Rozprawy doktorskie: „Obesity – Complications”

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Bell, Lana Michelle. "The medical complications of childhood obesity". University of Western Australia. School of Population Health, 2008. http://theses.library.uwa.edu.au/adt-WU2008.0139.

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[Truncated abstract] Introduction: Childhood obesity is currently a serious worldwide public health issue associated with many medical and psychosocial complications. The increasing disease burden with the potential for the development of medical co-morbidities has implications for future health care provision. This thesis adds to the understanding of the medical complications of overweight and obesity in childhood. Design and Aims: Two different, but related, research studies are reported. The first study is a cross-sectional study, designed to quantify the medical complications of childhood obesity in primary school-aged children in Western Australia. This study aims to identify the medical complications of primary school children with overweight/obesity. The study also aims to compare the medical complications of obesity in a community sample who have never sought treatment with a clinical sample who are actively seeking treatment for overweight/obesity. Finally, this study also aims to examine the relationship between the medical complications of childhood obesity and a continuum of children's Body Mass Index z-scores, including those in the normal range. The second study is an exercise intervention study to investigate the effect of exercise on one specific medical complication of obesity, namely insulin resistance. This study aims to determine if a structured eight-week exercise program significantly changes insulin resistance in obese children, and to determine if this decrease in insulin resistance is associated with changes in body composition and inflammatory markers. ... Conclusion: The prevalence of the medical complications of overweight and obesity in primary school children indicates that all children should have body mass index regularly checked from a young age. Children who are overweight/obese should be screened for the presence of co-morbidities despite a young age. Parents and health professionals needs to be educated that childhood obesity is associated with medical co-morbidities and is not simply a social or cosmetic concern. The continuous nature of the BMI z-score/co-morbidities relationship suggests that public health and health education strategies should include adopting a populationbased approach to weight management. This continuous relationship means that even in the normal BMI spectrum, the risk of developing co-morbidities rises with increasing BMI. Such an approach would encourage maintenance of normal weight for all children, rather than targeting overweight/obese children only. Increased activity and decreased sedentary behaviours should be recommended for all children in line with the population-based public health approach suggested above. However, exercise has a specific role in weight management strategies for overweight/obese children, and in management strategies for adiposityrelated co-morbidities. Significant metabolic benefits of exercise occur in the absence of changes in body shape and weight. After an exercise program, simple blood investigations (such as lipid profiles, fasting insulin and OGTTs) are likely to miss important metabolic improvements and anthropometry (BMI calculation, waist circumference) may be more indicative of potential metabolic improvement and decreased co-morbidity risk.

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Yeung, Chun-yu. "Adipocyte- and epidermal-fatty acid-binding proteins in relation to obesity and its medical complications". Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B44204565.

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Stewart, Victoria Stephanie. "Weight-loss interventions performed to reduce the risk of obesity-related complications". ScholarWorks, 2014. https://scholarworks.waldenu.edu/dissertations/109.

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The management of obesity before a woman conceives is one of the most effective efforts a woman can take in decreasing her risk of obesity-related complications during pregnancy. Evidence supports the idea that maternal obesity influences maternal and fetal outcomes, leading to maternal and fetal morbidities. Physicians acknowledge the importance of screening women for obesity, but many do not refer patients for weight-loss therapy. In this study, the health belief model was used to explore the associations between participants' obesity risk of complications during pregnancy, the number of weight-loss interventions they attempted to implement prior to pregnancy, and how they viewed the success of their interventions. Participants were a random sample of 95 obese pregnant women older than 19 years participating in the supplemental WIC program in an urban community in Newark, New Jersey. A quantitative nonexperimental correlational study using descriptive and inferential statistics was used to analyze the data. The results of this study indicated that obese pregnant women did not perceive the risks associated with obesity as a problem, nor was there an association among the types of weight-loss methods attempted, the overall success of their weight-loss interventions, and ethnicity. Women who tried exercise and dietary restrictions or exercise only were more likely to experience success than those who tried other methods or combinations of methods (p = 0.012). The data provided can lead to better informed strategies by health care professionals to develop standards in healthcare, particularly obstetrics and gynecology offices and clinics, to help obese women be more compliant with treatment recommendations for reducing the risks of obesity-related health problems.

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Bailey, Swneke. "Genetic insights into obesity and its associated metabolic complications: a multiethnic perspective". Thesis, McGill University, 2011. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=104623.

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Obesity has become one of the biggest threats to global health, as it frequently co-occurs with a constellation of type 2 diabetes (T2D) and cardiovascular disease (CVD) risk factors and is associated with increased mortality. Genetic factors account for a substantial portion of the phenotypic variance in obesity and each of the correlated vascular disease risk factors. In this thesis, I describe the identification of several common genetic variants that predispose carriers to the complications associated with obesity. First, I report the identification of common variation within the gene of a protein secreted by visceral adipose tissue, visfatin, and demonstrate the influence of these variants on the inter-individual variation in fasting insulin levels. Second, I describe the identification of an interaction between the use of thiazolidinediones (TZDs), a class of anti-hyperglycemic medication, and variation in the nuclear factor of activated T-cells cytoplasmic component 2 (NFATC2) gene that results in edema and potentially congestive heart failure (CHF). Next, using a South Asian population sample for gene discovery, I identify a novel association between variation in the dipeptidyl peptidase 4 (DPP4) gene, a target of incretin-based anti-hyperglycemic medication, and apolipoprotein B (apoB) levels, a CVD risk factor and marker of the dyslipidemia associated with obesity. In addition, using observed differences between the Europeans and South Asians I was able to identify heterogeneity in the association between DPP4 and apoB caused by adiposity. Finally, I report an association between variation in the sterol regulatory element binding protein 1 (SREBF1) gene and body mass index (BMI) and demonstrate its potential contribution to observed differences in BMI among different ethnicities around the world. I also present data that strongly suggest that these differences may have been due to recent positive selection at this locus in human populations. The findings in this thesis illustrate the importance of common genetic variants in the pathogenesis of obesity, as well as its associated complications and highlight the regulation of glucose by adipose tissue as an important underlying feature.
L'obésité est devenue une des plus grandes menaces dans la santé publique, étant donné qu'elle est fréquemment co-reliée avec des facteurs de risque du diabète de type 2 (T2D) et de la maladie cardiovasculaire (CVD), et est donc associée à une mortalité accrue. Les facteurs génétiques représentent une partie substantielle de la variation phénotypique de l'obésité, ainsi que des facteurs de risque des maladies vasculaires qui y sont associés. Dans cette thèse, je décris l'identification de plusieurs variants génétiques communs qui prédisposent les porteurs aux complications associées à l'obésité. D'abord, je décris l'identification d'une variation commune dans le gène d'une protéine sécrétée par le tissu adipeux viscéral, visfatin, et démontre l'influence de ces variants sur la variation interindividuelle d'une insulinémie à jeun. Deuxièmement, je décris l'identification d'une interaction entre l'utilisation des thiazolidinediones une classe de médicaments anti-hyperglycémiques, et une variation génétique dans le gène nuclear factor of activated T-cells cytoplasmic component 2 (NFATC2) qui aboutit à l'œdème et potentiellement à l'insuffisance cardiaque congestive. Ensuite, en utilisant un échantillon de la population asiatique du Sud dans la découverte de gènes, j'identifie une nouvelle association entre la variation du gène dipeptidyl peptidase 4 (DPP4), une cible de la médication anti-hyperglycémique basée sur l'incretin, et les niveaux de l'apolipoprotéine B (apoB), un facteur de risque du CVD et un marqueur de la dyslipidémie associée à l'obésité. De plus, en utilisant des différences observées entre les Européens et les Asiatiques du Sud, j'ai pu identifier l'hétérogénéité dans l'association entre DPP4 et apoB causé par l'adiposité. Finalement, je décris une association entre la variation du gène sterol regulatory element binding protein 1 (SREBF1) et l'indice de masse corporelle (BMI) et démontre sa contribution potentielle aux différences de BMI observées parmi différentes ethnicités dans le monde entier. Je présente aussi des données qui suggèrent fortement que ces différences peuvent être dues à une récente sélection positive à ce locus dans des populations humaines. Les découvertes de cette thèse illustrent l'importance des variants génétiques communs dans la pathogenèse de l'obésité, ainsi que les complications qui s'y rattachent et mettent en évidence la régulation de glucose par le tissu adipeux comme étant une caractéristique sous-jacente importante.

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Liu, Tsz-chiu, i 廖子超. "Lipocalin-2 is a pro-inflammatory adipokine causally involved in obesity-associated endothelial dysfunction". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B45589434.

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Kaw, Roop, Priyanka Bhateja, y. Mar Hugo Paz, Adrian V. Hernández, Anuradha Ramaswamy, Loutfi S. Aboussouan i Abhishek Deshpande. "Postoperative Complications in Patients with Unrecognized Obesity Hypoventilation Syndrome Undergoing Elective Non-cardiac Surgery". American College of Chest Physicians, 2015. http://hdl.handle.net/10757/558500.

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BACKGROUND: Among patients with obstructive sleep apnea (OSA) a higher number of medical morbidities are known to be associated with those that have obesity hypoventilation syndrome (OHS) compared to OSA alone. OHS can therefore pose a higher risk of postoperative complications after elective non-cardiac surgery (NCS) and is often unrecognized at the time of surgery. The objective of this study was to retrospectively identify patients with OHS and compare their postoperative outcomes with those who have OSA alone. METHODS: Patients meeting criteria for OHS were identified within a large cohort of patients with OSA who underwent elective NCS at a major tertiary care center. We identified postoperative outcomes associated with OSA and OHS as well as the clinical determinants of OHS (BMI, AHI). Multivariable logistic or linear regression models were used for dichotomous or continuous outcomes, respectively. RESULTS: Patients with hypercapnia from definite or possible OHS, and overlap syndrome are more likely to develop postoperative respiratory failure [OR: 10.9 (95% CI 3.7-32.3), p<0.0001], postoperative heart failure (p<0.0001), prolonged intubation [OR: 5.4 (95% CI 1.9-15.7), p=0.002), postoperative ICU transfer (OR: 3.8 (95% CI 1.7-8.6), p=0.002]; longer ICU (beta coefficient: 0.86; SE: 0.32, p=0.009) and hospital length of stay (beta coefficient: 2.94; SE: 0.87, p=0.0008) when compared to patients with OSA. Among the clinical determinants of OHS, neither BMI nor AHI showed associations with any postoperative outcomes in univariable or multivariable regression. CONCLUSIONS: Better emphasis is needed on preoperative recognition of hypercapnia among patients with OSA or overlap syndrome undergoing elective NCS
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Ong, Kwok-leung, i 王國良. "Genetic variants of obesity- and inflammation-related genes in hypertension: genetic association studiesusing candidate gene approach". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B45200555.

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Stenberg, Erik. "Preventing complications in bariatric surgery". Doctoral thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-50649.

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Obesity is a major public health problem. Bariatric surgery is currently the only available treatment that offers sufficient weight-loss and metabolic benefits over time. Although bariatric surgery is considered safe now, serious complications still occur. The aim of this thesis was to identify factors associated with an increased risk for postoperative complication after laparoscopic gastric bypass surgery. Study I included patients operated with laparoscopic gastric bypass surgery in Sweden from May 2007 until September 2012. The risk for serious complication was low (3.4%). Suffering an intraoperative adverse event or conversion of the operation to open surgery were the strongest risk factors for postoperative complication. The annual operative volume and experience of the procedure at the institution were also important risk factors. Patient-specific risk factors appeared to be less important although age was associated with an increased risk. In Study II, a raised glycated haemoglobin A1c (HbA1c) was evaluated as a risk factor for serious postoperative complications in non-diabetics. A higher incidence of serious postoperative complications was seen with elevated HbA1c values, even at levels classified as ‘‘pre-diabetic’’. Study III was a multicentre, randomised clinical trial (RCT). 2507 patients planned for laparoscopic gastric bypass surgery were randomised to either mesenteric defects closure or non-closure. Closure of the mesenteric defects reduced the rate of reoperation for small bowel obstruction from 10.2% to 5.5% at 3 years after surgery. A small increase in the rate of serious postoperative complication within the first 30 days was seen with mesenteric defects closure. This relatively small increase in risk was however outweighed by the marked reduction of later reoperations for small bowel obstruction. Study IV was a comparison between study III and an observational study on the same population under the same period of time. Although the observational study reached the same conlusion as the RCT, the efficacy of mesenteric defects closure was less pronounced. Observational studies may thus be an alternative to RCTs under situations when RCTs are not feasible. The efficacy may however be underestimated.

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Yeung, Chun-yu, i 楊振宇. "Adipocyte- and epidermal-fatty acid-binding proteins in relation to obesity and its medical complications". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B44204565.

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Fuchs, Florent. "Obésité maternelle et macrosomie foetale : complications et prise en charge obstétricale". Thesis, Université Paris-Saclay (ComUE), 2015. http://www.theses.fr/2015SACLS037/document.

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Contexte : L'obésité est considérée par l'OMS comme une « épidémie » mondiale en raison de l'essor de sa prévalence et de ses conséquences sur la santé. Chez les patientes enceintes, son impact semble tout aussi préoccupant et sa prévalence en France atteint actuellement 10%. Certaines complications de l'obésité chez la femme enceinte ont été peu étudiées et notamment le lien particulier avec la macrosomie fœtale.Objectifs : Mieux appréhender la prise en charge des patientes enceintes obèses et de certaines complications qui en découlent.Méthodes : Trois séries de données différentes ont servi pour répondre à différentes questions sur la thématique de l'obésité et de la macrosomie. 1) Une évaluation de la faisabilité et de la qualité d'une échographie obstétricale du 2ème trimestre chez les patientes obèses a été réalisée via une étude mono centrique avec recueil prospectif des données. 2) Une étude des facteurs de risques de complications maternelles en cas d'accouchement d'un enfant macrosome, indépendamment de l'obésité maternelle et du poids de naissance de l'enfant a été menée sous la forme d'une étude prospective de cohorte d'enfant de plus de 4000g dans deux maternités d'Ile de France. 3) Enfin, une comparaison de la relation entre les complications maternelles de la grossesse et /ou néonatales et l'obésité a été menée entre la France (4 maternités de type III) et le Québec (données issues d'une étude randomisée dans toute la province) entre 2009 et 2011 via une étude comparative de deux échantillons transversaux de femmes enceintes (26 973 accouchements en France et 83 545 accouchements au Québec). Résultats : 1) Une échographie du deuxième trimestre de la grossesse chez une population obèse est possible, avec un taux de réussite en une fois de 70,4 %, (versus 82% ; p=0,08). Les facteurs d'amélioration de ce taux étaient : passer plus de temps lors de l'échographie (p=0,03), déplacer le fœtus de sorte que son dos soit en position latérale ou postérieure (p=0,01), et échographie réalisée par des échographistes expérimentés (p=0,03). Néanmoins, la qualité des images reste significativement moins bonne dans la population obèse (p=0,001). 2) La survenue de complications maternelles lors de la tentative d'accouchement vaginal d'un enfant de plus de 4000 g est de 6%. Les facteurs de risque de complications maternelles, outre le poids de naissance de l'enfant (p=0,004, Risque attribuable (RA)=10%), sont l'origine asiatique de la mère (p=0,04 ; RA=3%), une durée longue du travail (>10h) (p=0,02 ; RA=12%), et une césarienne au cours du travail (p=0,004 ; RA=17%). Les patientes multipares ayant déjà accouché par voie vaginale d'un enfant macrosome avaient un risque diminué de complications maternelles (p=0,03). 3) La prévalence de l'obésité était de 9,1% en France et 16,8% au Québec (p<0,001). L'obésité était associée de manière statistiquement significative (p<0,0001), à la fois en France et au Québec, à un risque accru de diabète gestationnel, de troubles hypertensifs de la grossesse, de prééclampsie, de mort fœtale in utero, d'accouchement par césarienne et de macrosomie. L'association était différente en France et au Québec (p interaction <0,005), pour la survenue du diabète gestationnel, de complications hypertensives de la grossesse et pour la macrosomie, avec une augmentation plus importante des complications avec l'IMC au Québec par rapport à la France.Conclusion : La compréhension de certaines complications inhérentes à l'obésité (complications médicales de la grossesse, faisabilité et qualité du dépistage échographique, complications obstétricales) est améliorée par les résultats de cette thèse
Background: According to WHO, obesity is considered as an "epidemic" condition due to the global growth of its prevalence and its impact on patient health. For pregnant patients, its impact seems equally worrying and its prevalence is now reaching 10% in France. Some complications of obesity in pregnant women have been little studied and particularly the special link with fetal macrosomia.Objectives: To better understand care and obstetric outcome of obese pregnant patients as well as some of their complications such as fetal macrosomia.Methods: Three different sets of data were used to deal with questions regarding obesity and macrosomia. 1) Assessment of feasibility and quality of second trimester ultrasound scan in obese patients was performed through a mono centric case-control study with prospective data collection. 2) A study of risk factors for maternal complications in case of the delivery of a macrosomic child, regardless of maternal obesity and child's birth weight, was conducted as a prospective cohort study including children with birthweight above 4000g in two “Ile de France” maternity wards. 3) Finally, a comparison of the relationship between maternal and/or neonatal complications of pregnancy and obesity was conducted in France (4 type III maternity wards) and in Quebec (data from a randomized study throughout the province) between 2009 and 2011 through a comparative study of two cross-sectional samples of pregnant women (26,973 births in France and 83,545 births in Quebec).Results: 1) Second trimester ultrasound scan in obese pregnant women is feasible, with a success rate of 70.4% (versus 82%; p=0.08). Factors of improvement were: to spend more time at ultrasound (p=0.03), to move the fetus so that its back is in lateral or posterior position (p=0.01) and when ultrasound was performed by experienced sonographers (p=0.03). However, the quality of the image remains significantly lower in the obese population (p=0.001). 2) The occurrence of maternal complications, when attempting vaginal birth of a child of more than 4000g, was 6%. Beyond childbirth weight (p=0.004, attributable risk (AR) = 10%), the risk factors of maternal complications were Asian ethnicity (p=0.04; AR=3%), prolonged labor (> 10h) (p=0.02; AR=12%), and caesarean section during labor (p=0.004; AR=17%). Multiparous women with a previous vaginal delivery of a macrosomic child had a lower risk of maternal complications (p=0.03). 3) The prevalence of obesity was 9.1% in France and 16.8% in Quebec (p <0.001). Obesity was significantly (p <0.0001) associated with, both in France and in Quebec, an increased risk of gestational diabetes, hypertensive disorders of pregnancy, preeclampsia, stillbirth, cesarean delivery and macrosomia. The strength of the association was different in France and Quebec (p of interaction <0.005) for the occurrence of gestational diabetes, hypertensive complications of pregnancy and macrosomia, with a larger increase in complications with body mass index in Quebec compared to France.Conclusion: Understanding some inherent complications of obesity (medical complications of pregnancy, feasibility and quality of ultrasound screening, obstetric complications) is enhanced by the result of this work

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Yang, Bo, i 杨波. "Role of lipocalin-2 in cardiac dysfunction associated with aging and dietary obesity". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B47869641.

