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Abstract
The effect of bariatric surgery on natriuretic peptide levels in patients with obesity is unclear. The purpose of this study was to conduct a systematic review and meta-analysis to determine the effect of bariatric surgery on BNP and NT-proBNP levels. MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to February 2020. Primary outcomes included change in NT-proBNP or BNP levels following bariatric surgery and change in weight and body mass index (BMI). Secondary outcomes included change in blood pressure, echocardiographic findings, and heart failure symptoms. MINORS tool was used to assess quality of evidence. Twelve studies with 622 patients were included. Most patients underwent Roux-en-Y gastric bypass (RYGB) (70.5%). Mean absolute reduction in BMI was 23%. NT-proBNP levels increased significantly from baseline at 6 months (mean difference (MD) 53.67 pg/mL; 95% CI, 28.72-78.61; P = <0.001, I2 = 99%; 8 studies) and 12 months (MD 51.16 pg/mL; 95% CI, 20.46-81.86; P = 0.001, I2 = 99%; 8 studies) post-bariatric surgery. BNP levels also increased significantly at 6 months (MD 17.57 pg/mL; 95% CI, 7.62-27.51; P <0.001, I2 = 95%; 4 studies). Systolic and diastolic blood pressure decreased significantly 12 months after surgery. Studies measuring echocardiographic findings saw improvement in LV mass and E/A ratio, but no significant change in ejection fraction. Bariatric surgery is associated with increased natriuretic peptide levels in the absence of deteriorating cardiac function, and may be associated with improved cardiac and metabolic function after the procedure.
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Liu Y, Jin J, Chen Y, Chen C, Chen Z, Xu L. Integrative analyses of biomarkers and pathways for adipose tissue after bariatric surgery. Adipocyte 2020; 9:384-400. [PMID: 32684073 PMCID: PMC7469525 DOI: 10.1080/21623945.2020.1795434] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We explored potential biomarkers and molecular mechanisms regarding multiple benefits after bariatric surgery. Differentially expressed genes (DEGs) for subcutaneous adipose tissue (AT) after bariatric surgery were identified by analyzing two expression profiles from the GEO. Subsequently, enrichment analysis, GSEA, PPI network, and gene-microRNAs and gene-TFs networks were interrogated to identify hub genes and associated pathways. Co-expressed DEGs included one that was up-regulated and 22 that were down-regulated genes. The enrichment analyses indicated that down-regulated DEGs were significantly involved in inflammatory responses. GSEA provided comprehensive evidence that most genes enriched in pro-inflammation pathways, while gene-sets after surgery enriched in metabolism. We identified nine hub genes in the PPI network, most of which were validated as highly expressed and hypomethylated in obesity by Attie Lab Diabetes and DiseaseMeth databases, respectively. DGIdb was also applied to predict potential therapeutic agents that might reverse abnormally high hub gene expression. Bariatric surgery induces a significant shift from an obese pro-inflammatory state to an anti-inflammatory state, with improvement in adipocyte metabolic function – representing key mechanisms whereby AT function improves after bariatric surgery. Our study deepens a mechanistic understanding of the benefits of bariatric surgery and provides potential biomarkers or treatment targets for further research.
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Affiliation(s)
- Yingshan Liu
- Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jing Jin
- Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yanshan Chen
- Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Chuna Chen
- Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhenguo Chen
- Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Lingling Xu
- Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
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Soares de Macedo JL, Corrêa Rosa S, Ribeiro Canedo L, Leão CCA, Marques da Silva FM, Farias do Nascimento Rocha JL, Vieira YO, de Rezende Filho Neto AV. The Impact of the Weight of Removed Tissue on the Development of Postoperative Complications in Patients Undergoing Abdominoplasty after Gastric Bypass. Obes Surg 2020; 31:2324-2329. [PMID: 33145721 DOI: 10.1007/s11695-020-05104-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients who undergo Roux-en-Y gastric bypass (RYGB) have significant weight loss, and abdominoplasty is an effective corrective surgery for removing excess skin. This study aimed to evaluate the impact of the weight of removed tissue on the development of postoperative complications in patients undergoing abdominoplasty without lipoaspiration after gastric bypass at the Federal District North Wing Regional Hospital, Brasília, Brazil. METHODS Data were analyzed from a prospective registry of patients who underwent abdominoplasty without lipoaspiration after gastric bypass from January 2011 to December 2018. The variables examined included body mass index (BMI) before RYGB and before plastic surgery, weight loss, weight of the excised abdominal flap, comorbidities, and medical complications. Analysis of the role of the weight of the removed tissue after abdominoplasty was performed to assess outcome measures. RESULTS One hundred sixty-three patients were included. The mean age of the patients was 42 years. Their BMI at the time of abdominoplasty was 27.49 kg/m2, and the average weight loss before abdominoplasty was 47.13 kg. The preweight loss BMI was 45.27 kg/m2, and the ∆BMI was 17.78 kg/m2. The overall complication rate was 29.4%. An amount of removed tissue from the abdomen ≥ 2000 g significantly increased the rates of postoperative complications (46.7% vs. 19.4%; p = 0.002; OR = 3.13). CONCLUSIONS Removal of ≥ 2000 g of tissue from the abdomen led to significantly more complications in patients who underwent abdominoplasty after gastric bypass. In addition, this group of patients was significantly associated with the presence of higher anthropometric variable values (BMI, weight loss, max BMI, and ∆BMI) and not associated with the presence of comorbidities.
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Affiliation(s)
- Jefferson Lessa Soares de Macedo
- Department of Plastic and Reconstructive Surgery, Asa Norte Regional Hospital, SQS 213 Bloco H Apto 303, Asa Sul, Brasília, DF, 70 292-080, Brazil. .,Post-Graduation Course in Health Sciences, University of Brasília, Brasília, DF, Brazil. .,Superior School of Health Sciences/FEPECS, Brasília, DF, Brazil.
| | - Simone Corrêa Rosa
- Department of Plastic and Reconstructive Surgery, Asa Norte Regional Hospital, SQS 213 Bloco H Apto 303, Asa Sul, Brasília, DF, 70 292-080, Brazil.,Post-Graduation Course in Health Sciences, University of Brasília, Brasília, DF, Brazil
| | - Lucas Ribeiro Canedo
- Superior School of Health Sciences/FEPECS, Brasília, DF, Brazil.,Department of General Surgery, Asa Norte Regional Hospital, Brasília, DF, Brazil
| | - Cássio Cesar Arrais Leão
- Department of Plastic and Reconstructive Surgery, Asa Norte Regional Hospital, SQS 213 Bloco H Apto 303, Asa Sul, Brasília, DF, 70 292-080, Brazil
| | - Fernando Marinho Marques da Silva
- Department of Plastic and Reconstructive Surgery, Asa Norte Regional Hospital, SQS 213 Bloco H Apto 303, Asa Sul, Brasília, DF, 70 292-080, Brazil
| | - João Lucas Farias do Nascimento Rocha
- Department of Plastic and Reconstructive Surgery, Asa Norte Regional Hospital, SQS 213 Bloco H Apto 303, Asa Sul, Brasília, DF, 70 292-080, Brazil.,Superior School of Health Sciences/FEPECS, Brasília, DF, Brazil.,Department of General Surgery, Asa Norte Regional Hospital, Brasília, DF, Brazil
| | - Yasmine Oliveira Vieira
- Department of Plastic and Reconstructive Surgery, Asa Norte Regional Hospital, SQS 213 Bloco H Apto 303, Asa Sul, Brasília, DF, 70 292-080, Brazil
| | - Altino Vieira de Rezende Filho Neto
- Department of Plastic and Reconstructive Surgery, Asa Norte Regional Hospital, SQS 213 Bloco H Apto 303, Asa Sul, Brasília, DF, 70 292-080, Brazil
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Chiappe EL, Martin M, Molli AI, Millan A, Tetzlaff W, Botta E, Ferraro F, Sáez MS, Lorenzon Gonzalez MV, Boero L, Sorroche P, Beskow A, Gutierrez M, Cerrone G, Gutt S, Frechtel G, Brites F. Effect of Roux-en-Y Gastric Bypass on Lipoprotein Metabolism and Markers of HDL Functionality in Morbid Obese Patients. Obes Surg 2020; 31:1092-1098. [PMID: 33128217 DOI: 10.1007/s11695-020-05076-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Morbid obesity represents the most severe form of obesity and surgical intervention would be its only successful treatment. Bariatric surgery could generate modifications in carbohydrate metabolism and in lipid profile plus lipoprotein-associated proteins and enzymes, such as lipoprotein-associated phoslipase A2 (Lp-PLA2), cholesteryl ester transfer protein (CETP), and paraoxonase (PON) 1. The aim of the present study was to analyze changes in inflammation markers, carbohydrate metabolism, and lipid parameters in patients who underwent bariatric surgery. METHODS Thirty-seven patients with morbid obesity were recruited. Evaluations were performed before (T0) and 1 (T1) and 6 (T2) months after surgery. Glucose, insulin, high-sensitivity C-reactive protein (hsCRP), triglycerides, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, apolipoproteins (apo) A-I, and B plus Interleukin 1β and 6 levels in addition to CETP, Lp-PLA2, and PON 1 activities were determined. RESULTS Body mass index decreased at T1 and T2 (p < 0.01). An improvement in all markers of insulin resistance (p < 0.05) was observed at T1. hsCRP levels diminished at T2 (p < 0.05). Triglyceride levels decreased at T1 and T2 (p < 0.05). HDL-C and apo A-I showed a decrease at T1 which was completely reversed at T2 (p < 0.05). Lp-PLA2 activity increased at T1, which was reversed at T2 (p < 0.05), and CETP activity was diminished at T2 (p < 0.05). PON and ARE activities decreased at T1 and partially recovered at T2 (p < 0.05). CONCLUSIONS These results would be indicative of a favorable effect of bariatric surgery on markers of carbohydrate metabolism and cardiovascular disease lipid risk factors.
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Affiliation(s)
- Ezequiel Lozano Chiappe
- Laboratorio de Lipidos y Aterosclerosis, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Av. Córdoba 2351, C1120, Buenos Aires, Argentina
| | - Maximiliano Martin
- Laboratorio de Lipidos y Aterosclerosis, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Av. Córdoba 2351, C1120, Buenos Aires, Argentina.
| | - Andrea Iglesias Molli
- Laboratorio de Genetica, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Av. Córdoba 2351, C1120, Buenos Aires, Argentina
| | - Andrea Millan
- Laboratorio de Genetica, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Av. Córdoba 2351, C1120, Buenos Aires, Argentina
| | - Walter Tetzlaff
- Laboratorio de Lipidos y Aterosclerosis, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Av. Córdoba 2351, C1120, Buenos Aires, Argentina
| | - Eliana Botta
- Laboratorio de Lipidos y Aterosclerosis, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Av. Córdoba 2351, C1120, Buenos Aires, Argentina
| | - Florencia Ferraro
- Laboratorio de Lipidos y Aterosclerosis, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Av. Córdoba 2351, C1120, Buenos Aires, Argentina
| | - Maria S Sáez
- Laboratorio Central, Hospital italiano de Buenos Aires, Pres. Tte. Gral. Juan Domingo Perón 4190, C1199 ABH, Buenos Aires, Argentina
| | - Maria V Lorenzon Gonzalez
- Laboratorio Central, Hospital italiano de Buenos Aires, Pres. Tte. Gral. Juan Domingo Perón 4190, C1199 ABH, Buenos Aires, Argentina
| | - Laura Boero
- Laboratorio de Lipidos y Aterosclerosis, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Av. Córdoba 2351, C1120, Buenos Aires, Argentina
| | - Patricia Sorroche
- Laboratorio Central, Hospital italiano de Buenos Aires, Pres. Tte. Gral. Juan Domingo Perón 4190, C1199 ABH, Buenos Aires, Argentina
| | - Axel Beskow
- Servicio de Clinica Médica, Sección Nutrición, Hospital italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199 ABH, Buenos Aires, Argentina
| | - Mercedes Gutierrez
- Servicio de Clinica Médica, Sección Nutrición, Hospital italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199 ABH, Buenos Aires, Argentina
| | - Gloria Cerrone
- Laboratorio de Genetica, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Av. Córdoba 2351, C1120, Buenos Aires, Argentina
| | - Susana Gutt
- Servicio de Clinica Médica, Sección Nutrición, Hospital italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199 ABH, Buenos Aires, Argentina
| | - Gustavo Frechtel
- Laboratorio de Genetica, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Av. Córdoba 2351, C1120, Buenos Aires, Argentina
| | - Fernando Brites
- Laboratorio de Lipidos y Aterosclerosis, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Av. Córdoba 2351, C1120, Buenos Aires, Argentina
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Valenzano A, Tartaglia N, Ambrosi A, Tafuri D, Monda M, Messina A, Sessa F, Campanozzi A, Monda V, Cibelli G, Messina G, Polito R. The Metabolic Rearrangements of Bariatric Surgery: Focus on Orexin-A and the Adiponectin System. J Clin Med 2020; 9:jcm9103327. [PMID: 33081283 PMCID: PMC7602946 DOI: 10.3390/jcm9103327] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/07/2020] [Accepted: 10/10/2020] [Indexed: 12/28/2022] Open
Abstract
The accumulation of adipose tissue represents one of the characteristics of obesity, increasing the risk of developing correlated obesity diseases such as cardiovascular disease, type 2 diabetes, cancer, and immune diseases. Visceral adipose tissue accumulation leads to chronic low inflammation inducing an imbalanced adipokine secretion. Among these adipokines, Adiponectin is an important metabolic and inflammatory mediator. It is also known that adipose tissue is influenced by Orexin-A levels, a neuropeptide produced in the lateral hypothalamus. Adiponectin and Orexin-A are strongly decreased in obesity and are associated with metabolic and inflammatory pathways. The aim of this review was to investigate the involvement of the autonomic nervous system focusing on Adiponectin and Orexin-A after bariatric surgery. After bariatric surgery, Adiponectin and Orexin-A levels are strongly increased independently of weight loss showing that hormone increases are also attributable to a rearrangement of metabolic and inflammatory mediators. The restriction of food intake and malabsorption are not sufficient to clarify the clinical effects of bariatric surgery suggesting the involvement of neuro-hormonal feedback loops and also of mediators such as Adiponectin and Orexin-A.
