Biomedical subjects

L Sjöström

Publications and source records attributed to L Sjöström.

At least 19 recordsLinked to original sources

PubMed2006

Determination of sentinel lymph node (SLN) status in primary breast cancer by prospective use of immunohistochemistry increases the rate of micrometastases and isolated tumour cells: analysis of 174 patients after SLN biopsy.

AIM: The objective of the present study was to evaluate the prospective use of immunohistochemistry (IHC) for histopathological diagnosis of sentinel lymph node(s) (SLN) in primary breast cancer using stage migration and non-SLN metastases as endpoints in relation to metastatic involvement. METHOD: Serial sectioning and prospective use of IHC were applied to SLN examination in addition to routine haematoxylin-eosin staining in 174 consecutive patients with unifocal T1-T2 breast cancer included in a National Sentinel Node Study. Axillary lymph node dissection (ALND) was performed in all cases with macrometastases, micrometastases and isolated tumour cells (ITC). RESULTS: The SLN was found in 173/174 patients and a metastatic foci was found in 50 patients including 28/50 with macrometastases, 16/50 with micrometastases and 6/50 with ITC. IHC detected 3/16 of the micrometastases and 4/6 of ITC. Stage migration from N0 to N1mi was encountered in 3/132 patients by use of IHC. Non-SLN metastases were noted in 15/28 of patients with macrometastases and in 3/16 of patients with micrometastases, whereas no patient with ITC had additional metastases (p=0.007). CONCLUSION: The prospective use of IHC and serial sectioning for histopathological diagnosis of SLNs increased the detection rate of N1mi and ITC, but only 3/132 patients were stage-migrated by use of IHC. Patients with ITC did not have any risk of non-SLN metastases, supporting that ALND can safely be omitted in this group of patients.

Adult↗

PubMed2006

Villonodular synovitis in the dog: a report of four cases.

Four cases of villonodular synovitis were diagnosed by histopathology. All four dogs were treated medically with either carprophen or a combination of carprophen and glucosamine complex (Cosequin). In three of the dogs the condition improved significantly, and these dogs returned to normal workload.

Animals↗

PubMed2005

Snacking frequency in relation to energy intake and food choices in obese men and women compared to a reference population.

OBJECTIVE: To investigate snacking frequency in relation to energy intake and food choices, taking physical activity into account, in obese vs reference men and women. DESIGN: Cross-sectional, descriptive study. SUBJECTS: In total, 4259 obese, middle-aged subjects (1891 men and 2368 women) from the baseline examination of the XENDOS study and 1092 subjects (505 men and 587 women) from the SOS reference study were included. MEASUREMENTS: A meal pattern questionnaire describing habitual intake occasions (main meals, light meals/breakfast, snacks, drink-only), a dietary questionnaire describing habitual energy and macronutrient intake and a questionnaire assessing physical activity at work and during leisure time were used. RESULTS: The obese group consumed snacks more frequently compared to the reference group (P<0.001) and women more frequently than men (P<0.001). Energy intake increased with increasing snacking frequency, irrespective of physical activity. Statistically significant differences in trends were found for cakes/cookies, candies/chocolate and desserts for the relation between energy intake and snacking frequency, where energy intake increased more by snacking frequency in obese subjects than in reference subjects. CONCLUSION: Obese subjects were more frequent snackers than reference subjects and women were more frequent snackers than men. Snacks were positively related to energy intake, irrespective of physical activity. Sweet, fatty food groups were associated with snacking and contributed considerably to energy intake. Snacking needs to be considered in obesity treatment, prevention and general dietary recommendations.

Adult↗

PubMed2004

Body composition in the SOS (Swedish Obese Subjects) reference study.