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Obesity is closely related to many medical complications such as type 2 diabetes, hypertension and heart failure. Obesity and other factors, including elevated blood glucose levels, hypertension, and dyslipidemia, constitute a constellation of symptoms known as the metabolic syndrome, which are the risk factors for coronary artery disease. Lipocalin-2 is a pro-inflammatory adipokine causally involved in the development of obesity-associated metabolic and cardiovascular diseases. Recent clinical and experimental evidences demonstrate an association between augmented circulating lipocalin-2 and cardiac dysfunction. However, little is known about the detailed roles of lipocalin-2 in regulating pathophysiological functions of the heart. The present study was designed to compare the heart functions of mice with normal (WT) or deficient lipocalin-2 (Lcn2-KO) expression and to examine the molecular mechanisms underlying lipocalin-2-mediated deteriorated effects in hearts. Echocardiographic analysis revealed that the myocardial contractile function was significantly improved in hearts of Lcn2-KO mice, under both standard chow and high fat diet conditions. The heart function before and after I/R injury (20-min of global ischemia followed by 60-min of reperfusion) was assessed using the Langendorff perfusion system. Compared with WT littermates, hearts from Lcn2-KO mice showed improved functional recovery and reduced infarct size following I/R. These phenomena can be observed in mice under both standard chow and high fat feeding conditions. Under baseline condition, the mitochondrial function of hearts from Lcn2-KO mice was significantly enhanced, as demonstrated by biochemical analysis of respiratory chain activity, markers of biogenesis and oxidative stress, as well as electron microscopic investigation of the mitochondrial ultrastructure. Acute or chronic administration of lipocalin-2 impaired cardiac functional recovery to I/R and dampened the mitochondrial function in hearts of Lcn2-KO mice. These effects were associated with an extensive modification of the fatty acyl chain compositions of intracellular phospholipids. In particular, lipocalin-2 facilitated the redistribution of linoleic acid (C18:2) among different types of phospholipid, including cardiolipin, which is exclusively located in the mitochondria inner membrane. The direct effects of lipocalin-2 on both H9c2 and NCM cells were also examined. TUNEL assay and flow cytometry analysis demonstrated that lipocalin-2 treatment promoted apoptosis in cardiomyocytes. Lipocalin-2 induced an early phase of phosphatidylserine exposure, followed by Bax-translocation and caspase-3 cleavage. The results collectively suggested that lipocalin-2 initiated the intrinsic mitochondria-mediated apoptotic pathway. In the hearts of Lcn2-KO mice, significantly reduced number of apoptotic cells was observed after I/R injury. In conclusion, lacking of lipocalin-2 improved heart function recovery during I/R injury via mitochondrial function restoration, phospholipids remodeling, and inhibition of cardiomyocytes apoptosis.
published_or_final_version
Pharmacology and Pharmacy
Doctoral
Doctor of Philosophy

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Sahu, Soumyadip. "Cross-talk of Leptin and Thrombospondin-1 in Atherosclerotic Complications". Kent State University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=kent1492525184445034.

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Newman, Lisa K. "The Association between BMI-for-age and Intra- and Post-General Anesthesia Airway Complications". The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1337213041.

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SAKAMOTO, JUNICHI, HIDEKI KASUYA, YOSHITOKU YOSHIDA, MD HARUN-OR-RASHID, KARLYGASH ZHUBANYSHEVA, ZAITUNA HAMIDULLINA, TALSHYN UKYBASOVA i GULZHAN AIMUKHAMETOVA. "THE IMPACT OF MATERNAL OBESITY ON MOTHER AND NEONATAL HEALTH: STUDY IN A TERTIARY HOSPITAL OF ASTANA, KAZAKHSTAN". Nagoya University School of Medicine, 2012. http://hdl.handle.net/2237/16025.

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Schneck, Anne-Sophie. "Effets de la chirurgie bariatrique sur les complications hépatiques de l’obésité". Thesis, Nice, 2014. http://www.theses.fr/2014NICE4144/document.

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La sleeve gastrectomie (SG) est une opération qui consiste à réduire le volume de l’estomac. L’hypothèse que d’autres mécanismes indépendants de la perte de poids sont impliqués dans l’amélioration des complications métaboliques de l’obésité après SG a été émise. L’effet de la SG chez des souris soumis à un régime High Fat Diet a été étudié chez trois groupes d’animaux : SG, sham pair fed (SPF) et sham. Le test de tolérance au glucose montrait une amélioration de l’insulinorésistance des animaux SG à J23. Au niveau hépatique les animaux SG montraient une diminution significative de la stéatose. Il existe donc des mécanismes améliorant les complications hépatiques et métaboliques de l’obésité qui sont en partie indépendants de la réduction de l’apport calorique. Dans le second volet nous avons étudié l’évolution à long terme des lésions hépatiques liées à la NASH chez des patients obèses morbides avec une NASH lors de la chirurgie bariatrique. Dix patients d’une cohorte prospective ont été inclus. La deuxième biopsie a été réalisée à une médiane de 57 mois après le RYGB. La perte de poids moyenne était de –13,3 points de l’IMC lors du suivi. La rémission du syndrome métabolique et du diabète a été observée chez 71,6 % et 100 % des patients respectivement. Le NAS score a été amélioré chez tous les patients. Le taux sérique moyen du fragment clivé de la cytokératine 18 (M30), marqueur de l’apoptose hépatocytaire, était significativement abaissé. Le RYGB a permis une amélioration à long terme des lésions hépatocytaires liées à la NASH chez les patients obèses morbides. L’amélioration post-opératoire de la souffrance hépatocytaire corrèle avec la baisse du taux sérique du M30
The mechanisms responsible for weight loss and improvement of metabolic disturbances have not been completely elucidated. We investigated the effect of sleeve gastrectomy (SG) on body weight, adipose tissue depots, glucose tolerance, and liver steatosis independent of reduced caloric intake in high-fat-diet-induced obese mice. Mice fed a high fat diet were divided into 3 groups: SG, sham-operated ad libitum fed and sham-operated pair fed. SG mice showed improved glucose tolerance and lower levels of liver steatosis. This was associated with a decrease in the ratios of the weight of pancreas, epididymal and inguinal adipose tissues to body weight. Reduced white adipose tissue inflammation, modification of adipose tissue development, and ectopic fat are potential mechanisms that may account for the reduced caloric intake independent effects of SG. We also investigated long-term impact of RYGB surgery on liver complications in morbidly obese patients with NASH. Ten morbidly obese patients with biopsy-proven NASH were followed after RYGB and underwent a second liver biopsy. The median interval between the RYGB and second liver biopsy was 57 months. Clinical and biological data were obtained at baseline and ≥40 months after RYGB. RYGB was associated with significant weight loss, improved hepatic steatosis, resolution of hepatic inflammation and hepatocyte ballooning. Hepatocyte apoptosis, as evaluated by serum K18 fragment improved within the first year and at 57 months. Hepatic fibrosis resolved in 90% of cases. RYGB in morbidly obese patients with NASH is associated with a long-term beneficial impact on hepatic steatosis, inflammation, injury and, possibly, fibrosis

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Linné, Yvonne. "Factors affecting weight development after pregnancy - the SPAWN (Stockholm Pregnancy And Women's Nutrition) study /". Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-405-4/.

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Leong, Wen Bun. "The impact of obstructive sleep apnoea in extreme obesity : the impact on ethnicity, glycaemia and diabetes related microvascular complications". Thesis, University of Birmingham, 2015. http://etheses.bham.ac.uk//id/eprint/5798/.

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Obesity is known to be associated with obstructive sleep apnoea (OSA) and Type 2 diabetes mellitus (T2DM). The effect of OSA in very severely obese individuals is not well documented. In this thesis, I compared the effect of OSA in South Asians and white Europeans, examined the effect of OSA on glycaemic control among T2DM, and explored the relationship between OSA and diabetic retinal and kidney diseases in a severely obese population. I also systematically reviewed the effect of OSA on diabetic kidney and retinal diseases. Findings from this thesis were 1) severely obese South Asians had greater severity of OSA compared to white Europeans and the mechanisms mediating this require further investigation, 2) a high OSA prevalence in T2DM individuals with a positive relationship between nocturnal hypoxia and glycaemic control, 3) severity of hypoxaemia during sleep may be an important factor in the development of diabetic retinal complications, 4) duration of hypoxaemia during sleep were inversely associated with renal function in T2DM and 5) from the systematic review, there is a need for future large cohort studies with long term follow-up data to examine the long-term effects of OSA and other sleep parameters on diabetic retinal and kidney diseases.

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Voisin, Sarah. "Bioinformatic and Biostatistic Analysis of Epigenetic Data from Humans and Mice in the Context of Obesity and its Complications". Doctoral thesis, Paris 6, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-300751.

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Worldwide obesity has more than doubled since 1980 and at least 2.8 million people die each year as a result of being overweight or obese. An elevated body weight is the result of the interplay between susceptibility gene variants and an obesogenic environment, and recent evidence shows that epigenetic processes are likely involved. The growing availability of high-throughput technologies has made it possible to assess quickly the entire epigenome of large samples at a relatively low cost. As a result, vast amounts of data have been generated and researchers are now confronted to both bioinformatic and biostatistic challenges to make sense of such data in the context of obesity and its complications. In this doctoral thesis, we explored associations between the human blood methylome and obesity-associated gene variants as well as dietary fat quality and quantity. We used well described preprocessing techniques and statistical methods, along with publicly available data from consortiums and other research groups, as well as tools for pathway enrichment and chromatin state inference. We found associations between obesityassociated SNPs and methylation levels at proximal promoters and enhancers, and some of these associations were replicated in multiple tissues. We also found that contrary to dietary fat quantity, dietary fat quality associates with methylation levels in the promoter of genes involved in metabolic pathways. Then, using a gene-targeted approach, we looked at the impact of an acute environmental stress (sleep loss) on the methylation and transcription levels of circadian clock genes in skeletal muscle and adipose tissue of healthy men. We found that a single night of wakefulness can alter the epigenetic and transcriptional profile of core circadian clock genes in a tissue-specific manner. Finally, we looked at the effects of chronic maternal obesity and subsequent weight loss on the transcription of epigenetic machinery genes in the fetus and placenta of mice. We found that the transcription of epigenetic machinery genes is highly sensitive to maternal weight trajectories, and particularly those of the histone acetylation pathway. Overall, this thesis demonstrated that genetics, obesogenic environment stimuli and maternal programming impact epigenetic marks at genomic locations relevant in the pathogenesis of obesity.

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Patouraux, Stéphanie. "Rôle de l'ostéopontine dans les complications hépatiques induites par l'alcool, l'obésité et l'ischémie-reperfusion". Thesis, Nice, 2014. http://www.theses.fr/2014NICE4134/document.

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L’ostéopontine (OPN) est une protéine synthétisée et sécrétée par de nombreux types cellulaires. Elle joue un rôle important dans la régulation de la réponse inflammatoire et immune. Elle est également pro-fibrogénique, et présente des propriétés anti-apoptiques. Les NAFLD et ALD sont les premières causes d’ hépatopathies en France. Le spectre de ces complications va de la stéatose à la stéatohépatite, la fibrose, la cirrhose voire le carcinome hépatocellulaire. Le tissu adipeux joue un rôle important dans la survenue et l’évolution des NAFLD. Nous montrons que l'OPN favorise l'inflammation du foie et du tissu adipeux dans les NAFLD, en favorisant le recrutement de macrophages, de cellules dendritiques et de lymphocytes T et en modulant la polarisation de ces cellules immunes. Chez les patients alcooliques, nous rapportons que l’OPN constitue un marqueur prédictif de la fibrose hépatique. Les lésions induites par l'IR hépatique sont la principale cause de dommages survenant au cours des chirurgies du foie. Le rôle de l'OPN lors de l’IR n’a pas été étudié dans le foie. Mes études ont mis en évidence que l'OPN pourrait jouer un rôle protecteur. Son invalidation (OPN-/-) aggrave les lésions hépatiques (inflammation, souffrance et nécrose hépatocytaire) induites par l’IR chez la souris. Ce rôle protecteur de l’OPN pourrait être dû à sa capacité à prévenir la mort hépatocytaire et à limiter la production toxique de NO dans les macrophages. L’ensemble de ces travaux a permis de mettre en évidence de nouveaux rôles de l'OPN dans les lésions induites par l'IR hépatique et pourrait constituer une cible thérapeutique pour les maladies chroniques du foie
Osteopontin (OPN) is a protein synthesized and secreted by many different types of cells. It plays an important part in the regulation of the inflammatory and immune response. OPN is also pro-fibrogenic, and has anti-apoptotic properties. The nonalcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD) are the leading causes of liver disease in France. The range of these complications goes from steatosis to steatohepatitis, fibrosis, cirrhosis and even hepatocellular carcinoma. Adipose tissue plays a significant part on the occurrence and evolution of the NAFLD. We show that OPN facilitates liver’s and adipose tissue’s inflammation in the NAFLD, by facilitating the intake of macrophages, dendritic cells and T cells, and by modulating the polarization of these immune cells. For alcoholic patients, we show that OPN is one of the predictive markers of liver fibrosis. The lesions induced by ischemia-reperfusion (IR) are the main cause of damages occurring during liver’s surgery. The role of OPN in hepatic injury induced by IR has not yet been investigated. My studies demonstrate that OPN could have a protecting role. OPN deficiency in mice (OPN-/-) increases hepatic lesions caused by IR (inflammation, and cell death). OPN could thus partially prevent hepatic injury and inflammation induced by IR. This could be due to its ability to prevent hepatocyte death and production of toxic NO by macrophages. OPN could thus be an important actor in the pathogenesis of chronic liver disease

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Rizzolli, Jacqueline. "Obesidade grau III : considerações sobre complicações clínicas e tratamento cirúrgico". reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2005. http://hdl.handle.net/10183/8411.

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A obesidade grau III ou também chamada obesidade mórbida é uma condição clínica freqüente e que vem apresentado crescimento progressivo, estando associada a elevadas taxas de morbi-mortalidade. Trata-se de uma doença de origem multifatorial, freqüentemente associada a comorbidezes, necessitando uma abordagem terapêutica que propicie redução de peso, melhora das doenças associadas e conseqüente melhora da qualidade de vida. O tratamento convencional deve ser sempre a primeira escolha, principalmente nos casos de inicio recente e sem antecedentes de tratamentos adequados prévios. A taxa de insucesso, contudo, é extremamente elevada, ocorrendo falha em mais de 90% dos casos. O tratamento cirúrgico atualmente é a alternativa com melhores resultados, porém com riscos de complicações a curto, médio e longo prazo, caso não seja realizado um rigoroso acompanhamento clinico, nutricional e psicológico em equipe multidisciplinar experiente. Esta revisão tem por objetivo discorrer sobre as morbidades associadas à obesidade grave, as opções de tratamento convencional e cirúrgico bem como riscos relacionados à persistência de um grande excesso de peso versus risco cirúrgico.
Morbid obesity is a frequent disease with a progressive increase in incidence and associated with high morbid and mortality rates. It is a multifactorial disease, and is usually associated with comorbidities. It is necessary specific treatment to reduce weight, to improve the comorbidities and obtain a better quality of life. The classic treatment, diet and exercise, should be the first choice, especially in cases of recent onset of severe obesity and poor quality previous treatments. Unfortunately, in more than 90% of the patients this kind of treatment will fail. Bariatric surgery is, nowadays, the best option of treatment, but has several risks of complications in the short, medium or long time followup, mostly in patients not followed by a specialized multidisciplinary team. This is a review about morbid obesity, comorbidities, options of treatment and the risks of stay severely obese versus surgical procedures.

