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Comparison of Oral Iron Supplement Formulations for Normalization of Iron Status Following Roux-EN-y Gastric Bypass Surgery: a Randomized Trial. Obes Surg 2018; 28:369-377. [PMID: 28779269 DOI: 10.1007/s11695-017-2858-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The evidence behind recommendations for treatment of iron deficiency (ID) following roux-en-y gastric bypass surgery (RYGB) lacks high quality studies. SETTING Academic, United States OBJECTIVE: The objective of the study is to compare the effectiveness of oral iron supplementation using non-heme versus heme iron for treatment of iron deficiency in RYGB patients. METHODS In a randomized, single-blind study, women post-RYGB and iron deficient received non-heme iron (FeSO4, 195 mg/day) or heme iron (heme-iron-polypeptide, HIP, 31.5 to 94.5 mg/day) for 8 weeks. Measures of iron status, including blood concentrations of ferritin, soluble transferrin receptor (sTfR), and hemoglobin, were assessed. RESULTS At baseline, the mean ± standard deviation for age, BMI, and years since surgery of the sample was 41.5 ± 6.8 years, 34.4 ± 5.9 kg/m2, and 6.9 ± 3.1 years, respectively; and there were no differences between FeSO4 (N = 6) or HIP (N = 8) groups. Compliance was greater than 94%. The study was stopped early due to statistical and clinical differences between groups. Values before and after FeSO4 supplementation, expressed as least square means (95% CI) were hemoglobin, 10.8 (9.8, 11.9) to 13.0 (11.9, 14.0) g/dL; sTfR, 2111 (1556, 2864) to 1270 (934, 1737) μg/L; ferritin, 4.9 (3.4, 7.2) to 15.5 (10.6, 22.6) μg/L; and sTfR:ferritin ratio, 542 (273, 1086) to 103 (51, 204); all p < 0.0001. With HIP supplementation, no change was observed in any of the iron status biomarkers (all p > 0.05). CONCLUSIONS In accordance with recommendations, oral supplementation using FeSO4, but not HIP, was efficacious for treatment of iron deficiency after RYGB.
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52
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Forde CG. From perception to ingestion; the role of sensory properties in energy selection, eating behaviour and food intake. Food Qual Prefer 2018. [DOI: 10.1016/j.foodqual.2018.01.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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53
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Hegazy TO, Khalifa I, Elshal M, Fahmy M. The Incidence of Nutritional Derangements in Patients Undergoing Sleeve Gastrectomy. Bariatr Surg Pract Patient Care 2018. [DOI: 10.1089/bari.2018.0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Tarek Osama Hegazy
- Department of General Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Ibrahim Khalifa
- Department of General Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Mohamed Elshal
- Department of General Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Mohamed Fahmy
- Department of General Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
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da Cruz SP, Matos A, Pereira S, Saboya C, da Cruz SP, Ramalho A. Roux-en-Y Gastric Bypass Aggravates Vitamin A Deficiency in the Mother-Child Group. Obes Surg 2018; 28:114-121. [PMID: 28676956 DOI: 10.1007/s11695-017-2791-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The objectives of this study are to compare the nutritional status of vitamin A in women who previously underwent Roux-en-Y gastric bypass (RYGB) who became pregnant or did not, in the same period after surgery, and to assess its effects on mother and child health. METHODOLOGY A retrospective longitudinal study conducted with women who previously underwent RYGB, paired by age and BMI measured before surgery, divided into group 1 (G1) comprising 77 women who did not become pregnant and group 2 (G2) with 39 women in their third gestational trimester. Both groups were assessed before surgery (T0) and in the same interval after surgery: less than or equal to 1 year (T1) or over 1 year (T2), during a maximum of 2 years. Serum concentrations of retinol and β-carotene, night blindness (NB), and gestational and neonatal complications were investigated [urinary tract infection, iron deficiency anemia, hypertensive syndrome of pregnancy, dumping syndrome, birth weight, gestational age at birth (GAB), and correlation between weight and GAB]. Data were analyzed by the Statistical Package for Social Sciences 21.0 (p < 0.05). RESULTS RYGB reduced the serum levels of retinol and β-carotene, especially before the first postsurgical year. When associated with pregnancy, inadequacy rate was 55% higher in T1 and T2. Comparing G1 to G2, we noted that pregnancy in women undergoing RYGB can contribute to increased inadequacy of retinol and β-carotene, reaching a higher percentage of women with NB after 1 postsurgical year. High prevalence of pregnancy/neonatal complications was found in T1 and T2. NB was correlated with inadequacy of β-carotene. CONCLUSION Pregnancy after RYGB aggravates vitamin A deficiency, increases the percentage of NB cases, and can contribute to pregnancy and neonatal complications even in 1 postsurgical year.
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Affiliation(s)
- Sabrina Pereira da Cruz
- School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. .,Center for Research on Micronutrients (NPqM), Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Andréa Matos
- School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Center for Research on Micronutrients (NPqM), Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Silvia Pereira
- School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Center for Research on Micronutrients (NPqM), Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Surgical Clinic Carlos Saboya, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos Saboya
- Center for Research on Micronutrients (NPqM), Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Surgical Clinic Carlos Saboya, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Brazilian Society of Bariatric and Metabolic Surgery, Rio de Janeiro, Brazil
| | - Suelem Pereira da Cruz
- Center for Research on Micronutrients (NPqM), Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andréa Ramalho
- Center for Research on Micronutrients (NPqM), Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Social and Applied Nutrition of the Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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55
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Hewitt S, Aasheim ET, Søvik TT, Jahnsen J, Kristinsson J, Eriksen EF, Mala T. Relationships of serum 25-hydroxyvitamin D, ionized calcium and parathyroid hormone after obesity surgery. Clin Endocrinol (Oxf) 2018; 88:372-379. [PMID: 29235126 DOI: 10.1111/cen.13531] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 12/01/2017] [Accepted: 12/05/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The high prevalence of secondary hyperparathyroidism (SHPT) after obesity surgery is a concern for long-term bone health. Limited knowledge exists about optimal vitamin D and suppression of parathyroid hormone (PTH) after these procedures. The aim of this study was to investigate the prevalence of SHPT and its relation to vitamin D status. DESIGN A cross-sectional study at Oslo University Hospital, Norway. PATIENTS A total of 502 consecutive patients, age 22-64 years, attending 2-year follow-up after Roux-en-Y gastric bypass. MEASUREMENTS A serum intact PTH >7.0 pmol/L in the absence of elevated serum ionized calcium (iCa) was considered as SHPT. Vitamin D status was defined by serum concentrations of 25-hydroxyvitamin D (S-25(OH)D). RESULTS Altogether, 171 patients (34%) had SHPT. The prevalence of SHPT varied across the range of S-25(OH)D (P < 0.001), being highest (71%) with S-25(OH)D < 25 nmol/L. Compared with S-25(OH)D < 50 nmol/L, the prevalence of SHPT was lower with S-25(OH)D ≥ 50 nmol/L (29.0%; RR = 0.64 (95%-CI:0.50-0.81)) and S-25(OH)D ≥ 75 nmol/L (27.7%; RR = 0.61 (95%-CI:0.44-0.84)). S-25(OH)D ≥ 100 nmol/L was associated with the lowest PTH and the lowest prevalence of SHPT (16.0%; RR = 0.35 (95%-CI:0.14-0.88) compared with S-25(OH)D < 50 nmol/L) and the most normal calcium distribution. These associations were most pronounced with iCa in the lower range. A synergistic association was found for S-25(OH)D and iCa on SHPT. CONCLUSIONS Vitamin D deficient patients had the highest prevalence of SHPT 2 years after gastric bypass. PTH and the prevalence of SHPT were notably lower with S-25(OH)D ≥ 100 nmol/L, compared with lower target levels.
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Affiliation(s)
- Stephen Hewitt
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erlend Tuseth Aasheim
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | | | - Jørgen Jahnsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Jon Kristinsson
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - Erik Fink Eriksen
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tom Mala
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
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Kornerup LS, Hvas CL, Abild CB, Richelsen B, Nexo E. Early changes in vitamin B12 uptake and biomarker status following Roux-en-Y gastric bypass and sleeve gastrectomy. Clin Nutr 2018; 38:906-911. [PMID: 29506877 DOI: 10.1016/j.clnu.2018.02.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/16/2018] [Accepted: 02/03/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Bariatric surgery increases the risk of micronutrient deficiencies, including vitamin B12 (B12) deficiency. We analysed early changes in biomarkers of B12 status following bariatric surgery. METHODS We prospectively included adult patients (n = 27) referred for either Roux-en-Y Gastric Bypass (RYGB) (n = 19) or Sleeve Gastrectomy (SG) (n = 8). Blood samples were drawn before surgery and 2 and 6 months following surgery for measurement of B12, holotranscobalamin (holoTC), and methylmalonic acid (MMA). The B12 absorption capacity was estimated from the increase in plasma holoTC two days after a standardised oral B12 challenge. RESULTS B12 status decreased following both RYBG and SG. While a decrease in plasma B12 was not evident until 6 months postoperatively, we observed a statistically significant decrease in plasma holoTC and increase in MMA already 2 months postoperatively. These changes were more pronounced at 6 months post surgery. Correspondingly, the B12 absorption capacity was decreased following surgery. CONCLUSIONS HoloTC and MMA were superior to B12 to detect early changes in B12 status following bariatric surgery. Our data challenge the current concept that liver B12 stores secure long-term maintenance of B12 status. They indicate that B12 treatment in pharmacological doses may be warranted immediately after surgery.
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Affiliation(s)
- L S Kornerup
- Department of Clinical Biochemistry, Aarhus University Hospital, Denmark; Department of Medicine, Regional Hospital Unit West Jutland, Denmark.
| | - C L Hvas
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Denmark
| | - C B Abild
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark
| | - B Richelsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark
| | - E Nexo
- Department of Clinical Biochemistry, Aarhus University Hospital, Denmark
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Guglielmi V, Bellia A, Gentileschi P, Lombardo M, D'Adamo M, Lauro D, Sbraccia P. Parathyroid hormone in surgery-induced weight loss: no glucometabolic effects but potential adaptive response to skeletal loading. Endocrine 2018; 59:288-295. [PMID: 29168114 DOI: 10.1007/s12020-017-1477-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/14/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Increased parathyroid hormone (PTH) is commonly associated with obesity, and its role in the pathogenesis of obesity-related glucometabolic abnormalities is uncertain. We aimed to explore the relationships of PTH with glucose/insulin homeostasis parameters before and after bariatric surgery-induced weight loss, and whether they depend or not on 25-hydroxyvitamin D (25OHD) status. METHODS We included 42 subjects (27 women, aged 40 ± 5 years, BMI 48.5 ± 7.3 kg/m2) without diabetes, chronic kidney disease, or hyperparathyroidism undergoing sleeve gastrectomy. The following parameters were evaluated before and 6 months after surgery: circulating levels of PTH, calcium, phosphorus, 25OHD, leptin, insulin growth factor (IGF)-1; 75-g oral glucose tolerance test to derive measures of insulin sensitivity (ISI) and secretion (Stumvoll index); dual-energy X-ray absorptiometry to assess fat distribution and bone mineral density. RESULTS Weight loss was accompanied by significant reduction of PTH levels (77.9 ± 19.1 vs. 60.5 ± 13.4 pg/ml; p = 0.005), without concomitant modification of 25OHD status. Both baseline PTH and its postoperative percent change resulted associated, with baseline fat mass (β = 0.615, p = 0.003) and its concurrent postoperative reduction (r = 0.419; p = 0.006), but neither with glucose homeostasis parameters nor their respective variations after weight loss. Interestingly, leptin reduction after weight loss was independently related to PTH change (β = 0.396, p = 0.015) and IGF-1 levels (β = 0.176, p = 0.059). CONCLUSIONS Circulating PTH decreases with fat mass reduction independent of 25OHD status, but it is not associated with improvement of insulin resistance and related metabolic parameters. Leptin and PTH may mediate the cross-talk between adipose tissue and parathyroid glands, which possibly contributes to bone adaptation to excess body weight.
