51
|
Misra S, Nandhini BD, Christinajoice S, Kumar SS, Prabhakaran S, Palanivelu C, Raj PP. Is Laparoscopic Roux-en-Y Gastric Bypass Still the Gold Standard Procedure for Indians? Mid- to Long-Term Outcomes from a Tertiary Care Center. Obes Surg 2020; 30:4482-4493. [PMID: 32725594 DOI: 10.1007/s11695-020-04849-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/04/2020] [Accepted: 07/08/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Laparoscopic Roux-en-Y gastric bypass (RYGB) is the oldest and most widely performed bariatric surgery worldwide. There is, however, a scarcity of mid- to long-term data of RYGB, especially from the Indian subcontinent. MATERIALS AND METHODS The study was a single-center, retrospective analysis from patients who underwent RYGB between January 2009 and November 2014 from a tertiary care center in India. Percent of total weight loss (%TWL) was taken as the primary outcome of the study. Secondary outcomes included type 2 diabetes mellitus (T2DM) remission, comorbidity resolution, revisional surgeries, and complications related to RYGB at 1 year, at 3 years, and during the long term, following surgery. Postoperative visits took place at 1 and 3 years, while the long-term outcome was at median 8.3 years (range 5.4-11.2 years), with a follow-up of 92.4% (488/528), 80.5% (424/527) and 69.5% (363/522), respectively. RESULTS Out of 528 patients studied, 56% were females. The mean body mass index (BMI) was 40.6 ± 6.9 kg/m2. The %TWL in the long-term follow-up was 21.8 ± 11.3%. T2DM remission rates at 1 year, at 3 years, and during the long term were 84.5%, 70.0%, and 60.0%, respectively. Preoperative HBA1c (p = 0.002) and insulin usage (p = 0.016) had a significant predictive effect on T2DM remission. Gastroesophageal reflux disease (GERD) improved significantly (p < 0.001). Early (< 30 days) and late (> 30 days) complications were observed in 2.3% and 4.3% of the patients, respectively. CONCLUSION Weight loss during mid to long-term follow-up was maintained in the majority of the patients after RYGB. However, a small proportion had significant weight regain in the long term. T2DM, GERD, and other comorbidities were well improved after RYGB.
Collapse
Affiliation(s)
- Shivanshu Misra
- Department of Bariatric and Metabolic Surgery, GEM Hospital & Research Center, Coimbatore, Tamil Nadu, 641045, India
| | - B Deepa Nandhini
- Department of Bariatric and Metabolic Surgery, GEM Hospital & Research Center, Coimbatore, Tamil Nadu, 641045, India
| | - S Christinajoice
- Department of Bariatric and Metabolic Surgery, GEM Hospital & Research Center, Coimbatore, Tamil Nadu, 641045, India
| | - S Saravana Kumar
- Department of Bariatric and Metabolic Surgery, GEM Hospital & Research Center, Coimbatore, Tamil Nadu, 641045, India
| | - S Prabhakaran
- Department of Bariatric and Metabolic Surgery, GEM Hospital & Research Center, Coimbatore, Tamil Nadu, 641045, India
| | - C Palanivelu
- Department of Bariatric and Metabolic Surgery, GEM Hospital & Research Center, Coimbatore, Tamil Nadu, 641045, India
| | - P Praveen Raj
- Department of Bariatric and Metabolic Surgery, GEM Hospital & Research Center, Coimbatore, Tamil Nadu, 641045, India.
| |
Collapse
|
52
|
Five-Year Outcomes of Laparoscopic Sleeve Gastrectomy in Japanese Patients with Class I Obesity. Obes Surg 2020; 30:4366-4374. [DOI: 10.1007/s11695-020-04789-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
53
|
Lim HS, Kim YJ, Lee J, Yoon SJ, Lee B. Establishment of Adequate Nutrient Intake Criteria to Achieve Target Weight Loss in Patients Undergoing Bariatric Surgery. Nutrients 2020; 12:nu12061774. [PMID: 32545878 PMCID: PMC7353322 DOI: 10.3390/nu12061774] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 12/17/2022] Open
Abstract
Although bariatric surgery is the best treatment modality for morbidly obese patients, a 10-30% rate of weight recidivism has been reported in various specialized centers. We examined changes in energy and macronutrients after bariatric surgery and performed analysis to establish appropriate nutritional guidelines for reaching the target percentage of weight loss after surgery. A total of 189 subjects who underwent bariatric surgery were classified into success and failure groups depending on whether or not they reached 50% loss of excess weight at 12 months after bariatric surgery. Physical examinations and dietary surveys were completed before and 1, 6, and 12 months after surgery. Using receiver operating characteristic (ROC) analysis, the optimal cutoff points for nutrient intakes for determining success after bariatric surgery were computed based on maximal Youden's index. At 6 and 12 months after surgery, the success group had significantly lower carbohydrate and fat intakes than the failure group. The cutoff calorie intake for success in weight loss was <835.0, <1132.5, and <1523.0 kcal/day at 1, 6, and 12 months post operation, respectively. With regard to protein, the cutoff intakes were >44.5, >41.5, and >86.5 g/day at 1, 6, and 12 months post operation, respectively. At 12 months, the cutoff ratio for energy obtained from carbohydrates, protein, and fat was <49.0, >24.5, and <28.0%, respectively. Our findings confirm that the level of diet control and nutrition restriction affect the achievement of target weight loss, emphasizing that long-term weight loss is related to compliance with nutrient recommendations.
Collapse
Affiliation(s)
- Hee-Sook Lim
- Department of Food and Nutrition, Yeonsung University, Anyang 14011, Korea;
| | - Yong Jin Kim
- Department of General Surgery, H Plus Yang Ji Hospital, Seoul 08779, Korea
- Correspondence: ; Tel.: +82-2-070-4665-9517
| | - Jihyun Lee
- Department of Nutrition, H Plus Yang Ji Hospital, Seoul 08779, Korea;
| | - Su-Jin Yoon
- Department of Nutrition, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea;
| | - Bora Lee
- Department of Statistics, Chung-Ang University, Seoul 06911, Korea;
| |
Collapse
|
54
|
Is the Current Micronutrient Supplementation Adequate in Preventing Deficiencies in Indian Patients? Short- and Mid-Term Comparison of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass. Obes Surg 2020; 30:3480-3488. [DOI: 10.1007/s11695-020-04674-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
55
|
Abstract
BACKGROUND Scarce data exists about serum enzyme in bariatric patients. We attempted to evaluate serum enzyme status in patients receiving Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) and to identify related predictors. METHODS We retrospectively reviewed the patients receiving RYGB and SG in our center from January 2013 to January 2018. Anthropometric data and serum enzyme data were collected preoperatively and 6 and 12 months postoperatively. RESULTS Five hundred patients (201 RYGB, 299 SG) were included. Serum enzyme abnormalities were common preoperatively, with 50.8% for elevated alanine aminotransferase (ALT), 33.0% for elevated aspartate aminotransferase (AST), 36.6% for elevated γ-glutamyltranspeptidase (γ-GT), 17.6% for elevated creatine kinase (CK), 15.2% for elevated lactic dehydrogenase (LDH), 9.0% for elevated adenosine deaminase (ADA), 6.2% for elevated hydroxybutyrate dehydrogenase (HBDH), and 8.4% for decreased superoxide dismutase (SOD). After RYGB and SG, the prevalence of serum ALT, AST, γ-GT, LDH, and HBDH abnormalities reduced. The levels of ALT, AST, γ-GT, ADA, cholinesterase (CHE), LDH, CK, and HBDH reduced significantly, while amylase and SOD levels increased. Age and preoperative γ-GT level were independent predictors of ALT, AST, γ-GT, and LDH change 1 year postoperatively. Preoperative ALT, AST, ALP, LDH, and HBDH levels could predict postoperative change, respectively. Gender and surgical procedure could predict postoperative ALP change. CONCLUSION Serum enzyme abnormalities are common in bariatric surgery candidates, with reduced prevalence of abnormalities postoperatively. RYGB and SG are related with reduced ALT, AST, γ-GT, ADA, CHE, LDH, CK, and HBDH levels, as well as increased amylase and SOD levels.
Collapse
|
56
|
OSSI (Obesity and Metabolic Surgery Society of India) Guidelines for Patient and Procedure Selection for Bariatric and Metabolic Surgery. Obes Surg 2020; 30:2362-2368. [DOI: 10.1007/s11695-020-04497-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
57
|
Wu T, Wong SKH, Law BTT, Grieve E, Wu O, Tong DKH, Leung DKW, Lam CLK, Wong CKH. Five-year effectiveness of bariatric surgery on disease remission, weight loss, and changes of metabolic parameters in obese patients with type 2 diabetes: A population-based propensity score-matched cohort study. Diabetes Metab Res Rev 2020; 36:e3236. [PMID: 31912598 DOI: 10.1002/dmrr.3236] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/09/2019] [Accepted: 11/11/2019] [Indexed: 12/11/2022]
Abstract
AIMS To compare disease remission rates, weight loss, and changes of metabolic parameters of patients after bariatric surgery with nonsurgical patients. METHODS Based on the 2006-2017 Hospital Authority database, a population-based retrospective cohort of obese type 2 diabetes mellitus (T2DM) patients with and without bariatric surgery were identified. Surgical patients were matched with nonsurgical patients on 1-to-5 propensity score. Remission rates of diabetes, hypertension, and dyslipidaemia were reported annually up to 60 months. Changes in weight loss measurements (Body Mass Index [BMI], percentage of total weight loss [%TWL], percentage of excess weight loss [%EWL], and percentage of rebound in excess weight loss [%REWL]) and metabolic parameters (haemoglobin A1c [HbA1c ], systolic blood pressure [SBP], diastolic blood pressure [DBP], and low-density lipoprotein cholesterol [LDL-C]) were measured for both groups. RESULTS Four hundred one surgical patients (310 restrictive surgeries; 91 bypass surgeries) and 1894 nonsurgical patients were included. Surgical patients had higher remission rates in diabetes and dyslipidaemia and better glycaemic control at 12 to 60 months (all Ps < .01). SBP and DBP were significantly lower for surgical group up to 12 months and similar between two groups after 12 months. Surgical patients had significantly lower BMI during follow-up period. %TWL and %EWL were higher in the surgery group (15.7% vs 3.7%; 48.8% vs 12.0%) at 60 months (P < .001); differences in %REWL between two groups were insignificant. The effectiveness of restrictive and bypass surgeries was similar at 60 months, although restrictive surgeries were slightly more effective in T2DM remission. CONCLUSIONS Bariatric surgery was effective in weight loss, remission of diabetes, and dyslipidaemia in 5-year post-surgery.