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Ander, Fredrik. "Perioperative complications in obese patients : A thesis on risk reducing strategies". Doctoral thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-59411.

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Aspiration of gastric content and delayed or failed intubation are the leading causes of anesthesia-related mortality and morbidity. In the recovery period, airway obstruction with subsequent hypoxia is a relatively common cause of morbidity, and is highly associated to the amount of opioids administered, especially in obese patients. The overall aim of this thesis was to study these risk factors for airway complications and postoperative hypoxia in obese patients, and to evaluate possible strategies for their prevention. In Study I, intubation times and incidence of failed intubation in obese patients were compared between direct laryngoscopy and videolaryngoscopy with the Stortz® C-MAC™. In Studies II and III, the effect of esmolol vs. remifentanil on the esophageal junction, and the possible analgesic properties of low-dose esmolol vs. placebo were evaluated using high-resolution manometry and the cold pressor test, respectively. Finally, in Study IV, the possible opioid-sparing effect of esmolol after laparoscopic gastric bypass surgery was evaluated. The use of videlaryngoscopy did not shorten intubation times, however appeared to reduce the incidence of failed intubation. Our results also show that esmolol has a favorable profile, compared to remifentanil, with regard to the protection against passive regurgitation and aspiration of gastric content. No analgesic effect of low-dose esmolol was however demonstrated. The intraoperative administration of esmolol instead of remifentanil also did not reduce the requirement of morphine for treatment of post-operative pain. The use of Stortz® C-MAC™ may be recommended for intubation of obese patients. Further studies are however required to clarify the possible role of esmolol in anesthesia.

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Kerrigan, Angela Mary. "Care of obese women during labour : the development of a midwifery intervention to promote normal birth". Thesis, University of Stirling, 2017. http://hdl.handle.net/1893/27479.

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Normal birth, defined as birth without induction of labour, anaesthetic, instruments or caesarean section conveys significant maternal and neonatal benefits. Currently one-fifth of women in the United Kingdom are obese. There is increasing evidence of the detrimental effects obesity has on intrapartum outcomes. There is a lack of research on how to minimise the associated risks of obesity through non-medicalised interventions and how to support obese women to maximise their opportunity for normal birth. This thesis aims to provide evidence to address this gap and develop an evidence-based intervention to promote normal birth. Using a methodological approach aligned with pragmatism, this research was conducted in four parts and underpinned by the Medical Research Council framework for the development of complex interventions. Part one was a national survey involving 24 maternity units. Part two was a qualitative study of the experiences of 24 health professionals and part three involved 8 obese women. The final part was a multi-disciplinary workshop that used consensus decision-making to design the intervention. Collectively, the findings suggest that intrapartum care of obese women is medicalised. Health professionals face challenges when caring for obese women but many strive to optimise the potential for normal birth by challenging practice and utilising ‘interventions’ to promote normality. The findings also demonstrate that obese women have an intrinsic fear of pregnancy and birth, have a desire for normal birth and ‘obese pregnancy’ presents a window of opportunity for change. The intervention consists of three component parts; an educational aspect (e-learning package), a clinical aspect (intrapartum care pathway) and a leadership aspect (ward champions). Whilst acknowledging the importance of safety, increasing intervention during labour for obese women may further increase the risk of complications, with detrimental effects. Addressing intrapartum management of obese women through non-medicalised interventions is of paramount importance in order to promote normality, maximise the opportunity for normal birth and reduce the associated morbidities.

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Hayes, Philip Michael. "Ethnic-specific associations between abdominal and gluteal fat distribution and the metabolic complications of obesity : implications for the use of liposuction". Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/12235.

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Includes bibliographical references.
More than three-quarters (77%) of the 40.5 million people living in South Africa are black African, of which more than 40% are urbanised. Black African women living in urban areas have a significantly higher prevalence (62%) of overweight than urban black males (28%) or white females (53%). It was previously thought that obesity in black South African women was not associated with deleterious metabolic sequelae and was termed "healthy" obesity...

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Anth, Marie. "En jämförelse mellan olika tekniker vid trakeal intubering av obesa patienter : - En litteraturstudie". Thesis, Umeå universitet, Institutionen för omvårdnad, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-85483.

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ABSTRAKT Syfte och mål: Att jämföra olika tekniker vid trakeal intubering av obesa patienter. Bakgrund: Fetma blir vanligare och behovet av kunskap inom vården ökar för att på ett säkert sätt ta hand om dessa patientgrupper. Anestesisjuksköterskan ska kunna hantera, prioritera och ta snabba beslut vid akuta tillstånd och förebygga komplikationer som kan uppstå. Kunskap och beredskap inför akuta situationer är av stor vikt för att hantera den svåra luftvägen och kunna ge en god och säker omvårdnad genom anestesin. Design: En litteraturstudie med kvantitativ ansats genomfördes. Metod: Databasen EBSCO genomsöktes gällande studier som var publicerade mellan 2003-2013 där följande tekniker gällande trakeal intubering hos obesa patienter valdes; intubering med larynxmask (ILMA), videolaryngoskop/glidescope vid vakenintubation och generell anestesi, Rapid Sequence Induction (RSI), the Shikani optical stylet, LMA Ctrach, flexibelt fiberoptiskt bronkoskop och Airtraq med sedvanlig och omvänd manöver. Dessa tekniker bedömdes efter intuberingstid, lyckad intubering vid första försöket, ömhet/skada i halsen och Body Mass Index (BMI). Åtta studier inkluderades av vilka en kvalitetsgranskning genomfördes. Resultat: RSI med vanligt laryngoskop hade högst frekvens gällande lyckad intubering på första försöket. Kortast intuberingstid ses vid användning av Airtraq laryngoskop med omvänd manöver. Längst tid tar vakenintubation med laryngoskop. När det gäller skada eller postoperativ ömhet i hals och svalg har det fiberoptiska bronkoskopet flest fall trots relativt kort intubationstid. Användning med Airtraq och omvänd manöver hade en låg frekvens gällande komplikationer i svalget samtidigt som intubationstiden var kort. Slutsats: Flera faktorer spelar in och det viktigaste är att en preoperativ bedömning gjorts och att den som intuberar har vana och erfarenhet av tekniken för en snabb och säker etablering av luftvägen.Relevans för klinisk verksamhet: Anestesisjuksköterskan kommer alltmer möta patienter med obesitas och kunskap om olika tekniker för att säkerställa luftvägarna hos överviktiga är av stor betydelse för en säker omvårdnad. Nyckelord: Intubering, fetma, teknik, luftvägar, komplikationer Strukturen på examensarbetet är justerat efter instruktioner från ”The Journal of Clinical Nursing”, en tänkbar tidskrift för publikation.

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Issa, Nahla. "Role of inflammation in the pathogenesis of insulin resistance in obesity : specific role of reactive oxygen and reactive nitrogen species". Doctoral thesis, Université Laval, 2016. http://hdl.handle.net/20.500.11794/26581.

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L’inflammation chronique associée à l’obésité contribue à la pathogénèse de plusieurs troubles métaboliques dont la résistance à l’insuline. Cette inflammation est associée avec le développement du stress oxydant et est reconnue comme un facteur impliqué dans l’inhibition de la signalisation de l’insuline. Ainsi, le but de ces études était d’évaluer le rôle du stress oxydant dans le développement de la résistance à l’insuline associée à l’inflammation. En particulier, nous avons cherché à évaluer le rôle de l’ion superoxyde et de radicaux lipidiques qui, associés à l’induction de la forme inductible de la NO synthase (iNOS), pourraient jouer un rôle clé dans la promotion de nitration de tyrosine des protéines impliquées dans la signalisation d’insuline, ainsi que dans la promotion des troubles métaboliques associés à l’obésité. Dans la première étude, nous avons démontré que le traitement d’adipocytes avec des cytokines induit l’expression de l'isoforme NADPH oxidase 3 (NOX3) de la famille des NADPH oxydases (NOX) et parallèlement augmente la production de l'ion superoxyde. Ce traitement a aussi augmenté la lipolyse et la phosphorylation de la lipase hormono-sensible. Fait intéressant, l’inhibition de l’activité de NOX avec le Diphenyleneiodonium (DPI), a renversé l’effet des cytokines sur la lipolyse, la production de superoxyde et la phosphorylation de la lipase hormono-sensible. De plus, l’inhibition spécifique de l’expression de NOX3 via l'expression d'un siRNA a eu le même effet que le DPI. Cela indique que NOX3 est la source majeure de production de superoxyde induit par l’inflammation et ainsi régule négativement la lipolyse par l’augmentation de l’activité de la lipase hormono-sensible. Dans la deuxième étude, nous avons identifié un rôle pour NOX3 et l'anion superoxyde dans le mécanisme de nitration de tyrosines sur Akt dans les cellules hépatiques FAO. Aussi, l’expression de NOX3 a augmenté dans les cellules hépatiques primaires traitées avec cytokines en même temps que l’augmentation de 3-nitrotyrosine, une empreinte reconnue de la formation de nitrotyrosine. Nous avons observé qu’une diète riche en lipides a pour effet d’augmenter la nitration sur tyrosine dans les foies de souris ainsi que dans les cellules hépatiques primaires isolées des foies de ces souris. De plus, cette diète a augmenté la nitration de tyrosines sur Akt dans le foie de souris obèses. Finalement, nous avons identifié deux résidus, tyrosine 152 et tyrosine 38, qui sont nitratés sur Akt1, et qui pourraient réguler négativement l’activité d’Akt lorsque nitratés. Dans la troisième étude, nous avons démontré que le captage des radicaux lipides avec le "spin trap" α -(4-Pyridyl-1-oxide)-N-tert-butylnitrone (POBN) dans les souris nourries avec une diète riche en lipides a diminué la masse adipeuse comparativement avec les souris obèse non traitées. Cet effet a été associé à une amélioration de la tolérance au glucose et de la sensibilité à l’insuline, ainsi que d'une diminution de l’inflammation dans la tissu adipeux. En plus, on a remarqué une amélioration de la fonction mitochondriale dans le muscle et le tissu adipeux. Dans le foie, la traitement avec POBN a empêché l’accumulation des lipides et a amélioré le métabolisme de glucose. L'ensemble de nos études démontre le rôle de l'anion superoxyde généré par NOX3 dans le mécanisme de nitration de tyrosine dans le foie et la modification de la fonction métabolique dans les adipocytes. Aussi, nous avons identifié deux tyrosines nitratées sur Akt1 qui pourraient être impliquées dans la régulation de son activité. Enfin, nous avons montré que POBN semble d’avoir un effet préventif sur l’obésité qui est associé avec l’amélioration des plusieurs paramètres métaboliques.
Chronic low-grade inflammation is considered one of the triggers of obesity-associated insulin resistance. Metabolic inflammation goes along with increased oxidative and nitrosative stress, but whether this promotes insulin resistance in obesity remains ill-defined. Thus, the primary objective of this thesis was to study the role of oxidative and nitrosative stress in the development of inflammation mediated insulin resistance and in particular to highlight the role of superoxide anion production, lipid radical generation, and iNOS induction, in mediating tyrosine nitration of insulin signaling proteins and other metabolic dysfunctions associated with obesity. In chapter I, we showed for the first time that treatment of adipocytes with cytokines induced NADPH oxidase-3 (NOX3) expression along with increasing superoxide production. Cytokine treatment also increased lipolysis as indicated by measuring free glycerol release and caused increase in the phosphorylation of hormone sensitive lipase. Interestingly, pharmacological inhibition of NOX activity by Diphenyleneiodonium (DPI) reversed the effect of cytokines on lipolysis and on the phosphorylation of HSL in line with decreasing superoxide production. Specific knockdown of NOX3 gene expression in adipocytes displayed the same effects as those exerted by DPI. These results indicate that NOX3 is the major NOX involved in superoxide production in 3T3L1 adipocytes and a regulator of lipolysis in inflammatory settings. In chapter II, we identified a new role of NOX3 and superoxide production in mediating tyrosine nitration on Akt in FAO hepatic cells. NOX3 expression was increased in primary hepatocytes after cytokine treatment together with an increase in 3-nitrotyrosine. Interestingly, primary hepatocytes isolated from high fat (HF) fed mice displayed more tyrosine nitration when compared to primary hepatocytes isolated from mice on chow diet. Also, we showed for the first time a tendency for high fat feeding to increase tyrosine nitration specifically on Akt. More importantly, two novel tyrosine nitrated sites on Akt1 were identified: tyrosine 152 and tyrosine 38, which seem to play a role in negatively regulating Akt activity when tyrosine nitrated. In chapter III, scavenging lipid radicals by α -(4-Pyridyl-1-oxide)-N-tert-butylnitrone (POBN) reversed the metabolic disorders caused by HF feeding in mice. POBN treated mice exhibited decrease in fat mass when compared to their HF counterparts. This effect was associated with enhanced glucose tolerance and insulin sensitivity. Also, adipose tissue inflammation was alleviated and mitochondrial function was ameliorated, insulin signaling in skeletal muscle was restored and mitochondrial oxidative metabolism was also enhanced. In the liver, POBN treatment prevented fat accumulation and enhanced lipid and glucose metabolism. Together these results highlight the important role of NOX3 generated superoxide in mediating tyrosine nitration in liver and in altering metabolic dysfunction in adipocytes. Also, two important tyrosine nitrated sites on Akt were identified that may possibly be involved in regulating its activity. Finally, the lipid radical scavenger, POBN, displayed anti-obesity effects in HF fed mice and this effect was associated with amelioration of several metabolic parameters.

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Lalanne-Mistrih, Marie-Laure. "Caractérisation des profils lipidiques plasmatiques des patients drépanocytaires guadeloupéens SS et SC à l'état stable. Profil lipidique et hémorhéologique des complications du sous-phénotype hyperhémolytique/vasculopatie et hypervisqueux/vaso occlusif. : Profil lipidique et hémorhéologique des complications du sous-phénotype hyperhémolytique/vasculopathie et hypervisqueux/vaso occlusif". Thesis, Antilles, 2019. http://www.theses.fr/2019ANTI0437.

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Les patients drépanocytaires ont un profil lipidique spécifique, à priori non athérogène.En 2009 est découvert qu’un taux d’apolipoprotéine AI et de HDL-cholestérol abaissés et de triglycérides élevés (HTG), constitue un profil lipidique plus souvent associé à une hypertension artérielle pulmonaire. Notre travail de thèse a consisté en l’étude, à l’état stable, des profils lipidiques des cohortes d’adultes drépanocytaires homozygotes SS (HbS/HbS) et hétérozygotes composites SC (HbS/HbC), à l’unité transversale de la Drépanocytose du CHU de la Guadeloupe, comparés ensuite à celui de la population générale guadeloupéenne (PGG). Nous avons aussi étudié les marqueurs hémorhéologiques, hématologiques, lipidiques et anthropométriques des sujets drépanocytaires SS et SC, en présence ou non d’une hypertension artérielle (HTA) et comparé les taux de leurs lipides, en fonction de la présence ou non d’antécédents de complications du phénotype visqueux/vaso-occlusif de la drépanocytose : crise vasoocclusive (CVO), syndrome thoracique aigu (STA) et ostéonécrose (OTN). Nous avons montré: *chez les adultes SS: 1) une HTG relative, comparativement aux SC et à la PGG ; 2) que TG>1.50g/L est un facteur de risque indépendant d’HTA relative et associé à plus d’antécédents de CVO et STA ; 3) que comparativement aux SC, leurs taux de lipides sont plus bas, excepté l’ApoB100 et les TG ; 4) que TG est indépendant de l’hémolyse, la glycémie à jeun, le sexe, l’obésité abdominale ou l’IMC ; 5) les marqueurs hémorhéologiques et les taux de lipides sont indépendants chez les SS et SC; 6) *chez les adultes SC, qu’un Non-HDL-Cholestérol>1.30g/L était plus souvent retrouvé associé à une OTN. En conclusion, ces travaux permettent de préciser pour la première fois le profil lipidique d’adultes drépanocytaires SS et SC, tous deux différents de celui de la PGG. Ils ont contribué également à isoler deux biomarqueurs lipidiques potentiels, associés à des antécédents de complications du phénotype visqueux/vasoocclusif de la drépanocytose, enrichissant leur compréhension physiopathologique, indépendamment des troubles hémorhéologiques déjà identifiés. Nous montrons pour la première fois que les TG>1.50g/L et le Non-HDL-cholestérol>1.30g/L, sont plus souvent associés, respectivement, aux antécédents de STA chez les patients SS et d’OTN chez les patients SC
Patients with sickle cell disease present a specific, apparently not atherogenic lipidprofile. In 2009, it was discovered that both decreased apolipoprotein AI and HDLcholesterol levels and high triglycerides (HTG), constituted a lipid profile more often associated with pulmonary arterial hypertension. Our thesis consisted in the study, at steady state, of the lipid profiles of SS homozygote (HbS/HbS) and SC heterozygote (HbS/HbC) cohorts of sickle cell patients, followed at the Reference Center of Sickle cell disease, also compared to that of the general population of Guadeloupe (PGG). We also studied hemorheological, hematologic, lipidic and anthropometric markers of SS and SC sickle cell patients, with and without hypertension, and compared the levels of their lipids, according to the presence or absence of a history of complications of the viscous/vasoocclusive phenotype of sickle cell disease: vaso-occlusive crisis (CVO), acute chest syndrome (ACS) and osteonecrosis (OTN). We have shown: * in SS adults : 1) relative HTG compared to SC and PGG; 2)TG> 1.50g/L is an independent risk factor for relative hypertension; 3)when TG>1.50g/L, more history of CVO and ACS; 4) compared with SC adults, their lipid levels are lower, except for both ApoB100 and TG; 5) TG level is independent of hemolysis, fasting blood glucose, sex, abdominal obesity or body mass index; 6) Hemorheological markers and lipid levels were independent inSS and SC; 7) * in SC adults, non-HDL-cholesterol>1.30g/L was more often foundassociated with OTN. In conclusion, this work makes it possible to specify for the firsttime the lipid profile of sickle cell SS and SC adults, both different from that of PGG. Italso helped to isolate two potential lipid biomarkers, associated with a history ofcomplications of the viscous/vasoocclusive phenotype of sickle cell disease, enriching their pathophysiological understanding, independently of previously identified haemorheological disorders. We show for the first time that TG>1.50g/L and Non- HDL-cholesterol>1.30g/L, are more often associated, respectively, with the history of ACS in SS patients and OTN in SC patients

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Afonso, Ricardo Alexandre da Silva Santos. "Sensibilidade à insulina pós-prandial: mecanismos fisiológicos e de activação e fisiopatologia na obesidade". Doctoral thesis, Faculdade de Ciências Médicas. Universidade Nova de Lisboa, 2008. http://hdl.handle.net/10362/5102.

