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Journal of Vascular Surgery Jul 2023In the present review, we assessed the effect of obesity on clinical outcomes for patients with peripheral arterial disease who had undergone endovascular or open lower... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
In the present review, we assessed the effect of obesity on clinical outcomes for patients with peripheral arterial disease who had undergone endovascular or open lower extremity revascularization surgery.
METHODS
A systematic search strategy of MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane Library was conducted. The included studies had compared obese and nonobese cohorts with peripheral arterial disease who had undergone endovascular or open lower extremity revascularization. The outcomes included mortality, major adverse cardiovascular events, major adverse limb events, surgical site infections, endovascular access site complications, and perioperative complications.
RESULTS
Eight studies were included with 171,648 patients. The obese patients (body mass index ≥30 kg/m) were more likely to be women, to have diabetes, and to have more cardiovascular comorbidities despite being younger. No association was found between obesity and peripheral arterial disease severity. Obesity was associated with an overall 22% decreased mortality risk after lower extremity revascularization (risk ratio [RR], 0.78; 95% confidence interval [CI], 0.71-0.85; P < .001; I = 0%; GRADE (grading of recommendations assessment, development, evaluation), very low quality). A subgroup analysis by intervention type showed similar findings (endovascular: RR, 0.79; 95% CI, 0.71-0.87; P < .001; I = 0%; open: RR, 0.70; 95% CI, 0.51-0.95; P = .024; I = 43%). Obesity was associated with a 14% decreased risk of major adverse cardiovascular events for open surgery only (RR, 0.86; 95% CI, 0.76-0.98; P = .021; I = 0%; GRADE, very low quality). Obesity was associated with an increased risk of surgical site infections pooled across intervention types (RR, 1.69; 95% CI, 1.34-2.14; P < .001; I = 78%; GRADE, very low quality). No association was found between obesity and major adverse limb events (RR, 1.02; 95% CI, 0.93-1.11; P = .73; I = 15%; GRADE, very low quality) or endovascular access site complications (RR, 1.11; 95% CI, 0.76-1.63; P = .58; I = 86%; GRADE, very low quality). Pooled perioperative complications did not differ between the obese and nonobese cohorts (RR, 1.04; 95% CI, 0.84-1.28; P = .73; I = 92%; GRADE, very low quality).
CONCLUSIONS
Obesity was associated with reduced mortality risk with both endovascular and open surgery, although a reduction in major adverse cardiovascular events was only observed with open surgery. In addition, obese patients had an increased risk of surgical site infections. Obesity was not associated with major adverse limb events, endovascular access site complications, or perioperative complications. The GRADE quality of evidence was very low. The findings from the present review suggest a survival advantage for obese patients with peripheral arterial disease. Future studies could focus on prospectively investigating the effect of obesity on peripheral arterial disease outcomes. A nuanced evaluation of body mass index as a preoperative risk factor is warranted.
Topics: Humans; Female; Male; Surgical Wound Infection; Vascular Surgical Procedures; Obesity; Peripheral Arterial Disease; Lower Extremity
PubMed: 36565774
DOI: 10.1016/j.jvs.2022.12.023 -
The Journal of Obstetrics and... Jan 2019The aim of this study is to perform a systematic review and meta-analysis on the relationship between excess weight and risk of recurrent pregnancy loss (RPL) and to... (Meta-Analysis)
Meta-Analysis
The aim of this study is to perform a systematic review and meta-analysis on the relationship between excess weight and risk of recurrent pregnancy loss (RPL) and to highlight the common immunological mechanisms of these two conditions. The PubMed and MEDLINE databases were searched for publications in English available as of November 2017. The search terms used were 'recurrent pregnancy loss', 'body mass index' (BMI), 'overweight' and 'obesity'. For calculation of the odds ratio (OR) and 95% confidence intervals (CI) for miscarriage in different BMI groups, RevMan software was used (Review Manager, Version 5.3.5 for Windows; The Cochrane Collaboration). In total, 100 publications including the search terms were identified. Six studies were included for qualitative analysis, and two studies were included for quantitative analysis (meta-analysis). The association between excess weight and RPL was significant (OR, 1.34; 95% CI, 1.05-1.70; P = 0.02). The isolated analyses of the groups of obese and overweight women revealed an association only between obesity and RPL (OR, 1.75; 95% CI, 1.24-2.47; P = 0.001). The data available in the current literature revealed that obese women with a history of RPL have a high risk of future pregnancy losses, a risk which was not found among overweight women.
