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Reczkowicz J, Mika A, Antosiewicz J, Kortas J, Proczko-Stepaniak M, Śledziński T, Kowalski K, Kaska Ł. Bariatric Surgery Induced Changes in Blood Cholesterol Are Modulated by Vitamin D Status. Nutrients 2022; 14:nu14102000. [PMID: 35631139 PMCID: PMC9145606 DOI: 10.3390/nu14102000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/06/2022] [Accepted: 05/07/2022] [Indexed: 12/10/2022] Open
Abstract
The effect of metabolically active bariatric surgery treatment on lipid metabolism is inconclusive. The authors of this study presume that initial vitamin D status may play a regulating role in influencing the beneficial post-effects of bariatric surgery, especially the lipid profile. The biochemical data obtained from 24 patients who had undergone laparoscopic one-anastomosis gastric bypass (OAGB) at baseline, 3 months before the surgery, at the time of surgery, and 6 months later, demonstrate that vitamin D status influenced the postoperative lipid profile. The baseline established the partition line which divided patients into two groups according to the stated calcidiol initial concentration level of 32 ng/mL. The data shows that OAGB induces a decrease in TG and hsCRP while increasing HDL. Conversely, in patients whose 25(OH)D3 was below 32 ng/mL TC significantly increased while those above this concentration remained in the normal physiological range. The changes induced by OAGB in TG, glucose, and hsCRP were similar in both groups. Unexpectedly, the surgery did not affect vitamin D metabolites. In conclusion, the results of the study suggest that a higher concentration of serum 25(OH)D3 may enhance the protective effects of OAGB.
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Affiliation(s)
- Joanna Reczkowicz
- Department of Bioenergetics and Physiology of Exercise, Medical University of Gdansk, 80-210 Gdansk, Poland;
| | - Adriana Mika
- Department of Pharmaceutical Biochemistry, Medical University of Gdansk, 80-211 Gdansk, Poland; (A.M.); (T.Ś.)
| | - Jędrzej Antosiewicz
- Department of Bioenergetics and Physiology of Exercise, Medical University of Gdansk, 80-210 Gdansk, Poland;
- Correspondence: (J.A.); (Ł.K.); Tel.: +48-583491456 (J.A.)
| | - Jakub Kortas
- Department of Health and Natural Sciences, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland;
| | - Monika Proczko-Stepaniak
- Department of General, Endocrine and Transplant Surgery, Faculty of Medicine, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland;
| | - Tomasz Śledziński
- Department of Pharmaceutical Biochemistry, Medical University of Gdansk, 80-211 Gdansk, Poland; (A.M.); (T.Ś.)
| | - Konrad Kowalski
- Masdiag Sp. z o.o. Company, Stefana Żeromskiego 33, 01-882 Warsaw, Poland;
| | - Łukasz Kaska
- Department of General, Endocrine and Transplant Surgery, Faculty of Medicine, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland;
- Correspondence: (J.A.); (Ł.K.); Tel.: +48-583491456 (J.A.)
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Glycated apolipoprotein B decreases after bariatric surgery in people with and without diabetes: A potential contribution to reduction in cardiovascular risk. Atherosclerosis 2022; 346:10-17. [DOI: 10.1016/j.atherosclerosis.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/19/2021] [Accepted: 01/13/2022] [Indexed: 11/17/2022]
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Bourbour F, Kabir A, Pazouki A, Mokhber S, Kord-Varkaneh H, Găman MA, Mohseni F, Mokhtari Z, Hekmatdoost A. Trends in Serum Vitamin D Levels within 12 Months after One Anastomosis Gastric Bypass (OAGB). Obes Surg 2021; 31:3956-3965. [PMID: 33881740 DOI: 10.1007/s11695-021-05434-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE To assess serum vitamin D trend from baseline to 12 months after one anastomosis gastric bypass (OAGB). MATERIALS AND METHODS In this observational cohort analysis of longitudinal data, we assessed the trend of serum vitamin D, and its associations with anthropometric, and biochemical measurements in 98 patients undergoing OAGB in a bariatric surgery center. All participants were on >800 IU/day vitamin D supplementation. RESULTS Vitamin D, lipid profile, creatinine, and albumin levels significantly improved at 12 months post-surgery. Vitamin D concentrations significantly increased from 26.52 ± 12.32 to 54.52 ± 27.90 ng/mL at 12 months. The correlations between vitamin D concentrations and weight, body mass index, lipid profile, ferritin, glycemic indices, and albumin were not significant. In addition, the correlations between vitamin D and parathormone, vitamin D receptor, calcium, phosphorus, body composition, and basal metabolic rate (BMR) did not reach the threshold of statistical significance at 12 months following bariatric surgery. Although there was a significant correlation between body weight and body composition (P < 0.001) and basal metabolic rate (BMR) (r = 0.762, P < 0.001) at 12 months, there were no significant correlations between weight change percent and body composition (P > 0.05), BMR (r = -0.101, P = 0.350), and vitamin D (r = 0.120, P = 0.271) at 12 months. CONCLUSION Our results showed that supplementation of vitamin D with dosage of >800 IU/day is sufficient for prevention of vitamin D deficiency within 12 months after OAGB surgery. Note: This data is mandatory.
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Affiliation(s)
- Fatemeh Bourbour
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.,Center of Excellence for Minimally Invasive Surgery Training, Iran University of Medical Sciences, Tehran, Iran.,Center of Excellence of European Branch of International Federation for Surgery of Obesity, Tehran, Iran
| | - Somayyeh Mokhber
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamed Kord-Varkaneh
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mihnea-Alexandru Găman
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Hematology, Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Fatemeh Mohseni
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zeinab Mokhtari
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azita Hekmatdoost
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Abdulrazzaq S, Elhag W, El Ansari W, Mohammad AS, Sargsyan D, Bashah M. Is Revisional Gastric Bypass as Effective as Primary Gastric Bypass for Weight Loss and Improvement of Comorbidities? Obes Surg 2021; 30:1219-1229. [PMID: 31865551 DOI: 10.1007/s11695-019-04280-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Revisional gastric bypass (R-RYGB) surgery is utilized for the management of inadequate weight loss or weight regain observed after some cases of bariatric surgeries. Data on the mid-term effectiveness of primary gastric bypass (P-RYGB) compared with R-RYGB (e.g., post sleeve gastrectomy/gastric banding) are controversial. METHODS Retrospective chart review of all patients who received P-RYGB and R-RYGB (January 2011-June 2015) at our center. One hundred twenty patients who underwent P-RYGB and 34 R-RYGB who completed 18 months follow-up were included. We compared the effectiveness of P-RYGB with R-RYGB by assessing four anthropometric, two glycemic, and four lipid parameters, as well as the control of type 2 diabetes (T2DM), hypertension, dyslipidemia (remission, improvement, persistence, relapse, de novo), mortality and complications rates. RESULTS A comparison of the effectiveness of P-RYGB with R-RYGB at 18 months revealed no significant differences in patients' age, gender, and preoperative BMI between groups. However, patients who received P-RYGB had lower mean weight (P = 0.001) and BMI (P < 0.001), reflected by a higher mean delta BMI (P = 0.02), total weight loss percentage (TWL%) (P < 0.0001) and excess weight loss percentage (EWL%) (P < 0.0001). No differences in glycemic parameters, lipid profiles, control of T2DM, hypertension, and dyslipidemia were observed. No death is reported and complication rates were comparable. CONCLUSIONS Although R-RYGB effectively addressed inadequate weight loss, weight regain, and recurrence of comorbidities after restrictive bariatric surgery, R-RYGB resulted in inferior weight loss compared with P-RYGB. Neither procedure differed in their clinical control of T2DM, hypertension, and dyslipidemia. Both procedures exhibited comparable complication rates.
