\\n\\n
Dr. Pletser’s experience includes 30 years of working with the European Space Agency as a Senior Physicist/Engineer and coordinating their parabolic flight campaigns, and he is the Guinness World Record holder for the most number of aircraft flown (12) in parabolas, personally logging more than 7,300 parabolas.
\\n\\nSeeing the 5,000th book published makes us at the same time proud, happy, humble, and grateful. This is a great opportunity to stop and celebrate what we have done so far, but is also an opportunity to engage even more, grow, and succeed. It wouldn't be possible to get here without the synergy of team members’ hard work and authors and editors who devote time and their expertise into Open Access book publishing with us.
\\n\\nOver these years, we have gone from pioneering the scientific Open Access book publishing field to being the world’s largest Open Access book publisher. Nonetheless, our vision has remained the same: to meet the challenges of making relevant knowledge available to the worldwide community under the Open Access model.
\\n\\nWe are excited about the present, and we look forward to sharing many more successes in the future.
\\n\\nThank you all for being part of the journey. 5,000 times thank you!
\\n\\nNow with 5,000 titles available Open Access, which one will you read next?
\\n\\nRead, share and download for free: https://www.intechopen.com/books
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'
Preparation of Space Experiments edited by international leading expert Dr. Vladimir Pletser, Director of Space Training Operations at Blue Abyss is the 5,000th Open Access book published by IntechOpen and our milestone publication!
\n\n"This book presents some of the current trends in space microgravity research. The eleven chapters introduce various facets of space research in physical sciences, human physiology and technology developed using the microgravity environment not only to improve our fundamental understanding in these domains but also to adapt this new knowledge for application on earth." says the editor. Listen what else Dr. Pletser has to say...
\n\n\n\nDr. Pletser’s experience includes 30 years of working with the European Space Agency as a Senior Physicist/Engineer and coordinating their parabolic flight campaigns, and he is the Guinness World Record holder for the most number of aircraft flown (12) in parabolas, personally logging more than 7,300 parabolas.
\n\nSeeing the 5,000th book published makes us at the same time proud, happy, humble, and grateful. This is a great opportunity to stop and celebrate what we have done so far, but is also an opportunity to engage even more, grow, and succeed. It wouldn't be possible to get here without the synergy of team members’ hard work and authors and editors who devote time and their expertise into Open Access book publishing with us.
\n\nOver these years, we have gone from pioneering the scientific Open Access book publishing field to being the world’s largest Open Access book publisher. Nonetheless, our vision has remained the same: to meet the challenges of making relevant knowledge available to the worldwide community under the Open Access model.
\n\nWe are excited about the present, and we look forward to sharing many more successes in the future.
\n\nThank you all for being part of the journey. 5,000 times thank you!
\n\nNow with 5,000 titles available Open Access, which one will you read next?
\n\nRead, share and download for free: https://www.intechopen.com/books
\n\n\n\n
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\r\n\tThe ocular hypertension represents one of the most important threats to the vision. Neurological damages induced by an alteration of the production and the outcome of aqueous humour determine symptoms only in the advanced stages of the disease, when it is very difficult to manage the disease. For this reason it is important to know the overall factors involved in the onset of this problem and how to handle all the device (more or less recently introduced) able to provide a diagnosis, to be able to select the proper treatment for the patient. It is important, in fact, to always remember that eye doctors are looking at patients and not just eye disease, so it is mandatory to have a broader point of view to select the appropriate treatment.
\r\n\r\n\tThe purpose of this book is to provide the readers insight into this very important disease.
