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 26,365 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Few large-scale epidemiologic studies have quantified the possible link between obesity and chronic renal failure (CRF). This study analyzed anthropometric data from a nationwide, population-based, case-control study of incident, moderately severe CRF. Eligible as cases were all native Swedes who were aged 18 to 74 yr and had CRF and whose serum creatinine for the first time and permanently exceeded 3.4 mg/dl (men) or 2.8 mg/dl (women) during the study period. A total of 926 case patients and 998 control subjects, randomly drawn from the study base, were enrolled. Face-to-face interviews, supplemented with self-administered questionnaires, provided information about anthropometric measures and other lifestyle factors. Logistic regression models with adjustments for several co-factors estimated the relative risk for CRF in relation to body mass index (BMI). Overweight (BMI>or=25 kg/m2) at age 20 was associated with a significant three-fold excess risk for CRF, relative to BMI<25. Obesity (BMI>or=30) among men and morbid obesity (BMI>or=35) among women anytime during lifetime was linked to three- to four-fold increases in risk. The strongest association was with diabetic nephropathy, but two- to three-fold risk elevations were observed for all major subtypes of CRF. Analyses that were confined to strata without hypertension or diabetes revealed a three-fold increased risk among patients who were overweight at age 20, whereas the two-fold observed risk elevation among those who had a highest lifetime BMI of >35 was statistically nonsignificant. Obesity seems to be an important-and potentially preventable-risk factor for CRF. Although hypertension and type 2 diabetes are important mediators, additional pathways also may exist.
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PMID:Obesity and risk for chronic renal failure. 1667 17

Bariatric surgery for the treatment of morbid obesity or overweight refractory to medical therapy was born at the beginning of second half of the twentieth century, and its first steps were uncertain and with a not jet well definite purpose. In fact the main result to be pursued seemed to be simply the reduction of body weight, and any change of anatomy of the digestive tract able to reduce the absorbtion of nutrients was judged adequate. But very early the adverse consequences of malabsorption so obtained became evident, and other operations possibly free from those complications were devised and clinically tested. So aside the by-pass operations many other surgical procedures found their room, all of them aiming to fight the ever more diffuse obesity of the people. This historical review of the various surgical procedures attempted in these last sixty years for morbid obesity is very interesting for a better understanding of the problem and to have a solid basis for future rational choices.
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PMID:[History and pathophysiologic analysis of the various techniques in bariatric surgery]. 1669 15

The rapid increase of morbid obesity has become an important task in the Western world in recent years. Since conservative treatments have failed to prove sufficient efficacy, surgery has turned out to be the most powerful option in treating morbid obesity. In this paper, the different surgical techniques with their advantages and drawbacks are presented. In general, there are restrictive, malabsorptive and combinations of both procedures available. The adjustable gastric banding (Figure 1) represents a purely restrictive operation. It is useful for patients with a relatively low body mass index (BMI) and a good understanding and control of their eating habits. By contrast, the duodenal switch (Figure 2) stands for a mainly malabsorptive procedure that might be indicated in patients with a very high BMI. The Roux-en-Y gastric bypass (Figure 3) is the most widely used bariatric procedure worldwide. It combines restriction and malabsorption. Today, almost two thirds of all bariatric procedures are performed laparoscopically, which has further enhanced the use of surgery in the treatment of morbid obesity. In conclusion, the treatment of morbid obesity represents a significant challenge in the Western world, and bariatric surgery plays a paramount role in the fight against overweight.
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PMID:[Benefits and risks of bariatric surgery]. 1677 May 60