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Affiliation(s)
- Sama Abdulrazzaq
- Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, 3050, Doha, Qatar
| | - Wahiba Elhag
- Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, 3050, Doha, Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, 3050, Doha, Qatar. .,College of Medicine, Qatar University, Doha, Qatar. .,Schools of Health and Education, University of Skovde, Skövde, Sweden.
| | | | - Davit Sargsyan
- Department of Metabolic and Bariatric Surgery, Hamad General Hospital, 3050, Doha, Qatar.,Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Moataz Bashah
- Department of Metabolic and Bariatric Surgery, Hamad General Hospital, 3050, Doha, Qatar.,Weill Cornell Medicine-Qatar, Doha, Qatar
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Ding L, Fan Y, Li H, Zhang Y, Qi D, Tang S, Cui J, He Q, Zhuo C, Liu M. Comparative effectiveness of bariatric surgeries in patients with obesity and type 2 diabetes mellitus: A network meta-analysis of randomized controlled trials. Obes Rev 2020; 21:e13030. [PMID: 32286011 PMCID: PMC7379237 DOI: 10.1111/obr.13030] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 12/30/2022]
Abstract
A network meta-analysis of randomized controlled trials (RCTs) was performed to determine the hierarchies of different bariatric surgeries in patients with obesity and type 2 diabetes mellitus (T2DM), in terms of diabetes remission and cardiometabolic outcomes. Seventeen RCTs and six bariatric surgeries, including single anastomosis (mini) gastric bypass (mini-GBP), biliopancreatic diversion without duodenal switch (BPD), laparoscopic-adjustable gastric banding (LAGB), laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGBP), greater curvature plication (GCP) and nonsurgical treatments (NST) were included. Mini-GBP, BPD, LSG, RYGBP and LAGB (from best to worst), as compared with NST, were all significantly associated with the remission of T2DM. For the follow-up period > 3 years, BPD, mini-GBP, RYGBP and LSG (from best to worst) were significantly superior to NST in achieving the remission of T2DM. For secondary outcomes, the overall ranking for bariatric surgeries was RYGBP > BPD > LSG > LAGB after comprehensively weighting glucose, weight, systolic and diastolic pressure, total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Mini-GBP has the greatest probability of achieving diabetes remission in adults with obesity and T2DM, yet BPD was the most effective in long-term diabetes remission. RYGBP appears to be the most favourable alternative treatment to manage patients with cardiometabolic conditions.
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Affiliation(s)
- Li Ding
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuxin Fan
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Hui Li
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Yalan Zhang
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Dongwang Qi
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Shaofang Tang
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Jingqiu Cui
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Qing He
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Chuanjun Zhuo
- Department of School of Mental Health, Jining Medical University, Jining, China
| | - Ming Liu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
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Roux-en-Y Gastric Bypass Is More Effective than Sleeve Gastrectomy in Improving Postprandial Glycaemia and Lipaemia in Non-diabetic Morbidly Obese Patients: a Short-term Follow-up Analysis. Obes Surg 2019; 28:3997-4005. [PMID: 30112599 DOI: 10.1007/s11695-018-3454-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: 01/06/2023]
Abstract
PURPOSE We aimed to compare the effects of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) on postprandial glucose and lipid metabolism in addition to weight loss and fasting metabolic profile, in non-diabetic patients undergoing bariatric surgery. METHODS Seventy-one patients were consecutively recruited and studied preoperatively, 3 and 6 months after surgery. Of these, 28 underwent RYGB (7 males, age 38 ± 9 years, BMI 46.9 ± 5.0 kg/m2), and 43 SG (9 males, age 38 ± 9 years, BMI 50.2 ± 7.0 kg/m2). A semi-liquid mixed meal was consumed, and blood samples were taken before, and every 30 min after meal ingestion up to 180 min postprandially, for measurement of glucose, insulin, and lipids. The overall postprandial response was assessed as area under the concentration-time curve (AUC). RESULTS Baseline metabolic parameters were similar between RYGB and SG. Both groups experienced comparable weight loss, and a similar improvement in fasting glucose, insulin, and insulin resistance. Total and LDL cholesterol levels were lower at 6 months after RYGB compared to SG, while there was no difference in HDL cholesterol or triglycerides. Glucose AUC was lower after RYGB compared to SG at both 3 (p = 0.008) and 6 months (p = 0.016), without any difference in postprandial insulin response. Triglyceride AUC was also lower in RYGB vs. SG at 3 and 6 months (p ≤ 0.001). CONCLUSIONS RYGB is superior to SG in improving postprandial glycaemia and lipaemia and cholesterol profile 6 months postoperatively in non-diabetic, severely obese patients. These findings imply procedure-specific effects, such as the malabsorptive nature of RYGB, and less likely a different incretin postoperative response.
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Roberts HM, Grant MM, Hubber N, Super P, Singhal R, Chapple ILC. Impact of Bariatric Surgical Intervention on Peripheral Blood Neutrophil (PBN) Function in Obesity. Obes Surg 2019; 28:1611-1621. [PMID: 29238916 PMCID: PMC5973997 DOI: 10.1007/s11695-017-3063-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Aim The aim of this study was to investigate the impact of weight loss following gastric band surgery on multiple measures of peripheral blood neutrophil (PBN) function. Material and Methods Twenty-three obese patients undergoing gastric band surgery were recruited to a longitudinal intervention study, alongside non-obese, healthy gender- and age-matched controls. Eighteen pairs of patients and controls completed all stages of the study. PBNs were isolated by density centrifugation and a comprehensive analysis of PBN function was undertaken at various stages of the patients’ bariatric surgical care pathway. Results Obese patients exhibited exaggerated PBN activity in response to various stimuli, characterised by higher reactive oxygen species (ROS) generation (n = 18, p < 0.001) and release of pro-inflammatory cytokines (n = 10, p < 0.05) and lower PBN extracellular trap (NET) formation (n = 18, p < 0.01). PBN chemotactic accuracy was also impaired prior to surgery (n = 18, p < 0.01). Weight loss was associated with normalised NET production and lower ROS production and cytokine release relative to healthy controls. However, chemotactic accuracy remained impaired in patients. Conclusions Weight loss following gastric band surgery was associated with a decrease in the pro-inflammatory activities of peripheral blood neutrophils (PBNs). A hyper-inflammatory PBN phenotype, involving excess ROS and cytokine release, reduced NET formation and chemotaxis, may lead to a reduced ability to eliminate infection, alongside inflammation-mediated tissue damage in obese individuals. Electronic supplementary material The online version of this article (10.1007/s11695-017-3063-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Helen M Roberts
- Periodontal Research Group, School of Dentistry, Institute of Clinical Science, University of Birmingham and Birmingham Dental Hospital (Birmingham Community Healthcare Trust), 5 Mill Pool Way, Edgbaston, Birmingham, B5 7ET, UK
| | - Melissa M Grant
- Periodontal Research Group, School of Dentistry, Institute of Clinical Science, University of Birmingham and Birmingham Dental Hospital (Birmingham Community Healthcare Trust), 5 Mill Pool Way, Edgbaston, Birmingham, B5 7ET, UK.
