Obese Adult Patients Research Articles

Assessment of systemic right ventricular function in adult overweight and obese patients with congenitally corrected transposition of the great arteries.

In congenitally corrected transposition of the great arteries the right ventricle (RV) supports systemic circulation, and patients are prone to develop heart failure over time. Chronic volume overload secondary to obesity may contribute to premature dysfunction of the systemic RV. The aim of our study was to assess the systemic RV function in overweight/obese adult patients with congenitally corrected transposition of the great arteries. Transthoracic echocardiographic studies and laboratory testing (N-terminal pro-B-type natriuretic peptide [NT-proBNP] assessment) were performed in patients with congenitally corrected transposition, who were scheduled for a routine examination, and the body mass index was calculated for each patient. We studied 56 adults (31 men; mean age 33.9 years); 22 of whom were overweight (body mass index [BMI] of 25-29.9 kg/m²) or obese (BMI of 30 kg/m² or more), and 34 of whom were normal weight (BMI below 25 kg/m²). Age, gender, heart rate, and blood pressure were similar in both groups. The mean NT-proBNP levels were not significantly different. On echocardiography, the overweight/obese patients had a decreased systemic RV fractional area change (0.38) compared to normal weight patients (0.43); p = 0.02. Moreover, a significant reduction in the global longitudinal strain in the overweight/obese group was observed (-15.3% vs. -18.3%; p = 0.01). Overweight/obesity in adult patients with congenitally corrected transposition of the great arteries is associated with impaired systemic RV function.

Dynamic Ultrasound-Guided Short-Axis Needle Tip Navigation Technique for Facilitating Cannulation of Peripheral Veins in Obese Patients.

This preliminary observational study evaluated a specific ultrasound technique for venous access. Ultrasound was utilized for navigating a needle and catheter within the vessel lumen after venopuncture. One hundred adult obese surgical patients without visible vessels on their upper extremities were enrolled. Forty-five different operators ranging from medical students to attending anesthesia faculty performed venous cannulation with the specific ultrasound technique. Veins in 95 patients were cannulated successfully on the first attempt. This ultrasound-guided protocol facilitates navigation of both the catheter and needle within a vessel, increasing the first-attempt success rate of peripheral venous cannulation in adult obese patients.

A comparative study of impact of obesity on maximum voluntary ventilation in young adult women

Background: Obesity has become a global epidemic. The prevalence and severity of obesity in young adult females are dramatically increasing worldwide. Along with other organs, respiratory system is also compromised. Obesity is likely the cause of pulmonary function decline which is linked to early morbidity and mortality. The maximum voluntary ventilation (MVV) test evaluates the respiratory endurance and is influenced by the respiratory muscle strength, the lung and chest compliance, and the control of breathing and airway resistance. In the case of obese individuals, this variable is reduced mainly by mechanical injury to the respiratory muscles, caused in particular by the excessive weight on the thorax. Hence, this study was done to know the impact of obesity on MVV in adult females. Aims and Objectives: The purpose of this study was to compare the pulmonary function test (PFT) parameter in obese adult females and non-obese adult female patient and to evaluate the impact of obesity on MVV. Materials and Methods: PFTs of 50 normal, healthy, non-obese females and 50 healthy but obese females, age group 18-30 years of Hubli city were determined and were compared. Criteria for obesity in our study taken were according to the WHO criteria of body mass index. The PFT was carried out with computerized Spirometer Eazy on-PC model. MVV parameter was used as a measure of lung function. Results: In our study, obese females had MVV (liters) of 58 ± 12.2, whereas corresponding values in controls was 87 ± 66. There was statistically highly significant difference between two groups (P < 0.01). There was statistically significant lower MVV in the obese group than the non-obese group (P < 0.01). Conclusion: In our study, MVV was significantly reduced in obese females compared to non-obese female. These data demonstrate MVV of obese adult females were significantly reduced when compared to the normal weight counterparts. Obesity had a significant impact on MVV parameter.