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Affiliation(s)
- Valeria Guglielmi
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome Tor Vergata, Rome, Italy
- Obesity Center and Internal Medicine Unit, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Alfonso Bellia
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome Tor Vergata, Rome, Italy.
| | - Paolo Gentileschi
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Mauro Lombardo
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
| | - Monica D'Adamo
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome Tor Vergata, Rome, Italy
- Obesity Center and Internal Medicine Unit, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Davide Lauro
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paolo Sbraccia
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome Tor Vergata, Rome, Italy
- Obesity Center and Internal Medicine Unit, University Hospital Policlinico Tor Vergata, Rome, Italy
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58
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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59
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Pekkarinen T, Mustonen H, Sane T, Jaser N, Juuti A, Leivonen M. Long-Term Effect of Gastric Bypass and Sleeve Gastrectomy on Severe Obesity: Do Preoperative Weight Loss and Binge Eating Behavior Predict the Outcome of Bariatric Surgery? Obes Surg 2017; 26:2161-2167. [PMID: 26843084 DOI: 10.1007/s11695-016-2090-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Few studies have examined weight loss sustainability after sleeve gastrectomy (SG). The purpose of this study was to determine long-term outcome after SG and gastric bypass (GBP) and learn whether preoperative weight loss and binge eating behavior can be used to predict outcome. MATERIALS AND METHODS Together, 257 patients (64 % women) were operated, 163 by GBP and 94 by SG. Binge eating was assessed by binge eating scale (BES) and preoperative weight loss was advised to all, including very low-calorie diet for 5 weeks. Postoperative visits took place at 1 and 2 years, and long-term outcome was at median 5 years (range 2.29-6.85). Multivariate linear regression analysis was used to predict outcome at 2-year and long-term control. RESULTS Median age was 48 years, weight 141.1 kg, and BMI 48.2 kg/m(2). Preoperative weight loss was median 4.9 % before GBP and 3.8 % before SG, P = 0.04. Total weight loss at year one was 24.1 % in GBP and 23.7 % in SG (P = 0.40), at year two 24.4 and 23.4 % (P = 0.26), and at long-term control 23.0 and 20.2 % (P = 0.006), respectively. Weight was analyzed in 93, 88, and 89 % of those alive, respectively. BES did not predict weight outcome, but larger preoperative weight loss predicted less postoperative weight loss at 2 years. CONCLUSION On long term, weight loss was better maintained after GBP compared with SG. Binge eating behavior was not a significant predictor, but larger preoperative weight loss predicted less postoperative weight loss for the next 2 years.
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Affiliation(s)
- Tuula Pekkarinen
- Abdominal Center, Peijas Hospital, Helsinki University Hospital, P.O. Box 900, FIN-00029 HUS, Vantaa, Finland.
| | - Harri Mustonen
- University of Helsinki and Helsinki University Hospital, P.O. Box 440, FIN-00029 HUS, Helsinki, Finland
| | - Timo Sane
- Abdominal Center, Meilahti Hospital, Helsinki University Hospital, P.O. Box 340, FIN-00029 HUS, Helsinki, Finland
| | - Nabil Jaser
- Abdominal Center, Peijas Hospital, Helsinki University Hospital, P.O. Box 900, FIN-00029 HUS, Vantaa, Finland
| | - Anne Juuti
- Abdominal Center, Peijas Hospital, Helsinki University Hospital, P.O. Box 900, FIN-00029 HUS, Vantaa, Finland
| | - Marja Leivonen
- Abdominal Center, Peijas Hospital, Helsinki University Hospital, P.O. Box 900, FIN-00029 HUS, Vantaa, Finland
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60
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Pona AA, Marek RJ, Heinberg LJ, Lavery M, Ashton K, Rish JM. Psychological Correlates of Body Image Dissatisfaction Before and After Bariatric Surgery. Bariatr Surg Pract Patient Care 2017. [DOI: 10.1089/bari.2017.0021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ashleigh A. Pona
- Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri
| | - Ryan J. Marek
- Department of Psychology, Kent State University, Kent, Ohio
| | - Leslie J. Heinberg
- Cleveland Clinic Bariatric and Metabolic Institute, Cleveland, Ohio
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Megan Lavery
- Cleveland Clinic Bariatric and Metabolic Institute, Cleveland, Ohio
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Kathleen Ashton
- Cleveland Clinic Bariatric and Metabolic Institute, Cleveland, Ohio
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Julie Merrell Rish
- Cleveland Clinic Bariatric and Metabolic Institute, Cleveland, Ohio
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
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Thorell A, MacCormick AD, Awad S, Reynolds N, Roulin D, Demartines N, Vignaud M, Alvarez A, Singh PM, Lobo DN. Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations. World J Surg 2017; 40:2065-83. [PMID: 26943657 DOI: 10.1007/s00268-016-3492-3] [Citation(s) in RCA: 327] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND During the last two decades, an increasing number of bariatric surgical procedures have been performed worldwide. There is no consensus regarding optimal perioperative care in bariatric surgery. This review aims to present such a consensus and to provide graded recommendations for elements in an evidence-based "enhanced" perioperative protocol. METHODS The English-language literature between January 1966 and January 2015 was searched, with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohort studies. Selected studies were examined, reviewed and graded. After critical appraisal of these studies, the group of authors reached a consensus recommendation. RESULTS Although for some elements, recommendations are extrapolated from non-bariatric settings (mainly colorectal), most recommendations are based on good-quality trials or meta-analyses of good-quality trials. CONCLUSIONS A comprehensive evidence-based consensus was reached and is presented in this review by the enhanced recovery after surgery (ERAS) Society. The guidelines were endorsed by the International Association for Surgical Metabolism and Nutrition (IASMEN) and based on the evidence available in the literature for each of the elements of the multimodal perioperative care pathway for patients undergoing bariatric surgery.
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Affiliation(s)
- A Thorell
- Karolinska Institutet, Department of Clinical Sciences, Danderyds Hospital & Department of Surgery, Ersta Hospital, 116 91, Stockholm, Sweden.
| | - A D MacCormick
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Department of Surgery, Counties Manukau Health, Auckland, New Zealand
| | - S Awad
- The East-Midlands Bariatric & Metabolic Institute, Derby Teaching Hospitals NHS Foundation Trust, Royal Derby Hospital, Derby, DE22 3NE, UK.,School of Clinical Sciences, University of Nottingham, Nottingham, NG7 2UH, UK
| | - N Reynolds
- The East-Midlands Bariatric & Metabolic Institute, Derby Teaching Hospitals NHS Foundation Trust, Royal Derby Hospital, Derby, DE22 3NE, UK
| | - D Roulin
- Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland
| | - M Vignaud
- Département d'anesthésie reanimation Service de chirurgie digestive, CHU estaing 1, place Lucie et Raymond Aubrac, Clermont Ferrand, France
| | - A Alvarez
- Department of Anesthesia, Hospital Italiano de Buenos Aires, Buenos Aires University, 1179, Buenos Aires, Argentina
| | - P M Singh
- Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - D N Lobo
- Gastrointestinal Surgery, National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
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Cruz S, Matos A, da Cruz SP, Pereira S, Saboya C, Ramalho A. Relationship between the Nutritional Status of Vitamin A per Trimester of Pregnancy with Maternal Anthropometry and Anemia after Roux-en-Y Gastric Bypass. Nutrients 2017; 9:E989. [PMID: 28885564 PMCID: PMC5622749 DOI: 10.3390/nu9090989] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/25/2017] [Accepted: 09/04/2017] [Indexed: 01/03/2023] Open
Abstract
The aim of this study was to compare the nutritional status of vitamin A per trimester of pregnancy, as well as to assess its influence on pre-pregnancy BMI, total gestational weight gain (TGWG) and presence of anemia in women who had previously undergone Roux-en-Y gastric bypass (RYGB). An analytical, longitudinal and retrospective study comprising 30 pregnant women who had previously undergone RYGB was undertaken. In all trimesters of pregnancy, the serum concentrations of retinol, β-carotene, stages of vitamin A deficiency (VAD), night blindness (NB), anemia and anthropometric variables were assessed. VAD in pregnancy affected 90% of women, 86.7% developed NB and 82.8% had mild VAD. TGWG above/below the recommended range was related to the low serum concentrations of β-carotene (p = 0.045) in the second trimester and women with TGWG above the recommended range showed 100% of inadequacy of this nutrient in the third trimester. Among the pregnant women with anemia, 90.9% had VAD and 86.4% had NB. This study highlights the importance of monitoring the nutritional status of vitamin A in prenatal care, due to its relationship with TGWG and the high percentage of VAD and NB found since the beginning of pregnancy. It also reaffirms the use of the cut-off <1.05 μmol/L for determining VAD.
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Affiliation(s)
- Sabrina Cruz
- School of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21.941-902, Brazil.
- Center for Research on Micronutrients (NPqM), Institute of Nutrition Josué de Castro of UFRJ), Rio de Janeiro 21.941-902, Brazil.
| | - Andréa Matos
- School of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21.941-902, Brazil.
- Center for Research on Micronutrients (NPqM), Institute of Nutrition Josué de Castro of UFRJ), Rio de Janeiro 21.941-902, Brazil.
- Fluminense Federal University (UFF), Rio de Janeiro 24.020-150, Brazil.
| | - Suelem Pereira da Cruz
- School of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21.941-902, Brazil.
- Center for Research on Micronutrients (NPqM), Institute of Nutrition Josué de Castro of UFRJ), Rio de Janeiro 21.941-902, Brazil.
| | - Silvia Pereira
- School of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21.941-902, Brazil.
- Center for Research on Micronutrients (NPqM), Institute of Nutrition Josué de Castro of UFRJ), Rio de Janeiro 21.941-902, Brazil.
- Multidisciplinary Center for Bariatric and Metabolic Surgery, Rio de Janeiro 22280-020, Brazil.
| | - Carlos Saboya
- Center for Research on Micronutrients (NPqM), Institute of Nutrition Josué de Castro of UFRJ), Rio de Janeiro 21.941-902, Brazil.
- Multidisciplinary Center for Bariatric and Metabolic Surgery, Rio de Janeiro 22280-020, Brazil.
- Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo 04.021-001, Brazil.
| | - Andréa Ramalho
- Center for Research on Micronutrients (NPqM), Institute of Nutrition Josué de Castro of UFRJ), Rio de Janeiro 21.941-902, Brazil.
- Fundação Oswaldo Cruz (ENSP/FIOCRUZ), Rio de Janeiro 21040-900, Brazil.
- Department of Social and Applied Nutrition of the Institute of Nutrition, UFRJ, Rio de Janeiro 21.941-902, Brazil.
