First, a recent study analyzed plasma biomarker levels in 1409 patients with ARDS and found that obese patients have lower levels of proinflammatory cytokines (IL-6, IL-8) and surfactant protein D (a marker of alveolar epithelial injury) compared to normal weight patients[30].Moreover, recent animal studies[50,51] suggested that obesity-associated attenuation of ALI was in part attributable to an obesity-associated abnormal neutrophil chemoattractant response. This evidence concerns the gene IL6 and acute respiratory distress syndrome.