Several studies have shown a pathological oxygenation (hypoxia/hyperoxia) on the adipose tissue in obese subjects. Additionally, the excess of body weight is often accompanied by a state of chronic low-degree inflammation. The inflammation phenomenon is a complex biological response mounted by tissues to combat injurious stimuli in order to maintain cell homeostasis. Furthermore, it is believed that the abnormal oxygen partial pressure occurring in adipose tissue is involved in triggering inflammatory processes. In this context, oxygen is used in modern medicine as a treatment for several diseases with inflammatory components. Thus, hyperbaric oxygenation has demonstrated beneficial effects, apart from improving local tissue oxygenation, on promoting angiogenesis, wound healing, providing neuroprotection, facilitating glucose uptake, appetite, and others. Nevertheless, an excessive hyperoxia exposure can lead to deleterious effects such as oxidative stress, pulmonary edema, and maybe inflammation. Interestingly, some of these favorable outcomes occur under high and low oxygen concentrations. Hereby, we review a potential therapeutic approach to the management of obesity as well as the oxygen-related inflammation accompanying expanded adipose tissue, based on elevated oxygen concentrations. To conclude, we highlight at the end of this review some areas that need further clarification.

Strategies designed to reduce adiposity and cardiovascular-accompanying manifestations have been based on nutritional interventions conjointly with physical activity programs. The aim of this 13-week study was to investigate the putative benefits associated to hypoxia plus exercise on weight loss and relevant metabolic and cardiorespiratory variables, when prescribed to obese subjects with sleep apnea syndrome following dietary advice. The participants were randomly distributed in the following three groups: control, normoxia, and hypoxia. All the subjects received dietary advice while, additionally, normoxia group was trained under normal oxygen concentration and Hypoxia group under hypoxic conditions. There was a statistically significant decrease in fat-free mass (Kg) and water (%) on the control compared to normoxia group (p < 0.05 and p < 0.01, respectively). Body weight, body mass index, and waist circumference decreased in all the groups after the study. Moreover, leukocyte count was increased after the intervention in hypoxia compared to control group (p < 0.05). There were no statistically significant variations within groups in other variables, although changes in appetite were found after the 13-week period. In addition, associations between the variations in the leukocyte count and fat mass have been found. The hypoxia group showed some specific benefits concerning appetite and cardiometabolic-related measurements as exertion time and diastolic blood pressure, with a therapeutical potential.

Background: Metabolic syndrome (MetS) is characterized by the clustering of hyperglycemia, hypertension, hypertriglyceridemia, low high-density lipoprotein cholesterol levels and central adiposity. Altitude has been proposed as a protective factor to prevent the development of MetS and its components.Aim: To determine whether living at geographical elevation is associated with MetS and its individual components after adjustment for potential confounders in an Ecuadoran population.Methods: The study included 260 Ecuadoran university graduates over 20 years of age, from the coastal or the Andean Altiplano region. The altitude of residence was imputed with the postal code of each participant residence according to the data of the Ecuadoran Geophysical Institute of the National Polytechnic School. MetS was defined according to the harmonizing definition. Logistic regression models were fitted to assess the relationship between altitude level and the prevalence of MetS and its individual components. To test the internal validity, re-sampling techniques were used (1,000 bootstrap samples).Results: Living at high altitude was associated with less hypercholesterolemia (OR = 0.24; p < 0.001), hyperglycemia (OR = 0.25; p < 0.05) and MetS (OR = 0.24; p < 0.05), after adjusting for potential confounders. At high altitude the bootstrapped logistic regression models showed lower prevalence of hypercholesterolemia (OR = 0.30; p < 0.05), hyperglycemia (OR = 0.22; p < 0.001) and MetS (OR = 0.28; p < 0.05). The MetS score (0-5 points) showed a reduction in the number of MetS components at high altitude compared to sea level (B = −0.34; p = 0.002). A statistically significant lower self-reported energy intake was found in high altitude compared to sea level after adjustment for potential confounders (p < 0.001).Conclusion: In the present study concerning a small Ecuadoran population composed of highly educated adults living at the coast and the Andean Altiplano, living at high altitude (2,758–2,787 m) was associated with a lower prevalence of MetS, hypercholesterolemia and hyperglycemia, compared to the participants at sea level (4–6 m). In addition, an inverse association between altitude and self-reported energy intake was found after adjusting for covariates, suggesting a physiological role of appetite at high altitude even in acclimated subjects.

Living in a geographically higher altitude affects oxygen availability. The possible connection between environmental factors and the development of metabolic syndrome (MetS) feature is not fully understood, being the available epidemiological evidence still very limited. The aim of the present study was to evaluate the longitudinal association between altitude and incidence of MetS and each of its components in a prospective Spanish cohort, The Seguimiento Universidad de Navarra (SUN) project. Our study included 6860 highly educated subjects (university graduates) free from any MetS criteria at baseline. The altitude of residence was imputed with the postal code of each individual subject residence according to the data of the Spanish National Cartographic Institute and participants were categorized into tertiles. MetS was defined according to the harmonized definition. Cox proportional hazards models were used to assess the association between the altitude of residence and the risk of MetS during follow-up. After a median follow-up period of 10 years, 462 incident cases of MetS were identified. When adjusting for potential confounders, subjects in the highest category of altitude (>456 m) exhibited a significantly lower risk of developing MetS compared to those in the lowest tertile (<122 m) of altitude of residence [Model 2: Hazard ratio = 0.75 (95% Confidence interval: 0.58–0.97); p for trend = 0.029]. Living at geographically higher altitude was associated with a lower risk of developing MetS in the SUN project. Our findings suggest that geographical elevation may be an important factor linked to metabolic diseases.

Obesity is a multifactorial, chronic, inflammatory disease that involves different processes, such as adipose tissue hypoxia. The aim of the current study was to characterize the effects of conditioned medium (CM) from lipopolysaccharide (LPS)-activated macrophages on the regulation of hypoxia-inducible factor 1α (HIF-1α)-related genes in murine adipocytes. For the in vitro analyses, 3T3-L1 murine adipocytes (9 days postdifferentiation) were incubated either in CM (25% medium of RAW 264.7 murine macrophages with 24 hr 500 ng/ml LPS), LPS at 500 ng/ml, or hypoxia (Hx; 1% O , 94% N , 5% CO ) for 24 hr. For the in vivo experiments, mice were fed a high-fat diet. Both epididymal white adipose tissue (eWAT) and adipocytes in CM showed upregulation of Glut1, Mcp1, Il10, Tnf, and Il1b. The secretion of IL-6, TNF-α, and MCP-1 was also increased in CM-treated adipocytes. Moreover, increased levels of HIF-1α subunit and nuclear factor kappa B p65 were found after CM treatment, linking Hx, and inflammation. HIF-1α directly bound vascular endothelial growth factor A (Vegfa) and uncoupling protein 2 (Ucp2) genes, up- and downregulating its expression, respectively. Furthermore, the oxygen consumption rate was 30% lower in CM. The siRNA knockdown of mammalian target of rapamycin (Mtor) reversed the induction of HIF-1α found in CM. The macrophage infiltration simulated through CM seems to be a similar environment to an abnormally enlarged eWAT. We have evidenced that HIF-1α plays a regulatory role in the expression of Vegfa and Ucp2 in CM. Finally, the inhibition of the mTOR pathway prevented the HIF-1α activation induced by CM. The involvement of HIF-1α under proinflammatory conditions provides insight into the origins of Hx in obesity.