Lifestyle Intervention with Weight Reduction

Tuomilehto, Henri; Seppä, Juha; Partinen, Markku; Peltonen, Markku; Gylling, Helena; Tuomilehto, Jaakko; Vanninen, Esko; Kokkarinen, Jouko; Sahlman, Johanna; Martikainen, Tarja; Soini, EJ; Randell, Jukka; Tukiainen, H; Uusitupa, Matti

doi:10.1164/rccm.200805-669oc

Cited by 354 publications

(102 citation statements)

References 44 publications

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“…Weight loss is strongly recommended for patients with obesity related diseases such as obstructive sleep apnea [51], [52], but the effect of early intervention on lung and cardiac function in asymptomatic obese subjects is less clear. It has previously been shown that surgical induced weight loss has positive effects on cardiac function [31], [53], [54], [55], [56].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary and Cardiac Function in Asymptomatic Obese Subjects and Changes following a Structured Weight Reduction Program: A Prospective Observational Study

et al. 2014

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BackgroundThe prevalence of obesity is rising. Obesity can lead to cardiovascular and ventilatory complications through multiple mechanisms. Cardiac and pulmonary function in asymptomatic subjects and the effect of structured dietary programs on cardiac and pulmonary function is unclear.ObjectiveTo determine lung and cardiac function in asymptomatic obese adults and to evaluate whether weight loss positively affects functional parameters.MethodsWe prospectively evaluated bodyplethysmographic and echocardiographic data in asymptomatic subjects undergoing a structured one-year weight reduction program.Results74 subjects (32 male, 42 female; mean age 42±12 years) with an average BMI 42.5±7.9, body weight 123.7±24.9 kg were enrolled. Body weight correlated negatively with vital capacity (R = −0.42, p<0.001), FEV1 (R = −0.497, p<0.001) and positively with P 0.1 (R = 0.32, p = 0.02) and myocardial mass (R = 0.419, p = 0.002). After 4 months the study subjects had significantly reduced their body weight (−26.0±11.8 kg) and BMI (−8.9±3.8) associated with a significant improvement of lung function (absolute changes: vital capacity +5.5±7.5% pred., p<0.001; FEV1+9.8±8.3% pred., p<0.001, ITGV+16.4±16.0% pred., p<0.001, SR tot −17.4±41.5% pred., p<0.01). Moreover, P0.1/Pimax decreased to 47.7% (p<0.01) indicating a decreased respiratory load. The change of FEV1 correlated significantly with the change of body weight (R = −0.31, p = 0.03). Echocardiography demonstrated reduced myocardial wall thickness (−0.08±0.2 cm, p = 0.02) and improved left ventricular myocardial performance index (−0.16±0.35, p = 0.02). Mitral annular plane systolic excursion (+0.14, p = 0.03) and pulmonary outflow acceleration time (AT +26.65±41.3 ms, p = 0.001) increased.ConclusionEven in asymptomatic individuals obesity is associated with abnormalities in pulmonary and cardiac function and increased myocardial mass. All the abnormalities can be reversed by a weight reduction program.

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Section: Discussionmentioning

confidence: 99%

Pulmonary and Cardiac Function in Asymptomatic Obese Subjects and Changes following a Structured Weight Reduction Program: A Prospective Observational Study

et al. 2014

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“…Although bariatric surgery leads to a greater weight loss at 1 year, intensive lifestyle interventions similar to that employed here lead to clinically significant weight loss and similar improvements in risk factors and resolution of comorbidities in patients with morbid obesity [23] . Randomized controlled trials strongly suggest that weight reduction from a healthy diet and increased physical activity may correct or at least improve symptoms in patients with mild OSA and in OSA patients with diabetes [12,24] .…”

Section: Discussionmentioning

confidence: 99%

“…Because of her morbid obesity, severe OSA and family history of cardiac disorders, we decided to put this patient on a VLCD as previously used safely and efficiently for the treatment of OSA [12,13] and in the long-term (i.e., > 12-month) treatment of severe obesity [17] . Furthermore, a review of randomized controlled trials has reported that VLCD with active follow-up treatment seems to be one of the better treatment modalities related to long-term weight-maintenance success [18] .…”

Section: Case Presentationmentioning

confidence: 99%

“…In contrast, lifestyle interventions, which combine very-low calorie diets (VLCD) with increased physical activity, promote a behavioral method of weight loss. Lifestyle interventions have been shown to be safe and effective for patients with OSA [12,13] , with beneficial outcomes maintained up to 1-year follow-up [14,15] . For instance, in a study of obese patients with mild to moderate OSA, treatment with a VLCD combined with aerobic and resistance exercise resulted in improvements in daytime sleepiness and quality of life as well as cardiometabolic outcomes [16] .…”

Section: Introductionmentioning

confidence: 99%

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Improving obstructive sleep apnea in a morbidly obese woman: Role of dietary modification and physical activity