",isbn:"978-1-83969-338-0",printIsbn:"978-1-83969-337-3",pdfIsbn:"978-1-83969-339-7",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,hash:"0ff71cc7e0d9f394f41162c0c825588a",bookSignature:"Prof. Michele Lanza",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/10343.jpg",keywords:"Ciliary Body, Intraocular Pressure, Trabecular Meshwork, Intraocular Pressure Measurements, Diagnosis, Drugs, Prostaglandin, Beta-Blockers, Alfa-Agonists, Surgical Treatment, Laser, Neuroprotective Therapy",numberOfDownloads:49,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"November 17th 2020",dateEndSecondStepPublish:"February 23rd 2021",dateEndThirdStepPublish:"April 24th 2021",dateEndFourthStepPublish:"July 13th 2021",dateEndFifthStepPublish:"September 11th 2021",remainingDaysToSecondStep:"2 months",secondStepPassed:!0,currentStepOfPublishingProcess:3,editedByType:null,kuFlag:!1,biosketch:"Associate Professor in Ophthalmology at Università della Campania, Luigi Vanvitelli, and an extraordinary researcher active in every aspect of anterior eye disease.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"240088",title:"Prof.",name:"Michele",middleName:null,surname:"Lanza",slug:"michele-lanza",fullName:"Michele Lanza",profilePictureURL:"https://mts.intechopen.com/storage/users/240088/images/system/240088.jpg",biography:"Michele Lanza was born in Avellino on 28/10/1976. After graduating in Medicine and Surgery at Medical School of Seconda Università di Napoli, he started the residency program in Ophthalmology in 2001. Today he is an Associate Professor in Ophthalmology at Università della Campania, Luigi Vanvitelli. His field of interest are anterior segment disease, keratoconus, glaucoma, corneal distrophies, and cataract. His research field are related to IOL power calculation, eye modification induced by refractive surgery, glaucoma progression, and validation of new diagnostic devices in Ophthalmology.",institutionString:'University of Campania "Luigi Vanvitelli"',position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:'University of Campania "Luigi Vanvitelli"',institutionURL:null,country:{name:"Italy"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"16",title:"Medicine",slug:"medicine"}],chapters:[{id:"75503",title:"Ocular Hypertension in Blacks",slug:"ocular-hypertension-in-blacks",totalDownloads:26,totalCrossrefCites:0,authors:[null]},{id:"75044",title:"Neuropathology in Hypertensive Glaucoma",slug:"neuropathology-in-hypertensive-glaucoma",totalDownloads:24,totalCrossrefCites:0,authors:[null]}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"259492",firstName:"Sara",lastName:"Gojević-Zrnić",middleName:null,title:"Mrs.",imageUrl:"https://mts.intechopen.com/storage/users/259492/images/7469_n.png",email:"sara.p@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. 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The medial crura function as pillars founded on the footplates.
The posterior 5–6 mm of the medial crura, which course laterally and often posteriorly, are called the footplates, and play a major role in the aesthetics of the nasal tip and therefore in rhinoplasty. The distance between the footplates ranges from 7.5 to 15 mm, the average being 11.4 mm.
Should the patient exhibit an overprojected tip, the result will be a divergent footplate (Fig. 1).
Anatomy of the lateral inferior cartilages with its portions, measures of its footplates (5–6 mm), normal distance between them (7.5–15 mm), and divergent lower lateral cartilages.
The columella is a relatively complex anatomical structure that is located in the nasal base between the nostrils. It is made of crura, muscle, skin, and soft tissue and does not only provide support to the nose but it is also an aesthetic component of great importance.
At the base of the columella the footplates protrude laterally giving amplitude to then adapt at the level of the medial crura. Deformities of the lower lateral cartilages lead to untoward aesthetics and functionality of the nostril and columella.
The ideal nostril possesses a teardrop shape with a long axis extending from the base to the apex. There is slight medial tilt of the long axis toward the midline (Fig. 2).
Nasal base which shows the columella, its cartilaginous structures, and the nostrils normal shape.
The columella shows a vast variety of deformities, anomalities, and variations that can result from genetic factors, trauma, altered growth, previous surgeries, or infections.The analysis of the deformity and its pathogenesis is of great importance as it will determine the surgical technique to follow.
In this article, we will focus on increasing the width of the columella as a result of one or both footplates being asymmetric in length, conformation (abnormally folded), and/or too separated and consequently protruding through the skin into the nasal vestibule. These entities may exist alone or in combination.
Anatomical alterations of the columella compromise the aesthetics of the nostrils and potentially its function, which is why the intimate relationship between nasal anatomy and physiology is crucial in rhinoplasty.
It is important to highlight that the ventilation can be affected especially when this alteration is combined with a narrow nostril, deviation or subluxation of the caudal portion of the nasal septum. A simple and effective method to evaluate this is the
It consists of narrowing the lower third of the columella with bayonet forceps, this way we open the external nasal valve and ask the patient if this maneuver improves nasal ventilation (Fig. 3).
It can be observed how the base of the columella is narrowed by the bayonet forceps to evaluate if throughout this maneuver we generate any repercussion on the nasal ventilation (Nostril Test).
The causes that create an increase in the width of the columella can be divided into primary and secondary causes.
Divergent alar cartilages associated with an excessive amount of soft tissue between the two intermediate pillars and footplates (Fig. 4a, b).
Asymmetrical footplates in size and/or shape (retracted) (Figs. 5a, b).
a, b) It can be observed how the columella widens symmetrically when both side pillars are divergent.
a, b) It can be observed how the columella widens asymmetrically at the expense of a longer and/or more bended lateral pillar.
The deviation of the caudal portion of the nasal septum can displace the footplate of the alar cartilage and widen the columella (Fig. 6a, b).
