Obesity-associated morbidity

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Obesity-associated morbidity
Medical complications of obesity.png
Obesity has a number of medical complications which negatively impact peoples' quality of life.
SpecialtyEndocrinology(other specialties)
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Obesity is an important risk factor for many chronic physical and mental illnesses. The generally accepted view is that being overweight causes similar health problems to obesity, but to a lesser degree.[1]

Cardiological[]

HeartAttack (Myocardial infarction)

Ischemic heart disease[]

Obesity is associated with cardiovascular diseases including angina and myocardial infarction.[2][3] A 2002 report concluded that 21% of ischemic heart disease is due to obesity[1] while a 2008 European consensus puts the number at 35%.[4]

Congestive heart failure[]

Having obesity is associated to about 11% of heart failure cases in men and 14% in women.[5]

High blood pressure[]

More than 85% of those with hypertension have a BMI greater than 25.[5] The risk of hypertension is 5 times higher in the obese as compared to those of normal weight. A definitive link between obesity and hypertension has been found using animal and clinical studies, which have suggested that there are multiple potential mechanisms for obesity-induced hypertension. These mechanisms include the activation of the sympathetic nervous system as well as the activation of the renin–angiotensin–aldosterone system.[6] The association between hypertension and obesity has been also well described in children.[7]

Abnormal cholesterol levels[]

Obesity is associated with increased LDL cholesterol (bad cholesterol) and lowered HDL cholesterol (good cholesterol).[5][8]

Deep vein thrombosis and pulmonary embolism[]

Obesity increases one's risk of venous thromboembolism by 2.3 fold.[9][10]

Dermatological[]

Obesity is associated with the incidence of stretch marks, acanthosis nigricans, lymphedema, cellulitis, hirsutism, and intertrigo.[11][12]

Endocrine[]

Gynecomastia in an obese male.

Diabetes mellitus[]

One of the strongest links between obesity and disease is that with type 2 diabetes. These two conditions are so strongly linked that researchers in the 1970s started calling it "diabesity".[5] Excess weight is behind 64% of cases of diabetes in men and 77% of cases in women.[13]

Gynecomastia[]

Obesity, according to a 2009 review, can be associated with elevated peripheral conversion of androgens into estrogens in some individuals.[14]


Gastrointestinal[]

Gastroesophageal reflux disease[]

Several studies have shown that the frequency and severity of GERD symptoms are higher in those who are obese.[15][16]

Cholelithiasis (gallstones)[]

According to NIH, obesity causes the amount of cholesterol in bile to rise, in turn the formation of stone can occur [5][17]

Reproductive system (or genital system)[]

Polycystic ovarian syndrome (PCOS)[]

Due to its association with insulin resistance, the risk of obesity increases with polycystic ovarian syndrome (PCOS). In the US approximately 60% of patients with PCOS have a BMI greater than 30. It remains uncertain whether PCOS contributes to obesity, or the reverse.[18]

Infertility[]

Obesity leads to infertility in both men and women. This is primarily due to excess estrogen interfering with normal ovulation in women[5] and altering spermatogenesis in men.[19] It is believed to cause 6% of primary infertility.[5][20] A review in 2013 came to the result that obesity increases the risk of oligospermia and azoospermia in men, with an of odds ratio 1.3.[21] Being morbidly obese increases the odds ratio to 2.0.[21]

Complications of pregnancy[]

Obesity is related to many complications in pregnancy including: haemorrhage, infection, increased hospital stays for the mother, and increased NICU requirements for the infant.[22] Obese women have more than twice the rate of C-sections compared to women of normal weight.[23] Obese women also have increased risk of preterm births and low birth weight infants.[24]

Birth defects[]

Those who are obese during pregnancy have a greater risk of have a child with a number of congenital malformations including: neural tube defects such as anencephaly and spina bifida, cardiovascular anomalies, including septal anomalies, cleft lip and palate, anorectal malformation, limb reduction anomalies, and hydrocephaly.[25]

Intrauterine fetal death[]

Maternal obesity is associated with an increased risk of intrauterine fetal death.[20]

Neurological[]

MCA Territory Infarct (stroke)

Stroke[]

Ischemic stroke is increased in both men and women who are obese.[5]

Meralgia paresthetica[]

Meralgia paresthetica is a neuropathic pain or numbness of the thighs, sometimes associated with obesity.[26]

Migraines[]

