Complexities and complications of extreme obesity

Authors

  • Haval Ali University of Texas Health Science Center at Houston (UTHealth Houston), McGovern Medical School, Department of Pathology and Laboratory Medicine, Houston, TX, USA https://orcid.org/0000-0003-4597-1997
  • Udit Naik University of Texas Health Science Center at Houston (UTHealth Houston), McGovern Medical School, Department of Pathology and Laboratory Medicine, Houston, TX, USA https://orcid.org/0000-0001-9193-3575
  • Michelle McDonald University of Texas Health Science Center at Houston (UTHealth Houston), McGovern Medical School, Department of Pathology and Laboratory Medicine, Houston, TX, USA https://orcid.org/0000-0001-6091-8196
  • Mohammad Almosa University of Texas Health Science Center at Houston (UTHealth Houston), McGovern Medical School, Department of Pathology and Laboratory Medicine, Houston, TX, USA https://orcid.org/0000-0003-3046-7640
  • Karen Horn University of Texas Health Science Center at Houston (UTHealth Houston), McGovern Medical School, Department of Pathology and Laboratory Medicine, Houston, TX, USA https://orcid.org/0000-0001-7853-1272
  • Alexis Staines University of Texas Health Science Center at Houston (UTHealth Houston), McGovern Medical School, Department of Pathology and Laboratory Medicine, Houston, TX, USA https://orcid.org/0000-0002-3934-9408
  • Louis Maximilian Buja University of Texas Health Science Center at Houston (UTHealth Houston), McGovern Medical School, Department of Pathology and Laboratory Medicine, Houston, TX, USA https://orcid.org/0000-0001-8386-7029

DOI:

https://doi.org/10.4322/acr.2021.402

Keywords:

Obesity, Morbid, Heart Failure, Pulmonary Embolism

Abstract

Obesity is a common chronic disorder and has detrimental long-term consequences if left untreated. Herein, we report a case of a young lady who suffered from morbid obesity and many of its consequences, and we present a literature review of these complications. While the cause of obesity is multifactorial, the genetic component is particularly important in the pathophysiology of marked obesity. Resistance to Leptin is considered one of the main causes of obesity. There is a unique relationship between polycystic ovary syndrome and obesity, as observed in our case. Obesity is associated with cardiovascular and lung diseases such as heart failure, thromboembolic disease, sleep apnea, and pulmonary hypertension. Our patient had cardiomegaly (730 gm) with eccentric hypertrophy of left and right ventricles. The coronary arteries and aorta were free of atherosclerosis, which is a surprising finding that relates to the mysterious phenomenon of obesity paradox. The terminal event in our young woman was multiple segmental and subsegmental pulmonary arterial thrombi/ thromboemboli superimposed on chronic cardiopulmonary stress due to massive obesity.

Downloads

Download data is not yet available.

References

World Health Organization (WHO). Fact sheet: obesity and overweight. Geneva: WHO; 2022.

Garrow JS, Webster J. Quetelet’s index (W/H2) as a measure of fatness. Int J Obes. 1985;9(2):147-53. PMid:4030199.

National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res.

;6(Suppl. 2):51S-209S. PMid:9813653.

Medical Advisory Secretariat. Bariatric surgery: an evidence-based analysis. Ont Health Technol Assess Ser. 2005;5(1):1-148. PMid:23074460.

Fryar CD, Carroll MD, Afful J. Prevalence of overweight, obesity, and severe obesity among adults aged 20 and over: United States, 1960-1962 through 2017-2018.

Washington, D.C.: NCHS Health E-Stats; 2020.

Kinlen D, Cody D, O’Shea D. Complications of obesity. QJM. 2018;111(7):437-43. http://dx.doi.org/10.1093/qjmed/hcx152. PMid:29025162.

González-Muniesa P, Mártinez-González MA, Hu FB, et al. Obesity. Nat Rev Dis Primers. 2017;3(1):17034. http://dx.doi.org/10.1038/nrdp.2017.34. PMid:28617414.