The deviation of the nasal spine can produce a deviated nasal septum and a displacement of the footplate of the alar cartilage and widen the columella (Fig. 7a, b).
a, b) Deviation of the caudal portion of the nasal septum that produces a displacement of the footplate of the alar cartilage widening the columella.
a, b) Deviation of the nasal spine that causes a slight deviation of the nasal septum, displacing the footplate of the alar cartilage, widening the columella.
In such cases, during surgery and with the individualization of the involved structures, the footplates of the alar cartilages tend to return to its usual position; however, the main pathology needs to be treated (septal deviation and/or nasal spine) and afterward the footplates of the alar cartilages have to be approximated by a stitch of transfixion.
The suture between the feet of the lower lateral cartilages not only closes but stretches the base of the columella and improves the shape of the nostrils.
The lower lateral cartilages are the main suppliers of structural support of the nasal tip; therefore, any excess, shortfall, or alteration will directly affect not only the shape but also the position of the nasal tip.
It is important to note that the approximation of the footplates through sutures will not only produce the desired changes but will also trigger unwanted effects, if a thorough preoperative evaluation of the nose was not fully performed.
When suturing the footplates of the alar cartilages to approximate them, as mentioned above, we narrow the columella and improve the shape of the nostril; if there is a lot of soft tissue between them, a slight forward flow of the base of the columella (Fig. 8) will occur. Removing soft tissue between the footplates and the medial pillars before making the suture prevents such further protuberance on the columella when looking at the profile.
The dotted lines show the forward flow of the base of the columella after approximating the footplates of the alar cartilages by a stitch of transfixion.
a, b) It is observed how the columella is refined and how the shape of the nostrils is improved through a transfixion stitch but also the nasal tip is slightly projected.
The approximation of the footplates will produce an increase of the tip projection, which means a positive effect if we have either a hypoprojected or normoprojected nose, but this is not a good suggestion if we are in presence of a hyperprojected nose (Fig. 9a,b), in which case you can resect a portion of the footplates and bring them closer with a stitch of transfixion.
We infiltrate the membranous septum with 2% lidocaine with epinephrine 1:50,000; this way we produce analgesia, vasoconstriction, and a hydraulic detachment. Later on, with a scalpel blade # 11 we make an incision of no more than 3 mm above the membranous septum where the footplates protrude, and with curved Iris scissors we separate them from the mucous membrane and the soft tissue, then through a U stitch of transfixion with mononylon 4-0 we approximate them and close the 2 incisions made in the membranous septum with mononylon 6-0 (Fig. 10).
Surgical sequence where the approximation of the footplates is shown by a U stitch.
If necessary, we can add a second suture on the base to approximate the soft tissue (Fig. 11).
Surgical technique used for wide columella in cases where the footplates are divergent, symmetrical, and the nasal tip is hypoprojected or normoprojected, if necessary we add a second stitch of transfixion in the soft tissue to refine even more the columella.
The resection of the footplates of the alar cartilages is performed when these are asymmetric (a longer and/or more bent footplate) (Fig. 12a, b) or in case of divergent alar cartilages associated with a hyperprojected nasal tip (Fig. 13a, b), this way not only do we refine the columella and shape the nostril but we also accomplish a slight decline of the nasal tip.
a, b) You can observe a wide columella; this is because the right footplate of the alar cartilage is more bent than usual.
a, b) You can observe a widened columella in the nasal base as a result of divergent alar cartilages. The nasal tip is hyperprojected when looking at the profile, which is why the ideal surgical technique is the partial resection of the footplates and its posterior approximation by a U stitch transfixion.
An infiltration with 2% lidocaine with epinephrine 1:50,000 is performed between the membranous septum and the footplates of the alar cartilages and between the divergent footplate and the soft tissue. We make a small 5 mm incision in the membranous septum at the level of the footplates with a scalpel blade # 11 and later on with Iris scissors we squeletize the divergent footplate of the alar cartilage (Fig. 14a, b). Note how in Fig. 15a, b, once the footplate is fully released it comes out easily. After that a portion of the footplate is resected with a sheet # 11 (Fig. 16a, b), then with a straight needle and a 4-0 mononylon the footplates are approximated by a U stitch transfixion; we make hemostasis control and close the incisions with mononylon 6-0 (Fig. 17a, b, c).
a, b) Dissection of the footplates of the divergent alar cartilages with Iris scissors.
a, b) It is observed how once the footplates are fully released they are introduced into nostril.
a, b) Resection of a portion of the footplates of the alar cartilage with a scalpel blade # 11.
a, b, c) Making a U stitch of transfixion witch mononylon 4-0 and closing the membranous septum with mononylon 6-0.
