by Saanvi Tatipalli, Aarav Bongirwar, Richa Mahajan, and Rohit Laddu, The GTF Group

Introduction

Welcome. We four are the members of Global Thrombosis Forum (GTF, www.gtfonline.net). We are a a non-profit organization that works on various projects to promote the awareness of Thrombosis in the community.

Venous thromboembolism (VTE) is the third most common cardiovascular disorder after a heart attack and stroke. It is estimated that VTE occurs among 1 to 2 per 1000 persons annually in the United States. VTE imposes a substantial burden on the US healthcare system. The initial clinical management, recurrence, and long-term complications of VTE compromise quality of life. VTE costs the healthcare system in the United States about $15 billion annually.

Obesity is a major public health problem not only in the United States, but also rapidly is becoming a global threat. Obesity is a major risk factor for some diseases such as heart disease, diabetes, high blood pressure, stroke, heart failure, depression, and VTE.

We researched the effect of obesity, fat intake, and body weight on the occurrence of VTE.

Obesity in India

Before we go any further, let us peek at obesity in the World. The statistics and the numbers would shock you. Approximately 39% of the global adult population has been classified as overweight (Body Mass Index (BMI) 25.0–29.9 kg/m2) or obese (BMI > 29.9kg/m2) in 2014, this number has doubled since 1975. The prevalence of obesity was 6.4% among women and 3.2% among men in 1975, it rose to an astonishing 14.9% and 10.8%, respectively by 2014. In India, the increasing prevalence of overweight and obesity has coincided with the demographic and epidemiological transitions, in which mortality and fertility have declined, and lifestyle-related diseases have become more common.

The prevalence of overweight and obesity in India is increasing faster than the world average. For example, the prevalence of the overweight population increased from 8.4% to 15.5% among women between 1998 and 2015, and the prevalence of obesity increased from 2.2% to 5.1% over the same period. Unfortunately, this fast-paced growth has been accompanied by notable increases in the burden of non-communicable diseases.

What is obesity?

Obesity is a complex disease involving an excessive amount of body fat. It is a medical problem that increases your risk of other diseases and health problems, such as heart disease, diabetes, high blood pressure, and certain cancers.

Obesity is a global health issue that is associated with a wide spectrum of disorders, including coronary artery disease, diabetes mellitus, hypertension, stroke, and VTE.

What is VTE?

VTE is one of the most common vascular disorders in the United States and Europe and is associated with significant mortality. A few of the scary factors from VTE are:

1. VTE is a very common vascular disorder that can lead to significant mortality.
2. VTE is the third most common CV disorder following heart attacks, and strokes.
3. VTE occurs to about 1 to 2 people out of 1000 people annually.
4. VTE and its variants cost the US about 2 billion dollars annually.
5. VTE encompasses two conditions, namely, DVT and PE.

Obesity can interact with other environmental or genetic factors and poses a significantly greater risk of VTE among individuals who are obese and who are exposed simultaneously to several other risk factors for VTE.

Recommended fat intake

The dietary recommended intake for fat in adults is 44-77 grams per day (20% to 35% of total calories from fat) for a 2000 calorie diet.

Types of fat

Saturated fat

Generally solid or waxy at room temperature and come mostly from animal products, with the exception of tropical oils.

Taking in too much saturated fat is linked with raising levels of “bad” LDL cholesterol in the blood and increasing internal inflammation.

Healthy adults should limit their saturated fat intake to no more than 10% of total calories.

For a person eating a 2000 calorie diet, this would be 22 grams of saturated fat or less per day.

• Pork, lamb, veal, and skin of poultry
• Hot dogs, Bologna, salami
• High fat dairy products, such as cream, ice cream, whole milk, 2% milk, cheese, 4% cottage cheese
• Butter, lard, bacon fat
• Tropical oils, such as palm, palm kernel, coconut oil
• Baked goods, such as cookies, pastries, croissants

Trans fat

Trans fatty acids are formed when a liquid fat is changed into a solid fat through a process called hydrogenation.

Many manufacturers use hydrogenated oils as an ingredient because it extends the shelf life and consistency of foods.

Trans fat will raise levels of “bad” LDL cholesterol and decrease levels of “good” HDL cholesterol.

• Shortening
• Powdered coffee cream, liquid flavored coffee cream
• Convenience foods, such as certain brands of pre-packaged baked goods
• Solid margarine

Cholesterol

Cholesterol is made by the liver. Therefore, only animal-based foods contain cholesterol.

If your cholesterol levels are normal, limit your intake to up to 300 mg per day.

If you have been diagnosed with high cholesterol, limit your intake to less than 200 mg per day.

Unsaturated fat

These fats are usually liquid at room temperature. Sources include monounsaturated and polyunsaturated. When used in place of saturated fat, monounsaturated and polyunsaturated fats help lower cholesterol levels.

Monounsaturated fat

These fats come from plant-based sources and include:

• Olive, canola, and peanut oils
• Nuts and nut butter
• Olives
• Avocado

Polyunsaturated fat

These fats come from plant-based sources and include:

• Safflower, sunflower, corn, soybean, and cottonseed oils
• Nuts

What is the relationship between fat intake and weight?

Being overweight may increase the risk of developing high blood pressure, diabetes, cardiovascular diseases (diseases of the heart and blood vessels), and certain forms of cancer. Therefore, it is important to lose weight if you are overweight.

