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Purpose To study nurse anesthetists' experiences of key factors for successful airway management in general anesthesia of adult obese patients. Design The study was a qualitative observational study with a descriptive approach. Methods Eight semistructured interviews were conducted. Data were analyzed using the critical incident technique. Findings Five key factors for successful general anesthesia of adult obese patients were identified. These factors were preparing and planning the anesthesia, optimizing patient position, optimizing ventilation through proper preoxygenation and increasing positive end-expiratory pressure, quickly securing the airway, and working in teams. Conclusions Knowledge of key factors that facilitate and improve the anesthesia care of obese patients is important to provide safe and quality anesthesia to this patient group as obese patients often have small margins and urgent situations can quickly arise. This knowledge enables the nurse anesthetist to be one step ahead and to be ready to take action if complications occur.

Background: Exercise, which is the keystone of type 2 diabetes millets (T2DM) and obesity treatment, has revealed a great variance of effects on adipokines levels. Vaspin is a new adipocytokine with insulin-sensitizing effects, but its regulation in obesity and physical exercise are not clear yet. Objective: Exploring the effect of continuous and intermittent exercise on circulating levels of vaspin and its relation to some metabolic changes and inflammatory markers in lean and obese rats. Material and methods: A total number of60 adult male local strain albino rats were used. Rats were divided into 2 main groups: group I" lean group, and group II "HFD group; Each group was further subdivided into 3 equal subgroups: group I A; control group with sedentary life, group I B; rats were exposed to continuous exercise, and group I C; rats were exposed to intermittent exercise. Serum vaspin, insulin, glucose, triglycerides, cholesterol, HDL, TNF and CRP levels were measured. In addition, BMI, HOMA-IR and atherogenic index were calculated in all groups. Results: Serum vaspin levels were higher in obese (HFD) than in lean rats. Vaspin levels increased in continuous and intermittent exercised lean groups, and decreased in HFD induced obesity. Vaspin correlated negatively with inflammatory markers, HOMA-IR, TC TG and positively with HDL-C. Conclusion: Serumvaspin levels were up regulated in HFD induced obesity. Intermittent exercise was more effective than continuous exercise in improving metabolic parameters and ameliorating inflammatory effect of obesity partially by modulating circulating vaspin levels in lean and obese rats.

The effects of lipid-lowering agents (LLA) on reducing systemic and oral inflammation have not been evaluated. Objective To assess the association of LLA use with high-sensitivity C-reactive protein (hs-CRP) and oral inflammation. Design Cross-sectional analysis using baseline data from 1,300 overweight/obese participants aged 40-65 years, recruited for the ongoing San Juan Overweight Adults Longitudinal Study. Serum hs-CRP was measured by ELISA, gingival/periodontal inflammation was evaluated as bleeding upon probing (BOP), and LLA was self-reported. Separate logistic models were performed for systemic and oral inflammation. Results 24% participants reported history of dyslipidemia, of which, 50.3% self-reported LLA use. Sixty percent of the participants had elevated hs-CRP (>3 mg/dL) and 50% had high BOP (defined as at or above the median: 21%). After adjusting for age, gender, smoking, HDL-C, physical activity, diabetes, blood pressure medications, and percent body fat composition, LLA users had significantly lower odds of elevated hs-CRP compared to LLA non-users (OR=0.55; 95% CI: 0.38-0.81). After adjusting for age, gender, smoking status, educational level, and mean plaque index, LLA users had significantly lower odds of high BOP compared to LLA non-users (OR= 0.62; 95% CI: 0.42-0.91). Conclusions Lipid-lowering agents may reduce both systemic and oral inflammatory responses. This article is protected by copyright. All rights reserved.

To prevent or remedy musculoskeletal conditions, the relationship between obesity and the characteristics of muscle mass and strength need to be clarified. [Subjects and Methods] A total of 259 Japanese males aged 30-64 years were classified into 4 groups according to the Japanese obesity criteria. Body composition was evaluated, and handgrip strength and knee extensor strength were measured for the upper and lower extremities, respectively. Physical performance was evaluated with a jump test. [Results] Obesity was positively correlated with skeletal muscle mass index, percentage of whole-body fat, and leg muscle strength and negatively correlated with the percentage of muscle mass index, body weight-normalized handgrip strength, and knee extensor strength, and the jump test results. [Conclusion] Weight loss may be a better approach than increasing muscle mass and strength to improve musculoskeletal conditions in obese adult males.

Background: Obesity is associated with multiple comorbidities and increased mortality, making it an important target for treatment. However, achieving and maintaining weight loss by diet and physical activity remains challenging, and may often require pharmacotherapy. Liraglutide 3.0 mg has recently been approved for weight management in the United States, Canada, and EU. The current analysis used a summative usability test to assess safety and effectiveness, ease of use, and training requirements for the novel liraglutide 3.0 mg pen injector. Methods: Of the 234 participants, half received instructions for use and video-based training and/or opportunity to handle the device. All participants (excluding pharmacists) performed 6 tasks followed by post- task interviews on task difficulty, device ease of use, and any use errors, close calls, and operational difficulties. Tasks included differentiation of correct box and pen injector, medication clarity assessment, normal, dose reversal, and end-of-content injection. Number/type of use errors, close calls, and operational difficulties were evaluated. Results: All assessed participants interpreted the instructions for use correctly. No potentially serious use errors, and low numbers of nonserious errors, were reported. Overall, participants committed 105 use errors related to handling, with no potential for harm. A total of 25 close calls and 44 operational difficulties were reported without any pattern indicative of a design flaw. Marked differences in the incidence of events were observed for trained versus untrained participants regardless of prior injection experience. Participants rated ease of use as 6.4/7. Conclusions: The liraglutide 3.0 mg pen injector is safe and easy to use for liraglutide administration. New device features allow for safe use after brief training.