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RESUMO A acção hipoglicemiante da insulina é máxima no estado pós-prandial e depende da substância hepática sensibilizadora da insulina (HISS). Esta dissertação visa o estudo do mecanismo de acção da insulina no estado pós-prandial e em particular da via dependente da HISS, em modelos animais fisiológicos e patológicos (obesidade e diabetes mellitus tipo 2). Avaliaram-se diferentes tipos de refeição quanto ao seu efeito potenciador da acção da insulina, em ratos Sprague-Dawley (modelo fisiológico). A administração intragástrica de glícidos não afecta a acção da insulina, mas a refeição mista (lípidos, glícidos e proteínas), promove a sensibilização para a acção da insulina, através de um processo que parece ser iniciado no intestino e envolve a activação da via da HISS. Nos estudos de obesidade, o primeiro modelo utilizado foi o rato alimentado com dieta hiperlipídica (HFD), no qual se observou uma insulinorresistência pós-prandial devida quase exclusivamente à perda de acção da HISS, que se correlaciona com a adiposidade (corporal e abdominal) e parece ser devida à diminuição da sua síntese. O segundo modelo de obesidade usado foi o rato Zucker obeso (OZR), modelo genético que apresenta uma diminuição idêntica de ambas as componentes de acção da insulina (dependente e independente da HISS). A alteração na via da HISS parece localizar-se a jusante da sua síntese, sugerindo que um ou vários pontos comuns entre as vias de sinalização intracelular da HISS e da insulina per se estão alterados, resultando num diminuto aporte de glucose. No OZR, a acção da HISS não se altera com a idade, apresentando-se baixa também às 52 semanas de idade. Em ratos não obesos (LZR), a acção da HISS diminui entre as 9 e 52 semanas, sendo acompanhada por um decréscimo menos acentuado, embora significativo, da acção da insulina per se. A diminuição da acção da HISS com a idade parece ser a principal causa de insulinorresistência pós-prandial em LZR velhos, não se agravando no OZR. No modelo de diabetes tipo 2 estudado, o rato Zucker diabético (ZDF), também ambas as componentes de acção da insulina estavam diminuídas. No entanto, a alimentação com ração Purina, ligeiramente mais energética e lipídica do que a ração standard, agrava a disfunção da via da HISS nestes animais, sugerindo que a sensibilidade à insulina em ratos ZDF é muito susceptível a factores nutricionais. A via da HISS é essencial para potenciar a acção da insulina do estado de jejum para o pós-prandial e a sua disfunção é em grande medida responsável pela insulinorresistência observada nos modelos animais de obesidade e diabetes estudados. xix SUMMARY Hypoglycemic insulin action is maximal in the postprandial state and depends on the hepatic insulin sensitizing substance (HISS). The present thesis focus on the postprandial insulin action and, in particular, on the HISS-dependent pathway, both in physiological and pathological (obesity and type 2 diabetes mellitus) animal models. Different meals were tested in Sprague-Dawley rats (physiological model) for their capacity to potentiate insulin action. It was observed that intragastric administration of either glucose or sucrose does not affect insulin sensitivity, unlike the mixed meal, composed of lipids carbohydrates and proteins, which significantly potentiated insulin action through a process that seems to be initiated at the intestine and involves activation of the HISS pathway. For the obesity studies, the first of the two obesity models used was the high fat-fed rat (HFD), in which the postprandial insulin resistance was almost exclusively caused by the decrease of HISS action, probably due to the impairment of HISS synthesis. This impairment correlates with both corporal and abdominal adiposity. The second obesity model used was the obese Zucker rat (OZR), a genetic model, which presented a similar impairment of both components of insulin action (HISSdependent and –independent). The modification in HISS pathway in OZR seems to be located downstream from HISS synthesis, that is, at its site of action – the skeletal muscle -, suggesting that one or several points common to both HISS and insulin per se signaling cascades are defective, resulting in a decreased glucose uptake. In OZR, HISS action does not decrease with age and is also low at 52 weeks of age. In non-obese rats (LZR), HISS action decreases from 9 to 52 weeks and it is accompanied by a lower, although significant, impairment of insulin action per se. HISS action impairment with aging seems to be the major cause of insulin resistance in old LZR, whereas insulin resistance is not aggravated in aging OZR. In the type 2 diabetes model, the diabetic Zucker rat (ZDF), both components of insulin action were also equally impaired. However, feeding the animals with Purina rat chow, which is slightly more caloric and more lipidic, induces additional HISS deterioration when compared with the standard lab diet, suggesting that insulin sensitivity in ZDF is very susceptible to nutritional factors. In conclusion, HISS pathway is essential to potentiate insulin action from the fasted to the fed state and its dysfunction is highly responsible for the insulin resistance observed in the obesity and diabetes animal models studied.

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Nguyen, Tu Marie-Sophie. "Effets de l’adiposité sur la microcirculation et les complications cutanées au cours de l’obésité". Thesis, Lyon 1, 2013. http://www.theses.fr/2013LYO10288.

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L'obésité et le diabète sont associés à des complications cutanées, en particulier des fonctions dermiques impliquées dans le maintien de la résistance mécanique de la peau. Cependant, les mécanismes par lesquels l'obésité provoque la fragilité du tissu cutané sont peu étudiés. Notre travail consistait à évaluer les effets d'un régime hypercalorique sur la microcirculation cutanée et les conséquences sur le développement de lésions cutanées. Les études ont été réalisées chez des souris C57Bl6/J développant une obésité induite par une alimentation enrichie en graisse et en sucre pendant 2, 4, 12 et 20 semaines. Les propriétés de la microcirculation cutanée sont évaluées par les variations du flux sanguin en réponse : 1) à l'acétylcholine afin de déterminer la vasodilatation endothélium-dépendante, 2) au nitroprussiate de sodium afin de déterminer la vasodilatation endothélium-indépendante, 3) à l'application de la pression locale afin de déterminer la vasodilatation induite par la pression (PIV). Ces études sont complétées par des explorations métaboliques (IPGTT, IPITT), morphologiques, immuno-histologiques et biochimiques pour caractériser les quatre modèles. Enfin, chaque modèle a été testé pour l'incidence d'ulcère de pression par l'application d'une pression unique de 85 mmHg. Dans ce travail de thèse, nous avons mis en évidence de nombreux mécanismes de compensation accompagnant l'évolution de l'obésité et qui permettent de maintenir les fonctions vasculaires intactes et permettent de s'adapter à l'environnement inflammatoire induit par l'alimentation hypercalorique. La PIV est un outil de diagnostic nous permettant d'évaluer l'intégrité de la fonction neurovasculaire et prédire l'incidence de lésions cutanées
Obesity and diabetes are associated to skin pathophysiology, particularly the dermal functions involved in maintaining the skin’s mechanical strength. The underlying mechanisms in pressure ulcer during obesity remain unclear. In this study we evaluated the effects of a hypercaloric diet on the cutaneous microcirculation and its consequences on pressure sores. C59Bl6/J mice were fed a high fat and high sugar diet during 2, 4, 12 and 20 weeks. Microvascular properties were assessed by measuring the skin blood flow variations in response to 1) acetylcholine in order to determine the endothelium-dependent vasodilation, 2) sodium nitroprusside in order to determine the endothelium-independent vasodilation, 3) local pressure application in order to determine the pressure-induced vasodilation (PIV). Each model was characterized for metabolic assessment (IPGTT, IPITT), hisological, immune-histological and biochemical measurements. Finally, each model was tested for pressure ulcer incidence with a 85 mmHg pressure application on skin layers. In this study, we found that obesity is a pathology in constant evolution that is associated with many compensatory mechanisms for maintaining vascular functions and for the adaptation of the skin tissue to an inflammatory environment induced by a hypercaloric diet. PIV has become a useful tool for pressure ulcer prediction

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Nzeako, Love Chibuihe. "Effectiveness of a 10-Week Weight Reduction Program in a Retail Clinic". ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4090.

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Obesity is a serious health problem that leads to several chronic diseases and premature deaths. TheIn this project,was used to evaluate the effectiveness of the the Weigh Forward (WF) program, a 10-week weight-loss program administered in retail clinics, was evaluated, and it is provided in retails stores. The project analysis was completed on a limited data set on The population consisted of 15 obese participantsmembers of the program, 18 years and above, at 13 dispersed clinics in Maryland and Virginia.in the WF program from 13 dispersed clinics in Maryland and VirgiObesity is a body mass index (BMI) > 30 kg/m2. Participants were 18 years and above The theory of planned behavior (TPB) was used as the framework from which to view the project. The project was usedpurpose was to determine the efficacy of the WF program for weight reduction by comparing the baseline body mass index (BMI) and the waist circumference (WC) to the BMI and WC at the end of the program. Descriptive The aanalysis was done using correlation coefficient on the 15 participants,, who completed the 10-week WF program. The result, showed the mean and mode for BMI reduction to be 2 kg/m2, and the mean and mode for the WC reduction was 3 inches. The percentage weight loss varied from 3-11%, with the completion rate for the enrolled participants at 29%. Thise study has implications for the social change because the findings support intensive behavioral modification as an effective approach to weight loss. The study can help healthcare providers appreciate the is the need to complete preventive care assessment on patients, identify patients with obesity, and provide these patients with the requisite information on the need to lose weight. Also, the clinicians provide the patients with information and available resources to enable help them lose weight. The mean and mode of 2 kg/m2 for BMI reduction, and 3 inches for the reduction in WC at the end of 10 weeks, showed that the WF program was effective for weight loss because the participants lost significant amount of weight. The findings from the project can guide the development of practice guidelines for administering the WF program in the retail clinic.

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Dertkigil, Sergio San Juan 1975. "Avaliação por imagem da distribuição da gordura corporal em obesos e suas correlações metabolicas". [s.n.], 2006. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311218.

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Orientador: Mario Jose Abdalla Saad
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
Made available in DSpace on 2018-08-11T14:59:49Z (GMT). No. of bitstreams: 1 Dertkigil_SergioSanJuan_M.pdf: 2116703 bytes, checksum: 70e0c18a251483a0c4be5861dc3adee8 (MD5) Previous issue date: 2006
Resumo: Introdução A obesidade tem sido considerada uma das mais importantes doenças da atualidade, tanto pela sua crescente prevalência quanto pela sua alta relevância de morbi-mortalidade. A segmentação da gordura em seus diferentes compartimentos vem ganhando importância na tentativa de explicar e influir no prognóstico das alterações metabólicas envolvidas na obesidade. Objetivos Estudar os diferentes tipos de compartimentalização de gordura e correlacionar com suas alterações metabólicas mais freqüentes e relevantes. Material e Métodos Foram avaliados 64 pacientes obesos do ambulatório de obesidade do HC-UNICAMP, através de tomografia computadorizada, para medição das gorduras subcutânea, visceral, infiltração hepática, pancreática e muscular, e correlacionar esses achados da distribuição regional de gordura com os fatores metabólicos clássicos, entre os quais, glicemia de jejum, insulinemia de jejum, HOMA-IR, frações de colesterol, marcadores hepáticos (_GT) e medidas antropométricas. Resultados Foram analisados 64 pacientes, 30 homens e 34 mulheres, que demonstraram diferença estatística entre a área de gordura visceral, densidade hepática e muscular, e apresentaram alta correlação com fatores metabólicos clássicos (HOMA-IR, TG e TG/HDL). A área de gordura subcutânea e a densidade pancreática não apresentaram diferenças estatísticas entre os grupos ou com os fatores metabólicos. Os pacientes com baixa quantidade de gordura visceral e alta quantidade de gordura subcutânea, apresentaram fatores metabólicos de menor risco cardiovascular. Nesses pacientes com padrão subcutâneo a densidade muscular e não gordura visceral ou gordura hepática se correlacionou mais fortemente com esses fatores de risco metabólico. Dos fatores utilizados aquele com melhor correlação com a gordura visceral, gordura hepática e muscular foi o índice TG/HDL. Conclusão A deposição da gordura nos compartimentos visceral e hepático apresentam papel importante na gênese da síndrome metabólica em pacientes obesos viscerais, enquanto em pacientes com deposição subcutânea o depósito muscular apresenta a maior correlação com os fatores metabólicos
Abstract: Introdution During past decades obesity is being considered one of the most important disease, both for raising prevalence and high morbi-mortality. The regional distribution of adiposity into different compartments araises as an important marker for the earlier diagnostic of metabolic syndrome. It is well established a strong association between visceral adiposity and several metabolic abnormalities, including type 2 diabetes mellitus, lipid metabolism impairment, hypertension and impaired inflammatory factors that may contribute to increase the risk of cardiovascular disease. Objective. Study the different types of regional adipose depots and to correlate these depots and the metabolic risk factors. Material e Methods Subjects included sixty four obese volunteers who received medical examination (30 men and 34 women) between 2002 and 2005. Inclusion criteria required the subjects to be nonsmokers, BMI > 30 Kg/m2, age between 18 and 60 years. The subjects were evaluated with computed tomography for measurement of visceral adiposity area, subcutaneous area, hepatic density, pancreatic and muscle density, and correlate them with the metabolic risk factors ( fasting plasma glucose, fasting serum insulin, HOMA-IR, cholesterol fractions, hepatic marker (_GT) and anthropometric measurements. Results Visceral adiposity, hepatic density and muscle density were different in gender and showed high correlation with metabolic factors (HOMA-IR, TG e TG/HDL). Subcutaneous area and pancreatic density did not showed correlation with the metabolic factors. The patients with high subcutaneous depot showed lower metabolic risk factors. In those patients, the muscle depot and not the visceral or liver adiposity had strong correlation with metabolic factors. TG/HDL had the strongest relationship with visceral, liver and muscle depots. Conclusion In obese patients, the regional adiposity, in special visceral and liver depots play important roles in the genesis of metabolic syndrome. In subcutaneous obese patients, the muscle depot has the strongest correlation coefficient with metabolic syndrome
Mestrado
Medicina Experimental
Mestre em Fisiopatologia Médica

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Nogues, Perrine. "Impact de l’obésité maternelle sur les fonctions placentaires : rôles de la leptine et de l'adiponectine Maternal obesity alters placental nutrient transport associated with inflammatory status and morphology modifications in human term placenta Maternal obesity influences expression and DNA methylation of the adiponectin and leptin systems in human third-trimester placenta". Thesis, Université Paris-Saclay (ComUE), 2019. http://www.theses.fr/2019SACLV101.