Collapse
Affiliation(s)
- Tingting Wu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | | | - Betty Tsz Ting Law
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Hong Kong, SAR, China
| | - Eleanor Grieve
- Health Economics and Health Technology Assessment, Institute of Health & Wellbeing, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment, Institute of Health & Wellbeing, UK
| | - Daniel King Hung Tong
- Surgery Centre, Hong Kong Sanatorium & Hospital, University of Glasgow, Hong Kong SAR, China
| | | | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
58
|
Malik S, Teh JL, Lomanto D, Kim G, So JBY, Shabbir A. Maternal and fetal outcomes of Asian pregnancies after bariatric surgery. Surg Obes Relat Dis 2020; 16:529-535. [PMID: 32085937 DOI: 10.1016/j.soard.2020.01.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/02/2019] [Accepted: 01/13/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Obesity is a risk factor for pregnancy-induced hypertension, preeclampsia, gestational diabetes, and large gestational age pregnancy. Bariatric surgery is widely accepted to treat obesity but associated with small for gestational age fetuses. OBJECTIVE To report maternal and fetal outcomes after bariatric surgery in morbidly obese Asian females. SETTING University Hospital, Singapore. METHODS We maintain a prospective cohort of patients who underwent bariatric surgery in our institution. Maternal and fetal outcomes are compared with a control group of 31 pregnancies matched for age, parity, presurgery weight, and year of delivery. RESULTS Twenty-four pregnancies occurred in 16 patients in our postoperative cohort. Morbidly obese women in the control group were more likely to develop gestational diabetes (19.3% versus 5.0%, P = .150) and pregnancy-induced hypertension/preeclampsia (32.2% versus 0%, P = .003) compared with the postoperative group. Of fetuses, 37.5% in the bariatric group had low birth weight compared with only 9.4% fetuses in the control group (P = .016). Preoperative body mass index, short interval between conception and surgery, and poor weight gain during pregnancy did not predict for small for gestational age fetuses. Subsequent weights were available for 37.5% of the children in the surgical cohort and none of these children exhibited growth retardation. CONCLUSION Bariatric surgery lowers the risk of maternal co-morbidities and large gestational age fetus during pregnancy. Asians are at high risk of small for gestational age pregnancies after bariatric surgery and should undergo close monitoring for fetal growth throughout their pregnancy.
Collapse
Affiliation(s)
- Sajid Malik
- Department of Surgery, National University Hospital, National University Health System, Singapore
| | - Jun Liang Teh
- Department of Surgery, National University Hospital, National University Health System, Singapore; Department of Surgery, Jurong Health Campus, National University Health System, Singapore
| | - Davide Lomanto
- Department of Surgery, National University Hospital, National University Health System, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | - Guowei Kim
- Department of Surgery, National University Hospital, National University Health System, Singapore
| | - Jimmy Bok-Yan So
- Department of Surgery, National University Hospital, National University Health System, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | - Asim Shabbir
- Department of Surgery, National University Hospital, National University Health System, Singapore.
| |
Collapse
|
59
|
Liu SYW, Wong SKH, Lam CCH, Ng EKW. Bariatric surgery for Prader-Willi syndrome was ineffective in producing sustainable weight loss: Long term results for up to 10 years. Pediatr Obes 2020; 15:e12575. [PMID: 31515962 DOI: 10.1111/ijpo.12575] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 08/12/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Obesity control in Prader-Willi syndrome (PWS) is notoriously difficult. The role of bariatric surgery in PWS remains controversial as long-term data are lacking. OBJECTIVES To evaluate the 10-year outcomes of bariatric surgery in PWS. METHODS This was a prospective observational study on PWS patients who received bariatric surgery and multidisciplinary follow-up programmes for obesity control. Outcomes on weight reduction and comorbidity resolution were evaluated. RESULTS Between 2008 and 2013, five PWS patients (two males, mean age 19.2 ± 3.0 years) with body mass index of 47.3 ± 6.9 kg m-2 received sleeve gastrectomy (n = 2), one anastomosis gastric bypass (n = 2), and Roux-en-Y gastric bypass (n = 1) after failing all non-operative weight loss programmes. The median follow-up was 8.4 ± 2.2 years. The best mean percentage of total weight loss (%TWL) was achieved at 2 years (24.7%). %TWL dropped to 23.3% at 3 years, 11.9% at 5 years, 4.1% at 8 years, and 0% at 10 years. Each patient had at least three comorbidities preoperatively, but none of them had resolution of any one of the comorbidities at the last follow-up. CONCLUSIONS Bariatric surgery could not produce sustainable long-term weight loss or comorbidity resolution in PWS. This study suggests that bariatric surgery cannot be recommended to PWS patients as a standard treatment.
Collapse
Affiliation(s)
- Shirley Yuk-Wah Liu
- Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Simon Kin-Hung Wong
- Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Candice Chuen-Hing Lam
- Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Enders Kwok-Wai Ng
- Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| |
Collapse
|
60
|
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|
61
|
Li YH, Wang BY, Huang YC, Tsao LC, Chan CP, Huang CY, Chang HC. Clinical Outcomes of Laparoscopic Greater Curvature Plication and Laparoscopic Sleeve Gastrectomy: a Case-Matched Control Study. Obes Surg 2019; 29:387-393. [PMID: 30251090 DOI: 10.1007/s11695-018-3527-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Laparoscopic greater curvature plication (LGCP) is a new bariatric procedure that is similar to laparoscopic sleeve gastrectomy (LSG) in that it uses a restrictive mechanism. Comparative studies between LGCP and LSG were still limited. The aim of this study was to compare the clinical outcomes of the two procedures based on the same clinical conditions. METHODS From January 2012 to December 2015, 260 patients with morbid obesity underwent LGCP and LSG in a single center. Data on patient demography, operation time, complications, hospital stay, body mass index loss, percentage of excess weight loss (%EWL), and improvement in comorbidities were collected. A propensity-matched analysis, incorporating pre-operative variables, was used to compare the short-term outcomes between LGCP and LSG. RESULTS Propensity matching produced 48 patients in each group. Patients who underwent LGCP were predominately female (75.5%, 41.1% of the LSG patients were female, p = 0.028). Baseline BMI and excess weight were significantly lower in the LGCP group (p < 0.001). The LSG group showed a greater decrease in excess body weight than the LGCP group (LSG, 47.36 ± 12.95% in 3 months, 57.97 ± 19.28% in 6 months, 66.28 ± 25.42% in 12 months; LGCP, 39.67 ± 12.58% in 3 months, 47.40 ± 19.30% in 6 months, 48.02 ± 20.17% in 12 months, p = 0.008, 0.032, 0.010). Perioperative complications and resolution of obesity-related comorbidities were not significantly different between the two groups. CONCLUSION LGCP and LSG are both feasible and safe procedures for surgical weight reduction. In short-term follow-ups, LSG demonstrates a better excess body weight reduction while having perioperative complications similar to LGCP.
Collapse
Affiliation(s)
- Yu-Hsien Li
- Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County, 500, Taiwan
| | - Bing-Yen Wang
- Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County, 500, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan
- Center for General Education, MingDao University, Changhua, Taiwan
- Ph.D. Program in Translational Medicine,National Chung Hsing University, Taichung, Taiwan
| | - Yu-Ching Huang
- Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County, 500, Taiwan
| | - Lien-Cheng Tsao
- Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County, 500, Taiwan
| | - Chien-Pin Chan
- Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County, 500, Taiwan
| | - Cheng-Yen Huang
- Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County, 500, Taiwan
| | - Hung-Chi Chang
- Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County, 500, Taiwan.
| |
Collapse
|
62
|
Chiang KM, Chang HC, Yang HC, Chen CH, Chen HH, Lee WJ, Pan WH. Genome-wide association study of morbid obesity in Han Chinese. BMC Genet 2019; 20:97. [PMID: 31852448 PMCID: PMC6921553 DOI: 10.1186/s12863-019-0797-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 11/28/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND As obesity is becoming pandemic, morbid obesity (MO), an extreme type of obesity, is an emerging issue worldwide. It is imperative to understand the factors responsible for huge weight gain in certain populations in the modern society. Very few genome-wide association studies (GWAS) have been conducted on MO patients. This study is the first MO-GWAS study in the Han-Chinese population in Asia. METHODS We conducted a two-stage GWAS with 1110 MO bariatric patients (body mass index [BMI] ≥ 35 kg/m2) from Min-Sheng General Hospital, Taiwan. The first stage involved 575 patients, and 1729 sex- and age-matched controls from the Taiwan Han Chinese Cell and Genome Bank. In the second stage, another 535 patients from the same hospital were genotyped for 52 single nucleotide polymorphisms (SNPs) discovered in the first stage, and 9145 matched controls from Taiwan Biobank were matched for confirmation analysis. RESULTS The results of the joint analysis for the second stage revealed six top ranking SNPs, including rs8050136 (p-value = 7.80 × 10- 10), rs9939609 (p-value = 1.32 × 10- 9), rs1421085 (p-value = 1.54 × 10- 8), rs9941349 (p-value = 9.05 × 10- 8), rs1121980 (p-value = 7.27 × 10- 7), and rs9937354 (p-value = 6.65 × 10- 7), which were all located in FTO gene. Significant associations were also observed between MO and RBFOX1, RP11-638 L3.1, TMTC1, CBLN4, CSMD3, and ERBB4, respectively, using the Bonferroni correction criteria for 52 SNPs (p < 9.6 × 10- 4). CONCLUSION The most significantly associated locus of MO in the Han-Chinese population was the well-known FTO gene. These SNPs located in intron 1, may include the leptin receptor modulator. Other significant loci, showing weak associations with MO, also suggested the potential mechanism underlying the disorders with eating behaviors or brain/neural development.