a b s t r a c t INTRODUCTION: Descent of the ureter into the inguinal canal or scrotum is rare but undoubtedly under- reported. Most known cases were recognized at the time of surgery for hernia repair. We encountered five cases recently. PRESENTATION OF CASE: We reviewed the records and CT images of five patients with inguinal hernias containing a segment of the ureter. All of our cases, like most reported cases, featured obese adult males. Our cases had different outcomes, ranging from inadvertent injury of the displaced ureter to correction of the anomaly at the time of hernia repair. DISCUSSION: In all of our cases, the affected ureter was displaced anteriorly from the psoas muscle by greater than 1 cm at the level of the L4 vertebra on abdominal CT. This association has not been previously described. CONCLUSION: Pre-operative diagnosis by CT can prevent injury to the ureter. We hypothesize that anterior displacement of the ureter at the level of L4 as seen on CT may be predictive of inguinoscrotal herniation of the ureter. © 2015 The Authors. Published by Elsevier Ltd. on behalf of Surgical Associates Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Origin of the great inter-individual variability of the fatty taste perception found in obese subjects is challenging. The fact that recent studies suggest interrelations between taste perception and oral microbiota composition, prompt us to explore the putative impact of such a connection in the context of obesity. To check this hypothesis, the oro-sensory perception thresholds of linoleic acid and the composition of oral microbiota surrounding the gustatory circumvallate papillae (CVPs) were analyzed in obese adult men (BMI ≥ 30 kg/m2, n = 42). A specific microbial signature (higher diversity, pro-inflammatory bacterial profile, lower methanogenesis activity) discriminated subjects with a degraded fatty taste sensitivity (perception threshold ≥ 0.05% LA = Low-LA tasters, n = 22) from high-LA tasters (n = 20). Collectively, these data substantiate the association between the microbial microenvironment surrounding CVPs and the fatty taste sensitivity and provide a plausible explanation about the variability of the fatty taste sensitivity in obesity.

Objective This study investigated the phases of change and the relationship between binge eating (BE) episodes and weight across 20 weeks of emotionally focused group therapy (EFGT) and combined therapy (CT) of EFGT plus dietary counselling for BE disorder. Methods We used a non-randomized observational study design that included 118 obese adult patients with BE disorder who were treated by manualized therapy protocols. Participants were assigned to treatment condition (EFGT or CT) based on consensus among clinicians. Participants were assessed weekly during the 20 weeks of therapy for weight and BE episodes and at pre-treatment and 6 months post-treatment. Results Binge eating episodes and weight significantly declined during EFGT and CT. Compared with EFGT, CT resulted in more rapid weight loss across weeks of therapy. BE episodes and weight significantly covaried, and their positive association increased as sessions progressed. Change in BE episodes and weight during treatment was best modelled by a cubic growth curve showing a slow rate of change in early sessions, a faster rate of change in middle sessions and a slower rate of change in late sessions. This cubic modelling of change was associated with better outcomes 6 months post-treatment. Conclusion Cubic modelling of change supported a three-stage model of EFGT and CT, and the cubic trajectory was associated with better outcomes at follow-up. The addition of dietary counselling to EFGT resulted in earlier response to treatment in terms of BE episodes and weight among those in the CT condition. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message Decline in binge eating (BE) episodes is related to decline in weight, and this relationship was greater towards the end of treatment. Emotionally focused group therapy plus dietary counselling that targets both affect regulation and nutritional problems resulted in faster rate of response early in treatment both in terms of BE episodes and weight. Combined emotionally focused group therapy and dietary counselling may provide clinicians with an additional approach to treating BE disorder.

Childhood obesity is now a global problem throughout the world. The major factors affecting weight regulation and the development of obesity in children are the result of a large number of biological, behavioral, social, environmental, and economic factors and the complex interactions between them that promote a positive energy balance. The changes in the dietary habits with the adoption of sedentary life style increases manifold obesity-related diseases and their complications. An obese child later on grows up to become an obese adult. Therefore, the role of primary prevention along with methodical diet control, behavioral changes, and physical activity are the important strategies against the battle of childhood obesity.