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Coleman KJ, Caparosa SL, Nichols JF, Fujioka K, Koebnick C, McCloskey KN, Xiang AH, Ngor EW, Levy SS. Understanding the Capacity for Exercise in Post-Bariatric Patients. Obes Surg 2017; 27:51-58. [PMID: 27229736 DOI: 10.1007/s11695-016-2240-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE The aim of this study is to conduct a pilot randomized trial testing an exercise program specifically adapted for post-bariatric patients. METHODS A total of 51 post-bariatric patients, 6-24 months post-surgery, were randomly assigned to usual care control (n = 25) or the exercise intervention (n = 26). The intervention included twice weekly 60-min group exercise classes with functional strength, flexibility, and aerobic activities; at least 3 days per week of self-directed exercise; daily pedometer; recording of steps and activities; and weekly telephone counseling. There was also a 6-month maintenance period. RESULTS Patients were 49 ± 12 years old, 84 % female, 59 % non-Hispanic white, with a BMI of 32.9 ± 5.7 kg/m2 and percent excess BMI loss since surgery of 56 ± 35 %. Patients were 14 ± 5 months post-surgery. A total of 44 patients (86 %) completed both phases of the program and all assessments. The following measures improved significantly for intervention participants with no significant change in control participants: yards walked in 6 min, seconds for 8-foot up-and-go, number of arm curls, and distance in inches for chair sit-and-reach. Intervention changes remained after 6 months of maintenance. CONCLUSIONS When compared to patients in usual care, a specially adapted exercise program for post-bariatric patients resulted in significant improvements in objectively monitored health outcomes. This program was delivered in a clinical setting and could be implemented in a variety of settings to improve health outcomes for post-bariatric patients.
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Affiliation(s)
- Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91104, USA.
| | - Susan L Caparosa
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91104, USA
| | - Jeanne F Nichols
- School of Exercise and Nutrition Science, San Diego State University, San Diego, CA, USA.,Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Ken Fujioka
- Nutrition and Metabolic Research Center, Scripps Clinic, La Jolla, CA, USA
| | - Corinna Koebnick
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91104, USA
| | - Kari N McCloskey
- Positive Choice Center, Kaiser Permanente Southern California, San Diego, CA, USA
| | - Anny H Xiang
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91104, USA
| | - Eunis W Ngor
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | - Susan S Levy
- School of Exercise and Nutrition Science, San Diego State University, San Diego, CA, USA
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Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KGMM, Zimmet PZ, Del Prato S, Ji L, Sadikot SM, Herman WH, Amiel SA, Kaplan LM, Taroncher-Oldenburg G, Cummings DE. Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: a Joint Statement by International Diabetes Organizations. Obes Surg 2017; 27:2-21. [PMID: 27957699 DOI: 10.1007/s11695-016-2457-9] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options. AIM The 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, was convened in collaboration with leading diabetes organizations to develop global guidelines to inform clinicians and policymakers about benefits and limitations of metabolic surgery for T2D. METHODS A multidisciplinary group of 48 international clinicians/scholars (75% nonsurgeons), including representatives of leading diabetes organizations, participated in DSS-II. After evidence appraisal (MEDLINE [1 January 2005-30 September 2015]), three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. These drafts were presented at the combined DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes (London, U.K., 28-30 September 2015), where they were open to public comment by other professionals and amended face-to-face by the Expert Committee. RESULTS Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2D. Numerous randomized clinical trials, albeit mostly short/midterm, demonstrate that metabolic surgery achieves excellent glycemic control and reduces cardiovascular risk factors. On the basis of such evidence, metabolic surgery should be recommended to treat T2D in patients with class III obesity (BMI ≥40 kg/m2) and in those with class II obesity (BMI 35.0-39.9 kg/m2) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients with T2D and BMI 30.0-34.9 kg/m2 if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI thresholds should be reduced by 2.5 kg/m2 for Asian patients. CONCLUSIONS Although additional studies are needed to further demonstrate long-term benefits, there is sufficient clinical and mechanistic evidence to support inclusion of metabolic surgery among antidiabetes interventions for people with T2D and obesity. To date, the DSS-II guidelines have been formally endorsed by 45 worldwide medical and scientific societies. Health care regulators should introduce appropriate reimbursement policies.
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Affiliation(s)
| | | | - Robert H Eckel
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Ruiz-Tovar J, Llavero C, Zubiaga L, Boix E. Maintenance of Multivitamin Supplements After Sleeve Gastrectomy. Obes Surg 2017; 26:2324-30. [PMID: 26843085 DOI: 10.1007/s11695-016-2084-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION After all bariatric procedures, multivitamin supplements are uniformly prescribed to minimize eventual deficiencies. These supplements are usually maintained long time, even during the whole life after malabsorptive techniques, while these are maintained at least during 1 year after restrictive procedures. Given that sleeve gastrectomy does not alter intestinal absorption, the supplements are possibly unnecessary, once the patient can take an adequate diet. PATIENTS AND METHODS A prospective randomized study of patients undergoing a laparoscopic sleeve gastrectomy was performed. Patients were randomized into two groups: those patients receiving the multivitamin supplement (Multicentrum, Pfizer, 1 tablet/day) during 3 months (group 1) and those receiving the supplement during 12 months (group 2). Laboratory data were recorded: vitamins (D, B12 and folic acid) and oligoelements (calcium, iron, phosphorus, magnesium and zinc) at 3, 6 and 12 months after surgery. RESULTS Eighty patients were included, 40 in each group. At 3 months, 7.5 % of the patients presented iron deficiency and 2.5 % ferritin one, similarly in both groups, that was corrected with specific extra iron supplements. At 6 months, one patient (2.5 %) in group 1 presented iron deficiency and one in group 2 vitamin D deficiency (NS). At 12 months, only one patient in group 2 presented vitamin D deficiency, treated with specific supplements. CONCLUSION The maintenance of multivitamin supplements more than 3 months postoperatively seems to be of no benefit. It is preferable monitoring laboratory values and adding specific supplements when necessary. CLINICALTRIALS. GOV IDENTIFIER NCT02620137.
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Affiliation(s)
- Jaime Ruiz-Tovar
- Department of Surgery, Bariatric Surgery Unit, University Hospital Rey Juan Carlos, Madrid, Spain.
| | | | - Lorea Zubiaga
- Department of Surgery, Bariatric Surgery Unit, General University Hospital Elche, Alicante, Spain
| | - Evangelina Boix
- Department of Endocrinology, Bariatric Surgery Unit, General University Hospital Elche, Alicante, Spain
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Registered Dietitians' Knowledge of Bariatric Nutrition Recommendations and Practice Implications. TOP CLIN NUTR 2017. [DOI: 10.1097/tin.0000000000000107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Frame-Peterson LA, Megill RD, Carobrese S, Schweitzer M. Nutrient Deficiencies Are Common Prior to Bariatric Surgery. Nutr Clin Pract 2017. [PMID: 28636832 DOI: 10.1177/0884533617712701] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Obesity, defined as a body mass index >30 kg/m2, is a growing worldwide epidemic currently effecting 1 in 10 adults, with rates as high as 40% in the United States. The only proven long-term treatment of severe obesity on a population level is surgical modification of the gastrointestinal anatomy to induce weight loss, termed bariatric surgery. With adequate physician guidance and appropriate candidate criteria, bariatric surgery is an option for effective long-term treatment of obesity and its related comorbidities. Complications of bariatric surgery can be seen in patients who are not compliant to the recommended lifestyle and dietary changes required following bariatric surgery, including nausea, vomiting, dumping syndrome, acid reflux, and nutrition deficiencies. Despite caloric density, the diet of patients prior to bariatric surgery is often of poor nutrition quality and does not meet recommended dietary guidelines for micronutrient intake, making this an at-risk population for micronutrient malnutrition. Currently, improvements are needed in standardization of nutrition assessment as well as micronutrient cutoffs for deficiency and insufficiency. In the meantime, utilizing our current tools to conduct nutrition assessment at baseline and implement supplementation where necessary may improve the nutrition status of patients undergoing bariatric surgery, both before and after surgery, which may improve their surgical outcomes.
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Affiliation(s)
| | - Robin D Megill
- 2 Georgetown University School of Medicine, Washington, DC, USA
| | - Suzanne Carobrese
- 1 The Johns Hopkins Center for Bariatric Surgery, Baltimore, Maryland, USA
| | - Michael Schweitzer
- 1 The Johns Hopkins Center for Bariatric Surgery, Baltimore, Maryland, USA
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Affiliation(s)
- Amy L. Christison
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
| | - Sandeep K. Gupta
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
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Al-Shurafa H, Elzaafarany AH, Albenmousa A, Balata MG. Primary experience of bariatric surgery in a newly established private obesity center. Saudi Med J 2017; 37:1089-95. [PMID: 27652359 PMCID: PMC5075372 DOI: 10.15537/smj.2016.10.14043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives: To assess the outcomes of different types of bariatric surgeries in a single newly established private obesity center. Methods: Retrospectively, we included patients who were entered in the registry for bariatric surgeries in the Obesity Unit, Riyadh National Hospital, Riyadh, Saudi Arabia between January 2013 and September 2014, and completed one year of follow up. Baseline characteristics, percent excess weight loss, and safety data were collected and analyzed. Results: A total of 79 patients were included. Based on the type of surgery, patients were divided into 3 groups: laparoscopic Roux-en-Y gastric bypass (RYGB), laparoscopic minigastric bypass (MGBP), and laparoscopic vertical sleeve gastrectomy (SG). After one year, RYGB and MGB patients lost more weight than SG patients. No mortality, or leak were reported and one patient had reoperation after revision laparoscopic RYGB for bleeding. There was one readmission, while 4 patients visited the emergency room for vomiting and dehydration (2 patients), anemia (one patient), and port site infection (one patient). Conclusion: Bariatric surgeries are safe when carried out by an experienced bariatric surgeon in the private sector. The outcome of this series is similar to the published results from large international obesity databases.
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Affiliation(s)
- Haider Al-Shurafa
- Department of Surgery, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Shankar SS, Mixson LA, Chakravarthy M, Chisholm R, Acton AJ, Jones R, Mattar SG, Miller DL, Petry L, Beals CR, Stoch SA, Kelley DE, Considine RV. Metabolic improvements following Roux-en-Y surgery assessed by solid meal test in subjects with short duration type 2 diabetes. BMC OBESITY 2017; 4:10. [PMID: 28265415 PMCID: PMC5331732 DOI: 10.1186/s40608-017-0149-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/14/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Glucose homeostasis improves within days following Roux-en-Y gastric bypass (RYGB) surgery. The dynamic metabolic response to caloric intake following RYGB has been assessed using liquid mixed meal tolerance tests (MMTT). Few studies have evaluated the glycemic and hormonal response to a solid mixed meal in subjects with diabetes prior to, and within the first month following RYGB. METHODS Seventeen women with type 2 diabetes of less than 5 years duration participated. Fasting measures of glucose homeostasis, lipids and gut hormones were obtained pre- and post-surgery. MMTT utilizing a solid 4 oz chocolate pudding performed pre-, 2 and 4 weeks post-surgery. Metabolic response to 4 and 2 oz MMTT assessed in five diabetic subjects not undergoing surgery. RESULTS Significant reductions in fasting glucose and insulin at 3 days, and in fasting betatrophin, triglycerides and total cholesterol at 2 weeks post-surgery. Hepatic insulin clearance was greater at 3 days post-surgery. Subjects exhibited less hunger and greater feelings of fullness and satisfaction during the MMTT while consuming 52.9 ± 6.5% and 51.0 ± 6.5% of the meal at 2 and 4 weeks post-surgery respectively. At 2 weeks post-surgery, glucose and insulin response to MMTT were improved, with greater GLP-1 and PYY secretion. Improved response to solid MMTT not replicated by consumption of smaller pudding volume in diabetic non-surgical subjects. CONCLUSIONS With a test meal of size and composition representative of the routine diet of post-RYGB subjects, improved glycemic and gut hormone responses occur which cannot be replicated by reducing the size of the MMTT in diabetic subjects not undergoing surgery. TRIAL REGISTRATION Clinical Trials.gov Identifier: NCT00957957 August 11, 2009.
