Obesity Decreases Perioperative Tissue Oxygenation

Kabon, Barbara; Nagele, Angelika; Reddy, Dayakar; Eagon, Chris; Fleshman, James W.; Sessler, Daniel I.; Kurz, Andrea

doi:10.1097/00000542-200402000-00015

Cited by 322 publications

(264 citation statements)

References 26 publications

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“…Adipocyte hypertrophy creates areas of local AT microhypoxia at the earliest stages of expansion (19). This has been verified by recent clinical observations in humans, which suggest that AT is poorly oxygenated in the obese state (20,21). The effects of the local AT hypoxia have been investigated both in isolated murine adipocytes and in animal models (4,(22)(23)(24)(25).…”

Section: Macrophages Major Constituents Of At and Mediators Of Remodmentioning

confidence: 74%

“…We have discussed hypoxia as a key player in expanding AT that serves as a driving force for macrophage infiltration. Compared to brown AT, white AT is not particularly well vascularized (4,20). The O 2 tension in obese white AT can reach levels as low as 15 mmHg, much lower than that in normal lean AT, in which values would typically reach 45-50 mmHg (23).…”

Section: Angiogenesis a Rate-limiting Step For At Expansion And Remomentioning

confidence: 94%

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Adipose tissue remodeling and obesity

Sun¹,

Kusminski²,

Scherer³

2011

J. Clin. Invest.

1,552

1,381

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To fulfill its role as the major energy-storing tissue, adipose has several unique properties that cannot be seen in any other organ, including an almost unlimited capacity to expand in a non-transformed state. As such, the tissue requires potent mechanisms to remodel, acutely and chronically. Adipocytes can rapidly reach the diffusional limit of oxygen during growth; hypoxia is therefore an early determinant that limits healthy expansion. Proper expansion requires a highly coordinated response among many different cell types, including endothelial precursor cells, immune cells, and preadipocytes. There are therefore remarkable similarities between adipose expansion and growth of solid tumors, a phenomenon that presents both an opportunity and a challenge, since pharmacological interventions supporting healthy adipose tissue adaptation can also facilitate tumor growth. IntroductionAdipose tissue (AT) can respond rapidly and dynamically to alterations in nutrient deprivation and excess through adipocyte hypertrophy and hyperplasia, thereby fulfilling its major role in wholebody energy homeostasis. AT remodeling is an ongoing process that is pathologically accelerated in the obese state, and thus, features such as reduced angiogenic remodeling, ECM overproduction, a heightened state of immune cell infiltration and subsequent proinflammatory responses prevail in many obese fat-pads (1). However, not all AT expansion is necessarily associated with pathological changes. The concept of the "metabolically healthy obese" state (2) suggests that some individuals can preserve systemic insulin sensitivity on the basis of "healthy" AT expansion, bypassing all of the aforementioned pathological consequences associated with obesity (3), thereby also avoiding the obesity-associated lipotoxic side effects. Many physiologically relevant processes important for human AT remodeling can be studied in rodent models, with the added advantage that processes related to AT expansion and reduction can occur at an extremely rapid rate. A 24-hour fast in a mouse is associated with a dramatic loss of AT mass and an acute remodeling process that involves rapid infiltration of macrophages; moreover, merely 24 to 48 hours of exposure to a high-fat diet (HFD) can cause a prompt increase in adipocyte size (4). AT is therefore an ideal model system to study rapid alterations in tissue expansion and reduction, as it adapts to a differential nutrient supply. Here, we will focus on key aspects of the intricate dynamics of AT remodeling and subsequent inflammatory consequences that arise from obesity.