OBJECTIVE: The primary objective was to establish population-based, sex- and age-specific reference data with respect to body composition variables. Secondary objectives were to relate body mass index (BMI) to anthropometric measurements reflecting central adiposity and to body fat (BF). Another objective was to examine if secular changes in adipose tissue distribution occurred during the sampling period, 1994-1999. DESIGN: Sex- and age-specific data on anthropometric measurements and body composition were cross-sectionally collected in the reference study of Swedish Obese Subjects. SUBJECTS: In total, 1135 randomly selected subjects (524 men and 611 women), aged 37-61 y, BMI 17.6-45.4 kg/m(2). MEASUREMENTS: Measures of body fatness and fat distribution (by dual energy X-ray absorptiometry and anthropometry) were collected. RESULTS: At BMI 25 kg/m(2), relative (absolute) BF mass was 24% (19 kg) in men vs 36% (25 kg) in women, waist circumference was 90 vs 85 cm, and sagittal trunk diameter was 21 vs 19 cm. BF and measures of centralized adipose tissue distribution increased with age in both sexes (P<0.01). In women, waist circumference and sagittal diameter increased (P<0.01) over the sampling period while BMI did not. CONCLUSIONS: Sex- and age-specific reference data on body composition are reported from a randomly selected sample of Swedish men and women. At given BMIs, women had more BF but smaller waist circumference than men. Secular increases in indices of central obesity were found in women but not in men.

Absorptiometry, Photon↗

PubMed2003

Predictive value of early weight loss in obesity management with orlistat: an evidence-based assessment of prescribing guidelines.

OBJECTIVE: To assess the clinical usefulness of published guidelines for the use of orlistat, by studying whether weight loss >/=2.5 kg during a 4 week dietary lead-in period, and weight losses of >/=5% after 12 weeks and >/=10% after 6 months of drug therapy predict weight loss and risk factor changes after 2 years. DESIGN: A retrospective analysis of pooled data from 2 multicentre, randomised, placebo-controlled clinical trials with similar design. SETTING: Twenty-nine centres throughout Europe. PARTICIPANTS: Two hundred and twenty men and women (BMI 28-43 kg/m(2)) who completed 2 years of treatment. INTERVENTION: After a 4 week hypocaloric diet plus placebo, 2 years of treatment with orlistat 120 mg tid, plus a hypocaloric diet for the first year and a weight maintenance diet in year two. MAIN OUTCOME MEASURES: Weight loss and obesity-related risk factor changes. RESULTS: Weight loss >/=5% body weight after 12 weeks of diet plus orlistat therapy was a good indicator of 2 year weight loss, whereas weight loss of >/=2.5 kg during the 4 week lead-in and >/=10% after 6 months did not add significantly to the prediction of 2 year outcomes. Patients who lost >/=5% of their weight at 12 weeks (n=104, 47.3%) lost significantly more weight after 2 years than others: -11.9% (95% confidence interval (CI) -13.4% to -10.3%) vs -4.7% (-5.7% to -3.7%) (P=0.0001), and had significantly greater reductions in total cholesterol, LDL-cholesterol, triglycerides, glucose, insulin, and blood pressure. Among those who achieved >/=5% weight loss at 12 weeks, the overall health benefits were not significantly greater in patients who went on to lose >/=10% body weight at 6 months compared with those who did not achieve >/=10% weight loss by month 6. CONCLUSIONS: Of the criteria currently suggested for assessing response to orlistat treatment, weight loss of >/=5% at 12 weeks accurately predicts sustained improvements in weight and major risk factors at 2 years, while other suggested criteria are less useful.

Adult↗

PubMed2003

Psychosocial functioning in the obese before and after weight reduction: construct validity and responsiveness of the Obesity-related Problems scale.

