Monday, 4 November 2013

Obesity and Pulmonary Hypertension

A. Obesity is defined as a medical condition of excess body fat has accumulated overtime, while overweight is a condition of excess body weight relatively to the height. According to the Body Mass Index(BMI), a BMI between 25 to 29.9 is considered over weight, while a BMI of over 30 is an indication of obesity. According to the statistic, 68% of American population are either overweight or obese.

B. How to calculate your BMI index
BMI= weight (kg)/ height (m2)

C. Pulmonary Hypertension is defined as a condition of abnormally high blood pressure in the lungs' arteries as a result of the small arteries have become narrowed of which no longer carry enough blood to the heart.

D. How obesity associates with Pulmonary Hypertension
1. In a study of "Role of obesity in cardiomyopathy and pulmonary hypertension" by Dela Cruz CS, Matthay RA. (Source fromSection of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520-8057, USA.), posted in PubMed, researchers imdicated in abstract that The authors also briefly explore whether obesity plays a role in the development of pulmonary hypertension. Better recognition and understanding of both obesity cardiomyopathy and pulmonary hypertension are needed in the obese patient population.

2. According to the srudy of "Respiratory health in overweight and obese Chinese children" by He QQ, Wong TW, Du L, Jiang ZQ, Qiu H, Gao Y, Liu JW, Wu JG, Yu IT. (Source from Department of Community and Family Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, PR China), posted in PubMed, researchers found that Our findings demonstrate that overweight and obesity are high risks for children's respiratory symptoms and diseases. Pulmonary function was not adversely affected by obesity in schoolchildren.

3. In an abstract of a study of "The effect of obesity on pulmonary lung function of school aged children in Greece" by Spathopoulos D, Paraskakis E, Trypsianis G, Tsalkidis A, Arvanitidou V, Emporiadou M, Bouros D, Chatzimichael A. (Source from Department of Paediatrics, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece), posted in PubMed, researchers found that High BMI remained a strong independent risk factor for asthma (OR = 2.17, 95% CI = 1.22-3.87, P = 0.009) and for atopy (OR = 2.06, 95% CI = 1.32-3.22, P = 0.002). The effect of increased BMI on asthma was significant in girls, but not in boys (OR = 2.73, 95% CI = 1.09-6.85, P = 0.032; OR = 1.74, 95% CI = 0.83-3.73, P = 0.137, respectively). In conclusion we have shown that high BMI remains an important determinant of reduced spirometric parameters, a risk factor for atopy in both genders and for asthma in girls.

4. 4. According to the abstact of "Comparison of body habitus in patients with pulmonary arterial hypertension enrolled in the Registry to Evaluate Early and Long-term PAH Disease Management with normative values from the National Health and Nutrition Examination Survey" by Burger CD, Foreman AJ, Miller DP, Safford RE, McGoon MD, Badesch DB. (Source fromDivision of Pulmonary Medicine, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA., posted in PubMed, researchers indicated that Mean BMI of the REVEAL patients was the same as that of the NHANES normal comparison group; however, there were higher percentages of obese and underweight patients in REVEAL. This discrepancy can be explained by the balancing effect of more overweight and underweight patients in different PAH subgroups. The reason for the increased frequency of obesity in idiopathic PAH is unknown, and additional study is needed.

5. In a study of "Prospective study of BMI and the risk of pulmonary embolism in women" by Kabrhel C, Varraso R, Goldhaber SZ, Rimm EB, Camargo CA. (Source from Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA., posted in PubMed, researchers found that . There was a strong positive association between BMI, the risk of idiopathic PE (relative risk (RR) = 1.08 (95% confidence interval (CI), 1.06-1.10) per 1 kg/m(2) increase in BMI, P < 0.001) and nonidiopathic PE (RR = 1.08 (95% CI, 1.07-1.10), P < 0.001). The association was linear, and apparent even with modest increases in BMI (22.5-25 kg/m(2)). The risk increased nearly sixfold among subjects with BMI >or=35 kg/m(2), and was present in multiple subgroups. Increasing BMI has a strong, linear association with the development of PE in women. Clinicians should consider BMI when assessing the risk of PE in their patients.

6. Etc.

E. Treatments of Obesity and Pulmonary Hypertension
1. According to the abstract of the study of "Lorcaserin for the treatment of obesity" by Redman LM, Ravussin E. (Source from Pennington Biomedical Research Center, Baton Rouge, Louisiana 70808, USA., posted in PubMed, researchers found that Preclinical and clinical studies indicate lorcaserin is well tolerated and not associated with cardiac valvulopathy or pulmonary hypertension suggesting that lorcaserin is a selective 5-HT(2C) receptor agonist and has little or no activation of the 5-HT(2B) and 5-HT(2A) receptors, respectively. Lorcaserin acts to alter energy balance through a reduction in energy intake and without an increase in energy expenditure and achieved the U.S. Food and Drug Administration guidelines for weight loss efficacy. It remains to be determined whether or not lorcaserin will be approved for the long-term management of obesity.

2. In an abstract of the study of "Pulmonary considerations in obesity and the bariatric surgical patient" by Davis G, Patel JA, Gagne DJ. (Source from Houston Surgical Consultants, 6560 Fannin Street, Suite 738, Houston, TX 77030, USA., posted in PubMed, researchers indicated that Bariatric surgery has been shown to be the most effective modality of reliable and durable treatment for severe obesity. Surgical weight loss improves and, in most cases, completely resolves the pulmonary health problems associated with obesity.

3. According to the study of "Obesity duration is associated to pulmonary function impairment in obese subjects" by Santamaria F, Montella S, Greco L, Valerio G, Franzese A, Maniscalco M, Fiorentino G, Peroni D, Pietrobelli A, De Stefano S, Sperlì F, Boner AL. (Source from Department of Pediatrics, Federico II University, Naples, Italy., posted in PubMed, researchers found that Duration of obesity was significantly related to all PFTs (P ≤ 0.001). In a multiple regression analysis where duration and severity of obesity, hypertension, atopy, asthma, and family history of atopic diseases were independent variables, duration of obesity was a predictor of lower PFTs (P < 0.01). Of the remaining variables, only hypertension contributed to lower lung volumes. In obese individuals, lung function was significantly lower in subjects with greater years of obesity. Fat loss programs should be encouraged to prevent late pulmonary function impairment.

4. Etc.
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