Obesity: physiologic changes and implications for preoperative management

BMC Anesthesiology

Vilma E. Ortiz¹  Jean Kwo¹ 

[1] Department of Anesthesia, Critical Care & Pain Medicine, Associate Anesthetist, Massachusetts General Hospital, 55 Fruit Street, Boston 02114, MA, USA

关键词: Insulin resistance;    Body mass index;    Bariatric;    Obstructive sleep apnea (OSA);    Metabolic syndrome;    Preoperative evaluation;    Morbid obesity;    Obesity;   

Others  :  1217260
DOI  :  10.1186/s12871-015-0079-8

 received in 2014-12-02, accepted in 2015-06-24,  发布年份 2015

【 摘 要 】

The proportion of patients defined as obese continues to grow in many westernized nations, particularly the United States (USA). This trend has shifted the perioperative management of obese patients into the realm of routine care. As obese patients present for all types of procedures, it is crucial for anesthesiologists, surgeons, internists, and perioperative health care providers alike to have a firm understanding of their altered multi-organ physiology in order to safely prepare the obese patient for an operation. A careful preoperative evaluation may also serve to identify risk factors for postoperative adverse events. Subsequently, preoperative measures may be implemented to mitigate these complications. In this manuscript we address the major considerations for the preoperative evaluation of the severely obese patient.

