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Costa M, Trovão Lima A, Morais T, Almeida RF, Nora M, Guimarães M, Monteiro MP. Does Reconstruction Type After Gastric Resection Matters for Type 2 Diabetes Improvement? J Gastrointest Surg 2020; 24:1269-1277. [PMID: 31140062 DOI: 10.1007/s11605-019-04255-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/29/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Gastrointestinal (GI) surgery involving gastric resection and bypass of intestinal segments was reported to facilitate glucose control in obese patients with type 2 diabetes (T2D). AIM Our aim was to assess whether the type of post-gastrectomy GI reconstruction also influences glucose control in T2D patients with BMI below 35 kg/m2 submitted to gastrointestinal surgery without bariatric intention. METHODS A cohort of T2D Caucasian patients (n = 40) with upper GI malignancy (n = 33) or complicated reflux disease (n = 7) were submitted to either a gastrectomy plus Billroth II (BII) gastrojejunal anastomosis (n = 17), a gastrectomy plus Roux-en-Y gastrojejunostomy (RY) reconstruction (n = 18; subtotal gastrectomy n = 7 and total gastrectomy n = 11), or atypical gastrectomy without reconstruction (no-R) (n = 5). Patients were evaluated before and 2 years after surgery for body weight, Hb1Ac, need of glucose lowering drugs, and presence of diabetes. RESULTS Body mass index (BMI) decreased after every surgical procedure when compared to baseline (- 0.9 ± 0.8 kg/m2 for BII vs - 4.3 ± 2.6 kg/m2 for RY vs - 4.6 ± 2.5 kg/m2 for no-R, p < 0.05), which was only significantly different after RY surgeries. Diabetes remission occurred in 5.9% of BII patients, in 27.8% of RY patients, and 0% of no-R patients, while in patients with persistent T2D, the needs for glucose-lowering drugs were significantly also decreased after RY (31.3% BII vs 66.7% RY vs 25% no-R, p = 0.03). CONCLUSIONS T2D Caucasian patients undergoing post-gastrectomy GI reconstructions without a bariatric intention experience a significant improvement of T2D, in a magnitude that could be influenced by the technical procedure performed in favor of RY reconstruction. Thus, presence of T2D should be taken into consideration when deciding for the type of post-gastrectomy GI reconstruction.
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Affiliation(s)
- Mariana Costa
- Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Hospital São Sebastião, Rua Dr. Cândido de Pinho, Santa Maria da Feira, Portugal
| | - Artur Trovão Lima
- Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Hospital São Sebastião, Rua Dr. Cândido de Pinho, Santa Maria da Feira, Portugal
| | - Tiago Morais
- Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal
| | - Rui F Almeida
- Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Hospital São Sebastião, Rua Dr. Cândido de Pinho, Santa Maria da Feira, Portugal
| | - Mário Nora
- Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Hospital São Sebastião, Rua Dr. Cândido de Pinho, Santa Maria da Feira, Portugal
- Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal
| | - Marta Guimarães
- Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Hospital São Sebastião, Rua Dr. Cândido de Pinho, Santa Maria da Feira, Portugal.
- Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal.
- Department of Anatomy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal.
| | - Mariana P Monteiro
- Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal
- Department of Anatomy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
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Madadi F, Jawad R, Mousati I, Plaeke P, Hubens G. Remission of Type 2 Diabetes and Sleeve Gastrectomy in Morbid Obesity: a Comparative Systematic Review and Meta-analysis. Obes Surg 2020; 29:4066-4076. [PMID: 31655953 DOI: 10.1007/s11695-019-04199-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The sleeve gastrectomy (SG) has gained popularity which has resulted in a rising number of patients with T2DM to undergo this procedure. This systematic review and meta-analysis aimed to compare the long-term effects of SG on T2DM remission with remission seen after Roux-en-Y gastric bypass (RYGB) or gastric banding (GB). METHODS A literature search was performed in PubMed and Cochrane Library using the following search terms: 'sleeve gastrectomy', 'diabetes', 'gastric bypass' and 'gastric banding'. Studies published between January 2000 and April 2018, and with following inclusion criteria were selected for this review: BMI ≥ 35 kg/m2, age ≥ 18 years, follow-up ≥ 1 year, T2DM. Data was statistically analysed using a random-effects model and results were expressed as odds ratio with 95% confidence interval. RESULTS After exclusion, 35 out of an initial 748 studies, consisting of 18 138 T2DM patients, remained for inclusion. Of these patients, 2480 underwent a SG. The remaining patients underwent a RYGB (n = 10,597) or GB (n = 5061). One year postoperatively, SG patients reached significantly (OR 0.71, p = 0.003) less T2DM remission than RYGB. After stratifying for different criteria for remission, RYGB still tended to result in higher remission rates, but the difference was not statistically significant. Beyond 1 year of follow-up, the difference between RYGB and SG in terms of T2DM remission decreased. SG was superior to the GB (OR 2.17, p = 0.001) after 1 year of follow-up. CONCLUSION This review demonstrates important remission of T2DM following SG. Nevertheless, as remission was significantly more often observed following RYGB surgery, the latter procedure remains the gold standard for reaching T2DM remission in patients with concurrent obesity.
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Affiliation(s)
- Ferdous Madadi
- Faculty of Medicine and Health Care, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium. .,Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium.
| | - Rami Jawad
- Faculty of Medicine and Health Care, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Ismail Mousati
- Faculty of Medicine and Health Care, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Philip Plaeke
- Laboratory of Experimental Medicine and Pediatrics (LEMP), University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Guy Hubens
- Department of Abdominal Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium.,Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
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53
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Sarkar S, Anokye-Danso F, Tronieri JS, Millar JS, Alamuddin N, Wadden TA, Ahima RS. Differential Effects of Roux-en-Y Gastric Bypass Surgery and Laparoscopic Sleeve Gastrectomy on Fatty Acid Levels. Obes Surg 2020; 29:3941-3947. [PMID: 31290107 DOI: 10.1007/s11695-019-04062-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bariatric surgery is associated with improved cardiovascular outcomes and also affects lipid levels, but few studies have compared the effects of Roux-en-Y gastric bypass (RYGB) surgery with those of laparoscopic sleeve gastrectomy (LSG) on serum fatty acid levels. The present study compares the effects of RYGB and LSG surgeries on serum fatty acid levels. METHODS The study participants were women who were undergoing either RYGB or LSG and body mass index (BMI)-matched controls. Fasting blood samples to measure glucose, insulin, and fatty acids were drawn at baseline and at 6 and 18 months from baseline. RESULTS Serum fatty acid data were available for 57 participants at baseline, of whom 56 had data at 6 months and 41 had data at 18 months from baseline. Compared with baseline, serum non-esterified fatty acids (NEFAs) levels were significantly higher at 6 and 18 months in the LSG group compared with the RYGB group. In the RYGB group, 2 saturated fatty acids (SFAs), 2 monounsaturated fatty acids (MUFAs), and 1 polyunsaturated fatty acid (PUFA) were significantly decreased after surgery, compared with those of the LSG group. CONCLUSIONS A significant increase in NEFAs was seen after LSG, compared with RYGB. Compared with the LSG group, several serum fatty acids were significantly reduced after RYGB. TRIAL REGISTRATION NCT01228097.
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Affiliation(s)
- Sudipa Sarkar
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Frederick Anokye-Danso
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jena Shaw Tronieri
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - John S Millar
- Metabolic Tracer Resource, Institute for Diabetes, Obesity and Metabolism, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Naji Alamuddin
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas A Wadden
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Rexford S Ahima
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Aldawudi I, Katwal PC, Jirjees S, Htun ZM, Khan S. Future of Bariatric Embolization: A Review of Up-to-date Clinical Trials. Cureus 2020; 12:e7958. [PMID: 32509483 PMCID: PMC7270878 DOI: 10.7759/cureus.7958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Obesity is a significant health issue with an overall rise in mortality; it has multiple risk factors, including hormonal effects, which play a significant role in the balance of food intake and weight gain. Ghrelin is an anabolic hormone secreted from stomach fundus and plays a significant role in this regulation. Management of obesity involves multiple interventions, including lifestyle adjustment, pharmacotherapy, and bariatric surgery. Bariatric embolization is a relatively new procedure; several animal studies show that embolization of the left gastric artery reduces serum ghrelin and induces weight loss. Also, several clinical studies were conducted in the past ten years which have shown bariatric embolization's effectiveness in inducing weight loss: a meta-analysis of 47 patients included in six different clinical studies of left gastric artery embolization resulted in 8% total weight loss from baseline body weight. Many studies also show this procedure's effect on lowering the HgA1C level and lipid profile. Clinical studies mostly reported minor adverse effects such as transient abdominal discomfort, nausea and vomiting, gastric ulcers, and major adverse effects were uncommon, suggesting the procedure is well tolerated. It may be an alternative line of management in patients who are not suitable candidates for bariatric surgery. Although future clinical studies will provide an answer to several questions like the exact effects of the procedure on diabetes and metabolic syndrome, future studies are also needed to establish particular guidelines to match different patient characteristics with their optimal procedural techniques and pre- and post-procedure evaluation tests.
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Affiliation(s)
- Israa Aldawudi
- Radiology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Prakash C Katwal
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Srood Jirjees
- Neurology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Zin Mar Htun
- Internal Medicine, California Institute of Behavioral Neuroscience and Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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55
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Han L, Han H, Wang L, Ruan Y, Wei X, He J, Lu X. Prior bariatric surgery is associated with lower complications, in-hospital mortality, and healthcare utilization after elective spine fusion surgery. Surg Obes Relat Dis 2020; 16:760-767. [PMID: 32278540 DOI: 10.1016/j.soard.2019.12.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/20/2019] [Accepted: 12/26/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Grade 3 obesity could potentially increase postoperative complications after spinal fusion surgery. However, the relationship between prior bariatric surgery (BS) and postoperative complications after spinal fusion surgery is not well-established. SETTING Inpatient hospital admissions from the Nationwide Inpatient Sample. METHODS Patients with a primary procedure of spinal fusion surgery discharged between 2006 and 2014 were identified. In-hospital outcomes included postoperative complications, mortality, cost, and length of stay were compared between patients with prior BS and grade 3 obesity. RESULTS A total of 3,132,192 patients who underwent elective spinal fusion surgery were identified. There were 33,936 (1.1%) patients with a diagnosis of prior BS. The prevalence of prior BS increased significantly from .1% in 2006 to 1.5% in 2014. Compared with patients with grade 3 obesity, patients with prior BS were younger, more likely to be female, had less co-morbidities, and higher proportion of cervical surgery. Multivariable analysis indicated that patients with prior BS had lower risk of overall complications (odds ratio [OR]: .44; 95% confidence interval [CI]: .38-.49), neurologic (OR: .55; 95%CI: .35-.84), respiratory (OR: .30; 95%CI: .23-.37), cardiac (OR: .38; 95%CI: .24-.60), gastrointestinal (OR: .61; 95%CI: .44-.84), urinary and renal (OR: .34; 95%CI: .26-.44), venous thromboembolism (OR: .35; 95%CI: .19-.63), wound-related complications (OR: .67; 95%CI: .53-.85), and in-hospital mortality (OR: .12; 95%CI: .02-.88). Prior BS was also related to 13% shorter length of stay and 2% lower cost. CONCLUSIONS Among patients undergoing spinal fusion surgery, prior BS is associated with lower complications, in-hospital mortality, and healthcare utilization. BS might mitigate risk of worse outcomes associated with grade 3 obesity after spine fusion surgery.
