General cross-tabulation matrix for comparing two maps from different points in time
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"10450",leadTitle:null,fullTitle:"Evolutionary Psychology Meets Social Neuroscience",title:"Evolutionary Psychology Meets Social Neuroscience",subtitle:null,reviewType:"peer-reviewed",abstract:"This book aims to open a debate full of theoretical and experimental contributions among the different disciplines in social research, psychology, neuroscience, and sociology and to give an innovative vision to the present research and future perspective on the topic. The fundamental research areas of evolutionary psychology can be divided into two broad categories: the basic cognitive processes, and the way they evolved within the species, and the adaptive social behaviors that derive from the theory of evolution: survival, parenting, family and kinship, interactions with nonparents, and cultural evolution. Evolutionary Psychology Meets Social Neuroscience explains at individual and group level the fundamental behaviors of social life, such as altruism, cooperation, competition, social exclusion, and social support.",isbn:"978-1-83968-871-3",printIsbn:"978-1-83968-870-6",pdfIsbn:"978-1-83968-872-0",doi:"10.5772/intechopen.92465",price:100,priceEur:109,priceUsd:129,slug:"evolutionary-psychology-meets-social-neuroscience",numberOfPages:82,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"bd4df54e3fb185306ec3899db7044efb",bookSignature:"Rosalba Morese, Vincenzo Auriemma and Sara Palermo",publishedDate:"January 7th 2022",coverURL:"https://cdn.intechopen.com/books/images_new/10450.jpg",numberOfDownloads:900,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:0,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"September 18th 2020",dateEndSecondStepPublish:"December 21st 2020",dateEndThirdStepPublish:"February 24th 2021",dateEndFourthStepPublish:"May 15th 2021",dateEndFifthStepPublish:"July 14th 2021",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"214435",title:"Dr.",name:"Rosalba",middleName:null,surname:"Morese",slug:"rosalba-morese",fullName:"Rosalba Morese",profilePictureURL:"https://mts.intechopen.com/storage/users/214435/images/system/214435.jpg",biography:"Rosalba Morese, born in Italy, holds a bachelor\\'s degree in psychology at the University of Parma and a Ph.D. in neuroscience at the University of Turin. She aims to develop new techniques and approaches in cognitive science and social neuroscience. She is an expert in experimental neuroscience, neuroeconomics, psychophysiology, and cognitive and social neuroscience. She performs neuroimaging studies in social contexts in order to investigate neural correlates involved during social interactions, such as, social exclusion, social support, empathy, communicative intention, social decision-making, in-group and out-group settings, etc. She currently works at Università della Svizzera italiana, Lugano, Switzerland.\n\nFor more information: http://usi.to/xuj",institutionString:"Faculty of Biomedical Sciences",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"8",totalChapterViews:"0",totalEditedBooks:"4",institution:{name:"Universita della Svizzera Italiana",institutionURL:null,country:{name:"Switzerland"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"338363",title:"Dr.",name:"Vincenzo",middleName:null,surname:"Auriemma",slug:"vincenzo-auriemma",fullName:"Vincenzo Auriemma",profilePictureURL:"https://mts.intechopen.com/storage/users/338363/images/system/338363.jpg",biography:"Vincenzo Auriemma, born in Italy, holds a bachelor\\'s degree in sociology at the University of Salerno and a Ph.D. in sociology at the same university. He developed new techniques for empathy analysis in the relationship between sociology and social neuroscience. He is an expert in the history of sociological thought, neurosociology, institutions of sociology, and general sociology. He carries out transdisciplinary studies based on the relationship of sociology with other sciences in the investigation of empathy on both individuals and groups, in order to investigate whether it is a culturally constructed or genetically given aspect. He currently works as a postdoc research fellow at the Department of Political and Social Studies of the University of Salerno. He is the scientific director of the National Passa la Palla Network, which deals with combating bullying and cyberbullying, and is a member of both the Italian Association of Sociology (AIS) and the Sociology of the Person (SPe). He is part of a research group that focuses on the analysis of dropout in psychotherapy as a methodology of transdisciplinary research between the University of Cassino and the University of Salerno and a member of a research group that studies the well-being of patients and healthcare personnel at San Giovanni di Dio e Ruggi d\\'Aragona University Hospital, an affiliate of the University of Salerno.",institutionString:"University of Salerno",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"University of Salerno",institutionURL:null,country:{name:"Italy"}}},coeditorTwo:{id:"233998",title:"Ph.D.",name:"Sara",middleName:null,surname:"Palermo",slug:"sara-palermo",fullName:"Sara Palermo",profilePictureURL:"https://mts.intechopen.com/storage/users/233998/images/system/233998.png",biography:"Sara Palermo has an MSc in clinical psychology and a PhD in experimental neuroscience. She is specialty chief editor of Frontiers in Psychology, Neuropsychology, and scientific director of the Italian National Institute of Philanthropy, Filantropolis. She is a member of the Italian Society of Neuropsychology, the Italian Association of Psychogeriatrics, the Italian Society of Neurology for Dementia, and the Society for Interdisciplinary Placebo Studies. She was a member of the European Innovation Partnership on Active and Healthy Ageing (EIP AHA), for which she was involved in Action Group A3: Action for Prevention of Functional Decline and Frailty. Dr Palermo works as a researcher at the Department of Psychology - University of Turin (Italy) and as Scientific Consultant at the Fondazione IRCCS, Istituto Neurologico Carlo Besta (FINCB), Milan, Italy.",institutionString:"University of Turin, Italy & The Foundation of the Carlo Besta Neurological Institute IRCCS",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"6",totalChapterViews:"0",totalEditedBooks:"5",institution:{name:"University of Turin",institutionURL:null,country:{name:"Italy"}}},coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"278",title:"Social Psychology",slug:"social-psychology"}],chapters:[{id:"79433",title:"Introductory Chapter: (trans) Disciplinarity - A New Alliance between Sociology and Neuroscience",doi:"10.5772/intechopen.100605",slug:"introductory-chapter-em-trans-em-disciplinarity-a-new-alliance-between-sociology-and-neuroscience",totalDownloads:107,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Vincenzo Auriemma, Chiara Fante, Rosalba Morese and Sara Palermo",downloadPdfUrl:"/chapter/pdf-download/79433",previewPdfUrl:"/chapter/pdf-preview/79433",authors:[{id:"214435",title:"Dr.",name:"Rosalba",surname:"Morese",slug:"rosalba-morese",fullName:"Rosalba Morese"},{id:"439522",title:"Dr.",name:"Vincenzo",surname:"Auriemma",slug:"vincenzo-auriemma",fullName:"Vincenzo Auriemma"},{id:"439523",title:"Dr.",name:"Chiara",surname:"Fante",slug:"chiara-fante",fullName:"Chiara Fante"},{id:"439524",title:"Dr.",name:"Sara",surname:"Palermo",slug:"sara-palermo",fullName:"Sara Palermo"}],corrections:null},{id:"77185",title:"An Evolutionary Approach to the Adaptive Value of Belief",doi:"10.5772/intechopen.97538",slug:"an-evolutionary-approach-to-the-adaptive-value-of-belief",totalDownloads:252,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"The word “belief” evokes concepts such as religious or political beliefs, however there is more to belief than cultural aspects. The formation of beliefs depends on information acquired through subjective sampling and informants. Recent developments in the study of animal cognition suggest that animals also hold beliefs and there are some aspects that underly the formation of beliefs which are shared with other animal species, namely the relationship between causality, predictability and utility of beliefs. This review explores the biological roots of belief formation and suggests explanations for how evolution shaped the mind to harbour complex concepts based on linguistic structures held by humans. Furthermore, it suggests that beliefs are shaped by the type and process of information acquisition which progresses through three levels of complexity.",signatures:"Anabela Pinto",downloadPdfUrl:"/chapter/pdf-download/77185",previewPdfUrl:"/chapter/pdf-preview/77185",authors:[{id:"343920",title:"Ph.D.",name:"Anabela",surname:"Pinto",slug:"anabela-pinto",fullName:"Anabela Pinto"}],corrections:null},{id:"78719",title:"Social Inclusion and Exclusion: How Evolution Changes Our Relational and Social Brain",doi:"10.5772/intechopen.99916",slug:"social-inclusion-and-exclusion-how-evolution-changes-our-relational-and-social-brain",totalDownloads:147,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"Belonging to social groups is an important need for human beings and social exclusion has a significant psychological impact on individual wellbeing. Social neuroscience has clarified the similarity of the neuronal substrate between physical pain and social pain during the experience of social exclusion. Pain is the oldest signal that something is wrong for our brain, and the anticipation of pain motivates a move away from perceived dangerous or noxious stimuli. The Evolutionary Theory of Motivation (ETM) considered group affiliation as an adaptive goal that supports the individual\\'s adaptation to the environment; however, invalidating experiences may induce avoidance of its pursuit. In this perspective, social exclusion could thus be considered as the result of failures at one or more levels of the human motivational systems. This chapter attempts to understand the neuroscience findings on social exclusion in this theoretical framework.",signatures:"Chiara Fante, Sara Palermo, Vincenzo Auriemma and Morese Rosalba",downloadPdfUrl:"/chapter/pdf-download/78719",previewPdfUrl:"/chapter/pdf-preview/78719",authors:[{id:"214435",title:"Dr.",name:"Rosalba",surname:"Morese",slug:"rosalba-morese",fullName:"Rosalba Morese"},{id:"429517",title:"Dr.",name:"Fante",surname:"Chiara",slug:"fante-chiara",fullName:"Fante Chiara"},{id:"429518",title:"Dr.",name:"Sara",surname:"Palermo",slug:"sara-palermo",fullName:"Sara Palermo"},{id:"429519",title:"Dr.",name:"Vincenzo",surname:"Auriemma",slug:"vincenzo-auriemma",fullName:"Vincenzo Auriemma"}],corrections:null},{id:"76704",title:"Social Supports Available to Persons with Disabilities in Nigeria",doi:"10.5772/intechopen.97790",slug:"social-supports-available-to-persons-with-disabilities-in-nigeria",totalDownloads:246,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Disability entails more than the mere physical deformity such as stroke; however, a disability could manifest in different forms; mental, emotional, sensory and intellectual disability among others. People with disability are faced with a lot of challenges and they experience depression, isolation and social exclusion which were explained in studies from the natural and behavioral sciences. Also, Social workers and Psychologists alike have often discussed the importance of social inclusion and social support for people living with a disability. Social support helps to reduce psychological stress, enhance the quality of life and achieve social inclusion. Lack of social support increases the risk of depression, social exclusion, maladaptive behaviors and mortality. In this paper, we will give a thorough explanation of Social support and its forms. We emphasized the influence of neurobiology, personality features, social system and perception on who gets social support and to what extent. The paper also discussed Nigeria’s perceptions of disability and the social support networks in Nigeria, using vast literature. From literature, social supports are of different kinds however, this paper emphasized the need for functional social support which entails changing negative perceptions about disability. In other words, social support should not be just assisting the individual to access their immediate needs but should entail involving them in decision making – social inclusion.",signatures:"Chinyere Onalu and Nneka Nwafor",downloadPdfUrl:"/chapter/pdf-download/76704",previewPdfUrl:"/chapter/pdf-preview/76704",authors:[{id:"343216",title:"Mrs.",name:"Chinyere",surname:"Onalu",slug:"chinyere-onalu",fullName:"Chinyere Onalu"},{id:"350015",title:"Ms.",name:"Nneka",surname:"Nwafor",slug:"nneka-nwafor",fullName:"Nneka Nwafor"}],corrections:null},{id:"76564",title:"Biological Determinants of Hostility",doi:"10.5772/intechopen.97526",slug:"biological-determinants-of-hostility",totalDownloads:149,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Our aim was to study the association of hostility with the DRD4, DAT, MAOA genes in an open male population of 25–64 years old. A representative sample of men aged 25–64 years (n = 657 men, average age 44.3 ± 0.4 years) was examined in 1994–1995 and 45–64 years old (n = 781 men, average age - 56.48 ± 0.2 years) in 2003–2005 using the methods proposed by the WHO international program “MONICA-psychosocial” and “HAPIEE”. All respondents completed the hostility questionnaire on their own. Genotyping of the DRD4, DAT and MAOA gene polymorphisms was carried out. It was established that the level of hostility in the male population was 76.9% in the group of 25–64 years old and 60.3% in the group of 45–64 years old. Genotypes 4/6, 4/7 of the DRD4 gene are reliably associated with a high level of hostility; the genotype 4/4 of the DRD4 gene is associated with an average and lower level of hostility. There was no association of individual genotypes and VNTR alleles of DAT gene polymorphism with different levels of hostility. It was found that among individuals with low-active alleles of the MAOA-L gene (alleles 2 and 3), a high level of hostility was more common - 50.9%. The results of constructing a logistic regression model showed that the presence of low-active alleles (2; 3) of the MAOA gene increases the likelihood of hostility OR = 2.103 (95% CI 1.137–3.889, p = 0.018). Based on the received data we can assume that the long alleles of the DRD4 gene and the low-level allele of the MAOA-L gene are associated with hostility.",signatures:"Valery V. Gafarov, Elena A. Gromova, Vladimir N. Maksimov, Igor V. Gagulin and Almira V. Gafarova",downloadPdfUrl:"/chapter/pdf-download/76564",previewPdfUrl:"/chapter/pdf-preview/76564",authors:[{id:"325050",title:"Dr.",name:"Elena A.",surname:"Gromova",slug:"elena-a.-gromova",fullName:"Elena A. Gromova"},{id:"325389",title:"Dr.",name:"Valery V.",surname:"Gafarov",slug:"valery-v.-gafarov",fullName:"Valery V. 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Many hydrological systems of the tropical regions are relatively densely populated, with relatively high rates of population growth, which has serious implications in the relationships between people and environmental services [12]. In mountainous regions, mostly poor people are settled in steep hillsides (slopes above 15%), usually practicing a smallholder farming system with agricultural production in small parcels for subsistence purposes, as well as shifting cultivation and slash & burn agriculture, which represent a pressure over natural resources in areas which are ecologically fragile and environmentally sensitive. About 25 to 30% of Central America and northern South America consist of mountainous areas where the conditions above mentioned are quite common [13]. Thus, the dynamics of natural resources use in river basins and watersheds across the mountain regions in the tropics are determined by three factors: environmental, social and economical conditions [4] [9] [12] [14] [15].
According to [8], the LULC changes have a notorious impact on climate, at local and regional levels, due to the modifications in the carbon cycle, the local evapotranspiration patterns, as well as precipitation regimes. This fact justifies many concerns about the implications that the LULC changes could have in the water resources, particularly in the hydrological regimes worldwide. These concerns have been motivating the analysis of the relationships between the LULC changes and the hydrological regimes (river flows, runoff dynamic, floodings, water depletion, etc) in a spatial-temporal perspective. Some examples of these includes: [16 - 31].
Certainly, these are valuable experiences to deal with such a complex task; however, there are still many gaps in this process to be solved, and many questions to be answered. Moreover, many of these experiences are all spatially confined to temperate regions, where biophysical as well as socioeconomic conditions are particular. Tropical ecosystems are very different from their counterparts in higher latitudes. They have different geological and evolutionary histories, and different climatic extremes and dynamics. The number of interacting species is typically much higher in tropical ecosystems, including streams networks also, and the interactions are often more complex [9]. Social, economical and political conditions in tropical rural areas are also very complex; thus, the poverty, depressive local economies, instability and lack of plans and investment programs are always current, and usually such complex realities and the collateral relationship has not been well studied so far. Thus, the knowledge remains still weak and the lack of information about local and regional environmental dynamic is remarkable [11] [14] [15] [32] [33] [34] [35].
The river basins are subject to constant processes of change, so the state and the structure of river landscapes and land resources are primarily determined by the type and intensity of the utilisation of the ecological, economic, social or cultural functions provided by the river systems. The new paradigm recognize the river basins as complex, ecological and interactive systems, which means that the integrated water resource management follows the central themes of the
The Andean region in Venezuela is considered the most important “
Located in the northern part of that region, the Boconó River Basin can be considered as a representative case of the complex dynamics characterizing the Andean hydrological systems. Having a total surface area of 1580 km2 and a wide altitudinal range, the River Basin harbor many ecosystems ranging from the Sub-Andean Páramo in the upland areas, to the Savannah ecosystem downstream in the upper plains of the Llanos region. With an annual yield of 2,300 million m3 and a very acceptable chemical quality, the Boconó River was included into the regional planning policies in the Seventies, in order to develop the water resources in the lowlands region, so that the Boconó – Tucupido Dam systems were built in the Llanos region, in order to generate energy, flooding control and for irrigated cropping also [37].