Dexmedetomidine infusion versus placebo for analgesia and prevention of emergence agitation in morbidly obese patients undergoing laparoscopic sleeve gastrectomy

Background Emergence agitation (EA) can occur following recovery from general anesthesia. The patient may exhibit aggressive behavior, disorientation, agitation, and restlessness. If untreated, this complication may result in significant morbidity. EA has been poorly investigated in patients undergoing laparoscopic sleeve gastrectomy. Aim The aim was to assess the efficacy of perioperative dexmedetomidine infusion on EA and quality of recovery after elective laparoscopic sleeve gastrectomy in morbidly obese adult patients. Materials and methods A total of 60 patients undergoing laparoscopic sleeve gastrectomy were randomized into two groups (30 patients each). The dexmedetomidine group (group D, N=30) received dexmedetomidine infusion, whereas the control group (group C, N=30) received normal saline in the same volume and rate as placebo. Propofol, fentanyl, and atracurium were used for induction of anesthesia, and isoflurane was used for maintenance of anesthesia. Postoperative hemodynamic variables, postoperative pain, the need for ‘rescue’ analgesics and antiemetics, and the incidence of agitation were recorded up to 2 h postoperatively. Pain was evaluated using the visual analog scale score in the postanesthesia care unit on arrival, at 5 min, and then every 15 min for 120 min. EA was evaluated at the same time intervals by Richmond agitation-sedation scale (RASS). Pethidine 50 mg intravenously was given for pain (if pain score >4) or severe agitation (RASS score >+1). Results No patients in group D experienced postoperative EA during the second hour postoperatively (RASS ˂1). On the contrary, RASS scores of patients in group C were 2 (2–3) on arrival to postanesthesia care unit and greater than +1 during the remaining time up to 2 h postoperatively, indicating postoperative EA. In group C, 25 (92.5%) patients required rescue analgesia compared with only five (18.5%) patients in group D. Hemodynamic parameters were stable in group D. Conclusion Dexmedetomidine infusion during laparoscopic sleeve gastrectomy for morbidly obese patients is beneficial and effective in preventing postoperative pain and postoperative EA.

Do sleeve gastrectomy and gastric bypass influence treatment with proton pump inhibitors 4 years after surgery? A nationwide cohort

BackgroundGastroesophageal reflux disease (GERD) is a common obesity-related co-morbidity that routinely is treated by continuous proton pump inhibitor (PPI) therapy. A number of concerns have been raised regarding the risk of de novo GERD or exacerbation of preexisting GERD after sleeve gastrectomy (SG). ObjectiveTo assess PPI use at 4 years after bariatric surgery. SettingFrench National Health Insurance. MethodsData were extracted from the French National Health Insurance database. All adult obese patients who had undergone gastric bypass (GBP) (n = 8250) or SG (n = 11,923) in 2011 in France were included. Patients were considered to be on continuous PPI therapy when PPIs were dispensed≥6 times per year. Logistic regression models were used to compute odds ratios for potential risk factors for PPI reimbursement 4 years after surgery. ResultsOverall, continuous use of PPIs increased from baseline to 4 years after SG and GBP, from 10.9% to 26.5% (P<.001) and from 11.4% to 21.9% (P<.001), respectively. Among patients who underwent PPI therapy before surgery, those who had undergone SG were more likely to continue PPI therapy 4 years after surgery compared with those who underwent GBP (72.7% versus 59.2%; P<.001). In multivariate analyses, the major risk factors for persistent continuous PPI treatment 4 years after surgery were the following: SG (odds ratio [OR] = 1.87; 95% confidence interval [CI] 1.55–2.25), higher body mass index (OR 1.85; 95% CI 1.35–2.5), and preoperative antidepressant treatment (OR 1.89; 95% CI 1.56–2.29). ConclusionAt a nationwide scale, continuous PPI treatment is used by 1 of 10 obese patients before bariatric surgery, but by 1 of 4 patients 4 years after surgery. SG compared with GBP, higher body mass index, and other coexisting conditions are the 3 major risk factors for medium-term continuous PPI therapy.

Impact of a prophylactic combination of dexamethasone-ondansetron on postoperative nausea and vomiting in obese adult patients undergoing laparoscopic sleeve gastrectomy during closed-loop propofol-remifentanil anaesthesia: A randomised double-blind placebo-controlled study.

