Relationship Between Obesity and Ventilator-Associated Pneumonia

Nseir, Saad; Gouge, Amélie Le; Pouly, Olivier; Lascarrou, Jean-Baptiste; Lachérade, Jean-Claude; Mira, Jean‐Paul; Mercier, Emmanuelle; Declercq, Pierre-Louis; Sirodot, Michel; Piton, Gaël; Tinturier, F.; Coupez, Elisabeth; Gaudry, Stéphane; Djibré, Michel; Thévenin, Didier; Balduyck, Malika; Reignier, Jean

doi:10.1016/j.chest.2021.01.081

Cited by 13 publications

(9 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The investigators observed that the incidence of ventilator-associated pneumonia was comparable between obese and nonobese patients. 22 Consistent with previous population studies describing an obesity paradox, [23][24][25][26] children with obesity and neurologic disorders in our study cohort were less likely to develop postoperative pneumonia than healthy weight or overweight children with neurologic disorders. One study examining the obesity paradox in community-acquired pneumonia in adult patients found that obesity and overweight were associated with a reduction of 5.7% and 8.6%, respectively, in 30-day mortality, suggesting a lower risk of obese than for overweight subjects.…”

Section: Discussionsupporting

confidence: 92%

Risk assessment of postoperative pneumonia in children with neurologic disorders and obesity

Owusu-Bediako

Mpody

Iobst

et al. 2022

Pediatric Anesthesia

View full text Add to dashboard Cite

Introduction Postoperative pneumonia increases the risk of postsurgical mortality, making it a serious healthcare‐associated complication. Children with preoperative neuromuscular impairments have a higher risk of postoperative pneumonia. Obesity is also a risk factor for postoperative pulmonary complications, including pneumonia. Moreover, obesity is increasingly prevalent among children living with a neurological diagnosis. Whether obesity increases the risk of postoperative pneumonia among children with neurologic diseases remains largely unknown. Therefore, we assessed the risk of postoperative pneumonia among children with neurologic diagnoses based on their obesity status. Methods We analyzed a retrospective cohort of children ≤18 years from the National Surgical Quality Improvement Program (2012–2019) database who underwent inpatient orthopedic surgery. We used Cox proportional regression model to estimate the hazard ratio for the association between neurologic disorders and postoperative pneumonia. In addition, we included an interaction term between body mass index and neurologic disorders to evaluate the moderating effect of obesity status and then performed stratified analyses to compare the magnitude of hazard ratios across body mass index subgroups. Results A total of 60 745 children underwent inpatient orthopedic surgery during the study period, of whom 43.6% were healthy weight and 30.8% overweight/obese. The median age was 13 years (Interquartile range: 8–15). The incidence of postoperative pneumonia was higher among healthy weight patients with neurologic disorders than healthy weight patients without any neurologic disorders [Hazard ratio: 3.55 vs. 0.34]. Furthermore, the association between neurologic disorders and postoperative pneumonia was strongest among overweight patients than healthy weight or obese patients [Hazard ratio:11.88 vs. 9.45 vs. 4.40]. This observation was consistent across the various neurologic disorders analyzed. Conclusion Childhood obesity buffered the association between neurologic disorders and postoperative pneumonia, consistent with an ‘obesity paradox’. Further research exploring the underlying mechanisms for the obesity paradox in children with neurologic disorders is warranted.

show abstract

Section: Discussionsupporting

confidence: 92%

Risk assessment of postoperative pneumonia in children with neurologic disorders and obesity

Owusu-Bediako

Mpody

Iobst

et al. 2022

Pediatric Anesthesia

View full text Add to dashboard Cite

show abstract

“…On the other hand, other studies, while confirming a higher rate of invasive ventilation and ICU admission among obese patients, found a similar rate of death in obese and lean patients [6,7,26]. The lack of negative influence of obesity on mortality or even the protective influence, known as the obesity paradox, has been already described in community-acquired, ventilator-associated pneumonia and ARDS with variable followup [8,9,38]. Consistent with these findings, we did not find a difference in mortality between obese patients and their lean counterparts or in patients with or without MS.…”