To evaluate influence of laparoscopic gastric banding (LGB) on quality of life (QOL) in patients with morbid obesity. Laparoscopic adjustable gastric banding is a popular bariatric operation in Europe. The objectives of surgical therapy in patients with morbid obesity are reduction of body weight, and a positive influence on the obesity-related comorbidity as well the concomitant psychologic and social restrictions of these patients. In a prospective clinical trial, development of the individual patient QOL was analyzed, after LGB in patients with morbid obesity. From October 1999 to January 2001, 152 patients [119 women, 33 men, mean age 38.4 y (range 24 to 62), mean body mass index 44.3 (range 38 to 63)] underwent evaluation for LGB according the following protocol: history of obesity; concise counseling of patients and relative on nonsurgical treatment alternatives, risk of surgery, psychologic testing, questionnaire for eating habits, necessity of lifestyle change after surgery; medical evaluation including endocrinologic and nutritionist work-up, upper GI endoscopy, evaluation of QOL using the Gastro Intestinal Quality of Life Index (GIQLI). Decision for surgery was a multidisciplinary consensus. This group was follow-up at least 2 years, focusing on weight loss and QOL. Mean operative time was 82 minutes; mean hospital stay was 2.3 days and the mean follow-up period was 34 months. The BMI dropped from 44.3 to 29.6 kg/m and all comorbid conditions improved markedly: diabetes melitus resolved in 71% of the patients, hypertension in 33%, and sleep apnea in 90%. However, 26 patients (17%) had late complications requiring reoperation. Preoperative global GIQLI score was 95 (range 56 to 140), significant different of the healthy volunteers score (120) (70 to 140) P < 0.001. Correlated with weight loss (percentage loss of overweight and BMI), the global score of the group increased to 100 at 3 months, 104 at 6, 111 at 1 year to reach 119 at 2 years which is no significant different of healthy patients. Analyzing the subscale, physical condition, emotional status, and social integration increased significantly (P < 0.001) from preoperative to end of follow-up. Digestive symptoms were not modified. In case of failure of the procedure (10.5%) global Giqli score is not modified. Patients who have required successful revisional surgery for late complications (6.5%) have an excellent QOL outcome that are not different from the whole group. Together with a satisfactory reduction of the excess overweight, laparoscopic gastric banding may lead in a carefully selected population of patients with morbid obesity to a significant improvement of patient QOL, in at least 2 years follow-up.
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PMID:Quality of life after laparoscopic gastric banding: Prospective study (152 cases) with a follow-up of 2 years. 1680 53

More than 70% of men who are candidates for radical prostatectomy can be classified as either overweight or obese by body mass index. The role for laparoscopic radical prostatectomy (LRP) in treating these patients remains to be defined. A wealth of experience from bariatric surgery confirms that laparoscopic procedures can be performed successfully, even in the setting of morbid obesity, despite well-defined derangements in respiratory dynamics. Using the technical modifications outlined here, LRP can be performed safely and effectively in obese patients. Obesity raises the degree of difficulty for LRP, however, resulting in longer operative times and possibly a higher rate of open conversion. For this reason, surgeons early in their LRP experience are advised to avoid obese patients until they have become facile in the performance of LRP in normal-weight individuals.
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PMID:Laparoscopic radical prostatectomy in obese patients: feasible or foolhardy? 1698 7

The interplay between obesity and respiratory function has implications on lung functions, sleep disordered breathing and asthma. Severe obesity can restrict lung functions in childhood, but the extent of obstructive disease due to obesity in childhood is not clear. Obesity is clearly linked to the increased incidence of sleep disordered breathing in childhood. Most obese children with sleep disordered breathing have tonsillo-adenoidal hypertrophy contributing to sleep apnea. The presence of sleep apnea is a consideration in recommending bariatric surgery in the appropriate setting. Obese children with asthma tend to have more symptoms of asthma. Obese children, particularly girls, have a greater likelihood of developing asthma later in life. Further investigations of the various interactions between obesity and respiratory function are currently needed. Obesity is on the rise in US, reflected in the 3 times higher prevalence of overweight (body mass index > 95th percentile) in children 6 to 19 years of age (1). The prevalence of morbid or severe obesity, defined as a body mass index (BMI) of 40 or more in adults (2), has also increased from 2.9%, in the years 1988-1994, to 4.7% in the years 1999-2000 (3). In children, severe obesity has been defined as a BMI standard deviation score > 2.5 (4). The interactions between morbid obesity and the respiratory system have become more relevant today and can be broadly discussed in relation to lung functions and exercise capacity; sleep disordered breathing; and asthma.
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PMID:Pulmonary dysfunction and sleep apnea in morbid obesity. 1723 47