In the following figures two surgical cases are shown:
Pre- and postsurgical patient presenting divergent footplates.
Dear Authors please add caption
The diagnosis is confirmed during surgery, where just by making a hemitransfixion incision on the membranous septum and releasing the nasal septum its caudal portion is deflected to the right (Fig. 20a, b). In this case, we center the nasal septum and join the footplates through point U of transfixion; in Fig. 21a, b, the pre- and postoperative photos are displayed.
Dear Authors please add caption
Dear Authors please add caption
In this article, we try to show the reader that the nasal base is an aesthetic component that is as important as the dorsum or nasal tip, but surprisingly it does not get the attention it deserves and also that with detailed preoperative analysis and surgical or simple minimally invasive techniques we can achieve a symmetrical and harmonious nasal base.
A famous ancient proverb states that “Eat breakfast like a king, lunch like a prince, and dinner like a pauper.” In today’s era, these words have long been discarded. The magnitude of obesity has reached in pandemic proportion due to new technology and modern life, which makes life easier and less active along with the intake of high energy dense food for better taste [1, 2, 3]. This is one of the biggest public health concerns of today’s era, which affects the individual not only physically but also physiologically and psychologically.
The World Health Organization (WHO) has reported that obesity has been growing at an alarming rate worldwide and has nearly been tripled between 1975 and 2016. It was also reported by WHO in the year 2016 that more than 1.9 billion adults, 18 years and older, were overweight; of these over 650 million were obese (https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight) [4].
Nowadays, obesity is regarded as a complex dysfunctional neuroendocrine problem in which genetic makeup and environmental factors act in concert. The nongenetic risk factors encompass a wide range of social, physiological, environmental, and behavioral factors. Sedentary lifestyle and overconsumption of high-fat and energy dense foods are a major contributor to energy imbalance. The altered phenomenon of hunger and satiety, lack of physical activity, decreased thermogenesis, and resting metabolic rate over a long period of time may lead to the energy imbalance.
In addition, other external factors such as age, gender, food preference, breakfast skipping, medications, chemical toxicity, disorders of the endocrine system, socioeconomic status, and a psychological factor may give rise to weight gain problems. It is considered as a major contributor to the global burden of chronic diseases like hypertension, type 2 diabetes, hypercholesterolemia, heart diseases, insulin resistance, atherosclerosis, ischemic heart diseases, respiratory diseases, orthopedic disorders, several types of cancer, hormonal imbalance, disability, and many other diseases. Overweight and obesity also play a pivotal role in the development of low-grade inflammation, which contribute to the development of obesity-linked disorders, in particular to metabolic dysfunction [5]. However, a growing body of knowledge suggests that a possible convergence of an inflammatory state, which results in chronic inflammation and oxidative stress, is localized within adipose tissue [6] as shown in Figure 1. Adipose tissue inflammation plays a crucial role in promulgating obesity-related metabolic complications including the development of insulin resistance [6, 7, 8].
Overnutrition (overconsumption of high-fat and energy dense foods), lack of physical activity, sedentary lifestyle, and genetic susceptibility are the leading factors associated with the development of obesity. In addition to dysfunctional angiogenesis, an obese state is characterized by an abnormal inflammatory response, low antioxidant capacity, and reduced insulin sensitivity that may eventually lead to the generation of inflammation, oxidative stress, and insulin resistance. The figure was modified from the following review paper by Dludla et al. [
Over the past decades, it is well established that adipose tissue is not merely a fat storage depot but has been recognized as an endocrine organ capable of producing various bioactive substances. It then became evident that white adipose tissue (WAT) secretes ample of peptides. Few of them regulate the inflammatory processes such as leptin and adiponectin, whereas others are well-known cytokines such as interleukin (IL)-6, IL-1 and its receptor antagonist (IL-1Ra), and tumor necrosis factor (TNF)-α [9]. As we know, obesity is one of the major causes of atherosclerosis, which is recognized as a chronic vascular inflammatory process in which cytokines and chemokines play a dramatic role [9, 10]. White adipose tissue plays an important role in metabolism and inflammation as illustrated in Figure 2.
