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El-Eshmawy MM. Impact of obesity on liver function tests: is nonalcoholic fatty liver disease the only player? A review article. Porto Biomed J 2023; 8:e228. [PMID: 37846300 PMCID: PMC10575409 DOI: 10.1097/j.pbj.0000000000000228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 10/18/2023] Open
Abstract
Objectives Obesity and nonalcoholic fatty liver disease (NAFLD) are common worldwide health problems with a strong relationship in between. NAFLD is currently the most common cause of abnormal liver function tests (LFT) because of obesity pandemic. The question is NAFLD the only player of abnormal LFT in obesity? Methodology This article reviews the most important topics regarding the derangements of LFT in obesity through a PubMed search strategy for all English-language literature. Results The reported abnormal LFT in obesity were increased serum levels of transaminases (alanine aminotransaminase, aspartate aminotransaminase), gamma glutamyl transferase, and alkaline phosphatase and decreased serum levels of bilirubin and albumin. Besides novel potential hepatic markers of NAFLD/NASH such as triglycerides/high-density lipoprotein cholesterol ratio, sex hormone-binding globulin, fibroblast growth factor 21, and markers of hepatocyte apoptosis i.e. cytokeratin 18 and microribonucleic acids (miRNAs). Beyond NAFLD, there are other underlying players for the abnormal LFT in obesity such as oxidative stress, inflammation, and insulin resistance. Conclusion Derangements of LFT in obesity are attributed to NAFLD but also to obesity itself and its related oxidative stress, insulin resistance, and chronic inflammatory state. Abnormal LFT predict more than just liver disease.
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Affiliation(s)
- Mervat M. El-Eshmawy
- Department of Internal Medicine, Mansoura Specialized Medical Hospital, Faculty of Medicine, Mansoura University, Egypt
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Chiaramonte A, Testi S, Pelosini C, Micheli C, Falaschi A, Ceccarini G, Santini F, Scarpato R. Oxidative and DNA damage in obese patients undergoing bariatric surgery: A one-year follow-up study. Mutat Res 2023; 827:111827. [PMID: 37352694 DOI: 10.1016/j.mrfmmm.2023.111827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 06/25/2023]
Abstract
The pathogenesis of obesity and related comorbidities has long been associated with oxidative stress. The excess of adipose tissue contributes to the production of free radicals that sustain both a local and a systemic chronic inflammatory state, whereas its reduction can bring to an improvement in inflammation and oxidative stress. In our work, using the fluorescent lipid probe BODIPY® 581/591 C11 and the γH2AX foci assay, a well-known marker of DNA double strand breaks (DSB), we evaluated the extent of cell membrane oxidation and DNA damage in peripheral blood lymphocytes of normal weight (NW) controls and obese patients sampled before and after bariatric surgery. Compared to NW controls, we observed a marked increase in both the frequencies of oxidized cells or nuclei exhibiting phosphorylation of histone H2AX in preoperatory obese patients. After bariatric surgery, obese patients, resampled over one-year follow-up, improved oxidative damage and reduced the presence of DSB. In conclusion, the present study highlights the importance for obese patients undergoing bariatric surgery to also monitor these molecular markers during their postoperative follow-up.
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Affiliation(s)
- Anna Chiaramonte
- Unità di Genetica, Dipartimento di Biologia, University of Pisa, Pisa, Italy
| | - Serena Testi
- Unità di Genetica, Dipartimento di Biologia, University of Pisa, Pisa, Italy
| | - Caterina Pelosini
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital, Pisa, Italy
| | - Consuelo Micheli
- Unità di Genetica, Dipartimento di Biologia, University of Pisa, Pisa, Italy
| | - Aurora Falaschi
- Unità di Genetica, Dipartimento di Biologia, University of Pisa, Pisa, Italy
| | - Giovanni Ceccarini
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital, Pisa, Italy
| | - Ferruccio Santini
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital, Pisa, Italy
| | - Roberto Scarpato
- Unità di Genetica, Dipartimento di Biologia, University of Pisa, Pisa, Italy.
