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The Effect of Acute Intermittent Hypoxia, a Simulating Model of Obstructive Sleep Apnea, on Adipose Tissue Lipolysis in Healthy Humans
Abstracts / Can J Diabetes 39 (2015) S38eS74
[11.4;6.8]) (all p<0.0001), low-density lipoprotein cholesterol (2.4% [4.0;0.9]) and high-density lipoprotein-cholesterol (1.9% [0.7;3.0]) (both p<0.01); and free fatty acids (4.2% [7.3;0.9]) (p<0.05). Improvements in high-sensitivity C-reactive protein (ETD 30.5% [34.3;26.5]), plasminogen activator inhibitor-1 (21.3% [25.7;16.7]) and adiponectin (8.5% [5.5;11.6]) (all p<0.0001) were observed with liraglutide vs. placebo.
P4.15 Experiences and Perceptions of Community-based Occupational Therapists’ Regarding their Work with Adults with Morbid Obesity JENNIFER Y. LEE*, JENNA VAN DER ZALM, SHANNON VAN STRALEN, PAULA VOIGT, LAUREN WOU, VINCENT G. DEPAUL St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada Objective: Since 1985, the prevalence of morbid obesity in Canada has increased 6-fold. Obesity has been shown to impact occupational performance due to personal (e.g. physical capacity) and environmental factors (e.g. stigma, built environment). Occupational therapists (OTs) possess a broad scope of knowledge and skills to enable meaningful occupation that assist in their work with clients with obesity. The purpose of this study was to explore the experiences, challenges, perceptions, and needs of communitybased OTs regarding their work with this population. Methods: A web-based needs assessment was distributed to OTs working in the Hamilton, Niagara, Haldimand, and Brant regions in southern Ontario. The survey was comprised of open and closedended questions based on a literature review and a pilot study exploring the experiences of hospital-based clinicians. Results: Responses indicated that interventions addressing basic functions (e.g. transfers) and home environment were implemented more frequently and with more confidence than interventions related to health promotion, weight management and mental health. Perceived challenges included limited funding for equipment and services, availability of bariatric equipment, and limited allowable visits to adequately address client needs. Conclusion: The results of this study highlight challenges faced by community-based OTs in their work with individuals with morbid obesity. Barriers to more comprehensive and effective therapy practice include limited therapist confidence, access to funding, equipment, and time. Population-specific professional education and increased advocacy for systems-level changes may help OTs more effectively address client needs and improve health, function, and quality of life in this complex population.
P4.16 Do Obese Long-Term Care Residents Fall Differently than Underweight Residents? IRIS C. LEVINE*1, 3, YIJIAN YANG 2, 3, STEPHEN N. ROBINOVITCH 2, 3, ANDREW C. LAING 1, 3 1 University of Waterloo, Waterloo, ON, Canada 2 Simon Fraser University, Burnaby, BC, Canada 3 Technology for Injury Prevention in Seniors, Burnaby, BC, Canada While underweight fallers suffer the greatest rate of hip and wrist fractures, obese fallers are also susceptible to lower leg and ankle fragility fractures. Differences in balance control mechanisms, control of body segments during a fall, and impact mechanics may help explain these differences. The goal of this study was to determine whether there were differences in fall cause and circumstances between low-body mass index (BMI) and high-BMI older adults who suffered falls. A validated questionnaire was used to analyze real-life fall videos of 25 low-BMI (lowest-available quartile, BMI <20.8) and 25 high-BMI (highest-available quartile, BMI >27.6) older-adult long-term care (LTC) residents to determine the cause and circumstances of each incident. Comparisons were
S49
made between BMI groups for the initiation, descent and impact stages of the fall. Low- and high-BMI groups did not differ in number of comorbidities, activity type, mobility aid use, attempts to grasp objects, falling direction, landing direction or impacting segments. Underweight fallers utilized larger stepping responses (X2¼8.384, p¼0.039). Overweight fallers were more likely to suffer fall due to tripping or stumbling than underweight fallers (X2¼3.947, p¼0.047). Smaller step responses in overweight fallers may be due to larger limb segment inertia or lower foot-floor clearance, and is less effective for preventing falls. Our results match experimental results and injury patterns reported in literature, with a greater rate of tripping by high-BMI than low-BMI fallers. Tripping falls and smaller step responses could contribute to the generation of larger moments at the ankle prior to impact which may increase ankle injury risk.