Collapse
Affiliation(s)
- Kuang-Mao Chiang
- Institute of Biomedical Sciences, Academia Sinica, Taipei City, Taiwan
| | - Heng-Cheng Chang
- Department of Gynecology and Obstetrics, School of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Hsin-Chou Yang
- Institute of Statistical Science, Academia Sinica, Taipei City, Taiwan
| | - Chien-Hsiun Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei City, Taiwan
| | - Hsin-Hung Chen
- Department of Nutrition and Health Science, Chang Jung Christian University, Tainan City, Taiwan
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, Taoyuan City, Taiwan
| | - Wen-Harn Pan
- Institute of Biomedical Sciences, Academia Sinica, Taipei City, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| |
Collapse
|
63
|
Ha J, Kwon Y, Kim NH, Park S, Menzo EL, Rosenthal RJ. Discordance in prediction for prognosis of type 2 diabetes after metabolic surgery: comparison of the ABCD, DiaRem, and individualized metabolic surgery models. Ann Surg Treat Res 2019; 97:309-318. [PMID: 31824886 PMCID: PMC6893221 DOI: 10.4174/astr.2019.97.6.309] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/22/2019] [Accepted: 10/31/2019] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Metabolic surgery has been performed as a treatment option for uncontrolled type 2 diabetes (T2D), and several scoring systems for predicting postoperative T2D remission have been proposed. This study was designed to assess consistency of 3 existing scoring systems in patients with T2D duration <1 year. METHODS This study included 186 patients with T2D enrolled in a university hospital prospective database between 2011 and 2013. Externally validated scoring systems for predicting T2D prognosis after metabolic surgery were identified and selected through systematic literature search. We assessed concordance between ABCD, DiaRem, and individualized metabolic surgery (IMS) scores in participants using kappa statistical analysis and 1-way analysis of variance. RESULTS Of the participants, 52 and 82 patients were expected to have favorable T2D remission after metabolic surgery with ABCD score of 10-5 and DiaRem score of 0-7, respectively, and a slight-to-fair concordance was shown between the 2 scoring systems (kappa measure, 0.07; standard error [SE], 0.05 and kappa measure, 0.25; SE, 0.19, respectively). The DiaRem score increased with T2D severity determined by IMS score (P < 0.001), while the ABCD score showed no significant association with IMS score. CONCLUSION ABCD and DiaRem scores showed significant discordance when applied to potential metabolic surgery candidates in whom postoperative T2D remission rate was highly expected. The IMS score showed a dose-response association with DiaRem score but had no significant association with the ABCD score.
Collapse
Affiliation(s)
- Jane Ha
- Department of Medicine, Korea University College of Medicine, Seoul, Korea
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, Korea
| | - Yeongkeun Kwon
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, Korea
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
| | - Nam Hoon Kim
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sungsoo Park
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, Korea
- Division of Foregut Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Emanuele Lo Menzo
- Bariatric and Metabolic Institute, Section of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Raul J. Rosenthal
- Bariatric and Metabolic Institute, Section of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, FL, USA
| |
Collapse
|
64
|
Abstract
Background The prevalence of obesity and obesity-related disorders is rapidly increasing among the Chinese populations. Bariatric surgery is becoming more and more popular in China, yet little cases were performed compared with western countries. The acceptance of this new treatment modality in Chinese bariatric surgery candidates was seldom studied. Objective To investigate the factors affecting the choice of bariatric surgery in Chinese patients with obesity and metabolic disorders, so as to promote the popularization of bariatric surgery in developing countries like China Methods Patients with obesity and related metabolic disorders meet the indications for bariatric surgery in the Department of Metabolic and Bariatric Surgery in the First Affiliated Hospital of Jinan University between January 2016 and April 2017 were asked to answer a questionnaire about the demographics of the patients, social economic status, present and past history, family history, etc. The data collected and the relationship of the acceptance of bariatric surgery were analyzed. Results There were 157 patients (51 males, 32.5%; 106 females, 67.5%) with mean BMI 38.7 ± 8.1 kg/m2 answered the questionnaire. One hundred twenty-three of them (78%) accepted bariatric surgery. By univariate analysis, it was found that patients’ weight, BMI, family support, medical insurance, past surgical history, family history of T2DM, and obesity-related comorbidities and symptoms are correlated with the acceptance of bariatric surgery. By multivariate analysis, it was found that patients’ weight (P = 0.024), BMI (P = 0.007), family support (P < 0.001), medical insurance (P < 0.001), past surgical history (P = 0.011), family history of T2DM (P = 0.020), and obesity-related comorbidities and symptoms (P = 0.030) are statistically significant and were positively correlated with the acceptance of bariatric surgery. Age, height, gender, history of smoking and alcohol consumption, family history of obesity, history of hypertension and T2DM, education level, and marital status were not statistically significant (P < 0.05). Conclusions Patients with heavier weight, higher BMI, family support, medical insurance reimbursement, past surgical history, family history of T2DM, and obesity-related comorbidities and symptoms are more likely to consider bariatric surgery in Chinese bariatric surgery candidates. It will be important to provide appropriate healthcare education and support to patients focusing on both obesity-related health risks and options of surgical treatment so to improve their acceptance of bariatric surgery.
Collapse
|
65
|
Long-term outcomes of laparoscopic sleeve gastrectomy from the Indian subcontinent. Obes Surg 2019; 29:4043-4055. [DOI: 10.1007/s11695-019-04103-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
66
|
Navarrete Aulestia S, Leyba JL, Navarrete Llopis S, Pulgar V. One Anastomosis Gastric Bypass/Minigastric Bypass in Patients with BMI < 35 kg/m 2 and Type 2 Diabetes Mellitus: Preliminary Report. Obes Surg 2019; 29:3987-3991. [PMID: 31297740 DOI: 10.1007/s11695-019-04071-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Obesity in the world has been increasing, and the number of diabetic patients will increase by 114%, and the best treatment results are achieved through surgery. Several techniques have been described; the gastric bypass of an anastomosis (MGB/OAGB) has been gaining popularity for its simplicity and good results. We present a prospective study with this technique in 16 mild obesity patients with type 2 diabetes mellitus or peripheral insulin resistance. OBJECTIVE To evaluate weight loss as well as metabolic changes by measuring fasting glycemia and Hb A1c after 1 year of follow-up. MATERIAL AND METHODS Sixteen patients were operated on with the OAGB/MGB technique from September 2014 to January 2016, with some form of metabolic syndrome, whether DM2, RPI, HBP, or dyslipidemia, including patients in the study with a follow-up of at least 12 months. RESULTS There were 13 cases of female sex and 3 of male, average age of 42.9 years, with an average weight of 87.7 kg and BMI of 32.2 kg/m2. Metabolic values were fasting glycemia of 193.6 ± 52.9 mg/dl and HbA1c of 8.4% ± 1 (preop) and glycemia posop, 78.8 ± 7.6 mg/dl; HbA1c posop, 6.1 ± 0.2; preop weight, 87.7 ± 14 kg (69-116); weight posop, 66.8 ± 10.5 kg (49-90); BMI preop, 32.2 ± 1.8 (30-34.9); BMI posop, 25.4 ± 1.7 (21.7-27.6); percentage of excess weight lost, 87.6 ± 11.8 (70.9-100) % with 100% remission of diabetes. CONCLUSION The results show the benefits of MGB/OAGB in mild obese diabetic patients.
Collapse
|
67
|
|
68
|
Seo MH, Lee WY, Kim SS, Kang JH, Kang JH, Kim KK, Kim BY, Kim YH, Kim WJ, Kim EM, Kim HS, Shin YA, Shin HJ, Lee KR, Lee KY, Lee SY, Lee SK, Lee JH, Lee CB, Chung S, Cho YH, Choi KM, Han JS, Yoo SJ. 2018 Korean Society for the Study of Obesity Guideline for the Management of Obesity in Korea. J Obes Metab Syndr 2019; 28:40-45. [PMID: 31089578 PMCID: PMC6484940 DOI: 10.7570/jomes.2019.28.1.40] [Citation(s) in RCA: 363] [Impact Index Per Article: 72.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/12/2018] [Accepted: 12/11/2018] [Indexed: 02/06/2023] Open
Abstract
Obesity increases the risks of diabetes, hypertension, and cardiovascular diseases, ultimately contributing to mortality. Korean Society for the Study of Obesity (KSSO) was established to improve the management of obesity through research and education; to that end, the Committee of Clinical Practice Guidelines of KSSO reviews systemic evidence using expert panels to develop clinical guidelines. The clinical practice guidelines for obesity were revised in 2018 using National Health Insurance Service Health checkup data from 2006 to 2015. Following these guidelines, we added a category, class III obesity, which includes individuals with body mass index (BMI) ≥35 kg/m2. Agreeing with the International Federation for the Surgery of Obesity and Metabolic Disorders, Asian Pacific Chapter consensus, we determined that bariatric surgery is indicated for Korean patients with BMI ≥35 kg/m2 and for Korean patients with BMI ≥30 kg/m2 who have comorbidities. The new guidelines focus on guiding clinicians and patients to manage obesity more effectively. Our recommendations and treatment algorithms can serve as a guide for the evaluation, prevention, and management of overweight and obesity.
