Basal GLP-1 levels in morbidly obese patients following biliopancreatic diversion surgery

BACKGROUND

Previous studies addressing the changes of glucagon-like peptide-1 (GLP-1) concentrations in morbidly obese patients after bariatric surgery have demonstrated conflicting results. The aim of the present study was to investigate the changes in serum GLP-1 levels 9 months after biliopancreatic diversion in morbidly obese patients without diabetes mellitus.

METHODS

A sample of 40 morbidly obese patients without diabetes mellitus was enrolled. Biochemical and anthropometrical evaluations were conducted at basal and 9 months after surgery.

RESULTS

The mean patient age was 46.6 ± 13.1 years, and the mean preoperative body mass index (BMI) was 47.1 ± 18.1. A significant decrease in BMI, weight, waist circumference, fat mass, glucose, LDL cholesterol, total cholesterol, and triglyceride levels was observed after 9 months. Serum basal GLP-1 levels did not change after surgery (0.65 ± 0.18 ng/ml vs. 0.66 ± 0.17 ng/ml; n.s.). Postsurgical correlation analysis showed a negative association between basal GLP-1 and HDL cholesterol (r = -0.57; p < 0.01).

CONCLUSIONS

Fasting GLP-1 concentrations did not change after massive weight loss with biliopancreatic diversion in morbidly obese patients without diabetes mellitus.

Ability of commercially available dairy ration programs to predict duodenal flows of protein and essential amino acids in dairy cows

The objective of this analysis was to compare the rumen submodel predictions of 4 commonly used dairy ration programs to observed values of duodenal flows of crude protein (CP), protein fractions, and essential AA (EAA). The literature was searched and 40 studies, including 154 diets, were used to compare observed values with those predicted by AminoCow (AC), Agricultural Modeling and Training Systems (AMTS), Cornell-Penn-Miner (CPM), and National Research Council 2001 (NRC) models. The models were evaluated based on their ability to predict the mean, their root mean square prediction error (RMSPE), error bias, and adequacy of regression equations for each protein fraction. The models predicted the mean duodenal CP flow within 5%, with more than 90% of the variation due to random disturbance. The models also predicted within 5% the mean microbial CP flow except CPM, which overestimated it by 27%. Only NRC, however, predicted mean rumen-undegraded protein (RUP) flows within 5%, whereas AC and AMTS underpredicted it by 8 to 9% and CPM by 24%. Regarding duodenal flows of individual AA, across all diets, CPM predicted substantially greater (>10%) mean flows of Arg, His, Ile, Met, and Lys; AMTS predicted greater flow for Arg and Met, whereas AC and NRC estimations were, on average, within 10% of observed values. Overpredictions by the CPM model were mainly related to mean bias, whereas the NRC model had the highest proportion of bias in random disturbance for flows of EAA. Models tended to predict mean flows of EAA more accurately on corn silage and alfalfa diets than on grass-based diets, more accurately on corn grain-based diets than on non-corn-based diets, and finally more accurately in the mid range of diet types. The 4 models were accurate at predicting mean dry matter intake. The AC, AMTS, and NRC models were all sufficiently accurate to be used for balancing EAA in dairy rations under field conditions.

Lys656Asn polymorphism of leptin receptor, leptin levels and insulin resistance in patients with non alcoholic fatty liver disease

BACKGROUND

Some studies have pointed to a role of leptin and insulin resistance in pathogenesis of non alcoholic fatty liver disease (NAFLD). The aim of our study was to investigate the influence of Lys656Asn polymorphism LEPR gene on the histological changes, insulin resistance and leptin levels in overweight patients.

MATERIAL AND METHODS

A population of 76 patients with NAFLD was recruited in a cross sectional study. A biochemical analysis of serum was measured. Genotype of LEPR gene Lys656Asn was studied.

