Background and Objective A highly nuanced relationship exists between obesity and lung cancer. The association between obesity and lung cancer risk/prognosis varies depending on age, gender, race, and the metric used to quantify adiposity. Increased body mass index (BMI) is counterintuitively associated with decreased lung cancer incidence and mortality, giving rise to the term ‘obesity paradox’. Potential explanations for this paradox are BMI being a poor measure of obesity, confounding by smoking and reverse causation. A literature search of this topic yields conflicting conclusions from various authors. We aim to clarify the relationship between various measures of obesity, lung cancer risk, and lung cancer prognosis. Methods The PubMed database was searched on 10 August 2022 to identify published research studies. Literature published in English between 2018 and 2022 were included. Sixty-nine publications were considered relevant, and their full text studied to collate information for this review. Key Content and Findings Lower lung cancer incidence and better prognosis was associated with increased BMI even after accounting for smoking and pre-clinical weight loss. Individuals with high BMI also responded better to treatment modalities such as immunotherapy compared to individuals with a normal BMI. However, these associations varied highly depending on age, gender, and race. Inability of BMI to measure body habitus is the main driver behind this variability. The use of anthropometric indicators and image-based techniques to quantify central obesity easily and accurately is on the rise. Increase in central adiposity is associated with increased incidence and poorer prognosis of lung cancer, contrasting BMI. Conclusions The obesity paradox may arise due to the improper use of BMI as a measure of body composition. Measures of central obesity better portray the deleterious effects of obesity and are more appropriate to be discussed when talking about lung cancer. The use of obesity metrics based on anthropometric measurements and imaging modalities has been shown to be feasible and practical. However, a lack of standardization makes it difficult to interpret the results of studies using these metrics. Further research must be done to understand the association between these obesity metrics and lung cancer.

/pdf/obesity-and-lung-cancer-a-narrative-review-1gzr0btf.pdf

Obesity and lung cancer—a narrative review

Background Many clinical trials have looked at the relationship between obesity and lung cancer (LC), however, there is scarcity of literature specifically addressing the association between metabolically healthy obesity and metastasis in LC patients. To address this gap in the body of evidence, the study was conducted to observe the association between metabolically healthy obesity and metastasis in LC patients. Methods We conducted a pre-registered systematic review by searching six major online databases to identify studies relevant related to our investigation, in adherence with the PRISMA guidelines. A proper data extraction protocol was further established to synthesize the findings from the selected papers through a meta-analysis. Results Eleven (11) studies met the requisite selection criterion and were included in the study. A random-effect model was used. Obesity was found to have a significant impact on readmission in LC patients. The combined analysis showed a significant effect size of 0.08 (95% CI 0.07 to 0.08), indicating a noticeable impact of obesity. It was also assessed that obese individuals had a 34% reduced risk of LC compared to normal weight individuals. Obesity was associated with a lower risk of surgical complications with a pooled risk ratio of 0.13 (95% CI 0.12 to 0.14). A statistically significant decreased risk of LC (pooled RR = 0.72, 95% CI: 0.68 to 0.77) was also observed in the obese individuals. Conclusion The analysis reveals that obesity is associated with a noticeable increase in readmissions, although the impact on LC risk itself is negligible. Moreover, obesity appears to have a beneficial effect by reducing the risk of surgical complications. These results highlight the complex relationship between the two aforementioned factors, emphasizing the importance of considering obesity as a significant factor in patient management and healthcare decision-making. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42023427612.

Association between metabolically healthy obesity and metastasis in lung cancer patients – a systematic review and meta-analysis