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Affiliation(s)
- Anna Valenzano
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (A.V.); (F.S.); (G.C.)
| | - Nicola Tartaglia
- General Surgery, Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy; (N.T.); (A.A.)
| | - Antonio Ambrosi
- General Surgery, Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy; (N.T.); (A.A.)
| | - Domenico Tafuri
- Department of Motor Sciences and Wellness, University of Naples “Parthenope”, 80133 Naples, Italy;
| | - Marcellino Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (M.M.); (A.M.); (V.M.)
| | - Antonietta Messina
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (M.M.); (A.M.); (V.M.)
| | - Francesco Sessa
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (A.V.); (F.S.); (G.C.)
| | - Angelo Campanozzi
- Pediatrics, Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy;
| | - Vincenzo Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (M.M.); (A.M.); (V.M.)
| | - Giuseppe Cibelli
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (A.V.); (F.S.); (G.C.)
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (A.V.); (F.S.); (G.C.)
- Correspondence: (G.M.); (R.P.); Tel.: +39-0881588095 (G.M.)
| | - Rita Polito
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (A.V.); (F.S.); (G.C.)
- Correspondence: (G.M.); (R.P.); Tel.: +39-0881588095 (G.M.)
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Metabolic outcomes after revisional bariatric surgery: a systematic review and meta-analysis. Surg Obes Relat Dis 2020; 16:1442-1454. [DOI: 10.1016/j.soard.2020.05.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/18/2020] [Accepted: 05/29/2020] [Indexed: 12/17/2022]
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Poelemeijer YQM, Liem RSL, Våge V, Mala T, Sundbom M, Ottosson J, Nienhuijs SW. Gastric Bypass Versus Sleeve Gastrectomy: Patient Selection and Short-term Outcome of 47,101 Primary Operations From the Swedish, Norwegian, and Dutch National Quality Registries. Ann Surg 2020; 272:326-333. [PMID: 32675546 DOI: 10.1097/sla.0000000000003279] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of this study was to compare the use and short-term outcome of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in Sweden, Norway, and the Netherlands. BACKGROUND Although bariatric surgery is performed in high volumes worldwide, no consensus exists regarding the choice of bariatric procedure for specific groups of patients. METHODS Data from 3 national registries for bariatric surgery were used. Patient selection, perioperative data (severe complications, mortality, and rate of readmissions within 30 days), and 1-year results (follow-up rate and weight loss) were studied. RESULTS A total of 47,101 primary operations were registered, 33,029 (70.1%) RYGB and 14,072 (29.9%) SG. Patients receiving RYGB met international guidelines for having bariatric surgery more often than those receiving SG (91.9% vs 83,0%, P < 0.001). The 2 procedures did not differ in the rate of severe complications (2.6% vs 2.4%, P = 0.382), nor 30-day mortality (0.04% vs 0.03%, P = 0.821). Readmission rates were higher after RYGB (4.3% vs 3.4%, P < 0.001).One-year post surgery, less RYGB-patients were lost-to follow-up (12.1% vs 16.5%, P < 0.001) and RYGB resulted in a higher rate of patients with total weight loss of more than 20% (95.8% vs 84.6%, P < 0.001). While the weight-loss after RYGB was similar between hospitals, there was a great variation in weight loss after SG. CONCLUSION This study reflects the pragmatic use and short-term outcome of RYGB and SG in 3 countries in North-Western Europe. Both procedures were safe, with RYGB having higher weight loss and follow-up rates at the cost of a slightly higher 30-day readmission rate.
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Affiliation(s)
- Youri Q M Poelemeijer
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, Netherlands
- Leiden University Medical Center, Department of Surgery, Leiden, Netherlands
| | - Ronald S L Liem
- Groene Hart Hospital, Department of Surgery, Gouda, Netherlands
- Dutch Obesity Clinic, The Hague, Netherlands
| | - Villy Våge
- Scandinavian Obesity Surgery Registry, Bergen, Norway
| | - Tom Mala
- Oslo University Hospital, Department of Gastrointestinal Surgery, Oslo, Norway
| | - Magnus Sundbom
- Uppsala University, Department of Surgical Sciences, Uppsala, Sweden
| | - Johan Ottosson
- Örebro University Hospital, Department of Surgery, Örebro, Sweden
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Vos N, Oussaada SM, Cooiman MI, Kleinendorst L, Ter Horst KW, Hazebroek EJ, Romijn JA, Serlie MJ, Mannens MMAM, van Haelst MM. Bariatric Surgery for Monogenic Non-syndromic and Syndromic Obesity Disorders. Curr Diab Rep 2020; 20:44. [PMID: 32729070 PMCID: PMC7391392 DOI: 10.1007/s11892-020-01327-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW The global prevalence of obesity has increased rapidly over the last decades, posing a severe threat to human health. Currently, bariatric surgery is the most effective therapy for patients with morbid obesity. It is unknown whether this treatment is also suitable for patients with obesity due to a confirmed genetic defect (genetic obesity disorders). Therefore, this review aims to elucidate the role of bariatric surgery in the treatment of genetic obesity. RECENT FINDINGS In monogenic non-syndromic obesity, an underlying genetic defect seems to be the most important factor determining the efficacy of bariatric surgery. In syndromic obesity, bariatric surgery result data are scarce, and even though some promising follow-up results have been reported, caution is required as patients with more severe behavioral and developmental disorders might have poorer outcomes. There is limited evidence in support of bariatric surgery as a treatment option for genetic obesity disorders; hence, no strong statements can be made regarding the efficacy and safety of these procedures for these patients. However, considering that patients with genetic obesity often present with life-threatening obesity-related comorbidities, we believe that bariatric surgery could be considered a last-resort treatment option in selected patients.
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Affiliation(s)
- Niels Vos
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Sabrina M Oussaada
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Mellody I Cooiman
- Department of Bariatric Surgery, Rijnstate Hospital and Vitalys Clinic, Arnhem, The Netherlands
| | - Lotte Kleinendorst
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Kasper W Ter Horst
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Eric J Hazebroek
- Department of Bariatric Surgery, Rijnstate Hospital and Vitalys Clinic, Arnhem, The Netherlands
| | - Johannes A Romijn
- Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Mireille J Serlie
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marcel M A M Mannens
- Genome Diagnostics Laboratory, Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Mieke M van Haelst
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands.
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands.
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Metabolic adaptations after bariatric surgery: adipokines, myokines and hepatokines. Curr Opin Pharmacol 2020; 52:67-74. [PMID: 32688292 DOI: 10.1016/j.coph.2020.06.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 12/23/2022]
Abstract
This review addresses the impact of bariatric surgery on the endocrine aspects of white adipose tissue, muscle and the liver. We describe literature supporting the notion that adipokines, myokines and hepatokines likely act in concert and drive many of the long-term metabolic improvements following surgery. Circulating adiponectin is increased while secretion of pro-inflammatory interleukins (1, 6 and 8) decreases, alongside leptin secretion. The metabolic improvements observed in the muscle might relate to reduction of myokines contributing to insulin resistance (including myostatin, brain-derived neurotrophic factor and fibroblast growth factor-21). Subject to exception, hepatokine secretion is generally increased (such as insulin-like growth factor-binding protein 2, adropin and sex hormone-binding globulin). In conclusion, bariatric surgery restores metabolic functions by enhancing the time-dependent secretion of anti-inflammatory, insulin-sensitizing and antilipemic factors. Further research is needed to understand the molecular mechanisms by which these factors may trigger the remission of obesity-related comorbidities following bariatric surgery.
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Changes in Central 24-h Ambulatory Blood Pressure and Hemodynamics 12 Months After Bariatric Surgery: the BARIHTA Study. Obes Surg 2020; 30:195-205. [PMID: 31346932 DOI: 10.1007/s11695-019-04107-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Weight loss is associated to blood pressure (BP) reduction in obese patients. There is no information on central 24-h BP changes after bariatric surgery (BS). METHODS AND RESULTS In this study, we analyzed changes in 24-h BP 12 months following BS, with intermediate evaluations at 1, 3, and 6 months, in severely obese adults. The primary endpoint was aortic (central) 24-h systolic BP changes. Circadian BP patterns and hypertension resolution were also assessed. As secondary endpoints, we analyze changes in central 24-h diastolic BP as well as in all office and ambulatory peripheral BP parameters. Obese adults scheduled for BS as routine clinical care were recruited. We included 62 patients (39% with hypertension, 77% women, body mass index, 42.6 ± 5.5 kg/m2). Reduction in body weight was mean (IQR) 30.5% (26.2-34.4) 1 year after BS. Mean (95% CI) change in central 24-h systolic BP was - 3.1 mmHg (- 5.5 to - 0.7), p = 0.01 after adjustment for age, sex, and baseline hypertensive status. BP parameter changes were different between normotensives and hypertensives. Mean (95% CI) change in central 24-h systolic BP was - 5.2 mmHg (- 7.7 to - 2.7), p < 0.001, in normotensives and - 0.5 mmHg (- 5.1 to 4.0), p = 0.818, in hypertensives. There was a remission of hypertension in 48% of patients. Most patients had a reduced dipping pattern, similarly at baseline and 12 months after BS. CONCLUSIONS Among patients with severe obesity, there was a substantial central 24-h systolic BP decrease 12 months following BS. Importantly, this change was observed in those patients with normal BP at baseline. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03115502.
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Nock NL, Jiang H, Borato L, Alberts J, Dimitropoulos A. Insights to the neural response to food cues in class III compared with class I and II obese adults using a sample of endometrial cancer survivors seeking weight loss. Nutr Diabetes 2020; 10:21. [PMID: 32541652 PMCID: PMC7296040 DOI: 10.1038/s41387-020-0124-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 11/23/2022] Open
Abstract
Background The rates of severe or Class III obesity (BMI ≥ 40.0 kg/m2) and endometrial cancer (EC) incidence and mortality have been increasing significantly in the United States. Adults with severe obesity are more likely to die and women with severe obesity have a higher risk of EC development and mortality than those with Class I/II obesity (BMI: 30–<40 kg/m2). However, no prior studies have evaluated the neural response to food cues by obesity severity/class in adults with or without cancer. Methods We conducted a functional magnetic resonance imaging visual food cue task in 85 obese Stage I EC survivors who were seeking weight loss in a lifestyle intervention at baseline. We evaluated the neural response to high-calorie vs. non-food images after an overnight fast (fasted state) and after eating a standardized meal (fed state), and grouped patients by obesity class (Class I/II: n = 38; Class III: n = 47). Results In the fasted state, we found increased activation in several regions including the dorsolateral prefrontal cortex (DLPFC) in Class III and Class I/II patients (whole brain cluster corrected (WBCC), p < 0.05), which was significantly higher in Class III vs. Class I/II (p < 0.05). We found decreased activation in the insula in the fasted state, which was significantly lower in Class I/II vs. Class III (p = 0.03). In the fed state, we found increased activation in the DLPFC in Class III and Class I/II (WBCC, p < 0.05). The increased activation in cognitive control/inhibition regions (DLPFC) is consistent with the summative literature; however, the decreased activation in taste information processing regions (insula) was unexpected. Conclusions Our results provide novel insights on food cue response between different classes of obesity and highlight the importance of targeting the DLPFC in weight loss interventions, particularly in severely obese patients. Additional studies examining food-related neural circuitry between different classes of obesity are needed.
