive correlation between waist circumference and FVC and FEV1. Conversely, there was a negative correlation between waist circumference and the FEV1/FVC ratio.

CONCLUSIONS

Our findings indicate that in the fully adjusted model, waist circumference, independent of BMI, positively correlates with FVC and FEV1 while exhibiting a negative correlation with FEV1/FVC among middle-aged and older adults in the United States. These results underscore the importance of considering abdominal obesity as a potential factor influencing lung function in American middle-aged and older adults.

Obesity hypoventilation syndrome, literature review

Obesity is a global health concern that has been increasing over the years, and it is associated with several pathophysiological changes affecting the respiratory system, including alveolar hypoventilation. Obesity hypoventilation syndrome (OHS) is one of the six subtypes of sleep-hypoventilation disorders. It is defined as the presence of obesity, chronic alveolar hypoventilation leading to daytime hypercapnia and hypoxia, and sleep-disordered breathing. The existence of a sleep disorder is one of the characteristics that patients with OHS present. Among them, 90% of patients have obstructive sleep apnea (OSA), and the remaining 10% of patients with OHS have non-obstructive sleep hypoventilation without OSA or with mild OSA. This review aims to provide a comprehensive understanding of the epidemiological and pathophysiological impact of OHS and to highlight its clinical features, prognosis, and severity, as well as the available treatment options.

Lipotoxicity: The missing link between diabetes and periodontitis?

Lipotoxicity refers to the accumulation of lipids in tissues other than adipose tissue (body fat). It is one of the major pathophysiological mechanisms responsible for the progression of diabetes complications such as non-alcoholic fatty liver disease and diabetic nephropathy. Accumulating evidence indicates that lipotoxicity also contributes significantly to the toxic effects of diabetes on periodontitis. Therefore, we reviewed the current in vivo, in vitro, and clinical evidence of the detrimental effects of lipotoxicity on periodontitis, focusing on its molecular mechanisms, especially oxidative and endoplasmic reticulum stress, inflammation, ceramides, adipokines, and programmed cell death pathways. By elucidating potential therapeutic strategies targeting lipotoxicity and describing their associated mechanisms and clinical outcomes, including metformin, statins, liraglutide, adiponectin, and omega-3 PUFA, this review seeks to provide a more comprehensive and effective treatment framework against diabetes-associated periodontitis. Furthermore, the challenges and future research directions are proposed, aiming to contribute to a more profound understanding of the impact of lipotoxicity on periodontitis.

Italian Association of Hospital Cardiologists position paper-obesity in adults: a clinical primer

Obesity is a chronic and relapsing disease characterized by the interaction between individual predispositions and an obesogenic environment. Recent advances in understanding the mechanisms of energetic homoeostasis paved the way to more effective therapeutic approaches compared with traditional treatments. Since obesity is a complex disease, it necessitates a multi-disciplinary approach whose implementation remains challenging. Nonetheless, emerging pharmacological interventions appear promising. Currently, therapeutic success is discreet in the short term but often fails to maintain long-term weight loss due to a high likelihood of weight regain. Cardiologists play a key role in managing patients with obesity, yet often lack familiarity with its comprehensive management. The aim of this document is to summarize knowledge to consolidate essential knowledge for clinicians to effectively treat patients living with obesity. The paper emphasizes the pivotal role of a strong patient-clinician relationship in navigating successful treatment. We analyse the criteria commonly used to diagnose obesity and point out the strengths and limitations of different criteria. Furthermore, we discuss the role of obesiologists and the contributions of cardiologists. In addition, we detail key components of effective therapeutic strategies, including educational aspects and pharmacological options.

Role of bronchial hyperresponsiveness in patients with obstructive sleep apnea with asthma-like symptoms

BACKGROUND

Obstructive sleep apnea (OSA) is one of the major co-morbidities and aggravating factors of asthma. In OSA-complicated asthma, obesity, visceral fat, and systemic inflammation are associated with its severity, but the role of bronchial hyperresponsiveness (BHR) is unclear. We investigated the involvement of BHR and mediastinal fat width, as a measure of visceral fat, with OSA severity in patients with OSA and asthma-like symptoms.