Segula D. Complications of obesity in adults: a short review of the literature. Malawi Med J. 2014;26(1):20-4. PMid:24959321.

Tsuboi N, Okabayashi Y, Shimizu A, Yokoo T. The renal pathology of obesity. Kidney Int Rep. 2017;2(2):251-60. http://dx.doi.org/10.1016/j.ekir.2017.01.007. PMid:29142961.

Pafili K, Roden M. Nonalcoholic fatty liver disease (NAFLD) from pathogenesis to treatment concepts in humans. Mol Metab. 2021;50:101122. http://dx.doi.org/10.1016/j.molmet.2020.101122. PMid:33220492.

Tarantino G, Citro V, Conforti P, Balsano C, Capone D. Is there a link between basal metabolic rate, spleen volume and hepatic growth factor levels in patients with

obesity-related NAFLD? J Clin Med. 2019;8(10):1510. http://dx.doi.org/10.3390/jcm8101510. PMid:31547124.

Escobar-Morreale HF. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrinol. 2018;14(5):270-84. http://dx.doi.

org/10.1038/nrendo.2018.24. PMid:29569621.

LavieCJ, Milani RV, VenturaHO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol. 2009;53(21):1925-32. http://dx.doi.org/10.1016/j.jacc.2008.12.068. PMid:19460605.

Alpert MA, Omran J, Bostick BP. Effects of obesity on cardiovascular hemodynamics, cardiac morphology, and ventricular function. Curr Obes Rep. 2016;5(4):424-34. http://dx.doi.org/10.1007/s13679-016-0235-6. PMid:27744513.

Després JP, Carpentier AC, Tchernof A, Neeland IJ, Poirier P. Management of obesity in cardiovascular practice: JACC focus seminar. J Am Coll Cardiol. 2021;78(5):513-31. http://dx.doi.org/10.1016/j.jacc.2021.05.035. PMid:34325840.

Szczepaniak LS, Victor RG, Orci L, Unger RH. Forgotten but not gone: the rediscovery of fatty heart, the most common unrecognized disease in America. CircRes. 2007;101(8):759-67. http://dx.doi.org/10.1161/CIRCRESAHA.107.160457. PMid:17932333.

Ren J, Wu NN, Wang S, Sowers JR, Zhang Y. Obesity cardiomyopathy: evidence, mechanisms, and therapeutic implications. Physiol Rev. 2021;101(4):1745-807. http://dx.doi.org/10.1152/physrev.00030.2020. PMid:33949876.

Brodsky SV, Barth RF, Mo X, et al. An obesity paradox: an inverse correlation between body mass index and atherosclerosis of the aorta. Cardiovasc Pathol. 2016;25(6):515-20. http://dx.doi.org/10.1016/j.carpath.2016.09.002. PMid:27683962.

Barth RF, Maximilian Buja L, Cao L, Brodsky SV. An obesity paradox: increased body mass index is associated with decreased aortic atherosclerosis. Curr Hypertens Rep. 2017;19(7):55. http://dx.doi.org/10.1007/s11906-017-0753-y. PMid:28593612.

Brodsky SV, Ganju R, Mishra S, et al. Genomic analysis of an obesity paradox: a microarray study of the aortas of morbidly obese decedents with mild and severe

atherosclerosis. Crit Pathw Cardiol. 2019;18(1):57-60. http://dx.doi.org/10.1097/HPC.0000000000000169. PMid:30747767.

Qaisar S, Brodsky LD, Barth RF, et al. An unexpected paradox: wall shear stress in the aorta is less in patients with severe atherosclerosis regardless of obesity. Cardiovasc Pathol. 2021;51:107313. http://dx.doi.org/10.1016/j.carpath.2020.107313. PMid:33242600.

Wagenvoort CA. Pathology of pulmonary thromboembolism. Chest. 1995;107(1, Suppl.):10S-7S. http://dx.doi.org/10.1378/chest.107.1_Supplement.10S. PMid:7813322.

