Revisiones_bibliográficas TyO_Web: Obesidad / Obesity

lunes, 2 de octubre de 2017

Obesidad / Obesity

Octubre 2, 2017. No. 2829

El papel del aumento del índice de masa corporal en la evolución de la sepsis. Una revisión sistemática y meta-análisis.

The role of increased body mass index in outcomes of sepsis: a systematic review and meta-analysis.

Wang S1,2, Liu X3, Chen Q4, Liu C1, Huang C5, Fang X6.

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BMC Anesthesiol. 2017 Aug 31;17(1):118. doi: 10.1186/s12871-017-0405-4.

Abstract

BACKGROUND: The role of increased body mass index (BMI) in sepsis is controversial. We aimed to evaluate the associations between overweight (25 kg/m2 < BMI ≤ 29.9 kg/m2), obese (30 kg/m2 < BMI ≤ 39.9 kg/m2) and morbidly obese (BMI > 40 kg/m2) BMIs and outcomes in septic patients. METHODS: We searched the PubMed, Embase, Web of Science, Cochrane Library and ClinicalTrials.gov databases for studies published by December 1, 2016. Electronic database searches yielded 3713 articles, eight of which were included in this meta-analysis. Data were independently extracted by two reviewers, and a third reviewer participated in making decisions as needed. We used Review Manager to conduct the analysis, and the outcomes were reported with odds ratios (ORs) or mean differences (MDs). The primary outcome was mortality, and the secondary outcome was length of stay (LOS) in the intensive care unit (ICU) or the hospital. RESULTS: Data from eight studies involving a total of 9696 patients were pooled in our final analysis. Compared with patients with normal BMI (18.5 kg/m2 < BMI ≤ 24.9 kg/m2), patients with BMI ≥ 25 kg/m2 exhibited decreased mortality (OR 0.81; 95% confidence interval (CI), 0.74-0.89, P < 0.0001). In subgroup analysis, compared with normal-weight patients, overweight patients had lower mortality (OR 0.87; 95% CI 0.77-0.97, P = 0.02), whereas obese (OR 0.89, 95% CI 0.72-1.10, P = 0.29) and morbidly obese (OR 0.64, 95% CI 0.38-1.08, P = 0.09) patients did not exhibit significantly reduced mortality. CONCLUSIONS: In sepsis cases, overweight, but not obesity or morbid obesity, was associated with lower mortality. Further prospective studies are needed to clarify this relationship.

KEYWORDS: Body mass index; Length of stay; Mortality; Obesity; Sepsis

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Aumento del índice de masa corporal y la mortalidad ajustada en pacientes en UCI con sepsis o choque séptico: una revisión sistemática y meta-análisis.

Increased body mass index and adjusted mortality in ICU patients with sepsis or septic shock: a systematic review and meta-analysis.

Pepper DJ1, Sun J2, Welsh J3, Cui X2, Suffredini AF2, Eichacker PQ2.

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Crit Care. 2016 Jun 15;20(1):181. doi: 10.1186/s13054-016-1360-z.

Abstract

BACKGROUND: At least 25 % of adults admitted to intensive care units (ICU) in the United States have an overweight, obese or morbidly obese body mass index (BMI). The effect of BMI on adjusted mortality in adults requiring ICU treatment for sepsis is unclear. We performed a systematic review of adjusted all-cause mortality for underweight, overweight, obese and morbidly obese BMIs relative to normal BMI for adults admitted to the ICU with sepsis, severe sepsis, and septic shock.

CONCLUSIONS: This is the first meta-analysis to show that overweight or obese BMIs reduce adjusted mortality in adults admitted to the ICU with sepsis, severe sepsis, or septic shock. More rigorous studies that address these limitations are needed to clarify the impact of BMI on sepsis ICU outcomes.

KEYWORDS: Body mass index; Meta-analysis; Mortality; Obesity; Overweight; Sepsis

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Obesidad simple y función renal.

Simple obesity and renal function.

Sikorska D1,2, Grzymislawska M3, Roszak M4,5, Gulbicka P6, Korybalska K4, Witowski J4.

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J Physiol Pharmacol. 2017 Apr;68(2):175-180.

Abstract

Increasing evidence accumulate to suggest that obesity increases the risk of chronic kidney disease independently of dyslipidemia, diabetes, and hypertension. This so-called obesity-related glomerulopathy is characterized at early stages by glomerular hypertrophy with or without secondary focal segmental glomerulosclerosis. Since, however, kidney biopsies are usually not performed at this phase, an early diagnosis of the disease is often difficult. Here, we review new developments in the pathophysiology of obesity-associated kidney dysfunction and discuss the potential of appropriate monitoring of glomerular filtration rate and albuminuria for early detection of the disease. We also present the benefits conferred by even moderate dietary restriction on the course of the disease.

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