Collapse
Affiliation(s)
- Mi Hae Seo
- Division of Endocrinology, Department of Internal Medicine, Soonchunhyang University Gumi Hospital, Soonchunhyang University School of Medicine, Gumi,
Korea
| | - Won-Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Sung Soo Kim
- Department of Family Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon,
Korea
| | - Jae-Heon Kang
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Jee-Hyun Kang
- Department of Family Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon,
Korea
| | - Kyoung Kon Kim
- Department of Family Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon,
Korea
| | - Bo-Yeon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon,
Korea
| | - Yang-Hyun Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul,
Korea
| | - Won-Jun Kim
- Department of Endocrinology and Metabolism, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung,
Korea
| | - Eun Mi Kim
- Department of Dietetics, Kangbuk Samsung Hospital, Seoul,
Korea
| | - Hyun Soo Kim
- Department of Sport Science, Seoul National University of Science and Technology, Seoul,
Korea
| | - Yun-A Shin
- Department of Exercise Prescription and Rehabilitation, Dankook University, Cheonan,
Korea
| | - Hye-Jung Shin
- Department of Pediatrics, National Medical Center, Seoul,
Korea
| | - Kyu Rae Lee
- Department of Family Medicine, Dongincheon Gil Hospital, Gachon University of Medicine and Science, Incheon,
Korea
| | - Ki Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon,
Korea
| | - Sang Yeoup Lee
- Department of Family Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan,
Korea
| | - Seong-Kyu Lee
- Department of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon,
Korea
| | - Joo Ho Lee
- Department of Surgery, Ewha Medical Center, Seoul,
Korea
| | - Chang Beom Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri,
Korea
| | - Sochung Chung
- Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul,
Korea
| | - Young Hye Cho
- Family Medicine Clinic and Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan,
Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Jung Soon Han
- Research Institute of Human Ecology, Korea University, Seoul,
Korea
| | - Soon Jib Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon,
Korea
| | | |
Collapse
|
69
|
Lechmiannandan S, Panirselvam M, Muninathan P, Hussin N, Rajan R, Sidi H, Kosai NR, Vinayak CR. Resolution of Female Sexual Dysfunction (FSD) Among the Obese Multiethnic Malaysian Women Now a Reality with Bariatric Surgery: a Prospective Pilot Study in Malaysia. Obes Surg 2019; 29:1571-1575. [PMID: 30706310 DOI: 10.1007/s11695-019-03722-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Female sexual dysfunction (FSD) among the obese women is often under diagnosed and ignored especially in Malaysia, a nation of conservative multiethnic society. There are only a few studies on FSD resolution post-bariatric surgery. The objective was to identify the rate and resolution or improvement of FSD, among obese multiethnic Malaysian women post-bariatric surgery. MATERIAL AND METHODS This is a prospective study of women undergoing bariatric surgery, between May 2017 and April 2018. FSD was diagnosed using the Malay version of Female Sexual Function Index (MVFSFI) questionnaire. Patients filled up the questionnaire before and 6 months after surgery. Association between BMI reduction and FSFI score improvement was measured using Fisher's exact test. Outcomes between types of surgery (sleeve gastrectomy and gastric bypass) was compared. RESULTS Fifty-two women completed the study. The mean age was 38.77 ± 6.7. There were 44 (84.6%) Malay patients, 7 (13.5%) Indian patients, and 1 (1.9%) Chinese patient. There was a significant reduction in mean BMI, 39.89 ± 6.9 pre-surgery to 30.32 ± 5.4 post-surgery (p value < 0.001). The rate of FSD among the obese is 75.0% pre-surgery compared to 36.0% post-surgery. There was a significant improvement in mean FSFI score pre- and post-surgery: 18.73 and 25.93 respectively and in each of all 6 domains (p value < 0.001). There was a significant association between BMI reduction and improvement in FSFI score (p = 0.019). There was no difference in outcomes between types of surgery. CONCLUSION FSD is highly prevalent among the obese multiethnic Malaysian women. Bariatric surgery has proven benefit in resolving FSD across all sexual domains and should be considered as a management option in this group of women.
Collapse
Affiliation(s)
| | - Mayurran Panirselvam
- Minimally Invasive, Upper Gastrointestinal and Bariatric Surgery Unit, Department of Surgery, Faculty of Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Prema Muninathan
- Clinical Research Centre, Hospital Taiping, Jalan Taming Sari, 34000, Taiping, Perak, Malaysia
| | - Narwani Hussin
- Clinical Research Centre, Hospital Taiping, Jalan Taming Sari, 34000, Taiping, Perak, Malaysia
| | - Reynu Rajan
- Minimally Invasive, Upper Gastrointestinal and Bariatric Surgery Unit, Department of Surgery, Faculty of Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Hatta Sidi
- Department of Psychiatry, Faculty of Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Nik Ritza Kosai
- Minimally Invasive, Upper Gastrointestinal and Bariatric Surgery Unit, Department of Surgery, Faculty of Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, 56000, Kuala Lumpur, Malaysia
| | - C Rajkumar Vinayak
- Bariatric Surgery Unit, Department of Surgery, Hospital Taiping, Jalan Taming Sari, 34000, Taiping, Perak, Malaysia
| |
Collapse
|
70
|
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|
71
|
Totally endoscopic sublay (TES) repair for midline ventral hernia: surgical technique and preliminary results. Surg Endosc 2018; 34:1543-1550. [DOI: 10.1007/s00464-018-6568-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/26/2018] [Indexed: 12/11/2022]
|
72
|
Abstract
INTRODUCTION Acupoint embedment, a modified acupuncture technique, is gaining its popularity in weight control in adult obesity or overweight nowadays. The objective of this study was to investigate the clinical efficacy of acupoint embedment in weight control of adult obesity or overweight by systematically assess available randomized controlled trials (RCTs) and analyze the integrated findings. A total of 529 literatures were initially searched from the databases. Five RCTs in assessing the effect of acupoint embedment versus sham control group were identified. RESULTS A total of 219 subjects in the intervention group and 206 subjects in the control group from 5 eligible studies were eventually included in this meta-analysis. Mean body mass index (BMI) decreased 0.94 kg/m (95% confidence interval [CI]: -1.56 to -0.32, P = .003) more in acupoint embedment group than the sham control group. Meanwhile, subjects received acupoint embedment had 2.97 kg (95% CI: -4.44 to -1.49, P < .0001) decrease in mean body weight more than in sham control group. Both parameters were statistically significant. Adverse events including bruise, soreness and cramp, patchy skin induration, erythema were reported, yet none involved hospitalization or mortality. Interestingly, stomach meridian and spleen meridian involved in all 5 studies. CONCLUSION This meta-analysis showed that acupoint embedment was more effective in weight control than the sham control group. Together with its convenience and low cost, acupoint embedment may be considered as an alternative treatment in weight control.
Collapse
Affiliation(s)
- William C. Cho
- Department of Clinical Oncology, Queen Elizabeth Hospital
| | - Ching Li
- School of Chinese Medicine, The Chinese University of Hong Kong
| | - Hai-Yong Chen
- School of Chinese Medicine, The University of Hong Kong, Hong Kong
| |
Collapse
|
73
|
Metabolic surgery for inadequately controlled type 2 diabetes in nonseverely obese Japanese: a prospective, single-center study. Surg Obes Relat Dis 2018; 14:978-985. [DOI: 10.1016/j.soard.2018.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/15/2018] [Accepted: 03/18/2018] [Indexed: 01/19/2023]
|
74
|
Nutritional Deficiencies in Chinese Patients Undergoing Gastric Bypass and Sleeve Gastrectomy: Prevalence and Predictors. Obes Surg 2018; 28:2727-2736. [PMID: 29754386 DOI: 10.1007/s11695-018-3225-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
75
|
Revision Procedures After Failed Adjustable Gastric Banding: Comparison of Efficacy and Safety. Obes Surg 2018; 27:2861-2867. [PMID: 28569358 DOI: 10.1007/s11695-017-2716-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Laparoscopic adjustable gastric banding (LAGB) was one of the commonly performed bariatric operations; however, it carries a high revision rate. The aim of the present study was to report the long-term outcomes of LAGB and compare the outcomes between the different revision procedures. METHODS All patients who underwent LAGB in a large bariatric center in Asia between May 2002 and April 2011 were included. Interval between primary LAGB to the revision operation, the reason and type of revision surgery were identified and analyzed. RESULTS A total of 275 consecutive patients were included. All of the procedures were completed laparoscopically with no major complications. The percentage of excess weight loss (%EWL) at 10-year follow-up was 45%. In this study, 53 patients (19.3%) had revision surgery, including with 26 single anastomosis (mini-) gastric bypass (R-LSAGB) (49%), 17 sleeve gastrectomy (R-LSG) (32.1%), 9 Roux-en-Y gastric bypass (R-LRYGB) (17%), and 1 other procedure (1.9%). A major complication occurred in 6 patients (11.3%). All of the follow-up patients with revision surgeries had %EWL > 50% at the 2-year follow-up. R-LSAGB patients achieved better weight loss than those who underwent R-LSG and R-LRYGB (p = 0.001). CONCLUSIONS The long-term result for weight loss after LAGB is unsatisfactory. The revision of failed LAGB to other bariatric surgeries is safe and can be performed in one stage with a low complication rate. Patients who underwent R-LSAGB had better weight loss results than the R-LSG or R-LRYGB patients.
Collapse
|
76
|
Chitturi S, Wong VWS, Chan WK, Wong GLH, Wong SKH, Sollano J, Ni YH, Liu CJ, Lin YC, Lesmana LA, Kim SU, Hashimoto E, Hamaguchi M, Goh KL, Fan J, Duseja A, Dan YY, Chawla Y, Farrell G, Chan HLY. The Asia-Pacific Working Party on Non-alcoholic Fatty Liver Disease guidelines 2017-Part 2: Management and special groups. J Gastroenterol Hepatol 2018; 33:86-98. [PMID: 28692197 DOI: 10.1111/jgh.13856] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 05/31/2017] [Accepted: 06/25/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Shiv Chitturi
- Gastroenterology and Hepatology Unit, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Wah-Kheong Chan
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Simon Kin-Hung Wong
- Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Yen-Hsuan Ni
- Hepatitis Research Center, National Taiwan University, Taipei, Taiwan
| | - Chun-Jen Liu
- Department of Internal Medicine, Hepatitis Research Center, Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Yu-Cheng Lin
- Hepatitis Research Center, National Taiwan University, Taipei, Taiwan
| | | | - Seung Up Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Etsuko Hashimoto
- Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Khean-Lee Goh
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jiangao Fan
- Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Yock Young Dan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yogesh Chawla
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Geoff Farrell
- Gastroenterology and Hepatology Unit, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Henry Lik-Yuen Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong
| |
Collapse
|
77
|
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|
78
|
Kwon O, Lee YJ, Yu JH, Kim MS, Heo Y. The Recovery of Beta-Cell Function is Critical for Antidiabetic Outcomes of Gastric Bypass in Asian Subjects with Type 2 Diabetes and a Body Mass Index Below 30. Obes Surg 2017; 27:541-544. [PMID: 27878422 DOI: 10.1007/s11695-016-2455-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Type 2 diabetes (T2D) in Asian populations is characterized by a lower body mass index (BMI) than in Caucasian cases. This pilot study investigated antidiabetic outcomes after a Roux-en-Y gastric bypass (RYGB) in Asian subjects with T2D and BMI < 30. Fifteen Koreans with poorly controlled T2D and BMI 23-30 underwent RYGB. Two years after RYGB, seven patients achieved HbA1c < 6.5% without medication (target-achieved). The other cases also showed improved glycemic control. The insulin secretory response during an oral glucose tolerance test was significantly restored in the target-achieved group. Postoperative changes in insulin sensitivity and body weight did not differ between these groups. Beta-cell function improvement is an important determinant of the long-term antidiabetic outcomes of RYGB in Asian subjects with BMI < 30.
