Postmortem examination in the morbidly obese

Fryer, Eve; Roberts, Ian; Sheppard, Mary N.; Verrill, Clare

doi:10.1111/his.12224

Cited by 11 publications

(17 citation statements)

References 29 publications

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“…This is consistent with the declaration of many publications that increased BMI is more hazardous for younger individuals . Our analyses aligned with previous reports that the most common causes of death were related to cardiovascular and respiratory disease when obesity was listed as a contributing factor in part II of the death certificate .…”

Section: Discussionsupporting

confidence: 92%

“…The risk of sudden death due to an arrhythmia or unexpected cardiac death is nearly 40 times greater in the obese population as compared to the nonobese . Despite the known association between mortality and obesity, obesity is infrequently listed on the death certificate . Inconsistent certification of deaths due to, or contributed by, obesity vastly underestimates the effect obesity has on mortality.…”

mentioning

confidence: 99%

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Correcting the Count: Improving Vital Statistics Data Regarding Deaths Related to Obesity

McCleskey

Davis

Dye

2017

Journal of Forensic Sciences

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Obesity can involve any organ system and compromise the overall health of an individual, including premature death. Despite the increased risk of death associated with being obese, obesity itself is infrequently indicated on the death certificate. We performed an audit of our records to identify how often "obesity" was listed on the death certificate to determine how our practices affected national mortality data collection regarding obesity-related mortality. During the span of nearly 25 years, 0.2% of deaths were attributed to or contributed by obesity. Over the course of 5 years, 96% of selected natural deaths were likely underreported as being associated with obesity. We present an algorithm for certifiers to use to determine whether obesity should be listed on the death certificate and guidelines for certifying cases in which this is appropriate. Use of this algorithm will improve vital statistics concerning the role of obesity in causing or contributing to death.

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Section: Discussionsupporting

confidence: 92%

mentioning

confidence: 99%

Correcting the Count: Improving Vital Statistics Data Regarding Deaths Related to Obesity

McCleskey

Davis

Dye

2017

Journal of Forensic Sciences

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“…Instead, the majority of deaths were natural (N = 108), the leading causes of which were cardiac, pulmonary thromboembolism, and respiratory (32.6%, 12.5%, and 11.8% of all deaths, respectively). These results are similar to that of a study by Fryer et al, which found cardiac, respiratory, and pulmonary thromboembolism conditions to be the predominant causes of death in 42.6%, 19.8%, and 13.9% of their cases, respectively (16). Other studies have also shown that the prevalence of death due to cardiac causes is significantly higher in obese cohorts (14) and that obesity is not only a risk factor for fatal pulmonary thromboembolism (14,23,24), but that this becomes increasingly significant with rising BMI (15).…”

Section: Discussionsupporting

confidence: 92%

Obesity, Body Mass Index, and Homicide

Omond

Langlois

Byard

2016

Journal of Forensic Sciences

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The body mass indexes (BMIs) of 100 randomly selected homicide cases from the files of Forensic Science SA were compared to the Australian and South Australian populations. There were 70 males and 30 females (M:F = 2.3:1; age range 18-84 years; mean 42.3 years). There was a substantially lower proportion of obese individuals in the homicide population compared to the general Australian and South Australian populations (19% [vs.] 27.9% and 30%, respectively). A second group of 144 randomly selected autopsy cases where the BMI was ≥40 kg/m was analyzed. There were 77 males and 67 females (M:F = 1.2:1; age range 23-78 years; mean 46.7 years). The majority of deaths were natural (N = 108), with no homicides. A negative association between obesity and homicide has, therefore, been demonstrated. Reasons for the lower numbers of obese/morbidly obese individuals among homicide victims are unclear, but may include physical protection afforded by fat padding from sharp force injuries, and relative sociodemographic isolation.

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“…Furthermore, histological or anatomical heterogeneity has the potential to confound study results (despite the best efforts of histopathologists and others to classify tumours accurately). In addition, the final cause of death in overweight people, as in lean subjects, is most often a cardiovascular or respiratory problem rather than GI disease …”

Section: Resultsmentioning

confidence: 99%

“…In addition, the final cause of death in overweight people, as in lean subjects, is most often a cardiovascular or respiratory problem rather than GI disease. 90 Despite these considerations, there is no doubt that accumulation of body fat increases the risk of multiple non-neoplastic GI disorders and of oesophageal adenocarcinoma, CRC, and gallbladder cancer ( Table 1). One report estimated that 20% of gallbladder cancers and 11% of CRCs are 'attributable to obesity', and some experts have suggested even higher figures.…”

Section: Resultsmentioning

confidence: 99%

Obesity and metabolic syndrome: pathological effects on the gastrointestinal tract

Feakins

2016

Histopathology

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Obesity is an increasingly common problem worldwide and a risk factor for a variety of gastrointestinal (GI) diseases, both non-neoplastic (e.g. gastro-oesophageal reflux and Barrett's oesophagus) and neoplastic (e.g. oesophageal adenocarcinoma, colorectal carcinoma, and gallbladder cancer). Furthermore, obesity is associated with worse GI cancer outcomes. Body mass index is a commonly used measure of fat accumulation, although specific patterns such as abdominal/central obesity and visceral fat quantity sometimes predict disease risk more accurately. Metabolic syndrome (MS) is a related condition characterized by central adiposity and insulin resistance. The reasons for the associations with neoplasia are diverse. Established cancer-related conditions that have a higher prevalence in overweight subjects include Barrett's oesophagus and gallstones. Preneoplastic lesions such as colorectal adenoma, colorectal serrated lesions and pancreatic intraepithelial neoplasia are also associated with obesity/MS. At the cellular level, adipocytes can release carcinogens such as adipokines, insulin-like growth factor, and vascular endothelial growth factor. Inflammatory cells constitute a further potential source of carcinogens; in obese subjects, their numbers are increased systemically and in adipose tissue. Animal studies have contributed additional information. For example, mice with a genetic predisposition to develop colorectal carcinoma given a high-fat diet have larger and more numerous intestinal adenomas than controls, and there may be demonstrably higher levels of mucosal oncogenic factors. The associations between obesity and GI disease are of variable strength, and the underlying mechanisms are incompletely understood, but it is clear that obesity and MS have a significant, potentially avoidable and often under-recognized impact on the population burden of GI disease.

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Postmortem examination in the morbidly obese

Cited by 11 publications

References 29 publications

Correcting the Count: Improving Vital Statistics Data Regarding Deaths Related to Obesity

Correcting the Count: Improving Vital Statistics Data Regarding Deaths Related to Obesity

Obesity, Body Mass Index, and Homicide

Obesity and metabolic syndrome: pathological effects on the gastrointestinal tract

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