OBJECTIVE: The Obesity-related Problems scale (OP) is a self-assessment module developed to measure the impacts of obesity on psychosocial functioning. Our principal aim was to evaluate the construct validity and responsiveness of the OP scale. Our specific aims were to test: (1). the psychometric performance of OP; (2). if OP scores differed by gender and weight category; (3). if OP scores are inversely related to mental well-being; (4). if weight reduction in the obese is accompanied by improvements in psychosocial functioning (OP). SUBJECTS: Four samples were used: 6863 subjects in the SOS cross-sectional study; 2128 in the SOS intervention study; 1017 nonobese in the SOS reference study; and 3305 obese subjects in the XENDOS study. MEASUREMENTS: Psychosocial functioning was measured by OP. Overall mood was measured by MACL. Anxiety and depression symptoms were measured by HAD. RESULTS: Psychometric testing provided strong support for the construct validity of OP. Factor analysis confirmed the homogeneity of the construct and multitrait/multi-item scaling analysis demonstrated strong item-convergent/discriminant validity. Reliability coefficients were high and floor and ceiling effects were small. Psychometric results were cross-validated and replicated in subgroups by gender, age and body mass index (BMI). As expected, large differences in OP were observed between obese and nonobese (P<0.0001). Obese women reported more weight-related psychosocial problems than obese men (P<0.0001). Psychosocial disturbances (OP) among the obese were significantly related to poor mood (MACL; P<0.0001) and anxiety and depression symptoms (HAD; P<0.0001). Change in OP over time was strongly correlated with weight loss (P<0.0001). A distinct dose-response effect between weight reduction and improvements in OP was demonstrated. Scores on psychosocial functioning (OP) and mental well-being (MACL, HAD) in nonobese (BMI<30) surgical patients at 4-y follow-up were equal to scores observed in nonobese reference subjects (NS). CONCLUSION: OP is a psychometrically valid obesity-specific measure suitable for evaluating HRQL effects of obesity interventions. The negative impact of obesity on psychosocial functioning is considerable and disturbances are connected with poor mental well-being. Weight reduction in the obese is followed by improvements in both psychosocial functioning and mental well-being.

Affect↗

PubMed2003

Evaluation of two carrier protein-angiotensin I conjugate vaccines to assess their future potential to control high blood pressure (hypertension) in man.

AIMS: We aim to modulate the renin-angiotensin system (RAS) by active immunization against angiotensin I hormone (AI), potentially providing a novel conjugate vaccine treatment for hypertension in man. METHODS: Immunization studies in rat and human subjects compare the effectiveness of tetanus toxoid (TT) and keyhole limpet haemocyanin (KLH) vaccines for immunotherapy following conjugation with an AI peptide analogue (AI). Cardiovascular responses were assessed in immunized rats and human subjects (two-dose trial only), following increasing i.v. infusions of either AI or angiotensin II hormone (AII). RESULTS: The AI-TT and AI-KLH conjugate vaccines induced an equivalent immune response, and inhibition of the pressor effects to exogenous AI in rats. Single-dose clinical trials with both conjugate vaccines only resulted in an immune response to the KLH carrier protein. A two-dose clinical trial of AI-KLH conjugate vaccine resulted in a significant immune response to AI. A shift in diastolic blood pressure (DBP) dose-response was demonstrated following challenge with AI and AII for the study volunteer showing the largest anti-AI IgG induction. CONCLUSION: KLH was shown to be a suitable alternative to TT as a carrier protein for AI, thus supporting continued evaluation of our AI-KLH conjugate vaccine for treatment of hypertension in man.

Adolescent↗

PubMed2003

Primary secretory otitis media in the Cavalier King Charles spaniel: a review of 61 cases.

Sixty-one episodes of primary secretory otitis media (PSOM) were diagnosed in 43 Cavalier King Charles spaniels over a 10-year period. The principal findings were signs of moderate to severe pain localised to the head or cervical area, and/or neurological signs. Diagnosis was made by examination of the tympanic membrane and middle ear with the aid of an operating microscope under general anaesthesia. A bulging, but intact, tympanic membrane was found in most cases. Following myringotomy, a highly viscous mucus plug was found filling the middle ear. Treatment, consisting of removal of the mucus plug, flushing of the middle ear, and local and systemic medical therapy, had to be repeated between one and five times. The prognosis was good in all cases. PSOM is an important differential diagnosis in Cavalier King Charles spaniels with signs of pain involving the head and neck, and/or neurological signs.