A very significant portion of the area is still under natural Land Cover types, like the
On the other hand, there are also numerous sparse rural settlements representing a huge potential for agricultural production of some crops like coffee and vegetables (potatoes, carrots, onions, beans and others). The high accessibility through an intricate network of rural and local roads makes it easier to promote the sparse settlement in sloping hillsides across the area, being a crucial factor which determines the LULC changes contributing to the intensification of some erosion and land degradation processes [39].
All these conditions acting together in a strongly integrated way, resulting in a complex situation in which the increasingly sparse population is making even more pressure on natural land cover types, particularly on the
Nevertheless, the area continues to show a trend respect to the anthropogenic pressure, so the agricultural frontier is even more extended, meanwhile the forested land cover types tends to be decreased, and some land degradation processes like erosion and sediment yield seems to be even more intense. This has severe implications for the biodiversity, but also affects substantially the hydrological dynamic through changes in local microclimates, changes in moisture regimes, that eventually could lead changes in the hydrological regimes, especially the seasonal flows, peak flows, as well as changes in the water quality.
The main goal of this paper is to analyze the spatial dynamic of the Boconó River Basin during the Period 1988 – 2008, in terms of the main LULC changes and systematic transitions that have been occurring in the area under an ecosystem-oriented approach. They were discussed in terms of the implications that such changes and transitions have for the natural resources management at the river basin level (watershed management). The results showed here are only a partial output of the still ongoing PhD project: “Spatial changes and hydrological dynamic of the Boconó River Basin, north venezuelan Andes”, which is actually developed at the Eberhard Karls University – Tübingen, Germany.
The study was focused on the upland part of the Boconó River Basin, located in the south- east part of the State of Trujillo, between the coordinates 09°11’40” - 09°31’50” N and 70°04’08” – 70°22’53” W, with a surface area of 537.62 km2. The highest point in the Basin is 3400 m.a.s.l in the Páramo of Cendé, and the lowest point (outlet) is the confluence between the Boconó and Burate river (1100 m.a.s.l) (Fig. 1). The Boconó River drops from the north-east to the south-west, over a distance of approximately 57 km, having a mean runoff about 15, 55 m3/sec [33].
Location of the Study area
The area has a seasonally humid climate, having a wet period from April to October, and a dry period from November to March. Annual mean rainfall is about 1838 mm, and the annual mean temperature range from 19.7 °C to 21.5 °C [42]. The Basin has a relatively elongated form, and the drainage pattern is dendritic with a tendency to be rectangular, due to the intense tectonic activity [37].
The catchment is located within the tectonic axis formed by the Boconó Fault, which is the most important structural feature of the Venezuelan Andes [37]. The Fault cross longitudinally the river, separating the metamorphosed crystalline rocks in the north portion, from those less metamorphosed in the south part [33]. The basin has a massive and strongly dissected topography, so that the topographic conditions are quite complex and varied, determined by different landforms like: structural risks, erosion risks, structural escarpments, hillsides and alluvial accumulations, and a mean slope which range between 35 – 40% [43].
The lithological framework is generally highly jointed, due the tectonic dynamic, and the rocks basically correspond to the formations: Iglesias Group (gneisses and schist), Sierra Nevada (granites), Mucuchachí (Shale and phyllites) and Palmarito (shale and marl) [44]. Soils are in general relatively deep, with textural classes ranging from clayed to sandy loam, being Ultisols, Inceptisols and Alfisols the most important and representative taxonomic categories in the area [45].
The altitudinal gradient (2300 m.a.s.l) and the climatic conditions, particularly the intense rainfall regime, lead to the existence of the Tropical Montane Cloudy Forest, which cover the 44, 6 % of the total surface. Other important ecosystems in the area are: sub-montane forest, grass, sucessional shrubland, schrub and sub-alpine Páramo. These categories of land cover coexist also with specific land use types, which are very importance not only in economical terms, but in social and cultural perspectives also [46]. Shifting cultivation is located mostly in upland areas, where slash and burning are usual tasks. Conventional agriculture is also developed in lower parts and quaternary landforms, in some cases under irrigation. Coffee plantations are very usual between 800 and 2000 m above sea level, occupying an important portion of the Sub-montane forest. In a small proportion, the extensive grazing shows a moderate development, being usually spatially confined to the low parts and the quaternary landforms [42]. Finally, the 1, 6 % of total surface is occupied by urban use, being the Boconó city the most important urban system in the area.
In order to achieve the purpose of this project, a methodological approach combining remote sensing methods with spatial and multi-temporal analysis in GIS in an interactive way was implemented. At first, the study area was delineated from the SRTM data set (90 m spatial resolution) using the open source GIS software SAGA (System for Automated Geoscientific Analysis), in order to build the Digital Elevation Model (DEM), and also to prepare the basic thematic maps (Topography, Slope, Aspect, Drainage Network). Based on the structure pointed out by [47], the LULC mapping process was done in three main straightforward steps, as follows:
Three time-points were defined in order to analyse the LULC dynamic in the river basin: T0 (1988); T1 (1997); and T2 (2008). For each time-point a group of LANDSAT TM scenes corresponding to missions 4, 5 and 7 were compiled from USGS LANDSAT Archive and the Institute of Geography (IGCRN) – ULA (Venezuela), which were considered suitable to the research requirements. The compilation process was quite difficult because the study area is frequently covered by dense clouds, especially during the rainy season. It means that the cloudiness and fog represented a challenge to deal with into the classification process, leading to compile additional scenes for special processing. Thus, the compiled scenes were classified in two groups: “
All the LANDSAT scenes compiled were pre-processed individually to make the geometric and radiometric correction, as well as the enhancement of some elements like brightness, contrast, haze reduction and equalization, in order to improve the image quality. All these processes were carried out interactively.
The classification process was developed through a semi – supervised method, following a multi – level clustering for a multi – class segmentation of the scenes. The scenes were separately classified, a procedure considered highly flexible and extensively used in the past, with good results reported [47].
At the first level the scenes were classified through an unsupervised method using the “
Two groups of clusters were then identified: “
All the clusters were merged to form twelve final classes using the grouping process. Additionally, a spatial modelling process was done in order to make the altitudinal differentiation of the LC in the river basin, defining the Land Cover categories in an ecological sense, following the ecosystem approach. For this purpose the DEM was combined with the classified images using the ecological criteria from Sarmiento & Ataroff in [50]. Thus, the Land cover categories delineated are virtually “ecosystems units”. The classified scenes were finally filtered and exported to GIS software for the mapping creation and display processes.
The classifications were validated using conventional methods, depending on the availability of the reference ancillary data. For the T0 classification, only a land use map for 1980 was available in a non digital format. This map was then used as a reference source for the validation. A total of 255 validation points corresponding to reference pixels were randomly selected using the “
The multi-temporal evaluation process was conducted through spatial analysis in GIS. Hence, paired overlay was done in order to detect the changes occurred during the time-period considered. The Matrix operation used in this case allows two thematic images or vector files of different years to be compared [52]. This tool allowed to cross two different maps corresponding to the same area, in order to differentiate the changes occurred between the time-points. The resulting class values of a matrix operation are thus unique for each coincidence of two input class values described by rows (input layer 1) and columns (input layer 2) [53]; hence, the process produce two type of results: Maps which can illustrate the changes in a spatial context (land cover change map); and a
The
Time 2 | Total Time 1 | Loss | ||||
Time 1 | Category 1 | Category 2 | Category 3 | Category 4 | ||
Category 1 | ||||||
Category 2 | ||||||
Category 3 | ||||||
Category 4 | ||||||
Total Time 2 | ||||||
Gain |
General cross-tabulation matrix for comparing two maps from different points in time
Starting from the matrix-values, the Gain (G
On the other hand, the Loss (L
The swapping (S
The total change for each category (C
In order to intend a more detailed analysis of the LULC changes, particularly the systematic inter-category transitions, the methodology proposed by [54] was applied, which analyze the off-diagonal entries to identify systematic transitions of land change for a given landscape´s degree of persistence. For that, the transitions must be interpreted relative to the sizes of the categories, leading to define the gain/loss that would be expected if the gain/loss in each category were to occur randomly [54]. The randomly expected gains for each category were calculated using the Eq 5:
In this case, the gain as well as the proportion for each category at time 2 is considered fixed, distributing the gain across the other categories according the relative proportion of the other categories in time 1. The procedure to calculate the randomly expected losses for each category is quite similar to those explained above, using the Eq 6:
As in the gain, the equation assumes that the loss of each category is fixed, and then distributes the loss across the other categories according to the relative proportion of the other categories in time 2.
Finally, the systematic transitions were identified trough a comparison between the observed and expected values for gain and loss, for each category.
Twelve (12) LULC categories to be analyzed were identified in the Boconó River Basin for T0, T1 and T2 classifications. The Table 2 display the LULC categories, each with the corresponding identity-code, designation, as well as a brief description. The results showing the accuracy and the Kappa Coefficient for the three time-points are displayed on Table 3. Two important clarifications must be here pointed out:
1. - The Category Open-cleared Forest (Oc-F) correspond to the lower sectors of the Tropical Montane Cloudy Forest (Tmc-F), which are prone to a clearcutting process for logging and wood extraction, eliminating partly the canopy of the tallest forest species; the clearing alter greatly the phenological structure of the forest, resulting in a very specific and different spectral signal respect the climax or undisturbed forest. They were conveniently considered separated categories for practical purposes inherent to the research goals.
2.- Coffee plantations constitute an important land use practice in the area; however, during the classification process the plantations (shade coffee) usually showed a very similar spectral signal as the Sub-montane Forest, which is the ecosystem where these plantations are usually located. They couldn’t be effectively separated at this resolution level, and more detailed remote sensing material for the study area was no available. For that reason the coffee plantations were necessarily combined with the Category: Sub-montane Forest (Sm-F).
The corresponding surface values for the time-points analyzed (T0, T1 and T2), are gently resumed on Table 4. An overview of the differences among the period, lead us to set up a basic differentiation between the LULC categories in three main groups as follow:
LULC categories losing surface: basically the natural LC like forest (Tmc-F, Oc-F, Sm-F) and Grass (Gr-L) were included here. All of them show a decreasing trend between T0 and T2 (except Gr-L, which experienced a light increase between T1 – T2). The Tmc-F and Oc-F had a reduction of 3530, 43 ha between T0 – T2, representing the 12, 8 % of the total for the two categories combined in 1988. The reduction of the Sm-F in the river basin was more dramatic, losing the 43, 1% of the surface area respect to 1988, that is, 3244, 59 ha. On the other hand, Gr-L loosed 412, 11 ha between T0-T1, and slightly recovered 85, 05 ha in the next period, losing a total of 327, 06 ha (9 % of the total in 1988).
Land Use / Land Cover (LULC) Categories identified in the Boconó River Basin.
Indicator | T0 (1988) | T1 (1997) | T2 (2008) |
Producers Accuracy | 87,46 | 85,02 | 91,53 |
Users Accuracy | 87,62 | 82,90 | 91,67 |
Total Accuracy | 87,35 | 82,59 | 88,80 |
Kappa Coefficient | 0,79 | 0,79 | 0,87 |
Main results obtained in the Accuracy assessment for the T0, T1 and T2 classifications.
LULC Categories | 1988 (T0) | 1997 (T1) | 2008 (T2) | Dif T1-T0 | Dif T2-T1 | Dif total T2-T0 |
Area (ha) | Area (ha) | Area (ha) | ||||
Tropical Montane Cloudy Forest | 24573,78 | 23676,12 | 22493,97 | -897,66 | -1182,15 | -2079,81 |
Open-cleared Forest | 2973,51 | 1648,8 | 1522,89 | -1324,71 | -125,91 | -1450,62 |
Sub-Montane Forest | 7523,1 | 6224,13 | 4278,51 | -1298,97 | -1945,62 | -3244,59 |
Scrub | 1142,37 | 1199,88 | 1277,73 | 57,51 | 77,85 | 135,36 |
Grasland | 3662,82 | 3250,71 | 3335,76 | -412,11 | 85,05 | -327,06 |
Sub-andean Paramo | 1114,2 | 1117,71 | 1114,47 | 3,51 | -3,24 | 0,27 |
Grassland (Anthropogenic) | 1280,34 | 1181,16 | 2832,03 | -99,18 | 1650,87 | 1551,69 |
Cropping Area | 2202,84 | 2330,46 | 2867,4 | 127,62 | 536,94 | 664,56 |
Eroded Land | 28,62 | 27,27 | 39,87 | -1,35 | 12,6 | 11,25 |
Urban Area | 433,98 | 729,18 | 865,26 | 295,2 | 136,08 | 431,28 |
Flooding plain | 234,9 | 391,95 | 293,76 | 157,05 | -98,19 | 58,86 |
Sucessional Shrubland | 8591,67 | 11984,76 | 12840,75 | 3393,09 | 855,99 | 4249,08 |
Total | 53762,13 | 53762,13 | 53762,13 | - | - | - |
LULC evolution during the considered period
LULC categories gaining surface: they are basically the human-induced types of land cover categories (Gr-An, Cro-L and Ur-U), as well as the categories: Schr and S-Shr. They increased progressively during the period, except Gr-An, which experienced a decrease in T0 – T1; however, the evident increase experienced during T1-T2 justify the inclusion of the category in this group. Gr-An and Cro-L combined, gained 2216, 25 ha, representing an increase of 63, 6 % of the agriculture in the river basin respect 1988. The Urban use (Ur-U) experienced a dramatic increase during the whole period, gaining 99,36 % (431,28 ha) of the surface area that the category occupied in T0. Meanwhile, the LC category S-Shr experienced a big change, gaining almost 50% (49, 5%) of the surface area for T0; so it gained a total of 4249, 08 ha. respect 1988. During the period Schr category gained 135, 36 ha (12%) respect to T0.
Relatively stable LULC categories: here are included the rest of the LC categories: Sa-P, Ero-L and Fl-P. These categories showed a similar pattern during the whole period, in which they loosed and gained surface, but maintaining its proportionality respect the rest of the LULC categories. The Fl-P gained 157, 05 ha (67%) because of the flooding events occurred during the T0-T1. But in the second time-period it loosed 98, 19 ha to other categories.
These basic groups illustrate the general trends for the recent evolution of the LULCC in the river basin. However, they are only the initial framework to understand the spatial dynamic in the study area, so they cannot reflect conveniently the spatial changes in a quantitative/qualitative way. The next section provides a more comprehensive and detailed description of the LULC categorical changes for the two time-periods, in terms of quantification, net change, swapping as well as inter-category transitions.
The Figure 2 show the spatial distribution of the changes in the Boconó River Basin, which occurred within the both periods: T0 - T1 and T1 – T2. In the first period the River Basin experienced a total change of 30,34%, which means that 16309,89 ha were affected by a kind of spatial change processes, meanwhile the 69,66% of the surface area (37452,24 ha) was accounted as persistent landscape or simply persistence. Thus, persistence dominates widely the landscape system of the River Basin, which is considered normal, because the persistence usually dominates most landscapes, including those where authors claim that the change is important and / or large [54].
[55] accounted 92% of persistence for natural land covers in Mexico; in the Atlanta metropolitan area (one of the USA´s fastest growing metropolises), there have been 75% persistence over the last 3 decades (Yang & Lo, 2002) in [54]. [56] determined a persistence of 94, 2% in the community of Madrid – Spain. [57] accounted 93, 3 of landscape persistence in the State of Mexico – Mexico. Finally, [30] also detected a persistence of 80, 5% in the Catamayo-Chira Basin (Ecuador – Peru).
Although the persistence dominates the landscape, as usual, the persistence value of the Boconó River Basin can be considered slightly lower in comparison with those values above mentioned. This fact is important to highlight, considering that the whole river basin is defined as “
In the second period the total change was slight higher, with 18464, 7 ha affected by a type of change, representing the 34, 35% of the total area, and the persistence value descended to 65, 65 % of the total surface (35297, 46 ha).