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Affiliation(s)
- Lin Han
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Hedong Han
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Liang Wang
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yiming Ruan
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Xin Wei
- Department of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Jia He
- Department of Health Statistics, Second Military Medical University, Shanghai, China; Tongji University School of Medicine, Shanghai, China.
| | - Xuhua Lu
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
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56
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Gupta S, Beitner M, Skinner C, Hopkins G. Medium-term outcomes of converting laparoscopic adjustable gastric band to Roux-en-Y gastric bypass in patients with body mass index <35 kg/m2: a uniquely Australian perspective. Surg Obes Relat Dis 2020; 16:485-491. [DOI: 10.1016/j.soard.2019.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 09/19/2019] [Accepted: 11/02/2019] [Indexed: 12/15/2022]
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57
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Garruti G, De Fazio M, Capuano P, Martinez G, Rotelli MT, Puglisi F, Palasciano N, Giorgino F. Exercise and apulian hypocaloric diet affect adipokine changes and gastric banding-induced weight loss: A prospective study on severe obese subjects. Ann Med Surg (Lond) 2020; 52:10-15. [PMID: 32153773 PMCID: PMC7052402 DOI: 10.1016/j.amsu.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 11/29/2022] Open
Abstract
Background Adiponectin and Resistin correlate with insulin sensitivity and cardiovascular risk, respectively. This study aimed to identify lifestyle factors that modulate changes in Adiponectin and Resistin levels after gastric banding positioning (LapGB). Materials and methods Before (T0), 3 months (T3), 6 months (T6), and 12 months (T12) after LapGB, serum Adiponectin and Resistin levels were evaluated in a single-centre prospective study including a cohort of 27 non-diabetic obese subjects (S-Ob, BMI ≥35 kg/m2). After surgery, a dietitian checked the adherence of S-Ob to an Apulian hypocaloric diet (aphypoD)/physical activity (phA) and, according to their high or low compliance to aphypoD/phA, S-Ob were included in group 1 (n = 14) or 2 (n = 13) respectively. Serum Adiponectin and Resistin were also measured in 10 healthy controls. Results At baseline, Resistin levels were significantly higher and Adiponectin levels significantly lower in S-Ob than in controls. After surgery, group 1 showed a 50.2% excess weight loss (%EWL), significantly decreased Resistin levels at T12 and increased Adiponectin levels at both T6 and T12 as compared with baseline. Group 2 showed 24.6 %EWL at T12, decreased Adiponectin levels at T6 and T12 as compared with baseline, but unaltered Resistin levels. After surgery, group 1 followed aphypoD/phA, while group 2 did not. Conclusions LapGB fails to improve cardiovascular risk markers (Resistin) in S-Ob not improving lifestyle. Future studies might investigate these findings in a larger cohort and display whether aphypoD is more effective than other dietary intervention on cardiovascular risk in subjects undergoing LapGB or other Bariatric procedures. Gastric banding (LapGB) plus a 12-month lifestyle program was followed by a % excess weight loss >40. Resistin significantly declined in subjects adhering to a 1-year LapGB/lifestyle intervention. In subjects not following any lifestyle program after surgery, Adiponectin unexpectedly decreased. LapGB fails to change cardiovascular risk or insulin sensitivity without a healthy lifestyle.
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Affiliation(s)
- Gabriella Garruti
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Michele De Fazio
- Department of Emergency and Organ Transplantation, Section of General Surgery and Liver Transplantation, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Palma Capuano
- Department of Emergency and Organ Transplantation, Section of General Surgery and Liver Transplantation, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Gennaro Martinez
- Department of Emergency and Organ Transplantation, Section of General Surgery and Liver Transplantation, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Maria T Rotelli
- Department of Emergency and Organ Transplantation, Section of General Surgery and Liver Transplantation, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Francesco Puglisi
- Department of Emergency and Organ Transplantation, Section of General Surgery and Liver Transplantation, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Nicola Palasciano
- Department of Emergency and Organ Transplantation, Section of General Surgery and Liver Transplantation, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Francesco Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124, Bari, Italy
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58
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Chen KF, Chan LN, Senn TD, Oelschlager BK, Flum DR, Shen DD, Horn JR, Lin YS. The Impact of Proximal Roux-en-Y Gastric Bypass Surgery on Acetaminophen Absorption and Metabolism. Pharmacotherapy 2020; 40:191-203. [PMID: 31960977 DOI: 10.1002/phar.2368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGBS), a surgery that creates a smaller stomach pouch and reduces the length of small intestine, is one of the most common medical interventions for the treatment of obesity. AIM The aim of this study was to determine how RYGBS affects the absorption and metabolism of acetaminophen. MATERIALS AND METHODS Ten morbidly obese patients received 1.5 g of liquid acetaminophen (APAP) orally on three separate pharmacokinetic study days (i.e., pre-RYGBS baseline and 3 and 12 months post-RYGBS). Plasma was collected at pre-specified timepoints over 24 hours, and the samples were analyzed using liquid chromatography-mass spectrometry for APAP, APAPglucuronide (APAP-gluc), APAP-sulfate (APAP-sulf), APAP-cysteine (APAP-cys), and APAP-Nacetylcysteine (APAP-nac). RESULT Following RYGBS, peak APAP concentrations at the 3-month and 12-month visits increased by 2.0-fold compared to baseline (p=0.0039 and p=0.0078, respectively) and the median time to peak concentration decreased from 35 to 10 minutes. In contrast, peak concentrations of APAP-gluc, APAP-sulf, APAP-cys, and APAP-nac were unchanged following RYGBS. The apparent oral clearance of APAP and the ratios of metabolite area under the curve (AUC)-to-APAP AUC for all four metabolites decreased at 3 and 12 months post-RYGBS compared to the presurgical baseline. In a simulation of expected steady-state plasma concentrations following multiple dosing of 650 mg APAP every 4 hours, post-RYGBS patients had higher steady-state peak APAP concentrations compared to healthy individuals and obese pre-RYGBS patients, though APAP exposure was unchanged compared to healthy individuals. CONCLUSION Following RYGBS, the rate and extent of APAP absorption increased and decreased formation of APAP metabolites was observed, possibly due to downregulation of Phase II and cytochrome P450 2E1 enzymes.
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Affiliation(s)
- Kuan-Fu Chen
- Department of Pharmaceutics, University of Washington, Seattle, Washington
| | | | - Taurence D Senn
- Department of Medicinal Chemistry, University of Washington, Seattle, Washington
| | | | - David R Flum
- Department of Surgery, University of Washington, Seattle, Washington
| | - Danny D Shen
- Department of Pharmaceutics, University of Washington, Seattle, Washington
| | - John R Horn
- Department of Pharmacy, University of Washington, Seattle, Washington
| | - Yvonne S Lin
- Department of Pharmaceutics, University of Washington, Seattle, Washington
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Systematic review of online patient resources to support shared decision making for bariatric surgery. Int J Surg 2020; 74:34-38. [PMID: 31883844 DOI: 10.1016/j.ijsu.2019.12.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/11/2019] [Accepted: 12/22/2019] [Indexed: 12/14/2022]
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60
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Camacho-Ramírez A, Mayo-Ossorio MÁ, Pacheco-García JM, Almorza-Gomar D, Ribelles-García A, Belmonte-Núñez A, Prada-Oliveira JA, Pérez-Arana GM. Pancreas is a preeminent source of ghrelin after sleeve gastrectomy in Wistar rats. Histol Histopathol 2020; 35:801-809. [PMID: 31951010 DOI: 10.14670/hh-18-200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Many surgical techniques are employed in the treatment of severe obesity. A main consequence of these techniques is the improvement of type 2 Diabetes mellitus. Ghrelin is a gut hormone released in the gastric fundus and corpus, which has been related to diabetic improvement as mentioned in these papers. Sleeve gastrectomy and Roux-en Y Gastric Bypass are surgical techniques broadly employed in humans; both severely reduce the gastric surface. Paradoxically, the serum level of ghrelin in patients is preserved. We hypothesized about the role of embryonic pancreatic epsilon cells, which have the capacity to release ghrelin. We studied the changes in the epsilon cells and differentiation markers with immunostaining and ghrelin serum level and after surgery. We employed euglycemic male Wistar rats: two surgical groups (Sleeve gastrectomy and Roux-en Y Gastric Bypass) and two control groups. We reported a significant increase of ghrelin epsilon-cells in the pancreas and basal serum after Sleeve gastrectomy versus the control groups. The epsilon cellular increment was related to neogenesis, as the neurogenin-3 marker revealed. The Roux-en Y Gastric Bypass showed neither epsilon cell increase nor basal serum changes in ghrelin release. As a conclusion, we reported that the severe suppression of the fundus gastric produced the recovery of ghrelin released by the epsilon cells, which was indicative of an ontogenic embryonic pancreatic function.
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Affiliation(s)
- Alonso Camacho-Ramírez
- Surgery Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain.,Biomedical Science Research and Innovation Institute (INIBICA), Puerta del Mar University Hospital, Cádiz, Spain.,Asociación Gaditana de Apoyo al Investigador AGAI, Cádiz, Spain
| | - María Ángeles Mayo-Ossorio
- Surgery Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain.,Biomedical Science Research and Innovation Institute (INIBICA), Puerta del Mar University Hospital, Cádiz, Spain
| | - José Manuel Pacheco-García
- Surgery Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain.,Biomedical Science Research and Innovation Institute (INIBICA), Puerta del Mar University Hospital, Cádiz, Spain
| | - David Almorza-Gomar
- Biomedical Science Research and Innovation Institute (INIBICA), Puerta del Mar University Hospital, Cádiz, Spain.,Department of Operative Statistic and Research, University of Cádiz, Cádiz, Spain
| | - Antonio Ribelles-García
- Department of Human Anatomy and Embryology, Faculty of Medicine, University of Cádiz, Cádiz, Spain.,Sustainable Social Development Research Institute (INDESS), University of Cádiz, Cádiz, Spain
| | - Ana Belmonte-Núñez
- Department of Human Anatomy and Embryology, Faculty of Medicine, University of Cádiz, Cádiz, Spain
| | - J Arturo Prada-Oliveira
- Biomedical Science Research and Innovation Institute (INIBICA), Puerta del Mar University Hospital, Cádiz, Spain.,Asociación Gaditana de Apoyo al Investigador AGAI, Cádiz, Spain.,Department of Human Anatomy and Embryology, Faculty of Medicine, University of Cádiz, Cádiz, Spain.
| | - Gonzalo M Pérez-Arana
- Biomedical Science Research and Innovation Institute (INIBICA), Puerta del Mar University Hospital, Cádiz, Spain.,Department of Human Anatomy and Embryology, Faculty of Medicine, University of Cádiz, Cádiz, Spain.,Asociación Gaditana de Apoyo al Investigador AGAI, Cádiz, Spain
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Jalali SM, Azadbakht M, Azadbakht S, Daniali S, Farokhi E. Prevalence of secondary hyperparathyroidism following bariatric surgery. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.11.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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62
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Phillips CL, Grayson BE. The immune remodel: Weight loss-mediated inflammatory changes to obesity. Exp Biol Med (Maywood) 2020; 245:109-121. [PMID: 31955604 PMCID: PMC7016415 DOI: 10.1177/1535370219900185] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Obesity is an escalating world problem that contributes to the complexity and cost of treatment of metabolic disorders. Obesity is the result of increased storage of energy in the form of adipose tissue, reducing the quality of daily life, and interfering with longevity. Obesity is also a chronic, low-grade inflammatory disorder. The inflammatory processes affect many organ systems with expanded numbers of immune cells and increased cytokine production. Long-term weight loss is difficult to achieve and maintain. Lifestyle modifications, pharmacologic treatments, and surgical methods are increasingly utilized to ameliorate excess body weight and the comorbidities of obesity, such as diabetes, cardiovascular disease, dyslipidemia, and cancers. Weight loss is also touted to reduce inflammation. Here we review the current literature on human obesity-related systemic and local changes to the immune system and circulating inflammatory mediators. Further, we consider the impact of weight loss to reduce the burden of inflammation, bearing in mind the different methods of weight loss—behavioral change vs. surgical intervention.