【 授权许可】

   
2015 Ortiz and Kwo.

【 参考文献 】

• [1]Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Mullany EC, Biryukov S, Abbafati C, Abera SF et al.. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014; 384(9945):766-781.
• [2]Wang YC, McPherson K, Marsh T, Gortmaker SL, Brown M. Health and economic burden of the projected obesity trends in the USA and the UK. Lancet. 2011; 378(9793):815-825.
• [3]Eckardt KU, Coresh J, Devuyst O, Johnson RJ, Kottgen A, Levey AS, Levin A. Evolving importance of kidney disease: from subspecialty to global health burden. Lancet. 2013; 382(9887):158-169.
• [4]Chen J, Muntner P, Hamm LL, Jones DW, Batuman V, Fonseca V, Whelton PK, He J. The metabolic syndrome and chronic kidney disease in U.S. adults. Ann Intern Med. 2004; 140(3):167-174.
• [5]Fabricatore AN, Wadden TA, Higginbotham AJ, Faulconbridge LF, Nguyen AM, Heymsfield SB, Faith MS. Intentional weight loss and changes in symptoms of depression: a systematic review and meta-analysis. Int J Obes (Lond). 2011; 35(11):1363-1376.
• [6]Kernan WN, Inzucchi SE, Sawan C, Macko RF, Furie KL. Obesity: a stubbornly obvious target for stroke prevention. Stroke. 2013; 44(1):278-286.
• [7]Yusuf S, Hawken S, Ounpuu S, Bautista L, Franzosi MG, Commerford P, Lang CC, Rumboldt Z, Onen CL, Lisheng L et al.. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case–control study. Lancet. 2005; 366(9497):1640-1649.
• [8]Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004; 292(14):1724-1737.
• [9]Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. 2009; 9:88.
• [10]Aspden RM. Obesity punches above its weight in osteoarthritis. Nat Rev Rheumatol. 2011; 7(1):65-68.
• [11]Deyo RA, Bass JE. Lifestyle and low-back pain. The influence of smoking and obesity. Spine. 1989; 14(5):501-506.
• [12]Osborn DJ, Strain M, Gomelsky A, Rothschild J, Dmochowski R. Obesity and female stress urinary incontinence. Urology. 2013; 82(4):759-763.
• [13]Erlinger S. Gallstones in obesity and weight loss. Eur J Gastroenterol Hepatol. 2000; 12(12):1347-1352.
• [14]Willett WC, Dietz WH, Colditz GA. Guidelines for healthy weight. N Engl J Med. 1999; 341(6):427-434.
• [15]Wajchenberg BL. Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev. 2000; 21(6):697-738.
• [16]Tchernof A, Despres JP. Pathophysiology of human visceral obesity: an update. Physiol Rev. 2013; 93(1):359-404.
• [17]Pascot A, Lemieux I, Prud'homme D, Tremblay A, Nadeau A, Couillard C, Bergeron J, Lamarche B, Despres JP. Reduced HDL particle size as an additional feature of the atherogenic dyslipidemia of abdominal obesity. J Lipid Res. 2001; 42(12):2007-2014.
• [18]Revelo XS, Luck H, Winer S, Winer DA. Morphological and inflammatory changes in visceral adipose tissue during obesity. Endocr Pathol. 2014; 25(1):93-101.
• [19]Mathieu P, Poirier P, Pibarot P, Lemieux I, Despres JP. Visceral obesity: the link among inflammation, hypertension, and cardiovascular disease. Hypertension. 2009; 53(4):577-584.
• [20]Neels JG, Olefsky JM. Inflamed fat: what starts the fire? J Clin Invest. 2006; 116(1):33-35.
• [21]Harwood HJ. The adipocyte as an endocrine organ in the regulation of metabolic homeostasis. Neuropharmacology. 2012; 63(1):57-75.
• [22]Esser N, Legrand-Poels S, Piette J, Scheen AJ, Paquot N. Inflammation as a link between obesity, metabolic syndrome and type 2 diabetes. Diabetes Res Clin Pract. 2014; 105(2):141-150.
• [23]Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC et al.. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009; 120(16):1640-1645.
• [24]de Divitiis O, Fazio S, Petitto M, Maddalena G, Contaldo F, Mancini M. Obesity and cardiac function. Circulation. 1981; 64(3):477-482.
• [25]Timoh T, Bloom ME, Siegel RR, Wagman G, Lanier GM, Vittorio TJ. A perspective on obesity cardiomyopathy. Obes Res Clin Pract. 2012; 6(3):e175-262.
• [26]Alpert MA. Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci. 2001; 321(4):225-236.
• [27]Kenchaiah S, Evans JC, Levy D, Wilson PW, Benjamin EJ, Larson MG, Kannel WB, Vasan RS. Obesity and the risk of heart failure. N Engl J Med. 2002; 347(5):305-313.
• [28]Piper AJ, Grunstein RR. Big breathing: the complex interaction of obesity, hypoventilation, weight loss, and respiratory function. J Appl Physiol (1985). 2010; 108(1):199-205.
• [29]Reisin E, Frohlich ED. Obesity. Cardiovascular and respiratory pathophysiological alterations. Arch Intern Med. 1981; 141(4):431-434.