Background Accurate dosing of vancomycin is difficult due to high inter-individual variability of vancomycin pharmacokinetics (PK), and is particularly challenging in obese patients. Vancomycin is hydrophilic, yet total body weight (TBW) has traditionally been used for dosing in the general population, and also into the obese population. The aim of this study was to evaluate the performance of published vancomycin PK models in a large set of routine clinical data obtained from an obese population. Methods De-identified data were available from 1717 courses of vancomycin administered to obese adults (BMI ≥ 30) from hospitals across the United States, EU, and Australia. Three population PK models, Buelga et al. (2005), Goti et al. (2018), and an obese-specific model, Adane et al. (2015), were used to predict plasma concentrations at the time of each recorded vancomycin assay, and their accuracy and bias were compared. Goodness of fit at both the population and individual level was assessed, and elastic net regression was used to identify any sources of predictive error in the obese-specific model. Model parameters for each model were then re-estimated, and a variety of body size metrics were evaluated. Results The Buelga et al. one-compartment model had the best predictive ability (Table 1). In all models, bias (calculated as MME; mean per-patient mean predictive error) by obesity class was observed at both the population and individual levels, and unexpectedly was largest in the obese-specific model. In the obese-specific model, predictive error correlated with the use of TBW as a model covariate. A set of models derived from Adane et al. model were then developed to correct for weight. Using ideal body weight (IBW) on Vd and no correction for weight on CL provided the best fit. The derived model accounted for 81% of variance in plasma concentration and exhibited negligible bias by obesity class (population MME = -0.75 (i), -0.06 (ii), and -0.50 (iii) mg/L; individual MME = −0.20 (i), −0.02 (ii), and −0.02 (iii) mg/L). Conclusion Existing vancomycin population PK models for use in the obese population are biased in higher obesity classes due to the use of total body weight. A novel population PK model developed using ideal body weight exhibits negligible bias across obesity classes as well as improved predictive ability. Disclosures All authors: No reported disclosures.

Background: Obstructive sleep apnoea (OSA) is a potentially serious sleep order which is being proven to be an important etiological factor for multiple diseases. Obesity is most commonly associated with OSA. This study was conducted to know the prevalence of OSA in non-obese adult individuals using modified STOP-Bang questionnaire through online surveys and to evaluate the importance of internet and modern technology in the mass screening of OSA.Methods: Modified STOP-BANG questionnaire was used to study the prevalence of obstructive sleep apnoea in non-obese individuals. Instead of the routine marking of answers in a paper we used internet medium to do the study. Results: The study results showed 14.5% of the non- obese adult population involved in the study belong to the high-risk category of obstructive sleep apnoea.Conclusions:The study concluded that obstructive sleep apnoea not only occurs in obese adults but also prevalent among non-obese adults.

Repeated bouts of GH-releasing stimuli (both pharmacological and physiological, such as aerobic exercise) at 2-h intervals are associated with a blunting of somatotropic responsiveness in normal adults, while a persistent GH responsiveness to consecutive stimuli is reported to occur in children and adolescents. Recently, a single bout of respiratory muscle endurance training (RMET) by means of a specific commercially available device (Spiro Tiger®) has been shown to induce relevant GH responses in both normal-weighted and obese adult subjects. The aim of the present study was to evaluate GH responses to repeated bouts of RMET in obese adolescents and adults. Seven obese male adolescents (age: 15.7±0.4 years; body mass index, BMI: 38.0±3.3 kg/m2) and 10 obese adults (age: 22.2±1.4 years; BMI: 39.9±1.0 kg/m2) underwent an incremental progressive RMET protocol of 11 daily sessions. Blood samplings for GH determinations were collected during the 12th session, which was composed of 2 consecutive bouts of RMET (of identical intensity and duration: 1 min at a respiration rate of 28 acts/min, 5 min at 32 acts/min, 5 min at 34 acts/min, 4 min at 36 acts/min) at a 2-h interval in-between. Baseline GH levels significantly increased after the first bout of RMET in all subjects, higher GH peaks being found in obese adults than in obese adolescents (peaks: 14.3±2.1 ng/ml vs. 4.8±1.6 ng/ml, respectively, p

BACKGROUND: Obesity is a complex and incompletely understood disease.It is a population problem and should be tackled as such. OBJECTIVE: To study the prevalence of preobesity and obesity and nutritional profile of obese urban adult females. METHOD: A community based cross sectional study was carried out from Nov 2011 to May 2012 Total 553 adult females were enrolled. The data was analyzed by epi-info version. RESULTS: Prevalence of preobesity and obesity was found to be 17.18% and 6.5% respectively. CONCLUSION: As family is the first and most important of inculcating healthy habit and behavior, so particularly female should be made aware about causes and consequences of obesity from childhood level.

Unidas por la Vida, a behavioral weight-loss program, was developed for use among low-income, Mexican-American women with diabetes and their overweight/obese adult daughters. The program leverages community resources in a partnership between primary care and community-based organizations. This paper describes the program's implementation, lessons learned, and implications for sustainability.