RESULTS

Nineteen patients (25%) had the genotype Lys656Asn and 4 patients genotype Asn656Asn (mutant type group) and 53 patients (69.7%) Lys656Lys (wild type group). Body mass index, weight, fat mass, waist circumference, waist to hip ratio, glucose levels and HOMA-IR were higher in mutant than wild type group. LEPR polymorphism is in any way related with liver lesions. The multivariate analysis adjusted by age, sex, BMI and genotype showed an independently association of lobular inflammation 4.19 (CI95%: 1.37-12.77), portal inflammation 1.97 (CI95%: 1.05-3.74) and steatosis 9.23 (CI95%: 1.47-57.83) with HOMA. Liver steatosis was associated with leptin levels (1.09 (CI95%: 1.06-1.18)), too.

CONCLUSION

Lys656Asn polymorphism of LEPR gene is associated with obesity parameters, insulin resistance and glucose levels in patients with NAFLD. In logistic regression analysis, only insulin resistance was associated with portal inflammation), lobular inflammation and steatosis; liver steatosis was related with leptin levels, too.

Role of -55CT polymorphism of UCP3 gene on non alcoholic fatty liver disease and insulin resistance in patients with obesity

BACKGROUND AND AIMS

Some studies have pointed to a role of UCP3 in the regulation of biochemical and fat parameters in overweight patients. The aim of our study was to investigate the influence of -55CT polymorphism of UCP3 gene (rs1800849) on histological changes and insulin resistance in patients with non-alcoholic fatty liver disease (NAFLD).

MATERIAL AND METHODS

A population of 39 patients with NAFLD was recruited in a cross sectional study. The inclusion criterion was the presence of biopsy-proven NAFLD. A biochemical analysis of serum (lipid profile, and adipocytokines) was measured. An anthropometric analysis was assessed, too. Genotype of UCP3 gene -55CT was studied.

RESULTS

Nine patients (23%) had the genotype 55CC (mutant type group) and 30 patients (77%) 55CT (wild type group).TT genotype was not detected. Insulin levels and HOMA were higher in mutant type group (insulin: 17.7 +/- 10.9 mUI/L vs 11.9 +/- 4.7 mUI/L/; p < 0.05) and (HOMA: 3.2 +/- 1.8 vs 4.5 +/- 2.8; p < 0.05). Adiponectin levels were lower in mutants type group (36.5 +/- 28.1 ug/ml vs 21.5 +/- 18.6 ug/ml:p < 0.05). Moderate-severe inflammation and moderate-severe steatosis were more frequent in mutant type group, with higher levels of insulin and lower levels of adiponectin than mild stages.

CONCLUSION

-55CT genotype is associated with high insulin resistance and low adiponectin levels than -55CC genotype. Patients with -55CT genotype have more frequently moderate-severe steatosis and inflammation than -55CC genotype.

G 1359A polymorphism of the cannabinoid receptor gene (CNR1) and clinical results of biliopancreatic diversion

BACKGROUND

Bariatric surgery is the most effective long-term treatment for morbid obesity, reducing obesity-associated co-morbidities. We decide to investigate the role of the polymorphism (G1359A) of the cannabinoid (CB)1 receptor gene on clinical outcomes 1 year after biliopancreatic diversion in morbidly obese patients.

DESIGN

A sample of 66 morbidly obese patients (BMI >40 kg/m2) were operated. Weight, fat mass, blood pressure, basal glucose, triacylglycerols, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol were measured at basal visit and at each visit. The frequency of metabolic comorbidities was recorded at each visit.

RESULTS

Thirty-nine patients (59.1%) had genotype G1359G (wild type group) and 27 (40.9%) patients had genotype G1359A (mutant type group). In wild and mutant type groups, body mass index, weight, waist circumference, systolic blood pressure, glucose, total cholesterol, low-density lipoprotein cholesterol and triacylglycerols concentrations decreased, without statistical between genotype groups. Initial weight percent loss at 1 year of follow up was similar in both genotypes (33.1% vs 33.6%; ns).

CONCLUSION

The present study demonstrates that polymorphism G1359A in the CB1 receptor did not have a significant effect on biochemical and anthropometric improvements after biliopancreatic diversion surgery.

Influence of visfatin on histopathological changes of non-alcoholic fatty liver disease

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is a common liver disease. The aim of the present study was to explore the relation of visfatin with underlying histopathological changes of NAFLD patients.