Animals↗

PubMed2002

Meal patterns and obesity in Swedish women-a simple instrument describing usual meal types, frequency and temporal distribution.

OBJECTIVE: To characterize meal patterns in relation to obesity in Swedish women using a simple instrument describing meal frequency, meal types and temporal distribution. DESIGN: Cross-sectional parallel group design. SUBJECTS: Eighty-three obese women from the Swedish Obese Subjects (SOS) study were compared with 94 reference women, randomly recruited from the population. METHOD: A new, simplified and self-instructing questionnaire was used to assess meal patterns. Usual meal pattern was reported as time and meal type for each intake episode during a typical day. RESULTS: The obese women consumed 6.1 meals/day compared with 5.2 meals/day among the reference women (P<0.0001). All types of meals except 'drink meals' were significantly more frequently consumed in the obese group. The obese women also displayed a different meal pattern across the day, consuming a larger number of meals later in the day. As a result a larger fraction of each obese woman's total meals were consumed in the afternoon and in the evening/night. There was no difference in the number of obese vs reference women consuming breakfast. Snack meals were positively associated with total energy intake in both groups. CONCLUSIONS: A new simplified method assessing meal pattern revealed that the number of reported intake occasions across a usual day was higher in obese women compared with controls and the timing was shifted to later in the day. These findings should be considered in the treatment of obesity.

Adult↗

PubMed2002

Long-term effects of weight loss on pharmaceutical costs in obese subjects. A report from the SOS intervention study.

BACKGROUND: Although intentional weight reduction improves obesity-related comorbidities, the associations between weight reduction, medication and related costs are rarely studied. This study investigates the long-term effects of weight change on medication for diabetes and cardiovascular disease (CVD) in severely obese subjects. METHODS: In the intervention study Swedish Obese Subjects, 510 surgically and 455 conventionally treated obese patients have so far been followed for 6 y. Changes in the use and costs of medication were analyzed in relation to treatment and weight change. RESULTS: In comparison with controls, larger fraction of surgically treated patients discontinued the use of medication for CVD and diabetes at 2 and 6 y (risk ratios 0.56-0.77). Among subjects not initially on medication, surgery reduced the frequency of started treatments (risk ratios 0.08-0.80). Relative weight loss >or=10% was necessary to reduce costs of medication for CVD and diabetes among subjects with such treatment at baseline. To reduce initiation of new treatment against the two conditions, weight loss >or=15% was required. Over 6 y, the average annual cost for diabetes and CVD medication increased by 463 SEK (96%) in subjects with weight loss <5%, and decreased by 39 SEK(8%) in the weight loss group >or=15%. CONCLUSION: Long-term intentional weight loss is associated with reduced medication and medication costs for diabetes and CVD. The effects appear to be more marked among subjects who are initially on medication for these conditions, whereas greater weight reduction is needed to prevent new subjects from starting on medication.

Adult↗

PubMed2002

Whole-body mineral measurements in Swedish adolescents at 17 years compared to 15 years of age.