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Kaniel O, Sherf-Dagan S, Szold A, Langer P, Khalfin B, Kessler Y, Raziel A, Sakran N, Motro Y, Goitein D, Moran-Gilad J. The Effects of One Anastomosis Gastric Bypass Surgery on the Gastrointestinal Tract. Nutrients 2022; 14:nu14020304. [PMID: 35057486 PMCID: PMC8778673 DOI: 10.3390/nu14020304] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/28/2021] [Accepted: 01/06/2022] [Indexed: 02/05/2023] Open
Abstract
One anastomosis gastric bypass (OAGB) is an emerging bariatric procedure, yet data on its effect on the gastrointestinal tract are lacking. This study sought to evaluate the incidence of small-intestinal bacterial overgrowth (SIBO) following OAGB; explore its effect on nutritional, gastrointestinal, and weight outcomes; and assess post-OABG occurrence of pancreatic exocrine insufficiency (PEI) and altered gut microbiota composition. A prospective pilot cohort study of patients who underwent primary-OAGB surgery is here reported. The pre-surgical and 6-months-post-surgery measurements included anthropometrics, glucose breath-tests, biochemical tests, gastrointestinal symptoms, quality-of-life, dietary intake, and fecal sample collection. Thirty-two patients (50% females, 44.5 ± 12.3 years) participated in this study, and 29 attended the 6-month follow-up visit. The mean excess weight loss at 6 months post-OAGB was 67.8 ± 21.2%. The glucose breath-test was negative in all pre-surgery and positive in 37.0% at 6 months (p = 0.004). Positive glucose breath-test was associated with lower reported dietary intake and folate levels and higher vitamin A deficiency rates (p ≤ 0.036). Fecal elastase-1 test (FE1) was negative for all pre-surgery and positive in 26.1% at 6 months (p = 0.500). Both alpha and beta diversity decreased at 6 months post-surgery compared to pre-surgery (p ≤ 0.026). Relatively high incidences of SIBO and PEI were observed at 6 months post-OAGB, which may explain some gastrointestinal symptoms and nutritional deficiencies.
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Affiliation(s)
- Osnat Kaniel
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel;
| | - Shiri Sherf-Dagan
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel 40700, Israel; (S.S.-D.); (Y.K.)
- Department of Nutrition, Assuta Medical Center, Tel Aviv 69710, Israel
| | - Amir Szold
- Assia Medical Group, Assuta Medical Center, Tel Aviv 69710, Israel; (A.S.); (P.L.); (A.R.); (N.S.); (D.G.)
| | - Peter Langer
- Assia Medical Group, Assuta Medical Center, Tel Aviv 69710, Israel; (A.S.); (P.L.); (A.R.); (N.S.); (D.G.)
| | - Boris Khalfin
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (B.K.); (Y.M.)
| | - Yafit Kessler
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel 40700, Israel; (S.S.-D.); (Y.K.)
- Assia Medical Group, Assuta Medical Center, Tel Aviv 69710, Israel; (A.S.); (P.L.); (A.R.); (N.S.); (D.G.)
| | - Asnat Raziel
- Assia Medical Group, Assuta Medical Center, Tel Aviv 69710, Israel; (A.S.); (P.L.); (A.R.); (N.S.); (D.G.)
| | - Nasser Sakran
- Assia Medical Group, Assuta Medical Center, Tel Aviv 69710, Israel; (A.S.); (P.L.); (A.R.); (N.S.); (D.G.)
- Department of Surgery, Holy Family Hospital, Nazareth 16234, Israel
- The Azrieli Faculty of Medicine Safed, Bar-Ilan University, Ramat Gan 52900, Israel
| | - Yair Motro
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (B.K.); (Y.M.)
| | - David Goitein
- Assia Medical Group, Assuta Medical Center, Tel Aviv 69710, Israel; (A.S.); (P.L.); (A.R.); (N.S.); (D.G.)
- Department of Surgery C, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Jacob Moran-Gilad
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (B.K.); (Y.M.)