The prevalence of morbid obesity in the UK population is rising, bringing with it increased levels of cardiovascular disease, diabetes, arthritis and early mortality. The overall cost to the health service is high, and is set to increase over the coming decades as the overweight population ages. Dietary, lifestyle and pharmacological interventions offer at best reasonable, short-term weight reduction and often fail. Surgical intervention is a safe and effective means of delivering marked long-term weight reduction. This article compares and contrasts the options available for surgical treatment of morbid obesity based on a review of the current literature.
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PMID:Surgery for morbid obesity. 1726 72

Nonalcoholic fatty liver disease (NAFLD) is an emerging clinical entity. There is limited data on NAFLD from India. The objective of this article was to review all the published literature on NAFLD from India. The epidemiological studies including prevalence ofNAFLD amongst special groups like in those with unexplained rise in transaminases, diabetes mellitus and cryptogenic cirrhosis, studies on pathogenesis including insulin resistance, iron abnormalities, and studies available for the treatment of such patients have been reviewed. In addition some of the differences between Indian patients and those from the West have been highlighted. Available literature show that majority of Indian patients with NAFLD have overweight or obesity as per Asian Pacific criteria even though they do not have the kind of morbid obesity as seen in patients from the West. Other differences between Indian patients and those from the West include less of metabolic syndrome including its components like diabetes mellitus and hypertension, less of iron abnormalities and HFE gene mutations and mild histological disease at presentation in Indian patients. More data is required to substantiate these findings and to prove if NAFLD patients in India are different at presentation.
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PMID:Nonalcoholic fatty liver disease in India--is it different? 1754 90

Obesity is common in women and is associated with a number of adverse health outcomes including cardiovascular disease, infectious diseases, and cancer. We explore the relationship between obesity and immune cell counts in women in a longitudinal study of 322 women from 1999 through 2003 enrolled as HIV-negative comparators in the Women's Interagency HIV Study. Body mass index (BMI, kg/m(2)) was categorized as normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), obese (BMI 30-34.9), and morbidly obese (BMI >/=35). CD4 and CD8 counts and percents and total lymphocyte and white blood cell (WBC) counts were measured annually using standardized techniques. A mixed model repeated measures analysis was performed using an autoregressive correlation matrix. At the index visit, 61% of women were African American; mean age was 35 years, and median BMI was 29 kg/m(2). Immunologic parameters were in the reference range (median CD4 count, 995 cells/mm(3); CD8 count, 488 cells/mm(3); total lymphocyte count, 206 cells/mm(3); median WBC, 6 x 10(3) cells/mm(3)). In multivariate analyses, being overweight, obese, or morbidly obese were independently associated with higher CD4, total lymphocyte, and WBC counts than being normal weight; morbid obesity was associated with a higher CD8 count. The strongest associations between body weight and immune cell counts were demonstrated in the morbidly obese. Increasing body weight is associated with higher CD4, CD8, total lymphocyte, and WBC counts in women. Investigation into the impact of obesity on immune function and long-term adverse outcomes is needed.
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PMID:Obesity and immune cell counts in women. 1757 Feb 64

The prevalence of overweight has increased sharply since the 1980s, with morbid obesity rising at an even higher rate. Comorbidities related to adiposity now consume almost 10% of all US health care dollars. Unfortunately, overweight children already demonstrate elevations in cardiovascular risk factors. These children are extremely likely to remain obese in adulthood and are likely to progress to diabetes and heart and kidney diseases. It is not surprising, therefore, that the diagnosis of the metabolic syndrome is being made with increasing frequency in American adolescents. The authors show that noninvasive methods are now available to measure target organ damage related to obesity and the metabolic syndrome in children. They explore the data linking the cardiovascular risk factors that cluster as the metabolic syndrome to early subclinical atherosclerotic change such as left ventricular hypertrophy, carotid intima-media thickness, vascular function abnormalities, and microalbuminuria. Evidence for the benefits of treatment and guidelines for the assessment for target organ damage in children are provided.
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PMID:Noninvasive assessment of target organ injury in children with the metabolic syndrome. 1767 7


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