Migraine and obesity are comorbid. The risk of migraine rises 50% by BMI of 30 kg/m2 and 100% by BMI of 35 kg/m2.[27] The causal connection remains unclear.[28]

Carpal tunnel syndrome[]

The risk of carpal tunnel syndrome rises 7.4% for each 1 kg/m2 increase of body mass index.[29]

Dementia[]

Those who are obese have a rate of dementia 1.4 times greater than those of normal weight.[30]

Idiopathic intracranial hypertension[]

Idiopathic intracranial hypertension, or unexplained high pressure in the cranium, is a rare condition that can cause visual impairment, frequent severe headache, and tinnitus. It is most commonly seen in obese women.[31][32]

Multiple sclerosis[]

Women that are obese at age 18 have a greater than twofold increased risk of MS.[33]

Cancer (or oncological)[]

Hepatocellular carcinoma 1
Main article: Obesity and cancer

Many cancers occur at increased frequency in those who are overweight or obese. A study from the United Kingdom found that approximately 5% of cancer is due to excess weight.[34] These cancers include: [35]

A high body mass index (BMI) is associated with a higher risk of developing ten common cancers including 41% of uterine cancers and at least 10% of gallbladder, kidney, liver and colon cancers in the UK.[36] For those undergoing surgery for cancer, obesity is also associated with an increased risk of major postoperative complications compared with those of normal weight.[37]

Psychiatric[]

Risk of suicide decreases with increased body mass index in the United States.[38]

Depression[]

Obesity has been associated with depression.[5] The relationship is strongest in those who are more severely obese, those who are younger, and in women.[39] Suicide rate however decreases with increased BMI.[38]

Social stigmatization[]

A 2011 systematic review indicated that obese people draw negative reactions, furthermore people are less willing to help the affected individual in any situation.[40]

Respiratory system[]

Obstructive sleep apnea[]

Obesity is a risk factor for obstructive sleep apnea.[5][41]

Obesity hypoventilation syndrome[]

CPAP machine commonly used in OHS

Obesity hypoventilation syndrome is defined as the combination of obesity, hypoxia during sleep, and hypercapnia during the day, resulting from hypoventilation.[42]

Chronic lung disease[]

Obesity is associated with a number of chronic lung diseases, including asthma and COPD.[41] It is believed that a systemic pro-inflammatory state induced by some causes of obesity may contribute to airway inflammation, leading to asthma.[43]

Complications during general anaesthesia[]

Obesity significantly reduces and stiffens the functional lung volume, requiring specific strategies for respiratory management under general anesthesia.[44]

Obesity and asthma[]

The low grade systemic inflammation of obesity has been show to worsen lung function in asthma and increase the risk of developing an asthma exacerbation.[45]

Rheumatological and orthopedic[]

Gout

Gout[]

Compared to men with a BMI of 21–22.9, men with a BMI of 30–34.9 have 2.33 times more gout, and men with a BMI ≥ 35 have 2.97 times more gout. Weight loss decreases these risks.[46]

Poor mobility[]

There is a strong association between obesity and musculoskeletal pain and disability.[47]

Osteoarthritis[]

Increased rates of arthritis are seen in both weight-bearing and non-weight-bearing joints.[5] Weight loss and exercise act to reduce the risk of osteoarthritis.[48]

Low back pain[]

Obese individuals are twice to four times more likely to have lower back pain than their normal weight peers.[49]

Traumatic injury[]

In women, class II obesity (i.e. BMI = 35) is a risk factor for osteoporotic fractures in general, as well as for upper arm fractures.[50]

Urological and nephrological[]

Urinary system

Urinary incontinence[]

Urge, stress, and mixed incontinence all occur at higher rates in the obese.[51] The rates are about double that found in the normal weight population.[52] Urinary incontinence improves with weight lost.[53]

Chronic kidney disease[]

Obesity increases one's risk of chronic kidney disease by three to four times.[54]

Hypogonadism[]

In men, obesity and metabolic syndrome both increase estrogen and adipokine production. This reduces gonadotropin-releasing hormone, in turn reducing both luteinizing hormone and follicle stimulating hormone. The result is reduction of the testis' production of testosterone and a further increase in adipokine levels. This then feeds back to cause further weight gain.[55]

Erectile dysfunction[]

Obese men can experience erectile dysfunction, (as well as, in association with diabetes), however weight loss causes an improvement in their sexual functioning.[56][57]