METHODS

Patients with OSA who underwent BHR test and chest computed tomography scan for asthma-like symptoms were retrospectively enrolled. We evaluated the relationship between apnea-hypopnea index (AHI) and PC20 or anterior mediastinal fat width, stratified by the presence or absence of BHR.

RESULTS

OSA patients with BHR (n = 29) showed more obstructive airways and frequent low arousal threshold and lower mediastinal fat width, and tended to show fewer AHI than those without BHR (n = 25). In the overall analysis, mediastinal fat width was significantly positively correlated with AHI, which was significant even after adjustment with age and gender. This was especially significant in patients without BHR, while in OSA patients with BHR, there were significant negative associations between apnea index and airflow limitation, and hypopnea index and PC20.

CONCLUSIONS

Risk factors for greater AHI differed depending on the presence or absence of BHR in OSA patients with asthma-like symptoms. In the presence of BHR, severity of asthma may determine the severity of concomitant OSA.

Medium-term exposure to size-fractioned particulate matter and asthma exacerbations in China: A longitudinal study of asthmatics with poor medication adherence

BACKGROUND

Studies have shown that short- and long-term exposure to particulate matter (PM) can increase the risk of asthma morbidity and mortality. However, the effect of medium-term exposure remains unknown. We aim to examine the effect of medium-term exposure to size-fractioned PM on asthma exacerbations among asthmatics with poor medication adherence.

METHODS

We conducted a longitudinal study in China based on the National Mobile Asthma Management System Project that specifically and routinely followed asthma exacerbations in asthmatics with poor medication adherence from April 2017 to May 2019. High-resolution satellite remote-sensing data were used to estimate each participant's medium-term exposure (on average 90 days) to size-fractioned PM (PM1, PM2.5, and PM10) based on the residential address and the date of the follow-up when asthma exacerbations (e.g., hospitalizations and emergency room visits) occurred or the end of the follow-up. The Cox proportional hazards model was employed to examine the hazard ratio of asthma exacerbations associated with each PM after controlling for sex, age, BMI, education level, geographic region, and temperature.

RESULTS

Modelling results revealed nonlinear exposure-response associations of asthma exacerbations with medium-term exposure to PM1, PM2.5, and PM10. Specifically, for emergency room visits, we found an increased hazard ratio for PM1 above 22.8 µg/m3 (1.060, 95 % CI: 1.025-1.096, per 1 µg/m3 increase), PM2.5 above 38.2 µg/m3 (1.032, 95 % CI: 1.010-1.054), and PM10 above 78.6 µg/m3 (1.019, 95 % CI: 1.006-1.032). For hospitalizations, we also found an increased hazard ratio for PM1 above 20.3 µg/m3 (1.055, 95 % CI: 1.001-1.111) and PM2.5 above 39.2 µg/m3 (1.038, 95 % CI: 1.003-1.074). Furthermore, the effects of PM were greater for a longer exposure window (90-180 days) and among participants with a high BMI.

CONCLUSION

This study suggests that medium-term exposure to PM is associated with an increased risk of asthma exacerbations in asthmatics with poor medication adherence, with a higher risk from smaller PM.

Ketogenic nutritional therapy (KeNuT)-a multi-step dietary model with meal replacements for the management of obesity and its related metabolic disorders: a consensus statement from the working group of the Club of the Italian Society of Endocrinology (SIE)-diet therapies in endocrinology and metabolism

PURPOSE

The ketogenic nutritional therapy (KeNuT) is an effective dietary treatment for patients with obesity and obesity-related comorbidities, including type 2 diabetes, dyslipidaemia, hypertension, coronary artery disease, and some type of cancers. However, to date an official document on the correct prescription of the ketogenic diet, validated by authoritative societies in nutrition or endocrine sciences, is missing. It is important to emphasize that the ketogenic nutritional therapy requires proper medical supervision for patient selection, due to the complex biochemical implications of ketosis and the need for a strict therapeutic compliance, and an experienced nutritionist for proper personalization of the whole nutritional protocol.