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Affiliation(s)
| | - Lori A Mixson
- Experimental Medicine, Merck and Company, Rahway, NJ USA
| | | | - Robin Chisholm
- Division of Endocrinology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN USA
| | - Anthony J Acton
- Division of Endocrinology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN USA
| | | | - Samer G Mattar
- Department of Surgery, Oregon Health & Science University, Portland, OR USA
| | | | - Lea Petry
- Experimental Medicine, Merck and Company, Rahway, NJ USA
| | - Chan R Beals
- Experimental Medicine, Merck and Company, Rahway, NJ USA
| | - S Aubrey Stoch
- Experimental Medicine, Merck and Company, Rahway, NJ USA
| | - David E Kelley
- Experimental Medicine, Merck and Company, Rahway, NJ USA
| | - Robert V Considine
- Division of Endocrinology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN USA
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Forde CG, Leong C, Chia-Ming E, McCrickerd K. Fast or slow-foods? Describing natural variations in oral processing characteristics across a wide range of Asian foods. Food Funct 2017; 8:595-606. [DOI: 10.1039/c6fo01286h] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The structural properties of foods have a functional role to play in oral processing behaviours and sensory perception, and also impact on the meal size and the experience of fullness.
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Affiliation(s)
- C. G. Forde
- Clinical Nutrition Research Centre (CNRC)
- Centre for Translational Medicine
- Yong Loo Lin School of Medicine
- Singapore 117599
- Singapore
| | - C. Leong
- Clinical Nutrition Research Centre (CNRC)
- Centre for Translational Medicine
- Yong Loo Lin School of Medicine
- Singapore 117599
- Singapore
| | - E. Chia-Ming
- Clinical Nutrition Research Centre (CNRC)
- Centre for Translational Medicine
- Yong Loo Lin School of Medicine
- Singapore 117599
- Singapore
| | - K. McCrickerd
- Clinical Nutrition Research Centre (CNRC)
- Centre for Translational Medicine
- Yong Loo Lin School of Medicine
- Singapore 117599
- Singapore
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Himbert C, Ose J, Delphan M, Ulrich CM. A systematic review of the interrelation between diet- and surgery-induced weight loss and vitamin D status. Nutr Res 2016; 38:13-26. [PMID: 28381350 DOI: 10.1016/j.nutres.2016.12.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 11/30/2016] [Accepted: 12/03/2016] [Indexed: 12/30/2022]
Abstract
Obesity is a major global health problem and has been associated with vitamin D deficiency. Intentional weight loss may alter vitamin D status and, conversely, vitamin D supplementation has been hypothesized to aid in weight loss. A systematic literature search in PubMed/Medline identified 3173 articles of which 37 studies (randomized controlled trials (RCT) [n=17], non-RCTs [n=20]) are summarized as effect of: (I) diet-induced weight loss on vitamin D status (n=7), (II) vitamin D supplementation on diet-induced weight loss (n=11), (III) surgery-induced weight loss on vitamin D status (n=15), and (IV) vitamin D supplementation after surgery-induced weight loss on vitamin D status (n=5). While all studies on the effect of diet-induced weight loss on vitamin D status have consistently reported increased vitamin D levels, the targeted percentage of weight loss that is necessary for an increase has varied between 5% and >10%. N=11 RCTs testing the effect of vitamin D supplementation observe that vitamin D supplementation does not result in increased weight loss, but may affect body fat loss. Vitamin D deficiency and subsequent hyperparathyroidism have been detected in post-surgery patients, and there is evidence that vitamin D supplementation improves these post-surgery complications. We review the current evidence addressing the role of vitamin D status and supplementation in diet- and surgery-induced weight loss. Subsequently, we highlight gaps in current research and suggest directions for future research including differences in vitamin D supplementation dosages, indoor vs. outdoor exercise, and the assessment of vitamin D status in different body pools.
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Affiliation(s)
- Caroline Himbert
- Huntsman Cancer Institute, Population Sciences, Salt Lake City, UT; Department of Population Health Sciences, University of Utah, Salt Lake City, UT; University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jennifer Ose
- Huntsman Cancer Institute, Population Sciences, Salt Lake City, UT; Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Mahmoud Delphan
- Huntsman Cancer Institute, Population Sciences, Salt Lake City, UT; Department of Population Health Sciences, University of Utah, Salt Lake City, UT; Exercise Immunology, Physical Education and Sport Sciences Department, Tarbiat Modares University, Tehran, Iran
| | - Cornelia M Ulrich
- Huntsman Cancer Institute, Population Sciences, Salt Lake City, UT; Department of Population Health Sciences, University of Utah, Salt Lake City, UT.
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Figueroa-Vega N, Jordán B, Pérez-Luque EL, Parra-Laporte L, Garnelo S, Malacara JM. Effects of sleeve gastrectomy and rs9930506 FTO variants on angiopoietin/Tie-2 system in fat expansion and M1 macrophages recruitment in morbidly obese subjects. Endocrine 2016; 54:700-713. [PMID: 27581034 DOI: 10.1007/s12020-016-1070-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 07/18/2016] [Indexed: 01/01/2023]
Abstract
Angiogenesis in inflammation are hallmarks for adipose tissue expansion in obesity. The role of angiopoietin/Tie-2 system in adipose tissue expansion and immune cell recruitment is unclear. We studied the effect of sleeve gastrectomy and the influence of FTO rs9930506 polymorphism on Tie-2, angiopoietin-1 and angiopoietin-2 expression in morbid obesity. Fifteen morbidly obese subjects (4 men and 11 women) aged 24-55 years were followed-up 3 and 6 months after sleeve gastrectomy. Serum sTie-2, angiopoietin-1, angiopoietin-2, and hypoxia-inducible factor-1α concentrations were determined by ELISA. Tie-2 and its ligands in visceral and subcutaneous adipose tissue were localized by immunohistochemistry. Tie-2 expression was measured by flow cytometry in circulating monocytes and infiltrated macrophages. Comparisons before and after sleeve gastrectomy were carried out using ANOVA for repeated measures. rs9930506FTO genotyping was performed by PCR-RFLP. Circulating sTie-2 and angiopoietin-2 were higher before sleeve gastrectomy. Tie-2 and angiopoietin-2 mRNA levels were higher in subcutaneous adipose tissue than visceral and both decreased after surgery. Monocytes and infiltrated macrophages showed a pro-inflammatory phenotype, with increased Tie-2 expression that decreased 3 and 6 months after sleeve gastrectomy. Baseline sTie-2 correlated inversely with adiponectin levels. At baseline the rs9930506FTO AG ó GG genotypes carriers had more 34 kg than genotype carriers of rs9930506 AA. Weight and body mass index decreased at 6 months. We found that angiopoietin/Tie-2 system is mainly expressed in subcutaneous adipose tissue, contributing to expandability, fat accumulation, and monocytes attachment in obesity. Bariatric surgery favorably modifies the pro-angiogenic profile, allowed a reduced angiogenic expression in the circulation and adipose tissue.
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Affiliation(s)
- Nicté Figueroa-Vega
- Department of Medical Sciences, University of Guanajuato, León Campus, Av. 20 de Enero #929 Col. Obregón, C.P. 37320, León, Guanajuato, Mexico.
| | - Benjamín Jordán
- Service of Laparoscopy and Bariatric Surgery, Hospital General Regional de León, Av. 20 de Enero #927, Col. Obregón, C.P. 37320, León, Guanajuato, Mexico
| | - Elva Leticia Pérez-Luque
- Department of Medical Sciences, University of Guanajuato, León Campus, Av. 20 de Enero #929 Col. Obregón, C.P. 37320, León, Guanajuato, Mexico
| | - Luis Parra-Laporte
- Service of Laparoscopy and Bariatric Surgery, Hospital General Regional de León, Av. 20 de Enero #927, Col. Obregón, C.P. 37320, León, Guanajuato, Mexico
| | - Serafín Garnelo
- Service of Laparoscopy and Bariatric Surgery, Hospital General Regional de León, Av. 20 de Enero #927, Col. Obregón, C.P. 37320, León, Guanajuato, Mexico
| | - Juan Manuel Malacara
- Department of Medical Sciences, University of Guanajuato, León Campus, Av. 20 de Enero #929 Col. Obregón, C.P. 37320, León, Guanajuato, Mexico
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Timing of food intake is associated with weight loss evolution in severe obese patients after bariatric surgery. Clin Nutr 2016; 35:1308-1314. [DOI: 10.1016/j.clnu.2016.02.007] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/02/2016] [Accepted: 02/09/2016] [Indexed: 01/26/2023]
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Maleckas A, Gudaitytė R, Petereit R, Venclauskas L, Veličkienė D. Weight regain after gastric bypass: etiology and treatment options. Gland Surg 2016; 5:617-624. [PMID: 28149808 DOI: 10.21037/gs.2016.12.02] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Roux-en-Y gastric bypass (RYGB) is one of the most common operations performed for the patients with morbid obesity. Weight regain (WR) is a complication that may decrease efficiency of the surgical treatment and demand further interventions. Different factors including lifestyle, mental health, hormonal/metabolic and surgical plays role in WR after RYGB. Various treatment options have been proposed for WR. Conservative treatment is less effective than surgery. Endoscopic refashioning of gastric pouch/stoma fails to achieve sustainable weight loss. Surgical reduction of pouch has acceptable short-term results, but WR after 3 years is substantial. Banded gastric bypass achieves good short-term results, but long-term follow-up data are needed. Distalization of RYGB has a high risk of protein calorie malnutrition (PCM) and conversion to BP diversion (BPD)/duodenal switch (DS) is a technically demanding procedure. Both procedures achieve sustainable long-term weight loss. More studies are needed to explore long-term results of various surgical interventions for WR after RYGB.
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Affiliation(s)
- Almantas Maleckas
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania;; Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rita Gudaitytė
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rūta Petereit
- Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Linas Venclauskas
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Džilda Veličkienė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Malnutrition in Bariatric Surgery Candidates: Multiple Micronutrient Deficiencies Prior to Surgery. Obes Surg 2016; 26:833-8. [PMID: 26297429 DOI: 10.1007/s11695-015-1844-y] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Over 78 million American adults have obesity. Bariatric surgery is the leading means of durable weight loss. Nutritional deficiencies are commonly treated post-operatively but are often undiagnosed pre-operatively. Malnutrition is correlated with adverse surgical outcomes. OBJECTIVES The aim of this study is to assess pre-operative nutritional status in our bariatric surgery candidates in a cross-sectional study. METHODS We recruited 58 bariatric candidates approved to undergo the Roux-en Y gastric bypass. Nutritional status was determined for vitamins A, B12, D, E-α, and E-β/γ as well as thiamine, folate, and iron. We used clinical as well as frank deficiency cut-offs based on the Institute of Medicine and the World Health Organization guidelines. RESULTS This cohort was largely female (77.6%) and white (63.8%). Median age was 42.2 years. Median body mass index (BMI) was 46.3 kg/m(2). Multiple comorbidities (MCM) were present in 41.4%, 54.0% hypertension, 42.0% diabetic, 34.0% sleep apnea. Men had more comorbidities, 69.2 % with MCM. Folate and iron saturation varied significantly by sex. Vitamins A, D, E-α, and thiamine significantly varied by race. Vitamin D negatively correlated with BMI (p = 0.003) and age (p = 0.030). Vitamin A negatively correlated with age (p = 0.001) and number of comorbidities (p = 0.003). These pre-operative bariatric candidates had significant malnutrition, particularly in vitamin D (92.9%) and iron (36.2 to 56.9 %). Multiple micronutrient deficiency (MMND) was more common in blacks (50.0 versus 39.7% overall). Number of comorbidities did not correlate with MMND. CONCLUSIONS Malnutrition in one or multiple micronutrients is pervasive in this pre-operative bariatric cohort. The effect of pre-operative supplementation, especially vitamin D and iron, should be explored.