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L’obésité se définit par une accumulation excessive de masse grasse et une inflammation systémique chronique. Elle se mesure par un indice de masse corporelle supérieur à 30 kg/m². L’obésité maternelle est associée à de nombreux troubles de la santé et en particulier à un risque accru de développer des pathologies de la grossesse (pré éclampsie, diabète gestationnel). D’autre part, l’obésité maternelle impacte la descendance avec une augmentation des risques d’apparition de maladies métaboliques à l’âge adulte.Le placenta est un organe présent à l’interface entre la mère et le fœtus. Il assure des fonctions endocrines, d’échanges et de protection immunitaire.La leptine et l’adiponectine sont des adipokines majoritairement produites par le tissu adipeux. La leptine joue un rôle satiétogène et l’adiponectine exerce des effets insulino-sensibilisateurs. Elles sont donc impliquées dans l’homéostasie énergétique.Le placenta exprime la leptine et les récepteurs spécifiques de ces deux hormones. Il est bien établi que la leptine et l’adiponectine participent au contrôle des fonctions placentaires.Au cours de ce travail, nous nous sommes intéressés à l’impact de l’obésité maternelle (sans diabète gestationnel) sur les principales fonctions du placenta humain.Dans une première partie, nous avons montré que l’obésité maternelle entraîne i) une diminution de l’expression des transporteurs de nutriments, ii) une diminution du nombre de cellules immunitaires, iii) une altération des capillaires fœtaux et iv) une diminution de la production de cytokines pro-inflammatoires et de l’hormone chorionique gonadotrope (hCG) dans le placenta à terme.Dans une deuxième partie, nous avons montré que l’obésité maternelle altère l’expression des systèmes leptine et adiponectine (ligand et récepteurs) dans le placenta humain. En effet, l’obésité maternelle conduit à une diminution de l’expression des récepteurs des deux hormones et à une modification de la méthylation des régions promotrices des gènes codant pour les deux adipokines et leurs récepteurs.L’ensemble de ces résultats montre que l’obésité maternelle altère les fonctions endocrines, d’échanges et immunitaires du placenta. Cet organe transitoire semble s’adapter à un environnement maternel délétère
This research investigates the impact of maternal obesity without gestational diabetes on the major functions of the human placenta. Obesity is defined as an excessive accumulation of fat mass and chronic low grade inflammation. Obesity is indicated by a body mass index (BMI) higher than 30 m2/kg. Maternal obesity is associated with health disorders and creates a higher risk for the development of pregnancy complications (pre-eclampsia and gestational diabetes). In addition to obesity having an impact on a pregnant woman, the fetus is also at risk of developing metabolic disorders in adulthood.The placenta is the organ present at the interface between the mother and the fetus. The placenta’s role is to ensure endocrine functions, exchange functions, and immune protection.Leptin and adiponectin are mostly produced by the adipose tissue. Leptin is a key player in satiety, whereas adiponectin displays an insulin-sensitizing effect. Therefore, both are involved in the energy homeostasis and both are well-established as being involved in the control of placental functions.In this research, we investigated the impact of maternal obesity (without gestational diabetes) on the major functions of the human placenta.In a first part, we have shown that maternal obesity leads to i) a lower expression of nutrient transporters, ii) a lower count of immune cells, iii) an alteration of fetal capillaries, and iv) a decrease in the production of pro-inflammatory cytokines and gonadotropic chorionic hormone (hCG) in term placenta.Also covered in this research is that maternal obesity impairs the leptin and adiponectin systems (ligand and receptors) in the human placenta. Our results indicate maternal obesity is associated with a lower expression of the two adipokines receptors; as well as to a modification in the DNA methylation of promoter regions of the genes’ coding for the two hormones and their receptors.The conclusion of the research reveals how maternal obesity affects the endocrine, exchange, and immune functions of the placenta and how this transient organ seems to adapt itself to a harmful maternal environment

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Ulrici, Johanna. "Atemwegsassozierte Komplikationen bei übergewichtigen und adipösen Kindern in der Anästhesie". Doctoral thesis, Universitätsbibliothek Leipzig, 2012. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-86764.

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Übergewicht und Adipositas im Kindes- und Jugendalter sind Gesundheitsprobleme, die auch auf dem Gebiet der Anästhesie zunehmend relevant werden. In der vorliegenden Dissertationsschrift wurde untersucht, inwiefern übergewichtige Kinder und Jugendliche, im Vergleich zu nicht-übergewichtigen, Komplikationen des Atemwegsmanagementes und der Oxygenierung während einer Allgemeinanästhesie aufweisen und welche Bedeutung die Thematik in der deutschen Population für die Kinderanästhesie hat. Mit Hilfe spezieller Erfassungsbögen wurden folgende Parameter ermittelt und die übergewichtigen mit den nicht-übergewichtigen Studienteilnehmern verglichen: der Mallampati Score, schwierige Maskenventilation und Intubation, die Verwendung eines Atemwegshilfsmittels, der Cormack-Lehane Score und die Anzahl der Intubationsversuche. Daneben wurde die Inzidenz von Atemwegsobstruktionen (Broncho- und Laryngospasmen), Husten als Zeichen der Atemwegsirritation und Sauerstoffsättigungsabfälle um mehr als 10 % des Ausgangswertes erfasst. Es zeigte sich ein signifikant höherer Mallampati Score und ein signifikant häufigeres Auftreten von Husten (p < 0,05). Alle weiteren Parameter blieben ohne statistisch relevanten Unterschied, obwohl Atemwegshilfsmittel prozentual häufiger bei Übergewichtigen eingesetzt wurden. Bei einer gesonderten Analyse der in die Studie eingeschlossenen Untergewichtigen zeigte sich eine überraschend gehäufte Inzidenz hinsichtlich der schwierigen Laryngoskopie und einer Reintubation. Die verschiedenen Ursachen für die vorliegenden Ergebnisse werden in der Promotionsschrift detailliert diskutiert. Es wird insgesamt deutlich, dass nicht alleine Übergewicht und Adipositas ausschlaggebend für Atemwegskomplikationen sind, aber durchaus einen Risikofaktor darstellen. Darüber hinaus scheinen auch untergewichtige Kinder ein erhöhtes Risiko für Atemwegskomplikationen zu habe.

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Milbank, Edward. "Extracellular vesicles as a therapeutic strategy to prevent or reverse obesity and its metabolic complications in the field of nanomedicine Extracellular vesicles: Pharmacological modulators of the peripheral and central signals governing obesity Microparticles from apoptotic RAW 264.7 macrophage cells carry tumour necrosis factor-a functionally active on cardiomyocytes from adult mice". Thesis, Angers, 2016. http://www.theses.fr/2016ANGE0074.

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A ce jour, les thérapies anti-obésité restent limitées. De récente études ont fourni des résultats prometteurs en démontrant une diminution du poids de la souris via une injection stéréotaxique d’une forme dominante négative de l’AMPK (AMPK DN) directement dans le noyau ventromédial hypothalamique (VMH). Cependant, le potentiel thérapeutique de cette thérapie génique se voit entravé par une libération non spécifique de l’AMPK suite à une injection intraveineuse, plus adaptée à une approche clinique. Nous avons donc développé une approche de « nanobiomédecine » en utilisant des exosomes - nanovésicules contenant des lipides, des protéines et des acides nucléiques - pour délivrer l’AMPK DN spécifiquement au niveau du VMH. Des cellules dendritiques immatures ont été utilisées pour produire des exosomes non-inflammatoires. Pour permettre le ciblage spécifique du VMH par les exosomes, les cellules dendritiques ont été transfectées pour exprimer Lamp2b, une protéine exosomale, fusionnée au peptide de ciblage neuronal RVG. De façon intéressante, les exosomes Lamp2b-RVG ont été localisés au niveau du cerveau suite à une injection intraveineuse. Les exosomes Lamp2b-RVG ont ensuite été chargés par l’AMPK DN sous le contrôle d’un promoteur spécifique du VMH, apportant une double spéficité tissulaire aux exosomes. Les exosomes Lamp2b-RVG chargés avec l’AMPK DN induisaient une diminution de la phosphorylation de l’acetyl-CoA carboxylase dans des cellules Neu2A in vitro. De plus, l’injection intraveineuse d’exosomes Lamp2b-RVG chargés avec l’AMPK DN induisait une perte de poids de l’animal après 6 jours de traitement, démontrant le potentiel de cette approche de « nanobiomédecine »
Actual pharmacological therapies for treating obesity are limited. Promising results on decreasing mice body weight were obtained using a ventromedial nucleus hypothalamic (VMH) stereotaxic injection of a dominant negative isoform of AMPK (AMPK DN). However, DNA-mediated therapeutic potential is hampered by inadequate tissue specific delivery following a systemic injection - more adapted to a bedside approach -. Herein, we developed a nanobiomedicine approach using exosomes - nano-scaled endogenous vesicles containing lipids, proteins and nucleic acids - to deliver DNA in a hypothalamic specific way. Immature dendritic cells were used to generate non inflammatory exosomes. Exosome neuronal targeting aptitudes were achieved by constraining the dendritic cells to express Lamp2b, an exosomal protein, fused to the neuron-specific RVG peptide. Interestingly, DID-labelled Lamp2b-RVG exosomes were found into the mice brain following an intravenous injection. Isolated Lamp2b-RVG exosomes were then loaded by transfection-mediated techniques with AMPK DN under the control of a VMH specific promoter conferring double tissue expression specificity to the exosomes. AMPK DN-loaded exosomes induced a decrease of acetyl-CoA carboxylase phosphorylation in Neu2a neuronal cells in vitro. Furthermore, intravenously injected AMPK DN loaded exosomes induced a decrease of mice body weight following 6 days of treatment, demonstrating the potential of this nanobiomedicine approach

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Júnior, Carlos Kiyoshi Furuya. "Efeitos da cirurgia de Fobi-Capella na doença hepática gordurosa não alcoólica (DHGNA): estudo prospectivo de dois anos". Universidade de São Paulo, 2006. http://www.teses.usp.br/teses/disponiveis/5/5147/tde-31102006-142922/.

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Introdução: A incidência de obesidade é crescente e alarmante, principalmente no mundo ocidental. De acordo com o National Center for Health Statistics, cerca de 61% da população adulta nos Estados Unidos está acima do peso e 30% é obesa, sendo que 5 a 6% está classificada na faixa de obesidade Grau III. No Brasil, o Ministério da Saúde aponta que 32,9% dos brasileiros estão fora da faixa de peso ideal, e 4,8% dos homens e 11,7% das mulheres encaixam-se na faixa de obesidade Grau III. Devido a alta prevalência da Doença Hepática Gordurosa Não Alcoólica (DHGNA) em pacientes portadores de obesidade grave e os escassos conhecimentos acerca de sua evolução para doença crônica do fígado após cirurgias bariátricas, foram objetivos deste estudo avaliar os efeitos da cirurgia gastrorredutora com derivação intestinal em Y de Roux Cirurgia de Fobi-Capella) sobre DHGNA após 24 meses. Métodos: Dentre 40 pacientes com IMC > 40 kg/m2 submetidos à cirurgia bariátrica (cirurgia de Fobi-Capella) no período de 2001 a 2003, 18 pacientes foram seguidos por aproximadamente 24 meses (700 ± 42 dias) e incluídos no estudo, realizando-se exames laboratoriais, tais como enzimas hepáticas, perfil lipídico e glicêmico; e a biopsia hepática no perioperatório e 24 meses após a cirurgia. O diagnóstico histológico de DHGNA e Esteatohepatite Não Alcoólica (ENA) foi determinado segundo a classificação padronizada por meio da revisão pelo Pathology Committee of the NASH Clinical Research Network Americano, que designou e validou as características histológicas e um sistema de escore de atividade para DHGNA para estudos clínicos. esultados: O IMC médio inicial dos 18 pacientes foi de 51,7 ± 7 kg/m2 e na segunda biopsia, após 24 meses de seguimento foi de 32,3 ± 6 kg/m2, com excesso do índice de massa corpórea perdida de 72,56%. DHGNA foi constatada no exame histológico inicial em 100% dos pacientes, sendo steatohepatite em 67% (10 pacientes com escore de atividade da DHGNA maior ou igual a 5 e dois pacientes com escore 4 com algum grau de fibrose) e 33% com esteatose isolada. Dos pacientes com ENA, 8,3% apresentavam cirrose. Após cerca de 24 meses houve desaparecimento da esteatose em 89% e manutenção da esteatose Grau I em 11% (p < 0,001). Em relação à fibrose, observada inicialmente em 10 (55%) dos pacientes, somente 4 (22,22%) dos pacientes mantiveram algum grau de fibrose (p = 0,020). No que se refere ao infiltrado inflamatório, 78% mantiveram discreto infiltrado lobular (Grau I) não relacionado à degeneração gordurosa. A balonização hepatocelular desapareceu em 50% dos pacientes e manteve-se discreta (Grau I) em 50% (p < 0,001). Não houve diferença estatística no que se refere às aminotranferases no pré e pós-operatório tardio. Houve redução significativa dos lípides e glicemia em quase a totalidade dos pacientes. Conclusão: A correção da síndrome metabólica obtida pela acentuada perda de peso após cirurgia de Fobi-Capella promoveu melhora da esteatose, fibrose, e os escores de atividade da DHGNA menores que 5, respectivamente em 89%, 75% e 100%dos pacientes previamente portadores de DHGNA, não se observando efeito deletério na histologia hepática nesta série.
Background: The incidence of obesity is increasing in western countries at an alarming rate. The National Center for Health Statistics of United Stated estimated in adult population 61% the prevalence of overweight or obesity, and 30% has obesity, and 5 to 6% were classified in severe obesity. In Brazil, the Ministry of Health reported 32.9% the prevalence of overweight or obese in adult brazilian population, and severe obesity 4.8% were men and 11.7% were women. Although nonalcoholic fatty liver disease (NAFLD) has been proved very frequent among morbidly obese patients and the effect of weight loss after bariatric surgery in inflammation and fibrosis related NAFLD is still a matter of debate. The aim of this study was to evaluate the impact of Fobi-Capella surgery in NAFLD in a follow up of 24 months. Methods: Forty patients with body mass index (BMI) IMC > 40 kg/m2 were submitted to Roux-en-Y gastric bypass with intraoperatory liver biopsies between 2001 a 2003, and 18 patients were followed and selected to underwent a liver biopsies after 24 months (700 ± 42 days). Blood biochemical tests and liver histology were compared before and after weight loss. The histological diagnosis of Nonalcoholic fatty liver disease (NAFLD) and Nonalcoholic steatohepatitis (NASH) was analyzed using the classification proposed by Pathology Committee of the NASH Clinical Research Network, which designed and validated a histological feature scoring system that address the characteristics of NASH lesions and a NAFLD activity score (NAS) for use in clinical trials. Eighteen patients with body mass index >40 kg/m2 submitted to Roux-n-Y gastric bypass were enrolled, and wedge liver biopsy was obtained at the operation. After 24 months, patients agreed to be submitted to a percutaneous liver biopsy. Results: The initial average BMI of 18 patientes were 51.7 ± 7 kg/m2. After following 24 months, average BMI was 32.3 ± 6 kg/m2. The average of percent excess body mass index loss was 72.56%. NAFLD was present in all 18 patients at the initial biopsy, NASH in 67% (10 patient had score of NAS ? 5 and two patients with score 4 had some degree of fibrosis) and 33% with steatosis only; 8.3% of patients with NASH has cirrhosis. After 24 months steatosis disappeared in 89% (p < 0,001) and fibrosis disappeared in 60% of the patients (p = 0.020). Hepatocellular ballooning disappeared in 50% (p < 0.001). A slight lobular inflammatory infiltrate remained in 78%, apparently unrelated to fatty degeneration. Since liver biochemical variables AST and ALT had been found within normal limits in 88% and 89%, respectively of patients at initial biopsy, no difference was found 24 months later (p = 1.000). Lipid profile and blood sugar plasma concentration were closer to normal in all patients after 24 months of follow up (p < 0.05). Conclusions: The improvement of metabolic syndrome related a severe obesity after sustained weight loss surgery promoted significant improvement in liver histology. The steatosis, fibrosis and NAS ? 5 were decreased in 89%, 75% and 100% of patients, respectively. None patient had progression of hepatic fibrosis in this series.

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Paiva, Leticia Vieira de. "Estado nutricional em gestações de alta risco: complicações do parto, puerpério e análise do consumo dietético". Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-13062012-113155/.

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OBJETIVO: Analisar a associação entre o estado nutricional materno em gestações de alto risco e complicações do parto, do puerpério e análise do consumo dietético dessas gestantes. MÉTODOS: Estudo prospectivo e observacional realizado no período de agosto de 2009 a agosto de 2010, com os seguintes critérios de inclusão: puérperas até o quinto dia; idade acima de 18 anos; gestação de alto risco; feto único e vivo no início do trabalho de parto; parto na Instituição; peso materno aferido no dia do parto. O estado nutricional no final da gestação foi avaliado pelo índice de massa corporal (IMC), aplicando-se a curva de Atalah. As pacientes foram classificadas em: baixo peso, adequado, sobrepeso e obesidade. O consumo dietético foi avaliado por aplicação do questionário de frequência do consumo alimentar. As complicações do parto e do puerpério, investigadas durante o período de internação e 30 dias após a alta, foram: tipo de parto, infecção e/ou secreção em ferida cirúrgica, infecção urinária, infecção puerperal, febre, hospitalização, uso de antibióticos e morbidade composta (pelo menos uma das complicações puerperais citadas). RESULTADOS: Foram incluídas 374 puérperas classificadas pelo IMC final em: baixo peso (n=54, 14,4%); adequado (n=126, 33,7%); sobrepeso (n=105, 28,1%) e obesidade (n=89, 23,8%). Não houve diferença significativa na proporção de cesáreas quando comparados os seguintes grupos: baixo peso e adequado (68,3%), sobrepeso (76,2%) e obesidade (78,6%, P=0,201). A obesidade materna apresentou associação significativa com as seguintes complicações do puerpério: infecção de ferida cirúrgica (16,7%, P=0,042), infecção urinária (9,0%, P=0,004), uso de antibiótico (12,3%, P<0,001) e morbidade composta (25,6%, P=0,016). Aplicando-se o modelo de regressão logística, verificou-se que a obesidade no final da gestação é variável independente na predição da morbidade composta (OR: 2,09; IC95%: 1,15 - 3,80, P=0,015). A análise do consumo dietético demonstrou média de consumo energético semelhante nos grupos: baixo peso e adequado (2344 cal/dia), sobrepeso (2433 cal/dia) e obesidade (2450 cal/dia, P=0,640). Não se constatou diferença significativa no consumo médio diário de macro e micronutrientes entre os grupos estudados. CONCLUSÃO: A obesidade materna no final da gravidez, em pacientes de alto risco, está associada, de forma independente, com a ocorrência de complicações infecciosas no puerpério, demonstrando a necessidade de acompanhamento mais eficiente em relação ao ganho de peso materno nessas gestações
OBJECTIVE: To assess the association between maternal obesity and the occurrence of delivery and postpartum complications in high risk pregnancies, and to analyze the dietary intake of these pregnant women. METHODS: Prospective and observational study conducted from August 2009 to August 2010, with the following inclusion criteria: admission to the 5th day, maternal age 18-year-old, high-risk pregnancy, single pregnancy, fetus alive at the beginning of labor, birth at the institution, maternal weight measured at birth. Nutritional status in late pregnancy was assessed by body mass index (BMI), and applying the curve Atalah. The patients were classified as: underweight, appropriate, overweight and obesity. The dietary intake was evaluated applying a food frequency questionnaire. The complications of delivery and postpartum, investigated during the hospitalization and 30 days after discharge, were: infection and / or secretion in the surgical wound, urinary tract infection, puerperal infection, fever, hospitalization, antibiotics, and composite morbidity (at least one puerperal complication). RESULTS: We included 374 postpartum women classified by the final BMI: underweight (n=54, 14.4%), appropriate (n=126, 33.7%), overweight (n=105, 28.1%) and obesity (n=89, 23.8%). There was no significant difference in the proportion of cesarean when compared the following groups: underweight and appropriate (68.3%), overweight (76.2%) and obesity (78.6%, P=0.201). Maternal obesity was significantly associated with the following puerperal complications: surgical wound infection (16.8%, P=0.042), urinary tract infection (9.0%, P= 0.004), antibiotic use (12.3%, P<0.001) and composite morbidity (25.6%, P=0.016). The logistic regression model showed that obesity in late pregnancy is an independent variable in predicting the composite morbidity (OR: 2.09, 95% CI: 1.15 to 3.80, P=0.015). The analysis of dietary intake showed average energy consumption similar in the groups: underweight and appropriate (2344 cal/day), overweight (2433 cal/day) and obesity (2450 cal/day, P=0.640). There was no significant difference in the average daily consumption of macro-and micronutrients among the groups studied. CONCLUSION: Maternal obesity at the end of high-risk pregnancy is independently associated with the occurrence of postpartum infectious complications, showing the need for more efficient monitoring of maternal weight gain in these pregnancies

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Marques, Emerson Leonildo. "Efeito da perda de peso induzida por cirurgia bariátrica sobre metabolismo cerebral e função cognitiva". Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/5/5135/tde-24102014-104455/.