METHODS

This practical guide provides an update of main clinical indications and contraindications of ketogenic nutritional therapy with meal replacements and its mechanisms of action. In addition, the various phases of the protocol involving meal replacements, its monitoring, clinical management and potential side effects, are also discussed.

CONCLUSION

This practical guide will help the healthcare provider to acquire the necessary skills to provide a comprehensive care of patients with overweight, obesity and obesity-related diseases, using a multistep ketogenic dietary treatment, recognized by the Club of the Italian Society of Endocrinology (SIE)-Diet Therapies in Endocrinology and Metabolism.

ANMCO (Italian Association of Hospital Cardiologists) scientific statement: obesity in adults-an approach for cardiologists

Obesity is a complex, chronic disease requiring a multidisciplinary approach to its management. In clinical practice, body mass index and waist-related measurements can be used for obesity screening. The estimated prevalence of obesity among adults worldwide is 12%. With the expected further increase in overall obesity prevalence, clinicians will increasingly be managing patients with obesity. Energy balance is regulated by a complex neurohumoral system that involves the central nervous system and circulating mediators, among which leptin is the most studied. The functioning of these systems is influenced by both genetic and environmental factors. Obesity generally occurs when a genetically predisposed individual lives in an obesogenic environment for a long period. Cardiologists are deeply involved in evaluating patients with obesity. Cardiovascular risk profile is one of the most important items to be quantified to understand the health risk due to obesity and the clinical benefit that a single patient can obtain with weight loss. At the individual level, appropriate patient involvement, the detection of potential obesity causes, and a multidisciplinary approach are tools that can improve clinical outcomes. In the near future, we will probably have new pharmacological tools at our disposal that will facilitate achieving and maintaining weight loss. However, pharmacological treatment alone cannot cure such a complex disease. The aim of this paper is to summarize some key points of this field, such as obesity definition and measurement tools, its epidemiology, the main mechanisms underlying energy homeostasis, health consequences of obesity with a focus on cardiovascular diseases and the obesity paradox.Level of evidence V: report of expert committees.

Bariatric surgery decreases the capacity of plasma from obese asthmatic subjects to augment airway epithelial cell proinflammatory cytokine production

Obesity is a risk factor for asthma. Individuals with asthma and obesity often have poor asthma control and do not respond as well to therapies such as inhaled corticosteroids and long-acting bronchodilators. Weight loss improves asthma control, with a 5%-10% loss in body mass necessary and sufficient to lead to clinically relevant improvements. Preclinical studies have demonstrated the pathogenic contribution of adipocytes from obese mice to the augmented production of proinflammatory cytokines from airway epithelial cells and the salutary effects of diet-induced weight loss to decrease these consequences. However, the effects of adipocyte-derived products on airway epithelial function in human obesity remain incompletely understood. We utilized samples collected from a 12-mo longitudinal study of subjects with obesity undergoing weight loss (bariatric) surgery including controls without asthma and subjects with allergic and nonallergic obese asthma. Visceral adipose tissue (VAT) samples were collected during bariatric surgery and from recruited normal weight controls without asthma undergoing elective abdominal surgery. Human bronchial epithelial (HBEC3-KT) cells were exposed to plasma or conditioned media from cultured VAT adipocytes with or without agonists. Human bronchial smooth muscle (HBSM) cells were similarly exposed to adipocyte-conditioned media. Proinflammatory cytokines were augmented in supernatants from HBEC3-KT cells exposed to plasma as compared with subsequent visits. Whereas exposure to obese adipocyte-conditioned media induced proinflammatory responses, there were no differences between groups in both HBEC3-KT and HBSM cells. These data show that bariatric surgery and subsequent weight loss beneficially change the circulating factors that augment human airway epithelial and bronchial smooth muscle cell proinflammatory responses.NEW & NOTEWORTHY This longitudinal study following subjects with asthma and obesity reveals that weight loss following bariatric surgery decreases the capacity for plasma to augment proinflammatory cytokine secretion by human bronchial epithelial cells, implicating that circulating but not adipocyte-derived factors are important modulators in obese asthma.