- Correspondence: ; Tel.: +972-506-243-900
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The impact of preoperative vitamin administration on skeletal status following sleeve gastrectomy in young and middle-aged women: a randomized controlled trial. Int J Obes (Lond) 2021; 45:1925-1936. [PMID: 33980995 DOI: 10.1038/s41366-021-00845-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/29/2021] [Accepted: 04/26/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The appropriate strategies to minimize skeletal deterioration following bariatric surgeries are inconclusive. This randomized controlled trial evaluated the effect of preoperative vitamin supplementation on bone mineral density (BMD) and biochemical parameters in females post-sleeve gastrectomy (SG). METHODS Participants were randomized to a 2-month preoperative treatment with a multivitamin and vitamin D 4000 IU/d (intervention arm) or 1200 IU/d (control arm). Preoperative and 12-month postoperative follow-up evaluations included anthropometrics, biochemical parameters, and dual energy X-ray absorptiometry (DEXA). RESULTS Sixty-two females (median age 29.7 years and median BMI 43.4 kg/m2) were recruited, 87% completed the 12-month follow-up. For the intervention and control arms, significant and similar reductions at 12-months post-surgery were observed in BMD of the hip (-6.8 ± 3.7% vs. -6.0 ± 3.6%; P = 0.646) and of the femoral neck (-7.1 ± 5.8% vs. -7.2 ± 5.5%; P = 0.973). For the intervention compared to the control arm, the 25 hydroxyvitamin D (25(OH)D) increment was greater after 2 months treatment, and vitamin D deficiency rates were lower at 3 and 6-months follow-up (P < 0.016). However, at 12-months postoperative, 25(OH)D values and vitamin D deficiency were comparable between the arms (P > 0.339). Predictors for BMD decline in the total hip were the percentage of excess weight-loss, age>50 years, and lower initial BMI (P ≤ 0.003). CONCLUSIONS SG was associated with a significant decline in BMD of the hip and femoral neck in young and middle-aged women, and was unaffected by preoperative vitamin D supplementation. Females who are peri-menopausal or with greater postoperative weight-loss should be particularly followed for BMD decline.
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Comparison of Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy on Weight Loss, Weight Regain, and Remission of Comorbidities: A 5 Years of Follow-up Study. Obes Surg 2019; 30:440-445. [DOI: 10.1007/s11695-019-04183-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Sherf-Dagan S, Hod K, Mardy-Tilbor L, Gliksman S, Ben-Porat T, Sakran N, Zelber-Sagi S, Goitein D, Raziel A. The Effect of Pre-Surgery Information Online Lecture on Nutrition Knowledge and Anxiety Among Bariatric Surgery Candidates. Obes Surg 2019; 28:1876-1885. [PMID: 29455404 DOI: 10.1007/s11695-018-3134-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Best practices for patient education in bariatric surgery (BS) remain undefined. The aims of this study were to evaluate the effect of an online lecture on nutrition knowledge, weight loss expectations, and anxiety among BS candidates and present a new tool to assess this knowledge before BS. METHODS An interventional non-randomized controlled trial on 200 BS candidates recruited while attending a pre-BS committee. The first 100 consecutive patients were assigned to the control group and the latter 100 consecutive patients to the intervention group and were instructed to watch an online lecture of 15-min 1-2 weeks prior to surgery. All participants completed a BS nutrition knowledge and the state-trait anxiety inventory (STAI) questionnaires at the pre-BS committee and once again at the pre-surgery clinic. Body mass index (BMI), comorbidities, surgery type, marital status, and number of dietitian sessions were obtained from medical records. RESULTS Data for paired study questionnaires scores were available for 128 patients (n = 69 and n = 59 for the control and intervention groups, respectively), with a mean age and BMI of 40.3 ± 11.4 years and 41.3 ± 4.9 kg/m2, respectively. The BS nutrition knowledge and the state anxiety scores increased for both study groups at the pre-surgery clinic as compared to the pre-BS committee (P ≤ 0.028), but the improvement in the nutrition knowledge score was significantly higher for the intervention group (P = 0.030). No within or between-group differences were found for the trait anxiety items score. The "dream" and "realistic" weight goals were lower than the expected weight loss according to 70% excess weight loss (EWL) for both study groups at both time-points (P < 0.001 for all). CONCLUSION Education by an online lecture prior to the surgery improves BS nutrition knowledge, but not anxiety. ClinicalTrials.gov number: NCT02857647.
