Morbid Obesity and Premature Death in the Young

Abstract

Morbid obesity and related ectopic lipid accumulation play an important role in the pathogenesis of multi-organ damage. This autopsy report of a 25 year old Caucasian male with history of sleep apnea but non-compliant to continuous positive airway pressure illustrates the consequences of chronic fatty organ changes in a morbidly obese young male.

Fat, especially central obesity, plays an important role in the dysregulation of hemodynamic, metabolic, and inflammatory processes through mechanisms that include activation of release of free fatty acids, macrophage infiltration into adipose tissue, hepatic lipogenesis, adipose renin-angiotensin-aldosterone system, sympathetic activation, insulin resistance, oxidative and inflammatory stress. Lipid accumulation in the heart, skeletal muscle, pancreas, liver, and kidney play an important role in the pathogenesis of heart failure, potential arrhythmias and diabetes. Excess free fatty acids also impair normal cell signaling through central nervous system–acting signaling proteins (adipokines) which affect airway neuromuscular control. This coupled with mechanical compression within pharyngeal tissues and lungs lead to pharyngeal collapsibility and sleep apnea. Hypoxic status sets up the potential of arrhythmias and sudden death.