| | - Naomi Hubber
- Periodontal Research Group, School of Dentistry, Institute of Clinical Science, University of Birmingham and Birmingham Dental Hospital (Birmingham Community Healthcare Trust), 5 Mill Pool Way, Edgbaston, Birmingham, B5 7ET, UK
| | - Paul Super
- Birmingham Heartlands Hospital, Bordesley Green East, B9 5SS, Birmingham, UK
| | - Rishi Singhal
- Birmingham Heartlands Hospital, Bordesley Green East, B9 5SS, Birmingham, UK
| | - Iain L C Chapple
- Periodontal Research Group, School of Dentistry, Institute of Clinical Science, University of Birmingham and Birmingham Dental Hospital (Birmingham Community Healthcare Trust), 5 Mill Pool Way, Edgbaston, Birmingham, B5 7ET, UK
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Magno FCCM, Sousa PAMD, Rodrigues MP, Pereira LLP, Oliveira JEPD, Rosado EL, Carneiro JRI. Long term maintenance of glucose and lipid concentrations after Roux-en-Y gastric bypass. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:346-351. [PMID: 29791656 PMCID: PMC10118783 DOI: 10.20945/2359-3997000000047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 02/17/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Roux-en-Y gastric bypass (RYGB) reduces body weight and the comorbidities associated with obesity. The aim of this study was to evaluate whether glucose and lipid profiles were maintained during a 5-year follow-up period after RYGB. SUBJECTS AND METHODS Anthropometric and laboratory data from 323 patients who had undergone this operation were analyzed. Differences in laboratory variables between the baseline and 12, 24, 36, 48 and 60 months postoperatively (PO) were assessed using a one-way ANOVA test to compare the three groups. Delta significance using one-way ANOVA was performed to assess anthropometric variable in the postoperative period (p < 0.05). RESULTS 77 patients (24%) were included in Group 1 (G1), 101 (32%) in Group 2 (G2), and 141 (44%) in Group 3 (G3). The majority of patients, 71.7% in G1, 82.8% in G2, and 70% in G3, showed high triglycerides (TG) before surgery. A decrease in weight loss was observed in all groups followed by an increase in body weight in G2 and G3 at 36, 48 and 60 months. Laboratory results for G1, G2 and G3 showed no significant differences between groups at baseline and during the post-operative period. CONCLUSION Our results suggest that weight regain after RYGB has no significant impact on the long-term evolution of the lipid profile and glycemia.
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Kjellmo CA, Karlsson H, Nestvold TK, Ljunggren S, Cederbrant K, Marcusson-Ståhl M, Mathisen M, Lappegård KT, Hovland A. Bariatric surgery improves lipoprotein profile in morbidly obese patients by reducing LDL cholesterol, apoB, and SAA/PON1 ratio, increasing HDL cholesterol, but has no effect on cholesterol efflux capacity. J Clin Lipidol 2018; 12:193-202. [DOI: 10.1016/j.jacl.2017.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/24/2017] [Accepted: 10/11/2017] [Indexed: 11/27/2022]
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Effects of Weight Reduction After Sleeve Gastrectomy on Metabolic Variables in Saudi Obese Subjects in Aseer Province of Kingdom of Saudi Arabia. Obes Surg 2017; 27:2005-2014. [PMID: 28224472 DOI: 10.1007/s11695-017-2579-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The objectives of this study were to investigate the occurrence of oxidative stress, status of protective antioxidants enzymes, inflammatory biomarkers, and some metabolic health variables in the blood and to compare the results between those of the normal controls and obese patients submitted to sleeve gastrectomy-induced weight loss over a 1-year follow-up period. MATERIALS AND METHODS A prospective study was conducted in Aseer Central Hospital and Abha Private Hospital in the Kingdom of Saudi Arabia from January 2012 to January 2013 on 50 normal (BMI = 22-25 kg/m2) control subjects and 50 obese (BMI = 45-50 kg/m2) patients. A subset of 20 men and 80 women patients, aged 20-45 years, was included. The systemic blood cell counts were determined by Beckman Coulter UniCel analyzer. The occurrence of oxidative stress, the status of antioxidant enzyme system in the blood, levels of serum hepatic enzymes, cardiovascular risk factors, and serum sodium, potassium, copper, and zinc levels were determined by spectrophotometric procedures. The concentration of TSH and T4 were analyzed by Siemens Immunoassay System. RESULTS Group 1 (Obese: preoperative) This group compared with the normal controls exhibited significant (p < 0.05) increase in inflammatory biomarkers, a significant (p < 0.05) rise in hepatic enzymes, a significant (p < 0.05) decrease in serum total bilirubin. Concentration of serum total cholesterol (TC), triacylglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and fasting blood glucose(FBG) were significantly (p < 0.05) increased, but HDL cholesterol (HDL-C) was significantly depleted (p < 0.05). Serum urea and creatinine contents were significantly (p < 0.05) decreased. Serum copper and zinc levels were significantly (p < 0.05) increased. Group 2: Sleeve Gastrectomy Surgery (Obese: postoperative) This group compared with the obese group, preoperatively, demonstrated a profound reduction in body weight (-32%) as well as in BMI (-29%). Serum malondialdehyde, a stress index, was significantly (p < 0.001) inhibited and conversely, activities of antioxidant enzymes: superoxide dismutase(Cu-Zn SOD), glutathione peroxidase (GPx), glutathione-S-transferase (GST), glucose-6-phosphate dehydrogenase (G6PDH), and vitamin C, were remarkably (p < 0.001) increased. Furthermore, remarkable improvements in deranged metabolic variables approaching normality were discernible. Inflammatory biomarkers in the blood and hepatic enzymes in serum were significantly (p < 0.001) decreased. Levels of TC, TG, LDL-C, FBG, and HDL-C in serum exhibited significant (p < 0.05) reductions, a reversal toward normality. Serum albumin and total bilirubin concentrations were significantly increased (p < 0.001). Serum sodium, potassium, copper, zinc, and TSH levels were significantly (p < 0.001) decreased. CONCLUSIONS Obesity is a chronic disease of multifactorial origin and resulted in perturbations of whole body metabolism in this study. It is thus likely that this imbalance was associated with an inhibition in protective antioxidants and occurrence of oxidative stress. The staging concept of sleeve gastrectomy is a safe and effective approach with remarkable efficacy in sustaining weight loss and bringing back normal metabolism of variables in tissues over a 1-year follow-up period.
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Comparison of Effects of Sleeve Gastrectomy and Gastric Bypass on Lipid Profile Parameters in Indian Obese: a Case Matched Analysis. Obes Surg 2017; 27:2606-2612. [PMID: 28451932 DOI: 10.1007/s11695-017-2692-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Obesity is associated with increased mortality due to higher cardiovascular risk. A proportion of this risk is attributed to impaired lipid profile in the form of high levels of serum total cholesterol, triglycerides, and low levels of HDL cholesterol. Both sleeve gastrectomy (LSG) and gastric bypass (LGB) have been shown to have favourable effects on lipid profile with some variability in improvement. We aimed to study the difference in changes in lipid profile after LSG and LGB. METHODS We performed a retrospective case-matched study comparing effects of LSG and LGB on lipid profile of patients who underwent bariatric surgery from September 2014 to September 2015. The matching was done based on criteria of age and body mass index (BMI). RESULTS Out of a total of 92 selected patients, 69 patients underwent LSG and 23 patients underwent LGB. There was a significant improvement in serum triglycerides and HDL cholesterol with no significant reduction in serum total cholesterol in both LSG and LGB group. There was a significant reduction in cardiovascular risk calculated as total cholesterol: HDL cholesterol ratio following bariatric surgery (p = 0.002). CONCLUSION Both LSG and LGB have similar effects on lipid profile cardiovascular risk attributed to it in Indian obese. Thus, sleeve gastrectomy may be considered as effective as a gastric bypass for dyslipidaemia improvement in Indian patients.