As seen on Figure 2, the change have been occurring in the middle – lower part of the river basin, basically across the sloping dissected areas, the river valley and some extensive quaternary landforms located in the lowest part; in this case, the LULC categories coexist in a very intricate way, showing a very complex and strong patching effect, which is typical of landscapes where the categories are highly fragmented, originating the so – called “
A more detailed analysis of the transition Matrix derived for the two combined time-periods (T0-T1 and T1 – T2), using the approach proposed by [54], lead to interpret the changes in a more detailed perspective, as follows:
The Table 5 resume the landscape dynamic observed for the period T0 – T1. S-Shr was the most dynamic category in the river basin during this period, having a total change which represent the 22,4 % (12037,6 ha), of the total surface. It showed also the highest values for gain and losses respect the rest of LULC. During the period, S-Shr gained 14, 35% of surface area, losing at the same time 8 % to other categories. This category has also the highest value for swapping (16,1 % of the surface area), which means that this LCC constantly experienced changes during the period, losing surface area to other categories and gaining at the same time area from other categories whose changed to this one. Thus, 72% of the change for this category occurred as swapping-change dynamic.
Persistence and changing area in Boconó River Basin
The second more dynamic category in the area was Sm-F, which experienced a total change of 4485, 51 ha, representing the 8, 3% of the total surface area. In this period Sm-F gained 1593, 27 ha (third highest value), which in many cases could represent an expansion of the shade coffee plantations in the area (included in this category). However, it lost 2892, 24 ha (second highest value) to other categories, representing an important reduction of the forested cover in the area. The category has the third highest value of swapping (3186, 54 ha), which suggest that the Sub-montane Forest also experienced a swapping-change dynamic.
The third category experiencing important changes in the period is the Oc-F, with a total change value of 3721, 41 ha, (7 % of the total area). The Open-cleared Forest gained the fifth biggest portion of surface: 1198, 35 ha, suggesting that the clearcutting and logging in the lowest part of Tmc-F were intense during the period. However, it lost 2523, 06 ha (third biggest amount) to other categories, showing that the clearcutting and logging was also intense within the category. A total of 2396, 7 ha (fifth highest value) were swapping-change dynamic for this category.
LULC Category | Gain | Loss | Total Change | Swap | Absolute value of net change | |||||
ha | % | ha | % | ha | % | ha | % | ha | % | |
Tmc-F | 792,45 | 1,474 | 1690,11 | 3,143 | 2482,56 | 4,617 | 1584,9 | 2,948 | 947,66 | 1,669 |
Oc-F | 1198,35 | 2,229 | 2523,06 | 4,693 | 3721,41 | 6,922 | 2396,7 | 4,458 | 1324,71 | 2,464 |
Sm-F | 1593,27 | 2,963 | 2892,24 | 5,380 | 4485,51 | 8,343 | 3186,54 | 5,926 | 1298,97 | 2,417 |
Schr | 58,86 | 0,109 | 1,35 | 0,003 | 60,21 | 0,112 | 2,7 | 0,006 | 57,51 | 0,106 |
Gr-L | 1565,1 | 2,911 | 1977,21 | 3,678 | 3542,31 | 6,589 | 3130,2 | 5,822 | 412,11 | 0,767 |
Sa-P | 7,29 | 0,014 | 3,78 | 0,007 | 11,07 | 0,021 | 7,56 | 0,024 | 3,51 | 0,003 |
Gr-An | 1085,49 | 2,019 | 1184,67 | 2,204 | 2270,16 | 4,223 | 2170,98 | 4,038 | 99,18 | 0,185 |
Cro-L | 1789,2 | 3,328 | 1661,58 | 3,091 | 3450,78 | 6,419 | 3323,16 | 6,180 | 127,62 | 0,237 |
Ero-L | 13,59 | 0,025 | 14,94 | 0,028 | 28,53 | 0,053 | 27,18 | 0,052 | 1,35 | 0,003 |
Ur-U | 295,92 | 0,550 | 0,72 | 0,001 | 296,64 | 0,551 | 1,44 | 0,004 | 295,2 | 0,549 |
Fl-P | 195,03 | 0,363 | 37,98 | 0,071 | 233,01 | 0,434 | 75,96 | 0,142 | 157,05 | 0,292 |
S-Shr | 7715,34 | 14,350 | 4322,25 | 8,040 | 12037,6 | 22,390 | 8644,5 | 16,080 | 3393,09 | 6,310 |
Total | 16309,89 | 30,335 | 16309,89 | 30,339 | 16309,89 | 30,337 | 12275,91 | 22,84 | 4058,98 | 7,501 |
Landscape Dynamic in the Boconó River Basin for the Period T0 – T1 (1988 – 1997).
The fourth position in terms of total change (3542, 31 ha), gains (1565, 1 ha), loses (1977, 21 ha) and swapping (3130, 2 ha), is for Grassland; the balance between gains and losses, as well the swapping value, suggest that this category has a strong interaction with other LULCC. The fifth changing category with a total change of 3450, 78 ha (6, 4 % of the total area) is Cro-L, suggesting that the cropping area also experienced important changes during the period. The category gained 1789, 2 ha, which is the second highest value for the period, losing also 1661, 58 ha (sixth value). With the second highest value (3323, 16 ha), Cro-L experienced also a swapping-change dynamic in the area.
Tcm-F is located in the sixth position of total changes, with a total value of 2482, 56 ha (4, 6 % of the total). The category gained 792, 45 ha (seventh value), but lost 1690, 11 ha; meanwhile, 1584, 9 ha were accounted as swapping-change. Finally, Gr-An showed the seventh highest change, with 2270, 16 ha (4, 2 % of the total area). It gained 1085, 49 ha and lost 1184, 67 ha, with a swapping value of 2170, 98 ha.
Despite of the dynamic above described the values for net change shows some differences among the positions between categories. Having the highest net value of 3393, 09 ha, the S-Shr remains as the most dynamic category for the period. The Oc-F had the second highest net change value (1324, 71 ha), and the third position was for Sm-F (1298, 97 ha). The Tropical Montane Cloudy Forest had the fourth highest net change value (947, 66 ha), followed by Gr-L (412, 11 ha), and the sixth position is for the category Ur-U, with a net change value of 295, 2 ha (most of the change in this category is net change, as usual), and a swapping value which tends to be cero. These values lead to affirm that the LCC and particularly the Forested LCC experienced the most important net changes in the river basin during this period.
The Table 6 resume the landscape dynamic for the second period T1 – T2. Some slight differences can be observed respect to the last period. S-Shr remains as the most dynamic category, with a total change value of 11750, 85 ha (22 % of the total area). It gained 6303, 42 ha and lost 5447, 43 ha. The 93% of the total value for this category (10894, 86 ha), occurred as swapping-change dynamic. Sm-F remains in the second position, with a total change of 3638, 88 ha (7 % of the total area). It gained less surface than in the last period (846, 99 ha), which is the seventh observed value for the period. Meanwhile, the losses remained high, having the second highest value for the period (2791, 89 ha). A total of 1693, 98 ha changed in a swapping-change form.
LULC Category | Gain | Loss | Total Change | Swap | Absolute value of net change | |||||
ha | % | ha | % | ha | % | ha | % | ha | % | |
Tmc-F | 877,5 | 1,632 | 2023,74 | 3,764 | 2901,24 | 5,396 | 1755,0 | 3,266 | 1146,24 | 2,132 |
Oc_F | 990,63 | 1,843 | 1113,21 | 2,071 | 2103,84 | 3,914 | 1981,26 | 3,686 | 122,58 | 0,228 |
Sm-F | 846,99 | 1,575 | 2791,89 | 5,193 | 3638,88 | 6,768 | 1693,98 | 3,152 | 1944,9 | 3,618 |
Schr | 29,25 | 0,054 | 1,35 | 0,003 | 30,6 | 0,057 | 2,7 | 0,006 | 27,9 | 0,051 |
Gr-L | 1731,78 | 3,221 | 1646,73 | 3,063 | 3378,51 | 6,284 | 3293,46 | 6,126 | 85,05 | 0,158 |
Sa-P | 7,11 | 0,013 | 0,63 | 0,001 | 7,74 | 0,014 | 1,26 | 0,002 | 6,48 | 0,012 |
Gr-An | 2588,85 | 4,815 | 937,98 | 1,745 | 3526,83 | 6,560 | 1875,96 | 3,490 | 1650,87 | 3,070 |
Cro-L | 2000,25 | 3,721 | 1463,31 | 2,722 | 3463,56 | 6,443 | 2926,62 | 5,444 | 536,94 | 0,999 |
Ero-L | 17,46 | 0,032 | 4,86 | 0,009 | 22,32 | 0,041 | 9,72 | 0,018 | 12,6 | 0,023 |
Ur-U | 138,24 | 0,257 | 2,16 | 0,004 | 140,4 | 0,261 | 4,32 | 0,008 | 136,08 | 0,253 |
Fl-P | 36,54 | 0,068 | 134,73 | 0,251 | 171,27 | 0,319 | 73,08 | 0,136 | 98,19 | 0,183 |
S-Shr | 6303,42 | 11,725 | 5447,43 | 10,132 | 11750,85 | 21,857 | 10894,86 | 20,264 | 855,99 | 1,593 |
Total | 15568 | 28,956 | 15568 | 28,958 | 15568,02 | 28,957 | 12256,11 | 22,799 | 3311,91 | 6,16 |
Landscape Dynamic in the Boconó River Basin for the Period T1 – T2 (1997-2008)
The third category experiencing changes in the period is Gr-An, with a value of 3526, 83 ha (6, 6% of total area) for total change. It had the second higher value for gains in the period (2588, 85 ha), meanwhile the losses (937, 98 ha), were lower in comparison to the last period. Of the total value, 1875, 96 ha changed in a swapping-change form. The fourth position in this period is for Cro-L, having a value of 3463, 56 ha (6, 4% of the total area). Cropland gained 2000, 25 ha (the 3rd highest value) during the period, losing 1463, 31 ha (5th value), which can be explained for the type of agriculture applied in the area (small/scale agriculture with shifting cultivation and slash and burn practices). This could explain the high value for swapping (2926, 62 ha) which is the third highest value for the period.
The Gr-L had a total change of 3378, 51 ha (6, 3% of total area), as the fifth changing category. It maintained the same trend as in the last period, gaining 1731, 78 ha, losing 1646, 73 ha, with 3293, 46 ha as swapping-change value. The sixth position in this period was for the Tmc-F, which showed a total change of 2901, 24 ha (5, 4% of the total area). It showed the same trend for gain as in the last period (877, 5 ha), but the losses were quite higher (2023, 74 ha), with 1755, 0 ha as swapping-change dynamic value.
Finally, the Oc-F descended to the seventh position in the period, showing a total change of 2103, 84 ha (3, 9% of the total area). It gained 990, 63 ha, and lost 1113,21 ha, with a swapping value of 1981, 26 ha for the period.
The dynamic showed by the net change values changed slightly respect the last period. The category with the highest net change value was Sm-F (1944, 9 ha), followed by Gr-An (1650, 87 ha); and the Tmc-F reached the third position, with a net change of 1146 ha. S-Shr descended to the fourth position with 855, 99 ha, followed by Cro-L (536, 94 ha) and Ur-U in the sixth position, with a net change value of 136, 08 ha (most of the change occurring as net change).
Now is possible to derive the categorical trajectory of the changes which have been occurring in the river basin during the considered period. The Table 7 accounts for the most important inter-category transitions for T0-T1 in terms of Losses. The magnitude of the ratio (fifth column) indicates in all cases the strength of the systematic transition between categories [54].
The first thirteen rows on Table 7 indicate spatial patterns or transitions affecting the Forested Land Covers in the River Basin: Tmc-F, Oc-F and Sm-F. These transitions indicate changes associated with deterioration, decrease or disappearance of the Forested areas, depending on the LULC category for which the forested categories have been migrating during the period. For example, the first transition process: Tmc-F – Oc-F indicate that the Tropical Montane Cloudy Forest changed to Open-cleared Forest in 3,764 times more than would be expected If the change were to occur randomly, losing 348,65 ha more than the expected value. This transition, together with the second one, indicate that the TMCF is changing systematically to an intermediate stage (Open-cleared Forest or Successional Shrubland), before it can finally change or migrate to any human–induced types of Land Use categories (Gr-An or Cro-L). No transitions from Tmc-F to Land Use categories were observed. Similar transitional trends were observed in the Highlands of Chiapas – Mexico by [13] and [59], being also described in two different regions in Chile [60][61].
The processes driving the transitions of the Tmc-F are basically associated with: clearcutting, logging, wood extraction and also plants and non-wood extraction. These processes could have been occurring in a successive way, and particularly the logging is probably occurring in a selective form, as observed during the field validation. The selective extraction or harvesting of non-wood products (like Orchids and Bromeliads), has been also reported as a critical problem occurring in this ecosystem [9].
Another example is the transition Sm-F – Ero-L, indicating that in this portion of the surface area, the clearcutting/ logging processes derived in severe land degradation processes like erosion in 6,428 times more than expected, affecting 12, 33 ha. The rest of transitions contribute to explain the other change patterns occurring in the rest of categories, particularly in the human-induced types of Land Cover.
The most systematic transitions occurred in T0-T1, in terms of Losses
As seen on Table 7, Gr-L is basically migrating to Gr-An (174, 33 ha), Cro-L (316, 53 ha) and S-Shr (1224, 45 ha), and with less importance, to Fl-P (31, 32 ha) and Ur-U (31, 32 ha), respectively. Gr-An is basically migrating to Gr-L in 2,146 times more than expected (230, 4 ha). This contributes to explain the high swapping value observed for Gr-L during the period. The category Cro-L migrated to Ur-U in 3,164 times more than expected (98, 1 ha); to Fl-P in 2,874 (49, 05 ha), and to S-Shr in 1,187 times more than expected (846, 63 ha). Particularly the transition Cro-L – Fl-P indicates that the hydrological dynamic of the river, especially the peak flows or flooding events, affected cropping areas. The transition Ero-L – Fl-P suggests an intense hydrological dynamic during the period, which augmented the sediments emission of the river. [62] determined that the yield of sediments in the whole catchment area have increased by 914 % with respect of the estimated value in order to build the Boconó-Tucupido Dam System, located dowmstreams in the lowland region.
The transition Ur-U – Fl-P also suggest that the hydrological events occurred during the period, affected the urban area of Boconó city, which had been expanding across the fluvial plain of the River; it can be corroborated some rows below, with the transition Fl-P – Ur-U, in which the urban area grew up across the Flooding Plain 11,625 times more than expected (6,57 ha). Important flooding events occurred in 1988, 1989, 1991 and 1995 were analyzed by [63]; unfortunately, the historical data for the River Basin is quite deficient and no more reference data exist since 1997.
Finally, the transitions for the category S-Shr suggest a trend for the category to migrate to the human-induced types of Land Cover categories Gr-An (3,070 times more than expected); Cro-L (2,179 times more than expected) and Ur-U (0,114 times more than expected). The rest of the transitions suggest a regeneration process. Shrubland was also observed as a highly dynamic category in the Kalu District-Ethiopia by [64], and also in Central Chile by [60], which can be explained by the forms of cultivation above mentioned, mostly typical in these regions.
The Table 8 shows the most systematic inter-category transitions occurred in the period T0 – T1 in terms of gain. The first twelve transitions are associated to changes in the Forested Land Covers. Particularly the transition Sm-F – Ero-L indicate erosion processes occurring after the clearcutting of the Sub-montane Forest, in 5,489 times more than expected, affecting a total of 12,33 ha. On the other hand, the transitions Gr-An – Gr-l (4,760); Gr-An – S-Shr (2,231), and Gr-An - Sm-F (0,232) suggest a regeneration/revegetation process.
As seen on Table 8, the cropland area in the river basin is growing at the expense of the categories: Oc-F (176, 76 ha), Sm-F (339, 48 ha), Gr-L (316, 53 ha), Gr-An (100, 89 ha), and S-Shr (766, 53 ha). On the other hand, the Gr-An gained surface area migrating basically from: Oc-F (168, 93 ha), Gr-L (174, 33 ha), Cro-L (70, 11 ha), and from S-Shr (497, 34 ha).