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Affiliation(s)
- Charles L Phillips
- Program in Pathology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Bernadette E Grayson
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS 39216, USA
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Whitley J, Moore KJ, Carey ET, Louie M. The Effect of Bariatric Surgery on Perioperative Complications after Hysterectomy. J Minim Invasive Gynecol 2019; 27:1363-1369. [PMID: 31843695 DOI: 10.1016/j.jmig.2019.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 12/11/2022]
Abstract
STUDY OBJECTIVE To compare intraoperative and 30-day posthysterectomy outcomes between patients who had bariatric surgery before hysterectomy and patients with a body mass index (BMI) >40 kg/m2 without a history of bariatric surgery. DESIGN A retrospective cohort study. SETTING A tertiary-care, academic medical center. PATIENTS Patients with a history of bariatric surgery and patients with BMI >40 kg/m2 and no previous bariatric surgery who underwent any route of hysterectomy between January 1, 2000, and March 1, 2018. INTERVENTIONS After exclusion of patients with gynecologic malignancy and bariatric surgery reversal, 223 patients with a history of bariatric surgery were matched at a 1:2 ratio by year of hysterectomy to 446 randomly selected patients with a BMI >40 kg/m2 and no bariatric surgery before hysterectomy. Demographics, medical comorbidities, and surgical characteristics were collected by a manual chart review. Chi-square or Fisher's exact tests were used to compare the incidence of intraoperative and 30-day postoperative complications. Polytomous logistic regression was used to estimate the odds of major and minor postoperative complications. Binary logistic regression was used to estimate the odds of any intra- or postoperative complications. MEASUREMENTS AND MAIN RESULTS The mean BMI in the bariatric surgery group was 35.2 ± 7.9 kg/m2, compared with 46.3 ± 5.6 kg/m2 in the control group (p <.01). Fewer patients in the bariatric surgery group had obesity-related comorbidities than the group with no previous bariatric surgery (p <.01). There were lower odds of any intraoperative complication in the bariatric surgery group than in the group with no bariatric surgery (adjusted odds ratio, 0.32; 95% confidence interval [CI], 0.13-0.77), after adjusting for relevant confounding factors between groups. However, there was no difference in overall postoperative complications between women who had bariatric surgery and those who did not (adjusted odds ratio, 1.25; 95% CI, 0.82-1.91). When analyzed individually, a higher proportion of patients in the bariatric surgery group had postoperative cuff separation or dehiscence (1.4% [3/223], p = .04) and urinary retention (5.8% [13/223], p <.01). Combining all perioperative complications, we found no significant difference in minor complications, defined as Clavien-Dindo Grade 1 or 2 (adjusted odds ratio, 1.04; 95% CI, 0.68-1.60), major complications, defined as Clavien-Dindo Grade 3 or higher (adjusted odds ratio, 1.25; 95% CI, 0.61-2.54), or combined major and minor perioperative complications (adjusted odds ratio, 0.96; 95% CI, 0.63-1.44) between patients with a history of bariatric surgery and morbidly obese patients with no bariatric surgery before hysterectomy, after adjusting for relevant confounding factors between groups. CONCLUSION Compared with women who had a BMI >40 kg/m2, patients with a history of bariatric surgery before hysterectomy had a lower odds of complications during hysterectomy. However, despite lower BMI and fewer obesity-related medical comorbidities, there was no significant difference in posthysterectomy complications and no significant differences in overall major and minor complications.
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Affiliation(s)
- Julia Whitley
- Department of Obstetrics and Gynecology (Drs. Whitley, Carey, and Louie), School of Medicine.
| | - Kristin J Moore
- Department of Epidemiology, Gillings School of Global Public Health (Dr. Moore), University of North Carolina, Chapel Hill, NC
| | - Erin T Carey
- Department of Obstetrics and Gynecology (Drs. Whitley, Carey, and Louie), School of Medicine
| | - Michelle Louie
- Department of Obstetrics and Gynecology (Drs. Whitley, Carey, and Louie), School of Medicine
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New insight into the mechanisms of ectopic fat deposition improvement after bariatric surgery. Sci Rep 2019; 9:17315. [PMID: 31754142 PMCID: PMC6872729 DOI: 10.1038/s41598-019-53702-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/18/2019] [Indexed: 12/12/2022] Open
Abstract
Non-alcoholic fatty-liver disease (NAFLD) is frequent in obese patients and represents a major risk factor for the development of diabetes and its complications. Bariatric surgery reverses the hepatic features of NAFLD. However, its mechanism of action remains elusive. We performed a comprehensive analysis of the mechanism leading to the improvement of NAFLD and insulin resistance in both obese rodents and humans following sleeve-gastrectomy (SG). SG improved insulin sensitivity and reduced hepatic and monocyte fat accumulation. Importantly, fat accumulation in monocytes was well comparable to that in hepatocytes, suggesting that Plin2 levels in monocytes might be a non-invasive marker for the diagnosis of NAFLD. Both in vitro and in vivo studies demonstrated an effective metabolic regeneration of liver function and insulin sensitivity. Specifically, SG improved NAFLD significantly by enhancing AMP-activated protein kinase (AMPK) phosphorylation and chaperone-mediated autophagy (CMA) that translate into the removal of Plin2 coating lipid droplets. This led to an increase in lipolysis and specific amelioration of hepatic insulin resistance. Elucidating the mechanism of impaired liver metabolism in obese subjects will help to design new strategies for the prevention and treatment of NAFLD.
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Song Z, Dai X, Yu H, Luo Q, Zhang H, Wu L. Increased Serum IGFBP-1 and Reduced Insulin Resistance After Roux-En-Y Gastric Bypass in Chinese Patients with Type 2 Diabetes: a 6-Month Follow-Up. Obes Surg 2019; 28:3165-3171. [PMID: 29693217 DOI: 10.1007/s11695-018-3242-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study aimed to measure changes of insulin-like growth factor binding protein-1 (IGFBP-1) in patients with type 2 diabetes mellitus (T2D) following gastric bypass surgery. METHODS A total of 10 patients with T2D underwent laparoscopic Roux-en-Y gastric bypass (RYGB) surgery. Patient height, weight, waist circumference, and hip circumference were measured pre- and post-operatively at 6 months after surgery. Serum samples were collected at 6 months after surgery to determine fasting blood glucose, glycosylated Hb, fasting insulin, C-peptide, and 2-h postprandial blood glucose, insulin, and C-peptide. Serum was collected at 3 days and 6 months after surgery and IGFBP-1 level determined using ELISA. Serum samples were also collected from 30 healthy weight subjects and 27 overweight control subjects. RESULTS Body weight, BMI, and waist circumference were significantly improved following RYGB surgery. Blood glucose, fasting blood glucose, 2-h postprandial blood glucose, and HbA1c were also significantly improved. Fasting C-peptide and 2-h postprandial C-peptide were non-significantly reduced. Serum IGFBP-1 significantly increased at 3 days and 6 months after RYGB surgery. Pre-operative serum IGFBP-1 was not significantly different from healthy weight subjects or overweight subjects. CONCLUSION Increased serum level of IGF-binding proteins after RYGB in 6 months is increased post-surgery compared with overweight and healthy weight controls. IGFBP-1 may serve as part of new supplementary criteria for surgical selection and for defining the success of RYGB.
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Affiliation(s)
- Zhigao Song
- Department of Metabolic Surgery, General Hospital of Guangzhou Military Command, Southern Medical University, Guangzhou, 510515, China
| | | | - Hao Yu
- Department of Metabolic Surgery, General Hospital of Guangzhou Military Command, Southern Medical University, Guangzhou, 510515, China
| | - Qing Luo
- Department of Metabolic Surgery, General Hospital of Guangzhou Military Command, Southern Medical University, Guangzhou, 510515, China
| | - Hongbin Zhang
- Department of Metabolic Surgery, General Hospital of Guangzhou Military Command, Southern Medical University, Guangzhou, 510515, China.
| | - Liangping Wu
- Department of Metabolic Surgery, General Hospital of Guangzhou Military Command, Southern Medical University, Guangzhou, 510515, China. .,UDM Medical Group, Guangzhou, 510000, China.
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Sklyanik IA, Shestakova EA, Yurasov AV, Yashkov YI, Shestakova MV. [Glycemia normalization in patients with obesity and type 2 diabetes mellitus: bariatric surgery vs pharmacological therapy]. TERAPEVT ARKH 2019; 91:34-38. [PMID: 32598629 DOI: 10.26442/00403660.2019.10.000375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
AIMS To compare glucose - lowering and weight reduction capacity of bypass operations (gastric bypass (GB), biliopancreatic diversion (BPD) vs GLP-1 agonist liraglutide 3.0 mg (models of maximum incretin effect) for 6 months. MATERIALS AND METHODS 46 patients with type 2 diabetes and long history (≥10 years) of obesity were divided into 2 groups: surgery - group (n=23) and liraglutide - group (n=23), where liraglutide 3.0 mg in dose - escalation manner was added to baseline glucose - lowering therapy. Anthropometric parameters, HbA1c and insulin resistance (IR) by hyperinsulinemic euglycemic clamp (M-value) were measured before and 16 weeks after the intervention. With the stabilization of glycemia (≤6.5 mmol/l at fasting state, ≤8 mmol/l postprandial) the initial glucose - lowering therapy was canceled. RESULTS AND DISCUSSION Both surgery and liraglutide 3.0 mg provided target HbA1c in 16 weeks. Bypass operations led to elimination of glucose - lowering therapy in 82.6% patients due to a more significant weight reduction and decrease in IR. In liraglutide - group previous glucose - lowering therapy was cancelled in 78.3% patients, mainly receiving baseline mono - and two - component therapy. The most significant difference between interventions was achieved in BMI (-8.9 kg in surgery group vs -3.8 kg in liraglutide group, p.
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Affiliation(s)
| | | | - A V Yurasov
- Central Clinical Hospital No. 1 of Russian Railways
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Unamuno X, Portincasa P, Frühbeck G. A paradigm shift in bariatric surgery outcome evaluation? Lancet Diabetes Endocrinol 2019; 7:743-745. [PMID: 31383619 DOI: 10.1016/s2213-8587(19)30248-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Xabier Unamuno
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, University of Navarra, IdiSNA, CIBEROBN, 31008 Pamplona, Spain
| | - Piero Portincasa
- Division of Internal Medicine "Augusto Murri", Department of Biomedical Sciences and Human Oncology, Policlinico Hospital, University of Bari "Aldo Moro", Bari, Italy
| | - Gema Frühbeck
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, University of Navarra, IdiSNA, CIBEROBN, 31008 Pamplona, Spain.
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Ong MW, Tan CH, Cheng AKS. Prevalence and Determinants of Vitamin D Deficiency Among the Overweight and Obese Singaporeans Seeking Weight Management Including Bariatric Surgery: a Relationship with Bone Health. Obes Surg 2019; 28:2305-2312. [PMID: 29453514 DOI: 10.1007/s11695-018-3142-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: 01/09/2023]
Abstract
PURPOSE Low vitamin D status is prevalent worldwide and has been linked to a variety of pathologies including obesity in adults. The severity of vitamin D deficiency amongst the overweight and obese Singaporeans is not well documented. The purpose of this prospective observational study was to assess the prevalence and determinants of vitamin D deficiency in a multi-ethnic Asian population referred for weight management, including those seeking bariatric surgery. MATERIALS AND METHODS This was a cross-sectional study conducted among 111 consecutive subjects referred to a single institution weight management service in Singapore. The data collected included their anthropometric data, body mass index (BMI), body fat percentage, waist circumference, 25-hydroxyvitamin D [25(OH)D] and other bone turnover markers. RESULTS The average BMI among the 111 subjects was 40.1 ± 8.2 kg/m2 and mean age of 40 ± 10 years. Vitamin D deficiency was found in 75.7% of the population. There was a significant negative association of vitamin D with adiposity markers including BMI (r = - 0.31), body fat percentage (r = - 0.34) and waist circumference (r = - 0.26). Predictors of vitamin D deficiency included age > 50 years, female gender, waist circumference and body fat percentage. CONCLUSION Vitamin D deficiency is prevalent among this target population in Singapore regardless of ethnicity. In particular, the elderly, females, those with larger waist circumference and body fat percentage were significantly associated with lower serum 25(OH)D level. Hence, routine screening for the overweight and obese subjects in multi-ethnic Singapore seeking weight management is indicated.