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Affiliation(s)
- Nora L Nock
- Departments of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA. .,Case Comprehensive Cancer Center, Cleveland, OH, USA.
| | - Huangqi Jiang
- Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Lauren Borato
- Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Jay Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
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USTA E, AYGİN D. BARİATRİK CERRAHİDE UYGULANAN KAPSAMLI EĞİTİM VE DANIŞMANLIK HİZMETİ: YEME ÖZELLİKLERİ VE FİZİKSEL AKTİVİTE DÜZEYİNE ETKİSİ. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2020. [DOI: 10.33631/duzcesbed.621996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
This review addresses the interplay between obesity, type 2 diabetes mellitus, and cardiovascular diseases. It is proposed that obesity, generally defined by an excess of body fat causing prejudice to health, can no longer be evaluated solely by the body mass index (expressed in kg/m2) because it represents a heterogeneous entity. For instance, several cardiometabolic imaging studies have shown that some individuals who have a normal weight or who are overweight are at high risk if they have an excess of visceral adipose tissue-a condition often accompanied by accumulation of fat in normally lean tissues (ectopic fat deposition in liver, heart, skeletal muscle, etc). On the other hand, individuals who are overweight or obese can nevertheless be at much lower risk than expected when faced with excess energy intake if they have the ability to expand their subcutaneous adipose tissue mass, particularly in the gluteal-femoral area. Hence, excessive amounts of visceral adipose tissue and of ectopic fat largely define the cardiovascular disease risk of overweight and moderate obesity. There is also a rapidly expanding subgroup of patients characterized by a high accumulation of body fat (severe obesity). Severe obesity is characterized by specific additional cardiovascular health issues that should receive attention. Because of the difficulties of normalizing body fat content in patients with severe obesity, more aggressive treatments have been studied in this subgroup of individuals such as obesity surgery, also referred to as metabolic surgery. On the basis of the above, we propose that we should refer to obesities rather than obesity.
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Affiliation(s)
- Marie-Eve Piché
- From the Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval (M.-E.P., A.T., J.-P.D.), Université Laval, Québec, QC, Canada.,Department of Medicine, Faculty of Medicine (M.-E.P.), Université Laval, Québec, QC, Canada
| | - André Tchernof
- From the Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval (M.-E.P., A.T., J.-P.D.), Université Laval, Québec, QC, Canada.,School of Nutrition (A.T.), Université Laval, Québec, QC, Canada
| | - Jean-Pierre Després
- From the Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval (M.-E.P., A.T., J.-P.D.), Université Laval, Québec, QC, Canada.,Vitam - Centre de recherche en santé durable, CIUSSS - Capitale-Nationale (J.-P.D.), Université Laval, Québec, QC, Canada.,Department of Kinesiology, Faculty of Medicine (J.-P.D.), Université Laval, Québec, QC, Canada
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Koh ZJ, Tai BC, Kow L, Toouli J, Lakdawala M, Delko T, Kraljević M, Huang CK, Raj P, Cheng A, Rao J, Eng A, Kosai NR, Rajan R, Kim GW, Han SM, So JBY, Kasama K, Lee WJ, Kim YJ, Wong SKH, Ikramuddin S, Shabbir A. Influence of Asian Ethnicities on Short- and Mid-term Outcomes Following Laparoscopic Sleeve Gastrectomy. Obes Surg 2020; 29:1781-1788. [PMID: 30767187 DOI: 10.1007/s11695-019-03716-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE Prevalence of obesity in Asia has been on the increasing trend, with corresponding increase in utilisation of bariatric surgery. The objective of this study was to examine differences in weight loss outcomes following bariatric surgery between Asian ethnicities. MATERIALS AND METHODS A retrospective database review was conducted of patients undergoing primary laparoscopic sleeve gastrectomy between 2009 and 2013 in 14 centres from Singapore, Malaysia, Taiwan, Hong Kong, Japan, Korea, India, Australia, Switzerland, and the USA. All patients with available follow-up data at 12 months and 36 months post-surgery were included in this study. Outcome measures used were percentage excess weight loss (%EWL) and percentage total weight loss (%TWL). Differences in outcomes between ethnicities were analysed after adjusting for age, gender, baseline body mass index (BMI), and presence of diabetes. RESULTS The study population (n = 2150) consisted of 1122 Chinese, 187 Malays, 309 Indians, 67 Japanese, 259 Koreans, and 206 Caucasians. 67.1% were female and 32.9% were male. Mean age was 37.1 ± 11.2 years. Mean pre-operative BMI was 40.7 ± 8.1 kg/m2. With the Caucasian population as reference, Japanese had the best %TWL (3.90, 95% CI 1.16-6.63, p < 0.05) and %EWL (18.55, 95% CI 10.33-26.77, p < 0.05) while the Malays had the worst outcomes. Both Chinese and Koreans had better %EWL but worse %TWL as compared to Caucasians and there were no significant differences with the Indian study group. CONCLUSION There are differences in weight loss outcomes following bariatric surgery between Asian ethnicities.
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Affiliation(s)
- Zong Jie Koh
- Division of General Surgery, National University Health System, 1E, Kent Ridge Road, Singapore, 119228, Singapore.
| | - Bee Choo Tai
- Epidemiology and Public Health, Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Lilian Kow
- Bariatric Surgery, Flinders Medical Centre, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia
| | - James Toouli
- Bariatric Surgery, Flinders Medical Centre, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia
| | - Muffazal Lakdawala
- Bariatric Surgery, Digestive Health Institute, #L301, 3rd Floor, Trade View, Oasis City, Gate No. 4, Pandurang Budhkar Marg, Worli, Mumbai, 400013, India
| | - Tarik Delko
- General Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases Basel, Basel, Switzerland
| | - Marko Kraljević
- General Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases Basel, Basel, Switzerland
| | - Chih-Kun Huang
- General Surgery, China Medical University Hospital, No. 2, Yude Road, North District, 404, Taichung City, Taiwan
| | - Praveen Raj
- General Surgery, GEM Hospital and Research Center, 45, Pankaja Mill Rd, Coimbatore, 641045, India
| | - Anton Cheng
- General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - Jaideepraj Rao
- General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Alvin Eng
- General Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Nik Ritza Kosai
- Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Batu 9 Cheras, Wilayah Persekutuan, 56000, Kuala Lumpur, Malaysia
| | - Reynu Rajan
- Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Batu 9 Cheras, Wilayah Persekutuan, 56000, Kuala Lumpur, Malaysia
| | - Guo Wei Kim
- Division of General Surgery, National University Health System, 1E, Kent Ridge Road, Singapore, 119228, Singapore
| | - Sang-Moon Han
- General Surgery, Gangnam CHA General Hospital, 569, Nonhyon-ro, Gangnam-gu, Seoul, 135-081, South Korea
| | - Jimmy Bok Yan So
- Division of General Surgery, National University Health System, 1E, Kent Ridge Road, Singapore, 119228, Singapore
| | - Kazunori Kasama
- General Surgery, Yotsuya Medical Cube, 7-7 Nibanchō, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Wei-Jei Lee
- General Surgery, Min-Sheng General Hospital, #168 Jin-Kuo Rd, 330, Taoyuan City, Taiwan, Republic of China
| | - Yong Jin Kim
- General Surgery, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Hannam-dong, Yongsan-gu, Seoul, South Korea
| | - Simon Kin Hung Wong
- General Surgery, Institute of Digestive Disease, The Chinese University of Hong Kong, Room 94020, 7/F, Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - Sayeed Ikramuddin
- General Surgery, GI/Bariatric Surgery, University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA
| | - Asim Shabbir
- Division of General Surgery, National University Health System, 1E, Kent Ridge Road, Singapore, 119228, Singapore
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Iranmanesh P, Bajwa KS, Felinski MM, Shah SK, Wilson EB. Robotic Primary and Revisional Bariatric Surgery. Surg Clin North Am 2020; 100:417-430. [DOI: 10.1016/j.suc.2019.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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66
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The Impact of Ethnicity on Cardiovascular Risk Reduction and Heart Age After Bariatric Surgery. Obes Surg 2020; 30:1679-1684. [DOI: 10.1007/s11695-019-04341-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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67
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Long-term Impact of Mini-Gastric Bypass on Inflammatory Cytokines in Cohort of Morbidly Obese Patients: a Prospective Study. Obes Surg 2020; 30:2338-2344. [DOI: 10.1007/s11695-020-04471-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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68
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Salman MA, Abdallah A, Mikhail HMS, Abdelsalam A, Ibrahim AH, Sultan AAEA, El-ghobary M, Ismail AAM, Abouelregal TE, Omar MG, AbdelAal AA, Shaaban HED, GabAllah GMK, Tourky M, Salman AA. Long-term Impact of Mini-Gastric Bypass on Inflammatory Cytokines in Cohort of Morbidly Obese Patients: a Prospective Study. Obes Surg 2020. [DOI: https://doi.org/10.1007/s11695-020-04471-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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69
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Doğan S, Önmez A, Çetin MF, Özaydın İ, Pehlivan M. Residual Gastric Volume Relationship and Weight Loss After Laparoscopic Sleeve Gastrectomy. Obes Surg 2020; 30:1929-1934. [DOI: 10.1007/s11695-020-04417-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Pirlet C, Biertho L, Poirier P, Marceau S, Marceau P, Biron S, Hould FS, Lebel S, Lescelleur O, Julien F, Lafortune-Payette A, Bertrand OF. Comparison of Short and Long Term Cardiovascular Outcomes After Bariatric Surgery in Patients With vs Without Coronary Artery Disease. Am J Cardiol 2020; 125:40-47. [PMID: 31694775 DOI: 10.1016/j.amjcard.2019.09.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 12/12/2022]
Abstract
There is little data regarding the risks and benefits of bariatric surgery in patients with coronary artery disease (CAD). We aimed to assess the short- and long-term cardiovascular outcomes of patients with CAD undergoing bariatric surgery. Patients with a history of CAD were identified from a dedicated database with prospectively collected outcomes, comprising all 6795 patients who underwent bariatric surgery between January 1992 and October 2017. Patients were matched with patients who did not have CAD before the bariatric surgery procedure. The primary endpoints were mortality (cardiac and noncardiac) and major adverse cardiocerebral events (MACCE), including all-cause death, myocardial infarction, stroke, and myocardial revascularization at 30 days after bariatric surgery and throughout follow-up. After propensity score matching, 249 patients with chronic CAD were matched with 249 patients without CAD. Throughout follow-up (7.4 years; interquartile range 4.1 to 11.5, maximum 22 years), mortality (mainly cardiac mortality) remained significantly higher in the CAD compared with the non-CAD group (18% vs 10%, hazard ratio [HR] 1.70, 95% confidence interval [CI]: 1.03 to 2.79, p = 0.037). At 30 days, MACCE rate was significantly higher in the CAD compared with the non-CAD group (3.6% vs 0.4%, p = 0.011), essentially driven by non-ST elevation myocardial infarctions. After 30 days, MACCE rates remained significantly higher in the CAD group (30% vs 14%, HR 2.18, 95% CI: 1.45-3.28, p = 0.0002). In conclusion, patients with severe obesity and CAD referred to bariatric surgery were at a higher risk of early and late MACCE compared with non-CAD severely obese patients. Further study is required to define how this cardiovascular risk compares with nonoperated patients.