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Schmatz R, Bitencourt MR, Patias LD, Beck M, da C. Alvarez G, Zanini D, Gutierres JM, Diehl LN, Pereira LB, Leal CA, Duarte MF, Schetinger MR, Morsch VM. Evaluation of the biochemical, inflammatory and oxidative profile of obese patients given clinical treatment and bariatric surgery. Clin Chim Acta 2017; 465:72-79. [DOI: 10.1016/j.cca.2016.12.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 11/09/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
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Climent E, Benaiges D, Pedro-Botet J, Flores-Le Roux JA, Ramón JM, Villatoro M, Fontané L, Chillarón JJ, Goday A. Atherogenic Dyslipidemia Remission 1 Year After Bariatric Surgery. Obes Surg 2016; 27:1548-1553. [DOI: 10.1007/s11695-016-2504-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
Diabetes mellitus and obesity are closely interrelated and pose a major burden on health care in terms of morbidity and mortality. Weight loss has favorable metabolic benefits for glycemic control and improvement of metabolic syndrome. Bariatric surgery (BS) is the most effective treatment for weight loss with durable results as compared to lifestyle modification. BS procedures have been associated with significant reduction in abdominal obesity, metabolic syndrome components, and glycemic control requiring fewer medications. Long-term risks of surgery include nutritional deficiencies, osteoporosis, bone fractures, and hyperinsulinemic hypoglycemia, which need to be carefully balanced with metabolic benefits for individual patients.
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Affiliation(s)
- Sidra Azim
- Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic, 9500 Euclid Avenue (F-20), Cleveland, OH 44195, USA
| | - Sangeeta R Kashyap
- Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic, 9500 Euclid Avenue (F-20), Cleveland, OH 44195, USA.
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Carbajo MA, Fong-Hirales A, Luque-de-León E, Molina-Lopez JF, Ortiz-de-Solórzano J. Weight loss and improvement of lipid profiles in morbidly obese patients after laparoscopic one-anastomosis gastric bypass: 2-year follow-up. Surg Endosc 2016; 31:416-421. [PMID: 27317038 DOI: 10.1007/s00464-016-4990-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 05/12/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Obesity is the most frequent chronic metabolic disease globally. There is a direct correlation between increasing body mass index (BMI) and elevated total cholesterol (TC), low-density lipoprotein cholesterol (LDL), and triglycerides (Tg), and an inverse correlation with high-density lipoprotein cholesterol (HDL); all these lipid derangements are associated with an increased risk of cardiovascular disease. Our aim was to evaluate lipid profiles in morbidly obese patients before and after one-anastomosis gastric bypass (OAGB) performed at a single-center during a 2-year follow-up. PATIENTS AND METHODS A prospective, observational and descriptive study was carried out, including morbidly obese patients with at least one lipid abnormality, who underwent laparoscopic OAGB. Lipid profiles were evaluated preoperatively and at different intervals during a 2-year follow-up. RESULTS A total of 150 patients were included (73 % females and 27 % males). Mean age was 45.83 ± 10.65 years, mean BMI was 42.82 kg/m2 ± 6.43, and mean weight was 116.23 kg ± 22.70; 2 years after surgery, the latter two decreased to 24.73 ± 4.43 (p < 0.001) and 67.34 ± 13.35 (p < 0.001), respectively, thus leading to a mean weight loss (WL) of 48.85 kg ± 15.64 and mean %excess WL of 71.87 ± 13.41. Tg, TC and LDL levels significantly decreased: 123.60 ± 56.34 versus 84.79 ± 33.67, 194.33 ± 43.90 versus 173.65 ± 34.84, and 124.47 ± 36.07 versus 97.36 ± 25.05, respectively (p < 0.001); HDL levels significantly increased: 43.61 ± 9.85 versus 61.56 ± 12.63 (p < 0.001). CONCLUSION OAGB leads to substantial and durable WL in morbidly obese patients after a 2-year follow-up. Postoperative lipid profiles significantly improved; these changes translate into theoretical relevant cardiovascular risk benefits.
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Affiliation(s)
- Miguel A Carbajo
- Centro de Excelencia para el Estudio y Tratamiento de la Obesidad y la Diabetes, Calle Estacion, No. 12, 1°, 47004, Valladolid, Spain.
| | - Arlett Fong-Hirales
- Centro de Excelencia para el Estudio y Tratamiento de la Obesidad y la Diabetes, Calle Estacion, No. 12, 1°, 47004, Valladolid, Spain
| | - Enrique Luque-de-León
- Centro de Excelencia para el Estudio y Tratamiento de la Obesidad y la Diabetes, Calle Estacion, No. 12, 1°, 47004, Valladolid, Spain
| | | | - Javier Ortiz-de-Solórzano
- Centro de Excelencia para el Estudio y Tratamiento de la Obesidad y la Diabetes, Calle Estacion, No. 12, 1°, 47004, Valladolid, Spain
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Fallahi-Shahabad S, Mazidi M, Tavasoli A, Rezaie P, Rohani F, Habibzadeh S, Darchini-Maragheh E, Sefidi ZSS, Safarian M, Mobarhan MG, Rajabi MT, Norouzy A, Parizadeh SMR, Akhlaghi S, Tavalaie S, Firouzi F, Nematy M. Metabolic improvement of morbid obese patients following Roux-en-Y gastric bypass surgery: A prospective study in Mashhad, Iran. Indian J Gastroenterol 2016; 35:195-200. [PMID: 27206711 DOI: 10.1007/s12664-016-0661-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 04/28/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Obesity is one of the greatest public health concerns worldwide. Weight loss surgeries have been increased in recent decades due to the world's epidemic of obesity. The aim of this prospective study is investigating metabolic factors of morbid obese patients following Roux-en-Y gastric bypass surgery. METHODS This was a nonrandomized prospective cohort study conducted from 2010 to 2013 on 60 consecutive patients who had body mass index (BMI) of more than 40 kg/m(2) and met the surgical indication criteria of bariatric surgery. Upon discharge, patients were followed in outpatient clinic of Qaem Hospital, Mashhad, Iran, each 3 months for 12 months. Measurement of anthropometric and metabolic indices was done in each postoperative visit. RESULTS Mean BMI reduction was 15.26 ± 3.45 kg/m(2) in the patients with an average value of 28.84 ± 3.94 (range from 22 to 40 kg/m(2)), which was significantly lower than the base value (p < 0.001). After a 12-month follow up, patients had lower low-density lipoprotein, triglycerides, and total cholesterol (p < 0.001 for all the variables), while achieving a greater high-density lipoprotein (p = 0.004). An improvement was seen in all of hypertensive patients after a 3-month follow up and blood pressure remained within normal limit in further follow ups. Complete remission was observed in all the patients with obstructive sleep apnea. CONCLUSION It appears reasonable that multidisciplinary treatment including surgical alternatives should be concerned for all morbidly obese patients, considering high rate of failure of conservative medical therapy in this setting.