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Affiliation(s)
- Marc Weijie Ong
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore.
| | - Chun Hai Tan
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - Anton Kui Sing Cheng
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
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Unamuno X, Izaguirre M, Gómez-Ambrosi J, Rodríguez A, Ramírez B, Becerril S, Valentí V, Moncada R, Silva C, Salvador J, Portincasa P, Frühbeck G, Catalán V. Increase of the Adiponectin/Leptin Ratio in Patients with Obesity and Type 2 Diabetes after Roux-en-Y Gastric Bypass. Nutrients 2019; 11:nu11092069. [PMID: 31484347 PMCID: PMC6770152 DOI: 10.3390/nu11092069] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/23/2019] [Accepted: 08/29/2019] [Indexed: 12/15/2022] Open
Abstract
Bariatric surgery remains the most effective option for achieving important and sustained weight loss. We explored the effects of Roux-en-Y gastric bypass (RYGB) on the circulating levels of adiponectin, leptin, and the adiponectin/leptin (Adpn/Lep) ratio in patients with obesity and type 2 diabetes (T2D). Twenty-five T2D volunteers undergoing RYGB were included in the study, and further subclassified as patients that responded or not to RYBG, regarding remission of T2D. Anthropometric and biochemical variables were evaluated before and after RYGB. Obese patients with T2D exhibited an increase (p < 0.0001) in the Adpn/Lep ratio after RYGB. Changes in the Adpn/Lep ratio correlated better with changes in anthropometric data (p < 0.001) than with the variations of adiponectin or leptin alone. Multiple regression analysis revealed that the change in the Adpn/Lep ratio in patients with T2D was an independent predictor of the changes in body mass index (p < 0.001) and body fat percentage (p = 0.022). However, the Adpn/Lep ratio did not differ between individuals with or without T2D remission after RYGB. In summary, the current study demonstrated that after weight and body fat loss following RYGB, the Adpn/Lep ratio increased in patients with obesity and T2D.
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Affiliation(s)
- Xabier Unamuno
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 31008 Pamplona, Spain
| | - Maitane Izaguirre
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Javier Gómez-Ambrosi
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 31008 Pamplona, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Amaia Rodríguez
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 31008 Pamplona, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Beatriz Ramírez
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 31008 Pamplona, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Sara Becerril
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 31008 Pamplona, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Víctor Valentí
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 31008 Pamplona, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
- Department of Surgery, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Rafael Moncada
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 31008 Pamplona, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
- Department of Anesthesia, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Camilo Silva
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 31008 Pamplona, Spain
- Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Javier Salvador
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 31008 Pamplona, Spain
- Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Piero Portincasa
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro" Medical School, 70124 Bari, Italy
| | - Gema Frühbeck
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 31008 Pamplona, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
- Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Victoria Catalán
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 31008 Pamplona, Spain.
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain.
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Abstract
BACKGROUND Metabolic surgery is now considered as a therapeutic option in type 2 diabetes (T2D). However, few data are available regarding perioperative management of T2D. OBJECTIVES To assess current practice among bariatric teams regarding perioperative management of T2D in order to propose guidelines. METHODS A two-round Delphi method using online surveys was employed among bariatric teams experts (surgeons, diabetologists, anesthetists, nutritionists): first round, 63 questions covering 6 topics (characteristics of experts/teams, characteristics of patients, operative technique, pre/postoperative management, diabetes remission); second round, 44 items needing clarification. They were discussed within national congress of corresponding learned societies. Consensus was defined as ≥66% agreement. RESULTS A total of 170 experts participated. Experts favored gastric bypass to achieve remission (76.7%). Screening for retinopathy, cardiac ultrasound, and reaching an HbA1c<8% are required in the pre-operative period for 67%, 75.3% and 56.7% of experts, respectively. After surgery, insulin pump should not be stopped, basal insulin should be halved, and bolus insulin should be stopped except if severe hyperglycemia. DPP-IV inhibitors and metformin are preferred after surgery. Patients should be seen by a diabetologist within one month if on oral antidiabetic agents (71.8% of experts), 2 weeks if on injectable treatments (77.1% of experts), and immediately after surgery if on insulin pump (93.5% of experts). Long-term monitoring of HbA1c is necessary even if diabetes remission (100%). CONCLUSION Rapid postoperative modifications of blood glucose require a close monitoring and a prompt adjustment of diabetes medications.
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García-Prieto CF, Gil-Ortega M, Vega-Martín E, Ramiro-Cortijo D, Martín-Ramos M, Bordiú E, Sanchez-Pernaute A, Torres A, Aránguez I, Fernández-Alfonso M, Rubio MA, Somoza B. Beneficial Effect of Bariatric Surgery on Abnormal MMP-9 and AMPK Activities: Potential Markers of Obesity-Related CV Risk. Front Physiol 2019; 10:553. [PMID: 31133882 PMCID: PMC6517546 DOI: 10.3389/fphys.2019.00553] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 04/18/2019] [Indexed: 12/30/2022] Open
Abstract
Bariatric surgery (BS) results in sustained weight loss and may reverse inflammation, metabolic alterations, extracellular matrix remodeling and arterial stiffness. We hypothesize that increased stiffening in omental arteries from obese patients might be associated with an increase in MMP activity and a decrease in p-AMPK, together with systemic oxidative stress and inflammation. Moreover, BS could contribute to reversing these alterations. This study was conducted with 38 patients of Caucasian origin: 31 adult patients with morbid obesity (9 men and 22 women; mean age 46 years and BMI = 42.7 ± 1.0 kg/m2) and 7 non-obese subjects (7 women; mean age 45 years and BMI = 22.7 ± 0.6 kg/m2). Seventeen obese patients were studied before and 12 months after BS. The stiffness index β, an index of intrinsic arterial stiffness, was determined in omental arteries and was significantly higher in obese patients. Levels of phosphorylated AMPK (p-AMPKThr-172) and SIRT-1 were significantly lower in peripheral blood mononuclear cells (PBMCs) from obese patients than those from non-obese patients (p < 0.05) and were normalized after BS. Total and active MMP-9 activities, LDH, protein carbonyls and uric acid were higher in obese patients and reduced by BS. Moreover, there was a correlation between plasmatic LDH levels and the stiffness index β. BS has a beneficial effect on abnormal MMP-9, LDH and AMPK activities that might be associated with the development of arterial stiffness in obese patients. Since these parameters are easily measured in blood samples, they could constitute potential biomarkers of cardiovascular risk in morbid obesity.
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Affiliation(s)
- Concha F García-Prieto
- Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Marta Gil-Ortega
- Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Elena Vega-Martín
- Departamento de Farmacología, Facultad de Farmacia, Instituto Pluridisciplinar, Universidad Complutense de Madrid, Madrid, Spain
| | - David Ramiro-Cortijo
- Departamento de Fisiología, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Miriam Martín-Ramos
- Departamento de Farmacología, Facultad de Farmacia, Instituto Pluridisciplinar, Universidad Complutense de Madrid, Madrid, Spain
| | - Elena Bordiú
- Servicio de Endocrinología y Nutrición, Facultad de Medicina, Hospital Clínico San Carlos, Instituto de Investigaciones Sanitarias San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Andrés Sanchez-Pernaute
- Servicio de Cirugía, Facultad de Medicina, Hospital Clínico San Carlos, Instituto de Investigaciones Sanitarias San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Antonio Torres
- Servicio de Cirugía, Facultad de Medicina, Hospital Clínico San Carlos, Instituto de Investigaciones Sanitarias San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - I Aránguez
- Departamento de Bioquímica, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
| | - María Fernández-Alfonso
- Departamento de Farmacología, Facultad de Farmacia, Instituto Pluridisciplinar, Universidad Complutense de Madrid, Madrid, Spain
| | - Miguel A Rubio
- Servicio de Endocrinología y Nutrición, Facultad de Medicina, Hospital Clínico San Carlos, Instituto de Investigaciones Sanitarias San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Beatriz Somoza
- Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
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Izaguirre M, Gómez-Ambrosi J, Rodríguez A, Ramírez B, Becerril S, Valentí V, Moncada R, Unamuno X, Silva C, de la Higuera M, Salvador J, Monreal I, Frühbeck G, Catalán V. GLP-1 Limits Adipocyte Inflammation and Its Low Circulating Pre-Operative Concentrations Predict Worse Type 2 Diabetes Remission after Bariatric Surgery in Obese Patients. J Clin Med 2019; 8:jcm8040479. [PMID: 30970605 PMCID: PMC6518381 DOI: 10.3390/jcm8040479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/01/2019] [Accepted: 04/08/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Glucagon-like peptide (GLP)-1 has been proposed as a key candidate in glucose improvements after bariatric surgery. Our aim was to explore the role of GLP-1 in surgically-induced type 2 diabetes (T2D) improvement and its capacity to regulate human adipocyte inflammation. METHODS Basal circulating concentrations of GLP-1 as well as during an oral glucose tolerance test (OGTT) were measured in lean and obese volunteers with and without T2D (n = 93). In addition, GLP-1 levels were determined before and after weight loss achieved by Roux-en-Y gastric bypass (RYGB) (n = 77). The impact of GLP-1 on inflammation signalling pathways was also evaluated. RESULTS We show that the reduced (p < 0.05) circulating levels of GLP-1 in obese T2D patients increased (p < 0.05) after RYGB. The area under the curve was significantly lower in obese patients with (p < 0.01) and without (p < 0.05) T2D compared to lean volunteers while obese patients with T2D exhibited decreased GLP-1 levels at baseline (p < 0.05) and 120 min (p < 0.01) after the OGTT. Importantly, higher (p < 0.05) pre-operative GLP-1 concentrations were found in patients with T2D remission after RYGB. We also revealed that exendin-4, a GLP-1 agonist, downregulated the expression of inflammation-related genes (IL1B, IL6, IL8, TNF) and, conversely, upregulated the mRNA levels of ADIPOQ in human visceral adipocytes. Furthermore, exendin-4 blocked (p < 0.05) LPS-induced inflammation in human adipocytes via downregulating the expression and secretion of key inflammatory markers. CONCLUSIONS Our data indicate that GLP-1 may contribute to glycemic control and exert a role in T2D remission after RYGB. GLP-1 is also involved in limiting inflammation in human visceral adipocytes.
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Affiliation(s)
- Maitane Izaguirre
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain.
| | - Javier Gómez-Ambrosi
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 31008 Pamplona, Spain.
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain.
| | - Amaia Rodríguez
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 31008 Pamplona, Spain.
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain.
| | - Beatriz Ramírez
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 31008 Pamplona, Spain.
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain.
| | - Sara Becerril
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 31008 Pamplona, Spain.
| | - Víctor Valentí
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 31008 Pamplona, Spain.
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain.
- Department of Surgery, Clínica Universidad de Navarra, 31008 Pamplona, Spain.
| | - Rafael Moncada
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 31008 Pamplona, Spain.
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain.
- Department of Anesthesia, Clínica Universidad de Navarra, 31008 Pamplona, Spain.
| | - Xabier Unamuno
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 31008 Pamplona, Spain.
| | - Camilo Silva
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 31008 Pamplona, Spain.
- Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, 31008 Pamplona/Madrid, Spain.
| | - Magdalena de la Higuera
- Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, 31008 Pamplona/Madrid, Spain.
| | - Javier Salvador
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 31008 Pamplona, Spain.
- Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, 31008 Pamplona/Madrid, Spain.
| | - Ignacio Monreal
- Department of Biochemistry, Clínica Universidad de Navarra, 31008 Pamplona, Spain.
| | - Gema Frühbeck
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 31008 Pamplona, Spain.
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain.
- Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, 31008 Pamplona/Madrid, Spain.
| | - Victoria Catalán
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 31008 Pamplona, Spain.
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain.
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Ravacci GR, Ishida R, Torrinhas RS, Sala P, Machado NM, Fonseca DC, André Baptista Canuto G, Pinto E, Nascimento V, Franco Maggi Tavares M, Sakai P, Faintuch J, Santo MA, Moura EGH, Neto RA, Logullo AF, Waitzberg DL. Potential premalignant status of gastric portion excluded after Roux en-Y gastric bypass in obese women: A pilot study. Sci Rep 2019; 9:5582. [PMID: 30944407 PMCID: PMC6447527 DOI: 10.1038/s41598-019-42082-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 03/13/2019] [Indexed: 12/13/2022] Open
Abstract
We evaluated whether the excluded stomach (ES) after Roux-en-Y gastric bypass (RYGB) can represent a premalignant environment. Twenty obese women were prospectively submitted to double-balloon enteroscopy (DBE) with gastric juice and biopsy collection, before and 3 months after RYGB. We then evaluated morphological and molecular changes by combining endoscopic and histopathological analyses with an integrated untargeted metabolomics and transcriptomics multiplatform. Preoperatively, 16 women already presented with gastric histopathological alterations and an increased pH (≥4.0). These gastric abnormalities worsened after RYGB. A 90-fold increase in the concentration of bile acids was found in ES fluid, which also contained other metabolites commonly found in the intestinal environment, urine, and faeces. In addition, 135 genes were differentially expressed in ES tissue. Combined analysis of metabolic and gene expression data suggested that RYGB promoted activation of biological processes involved in local inflammation, bacteria overgrowth, and cell proliferation sustained by genes involved in carcinogenesis. Accumulated fluid in the ES appears to behave as a potential premalignant environment due to worsening inflammation and changing gene expression patterns that are favorable to the development of cancer. Considering that ES may remain for the rest of the patient’s life, long-term ES monitoring is therefore recommended for patients undergoing RYGB.