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INTRODUÇÃO: Obesidade e doença de Alzheimer afetam um número cada vez maior de pessoas no mundo. Nos últimos anos, surgiram várias evidências de que essas duas doenças estão interligadas, sendo obesidade um fator de risco para a ocorrência de demência. A doença de Alzheimer é de mau prognóstico e de difícil tratamento e estão envolvidos na sua patogênese fatores genéticos e ambientais. A obesidade é encarada como um fator ambiental modificável e, talvez, capaz de mudar a história natural da doença se precocemente controlada. A cirurgia bariátrica é o tratamento mais eficaz para obesidade severa; no entanto, não se sabe claramente o efeito da cirurgia bariátrica sobre o metabolismo cerebral e a função cognitiva. OBJETIVOS: Avaliar prospectivamente o impacto da perda de peso induzida pela cirurgia bariátrica sobre metabolismo cerebral e função cognitiva de obesos; correlacionar metabolismo cerebral e função cognitiva antes e após a cirurgia bariátrica com marcadores metabólicos e inflamatórios. MÉTODOS: 17 mulheres obesas realizaram tomografia computadorizada com emissão de pósitrons com flúor-desoxi-glicose (PET-FDG) para avaliação do metabolismo cerebral de repouso (metabolismo glicolítico regional), testes neuropsicológicos para avaliação da função cognitiva e dosagens de marcadores metabólicos e inflamatórios antes e após a cirurgia bariátrica e, foram comparadas com 16 mulheres de peso normal, eutróficas, pareadas em idade e escolaridade. Foram excluídas da seleção pacientes portadoras de diabetes, usuárias de medicação psicotrópica nos três meses que antecederam as avaliações, portadoras de doença psiquiátrica grave atual ou prévia e mulheres com história de pais acometidos por demência antes dos 70 anos de idade. Nas mulheres obesas as avaliações do metabolismo cerebral, da função cognitiva e das dosagens laboratoriais foram realizadas antes e aproximadamente seis meses após a cirurgia bariátrica, enquanto nas mulheres eutróficas foram realizadas apenas uma vez. Os dados de imagem foram processados através do programa Statistical Parametric Mapping (SPM versão 8) e os demais através do Statistical Analysis System (SAS versão 9.3). Os dados encontrados nas obesas antes da cirurgia foram comparados aos obtidos após a perda de peso e, ambos foram comparados aos dados obtidos nas mulheres eutróficas. RESULTADOS: Mulheres com idade média de 40,5±9,1 anos e índice de massa corporal (IMC) médio de 50.1±4,7 kg/m2 quando comparadas a mulheres de mesma faixa etária com IMC médio de 22.3±2,1 kg/m2 apresentaram aumento do metabolismo cerebral em algumas áreas, principalmente do giro cingulado posterior, com valor de p corrigido para comparações múltiplas de 0,004. No entanto, não encontramos diferença no desempenho dos testes neuropsicológicos entre os grupos. Após a perda de peso, o metabolismo cerebral das mulheres obesas ficou semelhante ao das mulheres eutróficas e houve melhora no desempenho de teste que avalia função executiva (Trail Making Test). CONCLUSÃO: Estudos mostram que o giro cingulado posterior é uma das primeiras áreas acometidas pela doença de Alzheimer e que o aumento do metabolismo cerebral regional pode ser deletério. Esta condição encontrada em obesas, parece ser revertida após a perda de peso induzida por cirurgia bariátrica, acompanhando melhora da função executiva e de marcadores metabólicos e inflamatórios
INTRODUCTION: Obesity and Alzheimer\'s disease affect a growing number of people in the world. In recent years, evidence has arisen suggesting that these two illnesses are linked, with obesity being a risk factor for the occurrence of dementia. Alzheimer\'s disease has an unfavorable prognosis, is hard to treat and genetic and environmental factors are involved in the pathogenesis. Obesity is regarded as a modifiable environmental factor and maybe capable of changing the natural prognosis of the disease if controlled at an early stage. Bariatric surgery is the most effective treatment for severe obesity, however the effect of bariatric surgery on cerebral metabolism and cognitive function is not clearly known. OBJECTIVES: Prospectively assess the impact of weight loss caused by bariatric surgery on the cerebral metabolism and cognitive function of the obese. Correlate the cerebral metabolism and cognitive function before and after bariatric surgery with metabolic and inflammatory markers. METHODS: 17 obese women performed computerized positron emission tomography with fluoro-deoxy-glucose (FDG-PET) for the assessment of resting cerebral metabolism (regional glycolytic metabolism), neuropsychological tests to assess cognitive function and doses of metabolic and inflammatory markers before and after bariatric surgery and compared with 16 women of normal weight, eutrophic, paired by age and level of education. Patients with diabetes, those who had used psychotropic medication within three months prior to the assessments, people with current or previous history of severe psychiatric illness and women with a family history of dementia before 70 years of age. The assessments of cerebral metabolism, cognitive function and laboratory doses were conducted before and approximately 6 months after bariatric surgery in the obese women, whereas the women of normal weight were only assessed once. The imaging data was processed using the Statistic Parametric Mapping (SPM version 8) program and the others through the Statistical Analysis System (SAS version 9.3). The data found in the obese women prior to surgery were compared with those after the weight loss, and both were compared to the data taken from the eutrophic women. RESULTS: Women with a mean age of 40.5±9.1 years and mean body mass index (BMI) of 50.1±4.7 kg/m2 when compared to women of the same age group with mean BMI of 22.3±2.1 kg/m2 presented increased cerebral metabolism in some areas, in particular of the posterior cingulate gyrus, with a corrected p value for multiple comparisons of 0.004. However, differences were not found between the groups for the performance of the neuropsychological tests. After weight loss, the cerebral metabolism of the obese women was similar to the eutrophic women and they performed better in the tests to assess executive function (Trail Making Test). CONCLUSION: Studies show that the posterior cingulate gyrus is one of the first areas affected by Alzheimer\'s disease and that having increased regional cerebral metabolism may be deleterious. This condition found in the obese, appears to be reversed after weight loss induced by bariatric surgery, followed by improved executive function and metabolic and inflammatory markers

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Bauvin, Pierre. "Modélisation de la stéatose hépatique (NAFLD) et de ses facteurs de risque par apprentissage sur des données de santé". Thesis, Lille 2, 2020. http://www.theses.fr/2020LIL2S028.

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La stéatose hépatique non-alcoolique (NAFLD) est une maladie chronique du foie regroupant la stéatose simple à évolution lente, et la stéatohépatite non-alcoolique (NASH), forme inflammatoire accélérant son évolution. On estime qu’une personne sur quatre dans le monde est atteinte de NAFLD, et cette prévalence augmente rapidement, en parallèle avec celle de ses principaux facteurs de risque : le surpoids, l’obésité et le diabète. Cette pathologie est asymptomatique jusqu’aux complications, la cirrhose et le cancer du foie (carcinome hépatocellulaire, CHC), ce qui induit un diagnostic tardif et un impact négatif sur la morbidité et mortalité associées. De plus, le diagnostic de référence nécessite une biopsie hépatique, un examen invasif qui ne peut être réalisé en routine. En conséquence, la progression de la maladie est mal connue et son estimation peut souffrir d’un biais de sélection, vers les patients présentant des facteurs de risques importants, qui nécessitaient une biopsie en premier lieu. Mieux l’appréhender permettrait de mettre en place des stratégies diminuant son fardeau.L’approche par modélisation est appropriée pour prendre en compte l’ensemble des patients susceptibles, sans avoir à réaliser d’étude de suivi à large échelle par biopsie hépatique chez des patients en majorité asymptomatiques. Les objectifs de cette thèse sont de décrire et quantifier la progression de la NAFLD, de prédire la morbidité et mortalité associées, ainsi que d’identifier la population à risque, par modèles de Markov. Pour cela, il est nécessaire de renseigner une partie des paramètres de progression via une revue de la littérature, de caractériser les états initiaux (population susceptible de développer la NAFLD) et les états finaux (mortalité due à la NAFLD), pour en déduire les paramètres de progression manquants entre l’entrée dans la maladie et la mortalité, par rétro-calcul.Pour caractériser la mortalité due à la NAFLD de manière exhaustive, nous avons identifié tous les patients avec une cirrhose ou un CHC à partir des bases de données nationales des hôpitaux, soit plus de 380 000 patients. Nous avons ensuite élaboré un algorithme d’identification pour déterminer l’étiologie sous-jacente à la complication hépatique, à partir de l’ensemble des séjours des patients identifiés. Cet algorithme nécessite d’identifier les patients avec cirrhose ou CHC d’origine alcoolique ou virale, pour obtenir par élimination uniquement les patients NAFLD.Une fois les données de mortalité spécifiques obtenues, nous avons estimé la population susceptible de développer la NAFLD, définie comme l’ensemble des individus avec un surpoids ou un diabète de type 2, en excluant la population de buveurs excessifs. Nous avons estimé la prévalence et l’incidence de cette population, et modélisé son évolution avec l’âge et les années, à partir de données individuelles d’enquêtes représentatives de la population française.Enfin, nous avons quantifié la progression de la NAFLD, et l’impact des facteurs de risque, via deux approches : à partir de la littérature, et à partir de données de biopsies de plus de 1 800 patients obèses candidats à la chirurgie bariatrique, aboutissant à un outil de prédiction de la progression de la NAFLD dans cette population. Nous avons choisi de rétro-calculer les paramètres de progression correspondant aux états asymptomatiques, les plus susceptibles au biais de sélection.Nous avons obtenu un modèle de l’évolution de la NAFLD, prenant en compte la distribution dynamique de la population parmi les classes de poids et le statut de diabète, et aboutissant aux statistiques observées de décès dus à la NAFLD. Le modèle prend en compte le sexe, l’âge, l’année, la classe d’IMC, le statut de diabète et la présence d’un polymorphisme génétique (PNPLA3 rs738409, C→G) comme covariables de progression. Il constitue un outil permettant d’évaluer l’impact d’un éventuel traitement ou d’une politique de santé publique sur la morbi-mortalité
Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease which is a combination of simple, slowly progressing steatosis, and non-alcoholic steatohepatitis (NASH), an inflammatory form which accelerates its progression. It is estimated that one in four people in the world is affected by NAFLD, and its prevalence is increasing rapidly, in parallel with the prevalence of its main risk factors: overweight, obesity and type 2 diabetes.This pathology is asymptomatic up to the complications, cirrhosis and liver cancer (hepatocellular carcinoma, HCC), which leads to late diagnosis and a negative impact on the associated morbidity and mortality. Furthermore, the reference diagnosis requires a liver biopsy, an invasive examination that cannot be performed routinely. As a result, the progression of the disease is poorly known and its estimation may suffer from a selection bias, towards patients with significant risk factors, who require a biopsy in the first place. A better understanding would allow the implementation of strategies to reduce its burden.The modelling approach is appropriate to take into account all susceptible patients, without having to carry out a large-scale follow-up study using liver biopsies in patients who are mostly asymptomatic. The objectives of this thesis are to describe and quantify the progression of NAFLD, to predict the associated morbidity and mortality, and to identify the population at risk, using Markov models. To do this, it is necessary to fill in some of the progression parameters via a literature review, to characterise the initial states (population likely to develop NAFLD) and the final states (mortality due to NAFLD), in order to deduce the missing progression parameters between the onset of the disease and mortality, by back-calculation.To exhaustively characterise NAFLD mortality, we identified all patients with cirrhosis or HCC from national hospital databases, representing more than 380,000 patients. We then developed an identification algorithm to determine the etiology underlying the hepatic complication, based on all the stays of the identified patients. This algorithm requires the identification of patients with cirrhosis or HCC of alcoholic or viral origin, to obtain by elimination only NAFLD patients. Once the specific mortality data had been obtained, we estimated the population likely to develop NAFLD, defined as all individuals with overweight or type 2 diabetes, excluding the population of excessive drinkers. We estimated the prevalence and incidence of this population, and modelled its evolution with age and years, based on individual data from surveys representative of the French population.Finally, we quantified the progression of NAFLD, and the impact of risk factors, using two approaches: from the literature, and from biopsy data from more than 1,800 obese patients who were candidates for bariatric surgery, resulting in a tool for predicting the progression of NAFLD in this population. We chose to back-calculate the progression parameters corresponding to the asymptomatic states, which are the most susceptible to selection bias.We obtained a model of the progression of NAFLD, taking into account the dynamic distribution of the population among weight classes and diabetes status, and resulting in the observed statistics of NAFLD deaths. The model takes into account gender, age, year, BMI (body mass index) class, diabetes status and the presence of a genetic polymorphism (PNPLA3 rs738409, C→G) as covariates of progression. It is a tool for assessing the impact of a possible treatment or public health policy on morbidity and mortality

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Laude-Trouillard, Marilia. "Complications hépatiques des surcharges pondérales : à propos d'une observation". Montpellier 1, 1998. http://www.theses.fr/1998MON11070.

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Masters, Heather R. "Maternal Obesity is an Independent Risk Factor for ICU Admission during Hospitalization for Delivery". University of Cincinnati / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1491559250082122.

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Boudet, Julie. "Obésité maternelle avant grossesse, allaitement du nourrisson et évolution du poids maternel en post partum". Thesis, Université Paris-Saclay (ComUE), 2018. http://www.theses.fr/2018SACLS022.

