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Kumar R, Saurabh G, Andley M, Yadav M, Satija B. Impact on carotid intima-media thickness after laparoscopic sleeve gastrectomy in patients with morbid obesity. Surg Endosc 2024; 38:2879-2886. [PMID: 38519611 DOI: 10.1007/s00464-024-10779-x] [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: 05/09/2023] [Accepted: 03/04/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND We aimed to investigate the impact of laparoscopic sleeve gastrectomy (LSG) on carotid intima-media thickness (CIMT) & left ventricular dysfunction (LVD) which are the independent predictors of subclinical atherosclerosis. METHODS To assess the change in CIMT & echocardiographic parameters of left ventricular function & correlate with %EWL 6 months and 12 months after LSG, the mean CIMT of bilateral common carotid arteries were measured at 3 different places & 7 parameters were assessed for left ventricular dysfunction after 6 and 12 months of LSG & correlated with the %EWL. RESULTS A total of 30 patients (27(90%) women & 3(10%) men) with the mean age of 38 ± 7.84 were prospectively enrolled. BMI was significantly reduced from 42.66 ± 3.79 to 37.93 ± 3.60 kg/m2 at six months to 36 ± 3.34 at 12 months after LSG. CIMT values were significantly decreased at 6 months after surgery from 0.50 ± 0.11 mm to 0.46 ± 0.09 mm (p < 0.01) to 0.39 ± 0.07 (p < 0.05) at 12 months. However, no significant change was observed in the right mean CCA values at 6 months after surgery 0.50 ± 0.11 mm vs 0.47 ± 0.09 mm (p = 0.07) as compared to decrease at 12 months after surgery to 0.40 ± 0.08 (p < 0.05). Left mean CCA values at 6 months changed from 0.50 ± 0.11 to 0.45 ± 0.09 (p < 0.01) and at 12 months after surgery to 0.39 ± 007(p < 0.05). On 2D ECHO, ejection fraction increased at 6 months from 60.80 ± 5.89 to 61.93 ± 4.47 (p < 0.5) to after 12 months at 64.30 ± 4.20 (p < 0.05). Wave deceleration time changed at 6 months from 170 ± 36.80 to 150 ± 28.82 (p < 0.05) to 12 months 139.07 ± 17.98 (p < 0.05). Peak early diastolic mitral annular velocity (e) changed at 6 months from 8.12 ± 1.66 to 7.02 ± 1.76 (p < 0.05) to 12 months 6.33 ± 0.76 (p < 0.05). Inter-ventricular septum thickness (IVSD) changed at 6 months from 0.99 ± 0.14 to 0.91 ± 0.14 (p < 0.05) to 12 months 0.82 ± 0.09 (p < 0.05). Intraventricular relaxation time (IVRT) at 6 months changed from 94.33 ± 21.71 to 84.36 ± 14.85 (p < 0.03) to 12 months after surgery 77.40 ± 10.19 (p < 0.05). Left atrial volume index (LAVI) at 6 months decreased from 38.08 ± 11.23 to 30.93 ± 7.16 (p < 0.01) to 12 months after surgery 25.43 ± 3.65 (p < 0.05). Left ventricular diastolic dysfunction [LVIDD] at 6 months changed from 4.32 ± 0.52 to 4.11 ± 0.52 (p < 0.02) to 3.94 ± 0.26 (p < 0.05) to 3.94 ± 0.26 (p < 0.05) at 12 months after surgery. PwD at 6 and 12 months changed from 1.00 ± 0.19 to 0.87 ± 0.10 (p < 0.01) to 0.82 ± 0.08 (p < 0.05) respectively. LV mass changed in 6 months from 148.37 ± 33.09 to 117 ± 29.90 (p < 0.001) to 12 months at 110.64 ± 20.79 (p < 0.05) and left ventricular mass index [LVMI] changed in 6 months from 70 ± 16.89 to 59.626 ± 15.35 (p < 0.001) reaching a value of 57.53 ± 11.18 (p < 0.05) at 12 months. The mean 10-year risk of death due to CVD calculated was significantly reduced from 5.45 ± 6.6 to 2.8 ± 1.7% at 6 months (p < 0.05). This significant decrease in CVD risk has a positive correlation with the decrease in CIMT over 6 months showing a correlation coefficient of 0.018 with statistically significant analysis (p value < 0.05). CONCLUSION We observed a significant reduction in CIMT & improvement in 2D ECHO parameters at 6 after LSG although no statistically significant change was observed in mean right CIMT & EF at 6 months.