Topics: Abortion, Habitual; Comorbidity; Female; Humans; Obesity; Pregnancy
PubMed: 30156037
DOI: 10.1111/jog.13799 -
Expert Review of Pharmacoeconomics &... Oct 2016Given the increasing clinical and economic burden of obesity, it is of major importance to identify cost-effective approaches for obesity management. Areas covered: This... (Review)
Review
Given the increasing clinical and economic burden of obesity, it is of major importance to identify cost-effective approaches for obesity management. Areas covered: This study aims to systematically review and compile an overview of published decision models for health economic assessments (HEA) in obesity, in order to summarize and compare their key characteristics as well as to identify, inform and guide future research. Of the 4,293 abstracts identified, 87 papers met our inclusion criteria. A wide range of different methodological approaches have been identified. Of the 87 papers, 69 (79%) applied unique /distinctive modelling approaches. Expert commentary: This wide range of approaches suggests the need to develop recommendations /minimal requirements for model-based HEA of obesity. In order to reach this long-term goal, further research is required. Valuable future research steps would be to investigate the predictiveness, validity and quality of the identified modelling approaches.
Topics: Cost of Illness; Cost-Benefit Analysis; Decision Support Techniques; Humans; Models, Economic; Obesity
PubMed: 27570095
DOI: 10.1080/14737167.2016.1230497 -
Transplantation Jul 2014The effects of obesity on outcomes reported after kidney transplantation have been controversial. The purpose of this systematic review and meta-analysis was to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The effects of obesity on outcomes reported after kidney transplantation have been controversial. The purpose of this systematic review and meta-analysis was to elucidate this issue.
METHODS
MEDLINE, EMBASE, Cochrane Library, and gray literature were searched up to August 6, 2013. Studies that compared obese and nonobese patients who underwent kidney transplantation and evaluated one of these outcomes-delayed graft function (DGF), acute rejection, graft or patient survival at 1 or 5 years after transplantation, or death by cardiovascular disease (CVD)-were included. Two independent reviewers extracted the data and assessed the quality of the studies.
RESULTS
From 1,973 articles retrieved, 21 studies (9,296 patients) were included. Obesity was associated with DGF (relative risk, 1.41; 95% confidence interval, 1.26-1.57; I=8%; Pheterogeneity=0.36), but not with acute rejection. Graft loss and death were associated with obesity only in the analysis of studies that evaluated patients who received a kidney graft before year 2000. No association of obesity with graft loss and death was found in the analysis of studies that evaluated patients who received a kidney graft after year 2000. Death by CVD was associated with obesity (relative risk, 2.07; 95% confidence interval, 1.17-3.64; I=0%; Pheterogeneity=0.59); however, most studies included in this analysis evaluated patients who received a kidney graft after year 2000.
CONCLUSION
In conclusion, obese patients have increased risk for DGF. In the past years, obesity was a risk factor for graft loss, death by CVD, and all-cause mortality. However, for the obese transplanted patient today, the graft and patient survival is the same as that of the nonobese patient.
Topics: Cardiovascular Diseases; Chi-Square Distribution; Delayed Graft Function; Graft Rejection; Graft Survival; Humans; Kidney Transplantation; Obesity; Odds Ratio; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 24911038
DOI: 10.1097/TP.0000000000000028 -
International Journal of Surgery... Aug 2018Trauma is one of the major causes of morbidity and mortality globally, especially in younger populations. With an increase in obesity globally, it is important to assess... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Trauma is one of the major causes of morbidity and mortality globally, especially in younger populations. With an increase in obesity globally, it is important to assess the potential differences in injury pattern and management of obese patients presenting with trauma compared to lean patients to try and improve patient care. This study aims to review the available literature comparing injury patterns between obese and non-obese patients.
METHODS
A systematic review of articles which assessed the association between obesity and different patterns of trauma and injury were assessed. Study quality was assessed using the Newcastle-Ottawa Scale. Data for injury patterns, type of trauma and patient course and outcome including length of ITU stay, length of intubation, length of hospital stay and mortality were collected. Summary data was assessed with random-effects meta-analysis.
RESULTS
21 studies with a total of 2,977,758 patients were identified. The majority of included patients had suffered blunt trauma. Lean patients were found to have a slightly increased risk of blunt trauma as a mechanism of injury (RR 1.02 p=<0.001), with a greater risk of head injury (lean patients RR 1.38 p=<0.001), reduced likelihood of extremity (lean RR 0.79 p=<0.001), and thoracic injury (lean RR 0.83 p = 0.002). There was no difference in risk of abdominal injury (p = 0.39).