The transition Cro-L – Sm-F could to indicate regeneration, or perhaps a change to coffee plantation, or a combination of both scenarios. The transition Cro-L – Gr-L could be explained by the type of cultivation usually practiced in the area, above mentioned.
The most systematic transitions occurred in T0-T1, in terms of Gains
The fact that the urban areas have been growing at the expense of croplands is corroborated again with the transition Cro-L – Ur-U, which indicates that the urban areas grew up from Cropland in 7,028 times more than expected (98,1 ha). The urban areas also grew up at the expense of other categories: Sm-F (61, 92 ha), Gr-L (31, 31 ha), S-Shr (84, 06 ha) and Gr-An (9, 72 ha). On the other hand, the Fl-P grew up at the expense of Cro-L in 5,108 times more than expected, affecting 49, 05 ha.
The transition Ero-L – Tmc-F suggest a regeneration/revegetation process, showing a high level of resilience for the TMCF to be regenerated after such disturbances like landslides, as in this case. The transition Ero-L - Fl-P focuses a source of sediments which were transported by the river during the period. On the other hand, the transition Fl-P – Ur-U confirms the fact that the urban areas (in this case, the urban area of Boconó city) is expanding through the Flooding plain. The last transitions help to confirm the higher swapping-change dynamic associated to the category S-Shr.
The Tables 9 and 10 resume the most systematic transitions occurred in the second period (T1 – T2) in terms of losses and gains, respectively.
As seen on Table 9, the number of rows accounting for changes in the Forested LC was reduced to 9, because of a slight reduction in the transitions of Sm-F, which explains the reduction in the swapping value observed in the category for this period.
The same trend in the transitions for the Tmc-F can be observed in this period, but additionally 5,31 ha of the area covered by the category was affected by erosion processes, particularly landslides. An incipient transition process for the Sa-P occurred during the period, suggesting that some changes derived by anthropogenic pressure have been occurring in the Páramo ecosystems of the river basin. The growing anthropogenic pressure over the Sub-Andean Páramo in the study area was already reported by [65].
The categories Gr-L, Gr-An and Cro-L show the same transitional trends as in the last period. The Urban use continued to growing up at the expense of croplands and the flooding plain, and at the same time, the urban area continued being affected by peak flows or flooding processes. Finally, the S-Shr showed migrating trends to Gr-An (3,168), Cro-L (1,719), to Gr-L (1,507) and to Oc-F (0,910) also.
Respect to the gains in this period, the Table 10 illustrates the trend, where the first ten rows show the changes affecting the Forested LCC. In general, the trends and patterns for the transitions observed on last period remain during the second period.
The category Gr-L showed less intensity in the swapping, meanwhile Cro-L gained surface at the expense of Oc-F (66, 78 ha), Sm-F (269, 37 ha), Gr-L (361, 17 ha), Gr-An (172, 44 ha), Fl-P (36, 9 ha) and S-Shr (1037, 97 ha). Gr-An gained surface migrating from Gr-L in 2,142 times more than expected (502, 83 ha), and also from Cro-L (213, 39 ha), and from S-Shr (1571, 40 ha).
The urban areas continued to growing up in the period, gaining surface area basically from Sm-F (43, 38 ha), Gr-An (3, 78 ha), Cro-L (46, 08 ha), Fl-P (5, 85 ha) and S-Shr (31, 95 ha). Particularly the urban area growing close or into the category Fl-P is vulnerable to the river dynamic. During this period the category S-Shr reported systematic transitions with all the rest of the categories, which explain the high value for swapping-change for the category in this period.
The most systematic transitions occurred in T1-T2, in terms of Losses
The most systematic transitions occurred in T1-T2, in terms of Gains
The dynamic of the LULC in the Boconó River Basin for the considered period and through the approach used in this project, lead to establish key elements and a support basis to be considered in the planning processes at the watershed level or even at regional planning level also. Considering that the Boconó River Basin constitute a double “
The systematic transitions show the trajectory or directionality of the changes in a categorical sense, leading to identify not only the categories which are more dynamic in a spatial-temporal perspective, but also the possible biophysical and anthropogenic processes driving the transitions. When both interpretations are correctly established, they simply lead to define the key elements to be considered in the land planning processes:
the way how the land resources have been used in the river basin during the last twenty years
the form how the land cover categories as ecosystems have been affected
the trends existing for the different Land Use/Land Cover categories, in a spatial/temporal perspective.
Particularly the spatial visualization (geographical visualization) results in a undoubtedly helpful tool for the planning process, allowing to perceive how these trends are spatially occurring, where are occurring specific processes accounted for problems to be solved, and where these problems are more diverse or intense (hot spots).
As an example, the Figure 3 show the geographic visualization of the transitions for the three main forested Land Cover Categories (LCC) (Tmc-F, Oc-F and Sm-F), for the period T0-T1. The transitions occurred during the Period T1-T2 are displayed on Figure 4. A simple observation of the maps, based on the systematic transitions above described, can lead to the following statements:
1.- The changes affecting the forested land covers, particularly the Tcm-F and the Sm-F tends to be produced in the boundary area between categories. The same trend was observed by [30] in Ecuador. This lead to define belts of clearcutting / logging, which are also called “
2.- Observing the two maps, is evident that in the first period, the Open-cleared Forest was systematically reduced among the river basin, meanwhile in the second period, the transition of the Tropical Montane Cloudy Forest was clearly spatially intensified. This lead to corroborate the fact that the dynamic of the TMCF is characterized by a systematic and progressive change, in which the category is migrating to an “intermediate” stage or LCC like Open-cleared Forest or Successional Shrubland, and in other successive stage it can to migrate to another LC or LU categories.
3.- Although the “Guaramacal National Park” was created on 1988, covering the flank south-east of the river basin [41], a “
Transition area for the Forested Categories in the period T0-T1
4.- The transitions Sm-F – Fl-P; Cro-L – Fl-P and Ur-U – Fl-P suggests a relevant hydrological dynamic occurring during the period studied. The LC Flooding Plain changed actively on last 20 years, accounting for important events like peak flows or even flash-floodings, which expanded the limits of the category among the area, affecting other categories like Sm-F, Cro-L and Ur-U. The dynamic accounted for the Forested LC and the increase of cultivated soils and grass could have been playing a role in the intensification of the hydrological events. The ecological conditions, and particularly the type and density of the land cover play a very important role in the hydrological behaviour and the hydrological response of the landscape. Many authors like: [9] [36] [38] [66] [67] [68] and [69] have been highlighting the importance of the forest ecosystems in the hydrological patterns. Particularly the TMCF is considered as “
Transition area for the Forested Categories in the period T1-T2
5.- The transitions Sm-F – Ero-L; S-Shr – Ero-L; and Cro-L – Ero-L, indicate that the area is highly susceptible to soil degradation processes like sheet erosion, rill erosion, landslides and so on, processes which have been activating through the migration of Forested LCC to other categories like Cro-L. Only intense erosive processes like landslides were observed in the classification. However, [39] identified severe erosion processes, especially sheet erosion, in the San Miguel and San Rafael Watersheds (within the study area), which are spatially extended due the high accessibility (intricate road network), the fragile soils and the highly jointed bedrocks.
The accessibility (roads network) has been considered as one of the most important and critical drivers facilitating the LULC change in many regions worldwide [1] [39] [57] [67] [70] [71] [72]. With the exception of the “Río Negro” Sector (See Figure 3), the Boconó River Basin presents a moderately high accessibility [43] [45] [63]. The results obtained by [39] in San Miguel / San Rafael watersheds through a regression tree analysis, revealed that the accessibility had the greatest level of contribution in the occurrence of soil erosion in the area, being the sectors where the cropland have been progressively expanding during the last decades. The occurrence of erosion processes was directly associated to the distance to the road network. This suggest that the accessibility could play a determinant role explaining the intensity and spatiality of the changes that the LULC have been experiencing in the River Basin, as demonstrated by studies conducted in other regions [1] [57] [70-72]. Due the nature and complexity of the variables usually involved, a rigorous analysis of the drivers of LULC change in the area was out of scope of this project, so that further research in this subject is strictly necessary in the near future, in order to comprehensively determine the causal relationship of the factors influencing the changes that affect the River Basin.
The Figures 5 and 6 show the transitions occurred in the Land Use Categories during the first and the second period, respectively. It can be clearly observed where the LUC grow up more intensively in the two periods. The superior window show the San Miguel – San Rafael Watersheds, the sectors where the croplands and the grass anthropogenic grew up more intensively for both periods. These are the sectors which have the most relevant problems related with land degradation in the area, as studied by [39]. The inferior window
Transition area for the Land Use categories in the period T0-T1
show the expanding process that the Boconó city experienced during the two periods, showing how the city has been expanding among the flooding plain, in areas susceptible to be flooded. The transition Ur-U – Fl-P clearly indicates that some urban sectors have been damaged during the two periods analyzed.
All these interpretations constitutes important tools having practical importance for the institutions or stakeholders involved with the environmental and land planning at local/regional level, being a rational basis to design new plans, or even to improve those which already exists, in order to guaranty the optimization of the natural resource uses in the river basin. This is very important to encourage the effectiveness of the protective figures defined for the whole river basin, accounting for a more sustainable evolution of the LULC in this important “
Transition area for the Land Use categories in the period T1-T2
The methodological approach combining the multitemporal LULC evaluation, together with the ecosystem approach and the inter-category transitional method, represented a very useful tool to define, to describe an to analyze the LULC system in the Boconó River Basin and the changes occurred in the last 20 years. The study demonstrated that the categories: Successional Srhubland (S-Shr), Sub-montane Forest (Sm-F), Open-cleared Forest (Oc-F) and Cropland (Cro-L) were the most dynamic among the two considered periods, accounting for the highest total change value, as well as gains, losses, swapping and net change.
The study also demonstrated that the changes and the reduction showed by the Tropical Montane Cloudy Forest in the area, cannot be directly associated to the expansion of land use categories like Cropland or Grass Anthropogenic. At least on the last 20 years, the TMCF have been changing to an intermediate condition for LC, basically to Open-cleared Forest (Oc-F) and Sucessional Srhubland (S-Shr). Even when the TMCF is under anthropogenic pressure, it can be only associated with logging, wood and timber extraction, as well as the extraction of non wood products and plants.
The systematic transitions that have been occurring in the LULC categories reveal that the land uses Cropland (Cro-L) and Grass Anthropogenic (Gr-An) have been growing, gaining surface basically from Sucessional Shrubland (S-Shr), Sub-montane Forest (Sm-F), and Grassland (Gr-L).This justify the higher values for swapping-change, observed in these categories. On the other hand, the urban areas (Ur-U) have been growing basically at the expense of Cro-L, Gr-L and Fl-P.
The systematic transitions Sm-F – Fl-P; Cro-L – Fl-P and Ur-U – Fl-P, as well as the variation of the category Fl-P during the period, suggest an intense dynamic of the river, and the occurrence of high peak flows and important flooding events during the period, which have been affecting the urban expanding area, as well as croplands. Probably, the decrease of the forested areas, and particularly the TMCF, as well as the increase of the croplands and the grass-anthropogenic, could be directly affecting the hydrological dynamic in the river basin, particularly the behavior of the seasonal flows.
Finally, the systematic transitions helped to focus specific processes that suggest the existence of problems which need to be solved into the land use planning or the watershed management processes. The “
Further rigorous research about the associated drivers for LULC change in the area is strictly necessary, in order to reach a comprehensive understanding of the dynamic and transitions of the LULC categories identified and characterized in this project, seeking to encourage the future decisions for land use planning within the watershed management at regional and local level.
We thank to the following institutions which helped in the development of this project: The United States Geological Survey (USGS) and the Institute of Geography (IGCRN) – Universidad de Los Andes, Venezuela, which were the provider of the LANDSAT scenes used in the classification process. The Centre of Geoinformatic and GIS (GIS Zentrum) of the Eberhard Karls University – Tübingen - Germany, which provided the technical support, software and personal who helped during the development of the project. Finally, thanks to DAAD (German Academic Exchange) and FUNDAYACUCHO (Fundación Gran Mariscal de Ayacucho), which have been providing the financial support for the development of the PhD program.
Living organisms are constitutionally wired to store energy for survival in periods of scarcity. Eel and salmon are reported to survive long periods without food [1, 2, 3]. The excess intake of calories leads to energy accumulation in the form of fat, glycogen, or starch. Plants store energy reserves as starch and oil. We were unable to find reports of adverse consequences of excess energy storage in plants and lower organisms. The stored energy helps the organism to tide over periods of calorie scarcity and during hibernation, aestivation, or migration in animals. In higher organisms, deposition of excess calories results in impairment of body functions with adverse effects on health and longevity. Obesity with adverse health effects has been reported in zebrafish [4], reptiles [5, 6], and birds [7].
Energy in humans is stored as glycogen or triacylglycerols (TAGs). Relative to the amount of calories that can be stored as triacylglycerols (TAGs), only a small amount of calories can be stored as glycogen. An adult liver can store up to 120 g glycogen, while the skeletal muscles can store up to 400 g glycogen. Triacylglycerols are hydrophobic energy-dense molecules that can be stored in large amounts in the adipocytes. Adipose tissue is the loose collection of adipocytes in a mesh of collagen fibers, deposited at various sites in the body. Preadipocytes, fibroblasts, vascular endothelial cells, adipose tissue macrophages, and small blood vessels are also present in the adipose tissue.
Increased mass of adipose tissue, abnormal site of deposition, or abnormal size of adipocytes can result in adverse consequences on health and quality of life (Table 1).
Physical problems | 1. Musculoskeletal disorders
|
2. Respiratory problems
| |
3. Lower limb venous disease
| |
4. Skin-related problems | |
5. Stress incontinence in females | |
Metabolic disorders | 1. Hyperglycemia |
2. Dyslipidemia | |
3. Gout Hyperglycemia increases risk of skin infections, eye diseases, and kidney diseases. Both hyperglycemia and dyslipidemia cause insulin resistances, leading to increased risk of type 2 diabetes, cardiovascular disease, stroke, and cancers. | |
Gut-associated diseases | 1. Cholelithiasis |
2. Pancreatitis | |
3. Fatty liver | |
4. Gastroesophageal reflux disease | |
Reproductive Health Issues | A. Males 1. Hypogonadism |
2. Gynecomastia | |
3. Decreased fertility | |
B. Females | |
1. Polycystic Ovarian Syndrome (PCOS) | |
2. Anovulation | |
3. Endometrial hyperplasia | |
C. Increased risk of complications in pregnancy | |
1. Gestational diabetes | |
2. Preeclampsia | |
3. Cesarian section | |
Economic issues | 1. Increased expense on obesity-related diseases |
2. Decreased pay | |
3. Decreased job opportunity | |
Mental and social issues | 1. Social stigma |
2. Bullying | |
3. Binge eating | |
4. Depression | |
Quality of life and mortality | 1. Increased risk of morbidity, mortality decreased quality of life |
Multiple consequences of obesity.
These result from the abnormally high weight of the affected person and are closely related to each other and to the other consequences of obesity including metabolic dysfunction and insulin resistance. For convenience, we have classified them into musculoskeletal disorders, skin-related problems, respiratory problems, lower-limb venous diseases, and urinary incontinence.
These include decreased mobility, loss of balance, and osteoarthritis, which are associated with abnormal increase in body weight (Figure 1).
Association of obesity with musculoskeletal disorders.
Obesity is one of the major causes for the loss of functional mobility. Altered posture and gait resulting from abnormal fat deposition, compromised bone strength, pain, and breathlessness compromise the mobility [8], which must be taken into account by treating physicians advising increased physical activity for weight loss. Decreased mobility results in further increase in weight.
Increased weight, decreased mobility, and altered posture result in loss of balance, increasing the risk of falls and injury [9]. In spite of the cushioning effect of the fat mass, falls in patients with obesity are more serious and require higher treatment costs and specialized care [10].
