Respiratory Muscle Strength Correlated with Abdominal Circumference in Obese Individuals in Pre-Bariatric Surgery
Ana Paula
Limongi Richardelli Veloso*, Karla Garcez Cusmanich, Renato de Mesquita Tauil,
Alexandre Marotta
*Corresponding
author: Ana
Paula Limongi Richardelli Veloso, Avenida Itália,
190, Jardim das Nações, 12030-212 Taubaté, SP, Brazil. Email:anapaulalrveloso@gmail.com
Received
Date: 26
September, 2017; Accepted Date: 16
October, 2017; Published Date: 23
October, 2017
Citation: Veloso APLR, Cusmanich KG, Tauil RM, Marotta A (2017) Respiratory Muscle Strength Correlated with Abdominal Circumference in Obese Individuals in Pre-Bariatric Surgery. J Surg 2017: 174.
1. Abstract
1.1. Background: The presence of alterations in respiratory mechanics of obese population, cause acceleration in the breathing pattern, making it of low amplitude and causing an increase in the work. The measures of Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure (MEP) can be used to quantify the strength of respiratory muscles.
1.2. Objective: To evaluate the relationship of increased abdominal circumference with respiratory muscle strength in obese patients in pre-operative bariatric surgery by comparing the values with the values predicted by the equation of Costa et al.
1.3.
Methods: This
study involved 154 patients. All belonging to the group of patients attended
the clinic Life Worth in process of pre-operative bariatric surgery. Were Measured
Inspiratory Pressures and Maximal Expiratory Pressure (MIP and MEP) by
manometer. Result: the average age of 37.7 ±
10.3 years, with a mean BMI of 41.5 ± 4.6,
showing the average circumference of 123.4 ±
12.2 cm. Showing a correlation of MIP and MEP with the CA to p<0.05.
1.4.
Conclusion: Both
genders, do not present a correlation of muscular strength with abdominal
circumference.
2. Keywords: Abdominal Circumference; Obesity; Respiratory Muscles
1. Introduction
In recent years, obesity is one of the main problems
of public health[1,2] Being a disease not
transmissible and chronic, with an
increase in adipose tissue, which is frequently related to health risks[3-6]Obesity is defined by a Body Mass Index (BMI)
according to the classification of the World Health Organization
(WHO)[1]is divided into: the top of the weight - overweight (BMI 25-29.9kg/m2) and obesity (BMI
30-34.9kg/m2) grade II (BMI 35-39.9kg/m2) level III (BMI
> 40 kg/m2)[2, 7-10]There are
various factors that interfere with the respiratory mechanics of obese [11] the
fat stored in the abdominal cavity (Gynoid) restricts the scalability and
reduces lung volumes[11,12]. There is a
general concept that complacency total respiratory is reduced by the impairment
chest and lung, being the component chest the more important. A reduction in
the compliance of the chest wall is attributed to fat around the ribs and chest[13].
The presence of alterations in respiratory mechanics of this population cause acceleration in the breathing pattern, making it of low amplitude and provoking an increase in work[11,14]The strength of respiratory muscles can be evaluated directly by means of static as the maximal respiratory pressures, using the manuvacuômentro. The measures of Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure (MEP) can be used to quantify respiratory muscle strength in healthy individuals of different ages[15]MIP is a measure of inspiratory muscle strength, while the MEP measures the strength of the abdominal muscles and intercostal[16]Due to the inefficacy of respiratory muscles, muscle strength and endurance may be reduced[7,17]The values of MIP and MEP are dependent not only on the strength of respiratory muscles, but also changes in lung volume in which they are incurred the measures and the corresponding pressure value of the elastic recoil of the respiratory system[15,18]The values of MIP and MEP measurements are compared with the values predicted by the equations of Costa[19].
According to Arora[20]the weight has an influence on the maximal respiratory pressures and may be related to muscle mass, therefore changes in weight could affect the mass of the diaphragm, influencing the respiratory muscle performance. Due and efficiency of combating obesity bariatric surgery has been considered the most effective method of treatment[8,21].The objective of this study was to correlate the increase in Waist Circumference (WC) with respiratory muscle strength in obese patients in pre-operative bariatric surgery, comparing the values with the values predicted by the equation of Costa [19].