DISCUSSION
Obese trauma patients present with different injury patterns compared to lean patients. This may have significant impact on resource requirements and patient outcomes and must be considered when planning or allocating resources for trauma care. Whether differing injury patterns relate to body habitus, lifestyle factors, or other confounders is unclear, but likely represents a combination of thereof.
Topics: Female; Humans; Obesity; Risk Factors; Thinness; Traumatology; Wounds, Nonpenetrating
PubMed: 29751089
DOI: 10.1016/j.ijsu.2018.05.004 -
International Journal of Obesity (2005) Nov 2015Job strain, the most widely used indicator of work stress, is a risk factor for obesity-related disorders such as cardiovascular disease and type 2 diabetes. However,... (Meta-Analysis)
Meta-Analysis Review
Job strain, the most widely used indicator of work stress, is a risk factor for obesity-related disorders such as cardiovascular disease and type 2 diabetes. However, the extent to which job strain is related to the development of obesity itself has not been systematically evaluated. We carried out a systematic review (PubMed and Embase until May 2014) and meta-analysis of cohort studies to address this issue. Eight studies that fulfilled inclusion criteria showed no overall association between job strain and the risk of weight gain (pooled odds ratio for job strain compared with no job strain 1.04, 95% confidence interval (CI) 0.99-1.09, NTotal=18 240) or becoming obese (1.00, 95% CI 0.89-1.13, NTotal=42 222). In addition, a reduction in job strain over time was not associated with lower obesity risk (1.13, 95% CI 0.90-1.41, NTotal=6507). These longitudinal findings do not support the hypothesis that job strain is an important risk factor for obesity or a promising target for obesity prevention.
Topics: Body Mass Index; Cardiovascular Diseases; Diabetes Mellitus, Type 2; Employment; Humans; Obesity; Occupational Diseases; Stress, Psychological; Weight Gain
PubMed: 26041697
DOI: 10.1038/ijo.2015.103 -
Iranian Journal of Kidney Diseases Mar 2023Obesity is a growing problem that causes various metabolic disorders and organ dysfunction. The present systematic review and meta-analysis examined the impact of... (Meta-Analysis)
Meta-Analysis
Obesity is a growing problem that causes various metabolic disorders and organ dysfunction. The present systematic review and meta-analysis examined the impact of obesity on the risk of kidney stones. This meta-analysis was designed according to PRISMA guidelines. This extensive search was conducted on June 6, 2022, using relevant keywords in databases including PubMed, Web of Science, EMBASE, and Scopus. The data collected from observational studies were recorded in a datasheet. Odds Ratio (OR) and their 95% confidence intervals (CI) evaluated the overall effect size. The Cochran Q test and the statistic I2 were used to evaluate the heterogeneity of studies. Egger's and Begg's tests assessed potential publication bias. We included 15 observational studies published between 2005 to 2022 in this analysis. Compared to nonobese individuals, the OR for developing kidney stones in obese participants was 1.35 (95% CI: 1.20 to 1.52, P < .001). Considering geographical location, the OR for the risk of developing kidney stones in obese individuals was 1.51 (95% CI: 1.11 to 2.05, P = .009) in North America, 1.33 (95% CI: 1.16 to 1.51, P < .001) in Europe, and 1.18 (95% CI: 1.08 to 1.29, P < .001) in Asia. Begg's test results (P = .625) demonstrated no publication bias. However, Egger's test results (P = .005) indicated publication bias. Based on the results, obesity increases the risk of kidney stone development. Therefore, community health programs should be implemented to reduce the incidence of obesity and lower the risk of kidney stones. DOI: 10.52547/ijkd.7223.