Progressive loss of articular cartilage and formation of osteophytes (bony spurs usually caused by local inflammation) result in osteoarthritis [11]. Obesity is a risk factor for OA of knee, hands, and wrist (but not of hip) [12]; thus excessive body weight alone cannot fully explain the increased incidence of OA in people with obesity. Increased body mass index (BMI) in obesity results in altered gait and increased strain on the knee, causing biomechanical joint loading [13]. This is associated with increased expression of matrix metalloproteinases in chondrocytes and increased degradation of proteoglycans [14]. Synthesis of DNA, proteoglycans, and collagen is decreased, contributing to the loss of cartilage in joints [14]. Chondrocytes subjected to high loading show increased expression of pro-inflammatory cytokines including TNF-α and IL-1(β), along with an increased expression of cyclooxygenase-2 leading to increased PGE2 (responsible for inflammatory pain) synthesis [15].
Increase in the amount of adipose tissue leads to metabolic dysfunction: obesity-related sarcopenia, deposition of intramuscular lipid, and chronic low-grade systemic inflammation, all of which contribute to osteoarthritis [16].
Insulin resistance, often seen in patients with obesity, causes decreased excretion of uric acid, leading to hyperuricemia [17, 18]. Adipose tissue is known to express all the components of renin-angiotensin system (RAS), including angiotensinogen [19]. The resulting hypertension may cause glomerular arteriolar damage and reduce uric acid excretion. Hyperuricemia and gout have been associated with osteoarthritis [20, 21].
Obesity is associated with various respiratory problems that are correlated with each other (Figure 2).
Association of obesity with respiratory disorders.
Increased fat deposition in the mediastinum and abdominal cavity increases intra-abdominal and pleural pressure, thus reducing compliance of the lungs. Altered breathing pattern, with decrease in expiratory reserve volume (ERV), functional reserve capacity (FRC), and tidal volume (TV), with slight increase in mean respiratory rate have been reported in subjects with obesity [22, 23], Obesity has little effect on the residual volume (RV) and total lung capacity (TLC) [24].
The relationship between obesity and asthma has been established by a meta-analysis involving more than 300,000 adults [25]. The expression of adipokines secreted by adipose tissue is different in persons with obesity. Decreased expression of adiponectin (anti-inflammatory adipokine) and increased expression of leptin (pro-inflammatory adipokine) have been reported in asthmatic patients with obesity [26]. Leptin, an anorexigenic hormone, increases metabolic rate and is involved in surfactant production and neonatal lung development [27]. Sood et al. [28] have reported a strong association between high BMI and high levels of serum leptin with asthma in adults.
Inflammatory cytokines such as TNF-α, IL-8, and monocyte chemoattractant protein-1 (MCP-1) have also been reported to be raised in persons with obesity. However, their role in asthma associated with obesity is not clear [29]. In older patients, abdominal obesity and metabolic syndrome have been reported to be associated with restrictive lung disease [30].
The prevalence of obstructive sleep apnea in adult persons with obesity is about 45%, compared with 25% in persons with normal weight [31]. Increased fat deposit in tissues surrounding the upper airway decreases the size of lumen and increases collapsibility of the upper airway. OSA may cause sleep fragmentation, which may lead to sleep deprivation [32]. Since experimental sleep deprivation and self-reported short sleep have been linked with metabolic dysregulation, it is possible that OSA may also be a contributing factor in metabolic dysregulation associated with obesity.
Venous diseases (blood clots, deep vein thrombosis, superficial venous thrombosis or phlebitis, chronic venous insufficiency or CVI, varicose and spider veins, and venous stasis ulcers) may be caused by one or more of the following factors: immobility (as in bed-ridden patients) leading to stagnation of blood), blood vessel injury caused by trauma/needles/intravenous catheters/infections, central venous hypertension, conditions that increase the blood coagulation, and pregnancy. Different cancers are associated with deep vein thrombosis.
Varicose veins and chronic venous insufficiency are more common in aged women compared with men. Obesity has been found to be associated with all types of lower limb venous diseases (Figure 3). Willenberg et al. [33] showed that lower limb venous flow parameters are different in healthy persons with and without obesity. Various epidemiological studies show that obesity is associated with chronic venous disease, phlebitis, and thromboembolism [34, 35, 36, 37]. Untreated CVI results in increased pressure and swelling leading to rupture of capillaries. The skin may appear reddish-brown and becomes sensitive to bumps and scratches. Burst capillaries may lead to inflammation and even ulcers.
Obesity as a cause of lower limb venous diseases.
Increased intra-abdominal pressure caused by central obesity is transmitted to the extremities via femoral veins leading to resistance to venous return, producing venous valvular insufficiency. The self-perpetuating cycle of worsening venous insufficiency causes venous stasis and distension of veins in the lower limb. Obesity produces a chronic low-grade inflammation, which damages the affected veins and increases the risk of thromboembolism [33].
Different problems of the integumentary system associated with obesity can be classified on the basis of their pathophysiologic origin (Figure 4). Skin lesions associated with mechanical causes include striae, lipodystrophy, plantar hyperkeratosis, and venous insufficiency. Acanthosis nigricans and skin tags or acrochordons are due to insulin resistance. Obesity-related hyperandrogenism may cause acne, hirsutism, and androgenic alopecia. Skin folds created by obesity increase the risk of intertrigo and infections.
Dermatological manifestations associated with obesity.
Striae or stretch marks are a type of scarring of the dermis associated with stretching of the dermis. Striae distensae may appear as a consequence of pregnancy, puberty, or obesity and appear on abdomen, breasts (in females), and shoulders (in body builders). They are more common in females. [38]. Striae atrophicans due to thinning of the skin may appear in adrenal gland disorders [39].
Other dermatological conditions with mechanical causes include intertrigo, conditions associated with chronic venous insufficiency, and lymphedema [40]. Intertrigo is an inflammation of skin resulting from friction between opposing skin surfaces of skin folds. It may have an infectious component. Axilla, groin, intergluteal, and inframammary areas may be involved [41]. Hot, humid climates and obesity (BMI > 30 kg/m2) are known to promote intertrigo. Persons with obesity tend to sweat more.
Dermatologic sequelae of chronic venous insufficiency (discussed above) are often seen in patients with obesity and include pitting edema, varicose veins, telangiectasia, hyperpigmentation, venous stasis ulcers, and scaling of the skin (stasis dermatitis) [42].
Blocking or damage of the lymphatic system resulting in accumulation of lymph in soft tissues, especially legs or arms, is called lymphedema. Obesity is a risk factor for secondary lymphedema [40].
These include skin tags, acanthosis nigricans, keratosis pilaris, hidradenitis suppurativa and hirsutism, and plantar hyperkeratosis.
Skin tags or acrochordons. Skin tags are soft cutaneous growths, usually benign, more commonly seen in persons with obesity, metabolic syndrome, type 2 diabetes, or in persons with family history of skin tags [43]. They occur in both males and females, usually later on in life, but are less common after the seventh decade. The polypoid lesions are skin-colored, brown, or red, 1–5 mm in size (rarely larger) with a loose edematous fibrovascular core, and may be attached to a fleshy stalk. They are more common in skin folds: axilla, groin, eyelids, and neck [44]. Although not painful, they can cause trouble by getting caught in clothing or jewelry, resulting in itching or bleeding. However, skin tags in large numbers may be seen in patients with Birt-Hogg-Dube (BHD) syndrome and tuberous sclerosis, where they appear around the neck: the molluscum pendulum necklace sign [45, 46].
Acanthosis nigricans (AN). Hyperpigmented velvety plaques usually in body folds, neck, knuckles, and scalp may be seen in patients with obesity. The condition was first reported more than an hundred years ago in the Atlas for Rare Skin Diseases. The term acanthosis nigricans was proposed by Paul Gerson Unna and published in 1891 in a case report by Sigmund Pollitzer [47]. Obesity-associated AN was previously called pseudo acanthosis nigricans; however, this term is incorrect. This is because the initial cases identified in Europe were associated with abdominal or pelvic malignancies. Association of AN with obesity was first reported by Robertson and Tasker in 1947 [48]. Like acrochordons, AN is also associated with insulin resistance often seen in obesity. Probably, the hyperinsulinemia seen in insulin resistance leads to direct and indirect activation of the insulin-like growth factor receptor, triggering proliferation of the dermal fibroblast and epidermal keratinocyte [49]. Friction and perspiration may also be involved in the development of AN [50].
Keratosis pilaris (chicken skin) is a benign condition of the skin in which sterile papules occur on the skin (collections of dead skin cells). Though these papules may occur anywhere on the body (except palms and soles), they are more common on the posterior aspect of upper arms, anterior aspects of thighs, face, and buttocks [51].
Hidradenitis suppurativa or acne inversa is a chronic painful condition of the terminal follicular epithelium in the apocrine gland–bearing skin (groin, bottom, axilla, breasts) [51]. It affects about 1% of the population and is strongly associated with smoking and obesity. It is also linked with hyperandrogenemia, as many patients have acne and hirsutism [52].
Hirsutism, acne vulgaris, and androgenic alopecia seen in some female patients with obesity (with or without polycystic ovarian syndrome, PCOS) are due to hyperandrogenemia, often associated with peripubertal obesity [51, 52, 53, 54]. Increased insulin production (hyperinsulinemia) due to insulin resistance in obesity increases IGF-1 levels and augments ovarian androgen production [55]. Hyperinsulinemia produces a decrease in serum level of steroid hormone binding globulin (SHBG), resulting in a further increase in the level of free testosterone. Treatments that reduce insulin levels usually correct hyperandrogenemia and ovulatory dysfunction [56].
Plantar hyperkeratosis (thickening of skin over metatarsophalangeal joints, caused due to increased pressure and mechanical stress placed on the feet) is seen in almost 50% patients with obesity [40]. Increased circulating levels of IGF-1 seen in hyperinsulinemia lead to overactivation of IGF-1 receptors on fibroblasts and keratinocytes. The abnormal IGF-1 signaling causes cellular hyperproliferation (Figure 4).
Obesity has been associated with an increased risk of skin, respiratory tract, and urinary tract infections [57]. An increased risk of community-acquired infections has been reported by Harpsoe et al. [58] in both overweight and underweight women. Obesity alters the function of skin, sebum, and sweat glands, affects the structure of collagen and subcutaneous fat, and slows wound healing. A number of skin infections that are more common in persons with obesity include candidiasis, candida folliculitis, furunculosis, tinea cruris, and folliculitis. Cellulitis is less common [42].
Normal adipose tissue in a nonobese person has a population of anti-inflammatory/regulatory immune cells: M2-macrophages and regulatory T cells. These are replaced by pro-inflammatory cells: M1 macrophages, Th1, Th17, and cytotoxic T cells in adipose tissue in persons with obesity [59]. Systemic immune adaptations in obesity include increased number of circulating monocytes, neutrophils, Th1, Th17, and Th22 cells. The pro-inflammatory cytokines produced by pathogenic adipose tissue (IL-1β, IL-6, IL-17, and IFN-γ) result in a chronic low-grade inflammation. Skin conditions such as psoriasis, atopic dermatitis, and eczema are strongly associated with obesity [60]. Hashba et al. [61] have suggested the association of lichen planus with obesity.
Urinary incontinence may be of different types: stress incontinence when pregnancy, childbirth, etc., weaken the muscles supporting and controlling bladder; urge incontinence caused by involuntary action of bladder muscles; and mixed incontinence that shares the causes of both stress and urge incontinence. Thyroid problems, uncontrolled diabetes, and medicines such as diuretics can worsen the problem of UI. High BMI, especially BMI higher than 40 kg/m2, has been strongly associated with stress predominant incontinence including mixed incontinence [62]. Central obesity increases the abdominal pressure, which increases the bladder pressure and urethral mobility, leading to UI. Chronic strain and stretching seen in pregnancy and abdominal obesity weaken the muscles and other structures of the pelvic floor. Surgical and non-surgical weight loss has been reported to decrease incontinence and improved quality of life.
Adipose tissue is a loose connective tissue in which about half the cells are adipocytes, the remaining is stromal vascular fraction containing preadipocytes, fibroblasts, endothelial cells, and macrophages [63]. The adipose tissue may be considered the largest endocrine gland in the body.
Based on the metabolic features of the adipocytes, adipose tissue (AT) can be white adipose tissue (WAT), which stores excess energy as fat, and brown adipose tissue (BAT), which dissipates stored energy as heat (Figure 5). Both WAT and BAT are present in mammals and are formed throughout life. In humans, WAT development begins during early to mid-gestation period. WAT adipocytes contain a large single (unilocular) droplet of triacylglycerols occupying 90% of the cell volume, with the cytoplasm and the nucleus squeezed to the periphery. Adipocytes of BAT are smaller, multilocular, and contain mitochondria and uncoupling protein-1 (UCP-1), which is involved in non-shivering thermogenesis. The brown appearance of BAT is due to high vasculature and high mitochondrial content. It has a high density of noradrenergic parenchymal fibers. BAT is 5–10 times more vascularized than WAT. A third type of adipose tissue, the beige or brite (brown in white) adipose tissue with paucilocular adipocytes is dispersed in the WAT [64, 65, 66]. Browning of WAT has been suggested under the influence of the hormone irisin, which is produced by the skeletal muscle during exercise [67]. Adipocytes of WAT and beige adipose tissue are predominantly derived from the Myf 5 negative progenitor cells, while adipocytes of BAT are predominantly from Myf 5 positive progenitor cells. Myf 5 or myogenic factor 5 is a gene for transcriptional factor expressed during embryonic myogenesis [68]. Brown and beige AT show anatomical decline with aging and protect from obesity and type 2 diabetes mellitus (T2DM).
Types of adipose tissue.
Based on the location of the white adipose tissue, it is broadly classified as subcutaneous and visceral (Figure 5). The subcutaneous adipose tissue (SAT) stores excess energy, provides insulation from heat and cold, and functions as an endocrine organ. Visceral adipose tissue (VAT) provides a protective padding around organs. Specialized adipose tissue is associated with the bone marrow, breast, retroorbital adipose tissue, and epicardium [69]. In persons having the same BMI, females tend to have more adipose tissue than males. Females also have more subcutaneous adipose tissue (SAT) compared with males. Localized fat pads, e.g., the synovia are considered as SAT. The SAT of lower trunk and gluteal-thigh region is further organized in two separate layers: the superficial SAT, SSAT (evenly distributed around the circumference of the abdomen), and the deep SAT, DSAT (most of which is located in the posterior half of the abdomen). The SSAT and DSAT are separated by the fascia of Scarpa. SSAT has a higher expression of metabolic regulatory genes, while DSAT has a higher level of expression of inflammatory genes and higher lipolytic activity. Thus, higher volume of DSAT is associated with higher levels of free fatty acids [70].
Bone marrow contains adipose tissue called the marrow adipose tissue (MAT), which increases in amount in periods of calorie restriction, in contrast to adipose tissue present at other sites in the body. Exercise results in decrease in the size of MAT, as well as of the adipocytes present in MAT. Adipocytes of MAT develop from the mesenchymal stem cells.
In some persons there is a variable lack of adipose tissue, which may be generalized or specific (abnormal distribution of adipose tissue). This condition is called lipodystrophy. Lack of sufficient adipose tissue results in increased levels of fatty acids in blood, as they cannot be stored as TGs in the adipocytes. Raised levels of fatty acids cause lipotoxicity, characterized by ectopic fat deposition in the muscle, liver, and pancreas, thus contributing to T2DM [71].
The mechanism of development of insulin resistance is complicated and is influenced by diverse factors, including the location and type of adipose tissue that increases in mass.