P4.17 The Effect of Acute Intermittent Hypoxia, a Simulating Model of Obstructive Sleep Apnea, on Adipose Tissue Lipolysis in Healthy Humans BIMIT MAHAT*, ÉTIENNE CHASSÉ, JEAN-FRANÇOIS MAUGER, PASCAL IMBEAULT University of Ottawa, Ottawa, ON, Canada Background: Obstructive sleep apnea (OSA) consists of repeated, involuntary breathing suspension during sleep. These events induce rapid depletion of blood/tissue oxygen content, phenomenon known as intermittent hypoxia. OSA has been associated with a w2-fold increase in cardiovascular disease (CVD) risk. Recent animal studies demonstrated that acute hypoxia stimulates adipose tissue lipolysis which could lead to ectopic fat storage and increase CVD risk. Whether intermittent hypoxia induces adipose tissue lipolysis in humans remains to be explored. Objectives: Characterize the lipolytic activity of adipocytes isolated from healthy humans acutely exposed to intermittent hypoxia after a meal. Methods: Using a randomized crossover design, healthy men (body fat: 9-19%) were subjected to 6 h of normoxia (21% oxygen, control session) or intermittent hypoxia (pulsed medical nitrogen, simulated OSA session) following the consumption of liquid meal. Subcutaneous abdominal adipose tissue biopsies were performed before and 3 h following the meal in each experimental session. Glycerol release, measured by bioluminescence, was used as an indicator of lipolysis. Results: Oxyhemoglobin desaturation was induced at a rate of 19.7 events/h. Basal and maximal lipolytic responses to isoprenaline (badrenoreceptor (AR) agonist) were significantly reduced in response to the meal in both conditions. Lipolytic responses to isoprenaline after the meal were comparable between control and OSA sessions. The maximal antilipolytic effects of epinephrine (mixed a2/b-AR agonist) or UK- 14304 (a2- AR agonist) after the meal were also comparable between control and OSA sessions. Conclusion: In healthy individuals, acute intermittent hypoxia does not seem to alter lipolytic responses of subcutaneous abdominal adipocytes.
P4.18 Thoughts, Feelings and Food: An Emotional Eating Group Curriculum Offered at the Edmonton Adult Bariatric Specialty Clinic NICOLA I. MICHAUD*, CHARLENE LEMISKI, CARLA DIDUCK, AMY KOBLE, MELLISA LAYMAN, JASON JONES Alberta Health Services, Edmonton, AB, Canada The Edmonton Adult Bariatric Specialty Clinic’s mission is to improve health and quality of life for patients with complex obesity by providing multidisciplinary lifestyle counselling, medical, and
[11.4;6.8]) (all p<0.0001), low-density lipoprotein cholesterol (2.4% [4.0;0.9]) and high-density lipoprotein-cholesterol (1.9% [0.7;3.0]) (both p<0.01); and free fatty acids (4.2% [7.3;0.9]) (p<0.05). Improvements in high-sensitivity C-reactive protein (ETD 30.5% [34.3;26.5]), plasminogen activator inhibitor-1 (21.3% [25.7;16.7]) and adiponectin (8.5% [5.5;11.6]) (all p<0.0001) were observed with liraglutide vs. placebo.
P4.15 Experiences and Perceptions of Community-based Occupational Therapists’ Regarding their Work with Adults with Morbid Obesity JENNIFER Y. LEE*, JENNA VAN DER ZALM, SHANNON VAN STRALEN, PAULA VOIGT, LAUREN WOU, VINCENT G. DEPAUL St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada Objective: Since 1985, the prevalence of morbid obesity in Canada has increased 6-fold. Obesity has been shown to impact occupational performance due to personal (e.g. physical capacity) and environmental factors (e.g. stigma, built environment). Occupational therapists (OTs) possess a broad scope of knowledge and skills to enable meaningful occupation that assist in their work with clients with obesity. The purpose of this study was to explore the experiences, challenges, perceptions, and needs of communitybased OTs regarding their work with this population. Methods: A web-based needs assessment was distributed to OTs working in the Hamilton, Niagara, Haldimand, and Brant regions in southern Ontario. The survey was comprised of open and closedended questions based on a literature review and a pilot study exploring the experiences of hospital-based clinicians. Results: Responses indicated that interventions addressing basic functions (e.g. transfers) and home environment were implemented more frequently and with more confidence than interventions related to health promotion, weight management and mental health. Perceived challenges included limited funding for equipment and services, availability of bariatric equipment, and limited allowable visits to adequately address client needs. Conclusion: The results of this study highlight challenges faced by community-based OTs in their work with individuals with morbid obesity. Barriers to more comprehensive and effective therapy practice include limited therapist confidence, access to funding, equipment, and time. Population-specific professional education and increased advocacy for systems-level changes may help OTs more effectively address client needs and improve health, function, and quality of life in this complex population.