SUBJECTS

A population of 55 NAFLD patients was analyzed in a cross-sectional study. A liver biopsy was realized. Weight, basal glucose, insulin, insulin resistance (HOMA), total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and visfatin levels were measured. A bioimpedance was performed.

RESULTS AND CONCLUSIONS

The mean age was 42.8 +/- 11.2 years, the mean BMI was 33.1 +/- 10.2 with 37 males (67.3%) and 18 females (32.7%). Probabilities to have; portal inflammation increased 1.11 (CI95%:1.03-1.50) with each increment of 1 ng/ml of visfatin concentration, high grade of steatosis increased 1.25 (CI 95%:1.06-1.61) with each unit of insulin concentrations, fibrosis increased 1.12 (CI 95%:1.02-1.43) with each unit of fat mass and lobulillar inflammation increased 13.4 (CI 95%:1.3-147) with each unit of HOMA-IR. Portal inflammation frequencies were different between groups (low visfatin group 13.07 < ng/ml: 37.5% versus high visfatin group 13.07 > ng/ml: 62.5%; P < 0.05). In conclusion, several histopathological changes in liver biopsies could be explained by insulin concentrations, HOMA-IR, and fat mass amount. Moreover, visfatin plasma concentrations could predict the presence of portal inflammation in NAFLD patients.

Clinical results and nutritional consequences of biliopancreatic diversion: three years of follow-up

BACKGROUND

Bariatric surgery is the most effective long-term treatment for morbid obesity, reducing obesity-associated comorbidities. The aim of our work was to describe clinical results and nutritional complications in morbidly obese patients with biliopancreatic diversion.

METHODS

We have analyzed a consecutive series of 64 patients who have been followed up for 3 years after undergoing open biliopancreatic diversion by the Scopinaro technique.

RESULTS

Initial excess weight loss was 29.3% at 6 months and 61.5% at 3 years. A significant improvement of body mass index, weight, waist circumference, fat mass, glucose level, total cholesterol, uric acid and triglycerides levels was detected. Ferritin, vitamin A, vitamin D, vitamin B(12), zinc and copper levels showed a low percentage of deficiency at basal time, but during the follow-up, the percentage of deficiency increased. Vitamin E and K did not show basal deficiency. However, after surgery, a moderate deficiency of both vitamins was detected (vitamin E 7.1% and vitamin K 8.3%). Folic acid deficiency was observed in 54.3% of the subjects at basal time, but decreased during the study.

CONCLUSION

Biliopancreatic diversion is an effective method of sustainable weight loss. However, micronutrient deficiencies can occur.

Influence of G308A polymorphism of tumor necrosis factor alpha gene on surgical results of biliopancreatic diversion

BACKGROUND

Bariatric surgery is the most effective long-term treatment for morbid obesity, reducing obesity-associated comorbidities. The purpose of the present study was to evaluate G308A polymorphism of the tumor necrosis factor (TNF) alpha gene on outcomes 1 year after biliopancreatic diversion.

METHODS

A sample of 41 morbidly obese patients (body mass index > 40 kg/m(2)) were operated on. Weight, fat mass, blood pressure, creatinine, uric acid, basal glucose, triacylglycerols, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were measured at basal visit and at each visit. Adipocytokines were measured at basal time and 12 months after surgery. The frequency of patients with diabetes mellitus, hypertension, and hyperlipidemia was recorded at each visit.

RESULTS

Thirty-two patients (78%) had genotype G308G [wild-type group and nine patients (22%) with G308A genotype (mutant-type group)]. Genotype A308A was not detected. In the wild group, body mass index, weight, uric acid, glucose, total cholesterol, low-density lipoprotein cholesterol, triacylglycerol, leptin, and systolic blood pressure decreased. In the mutant group, the same parameters improved. Adiponectin levels increased after surgery in both genotypes. Initial weight percent loss at 1 year of follow up was similar in both groups (32.2% vs 28.6%; ns).

CONCLUSION

The present study demonstrates that the G308A polymorphism in the TNF-alpha gene is not related to clinical outcomes after bariatric surgery.