• [30]Karason K, Lindroos AK, Stenlof K, Sjostrom L. Relief of cardiorespiratory symptoms and increased physical activity after surgically induced weight loss: results from the Swedish Obese Subjects study. Arch Intern Med. 2000; 160(12):1797-1802.
• [31]Mechanick JI, Youdim A, Jones DB, Timothy Garvey W, Hurley DL, Molly McMahon M, Heinberg LJ, Kushner R, Adams TD, Shikora S et al.. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis. 2013; 9(2):159-191.
• [32]Catheline JM, Bihan H, Le Quang T, Sadoun D, Charniot JC, Onnen I, Fournier JL, Benichou J, Cohen R. Preoperative cardiac and pulmonary assessment in bariatric surgery. Obes Surg. 2008; 18(3):271-277.
• [33]Kaw R, Pasupuleti V, Deshpande A, Hamieh T, Walker E, Minai OA. Pulmonary hypertension: An important predictor of outcomes in patients undergoing non-cardiac surgery. Respir Med. 2011; 105(4):619-624.
• [34]Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005; 294(15):1909-1917.
• [35]Lancaster RT, Hutter MM. Bands and bypasses: 30-day morbidity and mortality of bariatric surgical procedures as assessed by prospective, multi-center, risk-adjusted ACS-NSQIP data. Surg Endosc. 2008; 22(12):2554-2563.
• [36]Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, Sugarbaker DJ, Donaldson MC, Poss R, Ho KK et al.. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999; 100(10):1043-1049.
• [37]Gupta PK, Gupta H, Sundaram A, Kaushik M, Fang X, Miller WJ, Esterbrooks DJ, Hunter CB, Pipinos II, Johanning JM et al.. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation. 2011; 124(4):381-387.
• [38]Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, Davila-Roman VG, Gerhard-Herman MD, Holly TA, Kane GC et al.. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 130(24):e278-333.
• [39]Reilly DF, McNeely MJ, Doerner D, Greenberg DL, Staiger TO, Geist MJ, Vedovatti PA, Coffey JE, Mora MW, Johnson TR et al.. Self-reported exercise tolerance and the risk of serious perioperative complications. Arch Intern Med. 1999; 159(18):2185-2192.
• [40]McCullough PA, Gallagher MJ, Dejong AT, Sandberg KR, Trivax JE, Alexander D, Kasturi G, Jafri SM, Krause KR, Chengelis DL et al.. Cardiorespiratory fitness and short-term complications after bariatric surgery. Chest. 2006; 130(2):517-525.
• [41]Hammill BG, Curtis LH, Bennett-Guerrero E, O'Connor CM, Jollis JG, Schulman KA, Hernandez AF. Impact of heart failure on patients undergoing major noncardiac surgery. Anesthesiology. 2008; 108(4):559-567.
• [42]Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT et al.. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003; 42(6):1206-1252.
• [43]Rosendorff C, Lackland DT, Allison M, Aronow WS, Black HR, Blumenthal RS, Cannon CP, de Lemos JA, Elliott WJ, Findeiss L et al.. Treatment of hypertension in patients with coronary artery disease: a scientific statement from the american heart association, american college of cardiology, and american society of hypertension. Circulation. 2015; 131(19):e435-470.
• [44]Kannel WB, Brand N, Skinner JJ, Dawber TR, McNamara PM. The relation of adiposity to blood pressure and development of hypertension. The Framingham study Ann. Intern Med. 1967; 67(1):48-59.
• [45]Shihab HM, Meoni LA, Chu AY, Wang NY, Ford DE, Liang KY, Gallo JJ, Klag MJ. Body mass index and risk of incident hypertension over the life course: the Johns Hopkins Precursors Study. Circulation. 2012; 126(25):2983-2989.
• [46]Field AE, Coakley EH, Must A, Spadano JL, Laird N, Dietz WH, Rimm E, Colditz GA. Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Arch Intern Med. 2001; 161(13):1581-1586.
• [47]Sharma AM, Pischon T, Engeli S, Scholze J. Choice of drug treatment for obesity-related hypertension: where is the evidence? J Hypertens. 2001; 19(4):667-674.
• [48]Magnani JW, Hylek EM, Apovian CM. Obesity begets atrial fibrillation: a contemporary summary. Circulation. 2013; 128(4):401-405.
• [49]Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah AS, Habib RH. Obesity and risk of new-onset atrial fibrillation after cardiac surgery. Circulation. 2005; 112(21):3247-3255.
• [50]van Diepen S, Bakal JA, McAlister FA, Ezekowitz JA. Mortality and readmission of patients with heart failure, atrial fibrillation, or coronary artery disease undergoing noncardiac surgery: an analysis of 38 047 patients. Circulation. 2011; 124(3):289-296.