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Affiliation(s)
- Sahar Fallahi-Shahabad
- Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Mohsen Mazidi
- Key State Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Chaoyang, Beijing, China.,Institute of Genetics and Developmental Biology, International College University of Chinese Academy of Science (IC-UCAS), West Beichen Road, Chaoyang, China
| | - Alireza Tavasoli
- Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Peyman Rezaie
- Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Fatemeh Rohani
- Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Simindokht Habibzadeh
- Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Emadodin Darchini-Maragheh
- Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Zohreh Sadat Sang Sefidi
- Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Mohammad Safarian
- Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Majid Ghayour Mobarhan
- Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran.,Cardiovascular Research Center, Mashhad University of Medical Science, Mashhad, Iran
| | - Mohammad Taghi Rajabi
- Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Abdolreza Norouzy
- Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Seyed Mohammad Reza Parizadeh
- Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Saeid Akhlaghi
- Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Shima Tavalaie
- Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Fatemeh Firouzi
- Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Mohsen Nematy
- Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran.
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17
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Schmid H, Goelzer Neto CF, Dias LS, Weston AC, Espíndola MB, Pioner SR, De Carli LA. Metabolic syndrome resolution by Roux-en-Y gastric bypass in a real world: a case control study. Rev Assoc Med Bras (1992) 2016; 61:161-9. [PMID: 26107367 DOI: 10.1590/1806-9282.61.02.161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 10/22/2014] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES the aim of this study was to evaluate the efficacy of Roux-en-Y Gastric Bypass (RYGB), compared with nonsurgical treatment (NS group), as an instrument for inducing remission of co-morbidities related to Metabolic Syndrome (MetS) in patients with Obesity, grades 2 and 3 (Ob2,3). METHODS two hundred and fifty eight Ob2,3 patients were selected in a retrospective analysis and included in a case control study. MetS was defined as described by the International Diabetes Federation. One hundred and twenty-nine of these patients underwent RYGB (S group), and 129 were assessed as an NS group. RESULTS at baseline, S and NS groups did not differ in BMI, age, female sex and prevalence of MetS (p>0.05). For the S group the outcomes were a reduction in BMI of 38.1% (p<0.001), waist circumference of 28.6% (p<0.001), fasting plasma glucose of 10.5% (p<0.001), serum LDL-cholesterol of 21.9% (p<0.001) and of 85% in the number of patients with MetS (p<0.001). For the NS group, only a decrease of 4.12%(p=0.047) in triglyceride levels and of 5.9%(p=0.031) in Diastolic Blood Pressure was observed. In the NS group, 98.6% of the patients continued to have MetS. The number needed to treat (NNT) with surgery to resolve one case of MetS was 1.2 (CI 95%: 1.1 - 1.4). CONCLUSION in the real world, in the South of Brazil, compared with NS treatment and after 1 year of observation, RYGB is highly effective for decreasing the prevalence of MetS.
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Affiliation(s)
- Helena Schmid
- Hospital das Clínicas de Porto Alegre, Santa Casa de Porto Alegre, Universidade Federal do Rio Grande do Sul, RS, Brazil
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18
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Ramos RJ, Mottin CC, Alves LB, Benzano D, Padoin AV. EFFECT OF SIZE OF INTESTINAL DIVERSIONS IN OBESE PATIENTS WITH METABOLIC SYNDROME SUBMITTED TO GASTRIC BYPASS. ACTA ACUST UNITED AC 2016; 29Suppl 1:15-19. [PMID: 27683768 PMCID: PMC5064282 DOI: 10.1590/0102-6720201600s10005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/14/2016] [Indexed: 12/22/2022]
Abstract
Background: There is no consensus on the ideal size of intestinal loops in gastric bypass of
bariatric surgeries. Aim: To evaluate the metabolic outcome of patients submitted to gastric bypass with
alimentary and biliopancreatic loops of different sizes. Methods: Was conducted a retrospective cohort study in diabetic obese patients (BMI≥35
kg/m2) with metabolic syndrome submitted to gastric bypass. The
patients were divided into three groups according to the size of the intestinal
loop: group 1, biliopancreatic limb 50 cm length and alimentary limb 100 cm
length; group 2 , biliopancreatic limb 50 cm length and alimentary limb 150 cm
length; and group 3, biliopancreatic limb 100 cm length and alimentary limb 150 cm
length. The effect of gastric bypass with different sizes of intestinal loops in
relation to the parameters that define metabolic syndrome was determined. Results: Sixty-three patients were evaluated, and they had a mean age of 44.7±9.4 years.
All were diabetics, with 62 (98.4%) being hypertensive and 51 (82.2%)
dyslipidemic. The three groups were homogeneous in relation to the variables. In
24 months, there was a remission of systemic arterial hypertension in 65% of
patients in group 1, 62.5% in group 2 and 68.4% in group 3. Remission of diabetes
occurred in 85% of patients in group 1, 83% in group 2 and 84% in group 3. There
was no statistical difference in %LEW between the groups, and waist measurements
decreased in a homogeneous way in all groups. The size of loops also had no
influence on the improvement in dyslipidemia. Conclusion: Variation in size of intestinal loops does not appear to influence improvement in
metabolic syndrome in this group of patients.
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Affiliation(s)
- Rafael Jacques Ramos
- Obesity and Metabolic Syndrome Center, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul - PUCRS.,Program of Postgraduate Medicine and Health Sciences at PUCRS, Porto Alegre, RS, Brasil
| | - Cláudio Corá Mottin
- Obesity and Metabolic Syndrome Center, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul - PUCRS.,Program of Postgraduate Medicine and Health Sciences at PUCRS, Porto Alegre, RS, Brasil
| | - Letícia Biscaino Alves
- Obesity and Metabolic Syndrome Center, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul - PUCRS.,Program of Postgraduate Medicine and Health Sciences at PUCRS, Porto Alegre, RS, Brasil
| | - Daniela Benzano
- Obesity and Metabolic Syndrome Center, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul - PUCRS
| | - Alexandre Vontobel Padoin
- Obesity and Metabolic Syndrome Center, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul - PUCRS.,Program of Postgraduate Medicine and Health Sciences at PUCRS, Porto Alegre, RS, Brasil
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19
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Impact of post-laparoscopic sleeve gastrectomy weight loss on C-reactive protein, lipid profile and CA-125 in morbidly obese women. Wideochir Inne Tech Maloinwazyjne 2015; 10:521-6. [PMID: 26865887 PMCID: PMC4729734 DOI: 10.5114/wiitm.2015.56480] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/17/2015] [Indexed: 01/13/2023] Open
Abstract
Introduction Obesity increases production of adipose tissue-derived proteins, such as tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). Also there are elevated levels of C-reactive protein (CRP) and IL-6, CD8, and CD4, indicating chronic subclinical inflammation. Since obesity represents a serious risk factor in several metabolic diseases, identifying the status of carbohydrate antigen-125 (CA-125) would further link obesity and tumors. Aim To examine the effect of weight loss by laparoscopic sleeve gastrectomy (LSG) on plasma CRP, lipid profiles and CA-125 level in morbidly obese patients. Material and methods This prospective study was conducted in the Surgery Department, Fayoum University Hospital, between August 2013 and September 2015. To assess the effect of excess weight loss following this operation CRP, lipid profile and CA-125 were measured before and 12 months after the LSG operation for weight loss. The study included 30 cases of morbidly obese patients: 30 (100%) females aged 23–55 years who were considered clinically obese with a mean body mass index of 42.71 ±4.3 (38–46) kg/m2 and mean age of 40.3 ±8.5 (23–55) years. The National Institute of Health (NIH) inclusion criteria for bariatric surgery were used. Results A mean weight loss of 29.30% decreased plasma CRP, triglycerides, total cholesterol and low-density lipoprotein cholesterol (HDL cholesterol), CA-125 level and increased high-density lipoprotein cholesterol (HDL cholesterol) The percentage weight loss was significantly associated with changes in plasma CRP, triglycerides, total cholesterol, total HDL cholesterol and CA-125. Conclusions Weight loss by LSG improves inflammation, dyslipidemia and CA-125 level.