See also[]

  • Obesity hypoventilation syndrome

References[]

  1. ^ Jump up to: a b "Obesity and overweight". World Health Organization. Retrieved 2016-05-17.
  2. ^ Poirier P, Giles TD, Bray GA, et al. (May 2006). "Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss". Arteriosclerosis, Thrombosis, and Vascular Biology. 26 (5): 968–76. CiteSeerX 10.1.1.508.7066. doi:10.1161/01.ATV.0000216787.85457.f3. PMID 16627822.
  3. ^ Yusuf S, Hawken S, Ounpuu S, et al. (2004). "Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study". The Lancet. 364 (9438): 937–52. doi:10.1016/S0140-6736(04)17018-9. hdl:10983/21615. PMID 15364185.
  4. ^ Tsigos C, Hainer V, Basdevant A, et al. (2008). "Management of obesity in adults: European clinical practice guidelines". Obes Facts. 1 (2): 106–16. doi:10.1159/000126822. PMC 6452117. PMID 20054170. as PDF Archived 2015-10-17 at the Wayback Machine
  5. ^ Jump up to: a b c d e f g h i j k Haslam DW, James WP (October 2005). "Obesity". Lancet. 366 (9492): 1197–209. doi:10.1016/S0140-6736(05)67483-1. PMID 16198769. – via ScienceDirect (Subscription may be required or content may be available in libraries.)
  6. ^ Rahmouni K, Correia ML, Haynes WG, Mark AL (January 2005). "Obesity-associated hypertension: new insights into mechanisms". Hypertension. 45 (1): 9–14. doi:10.1161/01.HYP.0000151325.83008.b4. PMID 15583075.
  7. ^ Chiolero A, Bovet P, Paradis G, Paccaud F (March 2007). "Has blood pressure increased in children in response to the obesity epidemic?". Pediatrics. 119 (3): 544–53. doi:10.1542/peds.2006-2136. PMID 17332208.
  8. ^ Malnick, S. D. H.; Knobler, H. (2006-09-01). "The medical complications of obesity". QJM. 99 (9): 565–579. doi:10.1093/qjmed/hcl085. ISSN 1460-2725. PMID 16916862.
  9. ^ Ageno W, Becattini C, Brighton T, Selby R, Kamphuisen PW (January 2008). "Cardiovascular risk factors and venous thromboembolism: a meta-analysis". Circulation. 117 (1): 93–102. doi:10.1161/CIRCULATIONAHA.107.709204. PMID 18086925.
  10. ^ Darvall KA, Sam RC, Silverman SH, Bradbury AW, Adam DJ (February 2007). "Obesity and thrombosis". Eur J Vasc Endovasc Surg. 33 (2): 223–33. doi:10.1016/j.ejvs.2006.10.006. PMID 17185009.
  11. ^ Yosipovitch G, DeVore A, Dawn A (June 2007). "Obesity and the skin: skin physiology and skin manifestations of obesity". J. Am. Acad. Dermatol. 56 (6): 901–16, quiz 917–20. doi:10.1016/j.jaad.2006.12.004. PMID 17504714.
  12. ^ Hahler B (June 2006). "An overview of dermatological conditions commonly associated with the obese patient". Ostomy Wound Manage. 52 (6): 34–6, 38, 40 passim. PMID 16799182.
  13. ^ Peter G. Kopelman; Ian D. Caterson; Michael J. Stock; William H. Dietz (2005). Clinical obesity in adults and children: In Adults and Children. Blackwell. p. 493. ISBN 978-1-4051-1672-5.
  14. ^ Johnson, Ruth E.; Murad, M. Hassan (2009-11-01). "Gynecomastia: Pathophysiology, Evaluation, and Management". Mayo Clinic Proceedings. 84 (11): 1010–1015. doi:10.4065/84.11.1010. ISSN 0025-6196. PMC 2770912. PMID 19880691.
  15. ^ Anand G, Katz PO (2008). "Gastroesophageal reflux disease and obesity". Rev Gastroenterol Disord. 8 (4): 233–9. PMID 19107097.
  16. ^ Ayazi S, Hagen JA, Chan LS, et al. (August 2009). "Obesity and gastroesophageal reflux: quantifying the association between body mass index, esophageal acid exposure, and lower esophageal sphincter status in a large series of patients with reflux symptoms". J. Gastrointest. Surg. 13 (8): 1440–7. doi:10.1007/s11605-009-0930-7. PMC 2710497. PMID 19475461.