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L’objectif de cette thèse était de mesurer l’association de l’obésité maternelle avec la durée de l’allaitement maternel, au total et exclusif, en prenant en compte les caractéristiques sociodémographiques, périnatales et psychosociales ; puis d’évaluer si l’allaitement était, en France en 2012, associé à une diminution de la rétention du poids maternel dans l’année suivant l’accouchement, en particulier chez les femmes obèses.Les données de la cohorte prospective nationale Epifane ont été utilisées. En 2012, 3368 couples mère-enfant avaient été inclus en France métropolitaine. Le recueil de l’alimentation de l’enfant à la maternité puis à 1, 4, 8 et 12 mois postpartum a permis d’estimer les durées d’allaitement. Les facteurs sociodémographiques et périnataux associés à l’obésité maternelle (Indice de Masse Corporelle (IMC) avant grossesse ≥30 kg/m2) ont été identifiés par un modèle de régression logistique multinomiale. Des régressions de Poisson ont fourni des estimations de l’association entre obésité et durées d’allaitement, exclusif et total. Les associations entre durées d’allaitement et rétention de poids à 4 et 12 mois (définie comme la différence entre le poids maternel à 4 et 12 mois et le poids avant grossesse), ont été estimées par des régressions linéaires. Les facteurs de risque d’une rétention de poids modeste (entre 0,1 et 4,9 kg) ou majeure (≥5 kg) à un an, ont été identifiés par des régressions logistiques multinomialesL’obésité maternelle était associée à un ensemble de caractéristiques sociodémographiques et de complications périnatales, de façon différente selon la parité. Par ailleurs, elle était associée à une durée totale d’allaitement plus courte, comparé à une corpulence normale, indépendamment des caractéristiques sociodémographiques, périnatales, psychosociales, et de la parité. La parité modifiait l’association entre obésité et durée d’allaitement exclusif. Ainsi, chez les primipares, la durée d’allaitement exclusif était comparable chez les femmes obèses et celles de corpulence normale, quel que soit le niveau d’ajustement. Chez les multipares, la relation entre obésité maternelle et durée d’allaitement exclusif réduite observée dans le modèle ajusté sur les caractéristiques sociodémographiques, n’était plus significative lorsque les caractéristiques périnatales et psychosociales étaient ajoutées au modèle.A 4 mois, dans tous les groupes d’IMC avant grossesse, la rétention moyenne de poids postpartum n’était pas différente selon la durée d’allaitement exclusif ou prédominant. Néanmoins, la durée d’allaitement mixte était associée à une augmentation de la rétention de poids à 4 mois, chez les femmes obèses uniquement. A 12 mois, ni la durée d’allaitement exclusif ou prédominant, ni celle d’allaitement mixte n’étaient associées à la rétention de poids. Les risques d’une rétention de poids modeste ou majeure une année après avoir accouché, variaient toutefois selon un ensemble de caractéristiques sociodémographiques et périnatales. La durée totale d’allaitement maternel était plus faible chez les femmes obèses. Par ailleurs, nos travaux ne montrent pas un bénéfice de l’allaitement sur la diminution de la rétention de poids à 4 et 12 mois. Finalement, nos travaux apportent une meilleure compréhension des mécanismes impliqués dans la relation entre obésité et allaitement maternel ; l’identification des facteurs de risque de la rétention de poids ouvre de nombreuses perspectives de recherche. En termes de santé publique, ces travaux réaffirment la nécessité de prendre en compte les facteurs psychosociaux, les caractéristiques sociodémographiques, et les conditions de la grossesse dans la promotion de l’allaitement, notamment exclusif, et dans les actions visant à réduire la rétention de poids postpartum
The aim of this PhD dissertation was to measure the association of maternal obesity with any breastfeeding (ABF), and exclusive breastfeeding (EBF) durations, taking into account sociodemographic, perinatal and psychosocial factors; and to assess whether in France, in 2012, breasfeeding was associated with a reduction in PPWR during the first year of life, especially among women obese before pregnancy.We used data from the French population-based-birth-cohort Epifane. In 2012, 3,368 mother-infant dyads were included in mainland France. Information concerning infant’s feeding were collected at maternity ward and at 1, 4, 8, and 12 months, and were then used to define breastfeeding durations. Sociodemographic and perinatal factors associated with maternal obesity (Body Mass Index (BMI) before pregnancy ≥30 kg/m2) were identified using a multinomial logistic regression model. Poisson regression models have estimated associations of maternal obesity with ABF and EBF durations. Linear regression models were used to estimate the associations of breastfeeding durations (full breastfeeding (FBF) and partial breastfeeding) with PPWR at 4 and 12 months (defined as the difference between the maternal weight at 4 and 12 months after birth and maternal prepregnancy weight). Risk factors of moderate PPWR (0.1-4.9 kg) and major PPWR (≥5 kg) at 12 months were identified using multinomial logistic regression modelling.Maternal obesity was associated with sociodemographic characteristics and adverse perinatal outcomes. Such patterns varied among primiparous and multiparous women. Furthermore, maternal obesity was associated with a reduced ABF duration, compared to normal-weight, independently of sociodemographic, perinatal and psychosocial factors, and parity. Association of maternal obesity with EBF duration was modified by parity. Among primiparous women, obese women exclusively breastfed as long as normal-weight women, in all adjusted models. Among multiparous women, association between maternal obesity and reduced EBF duration, observed in the crude model and model adjusted on sociodemographic factors, was no more statistically significant when adjusting for perinatal and psychosocial factors.Four months after birth, FBF duration was not associated with PPWR, regardless of prepregnancy BMI class. However, partial breastfeeding duration was associated with an increased PPWR at 4 months among women obese before pregnancy. At 12 months, neither FBF duration nor partial breastfeeding duration was associated with PPWR. Nevertheless, we identified a set of sociodemographic and perinatal risk factors of moderate and major PPWR at 12 months.Maternal obesity was associated with a reduced ABF duration. Furthermore, our work does not confirm the hypothesis of a benefit of breastfeeding durations on PPWR at 4 and 12 months. Finally, our research provides a better understanding of mechanisms involved in the relation between maternal obesity and breastfeeding; the identification of PPWR risk factors opens new prospects of research. In terms of public health, our research reinforces the need to consider sociodemographic, perinatal and psychosocial characterictics of women in the promotion of breastfeeding, especially EBF, and in the interventions aimed at reducing PPWR

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Aufrere-Dubourg, Véronique. "Obésité et microalbuminurie". Montpellier 1, 1994. http://www.theses.fr/1994MON11131.

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Pedroso, Juan Carlos Montano [UNIFESP]. "Variáveis hematológicas e perfil do ferro na abdominoplastia após a cirurgia bariátrica". Universidade Federal de São Paulo (UNIFESP), 2011. http://repositorio.unifesp.br/handle/11600/9826.

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Made available in DSpace on 2015-07-22T20:50:27Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-05-25
Introdução: O tratamento da deformidade na parede abdominal resultante do emagrecimento após a cirurgia bariátrica é a abdominoplastia, a qual pode induzir anemia pós-operatória. Além disso, a cirurgia bariátrica promove uma tendência a deficiência de ferro. Baixas reservas de ferro comprometem a eritropoese. Não há estudo avaliando o grau de anemia e sua evolução após a abdominoplastia pós-bariátrica. Objetivo: Avaliar a anemia e sua evolução após a abdominoplastia pós-bariátrica. Métodos: Os valores de hemoglobina, reticulócitos, ferro, ferritina, e índice de saturação da transferrina foram mensurados na véspera da abdominoplastia e na primeira, quarta e oitava semana de pós-operatório. A hemoglobina também foi mensurada com 48h de pós-operatório. Vinte mulheres adultas foram operadas e tiveram seus dados comparados com 12 controles. Resultados: Os níveis de hemoglobina caíram, em média, de 12,98g/dL para 10,8g/dL com 48h. Houve um aumento significante da hemoglobina no sétimo dia com correção de um terço do déficit, sem aumentos significantes posteriores. Houve um aumento dos reticulócitos na primeira semana. O ferro sérico e índice de saturação de transferrina caíram na primeira semana e mantiveram-se baixos. Os níveis de ferritina apresentaram aumento não significante na primeira semana e posteriormente caíram. Nenhuma das pacientes foi transfundida. Conclusão: Os níveis de hemoglobina caíram após a abdominoplastia e demonstraram um aumento na primeira semana de pós-operatório, com correção de um terço do déficit de hemoglobina, porém, não recuperaram por completo na oitava semana. Ao término do seguimento, 45% das pacientes desenvolveram deficiência de ferro e apresentaram déficit de hemoglobina maior que as pacientes que mantiveram estoques de ferro normais
Background: The treatment of the abdominal wall deformity resulted from weight loss after bariatric surgery is a mixed type of abdominoplasty, which can induce post-operative anemia. In addition, bariatric surgery itself promotes a tendency to iron deficiency which could compromise erythropoiesis. To our knowledge, there is no study evaluating the degree of anemia and its recovery after post-bariatric abdominoplasty. Methods: The values of hemoglobin, reticulocytes, iron, ferritin and transferrin saturation index were measured the day prior to abdominoplasty and the first, fourth and eighth weeks after surgery. Hemoglobin was measured within 48h after surgery. Twenty adult women underwent surgery and had their data compared with 12 controls. Results: Hemoglobin levels dropped significantly from 12,98g/dL to 10,8g/dL within 48h. Hemoglobin increased significantly to 11,5g/dL by day seven, with correction of one third of the deficit, without significant increases thereafter. There was an increase in reticulocytes in the first week. Serum iron and transferrin saturation index fell in the first week and remained low. Ferritin levels showed no significant increase in the first week and subsequently fell. None of the patients received blood transfusion. Conclusion: Hemoglobin levels fell from 12,98 g/dL to 10,8 g/dL after abdominoplasty and showed an increase in the first week after surgery, with correction of one third of the deficit, but did not completely recover in the eighth week. At the end of the follow-up, 45% of the patients developed an iron deficiency and had a hemoglobin deficit higher than the patients that maintained normal iron stores.
TEDE
BV UNIFESP: Teses e dissertações

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Tardy-Poncet, Brigitte. "Potential roles of TFPI in both thrombotic and hemorrhagic diseases". Thesis, Saint-Etienne, 2012. http://www.theses.fr/2012STET007T/document.

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L'inhibiteur de la Voie du Facteur Tissulaire (TFPI) est une protéine régulatrice de la coagulation plasmatique intervenant à la phase initiale de la cascade. Il inhibe en présence de la protéine S (PS) le facteur Xa et ce complexe TFPI-Xa inactive ensuite le complexe FT-VIIa. Nous avons recherché une résistance à l'activité anticoagulante du TFPI. La sensibilité du plasma à une quantité fixe de TFPI a été évaluée sur la base d'un temps de thromboplastine diluée (TTD) réalisé avec et sans TFPI : - chez des patients ayant présenté une thrombose veineuse profonde inexpliquée ; cette résistance suspectée sur une 1ère étude n'a pas été confirmée sur la 2ème. - chez des patientes enceintes ; une résistance au TFPI acquise a été montrée et rapportée au déficit acquis en PS ; cependant le degré de résistance au TFPI ne peut pas être utilisé comme marqueur de risque de pathologie vasculaire placentaire. Chez des patients obèses l'effet inhibiteur des taux élevés de Lp(a) sur l'activité TFPI décrit in vitro n'a pas été retrouvé in vivo pas plus que l'effet de l'aspirine sur la normalisation des taux de Lp(a). Le TFPI joue un rôle dans les manifestations hémorragiques des hémophiles. Nous avons montré que les hémophiles B ont comparativement aux A des taux moindres de TFPI ce qui pourrait expliquer leur différence en terme de manifestations hémorragiques. Les taux de TFPI libre sont bien corrélés aux paramètres de la génération de thrombine surtout au temps de latence. En présence d’un anti TFPI humain la génération de thrombine est corrigée chez l'hémophile. Cette correction dépend de la concentration d'anti TFPI, est saturable et doit être étudiée sur du plasma riche en plaquettes
TFPI is a multivalent Kunitz-type proteinase inhibitor that directly inhibits FXa and produces FXa-dependent feedback inhibition of the FVIIa–TF complex. It was recently demonstrated that Protein S (PS) plays the role of TFPI cofactor by enhancing the TFPI inhibition of factor Xa in vivo. Approximately 80% of plasma TFPI circulates as a complex with plasma lipoproteins, about 5–20% circulating as free TFPI. Under quiescent conditions, approximately 50–80% of intravascular TFPI is stored in association with the endothelium. Full-length TFPI α carried in platelets constitutes 8-10% of the total amount of TFPI in the blood, corresponding to a quantity comparable to that of soluble full-length TFPI α in the plasma. We searched for resistance to TFPI activity in patients who presented idiopathic venous thrombosis at a young age. Plasma sensitivity to TFPI was evaluated on the basis of diluted prothrombin time (dPT) measured in patients and in control plasma in the presence (W) and absence (Wo) of exogenous TFPI. At the same time, dPT was measured on a reference plasma to establish a normalized ratio termed TFPI NR and defined as (dPT wTFPI/ dPT Wo TFPI) patient or control / (dPT wTFPI/ dPT Wo TFPI) reference plasma. In an initial study, we found that TFPI resistance could be considered as a new coagulation abnormality that could be related to unexplained thrombosis. In a second study, we failed to demonstrate a role of TFPI resistance in patients with venous thrombosis, abnormal TFPI NR being more likely related to the non-respect of preanalytical conditions rather than to an inherited trait. However, in another study, we showed that inherited or acquired PS deficiency was responsible for a TFPI resistance, providing an ex vivo demonstration that PS is the cofactor of TFPI activity. We showed that this TFPI resistance existed throughout pregnancy and that it disappeared when PS returned to normal values after delivery. We evaluated this TFPI resistance as a possible marker of the risk of a gestational vascular complication (GVC) in 72 patients at risk of developing a GVC. TFPI NR did not differ between GVC+ patients (n =15) and GVC– patients (n = 57). High levels of Lipoprotein(a) (Lp(a) have been shown to be an independent risk factor for cardiovascular disease, lowering of these levels not being achievable by any treatment except possibly aspirin. An in vitro study showed that TFPI activity could be inhibited by Lp(a). We did not confirm this TFPI inhibition in vivo in 20 obese patients with coronary insufficiency who had either normal Lp(a) levels (≤ 0.3 g/L; n = 15) or high Lp(a) levels (≥ 0.3 g/L; n = 5) . Moreover, we found no effect of aspirin treatment on Lp(a) whatever the initial level of Lp(a). Haemophilia B patients bleed less than haemophilia A patients. We showed that this difference in bleeding profile could be explained by lower free TFPI levels in haemophilia B patients compared to haemophilia A patients. In an ongoing study, we showed that in haemophilia A patients there was a strong correlation between the different parameters of thrombin generation (TG) and free TFPI. We also showed, in a TG assay performed in platelet-rich plasma (PRP) with a low TF concentration, that LT was sensitive to free TFPI levels whatever the type of haemophilia and whatever theseverity of the disease. We demonstrated that blocking TFPI by an anti-TFPI Antibody (Ab) allows complete correction of the TG profile in PRP. We showed that it is of major importance to perform a TG assay in PRP in order to evaluate the efficacy of anti-TFPI Ab in correcting TG parameters in haemophilia patients

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Silva, Leide Irislayne Macena da Costa e. "O efeito intergeracional no peso ao nascer e suas relações com as condições maternas, em crianças nascidas a termo no Hospital Universitário da USP". Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/5/5141/tde-08122014-152936/.