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Balen AH, Morley LC, Misso M, Franks S, Legro RS, Wijeyaratne CN, Stener-Victorin E, Fauser BCJM, Norman RJ, Teede H. The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance. Hum Reprod Update 2016; 22:687-708. [PMID: 27511809 DOI: 10.1093/humupd/dmw025] [Citation(s) in RCA: 342] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/01/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Here we describe the consensus guideline methodology, summarise the evidence-based recommendations we provided to the World Health Organisation (WHO) for their consideration in the development of global guidance and present a narrative review on the management of anovulatory infertility in women with polycystic ovary syndrome (PCOS). OBJECTIVE AND RATIONALE The aim of this paper was to present an evidence base for the management of anovulatory PCOS. SEARCH METHODS The evidence to support providing recommendations involved a collaborative process for: (i) identification of priority questions and critical outcomes, (ii) retrieval of up-to-date evidence and exiting guidelines, (iii) assessment and synthesis of the evidence and (iv) the formulation of draft recommendations to be used for reaching consensus with a wide range of global stakeholders. For each draft recommendation, the methodologist evaluated the quality of the supporting evidence that was then graded as very low, low, moderate or high for consideration during consensus. OUTCOMES Evidence was synthesized and we made recommendations across the definition of PCOS including hyperandrogenism, menstrual cycle regulation and ovarian assessment. Metabolic features and the impact of ethnicity were covered. Management includes lifestyle changes, bariatric surgery, pharmacotherapy (including clomiphene citrate (CC), aromatase inhibitors, metformin and gonadotropins), as well as laparoscopic surgery. In-vitro fertilization (IVF) was considered as were the risks of ovulation induction and of pregnancy in PCOS. Approximately 80% of women who suffer from anovulatory infertility have PCOS. Lifestyle intervention is recommended first in women who are obese largely on the basis of general health benefits. Bariatric surgery can be considered where the body mass index (BMI) is ≥35 kg/m2 and lifestyle therapy has failed. Carefully conducted and monitored pharmacological ovulation induction can achieve good cumulative pregnancy rates and multiple pregnancy rates can be minimized with adherence to recommended protocols. CC should be first-line pharmacotherapy for ovulation induction and letrozole can also be used as first-line therapy. Metformin alone has limited benefits in improving live birth rates. Gonadotropins and laparoscopic surgery can be used as second-line treatment. There is no clear evidence for efficacy of acupuncture or herbal mixtures in women with PCOS. For women with PCOS who fail lifestyle and ovulation induction therapy or have additional infertility factors, IVF can be used with the safer gonadotropin releasing hormone (GnRH) antagonist protocol. If a GnRH-agonist protocol is used, metformin as an adjunct may reduce the risk of ovarian hyperstimulation syndrome. Patients should be informed of the potential side effects of ovulation induction agents and of IVF on the foetus, and of the risks of multiple pregnancy. Increased risks for the mother during pregnancy and for the child, including the exacerbating impact of obesity on adverse outcomes, should also be discussed. WIDER IMPLICATIONS This guidance generation and evidence-synthesis analysis has been conducted in a manner to be considered for global applicability for the safe administration of ovulation induction for anovulatory women with PCOS.
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Affiliation(s)
- Adam H Balen
- Leeds Centre for Reproductive Medicine, Leeds Teaching Hospitals, Leeds LS14 6UH, UK
| | - Lara C Morley
- Leeds Centre for Reproductive Medicine, Leeds Teaching Hospitals, Leeds LS14 6UH, UK
| | - Marie Misso
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Monash Medical Centre, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia
| | - Stephen Franks
- Institute of Reproductive & Developmental Biology, Hammersmith Hospital, London, UK
| | - Richard S Legro
- Penn State College of Medicine, 500 University Drive, H103, Hershey, PA 17033, USA
| | | | | | - Bart C J M Fauser
- Department of Reproductive Medicine & Gynaecology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Robert J Norman
- The Robinson Institute, University of Adelaide, Norwich House, 55 King William Street, North Adelaide, SA 5005, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Monash Medical Centre, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia
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Balen AH, Morley LC, Misso M, Franks S, Legro RS, Wijeyaratne CN, Stener-Victorin E, Fauser BC, Norman RJ, Teede H. The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance. Hum Reprod Update 2016. [DOI: 10.1093/humupd/dmw025 [last accessed on 26.11.19]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Kruschitz R, Luger M, Kienbacher C, Trauner M, Klammer C, Schindler K, Langer FB, Prager G, Krebs M, Ludvik B. The Effect of Roux-en-Y vs. Omega-Loop Gastric Bypass on Liver, Metabolic Parameters, and Weight Loss. Obes Surg 2016; 26:2204-2212. [PMID: 27003699 PMCID: PMC4985536 DOI: 10.1007/s11695-016-2083-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Omega-loop gastric bypass (OLGB) results in weight loss (WL) but data on its impact on liver and glucose metabolism compared to Roux-en-Y gastric bypass (RYGB) is lacking. Therefore, the aim of this study was to compare the development of hepatic and metabolic markers as well as WL between the above-mentioned surgical groups during the first postoperative year. METHODS We retrospectively evaluated the respective parameters in non-diabetic morbidly obese patients who underwent either RYGB (n = 25) or OLGB (n = 25). RESULTS Compared to RYGB, OLGB showed a greater WL percentage. Liver transaminases dropped in RYGB, while rose in OLGB. No correlation between aspartate transaminase, alanine transaminase, and WL could be detected. Gamma-glutamyltransferase decreased significantly in RYGB over the first 3 months, while it increased in OLGB. We found higher levels of triglycerides, insulin, homeostasis model assessment of insulin resistance (HOMA2-IR), and liver fat percentage in RYGB at baseline, despite matching the groups for age, sex, and BMI. Those differences disappeared, except for triglycerides, within 1 year. All metabolic parameters correlated with WL. CONCLUSION OLGB results in greater WL but transiently deteriorated several liver parameters in the first postoperative year. This was not associated with WL. The impact of these results on hepatic outcomes such as non-alcoholic steatohepatitis and fibrosis progression requires further studies. In both groups, improved insulin resistance and sensitivity were correlated with higher WL and lower liver fat percentage, respectively.
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Affiliation(s)
- Renate Kruschitz
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine I with Diabetology, Endocrinology and Nephrology Rudolfstiftung Hospital, Karl Landsteiner Institute for Obesity and Metabolic Diseases, Vienna, Austria
| | - Maria Luger
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Special Institute for Preventive Cardiology And Nutrition – SIPCAN save your life, Salzburg, Austria
| | - Christian Kienbacher
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Carmen Klammer
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Karin Schindler
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Felix B. Langer
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Gerhard Prager
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Michael Krebs
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Bernhard Ludvik
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine I with Diabetology, Endocrinology and Nephrology Rudolfstiftung Hospital, Karl Landsteiner Institute for Obesity and Metabolic Diseases, Vienna, Austria
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Ayaz A, Akyol A, Cetin C, Besler HT. Effect of plate size on meal energy intake in normal weight women. Nutr Res Pract 2016; 10:524-529. [PMID: 27698960 PMCID: PMC5037070 DOI: 10.4162/nrp.2016.10.5.524] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND/OBJECTIVES Use of smaller plates to control food intake is a commonly recommended strategy for restricting energy intake, despite conflicting results. Therefore, the aim of this study was to examine whether or not three different sizes of plates influence energy intake during a multi-itemed buffet meal in normal weight women. SUBJECTS/METHODS This was a cross-over study conducted on 37 female participants aged 19-25 years with normal BMI levels. Participants were recruited from Hacettepe University and the surrounding community. On experimental days, participants ate a standard breakfast and were then randomly assigned to eat lunch using a small (19 cm), medium (23 cm), or large (28 cm) diameter plate. Visual analogue scale (VAS) scores on sensory and satiety outcomes were measured for all meals. Energy and macronutrient intakes during lunch were recorded. RESULTS There was no evidence that use of a smaller plate size reduced energy or specific macronutrient intake during the free choice lunch meal. Multiple visits to the serving table were not associated with energy or macronutrient intake. Plate size did not affect VAS scores during the test days. CONCLUSIONS Plate size did not influence energy intake, meal composition, or palatability in normal weight women during a multi-itemed open buffet lunch. Studies in natural settings at the population level are needed to clarify current outcomes.
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Affiliation(s)
- Aylin Ayaz
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Sıhhiye, Ankara 06100, Turkey
| | - Asli Akyol
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Sıhhiye, Ankara 06100, Turkey
| | - Cansu Cetin
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Sıhhiye, Ankara 06100, Turkey
| | - H Tanju Besler
- Eastern Mediterranean University, Faculty of Health Sciences, Department of Health Management Famagusta, North Cyprus Mersin 10, Turkey
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Ahmad N, Bawazir OA. Assessment and preparation of obese adolescents for bariatric surgery. Int J Pediatr Adolesc Med 2016; 3:47-54. [PMID: 30805468 PMCID: PMC6372431 DOI: 10.1016/j.ijpam.2016.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/02/2016] [Accepted: 02/02/2016] [Indexed: 01/18/2023]
Abstract
Obesity is generally considered an adult disease, although there has been a constant increase in the prevalence of overweight and obese children in the last few decades. Childhood obesity is not limited to developed countries, with increasing numbers being reported from developing countries as well as from Saudi Arabia. Young populations with obesity suffer from similar comorbidities as obese adults, including type 2 diabetes mellitus, dyslipidemia, obstructive sleep apnea, polycystic ovarian syndrome, pseudotumor cerebri, and fatty liver disease. Recent advances in weight loss surgery have given hope to obese adolescents who are refractory to lifestyle changes and low-calorie diet plans. This review emphasizes a holistic approach for obese adolescents and describes in detail a multidisciplinary team and their role in adolescent bariatric surgery. There are unique medical, psychological, and nutritional requirements during the pre-operative, immediate post-operative, and long-term phases to achieve a desirable outcome. Identification of an appropriate candidate for bariatric surgery is critical and must balance the risks and benefits of weight loss surgery. Different surgical procedures are available and should be tailored to the needs of the patient and the expertise of the surgeon.
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Affiliation(s)
- Noman Ahmad
- King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Osama A. Bawazir
- King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
- School of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
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Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KGMM, Zimmet PZ, Del Prato S, Ji L, Sadikot SM, Herman WH, Amiel SA, Kaplan LM, Taroncher-Oldenburg G, Cummings DE. Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations. Diabetes Care 2016; 39:861-77. [PMID: 27222544 DOI: 10.2337/dc16-0236] [Citation(s) in RCA: 539] [Impact Index Per Article: 67.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options. AIM The 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, was convened in collaboration with leading diabetes organizations to develop global guidelines to inform clinicians and policymakers about benefits and limitations of metabolic surgery for T2D. METHODS A multidisciplinary group of 48 international clinicians/scholars (75% nonsurgeons), including representatives of leading diabetes organizations, participated in DSS-II. After evidence appraisal (MEDLINE [1 January 2005-30 September 2015]), three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. These drafts were presented at the combined DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes (London, U.K., 28-30 September 2015), where they were open to public comment by other professionals and amended face-to-face by the Expert Committee. RESULTS Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2D. Numerous randomized clinical trials, albeit mostly short/midterm, demonstrate that metabolic surgery achieves excellent glycemic control and reduces cardiovascular risk factors. On the basis of such evidence, metabolic surgery should be recommended to treat T2D in patients with class III obesity (BMI ≥40 kg/m(2)) and in those with class II obesity (BMI 35.0-39.9 kg/m(2)) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients with T2D and BMI 30.0-34.9 kg/m(2) if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI thresholds should be reduced by 2.5 kg/m(2) for Asian patients. CONCLUSIONS Although additional studies are needed to further demonstrate long-term benefits, there is sufficient clinical and mechanistic evidence to support inclusion of metabolic surgery among antidiabetes interventions for people with T2D and obesity. To date, the DSS-II guidelines have been formally endorsed by 45 worldwide medical and scientific societies. Health care regulators should introduce appropriate reimbursement policies.
