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In this paper, we review the definition and the criteria of obesity and obesity disease in Japan. Obesity is defined for the subjects who are more than 25kg/m2 of body mass index (BMI). When such subjects have any diseases associated with obesity, they are diagnosed as obesity disease by the criteria decided in Japan Society for the Study of Obesity. According to the guideline for treatment and management of obesity disease 2006, obesity diseases are classified in two types of the following; one type is based on the qualitative changes of adipocytes (obesity disease with predominantly visceral fat or, so called, a type of metabolic syndrome), and the other is done on the quantative changes (obesity disease with predominantly subcutaneous fat). Obesity diseases with predominantly visceral fat are associated with diabetes mellitus, dyslipidemia, hypertension, and so far. On the other hand, obesity diseases with predominantly subcutaneous fat tend to induce osteoarthritis, obstructive sleep apnea syndrome (OSAS), and so far.
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PMID:[Criteria of obesity and obesity disease in Japan]. 1920 2

Obesity, especially upper body fat distribution, has become an increasingly important medical problem in children and adolescents. Outcomes related to childhood obesity include, as in adult population, hypertension, type 2 diabetes mellitus, dyslipidemia, left ventricular hypertrophy, obstructive sleep apnea, orthopedic and socio-psychological problems. Obese children are at approximately 3-fold higher risk for hypertension from non-obese ones. Obesity-hypertension appears to be characterized by a preponderance of isolated systolic hypertension, increased heart rate and blood pressure variability, increased levels of plasma catecholamine and aldosterone, and salt-sensitivity. Lifestyle changes of weight loss, healthier diet and regular physical exercise are effective in obesity-hypertension control, though pharmacological treatment is frequently necessary. Screening for dyslipidemia and impaired glucose tolerance should be performed in paediatric patients with obese hypertension on regular basis, at least once annually or semiannually to discover metabolic syndrome and to prevent its increased cardiovascular risk. Of course, prevention of obesity is the primary goal.
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PMID:[Hypertension in obese children and adolescents]. 1937 Sep 74

Obstructive sleep apnea syndrome (OSAS) is an independent and modifiable risk factor for cardiovascular diseases; however, the pathophysiological mechanisms underlying this association are not yet fully understood. Intermittent hypoxemia, one of the physiological markers of OSAS, is characterized by transient periods of oxygen desaturation followed by reoxygenation. The cycles of hypoxia-reoxygenation are associated with oxidative stress that, in turn, triggers the activation of pathways that lead to cardiovascular damage. These pathways include an increased chemoreflex sensitivity that induces the over-activation of the sympathetic nervous system, decreased baroreflex sensitivity, the activation of systemic inflammation pathways mediated primarily by the nuclear transcriptional factor kappaB that favors the development of atherosclerosis through the synthesis of cytokines and the expression of adhesion molecules, endothelial dysfunction with a decreased availability of nitric oxide, dyslipidemia, insulin resistance and stimulation of the renin-angiotensin system. Other mechanisms proposed include arousals that increase sympathetic activity and exaggerated intrathoracic pressure changes that generate high transmural pressure. Most of these mechanisms respond favorably to treatment with CPAP. A better understanding of the mechanisms of cardiovascular damage opens the possibility of instituting new treatments that will contribute to limiting the cardiovascular consequences associated with OSAS.
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PMID:[Mechanisms of cardiovascular damage in obstructive sleep apnea]. 1937 37

Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder leading to cardiovascular and metabolic complications. OSA is also a multicomponent disorder, with intermittent hypoxia (IH) as the main trigger for the associated cardiovascular and metabolic alterations. Indeed, recurrent pharyngeal collapses during sleep lead to repetitive sequences of hypoxia-reoxygenation. This IH induces several consequences such as hemodynamic, hormonometabolic, oxidative, and immuno-inflammatory alterations that may interact and aggravate each other, resulting in artery changes, from adaptive to degenerative atherosclerotic remodeling. Atherosclerosis has been found in OSA patients free of other cardiovascular risk factors and is related to the severity of nocturnal hypoxia. Early stages of artery alteration, including functional and structural changes, have been evidenced in both OSA patients and rodents experimentally exposed to IH. Impaired vasoreactivity with endothelial dysfunction and/or increased vasoconstrictive responses due to sympathetic, endothelin, and renin-angiotensin systems have been reported and also contribute to vascular remodeling and inflammation. Oxidative stress, inflammation, and vascular remodeling can be directly triggered by IH, further aggravated by the OSA-associated hormonometabolic alterations, such as insulin resistance, dyslipidemia, and adipokine imbalance. As shown in OSA patients and in the animal model, genetic susceptibility, comorbidities (obesity), and life habits (high fat diet) may aggravate atherosclerosis development or progression. The intimate molecular mechanisms are still largely unknown, and their understanding may contribute to delineate new targets for prevention strategies and/or development of new treatment of OSA-related atherosclerosis, especially in patients at risk for cardiovascular disease.
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PMID:Obstructive sleep apnea, immuno-inflammation, and atherosclerosis. 1940 44

Obesity has reached global epidemic proportions in both adults and children and is associated with numerous comorbidities, including hypertension (HTN), type II diabetes mellitus, dyslipidemia, obstructive sleep apnea and sleep-disordered breathing, certain cancers, and major cardiovascular (CV) diseases. Because of its maladaptive effects on various CV risk factors and its adverse effects on CV structure and function, obesity has a major impact on CV diseases, such as heart failure (HF), coronary heart disease (CHD), sudden cardiac death, and atrial fibrillation, and is associated with reduced overall survival. Despite this adverse association, numerous studies have documented an obesity paradox in which overweight and obese people with established CV disease, including HTN, HF, CHD, and peripheral arterial disease, have a better prognosis compared with nonoverweight/nonobese patients. This review summarizes the adverse effects of obesity on CV disease risk factors and its role in the pathogenesis of various CV diseases, reviews the obesity paradox and potential explanations for these puzzling data, and concludes with a discussion regarding the current state of weight reduction in the prevention and treatment of CV diseases.
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PMID:Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. 1979 83

There is increasing evidence of a causal relationship between sleep-disordered breathing and metabolic dysfunction. Metabolic syndrome (MetS), a cluster of risk factors that promote atherosclerotic cardiovascular disease, comprises central obesity, insulin resistance, glucose intolerance, dyslipidemia, and hypertension, manifestations of altered total body energy regulation. Excess caloric intake is indisputably the key driver of MetS, but other environmental and genetic factors likely play a role; in particular, obstructive sleep apnea (OSA), characterized by intermittent hypoxia (IH), may induce or exacerbate various aspects of MetS. Clinical studies show that OSA can affect glucose metabolism, cholesterol, inflammatory markers, and nonalcoholic fatty liver disease. Animal models of OSA enable scientists to circumvent confounders such as obesity in clinical studies. In the most widely used model, which involves exposing rodents to IH during their sleep phase, the IH alters circadian glucose homeostasis, impairs muscle carbohydrate uptake, induces hyperlipidemia, and upregulates cholesterol synthesis enzymes. Complicating factors such as obesity or a high-fat diet lead to progressive insulin resistance and liver inflammation, respectively. Mechanisms for these effects are not yet fully understood, but are likely related to energy-conserving adaptations to hypoxia, which is a strong catabolic stressor. Finally, IH may contribute to the morbidity of MetS by inducing inflammation and oxidative stress. Identification of OSA as a potential causative factor in MetS would have immense clinical impact and could improve the management and understanding of both disorders.
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PMID:Metabolic consequences of sleep-disordered breathing. 1950 16