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Hu Q, Lu Y, Hu F, He S, Xu X, Niu Y, Zhang H, Li X, Su Q. Resistant dextrin reduces obesity and attenuates adipose tissue inflammation in high-fat diet-fed mice. Int J Med Sci 2020; 17:2611-2621. [PMID: 33162789 PMCID: PMC7645326 DOI: 10.7150/ijms.45723] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 08/31/2020] [Indexed: 12/18/2022] Open
Abstract
Resistant dextrin (RD), a short chain glucose polymer, has been shown to improve type 2 diabetes mellitus (T2DM) in clinical studies. However, the improvement of adipose tissue inflammation and specific mechanisms of RD supplementation in obesity have not been fully investigated. Therefore, we examined whether RD attenuates obesity and adipose tissue inflammation in high-fat diet (HFD)-fed mice. Male C57BL/6 mice were fed a chow diet, a HFD or a HFD with RD supplementation for 12 weeks. Body weight (BW), fasting blood glucose (FBG), epididymal fat accumulation, serum total triglyceride (TG), free fatty acid (FFA) and inflammatory cytokine levels (TNF-α, IL-1β, IL-6, IL-10) were measured. Inflammation markers and macrophage infiltration in epididymal adipose tissue were observed. After 12 weeks of intervention, the body weight gain of mice in RD supplementation group was less than that in HFD group. FBG, epididymal fat accumulation, serum TG and FFA levels were reduced in RD supplementation group compared with HFD group. Moreover, serum and mRNA levels of IL-6 were significantly reduced in the RD supplementation group. In addition, RD supplementation reduced macrophage infiltration, regulated polarization of macrophage and inhibited NF-κB signaling in epididymal adipose tissue. In conclusion, RD reduces obesity and attenuates adipose tissue inflammation in HFD-fed mice, and the inhibition of NF-κB signaling may be a presumed mechanism for its effects.
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Affiliation(s)
- Qiuyue Hu
- Department of Endocrinology, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
| | - Yao Lu
- Department of Endocrinology, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
| | - Fan Hu
- Department of Endocrinology, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
| | - Sunyue He
- Department of Endocrinology, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
| | - Xiaoyuan Xu
- Department of Endocrinology, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
| | - Yixin Niu
- Department of Endocrinology, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
| | - Hongmei Zhang
- Department of Endocrinology, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
| | - Xiaoyong Li
- Department of Endocrinology, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
| | - Qing Su
- Department of Endocrinology, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
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Eley VA, Christensen R, Guy L, Dodd B. Perioperative Blood Pressure Monitoring in Patients With Obesity. Anesth Analg 2019; 128:484-491. [PMID: 30059399 DOI: 10.1213/ane.0000000000003647] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Blood pressure monitoring plays a key part in the preoperative, intraoperative, and postoperative care of all patients. In patients with obesity, hypertension indicates increased metabolic and surgical risk and may signal the presence of significant medical comorbidities, including obstructive sleep apnea. Avoidance of hypertension postoperatively is necessary to minimize bleeding risk after surgery. Hypotension in the postoperative period may be the first sign of significant complications that require urgent management. With the problem of being overweight or obese now affecting two-thirds of adults in Western countries, the proportion of patients with obesity in perioperative environments is similarly increasing. Detection of aberrations in blood pressure is contingent on the accuracy of blood pressure measurement methods. Patients with obesity tend to have a large arm circumference and "cone-shaped arms." Standard blood pressure cuffs fit such patients poorly, and this compromises the accuracy of measurements. Alternatives to arm blood pressure cuffs, some made specifically for individuals with obesity, have been evaluated but are not widely available to clinicians. This focused narrative review will discuss the relevance of hypertension management in the care of patients with obesity, highlight the currently available methods for perioperative monitoring of blood pressure, and explore the opportunities that exist to improve the perioperative blood pressure care in patients with obesity undergoing surgical procedures.
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Affiliation(s)
- Victoria A Eley
- From the Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia
| | - Rebecca Christensen
- From the Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia
| | - Louis Guy
- From the Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia
| | - Benjamin Dodd
- Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia.,Department of Surgery, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Ruiz-Tovar J, Sanchez-Santos R, Martín-García-Almenta E, García Villabona E, Hernandez AM, Hernández-Matías A, Ramírez JM. Rehabilitación multimodal en cirugía bariátrica. Cir Esp 2019; 97:551-559. [DOI: 10.1016/j.ciresp.2019.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/07/2019] [Accepted: 05/01/2019] [Indexed: 12/21/2022]
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75
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Haseeb YA. A Review of Obstetrical Outcomes and Complications in Pregnant Women after Bariatric Surgery. Sultan Qaboos Univ Med J 2019; 19:e284-e290. [PMID: 31897311 PMCID: PMC6930040 DOI: 10.18295/squmj.2019.19.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/08/2019] [Accepted: 07/07/2019] [Indexed: 12/15/2022] Open
Abstract
Bariatric surgery (BS) is a novel treatment for weight reduction with longer lasting health benefits. This review aimed to summarise the available evidence regarding the fetomaternal outcomes and the most common challenges and complications in pregnancies following BS. Google Scholar (Google LLC, Mountain View, California, USA) and PubMed® (National Library of Medicine, Bethesda, Maryland, USA) databases were searched for articles published until December 2018. A total of 64 articles were included in this review and results showed that BS mitigates the risk of gestational diabetes mellitus, hypertensive disorders in pregnancy and fetal macrosomia. However, it can also have detrimental effects on fetomaternal health. There is paucity of data regarding small for gestational age intrauterine growth restriction, premature rupture of membranes and long-term effects on the children born to women who underwent BS.
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Affiliation(s)
- Yasmeen A Haseeb
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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76
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Giaccari A. Sodium-glucose co-transporter inhibitors: Medications that mimic fasting for cardiovascular prevention. Diabetes Obes Metab 2019; 21:2211-2218. [PMID: 31209982 DOI: 10.1111/dom.13814] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 12/30/2022]
Abstract
Recent evidence that some diabetes drugs can prevent cardiovascular disease (CVD) has profoundly modified the treatment approach to type 2 diabetes mellitus. Sodium-glucose co-transporter-2 (SGLT2) inhibitors and almost all glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been shown, beyond their effect on glucose control, to lead to a significant decrease in the cardiovascular burden of diabetes. Although these results are well known, the mechanisms of action by which they prevent cardiovascular events are still poorly understood. Both GLP-1RAs and SGLT2 inhibitors promote weight loss, although through different mechanisms. SGLT2 inhibitors promote glycosuria, leading to significant caloric deficit and weight loss. Similarly, GLP-1RAs, probably through an anorexic effect on certain brain areas, inhibit calorie intake, with ensuing weight loss. Although it features less prominently in current treatment pathways, pioglitazone has also demonstrated cardiovascular benefits. Pioglitazone profoundly modifies several mechanisms and risk factors responsible for CVD; however, these mechanisms certainly do not include weight loss. Obesity, and consequent insulin resistance, are well known risk factors for CVD, and it would appear logical to attribute the positive cardiovascular effects of these two classes of drugs to weight loss. The direct metabolic effects of these two classes, however, are profoundly different. The present review proposes a unifying hypothesis to explain the reduction in CVD through three different mechanisms of curbing free fatty acid excess, all leading to the common mechanism of cellular caloric restriction. If this hypothesis is correct, the excellent results obtained with SGLT2 inhibitors could be attributed to their close simulation of fasting.
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Affiliation(s)
- Andrea Giaccari
- Centro Malattie Endocrine e Metaboliche, UOC Endocrinologia e Diabetologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto Patologia Speciale Medica e Semeiotica Medica, Universitá Cattolica del Sacro Cuore, Rome, Italy
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Ooi GJ, Earnest A, Doyle L, Laurie C, Wentworth JM, Sikaris K, le Roux CW, Burton PR, O'Brien PE, Brown WA. Detailed Description of Change in Serum Cholesterol Profile with Incremental Weight Loss After Restrictive Bariatric Surgery. Obes Surg 2019; 28:1351-1362. [PMID: 29159554 DOI: 10.1007/s11695-017-3015-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Dyslipidemia affects up to 75% of morbidly obese individuals and is a key driver of cardiovascular disease. Weight loss is an established strategy to improve metabolic risk, including dyslipidemia. We aimed to determine weight loss goals for resolution of serum lipid abnormalities, by measuring improvements during progressive weight loss in obese individuals. METHODS We performed a prospective cohort study of obese individuals with the metabolic syndrome undergoing adjustable gastric banding. Lipid levels were monitored monthly for 9 months, then three monthly until 24 months. RESULTS There were 101 participants included, age 47.4 ± 10.9 years with body mass index 42.6 ± 5.9 kg/m2. At 24 months, total body weight loss (TBWL) was 18.3 ± 7.9%. This was associated with significant improvements in high-density lipoprotein (HDL) (1.18 vs 1.47, p < 0.001), triglyceride (2.0 vs 1.4, p < 0.001), and total cholesterol to HDL ratio (TC:HDL) (4.6 vs 3.6, p < 0.001). Over this time, progressive and linear improvements in HDL, triglycerides, and TC:HDL were seen with incremental weight loss (observed at 2.5% TBWL intervals). Significant improvements occurred after a threshold weight loss of 7.5-12.5% TBWL was achieved, with odds ratio (OR) 1.48-2.50 for normalization. These odds improved significantly with increasing weight loss (OR 18.2-30.4 with > 25% TBWL). Despite significant weight loss, there was no significant change in low-density lipoprotein (LDL). CONCLUSION Significant improvements in triglycerides, HDL, and TC:HDL occur after 7.5-12.5% TBWL, with ongoing benefit after greater weight loss. LDL needs to be addressed independently, as this was not observed to respond to weight loss alone. TRIAL REGISTRATION NUMBER Australian Clinical Trials Registry (ACTRN12610000049077).
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Affiliation(s)
- Geraldine J Ooi
- Centre for Obesity Research and Education, Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3181, Australia. .,Department of Surgery, Alfred Hospital, Melbourne, Australia.
| | - Arul Earnest
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Lisa Doyle
- Centre for Obesity Research and Education, Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3181, Australia
| | - Cheryl Laurie
- Centre for Obesity Research and Education, Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3181, Australia
| | - John M Wentworth
- Walter and Eliza Hall Institute, Melbourne University, Melbourne, Australia
| | - Ken Sikaris
- Melbourne Pathology, East Melbourne, Australia
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College, Dublin, Ireland
| | - Paul R Burton
- Centre for Obesity Research and Education, Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3181, Australia.,Department of Surgery, Alfred Hospital, Melbourne, Australia
| | - Paul E O'Brien
- Centre for Obesity Research and Education, Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3181, Australia
| | - Wendy A Brown
- Centre for Obesity Research and Education, Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3181, Australia.,Department of Surgery, Alfred Hospital, Melbourne, Australia
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Bhandari M, Mathur W, Kosta S, Salvi P, Fobi M. Assessment of functional ability of nonambulatory patients with obesity: after and before bariatric surgery. Surg Obes Relat Dis 2019; 15:2087-2093. [PMID: 31711943 DOI: 10.1016/j.soard.2019.09.068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/10/2019] [Accepted: 09/12/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Functional ability is often impaired as a direct consequence of severe obesity. Bariatric surgery is the most effective treatment for severe obesity. OBJECTIVE To examine the effect of weight loss after bariatric surgery on patients with impaired functional ambulatory abilities due to obesity. SETTINGS A high-volume university-affiliated bariatric surgery center in India. METHOD We conducted a prospective study in a cohort of nonambulatory patients with functional disabilities (bedridden, wheelchair-bound, or walker-dependent) who underwent bariatric surgery. Data on sex, body mass index, co-morbid conditions, the severity of pain, and types of limitations in functional abilities were collected at baseline and at 1 year after bariatric surgery and analyzed. RESULTS Forty-five patients were enrolled in this study with 100% follow-up at 1 year. The mean age and body mass index of the patients were 54.7 ± 8.5 years and 54.2 ± 8.6 kg/m2, respectively. Thirty-four (75.5%) were female, 27 (60%) were walker-dependent, 14 (31.1%) were wheelchair-bound, and 4 (8.9%) were bedridden. At baseline 88.8% and 75.5% patients had severe knee and back pain, respectively. The percentage of total weight loss was 22% and 31% at 6 and 12 months, respectively. At 1 year, 37 (82.2%) patients were ambulating independently, only 1 (2.2%) patient was still bedridden, and 7 (15.5%) patients were walker-dependent. Mild, moderate, and severe classification on all functional ability scales were significantly improved. CONCLUSION Weight loss after bariatric surgery results in significant amelioration of knee and/or back pain with an improvement in functional abilities and quality of life.