Adipose tissue is a metabolically dynamic, highly active endocrine organ. White adipose tissue (WAT) produces a large variety of proteins regulating metabolism and inflammation, contributing to the maintenance of energy homeostasis and, probably, the pathogenesis of obesity-related metabolic and vascular complications. The figure was modified from the following research paper by Juge-Aubry et al. [
Cytokines are categorized as interleukins, interferons, chemokines, hematopoietic factors, and growth factors. They are knotted in many biological processes such as growth, differentiation, cell division, apoptosis, immunity, and inflammation [9]. Cytokines are produced by numerous cell types of the hematopoietic lineage including T cells, B cells, mast cells, macrophages, dendritic cells, and natural killer cells. In spite of these, cytokines are also produced by nonhematopoietic cells such as epithelial cells, hepatocytes, and fibroblasts [9, 12]. Evidence revealed that IL-1, IL-6, and TNF-α are characterized as a proinflammatory cytokine that activates both acute and chronic inflammatory responses [9]. Inhibitors that control inflammation can be categorized as anti-inflammatory cytokines, soluble receptors to cytokines, and naturally occurring proteins. Types of anti-inflammatory cytokines are IL-10, IL-4, and TGF-β; soluble receptors to cytokines are IL-1 and TNF-α; and naturally occurring proteins are IL-1Ra receptors. The classification of cytokines is depicted in Figure 3.
Classification of cytokines. (a) Classes of inflammatory cytokines. (b) Anti-inflammatory mediators. The figure was modified from the following research paper by Juge-Aubry et al. [
Chemokines are a type of cytokine that is a part of family molecules that are indulged in the chemotaxis of inflammatory cells via the generation of local concentration gradients. Chemokines play an important role in various physiological and pathological processes such as cell recruitment process and development of lymphoid organs or metastases. In spite of these, chemokines also participate in metabolic and inflammatory disorders such as rheumatoid arthritis, glomerulonephritis, and atherosclerosis via their innate ability to recruit and activate the inflammatory cells [9]. They are categorized into four subclasses according to the position of their cysteines (CXC, C, CX3C, and CC) [9, 13]. Chemokines that are produced from WAT are interferon-γ inducible protein 10 (IP-10 or CXCL10) and IL-8 (or CXCL8) belong to the CXC chemokines, while monocyte chemo-attractant protein-1 (MCP-1 or CCL2) and regulated upon activation normal T-cell express sequence (RANTES or CCL5) are CC chemokines [9, 13]. Previous studies showed that chemokines are paracrine rather than systemic factors, the significance of their secretion via adipose tissue may be seen in the context of fat depots found in close proximity to their target tissues, for example, subcutaneous fat in inflammatory skin diseases, perivascular adipose tissue in obesity-associated cardiovascular diseases, and perirenal fat in glomerulonephritis [9, 14].
In addition, several other metabolically important proteins with immunomodulatory actions are secreted by adipose tissue, including leptin, adiponectin, and resistin. The dysregulated expression of these factors, caused by excess adiposity and adipocyte dysfunction, has been linked to the pathogenesis of various disease processes through altered immune responses. As such, much attention has been paid to develop a better understanding of the immunoregulatory functions of adipose tissue. New factors secreted by adipose tissue have been identified that either promote inflammatory responses and metabolic dysfunction or contribute to the resolution of inflammation and have beneficial effects on obesity-linked metabolic disorders. These findings lend additional support to the notion that an imbalance of pro- and anti-inflammatory adipokines secreted by adipose tissue contributes to metabolic dysfunction [5].
Obesity is associated with alterations in immunity, a chronic low-grade inflammation, which is characterized by abnormal secretion of adipokines, that is, there is an increment in circulating proinflammatory cytokines and a decrement in anti-inflammatory cytokines. It is also linked with alteration in immunity. However, with the reduction in body weight, these parameters may reverse or come to the normal level. Although, it is still debatable how obesity triggers inflammation. Earlier, several hypotheses were proposed regarding the inflammation of obesity. The first one stated that overburden of nutrients in the adipocytes leads to intracellular stress that results in the stimulation of inflammatory cytokines [15, 16, 17].
The excessive nutrients may lead to aggregation of unfolded proteins in the endoplasmic reticulum (ER) via activation of the unfolded protein response (UPR) pathway [15, 17]. The pathway of UPR depends on basically three main sensors of ER, that is, PKR-like eukaryotic initiation factor 2α kinase (PERK), inositol-requiring enzyme 1 (IRE-1), and activating transcription factor 6 (ATF-6) [15, 18]. The activity of the C-Jun amino-terminal kinase (JNK) and inhibitor of IκB (IKK-β), serine-phosphorylation of insulin-receptor substrate protein 1 (IRS-1), and the nuclear factor-κB (NF-κB) pathway may increase by the activated sensors of ER that results in increased expression of proinflammatory cytokines [15, 16, 19, 20, 21].