Collapse
Affiliation(s)
- Obin Kwon
- Diabetes Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.,Division of Endocrinology and Metabolism, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Yeon Ji Lee
- Department of Family Medicine, Inha University School of Medicine, 7-206, 3-Ga, Sinheung-dong, Jung-Gu, Incheon, 22332, South Korea
| | - Ji Hee Yu
- Diabetes Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.,Division of Endocrinology and Metabolism, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Min-Seon Kim
- Diabetes Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea. .,Division of Endocrinology and Metabolism, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Yoonseok Heo
- Department of Surgery, Inha University School of Medicine, 7-206, 3-Ga, Sinheung-dong, Jung-Gu, Incheon, 22332, South Korea.
| |
Collapse
|
79
|
Du X, Dai R, Zhou HX, Su ML, Lu C, Zhou ZG, Cheng Z. Bariatric Surgery in China: How Is This New Concept Going? Obes Surg 2017; 26:2906-2912. [PMID: 27146500 DOI: 10.1007/s11695-016-2204-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Obesity has become an epidemic in developing countries including China. The use of bariatric surgery to treat obesity has grown in popularity worldwide, but it is still a new concept in China. This study aims to investigate the trends in bariatric surgery in China. METHODS An electronic search of the MEDLINE, EMBASE, and Chinese National Knowledge Infrastructure was conducted to select studies for this survey. RESULTS A total of 7779 bariatric procedures were reported from 2001 to 2015, most of which (89.2 %) were performed in the most recent 5 years. Further, 70.9 % of all procedures were performed to treat obesity and related comorbidities, defined as metabolic surgery. The data showed 89.4 % of all operations were performed laparoscopically. The absolute number of bariatric surgeries increased 148.7 times in the last 5 years compared to the 2001-2005 period. The percentage of laparoscopic Roux-en-Y gastric bypasses performed increased from 0 to 62.2 %, and the percentage of laparoscopic sleeve gastrectomies from 0 to 12.7 %. The percentage of laparoscopic adjustable gastric bands increased dramatically from 0 to 73.3 % in the 2006-2010 period, but it dropped quickly to 12.9 % in the 2011-2015 period. Most operations (66.7 %) were conducted in the East area, which is the most developed economic region in China. There was limited surgical innovation or original research reported in China. CONCLUSIONS Bariatric surgery is still at an early stage in China, but is now experiencing an explosive growth. A national registry system needs to be established to record and provide precise data.
Collapse
Affiliation(s)
- Xiao Du
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, People's Republic of China
| | - Ru Dai
- West China Medical School, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Hong-Xu Zhou
- West China Medical School, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Ming-Lian Su
- West China Medical School, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Chen Lu
- West China Medical School, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zong-Guang Zhou
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, People's Republic of China
| | - Zhong Cheng
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, People's Republic of China.
| |
Collapse
|
80
|
Ruan X, Zhang W, Cai H, Zheng R, Jiang F, Zhu H. Sleeve gastrectomy with duodenojejunal end-to-side anastomosis in the treatment of type 2 diabetes: the initial experiences in a Chinese population with a more than 4-year follow-up. Surg Obes Relat Dis 2017; 13:1683-1691. [DOI: 10.1016/j.soard.2017.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 07/08/2017] [Accepted: 07/10/2017] [Indexed: 12/13/2022]
|
81
|
Abstract
Traditionally, obesity and its related diseases have been considered a problem in Western countries. However, in the past two decades, urbanisation in many Asian countries has led to a sedentary lifestyle and overnutrition, setting the stage for the epidemic of obesity. This article reviews the epidemiological trend of obesity in Asia, with special emphasis on the emerging condition of non-alcoholic fatty liver disease (NAFLD). Currently, the population prevalence of NAFLD in Asia is around 25%, like many Western countries. While hepatocellular carcinoma and end-stage liver disease secondary to NAFLD remain uncommon, a rising trend has emerged. Around 8-19% of Asians with body mass indexes less than 25kg/m2 are also found to have NAFLD, a condition often described as "lean" or "non-obese" NAFLD. Although this condition is generally less severe than that in more obese patients, steatohepatitis and fibrotic disease are well recognized. Central adiposity, insulin resistance and weight gain are major risk factors, and genetic predisposition, such as the PNPLA3 polymorphism appears to be more important in the development of NAFLD in the non-obese population. Lifestyle modification remains the cornerstone of management for obesity and NAFLD, but few patients can achieve adequate weight reduction and even fewer can maintain the weight in the long run. While pharmacological agents have entered phase III development for steatohepatitis, Asian patients are under-represented in most drug trials. Future studies should define the optimal management of obesity and NAFLD in Asia.
Collapse
Affiliation(s)
- Jian-Gao Fan
- Center for Fatty Liver, Department of Gastroenterology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Seung-Up Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China; State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
| |
Collapse
|
82
|
Kular KS, Manchanda N, Cheema GK. Seven Years of Mini-Gastric Bypass in Type II Diabetes Patients with a Body Mass Index <35 kg/m(2). Obes Surg 2017; 26:1457-62. [PMID: 26475028 DOI: 10.1007/s11695-015-1941-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Mini-gastric bypass (MGB) is a safe, effective, and reversible procedure for patients with type II diabetes mellitus (T2DM) and morbid obesity. Less is known, however, about its long-term effects in patients with a body mass index (BMI) <35 kg/m(2). METHODS From February 2007 to February 2014, 1468 patients underwent MGB at our institution, including 983 with T2DM. Of these, 128 (82 women), of mean age 41.6 ± 10.2 years, had a BMI of 30-35 kg/m(2). Prospectively collected data were analyzed retrospectively. Factors assessed included disease duration, family history, medication use, remission, and biochemical indicators, including fasting plasma glucose, glycosylated hemoglobin (HbA1c), serum insulin, and C-peptide concentrations. Remission of T2DM was defined as HbA1c <6.0 % without medication. RESULTS Prior to surgery, patients had a mean BMI of 33.4 ± 3.3 kg/m(2), mean waist circumference of 104.5 ± 8.2 cm, mean C-peptide concentration of 3.4 ± 1.2 ng/ml, and mean T2DM duration of 6.5 ± 3.1 years. Within 6 months of MGB, 95 % of these patients had attained HbA1c <7 %. Complete remission rates at 1, 2, and 7 years were 64, 66, and 53 %, respectively. Mean HbA1c decreased from 10.7 ± 1.5 % at baseline to 6.2 ± 0.5% at 1 year, 5.4 ± 1.2 % at 3 years, and 5.7 ± 1.8 % at 7 years. No deaths occurred, but two (1.6 %) patients experienced major complications. CONCLUSIONS MGB provides good, long-term control of T2DM in patients with class I obesity. Early intervention results in higher remission rates.
Collapse
Affiliation(s)
- Kuldeepak S Kular
- Kular Medical Education and Research Society, Kular Group of Institutes, NH 1, Bija, Khanna, Ludhiana, Punjab, 141412, India.
| | - Naveen Manchanda
- Bariatric Surgery, Kular Hospital, NH 1, Bija, Khanna, Ludhiana, Punjab, India
| | - Gurpreet K Cheema
- Kular Group of Institutes, NH 1, Bija, Khanna, Ludhiana, Punjab, 141412, India
| |
Collapse
|
83
|
Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KGMM, Zimmet PZ, Del Prato S, Ji L, Sadikot SM, Herman WH, Amiel SA, Kaplan LM, Taroncher-Oldenburg G, Cummings DE. Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations. Surg Obes Relat Dis 2017; 12:1144-62. [PMID: 27568469 DOI: 10.1016/j.soard.2016.05.018] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options. AIM The 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, was convened in collaboration with leading diabetes organizations to develop global guidelines to inform clinicians and policymakers about benefits and limitations of metabolic surgery for T2D. METHODS A multidisciplinary group of 48 international clinicians/scholars (75% nonsurgeons), including representatives of leading diabetes organizations, participated in DSS-II. After evidence appraisal (MEDLINE [1 January 2005-30 September 2015]), three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. These drafts were presented at the combined DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes (London, U.K., 28-30 September 2015), where they were open to public comment by other professionals and amended face-to-face by the Expert Committee. RESULTS Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2D. Numerous randomized clinical trials, albeit mostly short/midterm, demonstrate that metabolic surgery achieves excellent glycemic control and reduces cardiovascular risk factors. On the basis of such evidence, metabolic surgery should be recommended to treat T2D in patients with class III obesity (BMI≥40 kg/m(2)) and in those with class II obesity (BMI 35.0-39.9 kg/m(2)) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients with T2D and BMI 30.0-34.9 kg/m(2) if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI thresholds should be reduced by 2.5 kg/m(2) for Asian patients. CONCLUSIONS Although additional studies are needed to further demonstrate long-term benefits, there is sufficient clinical and mechanistic evidence to support inclusion of metabolic surgery among antidiabetes interventions for people with T2D and obesity. To date, the DSS-II guidelines have been formally endorsed by 45 worldwide medical and scientific societies. Health care regulators should introduce appropriate reimbursement policies.
Collapse
Affiliation(s)
| | | | - Robert H Eckel
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
84
|
Alhambra-Expósito MR, Molina-Puerta MJ, Prior-Sánchez MI, Manzano-García G, Calañas-Continente A, Gálvez-Moreno MA. Variations in diabetes remission rates after bariatric surgery in Spanish adults according to the use of different diagnostic criteria for diabetes. BMC Endocr Disord 2017; 17:51. [PMID: 28810850 PMCID: PMC5556665 DOI: 10.1186/s12902-017-0201-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 08/02/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND There are multiple criteria to define remission of type 2 diabetes (DM2) after bariatric surgery but there is not a specific one widely accepted. Our objectives were to compare diagnostic criteria for DM2 remission after bariatric surgery: Criteria from Spanish scientific associations (SEEN/SEEDO/SED) and from the American Diabetes Association (ADA). We also aim to analyse the degree of correlation between these sets of criteria. METHODS Retrospective observational study in 127 patients undergoing bariatric surgery in a single centre (Hospital Universitario Reina Sofía, Córdoba, Spain) between January 2001 and December 2009. We analysed DM2 remission following bariatric surgery comparing DM2 diagnostic criteria approved by Spanish scientific associations and ADA criteria. RESULTS In total, 62.2% of patients were women; mean age was 47.1 years. Following surgery, 52% achieved complete remission according to ADA criteria, and 63.8% following the criteria approved by Spanish associations (p = 0.001);18.9 and 8.7%, respectively, showed partial remission (p = 0.007), and 29.1 and 27.6% no remission, according to the criteria approved by each association (p = 0.003). There was good correlation between both sets of criteria (Rho 0.781; p < 0.001). CONCLUSIONS In our series, using more stringent criteria for defining DM2 remission (ADA criteria) results in a lower rate of remission, although we found a a high degree of correlation between both sets of criteria.