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Affiliation(s)
| | | | - Robert H Eckel
- University of Colorado Anschutz Medical Campus, Aurora, CO
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Aron-Wisnewsky J, Verger EO, Bounaix C, Dao MC, Oppert JM, Bouillot JL, Chevallier JM, Clément K. Nutritional and Protein Deficiencies in the Short Term following Both Gastric Bypass and Gastric Banding. PLoS One 2016; 11:e0149588. [PMID: 26891123 PMCID: PMC4758752 DOI: 10.1371/journal.pone.0149588] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/01/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The number of morbidly obese patients undergoing bariatric surgery (BS) has increased dramatically in recent years. Therefore, monitoring food intake and its consequences in terms of nutritional status is necessary to prevent nutritional deficiencies. The aim of this study was to analyze the effect of food restriction on nutritional parameters in the short-term (≤3 months) period after BS in morbid obesity. METHOD In a prospective study, we followed 22 obese women who underwent Roux-en-Y gastric bypass (GBP) or adjustable gastric banding (AGB) at baseline (T0) and 1 (T1) and 3 (T3) months after surgery. We evaluated food intake, nutrient adequacy and serum concentrations of vitamins and minerals known to be at risk for deficiency following BS. RESULTS Before surgery, we observed suboptimal food intakes, leading to a risk of micronutrient deficiencies. Serum analysis confirmed nutritional deficiencies for iron and thiamine for 27 and 23% of the patients, respectively. The drastic energy and food reduction seen in the short term led to very low probabilities of adequacy for nutrients equivalent across both surgeries. Serum analysis demonstrated a continuous decrease in prealbumin during the follow-up, indicating mild protein depletion in 21 and 57% of GBP patients and 50 and 63% of AGB patients, respectively, at T1 and T3. Regarding vitamins and minerals, systematic supplementation after GBP prevented most nutritional deficiencies. By contrast, AGB patients, for whom there is no systematic supplementation, developed such deficiencies. CONCLUSIONS Our results suggest that cautious monitoring of protein intake after BS is mandatory. Furthermore, AGB patients might also benefit from systematic multivitamin and mineral supplementation at least in the short term.
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Affiliation(s)
- Judith Aron-Wisnewsky
- Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière hospital, Nutrition department, F-75013, Paris, France
- Sorbonne Universités, UPMC University Paris 06, UMR_S 1166 I, ICAN, Nutriomics team, F-75005, Paris, France
- INSERM, UMR_S U1166, NutriOmics team, F-75013, Paris, France
| | - Eric O Verger
- Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière hospital, Nutrition department, F-75013, Paris, France
- INSERM, UMR_S U1166, NutriOmics team, F-75013, Paris, France
| | - Carine Bounaix
- Sorbonne Universités, UPMC University Paris 06, UMR_S 1166 I, ICAN, Nutriomics team, F-75005, Paris, France
- INSERM, UMR_S U1166, NutriOmics team, F-75013, Paris, France
| | - Maria Carlota Dao
- Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière hospital, Nutrition department, F-75013, Paris, France
- INSERM, UMR_S U1166, NutriOmics team, F-75013, Paris, France
| | - Jean-Michel Oppert
- Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière hospital, Nutrition department, F-75013, Paris, France
| | - Jean-Luc Bouillot
- Assistance Publique-Hôpitaux de Paris, Visceral surgery Department, Ambroise Paré Hospital, 92100 Boulogne-Billancourt, France
| | - Jean-Marc Chevallier
- Assistance Publique-Hôpitaux de Paris, Visceral surgery Department, Hopital Europeen Georges Pompidou, F-75015, Paris, France
| | - Karine Clément
- Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière hospital, Nutrition department, F-75013, Paris, France
- Sorbonne Universités, UPMC University Paris 06, UMR_S 1166 I, ICAN, Nutriomics team, F-75005, Paris, France
- INSERM, UMR_S U1166, NutriOmics team, F-75013, Paris, France
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Coen PM, Goodpaster BH. A role for exercise after bariatric surgery? Diabetes Obes Metab 2016; 18:16-23. [PMID: 26228356 PMCID: PMC5642115 DOI: 10.1111/dom.12545] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/15/2015] [Accepted: 07/28/2015] [Indexed: 12/21/2022]
Abstract
Obesity predisposes an individual to develop numerous comorbidities, including type 2 diabetes, and represents a major healthcare issue in many countries worldwide. Bariatric surgery can be an effective treatment option, resulting in profound weight loss and improvements in metabolic health; however, not all patients achieve similar weight loss or metabolic improvements. Exercise is an excellent way to improve health, with well-characterized physiological and psychological benefits. In the present paper we review the evidence to determine whether there may be a role for exercise as a complementary adjunct therapy to bariatric surgery. Objectively measured physical activity data indicate that most patients who undergo bariatric surgery do not exercise enough to reap the health benefits of exercise. While there is a dearth of data on the effects of exercise on weight loss and weight loss maintenance after surgery, evidence from studies of caloric restriction and exercise suggest that similar adjunctive benefits may be extended to patients who perform exercise after bariatric surgery. Recent evidence from exercise interventions after bariatric surgery suggests that exercise may provide further improvements in metabolic health compared with surgery-induced weight loss alone. Additional randomized controlled exercise trials are now needed as the next step to more clearly define the potential for exercise to provide additional health benefits after bariatric surgery. This valuable evidence will inform clinical practice regarding much-needed guidelines for exercise after bariatric surgery.
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Affiliation(s)
- Paul M. Coen
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, FL 32804, USA
| | - Bret H. Goodpaster
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, FL 32804, USA
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Luger M, Kruschitz R, Langer F, Prager G, Walker M, Marculescu R, Hoppichler F, Schindler K, Ludvik B. Effects of omega-loop gastric bypass on vitamin D and bone metabolism in morbidly obese bariatric patients. Obes Surg 2015; 25:1056-62. [PMID: 25381120 DOI: 10.1007/s11695-014-1492-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Bariatric patients often suffer from nutrient deficiencies. Little is known about vitamin D levels and bone metabolism in patients undergoing omega-loop gastric bypass (OLGB). We, therefore, evaluated parameters of vitamin D metabolism preoperatively and during the first postoperative year. METHODS Within our cohort study, we retrospectively evaluated the respective parameters pre-, 3, 6, and 12 months postoperatively in patients with OLGB, between February 2011 and February 2013. RESULTS In patients [n = 50; age 46 (15) years, mean (SD); 12 male, 38 female] BMI was 45.4 (6.6) kg/m(2) preoperatively and decreased to 29.1 (3.8) kg/m(2) after 12 months, corresponding to a total body weight loss of 36 %. Preoperatively, the prevalence of vitamin D deficiency was 96 and 30 % demonstrated elevated parathyroid hormone yielding a prevalence of secondary hyperparathyroidism of 17 %. Postoperatively, subjects received individually adjusted vitamin D3 supplementation (95 % CI 200-3000 IU/day), according to the available guidelines at that time. Nevertheless, every third patient was vitamin D deficient at 12 months (80 %). In patients with preoperative BMI >45 vs. <45 kg/m(2), we observed a 3-fold higher risk for vitamin D deficiency over 12 months [OR = 3.10, 95 % CI (1.01-9.51), p = 0.048]. CONCLUSIONS To avoid vitamin D deficiency, morbidly obese patients, particularly those with higher preoperative BMI, should be regularly screened pre- and postoperatively. Standard postsurgical supplementation has not been adequate to restore 25-OHD status and current guidelines are not very specific in terms of timing and dosing of vitamin D3 supplementation. Consequently, further trials to enhance the evidence on vitamin D supplementation are warranted.
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Affiliation(s)
- Maria Luger
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria,
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Maghrabi AH, Wolski K, Abood B, Licata A, Pothier C, Bhatt DL, Nissen S, Brethauer SA, Kirwan JP, Schauer PR, Kashyap SR. Two-year outcomes on bone density and fracture incidence in patients with T2DM randomized to bariatric surgery versus intensive medical therapy. Obesity (Silver Spring) 2015; 23:2344-8. [PMID: 26193177 PMCID: PMC4701611 DOI: 10.1002/oby.21150] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 04/20/2015] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To determine the 2-year outcomes of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) vs. intensive medical therapy (IMT) on lean body mass, total bone mass, and bone mineral density (BMD) measures from the STAMPEDE trial. METHODS 54 subjects (BMI: 36 ± 1 kg/m(2) , age: 48 ± 4 years) with type 2 diabetes (T2DM) (HbA1c : 9.7 ± 2%) were randomized to IMT, RYGB, or SG and underwent DXA at baseline and at 1 and 2 years. RESULTS At 2 years, the reduction in BMI was similar after RYGB and SG and was greater than IMT (P < 0.001). Lean mass was reduced by ∼10%, total bone mineral content reduced by ∼8%, and hip BMD reduced by ∼9% in both surgical groups and was significantly greater than IMT despite increases in vitamin D intake in all groups. The change in hip BMD correlated with weight loss (r = 0.84, P < 0.0001) and changes in lean mass (r = 0.74, P < 0.0001) and leptin (r = 0.53, P < 0.0001). Peripheral fractures were self-reported in RYGB (4/18 patients), SG (2/19 patients), and IMT (4/16 patients). CONCLUSIONS Surgically induced weight loss is associated with modest reductions in lean mass, bone mineral content, and BMD, despite calcium and vitamin D supplementation in patients with T2DM. Awareness for bone loss is indicated for patients undergoing bariatric procedures.
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Affiliation(s)
- Adam H Maghrabi
- Institutes of Clinical Nutrition and Gastroenterology, The Cleveland Clinic, Ohio, USA
| | - Kathy Wolski
- Heart and Vascular Institute, The Cleveland Clinic, Cleveland, Ohio
| | - Beth Abood
- Endocrinology and Metabolism Institute, The Cleveland Clinic, Ohio, USA
| | - Angelo Licata
- Endocrinology and Metabolism Institute, The Cleveland Clinic, Ohio, USA
| | - Claire Pothier
- Heart and Vascular Institute, The Cleveland Clinic, Cleveland, Ohio
| | - Deepak L Bhatt
- Institutes of Clinical Nutrition and Gastroenterology, The Cleveland Clinic, Ohio, USA
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, USA
| | - Steven Nissen
- Heart and Vascular Institute, The Cleveland Clinic, Cleveland, Ohio
| | | | | | - Philip R Schauer
- Bariatric and Metabolic Institute, The Cleveland Clinic, Ohio, USA
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Controversies in perioperative anesthetic management of the morbidly obese: I am a surgeon, why should I care? Obes Surg 2015; 25:879-87. [PMID: 25726320 DOI: 10.1007/s11695-015-1635-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Over the last four decades, as the rates of obesity have increased, so have the challenges associated with its anesthetic management. In the present review, we discuss perioperative anesthesia management issues that are modifiable by the early involvement of the surgical team. We sum up available evidence or expert opinion on issues like patient positioning, postoperative analgesia, and the effect of continuous positive airway pressure (CPAP) ventilation on surgical anastomosis. We also address established predictors of higher perioperative risk and suggest possible management strategies and concerns of obese patients undergoing same day procedures. Finally, a generalized pharmacological model relevant to altered pharmacokinetics in these patients is presented.