The second hypothesis enumerates that overburdened adipocytes with fat cells intensely increase the infiltration of macrophages, which may lead to subsequent differentiation and activation of cytotoxic T cells. As a result, initiation and propagation of inflammatory cytokines cascades occur [15, 22]. Third hypothesis proposes that as during obesity, enlargement of adipose tissue happens as a result tissue becomes relatively hypoxic. Hypoxia within the adipose tissues results in the activation of inflammatory pathways [15, 23, 24]. Above all, the last hypothesis suggests that overburdened adipocytes themselves may directly activate immune pathogen sensors that result in chronic inflammation [15, 25].
The analysis of dietary intake is an approach to investigate a link between diet and overweight and obesity-related inflammation. Various studies reported that bioactive nutrients and dietary non-nutrients strongly influence health, metabolism, and progression of pathologic states that ultimately result in chronic degenerative diseases [26]. Many studies indicate that diet may affect body weight by controlling satiety and metabolic efficiency or by harmonizing insulin secretion and action [3, 27]. It is an essential key factor for immune response. Earlier, evidence revealed that undernutrition brings about immunosuppression due to susceptibility to infection. Whereas, overnutrition brings about immunoactivation due to susceptibility to inflammatory diseases. As a result, optimum nutrition is mandatory for a healthy immune balance of an individual [15] as shown in Figure 4.
Healthy immune balance between undernutrition and overnutrition. The figure was modified from the following research paper by Lee et al. [
Dietary components play an important role in obesity-related inflammation as enumerated below:
Carbohydrates are the main food source of a living organism and a major source of energy. Carbohydrates are also known as energy giving foods. The source of energy was estimated based on their glycemic index (GI) or glycemic load (GL) values. GI is the value given to the foods on how quickly they increase the glucose level postprandially and measures the quality of carbohydrate. GL calculates both the quality and quantity of carbohydrates [15, 28]. Earlier studies reported that, positive correlation exists between dietary GI and GL and biomarkers of inflammation because a low GI diet decreases the rate of glucose absorption in the body that subsequently reduces hyperglycemia and hyperinsulinemia that results in the reduction of systemic inflammation. Earlier, it was also reported that weight loss leads to improvement in insulin sensitivity and a reduction in the level of proinflammatory cytokines. Various health organization also reported that low GI diets help in managing diabetes and coronary heart diseases and considered as a weapon against obesity [29, 30].
Neuhouser et al. [31] revealed from randomized, crossover feeding study that respondents with high-fat mass (>32.0% for male and >25.0% for female) showed reduced CRP (
Fat is also one of the important sources of energy that serves both structural and metabolic functions of living organisms. The excessive accumulation of fat in the body leads to impairment of the immune system. A number of fatty acids have been studied including saturated, trans-fatty acids, and polyunsaturated fatty acids (PUFA) for their effect on inflammatory status [15].
The omega-3 (n-3) and omega-6 (n-6) PUFA families are precursors of eicosanoids, which play a vital role in the immune response [15]. Simpoulos [35] stated that high omega-6 fatty acids increase leptin and insulin resistance, whereas omega-3 fatty acids lead to homeostasis and weight loss. This is so because the high omega-6/omega-3 ratio is associated with overweight/obesity, whereas a balanced ratio decreases obesity and weight gain [35]. Another study showed that an increase in the intake of n-6:n-3 PUFA potentiates the inflammatory processes that ultimately lead to many inflammatory diseases such as nonalcoholic fatty liver disease (NAFLD), cardiovascular disease, diabetes, obesity, inflammatory bowel disease (IBD), rheumatoid arthritis, and Alzheimer’s disease. This change in the ratio of consumption of n-3/n-6 fatty acids changes the production of important mediators and regulators of inflammation and immune response that leads toward the proinflammatory state. Hence, it was concluded in the study that increasing the ratio of (n-3)/(n-6) PUFA in the diet may lead to a reduction in the incidence of chronic inflammatory diseases [36].
A clinical trial and in-vitro experiment study reported that supplementation of fish oil delineates the expression of adipose inflammatory genes including inflammasome-associated IL-18 and IL-1b and circulating IL-18 levels. In spite of this, it was also stated that both eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) decrease the inflammasome gene expression in obese human adipose and human adipocyte and macrophages [37]. Above all, various studies concluded that omega-3 fatty acids, namely EPA and DHA, have an anti-inflammatory effect.