In obese patients, the incidence of postoperative nausea and vomiting (PONV) following sleeve gastrectomy under titration of total intravenous anaesthesia (TIVA) and the relevance of risk factors to indicate prophylaxis is unknown. The hypothesis was that after automated TIVA, prophylaxis reduces PONV following laparoscopic sleeve gastrectomy. Our objective was to determine the incidence of PONV and evaluate the efficacy of dexamethasone and ondansetron as prophylaxis when automated intravenous anaesthesia is employed. A randomised, placebo-controlled, single-centre, double-blinded study. Secondary care centre in New Caledonia from June 2013 to January 2014. A total of 122 patients were randomised and 117 (92 women) were included in the analysis (58 in the prophylaxis group and 59 in the placebo group). Eligibility criteria included at least two of the known risk factors for PONV: female sex, nonsmoking status, prior history of PONV or motion sickness and expected postoperative opioid analgesia. Exclusion criteria included disorders limiting the use of the bispectral index. All patients received propofol and remifentanil controlled by the same automated system during induction and maintenance of general anaesthesia. The controller modifies the calculated effect-site concentrations according to bispectral index values. Patients received either intravenous dexamethasone 4 mg after tracheal intubation and ondansetron 4 mg during skin closure, or placebo. The primary endpoint was the cumulative incidences of 24-h PONV and severe PONV (vomiting or nausea with a score of ≥4 on an 11-point verbal rating scale). Data are presented as percentage (95% confidence interval). PONV in the first 24 h occurred in 45 (34 to 60)% of patients who received prophylaxis and 54 (41 to 67)% in the placebo group (P = 0.35). The numbers of patients who suffered severe PONV [19 (10 to 32)% in the prophylaxis group vs. 20 (11 to 33)%, P = 1, in the placebo group] and who required rescue antiemetic drugs [55 (41 to 68) vs. 63 (49 to 75)%, P = 0.46] were similar between the groups. The combination of dexamethasone and ondansetron was not effective in preventing PONV or severe PONV in obese patients undergoing laparoscopic sleeve gastrectomy after TIVA. Clinicaltrials.gov identifier: NCT01876290.

Predicting resting energy expenditure in underweight, normal weight, overweight, and obese adult hospital patients.

BackgroundWhen indirect calorimetry is not available, predictive equations are used to estimate resing energy expenditure (REE). There is no consensus about which equation to use in hospitalized patients. The objective of this study is to examine the validity of REE predictive equations for underweight, normal weight, overweight, and obese inpatients and outpatients by comparison with indirect calorimetry.MethodsEquations were included when based on weight, height, age, and/or gender. REE was measured with indirect calorimetry. A prediction between 90 and 110% of the measured REE was considered accurate. The bias and root-mean-square error (RMSE) were used to evaluate how well the equations fitted the REE measurement. Subgroup analysis was performed for BMI. A new equation was developed based on regression analysis and tested.Results513 general hospital patients were included, (253 F, 260 M), 237 inpatients and 276 outpatients. Fifteen predictive equations were used. The most used fixed factors (25 kcal/kg/day, 30 kcal/kg/day and 2000 kcal for female and 2500 kcal for male) were added. The percentage of accurate predicted REE was low in all equations, ranging from 8 to 49%. Overall the new equation performed equal to the best performing Korth equation and slightly better than the well-known WHO equation based on weight and height (49% vs 45% accurate). Categorized by BMI subgroups, the new equation, Korth and the WHO equation based on weight and height performed best in all categories except from the obese subgroup. The original Harris and Benedict (HB) equation was best for obese patients.ConclusionsREE predictive equations are only accurate in about half the patients. The WHO equation is advised up to BMI 30, and HB equation is advised for obese (over BMI 30). Measuring REE with indirect calorimetry is preferred, and should be used when available and feasible in order to optimize nutritional support in hospital inpatients and outpatients with different degrees of malnutrition.

Implementation in a Family Medicine Clinic of a Lifestyle Program Designed to Help Indigent, Obese Adult Patients Lose Weight