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20
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Nutritional Status, Body Composition, and Bone Health in Women After Bariatric Surgery at a University Hospital in Rio de Janeiro. Obes Surg 2015; 26:1517-24. [DOI: 10.1007/s11695-015-1910-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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21
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Griffo E, Nosso G, Lupoli R, Cotugno M, Saldalamacchia G, Vitolo G, Angrisani L, Cutolo PP, Rivellese AA, Capaldo B. Early improvement of postprandial lipemia after bariatric surgery in obese type 2 diabetic patients. Obes Surg 2015; 24:765-70. [PMID: 24374941 DOI: 10.1007/s11695-013-1148-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Bariatric surgery (BS) is able to positively influence fasting lipid profile in obese type 2 diabetic patients (T2DM), but no data is available on the impact of BS on postprandial lipid metabolism neither on its relation with incretin hormones. We evaluated the short-term (2 weeks) effects of BS on fasting and postprandial lipid metabolism in obese T2DM patients and the contribution of changes in active GLP-1. METHODS We studied 25 obese T2DM patients (age = 46 ± 8 years, BMI = 44 ± 7 kg/m2), of which 15 underwent sleeve gastrectomy and 10 underwent gastric bypass. Lipid and incretin hormone concentrations were evaluated for 3 h after ingestion of a liquid meal before and 2 weeks after BS. RESULTS After BS, there was a significant reduction in body weight (p < 0.001), fasting plasma glucose (p < 0.001), fasting plasma insulin (p < 0.05), HOMA-IR (p < 0.001), and fasting plasma lipids (p < 0.05). The meal response of plasma triglycerides, total cholesterol, and HDL cholesterol was significantly lower compared to pre-intervention (p < 0.05, p < 0.001). In particular, the incremental area under the curve (IAUC) of plasma triglycerides decreased by 60% (p < 0.005). The meal-stimulated response of active GLP-1 increased, reaching a statistical significance (p < 0.001). CONCLUSIONS BS leads to an early improvement of fasting and postprandial lipemia. The fall in fasting triglycerides is associated with an improvement of insulin resistance, while the reduction of postprandial lipemia is likely related to reduced intestinal lipid absorption consequent to bariatric surgery.
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Affiliation(s)
- E Griffo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini, 5 80131, Naples, Italy,
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22
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Exploring the impact of bariatric surgery on high density lipoprotein. Surg Obes Relat Dis 2015; 11:238-47. [DOI: 10.1016/j.soard.2014.07.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 07/14/2014] [Accepted: 07/16/2014] [Indexed: 01/06/2023]
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23
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Vander Naalt SJ, Gurria JP, Holterman AL. Surgical treatment of nonalcoholic fatty liver disease in severely obese patients. Hepat Med 2014; 6:103-12. [PMID: 25378958 PMCID: PMC4218902 DOI: 10.2147/hmer.s64819] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Obesity is a multi-organ system disease with underlying metabolic abnormalities and chronic systemic inflammation. Nonalcoholic fatty liver disease (NAFLD) is a hepatic manifestation of obesity metabolic dysfunction and its associated cardiovascular- and liver-related morbidities and mortality. Our current understanding of NAFLD pathogenesis, disease characteristics, the role of insulin resistance, chronic inflammation, gut–liver and gut–brain crosstalk and the effectiveness of pharmacotherapy is still evolving. Bariatric surgery significantly improves metabolic and NAFLD histology in severely obese patients, although its positive effects on fibrosis are not universal. Bariatric surgery benefits NAFLD through its metabolic effect on insulin resistance, inflammation, and insulinotropic and anorexinogenic gastrointestinal hormones. Further studies are needed to understand the natural course of NAFLD in severely obese patients and the role of weight loss surgery as a primary treatment for NAFLD.
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Affiliation(s)
- Steven J Vander Naalt
- University of Illinois College of Medicine at Peoria, Children's Hospital of Illinois, Department of Surgery/Pediatric Surgery, Peoria, IL, USA
| | - Juan P Gurria
- University of Illinois College of Medicine at Peoria, Children's Hospital of Illinois, Department of Surgery/Pediatric Surgery, Peoria, IL, USA
| | - AiXuan L Holterman
- University of Illinois College of Medicine at Peoria, Children's Hospital of Illinois, Department of Surgery/Pediatric Surgery, Peoria, IL, USA
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24
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A comparison of postoperative effects of bariatric surgery on medical markers of morbidity. Am J Surg 2014; 208:897-902; discussion 901-2. [PMID: 25440477 DOI: 10.1016/j.amjsurg.2014.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 09/12/2014] [Accepted: 09/15/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Bariatric surgery reduces the prevalence of diabetes and improves lipid profiles. Low-density lipoprotein particle (LDL-P) is a more accurate predictor of cardiovascular events than high-density lipoprotein (HDL) and LDL cholesterol. The effects of bariatric procedures on LDL-P have not been previously reported. METHODS Two hundred thirty patients undergoing bariatric surgery, including gastric bypass, sleeve gastrectomy, and laparoscopic adjustable gastric band placement at a single institution were included. HDL, LDL, hemoglobin A1c, and LDL-P were measured preoperatively and at 3, 6, and 12 months postoperatively. Weight was recorded at baseline and after 1 year. RESULTS There was a decrease in serum LDL-P levels, averaging 472.58 (P < .0001) over 1 year. HDL levels increased. Hemoglobin A1c and LDL levels declined. On average, patients lost 58% of excess weight. CONCLUSION LDL-P significantly decreased after bariatric surgery in relation to weight loss. It may be inferred that bariatric surgery decreases the risk of cardiovascular events.