Collapse
Affiliation(s)
| | - María J. Molina-Puerta
- UGC Endocrinología y Nutrición, Hospital Reina Sofía, Avenida Menéndez Pidal, s/n, 14004 Córdoba, Spain
| | - María I. Prior-Sánchez
- UGC Endocrinología y Nutrición, Hospital Reina Sofía, Avenida Menéndez Pidal, s/n, 14004 Córdoba, Spain
| | - Gregorio Manzano-García
- UGC Endocrinología y Nutrición, Hospital Reina Sofía, Avenida Menéndez Pidal, s/n, 14004 Córdoba, Spain
| | | | - María A. Gálvez-Moreno
- UGC Endocrinología y Nutrición, Hospital Reina Sofía, Avenida Menéndez Pidal, s/n, 14004 Córdoba, Spain
| |
Collapse
|
85
|
Lee J, Wong SKH, Liu SYW, Ng EKW. Is Preoperative Upper Gastrointestinal Endoscopy in Obese Patients Undergoing Bariatric Surgery Mandatory? An Asian Perspective. Obes Surg 2017; 27:44-50. [PMID: 27233898 DOI: 10.1007/s11695-016-2243-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The role of routine preoperative oesopha gogastroduodenoscopy (OGD) for all bariatric surgery candidates is controversial. We aim to investigate the prevalence of clinically significant OGD findings in a primarily Chinese obese population and identify factors that predict a normal screening OGD. METHODS Medical records of patients who underwent primary bariatric surgery in our centre from August 2002 to December 2014 were reviewed. OGD findings were classified into two groups: group 1 consisted of normal findings and abnormal findings that would not alter the surgical plan; group 2 consisted of lesions that might delay or alter the surgical procedure. RESULTS We identified 268 patients (169 female), of mean age 39.1 ± 10.8 years, mean baseline body weight 108.7 ± 6.1 kg and mean body mass index (BMI) 40.3 ± 6.1 kg/m2 for analysis. Overall prevalence of abnormal OGD findings was 51.1 %, which included gastritis (32.5 %), hiatus hernia (17.9 %), duodenitis (8.6 %) and erosive oesophagitis (7.5 %); 27.2 % had group 2 lesions. Univariate analysis revealed older age (p = 0.016), use of NSAIDs (p = 0.004) and presence of reflux symptoms (p = 0.029) as significant risk factors of group 2 lesions. On multivariate analysis, use of NSAIDs (p = 0.015) and reflux symptoms (p = 0.039) remained significant predictive factors. In the low-risk subgroup (40 years and younger, without reflux symptoms or use of NSAIDs), the prevalence of group 2 abnormalities was 18.9 %. CONCLUSIONS Significant endoscopic abnormalities are common among obese Chinese patients which may delay or change the surgical plan. The negative predictive value in low-risk patients was not strong. We therefore recommend routine preoperative endoscopy for all patients.
Collapse
Affiliation(s)
- June Lee
- Prince of Wales Hospital, Sha Tin, Hong Kong, China.
| | | | | | | |
Collapse
|
86
|
Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KGMM, Zimmet PZ, Del Prato S, Ji L, Sadikot SM, Herman WH, Amiel SA, Kaplan LM, Taroncher-Oldenburg G, Cummings DE. Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: a Joint Statement by International Diabetes Organizations. Obes Surg 2017; 27:2-21. [PMID: 27957699 DOI: 10.1007/s11695-016-2457-9] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options. AIM The 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, was convened in collaboration with leading diabetes organizations to develop global guidelines to inform clinicians and policymakers about benefits and limitations of metabolic surgery for T2D. METHODS A multidisciplinary group of 48 international clinicians/scholars (75% nonsurgeons), including representatives of leading diabetes organizations, participated in DSS-II. After evidence appraisal (MEDLINE [1 January 2005-30 September 2015]), three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. These drafts were presented at the combined DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes (London, U.K., 28-30 September 2015), where they were open to public comment by other professionals and amended face-to-face by the Expert Committee. RESULTS Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2D. Numerous randomized clinical trials, albeit mostly short/midterm, demonstrate that metabolic surgery achieves excellent glycemic control and reduces cardiovascular risk factors. On the basis of such evidence, metabolic surgery should be recommended to treat T2D in patients with class III obesity (BMI ≥40 kg/m2) and in those with class II obesity (BMI 35.0-39.9 kg/m2) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients with T2D and BMI 30.0-34.9 kg/m2 if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI thresholds should be reduced by 2.5 kg/m2 for Asian patients. CONCLUSIONS Although additional studies are needed to further demonstrate long-term benefits, there is sufficient clinical and mechanistic evidence to support inclusion of metabolic surgery among antidiabetes interventions for people with T2D and obesity. To date, the DSS-II guidelines have been formally endorsed by 45 worldwide medical and scientific societies. Health care regulators should introduce appropriate reimbursement policies.
Collapse
Affiliation(s)
| | | | - Robert H Eckel
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
87
|
Han SM, Kim SM. Prospective, double center, 1-year results of adjustable gastric banding with MIDBAND (gastro-gastric suture vs. non-gastro-gastric suture). Ann Surg Treat Res 2017; 92:419-422. [PMID: 28580346 PMCID: PMC5453874 DOI: 10.4174/astr.2017.92.6.419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/28/2016] [Accepted: 01/16/2017] [Indexed: 12/29/2022] Open
Abstract
Purpose Although laparoscopic adjustable gastric banding (LAGB) is a popular bariatric procedure, few comprehensive studies have been investigated on the use of non-gastro-gastric sutures (NGGSs) for decreasing postoperative complications. This study aimed to assess and compare the safety and effectiveness of MIDBAND with or without gastro-gastric sutures (GGSs). Methods Between February 2013 and March 2014, 41 severely obese patients underwent primary LAGB using pars flaccid technique at double center in South Korea. Excess weight loss, operative time and postoperative complications were assessed and compared between a GGS group (group 1) and a NGGS group (group 2), and patients were followed monthly for 1 year. Results Mean body mass indices in groups 1 and 2 were 38.4 ± 4.7 and 38.9 ± 5.0 kg/m2, respectively, and mean percentage excess weight losses (%EWLs) were 59.9% ± 28.4% and 50.9% ± 20.0%, respectively, at 6 months, and 75.8% ± 26.6% and 72.5% ± 27.5%, respectively, at 12 months, and these intergroup differences of %EWL were not significant (P = 0.256 and P = 0.704, respectively). Mean operative time (57.2 minutes) was shorter in group 2 than in group 1 (79.2 minutes) (P < 0.001). In terms of complications, pouch dilatation rates were similar in the 2 groups, and no case of gastric band erosion was encountered. Conclusion Operative time was shorter in the NGGS group, and pouch dilatation rates and %EWL were similar in the 2 groups. We conclude NGGS using MIDBAND is both straightforward and effective. A long-term prospective comparative study is needed to demonstrate the safety and efficacy of NGGS.
Collapse
Affiliation(s)
- Sang-Moon Han
- Department of Surgery, Gangnam CHA Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Seong Min Kim
- Department of Surgery, Gachon University Gil Hospital, Gachon University of Medicine and Science, Incheon, Korea
| |
Collapse
|
88
|
Kuo FC, Huang YH, Lin FH, Hung YJ, Hsieh CH, Lu CH, Su SC, Huang CL, Lee CH, Chu NF. Circulating Soluble IL-6 Receptor Concentration and Visceral Adipocyte Size Are Related to Insulin Resistance in Taiwanese Adults with Morbid Obesity. Metab Syndr Relat Disord 2017; 15:187-193. [PMID: 28346858 DOI: 10.1089/met.2016.0135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Morbid obesity is related to chronic inflammation and many metabolic complications. Interleukin (IL)-6 plays a pivotal pathophysiological role in obesity, and IL-6 trans-signaling through the soluble IL-6 receptor (sIL-6R) has a major proinflammatory effect. The aim of this study was to investigate the association between sIL-6R, adipocyte size, and insulin resistance in morbidly obese individuals. METHODS We measured concentrations of sIL-6R, high-sensitivity C-reactive protein, and lipid parameters and estimated homeostasis model assessment of insulin resistance (HOMA-IR) before the patients underwent bariatric surgery. Mesenteric adipose tissue was collected during surgery, and adipocyte size and concentrations of membrane-bound IL-6 receptor (mIL-6R) were evaluated. In total, 35 adults (20 men and 15 women) were recruited. RESULTS The subjects with high HOMA-IR (≥2.4) had higher fasting glucose/insulin, triglycerides, sIL-6R, and adipocyte size and lower high-density lipoprotein cholesterol and mIL-6R than those with low HOMA-IR (<2.4). Adipocyte size positively correlated with sIL-6R (r = 0.559, P = 0.001) and HOMA-IR (r = 0.773, P ≤ 0.001) independent of age, gender, body mass index (BMI), waist, and use of diabetic drugs. In addition, every 1 ng/mL increase in sIL-6R concentration corresponded to a 10.2% decrease in the likelihood of maintaining lower insulin resistance. Furthermore, an sIL-6R level of 77.45 ng/mL was a reasonable cutoff level to propose lower insulin resistance in morbidly obese subjects. CONCLUSIONS Circulating sIL-6R is more closely associated with insulin resistance status than waist-to-hip ratio or BMI in morbidly obese Taiwanese adults. sIL-6R may be a useful biomarker to assess insulin resistance among morbidly obese subjects.