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Affiliation(s)
- Rahil Kumar
- General Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Gyan Saurabh
- General Surgery, Lady Hardinge Medical College, New Delhi, India.
- Lady Hardinge Medical College, Room No 404, New Academic Block, 110001, New Delhi, India.
| | - Manoj Andley
- General Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Madhur Yadav
- General Medicine, Lady Hardinge Medical College, New Delhi, India
| | - Bhawna Satija
- Radiology, Lady Hardinge Medical College, New Delhi, India
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Esparham A, Roohi S, Ahmadyar S, Dalili A, Nelson PR, Khorgami Z. Impact of bariatric surgery on carotid intima-media thickness, flow-mediated dilation, and nitrite-mediated dilation: a systematic review and meta-analysis. Surg Obes Relat Dis 2023; 19:1188-1199. [PMID: 37429755 DOI: 10.1016/j.soard.2023.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/03/2023] [Accepted: 05/14/2023] [Indexed: 07/12/2023]
Abstract
Obesity is considered one of the independent risk factors for atherosclerosis and is strongly correlated with cardiovascular morbidity and mortality. Previous studies showed carotid intima-media thickness (CIMT), flow-mediated dilation (FMD), and nitrite-mediated dilatation (NMD) are reliable non-invasive markers of arterial damage and dysfunction. The aim of this study was to evaluate the effect of bariatric surgery on CIMT, FMD, and NMD markers in patients with obesity. A systematic search was performed in the PubMed, Embase, Scopus, and Web of Science databases until May 2022. All the English-published studies on the effect of bariatric surgery on CIMT, FMD, and NMD were included. A quantitative meta-analysis was performed, as well as subgroup analyses for the type of procedure and duration of follow-up. Meta-analysis of 41 studies with 1639 patients showed CIMT was significantly reduced by .11 mm after bariatric surgery (95% CI, -.14 to -.08; P < .001; mean follow-up = 10.8 mo). The pooled analysis of 23 studies with 1106 patients showed an increase of FMD by 4.57% after bariatric surgery (95% CI, 2.69-6.44; P < .001; mean follow-up = 11.5 mo). The results of a pooled analysis of 12 studies with 346 patients showed a significant increase of NMD by 2.46% after bariatric surgery (95% CI, .99-3.94; P < .001; mean follow-up = 11.4 mo). The random effect meta-regression demonstrated that baseline CIMT and FMD significantly affect the changes in CIMT and FMD. This meta-analysis showed bariatric surgery can improve CIMT, FMD, and NMD markers in patients with obesity. These improvements show the known effect of metabolic surgery in decreasing cardiovascular risk.
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Affiliation(s)
- Ali Esparham
- Student Research Committee, College of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Roohi
- Student Research Committee, College of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Soheil Ahmadyar
- Student Research Committee, College of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Dalili
- Department of General Surgery, School of Medicine, Surgical Oncology Research Center, Imam, Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Peter R Nelson
- Division of Vascular Surgery, Department of Surgery, University of Oklahoma, Tulsa, Oklahoma
| | - Zhamak Khorgami
- Department of Surgery, University of Oklahoma College of Community Medicine, Tulsa, Oklahoma; Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
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Change in Adipokines and Gastrointestinal Hormones After Bariatric Surgery: a Meta-analysis. Obes Surg 2023; 33:789-806. [PMID: 36607567 DOI: 10.1007/s11695-022-06444-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE The study aimed to perform a meta-analysis about the change in adipokines and gastrointestinal hormones after bariatric surgery in patients with obesity. MATERIALS AND METHODS We searched the Cochrane Central Register of Controlled Trials, EMBASE, and PubMed for related articles and used Review Manager 5.4 for data aggregation. Sensitivity and subgroup analysis were also conducted when feasible. RESULTS As a result, 95 articles involving 6232 patients were included in the meta-analysis. After bariatric surgery, the levels of leptin, ghrelin, C-reactive protein (CRP), interleukin-6 (IL-6), high-sensitivity C-reactive protein (Hs-CRP), tumor necrosis, factor-α (TNF-α), and interleukin-1β (IL-1β) reduced, while adiponectin, glucagon-like peptide-1 (GLP-1), and peptide YY (PYY) levels increased significantly. Subgroup analysis indicated that there was a more significant reduction in leptin level with a longer follow-up time. OAGB had a greater effect on increasing adiponectin level compared with other procedures. SG procedure would bring about reduced ghrelin, while BPD resulted in increased ghrelin. Meta-regression analysis found that publication year, study design, number of patients, preoperative age, preoperative BMI, and quality assessment score were not significantly related to change in leptin, adiponectin, and ghrelin levels. CONCLUSION Bariatric surgery was associated with a significant decrease in leptin, ghrelin, CRP, IL-6, Hs-CRP, TNF-α, and IL-1β, as well as increase in adiponectin, GLP-1, and PYY levels.
