Obesity and the Lung: What We Know Today

Brock, Judith; Billeter, Adrian T.; Müller‐Stich, Beat P.; Herth, Felix

doi:10.1159/000509735

Cited by 55 publications

(40 citation statements)

References 71 publications

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“…Severe obesity is also associated with sleep apnea syndrome, which, in turn, is associated with increased cardiovascular risk [19]. Moreover, increased abdominal fat may impair diaphragmatic and respiratory function [20]. Obesity per se may also increase the risk of comorbidities already known to contribute to COVID-19 severity such as diabetes mellitus and atherothrombosis [21].…”

Section: Obesity and Body Compositionmentioning

confidence: 99%

Hypovitaminosis D and the endocrine phenotype of COVID-19

Giustina

2021

Endocrine

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Background Vitamin D and its deficiency have recently been suspected to be involved in increased susceptibility and negative outcomes of COVID-19. This assumption was based on the well known immunomodulatory actions of vitamin D and on the consistent finding of low levels of 25 hydroxyvitamin D (25OHD) in hospitalized patients with COVID-19. Moreover, several studies reported a correlation between 25OHD levels and different clinical outcomes of the disease. Aim Aim of the current review was to approach the topic of vitamin D and COVID-19 from a different perspective summarizing the data which led to the evidence of the existence of an endocrine phenotype of COVID-19. Conclusions This review analyzed in the light of the current knowledge the possibility that several endocrine manifestations of COVID-19 could be holistically interpreted in the context of an inadequate vitamin D status. Keywords Vitamin D • Hypocalcemia • Vertebral fractures • Diabetes mellitus • Obesity • COVID-19

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Section: Obesity and Body Compositionmentioning

confidence: 99%

Hypovitaminosis D and the endocrine phenotype of COVID-19

Giustina

2021

Endocrine

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“…A large US registry study including >17,000 patients, confirmed these results and additionally found that BMI increase and decrease from a baseline BMI with the lowest probability of death incrementally increased the odds of mortality at 90 days and 1 year after transplantation (45). The mechanisms are not entirely clear; however, via mechanical and probably metabolic effects, lung mechanics are altered in the presence of obesity (46). Weight loss before transplantation was associated with improved shortand long-term clinical outcomes, independent of initial weight (47), and a first case reports describes the successful bariatric surgery in a young women with a BMI of 53.6 kg/m 2 4 years after lung transplantation (48).…”

Section: Behavioral Outcomesmentioning

confidence: 76%

The Transplant Evaluation Rating Scale Predicts Clinical Outcomes 1 Year After Lung Transplantation: A Prospective Longitudinal Study

et al. 2021

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Objectives: It has been recommended that all candidates for lung transplantation undergo pre-transplant psychosocial evaluation for risk assessment. However, psychosocial issues are only important if they correlate with outcomes after transplantation.Methods: In this prospective study patients who were referred for lung transplantation from 2016 to 2018 (n = 352) at Hannover Medical School were evaluated using the Transplant Evaluation Rating Scale (TERS). Clinical outcomes included listing, and post-transplant outcomes including mortality, medical aspects such as lung allograft dysfunction, hospitalizations, and renal function, behavioral aspects such as BMI and adherence, and mental issues such as levels of depression, anxiety, and quality of life. TERS scores were divided into tertiles and, in addition, the impact of the two subscale scores—“defiance” and “emotional sensitivity”—was investigated.Results: Of the patients who were transplanted (n = 271) and were still alive (n = 251), 240 had already reached their 1-year assessment at the end of 2020 and were evaluated 1 year after the operation. A subgroup of 143 received an extended mental assessment. BMI, adherence scores, levels of anxiety, depression, and quality of life 1 year post-transplantation differed significantly between TERS tertiles with higher TERS scores predicting less favorable outcomes. The TERS subscale “defiance” was predictive of BMI and adherence whereas the TERS subscale “emotional sensitivity” was predictive of symptoms of anxiety and depression, and quality of life 1 year after transplantation. Patients in the lowest TERS tertile were more likely to having been listed and—as a trend—to having survived the first year after transplantationConclusions: Our findings show that psychosocial factors as measured by TERS score are predictors of behavioral and mental outcomes 1 year after lung transplantation. The TERS allows us to focus on psychosocial risk factors that can be treated or minimized before or after transplantation.

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“…A large portion of overweight patients suffer from OSAS and half of the OSAS patients are overweight. Obviously, there is a mechanical element in the pathogenesis: with an accumulation of fatty tissue in throat and thoracic area the airway is narrowed, the vital capacity is reduced and therefore the breathing frequency is elevated [32]. The metabolic element is caused on the one hand by oxidative stress due to apnea episodes and by inflammatory processes mediated by adipocytokines from adipose tissue on the other hand [33, 34].…”

Section: Obstructive Sleep Apneamentioning

confidence: 99%

Metabolic Surgery: Paradigm Shift in Metabolic Syndrome/Diabetes Therapy

Rühle¹,

Billeter²,

Müller‐Stich³

2022

Visc Med

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Background: Obesity and metabolic disorders as type 2 diabetes (T2D), nonalcoholic fatty liver disease (NAFLD) or better called metabolic dysfunction fatty liver disease (MAFLD), arterial hypertension (AHT), and obstructive sleep apnea syndrome (OSAS) show a rising prevalence. The increased cardiovascular risk is one of the main causes for death of obese, metabolic ill patients. Sustainable and efficient therapeutic options are needed. Summary: Metabolic surgery not only permits a substantial and lasting weight loss but also ameliorates metabolic co-morbidities and reduces cardiovascular risk and mortality of obese patients. Most existing data focused on T2D, but evidence for other metabolic co-morbidities such as NAFLD, AHT, and OSAS increase constantly. After metabolic surgery, glycemic control of diabetic patients is superior compared to conservative treatment. Also, diabetes related micro- and macrovascular complications are reduced after surgery, and the median life expectancy is over 9 years longer. In patients with MAFLD, metabolic surgery leads to reduction of steatosis and fibrosis while the risk to develop a hepatocellular carcinoma is reduced significantly. Patients with OSAS have an improved lung function and continuous pressure airway treatment during the night is unnecessary in many patients. Patients with AHT need significantly less or even no antihypertensive medication after surgery and the hazard ratio of death is reduced by 49.2%. Therefore, the focus in treating obese and metabolic ill patients is no longer on pure weight loss but on improvement of co-morbidities and reduction of mortality. This is reflected by the updated S3-guidelines of 2018 that provide nationally established consistent guidelines with clear indications for metabolic surgery no longer focusing on body mass index (BMI) only. This article aims to give an overview over the existing literature concerning surgical treatment options for metabolic syndrome. Key Messages: Metabolic co-morbidities impact life-quality and life expectancy of obese patients. Metabolic surgery offers the chance to treat those metabolic co-morbidities independently of the preoperative BMI and should be considered early as a treatment option for obese patients.

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Obesity and the Lung: What We Know Today

Cited by 55 publications

References 71 publications

Hypovitaminosis D and the endocrine phenotype of COVID-19

Hypovitaminosis D and the endocrine phenotype of COVID-19

The Transplant Evaluation Rating Scale Predicts Clinical Outcomes 1 Year After Lung Transplantation: A Prospective Longitudinal Study

Metabolic Surgery: Paradigm Shift in Metabolic Syndrome/Diabetes Therapy

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