Collapse
Affiliation(s)
- Feng-Chih Kuo
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center , Taipei, Taiwan
| | - Ya-Hsien Huang
- 2 Clinical Laboratory Section, Cardinal Tien Hospital , New Taipei City, Taiwan .,3 School of Public Health, National Defense Medical Center , Taipei, Taiwan
| | - Fu-Huang Lin
- 3 School of Public Health, National Defense Medical Center , Taipei, Taiwan
| | - Yi-Jen Hung
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center , Taipei, Taiwan
| | - Chang-Hsun Hsieh
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center , Taipei, Taiwan
| | - Chieh-Hua Lu
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center , Taipei, Taiwan
| | - Sheng-Chiang Su
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center , Taipei, Taiwan
| | - Chia-Luen Huang
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center , Taipei, Taiwan
| | - Chien-Hsing Lee
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center , Taipei, Taiwan
| | - Nain-Feng Chu
- 3 School of Public Health, National Defense Medical Center , Taipei, Taiwan .,4 Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| |
Collapse
|
89
|
Abstract
Diet, exercise, cognitive behavioral therapy and pharmacotherapy are some of the means of assisting patients to lose weight, with bariatric surgery being the most effective. Over the last two decades, the increased awareness of the systemic benefits of bariatric surgery, as well as the improved safety and the wider use of the laparoscopic approach, has made bariatric surgery flourish. In the United Kingdom, the adjustable gastric band (10%), vertical sleeve gastrectomy (37%) and Roux-en-Y gastric bypass (45%) are the three most common procedures. Obesity-associated mortality and co-morbidities such as type 2 diabetes, hypertension, dyslipidemia, obstructive sleep apnea, renal dysfunction and depression improve significantly with bariatric surgery. The mechanisms of weight loss extend beyond restriction and malabsorption and include changes in hunger and satiety, food preferences, and possibly energy expenditure. Despite its safety and efficacy, bariatric surgery is underutilized as less than 1% of adults with obesity receive it. In view of the evolution of obesity into a global threat, access to bariatric surgery should be increased, whilst developing safer and less invasive weight loss treatments.
Collapse
Affiliation(s)
- E Panteliou
- a Section of Investigative Medicine, Division of Diabetes, Endocrinology & Metabolism , Imperial College London , London , UK
| | - A D Miras
- a Section of Investigative Medicine, Division of Diabetes, Endocrinology & Metabolism , Imperial College London , London , UK
| |
Collapse
|
90
|
Sethi P, Thillai M, Nain PS, Ahuja A, Vayoth SO, Khurana P. Effects of Laparoscopic Sleeve Gastrectomy on Central Obesity and Metabolic Syndrome in Indian Adults- A Prospective Study. J Clin Diagn Res 2017; 11:PC01-PC04. [PMID: 28273998 PMCID: PMC5324443 DOI: 10.7860/jcdr/2017/24477.9232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 12/08/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Increasing incidence of obesity in Indian population has led to an exponential rise in the number of bariatric operations performed annually. Laparoscopic Sleeve Gastrectomy (LSG) has been proposed to cause rapid remission of Type 2 Diabetes Melitus (T2DM) and metabolic syndrome in a weight loss independent manner. AIM To evaluate the effects of LSG on metabolic syndrome and central obesity in morbidly and severely obese Indian adults. Material and Methods: Study was conducted on 91 morbidly obese [Body Mass Index (BMI)>40 kg/m2] and severely obese (BMI>35 kg/m2) individuals who were suffering from diabetes, hypertension or dyslipidemia. The patients were followed up for six months and the trends of glycaemic control, mean blood pressure, lipid profile, weight loss parameters and changes in parameters of central obesity were studied. RESULTS Weight loss was significant at three months postsurgery and was sustained through six months. There was significant improvement in glycaemic control leading to reduction in need for oral hypoglycaemic agents or insulin in majority of them and even discontinuation of these medications in few patients. Hypertension and dyslipidemia also showed an improving trend through six months postsurgery. There was a significant impact on reduction of central obesity in these patients as marked by significant reduction in waist to hip ratio. CONCLUSION LSG produces sustainable weight loss with significant improvement in glycaemic status and control of metabolic syndrome in severe to morbidly obese patients. LSG is also efficacious in reducing central obesity in Indian population which is a major depressive ailment amongst obese individuals.
Collapse
Affiliation(s)
- Pulkit Sethi
- Senior resident, Department of G.I Surgery, Amrita institute of Medical Sciences and Research, Kochi, Kerala, India
| | - Manoj Thillai
- Senior resident, Department of G.I Surgery, Amrita institute of Medical Sciences and Research, Kochi, Kerala, India
| | - Prabhdeep Singh Nain
- Professor, Department of General surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ashish Ahuja
- Associate professor, Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sudheer Othiyil Vayoth
- Professor, Department of G.I Surgery, Amrita institute of Medical Sciences and Research, Kochi, Kerala, India
| | - Preetika Khurana
- Assistant professor, Department of Anaesthesia, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| |
Collapse
|
91
|
|
92
|
Charalampakis V, Tahrani AA, Helmy A, Gupta JK, Singhal R. Polycystic ovary syndrome and endometrial hyperplasia: an overview of the role of bariatric surgery in female fertility. Eur J Obstet Gynecol Reprod Biol 2016; 207:220-226. [DOI: 10.1016/j.ejogrb.2016.10.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/27/2016] [Accepted: 10/01/2016] [Indexed: 01/29/2023]
|
93
|
Abstract
BACKGROUND Morbidly obese patients with type 2 diabetes have shown significant improvement in glycemic control after Roux-en-Y gastric bypass (RYGB). This study aimed to elucidate the predictors of diabetes remission. METHODS A retrospective review of a prospectively established database identified 134 type 2 diabetes patients who underwent laparoscopic RYGB between January 2011 and February 2014. Partial and complete remission of diabetes was defined as glycated hemoglobin (HbA1c) level <6.5 and <6.0%, respectively, without the use of antidiabetic medication. Pre- and postoperative clinical outcomes were compared between the remission and non-remission groups to identify the predictors of partial or complete remission of diabetes. RESULTS The mean duration of diabetes and preoperative HbA1c level were 4.6 years and 8.0%, respectively. The body mass index (BMI) of the enrolled patients decreased from 37.9 to 28.8 kg/m(2) during the mean follow-up of 12.3 months; 61.8% of the patients achieved partial or complete remission of diabetes. Multivariate analysis revealed that age at operation (odds ratio [OR] = 0.880; 95% confidence interval [CI] 0.807-0.960), HbA1c level (OR = 0.527; 95% CI 0.325-0.854), and C-peptide level (OR = 1.463; 95% CI 1.054-2.029) in the preoperative laboratory study, and the percentage of total weight loss (%TWL) (OR = 1.186; 95% CI 1.072-1.313) after RYGB were the independent predictors of partial or complete diabetes remission. CONCLUSION The predictive factors for diabetes remission after RYGB include age at operation, HbA1c and C-peptide levels, and the %TWL after surgery.
Collapse
|
94
|
Du X, Zhou HX, Zhang SQ, Tian HM, Zhou ZG, Cheng Z. A comparative study of the metabolic effects of LSG and LRYGB in Chinese diabetes patients with BMI<35 kg/m 2. Surg Obes Relat Dis 2016; 13:189-197. [PMID: 27720418 DOI: 10.1016/j.soard.2016.08.499] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/25/2016] [Accepted: 08/26/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND The metabolic effects of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in type 2 diabetes (T2D) patients who do not meet National Institutes of Health indications has not been well studied. OBJECTIVES To compare the effectiveness of LSG and LRYGB in Chinese T2D patients with body mass index (BMI)<35 kg/m2. SETTING University hospital, China. METHODS A nonrandomized cohort of patients who underwent LRYGB (n = 64) and LSG (n = 19) were followed up for 3 years and the outcomes (weight loss and remission of diabetes and other metabolic parameters) were compared. Univariate and multivariate analyses were applied to find associated parameters of T2D remission. RESULTS In total, 5 patients (6%) were lost to follow-up. No significant differences in mean percentage of excess weight loss and BMI were observed between the 2 groups at 2 years. At 3-year follow-up, the LRYGB group had significantly higher percentage of excess weight loss and lower BMI. The total (complete and partial) remission rate achieved with both bariatric procedures was 75.9% at 1 year and 56.4% at 3 years. Surgical safety, diabetes remission, and remission of other obesity-related co-morbidities were comparable between the 2 groups. Patients who achieved complete or partial remission had lower fasting plasma glucose, lower plasma glucose at 2 hours, lower glycated hemoglobin, and higher fasting C peptide than the other patients at baseline. High recurrence rates of hypertension and hyperuricemia were observed at 3 years postoperation. CONCLUSIONS Both LSG and LRYGB are safe and effective bariatric procedures for T2D in this Chinese population with diabetes and BMI<35 kg/m2.
Collapse
Affiliation(s)
- Xiao Du
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Hong-Xu Zhou
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Si-Qin Zhang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Hao-Ming Tian
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Zong-Guang Zhou
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Zhong Cheng
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China.
| |
Collapse
|
95
|
Koh JC, Loo WM, Goh KL, Sugano K, Chan WK, Chiu WYP, Choi MG, Gonlachanvit S, Lee WJ, Lee WJJ, Lee YY, Lesmana LA, Li YM, Liu CJ, Matsuura B, Nakajima A, Ng EKW, Sollano JD, Wong SKH, Wong VWS, Yang Y, Ho KY, Dan YY. Asian consensus on the relationship between obesity and gastrointestinal and liver diseases. J Gastroenterol Hepatol 2016; 31:1405-13. [PMID: 27010240 DOI: 10.1111/jgh.13385] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/10/2016] [Accepted: 03/15/2016] [Indexed: 12/13/2022]
Abstract
The incidence of obesity is increasing in Asia, with implications on gastrointestinal (GI) and liver diseases. The Gut and Obesity in Asia Workgroup comprises regional experts with the aim of studying relationship between obesity and the GI and liver diseases in Asia. Through literature review and the modified Delphi process, consensus statements examining the impact of obesity on esophageal, gastric, pancreatic, colorectal, and liver diseases, exploring relationship between gut microbiome and obesity, and assessing obesity therapies have been produced by the Gut and Obesity in Asia Workgroup. Sixteen experts participated with 9/15 statements having strong consensus (>80% agreement). The prevalence of obesity in Asia is increasing (100% percentage agreement in brackets), and this increased prevalence of obesity will result in a greater burden of obesity-related GI and liver diseases (93.8%). There was consensus that obesity increases the risk of gastric cancer (75%) and colorectal neoplasia (87.5%). Obesity was also associated with Barrett's esophagus and esophageal adenocarcinoma (66.7%) and pancreatic cancer (66.7%) in Asia. The prevalence of non-alcoholic fatty liver disease (NAFLD) in Asia is on the rise (100%), and the risk of NAFLD in Asia (100%) is increased by obesity. Obesity is a risk factor for the development of hepatocellular carcinoma (93.8%). Regarding therapy, it was agreed that bariatric surgery was an effective treatment modality for obesity (93.8%) but there was less agreement on its benefit for NAFLD (62.5%). These experts' consensus on obesity and GI diseases in Asia forms the basis for further research, and its translation into addressing this emerging issue.