A review study was done by Rogero and Calder stated that saturated fatty acids induce inflammation by activating the TLR4 signaling pathway (TLR4 signaling pathway is recognized as the main pathway that triggers in obesity-induced inflammation) [38]. Another study revealed that the ingestion of excessive amounts of trans-fatty acids and saturated fatty acids is considered to be a risk factor for metabolic and degenerative diseases. It was also emphasized that saturated and trans-fatty acids favor a proinflammatory state leading to insulin resistance. These fatty acids can be indulged in several inflammatory pathways, contributing to disease progression in chronic inflammation, autoimmunity, allergy, cancer, atherosclerosis, hypertension, and heart hypertrophy as well as other metabolic and degenerative diseases. As a consequence, intake of dietary saturated and trans-fatty acids leads to lipotoxicity in several target organs by direct effects, represented by various inflammatory pathways, and through indirect effects, including an important alteration in the gut microbiota associated with endotoxemia process [39].
Fruits and vegetables comprise a myriad of nutrients, that is, vitamins, minerals, and many food compounds that have been inversely correlated with metabolic risk factors such as oxidative stress and inflammation. In a randomized controlled trial study, it was found that fruits and vegetables reduce the risk of metabolic disease that may be via modulation of gut microbiota. The study also revealed that fruits and vegetables decrease the secretion of interleukin-6 (IL-6) and lipopolysaccharide-binding protein (LBP) [40]. Another study done by Navarro et al. through factor analysis found that dietary patterns loaded with fruits and vegetables strongly negatively correlated with the secretion of hs-CRP among prepubertal girls [41]. An almost similar result was observed by Julia et al. that dietary pattern characterized by intake rich in vegetable and vegetable oil leads to the supply of essential fatty acids and antioxidant micronutrients showed a negative correlation with the risk of elevation of CRP [42]. Another cross-sectional study done on a group of 7574 Koreans found that an inverse correlation exists between vegetable pattern and CRP and the association appeared to be more predominant in men having hypertensive blood pressure [43]. Surprisingly, the study done by Salas-Salvado et al. (
Oxidative stress and imbalance in immune responses play a crucial role in the development of obesity and its associated comorbidities. Various epidemiological shown that several vitamins and minerals have a favorable response on the level of inflammatory markers, that is, CRP, IL-6, and TNF-α.
Various cross-sectional and intervention studies reported regarding overweight and obese respondents that they have lower circulating carotenoids in the plasma because of a high proportion of carotenoids, as lipid-soluble compounds, being stored in adipose tissue [15, 47]. The Women’s Health Study (
Vitamin C is effective in strengthening the immune system, capillary blood vessels, and protecting the dental health, as well as in the convenient use of iron, calcium, thiamine, riboflavin, folic acid, and vitamins A and E in the body. Vitamin C also acts as a cofactor for 15 different enzymes and shows the antioxidant activity as an electron donor reducing agent. It acts as a powerful free radical scavenger by protecting tissues against oxidative stress and reduces inflammation [52]. Totan et al. reported that vitamin C reduces the systemic inflammation by inhibiting CRP and TNF-α pathways. In spite of this, vitamin C inhibits hypoxia in adipose tissue that has the potential for protection against free radicals and decreasing lipid peroxidation. On the other hand, the study also revealed that vitamin C inhibits mature adipocyte formation and cell growth, inhibits lipolysis, and can be considered as a treatment model for obesity to offer solutions for abnormal fat accumulation [52]. Another study reported that vitamin C may improve inflammation by reducing the pro-inflammatory and inflammatory markers such as CRP, IL-6, and TNF-α [53]. Additionally, Fumeron et al. reported in the prospective, randomized, open-label trial study (
Magnesium is the second most abundant intracellular cation and is involved in about 300 biochemical reactions related to anabolic and catabolic actions in the body, such as glycolysis and protein and lipid metabolism [55, 56]. The Women’s Health Initiative Observational Study (
Flavonoids, a group of natural substances with variable phenolic structures, are found in fruits, vegetables, grains, bark, roots, stems, flowers, tea, and wine. Nowadays, flavonoids are considered essential components in various applications such as nutraceutical, pharmaceutical, medicinal, and cosmetic. This is attributed to their anti-oxidative, anti-inflammatory, anti-mutagenic, and anti-carcinogenic properties coupled with their capacity to modulate key cellular enzyme function [59]. According to National Health and Nutrition Examination Survey (NHANES), a large, cross-sectional survey National Centre for Health Statistic (
Phytoestrogens are plant-derived dietary compounds found in beans, seeds, and grains. The structure of phytoestrogens is similar to 17-β-oestradiol (E2), the primary female sex hormone. This structural similarity to E2 enables phytoestrogens to cause (anti) oestrogenic effects by binding to the oestrogen receptors [63]. Phytoestrogens had so many health benefits such as a lowered risk of menopausal symptoms such as hot flushes and osteoporosis, obesity, metabolic syndrome, and type 2 diabetes and lowered risks of cardiovascular disease, brain function disorders, breast cancer, prostate cancer, bowel cancer, and other cancers [63]. A randomized crossover clinical trial for 8 weeks (