Symptoms Arising From the Diaphragm Muscle: Function and Dysfunction

There can be many reasons that damage the function of the diaphragm, either transiently or permanently, involving one hemilate or both muscle portions. The diaphragm is associated only with breathing, but many other functions are related to it. The patient is not always aware of the presence of diaphragmatic dysfunction, and it is not always immediate to identify non-respiratory diaphragmatic symptoms. Pseudoanginal pain, night sweats, difficulty memorizing, or muscular and visceral problems of the pelvic floor are just some of the disorders linked to reduced diaphragmatic contractility. A decline in respiratory contractile force can be the basis for further pathological conditions that can increase the rate of mortality and morbidity. The article reviews the possible symptoms that may be presented by the patient, which are not necessarily related to lung function.

Winds of change a tale of: asthma and microbiome

The role of the microbiome in asthma is highlighted, considering its influence on immune responses and its connection to alterations in asthmatic patients. In this context, we review the variables influencing asthma phenotypes from a microbiome perspective and provide insights into the microbiome's role in asthma pathogenesis. Previous cohort studies in patients with asthma have shown that the presence of genera such as Bifidobacterium, Lactobacillus, Faecalibacterium, and Bacteroides in the gut microbiome has been associated with protection against the disease. While, the presence of other genera such as Haemophilus, Streptococcus, Staphylococcus, and Moraxella in the respiratory microbiome has been implicated in asthma pathogenesis, indicating a potential link between microbial dysbiosis and the development of asthma. Furthermore, respiratory infections have been demonstrated to impact the composition of the upper respiratory tract microbiota, increasing susceptibility to bacterial diseases and potentially triggering asthma exacerbations. By understanding the interplay between the microbiome and asthma, valuable insights into disease mechanisms can be gained, potentially leading to the development of novel therapeutic approaches.

The Effects of Diabetes and Being Overweight on Patients with Post-COVID-19 Syndrome

In the aftermath of the COVID-19 pandemic, post-COVID-19 syndrome (PCS) remains a challenge and may continue to pose a major health problem in the future. Moreover, the influences of type 2 diabetes and being overweight on PCS remain unclear. This study aimed to assess these influences. We performed an observational study from October 2020 to July 2022, which included 466 patients (269 males and 197 females) with a median age of 65. They were hospitalized due to COVID-19 pneumonia and had persistent symptoms after 1 month of COVID-19 infection. The patients were divided into four groups according to the study objectives: patients with type 2 diabetes, overweight patients, overweight patients with type 2 diabetes, and average-weight patients without type 2 diabetes. The clinical and demographic data collected during hospitalization and regular visits to the Community Healthcare Center dr. Adolf Drolc Maribor were analyzed. Our results showed that type 2 diabetes patients had more difficult courses of treatment and longer hospitalizations. Moreover, more type 2 diabetes patients underwent rehabilitation than the other study groups. The prevailing symptoms of our patients with PCS were dyspnea and fatigue, mostly among female patients with type 2 diabetes. Our study also showed that more women with type 2 diabetes and overweight women with type 2 diabetes suffered from secondary infections. Furthermore, more overweight patients were treated in the intensive care unit than patients from the other groups. However, our study showed an interesting result: patients with type 2 diabetes had the shortest PCS durations. Type 2 diabetes and being overweight are risk factors for PCS onset and prolonged duration. Therefore, our data that revealed a shorter duration of PCS in type 2 diabetes patients than the other investigated groups was unexpected. We believe that answering the questions arising from our unexpected results will improve PCS treatment in general.

Casual association between childhood body mass index and risk of psoriasis: A Mendelian randomization study

BACKGROUND

Observational studies have suggested that childhood body mass index (BMI) is associated with the risk of psoriasis. However, their causal relationship remains unclear. In this investigation, we aimed to determine whether an association exists between childhood BMI and psoriasis.