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Affiliation(s)
- Mohit Bhandari
- Mohak Bariatrics and Robotics Center, Indore, Madhya Pradesh, India.
| | - Winni Mathur
- Mohak Bariatrics and Robotics Center, Indore, Madhya Pradesh, India
| | - Susmit Kosta
- Mohak Bariatrics and Robotics Center, Indore, Madhya Pradesh, India
| | - Prashant Salvi
- Mohak Bariatrics and Robotics Center, Indore, Madhya Pradesh, India
| | - Mathias Fobi
- Mohak Bariatrics and Robotics Center, Indore, Madhya Pradesh, India
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Effect of Sleeve Gastrectomy on Proprotein Convertase Subtilisin/Kexin Type 9 (Pcsk9) Content and Lipid Metabolism in the Blood Plasma and Liver of Obese Wistar Rats. Nutrients 2019; 11:nu11092174. [PMID: 31510106 PMCID: PMC6770019 DOI: 10.3390/nu11092174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/30/2019] [Accepted: 08/30/2019] [Indexed: 12/12/2022] Open
Abstract
Nowadays, obesity and its complications are heavy burdens to western civilization. Surgical procedures remain one of the available therapies for obesity and obesity-associated diseases treatment. Among them, sleeve gastrectomy is the most common bariatric procedure. Despite the well-established fact that sleeve gastrectomy results in significant weight loss, some of its other divergent effects still need to be established. To fulfill this knowledge gap, we examined whether sleeve gastrectomy affects lipid metabolism in the plasma and liver of obese rats. We demonstrated that chronic high-fat diet feeding led to an increment in the level of Proprotein Convertase Subtilisin/Kexin (PCSK)-a regulator of plasma cholesterol concentration-in the liver, which was decreased after the gastrectomy. Moreover, we noticed significant increases in both plasma and liver contents of free fatty acids, diacylgycerides and triacylglycerides in the obese animals, with their reduction after the bariatric surgery. In conclusion, we revealed, presumably for the first time, that sleeve gastrectomy affects lipid metabolism in the liver of obese rats.
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Meta-Analysis of Differential miRNA Expression after Bariatric Surgery. J Clin Med 2019; 8:jcm8081220. [PMID: 31443156 PMCID: PMC6723285 DOI: 10.3390/jcm8081220] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 02/06/2023] Open
Abstract
Bariatric surgery is an efficient treatment for weight loss in obese patients and for resolving obesity comorbidities. However, the mechanisms behind these outcomes are unclear. Recent studies have indicated significant alterations in the transcriptome after surgery, specifically in the differential expression of microRNAs. In order to summarize the recent findings, we conducted a systematic summary of studies comparing microRNA expression levels before and after surgery. We identified 17 animal model and human studies from four databases (Ovid, Scopus, Web of Science, and PubMed) to be enrolled in this meta-analysis. From these studies, we identified 14 miRNAs which had the same direction of modulation of their expression after surgery in at least two studies (downregulated: hsa-miR-93-5p, hsa-miR-106b-5p, hsa-let-7b-5p, hsa-let-7i-5p, hsa-miR-16-5p, hsa-miR-19b-3p, hsa-miR-92a-3p, hsa-miR-222-3p, hsa-miR-142-3p, hsa-miR-140-5p, hsa-miR-155-5p, rno-miR-320-3p; upregulated: hsa-miR-7-5p, hsa-miR-320c). Pathway analysis for these miRNAs was done using database resources (DIANA-TarBase and KEGG pathway database) and their predicted target genes were discussed in relation with obesity and its comorbidities. Discrepancies in study design, such as miRNA source, bariatric surgery type, time of observation after surgery, and miRNA profiling methods, were also discussed.
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81
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Metabolic Surgery: Weight Loss, Diabetes, and Beyond. J Am Coll Cardiol 2019; 71:670-687. [PMID: 29420964 DOI: 10.1016/j.jacc.2017.12.014] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/13/2017] [Accepted: 12/15/2017] [Indexed: 12/16/2022]
Abstract
The alarming rise in the worldwide prevalence of obesity is paralleled by an increasing burden of type 2 diabetes mellitus. Metabolic surgery is the most effective means of obtaining substantial and durable weight loss in individuals with obesity. Randomized trials have recently shown the superiority of surgery over medical treatment alone in achieving improved glycemic control, as well as a reduction in cardiovascular risk factors. The mechanisms seem to extend beyond the magnitude of weight loss alone and include improvements in incretin profiles, insulin secretion, and insulin sensitivity. Moreover, observational data suggest that the reduction in cardiovascular risk factors translates to better patient outcomes. This review describes commonly used metabolic surgical procedures and their current indications and summarizes the evidence related to weight loss and glycemic outcomes. It further examines their potential effects on cardiovascular outcomes and mortality and discusses future perspectives.
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Body weight-dependent and independent improvement in lipid metabolism after Roux-en-Y gastric bypass in ApoE*3Leiden.CETP mice. Int J Obes (Lond) 2019; 43:2394-2406. [PMID: 31270430 DOI: 10.1038/s41366-019-0408-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 02/05/2019] [Accepted: 05/12/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND/OBJECTIVES The incidence of obesity and metabolic syndrome (MetS) has rapidly increased worldwide. Roux-en-Y gastric bypass (RYGB) achieves long-term weight loss and improves MetS-associated comorbidities. Using a mouse model with a humanized lipoprotein metabolism, we elucidated whether improvements in lipid and glucose metabolism after RYGB surgery are body weight loss-dependent or not. SUBJECTS/METHODS Male ApoE*3Leiden.CETP (ApoE3L.CETP) mice fed Western type diet for 6 weeks underwent RYGB or Sham surgery. Sham groups were either fed ad libitum or were body weight-matched (BWm) to the RYGB mice to discriminate surgical effects from body weight loss-associated effects. Before and after surgery, plasma was collected to assess the metabolic profile, and glucose tolerance and insulin sensitivity were tested. Twenty days after surgery, mice were sacrificed, and liver was collected to assess metabolic, histological and global gene expression changes after surgery. RESULTS RYGB induced a marked reduction in body weight, which was also achieved by severe food restriction in BWm mice, and total fat mass compared to Sham ad libitum mice (Sham AL). Total cholesterol, non-high-density lipoprotein cholesterol (non-HDL-C) and ceramide were strongly reduced 20 days after surgery in RYGB compared to BWm mice. Glucose tolerance and insulin sensitivity improved 13 days after surgery similarly in RYGB and BWm mice. Liver histology confirmed lipid reduction in RYGB and BWm mice while the transcriptomics data indicated altered genes expression in lipid metabolism. CONCLUSIONS RYGB surgery improves glucose metabolism and greatly ameliorates lipid metabolism in part in a body weight-dependent manner. Given that ApoE3L.CETP mice were extensively studied to describe the MetS, and given that RYGB improved ceramide after surgery, our data confirmed the usefulness of ApoE3L.CETP mice after RYGB in deciphering the metabolic improvements to treat the MetS.
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de Sousa GC, Cruz FF, Heil LB, Sobrinho CJS, Saddy F, Knibel FP, Pereira JB, Schultz MJ, Pelosi P, Gama de Abreu M, Silva PL, Rocco PRM. Intraoperative immunomodulatory effects of sevoflurane versus total intravenous anesthesia with propofol in bariatric surgery (the OBESITA trial): study protocol for a randomized controlled pilot trial. Trials 2019; 20:300. [PMID: 31138279 PMCID: PMC6540380 DOI: 10.1186/s13063-019-3399-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 05/06/2019] [Indexed: 02/06/2023] Open
Abstract
Background Obesity is associated with a chronic systemic inflammatory process. Volatile or intravenous anesthetic agents may modulate immune function, and may do so differentially in obesity. However, no study has evaluated whether these potential immunomodulatory effects differ according to type of anesthesia in obese patients undergoing laparoscopic bariatric surgery. Methods/design The OBESITA trial is a prospective, nonblinded, single-center, randomized, controlled clinical pilot trial. The trial will include 48 patients with a body mass index ≥ 35 kg/m2, scheduled for laparoscopic bariatric surgery using sleeve or a Roux-en-Y gastric bypass technique, who will be allocated 1:1 to undergo general inhalational anesthesia with sevoflurane or total intravenous anesthesia (TIVA) with propofol. The primary endpoint is the difference in plasma interleukin (IL)-6 levels when comparing the two anesthetic agents. Blood samples will be collected prior to anesthesia induction (baseline), immediately after anesthetic induction, and before endotracheal extubation. Levels of other proinflammatory and anti-inflammatory cytokines, neutrophil chemotaxis, macrophage differentiation, phagocytosis, and occurrence of intraoperative and postoperative complications will also be evaluated. Discussion To our knowledge, this is the first randomized clinical trial designed to compare the effects of two different anesthetics on immunomodulation in obese patients undergoing laparoscopic bariatric surgery. Our hypothesis is that anesthesia with sevoflurane will result in a weaker proinflammatory response compared to anesthesia with propofol, with lower circulating levels of IL-6 and other proinflammatory mediators, and increased macrophage differentiation into the M2 phenotype in adipose tissue. Trial registration Registro Brasileiro de Ensaios Clínicos, RBR-77kfj5. Registered on 25 July 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3399-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Giselle Carvalho de Sousa
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Centro de Ciências da Saúde, Avenida Carlos Chagas Filho, 373, Bloco G1-014, Ilha do Fundão, Rio de Janeiro, 21941-902, Brazil.,Department of Anesthesiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernanda Ferreira Cruz
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Centro de Ciências da Saúde, Avenida Carlos Chagas Filho, 373, Bloco G1-014, Ilha do Fundão, Rio de Janeiro, 21941-902, Brazil
| | - Luciana Boavista Heil
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Centro de Ciências da Saúde, Avenida Carlos Chagas Filho, 373, Bloco G1-014, Ilha do Fundão, Rio de Janeiro, 21941-902, Brazil
| | | | - Felipe Saddy
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Centro de Ciências da Saúde, Avenida Carlos Chagas Filho, 373, Bloco G1-014, Ilha do Fundão, Rio de Janeiro, 21941-902, Brazil.,Institute D'Or of Research and Teaching, Rio de Janeiro, Brazil
| | | | | | - Marcus J Schultz
- Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Marcelo Gama de Abreu
- Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Pedro Leme Silva
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Centro de Ciências da Saúde, Avenida Carlos Chagas Filho, 373, Bloco G1-014, Ilha do Fundão, Rio de Janeiro, 21941-902, Brazil
| | - Patricia Rieken Macedo Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Centro de Ciências da Saúde, Avenida Carlos Chagas Filho, 373, Bloco G1-014, Ilha do Fundão, Rio de Janeiro, 21941-902, Brazil.
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Norain A, Arafat M, Burjonrappa S. Trending Weight Loss Patterns in Obese and Super Obese Adolescents: Does Laparoscopic Sleeve Gastrectomy Provide Equivalent Outcomes in both Groups? Obes Surg 2019; 29:2511-2516. [PMID: 31044352 DOI: 10.1007/s11695-019-03867-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Many factors, including preoperative weight, may determine final weight loss after bariatric surgery; however, their proportional contribution is unclear. To such end, we evaluated weight loss patterns among obese adolescents. METHODS We evaluated 57 adolescents who underwent laparoscopic sleeve gastrectomy from 2011 to 2017. Data collection included demographics, anthropometrics, and comorbidities and was done over a 3-year follow-up period. Statistical analysis was performed using Student's t test and repeated measures ANOVA. RESULTS In the morbidly obese (MO) group, 82% were female, while 52% were male in the super obese (SMO) group (P < 0.0059). While 13/34 patients in the obese group achieved > 60% percent excess body weight loss (%EBWL), only 3/23 super obese patients achieved > 60% EBWL (P = 0.0695). %EBWL at 1-year follow-up significantly differed between the obese and super obese groups, 61.7 ± 14.6% and 47.7 ± 14.9% respectively (P = 0.035). The average BMI in the obese group was 29.8 at 1 year and 41.3 in the super obese group. There was a significant difference in the rate of excess weight loss (%EBWL/month) between the two groups (P < 0.01). There was good comorbidity resolution (about 70%) in both groups after surgery. CONCLUSION Comorbidity resolution after sleeve gastrectomy is excellent in the adolescent population irrespective of initial BMI. Consideration should be given to earlier bariatric intervention in SMO adolescents to facilitate return to near normal BMI. Focus on education of referral sources, such as community pediatricians and family practitioners to facilitate early bariatric evaluation should be considered. Weight loss in postsurgical SMO patients should be carefully monitored and adjunctive interventions should be considered.
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Affiliation(s)
- Abdullah Norain
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Mohammad Arafat
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Sathyaprasad Burjonrappa
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA. .,Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467-2401, USA. .,USF Health, Morsani College of Medicine, Tampa General Hospital, 1 Tampa General Circle, G 441, Tampa, FL, 33606, USA.
