<i>In vivo</i>reflectance-mode confocal microscopy assessments: impact of overweight on human skin microcirculation and histomorphology

Altıntaş, Ahmet; Aust, Matthias; Krämer, R.; Vogt, Peter M.; Altintas, M.A.

doi:10.1117/1.jbo.21.3.036009

Cited by 8 publications

(19 citation statements)

References 26 publications

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“…Individuals with obesity experience increased cutaneous blood flow to meet the oxygenation needs of tissue. However, the blood flow of adipose tissue generally decreases with obesity both after a meal and during a fasting state [ 61 , 72 ]. Conversely, Chin et al used laser doppler flowmetry and dynamic capillaroscopy to measure cutaneous blood flow at the nailfold of children of comparable age, sex, and skin temperature, but with different levels of obesity, finding significant increases in baseline cutaneous flow with obesity [ 61 ].…”

Section: Individual Variations In the Human Populationmentioning

confidence: 99%

“…Perhaps most detrimental to the PPG waveform is skin thickness, as it is directly correlated to BMI and can dampen PPG signal amplitude [ 56 , 70 ]. For example, the epidermal thickness of the volar forearm has been shown to be higher in overweight normotensive nondiabetic individuals compared to age- and sex-matched healthy controls [ 72 ]. Note that skin thickness in the literature has always showed an increase with obesity, but the increase is body site-dependent.…”

Section: Individual Variations In the Human Populationmentioning

confidence: 99%

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Sources of Inaccuracy in Photoplethysmography for Continuous Cardiovascular Monitoring

et al. 2021

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Photoplethysmography (PPG) is a low-cost, noninvasive optical technique that uses change in light transmission with changes in blood volume within tissue to provide information for cardiovascular health and fitness. As remote health and wearable medical devices become more prevalent, PPG devices are being developed as part of wearable systems to monitor parameters such as heart rate (HR) that do not require complex analysis of the PPG waveform. However, complex analyses of the PPG waveform yield valuable clinical information, such as: blood pressure, respiratory information, sympathetic nervous system activity, and heart rate variability. Systems aiming to derive such complex parameters do not always account for realistic sources of noise, as testing is performed within controlled parameter spaces. A wearable monitoring tool to be used beyond fitness and heart rate must account for noise sources originating from individual patient variations (e.g., skin tone, obesity, age, and gender), physiology (e.g., respiration, venous pulsation, body site of measurement, and body temperature), and external perturbations of the device itself (e.g., motion artifact, ambient light, and applied pressure to the skin). Here, we present a comprehensive review of the literature that aims to summarize these noise sources for future PPG device development for use in health monitoring.

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Section: Individual Variations In the Human Populationmentioning

confidence: 99%

Section: Individual Variations In the Human Populationmentioning

confidence: 99%

Sources of Inaccuracy in Photoplethysmography for Continuous Cardiovascular Monitoring

et al. 2021

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“…Overweight and obesity have been associated with dermal capillary rarefaction and impaired capillary recruitment in the skin. Using reflectance-mode confocal microscopy, Altintas et al found lower dermal capillary density (number of capillaries/tissue area) in overweight patients compared to lean subjects [68]. De Ciuceis et al studied the additive effect of hypertension and weight loss in obesity-induced cutaneous capillary rarefaction using cutaneous intravital video-microscopy [69].…”

Section: Skinmentioning

confidence: 99%

Capillary Rarefaction in Obesity and Metabolic Diseases—Organ-Specificity and Possible Mechanisms

Paavonsalo

Hariharan

Lackman

et al. 2020

Cells

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Obesity and its comorbidities like diabetes, hypertension and other cardiovascular disorders are the leading causes of death and disability worldwide. Metabolic diseases cause vascular dysfunction and loss of capillaries termed capillary rarefaction. Interestingly, obesity seems to affect capillary beds in an organ-specific manner, causing morphological and functional changes in some tissues but not in others. Accordingly, treatment strategies targeting capillary rarefaction result in distinct outcomes depending on the organ. In recent years, organ-specific vasculature and endothelial heterogeneity have been in the spotlight in the field of vascular biology since specialized vascular systems have been shown to contribute to organ function by secreting varying autocrine and paracrine factors and by providing niches for stem cells. This review summarizes the recent literature covering studies on organ-specific capillary rarefaction observed in obesity and metabolic diseases and explores the underlying mechanisms, with multiple modes of action proposed. It also provides a glimpse of the reported therapeutic perspectives targeting capillary rarefaction. Further studies should address the reasons for such organ-specificity of capillary rarefaction, investigate strategies for its prevention and reversibility and examine potential signaling pathways that can be exploited to target it.

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“…Epidermal thickness has been shown to increase with increasing BMI. 47 , 48 Altintas et al. 47 revealed through histology that there was 20% thicker epidermis in the forearm of overweight individuals versus their control group (54.8 versus

).…”

Section: Differences In the Primary Layers Of The Skin With Obesitymentioning

confidence: 99%

“… 47 , 48 Altintas et al. 47 revealed through histology that there was 20% thicker epidermis in the forearm of overweight individuals versus their control group (54.8 versus

). Epidermal skin appears thicker and rougher in the obese.…”

Section: Differences In the Primary Layers Of The Skin With Obesitymentioning

confidence: 99%

Skin optical properties in the obese and their relation to body mass index: a review

et al. 2022

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. Significance: Obesity is a worldwide epidemic contributing directly to several cardiovascular risk factors including hypertension and type 2 diabetes. Wearable devices are becoming better at quantifying biomarkers relevant for the management of health and fitness. Unfortunately, both anecdotal evidence and recent studies indicate that some wearables have higher levels of error when utilized by populations with darker skin tones and high body mass index (BMI). There is an urgent need for a better evaluation of the limits of wearable health technologies when used by obese individuals. Aims: (1) To review the current know-how on changes due to obesity in the skin epidermis, dermis, and subcutis that could affect the skin optical properties; (2) for the green wavelength range, to evaluate the difference in absorption and scattering coefficients from the abdominal skin between individuals with and without elevated BMI. The changes include alterations in layer thickness and cell size, as well as significant differences in chromophores and scatterer content, e.g., water, hemoglobin, collagen, and lipids. Approach: We have summarized literature pertaining to changes in skin and its components in obesity and report the results of our search using articles published between years 1971 and 2020. A linear model was used to demonstrate the absorption and reduced scattering coefficient of the abdominal skin of individuals with and without elevated BMI in the green wavelength range (530 to 550 nm) that is typically found in most wearables. Results: The general trends indicate a decrease in absorption for both dermis and subcutis and an increase in reduced scattering for both epidermis and dermis. At 544-nm wavelength, a typical wavelength used for photoplethysmography (PPG), the absorption coefficient’s relative percentage difference between high and low BMI skin, was 49% in the subcutis, 19% in the dermis, and negligible in the epidermis, whereas the reduced scattering coefficient relative difference was 21%, 29%, and 165% respectively. Conclusions: These findings suggest that there could be significant errors in the output of optical devices used for monitoring health and fitness if changes due to obesity are not accounted for in their design.

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In vivoreflectance-mode confocal microscopy assessments: impact of overweight on human skin microcirculation and histomorphology

Cited by 8 publications

References 26 publications

Sources of Inaccuracy in Photoplethysmography for Continuous Cardiovascular Monitoring

Sources of Inaccuracy in Photoplethysmography for Continuous Cardiovascular Monitoring

Capillary Rarefaction in Obesity and Metabolic Diseases—Organ-Specificity and Possible Mechanisms

Skin optical properties in the obese and their relation to body mass index: a review

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