2. Methodology
It is a study not randomized, with cross-sectional design, not controlled, experimental, mixed and aggregated. The study included 154 patients (36 men and 118 woman), with ages between 17 and 69 years. All who participated in the study, were patients who seek the Vida Vale clinic for bariatric surgery, accompanied by a multidisciplinary team specialized in the digestive systemteam specialized in Digestive system (Especializados em Moléstia do Aparelho Digestivo- EMAD). Included patients who had a Body Mass Index (BMI) = 35 kg/m2, with no current dependence on illicit drugs and alcoholism and presenting cognitive conditions for understanding simple orders. All volunteers were instructed on how to study procedures, in accordance with the requirements of Resolution 466/12 of the National Health Council. The study was approved by the research ethics in humans with the opinion number 1458166 and the participants investigated signed the informed consent form. The preoperative evaluation included clinical history, physical examination and measurements of respiratory muscle strength. The measures were obtained with the patient in the sitting position, using a manometer NS 120-SR of the mark Instrumentation Industries®, where the patient was instructed to put a stop nose and attaching his mouth in a disposable mouthpiece. For the measurement of MIP, individuals have expired in the filler until the residual volume and, subsequently, will generate a maximal inspiratory effort against an airway occlusion. For the MEP, individuals have inspired the nozzle up toTotal Lung Capacity (TLC), and then a maximum effort against expiratory an airway occlusion during this last measure, individuals held with the hands the muscles of the perioral face to prevent leakage and accumulation of air in the lateral region of the oral cavity. To this end, three measurements were performed and the biggest result was recorded in the record of each volunteer.
The anthropometric assessment, patients remained
in orthostatic position, without shoes. The body mass index was obtained
by a digital scale (Welmy; Santa Bárbara D'Oeste
- SP, Brazil), with a maximum capacity of 300 kg. Height was measured
by a stadiometer of own scales and the calculation of the BMI was
calculated using the equation: body mass index (kg)/estatura² (m)[22]The abdominal
circumference was measured with the patient standing in front of the examiner,
using a tape measure in centimeters, flexible and inelastic, directly on
the skin, without compressing the tissue, located between the ribs and the iliac
crest. Using the cut-off point of 94-102 cm for mens and 80-88 cm
for woman[23-26].The
data were analyzed by SPSS software v.20 (IBM SPSS Statistics). The
normality of the data was tested by means of the Shapiro-Wilk test, which
proved to be parametric and therefore, have been demonstrated in mean and
standard deviation. We calculated the simple frequency between men and woman.
The comparison between men and womanfor the variables studied was performed
using the Student's t-test for independent samples. The correlations were
performed through Pearson's correlation test. It was established the value of
statistical significance at p < 0.05.
3. Result
Table 1 shows the basic characteristics of the 154 patients involved and evaluated in this study for bariatric surgery, with an average age of 37.7 ± 10.3 years (17 to 69 years). The mean BMI was 41.5 ± 4.6 (35 to 57), with 56.49% of patients presenting degree III obesity. In relation to waist circumference, 100% of the volunteers are above the established by the society in accordance with the genres (94-102 cm for men and 80-88 cm for woman). Among men and woman, the mean waist circumference was 123.4 ± 12.2 cm (99 to 163 cm)
The illustration shows the distribution of
patients according to the classification of BMI. The mean body mass
index was of 41,5Kg/m² with a range of 35 to
57,5 kg/m², being the most prevalent among womanobesity
III with 50.42% and 77.14% also have obesity grade III (Figure 1).
demonstrates the maximum pressures carried out,
comparing with the pressures predicted, according to sex. With inspiratory
muscle strength in woman of 120.1 ± 37.3% of
predicted, expiration 60.6 ± 18% of
predicted; among men inspiratory muscle strength 52.2 ± 19.5% of predicted and expiratory 58.5 ± 17.6% of predicted.