Introduction. Efficacy of interventions in research settings maynot translate to usual-care settings. The impact of interventionsvaries depending upon factors, such as the proportion andcomposition of the population reached and engaged, as well asparticipation and implementation characteristics of providers.&#x0D; Methods. A lifestyle intervention meant to achieve a 5%loss of body weight in six months was offered to obese, indigentadult patients in a Family Medicine residency outpatientclinic. Implementation variables were assessed, includingdetermination of individual patient penetrationand participation rate, demographic representativeness,completion rate, outcomes, and differential impact, as wellas setting participation rates and implementation fidelity.&#x0D; Results. From a population of 743 potentially eligible patients,356 were invited to participate (48% penetration) and158 were enrolled (44% participation). Those enrolled wereheavier (BMI of 42.6 vs 39.0), younger (43.5 vs 47.0 years)and more likely female (87% vs 69%) than those not enrolled.Individual completion rate was 81%; overall weightloss was negligible. Setting participation was broad, butfidelity to background standard of care was only 50%.&#x0D; Conclusions. Providers were eager for a tool to help their obese,indigent patients lose weight, but the intervention proved ineffectiveand the usual care of enrolled patients was not stronglysupportive of their weight loss efforts. KS J Med 2016;9(4):77-82.

Observations on obesity patterns in tetralogy of Fallot patients from childhood to adulthood.

Obesity is increasingly prevalent, and abnormal body mass index is a risk factor for cardiovascular disease. There are limited data published regarding body mass index and CHD. We tested the hypothesis that body mass index and obesity prevalence are increasing in patients with tetralogy of Fallot over time by analysing time since surgery, age, height, weight, and body mass index among tetralogy of Fallot patients and demographic data from age-matched controls. NYHA class and left ventricular ejection fraction were analysed in adults. Body mass index was categorised into normal, overweight, and obese in this single-centre, retrospective chart review. Data were collected from 137 tetralogy of Fallot patients (71 men:66 women), of whom 40 had body mass index >25 kg/m2. Tetralogy of Fallot patients aged <6 years had lower body mass index (15.9 versus 17.1; p=0.042) until 16-20 years of age (27.4 versus 25.4; p=0.43). For adult tetralogy of Fallot patients, the mean body mass index was 26.5 but not statistically significantly different from the control cohort. Obese adult patients had significantly higher average NYHA class compared with those of normal weight (p=0.03), but no differences in left ventricular ejection fraction by echocardiography (p=0.55) or cardiac MRI (p=0.26) were noted. Lower body mass index was observed initially in tetralogy of Fallot patients, but by late adolescence no significant difference was observed. As adults, tetralogy of Fallot patients with higher body mass index had increased NYHA class but similar left ventricular ejection fraction.

Myelosuppression by chemotherapy in obese patients with gynecological cancers.

The American Society of Clinical Oncology provides clinical practice guidelines for appropriate cytotoxic chemotherapy dosing for obese adult patients with cancer. The panel recommends that actual body weight should be used when selecting cytotoxic chemotherapy doses regardless of obesity status. However, there have been no reports regarding the appropriate cytotoxic chemotherapy dosing for obese Japanese patients with cancer. We collected data from 216 gynecological cancer patients who were treated with at least one course of a paclitaxel and carboplatin (TC) regimen or a docetaxel and carboplatin (DC) regimen at Niigata University Medical and Dental Hospital from July 2006 to April 2014. Patients were divided into three groups according to body mass index (BMI): obese (BMI≥25), normal (BMI 18.5-24.9), and underweight (BMI<18.5), as defined by the Japan Society for the Study of Obesity. We analyzed hematological toxicities by full weight-based chemotherapy in each group. The rates of grade 3/4 leukocytopenia, neutropenia, and thrombocytopenia were not significantly different among the three BMI groups on all patient analyses. For the TC regimen, the obese and normal groups had significantly lower leukocytopenia (grade 3/4) rates than did the underweight group. Also, significant positive correlations between BMI and the nadirs of leukocytes, neutrophils, platelets, and hemoglobin were observed. For the DC regimen, no significant difference was observed among the BMI groups and the rate of grade 3/4 hematological toxicities. We did not observe stronger myelosuppression in obese cancer patients compared with non-obese cancer patients. Therefore, the cytotoxic chemotherapy dose should be calculated by the actual body weight and unnecessary dose reduction should be avoided.