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JUSTIFICATIVA E OBJETIVOS: Vários estudos têm mostrado o peso ao nascer de ambos os pais como preditor do peso de nascimento do descendente, com correlação mais fortemente transmitida através da linhagem materna, sugerindo que exposições desfavoráveis à mãe desde a sua própria vida intrauterina até os períodos de pré-concepção e gestacional, além dos genes herdados, influenciam o tamanho ao nascimento da prole. A preocupação atual se relaciona ao ciclo intergeracional do baixo peso ao nascer ou do peso ao nascer elevado entre gerações, com todos os agravos imediatos e a longo prazo que estão implicados em nascer pequeno para a idade gestacional e/ou baixo peso ou grande para a idade gestacional e/ou macrossômico. O presente trabalho tem o objetivo de estudar a correlação entre o peso ao nascer da criança com o peso ao nascer da mãe, com as condições maternas, em crianças nascidas a termo no Hospital Universitário da USP (HU-USP). MÉTODOS: Foram identificados 773 binômios mães-crianças, 773 crianças nascidas de 558 mães, com a informação documentada do peso ao nascer tanto do bebê quanto da mãe. As informações referentes aos antecedentes maternos, pré-natal e parto, e as medidas antropométricas de nascimento da criança e da mãe foram obtidas através do registro em prontuários, sendo 83,8% das mães nascidas no HU-USP. Foram constituídos grupos de estudo de peso ao nascer da criança [< 2.500 gramas (g) e >= 3.500 gramas (g)], e também foi realizado o estudo do comprimento ao nascer da criança <= 47,5cm (quartil inferior). Foram utilizados Chi-quadrado ou teste exato de Fisher, Spearman\'s Rho, e Odds-Ratio para investigar as relações entre o peso e comprimento ao nascer das crianças com variáveis maternas e das próprias crianças. RESULTADOS: As meninas (nascidas entre 1999-2014) foram mais pesadas ao nascer do que as suas mães (nascidas entre 1972-1998), com uma média no aumento do peso ao nascer de 79g entre as duas gerações. O peso ao nascer da criança < 2.500g não apresentou correlação alguma com o peso ao nascer materno < 2.500g (Fisher 0,264*; Spearman´s Rho 0,048; OR 2,1 e OR lower 0,7), e com a estatura materna na gestação no quartil inferior (< 157cm) (Chi2 sig 0,323; com Spearman´s Rho 0,036; OR 1,5 e OR lower 0,7). O baixo peso ao nascer da criança (< 2.500g) foi levemente correlacionado com o uso de drogas pela mãe durante a gestação (Fisher 0,083*; Spearman´s Rho 0,080;OR 4,9 e OR lower 1,0). O peso ao nascer da criança < 2.500g mostrou correlação acentuada com a idade gestacional menor que 38 semanas e 3 dias (Chi2 sig 0,002; Spearman´s Rho 0,113; OR 3,2 e OR lower 1,5). O peso ao nascer da criança >= 3.500g apresentou forte correlação com o peso ao nascer materno >= 3.500g (Chi2 sig 0; Spearman´s Rho +0,142; OR 0,5** e OR upper 0,7); sendo que quanto maior o IMC pré-gestacional da mãe maior a correlação com o peso de nascimento da criança >= 3.500g [(IMC materno pré gestacional >= 25,0 kg/m2 com Chi2 sig 0,013; Spearman´s Rho 0,09; OR 1,54 e OR upper 2,17) e (IMC materno pré gestacional >= 30,0 kg/m2 com Chi2 sig 0; Spearman´s Rho 0,137; OR 2,58 e OR upper 4,26)]. O peso ao nascer da criança >= 3.500g também foi correlacionado com o parto cesareano (Chi2 sig 0; Spearman´s Rho +0,132; OR 0,5** e OR upper 0,8). O comprimento ao nascer da criança no quartil inferior (<= 47,5cm) mostrou-se significante em mães que nasceram com peso < 3.500g (Chi2 sig 0; Spearman´s Rho -0,154; OR 3,2** e OR lower 1,8). O comprimento ao nascer da criança <= 47,5cm apresentou forte correlação com o uso de drogas pela mãe durante a gestação (Chi2 sig 0,004; Spearman´s Rho 0,105; OR 4,3 e OR lower 1,5). O comprimento ao nascer da criança <= 47,5cm apresentou tênue correlação com a estatura materna no quartil inferior (< 157cm) e com o tabagismo na gestação, evidenciados pelo Chi2 sig 0,012; Spearman´s Rho 0,091; OR 1,6 e OR lower 1,1 e Chi2 sig 0,012; Spearman´s Rho 0,091; OR 1,7 e OR lower 1,1, respectivamente. CONCLUSÕES: O peso de nascimento da mãe >= 3.500g e o sobrepeso ou obesidade pré-gestacional materna foram correlacionados com o peso ao nascer da criança >= 3.500g e maior comprimento ao nascer do recém-nascido, acoplado à tendência do aumento do peso ao nascer entre gerações de mães e filhas. Também, os descendentes com menores comprimentos ao nascimento são os filhos das mulheres com as mais baixas estaturas. A co-existência do ciclo intergeracional da obesidade e da \"falência do crescimento\" se mostrou presente na população estudada
BACKGROUND AND OBJECTIVES: Many studies have shown that both parents\' birth weight acts as a predictor for the descendant birth weight, with the correlation more strongly transmitted through maternal line. This suggests that adverse expositions to the mother, from her own intrauterine life until the pre-conception and pregnancy periods, in addition to the inherited genes, influences the size of the offspring at birth. The current preoccupation relates to the intergenerational cycle of low birth weight or increased birth weight between the generations, with all the immediate and long term aggravations that are implied in small birth size for the gestational age and/or low birth weight or large birth size for the gestational age and/or macrosomic. The present research aims to study the correlation between the child\'s birth weight with the mother\'s birth weight, and maternal conditions, in term infants born in the \"Hospital Universitário\" from the University of São Paulo. METHODS: 773 mother-infant binomials were identified (773 children born from 558 mothers) with information on both the baby\'s and the mother\'s birth weight recorded. The information referring to maternal antecedents, pre-natal, parturition and birth anthropometric measures of the infant and the mother were obtained through the registrations of their medical recordes. 83.8% of the mothers were born in the \"Hospital Universitário\". Group studies were constituted, dividing the sample according to birth weight [< 2.500 grams (g) and >= 3.500 grams (g)]. The length at birth was also studied in children <= 47,5cm (lower quartile). Chi-squared test or Fisher\'s exact test, Spearman\'s Rho and Odds-Ratio were performed in order to investigate the relation between the children\'s weight and length at birth and the mothers\' and children\'s variables. RESULTS: The girls (born between 1999 and 2014) were heavier at birth than their mothers (born between 1972 and 1998), with an average increase at birth weight between the generations of 79 grams. The child\'s birth weight < 2.500 grams did not show any correlation with maternal birth weight < 2.500 grams (Fisher 0.264*; Spearman\'s Rho 0.048; OR 2.1 and OR lower 0.7) nor with maternal stature below the lower quartile (< 157cm) (Chi2 sig 0.323; with Spearman\'s Rho 0.036; OR 1.5 and OR lower 0.7). The child\'s low birth weight (< 2.500g) was lightly correlated with drug use by the mother during pregnancy (Fisher 0.083*; Spearman\'s Rho 0.080; OR 4.9 and OR lower 1.0). The child\'s birth weight < 2.500g showed increased correlation with gestational age lower than 38 weeks and 3 days (Chi2 sig 0.002; Spearman\'s Rho 0.113; OR 3.2 and OR lower 1.5). The child\'s weight at birth >= 3.500g showed strong correlation with maternal weight at birth >= 3.500g (Chi2 sig 0; Spearman\'s Rho +0.142; OR 0.5** and OR upper 0.7). It was also revealed that the higher the maternal pre-pregnancy BMI, the stronger the correlation with child\'s birth weight >= 3.500g was [(maternal pre-pregnancy BMI >= 25,0 kg/m2 with Chi2 sig 0.013; Spearman\'s Rho 0.09; OR 1.54 and OR upper 2.17) and (maternal pre-pregnancy BMI >= 30,0 kg/m2 with Chi2 sig 0; Spearman\'s Rho 0.137; OR 2.58 and OR upper 4.26)]. The child\'s weight at birth >= 3.500g was also correlated with Caesarean section (Chi2 sig 0; Spearman\'s Rho +0.132; OR 0.5** and OR upper 0.8). Child\'s length at birth in the lower quartile (<= 47,5cm) was significant in mothers who were born with weight < 3.500g (Chi2 sig 0; Spearman\'s Rho -0.154; OR 3.2** and OR lower 1.8). The child\'s length at birth <= 47,5cm showed strong correlation with drug use by the mother during pregnancy (Chi2 sig 0.004; Spearman\'s Rho 0.105; OR 4.3 and OR lower 1.5). The child\'s length at birth <= 47,5cm showed tenuous correlation with maternal stature in the lower quartile (< 157cm) and with gestational smoking, demonstrated by Chi2 sig 0.012; Spearman\'s Rho 0.091; OR 1.6 and OR lower 1.1 and Chi2 sig 0.012; Spearman\'s Rho 0.091; OR 1.7 and OR lower 1.1, respectively. CONCLUSIONS: The mother\'s weight at birth >= 3.500g and the prenatal overweight or obesity were correlated with the child\'s weight at birth >= 3.500g and increased length at birth of the newborn, coupled with the tendency of increasing birth weight between generations of mothers and daughters. Also, descendants with smaller length at birth are the children of women with the lowest statures. The coexistence of the intergenerational vicious cycle of obesity and of \"growth failure\" was found on the studied population

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Borson-Chazot, Françoise. "Analyse de marqueurs intermédiaires pour l'estimation du risque vasculaire au cours de nouvelles approches thérapeutiques : gastroplastie pour obésité sévère et traitement substitutif du déficit en hormone de croissance de l'adulte". Lyon 1, 2000. http://www.theses.fr/2000LYO1T155.

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Hasimoto, Claudia Nishida. "Correlação entre os resultados pré-operatórios de testes cardiopulmonares e a evolução pós-operatória em cirurgia bariátrica". Botucatu, 2016. http://hdl.handle.net/11449/138208.

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Orientador: Daniele Cristina Cataneo
Resumo: Introdução: A obesidade é o acúmulo de gordura anormal ou excessiva que representa um risco potencial à saúde. A cirurgia bariátrica consiste em uma alternativa de tratamento cirúrgico da obesidade mórbida, permitindo uma perda de peso expressiva e duradoura com consequente melhoria das comorbidades associadas. A obesidade está associada a alterações da mecânica ventilatória e constitui um fator de risco para o desenvolvimento de complicações pulmonares no pós-operatório de cirurgias abdominais. Objetivo: Verificar se os testes de função respiratória, de força muscular respiratória e de exercícios são capazes de predizer complicações no pós-operatório em pacientes submetidos à cirurgia bariátrica. Método: Foram avaliados 174 pacientes (81% mulheres) submetidos à cirurgia bariátrica, no Hospital das Clínicas da Faculdade de Medicina de Botucatu. Todos os pacientes foram submetidos à medidas antropométricas, testes de espirometria, medida de pico de fluxo expiratório, manovacuometria, teste de caminhada de seis minutos e teste de escada. Os dados foram colhidos no período pré-operatório e correlacionados com as complicações pós-operatórias, incluindo as complicações cardiopulmonares e cirúrgicas. Resultados: A média de idade foi de 41,59 ± 10,70 anos. O índice de massa corpórea variou de 35,44 a 62,79 Kg/m2, com média de 46,74 ± 6,35 Kg/m2. As comorbidades mais prevalentes foram: hipertensão arterial sistêmica, diabetes mellitus, dislipidemia e hipotireoidismo. A taxa de compli... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Introduction: Obesity is the accumulation of abnormal or excessive fat which represents a potential health risk. The bariatric surgery consists of an alternative for surgical treatment of morbid obesity, thus allowing significant and lasting weight loss with consequent improvement of the related comorbidities. Obesity is associated with the changes in the ventilatory mechanics and poses a risk factor for the development of pulmonary complications in the post-operative period of abdominal surgeries. Objective: Check whether the respiratory function tests, the respiratory muscle strength and the exercises are able to foresee post-operative complications in patients undergoing bariatric surgery. Methodo: 174 patients (81% women) undergoing bariatric surgery were evaluated at the Clinical Hospital of the Botucatu School of Medicine. All the patients were submitted to anthropometric measures, spyrometry tests, the measurement of peak expiratory flow, manovacuometry, a 6-minute walking test and stair-climbing test. The data were collected in the pre-operative and correlated with the post-operative complications, including both the cardiopulmonary and surgical complications. Results: The average age was 41,59 ± 10,70 years. The BMI (Body Mass Index) varied from 35,44 to 62,79 kg/m2 with an average of 46,74 ± 6,35 kg/m2. The most prevalent comorbidities were: systemic arterial hypertension, diabetes mellitus, dyslipidemia and hypothyroidism. The post-operative complication rate was a... (Complete abstract click electronic access below)
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47

"Insulin sensitivity in Chinese: inter-relations with obesity and other components of the metabolic syndrome". 1999. http://library.cuhk.edu.hk/record=b6073143.

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by Patricia Jane Anderson.
"June 1999."
Thesis (Ph.D.)--Chinese University of Hong Kong, 1999.
Includes bibliographical references (p. 300-328).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Mode of access: World Wide Web.

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48

Libhaber, Carlos David. "The transition from obesity-induced left ventricular hypertrophy to abnormalities of cardiac function". Thesis, 2014.

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There is considerable evidence to show that obesity is associated with the development of heart failure independent of traditional risk factors. However, clarity is required on the process involved in the transition from obesity-associated left ventricular hypertrophy (LVH) to LV dysfunction. In the present thesis I evaluated the extent to which central obesity explains variations in LV diastolic function at a community level independent of LV mass (LVM), LV remodelling or haemodynamic factors; whether obesity-related increases in LVM exceeding that predicted by workload (inappropriate LVM [LVMinappr] or alternative haemodynamic factors explains variations in LV ejection fraction (EF) at a community level; whether regression of LVMinappr is more closely associated with improvements in EF than LVM or LVM index (LVMI); and whether obesity-associated insulin resistance may explain decreases in LV diastolic function and variations in LVMinappr. Data were obtained in either 626 or 478 participants whom were representative of a randomly selected community sample and in 168 mild to moderate hypertensives treated for 4 months. In 626 randomly selected participants over 16 years of age from a community sample with a high prevalence of excess adiposity (~24% overweight and ~43% obese) after adjustments for a number of confounders including age, sex, pulse rate, conventional diastolic (or systolic) blood pressure (BP), antihypertensive treatment, LVMI and the presence of diabetes mellitus or an HbA1c>6.1%; waist circumference (p=0.0012) was independently and inversely associated with a reduced early-ro-late transmitral velocity (E/A), with similar findings noted for e’/a’ in a subset of 212 participants with tissue Doppler measurements. Waist circumference-E/A relationships persisted even after adjustments for other adiposity indices including body mass index (BMI) (p<0.05-0.005). No independent relationships between adiposity indices and E/e’ were noted (n=212). In contrast to the effects on diastolic function, waist circumference was not correlated with EF (p=0.83). The independent relationship between waist circumference and E/A was second only to age and similar to BP in the magnitude of the independent effect on E/A. The inclusion of relative wall thickness rather than LVMI in the regression equation produced similar outcomes. The inclusion of carotid-femoral pulse wave velocity (PWV), or 24-hour BP as confounders, failed to modify the relationship between waist circumference and E/A. Thus, waist circumference is second only to age in the impact of the independent association with E/A in a community sample with a high prevalence of excess adiposity. This effect was not accounted for by left ventricular hypertrophy or remodelling, 24-hour BP or arterial stiffness. In 478 randomly selected participants from a community sample, waist circumference, but not BMI was independently associated with the homeostasis model assessment of insulin resistance (HOMA-IR). HOMA-IR was inversely correlated with E/A (p<0.0001) and in a multivariate model with adjustments for waist circumference, age, sex, conventional diastolic or systolic BP, diabetes mellitus or an HbA1c>6.1%, regular tobacco use, regular alcohol intake, pulse rate, treatment for hypertension and either LVMI or LV relative wall thickness in the model, the relationship betwreen HOMA-IR and E/A persisted (partial r=-0.13 to 0.14, p<0.005). With further adjustments for either 24-hour systolic or diastolic BP (partial r=-0.11, p<0.05, n=351) or for aortic PWV (partial r=-0.11, p<0.02, n=410), the independent relationship between HOMA-IR and E/A also remained. Therefore, the relationship between indices of an excess adiposity and abnormalities in LV diastolic function may be explained in-part by insulin resistance beyond haemodynamic factors. In 626 randomly selected adult participants from a community sample with a high prevalence of obesity, the strongest independent predictor of LVMinappr was BMI (p<0.0001). With adjustments for LV stress and other confounders there was a strong inverse relationship between LVMinappr and EF (partial r=-0.41, p<0.0001), whilst only modest inverse relations between LVM or LVMI and EF were noted (partial r=-0.07 to -0.09, p<0.05-0.09)(p<0.0001, comparison of partial r values). The independent relationship between LVMinappr and EF persisted with further adjustments for LVM or LVMI (partial r=-0.52, p<0.0001). LVMinappr and LV midwall fractional shortening were similarly inversely related (p<0.0001) and these relations were also stronger than and independent of LVM or LVMI. In conclusion, in a community sample with a high prevalence of obesity, inappropriate LVM is strongly and inversely related to variations in EF independent of and more closely than LVM or LVMI and BMI was the strongest independent determinant of inappropriate LVH. Therefore LVH is a compensatory response to workload, but when exceeding that predicted by workload, as may occur in obesity, is associated with LV systolic chamber decompensation. In 168 mild-to-moderate hypertensives treated for 4 months, although in patients with an LVMI>51g/m2.7 (n=112)(change in LVMI=-13.7±14.0 g/m2.7, p<0.0001), but not in patients with an LVMI≤51g/m2.7(n=56)(change in LVMI=1.3±9.3 g/m2.7) LVMI decreased with treatment; treatment failed to increase EF in either group (1.2±10.8% and 2.7±10.7% respectively). In contrast, in patients with inappropriate LVH (LVMinappr>150%, n=33) LVMinappr decreased (-32±27%, p<0.0001) and EF increased (5.0±10.3%, p<0.0001) after treatment, whilst in patients with a LVMinappr≤150% (n=135), neither LVMinappr (-0.5±23%), nor EF (0.9±10.3%) changed with therapy. With adjustments for circumferential LV wall stress and other confounders, whilst on-treatment decreases in LVM or LVMI were weakly related to an attenuated EF (partial r=0.17, p<0.05), on-treatment decreases in LVMinappr were strongly related to increases in EF even after further adjustments for LVM or LVMI (partial r=-0.63, confidence interval=-0.71 to -0.52, p<0.0001). In conclusion, decreases in LVMinappr are strongly related to on-treatment increases in EF beyond changes in LVM and LVMI. LVH can therefore be viewed as a compensatory change that preserves EF, but when in excess of that predicted by stroke work, as a pathophysiological process accounting for a reduced EF. In 478 participants of a randomly selected community sample with adjustments for waist circumference, age, sex, conventional systolic BP, diabetes mellitus or an HbA1c>6.1%, regular tobacco use, regular alcohol intake, pulse rate, and treatment for hypertension, an independent relationship between HOMA-IR and LVMinappr was noted (partial r=0.14, p<0.002). With further adjustments for either 24-hour systolic BP (partial r=0.11, p<0.05, n=351), aortic PWV (partial r=0.13, p<0.02, n=410), or circumferential LV wall stress (partial r=0.12, p<0.02, n=478) the independent relationship between HOMA-IR and LVMinappr also remained. Thus, the relationship between indices of an excess adiposity and LVM beyond haemodynamic factors may be explained in-part by insulin resistance. In conclusion, the results of the present thesis provide clarity on the process involved in the transition from obesity-associated LVH to LV dysfunction. In the present thesis I demonstrated that an index of central obesity explains a considerable proportion of the variation in LV diastolic function at a community level independent of LVM, LV remodelling and haemodynamic factors; that obesity-related increases in LVM exceeding that predicted by workload (LVMinappr) or alternative haemodynamic factors explains a marked proportion of variations in EF at a community level; that regression of LVMinappr is more closely associated with improvements in EF than LVM or LVM index (LVMI); and that obesity-associated insulin resistance may explain decreases in LV diastolic function and variations in LVMinappr and hence EF. Therefore, studies are warranted to evaluate the impact of interventions that improve insulin sensitivity on obesity-related decreases in LV diastolic function and increases in LVMinappr.

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49

"Up-regulation of heme oxygenase 1 and downstream bilirubin-mediated signaling cascade protect endothelial function in diabetes and obesity". 2013. http://library.cuhk.edu.hk/record=b5884535.

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Liu, Jian.
Thesis (Ph.D.)--Chinese University of Hong Kong, 2013.
Includes bibliographical references (leaves 127-152).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstracts also in Chinese.

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Castro, Alfredo Mendes. "Laparoscopic adjustable gastric band: complications, removal and revision in a portuguese highly differentiated obesity treatment center". Master's thesis, 2015. https://repositorio-aberto.up.pt/handle/10216/88139.

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