Introduction: Sedentary lifestyle, overweight and obesity in adult women have high prevalence.Objective: To determine the effects of a high intensity interval training program on the anthropometric profile of overweight or obese women.Materials and methods: 24 adult women, including 16 with overweight and 8 with obesity, between 26 and 49 years of age, were selected to participate in a two month high intensity training program (three sessions per week). Weight, height, BMI, muscle mass percentage, and fat mass and visceral fat percentages were assessed.Results: The adherent group (≥75% assistance) was composed by 16 participants, while the non-adherent group (assistance 75%), by 8 participants. No significant differences were found among both groups previous to and after the intervention (p≥0.05).The non-adherent group did not show any significant change, while the adherent group improved (p0.05) their variables of weight (p0.001), BMI (p0.001), fat mass percentage (p0.001), muscle mass percentage (p0.001) and visceral fat percentage (p=0.020) after the intervention.Conclusions: The training program improved the anthropometric profile of the participants without requiring specialized equipment or involving high costs, thus, this procedure is recommended for the treatment of malnutrition by excess in this type of population. Introducción.Existe una alta prevalencia de sedentarismo, sobrepeso y obesidad en mujeres adultas.Objetivo. Determinar los efectos de un programa de entrenamiento intervalado de alta intensidad sobre el perfil antropométrico de mujeres con sobrepeso u obesidad.Materiales y métodos. 24 mujeres adultas (16 con sobrepeso y 8 con obesidad) entre 26 y 49 años fueron reclutadas para participar en un programa de entrenamiento de alta intensidad durante dos meses (tres sesiones/semana). Se evaluó peso, talla, IMC, porcentaje de masa muscular, porcentaje de masa grasa y porcentaje de grasa visceral.Resultados. El grupo adherente (asistencia ≥75%) quedó compuesto por 16 participantes y el grupo no adherente (asistencia 75%) por ocho participantes. No existieron diferencias significativas pre y post intervención entre ambos grupos (p≥0.05). El grupo no adherente no presentó cambios importantes mientras que el grupo adherente mejoró (p0.05) las variables peso (p0.001), IMC (p0.001), porcentaje de masa grasa (p0.001), porcentaje de masa muscular (p0.001) y porcentaje de grasa visceral (p=0.020).Conclusiones. El programa de entrenamiento mejoró el perfil antropométrico de las participantes sin requerir implementos ni costos elevados para su desarrollo, por lo que es un procedimiento recomendable para el tratamiento de la malnutrición por exceso.

An obese preschool child may grow up to be an obese adult. The factors of obesity among preschool children have been documented as one of the factors that will lead to the risks of hypertension, psychosocial disturbances and heart complications that increase adult morbidity and mortality. Preliminary data were collected to identify the components needed in the construction of preschool health education in preventing obesity. Four main components were obtained: i) dietary, ii) physical development, iii) psychosocial development, and iv) physical activities. Therefore, a health education based on the above components will be developed as a guideline in order to assist with the problem of obesity among the preschool children.

The increasing prevalence of obesity has become one of the most challenging problems facing healthcare providers. Despite recommendations from the U.S. Preventive Services Task Force many health professionals fail to discuss obesity with their patients. This study sought to identify terms that individuals with obesity and being treated in primary care find the most and least acceptable for describing their excess weight. Three-hundred ninety obese adult primary care patients in the Philadelphia area were administered the Weight Preferences Questionnaire from January 2008 through February 2009. Ratings of 11 terms used to describe excess weight were transformed to a five-point scale, ranging from “very desirable” (+2) to neutral (0) to “very undesirable” (-2). The term “fatness” (mean score -1.1 ± 1.3) was rated as significantly more undesirable than all other descriptors (p < 0.001). The terms “excess fat” (-0.6 ± 1.3), “large size” (-0.6 ± 1.3), “obesity” (-0.5 ± 1.4), and “heaviness” (-0.4 ± 1.2) were rated as significantly more undesirable then the remaining terms, which included weight problem, body mass index (BMI), and excess weight (p

There is increasing evidence that obesity in humans is associated with infection with human adenovirus-36 (Adv36). Infection of experimental animals with Adv36 demonstrates that this virus causes obesity. Human studies have shown a prevalence of Adv36 infection of 30% or greater in obese adult humans, but a correlation with obesity has not always been demonstrated. In contrast, three published studies and one presented study with a total of 559 children all show that there is an increase in prevalence of Adv36 infection in obese children (28%) compared to non-obese children (10%). The explanation for the apparently more robust correlation of Adv36 infection with obesity in children vs. adults is not clear. The data in animals and people suggests that Adv36 has contributed to the worldwide increase in childhood obesity. More research is needed to identify prevalences and consequences of Adv36 infection in people of all age groups and geographic locations.

OBJECTIVE: To determine the prevalence of asthma in a group of obese adult candidates for bariatric surgery and to evaluate the severity of asthma in this group of patients. METHODS: This was a cross-sectional study involving 363 obese adults (body mass index > 35 kg/m2) evaluated by a pulmonologist, using clinical evaluation as a diagnostic tool for asthma. All patients underwent clinical evaluation and spirometry and were divided into two groups (asthma and control). The patients with asthma were stratified by the severity of asthma. RESULTS: The prevalence of asthma in the obese population studied was 18.5% (95% CI: 14.5-22.4). That prevalence was 20.4% (95% CI: 16.2-24.5) and 13.7% (95% CI: 10.1-17.2) in the women and the men, respectively. Asthma symptoms in the last twelve months were present in 8.0% (95% CI: 5.2-10.7), and the initial manifestation of asthma symptoms occurred during childhood/adolescence in 17.4% (95% CI: 13.5-21.3). In the asthma group, intermittent asthma was present in 29 patients (43.3%), mild persistent asthma in 7 (10.4%), moderate asthma in 25 patients (37.3%), and severe persistent asthma in 6 (9.0%). CONCLUSIONS: Using clinical evaluation as the diagnostic criterion, we found the prevalence of asthma to be high in this group of obese adults. Asthma was more common in females, and the initial manifestation of asthma symptoms more commonly occurred during childhood/adolescence. The severity of asthma in this group of obese adults was within the range of mean values predicted for the general population. Intermittent asthma, mild persistent asthma, and moderate persistent asthma predominated

[Purpose] The purpose of this study was to examine the effects of an eight-week exercise program on body composition, blood lipids, and hormone levels of 16 obese adult males. [Subjects and Methods] After an experimental group (n=8) and a control group (n=8) were organized, subject were examined: then, the experimental group performed endurance exercises for 8 weeks. At the end of the eight weeks, the two groups were examined again for weight, % body fat, and body fat mass via a bioelectrical impedance analysis (BIA). A blood sample was collected the day before the exercise program. Right after the exercise program, 5 ml of blood was collected and then centrifuged for 10 min at 3000 rpm. The centrifuged samples were stored at -73°C and sent to Green Cross for analysis; TC, TG, leptin, and insulin were analyzed. [Results] The experimental group showed a statistically significant decrease in % body fat and body fat mass as well as significant reductions in TC and TG and leptin concentrations. There was also a decrease in the exercise group's insulin concentration but is was not significant. [Conclusion] Eight weeks of exercise therapy increased energy consumption resulting in favorable changes in the body composition, blood lipid metabolism, and hormone levels in obese adult males.