P4.16 Do Obese Long-Term Care Residents Fall Differently than Underweight Residents? IRIS C. LEVINE*1, 3, YIJIAN YANG 2, 3, STEPHEN N. ROBINOVITCH 2, 3, ANDREW C. LAING 1, 3 1 University of Waterloo, Waterloo, ON, Canada 2 Simon Fraser University, Burnaby, BC, Canada 3 Technology for Injury Prevention in Seniors, Burnaby, BC, Canada While underweight fallers suffer the greatest rate of hip and wrist fractures, obese fallers are also susceptible to lower leg and ankle fragility fractures. Differences in balance control mechanisms, control of body segments during a fall, and impact mechanics may help explain these differences. The goal of this study was to determine whether there were differences in fall cause and circumstances between low-body mass index (BMI) and high-BMI older adults who suffered falls. A validated questionnaire was used to analyze real-life fall videos of 25 low-BMI (lowest-available quartile, BMI <20.8) and 25 high-BMI (highest-available quartile, BMI >27.6) older-adult long-term care (LTC) residents to determine the cause and circumstances of each incident. Comparisons were
S49
made between BMI groups for the initiation, descent and impact stages of the fall. Low- and high-BMI groups did not differ in number of comorbidities, activity type, mobility aid use, attempts to grasp objects, falling direction, landing direction or impacting segments. Underweight fallers utilized larger stepping responses (X2¼8.384, p¼0.039). Overweight fallers were more likely to suffer fall due to tripping or stumbling than underweight fallers (X2¼3.947, p¼0.047). Smaller step responses in overweight fallers may be due to larger limb segment inertia or lower foot-floor clearance, and is less effective for preventing falls. Our results match experimental results and injury patterns reported in literature, with a greater rate of tripping by high-BMI than low-BMI fallers. Tripping falls and smaller step responses could contribute to the generation of larger moments at the ankle prior to impact which may increase ankle injury risk.
P4.17 The Effect of Acute Intermittent Hypoxia, a Simulating Model of Obstructive Sleep Apnea, on Adipose Tissue Lipolysis in Healthy Humans BIMIT MAHAT*, ÉTIENNE CHASSÉ, JEAN-FRANÇOIS MAUGER, PASCAL IMBEAULT University of Ottawa, Ottawa, ON, Canada Background: Obstructive sleep apnea (OSA) consists of repeated, involuntary breathing suspension during sleep. These events induce rapid depletion of blood/tissue oxygen content, phenomenon known as intermittent hypoxia. OSA has been associated with a w2-fold increase in cardiovascular disease (CVD) risk. Recent animal studies demonstrated that acute hypoxia stimulates adipose tissue lipolysis which could lead to ectopic fat storage and increase CVD risk. Whether intermittent hypoxia induces adipose tissue lipolysis in humans remains to be explored. Objectives: Characterize the lipolytic activity of adipocytes isolated from healthy humans acutely exposed to intermittent hypoxia after a meal. Methods: Using a randomized crossover design, healthy men (body fat: 9-19%) were subjected to 6 h of normoxia (21% oxygen, control session) or intermittent hypoxia (pulsed medical nitrogen, simulated OSA session) following the consumption of liquid meal. Subcutaneous abdominal adipose tissue biopsies were performed before and 3 h following the meal in each experimental session. Glycerol release, measured by bioluminescence, was used as an indicator of lipolysis. Results: Oxyhemoglobin desaturation was induced at a rate of 19.7 events/h. Basal and maximal lipolytic responses to isoprenaline (badrenoreceptor (AR) agonist) were significantly reduced in response to the meal in both conditions. Lipolytic responses to isoprenaline after the meal were comparable between control and OSA sessions. The maximal antilipolytic effects of epinephrine (mixed a2/b-AR agonist) or UK- 14304 (a2- AR agonist) after the meal were also comparable between control and OSA sessions. Conclusion: In healthy individuals, acute intermittent hypoxia does not seem to alter lipolytic responses of subcutaneous abdominal adipocytes.
P4.18 Thoughts, Feelings and Food: An Emotional Eating Group Curriculum Offered at the Edmonton Adult Bariatric Specialty Clinic NICOLA I. MICHAUD*, CHARLENE LEMISKI, CARLA DIDUCK, AMY KOBLE, MELLISA LAYMAN, JASON JONES Alberta Health Services, Edmonton, AB, Canada The Edmonton Adult Bariatric Specialty Clinic’s mission is to improve health and quality of life for patients with complex obesity by providing multidisciplinary lifestyle counselling, medical, and