Depending on the location, WAT is further classified into different types (Figure 5) [72, 73]. Excess calorie intake leads to enlargement of adipocytes (hypertrophy) as well as increase in the number of adipocytes (hyperplasia) [74]. The new adipocytes may develop from preadipocytes or from adipocytes of BAT. Adipogenesis through differentiation of progenitor cells to adipocytes occurs through transcription factors such as peroxisome proliferator-activated receptor-γ (PPAR-γ), and CCAAT/enhancer binding protein-α [75]. Increase in the size of the adipocytes is associated with insulin resistance and inflammation. Adipose hypertrophy seen in morbid adiposity results in heterogeneity of cell size within the same depot of adipose tissue, with cell size ranging from 20 microns to 300 microns [76]. Usually, SAT contains more preadipocytes compared with VAT, so adipose hypertrophy is less in SAT [77]. Normal adipose tissue produces adipokines (leptin, adiponectin) that regulate appetite and energy metabolism and cytokines. Pro-inflammatory cytokines include TNF-α, visfatin, resistin, angiotensin II, serum amyloid alpha, plasminogen activator inhibitor, and IL-6, while anti-inflammatory cytokines include apelin, transforming growth factor beta (TGFβ), IL-10, IL-4, IL-13, and IL-1 receptor antagonist (IL-1Ra) [78]. Male hormones promote hypertrophy, while female hormones promote hyperplasia [79]. In lean adipose tissue, the adipose cells are 5–10% of all cells in the tissue; in obese adipose tissue, this number is as high as 60% [80]. Although the life span of adipocytes is about 8 years, increase in size beyond a critical cell size and nutrient excess produce endoplasmic reticulum stress, hypoxia, and death of adipocyte, attracting infiltration of macrophages. This is more in VAT. Adipocyte remnants are absorbed by macrophages, which become activated. In lean adipose tissue, the adipose tissue macrophages (ATMs) are predominantly M2 (anti-inflammatory) type. Pathologic adipose has greater number of M1 ATMs, which are pro-inflammatory and produce cytokines in large amounts after absorbing dead adipocytes. This results in chronic low-grade inflammation and insulin resistance.
In some persons with obesity, excess calories are preferentially stored in SAT, which does not produce inflammation. This type of obesity is also called metabolically healthy obesity (MHO) [81]. In contrast, increase in VAT is associated with abnormal blood lipid profile, i.e., dyslipidemia, insulin resistance, metabolic syndrome, type 2 diabetes, and hypertension. This type of obesity is called metabolically unhealthy obesity (MUHO) and is due to deposition of intraabdominal fat.
Hypertrophic stressed adipocytes are unable to take up free fatty acids, which are therefore diverted to other non-fat-storing organs such as muscle, liver, pancreas, and heart, where they are stored as ectopic fat. This results in impaired glucose uptake by muscle cells, decreased glucose utilization by liver and adipose causing hypertriglyceridemia, hyperglycemia, reduced amounts of HDL cholesterol, increased amounts of LDL and VLDL cholesterol, increased proportion of small, dense LDL particles, and insulin resistance. Products of fatty acid metabolism such as long-chain fatty acyl-Co A, diacyl glycerol (DAG), and ceramide are harmful to cells and aggravate insulin resistance by causing phosphorylation of the serine residues on the insulin receptor substrate (IRS) [82]. In skeletal muscle, lipid can be stored in adipocytes between muscle fibers, or as cytosolic triacylglycerols within the muscle cells (intramyocellular lipids, IMCLs). IMCLs are an adaptive response in endurance athletes and are present in close proximity to mitochondria. Increased IMCL stores in insulin resistance or T2DM is a consequence of raised free fatty acid levels in blood and impaired fatty acid oxidation in the muscle [83]. This may also be due to mitochondrial dysfunction.
Recent evidence suggests the role of leptin resistance and hyperleptinemia of obesity causes production of reactive oxygen species (ROS) and increases oxidative stress, promoting the risk of hypertension, heart disease, and cancer [84, 85, 86]. Endoplasmic reticulum stress, protein tyrosine phosphatase 1B, and suppressor of cytokine 3 (SOC3) signaling mediate leptin resistance and are also involved in insulin resistance [87].
Insulin resistance in the liver, adipose, and muscles coupled with ectopic fat in the pancreas contributes to hyperglycemia and T2DM. Deposition of ectopic fat in the pancreas is seen in almost two-thirds of patients with obesity. Most of this is due to adipocyte infiltration into pancreatic tissue rather than accumulation of intracellular lipid. Ectopic pancreatic fat is associated with an increased risk of T2DM and cardiovascular disease (CVD). Increased lipolysis and inflammation caused by ectopic pancreatic fat are also reported to promote acute pancreatitis [88].
Hepatic insulin resistance caused by DAG and ceramide promotes lipotoxicity, ectopic fat deposition, insulin resistance, and steatosis, leading to nonalcoholic fatty liver disease (NAFLD) [89].
Excess free fatty acids reaching the heart can be stored as epicardial adipose tissue (EAT), also called pericardial fat (present between the visceral and parietal pericardia), or surrounding the blood vessels (perivascular adipose tissue or PVAT). Although the cardiac muscle uses free fatty acids for obtaining energy, when delivered in excess these fatty acids are stored as ectopic fat in the cardiac myocyte, disrupting its function. Higher levels of LDL and VLDL receptors are expressed in the epicardial tissue from patients with T2DM. The PVAT produces adipokines and many molecules that affect vascular reactivity: monocyte chemotactic protein-1 (MCP-1)], nitric oxide, prostacyclin, and angiotensin II. PVAT present around the thoracic aorta resembles BAT, while the PVAT around the abdominal aorta resembles WAT [90, 91]. Healthy PVAT is largely anti-inflammatory, while dysfunctional PVAT promotes atherosclerosis.
Different types of cancers associated with obesity include breast, endometrial, prostrate, pancreatic, adenocarcinoma of esophagus, colon cancer, meningioma, and cancers of ovary, kidney, thyroid, liver, etc. [92, 93, 94]. Though different mechanisms have been proposed, chronic inflammation is a major factor for cancer initiation and progression. Excess nutrients activate metabolic signaling pathways such as c-Jun N-terminal kinase (JNK), nuclear factor κ B (NFκB), and protein kinase R that may promote development of neoplasm [95, 96]. Synthesis of IGF-1 is stimulated by insulin. IGF-1 promotes tumor growth via the PI3K/Akt/mTOR and the Ras/Raf/MAPK pathways [96]. IL-6, a pro-inflammatory cytokine produced during adipose tissue inflammation, activates the androgen receptor and promotes cell survival and proliferation in prostate cancer [97]. Aromatase, the rate-limiting enzyme of estrogen synthesis, is also stimulated by inflammatory cytokines and PGE2 [98, 99, 100, 101].
Risk of gallstones is increased in obesity. Chronic gall bladder inflammation from gallstones may predispose to cancer of the gall bladder [102]. Similarly, chronic inflammation of hepatitis may increase the risk of liver cancer [103].
Cancer survivorship, including cancer progression, prognosis, recurrence, and quality of life are reported to be worsened by obesity [104, 105]. Obesity is associated with an increased risk of treatment-related lymphedema in breast cancer survivors and incontinence in prostate cancer survivors (treated with radial prostatectomy) [106, 107]. Risk of local recurrence was higher in obese/overweight male patients with stage II or stage III renal cancer [108]. Similarly, obesity increases the risk of mortality in patients with multiple myeloma [109].
Ocular manifestations of obesity are less known and not well documented. Its association with age-related cataract, glaucoma, age-related maculopathy, and diabetic retinopathy has been reported [110, 111]. Cortical and posterior subcapsular or PSC cataracts have been most consistently associated with obesity. Obesity-induced leptin resistance and hyperlipidemia promote formation of reactive oxygen species, which are involved in cataract formation. Other complications of obesity: insulin resistance, hyperglycemia, diabetes, diabetes, and hypertension (see above) are known to be risk factors for cataract.
Increased retroorbital adipose tissue seen in obesity has been reported to be associated with increased intraocular pressure (IOP) [112, 113]. Raised IOP may be a risk factor for glaucoma. The AREDS (Age-Related Eye Disease Study) Report [114] has reported an association between obesity and age-related macular degeneration. (AMD) Oxidative stress secondary to hyperleptinemia may cause damage to lipids in Bruch membrane and secretion of excessive vascular endothelial growth factor (VEGF), which elicit invasion of neovascularization in Bruch membrane in neovascular AMD [115]. Inflammation may also play a role in AMD development. Diabetic retinopathy, a common complication of T2DM (which is associated with diabetes), can result in loss of vision [116]. Other diseases of the eye that may be associated with obesity include retinal vein occlusion, oculomotor nerve palsy, recurrent lower eyelid entropion, keratoconus, papilledema, floppy eyelid syndrome and benign intracranial hypertension (pseudotumor cerebri) [117, 118, 119, 120, 121].
Besides fatty liver and pancreatitis (discussed above), obesity is associated with increased risk of cholelithiasis (gall bladder stones) and gastroesophageal reflux disease (GERD).
About 90% gallstones are cholesterol stones while the rest are made of calcium bilirubinate, calcium complexes, mucin glycoproteins, or unconjugated bilirubin. Obesity and metabolic syndrome are two risk factors for the development of cholelithiasis, other factors being genetics, age, gender, parity, and presence of hepatitis C virus infection and chronic kidney disease [122]. Recent study by Su et al. [123] shows that obesity reduces the age of onset of gallstone formation. Energy-dense food such as increased consumption of refined carbohydrates and saturated fats with decreased intake of fiber, and medicines such as estrogen and progesterone can promote cholelithiasis [124]. Rapid weight loss of more than 1.5 kg/week can also promote gallstone formation [125].
Heartburn and regurgitation are typical manifestations of GERD. Epidemiologic data show an association of obesity with GERD and Barrett’s esophagus, a condition in which the lower part of the esophagus is damaged by repeated exposure to stomach acid [126, 127].
Obesity has been shown to cause sub-fecundity and infertility in both sexes [128, 129, 130]. Overweight and obesity result in changes in the hypothalamus-pituitary-gonadal (HPG) axis in both men and women, affecting hormone levels and gametogenesis.
Chronic inflammation along with insulin and leptin resistance is associated with increase in adipose tissue (see above), affecting reproductive issues.
Insulin resistance may be responsible for obesity-induced hypogonadism in males. Male obesity secondary hypogonadism or MOSH is caused by hyperestrogenism, metabolic endotoxemia, and hyperleptinemia. Hyperestrogenism decreases pituitary secretion of luteinizing hormone through a negative feedback action that impairs the synthesis and production of testosterone from Leydig cells. Hypercaloric diet with excess lipids causes breakdown of the normal leaky gut, facilitating passage of bacterial endotoxin from gut lumen into the blood stream (metabolic endotoxemia). Some animal studies suggest that bacterial endotoxin (Lipopolysaccharides-LPS) reduces testicular function by binding toll-like receptor 4 (TLR4) on Leydig cells, stimulating production of inflammatory cytokines [131, 132, 133, 134].
Obesity is associated with elevated levels of leptin and leptin resistance. Leptin prevents the neuropeptide Y (NPY) neurons from inhibiting the release of GnRH. Leptin resistance results in reduced release of GnRH, FSH, and LH and impairs spermatogenesis [135].
Kisspeptin, a hypothalamic peptide encoded by the KiSS1 gene, is an important neuromodulator involved in HPG axis and fertility control. Most kisspeptin cells are localized at the hypothalamic level in humans. Kisspeptin and its G-protein-coupled receptor (KISS 1R or GPR-54) increase the delivery of GnRH into portal circulation, resulting in enhanced secretion of LH and FSH from the anterior pituitary. Decreased endogenous kisspeptin secretion is seen in obesity-related hypogonadotropic hypogonadism (HH) [136, 137, 138, 139]. Increased leptin levels are associated with decreased total and free testosterone levels in males.
Hyperinsulinemia results in decreased production of sex hormone binding globulin (SHBG) by the hepatocytes, causing increased availability of free testosterone for reaction by aromatase in the adipose tissue. Aromatase converts testosterone to estradiol [140], further decreasing testosterone level with increase in estrogen level. This may result in pseudo-gynecomastia, with excess adipose deposition in breast area [134]. Sleep apnea associated with obesity disrupts the nocturnal rise in testosterone [134].
High waist circumference is associated with erectile dysfunction due to atherogenic effect on peripheral vasculature [141]. Low ejaculatory volume and oligo-zoospermia have been noted in males with increased BMI and waist circumference [142]. Increased testicular heat, elevated inflammatory mediators, and increased presence of reactive oxygen species in men with obesity affect the quality of sperms [143].
Earlier onset of menarche has been reported in adolescent females with overweight or obesity, compared with their normal-weight counterparts. The association of obesity with menstrual disorders, infertility, and recurrent miscarriages was recognized early [144, 145].
Insulin resistance promotes hyperandrogenemia and decreases the level of steroid hormone binding globulin (SHBG) resulting in elevated levels of free testosterone (discussed above). Aromatization of testosterone to estrogens by aromatase in the adipose tissue suppresses the release of gonadotrophin from the pituitary [140]. Elevated levels of leptin impair follicle development, ovulation, and oocyte maturation in women with obesity [146, 147].
This hormonal disorder is one of the most common endocrine disorder in premenopausal women, is also associated with obesity, metabolic syndrome, and T2DM. Irregular periods, anovulatory cycles, oligo-amenorrhea, excess androgen, hirsutism, and polycystic ovaries are the main characteristics of PCOS [148, 149]. Most women with PCOS have elevated levels of plasma free fatty acids, are insulin resistant, and have compensatory hyperinsulinemia. High levels of free fatty acids induce mitochondrial dysfunction, inflammation, oxidative stress, and immune disorders [150]. High levels of plasma free fatty acids cause increased synthesis of androgens in the ovary as well as in the zona reticularis of the adrenal gland. Insulin stimulates androgenesis by stimulating P450c17 activity in zona reticularis of the adrenal gland to produce DHEA and androstenedione [151]. Hyperinsulinemia causes decreased expression of SHBG by hepatocytes (see above), thus further increasing free testosterone levels. Aromatase (CYP19A1) in adipocytes as well as in the tissue of endometriosis converts androgens to estradiol, which inhibits the secretion of gonadotropin releasing hormone, resulting in decreased release FSH and LH from the pituitary. This affects maturation of follicles, production of estrogen, ovulation, maintenance of function of corpus luteum.
Women with PCOS may have problems in conceiving and increased risk of gestational diabetes and miscarriage or premature birth. Impairment of the hypothalamus-pituitary-gonadal (HPG) axis and follicular environment caused by obesity results in fertility problems, miscarriages, and complications in pregnancy.
Ovulation disorders account for at least 30% cases of infertility. Menstrual cycle without the release of ovum is called anovulatory cycle. Women with obesity have higher rates of anovulatory menstrual cycles [152, 153], the exact mechanism of which is not known. Common causes of anovulation include hyperandrogenism (as in PCOS, congenital adrenal hyperplasia, androgen-producing tumors), hyperprolactinemia, anorexia, excessive strenuous exercise, stress, thyroid dysfunction, primary pituitary dysfunction, premature ovarian failure, and certain medications. Obesity and strenuous exercise are known to alter profiles of insulin and adiponectin, thus impairing fertility in women. Obese women remain sub-fertile even in the absence of ovulatory dysfunction [154, 155].
Obesity affects the quality of sperm, ovum, embryo, placenta, and the uterine environment. The competence of the oocyte is defined in terms of its ability to become fertilized and support embryo development. Oocyte competence may be influenced by obesity. Machtinger et al. [156] have shown that oocytes from women with obesity are smaller in size, have more abnormal spindles and chromosome misalignment than those from women with normal BMI. Negative outcomes for women undergoing in vitro fertilization (IVF) are more common in women with higher BMI, due to the poor oocyte quality, lower preimplantation rate, and uterine receptivity [157]. Decreased rate of conception, infertility, early pregnancy loss, and reduced success of assisted reproductive technology (ART) have been reported in females with obesity [158].
High serum levels of insulin, insulin resistance, high levels of glucose, lactate, triglycerides, and C-reactive protein in the follicular fluid have a negative impact on oocyte maturation.
Mitochondria of the oocyte must be fully functional, as ATP generated by them are required for oocyte maturation and blastocyst formation. High levels of fuel molecules (glucose, free fatty acids, triglycerides, and cholesterol) in environment increase intracellular lipid accumulation and cause damage to the endoplasmic reticulum and mitochondria. Mice fed on high-fat diet have oocytes with accumulated lipid, increased reactive oxygen species (ROS), and have altered structure of mitochondria [159].
Abnormally thickened lining of the uterus due to disordered proliferation of endometrial glands or endometrial hyperplasia is caused by excess androgen with a relative deficiency of progesterone [160]. Untreated endometrial hyperplasia may develop into endometrial cancer [161]. Endogenous estrogen excess may occur in anovulatory cycles (during perimenopause or PCOS), obesity, and estrogen secreting tumors of the ovary. The most common symptom of endometrial hyperplasia is abnormal uterine bleeding.