Effect of Boussignac continuous positive airway pressure ventilation on Pao2 and Pao2/Fio2 ratio immediately after extubation in morbidly obese patients undergoing bariatric surgery: a randomized controlled trial

Study ObjectivePathophysiological changes after laparoscopic Roux-en-Y gastric bypass may increase the risk of pulmonary complications in morbidly obese patients. The purpose of the study was to assess the impact of immediate postextubation use of Boussignac continuous positive airway pressure (CPAP) on arterial oxygenation in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass. The hypothesis is that the use of CPAP may improve oxygenation in the postoperative period when compared to Venturi mask. DesignRandomized controlled study. SettingA tertiary referral hospital. PatientsRecruited morbidly obese adult patients undergoing laparoscopic Roux-en-Y gastric bypass. InterventionsBoussignac CPAP or Venturi mask was randomly applied immediately after extubation in the operating room and was maintained during the first 2 hours in the recovery room. MeasurementsPao2 and Pao2/fraction of inspired oxygen (Fio2) ratio values were measured preoperatively and at 1 (T1), 2 (T2), and 24 hours (T24) after extubation, through arterial blood samples. Secondary outcomes (spirometric parameters) were measured at the same periods. For comparison between groups, Student t test, Mann-Whitney U nonparametric test, and χ2 test were used. Statistical significance is at P < .05. Main ResultsTwenty-four patients were included, 12 in each group. There were no differences in preoperative evaluation. There were significant differences between groups in Pao2 and Pao2/Fio2 mean values at T1, T2, and T24, being superior in the Boussignac group. During the 24 hours postextubation, 9% of patients in the Boussignac group and 50% in the Venturi group had a Pao2 less than 60 mm Hg in at least 1 of the evaluations. After extubation, a Pao2/Fio2 ratio value less than 300 was observed in all patients in the Venturi group and in 55% in Boussignac group in at least 1 of the evaluations. There were no differences in spirometric parameters between groups at T1, T2, and T24. ConclusionsApplication of Boussignac CPAP for 2 hours after extubation improved oxygenation but did not improve forced expiratory volume at 1 second and forced vital capacity.

Daily vancomycin dose requirements as a continuous infusion in obese versus non-obese SICU patients.

BackgroundLimited data are available assessing vancomycin concentrations in obese critically ill patients. Currently, there are no studies evaluating dosing requirements in this population who receive vancomycin administered as a continuous infusion (CI). The aim of this study was to assess whether there was a difference in the weight-based maintenance dose required to reach a therapeutic vancomycin concentration at 24 hours when given as a CI in obese versus non-obese critically ill patients.MethodsA retrospective cohort study of adult obese patients admitted to the SICU between 2013 and 2015 receiving a vancomycin CI (CIV), and with 24-hour serum measurements were included. Obese patients (body mass index (BMI) ≥35 kg/m2) were matched with non-obese patients (BMI <30 kg/m2) based on renal function, age and acute physiology and chronic health evaluation (APACHE)-II score at admission. All patients in this study received a loading dose of 25 mg/kg then a maintenance dose based on renal function according to the protocol. The study was approved by the Institutional Review Board. The primary outcome was the weight-based total daily maintenance dose required to achieve a vancomycin level of 20 mg/L. The secondary endpoints included the achievement of a therapeutic level at 24 hours.ResultsTwenty-six matched pairs of patients met the inclusion criteria. Of these, 17 pairs had preserved renal function and 9 pairs required continuous venovenous hemofiltration. Mean BMI was 40.9 kg/m2 in obese and 24.8 kg/m2 in non-obese patients. To achieve a vancomycin concentration of 20 mg/L, the weight-based daily maintenance dose in obese patients was 25.6 mg/kg versus 43.8 mg/kg in non-obese patients (p <0.01). Therapeutic 24-hour levels were achieved in 24/26 obese versus 23/26 no-obese patients (p = 0.63). Mean 24-hour vancomycin level was 20.3 ± 3.81 mcg/ml in obese compared to 20.03 ± 3.79 mcg/ml in non-obese patients (p = 0.77). Mean daily maintenance doses required to achieve a level of 20 mcg/ml were 2961 ± 1670 mg in obese compared to 3189 ± 1600.69 mg in non-obese (p = 0.61).ConclusionsThe results of our study suggest that critically ill obese patients treated with CIV required a significantly lower maintenance dose per unit of body weight than non-obese patients to achieve the same target level.

Association of Preference-Based Health-Related Quality of Life with Weight Loss in Obese Adults.