A 4-mm patent ductus arteriosus (PDA) was serendipitously diagnosed during intraoperative transesophageal echocardiography for a noncardiac procedure in an obese adult patient with a history of decreased exercise tolerance and dyspnea, despite a negative preoperative transthoracic examination. This uncommon event poses questions regarding the relevance of this finding to the differential diagnosis of dyspnea in an obese adult with a negative transthoracic echocardiography study, given the unknown prevalence of this pathology and the absence of consensus regarding the clinical management.

The literature is not clear on the best method to empirically dose chemotherapy in obese adult patients. The purpose of our study was to determine whether a standard of practice existed, characterize current practices of empiric dose adjustment (EDA) in obese adult patients, and identify factors affecting this decision.An electronic survey was distributed to oncologists and board-certified oncology pharmacists via the Association of Community Cancer Centers and Board of Pharmaceutical Specialties e-mail distribution lists. The survey contained patient scenarios assessing the impact of various factors on EDA of chemotherapy, demographic information, and details of institutional policies.Responses were collected from 174 professionals. Pharmacists comprised 95% of respondents. Of these, 50% practiced in academic medical centers, and 19% practiced in institutions with a standard of practice regarding EDA for obesity. The most common methods of EDA were use of an adjusted body weight in the body-surface area (BSA) equation and capping BSA. Factors with the most impact on EDA were curative intent, degree of obesity, type of chemotherapy, and performance status.There is no standard of practice regarding EDA of chemotherapy in obese adult patients. Although many factors affect this decision, intent of treatment, degree of obesity, performance status, age, and type of medication seem to carry the most weight.

Objective Knowledge of accurate patient weight is vital to safe air medical transport and critical care. Patient weight is often unknown in emergency settings, and visual estimations have been shown to be inaccurate, especially in obese patients. We hypothesized that a simple formula based on anthropometric measurements could accurately predict patient weight for obese adult men and women. Methods Data from cross-sectional anthropometric measurements from the National Health and Nutrition Examination Survey (NHANES) III (1988–1994)—height, leg length, thigh circumference, and mid-arm circumference—were used to estimate patient weight among adult (18 years and older) men and nonpregnant women who weighed at least 100 kg (N = 1,471). Linear modeling was used to develop simple sex-specific linear models to estimate patient weight. Models were derived on a random 67% subset of the original sample and then validated against the remaining 33% to assess the model's predictive capacity. Results The combination of arm circumference and height yielded the best model: Women: weight (WT) = −64.6 + 2.15 × arm circumference (ARM) + 0.54 × height (HT) (adjusted R 2 : 0.55); men: WT = −93.2 + 3.29 × ARM + 0.43 × HT (adjusted R 2 : 0.59). Approximately 90% of patient weights were accurately estimated within a 15% error tolerance. Conclusion We have derived and validated simple equations with easy-to-use tables to accurately predict total body weight of obese men and women using only height and arm circumference. These tables may assist air medical transport pilots and medical crews make decisions about which patients may be safely transported, how far they may be transported, how much fuel is required, and how many crewmembers and family members may accompany them.

This study compared the chewing parameters in a group of obese adult patients scheduled for gastric bypass surgery with those of a control group.Chewing parameters were measured in two groups of subjects, one of 44 obese patients scheduled for gastric bypass surgery (body mass index [BMI] = 49.1 +/- 7.2) and the other of 30 non-obese control subjects (BMI = 20.9 +/- 2.1). In both groups, the subjects' dental status was characterized by the number of functional dental units. Kinematic parameters, namely chewing time (CT), number of chewing cycles (CC), and chewing frequency (CF), were video recorded during the mastication of five natural standardized foods (banana, apple, sweet jelly, peanut, and carrot). The particle size distribution of the expectorated bolus from carrot and peanuts was characterized by the 50th percentile (D (50)). Analysis was carried out to detect any effect of the fixed factors "dental status," "type of food," and "subject group" on the variations of the dependent factors CT, CC, CF, and D (50).In obese subjects, CT, CC, and D (50) were variables depending on both dental status and food. For fully dentate subjects, the group of patients with obesity showed higher values for CT and CC and lower values for D (50) for both carrot and peanuts than the control group.The chewing parameters were affected in fully dentate patients with morbid obesity compared with controls, emphasizing the need for a systematic evaluation of both dental status and chewing ability in patients scheduled for bariatric surgery.