METHODS

Using summary statistics for childhood BMI of European descent from publicly available GWAS meta-analyses (n = 39 620), we conducted Mendelian randomization (MR) research using the inverse variance weighting (IVW), weighted median, and MR-Egger regression techniques. The outcome was a genome-wide association studies (GWAS) for the self-reported non-cancer disease classification psoriasis in the UK Biobank population (total n = 337 159; case = 3871; control = 333 288).

RESULTS

We selected instrumental variables from 16 single-molecule polymorphisms that attained genome-wide significance in GWAS on childhood BMI. Using the IVW method, our findings supported a causal relationship between childhood BMI and psoriasis (beta = 0.003, standard error [SE] = 0.001, p = 0.006). Using MR-Egger regression analysis, we evaluated the potential for directional pleiotropy to bias our results (intercept = 0.00039, p-value = 0.247) and found no causal relationship between childhood BMI and psoriasis (beta = -0.002, SE = 0.004, p = 0.625). The weighted median method, however, provided proof of a causal relationship (beta = 0.003, SE = 0.001, p = 0.029). Cochran's Q test and the funnel plot revealed little proof of heterogeneity or asymmetry, indicating the lack of directional pleiotropy.

CONCLUSION

According to the findings of the MR analysis, an increased childhood BMI may be linked to a higher likelihood of psoriasis.

Ectopic and visceral fat deposition in aging, obesity, and idiopathic pulmonary fibrosis: an interconnected role

Idiopathic pulmonary fibrosis (IPF) is considered an age-related disease. Age-related changes, along with other factors such as obesity, hormonal imbalances, and various metabolic disorders, lead to ectopic fat deposition (EFD). This accumulation of fat outside of its normal storage sites is associated with detrimental effects such as lipotoxicity, oxidative stress, inflammation, and insulin resistance. This narrative review provides an overview of the connection between ectopic and visceral fat deposition in aging, obesity, and IPF. It also elucidates the mechanism by which ectopic fat deposition in the airways and lungs, pericardium, skeletal muscles, and pancreas contributes to lung injury and fibrosis in patients with IPF, directly or indirectly. Moreover, the review discusses the impact of EFD on the severity of the disease, quality of life, presence of comorbidities, and overall prognosis in IPF patients. The review provides detailed information on recent research regarding representative lipid-lowering drugs, hypoglycemic drugs, and lipid-targeting drugs in animal experiments and clinical studies. This may offer new therapeutic directions for patients with IPF.

Serum-Creatinine-to-Cystatin C-to-Waist-Circumference Ratios as an Indicator of Severe Airflow Limitation in Older Adults

BACKGROUND

This study aimed to investigate the association between the serum-creatinine-to-cystatin C-to-waist-circumference (CCR/WC) ratio with lung function and severe airflow limitation (SAL).

METHODS

The data were derived from the China Health and Retirement Longitudinal Study. Peak expiratory flow (PEF) was used as a measure of lung function parameter. Logistic and linear regression were utilized separately to evaluate the relationship between the CCR/WC ratio with PEF and SAL in baseline. Restricted cubic spline was used to explore potential non-linear associations between the CCR/WC ratio and SAL. Cox proportional-hazards models were used to assess the association between CCR/WC quartiles and the risk of new-onset SAL.

RESULTS

A total of 6105 participants were included. This study revealed a positive association between the CCR/WC ratio and lung function (PEF: β [partial coefficient]: 25.95, 95%CI: 12.72 to 39.18, p < 0.001; PEF/PEF prediction: β = 0.08, 95%CI: 0.05 to 0.12, p < 0.001) and an inverse association relationship with SAL (OR [odds ratio]: 0.64, 95% confidence interval [CI]: 0.47 to 0.85, p = 0.003). Subgroup analysis showed a significant association between the CCR/WC ratio and SAL in males (OR: 0.58, 95% CI: 0.37 to 0.90, p = 0.017) but not in females (p = 0.059). Cox regression analysis revealed a decreased risk of SAL in the quartiles (Q2-4) compared to the first quartile of the CCR/WC ratio (hazard ratios [HRs]: 0.49 to 0.73, all p < 0.05).

CONCLUSIONS

This study highlights a positive association between the CCR/WC ratio and lung function, with a potential protective effect against SAL.