The obesity epidemic is linked to substantial health care resource use, reduction in workforce and home productivity, and poor health-related quality of life (HRQOL). Changes in body mass index (BMI) are associated with improvements in HRQOL; the nature of this relationship, however, has not been reliably described. To determine the independent association between changes in BMI and change in utility-based HRQOL. Data were prospectively collected on 500 severely obese adult patients enrolled in a single-center obesity management clinic. Univariable and multivariable linear regressions were performed, adjusting for the effect of the intervention itself, obesity-related comorbidities, BMI at enrollment, age, and sex. A 1-unit reduction in BMI was associated with a 0.0075 (95% confidence interval 0.0041-0.0109) increase in the EuroQol five-dimensional questionnaire score. This relationship was unaltered in various analyses, and is likely applicable to any health-care-induced changes in BMI. The quantification of this association advances the understanding of the clinical benefits of interventions that affect BMI, and can inform more robust cost-utility analyses.

GLP-1 Agonists in Type 1 Diabetes Mellitus.

To review the use of GLP-1 agonists in patients with type 1 diabetes mellitus (T1DM). A search using the MEDLINE database, EMBASE, and Cochrane Database was performed through March 2016 using the search terms glucagon-like peptide 1 (GLP-1) agonists, incretin, liraglutide, exenatide, albiglutide, dulaglutide, type 1 diabetes mellitus All English-language trials that examined glycemic end points using GLP-1 agonists in humans with T1DM were included. A total of 9 clinical trials examining the use of GLP-1 agonists in T1DM were identified. On average, hemoglobin A1C (A1C) was lower than baseline, with a maximal lowering of 0.6%. This effect was not significant when tested against a control group, with a relative decrease in A1C of 0.1% to 0.2%. In all trials examined, reported hypoglycemia was low, demonstrating no difference when compared with insulin monotherapy. Weight loss was seen in all trials, with a maximum weight loss of 6.4 kg over 24 weeks. Gastrointestinal adverse effects are potentially limiting, with a significant number of patients in trials reporting nausea. The use of GLP-1 agonists should be considered in T1DM patients who are overweight or obese and not at glycemic goals despite aggressive insulin therapy; however, tolerability of these agents is a potential concern. Liraglutide has the strongest evidence for use and would be the agent of choice for use in overweight or obese adult patients with uncontrolled T1DM.

Evaluation of Effective Dose from CT Scans for Overweight and Obese Adult Patients Using the VirtualDose Software.

This paper evaluates effective dose (ED) of overweight and obese patients who undergo body computed tomography (CT) examinations. ED calculations were based on tissue weight factors in the International Commission on Radiological Protection Publication 103 (ICRP 103). ED per unit dose length product (DLP) are reported as a function of the tube voltage, body mass index (BMI) of patient. The VirtualDose software was used to calculate ED for male and female obese phantoms representing normal weight, overweight, obese 1, obese 2 and obese 3 patients. Five anatomic regions (chest, abdomen, pelvis, abdomen/pelvis and chest/abdomen/pelvis) were investigated for each phantom. The conversion factors were computed from the DLP, and then compared with data previously reported by other groups. It was observed that tube voltage and BMI are the major factors that influence conversion factors of obese patients, and that ED computed using ICRP 103 tissue weight factors were 24% higher for a CT chest examination and 21% lower for a CT pelvis examination than the ED using ICRP 60 factors. For body CT scans, increasing the tube voltage from 80 to 140 kVp would increase the conversion factors by as much as 19-54% depending on the patient's BMI. Conversion factor of female patients was ~7% higher than the factors of male patients. DLP and conversion factors were used to estimate ED, where conversion factors depended on tube voltage, sex, BMI and tissue weight factors. With increasing number of obese individuals, using size-dependence conversion factors will improve accuracy, in estimating patient radiation dose.

Effect of Intragastric Balloons on Liver Enzymes: A Systematic Review and Meta-Analysis.

