Research has reported various connections between obesity and chronic rhinosinusitis (chronic sinusitis). The main points are summarized below.

Connection Between Obesity and Chronic Rhinosinusitis

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1. Obesity Increases the Risk of Chronic Rhinosinusitis Numerous studies have found that obesity acts as an independent factor increasing the risk of chronic rhinosinusitis (CRS). Particularly, obese patients are more frequently associated with chronic rhinosinusitis compared to non-obese patients, regardless of other diseases like asthma¹²³.

2. Role of Inflammatory Response Obesity induces a systemic inflammatory state, which may be associated with the onset of chronic rhinosinusitis. In obese patients, levels of inflammatory cytokines (adipocytokines) and acute phase proteins increase, potentially affecting the immune system³⁴.

3. Association with Nasal Polyps Obesity appears to have a strong connection with chronic rhinosinusitis accompanied by nasal polyps (CRSwNP). Research suggests that not only general obesity but also central obesity may influence the inflammatory processes related to the formation of nasal polyps⁵⁴.

4. Obesity Levels and Sinusitis Prevalence Higher obesity levels are observed to be correlated with increased prevalence of sinusitis. For example, one study reported that 17% of individuals with a BMI of 30-35 (Class 1 obesity) and 7.8% of those with a BMI of 35 or higher (Class 2 obesity) suffered from chronic rhinosinusitis².

5. Interaction with Sleep and Stress Obese patients are more likely to experience sleep disturbances and higher stress levels, both of which can additionally elevate the risk of developing chronic rhinosinusitis⁶.

Conclusion

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Obesity is more than just a weight issue; it acts as a risk factor for various systemic diseases, particularly inflammatory diseases like chronic rhinosinusitis. Therefore, alongside weight management, appropriate treatment and preventive strategies are needed to reduce the likelihood of sinusitis occurrence and improve quality of life.

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Is Systemic Inflammatory State Different from Chronic Rhinosinusitis?

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While systemic inflammatory state and chronic rhinosinusitis (sinusitis) are closely related, they are not the same concept. The differences and relationships between the two are as follows.

1. Systemic Inflammation

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• Systemic inflammation refers to an inflammatory response occurring throughout the body, characterized by elevated inflammatory markers (cytokines, acute phase proteins) in the blood⁷⁸.
• It is commonly observed in chronic diseases such as obesity, diabetes, cardiovascular diseases, and rheumatoid arthritis.
• Systemic inflammation impacts various body organs and relates to changes in the immune system and overall health deterioration.

2. Chronic Rhinosinusitis (CRS)

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• Chronic rhinosinusitis refers to a localized inflammatory condition in the mucosa of the nose and sinuses lasting for at least 12 weeks⁹.
• It primarily manifests symptoms such as nasal obstruction, rhinorrhea, reduced smell, and facial pain, with localized T-cell immune dysregulation and changes in mucosal immune response being significant contributors⁷⁹.
• While chronic rhinosinusitis is primarily a localized disease, some patients may experience systemic changes, such as increased expression of specific inflammation-related genes in the blood⁷⁸.

3. Relationship Between the Two

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• Recent studies indicate that patients with chronic rhinosinusitis may exhibit systemic inflammatory responses, as evidenced by increased or decreased expression of specific inflammation-related genes (ctla4, jak1) in the blood⁷⁸.
• Furthermore, sinusitis patients often co-present with other systemic inflammatory diseases like asthma and rheumatoid arthritis, suggesting an interaction between chronic rhinosinusitis and systemic inflammation¹⁰.

In conclusion, while chronic rhinosinusitis is fundamentally a localized disease affecting the mucosa of the nose and sinuses, some patients may simultaneously exhibit or be affected by systemic inflammatory states. Thus, these concepts are closely interconnected yet distinguishable.

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Why Do Obesity and Chronic Rhinosinusitis Co-occur?

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The co-occurrence of obesity and chronic rhinosinusitis (chronic sinusitis) can be explained by several physiological and pathological factors. The primary causes are summarized below.

1. Chronic Inflammatory State

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Obesity increases the secretion of inflammatory substances (e.g., cytokines, adipokines) from adipose tissue, leading to a systemic chronic inflammatory state¹¹¹². This inflammatory response can affect the sinus mucosa, increasing the risk of chronic rhinosinusitis. The inflammatory response observed in obese patients is particularly closely associated with specific forms of sinusitis (e.g., chronic rhinosinusitis with nasal polyps, CRSwNP)¹³¹⁴.

2. Changes in the Immune System

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Obesity can negatively impact the immune system, weakening defenses against infections. Inflammatory mediators secreted by adipose tissue may exacerbate or dysregulate immune responses, increasing the likelihood of localized inflammatory diseases like sinusitis¹¹¹².

3. Association with Nasal Polyps

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Studies have shown a strong association between obesity and chronic rhinosinusitis accompanied by nasal polyps (CRSwNP). This is believed to result from increased inflammatory mediators activated through pathways related to nasal polyp formation due to obesity¹³¹⁵. Conversely, the association between obesity and chronic rhinosinusitis without polyps (CRSsNP) is relatively weak.

4. Central Obesity and Respiratory Diseases

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Central obesity refers to a state where body fat distribution is concentrated in the upper body and abdomen, increasing the risk of respiratory diseases and upper airway inflammatory conditions. Central obesity is particularly strongly associated with CRSwNP, likely due to more inflammatory mediators produced by abdominal fat¹⁴¹⁵.

5. Asthma and Other Comorbid Diseases

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Other diseases associated with obesity, such as asthma and diabetes, may contribute to the worsening or increased risk of developing sinusitis. For instance, asthma and sinusitis are closely linked, and obesity acts as a common factor that exacerbates both conditions¹⁶¹⁷.

Conclusion

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The primary reasons for the co-occurrence of obesity and chronic rhinosinusitis are the systemic chronic inflammatory state, changes in the immune system, and increased respiratory inflammation due to central obesity. To mitigate this association, weight management and appropriate treatment are crucial, especially in CRSwNP patients, where managing obesity may enhance treatment effectiveness.