Maximum Phonation Time in People with Obesity Not Submitted or Submitted to Bariatric Surgery

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Abstract

Background

Our aim in this investigation was to evaluate maximum phonation time in people with obesity not submitted to surgery and in people with obesity submitted to bariatric surgery and compare it with maximum phonation time of healthy volunteers. The hypothesis was that the reduced maximum phonation time in people with obesity would be corrected after surgery due to weight loss.

Method

Maximum phonation time was evaluated in 52 class III patients (Group A), 62 class III patients who were treated by surgery 3 to 115 months before (Group B), 20 controls (Group C), and 15 class III patients whose maximum phonation time was evaluated before and two to six months after surgery (Group D). Maximum phonation time was measured in the sitting position with the vowels /A/, /I/, and /U/.

Results

Maximal phonation time was shorter in groups A and B compared with that of controls. There was an increase in maximal phonation time after surgery (Group B); however, the difference was not significant when compared with that in group A. In group D, maximal phonation time for /A/ increased after the surgery. In group A, there was a negative correlation between maximal phonation time and weight or body mass index and a positive correlation between maximal phonation time and height. In group B, there was an almost significant positive relation between percentage of weight loss and maximal phonation time for /A/ ( p=0.08) and /I/ ( p=0.07). Mean values of spirometry testing (FEV ₁, FVC, and FEV ₁/FVC) in people with obesity (groups A and B), expressed as percentage of the predicted value, were within the normal range.

Conclusion

Compared with healthy controls, maximal phonation time is shorter in people with obesity, with a tendency to increase after bariatric surgery, as a possible consequence of weight loss.

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Most cited references 19

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Physiology of obesity and effects on lung function.

Cheryl M Salome, Gregory G King, Norbert Berend (2010)

In obese people, the presence of adipose tissue around the rib cage and abdomen and in the visceral cavity loads the chest wall and reduces functional residual capacity (FRC). The reduction in FRC and in expiratory reserve volume is detectable, even at a modest increase in weight. However, obesity has little direct effect on airway caliber. Spirometric variables decrease in proportion to lung volumes, but are rarely below the normal range, even in the extremely obese, while reductions in expiratory flows and increases in airway resistance are largely normalized by adjusting for lung volumes. Nevertheless, the reduction in FRC has consequences for other aspects of lung function. A low FRC increases the risk of both expiratory flow limitation and airway closure. Marked reductions in expiratory reserve volume may lead to abnormalities in ventilation distribution, with closure of airways in the dependent zones of the lung and ventilation perfusion inequalities. Greater airway closure during tidal breathing is associated with lower arterial oxygen saturation in some subjects, even though lung CO-diffusing capacity is normal or increased in the obese. Bronchoconstriction has the potential to enhance the effects of obesity on airway closure and thus on ventilation distribution. Thus obesity has effects on lung function that can reduce respiratory well-being, even in the absence of specific respiratory disease, and may also exaggerate the effects of existing airway disease.

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Reference spirometric values using techniques and equipment that meet ATS recommendations.

R. Gardner, R Crapo, A.-B. Morris (1981)

Forced expiratory volumes and flows were measured in 251 healthy nonsmoking men and women using techniques and equipment that meet American Thoracic Society (ATS) recommendations. Linear regression equations using height and age alone predict spirometric parameters as well as more complex equations using additional variables. Single values for 95% confidence intervals are acceptable and should replace the commonly used method of subtracting 20% to determine the lower limit of normal for a predicted value. Our study produced predicted values for forced vital capacity and forced expiratory volume in one second that were almost identical to those predicted by Morris and associates (1) when the data from their study were modified to be compatible with the back extrapolation technique recommended by the ATS. The study of Morris and colleagues was performed at sea level in rural subjects, whereas ours was performed at an altitude of 1,400 m in urban subjects. Either the present study or the study of Morris and co-workers, modified to back extrapolation, could be recommended for predicting normal values.

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Is Open Access

Obesity: systemic and pulmonary complications, biochemical abnormalities, and impairment of lung function

Thiago Mafort, Rogerio Rufino, Cláudia Costa … (2016)

Obesity is currently one of the major epidemics of this millennium and affects individuals throughout the world. It causes multiple systemic complications, some of which result in severe impairment of organs and tissues. These complications involve mechanical changes caused by the accumulation of adipose tissue and the numerous cytokines produced by adipocytes. Obesity also significantly interferes with respiratory function by decreasing lung volume, particularly the expiratory reserve volume and functional residual capacity. Because of the ineffectiveness of the respiratory muscles, strength and resistance may be reduced. All these factors lead to inspiratory overload, which increases respiratory effort, oxygen consumption, and respiratory energy expenditure. It is noteworthy that patterns of body fat distribution significantly influence the function of the respiratory system, likely via the direct mechanical effect of fat accumulation in the chest and abdominal regions. Weight loss caused by various types of treatment, including low-calorie diet, intragastric balloon, and bariatric surgery, significantly improves lung function and metabolic syndrome and reduces body mass index. Despite advances in the knowledge of pulmonary and systemic complications associated with obesity, longitudinal randomized studies are needed to assess the impact of weight loss on metabolic syndrome and lung function.

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Author and article information

Contributors

Roberto Oliveira Dantas:

ORCID: https://orcid.org/0000-0003-2183-0815

Journal

Journal ID (nlm-ta): J Obes

Journal ID (iso-abbrev): J Obes

Journal ID (publisher-id): JOBE

Title: Journal of Obesity

Publisher: Hindawi

ISSN (Print): 2090-0708

ISSN (Electronic): 2090-0716

Publication date Collection: 2019

Publication date (Electronic): 25 December 2019

Volume: 2019

Electronic Location Identifier: 5903621

Affiliations

¹Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900 Ribeirão Preto SP, São Paulo 14049-900, Brazil

²Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900 Ribeirão Preto SP, São Paulo 14049-900, Brazil

Author notes

Academic Editor: Eliot Brinton

Author information

Roberto Oliveira Dantas https://orcid.org/0000-0003-2183-0815

Article

DOI: 10.1155/2019/5903621

PMC ID: 6955128

SO-VID: 986ef1c3-9edb-441c-92ce-40bd2de8244f

License:

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Maximum Phonation Time in People with Obesity Not Submitted or Submitted to Bariatric Surgery

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Abstract

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Karger: Nutrition and Dietetics

Most cited references 19

Physiology of obesity and effects on lung function.

Reference spirometric values using techniques and equipment that meet ATS recommendations.

Obesity: systemic and pulmonary complications, biochemical abnormalities, and impairment of lung function

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