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Spadola CE, Wagner EF, Dillon FR, Trepka MJ, De La Cruz-Munoz N, Messiah SE. Alcohol and Drug Use Among Postoperative Bariatric Patients: A Systematic Review of the Emerging Research and Its Implications. Alcohol Clin Exp Res 2015; 39:1582-601. [PMID: 26241357 PMCID: PMC4608681 DOI: 10.1111/acer.12805] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 06/08/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Emerging research suggests that some bariatric surgery patients are at a heightened risk for developing substance use problems, especially alcohol use problems. METHODS An exhaustive literature review was conducted in January 2015 to investigate all articles published that included data on postoperative alcohol use, alcohol use disorders, and illicit drug use among bariatric surgery patients. RESULTS Twenty-three studies reported on alcohol and/or substance use among bariatric patients. Six studies longitudinally assessed alcohol use behaviors; 3 of these studies found an increase in alcohol use following surgery. Six studies were cross-sectional, and 2 studies assessed medical records. Five studies investigated the prevalence of admissions to substance abuse treatment, and 3 studies combined alcohol and drug use data in a single index. Six studies reported on illicit drug use and reported low-postoperative use. The studies' samples were primarily non-Hispanic white females in their upper 40s, and only 11 of the 23 studies utilized validated assessment instruments. CONCLUSIONS Studies employing longitudinal designs and large sample sizes indicate that bariatric patients who had the gastric bypass procedure are at an elevated risk for alcohol use problems postoperatively. Research also indicates that bariatric surgery patients might be overrepresented in substance abuse treatment facilities. Risk factors for problematic postoperative alcohol use include regular or problematic alcohol use presurgery, male gender, younger age, tobacco use, and symptoms of attention deficient and hyperactivity disorder. As a whole, however, studies indicate bariatric surgery patients demonstrate a low prevalence of problematic alcohol use, and studies about gastric bypass patients are not entirely conclusive. Prospective, longitudinal studies are needed, utilizing standardized and validated alcohol assessment instruments that follow postoperative bariatric patients well beyond 2 years, and account for types of bariatric procedure. Finally, study samples with greater racial/ethnic diversity and wider age ranges are needed.
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Affiliation(s)
- Christine E Spadola
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Eric F Wagner
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Frank R Dillon
- Department of Educational and Counseling Psychology, University at Albany, State University of New York, Albany, New York
| | - Mary Jo Trepka
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | | | - Sarah E Messiah
- Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, Florida
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Abstract
Obesity is reaching pandemic proportions, and the number of bariatric surgeries is increasing. Neurological complications of bariatric procedures are more and more frequently reported and physicians need to recognize and be able to manage them. Neurological complications may result from mechanical or inflammatory mechanisms, but mainly from nutritional deficiencies. Vitamin B12, folate, thiamine, vitamin D, and vitamin E are the most frequent deficiencies. Different patterns of complications can be observed that may differ from time to presentation. At an early stage, immediate peripherical nerve injury, Wernicke's encephalopathy, and polyradiculoneuropathy are the most frequent. Late complications may appear after years and include optic neuropathy, myelopathy, peripherical neuropathy, and myopathy. Bariatric surgery patients should benefit from careful nutritional follow-up with routine monitoring of micronutrients at 6 weeks and 3, 6, and 12 months post-op and then annually after surgery, and multivitamin supplementation for life.
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Affiliation(s)
- Anne Landais
- Neurology Department, University Hospital of Pointe-à-Pitre/CHU de Pointe-à-Pitre, Route de Chauvel, Guadeloupe, 97139, Abymes, France,
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91
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Coleman KJ, Brookey J. Gender and racial/ethnic background predict weight loss after Roux-en-Y gastric bypass independent of health and lifestyle behaviors. Obes Surg 2015; 24:1729-36. [PMID: 24802770 DOI: 10.1007/s11695-014-1268-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Our study investigated how demographic, health, and behavioral factors interacted to affect weight outcomes in bariatric patients. Roux-en-Y gastric bypass (RYGB) patients who were non-Hispanic black, Hispanic, or non-Hispanic white race/ethnicity, had no revisions to their RYGB during 2004-2009, and had at least 1 year of follow-up data for body weight after surgery (n = 860) were surveyed by phone about their health and behaviors. The main outcomes of interest were percent excess weight loss and percent of initial weight lost. Participants were 47 ± 11 years old, 54 % non-Hispanic white, 25 % Hispanic, and 21 % non-Hispanic black, 82 % female, 60 % married, 82 % had some college education, and 47 % had an annual income between $35,000 and $80,000. At the time of surgery, patients had lost 50 ± 29 % of their excess weight and had achieved 24 ± 15 % initial weight lost after an average of 54 months of follow-up. After accounting for weight at the time of surgery, demographics, and self-reported health and behavior, non-Hispanic black men had significantly greater weight loss compared to non-Hispanic white men (p < .05). There were no differences between racial/ethnic groups of women in weight outcomes. Percent excess weight loss was related to greater diet soda intake, and percent initial weight lost was related to greater water intake. Independent of health status and lifestyle behaviors, age, and weight at the time of surgery, race/ethnicity, gender, and diet soda and water intake were the strongest predictors of weight outcomes after RYGB surgery.
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Affiliation(s)
- Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 2nd Floor, Pasadena, CA, 91101, USA,
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92
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Luger M, Kruschitz R, Marculescu R, Haslacher H, Hoppichler F, Kallay E, Kienbacher C, Klammer C, Kral M, Langer F, Luger E, Prager G, Trauner M, Traussnigg S, Würger T, Schindler K, Ludvik B. The link between obesity and vitamin D in bariatric patients with omega-loop gastric bypass surgery - a vitamin D supplementation trial to compare the efficacy of postoperative cholecalciferol loading (LOAD): study protocol for a randomized controlled trial. Trials 2015; 16:328. [PMID: 26242295 PMCID: PMC4524369 DOI: 10.1186/s13063-015-0877-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 07/17/2015] [Indexed: 01/07/2023] Open
Abstract
Background Beyond its classical role in calcium homoeostasis and bone metabolism, vitamin D deficiency has been found to be associated with several diseases, including diabetes, non-alcoholic fatty liver disease, and even obesity itself. Importantly, there are limited data on therapeutic strategies for vitamin D deficiency in bariatric patients, and the procedure-specific guidelines may not be sufficient. To improve long-term outcomes, nutritional screening and appropriate supplementation to prevent nutrient deficiencies are urgently needed. Therefore, the aim of this study is to examine effects and safety of a forced dosing regimen of vitamin D versus conventional dose supplementation on vitamin D levels and other parameters in bariatric patients. Methods/Design The study includes loading plus repeat dosing compared with repeated administration of vitamin D without a loading dose, according to guidelines, in a prospective, double-blind, randomized controlled trial. Up to a triple oral loading dose is given on day 1, then 2 and 4 weeks after surgery (100,000 IU dose each time), followed by an oral maintenance dose (3420 IU/day). The control group (n = 25) will receive placebo, followed by administration of a standard dose (3420 IU/day). We hypothesize that a significant increase in vitamin D levels will occur in patients in the treatment group (n = 25) by 24 weeks after surgery. Further measurements are aimed at evaluating changes in inflammation, bone turnover, insulin resistance, blood pressure, liver, mental health, and gut microbiota of patients undergoing omega-loop gastric bypass surgery. Furthermore, possible associations between concentrations of vitamin D, the involved enzymes, or vitamin D receptor in adipose and/or liver tissues will be determined. Discussion To our knowledge, this trial is the first of its kind with this type of vitamin D supplementation in bariatric patients. Its major strength is the design and implementation of evaluation of influencing factors such as liver function, bone health, inflammation, insulin resistance, blood pressure, symptoms of depression, or microbiota. This alternative vitamin D dosing regimen has the potential to be a safe, fast, evidence-based treatment of vitamin D deficiency in bariatric patients. Owing to the increasing number of bariatric patients, it is also of interest to elucidate the link between obesity and vitamin D. Trial registration ClinicalTrials.gov identifier: NCT02092376. Registered on 17 March 2014.
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Affiliation(s)
- Maria Luger
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. .,Special Institute for Preventive Cardiology and Nutrition - SIPCAN, Guggenbichlerstraße 8/15, 5026, Salzburg, Austria.
| | - Renate Kruschitz
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Rodrig Marculescu
- Clinical Institute for Medical and Chemical Laboratory Diagnostics, Department of Laboratory Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Helmuth Haslacher
- Clinical Institute for Medical and Chemical Laboratory Diagnostics, Department of Laboratory Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Friedrich Hoppichler
- Special Institute for Preventive Cardiology and Nutrition - SIPCAN, Guggenbichlerstraße 8/15, 5026, Salzburg, Austria.
| | - Enikö Kallay
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Christian Kienbacher
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Carmen Klammer
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Melanie Kral
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Felix Langer
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Eva Luger
- Institute of Social Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria.
| | - Gerhard Prager
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Stefan Traussnigg
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Tanja Würger
- Department of Pathology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Karin Schindler
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Bernhard Ludvik
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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93
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Herman CK, Hoschander AS, Wong A. Post-Bariatric Body Contouring. Aesthet Surg J 2015; 35:672-87. [PMID: 25902949 DOI: 10.1093/asj/sjv008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The "epidemic" of obesity has recently been accompanied by a new "epidemic" of massive weight loss. The demand for post-bariatric contouring is rising and, as such, it is extremely important for plastic surgeons to be well versed in the treatment of these patients. Unfortunately, the problem is not solely surgical. OBJECTIVES The aim of this article is to understand the nutritional and psychological complications that can occur in patients following massive weight loss, to understand the anatomic deformities in massive weight loss as a means to correct those deformities surgically, and to understand the complications from post-bariatric contouring procedures in an effort to avoid them. METHODS This article discusses the nutritional and psychological considerations in the massive weight loss patient, anatomical considerations in this patient group, and the surgical techniques designed to address these anatomic concerns. Important pertinent studies are reviewed and discussed. RESULTS Anatomical changes are encountered in each region of the body: there are surgical options available to correct them, although potential complications are associated with these surgical procedures. These surgical options are reviewed as well as the risk and benefits associated with them. CONCLUSIONS There are many problems that need to be addressed in the massive weight loss patient prior to embarking on surgical treatment. Additionally, surgery on massive weight loss patients has unique considerations that distinguish these operations from those performed on the non-bariatric population.
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Affiliation(s)
- Charles K Herman
- Dr Herman is the Chief Medical Executive, Chairman of the Department of Surgery and Chief of the Division of Plastic and Reconstructive Surgery, Pocono Health Systems, East Stroudsburg, PA; Clinical Professor of Surgery, The Commonwealth Medical College, Scranton, PA; and Assistant Clinical Professor of Surgery, Albert Einstein College of Medicine, New York, NY. Dr. Hoschander is the Chief Resident and Dr. Wong is a Resident in the Division of Plastic Surgery, University of Miami, Miller School of Medicine, Miami, FL
| | - Ari S Hoschander
- Dr Herman is the Chief Medical Executive, Chairman of the Department of Surgery and Chief of the Division of Plastic and Reconstructive Surgery, Pocono Health Systems, East Stroudsburg, PA; Clinical Professor of Surgery, The Commonwealth Medical College, Scranton, PA; and Assistant Clinical Professor of Surgery, Albert Einstein College of Medicine, New York, NY. Dr. Hoschander is the Chief Resident and Dr. Wong is a Resident in the Division of Plastic Surgery, University of Miami, Miller School of Medicine, Miami, FL
| | - Anselm Wong
- Dr Herman is the Chief Medical Executive, Chairman of the Department of Surgery and Chief of the Division of Plastic and Reconstructive Surgery, Pocono Health Systems, East Stroudsburg, PA; Clinical Professor of Surgery, The Commonwealth Medical College, Scranton, PA; and Assistant Clinical Professor of Surgery, Albert Einstein College of Medicine, New York, NY. Dr. Hoschander is the Chief Resident and Dr. Wong is a Resident in the Division of Plastic Surgery, University of Miami, Miller School of Medicine, Miami, FL
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94
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dos Santos MVR, Ferreira GEC, de Oliveira ECP, Kreimer F, Campos JM, Ferraz AAB. Metabolic and endocrinological factors related to nephrolithiasis pre and post multiple techniques of bariatric surgery: a sistematic review. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2015; 27 Suppl 1:69-72. [PMID: 25409971 PMCID: PMC4743524 DOI: 10.1590/s0102-6720201400s100017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 07/24/2014] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Despite of benefits of bariatric surgery for obesity treatment, the procedure may be related to some complications. AIM Analyze studies to address the relation between nephrolithiasis and bariatric surgery. METHODS Ten papers about this theme were selected from 2005-2013 in Pubmed, describing the relation of nephrolithiasis or their risk factors with several types of bariatric surgery. RESULTS Retrospective studies with minimal follow-up of three years demonstrated 7,65% in surgery patients and 4,63% non-surgery with nephrolithiasis (p<0,05). Prospective studies (8 of 10) revealed large percentage of calculi appearing and significant increase in oxaluria. CONCLUSION There is correlation between obesity surgery and nephrolithiasis.