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85
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Pareek M, Bhatt DL, Schiavon CA, Schauer PR. Metabolic Surgery for Hypertension in Patients With Obesity. Circ Res 2019; 124:1009-1024. [DOI: 10.1161/circresaha.118.313320] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Manan Pareek
- From the Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (M.P., D.L.B.)
- Department of Cardiology, Nephrology, and Endocrinology, North Zealand Hospital, Hillerød, Denmark (M.P.)
| | - Deepak L. Bhatt
- From the Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (M.P., D.L.B.)
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Nakajima K, Iwane T, Higuchi R, Shibata M, Takada K, Uda J, Anan M, Sugiyama M, Nakamura T. Kanagawa Investigation of the Total Check-up Data from the National database (KITCHEN): protocol for data-driven population-based repeated cross-sectional and 6-year cohort studies. BMJ Open 2019; 9:e023323. [PMID: 30796118 PMCID: PMC6398776 DOI: 10.1136/bmjopen-2018-023323] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 12/02/2018] [Accepted: 12/12/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The unmitigated incidence of cardiometabolic diseases, such as type 2 diabetes and metabolic syndrome, has gained attention in Japan. 'Big data' can be useful to clarify conflicting observations obtained from studies with small samples and about rare conditions that are often neglected. We epidemiologically address these issues using data from health check-ups conducted in Kanagawa Prefecture, the prefecture with the second largest population in Japan, in the Kanagawa Investigation of the Total Check-up Data from the National Database (KITCHEN). METHODS AND ANALYSIS This research consists of a series of population-based cross-sectional studies repeated from 2008-2014 and 6-year cohort studies. Since 2017, we have reviewed the data of people living in Kanagawa Prefecture who underwent a health check-up mainly for general health and the prevention of metabolic syndrome. The sample size ranges from 1.2 million to 1.8 million people in the cross-sectional studies and from 370 000 to 590 000 people in the cohort studies. These are people aged 40-74 years, whose clinical parameters were measured and who responded individually to a questionnaire. We investigate potential associations and causalities of various aetiologies, including diabetes and metabolic syndrome, using clinical data and lifestyle information. With multidisciplinary analysis, including data-driven analysis, we expect to obtain a wide range of novel findings, to confirm indeterminate previous findings, especially in terms of cardiometabolic disease, and to provide new perspectives for human health promotion and disease prevention. ETHICS AND DISSEMINATION Ethical approval was received from the Ethics Committee of Kanagawa University of Human Services (10-43). The protocol was approved in December 2016 by the Japanese Ministry of Health, Labour and Welfare (No. 121). The study results will be disseminated through open platforms including journal articles, relevant conferences and seminar presentations.
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Affiliation(s)
- Kei Nakajima
- School of Nutrition and Dietetics, Faculty of Health and Social Services, Kanagawa University of Human Services, Yokosuka, Japan
- Department of Endocrinology and Diabetes, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Taizo Iwane
- School of Nutrition and Dietetics, Faculty of Health and Social Services, Kanagawa University of Human Services, Yokosuka, Japan
| | - Ryoko Higuchi
- School of Nutrition and Dietetics, Faculty of Health and Social Services, Kanagawa University of Human Services, Yokosuka, Japan
| | - Michi Shibata
- School of Nutrition and Dietetics, Faculty of Health and Social Services, Kanagawa University of Human Services, Yokosuka, Japan
- Department of nutrition, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kento Takada
- School of Nutrition and Dietetics, Faculty of Health and Social Services, Kanagawa University of Human Services, Yokosuka, Japan
| | - Jun Uda
- Graduate School of Health Care Sciences, Jikei Institute, Osaka-shi, Japan
| | - Mami Anan
- School of Nutrition and Dietetics, Faculty of Health and Social Services, Kanagawa University of Human Services, Yokosuka, Japan
| | - Michiko Sugiyama
- School of Nutrition and Dietetics, Faculty of Health and Social Services, Kanagawa University of Human Services, Yokosuka, Japan
| | - Teiji Nakamura
- School of Nutrition and Dietetics, Faculty of Health and Social Services, Kanagawa University of Human Services, Yokosuka, Japan
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Kane JA, Mehmood T, Munir I, Kamran H, Kariyanna PT, Zhyvotovska A, Yusupov D, Suleman UJ, Gustafson DR, McFarlane SI. Cardiovascular Risk Reduction Associated with Pharmacological Weight Loss: A Meta-Analysis. INTERNATIONAL JOURNAL OF CLINICAL RESEARCH & TRIALS 2019; 4. [PMID: 31058246 DOI: 10.15344/2456-8007/2019/131] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Obesity is a growing pandemic that is associated with multiple cardiovascular disease (CVD) risk factors such as hypertension, diabetes, dyslipidemia and obstructive sleep apnea. With the increase in obesity rates where nearly two thirds of Americans are either obese or overweight, there has been an increase in the use of pharmacological therapy weight loss. While these therapies have shown benefit in weight reduction, the clinical impact these pharmacological agents on overall CVD outcomes has yet to be determined. AIM We aimed to assess the effect of pharmacological agents used for weight reduction on CVD risk and all-cause mortality. METHODS We conducted a meta-analysis of peer-reviewed literature that evaluated the impact of anti-obesity drugs on cardiovascular outcomes. Key words used included: "orlistat", "lorcaserin", "phentermine/topiramate" or "naltrexone/bupropion" and "cardiovascular outcomes" among others. We reviewed 791 articles, only 47 studies were randomized controlled trials and only 7 studies fulfilled all the inclusion criteria including, quantitative data on cardiovascular risk factors such as, Hemoglobin A1C (A1C), changes in body mass index (BMI), blood pressure and CVD morbidity and mortality. Data was retrieved from these studies and evaluated with comprehensive meta-analysis software® to assess pooled effects for medical management versus placebo. RESULTS There were 7 studies included in the final analysis, with a total of 18,598 subjects, of which 8,685 were in the intervention (INT) group and 9,913 in the control (CTRL) group. For all cause mortality, there were 45 events in the INT and 55 in the CTRL groups, suggesting no significant difference between the two groups (OR: 0.843, 95%CI: 0.571-1.244, Z: -0.860, P: 0.390). For CVD mortality, there were 17 events in the INT and 36 events in the CTRL groups suggesting a significant mortality benefit in the INT group (OR:0.496, 95% CI: 0.282-0.873, Z: -2.433, P: 0.015). There was a significant absolute reduction in A1C in the INT group (Hg: -0.238, 95%CI: -0.291 to -0.186, Z: -8.937, P< 0.001). The percentage weight reduction was significantly higher for the INT group compared to the CTRL group (Hg: -0.431, 95%CI: -0.477 to -0.385, Z: -18.472, P< 0.001) and the blood pressure reduction was higher for the INT group compared to the CTRL group. (Hg: -0.052, 95%CI: -0.101- -0.003, Z: -2.086, P: 0.037). The heterogeneity observed for our meta analysis is Q: 1.884, df: 6, P: 0.930. CONCLUSIONS Our study demonstrated the favorable and significant effect of pharmacological weight reduction strategies on weight loss, blood pressure reduction, glycemic control (A1C reduction), and CVD mortality.While weight loss without pharmacological means has been shown to reduce CVD risk, the mechanism by which weight loss medications impact CVD risk reduction could be a direct effect of these agents or merely an effect of weight reduction itself. Weight loss has been noted to modify risk factors via improving insulin sensitivity, reducing inflammation, decreasing blood pressure and modifying the lipid profile, In addition, the mechanism of action of the medications are not directly anti-inflammatory, and do not directly modify insulin sensitivity, blood pressure or the lipid profile. Thus, it is most likely that the benefit on cardiovascular disease from these therapies is via weight reduction and not direct medication effect.Given the limited efficacy of the lifestyle modification on sustained weight loss and the surgical risk and limited availability of bariatric surgical options. Our data suggests pharmacological weight loss therapy may be a valuable treatment option to reduce CVD risk in obese patients. Further research is needed to clarify the effects these therapies on overall mortality and evaluate the mechanisms by which these medications reduce CVD risk factors and mortality.
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Affiliation(s)
- Jesse A Kane
- Department of Internal Medicine, Divisions of Cardiovascular Disease and Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Talha Mehmood
- Department of Internal Medicine, Divisions of Cardiovascular Disease and Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Irsa Munir
- Department of Internal Medicine, Divisions of Cardiovascular Disease and Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Haroon Kamran
- Department of Internal Medicine, Divisions of Cardiovascular Disease and Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Pramod Theetha Kariyanna
- Department of Internal Medicine, Divisions of Cardiovascular Disease and Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Angelina Zhyvotovska
- Department of Internal Medicine, Divisions of Cardiovascular Disease and Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Denis Yusupov
- Department of Internal Medicine, Divisions of Cardiovascular Disease and Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Umer Javed Suleman
- Department of Internal Medicine, Divisions of Cardiovascular Disease and Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Deborah R Gustafson
- Department of Neurology, State University of New York - Downstate Medical Center, Brooklyn, NY 11203, USA.,Neuropsychiatric Epidemiology Unit, University of Gothenburg, Gothenburg, Sweden
| | - Samy I McFarlane
- Department of Internal Medicine, Divisions of Cardiovascular Disease and Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA
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Leblanc MÈ, Auclair A, Leclerc J, Bussières J, Agharazii M, Hould FS, Marceau S, Brassard P, Godbout C, Grenier A, Cloutier L, Poirier P. Blood Pressure Measurement in Severely Obese Patients: Validation of the Forearm Approach in Different Arm Positions. Am J Hypertens 2019; 32:175-185. [PMID: 30312368 DOI: 10.1093/ajh/hpy152] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 10/05/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Blood pressure measurement in severe obesity may be technically challenging as the cuff of the device may not fit adequately around the upper arm. The aim of the study was to assess the agreement between intra-arterial blood pressure values (gold standard) compared with forearm blood pressure measurements in severely obese patients in different arm positions. METHODS Thirty-three severely obese patients and 21 controls participated in the study. Pairs of intra-arterial blood pressures were compared with simultaneous forearm blood pressure measurement using an oscillometric device in 4 positions: (i) supine, (ii) semi-fowler with the forearm resting at heart level, (iii) semi-fowler with the arm downward, and (iv) semi-fowler with the arm raised overhead. Degree of agreement between measurements was assessed. RESULTS Overall, correlations of systolic and diastolic blood pressure measurements between the gold standard and forearm blood pressure were 0.95 (n = 722; P < 0.001) and 0.89 (n = 482; P < 0.001), respectively. Systolic blood pressure measured using the forearm approach in the supine and the semi-fowler positions with arm downward showed the best agreement when compared with the gold standard (-4 ± 11 (P < 0.001) and 2 ± 14 mm Hg (P = 0.19), respectively). In the control group, better agreement was found between the supine and semi-fowler positions with the arm resting at heart level (1 ± 9 mm Hg (P = 0.29) and -3 ± 10 mm Hg (P = 0.01), respectively). CONCLUSIONS Forearm systolic blood pressure consistently agreed with the gold standard in the supine position. This method can be of use in clinical settings when upper-arm measurement is challenging in severe obesity.