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25
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Al-Nowaylati AR, Al-Haddad BJS, Dorman RB, Alsaied OA, Lake JR, Chinnakotla S, Slusarek BM, Sampson BK, Ikramuddin S, Buchwald H, Leslie DB. Gastric bypass after liver transplantation. Liver Transpl 2013; 19:1324-9. [PMID: 24039124 DOI: 10.1002/lt.23734] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 08/01/2013] [Accepted: 08/12/2013] [Indexed: 02/06/2023]
Abstract
Few data are available for assessing the outcomes of bariatric surgery for patients who have undergone orthotopic liver transplantation (OLT). The University of Minnesota bariatric surgery database and transplant registry were retrospectively reviewed to identify patients who had undergone OLT and then open Roux-en-Y gastric bypass (RYGB) surgery between 2001 and 2009. Comorbidity-appropriate laboratory values, body mass indices (BMIs), histopathology reports, and immunosuppressive regimens were collected. Seven patients were identified with a mean age of 55.4 ± 8.64 years and a mean follow-up of 59.14 ± 41.49 months from the time of RYGB. The mean time between OLT and RYGB was 26.57 ± 8.12 months. The liver disease etiologies were hepatitis C (n = 4), jejunoileal bypass surgery (n = 1), hemangioendothelioma (n = 1), and alcoholic cirrhosis (n = 1). There were 2 deaths for patients with hepatitis C 6 and 9 months after bariatric surgery due to multiple-organ dysfunction syndrome and metastatic esophageal squamous carcinoma, respectively. One patient with hepatitis C required a reversal of the RYGB because of malnutrition and an inability to tolerate oral intake. Four of the 7 patients had type 2 diabetes mellitus (T2DM), 4 had hypertension, and 6 patients had dyslipidemia. All patients were on immunosuppressive medications, but only 4 were on corticosteroids. Glycemic control was improved in all surviving patients with T2DM. The mean BMI was 34.27 ± 5.51 kg/m(2) before OLT and 44.34 ± 6.08 kg/m(2) before RYGB; it declined to 26.47 ± 5.53 kg/m(2) after RYGB. In conclusion, in this case series of patients undergoing RYGB after OLT, we observed therapeutic weight loss, improved glycemic control, and improved high-density lipoprotein levels in the presence of continued dyslipidemia. RYGB may have contributed to the death of 1 patient due to multiple-organ dysfunction syndrome.
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Affiliation(s)
- Abdl-Rawf Al-Nowaylati
- Division of Gastrointestinal and Bariatric Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN
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26
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Bays HE, Toth PP, Kris-Etherton PM, Abate N, Aronne LJ, Brown WV, Gonzalez-Campoy JM, Jones SR, Kumar R, La Forge R, Samuel VT. Obesity, adiposity, and dyslipidemia: a consensus statement from the National Lipid Association. J Clin Lipidol 2013; 7:304-83. [PMID: 23890517 DOI: 10.1016/j.jacl.2013.04.001] [Citation(s) in RCA: 288] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 04/02/2013] [Accepted: 04/03/2013] [Indexed: 01/04/2023]
Abstract
The term "fat" may refer to lipids as well as the cells and tissue that store lipid (ie, adipocytes and adipose tissue). "Lipid" is derived from "lipos," which refers to animal fat or vegetable oil. Adiposity refers to body fat and is derived from "adipo," referring to fat. Adipocytes and adipose tissue store the greatest amount of body lipids, including triglycerides and free cholesterol. Adipocytes and adipose tissue are active from an endocrine and immune standpoint. Adipocyte hypertrophy and excessive adipose tissue accumulation can promote pathogenic adipocyte and adipose tissue effects (adiposopathy), resulting in abnormal levels of circulating lipids, with dyslipidemia being a major atherosclerotic coronary heart disease risk factor. It is therefore incumbent upon lipidologists to be among the most knowledgeable in the understanding of the relationship between excessive body fat and dyslipidemia. On September 16, 2012, the National Lipid Association held a Consensus Conference with the goal of better defining the effect of adiposity on lipoproteins, how the pathos of excessive body fat (adiposopathy) contributes to dyslipidemia, and how therapies such as appropriate nutrition, increased physical activity, weight-management drugs, and bariatric surgery might be expected to impact dyslipidemia. It is hoped that the information derived from these proceedings will promote a greater appreciation among clinicians of the impact of excess adiposity and its treatment on dyslipidemia and prompt more research on the effects of interventions for improving dyslipidemia and reducing cardiovascular disease risk in overweight and obese patients.
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Affiliation(s)
- Harold E Bays
- Louisville Metabolic and Atherosclerosis Research Center, 3288 Illinois Avenue, Louisville, KY 40213, USA.
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27
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Moustarah F, Gilbert A, Després JP, Tchernof A. Impact of gastrointestinal surgery on cardiometabolic risk. Curr Atheroscler Rep 2013; 14:588-96. [PMID: 23054664 DOI: 10.1007/s11883-012-0288-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Bariatric surgery has gained acceptance as the only treatment with long-term efficacy for severe obesity. Recent publications emphasize the usefulness of bariatric surgery in the reduction of long-term cardiometabolic risk, cardiovascular disease incidence and mortality, and the management of uncontrolled type 2 diabetes (T2DM), an important cardiovascular risk factor in individuals with severe obesity. The present review article offers a brief overview of the literature published over the past several months relevant to cardiometabolic outcomes in bariatric surgery patients. A recent report from the Swedish Obese Subjects (SOS) study specifically reported a reduced incidence of cardiovascular events on long-term prospective follow-up after bariatric surgery. In addition, abundant studies have been recently published on gastric bypass surgery showing high T2DM remission rates as well as improved blood lipids and inflammatory markers after surgery. Sleeve gastrectomy is increasingly performed as a stand-alone operation. Recent reports on this surgery pertaining to cardiometabolic risk showed variable T2DM remission rates that may possibly be explained by age of the patients and duration of T2DM. Available data suggest a possible favorable impact of the surgery on CRP levels and improvements in the blood lipid profile. How sleeve gastrectomy compares to other surgical approaches will require further study. Biliopancreatic diversion with duodenal switch has been reported to offer some of the best long-term weight loss for obese patients. Approximately 9 out of 10 patients treated with this surgical procedure show long-term remission rates of T2DM. Significant improvements in the cardiometabolic risk profile are also observed after BPD-DS; they are especially pronounced regarding dyslipidemia. In conclusion, bariatric procedures improve the cardiometabolic risk profile, a phenomenon that appears to be only partly explained by the magnitude of the weight loss. Significant variations are observed with respect to the type of surgery and patient characteristics. More research is clearly needed on the short and long-term cardiometabolic outcome of obesity surgeries.
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Affiliation(s)
- Fady Moustarah
- Institut Universitaire de Cardiologie et Pneumologie de Québec and Université Laval, 2725 Chemin Ste-Foy, Quebec, QC G1V 4G5, Canada.
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Davidson MH, Tonstad S, Oparil S, Schwiers M, Day WW, Bowden CH. Changes in cardiovascular risk associated with phentermine and topiramate extended-release in participants with comorbidities and a body mass index ≥27 kg/m(2). Am J Cardiol 2013; 111:1131-8. [PMID: 23375187 DOI: 10.1016/j.amjcard.2012.12.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 12/17/2012] [Accepted: 12/17/2012] [Indexed: 12/28/2022]
Abstract
The aim of this analysis was to evaluate changes in cardiovascular risk factors in obese patients with dyslipidemia and/or hypertension receiving phentermine (PHEN) and topiramate extended-release (TPM ER). In the 56-week, randomized, double-blind, placebo-controlled, multicenter CONQUER trial, PHEN/TPM ER demonstrated significant weight loss compared with placebo in overweight or obese participants with ≥2 weight-related co-morbidities. Participants with body mass indexes of 27 to 45 kg/m(2) were randomized to placebo, PHEN 7.5 mg/TPM ER 46 mg, or PHEN 15 mg/TPM ER 92 mg; participants also received lifestyle modification counseling. Primary end points were percentage weight loss and the proportion of participants achieving ≥5% weight loss. Additional end points were changes in lipid variables in the dyslipidemia population and blood pressure in the hypertensive population, stratified by treatment and magnitude of weight loss. PHEN/TPM ER produced significantly greater dose-related mean percentage weight loss compared with placebo in the subgroups of participants with dyslipidemia and those with hypertension. Regardless of treatment group assignment, participants with dyslipidemia who lost ≥5% of their baseline weight experienced significantly greater reductions in triglycerides (-14.5% to -39.8%), and in non-high-density lipoprotein cholesterol (-9.4% to -14.8%) than those losing <5% of their weight (p <0.05). Similarly, participants with hypertension at baseline showed reduced systolic blood pressure by -7.5 to -11.8 mm Hg (p <0.001 vs those with <5% weight loss). In conclusion, the dose-related weight loss induced by PHEN/TPM ER treatment was accompanied by significant improvements in cardiovascular disease risk factors in participants who had dyslipidemia or hypertension at baseline, suggesting that facilitating weight loss by augmenting lifestyle changes with pharmacotherapies may decrease the risk for cardiovascular disease in obese and overweight patients with co-morbidities.