Women with obesity have a higher risk of miscarriage, gestational diabetes, preeclampsia, premature delivery, cesarean section, and post-partum hemorrhage. Maternal obesity with poor glycemic control may result in fetal macrosomia and associated complications. Twenty percent less detection of fetal anomalies has been reported in women with obesity [162].
A Danish cohort study [163] involving more than 5000 women reported a hazard ratio for miscarriage of 1.23 for women with obesity conceiving spontaneously. Risk of miscarriage is higher in women with obesity who conceive with IVF, even when using donor eggs from women with normal BMI.
Schummers et al. [164] studied 226,000 singleton pregnancies in British Columbia. They have reported an incidence of gestational diabetes of 7.9%. The risk of gestational diabetes was doubled with a BMI > 30, and more than tripled at BMI > 40 kg/m2.
Women with overweight have double the risk of preeclampsia, while women with obesity have triple the risk, compared with women with normal BMI [164, 165]. Increased physical activity during pregnancy may reduce the risk of both gestational diabetes and preeclampsia.
Obesity has been shown to increase the risk of preterm delivery [165, 166]. This may be due to increased levels of circulating cytokines and inflammatory proteins in women with obesity.
The rate of Cesarean section increases with increase in maternal BMI [165, 167]. There is also an increased risk of wound infection, dehiscence, post-partum hemorrhage, and deep vein thrombosis. Duration of labor is longer in women with obesity. There is an increased risk of fetal distress, instrumental delivery, and shoulder dystocia in women with obesity.
Obesity is a risk factor for various diseases (see above). Expenses on medicine, loss of pay due to absence from work caused by illness, reduced job opportunities, etc., lead to constraint on family budget [168].
These include the medical expenses on obesity-related diseases. Expense on medicines for hypertension, type 2 diabetes, dyslipidemia, kidney diseases, stroke; and medical expenses incurred on hospitalization for various conditions affect the family budget as well as the budget of the country [169].
Absence from work due to disease results in decreased pay and early mortality affects the family income. Kjellberg et al. [170] report a 2% decrease in income, 3% increase in social transfer payments, and a 4% increase in healthcare costs per BMI point above 30. Thus, the indirect costs constitute the greatest proportion of total costs associated with obesity. Lee et al. [171] have reported that women with higher BMI are 0.33 times less likely to have service jobs, earn 9% lower monthly wages, and are half as likely to have jobs with bonuses compared with those with normal BMI.
Obesity is considered a social stigma in most societies. People with obesity are considered responsible for their condition and are often the victims of teasing and bullying, at all ages, from preschool through adolescence to adulthood [172, 173, 174, 175, 176].
Bullying is intentional unprovoked aggression that may be physical (hitting, shoving), mental (name calling, spreading rumors, social exclusion, fat shaming on social media) or both, which causes harm to the victim. It involves an imbalance of physical or psychological power. Weight-based victimization is more common at younger age, but may be observed in adults also [177]. It has been noted that pre-adolescent or adolescent boys with overweight or obesity who are stronger than their peer may show bullying behavior, victimizing those who are physically weaker than them [178].
Binge eating disorder (BED) is a type of disordered eating in which the individual consumes a relatively large amount of food in a short span of time, compared with other people of the same age, gender, and weight. BED affects 1–3% of the general population. People with BED are 3–6 times more likely to be overweight or obese than persons without eating disorders [179]. Around 30% persons with BED report a history of childhood obesity [180].
Meta-analysis conducted by Luppino et al. [181] shows a reciprocal link between depression and obesity. Obesity increases the risk of depression, and depression is predictive of developing obesity. Both obesity and depression are common and both are risk factors for cardiovascular diseases [182]. Depression is also an important cause of premature mortality, primarily due to suicide.
Obesity and the associated diseases affect the quality of life and influence the length of life span [183].
Health-related quality of life encompasses physical, mental, and social health and is influenced by factors such as socioeconomic status, culture, and environment of the person concerned. The degree of obesity is inversely proportional with the quality of life, as persons with higher BMI values are more likely to have obesity-associated diseases [184].
At least 2.8 million people die annually as a consequence of being overweight or obese. Many complications of obesity are mentioned above that deteriorate the quality of life and may promote early death. Most of the deaths are a direct consequence of cardiovascular problems or cancer [185].
Obesity is a condition that can compromise health and is closely associated with various medical conditions caused by increased body mass, metabolic derangement, psychological effects, or economic or social aspects. Awareness about the causes and consequences of obesity should be created among the general public so that persons with obesity may receive timely care with empathy.
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Noteworthy, the stroke — related brain tissue metabolic damages involve an essential ATP deplete clash along with a suppression of brain specific nucleotide — associated kinases and ATP synthase, both Mg2+ — dependent complex enzyme “machineries”. This itself makes the latter’s a legitimate target for some advanced pharmaceuticals as long as the drug — induced overstimulation of corresponding enzymatic activity is the case. Thus, magnetic isotope effects (MIE) of the nuclear spin possessing paramagnetic 25Mg2+ ions might modulate the brain creatine kinase, alfa-glycerophosphate kinase and pyruvate kinase catalytic activities in a way of a remarkable ATP hyperproduction required to compensate the hypoxia caused acute metabolic breakdown. To realize the Magnesium-25 pharmacological potential, a low-toxic amphiphilic cationite nanoparticles were introduced lately. 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He has developed various compounds including a drug for acute promyelocytic leukemia.",institutionString:"Tokyo Medical and Dental University",institution:{name:"Tokyo Medical and Dental University",country:{name:"Japan"}}},{id:"268659",title:"Ms.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/268659/images/8143_n.jpg",biography:"Dr. Zhan received his undergraduate and graduate training in the fields of preventive medicine and epidemiology and statistics at the West China University of Medical Sciences in China during 1989 to 1999. He received his post-doctoral training in oncology and cancer proteomics for two years at the Cancer Research Institute of Human Medical University in China. In 2001, he went to the University of Tennessee Health Science Center (UTHSC) in USA, where he was a post-doctoral researcher and focused on mass spectrometry and cancer proteomics. Then, he was appointed as an Assistant Professor of Neurology, UTHSC in 2005. He moved to the Cleveland Clinic in USA as a Project Scientist/Staff in 2006 where he focused on the studies of eye disease proteomics and biomarkers. He returned to UTHSC as an Assistant Professor of Neurology in the end of 2007, engaging in proteomics and biomarker studies of lung diseases and brain tumors, and initiating the studies of predictive, preventive, and personalized medicine (PPPM) in cancer. In 2010, he was promoted to Associate Professor of Neurology, UTHSC. Currently, he is a Professor at Xiangya Hospital of Central South University in China, Fellow of Royal Society of Medicine (FRSM), the European EPMA National Representative in China, Regular Member of American Association for the Advancement of Science (AAAS), European Cooperation of Science and Technology (e-COST) grant evaluator, Associate Editors of BMC Genomics, BMC Medical Genomics, EPMA Journal, and Frontiers in Endocrinology, Executive Editor-in-Chief of Med One. He has\npublished 116 peer-reviewed research articles, 16 book chapters, 2 books, and 2 US patents. His current main research interest focuses on the studies of cancer proteomics and biomarkers, and the use of modern omics techniques and systems biology for PPPM in cancer, and on the development and use of 2DE-LC/MS for the large-scale study of human proteoforms.",institutionString:null,institution:{name:"Xiangya Hospital Central South University",country:{name:"China"}}},{id:"40482",title:null,name:"Rizwan",middleName:null,surname:"Ahmad",slug:"rizwan-ahmad",fullName:"Rizwan Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/40482/images/system/40482.jpeg",biography:"Dr. Rizwan Ahmad is a University Professor and Coordinator, Quality and Development, College of Medicine, Imam Abdulrahman bin Faisal University, Saudi Arabia. Previously, he was Associate Professor of Human Function, Oman Medical College, Oman, and SBS University, Dehradun. Dr. Ahmad completed his education at Aligarh Muslim University, Aligarh. He has published several articles in peer-reviewed journals, chapters, and edited books. His area of specialization is free radical biochemistry and autoimmune diseases.",institutionString:"Imam Abdulrahman Bin Faisal University",institution:{name:"Imam Abdulrahman Bin Faisal University",country:{name:"Saudi Arabia"}}},{id:"41865",title:"Prof.",name:"Farid A.",middleName:null,surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41865/images/system/41865.jpg",biography:"Farid A. Badria, Ph.D., is the recipient of several awards, including The World Academy of Sciences (TWAS) Prize for Public Understanding of Science; the World Intellectual Property Organization (WIPO) Gold Medal for best invention; Outstanding Arab Scholar, Kuwait; and the Khwarizmi International Award, Iran. He has 250 publications, 12 books, 20 patents, and several marketed pharmaceutical products to his credit. He continues to lead research projects on developing new therapies for liver, skin disorders, and cancer. Dr. Badria was listed among the world’s top 2% of scientists in medicinal and biomolecular chemistry in 2019 and 2020. He is a member of the Arab Development Fund, Kuwait; International Cell Research Organization–United Nations Educational, Scientific and Cultural Organization (ICRO–UNESCO), Chile; and UNESCO Biotechnology France",institutionString:"Mansoura University",institution:{name:"Mansoura University",country:{name:"Egypt"}}},{id:"329385",title:"Dr.",name:"Rajesh K.",middleName:"Kumar",surname:"Singh",slug:"rajesh-k.-singh",fullName:"Rajesh K. Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",biography:"Dr. Singh received a BPharm (2003) and MPharm (2005) from Panjab University, Chandigarh, India, and a Ph.D. (2013) from Punjab Technical University (PTU), Jalandhar, India. He has more than sixteen years of teaching experience and has supervised numerous postgraduate and Ph.D. students. He has to his credit more than seventy papers in SCI- and SCOPUS-indexed journals, fifty-five conference proceedings, four books, six Best Paper Awards, and five projects from different government agencies. He is currently an editorial board member of eight international journals and a reviewer for more than fifty scientific journals. He received Top Reviewer and Excellent Peer Reviewer Awards from Publons in 2016 and 2017, respectively. He is also on the panel of The International Reviewer for reviewing research proposals for grants from the Royal Society. He also serves as a Publons Academy mentor and Bentham brand ambassador.",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",country:{name:"India"}}},{id:"142388",title:"Dr.",name:"Thiago",middleName:"Gomes",surname:"Gomes Heck",slug:"thiago-gomes-heck",fullName:"Thiago Gomes Heck",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/142388/images/7259_n.jpg",biography:null,institutionString:null,institution:{name:"Universidade Regional do Noroeste do Estado do Rio Grande do Sul",country:{name:"Brazil"}}},{id:"336273",title:"Assistant Prof.",name:"Janja",middleName:null,surname:"Zupan",slug:"janja-zupan",fullName:"Janja Zupan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/336273/images/14853_n.jpeg",biography:"Janja Zupan graduated in 2005 at the Department of Clinical Biochemistry (superviser prof. dr. Janja Marc) in the field of genetics of osteoporosis. Since November 2009 she is working as a Teaching Assistant at the Faculty of Pharmacy, Department of Clinical Biochemistry. In 2011 she completed part of her research and PhD work at Institute of Genetics and Molecular Medicine, University of Edinburgh. She finished her PhD entitled The influence of the proinflammatory cytokines on the RANK/RANKL/OPG in bone tissue of osteoporotic and osteoarthritic patients in 2012. From 2014-2016 she worked at the Institute of Biomedical Sciences, University of Aberdeen as a postdoctoral research fellow on UK Arthritis research project where she gained knowledge in mesenchymal stem cells and regenerative medicine. She returned back to University of Ljubljana, Faculty of Pharmacy in 2016. She is currently leading project entitled Mesenchymal stem cells-the keepers of tissue endogenous regenerative capacity facing up to aging of the musculoskeletal system funded by Slovenian Research Agency.",institutionString:null,institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"357453",title:"Dr.",name:"Radheshyam",middleName:null,surname:"Maurya",slug:"radheshyam-maurya",fullName:"Radheshyam Maurya",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/357453/images/16535_n.jpg",biography:null,institutionString:null,institution:{name:"University of Hyderabad",country:{name:"India"}}},{id:"418340",title:"Dr.",name:"Jyotirmoi",middleName:null,surname:"Aich",slug:"jyotirmoi-aich",fullName:"Jyotirmoi Aich",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038Ugi5QAC/Profile_Picture_2022-04-15T07:48:28.png",biography:"Biotechnologist with 15 years of research including 6 years of teaching experience. Demonstrated record of scientific achievements through consistent publication record (H index = 13, with 874 citations) in high impact journals such as Nature Communications, Oncotarget, Annals of Oncology, PNAS, and AJRCCM, etc. Strong research professional with a post-doctorate from ACTREC where I gained experimental oncology experience in clinical settings and a doctorate from IGIB where I gained expertise in asthma pathophysiology. A well-trained biotechnologist with diverse experience on the bench across different research themes ranging from asthma to cancer and other infectious diseases. An individual with a strong commitment and innovative mindset. Have the ability to work on diverse projects such as regenerative and molecular medicine with an overall mindset of improving healthcare.",institutionString:"DY Patil Deemed to Be University",institution:null},{id:"349288",title:"Prof.",name:"Soumya",middleName:null,surname:"Basu",slug:"soumya-basu",fullName:"Soumya Basu",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035QxIDQA0/Profile_Picture_2022-04-15T07:47:01.jpg",biography:"Soumya Basu, Ph.D., is currently working as an Associate Professor at Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India. With 16+ years of trans-disciplinary research experience in Drug Design, development, and pre-clinical validation; 20+ research article publications in journals of repute, 9+ years of teaching experience, trained with cross-disciplinary education, Dr. Basu is a life-long learner and always thrives for new challenges.