A diet high in fat can lead to weight gain.

What causes obesity?

• Lack of exercise
• Excessive intake of food
• A meal that contains high fat can affect an individual in countless harmful ways. It can even result in death from heart disease due to a spike in blood clotting.
• Food with high cholesterol may trigger the production of plaque, a fat substance that could obstruct blood vessels.
• Individuals who have already suffered from heart problems generally have a high level of Factor VII, a protein that contributes to blood coagulation.
• When eating foods high in fat, putting the individual at a higher risk.
• The type of fat someone consumes is not a factor in whether or not they are at risk of heart disease; this means that eating a high amount of any type of fat can result in unprecedented ways, thus making it vital to reduce fat intake and eat sources with more fruits and vegetables.

How is obesity diagnosed?

One way obesity can be diagnosed is by calculating the body mass index, or BMI is a relatively simple calculation of an individual’s weight or mass divided by their height squared. It is a marker of excess weight and correlates well with body fat content in adults. It is generally calculated to classify whether someone is underweight, healthy, overweight, or obese. Generally, if an individual’s BMI is greater than 30, they would be considered obese. If it averages between the 25-30 range, they would be considered overweight. Furthermore, if an individual has around 18.5 to 25, they would be healthy or average; if the Body mass index is less than 18.5, the individual is likely considered underweight. Calculating this can help doctors understand at what risk someone is to specific illnesses, like obesity, and is instrumental to control to maintain a healthy lifestyle.

1. The most frequently used indicator for obesity BMI.
2. Calculating one’s Body Fat Percentage with an MRI or Magnetic Resonance Imaging.
3. Obesity is associated with comorbidities such as hypertension and stroke, which are both ways to increase the chance to get thrombosis.
4. It is also linked with mortality in the elderly.
5. As an increase in age occurs, the BMI naturally goes up

How is obesity related to VTE?

DVT or Deep Vein Thrombosis usually occurs in your deep veins which are located in your legs or pelvis.

If that blood clot starts moving up through your veins and into your heart or lungs, it is considered PE or Pulmonary Embolism.

DVT does not cause immediate death, but if it becomes PE, it can be lethal. Everyone under the right circumstances and risk factors can get VTE

Blacks or African Americans have the highest chance out of every ethnicity followed by Whites, Hispanics, and then Asians.

The Danish Prospective Study was conducted in a very large population.  Here are some of the important points to note from the study:

Data collected from 57,054 people

1. Ages 50-64
2. Males: 27,178
3. Females: 29,876
4. Years for the study: 1993 and 1997
5. Measurements:

• Bodyweight
• BMI
• Waist circumference
• Hip circumference
• Total body fat.

The study showed the following results:

1. An increase in hip circumference caused VTE in women
2. An increase in waist circumference caused VTE in men
3. All measurements of obesity are predictors of the risk for VTE.
4. Obesity was associated with venous thromboembolism (VTE).

Conclusion

In conclusion, we researched the relationship between body weight, fat intake, and blood clots. We found that obesity can increase the risk of thrombotic conditions occurring in the population. Our message to the public is to make sure to maintain a healthy lifestyle so that one does not get obese and has a higher risk to get a blood clot. If we stop one blood clot, we have saved one life.

Acknowledgments  

We acknowledge the help of Dr. Atul Laddu for guiding us and giving us this opportunity. We also would like to thank Sateesh Tatipalli for mentoring us and all of our parents for their support.

References

1. High-Fat Meal May Raise Risk Of Blood Clotting — Increasing Heart Attack And Stroke Risk- ST
2. https://www.eurekalert.org/pub_releases/1997-11/AHA-HMMR-241197.php
3. The effects of obesity on venous thromboembolism: A review AB
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520798/
5. Obesity increases the risk of obtaining VTE or Venous Thromboembolism.
6. Anthropometry, Body Fat, and Venous Thromboembolism: A Danish Follow-Up Study- RM and RL

https://www.ahajournals.org/doi/epub/10.1161/CIRCULATIONAHA.109.863241

7. https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html#:~:text=Body%20mass%20index%20(BMI)%20is,square%20of%20height%20in%20meters.

About the authors

 Aarav Bongirwar: Arav is an 8th grader going to the Webb Bridge Middle School in Alpharetta, Georgia. Arav has been in GTF for about a year and a half and would like to be a surgeon. The things that interest him include tennis, video games, and science, but more specifically anatomy of the human body.

 Richa Mahajan: Richa is in 8th grade in Autrey Mill Middle School. This is Richa’s first year in GTF. Richa likes reading and talking to her friends. One of her life’s goals is to be a cardiologist.

 Rohit Laddu : Rohit is a 7th grader student in Olivette, MO going to the St. Michaels School in Clayton, Missouri. He likes Tae Kwon Do, Video games, camping, and drawing. He has joined the Global Thrombosis Forum recently but has been very involved and interested in the GTF activities. When Rohit grows up, he wants to become a veterinarian so that he can help animals around the world.

 Saanvi Tatipalli: Saanvi is currently an 8th grader at Lakeside Middle School, and an active member of GTF. She says that she has learned a lot through GTF and is extremely fortunate to be a part of it. She has many aspirations, inspirations, and passions in life. Some of her current passions include writing, dancing, and art. One day, she endeavors to author stories and become an attorney while advocating for justice in her community.