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Affiliation(s)
| | - Keren Hod
- Research division, Epidemiological service, Assuta Medical Center, Tel Aviv, Israel
| | | | - Shir Gliksman
- Department of Nutrition, Assuta Medical Center, Rishon LeZion, Israel.,School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Tair Ben-Porat
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Nasser Sakran
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel.,Department of Surgery A, Emek Medical Center, Afula, affiliated with Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Shira Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,Department of Gastroenterology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - David Goitein
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel.,Department of Surgery C, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Asnat Raziel
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel
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Golzarand M, Toolabi K, Hedayati M, Azam K, Douraghi M, Djafarian K. Comparative Study of Resting Metabolic Rate and Plasma Amino Acid Profile in Patients Who Underwent Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy: 6-Month Follow-up Study. Obes Surg 2019; 29:3125-3132. [DOI: 10.1007/s11695-019-03969-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Sherf Dagan S, Keidar A, Raziel A, Sakran N, Goitein D, Shibolet O, Zelber-Sagi S. Do Bariatric Patients Follow Dietary and Lifestyle Recommendations during the First Postoperative Year? Obes Surg 2018; 27:2258-2271. [PMID: 28303504 DOI: 10.1007/s11695-017-2633-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Data on adherence to postoperative lifestyle recommendations by bariatric patients are scarce. Thus, the aim of this study was to evaluate adherence to selected recommendations during the first year following laparoscopic sleeve gastrectomy (LSG) surgery. METHODS A prospective cohort study with 12 months of follow-up on 100 LSG patients was conducted. Data were collected at baseline and at 3 (M3), 6 (M6), and 12 (M12) months post-surgery and included anthropometrics, biochemical tests, food intake, food tolerance, common surgery-related side effects, physical activity (PA), supplementation, and number of follow-up meetings with a dietitian. RESULTS Data were available for 77 patients (57.1% women, mean age 43.1 ± 9.3 years and preoperative BMI 42.1 ± 4.8 kg/m2). Only a minority of the patients adhered to the recommended protein intake ≥60 g/day at all time points (≤40.3%) and ≥6 meetings with a dietitian at M12 (41.6%). Half of the patients performed ≥150 min/week of PA at all time points (≤50.6%) as recommended. PA of ≥150 min/week was associated with better lipid and glucose changes at M6 and M12 (P ≤ 0.044). Most of the patients adhered to the recommended supplementation at all time points (≥57.1%). Adherence to supplementation at M12 was significantly associated with higher serum levels of folic acid, iron, hemoglobin, and vitamins D and B12 (P ≤ 0.056 for all). Adherence to all recommendations was not significantly associated with excess weight loss ≥60% at M12 (P ≥ 0.195 for all). CONCLUSION Bariatric patients have medium to high adherence to the major lifestyle recommendations during the first year following LSG; however, adherence to those recommendations was not related to better weight loss at short-term follow-up. Adherence to recommended supplementation was associated with better micronutrient status 1 year postoperatively.
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Affiliation(s)
- Shiri Sherf Dagan
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
- Assuta Medical Center, Tel-Aviv, Israel.
- Department Gastroenterology, Tel-Aviv Medical Center, 6 Weizman St., 6423906, Tel-Aviv, Israel.
| | - Andrei Keidar
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Assuta Medical Center, Tel-Aviv, Israel
- Department of Surgery, Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel
| | | | - Nasser Sakran
- Assuta Medical Center, Tel-Aviv, Israel
- Department of Surgery A, Emek Medical Center, Afula, affiliated with Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - David Goitein
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Assuta Medical Center, Tel-Aviv, Israel
- Department of Surgery C, Sheba Medical Center, Tel Hashomer, Israel
| | - Oren Shibolet
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department Gastroenterology, Tel-Aviv Medical Center, 6 Weizman St., 6423906, Tel-Aviv, Israel
| | - Shira Zelber-Sagi
- Department Gastroenterology, Tel-Aviv Medical Center, 6 Weizman St., 6423906, Tel-Aviv, Israel
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Oved I, Vaiman IM, Hod K, Mardy-Tilbor L, Torban Y, Sherf Dagan S. Poor Health Behaviors Prior to Laparoscopic Sleeve Gastrectomy Surgery. Obes Surg 2017; 27:469-475. [PMID: 27613191 DOI: 10.1007/s11695-016-2358-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Identifying eating and lifestyle behaviors prior to bariatric surgery may assist in better selecting and preparing patients and might lead to improved success rate. The current study aimed to assess eating behaviors and lifestyle trends among laparoscopic sleeve gastrectomy (LSG) candidates and to compare those trends between genders. METHODS This descriptive study was conducted in the bariatric clinic at the Haifa Assuta Medical Center. Data was gathered from medical records of LSG candidates that were evaluated before surgery in our institution between 2008 and 2011. The data included demographics, comorbidities, anthropometrics, weight management history, and lifestyle parameters. Eating pattern and eating habits were determined by eating habits questionnaires. RESULTS A total of 266 LSG surgery candidates (71.4 % female) with an average age of 40.7 ± 10.9 years and pre-surgery BMI of 42.4 ± 4.8 kg/m2 were studied. More than half of the patients have family history of obesity and their onset of obesity was before the age of 18 years (54.5 and 57.9 %, respectively). Most of the patients reported on poor eating habits and sedentary lifestyle: 65.1 % do not eat regular meals, 70.3 % skip over breakfast, 61.9 % presented loss of control eating, 45 % frequently consume sweets, and 80.1 % were classified as none active. There were no differences in eating patterns or lifestyle parameters between genders. CONCLUSION High occurrence of unhealthy eating habits and a non-active lifestyle were detected in morbid obese candidates for LSG surgery. More efforts should be directed towards nutritional and lifestyle education prior to the surgery.