Intragastric balloons (IGBs) are safe and effective in inducing weight loss in obese patients. The objective of this study was to review and analyze the available data of the effect of IGB on markers of nonalcoholic fatty liver disease (NAFLD) and liver enzymes. Searches were performed of MEDLINE and Embase databases from inception through January 2016. Study inclusion criteria were the following: ≥5 overweight or obese adult patients undergoing intragastric balloon placement, with liver tests [alanine aminotransferase (ALT) or gamma-glutamyl transpeptidase (GGT)] or markers of NAFLD (e.g., imaging, biopsy) reported before balloon insertion and after balloon removal at 6months. Nine observational studies and one randomized trial were identified. ALT decreased by -10.02U/l (95% CI, -13.2, -6.8), GGT decreased by -9.82U/l (95% CI, -12.9, -6.8), and BMI decreased by -4.98 kg/m(2)(-5.6, -4.4) with IGB therapy. Hepatic steatosis improved from baseline after 6months of balloon therapy by magnetic resonance imaging (fat fraction, 16.7±10.9-7.6±9.8, p=0.003), ultrasound (severe liver steatosis, 52-4%, p<0.0001). Histological NAFLD activity score was lower after 6months of IGB versus control with sham endoscopy and diet (2±0.75 vs. 4±2.25, p=0.03). The use of intragastric balloon decreases liver enzymes and is potentially an effective short-term treatment for NAFLD as part of a multidisciplinary approach. Larger, more rigorous trials are needed to confirm the effect of IGBs on NAFLD.

Bariatric Surgery in Obese Patients With Type 1 Diabetes.

There is a paucity of data on the impact of bariatric surgery in type 1 diabetes (T1D). The aim of this review was to quantify the overall effects of bariatric surgery in obese patients with T1D. We searched PubMed, Scopus, ISI Web of Knowledge, and Google Scholar from their inception to December 2015 to identify all relevant studies of bariatric surgery in adult obese patients with T1D. The review included 17 studies with 107 individuals, including 10 case series and 7 case reports. Overall, the dominant procedure was gastric bypass (n = 70; 65%). All studies reported a significant reduction in excess weight. A significant reduction in weight-adjusted daily insulin requirements was shown in all case series except one. Pooled mean ± SD of pre- and postoperative glycated hemoglobin (HbA1c) for the entire cohort with available data (n = 96) was 8.4 ± 1.3% and 7.9 ± 1.1%, respectively (P = 0.01). In addition to common postoperative complications, profound glycemic changes (diabetic ketoacidosis and hypoglycemia) and gastrointestinal dysmotility symptoms (prolonged ileus and acute gastric remnant dilation) have been reported. No surgical mortality was reported. Bariatric surgery leads to significant weight loss in severely obese patients with T1D and results in a significant improvement in insulin requirements and glycemic status. The favorable metabolic effects of bariatric surgery may facilitate medical management of and cardiovascular risk reduction in T1D in the setting of severe obesity. Diabetic ketoacidosis and hypoglycemia are potentially serious complications. Short-term results of bariatric surgery in patients with T1D are encouraging, but larger and longer-term studies are needed.

PHS113 - Economic Burden Attributable to Obesity in Adult Patients with Rheumatoid Arthritis in the United States

PHS113 - Economic Burden Attributable to Obesity in Adult Patients with Rheumatoid Arthritis in the United States

Costs and outcomes of increasing access to bariatric surgery for obesity: cohort study and cost-effectiveness analysis using electronic health records