AIM: To provide reference data for bone mineral variables in 15- and 17-y-old adolescents and to analyse the relationships between these variables and measures of bone and body size, gender, puberty, growth, various lifestyle and environmental factors and socioeconomic background. METHODS: In the same 321 randomly selected adolescents (147 boys and 174 girls) living in two different regions of Sweden, the total bone mineral content (TBMC), bone area (BA) and total bone mineral density (TBMD) were assessed by dual-energy X-ray absorptiometry at ages 15 and 17 y. The effects of bone and body size, gender, growth, sexual maturity, physical activity, region of domicile, social conditions, food habits, smoking and alcohol intake on TBMC and TBMD were examined in multivariate analyses. RESULTS: In the 15-y-old adolescents, BA, height, gender, physical activity, maturity and weight explained 91% and 48%, of the variance in TBMC and TBMD, respectively. In similar analyses in the 17-y-olds, the corresponding figures were 92% and 62%, respectively, when BA, height, growth, physical activity, gender and region emerged as significant in the model. In all these analyses, BA explained most of the variance in TBMC and TBMD. No significant reduction of variance was found when different measures of social conditions, smoking, food habits, alcohol or dietary intakes of energy, calcium or vitamin D were included in the models. The reason why region of domicile had a significant impact on TBMC in the 17-y-olds is not known. The fact that the normal fluoride concentration in drinking water (1.1 mg/L) is 10 times higher in the region where TBMC was higher than in the other region is an interesting observation. CONCLUSION: Almost 90% of the variance in TBMC and 50% of that in TBMD was explained by measures of bone and body size and only a few percent by gender, physical activity, Tanner stage, growth and region of domicile.

Adolescent↗

PubMed2002

A method to obtain the same levels of CT image noise for patients of various sizes, to minimize radiation dose.

The aim of this study was to develop a method of obtaining the same levels of CT image noise for patients of various sizes to minimize radiation dose. Two CT systems were evaluated regarding noise characteristics using phantoms and dosimetric measurements. Both CT systems performed well at dose levels used in normal clinical imaging, but only one was found to be suitable for low radiation dose applications. The CT system with the lowest noise level was used for further detailed studies. A simple strategy for manual selection of patient-specific scan parameters, considering patient size and required image quality, was implemented and verified on 11 volunteers. Images were obtained with at least the prescribed image quality at significantly reduced radiation dose levels compared with standard scan parameters. Depending on the diameter of the tomographic section, i.e. size of the subject, the dose levels could be reduced to 1-45% of the radiation dose with standard scan parameters (120 kV, 250 mAs, 10 mm). The results indicate a general potential for dose reduction in CT for slim patients. For tissue volume determination, large dose reductions can be achieved by adjusting the scan parameters for each individual. The concept of patient-specific scan parameters could be fully automated in the CT system design, but would require the scan to be specified in terms of image quality rather than X-ray tube load.

Adult↗

PubMed2001

Principles for enhanced recruitment of subjects in a large clinical trial. the XENDOS (XENical in the prevention of Diabetes in Obese Subjects) study experience.

In most clinical trials it is problematic to recruit enough patients within a reasonable time period. Prolonged or inefficient recruitment or both can have negative scientific and economic consequences. The XENDOS (XENical in the prevention of Diabetes in Obese Subjects) study is an ongoing randomized, double-blind, placebo-controlled, prospective, multicenter trial investigating whether orlistat combined with hypocaloric diet and moderate physical exercise can reduce the incidence of diabetes in obese subjects. To implement the XENDOS protocol and recruit the study patients, we designed a system for centralized patient recruitment and centralized scheduling of patients and staff at the 22 collaborating centers. The recruitment and inclusion phase was divided into a series of different consecutive examinations of increasing complexity. Relatively simple initial examinations enabling a large throughput of patients were followed by more detailed examinations of fewer subjects, by then known to fulfil some of the study-specific requirements. With the aid of object-oriented techniques, the software was modularized to enable concurrent engineering. We also selected a structure where plug-in modules handling specific tasks could be added to the system as needed. The design was supported by a flow-oriented view of the progress of the patients through the study. With this overall solution we managed to include 3305 subjects (98.8% of the requested number) within less than 4 months. The sex distribution (44.8% men) and the number of patients with impaired glucose tolerance (IGT), (21.1%) were in close accordance with, or far better than, the requirements of the protocol (45% men, at least 10% IGT patients). The basic design of the XENDOS information system can be adapted to fulfil the requirements of other study protocols within the fields of obesity, diabetes, hypertension, coronary heart disease, etc. Shortening the recruitment and inclusion phase of large clinical trials is of great value both to be medical society and the pharmaceutical industry.