  17. ^ "Gallstones". www.niddk.nih.gov. Retrieved 13 May 2016.
  18. ^ Samer El Hayek; Lynn Bitar; Layal H. Hamdar; Fadi G. Mirza; Georges Daoud (5 April 2016). "Poly Cystic Ovarian Syndrome: An Updated Overview". Frontiers in Physiology. 7: 124. doi:10.3389/fphys.2016.00124. PMC 4820451. PMID 27092084.
  19. ^ Hammoud AO, Gibson M, Peterson CM, Meikle AW, Carrell DT (October 2008). "Impact of male obesity on infertility: a critical review of the current literature". Fertil. Steril. 90 (4): 897–904. doi:10.1016/j.fertnstert.2008.08.026. PMID 18929048.
  20. ^ Jump up to: a b Arendas K, Qiu Q, Gruslin A (June 2008). "Obesity in pregnancy: pre-conceptional to postpartum consequences". J Obstet Gynaecol Can. 30 (6): 477–88. doi:10.1016/s1701-2163(16)32863-8. PMID 18611299.
  21. ^ Jump up to: a b [1] Sermondade, N.; Faure, C.; Fezeu, L.; et al. (2012). "BMI in relation to sperm count: An updated systematic review and collaborative meta-analysis". Human Reproduction Update. 19 (3): 221–231. doi:10.1093/humupd/dms050. PMC 3621293. PMID 23242914.
  22. ^ Heslehurst N, Simpson H, Ells LJ, et al. (November 2008). "The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis". Obes Rev. 9 (6): 635–83. doi:10.1111/j.1467-789X.2008.00511.x. PMID 18673307. Archived from the original on 2019-04-01. Retrieved 2018-11-07.
  23. ^ Poobalan AS, Aucott LS, Gurung T, Smith WC, Bhattacharya S (January 2009). "Obesity as an independent risk factor for elective and emergency caesarean delivery in nulliparous women--systematic review and meta-analysis of cohort studies". Obes Rev. 10 (1): 28–35. doi:10.1111/j.1467-789X.2008.00537.x. PMID 19021871.
  24. ^ McDonald SD, Han Z, Mulla S, Beyene J (2010). "Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses". BMJ. 341: c3428. doi:10.1136/bmj.c3428. PMC 2907482. PMID 20647282.
  25. ^ Stothard KJ, Tennant PW, Bell R, Rankin J (February 2009). "Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis". JAMA. 301 (6): 636–50. doi:10.1001/jama.2009.113. PMID 19211471.
  26. ^ Patijn J, Mekhail N, Hayek S, Lataster A, van Kleef M, Van Zundert J (May–June 2011). "Meralgia Paresthetica". Pain Practice. 11 (3): 302–8. doi:10.1111/j.1533-2500.2011.00458.x. PMID 21435164.
  27. ^ Chai NC, Scher AI, Moghekar A, Bond DS, Peterlin BL (February 2014). "Obesity and headache: part I--a systematic review of the epidemiology of obesity and headache". Headache. 54 (2): 219–34. doi:10.1111/head.12296. PMC 3971380. PMID 24512574.
  28. ^ Peterlin BL, Sacco S, Bernecker C, Scher AI (April 2016). "Adipokines and Migraine: A Systematic Review". Headache. 56 (4): 622–44. doi:10.1111/head.12788. PMC 4836978. PMID 27012149.
  29. ^ Shiri R, Pourmemari MH, Falah-Hassani K, Viikari-Juntura E (December 2015). "The effect of excess body mass on the risk of carpal tunnel syndrome: a meta-analysis of 58 studies". Obesity Reviews. 16 (12): 1094–104. doi:10.1111/obr.12324. PMID 26395787.
  30. ^ Beydoun MA, Beydoun HA, Wang Y (May 2008). "Obesity and central obesity as risk factors for incident dementia and its subtypes: A systematic review and meta-analysis". Obes Rev. 9 (3): 204–18. doi:10.1111/j.1467-789X.2008.00473.x. PMC 4887143. PMID 18331422.
  31. ^ Wall M (March 2008). "Idiopathic intracranial hypertension (pseudotumor cerebri)". Curr Neurol Neurosci Rep. 8 (2): 87–93. doi:10.1007/s11910-008-0015-0. PMID 18460275.