BackgroundBariatric surgery is known to be an effective treatment for extreme obesity but access to these procedures is currently limited.ObjectiveThis study aimed to evaluate the costs and outcomes of increasing access to bariatric surgery for severe and morbid obesity.Design and methodsPrimary care electronic health records from the UK Clinical Practice Research Datalink were analysed for 3045 participants who received bariatric surgery and 247,537 general population controls. The cost-effectiveness of bariatric surgery was evaluated in severe and morbid obesity through a probabilistic Markov model populated with empirical data from electronic health records.ResultsIn participants who did not undergo bariatric surgery, the probability of participants with morbid obesity attaining normal body weight was 1 in 1290 annually for men and 1 in 677 for women. Costs of health-care utilisation increased with body mass index category but obesity-related physical and psychological comorbidities were the main drivers of health-care costs. In a cohort of 3045 adult obese patients with first bariatric surgery procedures between 2002 and 2014, bariatric surgery procedure rates were greatest among those aged 35–54 years, with a peak of 37 procedures per 100,000 population per year in women and 10 per 100,000 per year in men. During 7 years of follow-up, the incidence of diabetes diagnosis was 28.2 [95% confidence interval (CI) 24.4 to 32.7] per 1000 person-years in controls and 5.7 (95% CI 4.2 to 7.8) per 1000 person-years in bariatric surgery patients (adjusted hazard ratio was 0.20, 95% CI 0.13 to 0.30;p &lt; 0.0001). In 826 obese participants with type 2 diabetes mellitus who received bariatric surgery, the relative rate of diabetes remission, compared with controls, was 5.97 (95% CI 4.86 to 7.33;p &lt; 0.001). There was a slight reduction in depression in the first 3 years following bariatric surgery that was not maintained. Incremental lifetime costs associated with bariatric surgery were £15,258 (95% CI £15,184 to £15,330), including costs associated with bariatric surgical procedures of £9164 per participant. Incremental quality-adjusted life-years (QALYs) were 2.142 (95% CI 2.031 to 2.256) per participant. The estimated cost per QALY gained was £7129 (95% CI £6775 to £7506). Estimates were similar across gender, age and deprivation subgroups.LimitationsIntervention effects were derived from a randomised trial with generally short follow-up and non-randomised studies of longer duration.ConclusionsBariatric surgery is associated with increased immediate and long-term health-care costs but these are exceeded by expected health benefits to obese individuals with reduced onset of new diabetes, remission of existing diabetes and lower mortality. Diverse obese individuals have clear capacity to benefit from bariatric surgery at acceptable cost.Future workFuture research should evaluate longer-term outcomes of currently used procedures, and ways of delivering these more efficiently and safely.FundingThe National Institute for Health Research (NIHR) Health Services and Delivery Research programme. Martin C Gulliford and A Toby Prevost were supported by the NIHR Biomedical Research Centre at Guy’s and St Thomas’ Hospitals. Peter Littlejohns was supported by the South London Collaboration for Leadership in Applied Health Research and Care. The funders did not engage in the design, conduct or reporting of the research.

Obese motorcycle riders have a different injury pattern and longer hospital length of stay than the normal-weight patients.

BackgroundThe adverse effects of obesity on the physical health have been extensively studied in the general population, but not in motorcycle riders (includes both drivers and pillions). The aim of this study was to compare injury patterns, injury severities, mortality rates, and in-hospital or intensive care unit (ICU) length of stay (LOS) between obese and normal-weight patients who were hospitalized for the treatment of trauma following motorcycle accidents in a level I trauma center.MethodsDetailed data of 466 obese adult patients with a body mass index (BMI) ≥30 kg/m2 and 2701 normal-weight patients (25 > BMI ≥18.5 kg/m2) who had sustained motorcycle accident-related injuries were retrieved from the Trauma Registry System between January 1, 2009 and December 31, 2013. We used the Pearson’s chi-squared test, Fisher’s exact test, and independent Student’s t-test to analyze differences between the two groups.ResultsCompared to normal-weight motorcycle riders, more obese riders were men and drivers as opposed to pillions. In addition, fewer obese motorcycle riders showed alcohol intoxication. Analyses of the patients’ Abbreviated Injury Scale (AIS) scores revealed that obese motorcycle riders presented with a higher rate of injury to the thorax, but a lower rate of injury to the face than normal-weight patients. In addition, obese motorcycle riders had a 2.7-fold greater incidence of humeral, 1.9-fold greater incidence of pelvic, and 1.5-fold greater incidence of rib fractures. In contrast, normal-weight motorcycle riders sustained a significantly higher rate of maxillary and clavicle fractures. Obese motorcycle riders had a significant longer in-hospital LOS than normal-weight motorcycle riders did (10.6 days vs. 9.5 days, respectively; p = 0.044), with an increase in in-hospital LOS of 0.82 days associated with every 10-unit increase in BMI. No statistically significant differences in Injury Severity Score (ISS), New Injury Severity Score (NISS), Trauma-Injury Severity Score (TRISS), mortality, percentage of patients admitted to the ICU, or LOS in the ICU were found between obese and normal-weight patients.DiscussionNo differences of injury severity, mortality, and LOS in the ICU between obese and normal-weight motorcycle riders in this study may be partly attributed to the motorcycle injuries occur at relatively low velocity, considering that the riding of majority of motorcycles are forbidden on highways in Taiwan and that most traffic accidents occur in relatively crowded streets.ConclusionObese motorcycle riders had different injury characteristics and bodily injury patterns than normal-weight motorcycle riders. Moreover, they had a longer in-hospital LOS; this was particularly true for those with pelvic fractures. However, injury severity and mortality were not significantly different between the two groups.