Establishment and application of the BRP prognosis model for idiopathic pulmonary fibrosis

BACKGROUND

Idiopathic pulmonary fibrosis (IPF) is the most common idiopathic interstitial lung disease. Clinical models to accurately evaluate the prognosis of IPF are currently lacking. This study aimed to construct an easy-to-use and robust prediction model for transplant-free survival (TFS) of IPF based on clinical and radiological information.

METHODS

A multicenter prognostic study was conducted involving 166 IPF patients who were followed up for 3 years. The end point of follow-up was death or lung transplantation. Clinical information, lung function tests, and chest computed tomography (CT) scans were collected. Body composition quantification on CT was performed using 3D Slicer software. Risk factors in blood routine examination-radiology-pulmonary function (BRP) were identified by Cox regression and utilized to construct the "BRP Prognosis Model". The performance of the BRP model and the gender-age-physiology variables (GAP) model was compared using time-ROC curves, calibration curves, and decision curve analysis (DCA). Furthermore, histopathology fibrosis scores in clinical specimens were compared between the different risk stratifications identified by the BRP model. The correlations among body composition, lung function, serum inflammatory factors, and profibrotic factors were analyzed.

RESULTS

Neutrophil percentage > 68.3%, pericardial adipose tissue (PAT) > 94.91 cm3, pectoralis muscle radiodensity (PMD) ≤ 36.24 HU, diffusing capacity of the lung for carbon monoxide/alveolar ventilation (DLCO/VA) ≤ 56.03%, and maximum vital capacity (VCmax) < 90.5% were identified as independent risk factors for poor TFS among patients with IPF. We constructed a BRP model, which showed superior accuracy, discrimination, and clinical practicability to the GAP model. Median TFS differed significantly among patients at different risk levels identified by the BRP model (low risk: TFS > 3 years; intermediate risk: TFS = 2-3 years; high risk: TFS ≈ 1 year). Patients with a high-risk stratification according to the BRP model had a higher fibrosis score on histopathology. Additionally, serum proinflammatory markers were positively correlated with visceral fat volume and infiltration.

CONCLUSIONS

In this study, the BRP prognostic model of IPF was successfully constructed and validated. Compared with the commonly used GAP model, the BRP model had better performance and generalization with easily obtainable indicators. The BRP model is suitable for clinical promotion.

Pharmacological modulation of adaptive thermogenesis: new clues for obesity management?

BACKGROUND

Adaptive thermogenesis represents the main mechanism through which the body generates heat in response to external stimuli, a phenomenon that includes shivering and non-shivering thermogenesis. The non-shivering thermogenesis is mainly exploited by adipose tissue characterized by a brown aspect, which specializes in energy dissipation. A decreased amount of brown adipose tissue has been observed in ageing and chronic illnesses such as obesity, a worldwide health problem characterized by dysfunctional adipose tissue expansion and associated cardiometabolic complications. In the last decades, the discovery of a trans-differentiation mechanism ("browning") within white adipose tissue depots, leading to the generation of brown-like cells, allowed to explore new natural and synthetic compounds able to favour this process and thus enhance thermogenesis with the aim of counteracting obesity. Based on recent findings, brown adipose tissue-activating agents could represent another option in addition to appetite inhibitors and inhibitors of nutrient absorption for obesity treatment.

PURPOSE

This review investigates the main molecules involved in the physiological (e.g. incretin hormones) and pharmacological (e.g. β3-adrenergic receptors agonists, thyroid receptor agonists, farnesoid X receptor agonists, glucagon-like peptide-1, and glucagon receptor agonists) modulation of adaptive thermogenesis and the signalling mechanisms involved.

The Medical Burden of Obesity and Overweight in the US Military: Association of BMI with Clinically Diagnosed Medical Conditions in United States Military Service Members

BACKGROUND

A high BMI is associated with various medical conditions, notably type 2 diabetes, cardiovascular disease, and mental health disorders. In the US military, BMI increased linearly between 1975 and 2015.

OBJECTIVE

This cross-sectional study investigated the associations between BMI and a comprehensive range of clinically diagnosed medical conditions (CDMCs) in US military service members (SMs).