  32. ^ Julayanont P, Karukote A, Ruthirago D, Panikkath D, Panikkath R (19 February 2016). "Idiopathic intracranial hypertension: ongoing clinical challenges and future prospects". Journal of Pain Research. 9: 87–99. doi:10.2147/JPR.S60633. PMC 4767055. PMID 26929666.
  33. ^ Munger KL, Chitnis T, Ascherio A (2009). "Body size and risk of MS in two cohorts of US women". Neurology. 73 (19): 1543–50. doi:10.1212/WNL.0b013e3181c0d6e0. PMC 2777074. PMID 19901245.
  34. ^ Reeves GK, Pirie K, Beral V, Green J, Spencer E, Bull D (2016). "Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study". BMJ. 335 (7630): 1134. doi:10.1136/bmj.39367.495995.AE. PMC 2099519. PMID 17986716.
  35. ^ Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (April 2003). "Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults". N. Engl. J. Med. 348 (17): 1625–38. doi:10.1056/NEJMoa021423. PMID 12711737.
  36. ^ Lyford, Joanna (August 2014). "Rising obesity levels in UK could result in 4,000 extra cancer cases each year". The Pharmaceutical Journal.
  37. ^ STARSurg (2016). "Multicentre prospective cohort study of body mass index and postoperative complications following gastrointestinal surgery". BJS. 103 (9): 1157–1172. doi:10.1002/bjs.10203. PMC 4973675. PMID 27321766.
  38. ^ Jump up to: a b Mukamal KJ, Rimm EB, Kawachi I, O'Reilly EJ, Calle EE, Miller M (November 2009). "Body Mass Index and Risk of Suicide Among One Million US Adults". Epidemiology. 21 (1): 82–6. doi:10.1097/EDE.0b013e3181c1fa2d. PMID 19907331.
  39. ^ Dixon JB, Dixon ME, O'Brien PE (September 2003). "Depression in association with severe obesity: changes with weight loss". Arch. Intern. Med. 163 (17): 2058–65. doi:10.1001/archinte.163.17.2058. PMID 14504119.
  40. ^ Sikorski, Claudia; Luppa, Melanie; Kaiser, Marie; Glaesmer, Heide; Schomerus, Georg; König, Hans-Helmut; Riedel-Heller, Steffi G (2011-08-23). "The stigma of obesity in the general public and its implications for public health - a systematic review". BMC Public Health. 11: 661. doi:10.1186/1471-2458-11-661. ISSN 1471-2458. PMC 3175190. PMID 21859493.
  41. ^ Jump up to: a b Poulain M, Doucet M, Major GC, et al. (April 2006). "The effect of obesity on chronic respiratory diseases: pathophysiology and therapeutic strategies". CMAJ. 174 (9): 1293–9. doi:10.1503/cmaj.051299. PMC 1435949. PMID 16636330.
  42. ^ Olson, Amy L.; Zwillich, Clifford (2005-09-01). "The obesity hypoventilation syndrome". The American Journal of Medicine. 118 (9): 948–956. doi:10.1016/j.amjmed.2005.03.042. ISSN 0002-9343. PMID 16164877. – via ScienceDirect (Subscription may be required or content may be available in libraries.)
  43. ^ Sutherland ER (August 2008). "Obesity and asthma". Immunol Allergy Clin North Am. 28 (3): 589–602, ix. doi:10.1016/j.iac.2008.03.003. PMC 2504765. PMID 18572109.
  44. ^ Hodgson LE, Murphy PB, Hart N (May 2015). "Respiratory management of the obese patient undergoing surgery". Journal of Thoracic Disease. 7 (5): 943–52. doi:10.3978/j.issn.2072-1439.2015.03.08. PMC 4454851. PMID 26101653.
  45. ^ Peters, Michael C; McGrath, Kelly Wong; Hawkins, Gregory A; Hastie, Annette T; Levy, Bruce D; Israel, Elliot; Phillips, Brenda R; Mauger, David T; Comhair, Suzy A; Erzurum, Serpil C; Johansson, Mats W; Jarjour, Nizar N; Coverstone, Andrea M; Castro, Mario; Holguin, Fernando; Wenzel, Sally E; Woodruff, Prescott G; Bleecker, Eugene R; Fahy, John V (July 2016). "Plasma interleukin-6 concentrations, metabolic dysfunction, and asthma severity: a cross-sectional analysis of two cohorts". The Lancet Respiratory Medicine. 4 (7): 574–584. doi:10.1016/S2213-2600(16)30048-0. PMC 5007068. PMID 27283230.