Oncogenic hypophosphatemic osteomalacia associated with a nasal hemangiopericytoma

We report a patient with a nasal hemangiopericytoma associated with an oncogenic hypophosphatemic osteomalacia (OHO). This syndrome results from tumor products that decrease renal tubular phosphate resorption, leading to the osteomalacia. This patient presented with classic bone manifestations of osteomalacia and a nasal tumor. Laboratory studies performed before the first resection of the tumor included normal serum calcium, hypophosphatemia due to decreased tubular reabsorption of phosphate, and an undetectable serum 1,25 dihydroxy vitamin D level. Serum parathormone level was normal. Anterior iliac crest bone biopsy showed characteristic signs of osteomalacia that included increased osteoid and delayed mineralization. A partial resection of the nasal tumor was performed. After the first surgery the patient showed detectable serum level of 1,25 dihydroxy vitamin D, and transient normalization of the tubular reabsorption of phosphate. The patient was also treated with phosphate supplements and vitamin D with transient control of her clinical manifestations and improvement of the radiographic signs of osteomalacia. Three months after surgery, the serum level of 1,25 dihydroxy vitamin D level again became undetectable. After selective embolization of the tumor, followed by an apparent complete tumor resection and postoperative radiation therapy, her hypophosphatemia and decreased phosphate tubular reabsorption persisted. Therefore, biochemical changes associated with hemangiopericytoma induced OHO may persist even after apparent total tumor resection. Clinicians should be aware of the oncogenic basis for some osteomalacia, as seen in this patient.

Tumour necrosis factor (TNF)alpha -308 G/G promoter polymorphism and TNFalpha levels correlate with a better response to adalimumab in patients with rheumatoid arthritis

OBJECTIVE

To investigate the influence of -308 tumour necrosis factor-alpha (TNFalpha) promoter polymorphism and circulating TNFalpha levels in the clinical response to adalimumab treatment in patients with rheumatoid arthritis (RA).

METHODS

Eighty-one patients with active RA were genotyped for the -308 TNFalpha polymorphism by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis and subdivided into two groups for each polymorphism (G/A and G/G genotype). All received 40 mg of adalimumab subcutaneously every other week. We compared the groups' clinical responses to adalimumab at 8, 16, and 24 weeks using the Disease Activity Score in 28 joints (DAS28).

RESULTS

Both groups showed a significant improvement from baseline. A significant difference between groups was found at week 24. We found that 88.2% of G/G versus 68.4% of G/A for the -308 polymorphism were DAS28 responders (p = 0.05). The score improvement at week 24 was 2.5 +/- 1.3 in the G/G group and 1.8 +/- 1.3 in the G/A group for the -308 polymorphism (p = 0.04). The median of serum TNFalpha levels of the G/A group were lower than those of the G/G group, and statistically different at weeks 8 and 24 (p < 0.039 and p < 0.043). When comparing baseline levels to those achieved at 8, 16, and 24 weeks for the whole group, only responder patients showed a statistically significant overall increase in TNFalpha over time (p < 0.000001).

CONCLUSION

A relationship between DAS28 improvement, the -308 G/G polymorphism, and increased circulating TNFalpha levels was found in Chilean RA patients treated with adalimumab.

The route of absorbed nitrogen into milk protein

A database reviewing the metabolism of nitrogen (N) compounds from absorption to milk has been compiled from 14 published and unpublished studies (33 treatments) that measured the net flux of N compounds across the splanchnic tissues in dairy cows. Apparent N digestibility averaged 0·65, with this then partitioned between 0·34 excreted in urine and 0·31 secreted as milk.

Nitrogen metabolites are absorbed from the lumen of the gut into the portal vein, mainly as free amino acids (AA) and ammonia; these represented 0·58 and 0·57 of digested N, respectively. All of the ammonia absorbed was removed by the liver with, as a result, a net splanchnic flux of zero. Detoxification of ammonia by the liver and catabolism of AA results in production of urea as an end-product. Hepatic ureagenesis is a major cross-road in terms of whole body N exchange, being the equivalent of 0·81 of digested N. Therefore, salvage of a considerable part of this ureagenesis is needed to support milk protein synthesis. This salvage occurs via transfer of urea from the blood circulation into the lumen of the gut. On average, 0·47 of hepatic ureagenesis was returned to the gut via the portal-drained viscera (equivalent to 0·34 of digested N) with 0·56 of this then used for anabolic purposes e.g. as precursor N for microbial protein synthesis. On average, 0·65 of estimated digestible AA was recovered in the portal vein. This loss (0·35) is due to oxidation of certain AA across the gut wall and non-absorption of endogenous secretions. The magnitude of this loss is not uniform among AA and varies between less than 0·05 for histidine to more than 0·90 for some non-essential AA, such as glutamine.