Topics: Humans; Obesity; Kidney Calculi; Observational Studies as Topic
PubMed: 37060339
DOI: No ID Found -
Gynecological Endocrinology : the... 2016We aimed at investigating whether insulin resistance (IR)/sensitivity are impaired in obese/non-obese polycystic ovary syndrome (PCOS) and obese/non-obese healthy... (Meta-Analysis)
Meta-Analysis Review
We aimed at investigating whether insulin resistance (IR)/sensitivity are impaired in obese/non-obese polycystic ovary syndrome (PCOS) and obese/non-obese healthy controls. A comprehensive literature search was performed for observational, English language studies. Meta-analysis was performed with the random effects model according to the heterogeneity. Eligible studies, involving 3037 women in four groups of: 1-obese, PCOS; 2-non-obese, PCOS, 3-obese, non-PCOS and 4-Non-obese, non-PCOS were included. Based on the insulin resistance index (HOMA-IR) analysis, the pooled mean (95% Conf. Interval) of HOMA IR in groups 1-4 were 4.38 (3.84, 4.92), 2.68 (2.16, 3.20), 2.44 (2.06, 2.82) and 1.34 (1.06, 1.63), respectively. Meta-analysis showed that group 1 (obese, PCOS patients) statistically have the highest IR and group 4 (non-obese, non-PCOS women) have the highest insulin sensitivity. Group 2 (non-obese, PCOS patients) and group 3 (obese, non-PCOS women) were between this range and they had lower IR than group 1 (obese, PCOS) and lower insulin sensitivity than group 4 (non-obese, non-PCOS). So, there were statistical differences between all groups except between groups 2 and 3. Insulin sensitivity indexes (quickie and ISI), also confirm the IR index (HOMA-IR) results. Based on different IR/sensitivity indexes, we found no evidence of any different effects of BMI ≥ 30 kg/m(2) on IR/sensitivity. In conclusion, PCOS status intensifies the adverse effects of obesity on IR, it has to be appropriately addressed in primary and secondary preventive cares and treatments provided for these women.
Topics: Adiponectin; Adult; Blood Glucose; Female; Humans; Insulin; Insulin Resistance; Obesity; Polycystic Ovary Syndrome
PubMed: 27052492
DOI: 10.3109/09513590.2015.1117069 -
Journal of Clinical Nursing Sep 2022To review the literature regarding the effects of mirror exposure on behaviour and obese patients. The review explored how mirror exposure influences behaviour in obese... (Review)
Review
AIMS AND OBJECTIVES
To review the literature regarding the effects of mirror exposure on behaviour and obese patients. The review explored how mirror exposure influences behaviour in obese patients in terms of activity level, psychology and eating habits.
BACKGROUND
Obesity is a major epidemic that affects people worldwide but is more predominant in the Western world. Many health issues are directly linked to obesity, and current therapies have failed to provide a sustainable resolution to this problem. Mirror exposure has been used in eating disorders such as anorexia nervosa, bulimia and binge eating; however, there exists a gap in the use of mirrors in obese patients. The literature review focuses on the effects of mirror exposure on behaviour and obese patients.
METHOD
A literature review of articles published between 2006 and 2020 related to mirror exposure in obese patients and the related effects.
RESULTS
Literature that explicitly discussed mirror exposure in obese patients was included; five research articles were reviewed.
CONCLUSIONS
Mirror exposure can influence behaviour modification in obese patients. Therefore, the use of mirrors should be considered as an adjunct therapy in this group of patients.
RELEVANCE TO CLINICAL PRACTICE
Mirror exposure can positively alter behaviour in obese patients and can be used as an intervention in clinical practice to assist in weight loss and improve health outcomes.
Topics: Anorexia Nervosa; Binge-Eating Disorder; Bulimia Nervosa; Humans; Obesity; Weight Loss
PubMed: 34741363
DOI: 10.1111/jocn.16107 -
Journal of Gastrointestinal Surgery :... Oct 2017The aim of this meta-analysis is to comprehensively review and quantify the excess risk of surgical site infections (SSI) in obese patients following colorectal surgery. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The aim of this meta-analysis is to comprehensively review and quantify the excess risk of surgical site infections (SSI) in obese patients following colorectal surgery.
METHODS
A systematic electronic search of the MEDLINE and EMBASE databases identified studies that investigated the association of obesity, defined by body mass index (BMI) with SSI among colorectal surgery patients.
RESULTS
Twelve studies were included in the final analysis. Patients with BMI ≥30 kg/m were at 1.5 times (pooled OR 1.51, 95% CI: 1.39, 1.63, p < 0.001) higher odds of developing SSI after colorectal surgery when compared to BMI <30 kg/m. Subgroup analysis of the eight studies that investigated only elective procedures showed that the odds of developing SSI when BMI ≥30 kg/m is 1.6 times that of those with BMI <30 kg/m (pooled OR 1.60; 95% CI 1.34, 1.86; p < 0.001). The odds of having SSI when BMI is 25-29.9 kg/m are 1.2 times than those with BMI <25 kg/m (pooled OR 1.17; 95% CI 1.07, 1.28; p < 0.001).
CONCLUSION
Overweight and obese patients carry at least 20% and 50% higher odds of developing SSI after colorectal surgery compared to normal weight patients, respectively.
Topics: Body Mass Index; Colon; Humans; Obesity; Odds Ratio; Overweight; Rectum; Risk Factors; Surgical Wound Infection
PubMed: 28785932
DOI: 10.1007/s11605-017-3494-y