4. Discussion
One of the goals of the preoperative evaluation, in patients who are candidates for bariatric surgery, is to identify if there are reductions in the volumes, strength and abilities due to the increase in weight, as described in the literature[27] obesity may alter respiratory mechanics, lung volumes, airway resistance and respiratory muscles[28]In this study, the muscle strength and maximal expiratory pressure of patients are reduced when compared to normal values. A study[29]was conducted to evaluate the muscle strength respiratory function in morbidly obese patients by means of pressure manometry. At the end of the study, concluded that overweight and obesity have significant injury in the ventilatory pressures maximal inspiratory pressure and maximal expiratory pressure, because they might interfere in the movement of the diaphragm and chest wall excursion[29] As seen in our study, the pressures are reduced, except the inspiratory muscles of woman, showing above normal values. Magnani and Caetano[30] evaluated the circumference and the respiratory pressures of 99 obese individuals aged between 20 and 64 years and found that obesity does not interfere with the pressure generated by muscles breathing, even in obese patients with the distribution of body fat more superior, shown by the waist/hip ratio. In another study[31]with 103 obese women(57 obese and 46 healthy), concluded that obese womanhas a higher respiratory muscle strength when compared to healthy. The variables of the bioimpedance and obesity had a direct relationship with the respiratory muscle strength. The variables of waist circumference and waist-hip/ did not influence the strength under obese. In harmony with our findings, the increase in circumference has no relation with the force.
The increase in respiratory muscle strength in patients can be explained
by an adaptation to chronic overload that accompanies obesity, shown by the
largest amount of fibers of type II and a small amount of fibers of type I[32]and this is a possible explanation for the
inspiratory muscle strength of womanbeing higher than the predicted value.
Second Forti [33]obese woman morbid showed higher inspiratory
muscle strength than eutrophic, and seem to have similarity in the
behavior of the force of the expiratory muscles, however these findings are
inconclusive. Complementing that of the three equations
used to reference value, The Harik-Khan seems to be more
appropriate to calculate the values MIP for obese vicious. Although some
studies[27,29] show that the lung
capacity and forces are reduced in the morbid obese
patient, others have shown that morbidly obese patients when compared to
normal patients, do not present a significant difference in lung function.
There is a general concept that complacency total respiratory is reduced by the
impairment chest[28]however, the literature
shows a large discrepancy on the subject and on standardization of reference
values.
The proposal of the study was to verify if the abdominal circumference
has an influence on the forces of respiratory muscle of obese patients.
Considering the data obtained with the evaluation, it was possible to
compare the influence of BMI on the strength respiratory, noting a
negative correlation between waist circumference and the MIP and MEP in
patients, even those with a decrease of force, calculated by the equations proposed by Costa[19].
5. Conclusion
The men evaluated presented respiratory muscle strength less than the predicted, since the obese patients, only maximal expiratory pressure were reduced. Both sexes show no correlation of muscular strength with abdominal circumference.
Figure 1. Percent of degree of obesity according to sex.
Figure 2. Comparison of strength measured with force predicted for the men.
Figure 3. Comparison of strength measured with force predicted for the womansex.
|
Men (n=36)
|
Woman(n=118) |
P value |
Age in years |
39.6 ± 13.2 |
37.1 ± 9.2 |
0.310 |
BMI kg/m2 |
43.2 ± 5.5 |
40.9 ± 4.2 |
0.027* |
CA cm |
135.0 ± 10.7 |
119.8 ± 10.3 |
0.001* |
Table 1: Demographic and anthropometric
|
Men (n=36)
|
Woman(n=118) |
P value |
Correlation with CA |
|
MIP |
89.9 ± 21 |
68.8 ± 22.4 |
0.001* |
0.198 |
|
Predicted PI |
180.4± 28.1 |
57.2± 4.2 |
0.001 |
0.046 |
|
MEP |
75.4 ± 17.5 |
56.7 ± 16.1 |
0.001 |
0.332 |
|
Predicted PE |
132.8 ± 18.5 |
94.1 ± 5.3 |
0.001 |
0.046 |
Table 2: Values of MIP and MEP measured and predicted.
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