Collapse
Affiliation(s)
| | - Wai Mun Loo
- Department of Medicine, National University of Singapore, Singapore
| | - Khean Lee Goh
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Wah Kheong Chan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wai Yan Philip Chiu
- Department of Surgery, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Myung-Gyu Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Sutep Gonlachanvit
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan
| | | | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Laurentius A Lesmana
- Department of Internal Medicine, Faculty of Medicine, University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia
| | - You-Ming Li
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chun Jen Liu
- Department of Internal Medicine, Graduate Institute of Clinical Medicine, Hepatitis Research Center, National Taiwan University College of Medicine and National Taiwan University Hospital, Taiwan
| | - Bunzo Matsuura
- Department of Lifestyle-Related Medicine and Endocrinology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Japan
| | - Enders Kwok Wai Ng
- Department of Surgery, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Jose D Sollano
- Department of Medicine, University of Santo Tomas, Manila, Philippines
| | - Simon Kin Hung Wong
- Department of Surgery, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Vincent W S Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Yunsheng Yang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Khek Yu Ho
- Department of Medicine, National University of Singapore, Singapore
| | - Yock Young Dan
- Department of Medicine, National University of Singapore, Singapore
| |
Collapse
|
96
|
Abstract
BACKGROUND Neither hormone levels nor malabsorption alone fully explains the distinct weight loss after bariatric surgery in morbidly obese patients. Postoperatively, patients regularly report a change in the sense of taste and the development of food aversions. Hedonic and sensory components like olfactory and gustatory stimuli significantly affect appetite and flavour. METHODS We prospectively analysed the orthonasal olfactory and gustatory function with psychophysical testing in 44 patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) or adjustable gastric banding (AGB) and in 23 healthy controls. RESULTS About 22.7 % of morbidly obese patients were hyposmic, showing significantly lower threshold-discrimination-identification (TDI) scores (p = 0.009) with decreased discrimination and identification ability. In addition, 22.7 % of patients were tested to be limited in gustatory function, with significantly lower taste strip test (TST) scores (p = 0.003). Six months after surgery, olfactory and gustatory function was not different when compared to healthy controls. CONCLUSIONS Due to obesity, patients frequently show impaired olfactory and gustatory function. Six months after laparoscopic bariatric surgery, both chemosensory functions improve. The TDI test is an appropriate tool to measure olfactory function in obese patients.
Collapse
|
97
|
Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KGMM, Zimmet PZ, Del Prato S, Ji L, Sadikot SM, Herman WH, Amiel SA, Kaplan LM, Taroncher-Oldenburg G, Cummings DE. Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations. Diabetes Care 2016; 39:861-77. [PMID: 27222544 DOI: 10.2337/dc16-0236] [Citation(s) in RCA: 539] [Impact Index Per Article: 67.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options. AIM The 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, was convened in collaboration with leading diabetes organizations to develop global guidelines to inform clinicians and policymakers about benefits and limitations of metabolic surgery for T2D. METHODS A multidisciplinary group of 48 international clinicians/scholars (75% nonsurgeons), including representatives of leading diabetes organizations, participated in DSS-II. After evidence appraisal (MEDLINE [1 January 2005-30 September 2015]), three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. These drafts were presented at the combined DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes (London, U.K., 28-30 September 2015), where they were open to public comment by other professionals and amended face-to-face by the Expert Committee. RESULTS Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2D. Numerous randomized clinical trials, albeit mostly short/midterm, demonstrate that metabolic surgery achieves excellent glycemic control and reduces cardiovascular risk factors. On the basis of such evidence, metabolic surgery should be recommended to treat T2D in patients with class III obesity (BMI ≥40 kg/m(2)) and in those with class II obesity (BMI 35.0-39.9 kg/m(2)) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients with T2D and BMI 30.0-34.9 kg/m(2) if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI thresholds should be reduced by 2.5 kg/m(2) for Asian patients. CONCLUSIONS Although additional studies are needed to further demonstrate long-term benefits, there is sufficient clinical and mechanistic evidence to support inclusion of metabolic surgery among antidiabetes interventions for people with T2D and obesity. To date, the DSS-II guidelines have been formally endorsed by 45 worldwide medical and scientific societies. Health care regulators should introduce appropriate reimbursement policies.
Collapse
Affiliation(s)
| | | | - Robert H Eckel
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
98
|
Liu SYW, Wong SKH, Lam CCH, Yung MY, Kong APS, Ng EKW. Long-term Results on Weight Loss and Diabetes Remission after Laparoscopic Sleeve Gastrectomy for A Morbidly Obese Chinese Population. Obes Surg 2016; 25:1901-8. [PMID: 25761944 DOI: 10.1007/s11695-015-1628-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is an effective stand-alone bariatric procedure with favorable short-term results on weight reduction and comorbidity resolution. This study aims to evaluate the long-term results of LSG to see if weight reduction and diabetic improvement are sustainable. METHODS We conducted a prospective observational study on patients receiving LSG as an index stand-alone bariatric operation in our unit. RESULTS Between 2006 and 2014, there were 140 patients (91 females) aged 37.9 ± 10.5 years with a body mass index of 41.0 ± 7.0 kg/m(2). At 1-year (n = 123), 2-year (n = 99), 3-year (n = 77), 4-year (n = 52), and 5-year (n = 44) follow-ups, the mean percentages of excess weight loss (%EWL) were 70.5, 65.2, 60.2, 53.2, and 57.2%, respectively, while the corresponding proportions with failed weight loss (%EWL <30%) were 7.3, 9.1, 13.0, 25.0, and 22.7%. Weight regain (>25% rebound in %EWL) was evident with time as 0, 1.0, 11.6, 19.2, and 29.5% in the first 5-year follow-ups. In 65 patients with type 2 diabetes mellitus, remission (complete and partial) was achieved in 34.5% at 1-year, 52.7% at 3-year, and 70.6% at 5-year follow-ups. Proportions of patients having optimal glycemic control (HbA1c <7%) increased significantly from 26.2% preoperatively to 80.9% at the first year and maintained at 78.6% at the fifth year (P < 0.001). CONCLUSIONS LSG was effective in achieving substantial weight reduction and improved diabetic control for morbidly obese patients. Although weight regain was possible with time, majority of patients could maintain sustainable weight loss, diabetes remission, and glycemic improvement in the long run.
Collapse
Affiliation(s)
- Shirley Yuk-Wah Liu
- Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong,
| | | | | | | | | | | |
Collapse
|
99
|
Park JY, Kim YJ. Efficacy of Laparoscopic Sleeve Gastrectomy in Mildly Obese Patients with Body Mass Index of 30-35 kg/m(2). Obes Surg 2016; 25:1351-7. [PMID: 25656261 DOI: 10.1007/s11695-015-1575-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has recently gained rapidly increasing popularity as a stand-alone procedure for the treatment of morbid obesity. This study aimed to evaluate the efficacy of LSG in mildly obese patients with a body mass index (BMI) of 30-35 kg/m(2). METHODS One hundred ninety-two patients who consecutively underwent LSG between April 2009 and December 2012 were retrospectively reviewed. The patients were classified into a lower BMI (30-35 kg/m(2)) and higher BMI group (>35 kg/m(2)). Demographics and surgical outcomes were compared between the groups. RESULTS Forty-nine patients (25.5 %) belonged to the lower BMI group, while the other 143 (74.5 %) to the higher BMI group. The preoperative BMI of each group was 32.7 ± 1.6 and 42.6 ± 6.6 kg/m(2), respectively. Severe complications requiring invasive intervention developed only in the higher BMI group (4/143, 2.8 %). The percent of excess weight loss (%EWL) in the lower BMI group was 86.1 % at mean follow-up of 24 months, which was significantly greater than in the higher BMI group (61.9 %, p<0.001). Serial follow-up showed that %EWL was significantly greater in the lower BMI group until 2 years postoperatively, and the difference became statistically insignificant thereafter. The resolution of comorbidities was observed in more than 80 % of the patients both in lower and higher BMI groups. CONCLUSION LSG achieved excellent outcomes without severe complications for mildly obese patients. LSG could serve as a safe and effective stand-alone procedure to achieve sustained weight loss and comorbidity resolution in patients with a lower BMI.
Collapse
Affiliation(s)
- Ji Yeon Park
- Department of Surgery, Soonchunhyang University Seoul Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul, 140-743, Republic of Korea
| | | |
Collapse
|
100
|
Prevalence of electrolyte and nutritional deficiencies in Chinese bariatric surgery candidates. Surg Obes Relat Dis 2015; 12:629-634. [PMID: 27012874 DOI: 10.1016/j.soard.2015.12.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 11/15/2015] [Accepted: 12/07/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Electrolyte and nutritional deficiencies have been reported in Western populations seeking bariatric surgery. However, data are scarce for Chinese patients. OBJECTIVES To investigate the prevalence of electrolyte and nutritional deficiencies in Chinese bariatric surgery candidates and to explore their associations with patients' demographic data. SETTING University hospital, China. METHODS Demographical data of 211 patients presenting for bariatric surgery were collected on gender, age, body mass index (BMI) and waist circumference (WC). Blood biochemical data were collected on some nutrients (hemoglobin, albumin, globulin, folate, vitamin B12, calcium, phosphorus, iron, ferritin, magnesium, parathyroid hormone [PTH], and vitamin D) and some electrolytes (potassium, sodium, and chloride). RESULTS Deficiencies were found for hemoglobin (2.8%), albumin (11.8%), globulin (1.4%), folate (32.2%), vitamin B12 (4.7%), corrected calcium (13.7%), phosphorus (10.4%), iron (9.0%), ferritin (1.9%), vitamin D (80.0%), potassium (5.7%), sodium (7.6%), and chloride (15.6%). Secondary hyperparathyroidism was found in 17.3%; no hypomagnesemia was encountered. A significant correlation was observed between age and folate, corrected calcium and PTH levels (r = .257, -.206, and .273, respectively; P<.05). Greater BMI was associated with lower albumin and folate (r = -.338 and -.370, respectively) and with higher globulin and phosphorus levels (r = .267 and .138, respectively). Folate deficiency was more common in the 18- to 30-year-old age group (P = .042) and the patients with BMI>45 kg/m(2) (P = .001). WC had an association with rates of albumin, folate, and corrected calcium deficiencies, as well as hemoglobin, albumin, and globulin, folate, phosphorus, and ferritin levels. CONCLUSION Electrolyte and nutritional deficiencies are common in Chinese bariatric surgery candidates. Routine evaluation of electrolyte and nutritional levels should be carried out in this population.
Collapse
|