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Affiliation(s)
- Marie-Ève Leblanc
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
- Faculty of pharmacy, Laval University, Québec, Canada
| | - Audrey Auclair
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Jacinthe Leclerc
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
- Nursing department, Université du Québec à Trois-Rivières, Québec, Canada
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Jean Bussières
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
- Faculty of medicine, Laval University, Québec, Canada
| | - Mohsen Agharazii
- Faculty of medicine, Laval University, Québec, Canada
- Research Center, Division of Nephrology, Centre Hospitalier Universitaire de Québec, Hôtel-Dieu de Québec, Quebec, Canada
| | - Frédéric-Simon Hould
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
- Faculty of medicine, Laval University, Québec, Canada
| | - Simon Marceau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
- Faculty of medicine, Laval University, Québec, Canada
| | - Patrice Brassard
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
- Department of Kinesiology, Laval University, Québec, Canada
| | - Christian Godbout
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Audrey Grenier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Lyne Cloutier
- Nursing department, Université du Québec à Trois-Rivières, Québec, Canada
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
- Faculty of pharmacy, Laval University, Québec, Canada
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Izquierdo AG, Crujeiras AB. Obesity-Related Epigenetic Changes After Bariatric Surgery. Front Endocrinol (Lausanne) 2019; 10:232. [PMID: 31040824 PMCID: PMC6476922 DOI: 10.3389/fendo.2019.00232] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 03/22/2019] [Indexed: 12/13/2022] Open
Abstract
Objective: In recent years, an increasing number of studies have begun focusing on epigenetics as a link between environmental factors and a greater predisposition to the development of obesity and its comorbidities. An important challenge in this field is the evaluation of the possibility of the reversal of obesity-related epigenetic marks by means of therapy to induce weight loss and if the beneficial effects of therapy in reducing obesity are mediated by epigenetic mechanisms. We aimed to offer an outline of the current results regarding to the impact of bariatric surgery on epigenetic regulation, as well as to show if the beneficial effect of this intervention could be mediated by epigenetic mechanisms. Methods: A review of the scientific publications in PubMed was performed by using key words related to obesity, epigenetics and bariatric surgery to provide an update of recent findings in this area of research. The most relevant and recently published articles and abstracts were selected to frame this review. Results: Previous studies have demonstrated the presence of differential DNA methylation after bariatric surgery and the differential expression of non-coding RNAs. Therefore, epigenetic regulation could mediate the benefit of bariatric surgery on body weight and the metabolic disturbances associated with excess body weight, such as insulin resistance, hypertension, and cardiovascular disease. This evidence is relatively new as epigenetic regulation was first evaluated in the obesity field only a few years ago. However, there is an urgent need to perform longitudinal studies to evaluate the capacity of epigenetic marks in the prediction of bariatric surgery response. Conclusions: Bariatric surgery appears to be capable of partially reversing the obesity-related epigenome. The identification of potential epigenetic biomarkers predictive for the success of bariatric surgery may open new doors to personalized therapy for severe obesity.
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Affiliation(s)
- Andrea G. Izquierdo
- Epigenomics in Endocrinology and Nutrition Group, Instituto de Investigacion Sanitaria (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain
| | - Ana B. Crujeiras
- Epigenomics in Endocrinology and Nutrition Group, Instituto de Investigacion Sanitaria (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain
- *Correspondence: Ana B. Crujeiras
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90
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Iyngkaran P, Liew D, Neil C, Driscoll A, Marwick TH, Hare DL. Moving From Heart Failure Guidelines to Clinical Practice: Gaps Contributing to Readmissions in Patients With Multiple Comorbidities and Older Age. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2018; 12:1179546818809358. [PMID: 30618487 PMCID: PMC6299336 DOI: 10.1177/1179546818809358] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 09/14/2018] [Indexed: 12/20/2022]
Abstract
This feature article for the thematic series on congestive heart failure (CHF) readmissions aims to outline important gaps in guidelines for patients with multiple comorbidities and the elderly. Congestive heart failure diagnosis manifests as a 3-phase journey between the hospital and community, during acute, chronic stable, and end-of-life (palliative) phases. This journey requires in variable intensities a combination of multidisciplinary care within tertiary hospital or ambulatory care from hospital outpatients or primary health services, within the general community. Management goals are uniform, ie, to achieve the lowest New York Heart Association class possible, with improvement in ejection fraction, by delivering gold standard therapies within a CHF program. Comorbidities are an important common denominator that influences outcomes. Comorbidities include diabetes mellitus, chronic obstructive airways disease, chronic renal impairment, hypertension, obesity, sleep apnea, and advancing age. Geriatric care includes the latter as well as syndromes such as frailty, falls, incontinence, and confusion. Many systems still fail to comprehensively achieve all aspects of such programs. This review explores these factors.
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Affiliation(s)
- Pupalan Iyngkaran
- Northern Territory Medical Program, Flinders University, Darwin, NT, Australia
- Pupalan Iyngkaran, Yellow Building 4 Cnr University Drive North & University Drive West Charles Darwin University, Casuarina, NT 0815, Australia.
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Christopher Neil
- Department of Medicine—Western Precinct, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrea Driscoll
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
- Austin Health, Melbourne, VIC, Australia
| | | | - David L Hare
- Cardiovascular Research, The University of Melbourne, Melbourne, VIC, Australia
- Heart Failure Services, Austin Health, Melbourne, VIC, Australia
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91
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Goldstein SP, Thomas JG, Vithiananthan S, Blackburn GA, Jones DB, Webster J, Jones R, Evans E, Dushay J, Moon J, Bond DS. Multi-sensor ecological momentary assessment of behavioral and psychosocial predictors of weight loss following bariatric surgery: study protocol for a multicenter prospective longitudinal evaluation. BMC OBESITY 2018; 5:27. [PMID: 30410772 PMCID: PMC6217766 DOI: 10.1186/s40608-018-0204-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/11/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Bariatric surgery is currently the most effective strategy for producing significant and durable weight loss. Yet, not all patients achieve initial weight loss success and some degree of weight regain is very common, sometimes as early as 1-2 years post-surgery. Suboptimal weight loss not fully explained by surgical, demographic, and medical factors has led to greater emphasis on patient behaviors evidenced by clinical guidelines for appropriate eating and physical activity. However, research to inform such guidelines has often relied on imprecise measures or not been specific to bariatric surgery. There is also little understanding of what psychosocial factors and environmental contexts impact outcomes. To address research gaps and measurement limitations, we designed a protocol that innovatively integrates multiple measurement tools to determine which behaviors, environmental contexts, and psychosocial factors are related to outcomes and explore how psychosocial factors/environmental contexts influence weight. This paper provides a detailed description of our study protocol with a focus on developing and deploying a multi-sensor assessment tool to meet our study aims. METHODS This NIH-funded prospective cohort study evaluates behavioral, psychosocial, and environmental predictors of weight loss after bariatric surgery using a multi-sensor platform that integrates objective sensors and self-report information collected via smartphone in real-time in patients' natural environment. A target sample of 100 adult, bariatric surgery patients (ages 21-70) use this multi-sensor platform at preoperative baseline, as well as 3, 6, and 12 months postoperatively, to assess recommended behaviors (e.g., meal frequency, physical activity), psychosocial indicators with prior evidence of an association with surgical outcomes (e.g., mood/depression), and key environmental factors (e.g., type/quality of food environment). Weight also is measured at each assessment point. DISCUSSION This project has the potential to build a more sophisticated and valid understanding of behavioral and psychosocial factors contributing to success and risk after bariatric surgery. This new understanding could directly contribute to improved (i.e., specific, consistent, and validated) guidelines for recommended pre- and postoperative behaviors, which could lead to improved surgical outcomes. These data will also inform behavioral, psychosocial, and environmental targets for adjunctive interventions to improve surgical outcomes. TRIAL REGISTRATION Registered trial NCT02777177 on 5/19/2016.
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Affiliation(s)
- Stephanie P. Goldstein
- Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, The Miriam Hospital/Warren Alpert Medical School of Brown University, 196 Richmond Street, Providence, RI 02909 USA
| | - J. Graham Thomas
- Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, The Miriam Hospital/Warren Alpert Medical School of Brown University, 196 Richmond Street, Providence, RI 02909 USA
| | - Sivamainthan Vithiananthan
- Department of Surgery, The Miriam Hospital/Warren Alpert Medical School of Brown University, 195 Collyer Street, Providence, RI 02904 USA
| | - George A. Blackburn
- Beth Israel Deaconess Medical Center, Department of Surgery, Center for the Study of Nutrition Medicine, Feldberg 880, East Campus, 330 Brookline Avenue, Boston, MA 02215 USA
| | - Daniel B. Jones
- Beth Israel Deaconess Medical Center, Department of Surgery, Center for the Study of Nutrition Medicine, Feldberg 880, East Campus, 330 Brookline Avenue, Boston, MA 02215 USA
| | - Jennifer Webster
- Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, The Miriam Hospital/Warren Alpert Medical School of Brown University, 196 Richmond Street, Providence, RI 02909 USA
| | - Richard Jones
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Butler Hospital, 345 Blackstone Boulevard, Box G-BH, Providence, RI 02906 USA
| | - E.Whitney Evans
- Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, The Miriam Hospital/Warren Alpert Medical School of Brown University, 196 Richmond Street, Providence, RI 02909 USA
| | - Jody Dushay
- Department of Medicine, Division of Endocrinology, Beth Israel Deaconess Medical Center, Feldberg 880, East Campus, 330 Brookline Avenue, Boston, MA 02215 USA
| | - Jon Moon
- MEI Research, Ltd, 6016 Schaefer Road, Edina, MN 55436 USA
| | - Dale S. Bond
- Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, The Miriam Hospital/Warren Alpert Medical School of Brown University, 196 Richmond Street, Providence, RI 02909 USA
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Ramos-Molina B, Castellano-Castillo D, Alcaide-Torres J, Pastor Ó, de Luna Díaz R, Salas-Salvadó J, López-Moreno J, Fernández-García JC, Macías-González M, Cardona F, Tinahones FJ. Differential effects of restrictive and malabsorptive bariatric surgery procedures on the serum lipidome in obese subjects. J Clin Lipidol 2018; 12:1502-1512. [PMID: 30143432 DOI: 10.1016/j.jacl.2018.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/17/2018] [Accepted: 07/18/2018] [Indexed: 12/12/2022]
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Pirlet C, Ruzsa Z, Costerousse O, Nemes B, Merkely B, Poirier P, Bertrand OF. Transradial left gastric artery embolization to treat severe obesity: A pilot study. Catheter Cardiovasc Interv 2018; 93:365-370. [DOI: 10.1002/ccd.27846] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 07/28/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Charles Pirlet
- Department of Cardiology, Quebec Heart-Lung Institute; Quebec Canada
| | - Zoltan Ruzsa
- Semmelweis University of Budapest; Cardiac and Vascular Center; Budapest Hungary
- Bács-Kiskun County Hospital, Invasive Cardiology; Kecskemét Hungary
| | | | - Balázs Nemes
- Semmelweis University of Budapest; Cardiac and Vascular Center; Budapest Hungary
| | - Béla Merkely
- Bács-Kiskun County Hospital, Invasive Cardiology; Kecskemét Hungary
| | - Paul Poirier
- Department of Cardiology, Quebec Heart-Lung Institute; Quebec Canada
- Faculty of Pharmacy; Laval University; Quebec Canada
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Tarasco E, Pellegrini G, Whiting L, Lutz TA. Phenotypical heterogeneity in responder and nonresponder male ApoE*3Leiden.CETP mice. Am J Physiol Gastrointest Liver Physiol 2018; 315:G602-G617. [PMID: 29975550 DOI: 10.1152/ajpgi.00081.2018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The metabolic syndrome (MetS) is a major health issue worldwide and is associated with obesity, insulin resistance, and hypercholesterolemia. Several animal models were used to describe the MetS; however, many of them do not mimic well the MetS pathophysiology in humans. The ApoE*3Leiden.CETP mouse model overcomes part of this limitation, since they have a humanised lipoprotein metabolism and a heterogeneous response to MetS, similar to humans. The reported heterogeneity among them and their common classification refer to responder (R) and nonresponder (NR) mice; R mice show increased body weight, cholesterol, and triglycerides levels, whereas NR mice do not show this expected phenotype when fed a Western type diet. To define better the differences between R and NR mice, we focused on feeding behavior, body weight gain, glucose tolerance, and lipid parameters, and on an extensive pathological examination along with liver histology analysis. Our data confirmed that R mice resemble the pathological features of the human MetS: obesity, dysplipidemia, and glucose intolerance. NR mice do not develop the full dysmetabolic phenotype because of a severe inflammatory hepatic condition, which may heavily affect liver function. We conclude that R and NR mice are metabolically different and that NR mice have indications of severely impaired liver function. Hence, it is critical to identify and separate the respective mice to decrease data heterogeneity. Clinical chemistry and histological analysis should be used to confirm retrospectively the animals' classification. Moreover, we point out that NR mice may not be an appropriate control for studies involving ApoE*3Leiden.CETP R mice. NEW & NOTEWORTHY When compared with some other animal models, ApoE*3Leiden.CETP mice are better models to describe the metabolic syndrome. However, there is phenotypic heterogeneity between "responder" and "nonresponder" mice, the latter showing some evidence of hepatic pathology. A full phenotypic characterization and eventually postmortem analysis of the liver are warranted.