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Affiliation(s)
- Graziela Rosa Ravacci
- Departamento de Gastroenterologia, Laboratorio Metanutri (LIM35), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Robson Ishida
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Raquel Suzana Torrinhas
- Departamento de Gastroenterologia, Laboratorio Metanutri (LIM35), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Priscila Sala
- Departamento de Gastroenterologia, Laboratorio Metanutri (LIM35), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Natasha Mendonça Machado
- Departamento de Gastroenterologia, Laboratorio Metanutri (LIM35), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Danielle Cristina Fonseca
- Departamento de Gastroenterologia, Laboratorio Metanutri (LIM35), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Gisele André Baptista Canuto
- Departamento de Quimica Analitica, Instituto de Quimica, Universidade Federal da Bahia, Salvador, BA, Brazil.,Departamento de Quimica Fundamental, Instituto de Quimica, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ernani Pinto
- Faculdade de Ciências Farmacêuticas, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | | | - Paulo Sakai
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Joel Faintuch
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marco Aurelio Santo
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | | | | | - Dan Linetzky Waitzberg
- Departamento de Gastroenterologia, Laboratorio Metanutri (LIM35), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Frühbeck G, Busetto L, Dicker D, Yumuk V, Goossens GH, Hebebrand J, Halford JGC, Farpour-Lambert NJ, Blaak EE, Woodward E, Toplak H. The ABCD of Obesity: An EASO Position Statement on a Diagnostic Term with Clinical and Scientific Implications. Obes Facts 2019; 12:131-136. [PMID: 30844811 PMCID: PMC6547280 DOI: 10.1159/000497124] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/22/2019] [Indexed: 12/11/2022] Open
Abstract
Obesity is a frequent, serious, complex, relapsing, and chronic disease process that represents a major public health problem. The coining of obesity as an adiposity-based chronic disease (ABCD) is of particular relevance being in line with EASO's proposal to improve the International Classification of Diseases ICD-11 diagnostic criteria for obesity based on three dimensions, namely etiology, degree of adiposity, and health risks. The body mass index as a unique measurement of obesity does not reflect the whole complexity of the disease. Obesity complications are mainly determined by 2 pathological processes, i.e., physical forces (fat mass disease) as well as endocrine and immune responses (sick fat disease), which are embedded in a cultural and physical context leading to a specific ABCD stage.
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Affiliation(s)
- Gema Frühbeck
- European Association for the Study of Obesity (EASO), Teddington, United Kingdom,
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, University of Navarra, IdiSNA, CIBEROBN, Spanish Health Institute Carlos III, Pamplona, Spain,
| | - Luca Busetto
- European Association for the Study of Obesity (EASO), Teddington, United Kingdom
- Department of Medicine, University of Padova, Padova, Italy
| | - Dror Dicker
- European Association for the Study of Obesity (EASO), Teddington, United Kingdom
- Department of Internal Medicine D and Obesity Clinic, Hasharon Hospital, Rabin Medical Center, Petah Tikva, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Volkan Yumuk
- European Association for the Study of Obesity (EASO), Teddington, United Kingdom
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Gijs H Goossens
- European Association for the Study of Obesity (EASO), Teddington, United Kingdom
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Johannes Hebebrand
- European Association for the Study of Obesity (EASO), Teddington, United Kingdom
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jason G C Halford
- European Association for the Study of Obesity (EASO), Teddington, United Kingdom
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Nathalie J Farpour-Lambert
- European Association for the Study of Obesity (EASO), Teddington, United Kingdom
- Obesity Prevention and Care Program Contrepoids, Service of Therapeutic Education for Chronic Diseases, Department of Community Health, Primary Care and Emergency, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Ellen E Blaak
- European Association for the Study of Obesity (EASO), Teddington, United Kingdom
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Euan Woodward
- European Association for the Study of Obesity (EASO), Teddington, United Kingdom
- EASO Secretariat, Middlesex, United Kingdom
| | - Hermann Toplak
- European Association for the Study of Obesity (EASO), Teddington, United Kingdom
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
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75
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Choromańska B, Myśliwiec P, Razak Hady H, Dadan J, Myśliwiec H, Chabowski A, Mikłosz A. Metabolic Syndrome is Associated with Ceramide Accumulation in Visceral Adipose Tissue of Women with Morbid Obesity. Obesity (Silver Spring) 2019; 27:444-453. [PMID: 30724038 PMCID: PMC6590193 DOI: 10.1002/oby.22405] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/26/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Accelerated transmembrane transport of long-chain fatty acids dependent on fatty acid transporters is responsible for lipid accumulation and, eventually, the development of metabolic syndrome. This study determined the content of lipids (ceramide [CER], diacylglycerol [DAG], triacylglycerol, and free fatty acid [FFA]) and the expression of fatty acid translocase (FAT/CD36) and plasma membrane fatty acid-binding protein in visceral adipose tissue (VAT) and subcutaneous adipose tissue of women with morbid obesity without metabolic syndrome (MetSx-) or with metabolic syndrome (MetSx+) and compared the results with those of lean controls without metabolic syndrome. METHODS Lipid content and fatty acid composition in each lipid subclass were estimated by gas liquid chromatography. For total, plasma membrane, and mitochondrial expression of fatty acid transporters, subfractionation with subsequent Western blot technique was used. RESULTS A greater content of triacylglycerol in VAT of participants with obesity (MetSx-) was found. However, only the MetSx+ subjects had increased content of CER in VAT in relation to subcutaneous adipose tissue in MetSx+ and lean individuals. This was accompanied by increased total and membrane expression of FAT/CD36 in VAT in MetSx+ subjects. Accordingly, mitochondrial expression of FAT/CD36 and plasma membrane fatty acid-binding protein was decreased in both groups of subjects with obesity. CONCLUSIONS Metabolic syndrome is associated with the accumulation of CER in VAT, possibly related to increased FAT/CD36 protein expression.
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Affiliation(s)
- Barbara Choromańska
- Department of General and Endocrinological SurgeryMedical University of BiałystokBiałystokPoland
| | - Piotr Myśliwiec
- Department of General and Endocrinological SurgeryMedical University of BiałystokBiałystokPoland
| | - Hady Razak Hady
- Department of General and Endocrinological SurgeryMedical University of BiałystokBiałystokPoland
| | - Jacek Dadan
- Department of General and Endocrinological SurgeryMedical University of BiałystokBiałystokPoland
| | - Hanna Myśliwiec
- Department of Dermatology and VenereologyMedical University of BiałystokBiałystokPoland
| | - Adrian Chabowski
- Department of PhysiologyMedical University of BiałystokBiałystokPoland
| | - Agnieszka Mikłosz
- Department of PhysiologyMedical University of BiałystokBiałystokPoland
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Camacho-Ramírez A, Almorza-Gomar D, Díaz-Gómez A, Mateo-Gavira I, Macias-Rodriguez M, Pérez-Arana GM, Prada-Oliveira JA. The histomorphometric parameters of endocrine pancreas after bariatric surgery in healthy animal models. Tissue Cell 2019; 57:78-83. [PMID: 30947967 DOI: 10.1016/j.tice.2019.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/25/2019] [Accepted: 02/25/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND The aim of this study is to describe in depth how different bariatric surgeries affect to the cellularity of β-cells in the pancreatic islet. There are much data regarding the possible physiological mechanisms involved in resolution of type 2 diabetes after bariatric surgery. But these data usually are controversial. We reported a direct influence of bariatric surgical technique on endocrine pancreas cellular turnover. Some surgeries increase proliferation processes of the β-cells. Our objective is to report the histomorphometric mechanism that these techniques stimulate over the cellularity of pancreatic islet. METHOD To this purpose, we used adult male Wistar rats to undergo the different techniques. We developed three surgical techniques (Sleeve gastrectomy and Y-Roux Gastric bypass as the most usual bariatric techniques, and a purely malabsorptive technique); moreover two control groups were performed (Sham and fasting controls). RESULTS We completed a sequence of morphometric studies to conclude the behaviour of endocrine pancreatic β-cell islet, correlating several histomorphometry parameters. CONCLUSION Our purpose was to show a comprehensive interpretation to the consequences that bariatric surgeries had on the pancreatic islets cellularity. Moreover, we included the main tests to report the cellularity in histological samples.
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Affiliation(s)
| | | | - Alfredo Díaz-Gómez
- Instituto para Investigación en Biomedicina (INIBICA). University of Cádiz, Avda. Ana de Viya, 21. Cádiz, 11009
| | - Isabel Mateo-Gavira
- Endocrinology and Nutrition Service, Universitary Hospital Puerta del Mar, Cádiz, 11010
| | | | - Gonzalo M Pérez-Arana
- Instituto para Investigación en Biomedicina (INIBICA). University of Cádiz, Avda. Ana de Viya, 21. Cádiz, 11009
| | - J Arturo Prada-Oliveira
- Department of Human Anatomy and Embryology, Faculty of Medicine, University of Cádiz, Plaza Fragela s/n, Cádiz, 11003.
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77
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Lucas JM, Kozlowski KF. The Underutilization of Lifestyle Modifications in Primary Care Medicine. EXERCISE MEDICINE 2019. [DOI: 10.26644/em.2019.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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de Oliveira TL, Libanori HT, Pinheiro MM. Axial Spondyloarthritis after bariatric surgery: a 7-year retrospective analysis. Adv Rheumatol 2019; 59:8. [PMID: 30764886 DOI: 10.1186/s42358-019-0050-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 01/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent decades, obesity has become a public health problem in many countries. The objective of this study was to evaluate the main joint and extra-articular manifestations related to spondyloarthritis (SpA) after bariatric surgery (BS) in a retrospective cohort. METHODS Demographic, clinical, laboratory and imaging data from nine patients whose SpA symptoms started after a BS have been described. Modified New York (mNY) criteria for ankylosing spondylitis (AS) and the Assessment of Spondyloarthritis International Society (ASAS) criteria for axial (ax-SpA) and peripheral (p-SpA) spondyloarthritis were applied. RESULTS The mean weight reduction after BS was 49.3 ± 21.9 kg. The BS techniques were Roux-en-Y gastric bypass (n = 8; 88.9%) and biliopancreatic diversion with duodenal switch (n = 1; 11.1%). Four (44.4%) patients had no axial or peripheral pain complaints before BS, while the other four (44.4%) had sporadic non-inflammatory back pain that had been attributed to obesity. One patient (11.1%) had persistent chronic back pain. In all nine cases, patients reported back pain onset or pattern (intensity or night pain) change after BS (mean time 14.7 ± 18 months). In addition, 8 of them (88.9%) were human leukocyte antigen (HLA)-B27 positive. All nine patients could be classified according to ASAS criteria as ax-SpA and five (55.6%) patients were classified as AS, according to the mNY criteria. CONCLUSION Our data highlight a temporal link between SpA onset symptoms and the BS, suggesting a possible causal plausibility between the two events.