  46. ^ Choi HK, Atkinson K, Karlson EW, Curhan G (April 2005). "Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study". Arch. Intern. Med. 165 (7): 742–8. doi:10.1001/archinte.165.7.742. PMID 15824292.
  47. ^ Tukker A, Visscher T, Picavet H (April 2008). "Overweight and health problems of the lower extremities: osteoarthritis, pain and disability". Public Health Nutr. 12 (3): 359–68. doi:10.1017/S1368980008002103. PMID 18426630.
  48. ^ Yu SP, Hunter DJ (August 2015). "Managing osteoarthritis". Australian Prescriber. 38 (4): 115–9. doi:10.18773/austprescr.2015.039. PMC 4653978. PMID 26648637.
  49. ^ Molenaar EA, Numans ME, van Ameijden EJ, Grobbee DE (November 2008). "[Considerable comorbidity in overweight adults: results from the Utrecht Health Project]". Ned Tijdschr Geneeskd (in Dutch). 152 (45): 2457–63. PMID 19051798.
  50. ^ Johansson, Helena; Kanis, John A; Odén, Anders; McCloskey, Eugene; Chapurlat, Roland D; Christiansen, Claus; Cummings, Steve R; Diez-Perez, Adolfo; Eisman, John A; Fujiwara, Saeko; Glüer, Claus-C; Goltzman, David; Hans, Didier; Khaw, Kay-Tee; Krieg, Marc-Antoine; Kröger, Heikki; LaCroix, Andrea Z; Lau, Edith; Leslie, William D; Mellström, Dan; Melton, L Joseph; O'Neill, Terence W; Pasco, Julie A; Prior, Jerilynn C; Reid, David M; Rivadeneira, Fernando; van Staa, Tjerd; Yoshimura, Noriko; Zillikens, M Carola (January 2014). "A Meta-Analysis of the Association of Fracture Risk and Body Mass Index in Women". Journal of Bone and Mineral Research. 29 (1): 223–233. doi:10.1002/jbmr.2017. PMID 23775829.
  51. ^ Hunskaar S (2008). "A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women". Neurourol. Urodyn. 27 (8): 749–57. doi:10.1002/nau.20635. PMID 18951445.
  52. ^ Bart S, Ciangura C, Thibault F, et al. (September 2008). "[Stress urinary incontinence and obesity]". Prog. Urol. (in French). 18 (8): 493–8. doi:10.1016/j.purol.2008.04.015. PMID 18760738.
  53. ^ Subak LL, Wing R, West DS, et al. (January 2009). "Weight loss to treat urinary incontinence in overweight and obese women". N. Engl. J. Med. 360 (5): 481–90. doi:10.1056/NEJMoa0806375. PMC 2877497. PMID 19179316.
  54. ^ Ejerblad E, Fored CM, Lindblad P, Fryzek J, McLaughlin JK, Nyrén O (2006). "Obesity and risk for chronic renal failure". J. Am. Soc. Nephrol. 17 (6): 1695–702. doi:10.1681/ASN.2005060638. PMID 16641153.
  55. ^ Corona G, Bianchini S, Sforza A, Vignozzi L, Maggi M (October 2015). "Hypogonadism as a possible link between metabolic diseases and erectile dysfunction in aging men". Hormones (Athens). 14 (4): 569–78. doi:10.14310/horm.2002.1635. PMID 26732155.
  56. ^ Corona, Giovanni; Rastrelli, Giulia; Filippi, Sandra; Vignozzi, Linda; Mannucci, Edoardo; Maggi, Mario (2014-01-01). "Erectile dysfunction and central obesity: an Italian perspective". Asian Journal of Andrology. 16 (4): 581–591. doi:10.4103/1008-682X.126386. ISSN 1008-682X. PMC 4104087. PMID 24713832.
  57. ^ Chitaley, Kanchan; Kupelian, Varant; Subak, Leslee; Wessells, Hunter (2009-12-01). "Diabetes, Obesity and Erectile Dysfunction: Field Overview and Research Priorities". The Journal of Urology. 182 (6 Suppl): S45–S50. doi:10.1016/j.juro.2009.07.089. ISSN 0022-5347. PMC 2864637. PMID 19846136.

Further reading[]

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