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Affiliation(s)
- Irit Oved
- Department of Nutrition, Assuta Medical Center, Haifa, Israel
| | | | - Keren Hod
- Research Division, Epidemiological Service, Assuta Medical Center, Tel Aviv, Israel
| | | | - Yakov Torban
- Department of Anesthesia, Assuta Medical Center, Haifa, Israel
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Dakour Aridi H, Khazen G, Safadi BY. Comparison of Outcomes Between Laparoscopic Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in a Lebanese Bariatric Surgical Practice. Obes Surg 2017; 28:396-404. [DOI: 10.1007/s11695-017-2849-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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11
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Sherf Dagan S, Tovim TB, Keidar A, Raziel A, Shibolet O, Zelber-Sagi S. Inadequate protein intake after laparoscopic sleeve gastrectomy surgery is associated with a greater fat free mass loss. Surg Obes Relat Dis 2016; 13:101-109. [PMID: 27521254 DOI: 10.1016/j.soard.2016.05.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 05/07/2016] [Accepted: 05/31/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Low postoperative protein intake may represent a modifiable risk factor that leads to fat free mass (FFM) loss postlaparoscopic sleeve gastrectomy (LSG), but data concerning this phenomenon is scarce. OBJECTIVES To evaluate the association between daily protein intake and relative FFM loss at 6 (M6) and 12 (M12) months after LSG surgery. SETTINGS Private hospital and university hospital. METHODS A prospective cohort study with 12 months follow-up of 77 patients who underwent LSG surgery. Anthropometrics including body composition analysis measured by multifrequency bioelectrical impedance analysis, 3-day food diaries, food intolerance, and habitual physical activity were evaluated at baseline and at M3, M6, and M12. RESULTS Repeated body composition measurements and food diary were available for 77 patients (45 women) at M6 and for 68 patients at M12. Mean age was 42.7±9.4 years and mean preoperative body mass index was 42.2±4.8 kg/m2. A protein intake of≥60 g/d was achieved in 13.3%, 32.5% and 39.7% of the study participants at M3, M6 and M12, respectively. FFM significantly decreased at M6 and stabilized at M12. Protein intake of≥60 g/d was associated with a significantly lower relative FFM loss at M6 among women (8.9±6.5% versus 12.4±4.1%; P = .039) and this trend was also reported among men (9.5±5.5% versus 13.4±6.0%; P = .068). A logistic regression for the prediction of FFM loss of≥10% at M6, indicated that protein intake≥60 g/d is a strong protective factor (odds ratio = 0.29, 95% confidence interval .09-.96, P = .043). CONCLUSION Our study supports the currently recommended protein intake goal of≥60 g/d as an efficient strategy for better preservation of FFM post-LSG.