Section: Discussionmentioning

confidence: 79%

“…In the course of the ongoing pandemic, robust evidence has identified obesity as a common risk factor for negative outcomes in infections caused by SARS-CoV-2 (COVID-19) [4]. However, as regards mortality, the relationship with obesity in COVID-19 is still unclear, since some studies demonstrated a negative [5] or neutral impact [6,7], near to the so-called "obesity paradox", which is the inverse correlation between body mass index (BMI) and mortality, already described in infectious [8,9] and non-infectious diseases [10,11]. These conflicting results might be explained by the questionable use of BMI, since it does not distinguish between visceral and subcutaneous fat tissue.…”

Section: Introductionmentioning

confidence: 99%

The impact of body composition on mortality of COVID-19 hospitalized patients: A prospective study on abdominal fat, obesity paradox and sarcopenia

Graziano

Peghin

Martino

et al. 2022

Clinical Nutrition ESPEN

View full text Add to dashboard Cite

“…Although obesity increases the risk of mortality in the general population, it has been associated with improved survival among critically ill patients [ 10 – 12 ]. Similarly, a meta-analysis including 6,268 patients with ARDS revealed that obese patients with ARDS have lower mortality than those with a normal BMI [ 7 , 8 , 26 ]. This counterintuitive phenomenon is referred to as the “obesity paradox in ARDS”, and the underlying mechanism for this intriguing phenomenon has yet to be elucidated.…”

Section: Discussionmentioning

confidence: 99%

Adipose-Derived Circulating Exosomes Promote Protection of the Pulmonary Endothelial Barrier by Inhibiting EndMT and Oxidative Stress through Down-Regulation of the TGF-β Pathway: A Potential Explanation for the Obesity Paradox in ARDS

Deng

Chen

et al. 2022

Oxidative Medicine and Cellular Longevity

View full text Add to dashboard Cite

The “obesity paradox in acute respiratory distress syndrome” (ARDS) refers to the phenomenon in which obesity is associated with higher morbidity but lower mortality in patients with ARDS. Endothelial-to-mesenchymal transition (EndMT) represents a key link in the interaction between endothelial disruption and mesenchymal fibrosis under inflammatory and oxidative conditions, which represent the intersectional pathophysiology of ARDS. Adipose tissue is considered to constitute the major source of circulating exosomal microRNAs (miRNAs), which act as genetic forms of adipokines for cell–cell crosstalk. We aimed to demonstrate the regulation and mechanism of adipose-derived exosomes in the obesity paradox in ARDS. High-fat-induced obese mice and lean control mice were subjected to ARDS insult to investigate the effects of obesity on ARDS and microarray analysis was performed to screen for differences in circulating miRNAs. In addition, mice and pulmonary endothelial cells were administered with adipose-derived exosomal miR-122-5p to investigate the underlying molecular mechanisms. We found high-fat diet-induced obesity protected against ARDS in mice by reinforcing endothelial barrier and attenuating fibroproliferation. Circulating exosomes produced in the obese state mediated these protective effects by inhibiting EndMT and oxidative stress. Mechanistically, adipose-derived exosomal miR-122-5p promoted the integrity and function of pulmonary endothelial barrier and alleviated fibrogenesis by suppressing EndMT and oxidative stress through down-regulation of the transforming growth factor β1 (TGF-β1)/TGF-β receptor 1 (TGF-βR1)/Smad2 pathway in vivo and in vitro. In conclusion, adipose-derived circulating exosomal miR-122-5p protects against ARDS by reinforcing pulmonary endothelial barrier through inhibition of EndMT and oxidative stress via down-regulation of the TGF-β pathway, which propose a potential explanation for the obesity paradox in ARDS and indicate promising prospects for adipose-derived exosomes in cell-free therapies for ARDS.

show abstract

Relationship Between Obesity and Ventilator-Associated Pneumonia

Cited by 13 publications

References 25 publications

Risk assessment of postoperative pneumonia in children with neurologic disorders and obesity

Risk assessment of postoperative pneumonia in children with neurologic disorders and obesity

The impact of body composition on mortality of COVID-19 hospitalized patients: A prospective study on abdominal fat, obesity paradox and sarcopenia

Adipose-Derived Circulating Exosomes Promote Protection of the Pulmonary Endothelial Barrier by Inhibiting EndMT and Oxidative Stress through Down-Regulation of the TGF-β Pathway: A Potential Explanation for the Obesity Paradox in ARDS

Contact Info

Product

Resources

About