Several previously reported studies have shown that in rodents exogenously administered dehydroepiandrosterone (DHEA) can cause numerous metabolic changes. In the present study some additional metabolic effects of DHEA are presented using old lean and obese Zucker rats. With this experimental model most of the effects were found to occur in the obese rat. These included decreases in serum insulin and cholesterol as well as a decrease in hepatic acyl-CoA cholesterol-acyl transferase activity. In both lean and obese rats an increase in hepatic long-chain fatty acyl-CoA hydrolase was found. This increase in activity may partially explain DHEA's effect on decreasing body weight in rodents.

BackgroundQatar ranks among the top countries with highest prevalence of diabetes and obesity. Obesity is generally measured by a Body mass index (BMI). BMI has been found to be independent risk factor for development of diabetes. Also, diabetes when associated with obesity leads not only to its poor control but also causes increased long-term complications from diabetes.AimTo delineate the pattern of obesity among residents of Qatar and to classify them as per World Health Organization criteria. Secondary objectives included assessing the pattern of diabetes with increasing body mass index.MethodAll consecutive obese adult patients attending pre-surgical screening endoscopy clinic over an 18 months period were included. Patients under 14 years of age and those who had previous surgical treatment were excluded. Body mass index (BMI) was calculated as per standard criteria [weight (Kg)/Height (meters) 2] and was then classified as per World Health Organization criteria. Overweight, Type 1, Type 2 and Type 3 obesity was defined as BMI more than >25, >30, >35 and >40 respectively. Diabetes was defined as fasting plasma glucose ≥ 7 mmol/l. All patients underwent gastroduodenoscopy to assess the presence of helicobacter infection and evidence of mucosal inflammation prior to surgical treatment of obesity.ResultsA total of 529 patients with a mean age of 36.8 years were included 31.4% of obese patients were in 15–30 year age group. The mean weight, height and BMI were 123.6 Kg, 1.65 meters and 45.2 respectively. Overweight, Type I, II and III obesity was seen in 3 (0.6%), 30 (5.6%), 95(17.8%) and 401 (76%) patients respectively. Overall 34.5% had associated comorbid diseases. Type 2 Diabetes were seen in 11.1% of the patients. Diabetes was seen in 0%, 26.7%, 8.4% and 6.7% in overweight, Type I, Type II, Type III obesity respectively. Diabetes was significantly lower among very severely obese patients (Type III) as compared to those with overweight, moderately and severely obese patients (Overweight, Type I and II) (27/401, 6.7% versus 16/84,19% p = . 03).No correlation was found related to age, sex or helicobacter infection.ConclusionsAmong the residents of Qatar, 11% of obese patients were found to have diabetes. The highest prevalence of diabetes was seen in people with BMI of 25–30 (type 1 obese people). Diabetes prevalence did not increase with increasing obesity.

SummaryCommon beans (Phaseolus vulgarisL.) are a nutrient-dense, low glycemic index food that supports healthy weight management in people and was examined for dogs. The objectives of this study were to evaluate the apparent total tract digestibility (ATTD) and nutrient utilisation of navy (NB) and black (BB) bean-based diets in overweight or obese companion dogs undergoing a weight loss intervention. A nutritionally complete, dry extruded dog food was used as the control (CON) diet and two isocaloric, nutrient matched bean diets, containing either 25% w/w cooked BB or NB powder formed the test diets. Diets were fed to adult, overweight companion dogs for either four weeks (short-term study, n = 30) or for twenty-six weeks (long-term study, n = 15) at 60% of maintenance calories for ideal weight. Apparent weight loss increased over time in both the short- and long-term studies (p

Electronic blood pressure (BP) measurement devices are the preferred choice of patients owing to their user-friendly nature; however, there is a requirement to investigate the accuracy and reliability of these devices. The objective of this study is to evaluate the accuracy of the Omron M6 upper-arm BP device against the mercury sphygmomanometer in adults and obese adults according to the International Protocol criteria.One hundred and twenty-one patients, older than 30 years of age, were studied and classified on the basis of the range of the International Protocol. BP measurements at the upper arm with the Omron M6 were compared with the results obtained by two trained observers using a mercury sphygmomanometer. Nine sequential BP measurements were taken. A total of 33 participants were selected for each validation study. During the validation study, 99 measurements were performed on 33 participants for comparison. The first phase was performed on 15 participants, and if the device passed this phase, 18 more participants were selected. Having a two-fold purpose, this study was conducted on both adult and obese adult patients.Mean discrepancies and standard deviations of the monitor-mercury sphygmomanometer were 1.1+/-4.0 mmHg for systolic BP (SBP) and -0.5+/-3.5 mmHg for diastolic BP (DBP) in the adult group. The device passed phase 1 in 15 participants. In phase 2.1, out of a total of 99 comparisons, 88, 96, and 97 for SBP, and 88, 98, and 99 for DBP were5,10, and15 mmHg, respectively. Mean discrepancies and standard deviations of the monitor-mercury sphygmomanometer were 1.7+/-4.8 mmHg for SBP and -0.8+/-4.3 mmHg for DBP in the obese adult group. The device passed phase 1 in 15 participants. In phase 2.1, out of a total of 99 comparisons, 82, 90, and 97 for SBP, and 80, 97, and 99 for DBP were5,10, and15 mmHg, respectively. It was found that the Omron M6 automatic monitor, which measures BP at the upper arm, produced results in accordance with the criteria of phases 2.1 and 2.2 in both SBP and DBP, when applied to adults and to obese adults.It was concluded that the Omron M6 device, which measures BP at the upper arm, was deemed to be in accordance with the International Protocol criteria and can be recommended for use by adults and obese adults.

