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doi:10.1378/chest.06-1513
(Chest. 2007; 131:362-367)
© 2007 American College of Chest Physicians
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Waist-to-Hip Ratio Is Associated With Pulmonary Gas Exchange in the Morbidly Obese*

Gerald S. Zavorsky, PhD; Juan M. Murias, MSc; Do Jun Kim, MSc; Jennifer Gow, MSc; Jean-Loup Sylvestre, MSc and Nicolas V. Christou, MD, PhD

* From the Departments of Anesthesia (Dr. Zavorsky, Mr. Murias Mr. Kim, and Ms. Gow) and Surgery (Mr. Sylvestre and Dr. Christou), Bariatric Clinic, McGill University Health Center, Royal Victoria Hospital, Montreal, QC, Canada.

Correspondence to: Gerald S. Zavorsky, PhD, Assistant Professor, Department of Anesthesia, McGill University Health Center, Montreal General Hospital, 1650 Cedar Ave, Room D10–144, Montreal, QC, Canada H3G 1A4; e-mail: gerald.zavorsky{at}mcgill.ca

Abstract

Backround: Morbidly obese individuals (ie, body mass index [BMI], ≥ 40 kg/m2) may have a pulmonary gas exchange impairment due to the large fat mass surrounding their abdomen.

Purpose: To examine the effect of the waist-to-hip (W/H) ratio on pulmonary gas exchange in the morbidly obese.

Methods: Twenty-five morbidly obese individuals (mean [± SD] age, 39 ± 10 years; mean BMI, 49 ± 7 kg/m2; mean body fat, 50 ± 6%; mean waist circumference, 135 ± 15 cm; mean W/H ratio, 0.97 ± 0.11) scheduled for bariatric surgery were recruited. Arterial blood was sampled in duplicate after 5 min of rest sitting upright.

Results: The mean PaO2 at rest was 88 ± 7 mm Hg (range, 72 to 108 mm Hg), the alveolar-arterial oxygen pressure difference (P[A-a]O2) was 19 ± 9 mm Hg (range, 1 to 37 mm Hg), and the PaCO2 was 38 ± 3 mm Hg (range, 32 to 44 mm Hg). Linear regression showed that 32% and 36%, respectively, of the variance in the P(A-a)O2 and PaO2 were explained by the W/H ratio (p < 0.004 for both). As well, 20% of the variance in PaCO2 was explained by the W/H ratio (p = 0.02). Men had larger W/H ratios (p < 0.01) and poorer gas exchange (p = 0.06) compared to women (mean difference: PaO2, –7 mm Hg; P[A-a]O2, 6 mm Hg).

Conclusion: Morbidly obese men showed a trend to have poorer pulmonary gas exchange compared to morbidly obese women, and a significant part of the blood gas status in these patients is associated with the W/H ratio.

Key Words: arterial blood gases • gas exchange impairment • metabolic syndrome






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