Obesity is an Independent Risk Factor for Mortality in Otherwise Healthy Patients After Hepatectomy

Perez, Maria Gabriela Urdaneta; Garwe, Tabitha; Stewart, Katharine E.; Sarwar, Zoona; Morris, Katherine T.

doi:10.1016/j.jss.2020.05.024

Cited by 8 publications

(10 citation statements)

References 22 publications

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“…There were 28 studies 70,96,107,109,150,156,160–181 (29 cohorts; 2,068,365 participants) with surgical populations (Table S3): 17 cohorts in North America, 6 were in Europe, 4 in East Asia, and 1 each in South Asian and the Pacific. Mean age of participants ranged from 46 to 83 years.…”

Section: Resultsmentioning

confidence: 99%

“…There was one large study 165 whose dataset overlapped with other studies' datasets. 161,162,168,172,179,180 When we removed that one large study, the unadjusted results were no longer significant (β À0.323 [95% CI À0.756, 0.110]), and adjusted results remained non-significant (β À0.730 [95% CI À1.786, 0.326]). Replacing the quadratic term for BMI with a linear term did importantly change the results (Table 2).…”

Section: Surgical Populationsmentioning

confidence: 99%

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Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

2023

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SummaryFasting insulin and c‐reactive protein confound the association between mortality and body mass index. An increase in fat mass may mediate the associations between hyperinsulinemia, hyperinflammation, and mortality. The objective of this study was to describe the “average” associations between body mass index and the risk of mortality and to explore how adjusting for fasting insulin and markers of inflammation might modify the association of BMI with mortality. MEDLINE and EMBASE were searched for studies published in 2020. Studies with adult participants where BMI and vital status was assessed were included. BMI was required to be categorized into groups or parametrized as non‐first order polynomials or splines. All‐cause mortality was regressed against mean BMI squared within seven broad clinical populations. Study was modeled as a random intercept. β coefficients and 95% confidence intervals are reported along with estimates of mortality risk by BMIs of 20, 30, and 40 kg/m2. Bubble plots with regression lines are drawn, showing the associations between mortality and BMI. Splines results were summarized. There were 154 included studies with 6,685,979 participants. Only five (3.2%) studies adjusted for a marker of inflammation, and no studies adjusted for fasting insulin. There were significant associations between higher BMIs and lower mortality risk in cardiovascular (unadjusted β −0.829 [95% CI −1.313, −0.345] and adjusted β −0.746 [95% CI −1.471, −0.021]), Covid‐19 (unadjusted β −0.333 [95% CI −0.650, −0.015]), critically ill (adjusted β −0.550 [95% CI −1.091, −0.010]), and surgical (unadjusted β −0.415 [95% CI −0.824, −0.006]) populations. The associations for general, cancer, and non‐communicable disease populations were not significant. Heterogeneity was very large (I2 ≥ 97%). The role of obesity as a driver of excess mortality should be critically re‐examined, in parallel with increased efforts to determine the harms of hyperinsulinemia and chronic inflammation.

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Section: Resultsmentioning

confidence: 99%

Section: Surgical Populationsmentioning

confidence: 99%

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

2023

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“…There is experimental and clinical data showing that hepatic regeneration is impaired in steatotic livers (9)(10)(11). However, the influence of obesity and NASH on PHLF and morbidity is unclear (3,(12)(13)(14). This study investigated postoperative outcomes after liver resection (LR) in a large cohort of patients.…”

Section: Original Articlementioning

confidence: 99%

“…Length of stay (days), median [IQR]11[8][9][10][11][12][13][14][15] 11[8-15] 10.5 [8-16] 10 [8-14] 0.56 BMI, body mass index; PHLF, post-hepatectomy liver failure; IQR, interquartile range.…”

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confidence: 99%

Obesity and its influence on liver dysfunction, morbidity and mortality after liver resection

Kampf¹,

Sponder²,

Fitschek³

et al. 2023

Hepatobiliary Surg Nutr

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Background: Obesity and associated steatosis is an increasing health problem worldwide. Its influence on post-hepatectomy liver failure (PHLF) and after liver resection (LR) is still unclear.Methods: Patients who underwent LR were investigated and divided into three groups [normal weight: body mass index (BMI) 18.5-24.9 kg/m 2 , overweight: BMI 25.0-29.9 kg/m 2 , obese: BMI ≥30 kg/m 2 ] in this retrospective study. Primary aim of this study was to assess the influence of BMI and nonalcoholic steatohepatitis (NASH) on PHLF and morbidity.Results: Of 888 included patients, 361 (40.7%) had normal weight, 360 (40.5%) were overweight, 167 (18.8%) were obese. Median age was 62.5 years (IQR, 54-69 years). The primary indication for LR was colorectal liver metastases (CLM) (n=366, 41.2%). NASH was present in 58 (16.1%) of normal weight, 84 (23.3%) of overweight and 69 (41.3%) of obese patients (P<0.001). PHLF occurred in 16.3% in normal weight, 15.3% in overweight and 11.4% in obese patients (P=0.32). NASH was not associated with PHLF.There was no association between patients' weight and the occurrence of postoperative complications (P=0.45). At multivariable analysis solely major LR (OR 2.7, 95% CI: 1.83-4.04; P<0.001) remained a significant predictor for PHLF.Conclusions: Postoperative complications and PHLF are comparable in normal weight, overweight and obese patients and LRs using modern techniques can be safely performed in these patients.

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“…Increasing pyroptosis is commonly observed in patients with diabetes. In addition, except hyperglycemia, high lipid, insulin resistance, and hyperinsulinemia all contribute to pyroptosis in DbCM via increasing ROS ( Lee and Kim, 2017 ; Kar et al, 2019 ; Urdaneta Perez et al, 2020 ), which is seen as a significant activator inducing the NLRP3 inflammasome. Pyroptosis has been identified to occur in various heart cell types in DbCM including cardiomyocytes, endothelial cells (ECs), and cardiac fibroblasts ( Qiu et al, 2017 ; Zhaolin et al, 2019 ; Chen et al, 2020 ).…”

Section: Pyroptosis In Diabetic Cardiomyopathymentioning

confidence: 99%

Pyroptosis and Its Regulation in Diabetic Cardiomyopathy

Meng

et al. 2022

Front. Physiol.

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Diabetic cardiomyopathy (DbCM) is a prevalent disease, characterized by contractile dysfunction and left ventricular hypertrophy. Patients with DbCM have high morbidity and mortality worldwide. Recent studies have identified that pyroptosis, a kind of cell death, could be induced by hyperglycemia involved in the formation of DbCM. This review summarizes the regulatory mechanisms of pyroptosis in DbCM, including NOD-like receptor3, AIM2 inflammasome, long non-coding RNAs, microRNAs, circular RNA, autophagy, and some drugs.

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Obesity is an Independent Risk Factor for Mortality in Otherwise Healthy Patients After Hepatectomy

Cited by 8 publications

References 22 publications

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

Obesity and its influence on liver dysfunction, morbidity and mortality after liver resection

Pyroptosis and Its Regulation in Diabetic Cardiomyopathy

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