The prevalence of obesity has risen sharply during the last 4 decades imposing a serious health burden to modern society. Obesity is known to cause and exacerbate many chronic diseases such as diabetes, hypertension, dyslipidemia, coronary heart disease, stroke, obstructive sleep apnea and certain cancers, among many others. The rise in obesity prevalence is mainly caused by overconsumption of energy, coupled to a sedentary life in susceptible individuals. Weight homeostasis is paramount for survival and its control is coordinated by neural and endocrine signals emanating from the fat tissue, digestive system and brain. During thousands of years humans were challenged by nutrient deprivation, developing an efficient mechanism to store energy. It explains the difficulty in losing weight, making obesity prevention the main effective health approach to halt the obesity epidemic.
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PMID:Future of obesity prevention and treatment. 1974 96

Characterised by abnormal breathing during sleep, obstructive sleep apnea (OSA) is strongly associated with obesity. Visceral obesity is a component of metabolic syndrome with insulin resistance, hypertension and dyslipidemia. OSA may also represent an independent risk factor for cardiovascular disease, especially hypertension, diabetes mellitus and dyslipidemia. Abdominal adiposity is an important factor for the development of OSA and associated metabolic disorders. Diagnosis of metabolic syndrome can be made using usual markers like waist circumference, arterial pressure measurement, fasting blood glucose, fasting cholesterol, triglyceride and HDL-cholesterol. Those parameters should be systematically evaluated in case of OSA.
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PMID:[Which complementary studies and metabolic monitoring must be performed in OSAS? For which patients?]. 1978 52

Recent statistics indicate that overweight and obesity have become an increasingly serious clinical and socioeconomic problem worldwide, and one of the greatest public health challenges of our time. In the United States, 133.6 million (66%) adults are overweight or obese (body mass index [BMI] >/=25 kg/m(2)), with 63.3 million (31.4%) considered to be obese (BMI >/=30 kg/m(2)). The International Obesity Task Force estimates that worldwide at least 1.1 billion adults are overweight, including 312 million who are obese. Overweight and obese patients are at an increased risk for developing numerous cardiometabolic complications, including hypertension, type 2 diabetes mellitus, dyslipidemia, and cardiovascular diseases, as well as conditions such as osteoarthritis, obstructive sleep apnea, hepatobiliary diseases, and certain types of cancers. Owing to the major health risks and complications associated with obesity, which negatively affect quality of life and reduce average life expectancy, in addition to placing an enormous burden on health care resources, the treatment of overweight and obesity is a public health imperative. Treatment must begin with long-term lifestyle changes, including increased physical activity and dietary modifications. For overweight and obese individuals for whom lifestyle changes alone are insufficient, pharmacotherapy may be added. However, patients who choose adjunctive pharmacotherapy should be advised of the risks and benefits of drug therapy, the lack of long-term safety data, and the temporary and modest nature of the weight loss that can be achieved with these agents. Bariatric surgery is an effective treatment option for morbidly obese patients or obese patients with multiple comorbidities who have not been successful in achieving sufficient weight loss with nonsurgical approaches. However, appropriate candidates for bariatric surgery must also be committed to long-term lifestyle changes.
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PMID:Treatment of overweight and obesity: lifestyle, pharmacologic, and surgical options. 1978 64

The increasing prevalence of obesity in children seems to be associated with an increased prevalence of obstructive sleep apnea syndrome (OSAS) in children. Possible pathophysiological mechanisms contributing to this association include the following: adenotonsillar hypertrophy due to increased somatic growth, increased critical airway closing pressure, altered chest wall mechanics, and abnormalities of ventilatory control. However, the details of these mechanisms and their interactions have not been elucidated. In addition, obesity and OSAS are both associated with metabolic syndrome, which is a constellation of features such as hypertension, insulin resistance, dyslipidemia, abdominal obesity, and prothrombotic and proinflammatory states. There is some evidence that OSAS may contribute to the progression of metabolic syndrome with a potential for significant morbidity. The treatment of OSAS in obese children has not been standardized. Adenotonsillectomy is considered the primary intervention followed by continuous positive airway pressure treatment if OSAS persists. Other methods such as oral appliances, surgery, positional therapy, and weight loss may be beneficial for individual subjects. The present review discusses these issues and suggests an approach to the management of obese children with snoring and possible OSAS.
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PMID:Childhood obesity and obstructive sleep apnea syndrome. 1987 14


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