Adult↗

PubMed2001

Blood pressure and pulse pressure during long-term weight loss in the obese: the Swedish Obese Subjects (SOS) Intervention Study.

OBJECTIVE: Recently we reported a complete relapse in the blood pressure (BP) of obese subjects despite a maintained 16% weight loss over 8 years. This relapse is now analyzed as a function of several variables. Pulse pressure (PP) is an independent risk factor of cardiovascular mortality. We now examine the development of PP in the obese and whether it can be modified by weight-reducing gastric surgery. RESEARCH METHODS AND PROCEDURES: A total of 1157 patients treated with gastric surgery and 1031 obese controls (body mass index of 41.0 +/- 4.6 kg/m(2) [mean +/- SD], age 48 +/- 6 years) were followed for 5.5 +/- 2.1 (range 3 to 10) years. To separate the effect of weight change from effect of time on BP, the patients were divided in cohorts based on follow-up time. RESULTS: Gastric surgery resulted in a maximum weight loss after 1 year that was followed by a moderate relapse. After 5.5 years, weight loss in the intervention group was 18 +/- 11% of initial body weight. Very little weight change was seen in controls. Systolic BP decreased in the intervention group during the first 6 months but had relapsed to control values at last examination. The adjusted change in PP was +4.7 mm Hg in obese controls but +2.9 mm Hg in the intervention group (p < 0.001). Final BP values were more closely related to follow-up time and ongoing weight increase than to initial body weight or initial weight loss. DISCUSSION: Effects of time (aging) and weight change per year on BP can be separated. An early increase in PP could be observed in the obese. This increase could be modified by weight-reducing gastric surgery.

Adult↗

PubMed2001

The Swedish Obese Subjects (SOS) study--rationale and results.

OBJECTIVE: Obesity is associated with increased morbidity and mortality. Several observational epidemiological studies have indicated that weight gain and weight loss, even in the obese, is also related to an increased mortality. The Swedish Obese Subjects (SOS) study was initiated in 1987 as an attempt to elucidate this paradox. DESIGN: Two thousand matched patient pairs will be followed for 10 y each. One pair member is surgically treated, while the other receives conventional obesity treatment. By February 2000, 1879 patient pairs have been recruited. RESULTS: The two-y weight reduction was 28+/-15 kg among the operated patients and 0.5+/-8.9 kg among the obese controls. After eight years the weight loss was 20+/-16 kg in the surgical group, while the controls had gained 0.7+/-12 kg. Weight reductions achieved in the surgical group reduced the two-y incidence of diabetes 32 times as compared to the controls. After eight years there was still a 5-fold reduction in diabetes incidence. The two-y incidence of hypertension was similarly reduced 2.6 times in the surgical group. After eight years the incidence of hypertension was almost equal in the two study groups. CONCLUSION: Compared to weight stability, large intentional weight loss results in substantial reductions in the two-y incidence of several cardiovascular risk factors. After eight years there is still a reduced risk of developing diabetes in the surgical group, while the incidence of hypertension is equal in the two treatment groups. Whether intentional weight loss will reduce mortality is still too early to tell.

Adult↗

PubMed2001

Mutations in the preproghrelin/ghrelin gene associated with obesity in humans.