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Section: Macrophages Major Constituents Of At and Mediators Of Remodmentioning

confidence: 74%

Section: Angiogenesis a Rate-limiting Step For At Expansion And Remomentioning

confidence: 94%

Adipose tissue remodeling and obesity

Sun¹,

Kusminski²,

Scherer³

2011

J. Clin. Invest.

1,552

1,381

View full text Add to dashboard Cite

show abstract

“…SSI is the most common complication after colectomy, and obesity or overweight is thought to increase this risk by 2.5-to 5-fold as compared with patients of normal weight [13][14][15][16]. This risk may be related to the decreased oxygen tension in relatively avascular adipose tissue, differences in wound healing, greater wound size, or technical difficulties [13,17]. However, another report suggests that obesity or overweight is not a risk factor for SSI after colectomy [18].…”

Section: Discussionmentioning

confidence: 99%

Overweight is a risk factor for surgical site infection following distal gastrectomy for gastric cancer

et al. 2012

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Background Our objective was to assess the risk factors for surgical site infections (SSIs) in gastric surgery using the results of the Osaka Gastrointestinal Cancer Chemotherapy Study Group (OGSG) 0501 phase 3 trial. Methods The OGSG 0501 trial was conducted to compare standard prophylactic antibiotic administration versus extended prophylactic antibiotic administration in 355 patients who underwent open distal gastrectomy for gastric cancer. Various risk factors associated with the incidence of SSI following gastrectomy were analyzed from the results of this multi-institutional randomized controlled trial. Results Among the 355 patients, there were 24 SSIs, for an overall SSI rate of 7 %. Multivariate analysis using eight baseline factors (administration of antibiotics, age, sex, body mass index [BMI], prognostic nutritional index, tumor stage, lymph node dissection, reconstructive method) identified that BMI C25 kg/m 2 was an independent risk factor for the occurrence of SSI (odds ratio 2.82; 95 % confidence interval [CI] 1.05-7.52; P = 0.049). BMI also showed significant relationships with the volume of blood loss and the operation time (P = 0.001 and P \ 0.001, respectively). Conclusion Compared with patients of normal weight, overweight patients had a significantly higher risk of SSI after distal gastrectomy for cancer.

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“…It is widely recognized that obese subjects often present a low-degree chronic inflammation within the adipose tissue [27,33]. Furthermore, it has been reported that this tissue is under chronic hypoxic conditions during the development of obesity [22,48], although a situation of decreased adipose tissue oxygen tension in obese compared to lean men may not always occur [18], which would be explained by a lower adipose tissue oxygen consumption.…”

Section: Discussionmentioning

confidence: 99%

Effects of hyperoxia exposure on metabolic markers and gene expression in 3T3-L1 adipocytes

et al. 2012

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Adipose tissue often becomes poorly oxygenated in obese subjects. This feature may provide cellular mechanisms involving chronic inflammation processes such as the release of proinflammatory cytokines and macrophage infiltration. In this context, the purpose of the present study was to determine whether a hyperoxia exposure on mature adipocytes may influence the expression of some adipokines and involve favorable changes in specific metabolic variables. 3T3-L1 adipocytes (14 days differentiated) were treated with 95% oxygen for 24 h. Cell viability, intra and extracellular reactive oxygen especies (ROS) content, glucose uptake and lactate and glycerol concentrations were measured in the culture media. Also, mRNA levels of HIF-1, leptin, IL-6, MCP-1, PPAR-, adiponectin, and ANGPTL-4 were analyzed.Hyperoxia treatment increased intra and extracellular ROS content, reduced glucose uptake and lactate release and increased glucose release. It also led to an upregulation of the expression of IL-6, MCP-1 and PPAR-, while ANGPTL4 was downregulated in the hyperoxia group with respect to control. The present data shows that hyperoxia treatment seems to provoke an inflammatory response due to the release of ROS and the upregulation of pro-inflammatory adipokines, such as IL-6 and MCP-1. On the other hand, hyperoxia may have an indirect effect on the improvement of insulin sensitivity, due to the upregulation of PPAR- gene expression as well as a possible modulation of both glucose and lipid metabolic markers. To our knownledge, this is the first study analyzing the effect of hyperoxia in 3T3-L1 adipocytes.

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Obesity Decreases Perioperative Tissue Oxygenation

Abstract: Wound and tissue hypoxia were common in obese patients in the perioperative period and most pronounced during surgery. Even with supplemental oxygen tissue, oxygen tension in obese patients was reduced to levels that are associated with a substantial increase in infection risk.

Cited by 322 publications

References 26 publications

Adipose tissue remodeling and obesity

Adipose tissue remodeling and obesity

Overweight is a risk factor for surgical site infection following distal gastrectomy for gastric cancer

Effects of hyperoxia exposure on metabolic markers and gene expression in 3T3-L1 adipocytes

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