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Intra‐abdominal pressure, sagittal abdominal diameter and obesity comorbidity
Open accessAbstract
Objectives. To determine relationship of intraabdominal pressure to central obesity and the comorbidity of obesity. Design. Non‐randomized, prospective. Setting. University hospital, operating room. Subjects. Eighty‐four anaesthetized consecutive patients prior to gastric bypass for morbid obesity and five non‐obese patients before colectomy for ulcerative colitis. Main outcome measures. Weight, body mass index (BMI), co‐morbid history, sagittal abdominal diameter, waist:hip (W∶H) ratio and urinary bladder pressure, as an estimate of intra‐abdominal pressure. Results. Urinary bladder pressure was greater in the obese than the non‐obese (18±0.7 vs. 7±1.6 cm H 2 O, P < 0.001), correlated with sagittal abdominal diameter (r = +0.67, P < 0.001) and was greater (P < 0.05) in patients with, than those without, morbidity probably (hypoventilation, gastroesophageal reflux, venous stasis, stress incontinence, incisional hernia) or possibly (hypertension, diabetes) due to increased abdominal pressure. W∶H ratio correlated with urinary bladder pressure in men (r = +0.6, P < 0.05) but not women (r = −0.3). Conclusions. Increased sagittal abdominal diameter was associated with increased intraabdominal pressure which contributed to obesity‐related comorbidity. W∶H ratio was not a reliable indicator of intraabdominal pressure for women who often have both peripheral and central obesity. Further studies are needed to evaluate the relationship between intraabdominal pressure and Type II diabetes and hypertension.
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“In patients with visceral obesity, intra-abdominal pressure rises in proportion to sagittal abdominal diameter, reaching levels as high as 35–40 mmHg27.”
From Obesity-Induced Hypertension: Interaction of Neurohumoral and Renal Mechanisms (2015) · cites this paper as [27]
Experimental — accuracy not yet measuredIn the citing paper
“Pressure in the abdominal cavity may be elevated to >40 cm H20 in patients with large sagittal abdominal diameters52.”
From Obesity, kidney dysfunction and hypertension: mechanistic links (2019) · cites this paper as [52]
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Obesity-hypertension: an ongoing pandemic
Francischetti, E. A., & Genelhu, V. A. (2007) · International Journal of Clinical Practice · doi:10.1111/j.1742-1241.2006.01262.x · Cited by 130
Obesity and Pelvic Floor Disorders
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Urinary and Anal Incontinence in Morbidly Obese Women Considering Weight Loss Surgery
Richter, H. E., Burgio, K. L., Clements, R. H., Goode, P. S., Redden, D. T., & Varner, R. E. (2005) · Obstetrics and Gynecology · doi:10.1097/01.aog.0000187299.75024.c4 · Cited by 122
Abdominal compartment syndrome.
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“Abdominal decompression and weight loss via bariatric surgery have been shown to reverse benign ICP associated with IAH [9,27].”
BackgroundNguyen, N. T., Perez, R. V., Fleming, N., et al. (2002) · Journal of the American College of Surgeons · doi:10.1016/s1072-7515(02)01321-2 · Cited by 122
Correlations between intra-abdominal pressure and obesity-related co-morbidities
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Paolini, J.-B. M., Mancini, J., Genestal, M., Gonzalez, H., McKay, R. E., Samii, K., & Fourcade, O. A. (2010) · Critical Care Medicine · doi:10.1097/ccm.0b013e3181d8cd8b · Cited by 113
“Some authors have shown that a high SAD is associated with a higher urinary bladder pressure, which could predispose to the acute compartment syndrome (44).”
BackgroundLong‐term Results of Polyglactin Mesh for the Prevention of Incisional Hernias in Obese Patients
Pans, A., Elen, P., Dewé, W., et al. (1998) · World Journal of Surgery · doi:10.1007/s002689900420 · Cited by 112
Venous Hypertension, Inflammation and Valve Remodeling
Takase, S., Pascarella, L., Lerond, L., Bergan, J. J., & Schmid-Schönbein, G. W. (2004) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2004.05.012 · Cited by 111
Surveyed Opinion of American Trauma Surgeons on the Prevention of the Abdominal Compartment Syndrome
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BMI, Waist Circumference, and Incident Urinary Incontinence in Older Women
Townsend, M. K., Curhan, G. C., Resnick, N. M., & Grodstein, F. (2008) · Obesity · doi:10.1038/oby.2008.14 · Cited by 111
Malbrain, M. L. N. G., laet, I. D., & Cheatham, M. L. (2007) · Acta Clinica Belgica · doi:10.1179/acb.2007.62.s1.007 · Cited by 110
“For example, it has been demonstrated that increased sagittal abdominal diameter in morbidly obese patients is associated with elevated IAP in the absence of other signifi cant pathophysiology (17).”