According to the Food and Agriculture Organization of the United Nations (FAO) and WHO, probiotics are defined as “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host” [66, 67]. Earlier studies reported that probiotic bacteria, when administered orally, are able to modulate the immune system; however, differences exist in the immunomodulatory effects of different probiotic strains [15]. A randomized, double-blind, and placebo-controlled parallel-group intervention study compared
According to FAO/WHO, prebiotics is defined as “non-digestible food ingredients that beneficially affect the host by selectively stimulating the growth and/or activity of one or a limited number of bacterial species already established in the colon, and thus improve the host health” [67, 69]. Russo et al. reported in the study that intake of 11% enriched inulin-enriched pasta for 5 weeks improved lipidic and glicidic metabolism as well as insulin resistance in healthy young subjects [70]. Another study reported that intake of oligofructose (type of prebiotics) supplementation (8 g/day for 3 weeks) in the elderly (
Synbiotics are defined as a combination of suitable probiotics and prebiotics that enhances survival and activity of the organism, for example, a fructooligosaccharide (FOS) in conjunction with a Bifidobacterium strain or lactitol in conjunction with
The pandemic of obesity and its associated comorbidities derives our attention to the mechanism associated with a pathological condition. Earlier investigations revealed how cells and tissues respond to the stress of overnutrition and about the interplay between adipose tissue and other cell types that are critically involved in energy homeostasis. These findings also suggest the inflammatory response of obesity that might be beneficial or harmful, depending on the stage and degree of obesity, as well as other factors [76]. Previously, it was also reported that obesity and its associated comorbidities are due to intermingled interactions between genetic, metabolic, and environmental factors in which dietary pattern plays a central role [77].
The current review is a narrative review of the impact of inflammation on weight management. In this review, a model is outlined in which inflammation is closely associated with obesity. However, this is a simplified view. Earlier studies reveal that severely underweight people such as patients with anorexia nervosa (AN) also display an overproduction of inflammatory cytokines. Dalton et al. reported from an exploratory cross-sectional study that interleukin (IL)-6, IL-15, and vascular cell adhesion molecule (VCAM)-1 concentrations were significantly elevated, and concentrations of BDNF (brain-derived neurotrophic factor), tumor necrosis factor (TNF)-β, and vascular endothelial growth factor (VEGF)-A were significantly lower in anorexia nervosa (AN) participants [78]. An almost similar result was reported through meta-analysis by Solmi et al. that patients with anorexia nervosa (AN) have increased TNF-α, IL6, IL1-β, and TNF-R-II levels but decreased C-reactive protein and IL-6R [79]. Earlier studies also reported that immunosuppressive medications such as corticosteroids lead to visceral adiposity. Galitzky and Bouloumie reported that long-term exposure of glucocorticoids (GCs), either due to anti-inflammatory and immunosuppressive therapies or endocrine disturbances, accumulation of abdominal fat was observed in individuals with Cushing syndrome [80]. Lee et al. stated in the study that glucocorticoids (GCs) have profound effects on adipose tissue, adipogenesis, adipose tissue metabolic, and endocrine function. In the study, it was found that glucocorticoids (GCs) have multiple, depot-dependent effects on adipocyte gene expression and metabolism that enhances central fat deposition and lead to visceral obesity [81]. Further, contradicting study results are not included in the current study in order to provide a stringent model. Additionally, due to the limited space, important aspects of the topic such as physical activity and its influence on body weight regulation and cytokine production in detail are not included in the current study.
As we know that obesity is the condition of excessive accumulation of fat as a result of disequilibrium between energy intake and its expenditure. Several studies showed that adipose tissue acts as an endocrine organ that plays a critical role in maintaining the homeostasis of immunity. Studies also reported that obesity plays a pivotal role in the development of low-grade inflammation. As a result, optimal nutrition is required for maintaining a healthy immune balance. A healthy diet comprising of appropriate GI/GL, n-3 PUFAs, less amount of saturated and trans-fatty acids, vitamins, minerals, flavonoids, phytoestrogens, probiotics, prebiotics, and Synbiotics is beneficial in combating the obesity and its related complications.
Therefore, it is concluded that consuming different dietary components rather than a single component may prove beneficial in combating the burden of weight gain as its associated comorbidities.
I express my deep sense of gratitude to my beloved husband Mr. Nirmal Kumar for his untiring help, opinions, and valuable suggestions with overwhelming encouragement. I am also deeply regretted if I am not able to cite the papers of all those authors who have contributed to our understanding of this topic.
The author declares no conflict of interest.
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