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Affiliation(s)
- Thauana Luiza de Oliveira
- Rheumatology Division, Spondyloarthritis Section, Universidade Federal de São Paulo, Rua Leandro Dupré, 204, Conjunto 74, Vila Clementino, São Paulo, SP, CEP 04025-010, Brazil.
| | | | - Marcelo M Pinheiro
- Rheumatology Division, Spondyloarthritis Section, Universidade Federal de São Paulo, Rua Leandro Dupré, 204, Conjunto 74, Vila Clementino, São Paulo, SP, CEP 04025-010, Brazil
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Liakopoulos V, Franzén S, Svensson AM, Miftaraj M, Ottosson J, Näslund I, Gudbjörnsdottir S, Eliasson B. Pros and cons of gastric bypass surgery in individuals with obesity and type 2 diabetes: nationwide, matched, observational cohort study. BMJ Open 2019; 9:e023882. [PMID: 30782717 PMCID: PMC6340417 DOI: 10.1136/bmjopen-2018-023882] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Long-term effects of gastric bypass (GBP) surgery have been presented in observational and randomised studies, but there are only limited data for persons with obesity and type 2 diabetes mellitus (T2DM) regarding postoperative complications. DESIGN This is a nationwide observational study based on two quality registers in Sweden (National Diabetes Register, NDR and Scandinavian Obesity Surgery Register, SOReg) and other national databases. SETTING After merging the data, we matched individuals with T2DM who had undergone GBP with those not surgically treated for obesity on propensity score, based on sex, age, body mass index (BMI) and calendar time. The risks of postoperative outcomes (rehospitalisations) were assessed using Cox regression models. PARTICIPANTS We identified 5321 patients with T2DM in the SOReg and 5321 matched controls in the NDR, aged 18-65 years, with BMI >27.5 kg/m² and followed for up to 9 years. PRIMARY AND SECONDARY OUTCOME MEASURES We assessed risks for all-cause mortality and hospitalisations for cardiovascular disease, severe kidney disease, along with surgical and other medical conditions. RESULTS The results agree with the previously suggested lower risks of all-cause mortality (49%) and cardiovascular disease (34%), and we also found positive effects for severe kidney disease but significantly increased risks (twofold to ninefold) of several short-term complications after GBP, such as abdominal pain and gastrointestinal conditions, frequently requiring surgical procedures, apart from reconstructive plastic surgery. Long-term, the risk of anaemia was 92% higher, malnutrition developed approximately three times as often, psychiatric diagnoses were 33% more frequent and alcohol abuse was three times as great as in the control group. CONCLUSIONS This nationwide study confirms the benefits and describes the panorama of adverse events after bariatric surgery in persons with obesity and T2DM. Long-term postoperative monitoring and support, as better selection of patients by appropriate specialists in interdisciplinary settings, should be provided to optimise the outcomes.
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Affiliation(s)
- Vasileios Liakopoulos
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Stefan Franzén
- National Diabetes Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
- Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ann-Marie Svensson
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- National Diabetes Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
| | - Mervete Miftaraj
- National Diabetes Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ingmar Näslund
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Soffia Gudbjörnsdottir
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- National Diabetes Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
| | - Björn Eliasson
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
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Nedeljkovic-Arsenovic O, Banovic M, Radenkovic D, Rancic N, Polovina S, Micic D, Nedeljkovic I. The Amount of Weight Loss Six Months after Bariatric Surgery: It Makes a Difference. Obes Facts 2019; 12:281-290. [PMID: 31104054 PMCID: PMC6696766 DOI: 10.1159/000499387] [Citation(s) in RCA: 14] [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: 02/01/2019] [Accepted: 03/05/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Bariatric surgery, especially Roux-en-Y gastric bypass (RYGB), has become the most frequently used therapy for morbid obesity. OBJECTIVES The aim of this study was to examine the effects of surgically induced weight loss on cardiopulmonary function 6 months after the procedure, as well as the effect of such an intervention on well-known risk factors for cardiovascular diseases. METHODS This is a cross-sectional study on 66 morbidly obese patients (BMI ≥40 or ≥35 kg/m2 with present comorbidities), comparing their cardiopulmonary function prior to and 6 months after RYGB surgery. RESULTS The substantial amount of weight loss (29.80 ± 13.27 kg) after RYGB surgery was associated with significant reduction of comorbidities, especially diabetes and sedentary lifestyle (p = 0.005 and p = 0.002, respectively). Regarding functional capacity, there was significant increase in peak oxygen uptake (VO2 peak, p = 0.003), duration of exercise testing, metabolic equivalents (exercise time and METs, p < 0.001), and in peak O2 pulse. These findings were particularly pronounced in a group of patients who had lost more than 18% of initial weight. CONCLUSIONS Reduction of body weight after RYGB surgery is associated with significantly improved cardiorespiratory function 6 months after surgery, especially in patients who lost more than 18% of their initial body weight. In addition, substantial decreases in body weight were also associated with a reduction of cardiovascular risk factors such as diabetes, smoking, hypertriglyceridemia, and sedentary lifestyle.
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Affiliation(s)
| | - Marko Banovic
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinical Center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - Dejan Radenkovic
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinical Center of Serbia, Department of Digestive Surgery, Belgrade, Serbia
| | - Nemanja Rancic
- Centre for Clinical Pharmacology, Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Snezana Polovina
- Clinical Center of Serbia, Department of Endocrinology, Belgrade, Serbia
- Faculty of Pharmacy, University of Novi Sad, Novi Sad, Serbia
| | - Dragan Micic
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinical Center of Serbia, Department of Endocrinology, Belgrade, Serbia
| | - Ivana Nedeljkovic
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinical Center of Serbia, Department of Cardiology, Belgrade, Serbia
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81
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The Relationship Between Histopathologic Findings and Body Mass Index in Sleeve Gastrectomy Materials. Obes Surg 2019. [DOI: 10.1007/s11695-018-3518-z
expr 973038445 + 868490687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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82
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Ohira M, Yamaguchi T, Saiki A, Nakamura S, Tanaka S, Oka R, Watanabe Y, Sato Y, Oshiro T, Murano T, Tatsuno I. Laparoscopic Sleeve Gastrectomy Significantly Increases Serum Lipoprotein Lipase Level in Obese Patients. Obes Facts 2019; 12:357-368. [PMID: 31167211 PMCID: PMC6696888 DOI: 10.1159/000500360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/15/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Obesity is one of the causes of metabolic disorders. Laparoscopic sleeve gastrectomy (LSG) confers beneficial effects not only on body weight (BW) but also on metabolic disorders. The lipoprotein lipase (LPL) level in preheparin serum is associated with visceral adipose tissue and reflects insulin resistance. However, the change in serum preheparin LPL levels after LSG remains unclear. This study aimed to examine the effect of LSG on preheparin LPL level in obese patients compared with nonsurgical treatment. METHODS We retrospectively reviewed a total of 100 obese patients who were treated for obesity and had preheparin LPL levels measured before and 12 months after LSG or after 12 months of nonsurgical treatment. Fifty-six patients received LSG (LSG group), and 44 patients had no surgical treatment (nonsurgical group). We compared clinical parameters such as body mass index (BMI), hemoglobin A1c (HbA1c), and preheparin LPL level before and 12 months after treatment. RESULTS BMI and HbA1c decreased significantly in both groups, but decreases in both parameters were greater in the LSG group than in the nonsurgical group. Estimated glomerular filtration was significantly improved only in the LSG group. Preheparin LPL level increased significantly only in the LSG group (from 45.8 ± 21.6 to 75.0 ± 34.9 ng/mL, p < 0.001). Multiple regression identified LSG and decreased BMI as independent predictors of preheparin LPL level increase. CONCLUSIONS These results suggest that LSG independently increases pre-heparin LPL level beyond BW reduction in obese patients.
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Affiliation(s)
- Masahiro Ohira
- Center for Diabetes, Endocrinology, and Metabolism, Toho University Sakura Medical Center, Chiba, Japan,
| | - Takashi Yamaguchi
- Center for Diabetes, Endocrinology, and Metabolism, Toho University Sakura Medical Center, Chiba, Japan
| | - Atsuhito Saiki
- Center for Diabetes, Endocrinology, and Metabolism, Toho University Sakura Medical Center, Chiba, Japan
| | - Shoko Nakamura
- Center for Diabetes, Endocrinology, and Metabolism, Toho University Sakura Medical Center, Chiba, Japan
| | - Shou Tanaka
- Center for Diabetes, Endocrinology, and Metabolism, Toho University Sakura Medical Center, Chiba, Japan
| | - Rena Oka
- Center for Diabetes, Endocrinology, and Metabolism, Toho University Sakura Medical Center, Chiba, Japan
| | - Yasuhiro Watanabe
- Center for Diabetes, Endocrinology, and Metabolism, Toho University Sakura Medical Center, Chiba, Japan
| | - Yuta Sato
- Center for Diabetes, Endocrinology, and Metabolism, Toho University Sakura Medical Center, Chiba, Japan
| | - Takashi Oshiro
- Department of Surgery, Toho University Sakura Medical Center, Chiba, Japan
| | - Takeyoshi Murano
- Department of Clinical Laboratory Medicine, Toho University Sakura Medical Center, Chiba, Japan
| | - Ichiro Tatsuno
- Center for Diabetes, Endocrinology, and Metabolism, Toho University Sakura Medical Center, Chiba, Japan
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83
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Pérez-Pevida B, Escalada J, Miras AD, Frühbeck G. Mechanisms Underlying Type 2 Diabetes Remission After Metabolic Surgery. Front Endocrinol (Lausanne) 2019; 10:641. [PMID: 31608010 PMCID: PMC6761227 DOI: 10.3389/fendo.2019.00641] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 09/04/2019] [Indexed: 01/19/2023] Open
Abstract
Type 2 diabetes prevalence is increasing dramatically worldwide. Metabolic surgery is the most effective treatment for selected patients with diabetes and/or obesity. When compared to intensive medical therapy and lifestyle intervention, metabolic surgery has shown superiority in achieving glycemic improvement, reducing number of medications and cardiovascular risk factors, which translates in long-term benefits on cardiovascular morbidity and mortality. The mechanisms underlying diabetes improvement after metabolic surgery have not yet been clearly understood but englobe a complex interaction among improvements in beta cell function and insulin secretion, insulin sensitivity, intestinal gluconeogenesis, changes in glucose utilization, and absorption by the gut and changes in the secretory pattern and morphology of adipose tissue. These are achieved through different mediators which include an enhancement in gut hormones release, especially, glucagon-like peptide 1, changes in bile acids circulation, gut microbiome, and glucose transporters expression. Therefore, this review aims to provide a comprehensive appraisal of what is known so far to better understand the mechanisms through which metabolic surgery improves glycemic control facilitating future research in the field.
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Affiliation(s)
- Belén Pérez-Pevida
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, Hammersmith Campus, London, United Kingdom
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
- *Correspondence: Belén Pérez-Pevida
| | - Javier Escalada
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
- Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), ISCIII, Pamplona, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Alexander D. Miras
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, Hammersmith Campus, London, United Kingdom
| | - Gema Frühbeck
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
- Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), ISCIII, Pamplona, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Gema Frühbeck
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84
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Ahechu P, Zozaya G, Martí P, Hernández-Lizoáin JL, Baixauli J, Unamuno X, Frühbeck G, Catalán V. NLRP3 Inflammasome: A Possible Link Between Obesity-Associated Low-Grade Chronic Inflammation and Colorectal Cancer Development. Front Immunol 2018; 9:2918. [PMID: 30619282 PMCID: PMC6297839 DOI: 10.3389/fimmu.2018.02918] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/28/2018] [Indexed: 02/06/2023] Open
Abstract
Emerging evidence reveals that adipose tissue-associated inflammation is a main mechanism whereby obesity promotes colorectal cancer risk and progression. Increased inflammasome activity in adipose tissue has been proposed as an important mediator of obesity-induced inflammation and insulin resistance development. Chronic inflammation in tumor microenvironments has a great impact on tumor development and immunity, representing a key factor in the response to therapy. In this context, the inflammasomes, main components of the innate immune system, play an important role in cancer development showing tumor promoting or tumor suppressive actions depending on the type of tumor, the specific inflammasome involved, and the downstream effector molecules. The inflammasomes are large multiprotein complexes with the capacity to regulate the activation of caspase-1. In turn, caspase-1 enhances the proteolytic cleavage and the secretion of the inflammatory cytokines interleukin (IL)-1β and IL-18, leading to infiltration of more immune cells and resulting in the generation and maintenance of an inflammatory microenvironment surrounding cancer cells. The inflammasomes also regulate pyroptosis, a rapid and inflammation-associated form of cell death. Recent studies indicate that the inflammasomes can be activated by fatty acids and high glucose levels linking metabolic danger signals to the activation of inflammation and cancer development. These data suggest that activation of the inflammasomes may represent a crucial step in the obesity-associated cancer development. This review will also focus on the potential of inflammasome-activated pathways to develop new therapeutic strategies for the prevention and treatment of obesity-associated colorectal cancer development.