BackgroundElevated Body Mass Disrupts the Barrier to Gastroesophageal Reflux
Wajed, S. (2001) · Archives of Surgery · doi:10.1001/archsurg.136.9.1014 · Cited by 109
“Obese individuals have a higher intra-abdominal resting pressure, and this relates to the sagittal abdominal diameter.(14) Excess fat deposition in and around abdominal viscera, in addition to elevating intra-abdominal pressure, may interfere with and delay gastric emptying.”
BackgroundIntra-abdominal hypertension and the abdominal compartment syndrome
MOORE, A., Hargest, R., Martin, M., et al. (2004) · British journal of surgery · doi:10.1002/bjs.4703 · Cited by 108
Surgical Management of Obesity: A Review of the Evidence Relating to the Health Benefits and Risks
Lara, M. D., Kothari, S. N., & Sugerman, H. J. (2005) · Treatments in Endocrinology · doi:10.2165/00024677-200504010-00006 · Cited by 107
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Exploring the pathogenesis of IIH: An inflammatory perspective
Sinclair, A. J., Ball, A. K., Burdon, M., Clarke, C. E., Stewart, P. M., Curnow, J., & Rauz, S. (2008) · Journal of Neuroimmunology · doi:10.1016/j.jneuroim.2008.06.029 · Cited by 107
“This theory does not explain why despite ubiquitous elevation of intra-abdominal pressure in obese patients (Sugerman et al., 1997; Whiteley et al., 2006), only a small proportion of patients develop IIH.”
BackgroundThe polycompartment syndrome: a concise state-of-the-art review
Malbrain, M. L. N. G., Roberts, D. J., Sugrue, M., Keulenaer, B. L. D., Ivatury, R. R., Pelosi, P. P., Verbrugge, F. H., Wise, R., & Müllens, W. (2014) · Anestezjologia, Intensywna Terapia · doi:10.5603/ait.2014.0064 · Cited by 103
Obesity and lower limb venous disease – The epidemic of phlebesity
Davies, H., Popplewell, M. A., Singhal, R., Smith, N., & Bradbury, A. W. (2016) · Phlebology The Journal of Venous Disease · doi:10.1177/0268355516649333 · Cited by 102
Venous thromboembolism has the same risk factors as atherosclerosis
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Increased Intraabdominal Pressure in Abdominoplasty: Delineation of Risk Factors
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Abdominal pressure in the critically ill
Malbrain, M. L. N. G. (2000) · Current Opinion in Critical Care · doi:10.1097/00075198-200002000-00003 · Cited by 97
Bariatric surgery and progression of chronic kidney disease
Navaneethan, S. D., & Yehnert, H. (2009) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2009.01.006 · Cited by 100
Menzo, E. L., Hinojosa, M. W., Carbonell, A. M., Krpata, D. M., Carter, J. T., & Rogers, A. M. (2018) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2018.07.005 · Cited by 98
Clinical Approach to the Critically Ill, Morbidly Obese Patient
El-Solh, A. (2004) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200309-1256cc · Cited by 98
“Multiple trauma, massive hemorrhage, and protracted surgical operations with extraordinary volume resuscitation are the situations in which this syndrome is most frequently encountered (24).”
BackgroundAbdominal compartment syndrome in the intensive care unit
Morken, J. J., & West, M. A. (2001) · Current Opinion in Critical Care · doi:10.1097/00075198-200108000-00010 · Cited by 98
Malbrain, M. L. N. G., laet, I. D., Waele, J. J. D., et al. (2014) · Anestezjologia, Intensywna Terapia · doi:10.5603/ait.2014.0063 · Cited by 95
Multisystem organ failure secondary to increased intraabdominal pressure
Sugerman, H. J., Bloomfield, G. L., & Saggi, B. (1999) · Infection · doi:10.1007/bf02565176 · Cited by 94
Self-citationIntra-Abdominal Hypertension: Evolving Concepts
Malbrain, M. L. N. G., & laet, I. E. D. (2009) · Clinics in Chest Medicine · doi:10.1016/j.ccm.2008.09.003 · Cited by 88
Obesity and Stress Urinary Incontinence: Impact on Pathophysiology and Treatment
Fuselier, A., Hanberry, J., Lovin, J. M., & Gomelsky, A. (2018) · Current Urology Reports · doi:10.1007/s11934-018-0762-7 · Cited by 89
RATIONAL INTRAABDOMINAL PRESSURE MONITORING: HOW TO DO IT?