• [51]Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, Kellen JC, Greene HL, Mickel MC, Dalquist JE et al.. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002; 347(23):1825-1833.
• [52]January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, Conti JB, Ellinor PT, Ezekowitz MD, Field ME et al.. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014; 64(21):e1-76.
• [53]D'Avila Melo SM, Melo VA, Menezes Filho RS, Santos FA. Effects of progressive increase in body weight on lung function in six groups of body mass index. Rev Assoc Med Bras. 2011; 57(5):509-515.
• [54]Fernandez-Bustamante A, Hashimoto S, Serpa Neto A, Moine P, Vidal Melo MF, Repine JE. Perioperative lung protective ventilation in the era of the obesity epidemic. BMC Anesthesiol. 2015; 15:56.
• [55]Schwab RJ, Pasirstein M, Pierson R, Mackley A, Hachadoorian R, Arens R, Maislin G, Pack AI. Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. Am J Respir Crit Care Med. 2003; 168(5):522-530.
• [56]King GG, Brown NJ, Diba C, Thorpe CW, Munoz P, Marks GB, Toelle B, Ng K, Berend N, Salome CM. The effects of body weight on airway calibre. Eur Respir J. 2005; 25(5):896-901.
• [57]Isono S. Obesity and obstructive sleep apnoea: mechanisms for increased collapsibility of the passive pharyngeal airway. Respirology. 2012; 17(1):32-42.
• [58]Huang J, Pinto SJ, Yuan H, Katz ES, Karamessinis LR, Bradford RM, Gallagher PR, Hannigan JT, Nixon T, Ward MB et al.. Upper airway collapsibility and genioglossus activity in adolescents during sleep. Sleep. 2012; 35(10):1345-1352.
• [59]Bilston LE, Gandevia SC. Biomechanical properties of the human upper airway and their effect on its behavior during breathing and in obstructive sleep apnea. J Appl Physiol (1985). 2014; 116(3):314-324.
• [60]Han F, Chen E, Wei H, He Q, Ding D, Strohl KP. Treatment effects on carbon dioxide retention in patients with obstructive sleep apnea-hypopnea syndrome. Chest. 2001; 119(6):1814-1819.
• [61]Piper AJ, Grunstein RR. Obesity hypoventilation syndrome: mechanisms and management. Am J Respir Crit Care Med. 2011; 183(3):292-298.
• [62]Chau EH, Lam D, Wong J, Mokhlesi B, Chung F. Obesity hypoventilation syndrome: a review of epidemiology, pathophysiology, and perioperative considerations. Anesthesiology. 2012; 117(1):188-205.
• [63]Flum DR, Belle SH, King WC, Wahed AS, Berk P, Chapman W, Pories W, Courcoulas A, McCloskey C, Mitchell J et al.. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009; 361(5):445-454.
• [64]Weingarten TN, Flores AS, McKenzie JA, Nguyen LT, Robinson WB, Kinney TM, Siems BT, Wenzel PJ, Sarr MG, Marienau MS et al.. Obstructive sleep apnoea and perioperative complications in bariatric patients. Br J Anaesth. 2011; 106(1):131-139.
• [65]O'Keeffe T, Patterson EJ. Evidence supporting routine polysomnography before bariatric surgery. Obes Surg. 2004; 14(1):23-26.
• [66]Mokhlesi B, Hovda MD, Vekhter B, Arora VM, Chung F, Meltzer DO. Sleep-disordered breathing and postoperative outcomes after elective surgery: analysis of the nationwide inpatient sample. Chest. 2013; 144(3):903-914.
• [67]Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology. 2014; 120(2):268-286.
• [68]Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008; 108(5):812-821.
• [69]Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991; 14(6):540-545.
• [70]Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999; 131(7):485-491.
• [71]Chung F, Yang Y, Liao P. Predictive performance of the STOP-Bang score for identifying obstructive sleep apnea in obese patients. Obes Surg. 2013; 23(12):2050-2057.
• [72]Ireland CJ, Chapman TM, Mathew SF, Herbison GP, Zacharias M. Continuous positive airway pressure (CPAP) during the postoperative period for prevention of postoperative morbidity and mortality following major abdominal surgery. Cochrane Database Syst Rev. 2014; 8:CD008930.
• [73]Gupta RM, Parvizi J, Hanssen AD, Gay PC. Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case–control study. Mayo Clin Proc. 2001; 76(9):897-905.
• [74]Gottlieb DJ, Punjabi NM, Mehra R, Patel SR, Quan SF, Babineau DC, Tracy RP, Rueschman M, Blumenthal RS, Lewis EF et al.. CPAP versus oxygen in obstructive sleep apnea. N Engl J Med. 2014; 370(24):2276-2285.
• [75]Overweight, Obesity, and Incident Asthma. Am J Resp Crit Care. 2007; 175(7):661-666.
• [76]Anne E, Dixon FH, Sood A, Salome CM, Pratley RE, Beuther DA, Celedo’n JC, Shore SA. An Official American Thoracic Society Workshop Report: Obesity and Asthma. Proc Am Thorac Soc. 2010; 7:325-335.