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Affiliation(s)
- Patricia Ahechu
- Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Gabriel Zozaya
- Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Pablo Martí
- Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Jorge Baixauli
- Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Xabier Unamuno
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Pamplona, Spain
| | - Gema Frühbeck
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Pamplona, Spain.,Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.,Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - Victoria Catalán
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Pamplona, Spain.,Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
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85
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Wei JH, Lee WJ, Chong K, Lee YC, Chen SC, Huang PH, Lin SJ. High Incidence of Secondary Hyperparathyroidism in Bariatric Patients: Comparing Different Procedures. Obes Surg 2018; 28:798-804. [PMID: 28921422 DOI: 10.1007/s11695-017-2932-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bariatric surgery is an effective therapy for morbid obesity but may reduce calcium absorption and significantly decrease the bone mineral density. This study examined the prevalence of secondary hyperparathyroidism (SHPT) in obese subjects during follow-up after different bariatric surgeries. We investigated predictors of SHPT. METHODS We enrolled 1470 obese subjects undergoing bariatric/metabolic surgery with at least 1-year follow-up, including 322 patients undergoing Roux-en-Y gastric bypass (RYGB), 695 undergoing single anastomosis (mini-) gastric bypass (SAGB), 93 undergoing laparoscopic adjustable gastric banding (LAGB), and 360 undergoing sleeve gastrectomy (SG). Five years of data were available for 215 patients. Patients were instructed to supplement their diet according to the guideline. Calcium, parathyroid hormone (PTH), and vitamin D levels were measured before surgery and at 1 and 5 years after surgery. SHPT was defined as PTH > 69 pg/mL. RESULTS The overall prevalence of SHPT was high, 21.0% before surgery and was not different between patients with different bariatric procedures. Pre-operative PTH correlated with age, BMI, and vitamin D levels. Multi-variate analysis confirmed that vitamin D level was the only independent predictor of SHPT before surgery. The prevalence of SHPT increased to 35.4% at 1 year after surgery and 63.3% at 5 years after surgery. SAGB had the highest prevalence of SHPT (50.6%) followed by RYGB (33.2%), LAGB (25.8%), and SG (17.8%) at 1 year after surgery. At 5 years after surgery, SAGB still had the highest prevalence of SHPT (73.6%), followed by RYGB (56.6%), LAGB (38.5%), and SG (41.7%). Serum PTH at 1 year after surgery correlated with decreased BMI and weight loss. Multi-variate analysis confirmed that age, sex, calcium level, and bypass procedure were independent predictor of SHPT after surgery. CONCLUSIONS The prevalence of SHPT is high in morbidly obese patients before bariatric surgery which is related to vitamin D deficiency. The prevalence of SHPT increased continually along with the time after bariatric surgery, especially in patients receiving SAGB, followed by RYGB. The supplementation of vitamin D and calcium have to be higher in bypass procedure, especially in malabsorptive procedure.
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Affiliation(s)
- Jih-Hua Wei
- Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan.,Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan.,Department of Nutrition and Health Sciences, School of Healthcare Management, Kai-Nan University, Taoyuan, Taiwan
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Tauoyan, Taiwan, Republic of China.
| | - Keong Chong
- Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Yi-Chih Lee
- Department of International Business, Chien Hsin University of Science and Technology, Taoyuan, Taiwan
| | - Shu-Chun Chen
- Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Tauoyan, Taiwan, Republic of China
| | - Po-Hsun Huang
- Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan.,Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Cardiovascular Medicine, Department of Internal medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shing-Jong Lin
- Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan.,Division of Cardiovascular Medicine, Department of Internal medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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86
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Ulrich CM, Himbert C, Holowatyj AN, Hursting SD. Energy balance and gastrointestinal cancer: risk, interventions, outcomes and mechanisms. Nat Rev Gastroenterol Hepatol 2018; 15:683-698. [PMID: 30158569 PMCID: PMC6500387 DOI: 10.1038/s41575-018-0053-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Obesity increases the risk of multiple gastrointestinal cancers and worsens disease outcomes. Conversely, strong inverse associations have emerged between physical activity and colon cancer and possibly other gastrointestinal malignancies. The effect of weight loss interventions - such as modifications of diet and/or physical activity or bariatric surgery - remains unclear in patients who are obese and have gastrointestinal cancer, although large clinical trials are underway. Human intervention studies have already shed light on potential mechanisms underlying the energy balance-cancer relationship, with preclinical models supporting emerging pathway effects. Central to interventions that reduce obesity or increase physical activity are pluripotent cancer-preventive effects (including reduced systemic and adipose tissue inflammation and angiogenesis, altered adipokine levels and improved insulin resistance) that directly interface with the hallmarks of cancer. Other mechanisms, such as DNA repair, oxidative stress and telomere length, immune function, effects on cancer stem cells and the microbiome, could also contribute to energy balance effects on gastrointestinal cancers. Although some mechanisms are well understood (for instance, systemic effects on inflammation and insulin signalling), other areas remain unclear. The current state of knowledge supports the need to better integrate mechanistic approaches with preclinical and human studies to develop effective, personalized diet and exercise interventions to reduce the burden of obesity on gastrointestinal cancer.
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Affiliation(s)
- Cornelia M. Ulrich
- Huntsman Cancer Institute, Salt Lake City, UT, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.,
| | - Caroline Himbert
- Huntsman Cancer Institute, Salt Lake City, UT, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Andreana N. Holowatyj
- Huntsman Cancer Institute, Salt Lake City, UT, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Stephen D. Hursting
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA.,UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
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87
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Frühbeck G, Gómez-Ambrosi J, Rodríguez A, Ramírez B, Valentí V, Moncada R, Becerril S, Unamuno X, Silva C, Salvador J, Catalán V. Novel protective role of kallistatin in obesity by limiting adipose tissue low grade inflammation and oxidative stress. Metabolism 2018; 87:123-135. [PMID: 29679615 DOI: 10.1016/j.metabol.2018.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/19/2018] [Accepted: 04/09/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Kallistatin plays an important role in the inhibition of inflammation, oxidative stress, fibrosis and angiogenesis. We aimed to determine the impact of kallistatin on obesity and its associated metabolic alterations as well as its role in adipocyte inflammation and oxidative stress. METHODS Samples obtained from 95 subjects were used in a case-control study. Circulating concentrations and expression levels of kallistatin as well as key inflammation, oxidative stress and extracellular matrix remodelling-related genes were analyzed. Circulating kallistatin concentrations were measured before and after weight loss achieved by Roux-en-Y gastric bypass (RYGB). The impact of kallistatin on lipopolysaccharide (LPS)- and tumour necrosis factor (TNF)-α-mediated inflammatory as well as oxidative stress signalling pathways was evaluated. RESULTS We show that the reduced (P < 0.00001) circulating levels of kallistatin in obese patients increased (P < 0.00001) after RYGB. Moreover, gene expression levels of SERPINA4, the gene coding for kallistatin, were downregulated (P < 0.01) in the liver from obese subjects with non-alcoholic fatty liver disease. Additionally, we revealed that kallistatin reduced (P < 0.05) the expression of inflammation-related genes (CCL2, IL1B, IL6, IL8, TNFA, TGFB) and, conversely, upregulated (P < 0.05) mRNA levels of ADIPOQ and KLF4 in human adipocytes in culture. Kallistatin inhibited (P < 0.05) LPS- and TNF-α-induced inflammation in human adipocytes via downregulating the expression and secretion of key inflammatory markers. Furthermore, kallistatin also blocked (P < 0.05) TNF-α-mediated lipid peroxidation as well as NOX2 and HIF1A expression while stimulating (P < 0.05) the expression of SIRT1 and FOXO1. CONCLUSIONS These findings provide, for the first time, evidence of a novel role of kallistatin in obesity and its associated comorbidities by limiting adipose tissue inflammation and oxidative stress.
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Affiliation(s)
- Gema Frühbeck
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain; Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, Pamplona, Spain.
| | - Javier Gómez-Ambrosi
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain; Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Amaia Rodríguez
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain; Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Beatriz Ramírez
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain; Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Víctor Valentí
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain; Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Rafael Moncada
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain; Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; Department of Anesthesia, Clínica Universidad de Navarra, Pamplona, Spain
| | - Sara Becerril
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain
| | - Xabier Unamuno
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain
| | - Camilo Silva
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain; Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - Javier Salvador
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain; Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - Victoria Catalán
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain; Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
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88
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Adalı Y, Binnetoğlu K, Eroğlu HA, Kaya N, Güvendi GF. The Relationship Between Histopathologic Findings and Body Mass Index in Sleeve Gastrectomy Materials. Obes Surg 2018; 29:277-280. [DOI: 10.1007/s11695-018-3518-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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89
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Carbone F, Montecucco F. Novel cardiovascular risk biomarkers in carotid atherogenesis. Biomark Med 2018; 12:1065-1067. [PMID: 30227729 DOI: 10.2217/bmm-2018-0198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genova 10 Largo Benzi, 16132, Genoa, Italy & Center of Excellence for Biomedical Research (CEBR), University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
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90
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Examination of the Effectiveness of a Brief, Adapted Dialectical Behavior Therapy-Skills Training Group for Bariatric Surgical Candidates. Obes Surg 2018; 29:252-261. [DOI: 10.1007/s11695-018-3515-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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91
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Tanaka S, Kanazawa I, Sugimoto T. Visceral fat accumulation is associated with increased plasma sphingosine-1-phosphate levels in type 2 diabetes mellitus. Diabetes Res Clin Pract 2018; 143:146-150. [PMID: 30006309 DOI: 10.1016/j.diabres.2018.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/09/2018] [Accepted: 07/02/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Accumulating evidence has shown that sphingosine-1-phosphate (S1P) plays roles in glucose and fat metabolism. However, the association between plasma S1P levels and fat mass, especially visceral fat mass, remains unknown. METHODS In this cross-sectional study, 80 men with type 2 diabetes mellitus (T2DM) were recruited to investigate the association of plasma S1P levels with body fat parameters. Visceral (VFA) and subcutaneous fat (SFA) areas were evaluated by performing computed tomography scan, and fat mass (FM) and lean body mass (LBM) were examined by whole body dual-energy X-ray absorptiometry. RESULTS Multiple regression analysis adjusted for age, T2DM duration, serum creatinine, and body mass index (BMI) showed that S1P was significantly and positively associated with fasting plasma glucose (β = 0.25, p = 0.027), HbA1c (β = 0.28, p = 0.012), and urine C-peptide (β = 0.29, p = 0.014). Moreover, multiple regression analysis adjusted for age, T2DM duration, serum creatinine, HbA1c, and urine C-peptide showed that BMI (β = 0.32, p = 0.008), VFA (β = 0.33, p = 0.008), SFA (β = 0.26, p = 0.039), FM (β = 0.37, p = 0.003), and LBM (β = 0.35, p = 0.01). FM was significantly and positively associated with S1P after additional adjustment for LBM (β = 0.29, p = 0.028), whereas LBM was not after adjustment for FM. Moreover, VFA was significantly and positively associated with S1P after additional adjustment for SFA (β = 0.27, p = 0.039), whereas SFA was not after adjustment for VFA. CONCLUSION This is the first study to show that increased plasma S1P levels are associated with blood glucose levels and accumulation of fat mass, especially visceral fat mass, in men with T2DM.
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Affiliation(s)
- Sayuri Tanaka
- Department of Internal Medicine 1, Shimane University Faculty of Medicine, Shimane 693-8501, Japan
| | - Ippei Kanazawa
- Department of Internal Medicine 1, Shimane University Faculty of Medicine, Shimane 693-8501, Japan.
| | - Toshitsugu Sugimoto
- Department of Internal Medicine 1, Shimane University Faculty of Medicine, Shimane 693-8501, Japan
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Unamuno X, Gómez-Ambrosi J, Rodríguez A, Becerril S, Frühbeck G, Catalán V. Adipokine dysregulation and adipose tissue inflammation in human obesity. Eur J Clin Invest 2018; 48:e12997. [PMID: 29995306 DOI: 10.1111/eci.12997] [Citation(s) in RCA: 349] [Impact Index Per Article: 58.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 07/10/2018] [Indexed: 12/13/2022]
Abstract
Obesity, a worldwide epidemic, confers increased risk for multiple serious conditions, including type 2 diabetes, cardiovascular diseases, nonalcoholic fatty liver disease and cancer. Adipose tissue is considered one of the largest endocrine organs in the body as well as an active tissue for cellular reactions and metabolic homeostasis rather than an inert tissue for energy storage. The functional pleiotropism of adipose tissue relies on its ability to synthesize and release a large number of hormones, cytokines, extracellular matrix proteins and growth and vasoactive factors, collectively termed adipokines that influence a variety of physiological and pathophysiological processes. In the obese state, excessive visceral fat accumulation causes adipose tissue dysfunctionality that strongly contributes to the onset of obesity-related comorbidities. The mechanisms underlying adipose tissue dysfunction include adipocyte hypertrophy and hyperplasia, increased inflammation, impaired extracellular matrix remodelling and fibrosis together with an altered secretion of adipokines. This review describes how adipose tissue becomes inflamed in obesity and summarizes key players and molecular mechanisms involved in adipose inflammation.