METHODS

A stratified random sample of SMs (n=26,177) completed an online questionnaire reporting their height, weight, and demographic/lifestyle characteristics. Medical conditions for 6 mo before questionnaire completion were obtained from a comprehensive military electronic medical surveillance system and grouped into 39 CDMCs covering both broad (largely systemic) and specific medical conditions. BMI was calculated as weight/height2 (kg/m2). The prevalence of CDMCs was compared among normal weight (<25.0 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30 kg/m2) SMs.

RESULTS

After multivariable adjustment for demographic/lifestyle characteristics, higher BMI was associated with higher odds of a diagnosed medical condition in 30 of 39 CDMCs, with all 30 displaying dose-response relationships. The 5 major CDMCs with the largest odds ratios comparing obese to normal weight were endocrine/nutritional/metabolic diseases (OR=2.67, 95%CI=2.24-3.15), nervous system diseases (odds ratio [OR]=2.59, 95%CI=2.32-2.90), circulatory system diseases (OR=2.56, 95%CI=2.15-3.06), musculoskeletal system diseases (OR=1.92, 95%CI=1.76-2.09), and mental/behavioral disorders (OR=1.69, 95%CI=1.51-1.90). Compared with normal weight SMs, overweight or obese SMs had a higher number of CDMCs (1.8±1.9 vs. 2.0±2.0 and 2.5±2.3, mean ± standard deviation, respectively, P<0.01).

CONCLUSIONS

In a young, physically active population, higher BMI was associated with a host of medical conditions, even after adjustment for demographic/lifestyle characteristics. The US Department of Defense should improve nutrition education and modify other factors that contribute to overweight and obesity. This study demonstrates that the medical burden of obesity is substantial in overweight and obese SMs.

Management of Obesity-Related Inflammatory and Cardiovascular Diseases by Medicinal Plants: From Traditional Uses to Therapeutic Targets

Inflammation is a crucial factor in the development and progression of cardiovascular diseases (CVD). Cardiac remodeling in the presence of persistent inflammation leads to myocardial fibrosis and extracellular matrix changes, which reduce cardiac function, induce arrhythmias, and finally, cause heart failure. The majority of current CVD treatment plans concentrate on reducing risk factors such as hyperlipidemia, type 2 diabetes, and hypertension. One such strategy could be inflammation reduction. Numerous in vitro, animal, and clinical studies indicate that obesity is associated with low-grade inflammation. Recent studies have demonstrated the potential of medicinal plants and phytochemicals to cure and prevent obesity and inflammation. In comparison to conventional therapies, the synergistic effects of several phytochemicals boost their bioavailability and impact numerous cellular and molecular targets. Focusing on appetite, pancreatic lipase activity, thermogenesis, lipid metabolism, lipolysis and adipogenesis, apoptosis in adipocytes, and adipocyte life cycle by medicinal plants and phytochemicals represent an important goal in the development of new anti-obesity drugs. We conducted an extensive review of the literature and electronic databases, including Google Scholar, PubMed, Science Direct, and MedlinePlus, for collecting data on the therapeutic effects of medicinal plants/phytochemicals in curing obesity and its related inflammation and CVD diseases, including cellular and molecular mechanisms, cytokines, signal transduction cascades, and clinical trials.

The Importance of the Diaphragm in Neuromotor Function in the Patient with Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a constant and chronic narrowing of the respiratory airways, with numerous associated symptoms, not always related to the pathological adaptation of the lungs. Statistical projections show that COPD could become the third leading cause of death globally by 2030, with a significant increase in deaths by 2060. Skeletal muscle dysfunction, including the diaphragm, is one of the causes linked to the increase in mortality and hospitalization. Little emphasis is given by the scientific literature to the importance of the diaphragm towards functional neuromotor pathological expressions. The article reviews the adaptation of the skeletal muscles, with greater attention to the adaptations of the diaphragm, thereby highlighting the non-physiological variations that the main respiratory muscle undergoes and the neuromotor impairment found in COPD. The text could be an important reflection from a clinical and rehabilitation point of view, to direct greater attention to the function and adaptation of the diaphragm muscle.