• [77]Ramakrishna G, Sprung J, Ravi BS, Chandrasekaran K, McGoon MD. Impact of pulmonary hypertension on the outcomes of noncardiac surgery: predictors of perioperative morbidity and mortality. J Am Coll Cardiol. 2005; 45(10):1691-1699.
• [78]McLaughlin VV, Archer SL, Badesch DB, Barst RJ, Farber HW, Lindner JR, et al. ACCF/AHA 2009 expert consensus document on pulmonary hypertension: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: developed in collaboration with the American College of Chest Physicians, American Thoracic Society, Inc., and the Pulmonary Hypertension Association. Circulation. 2009, 119(16):2250–2294
• [79]Minai OA, Yared JP, Kaw R, Subramaniam K, Hill NS. Perioperative risk and management in patients with pulmonary hypertension. Chest. 2013; 144(1):329-340.
• [80]Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, Marks JS. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003; 289(1):76-79.
• [81]Perna M, Romagnuolo J, Morgan K, Byrne TK, Baker M. Preoperative hemoglobin A1c and postoperative glucose control in outcomes after gastric bypass for obesity. Surg Obes Relat Dis. 2012; 8(6):685-690.
• [82]Dietrich P, Hellerbrand C. Non-alcoholic fatty liver disease, obesity and the metabolic syndrome. Best Pract Res Clin Gastroenterol. 2014; 28(4):637-653.
• [83]Calori G, Lattuada G, Ragogna F, Garancini MP, Crosignani P, Villa M, Bosi E, Ruotolo G, Piemonti L, Perseghin G. Fatty liver index and mortality: the Cremona study in the 15th year of follow-up. Hepatology. 2011; 54(1):145-152.
• [84]Pais R, Charlotte F, Fedchuk L, Bedossa P, Lebray P, Poynard T, Ratziu V, Group LS. A systematic review of follow-up biopsies reveals disease progression in patients with non-alcoholic fatty liver. J Hepatol. 2013; 59(3):550-556.
• [85]Lazo M, Clark JM. The epidemiology of nonalcoholic fatty liver disease: a global perspective. Semin Liver Dis. 2008; 28(4):339-350.
• [86]Machado M, Marques-Vidal P, Cortez-Pinto H. Hepatic histology in obese patients undergoing bariatric surgery. J Hepatol. 2006; 45(4):600-606.
• [87]Ratziu V, Bellentani S, Cortez-Pinto H, Day C, Marchesini G. A position statement on NAFLD/NASH based on the EASL 2009 special conference. J Hepatol. 2010; 53(2):372-384.
• [88]Kroh M, Liu R, Chand B. Laparoscopic bariatric surgery: what else are we uncovering? Liver pathology and preoperative indicators of advanced liver disease in morbidly obese patients. Surg Endosc. 2007; 21(11):1957-1960.
• [89]Kashyap SR, Diab DL, Baker AR, Yerian L, Bajaj H, Gray-McGuire C, Schauer PR, Gupta M, Feldstein AE, Hazen SL et al.. Triglyceride levels and not adipokine concentrations are closely related to severity of nonalcoholic fatty liver disease in an obesity surgery cohort. Obesity. 2009; 17(9):1696-1701.
• [90]Hernaez R, Lazo M, Bonekamp S, Kamel I, Brancati FL, Guallar E, Clark JM. Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis. Hepatology. 2011; 54(3):1082-1090.
• [91]Sanyal AJ, Brunt EM, Kleiner DE, Kowdley KV, Chalasani N, Lavine JE, Ratziu V, McCullough A. Endpoints and clinical trial design for nonalcoholic steatohepatitis. Hepatology. 2011; 54(1):344-353.
• [92]Ekstedt M, Hagstrom H, Nasr P, Fredrikson M, Stal P, Kechagias S, Hultcrantz R. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015; 61(5):1547-1554.
• [93]Brea A, Puzo J. Non-alcoholic fatty liver disease and cardiovascular risk. Int J Cardiol. 2013; 167(4):1109-1117.
• [94]Merrell MD, Cherrington NJ. Drug metabolism alterations in nonalcoholic fatty liver disease. Drug Metab Rev. 2011; 43(3):317-334.
• [95]El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014; 63(6):871-880.
• [96]Maltby JR, Pytka S, Watson NC, Cowan RA, Fick GH. Drinking 300 mL of clear fluid two hours before surgery has no effect on gastric fluid volume and pH in fasting and non-fasting obese patients. Can J Anaesth. 2004; 51(2):111-115.
• [97]Glasbrenner B, Pieramico O, Brecht-Krauss D, Baur M, Malfertheiner P. Gastric emptying of solids and liquids in obesity. Clin Investig. 1993; 71(7):542-546.
• [98]Pandeya N, Green AC, Whiteman DC, Australian Cancer S. Prevalence and determinants of frequent gastroesophageal reflux symptoms in the Australian community. Dis Esophagus. 2012; 25(7):573-583.
• [99]Akiyama T, Yoneda M, Maeda S, Nakajima A, Koyama S, Inamori M. Visceral obesity and the risk of Barrett’s esophagus. Digestion. 2011; 83(3):142-145.