Waele, J. J. D., laet, I. D., & Malbrain, M. L. N. G. (2007) · Acta Clinica Belgica · doi:10.1179/acb.2007.62.s1.004 · Cited by 86
“Related to diminished abdominal wall compliance − Mechanical ventilation, especially fi ghting with the ventilator and the use of accessory muscles (47, 48) − Use of positive end expiratory pressure (PEEP) or the presence of auto-PEEP (49-51) − Basal pleuroneumonia − High body mass index (40, 52-55) − Pneumoperitoneum…”
BackgroundThe neglected role of abdominal compliance in organ-organ interactions
Malbrain, M. L. N. G., Peeters, Y., & Wise, R. (2016) · Critical Care · doi:10.1186/s13054-016-1220-x · Cited by 86
“Morbidly obese patients with an android (mainly visceral and sphere shaped) fat distribution have a limited reserve to accommodate excess IAV than those patients who, for a similar BMI or abdominal perimeter, have a gynoid (mainly subcutaneous and ellipse shaped) fat distribution [17, 29].”
BackgroundThe Effect of Obesity Surgery on Obesity Comorbidity
Bouldin, M. J., Ross, L. A., Sumrall, C. D., Loustalot, F. V., Low, A. K., & Land, K. K. (2006) · The American Journal of the Medical Sciences · doi:10.1097/00000441-200604000-00004 · Cited by 84
Malbrain, M., Roberts, D., Laet, I. D. D., Waele, J. D., Sugrue, M., Schachtrupp, A., Duchesne, J., van Ramshorst, G. V., Keulenaer, B. D. D., Kirkpatrick, A., et al. (2014) · Anaesthesiology Intensive Therapy · doi:10.5603/ait.2014.0062 · Cited by 73
Regueira, T., Bruhn, A., Hasbun, P., Aguirre, M., Romero, C., Llanos, O., Castro, R., Bugedo, G., & Hernandez, G. (2008) · Journal of Critical Care · doi:10.1016/j.jcrc.2007.12.013 · Cited by 84
“Previous studies on IAH have focused mainly on trauma [14-16], surgical [17-19], burned [20], and obese [16] patients, and an elevated prevalence of IAH has also been reported in sepsis [21].”
BackgroundSleep and Nocturnal Gastroesophageal Reflux
Lim, K. G., Morgenthaler, T. I., & Katzka, D. A. (2018) · CHEST Journal · doi:10.1016/j.chest.2018.05.030 · Cited by 84
El-Atat, F. A., Aneja, A., McFarlane, S. I., & Sowers, J. R. (2003) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/s0889-8529(03)00070-7 · Cited by 83
Carlsson, L. M. S., Romeo, S., Jacobson, P., Burza, M. A., Maglio, C., Sjöholm, K., Svensson, P., Haraldsson, B. S., Peltonen, M., & Sjöström, L. (2014) · International Journal of Obesity · doi:10.1038/ijo.2014.72 · Cited by 83
Zaidi, E., & Daly, B. (2006) · American Journal of Roentgenology · doi:10.2214/ajr.05.0033 · Cited by 81
“This measurement has been used as an index of abdominal obesity in prior studies [14–16].”
MethodBlaser, A. R., Björck, M., Keulenaer, B. L. D., & Regli, A. (2015) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/ta.0000000000000616 · Cited by 79
“Monitoring of IAP at the time of abdominal closure and in the first days after abdominal closure is advisable in patients with decreased AC.”
BackgroundInfluential
Metadata
- Authors
- SUGERMAN, H., WINDSOR, A., BESSOS, M., & WOLFE, L.
- Affiliations
- Virginia Commonwealth University (US)
- Corresponding author
- SUGERMAN, H.
- ORCID
- WINDSOR, A.
- Venue
- Journal of Internal Medicine
- Publisher
- Wiley
- Published
- 1997-01
- Volume
- 241
- Issue
- 1
- Pages
- 71-79
- ISSN
- 0954-6820 (ISSN-L)
- 1365-2796
- OpenAlex
- W1976707172
- Cited by
- 486
- References
- 0
- Citations by year
- 2026: 8 · 2025: 9 · 2024: 13 · 2023: 15 · 2022: 9 · 2021: 25 · 2020: 14 · 2019: 16 · 2018: 19 · 2017: 18 · 2016: 20 · 2015: 30 · 2014: 19 · 2013: 16 · 2012: 21
- FWCI
- 11.11
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Abdominal Surgery and Complications
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- intra-abdominal pressure, sagittal abdominal diameter, obesity-related comorbidities, abdominal obesity, bladder pressure, waist-to-hip ratio, morbid obesity, gastric bypass, ulcerative colitis, colectomy, obesity-related morbidity, sex differences
- MeSH terms
- Abdomen, Adult, Urinary Bladder, Female, Humans, Male, Obesity, Morbid, Prospective Studies
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