Herbal medicine for the treatment of obesity-associated asthma: a comprehensive review

Obesity is fast growing as a global pandemic and is associated with numerous comorbidities like cardiovascular disease, hypertension, diabetes, gastroesophageal reflux disease, sleep disorders, nephropathy, neuropathy, as well as asthma. Studies stated that obese asthmatic subjects suffer from an increased risk of asthma, and encounter severe symptoms due to a number of pathophysiology. It is very vital to understand the copious relationship between obesity and asthma, however, a clear and pinpoint pathogenesis underlying the association between obesity and asthma is scarce. There is a plethora of obesity-asthma etiologies reported viz., increased circulating pro-inflammatory adipokines like leptin, resistin, and decreased anti-inflammatory adipokines like adiponectin, depletion of ROS controller Nrf2/HO-1 axis, nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-3 (NLRP3) associated macrophage polarization, hypertrophy of WAT, activation of Notch signaling pathway, and dysregulated melanocortin pathway reported, however, there is a very limited number of reports that interrelates these pathophysiologies. Due to the underlying complex pathophysiologies exaggerated by obese conditions, obese asthmatics respond poorly to anti-asthmatic drugs. The poor response towards anti-asthmatic drugs may be due to the anti-asthmatics approach only that ignores the anti-obesity target. So, aiming only at the conventional anti-asthmatic targets in obese-asthmatics may prove to be futile until and unless treatment is directed towards ameliorating obesity pathogenesis for a holistic approach towards amelioration of obesity-associated asthma. Herbal medicines for obesity as well as obesity-associated comorbidities are fast becoming safer and more effective alternatives to conventional drugs due to their multitargeted approach with fewer adverse effects. Although, herbal medicines are widely used for obesity-associated comorbidities, however, a limited number of herbal medicines have been scientifically validated and reported against obesity-associated asthma. Notable among them are quercetin, curcumin, geraniol, resveratrol, β-Caryophyllene, celastrol, tomatidine to name a few. In view of this, there is a dire need for a comprehensive review that may summarize the role of bioactive phytoconstituents from different sources like plants, marine as well as essential oils in terms of their therapeutic mechanisms. So, this review aims to critically discuss the therapeutic role of herbal medicine in the form of bioactive phytoconstituents against obesity-associated asthma available in the scientific literature to date.

Increased Abdominal Perimeter Differently Affects Respiratory Function in Men and Women

Obesity is a worldwide epidemic being the main cause of cardiovascular, metabolic disturbances and chronic pulmonary diseases. The increase in body weight may affect the respiratory system due to fat deposition and systemic inflammation. Herein, we evaluated the sex differences in the impact of obesity and high abdominal circumference on basal ventilation. Thirty-five subjects, 23 women and 12 men with a median age of 61 and 67, respectively, were studied and classified as overweight and obese according to body mass index (BMI) and were also divided by the abdominal circumference. Basal ventilation, namely, respiratory frequency, tidal volume, and minute ventilation, was evaluated. In normal and overweight women, basal ventilation did not change, but obese women exhibited a decrease in tidal volume. In men, overweight and obese subjects did not exhibit altered basal ventilation. In contrast, when subjects were subdivided based on the abdominal perimeter, a higher circumference did not change the respiratory frequency but induced a decrease in tidal volume and minute ventilation in women, while in men these two parameters increased. In conclusion, higher abdominal circumference rather than BMI is associated with alterations in basal ventilation in women and men.

Obesity as a Risk Factor for Severe COVID-19 in Hospitalized Patients: Epidemiology and Potential Mechanisms

SARS-CoV-2 infection is a global public health problem, causing significant morbidity and mortality. Evidence shows that obesity is a recognized risk factor for hospitalization, admission to critical care units, and the development of serious complications from COVID-19. This review analyzes the available epidemiological evidence that relates obesity to a higher risk of severity and mortality from COVID-19, examining the possible pathophysiological mechanisms that explain this phenomenon on a cellular and molecular level.