Marongiu F, Mameli A, Grandone E, Barcellona D. Pulmonary thrombosis: a clinical pathological entity distinct from pulmonary embolism? Semin Thromb Hemost. 2019;45(8):778-83. http://dx.doi.org/10.1055/s-0039-1696942. PMid:31537029.

Cao Y, Geng C, Li Y, Zhang Y. In situ pulmonary artery thrombosis: a previously overlooked disease. Front Pharmacol. 2021;12:671589. http://dx.doi.org/10.3389/

fphar.2021.671589. PMid:34305592.

Lucena J, Rico A, Vázquez R, et al. Pulmonary embolism and sudden-unexpected death: prospective study on 2477 forensic autopsies performed at the Institute of Legal Medicine in Seville. J Forensic Leg Med. 2009;16(4):196-201. http://dx.doi.org/10.1016/j.jflm.2008.08.015. PMid:19329075.

Mullin CJ, Klinger JR. Chronic thromboembolic pulmonary hypertension. Heart Fail Clin. 2018;14(3):339-51. http://dx.doi.org/10.1016/j.hfc.2018.02.009. PMid:29966632.

Matthews DT, Hemnes AR. Current concepts in the pathogenesis of chronic thromboembolic pulmonary Forensic Med Pathol. 2012;33(4):368-72. http://dx.doi.

org/10.1097/PAF.0b013e31823d29ad. PMid:22182984.

Piazza G, Goldhaber SZ. Chronic thromboembolic pulmonary hypertension. N Engl J Med. 2011;364(4):351-60. http://dx.doi.org/10.1056/NEJMra0910203.

PMid:21268727.

Molina DK, DiMaio VJ. Normal organ weights in men: Part I-the heart. Am J Forensic Med Pathol. 2012;33(4):3627.http://dx.doi.org/10.1097/PAF.0b013e31823d298b.PMid:22182983.

Cui H, López M, Rahmouni K. The cellular and molecular bases of leptin and ghrelin resistance in obesity. Nat Rev Endocrinol. 2017;13(6):338-51. http://dx.doi.

org/10.1038/nrendo.2016.222. PMid:28232667.

Izquierdo AG, Crujeiras AB, Casanueva FF, Carreira MC. Leptin, obesity, and leptin resistance: where are we 25 years later? Nutrients. 2019;11(11):2704. http://dx.doi. org/10.3390/nu11112704. PMid:31717265.

Molina DK, DiMaio VJ. Normal organ weights in men: part II-the brain, lungs, liver, spleen, and kidneys. Am J Forensic Med Pathol. 2012;33(4):368-72. http://dx.doi.

org/10.1097/PAF.0b013e31823d29ad. PMid:22182984.

Molina DK, DiMaio VJ. Normal organ weights in women: part I-the heart.Am J Forensic Med Pathol. 2015;36(3):176-81. http://dx.doi.org/10.1097/PAF.0000000000000174.PMid:26153896.

Molina DK, DiMaio VJ. Normal organ weights in women: part II-the brain, lungs, liver, spleen, and kidneys. Am J Forensic Med Pathol. 2015;36(3):182-7. http://dx.doi.org/10.1097/PAF.0000000000000175. PMid:26108038.

Finocchiaro G, Papadakis M, Dhutia H, et al. Obesity and sudden cardiac death in the young: clinical and pathological insights from a large national registry.

Eur J Prev Cardiol. 2018;25(4):395-401. http://dx.doi.org/10.1177/2047487317751291. PMid:29319343.

Katta N, Loethen T, Lavie CJ, Alpert MA. Obesity and coronary heart disease: epidemiology, pathology, and coronary artery imaging. Curr Probl Cardiol.

;46(3):100655. http://dx.doi.org/10.1016/j.cpcardiol.2020.100655. PMid:32843206.

Downloads

Published

2022-10-05

Issue

Section

Autopsy Case Report and Review

How to Cite

Complexities and complications of extreme obesity. (2022). Autopsy and Case Reports, 12, e2021402. https://doi.org/10.4322/acr.2021.402