A second database (six studies, 14 treatments) was constructed to further examine the subsequent fate of absorbed essential AA. When all AA are aggregated, the liver removed, on average, 0·45 of portal absorption but this value hides the considerable variation between individual AA. Simplistically, the AA behave as two major groups: one group undergoes very little hepatic removal and includes the branched-chain AA and lysine. For the second group, removal varies between 0·35 and 0·50 of portal absorption, and includes histidine, methionine and phenylalanine. For both groups, however, the efficiency of transfer of absorbed AA into milk protein decreases with increasing supply of protein. This loss of efficiency is linked directly with increased hepatic removal of AA from the second group and, probably, increased catabolism by peripheral tissues, including the mammary gland, of AA from the first group. Therefore, we must stop using fixed factors of conversion of digestible AA to milk in our predictive schemes and acknowledge that metabolism of AA between delivery from the duodenum and conversion to milk protein will vary with nutrient supply. New information evolving from re-analysis of the literature and recent studies will allow better models to be devised for the prediction of nutrient-based responses by the lactating cow. Consideration of biological efficiency, rather than maximal milk yield, will lead to systems that are economically more sensible for the farmer and that have better environmental impacts.

Comparison of Net Portal Absorption with Predicted Flow of Digestible Amino Acids: Scope for Improving Current Models?

This study was undertaken to determine the relationship between measured net portal absorptions (NPA) and flows of digestible essential amino acids (EAA) predicted with the National Research Council model (NRC, 2001) or the Cornell Net Carbohydrate and Protein System model (CNCPS, version 5.0.34). Net portal absorption data were obtained from 33 measurements of portal-arterial plasma EAA concentration differences among 8 treatments in lactating dairy cows, with plasma flow estimated from downstream dilution of para amino-hippurate. The predicted digestible flows from NRC (2001) related better than CNCPS to NPA observed in our studies, as shown by the lower standard errors on the slopes for all EAA and lower root mean prediction errors for all EAA except Met and Phe. However, the partitioning of the prediction error indicated a systematic underprediction (mean bias) for the NRC model (2001), with the exception of Ile. It is important to note that a relationship of unity was not expected, as discussed in the paper, because of losses of EAA through portal-drained viscera metabolism. A revised set of predictive equations for digestible EAA was obtained using a subset of data from NRC (2001) limited to trials conducted with dairy cows. This increased the predicted flows of digestible EAA by only 2%. Flows of digestible EAA were also estimated using a factorial approach, assuming an AA composition for each fraction of the duodenal flow estimated by NRC (undegradable, microbial, and endogenous proteins). This resulted in a slight improvement in the slope of the regression between predicted flows and measured NPA, but still yielded predicted digestive flows that were too low to support observed NPA. Finally, on the basis of literature values, increment of the digestibility of the undegradable fraction of forages and of microbial protein is suggested to improve the relationship between predicted digestible flows and NPA. Overall, this study indirectly confirms, across EAA, smaller losses through gut metabolism for His, Met, and Lys, intermediate losses for the branched-chain AA with the higher losses for Thr.

Liver Transplantation: Experience With Our First 100 Cases

OBJECTIVES

Our goal was to evaluate the results of the first 100 liver transplants performed in our institution.

METHODS

We retrospectively analyzed the first 100 liver transplants undertaken in adults from November 2001 to August 2005.

RESULTS

The mean age of the recipients was 50 years (20 to 69) and 73% were men. The mean waiting time was 35 days. The mean age of the donors was 60 years (15 to 87), and 60% were men. One-year patient and graft survival rates were 93% and 90%, respectively. Three-year patient and graft survival rates were 85% and 82%, respectively. The need for retransplantation was 3%. Surgical complications included hepatic artery stenoses, 2%; hepatic artery thromboses, 2%; biliary leaks, 6%; and biliary stenoses, 14%.