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Affiliation(s)
| | | | | | - Flavio Kreimer
- Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, PE, Brazil
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95
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Aaseth E, Fagerland MW, Aas AM, Hewitt S, Risstad H, Kristinsson J, Bøhmer T, Mala T, Aasheim ET. Vitamin concentrations 5 years after gastric bypass. Eur J Clin Nutr 2015; 69:1249-55. [PMID: 26081488 DOI: 10.1038/ejcn.2015.82] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 04/22/2015] [Accepted: 04/23/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND/OBJECTIVES Few studies have investigated the effects of bariatric surgery on vitamin status in the long term. We examined changes in vitamin status up to 5 years after Roux-en-Y gastric bypass surgery. SUBJECTS/METHODS Using a retrospectively maintained database of patients undergoing weight loss surgery, we identified all patients operated with Roux-en-Y gastric bypass at our tertiary care hospital during July 2004-May 2008. Data on vitamin concentrations and patient-reported intake of dietary supplements were collected up to July 2012. Linear mixed models were used to estimate changes in vitamin concentrations during follow-up, adjusting for age and sex. All patients were recommended daily oral multivitamin, calcium/vitamin D and iron supplements and 3-monthly intramuscular B-12 after surgery. RESULTS Out of the 443 patients operated with gastric bypass, we included 441 (99.5%) patients with one or more measurements of vitamin concentrations (75.1% women; mean age 41.5 years, mean body mass index 46.1 kg/m(2) at baseline). At 5 years after surgery, the patients' estimated mean vitamin concentrations were either significantly higher (vitamin B-6, folic acid, vitamin B-12, vitamin C and vitamin A) or not significantly different (thiamine, 25-hydroxyvitamin D and lipid-adjusted vitamin E) compared with before surgery. Use of multivitamin, calcium/vitamin D and vitamin B-12 supplements was reported by 1-9% of patients before surgery, 79-84% of patients at 1 year and 52-83% of patients 5 years after surgery. CONCLUSIONS In patients who underwent gastric bypass surgery, estimated vitamin concentrations were either significantly increased or unchanged up to 5 years after surgery.
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Affiliation(s)
- E Aaseth
- Department of Morbid Obesity and Bariatric Surgery, Oslo University Hospital, Oslo, Norway
| | - M W Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - A-M Aas
- Department of Nutrition and Dietetics, Oslo University Hospital, Oslo, Norway
| | - S Hewitt
- Department of Morbid Obesity and Bariatric Surgery, Oslo University Hospital, Oslo, Norway
| | - H Risstad
- Department of Morbid Obesity and Bariatric Surgery, Oslo University Hospital, Oslo, Norway
| | - J Kristinsson
- Department of Morbid Obesity and Bariatric Surgery, Oslo University Hospital, Oslo, Norway
| | - T Bøhmer
- Department of Endocrinology, Oslo University Hospital, Oslo, Norway
| | - T Mala
- Department of Morbid Obesity and Bariatric Surgery, Oslo University Hospital, Oslo, Norway
| | - E T Aasheim
- Department of Morbid Obesity and Bariatric Surgery, Oslo University Hospital, Oslo, Norway
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96
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Martin KA, Mani MV, Mani A. New targets to treat obesity and the metabolic syndrome. Eur J Pharmacol 2015; 763:64-74. [PMID: 26001373 DOI: 10.1016/j.ejphar.2015.03.093] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 03/19/2015] [Accepted: 03/30/2015] [Indexed: 01/12/2023]
Abstract
Metabolic syndrome (MetS) is a cluster ofassociated metabolic traits that collectively confer unsurpassed risk for development of cardiovascular disease (CVD) and type 2 diabetes compared to any single CVD risk factor. Truncal obesity plays an exceptionally critical role among all metabolic traits of the MetS. Consequently, the prevalence of the MetS has steadily increased with the growing epidemic of obesity. Pharmacotherapy has been available for obesity for more than one decade, but with little success in improving the metabolic profiles. The serotonergic drugs and inhibitors of pancreatic lipases were among the few drugs that were initially approved to treat obesity. At the present time, only the pancreatic lipase inhibitor orlistat is approved for long-term treatment of obesity. New classes of anti-diabetic drugs, including glucagon-like peptide 1 receptor (GLP-1R) agonists and Dipeptidyl-peptidase IV (DPP-IV) inhibitors, are currently being evaluated for their effects on obesity and metabolic traits. The genetic studies of obesity and metabolic syndrome have identified novel molecules acting on the hunger and satiety peptidergic signaling of the gut-hypothalamus axis or the melanocortin system of the brain and are promising targets for future drug development. The goal is to develop drugs that not only treat obesity, but also favorably impact its associated traits.
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Affiliation(s)
- Kathleen A Martin
- Department of Internal Medicine, Yale University School of Medicine, USA
| | | | - Arya Mani
- Department of Internal Medicine, Yale University School of Medicine, USA; Department of Genetics, Yale University School of Medicine, USA.
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97
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Herman KM, Carver TE, Christou NV, Andersen RE. Keeping the weight off: physical activity, sitting time, and weight loss maintenance in bariatric surgery patients 2 to 16 years postsurgery. Obes Surg 2015; 24:1064-72. [PMID: 24682779 DOI: 10.1007/s11695-014-1212-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Bariatric surgery patients often exhibit low levels of physical activity (PA), despite the presumed importance of PA as an adjunct to surgery for successful weight loss. Little is known regarding the associations of PA and sedentary behaviors to weight loss outcomes in the long term following surgery. The objective of the study was to assess the associations of PA and sitting time with weight status, weight loss, and weight maintenance outcomes in bariatric patients 2-16 years postsurgery. METHODS A total of 303 Roux-en-Y Gastric Bypass patients (73% female; mean age 47 ± 10 years, mean 7 ± 4 years since surgery) completed a telephone questionnaire. Patients reported moderate-to-vigorous PA (MVPA: # sessions/week ≥30 min) and average daily sitting time (h/day). Associations with various weight outcomes were assessed. RESULTS Only 48% of patients reported ≥1 session/week MVPA, and mean reported sitting time was 7 ± 4 h/day. Neither MVPA nor sitting time was associated with weight loss outcomes at patients' lowest weight postsurgery. However, both MVPA and sitting time were independently positively and inversely, respectively, associated with total (kg) weight loss, % weight loss, and % excess weight loss at current weight, as well as weight loss maintained vs. regained, controlling for age, sex, surgery type, presurgery BMI, total initial weight loss, and time since surgery. CONCLUSIONS Results demonstrate associations between MVPA and high sitting time and weight loss outcomes among bariatric patients in the long term. The implications for long-term weight management and concomitant health outcomes highlight the need for appropriate follow-up and interventions in this unique high-risk patient population.
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Affiliation(s)
- Katya M Herman
- Department of Kinesiology and Physical Education, McGill University, 475 Pine Ave W, Montreal, QC, H2W 1S4, Canada,
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98
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Medication use following bariatric surgery: factors associated with early discontinuation. Obes Surg 2015; 24:696-704. [PMID: 24234778 DOI: 10.1007/s11695-013-1131-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Medication discontinuation is a common result of bariatric surgery. The influence of individual patient characteristics and surgical outcomes on overall and specific medication discontinuation is not well understood. The purpose of the current study was to assess changes in medication use and identify individual characteristics and surgical outcomes associated with medication discontinuation among bariatric patients. METHODS The patients included in the current study received bariatric surgery from the Northern Colorado Surgical Associates of Fort Collins, Colorado, USA, between October 2007 and September 2010. Demographic, weight, health, and medication data from 400 patients with at least one 6- or 12-month post-operative appointment were extracted from the Bariatric Outcome Longitudinal Database. Multivariate regression analyses were used to investigate how patient factors affect total medication use over time, use of medications grouped by co-morbidity post-operatively, and use of specific medication classes post-operatively. RESULTS Baseline co-morbidities, particularly type 2 diabetes,male sex, and Roux-en-Y gastric bypass surgery were significantly associated with decreased total medication use following surgery.Weight loss, systemic disease, sex, baseline co-morbidities, surgical complications, and race were significantly associated with continued use of specific medications following surgery. CONCLUSIONS Bariatric surgery can help patients with certain characteristics discontinue medications but is not effective for all patients. Baseline health, sex, race, bariatric procedure,surgical complications, and post-operative weight loss may affect how bariatric patients' medication use changes preoperatively to post-operatively.
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99
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Abstract
Bariatric surgery is the most effective therapeutic option for obese patients; however, it carries substantial risks, including procedure-related complications, malabsorption, and hormonal disturbance. Recent years have seen an increase in the bariatric surgeries performed utilizing either an independent or a combination of restrictive and malabsorptive procedures. We review some complications of bariatric procedures more specifically, hypoglycemia and osteoporosis, the recommended preoperative assessment and then regular follow up, and the therapeutic options. Surgeon, internist, and the patient must be aware of the multiple risks of this kind of surgery and the needed assessment and follow up.
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Affiliation(s)
- Anwar A. Jammah
- Department of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia,Address for correspondence: Dr. Anwar A. Jammah, PO Box - 2925, Riyadh - 11461, Kingdom of Saudi Arabia. E-mail:
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100
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Role of intraoperative fluids on hospital length of stay in laparoscopic bariatric surgery: a retrospective study in 224 consecutive patients. Surg Endosc 2014; 29:2960-9. [PMID: 25515983 DOI: 10.1007/s00464-014-4029-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Studies are unclear regarding optimal intraoperative fluid management during laparoscopic bariatric surgery. The purpose of this 1-year study was to investigate the role of intraoperative fluid administration on hospital length of stay (hLOS) and postoperative complications in laparoscopic bariatric surgery. METHODS Patient data analyzed included previously reported demographics, comorbidities, and intraoperative fluid administration on the duration of hLOS and incidence of postoperative complications. RESULTS Logistic regression analysis of demographic and comorbidity variables revealed that BMI (P = 0.0099) and history of anemia (P = 0.0084) were significantly associated with hLOS (C index statistic, 0.7). Lower rates of intraoperative fluid administration were significantly associated with longer hLOS (P = 0.0005). Recursive partitioning observed that patients who received <1,750 ml of intraoperative fluids resulted in longer hLOS when compared to patients who received ≥ 1,750 ml (LogWorth = 0.5). When intraoperative fluid administration rates were defined by current hydration guidelines for major abdominal surgery, restricted rates (<5 ml/kg/h) were associated with the highest incidence of extended hLOS (>1 postoperative day) at 54.1 % when compared to 22.9 % with standard rates (5-7 ml/kg/h) and were lowest at 14.5 % in patients receiving liberal rates (>7 ml/kg/h) (P < 0.0001). Finally, lower rates of intraoperative fluid administration were significantly associated with delayed wound healing (P = 0.03). CONCLUSIONS The amount of intravenous fluids administered during laparoscopic bariatric surgery plays a significant role on hLOS and on the incidence of delayed wound healing.
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