Plourde

Kline²

2013

Clinical Nursing Studies

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Introduction: With obstructive sleep apnea (OSA) present in over 50% of those who are morbidly obese and the well-documented effects of OSA on health and functioning, proper management of this condition is an important consideration among treatment providers. Weight loss is a common goal for patients, though bariatric surgery carries significant risk for those with OSA. As a means of achieving weight loss, lifestyle interventions have been shown to significantly reduce OSA severity with minimal side effects. However, whether these controlled studies can be effectively applied to clinical practice for treating OSA is unknown. We describe how an intensive lifestyle intervention was successfully employed for the treatment of severe OSA in clinical practice.Case presentation: The patient, a 27 year old morbidly obese Caucasian woman (body mass index [BMI] = 56.2 kg/m 2 , neck circumference = 42 cm), presented with severe OSA (apnea-hypopnea index = 42) to our obesity clinic after refusing bariatric surgery. She was treated with a very-low-calorie diet for 6 months followed by a low-calorie diet for another 10 months combined with a progressive moderate-intensity exercise program and close medical supervision by a multidisciplinary management team. With treatment, she was able to reduce her weight by 38% (current BMI = 34.6 kg/m 2 ), decrease her neck circumference by 17% (currently 35 cm), and discontinue OSA treatment with continuous positive airway pressure. Conclusion:This case demonstrates that the use of dietary modification combined with physical activity may be a safe and effective option for improving OSA in obese patients. In particular, physical activity may be beneficial for the management of OSA for reasons beyond facilitating weight loss.

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“…Numerous studies, both large population-based and clinical, have concretely established relationships between obstructive sleep apnoea, type 2 diabetes, and obesity. [8][9][10][11] As the obesity epidemic continues, the prevalence of OSA and type 2 diabetes will increase. Many patients with type 2 diabetes have OSA, but unfortunately majority of them are unaware of it and remain undiagnosed.…”

Section: Introductionmentioning

confidence: 99%

A cross-sectional study to assess burden of obstructive sleep apnoea among type 2 diabetic patients attending urban health centre in an urban slum of south India

Undi¹,

Annadani²,

Badesaab³

2016

Int J Community Med Public Health

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INTRODUCTIONSleep apnoea is characterized by the cessation of airflow during sleep. There are three main types: obstructive, central, and mixed, and Obstructive sleep apnoea (OSA) is the most common. OSA is repetitive episodes of partial (hypopnea) or complete (apnoea) upper airway obstruction during sleep, resulting in a reduction or stoppage of airflow, followed by awakenings from sleep. OSA is a chronic disorder that often requires lifelong care. The signs, symptoms and consequences of OSA are a direct result of derangements that occur due to repetitive collapse of upper airway. OSA is affecting between 2% and 4% of middle aged adult population (3.6% in Indian adult population). It has been documented that OSA is a significant risk factor in the development of other clinical diseases including hypertension, cardiac arrhythmias, myocardial infarction, stroke, decreased cognitive abilities and excessive ABSTRACT Background: Obstructive sleep apnoea (OSA) is repetitive episodes of partial (hypopnea) or complete (apnoea) upper airway obstruction during sleep, resulting in a reduction or stoppage of airflow, followed by awakenings from sleep. Numerous studies, have concretely established relationships between OSA, type 2 diabetes mellitus (T2DM), and obesity. As the obesity epidemic continues in India, the prevalence of OSA and T2DM will increase. Many patients with T2DM have OSA, but unfortunately majority of them don't know it and remain undiagnosed especially in urban slums. OSA must be detected and treated immediately instead of waiting for years to decide whether there is a problem or not. Hence, the present study was done. Objective of the study is to assess the magnitude of OSA among the type 2 diabetic patients attending urban health centre (UHC) of an urban slum. Methods: This was a cross-sectional study done in an UHC of an urban slum in South India. The sample size was 71. After obtaining written informed consent, the data was collected from previously diagnosed T2DM patients attending UHC using a validated structured questionnaire (STOPBANG and ESS) by interview technique. Results: 66.2% of subjects had high risk of OSA (35.2% had intermediate risk and 31.0% had severe risk of OSA). 40.8% had excessive daytime sleepiness, EDS (22.5% of participants had abnormal/severe EDS, 18.3% had moderate EDS). Conclusions: Nearly two third of T2DM patients had high risk of OSA and half of them had EDS, which was not detected earlier during their routine visits to hospitals in urban slum.

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Lifestyle Intervention with Weight Reduction

Abstract: VLCD combined with active lifestyle counseling resulting in marked weight reduction is a feasible and effective treatment for the majority of patients with mild OSA, and the achieved beneficial outcomes are maintained at 1-year follow-up.

Cited by 354 publications

References 44 publications

Pulmonary and Cardiac Function in Asymptomatic Obese Subjects and Changes following a Structured Weight Reduction Program: A Prospective Observational Study

Pulmonary and Cardiac Function in Asymptomatic Obese Subjects and Changes following a Structured Weight Reduction Program: A Prospective Observational Study

Improving obstructive sleep apnea in a morbidly obese woman: Role of dietary modification and physical activity

A cross-sectional study to assess burden of obstructive sleep apnoea among type 2 diabetic patients attending urban health centre in an urban slum of south India

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