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Zhou H, Jin Y, Dai S, Dai C, Ye X. Effect of bariatric surgery on carotid intima-media thickness: A meta-analysis based on observational studies. Front Surg 2023; 9:1068681. [PMID: 36704511 PMCID: PMC9871789 DOI: 10.3389/fsurg.2022.1068681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
Objective This meta-analysis aimed to investigate the effect of bariatric surgery on CIMT in people with obesity. Methods PubMed, Web of Science, Embase, and the Cochrane Library were searched for observational studies assessing the effect of bariatric surgery on CIMT from inception to August 2022. Mean difference (MD) and 95% confidence intervals were calculated to assess CIMT. Results A total of 23 studies, including 1,349 participants, were eligible to participate in this meta-analysis. The results revealed that CIMT was significantly decreased at 6 months, 12 months, and more than 18 months after bariatric surgery compared with baseline (6 months: MD = 0.09; P < 0.01; 12 months: MD = 0.12; P < 0.01; more than 18 months: MD = 0.14; P = 0.02). Meanwhile, laparoscopic Roux-en-Y gastric bypass (LRYGB) seemed to be more effective than laparoscopic sleeve gastrectomy (LSG) in lowering CIMT in terms of the type of surgery (LSG: MD = 0.11; P < 0.01; LRYGB: MD = 0.14; P < 0.01). Lastly, the benefits of bariatric surgery on CIMT was independent of gender (Male: MD = 0.06; P = 0.04; Female: MD = 0.08; P = 0.03). Conclusions Bariatric surgery is consistently effective in reducing CIMT in people with obesity.
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Affiliation(s)
- Hui Zhou
- Department of Ultrasound, The Affiliated Hospital of Ningbo University, LiHuiLi Hospital, Ningbo, China
| | - Yangli Jin
- Department of Ultrasound, Ningbo Yinzhou No. 2 Hospital, Ningbo, China
| | - Senjie Dai
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Chenglong Dai
- School of Medical Imaging, Hangzhou Medical College, Hangzhou, China
| | - Xia Ye
- General Family Medicine, Ningbo Yinzhou No. 2 Hospital, Yinzhou district, ningbo, China,Correspondence: Xia Ye
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Cobeta P, Pariente R, Osorio A, Marchan M, Blázquez L, Pestaña D, Galindo J, Botella-Carretero JI. The Beneficial Changes on Inflammatory and Endothelial Biomarkers Induced by Metabolic Surgery Decreases the Carotid Intima-Media Thickness in Men. Biomolecules 2022; 12:biom12121827. [PMID: 36551255 PMCID: PMC9775021 DOI: 10.3390/biom12121827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Obesity increases cardiovascular risk in men through several mechanisms. Among them, low-grade chronic inflammation and obesity-associated hypogonadism have been described. We aimed to study the effects of metabolic surgery on the carotid-intima media thickness through changes in inflammatory, endothelial biomarkers, and testosterone. We included 60 men; 20 submitted to laparoscopic Roux-en-Y gastric bypass (RYGB), 20 to sleeve gastrectomy (SG), and 20 to lifestyle modification (controls). Several inflammatory and endothelial biomarkers and total testosterone (TT) were measured at baseline and six months after surgery. Free testosterone (FT) was calculated, and carotid intima-media thickness (cIMT) was measured by ultrasonography. Compared to controls, cIMT decreased after surgery concomitantly with CRP, PAI-1, sICAM-1, and IL-18 (p < 0.01) and with an increase in sTWEAK (p = 0.027), with no differences between RYGB and SG. The increase in TT and FT after surgery correlated with the changes in cIMT (p = 0.010 and p = 0.038, respectively), but this association disappeared after multivariate analysis. Linear regression showed that sTWEAK (ß = -0.245, p = 0.039), PAI-1 (ß = 0.346, p = 0.005), and CRP (ß = 0.236, p = 0.049) were associated with the changes in cIMT (R2 = 0.267, F = 6.664, p = 0.001). In conclusion, both RYGB and SG induced improvements in inflammation and endothelial biomarkers that drove a decrease in cIMT compared to men with obesity who submitted to diet and exercise.