CONCLUSIONS

These results are no different from the overall results for liver transplantation in Spain during the same period.

Production of indolic compounds by rumen bacteria isolated from grazing ruminants

AIM

To screen rumen bacterial cultures and fresh ruminal isolates for indole and skatole production.

METHODS AND RESULTS

Culture collection strains and fresh bacterial isolates from rumen contents of sheep and dairy cows were screened for the production of indolic compounds. Clostridium aminophilum FT, Peptostreptococcus ssp. S1, Fusobacterium necrophorum D4 produced indole and Clostridium sticklandii SR produced indoleacetic acid. Fresh isolates from sheep (TrE9262 and TrE7262) and dairy cows (152R-1a, 152R-1b, 152R-3 and 152R-4) produced indole, indolepropionic acid, tryptophol and skatole from the fermentation of tryptophan and indoleacetic acid. Glucose altered the indolic compounds produced in some, but not all, isolates. TrE7262 and 152R-4 were identified as Clostridium sporogenes and 152R-1b as a new Cl. aminophilum strain. Isolates TrE9262, 152R-1a and 152R-3 were not closely related to any described species but belong to Megasphaera, Prevotella and Actinomyces genera, respectively.

CONCLUSIONS

Rumen bacteria that produced a range of indolic compounds were identified. Some isolates are distinct from the previously described bacteria and may represent novel species.

SIGNIFICANCE AND IMPACT OF THE STUDY

These observations will contribute to understanding skatole and indole formation in the rumen and will lead to methods that control the formation of indolic compounds in pasture-grazed ruminants.

[Effectiveness of infliximab in patients with Behçet syndrome and severe uveoretinitis. Report of five cases]

The efficacy and safety of repeated administration of infliximab was evaluated in five patients (two men, three women) with Behçet syndrome accompanied by severe uveoretinitis. Ocular and extra ocular inflammation was suppressed in all patients during the observation period without any serious adverse reactions. The results in these patients suggests that TNF-á blockade is effective in patients with severe ocular Behçet syndrome.

What is the True Supply of Amino Acids for a Dairy Cow?

Improving the prediction of milk protein yield relies on knowledge of both protein supply and requirement. Definition of protein/amino acid supply in ruminants is a challenging task, due to feedstuff variety and variability and to the remodeling of nutrient intake by the rumen microflora. The questions arise, therefore, how and where should we measure the real supply of AA in the dairy cow? This review will follow the downstream flow of AA from duodenum to peripheral tissue delivery, with a glance at the efficiency of transfer into milk protein. Duodenal AA flow comprises rumen undegradable feed, microbial protein, and endogenous secretions. Most attention has been directed toward definition of the first two contributions but the latter fraction can represent as much as 20% of duodenal flow. More information is needed on what factors affect its magnitude and overall impact. Once digested, AA are absorbed into the portal vein. The ratio of portal absorption to small intestinal apparent digestion varies among essential AA, from 0.43 (threonine) to 0.76 (phenylalanine), due to the contributions of preduodenal endogenous secretions to the digestive flow, non-reabsorption of endogenous secretions and gut oxidation of AA. Few data are available on these phenomena in dairy cows but the evidence indicates that they alter the profile of AA available for anabolic purposes. Recent comparisons of estimated duodenal flux and measured portal flux have prompted a revisit of the NRC (2001) approach to estimate AA flows at the duodenum. Changes to the model are proposed that yield predictions that better fit the current knowledge of AA metabolism across the gut. After absorption, AA flow first to the liver where substantial and differential net removal occurs, varying from zero for the branched-chain AA to 50% of portal absorption for phenylalanine. This process alters the pattern of net supply to the mammary gland. Overall, intermediary metabolism of AA between the duodenum and the mammary gland biologically explains the decreased efficiency of the transfer of absorbed AA into milk protein as maximal yield is approached. Therefore, variable, rather than fixed, factors for transfer efficiencies must be incorporated into future predictive models.