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Affiliation(s)
- Erika Tarasco
- Institute of Veterinary Physiology, Vetsuisse Faculty University of Zurich , Zurich , Switzerland.,Zurich Center for Integrative Human Physiology, University of Zurich , Zurich , Switzerland
| | - Giovanni Pellegrini
- Laboratory for Animal Model Pathology, Institute of Veterinary Pathology, Vetsuisse Faculty University of Zurich , Zurich , Switzerland
| | - Lynda Whiting
- Institute of Drug and Discovery Biology, University of Monash , Victoria , Australia
| | - Thomas A Lutz
- Institute of Veterinary Physiology, Vetsuisse Faculty University of Zurich , Zurich , Switzerland.,Zurich Center for Integrative Human Physiology, University of Zurich , Zurich , Switzerland
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95
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Risk of cardiomyopathy and cardiac arrhythmias in patients with nonalcoholic fatty liver disease. Nat Rev Gastroenterol Hepatol 2018; 15:425-439. [PMID: 29713021 DOI: 10.1038/s41575-018-0010-0] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a common, progressive liver disease that affects up to one-quarter of the adult population worldwide. The clinical and economic burden of NAFLD is mainly due to liver-related morbidity and mortality (nonalcoholic steatohepatitis, cirrhosis or hepatocellular carcinoma) and an increased risk of developing fatal and nonfatal cardiovascular disease, chronic kidney disease and certain types of extrahepatic cancers (for example, colorectal cancer and breast cancer). Additionally, there is now accumulating evidence that NAFLD adversely affects not only the coronary arteries (promoting accelerated coronary atherosclerosis) but also all other anatomical structures of the heart, conferring an increased risk of cardiomyopathy (mainly left ventricular diastolic dysfunction and hypertrophy, leading to the development of congestive heart failure), cardiac valvular calcification (mainly aortic-valve sclerosis), cardiac arrhythmias (mainly atrial fibrillation) and some cardiac conduction defects. This Review focuses on the association between NAFLD and non-ischaemia-related cardiac disease, discusses the putative pathophysiological mechanisms and briefly summarizes current treatment options for NAFLD that might also beneficially affect cardiac disease.
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96
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Piché ME, Poirier P, Lemieux I, Després JP. Overview of Epidemiology and Contribution of Obesity and Body Fat Distribution to Cardiovascular Disease: An Update. Prog Cardiovasc Dis 2018; 61:103-113. [PMID: 29964067 DOI: 10.1016/j.pcad.2018.06.004] [Citation(s) in RCA: 290] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 06/21/2018] [Indexed: 01/14/2023]
Abstract
Obesity is recognized as a heterogeneous condition in which individuals with similar body mass index may have distinct metabolic and cardiovascular risk profiles. Susceptibility to obesity-related cardiometabolic complications is not solely mediated by overall body fat mass, but is largely dependent upon individual differences in regional body fat distribution and ability of subcutaneous adipose tissue to expand. The present review will discuss to what extent the individual variation in body fat distribution is one of the clinical key variables explaining the metabolic heterogeneity of obesity and its related cardiovascular risk. We will present the evidence for the complex nature of the relationship between obesity and cardiovascular disease, outline our current understanding of the mechanisms involved, and identify future direction of research pertinent to this interaction.
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Affiliation(s)
- Marie-Eve Piché
- Quebec Heart and Lung Institute, Québec, Canada; Faculty of Medicine, Université Laval, Québec, Canada.
| | - Paul Poirier
- Quebec Heart and Lung Institute, Québec, Canada; Faculty of Pharmacy, Université Laval, Québec, Canada
| | | | - Jean-Pierre Després
- Quebec Heart and Lung Institute, Québec, Canada; Faculty of Medicine, Université Laval, Québec, Canada
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97
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English WJ, Williams DB. Metabolic and Bariatric Surgery: An Effective Treatment Option for Obesity and Cardiovascular Disease. Prog Cardiovasc Dis 2018; 61:253-269. [PMID: 29953878 DOI: 10.1016/j.pcad.2018.06.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 06/21/2018] [Indexed: 01/07/2023]
Abstract
Obesity is a chronic and debilitating disease that has become a global epidemic. Especially severe in the Unites States, obesity currently affects almost 40% of the population. Obesity has a strong causal relationship with numerous serious comorbidities that impair quality of life, shorten life expectancy, and carry a major economic burden. Obesity has particular relevance to cardiologists because it contributes directly to several major cardiovascular diseases and, consequently, increases overall cardiovascular mortality. Multiple treatment options are available, but metabolic and bariatric surgery offers the most effective and durable treatment for obesity. Moreover, metabolic and bariatric operations alleviate and often completely eliminate numerous comorbidities, particularly type 2 diabetes and other cardiovascular risk factors, such as hypertension and dyslipidemia. With their low risk of complications and morbidity, metabolic and bariatric operations significantly improve quality of life and overall survival, particularly reducing death due to cardiovascular disease.
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Affiliation(s)
- Wayne J English
- Vanderbilt University Medical Center, 1161 21(st) Avenue South, Room D5203 MCN, Nashville, TN 37232-2577, United States of America.
| | - D Brandon Williams
- Vanderbilt University Medical Center, 1161 21(st) Avenue South, Room D5203 MCN, Nashville, TN 37232-2577, United States of America.
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98
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Jansen A, Polder A, Müller MHB, Skjerve E, Aaseth J, Lyche JL. Increased levels of persistent organic pollutants in serum one year after a great weight loss in humans: Are the levels exceeding health based guideline values? THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 622-623:1317-1326. [PMID: 29890598 DOI: 10.1016/j.scitotenv.2017.11.241] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/27/2017] [Accepted: 11/20/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND With the growing prevalence of obesity, an increased number of bariatric surgeries are being performed. Lipophilic persistent organic pollutants (POPs) are stored in adipose tissue, and an increased release of lipophilic POPs into the blood circulation may occur following rapid weight loss such as after bariatric surgery. OBJECTIVES To evaluate and compare POP levels in serum before and after bariatric surgery, and to assess if the POP levels exceeded health based guideline values, with particular focus on women of childbearing age (WCBA). METHODS Serum samples from 63 patients before and one year after bariatric surgery were analysed for organochlorine pesticides (OCPs); polychlorinated biphenyls (PCBs); and brominated flame retardants (BFRs). RESULTS Mean weight loss one year after surgery was 32.1kg. The levels of all the analysed POPs in serum increased during the study period. Median levels of dichlorodiphenyldichloroethylene (p,p'-DDE), hexachlorobenzen (HCB) and PCB-153 increased from 90.2ng/g lipid weight (lw) to 158.5ng/glw, from 21.1ng/glw to 36.4ng/glw and from 48.7ng/glw to 71.5ng/glw, respectively. The highest percentage increase was observed for PCB -138, with 83.1%. BFRs were detected in low sample numbers and at low levels. Guideline values for ΣPCB6 in serum were exceeded for 5% of the participants. CONCLUSIONS Weight loss after bariatric surgery resulted in increases of POPs levels in serum between 46.7%-83.1%. Guideline values for ΣPCB6 in serum were exceeded for 5% of the participants. For WCBA, the possible transfer of comparable levels to infants warrants further attention.
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Affiliation(s)
- Aina Jansen
- Center for Morbid Obesity, Department of Surgery, Innlandet Hospital Trust, Kyrre Grepps Gate 11, N-2819 Gjøvik, Norway; Department of Food Safety and Infection Biology, Norwegian University of Life Sciences (NMBU), Campus Adamstuen, P.O. Box 8146 Dep, N-0033 Oslo, Norway.
| | - Anuschka Polder
- Department of Food Safety and Infection Biology, Norwegian University of Life Sciences (NMBU), Campus Adamstuen, P.O. Box 8146 Dep, N-0033 Oslo, Norway
| | - Mette H B Müller
- Department of Food Safety and Infection Biology, Norwegian University of Life Sciences (NMBU), Campus Adamstuen, P.O. Box 8146 Dep, N-0033 Oslo, Norway
| | - Eystein Skjerve
- Department of Food Safety and Infection Biology, Norwegian University of Life Sciences (NMBU), Campus Adamstuen, P.O. Box 8146 Dep, N-0033 Oslo, Norway
| | - Jan Aaseth
- Innlandet Hospital Trust, Kongsvinger Hospital Division, Parkveien 35, N-2212 Kongsvinger, Norway; Faculty of Public Health, Inland Norway University of Applied Sciences, PO Box 400, N-2418 Elverum, Norway
| | - Jan L Lyche
- Department of Food Safety and Infection Biology, Norwegian University of Life Sciences (NMBU), Campus Adamstuen, P.O. Box 8146 Dep, N-0033 Oslo, Norway
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99
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Auclair A, Biertho L, Marceau S, Hould FS, Biron S, Lebel S, Julien F, Lescelleur O, Lacasse Y, Piché ME, Cianflone K, Parlee SD, Goralski K, Martin J, Bastien M, St-Pierre DH, Poirier P. Bariatric Surgery-Induced Resolution of Hypertension and Obstructive Sleep Apnea: Impact of Modulation of Body Fat, Ectopic Fat, Autonomic Nervous Activity, Inflammatory and Adipokine Profiles. Obes Surg 2018; 27:3156-3164. [PMID: 28555408 DOI: 10.1007/s11695-017-2737-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Obesity-associated systemic hypertension (HTN) and obstructive sleep apnea (OSA) have multiple pathophysiological pathways including ectopic fat deposition, inflammation, altered adipokine profile, and increased sympathetic nervous activity. We characterized these potential mechanisms in severely obese patients with or without HTN and OSA. We also compared changes of these mechanisms at 12 months following biliopancreatic diversion with duodenal switch (BPD-DS) surgery according to HTN and OSA resolution. METHODS Sixty-two severely obese patients were evaluated at baseline and 12 months; 40 patients underwent BPD-DS. Blood samples, bioelectrical impedance analysis, computed tomography scan, and 24-h heart rate monitoring were performed. OSA have been determined with polysomnography and HTN with blood pressure measurement and medical file. RESULTS Patients with HTN (n = 35) and OSA (n = 32) were older men with higher ectopic fat deposition and lower parasympathetic nervous activity without difference in adipokines and inflammatory markers. Lower reduction in weight was observed in patients with unresolved HTN (-40.9 ± 3.3 kg vs. -55.6 ± 3.8 kg; p = 0.001) and OSA (-41.4 ± 10.7 kg vs. -51.0 ± 15.2 kg; p = 0.006). Visceral adipose tissue reduction was lower in patients with unresolved HTN (-171.0 ± 25.7 cm2 vs. -274.5 ± 29.0 cm2; p = 0.001) in contrast to a trend for lower abdominal subcutaneous adipose tissue reduction in patients with unresolved OSA (-247.7 ± 91.5 cm2 vs. -390.5 ± 109.1 cm2; p = 0.08). At 12 months, parasympathetic activity was lowest in unresolved HTN and OSA patients, without difference in adipokines and inflammatory biomarkers. CONCLUSION Lower ectopic fat mobilization, lower level of parasympathetic nervous activity, and lower subcutaneous adiposity mobilization may play a role in the pathophysiology of unresolved HTN and OSA following BPD-DS surgery.
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Affiliation(s)
- Audrey Auclair
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculty of Pharmacy, Laval University, Québec, Canada
| | - Laurent Biertho
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculty of Medicine, Laval University, Québec, Canada
| | - Simon Marceau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculty of Medicine, Laval University, Québec, Canada
| | - Frédéric-Simon Hould
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculty of Medicine, Laval University, Québec, Canada
| | - Simon Biron
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculty of Medicine, Laval University, Québec, Canada
| | - Stéfane Lebel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculty of Medicine, Laval University, Québec, Canada
| | - François Julien
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculty of Medicine, Laval University, Québec, Canada
| | - Odette Lescelleur
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculty of Medicine, Laval University, Québec, Canada
| | - Yves Lacasse
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Marie-Eve Piché
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculty of Medicine, Laval University, Québec, Canada
| | - Katherine Cianflone
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Sebastian Demian Parlee
- Department of Molecular & Integrative Physiology, University of Michigan School of Medicine, Detroit, USA
| | - Kerry Goralski
- College of Pharmacy, Dalhousie University, Halifax, Canada.,Department of Pharmacology, Dalhousie University, Halifax, Canada
| | - Julie Martin
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculty of Pharmacy, Laval University, Québec, Canada
| | - Marjorie Bastien
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculty of Pharmacy, Laval University, Québec, Canada
| | - David H St-Pierre
- Department of Exercise Sciences, Université du Québec à Montréal, Québec, Canada
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada. .,Faculty of Pharmacy, Laval University, Québec, Canada.
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Has the Time Come to Be More Aggressive With Bariatric Surgery in Obese Patients With Chronic Systolic Heart Failure? Curr Heart Fail Rep 2018; 15:171-180. [DOI: 10.1007/s11897-018-0390-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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