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Affiliation(s)
- Shiri Sherf Dagan
- Assuta Medical Center, Tel Aviv, Israel; Department of Gastroenterology, Tel-Aviv Medical Center, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Tali Ben Tovim
- Department of Gastroenterology, Tel-Aviv Medical Center, Tel-Aviv, Israel; School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Andrei Keidar
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Surgery, Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel
| | | | - Oren Shibolet
- Department of Gastroenterology, Tel-Aviv Medical Center, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shira Zelber-Sagi
- Department of Gastroenterology, Tel-Aviv Medical Center, Tel-Aviv, Israel; School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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12
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Spitznagel MB, Gunstad J, Manderino L, Heinberg L. Liver Fibrosis Predicts Cognitive Function Following Bariatric Surgery: A Preliminary Investigation. Obesity (Silver Spring) 2015; 23:1957-9. [PMID: 26414561 DOI: 10.1002/oby.21219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 06/10/2015] [Accepted: 06/15/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Obesity is a well-established risk factor for poor neurological outcomes, and bariatric surgery has been shown to improve many aspects of cognitive function. Factors underlying improved cognition following surgery are not yet fully established. A recent study of bariatric surgery patients demonstrated lower preoperative alkaline phosphatase concentrations were linked to greater postoperative cognitive improvement, but this link has not been examined via liver biopsy. The current study examined postoperative cognitive function in individuals with and without fibrosis at the time of bariatric surgery. It expected that those with fibrosis would demonstrate poorer postoperative cognition. METHODS Thirty-six bariatric surgery patients underwent routine liver biopsy at the time of surgery and completed cognitive testing 1 month postoperatively. RESULTS Bariatric surgery patients with fibrosis demonstrated poorer performance on a task of executive function (maze errors, P = 0.01) and verbal memory (recognition memory, P = 0.01). CONCLUSIONS Bariatric surgery patients with fibrosis demonstrated poorer cognition following surgery, providing further evidence for the connection between liver disease and cognitive function. Future work examining mechanisms underlying bariatric postoperative cognitive changes should include examination of broader metabolic functions, particularly liver function.
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Affiliation(s)
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
| | - Lisa Manderino
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
| | - Leslie Heinberg
- Behavioral Services, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Psychiatry and Psychology, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
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Ghoghaei M, Taghdiri F, Khajeh E, Azmoudeh Ardalan F, Sedaghat M, Hosseini Shirvani S, Zarei S, Toolabi K. Parathyroid Hormone Levels May Predict Nonalcoholic Steatohepatitis in Morbidly Obese Patients. HEPATITIS MONTHLY 2015; 15:e29697. [PMID: 26300934 PMCID: PMC4539792 DOI: 10.5812/hepatmon.29697v2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 06/12/2015] [Accepted: 06/16/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obesity as a worldwide health problem is associated with nonalcoholic steatohepatitis (NASH). Since severe liver injury may be present in asymptomatic obese patients and a definite diagnosis of nonalcoholic steatohepatitis can only be made after an invasive procedure of liver biopsy, there is a need for noninvasive methods to predict the probability of NASH. OBJECTIVES To investigate the role of vitamin D endocrine system in predicting the probability of presence of NASH in asymptomatic morbidly obese candidates of bariatric surgery. PATIENTS AND METHODS From December 09 to March 11, every patient undergoing bariatric surgery had a liver biopsy. Nonalcoholic steatohepatitis was diagnosed using the Lee's criteria, the baseline labs obtained and the association between laboratory data and presence of NASH assessed. RESULTS Forty-six patients (34 women, aged 36.5 ± 10.6 years) were analyzed. The mean levels of liver enzymes were significantly higher in the group with NASH (P value < 0.01). In an unadjusted logistic model, PTH was the only variable in vitamin D endocrine system which was significantly associated with NASH (odds ratio (OR): 1.04, 95%CI: 1.01 - 1.07). After adjustment for possible confounding factors, age (OR: 1.22, 95%CI: 1.00 - 1.50) and PTH (OR: 1.08, 95%CI: 1.01 - 1.16) were predictive factors for NASH (P value < 0.05). CONCLUSIONS Elevated serum PTH level was the predictive factor for NASH in morbidly obese patients. Also, we reported elevated serum liver enzymes, high serum PTH levels and older age as predictors of NASH in patients seeking obesity surgical treatments.