Childhood obesity has reached epidemic proportions around the world. However, there is limited information for the pediatric anesthesiologist. We review the current literature for pediatrics and make extrapolations from management of obese adult patients. This paper covers current definitions and some epidemiology of childhood obesity. We discuss potential co-morbidities for both children and adults. We detail what is known regarding pharmacology for obese patients. We provide details to assist with the preoperative evaluation, and make recommendations for intraoperative and postoperative management. Management of these patients can be challenging and complex; and we hope to provide tools to make it safer.

Objective: The aim of our study was to evaluate the accuracy of the equations to estimate REE in obese patents and develop a new equation in our obese population. Subjects and Methods: A population of 200 obesity outpatients was analyzed in a prospective way. The following variables were specifically recorded: age, weight, body mass index (BMI), waist circumference, and waist-to-hip ratio. Basal glucose, insulin, and TSH (thyroid-stimulating hormone) were measured. An indirect calorimetry and a tetrapolar electrical bioimpedance were performed. REE measured by indirect calorimetry was compared with REE obtained by prediction equations to obese or nonobese patients. Results: The mean age was 44.8 ± 16.81 years and the mean BMI 34.4 ± 5.3. Indirect calorimetry showed that, as compared to women, men had higher resting energy expenditure (REE) (1,998.1 ± 432 vs. 1,663.9 ± 349 kcal/day; p < 0.05) and oxygen consumption (284.6 ± 67.7 vs. 238.6 ± 54.3 ml/min; p < 0.05). Correlation analysis among REE obtained by indirect calorimetry and REE predicted by prediction equations showed the next data; Berstein’s equation (r = 0.65; p < 0.05), Harris Benedict’s equation (r = 0.58; p < 0.05), Owen’s equation (r = 0.56; p < 0.05), Ireton’s equation (r = 0.58; p < 0.05) and WHO’s equation (r = 0.57; p < 0.05). Both the Berstein’s and the Ireton’s equations overpredicted REE and showed nonsignificant mean differences form measured REE. The Owen’s, WHO’s, and Harris Benedict’s equations underpredicted REE. Our male prediction equation was REE = 58.6 + (6.1×weight (kg)) + (1,023.7×height (m)) – (9.5×age). The female model was REE = 1,272.5 + (9.8×weight (kg)) – (61.6×height (m)) – (8.2×age). Our prediction equations showed a nonsignificant difference with REE measured (–3.7 kcal/day) with a significant correlation coefficient (r = 0.67; p < 0.05). Conclusion: Previously developed prediction equations overestimated and underestimated REE measured. WHO equation developed in normal weight individuals provided the closest values. The two new equations (male and female equations) developed in our study had a good accuracy.

Obesity is an overwhelming public threat. It has been estimated that more than one third of the adult population is obese despite the fact that the prevalence has remained stable since 2004.[1][1] The good news is that the prevalence of obesity has leveled off; the bad news is that the number

Purpose: Tube voltages below 120 kVp are increasingly used in clinical CT. There are concerns that dose to superficial organs such as skin, thyroid, and breasts may be elevated at a low-kVp setting. Our purpose was to investigate the effect of low-kVp imaging on the dose received by deep-seated and superficial organs as well as the effective dose. Methods: Three computational patient models were included. They represented normal-weight, overweight, and obese adult females (BMI: 20–42). A Monte Carlo program developed and validated for a 128-slice CT system (Definition Flash, Siemens Healthcare) was used to simulate organ dose for chest and abdomen-pelvis scans at 70, 80, 100, 120, 140 kVps. Organ dose was subsequently used to calculate effective dose. Results: In chest CT, when CTDIvol was held constant, thyroid, breast, lung, and esophagus doses reduced with reducing kVp and were 22%, 5%, 9%, and 20% lower at 70 than 120 kVp for the normal-weight patient. The dose reduction percentages were even greater in general for the overweight and obese patients. Similar reduction in liver, colon, bladder, and ovary doses was found in abdomen-pelvis CT. Whole body averaged skin dose was nearly independent of kVp. In contrast, peak skin dose (over a 2 × 2 cm2 area) increased with reducing kVp and was 8–10% higher at 70 than 120 kVp. Regardless of patient size and exam type, when DLP was kept constant, effective dose reduced with reducing kVp and was 12–27% lower at 70 than 120 kVp. Conclusion: In adult body CT, using a low kVp setting to reduce CTDIvol corresponds to an even greater reduction in effective dose as well as the average dose received by deep-seated and most superficial organs. Provided that the low-kVp setting reduces CTDIvol by >10%, there will be no elevation of peak skin dose.

This study aimed to analyze the effect of rosella beverage intervention toward blood lipid profiles (total cholesterol, triglycerides, HDL and LDL) and antropometric in obese adult men. The current study was a quasi experimental study with pre-post test. Twentyfive obese men subjects in IPB Security Unit were randomly assigned to a control group (n = 11) and intervention group (n = 14). The intervention group consumed a rosela beverage containing anthocyanin 81.16 mg/g and the control group consumed a placebo beverage that did not contain anthocyanin for 6 weeks. Rosella beverage has contained anthocyanin 81.16 mg/g and antioxidant activity 64.8 mg vitamin C/100 g. The results showed that the presence of intervention could effectively reduce weight, body weight and BMI compared to before intervention (p 0.05). This indicates that the intervention of roselle beverages could improved the lipid profile in obese adults.