Background Metabolic disorders and overweight or obesity are highly prevalent and intricately linked in patients with chronic heart failure (CHF). However, it remains unclear whether there is an interactive effect between these conditions and the prognosis of heart failure, and whether such an interaction is influenced by stratification based on age and sex. Methods A total of 4,955 patients with CHF were enrolled in this study. Metabolic status was assessed according to the presence or absence of metabolic syndrome (MetS). BMI categories included normal weight and overweight or obesity (BMI &amp;lt; 24, ≥ 24 kg/m 2 ). Patients were divided into four phenotypes according to their metabolic status and BMI: metabolically healthy with normal weight (MHNW), metabolically unhealthy with normal weight (MUNW), metabolically healthy with overweight or obesity (MHO), and metabolically unhealthy with overweight or obesity (MUO). The incidence of primary outcomes, including all-cause and cardiovascular (CV) death, was recorded. Results During a mean follow-up of 3.14 years, a total of 1,388 (28.0%) all-cause deaths and 815 (16.4%) CV deaths were documented. Compared to patients with the MHNW phenotype, those with the MUNW (adjusted hazard ratio [aHR], 1.66; 95% confidence interval [CI], 1.38–2.00) or MUO (aHR, 1.42 [95% CI, 1.24–1.63]) phenotypes had a greater risk of all-cause death, and those with the MHO phenotype (aHR, 0.61 [95% CI, 0.51–0.72]) had a lower risk of all-cause death. Moreover, the above phenomenon existed mainly among males and elderly females (aged ≥ 60 years). In nonelderly females (aged &amp;lt; 60 years), the detrimental effects of MetS were lower (aHR, 1.05 [95% CI, 0.63–1.75] among MUNW group and aHR, 0.52 [95% CI, 0.34–0.80] among MUO group), whereas the protective effects of having overweight or obesity persisted irrespective of metabolic status (aHR, 0.43 [95% CI, 0.26–0.69] among MHO group and aHR, 0.52 [95% CI, 0.34–0.80] among MUO group). Similar results were obtained in the Cox proportional risk analysis of the metabolic overweight/obesity phenotypes and CV death. Conclusions In male and elderly female patients with CHF, the detrimental effects of MetS outweighed the protective benefits of having overweight or obesity. Conversely, in nonelderly females, the protective effects of having overweight or obesity were significantly greater than the adverse impacts of MetS. 

Associations between metabolic overweight/obesity phenotypes and mortality risk among patients with chronic heart failure

Background: Post gastric sleeve surgery, the changes in gastrointestinal physiology result in altered absorption and nutrient deficiencies. These patients need specialized nursing guidance to prevent unnecessary gastrointestinal symptoms. Aim: The study aims to examine the effect of hybrid nursing guidance on eating patterns and perception among patients post gastric sleeve. Design: quasi experimental (per-posttest) research design. Sample: A convenient sample of Eighty adult male and female patients. The sample was divided into two groups (study group 50 patients) and (control group 30 patients) undergoing gastric sleeve surgery Setting: Department of plastic surgery, gastric sleeve surgery unit and obesity outpatient clinic at Assiut university hospital. Tools: The data were collected by using three tools: (1) An interview questionnaire sheet (2) three-factor eating questionnaire and (3) Body image perception questionnaire. Results: there was a statistically significant difference in knowledge scores between study and control groups between the pre and posttest after 6 th months from the application of the hybrid nursing guidance, as well as patients' eating practice pattern wear enhanced significantly post application of the hybrid nursing guidance, also patients complications post gastric sleeve were improved, finally patient‘ perception was significantly higher comparing to pre application values with (p = 0.001) . Conclusion: This study showed that implementation of hybrid nursing guidance contributed positively with the changes of the patients post gastric sleeve surgery regarding eating practice pattern, prevent unnecessary gastrointestinal complications, and higher perception comparing to pre application of the hybrid nursing discharge guidance. Recommendation: Nurses should apply these guidelines as hospital routine care in the study place, as it will help patients adapt to their situation and increase their wellbeing as the initial aim.

https://doi.org/10.21608/asnj.2023.206283.1572

Effect of Hybrid Nursing Guidance on Eating Patterns and Perception among Patients Post Gastric Sleeve

Associations of accelerated biological aging and metabolic heterogeneity of obesity with rheumatoid arthritis: a prospective cohort study

Association between metabolic overweight/obesity phenotypes and readmission risk in patients with lung cancer: A retrospective cohort study

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Association between metabolic overweight/obesity phenotypes and readmission risk in patients with lung cancer: A retrospective cohort study