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Affiliation(s)
- Morteza Ghoghaei
- Department of Internal Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Foad Taghdiri
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Elias Khajeh
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Farid Azmoudeh Ardalan
- Department of Pathology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mojtaba Sedaghat
- Department of Community Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
| | | | - Shadi Zarei
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Karamollah Toolabi
- Department of General Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Karamollah Toolabi, Department of General Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9123212787, Fax: +98-66486772, E-mail:
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Laparoscopic Adjustable Gastric Banded Plication (Lagbp): Standardization of Surgical Technique and Analysis of Surgical Outcomes. Obes Surg 2015; 26:85-90. [DOI: 10.1007/s11695-015-1723-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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15
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The effects of cystatin C and alkaline phosphatase changes on cognitive function 12-months after bariatric surgery. J Neurol Sci 2014; 345:176-80. [PMID: 25073570 DOI: 10.1016/j.jns.2014.07.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/25/2014] [Accepted: 07/15/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND The mechanisms for improved cognitive function post-bariatric surgery are not well understood. Markers of kidney and liver function (i.e., cystatin C and alkaline phosphatase (ALP)) are elevated in obese individuals and associated with poor neurocognitive outcomes in other samples. Bariatric surgery can improve cystatin C and ALP levels, but no study has examined whether such changes correspond to post-operative cognitive benefits. METHODS 78 bariatric surgery patients completed a computerized cognitive test battery prior to and 12-months after surgery. All participants underwent an eight-hour fasting blood draw to quantify cystatin C and ALP concentrations. RESULTS Cognitive function improved after surgery. Cystatin C levels decreased at the 12-month follow-up; however, no changes were found in ALP concentrations. At baseline, higher cystatin C levels predicted worse attention/executive function, but no such effects emerged for ALP. Regression analyses controlling for possible medical and demographic confounds and baseline factors revealed that decreased ALP levels following surgery predicted better attention/executive function and memory abilities. Post-surgery changes in cystatin C did not correspond to cognitive improvements. CONCLUSIONS Decreased ALP levels predicted better cognition following bariatric surgery, suggesting improved liver function as a possible mechanism of post-operative cognitive benefits. Future studies with neuroimaging and longer follow-up periods are needed to determine whether bariatric surgery can decrease risk for adverse brain changes and dementia in severely obese persons via improved metabolic function.
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Oberbach A, Neuhaus J, Inge T, Kirsch K, Schlichting N, Blüher S, Kullnick Y, Kugler J, Baumann S, Till H. Bariatric surgery in severely obese adolescents improves major comorbidities including hyperuricemia. Metabolism 2014; 63:242-9. [PMID: 24332707 DOI: 10.1016/j.metabol.2013.11.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 11/13/2013] [Accepted: 11/15/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Serum uric acid (sUA) is believed to contribute to the pathogenesis of metabolic comorbidities like hypertension, insulin-resistance (IR) and endothelial dysfunction (EDF) in obese children. The present pilot study investigated the association between sUA concentrations and loss of body weight following laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y-gastric bypass (RYGB) in severely obese adolescents. MATERIALS/METHODS 10 severely obese adolescents underwent either LSG (n=5) or RYGB (n=5). 17 normal weight, healthy, age- and gender-matched adolescents served as a normal weight peer group (NWPG). Pre- and 12 months postoperatively, sUA and relevant metabolic parameters (glucose homeostasis, transaminases, lipids) were compared. RESULTS Preoperatively, sUA was significantly elevated in patients with severe obesity compared to NWPG. Twelve months after LSG and RYGB, a significant decrease in sUA, BMI, CVD risk factors, hepatic transaminases, and HOMA-IR was observed. Reduction in SDS-BMI significantly correlated with changes in sUA. CONCLUSIONS sUA levels and metabolic comorbidities improved following bariatric surgery in severely obese adolescents. The impact of changes in sUA on long-term clinical complications of childhood obesity deserves further study.
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Affiliation(s)
- Andreas Oberbach
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany; University of Dresden, Department of Health Sciences/Public Health, Dresden, Germany
| | - Jochen Neuhaus
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - Thomas Inge
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Katharina Kirsch
- Department of Cardiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Nadine Schlichting
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University Leipzig, Leipzig, Germany
| | - Susann Blüher
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University Leipzig, Leipzig, Germany; Department of Women and Child Health, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Yvonne Kullnick
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University Leipzig, Leipzig, Germany
| | - Joachim Kugler
- University of Dresden, Department of Health Sciences/Public Health, Dresden, Germany
| | - Sven Baumann
- Helmholtz Centre for Environmental Research, Department of Metabolomics, Leipzig, Germany
| | - Holger Till
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria.
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