Objectives: The purpose of this study was to compare predictions and measurements of the resting energy expenditure (REE) of overweight and obese adult women in Korea. Methods: The subjects included 65 overweight or obese adult women ranging in age from 20~60 with a recorded body mass index (BMI) of...

Objectives: Sarcopenic obesity has not yet been widely defined. The aim of this study was to evaluate the prevalence of sarcopenia in a group of severely obese adults from southern Italy by using two different indexes: percentage of skeletal muscle mass (SMP) and skeletal muscle mass normalized for height (SMI); and to determine SMP and SMI cutoff points in a southern Italy reference population. Methods: Skeletal muscle mass of 131 consecutive obese adult outpatients (51 men and 80 women; ages 45-67 y; body mass index 44.6 ± 7.7 kg/m(2)), was assessed by bioimpedance analysis. SMP and SMI cutoff points to identify moderate and severe sarcopenia were calculated in a reference group of 500 young southern Italy adults (100 men and 400 women; ages 18-40 y; body mass index 25.2 ± 5.6 kg/m(2)) and applied to assess the prevalence of sarcopenia in the study population. Results: SMP cutoff points to identify moderate and severe sarcopenia were, 28.8% to 35.6% and ≤ 28.7% in men and 23.1% to 28.4% and ≤ 23% in women, respectively. The corresponding values for SMI were 8.44 to 9.53 kg/m(2) and ≤ 8.43 kg/m(2) in men, 6.49 to 7.32 kg/m(2) and ≤ 6.48 kg/m(2) in women. According to SMP, 23 of 51 (45.1%) men and 19 of 80 (23.8%) women were moderately sarcopenic; 28 of 51 (54.9%) men and 61 of 80 (76.3%) women met the definition of severe sarcopenia. Based on SMI, only 2 of 51 (3.9%) men were moderately sarcopenic. Conclusions: This study confirms that sarcopenia rates vary widely in obese patients depending on the criteria used. SMP as a screening tool to identify a sarcopenia at-risk population.

The 2009-2010 National Health and Nutritional Examination Survey (NHANES) found that 34% of adolescents are overweight and 18% obese. The chance of an overweight/obese adolescent becoming an overweight/obese adult by age 35 is 60%. Hispanic youth are at risk for becoming obese related to eating habits. This paper describes an intervention, I Choose Health (Elijo Salud), with Hispanic church youth.

Pedestrian PCS (pre-Collision System), as a novel active pedestrian safety equipment to reduce pedestrian fatalities, was introduced by several vehicle manufacturers in recent years. How to evaluate this system is still in study. This paper describes the development of a set of mannequins for pedestrian PCS evaluation. These mannequins represent relevant physical properties of human beings that are used by most common PCS sensors in vehicles for pedestrian detection. Three different mannequin sizes were generated to represent child, fit adult and obese adult of U.S. pedestrians. These sizes were generated using a K-means clustering method with crash weighted NHANES (National Health and Nutrition Examination Survey) data. To ensure that the mannequin provides the same radar cross section (RCS) as a pedestrian in the view of a 77GHz automotive radar, a special mannequin skin was developed. To make the mannequin move like a real human in the view of PCS cameras, mannequins were configured with 6 degrees of freedom articulation, 2 for shoulders, 2 for hips, and 2 for knees. The mannequin limbs are detachable at crash in order to protect the mannequin motion driving system. To ensure that the mannequins move like a real human, a gait planning method was adopted to generate different walking speed based on the gaiting research in medical fields. Other mannequin features are to support various test setups, low weight for test vehicle safety, and crash forgiveness. The mannequins were used in hundreds of PCS test runs at different crash angles and vehicle speeds.

Occupational physicians should be familiar with the risk factors and clinical presentation of pulmonary thromboembolism (PTE). PTE belongs to the group ofis a cardiovascular diseases, which are the main cause (40%) of death in Spanish workplaces; at present, they may be considered a work-related injury because of the doctrinal evolution in the legal interpretation of the presumption of iuris tantum. We present the case of a hypertensive and obese adult male who suffered a PTE at his workplace. The availability of a portable pulse oximeter (room air SpO2, 92%) was critical in guiding the decision to refer him urgently to the hospital, where the diagnosis was confirmed. We can conclude that, independently of whether this event is later deemed to be work-related (in this case it was not), occupational physicians must know how to correctly manage and refer affected workers.El médico del trabajo debe conocer los factores de riesgo y sospechar la presencia de un tromboembolismo pulmonar (TEP) ante un cuadro clínico compatible. El TEP pertenece a las enfermedades cardiovasculares que son la primera causa (40%) de mortalidad en el lugar de trabajo en España, y actualmente pueden considerarse accidente de trabajo por la evolución doctrinal en la interpretación jurisprudencial de la presunción iuris tantum. Presentamos un varón hipertenso y obeso que tras un periodo de reposo relativo, por un esguince de tobillo, presentó un TEP en su puesto de trabajo. La información que nos facilitó un pulsioxímetro portátil (92% SpO2) nos fue de gran ayuda para derivarlo urgentemente al medio hospitalario donde se confirmó el diagnóstico de presunción. Ya sea considerado posteriormente accidente de trabajo o no (en este caso no lo fue), el médico del trabajo está obligado a atender y derivar adecuadamente al trabajador afectado.