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Affiliation(s)
- Pilar Cobeta
- Department of Anesthesiology, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria—IRyCIS, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Roberto Pariente
- Department of Inmunology, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Alvaro Osorio
- Instituto Ramón y Cajal de Investigación Sanitaria—IRyCIS, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Department of Angiology and Vascular Surgery, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Marta Marchan
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Luis Blázquez
- Instituto Ramón y Cajal de Investigación Sanitaria—IRyCIS, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - David Pestaña
- Department of Anesthesiology, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Julio Galindo
- Instituto Ramón y Cajal de Investigación Sanitaria—IRyCIS, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - José I. Botella-Carretero
- Instituto Ramón y Cajal de Investigación Sanitaria—IRyCIS, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Correspondence: ; Tel.: +34-913368343
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Melchor-López A, Suárez-Cuenca JA, Banderas-Lares DZ, De la Peña-Sosa G, Salamanca-García M, Vera-Gómez E, Hernández-Patricio A, Gutiérrez-Buendía JA, Zamora-Alemán CR, Alcaráz-Estrada SL, Ortiz-Fernández M, Montoya-Ramírez J, Felipe Gaytán-Fuentes O, Escamilla-Tilch M, Pineda-Juárez JA, Antonio Téllez-González M, Rodríguez-Arellano ME, Contreras-Ramos A, Hernández-Muñoz RE, Gutiérrez-Salinas J, García S, Mondragón-Terán P. The metabolic phenotype of the patient influences the reduction in carotid intima-media thickness achieved following metabolic surgery. J Int Med Res 2022; 50:3000605221137475. [DOI: 10.1177/03000605221137475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives To determine whether metabolic phenotype is associated with the change in carotid intima-media thickness (CIMT) in patients undergoing bariatric /metabolic surgery (BMS). Methods We performed a case-control study of BMS candidates who had metabolically unhealthy obesity (MUO) or metabolically healthy obesity (MHO). We measured the change in CIMT during the 9 months following BMS. The plasma tumor necrosis factor-α, interleukin-1β, adiponectin, leptin, nitric oxide (NO), vascular endothelial growth factor A (VEGF-A), and malondialdehyde concentrations were determined, adipocyte area was measured histologically, and adipose tissue area was estimated using computed tomography. Results Fifty-six patients (mean age 44.5 years, mean body mass index 44.9 kg/m2, 53% women, and 53% had MUO) were studied. Nine months following BMS, the MUO phenotype was not associated with a significant reduction in CIMT, and that of the MHO group was larger. In addition, fewer participants achieved a 10% reduction in CIMT in the MUO group. A CIMT reduction was associated with lower VEGF-A and NO in the MUO group, while that in the MHO group was associated with a higher NO concentration. Conclusion The metabolic phenotype of patients may influence their change in CIMT following BMS, probably through circulating vasodilatory and pro-inflammatory molecules.