• [100]Lagergren J, Bergstrom R, Lindgren A, Nyren O. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med. 1999; 340(11):825-831.
• [101]Rasmussen JJ, Fuller W, Ali MR. Marginal ulceration after laparoscopic gastric bypass: an analysis of predisposing factors in 260 patients. Surg Endosc. 2007; 21(7):1090-1094.
• [102]Verma S, Sharma D, Kanwar P, Sohn W, Mohanty SR, Tortolani AJ, Gorecki P. Prevalence of Helicobacter pylori infection in bariatric patients: a histologic assessment. Surg Obes Relat Dis. 2013; 9(5):679-685.
• [103]Ramaswamy A, Lin E, Ramshaw BJ, Smith CD. Early effects of Helicobacter pylori infection in patients undergoing bariatric surgery. Arch Surg (Chicago, Ill : 1960). 2004; 139(10):1094-1096.
• [104]Han MS, Jung DY, Morel C, Lakhani SA, Kim JK, Flavell RA, Davis RJ. JNK expression by macrophages promotes obesity-induced insulin resistance and inflammation. Science. 2013; 339(6116):218-222.
• [105]Singh A, Foster GD, Gunawardana J, McCoy TA, Nguyen T, Vander Veur S, Komaroff E, Rao AK. Elevated circulating tissue factor procoagulant activity, factor VII, and plasminogen activator inhibitor-1 in childhood obesity: evidence of a procoagulant state. Br J Haematol. 2012; 158(4):523-527.
• [106]Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, Samama CM. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl):e227S-277S.
• [107]Raftopoulos I, Martindale C, Cronin A, Steinberg J. The effect of extended post-discharge chemical thromboprophylaxis on venous thromboembolism rates after bariatric surgery: a prospective comparison trial. Surg Endosc. 2008; 22(11):2384-2391.
• [108]Keeling WB, Haines K, Stone PA, Armstrong PA, Murr MM, Shames ML. Current indications for preoperative inferior vena cava filter insertion in patients undergoing surgery for morbid obesity. Obes Surg. 2005; 15(7):1009-1012.
• [109]Birkmeyer NJ, Share D, Baser O, Carlin AM, Finks JF, Pesta CM, Genaw JA, Birkmeyer JD. Preoperative placement of inferior vena cava filters and outcomes after gastric bypass surgery. Ann Surg. 2010; 252(2):313-318.
• [110]Garcia DA, Baglin TP, Weitz JI, Samama MM. Parenteral anticoagulants: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl):e24S-43S.
• [111]Garcia OP, Long KZ, Rosado JL. Impact of micronutrient deficiencies on obesity. Nutr Rev. 2009; 67(10):559-572.
• [112]Lefebvre P, Letois F, Sultan A, Nocca D, Mura T, Galtier F. Nutrient deficiencies in patients with obesity considering bariatric surgery: a cross-sectional study. Surg Obes Relat Dis. 2014; 10(3):540-546.
• [113]Pereira-Santos M, Costa PR, Assis AM, Santos CA, Santos DB. Obesity and vitamin D deficiency: a systematic review and meta-analysis. Obes Rev. 2015; 16:341-9.
• [114]Simon GEVKM, Saunders K, Miglioretti DL, Crane PK, van Belle G, Kessler RC. Association Between Obesity and Psychiatric Disorders in the US Adult Population. Arch Gen Psychiatry. 2006; 63(7):824-839.
• [115]Petry NMBD, Pietrzak RH, Wagner JA. Overweight and obesity are associated with psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychosom Med. 2008; 70(3):288-297.
• [116]Taylor VHMR, Remington G, Levitan RD, Stonehocker B, Sharma AW. Beyond Pharmacotherapy: Understanding the Links Between Obesity and Chronic Mental Illness. Can J Psychiarry. 2012; 57(1):15-12.
• [117]Andreyeva TPR, Brownell KD. Changes in Perceived Weight Discrimination Among Americans, 1995–1996 Through 2004–2006. Obesity (Silver Spring). 2008; 16(5):1129-1134.
• [118]Lemanu DP, Srinivasa S, Singh PP, Johannsen S, MacCormick AD, Hill AG. Optimizing perioperative care in bariatric surgery patients. Obes Surg. 2012; 22(6):979-990.
• [119]Naimark A, Cherniack RM. Compliance of the respiratory system and its components in health and obesity. J Appl Physiol. 1960; 15:377-382.
• [120]Jones RL, Nzekwu MM. The effects of body mass index on lung volumes. Chest. 2006; 130(3):827-833.
• [121]Watson RA, Pride NB. Postural changes in lung volumes and respiratory resistance in subjects with obesity. J Appl Physiol (1985). 2005; 98(2):512-517.
• [122]Steier J, Lunt A, Hart N, Polkey MI, Moxham J. Observational study of the effect of obesity on lung volumes. Thorax. 2014; 69(8):752-759.
• [123]Littleton SW. Impact of obesity on respiratory function. Respirology. 2012; 17(1):43-49.
• [124]Lazarus R, Sparrow D, Weiss ST. Effects of obesity and fat distribution on ventilatory function: the normative aging study. Chest. 1997; 111(4):891-898.