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Nikolic D, Katsiki N, Montalto G, Isenovic ER, Mikhailidis DP, Rizzo M. Lipoprotein subfractions in metabolic syndrome and obesity: clinical significance and therapeutic approaches. Nutrients 2013; 5:928-48. [PMID: 23507795 PMCID: PMC3705327 DOI: 10.3390/nu5030928] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 03/06/2013] [Accepted: 03/06/2013] [Indexed: 02/07/2023] Open
Abstract
Small, dense low density lipoprotein (sdLDL) represents an emerging cardiovascular risk factor, since these particles can be associated with cardiovascular disease (CVD) independently of established risk factors, including plasma lipids. Obese subjects frequently have atherogenic dyslipidaemia, including elevated sdLDL levels, in addition to elevated triglycerides (TG), very low density lipoprotein (VLDL) and apolipoprotein-B, as well as decreased high density lipoprotein cholesterol (HDL-C) levels. Obesity-related co-morbidities, such as metabolic syndrome (MetS) are also characterized by dyslipidaemia. Therefore, agents that favourably modulate LDL subclasses may be of clinical value in these subjects. Statins are the lipid-lowering drug of choice. Also, anti-obesity and lipid lowering drugs other than statins could be useful in these patients. However, the effects of anti-obesity drugs on CVD risk factors remain unclear. We review the clinical significance of sdLDL in being overweight and obesity, as well as the efficacy of anti-obesity drugs on LDL subfractions in these individuals; a short comment on HDL subclasses is also included. Our literature search was based on PubMed and Scopus listings. Further research is required to fully explore both the significance of sdLDL and the efficacy of anti-obesity drugs on LDL subfractions in being overweight, obesity and MetS. Improving the lipoprotein profile in these patients may represent an efficient approach for reducing cardiovascular risk.
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Affiliation(s)
- Dragana Nikolic
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, 90127, Italy; E-Mails: (D.N.); (G.M.)
| | - Niki Katsiki
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, 54124, Greece; E-Mail:
| | - Giuseppe Montalto
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, 90127, Italy; E-Mails: (D.N.); (G.M.)
| | - Esma R. Isenovic
- Laboratory of Radiobiology and Molecular Genetics, Institute Vinca, University of Belgrade, Belgrade, 11000, Serbia; E-Mail:
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Campus, University College London Medical School, University College London (UCL), Pond Street, London, NW3 2QG, UK; E-Mail:
| | - Manfredi Rizzo
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, 90127, Italy; E-Mails: (D.N.); (G.M.)
- Euro-Mediterranean Institute of Science and Technology, Palermo, 90139, Italy
- Author to whom correspondence should be addressed; E-Mail: ; Tel./Fax: +39-091-655-2945
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30
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Lipoprotein subfractions in metabolic syndrome and obesity: clinical significance and therapeutic approaches. Nutrients 2013. [PMID: 23507795 DOI: 10.3390/nu5030928.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Small, dense low density lipoprotein (sdLDL) represents an emerging cardiovascular risk factor, since these particles can be associated with cardiovascular disease (CVD) independently of established risk factors, including plasma lipids. Obese subjects frequently have atherogenic dyslipidaemia, including elevated sdLDL levels, in addition to elevated triglycerides (TG), very low density lipoprotein (VLDL) and apolipoprotein-B, as well as decreased high density lipoprotein cholesterol (HDL-C) levels. Obesity-related co-morbidities, such as metabolic syndrome (MetS) are also characterized by dyslipidaemia. Therefore, agents that favourably modulate LDL subclasses may be of clinical value in these subjects. Statins are the lipid-lowering drug of choice. Also, anti-obesity and lipid lowering drugs other than statins could be useful in these patients. However, the effects of anti-obesity drugs on CVD risk factors remain unclear. We review the clinical significance of sdLDL in being overweight and obesity, as well as the efficacy of anti-obesity drugs on LDL subfractions in these individuals; a short comment on HDL subclasses is also included. Our literature search was based on PubMed and Scopus listings. Further research is required to fully explore both the significance of sdLDL and the efficacy of anti-obesity drugs on LDL subfractions in being overweight, obesity and MetS. Improving the lipoprotein profile in these patients may represent an efficient approach for reducing cardiovascular risk.
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Verdam FJ, Schouten R, Greve JW, Koek GH, Bouvy ND. An update on less invasive and endoscopic techniques mimicking the effect of bariatric surgery. J Obes 2012; 2012:597871. [PMID: 22957215 PMCID: PMC3432381 DOI: 10.1155/2012/597871] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 04/02/2012] [Accepted: 04/30/2012] [Indexed: 12/11/2022] Open
Abstract
Obesity (BMI 30-35 kg/m(2)) and its associated disorders such as type 2 diabetes, nonalcoholic fatty liver disease, and cardiovascular disease have reached pandemic proportions worldwide. For the morbidly obese population (BMI 35-50 kg/m(2)), bariatric surgery has proven to be the most effective treatment to achieve significant and sustained weight loss, with concomitant positive effects on the metabolic syndrome. However, only a minor percentage of eligible candidates are treated by means of bariatric surgery. In addition, the expanding obesity epidemic consists mostly of relatively less obese patients who are not (yet) eligible for bariatric surgery. Hence, less invasive techniques and devices are rapidly being developed. These novel entities mimic several aspects of bariatric surgery either by gastric restriction (gastric balloons, gastric plication), by influencing gastric function (gastric botulinum injections, gastric pacing, and vagal nerve stimulation), or by partial exclusion of the small intestine (duodenal-jejunal sleeve). In the last decade, several novel less invasive techniques have been introduced and some have been abandoned again. The aim of this paper is to discuss the safety, efficacy, complications, reversibility, and long-term results of these latest developments in the treatment of obesity.
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Affiliation(s)
- Froukje J. Verdam
- Department of General Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Ruben Schouten
- Department of Surgery, Bariatric Centre Lievensberg Hospital, P.O. Box 135, 4600 AC Bergen op Zoom, The Netherlands
| | - Jan Willem Greve
- Department of General Surgery, Atrium Medical Parkstad Centre, 6401 CX Heerlen, The Netherlands
| | - Ger H. Koek
- Department of Gastroenterology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Nicole D. Bouvy
- Department of General Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
- *Nicole D. Bouvy:
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