\r\nHer research area is the design and synthesis of small molecule partial agonists of PPAR-γ in lung cancer. She is also using artificial intelligence and deep learning methods to understand the exosomal miRNA’s role in cancer metastasis. Dr. Basu is the recipient of many awards including the Early Career Research Award from the Department of Science and Technology, Govt. of India. She is a reviewer of many journals like Molecular Biology Reports, Frontiers in Oncology, RSC Advances, PLOS ONE, Journal of Biomolecular Structure & Dynamics, Journal of Molecular Graphics and Modelling, etc. She has edited and authored/co-authored 21 journal papers, 3 book chapters, and 15 abstracts. She is a Board of Studies member at her university. She is a life member of 'The Cytometry Society”-in India and 'All India Cell Biology Society”- in India.",institutionString:"Dr. D.Y. Patil Vidyapeeth, Pune",institution:{name:"Dr. D.Y. Patil Vidyapeeth, Pune",country:{name:"India"}}},{id:"354817",title:"Dr.",name:"Anubhab",middleName:null,surname:"Mukherjee",slug:"anubhab-mukherjee",fullName:"Anubhab Mukherjee",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y0000365PbRQAU/ProfilePicture%202022-04-15%2005%3A11%3A18.480",biography:"A former member of Laboratory of Nanomedicine, Brigham and Women’s Hospital, Harvard University, Boston, USA, Dr. Anubhab Mukherjee is an ardent votary of science who strives to make an impact in the lives of those afflicted with cancer and other chronic/acute ailments. He completed his Ph.D. from CSIR-Indian Institute of Chemical Technology, Hyderabad, India, having been skilled with RNAi, liposomal drug delivery, preclinical cell and animal studies. He pursued post-doctoral research at College of Pharmacy, Health Science Center, Texas A & M University and was involved in another postdoctoral research at Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute, Santa Monica, California. In 2015, he worked in Harvard-MIT Health Sciences & Technology as a visiting scientist. He has substantial experience in nanotechnology-based formulation development and successfully served various Indian organizations to develop pharmaceuticals and nutraceutical products. He is an inventor in many US patents and an author in many peer-reviewed articles, book chapters and books published in various media of international repute. Dr. Mukherjee is currently serving as Principal Scientist, R&D at Esperer Onco Nutrition (EON) Pvt. Ltd. and heads the Hyderabad R&D center of the organization.",institutionString:"Esperer Onco Nutrition Pvt Ltd.",institution:null},{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/319365/images/system/319365.png",biography:"Manash K. Paul is a Principal Investigator and Scientist at the University of California Los Angeles. He has contributed significantly to the fields of stem cell biology, regenerative medicine, and lung cancer. His research focuses on various signaling processes involved in maintaining stem cell homeostasis during the injury-repair process, deciphering lung stem cell niche, pulmonary disease modeling, immuno-oncology, and drug discovery. He is currently investigating the role of extracellular vesicles in premalignant lung cell migration and detecting the metastatic phenotype of lung cancer via machine-learning-based analyses of exosomal signatures. Dr. Paul has published in more than fifty peer-reviewed international journals and is highly cited. He is the recipient of many awards, including the UCLA Vice Chancellor’s award, a senior member of the Institute of Electrical and Electronics Engineers (IEEE), and an editorial board member for several international journals.",institutionString:"University of California Los Angeles",institution:{name:"University of California Los Angeles",country:{name:"United States of America"}}},{id:"311457",title:"Dr.",name:"Júlia",middleName:null,surname:"Scherer Santos",slug:"julia-scherer-santos",fullName:"Júlia Scherer Santos",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311457/images/system/311457.jpg",biography:"Dr. Júlia Scherer Santos works in the areas of cosmetology, nanotechnology, pharmaceutical technology, beauty, and aesthetics. Dr. Santos also has experience as a professor of graduate courses. Graduated in Pharmacy, specialization in Cosmetology and Cosmeceuticals applied to aesthetics, specialization in Aesthetic and Cosmetic Health, and a doctorate in Pharmaceutical Nanotechnology. Teaching experience in Pharmacy and Aesthetics and Cosmetics courses. She works mainly on the following subjects: nanotechnology, cosmetology, pharmaceutical technology, aesthetics.",institutionString:"Universidade Federal de Juiz de Fora",institution:{name:"Universidade Federal de Juiz de Fora",country:{name:"Brazil"}}},{id:"219081",title:"Dr.",name:"Abdulsamed",middleName:null,surname:"Kükürt",slug:"abdulsamed-kukurt",fullName:"Abdulsamed Kükürt",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/219081/images/system/219081.png",biography:"Dr. Kükürt graduated from Uludağ University in Turkey. He started his academic career as a Research Assistant in the Department of Biochemistry at Kafkas University. In 2019, he completed his Ph.D. program in the Department of Biochemistry at the Institute of Health Sciences. He is currently working at the Department of Biochemistry, Kafkas University. He has 27 published research articles in academic journals, 11 book chapters, and 37 papers. He took part in 10 academic projects. He served as a reviewer for many articles. He still serves as a member of the review board in many academic journals.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"178366",title:"Associate Prof.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",biography:"Volkan Gelen is a Physiology specialist who received his veterinary degree from Kafkas University in 2011. Between 2011-2015, he worked as an assistant at Atatürk University, Faculty of Veterinary Medicine, Department of Physiology. In 2016, he joined Kafkas University, Faculty of Veterinary Medicine, Department of Physiology as an assistant professor. Dr. Gelen has been engaged in various academic activities at Kafkas University since 2016. There he completed 5 projects and has 3 ongoing projects. He has 60 articles published in scientific journals and 20 poster presentations in scientific congresses. His research interests include physiology, endocrine system, cancer, diabetes, cardiovascular system diseases, and isolated organ bath system studies.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"418963",title:"Dr.",name:"Augustine Ododo",middleName:"Augustine",surname:"Osagie",slug:"augustine-ododo-osagie",fullName:"Augustine Ododo Osagie",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/418963/images/16900_n.jpg",biography:"Born into the family of Osagie, a prince of the Benin Kingdom. I am currently an academic in the Department of Medical Biochemistry, University of Benin. Part of the duties are to teach undergraduate students and conduct academic research.",institutionString:null,institution:{name:"University of Benin",country:{name:"Nigeria"}}},{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192992/images/system/192992.png",biography:"Prof. Shagufta Perveen is a Distinguish Professor in the Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Dr. Perveen has acted as the principal investigator of major research projects funded by the research unit of King Saud University. She has more than ninety original research papers in peer-reviewed journals of international repute to her credit. She is a fellow member of the Royal Society of Chemistry UK and the American Chemical Society of the United States.",institutionString:"King Saud University",institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"49848",title:"Dr.",name:"Wen-Long",middleName:null,surname:"Hu",slug:"wen-long-hu",fullName:"Wen-Long Hu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49848/images/system/49848.jpg",biography:"Wen-Long Hu is Chief of the Division of Acupuncture, Department of Chinese Medicine at Kaohsiung Chang Gung Memorial Hospital, as well as an adjunct associate professor at Fooyin University and Kaohsiung Medical University. Wen-Long is President of Taiwan Traditional Chinese Medicine Medical Association. He has 28 years of experience in clinical practice in laser acupuncture therapy and 34 years in acupuncture. He is an invited speaker for lectures and workshops in laser acupuncture at many symposiums held by medical associations. He owns the patent for herbal preparation and producing, and for the supercritical fluid-treated needle. Dr. Hu has published three books, 12 book chapters, and more than 30 papers in reputed journals, besides serving as an editorial board member of repute.",institutionString:"Kaohsiung Chang Gung Memorial Hospital",institution:{name:"Kaohsiung Chang Gung Memorial Hospital",country:{name:"Taiwan"}}},{id:"298472",title:"Prof.",name:"Andrey V.",middleName:null,surname:"Grechko",slug:"andrey-v.-grechko",fullName:"Andrey V. Grechko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/298472/images/system/298472.png",biography:"Andrey Vyacheslavovich Grechko, Ph.D., Professor, is a Corresponding Member of the Russian Academy of Sciences. He graduated from the Semashko Moscow Medical Institute (Semashko National Research Institute of Public Health) with a degree in Medicine (1998), the Clinical Department of Dermatovenerology (2000), and received a second higher education in Psychology (2009). Professor A.V. Grechko held the position of Сhief Physician of the Central Clinical Hospital in Moscow. He worked as a professor at the faculty and was engaged in scientific research at the Medical University. Starting in 2013, he has been the initiator of the creation of the Federal Scientific and Clinical Center for Intensive Care and Rehabilitology, Moscow, Russian Federation, where he also serves as Director since 2015. He has many years of experience in research and teaching in various fields of medicine, is an author/co-author of more than 200 scientific publications, 13 patents, 15 medical books/chapters, including Chapter in Book «Metabolomics», IntechOpen, 2020 «Metabolomic Discovery of Microbiota Dysfunction as the Cause of Pathology».",institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"199461",title:"Prof.",name:"Natalia V.",middleName:null,surname:"Beloborodova",slug:"natalia-v.-beloborodova",fullName:"Natalia V. Beloborodova",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/199461/images/system/199461.jpg",biography:'Natalia Vladimirovna Beloborodova was educated at the Pirogov Russian National Research Medical University, with a degree in pediatrics in 1980, a Ph.D. in 1987, and a specialization in Clinical Microbiology from First Moscow State Medical University in 2004. She has been a Professor since 1996. Currently, she is the Head of the Laboratory of Metabolism, a division of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation. N.V. Beloborodova has many years of clinical experience in the field of intensive care and surgery. She studies infectious complications and sepsis. She initiated a series of interdisciplinary clinical and experimental studies based on the concept of integrating human metabolism and its microbiota. Her scientific achievements are widely known: she is the recipient of the Marie E. Coates Award \\"Best lecturer-scientist\\" Gustafsson Fund, Karolinska Institutes, Stockholm, Sweden, and the International Sepsis Forum Award, Pasteur Institute, Paris, France (2014), etc. Professor N.V. Beloborodova wrote 210 papers, five books, 10 chapters and has edited four books.',institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"354260",title:"Ph.D.",name:"Tércio Elyan",middleName:"Azevedo",surname:"Azevedo Martins",slug:"tercio-elyan-azevedo-martins",fullName:"Tércio Elyan Azevedo Martins",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/354260/images/16241_n.jpg",biography:"Graduated in Pharmacy from the Federal University of Ceará with the modality in Industrial Pharmacy, Specialist in Production and Control of Medicines from the University of São Paulo (USP), Master in Pharmaceuticals and Medicines from the University of São Paulo (USP) and Doctor of Science in the program of Pharmaceuticals and Medicines by the University of São Paulo. Professor at Universidade Paulista (UNIP) in the areas of chemistry, cosmetology and trichology. Assistant Coordinator of the Higher Course in Aesthetic and Cosmetic Technology at Universidade Paulista Campus Chácara Santo Antônio. Experience in the Pharmacy area, with emphasis on Pharmacotechnics, Pharmaceutical Technology, Research and Development of Cosmetics, acting mainly on topics such as cosmetology, antioxidant activity, aesthetics, photoprotection, cyclodextrin and thermal analysis.",institutionString:null,institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"334285",title:"Ph.D. Student",name:"Sameer",middleName:"Kumar",surname:"Jagirdar",slug:"sameer-jagirdar",fullName:"Sameer Jagirdar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334285/images/14691_n.jpg",biography:"I\\'m a graduate student at the center for biosystems science and engineering at the Indian Institute of Science, Bangalore, India. I am interested in studying host-pathogen interactions at the biomaterial interface.",institutionString:null,institution:{name:"Indian Institute of Science Bangalore",country:{name:"India"}}},{id:"329248",title:"Dr.",name:"Md. Faheem",middleName:null,surname:"Haider",slug:"md.-faheem-haider",fullName:"Md. Faheem Haider",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329248/images/system/329248.jpg",biography:"Dr. Md. Faheem Haider completed his BPharm in 2012 at Integral University, Lucknow, India. In 2014, he completed his MPharm with specialization in Pharmaceutics at Babasaheb Bhimrao Ambedkar University, Lucknow, India. He received his Ph.D. degree from Jamia Hamdard University, New Delhi, India, in 2018. He was selected for the GPAT six times and his best All India Rank was 34. Currently, he is an assistant professor at Integral University. Previously he was an assistant professor at IIMT University, Meerut, India. He has experience teaching DPharm, Pharm.D, BPharm, and MPharm students. He has more than five publications in reputed journals to his credit. Dr. Faheem’s research area is the development and characterization of nanoformulation for the delivery of drugs to various organs.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"329795",title:"Dr.",name:"Mohd Aftab",middleName:"Aftab",surname:"Siddiqui",slug:"mohd-aftab-siddiqui",fullName:"Mohd Aftab Siddiqui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329795/images/15648_n.jpg",biography:"Dr. Mohd Aftab Siddiqui is currently working as Assistant Professor in the Faculty of Pharmacy, Integral University, Lucknow for the last 6 years. He has completed his Doctor in Philosophy (Pharmacology) in 2020 from Integral University, Lucknow. He completed his Bachelor in Pharmacy in 2013 and Master in Pharmacy (Pharmacology) in 2015 from Integral University, Lucknow. He is the gold medalist in Bachelor and Master degree. He qualified GPAT -2013, GPAT -2014, and GPAT 2015. His area of research is Pharmacological screening of herbal drugs/ natural products in liver and cardiac diseases. He has guided many M. Pharm. research projects. He has many national and international publications.",institutionString:"Integral University",institution:null},{id:"333824",title:"Dr.",name:"Ahmad Farouk",middleName:null,surname:"Musa",slug:"ahmad-farouk-musa",fullName:"Ahmad Farouk Musa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333824/images/22684_n.jpg",biography:"Dato’ Dr Ahmad Farouk Musa\nMD, MMED (Surgery) (Mal), Fellowship in Cardiothoracic Surgery (Monash Health, Aust), Graduate Certificate in Higher Education (Aust), Academy of Medicine (Mal)\n\n\n\nDato’ Dr Ahmad Farouk Musa obtained his Doctor of Medicine from USM in 1992. He then obtained his Master of Medicine in Surgery from the same university in the year 2000 before subspecialising in Cardiothoracic Surgery at Institut Jantung Negara (IJN), Kuala Lumpur from 2002 until 2005. He then completed his Fellowship in Cardiothoracic Surgery at Monash Health, Melbourne, Australia in 2008. He has served in the Malaysian army as a Medical Officer with the rank of Captain upon completing his Internship before joining USM as a trainee lecturer. He is now serving as an academic and researcher at Monash University Malaysia. He is a life-member of the Malaysian Association of Thoracic & Cardiovascular Surgery (MATCVS) and a committee member of the MATCVS Database. He is also a life-member of the College of Surgeons, Academy of Medicine of Malaysia; a life-member of Malaysian Medical Association (MMA), and a life-member of Islamic Medical Association of Malaysia (IMAM). Recently he was appointed as an Interim Chairperson of Examination & Assessment Subcommittee of the UiTM-IJN Cardiothoracic Surgery Postgraduate Program. As an academic, he has published numerous research papers and book chapters. He has also been appointed to review many scientific manuscripts by established journals such as the British Medical Journal (BMJ). He has presented his research works at numerous local and international conferences such as the European Association for Cardiothoracic Surgery (EACTS) and the European Society of Cardiovascular Surgery (ESCVS), to name a few. He has also won many awards for his research presentations at meetings and conferences like the prestigious International Invention, Innovation & Technology Exhibition (ITEX); Design, Research and Innovation Exhibition, the National Conference on Medical Sciences and the Annual Scientific Meetings of the Malaysian Association for Thoracic and Cardiovascular Surgery. He was awarded the Darjah Setia Pangkuan Negeri (DSPN) by the Governor of Penang in July, 2015.",institutionString:null,institution:{name:"Monash University Malaysia",country:{name:"Malaysia"}}},{id:"30568",title:"Prof.",name:"Madhu",middleName:null,surname:"Khullar",slug:"madhu-khullar",fullName:"Madhu Khullar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/30568/images/system/30568.jpg",biography:"Dr. Madhu Khullar is a Professor of Experimental Medicine and Biotechnology at the Post Graduate Institute of Medical Education and Research, Chandigarh, India. She completed her Post Doctorate in hypertension research at the Henry Ford Hospital, Detroit, USA in 1985. She is an editor and reviewer of several international journals, and a fellow and member of several cardiovascular research societies. Dr. Khullar has a keen research interest in genetics of hypertension, and is currently studying pharmacogenetics of hypertension.",institutionString:"Post Graduate Institute of Medical Education and Research",institution:{name:"Post Graduate Institute of Medical Education and Research",country:{name:"India"}}},{id:"223233",title:"Prof.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/223233/images/system/223233.png",biography:"Xianquan Zhan received his MD and Ph.D. in Preventive Medicine at West China University of Medical Sciences. He received his post-doctoral training in oncology and cancer proteomics at the Central South University, China, and the University of Tennessee Health Science Center (UTHSC), USA. He worked at UTHSC and the Cleveland Clinic in 2001–2012 and achieved the rank of associate professor at UTHSC. Currently, he is a full professor at Central South University and Shandong First Medical University, and an advisor to MS/PhD students and postdoctoral fellows. He is also a fellow of the Royal Society of Medicine and European Association for Predictive Preventive Personalized Medicine (EPMA), a national representative of EPMA, and a member of the American Society of Clinical Oncology (ASCO) and the American Association for the Advancement of Sciences (AAAS). He is also the editor in chief of International Journal of Chronic Diseases & Therapy, an associate editor of EPMA Journal, Frontiers in Endocrinology, and BMC Medical Genomics, and a guest editor of Mass Spectrometry Reviews, Frontiers in Endocrinology, EPMA Journal, and Oxidative Medicine and Cellular Longevity. He has published more than 148 articles, 28 book chapters, 6 books, and 2 US patents in the field of clinical proteomics and biomarkers.",institutionString:"Shandong First Medical University",institution:{name:"Affiliated Hospital of Shandong Academy of Medical Sciences",country:{name:"China"}}},{id:"297507",title:"Dr.",name:"Charles",middleName:"Elias",surname:"Assmann",slug:"charles-assmann",fullName:"Charles Assmann",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/297507/images/system/297507.jpg",biography:"Charles Elias Assmann is a biologist from Federal University of Santa Maria (UFSM, Brazil), who spent some time abroad at the Ludwig-Maximilians-Universität München (LMU, Germany). He has Masters Degree in Biochemistry (UFSM), and is currently a PhD student at Biochemistry at the Department of Biochemistry and Molecular Biology of the UFSM. His areas of expertise include: Biochemistry, Molecular Biology, Enzymology, Genetics and Toxicology. 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