Ghrelin and preproghrelin sequences were determined in 96 unrelated female subjects with severe obesity (mean body mass index (BMI) 42.3 +/- 3.4 kg/m(2)) and in 96 non-obese female controls (mean BMI 23.0 +/- 1.4 (kg/m2) of the Swedish Obese Subjects cohort. A mutation at amino acid position 51 (Arg51Gln) of the preproghrelin sequence that corresponds to the last amino acid in mature ghrelin product was identified in six (all heterozygotes) obese subjects (6.3%) but not among controls (p < 0.05). The self-reported weight at 20, 30, and 40 years of age tended to be 7.5, 4.7 and 6.4 kg lower, respectively, among obese Gln allele carriers versus obese non-carriers. In addition, a mutation at codon 72 of the preproghrelin gene (Leu72Met) was detected in 15 obese (12 hetero- and 3 homozygotes) and 12 control (all heterozygotes) subjects. This mutation outside the coding region of the mature ghrelin product tended to be associated with lower age of self-reported onset of obesity (15.6 +/- 7.9 vs. 20.5 +/- 10.5 years; p = 0.09). In addition to these two mutations in coding regions, a G274A base change in a non-coding region between exons one and two was found only in two obese individuals. The Arg51Gln amino acid substitution may alter the cleavage site of endoproteases and the length of the mature ghrelin product. The functional significance of the Leu72Met mutation and a G274A base change remains to be determined. In conclusion, the data provide evidence that a low frequency sequence variation in the ghrelin gene could play a role in the etiology of obesity.

Adult↗

PubMed2001

Obesity-related coping and distress and relationship to treatment preference.

OBJECTIVES: The primary purpose was to define obesity-related strategies for coping with psychological problems connected with obesity. We also wanted to identify obesity-related distress and explore the effect of coping on distress. Thirdly, we wanted to investigate differences in coping and distress related to choice of surgery or conventional treatment. DESIGN: Cross-sectional data from patients in the Swedish Obese Subjects (SOS) intervention study. METHODS: An obesity-related questionnaire concerning coping and distress was created and evaluated in 2510 patients from the SOS study, using multitrait, exploratory and confirmatory factor analysis procedures. RESULTS: Three coping factors were defined. Social Trust and Fighting Spirit were problem-focused, whereas Wishful Thinking was emotion-focused. Surgical candidates displayed lower levels of problem-focused and higher levels of emotion-focused coping. We also identified two distress factors: Intrusion and Helplessness. Wishful Thinking was positively related to distress, and Social Trust and Fighting Spirit were inversely related, thus explaining the higher levels of distress reported by the surgical candidates. CONCLUSIONS: In our sample, emotion-focused coping proved maladaptive and was associated with increased distress. Problem-focused coping, however, was adaptive and associated with reduced distress. These findings partly explain psychological morbidity and should be taken into consideration in the treatment of obese people.

Adaptation, Psychological↗

PubMed2000

Relief of cardiorespiratory symptoms and increased physical activity after surgically induced weight loss: results from the Swedish Obese Subjects study.

BACKGROUND: Obese people frequently suffer from shortness of breath and chest discomfort on exertion, and they often have a sedentary lifestyle. In the present study of patients with severe obesity, we investigated the effects of surgically induced weight loss on cardiorespiratory symptoms and leisure-time physical activity. METHODS: The Swedish Obese Subjects study is an ongoing intervention trial of obesity consisting of 1 surgically treated group and 1 matched control group. Information on smoking habits, hypertension, diabetes, and sleep apnea was obtained from 1210 surgical cases and 1099 controls who were observed for 2 years. Patients were also asked about symptoms of breathlessness and chest pain and their levels of leisure-time physical activity. RESULTS: The surgically treated group displayed a mean weight loss of 28 kg (23%) compared with the control group in which the average weight remained unchanged (P<.001). The rates of hypertension, diabetes, and apneas during sleep decreased in surgical cases compared with controls (P<.001), while smoking habits remained largely the same. The surgical group also displayed highly significant improvements in dyspnea and chest pain and increases in physical activity compared with the control group (P<.001). The odds ratio for self-reported breathlessness, chest discomfort, or sedentary behavior after 2 years decreased progressively with the degree of weight loss. Furthermore, patients who recovered from apneas during sleep reduced their odds of having dyspnea and chest discomfort at follow-up, independent of changes in weight. CONCLUSIONS: Surgically induced weight loss in patients with severe obesity is associated with a marked relief in symptoms of dyspnea and chest pain and promotes increased leisure-time physical activity. Sleep-disordered breathing may be involved in the pathophysiology of breathlessness and chest discomfort in obese subjects.

Adult↗