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Affiliation(s)
- Xabier Unamuno
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain
| | - Javier Gómez-Ambrosi
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain.,Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Amaia Rodríguez
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain.,Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Sara Becerril
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain.,Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Gema Frühbeck
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain.,Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - Victoria Catalán
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain.,Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
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93
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Abstract
Purpose of review The obesity epidemic is a global health crisis of staggering proportion. Excess body weight is a major risk factor for the development of cardiovascular disease (CVD). We review temporal trends in obesity rates, pertinent pathophysiology to understand mechanisms of disease, and treatment strategies in the context of reducing cardiovascular risk. Recent findings The prevalence of obesity is increasing in recent decades and is driven by a complex interplay of economic, environmental, and biological factors. In developed countries, changes in foodintake, such as increased consumption of energy-dense and added sugar have contributed significantly to weight gain. Single nucleotide variations in genes and alterations in the gut microbiome have been associated with the obese phenotype. The description of an obesity paradox in patients with CVD may have several explanations, including limitations of body mass index (BMI) to assess adiposity, selection bias, and lead-time bias with earlier onset of disease. Evidence-based treatments for weight loss include lifestyle intervention, pharmacotherapy, and bariatric surgery. Data on the long-term effects of these therapies on cardiovascular risk are limited. Summary Overweight and obesity are associated with increased cardiovascular morbidity and mortality over the lifespan. Despite our increasing understanding of biological and environmental drivers of obesity, more work is needed in developing effective prevention strategies and implementation of evidence-based treatments to promote cardiovascular health and reduce cardiovascular risk. Ultimately, efforts to prevent and postpone cardiovascular morbidity should include focus on maintenance of normal BMI (primordial prevention) for a longer and healthier life, free of CVD.
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94
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Antioxidant Status in the Soleus Muscle of Sprague-Dawley Rats in Relation to Duodenal-Jejunal Omega Switch and Different Dietary Patterns. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:3795070. [PMID: 30116479 PMCID: PMC6079358 DOI: 10.1155/2018/3795070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 06/05/2018] [Indexed: 12/17/2022]
Abstract
Background Obesity and chronic ingestion of lipid-rich meals are related to an enhanced oxidative stress (OS). Aims To examine the influence of duodenal-jejunal omega switch surgery in combination with different diets on the antioxidative status in the soleus muscle of rats. Methods After 8 weeks on a high-fat diet (HF) or control diet (CD), rats underwent duodenal-jejunal omega switch (DJOS) or SHAM (control) surgery. After surgery, for the next 8 weeks, half of DJOS/SHAM animals were kept on the same diet as before, and half had a changed diet. The total superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione-S-transferase (GST), and glutathione reductase (GR) activity as well as malondialdehyde (MDA) concentration were measured in the soleus of rats. Results CAT and GPx activity were significantly lower after DJOS surgery versus SHAM, regardless of the type of diet. The activity of CAT, SOD, GR, CuZnSOD, and GPx was altered in the CD/HF or HF/CD groups. After DJOS, the lowest muscle concentration of MDA was observed in the CD/CD group and the highest in CD/HF. Conclusions DJOS surgery significantly decreases the antioxidative system in soleus muscles of rats. CD/HF and HF/CD dietary patterns lead to an increase in antioxidative activity, while remaining on unchanged diet (CD or HF) is associated with a reduced oxidative stress.
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95
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Persson PB, Bondke Persson A. Metabolism, obesity and the metabolic syndrome. Acta Physiol (Oxf) 2018; 223:e13096. [PMID: 29754459 DOI: 10.1111/apha.13096] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- P. B. Persson
- Charité - Universitätsmedizin Berlin; Humboldt-Universität zu Berlin, and Berlin Institute of Health; Institute of Vegetative Physiology; Berlin Germany
| | - A. Bondke Persson
- Charité - Universitätsmedizin Berlin; Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Germany
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96
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Laurent I, Tang S, Astère M, Wang KR, Deng S, Xiao L, Li QF. Liquid L-thyroxine versus tablet L-thyroxine in patients on L- thyroxine replacement or suppressive therapy: a meta-analysis. Endocrine 2018; 61:28-35. [PMID: 29572710 DOI: 10.1007/s12020-018-1574-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/04/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE To compare the effectiveness of liquid L-T4 (L-thyroxine) and tablet L-T4 in patients on L-T4 replacement or suppressive therapy. METHODS The Cochrane Library, PubMed, Embase, and Web of Science databases were searched to identify relevant articles. All prospective or randomized controlled studies (RCTs) comparing liquid L-T4 and tablet L-T4 in patients on L-T4 replacement or suppressive therapy were included in the analysis. RESULTS Overall, the initial search of the four databases identified 1278 published studies; of these, eight studies were ultimately included in the meta-analysis. TSH (thyroid stimulating hormone) levels were significantly suppressed in patients on liquid L-T4 compared with those on tablet L-T4, in patients on L-T4 suppressive therapy with L-T4 malabsorption (Mean Difference (MD) = -2.26, 95% Confidence Interval (CI): -3.59, -0.93; P = 0.0009)). However, liquid L-T4 and tablet L-T4 did not show a statistically significant difference in patients on L-T4 suppressive therapy without malabsorption (MD = 0.08, 95% CI: -0.31, 0.47; P = 0.69). TSH levels were significantly normalized in patients on liquid L-T4 compared with those on tablet L-T4, in Patients on L-T4 replacement therapy with L-T4 malabsorption (MD = -3.20, 95% CI: -5.08, -1.32; P = 0.0009). However, liquid L-T4 and tablet L-T4 did not show a statistically significant difference in patients on L-T4 replacement therapy without malabsorption (MD = 0.91, 95% CI: -0.03, 1.86; P = 0.06). CONCLUSION Liquid L-T4 is more efficient than tablet L-T4 in patients on L-T4 replacement or suppressive therapy with malabsorption. No significant differences were observed in patients without malabsorption. Further studies should be conducted to verify these findings.
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Affiliation(s)
- Irakoze Laurent
- Department of Endocrinology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Kabezi Hospital, Ministry of Public Health and Fighting AIDS, Kabezi, Burundi
| | - Siying Tang
- Department of Endocrinology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Manirakiza Astère
- Department of Oncology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kan Ran Wang
- Department of Endocrinology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shuhua Deng
- Department of Endocrinology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ling Xiao
- Department of Nursing, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Fu Li
- Department of Endocrinology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Alukaidey S, Heerasing N. Editorial: de novo inflammatory bowel disease following bariatric surgery-potential implications for research and clinical practice. Aliment Pharmacol Ther 2018; 47:1539-1540. [PMID: 29878431 DOI: 10.1111/apt.14611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- S Alukaidey
- University Hospital Geelong, Geelong, Victoria, Australia
| | - N Heerasing
- University Hospital Geelong, Geelong, Victoria, Australia.,Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon
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98
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Downregulation of lncRNA MALAT1 contributes to renal functional improvement after duodenal-jejunal bypass in a diabetic rat model. J Physiol Biochem 2018; 74:431-439. [DOI: 10.1007/s13105-018-0636-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 05/01/2018] [Indexed: 02/07/2023]
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99
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Sherf-Dagan S, Schechter L, Lapidus R, Sakran N, Goitein D, Raziel A. Perceptions of Success in Bariatric Surgery: a Nationwide Survey Among Medical Professionals. Obes Surg 2018; 28:135-141. [PMID: 28695458 DOI: 10.1007/s11695-017-2800-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Various definitions for bariatric surgery (BS) success exist, with weight loss and comorbidity resolution outcomes being the most prominent. The study's aim was to compare how various healthcare professionals perceive success in BS. METHODS A 29-item, 10-point Likert scale online survey was distributed via email to Israeli healthcare professionals involved in the different BS aspects using common national professional organizations. These included bariatric surgeons, dietitians, social workers, psychologists, psychiatrists, primary care physicians, gastroenterologists, and nurses. Statement relevancy to BS success was rated. An item was classed as "very important" for BS success if at least 70% of participants rated it 8 or higher in each subgroup. Inter-observer agreement was calculated using kappa statistics. Data on specific occupation, years-in-practice, and major workplace were collected as well. RESULTS A total of 155 responses was obtained. The majority of respondents were dietitians (34.8%, n = 54), followed by bariatric surgeons (31.0%, n = 48) and nurses (14.8%, n = 23). Most respondents work mainly at public hospitals (32.9%, n = 51), followed by private hospitals (26.5%, n = 41). The mean years-in-practice among all healthcare professionals was 8.5 ± 8.5 years. Overall inter-observer agreement for prioritized items in accordance to BS success among all health professional subgroups was fair (Fleiss kappa = 0.278, P < 0.001), while dietitians and mental health specialists showed the highest agreement rate (Cohen's kappa = 0.592, P < 0.001). CONCLUSION The study highlights the various views on defining BS success by different healthcare professionals, although there was some overlap of core outcomes prioritized by all professionals. International uniform definitions for BS success are required.
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Affiliation(s)
- Shiri Sherf-Dagan
- Department of Nutrition, Assuta Medical Center, 20 Habarzel St, 69710, Tel Aviv, Israel.
| | - Lihi Schechter
- Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Rita Lapidus
- Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Nasser Sakran
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel.,Department of Surgery A, Emek Medical Center, Afula, Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - David Goitein
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel.,Department of Surgery C, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Asnat Raziel
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel
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100
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Broström A, Pakpour AH, Ulander M, Nilsen P. Development and psychometric evaluation of the Swedish propensity to achieve healthy lifestyle scale in patients with hypertension. J Clin Nurs 2018; 27:4040-4049. [PMID: 29776007 DOI: 10.1111/jocn.14535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To develop and validate a Swedish questionnaire to measure propensity for behaviour change regarding food habits, physical activity and weight reduction in patients with hypertension. DESIGN Cross-sectional design. METHODS A total of 270 consecutive patients with hypertension diagnosed at four primary care centres in Sweden were included. The 6-item Swedish version of the Propensity to Achieve Healthy Lifestyle Scale (PAHLS) was developed to measure propensity for behaviour change regarding food habits, physical activity and weight reduction. The PAHLS (i.e., including three items for preparedness and three items for capacity) was developed by three multiprofessional researchers inspired by the transtheoretical model of behaviour change in collaboration with clinically active nurses. Data were collected by questionnaires on food habits (i.e., the Food Frequency Questionnaire), physical activity (the International Physical Activity Questionnaire), propensity for a healthy lifestyle (the PHLQ), as well as during a clinical examination. Exploratory (EFA) and confirmatory factor analyses (CFA), as well as Rasch analysis, were used. RESULTS Of the 270 patients (50% women), 27% scored low levels of physical activity on the International Physical Activity Questionnaire, and 34% of the patients were obese (body mass index ≥30 kg/m2 ). The EFA (explaining 54% of the variance) showed unidimensionality for the PAHLS that was supported by both CFA and Rasch analyses. No floor and 1.9% ceiling effects were found. Multiple group CFA (an extension of structural equation modelling) showed that the PAHLS operated equivalently across both male and female patients. Internal consistency (Cronbach's alpha 0.83) and composite reliability (0.89) were good. CONCLUSION The initial testing of PAHLS provided good validity and reliability scores to measure propensity for behaviour change in patients with hypertension. RELEVANCE TO CLINICAL PRACTICE The PAHLS can be used by nurses as a tool to simplify shared decision-making in relation to behavioural changes.
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Affiliation(s)
- Anders Broström
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden
| | - Amir H Pakpour
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Martin Ulander
- Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.,Department of Clinical and Experimental Medicine, Division of Clinical Neurophysiology, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Per Nilsen
- Division of Social Medicine and Public Health Science, Department of Health and Society, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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