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Affiliation(s)
- Alberto Melchor-López
- Internal Medicine Department, Hospital General “Xoco” SS CDMX, Mexico City, Mexico
- Internal Medicine Department, Instituto Mexicano del Seguro Social, H.G.Z. No. 8 “Gilberto Flores Izquierdo”, and H.G.Z. No. 58 “Manuel Ávila Camacho”, Mexico City, Mexico
| | - Juan Antonio Suárez-Cuenca
- Internal Medicine Department, Hospital General “Xoco” SS CDMX, Mexico City, Mexico
- Internal Medicine Department, Instituto Mexicano del Seguro Social, H.G.Z. No. 8 “Gilberto Flores Izquierdo”, and H.G.Z. No. 58 “Manuel Ávila Camacho”, Mexico City, Mexico
- Laboratory of Experimental Metabolism and Clinical Research, Division of Research, Centro Médico Nacional “20 de Noviembre” ISSSTE, Mexico City. Mexico
| | - Diana Zaineff Banderas-Lares
- Laboratory of Experimental Metabolism and Clinical Research, Division of Research, Centro Médico Nacional “20 de Noviembre” ISSSTE, Mexico City. Mexico
| | - Gustavo De la Peña-Sosa
- Laboratory of Experimental Metabolism and Clinical Research, Division of Research, Centro Médico Nacional “20 de Noviembre” ISSSTE, Mexico City. Mexico
| | | | - Eduardo Vera-Gómez
- Laboratory of Experimental Metabolism and Clinical Research, Division of Research, Centro Médico Nacional “20 de Noviembre” ISSSTE, Mexico City. Mexico
| | - Alejandro Hernández-Patricio
- Laboratory of Experimental Metabolism and Clinical Research, Division of Research, Centro Médico Nacional “20 de Noviembre” ISSSTE, Mexico City. Mexico
| | - Juan Ariel Gutiérrez-Buendía
- Laboratory of Experimental Metabolism and Clinical Research, Division of Research, Centro Médico Nacional “20 de Noviembre” ISSSTE, Mexico City. Mexico
| | - Carlos Ramiro Zamora-Alemán
- Laboratory of Experimental Metabolism and Clinical Research, Division of Research, Centro Médico Nacional “20 de Noviembre” ISSSTE, Mexico City. Mexico
| | | | - Moisés Ortiz-Fernández
- Bariatric Surgery Department, Centro Médico Nacional “20 de Noviembre” ISSSTE, Mexico City, Mexico
| | - Jesús Montoya-Ramírez
- Bariatric Surgery Department, Centro Médico Nacional “20 de Noviembre” ISSSTE, Mexico City, Mexico
| | | | - Mónica Escamilla-Tilch
- Tissue Engineering & Regenerative Medicine Research Group, Coordinación de Investigación, Centro Médico Nacional “20 de Noviembre” ISSSTE, Mexico City, Mexico
| | - Juan Antonio Pineda-Juárez
- Tissue Engineering & Regenerative Medicine Research Group, Coordinación de Investigación, Centro Médico Nacional “20 de Noviembre” ISSSTE, Mexico City, Mexico
| | - Mario Antonio Téllez-González
- Tissue Engineering & Regenerative Medicine Research Group, Coordinación de Investigación, Centro Médico Nacional “20 de Noviembre” ISSSTE, Mexico City, Mexico
| | | | - Alejandra Contreras-Ramos
- Laboratorio de Biología del Desarrollo y Teratogénesis Experimental, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Rolando Efraín Hernández-Muñoz
- Departamento de Biología Celular y Desarrollo, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México (UNAM), Coyoacán, Mexico City, Mexico
| | | | - Silvia García
- Laboratory of Experimental Metabolism and Clinical Research, Division of Research, Centro Médico Nacional “20 de Noviembre” ISSSTE, Mexico City. Mexico
| | - Paul Mondragón-Terán
- Tissue Engineering & Regenerative Medicine Research Group, Coordinación de Investigación, Centro Médico Nacional “20 de Noviembre” ISSSTE, Mexico City, Mexico
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Jamialahmadi T, Alidadi M, Atkin SL, Kroh M, Almahmeed W, Moallem SA, Al-Rasadi K, Rodriguez JH, Santos RD, Ruscica M, Sahebkar A. Effect of Bariatric Surgery on Flow-Mediated Vasodilation as a Measure of Endothelial Function: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:4054. [PMID: 35887817 PMCID: PMC9323618 DOI: 10.3390/jcm11144054] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/20/2022] [Accepted: 06/23/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives. Flow mediated vasodilation (FMD) is a marker of endothelial function and its decline is related to increased cardiovascular risk. This systematic review and meta-analysis evaluated the impact of bariatric surgery on FMD. Materials and methods. A systematic literature search in PubMed, Scopus, Embase, and Web of Science was performed to 1 May 2021. Meta-analysis was performed using Comprehensive Meta-Analysis (CMA) V2 software. All types of bariatric surgery were considered, with the inclusion that FMD had to have been tested before and after the surgical procedure. Meta-analysis was carried out using a random-effects model and the generic inverse variance approach. The leave-one-out approach was used for sensitivity analysis. To assess metabolic parameter confounders, a weighted random-effects meta-regression was used. Results. A meta-analysis and a systematic review of 23 studies (n = 891 individuals) demonstrated improvement in FMD following bariatric surgery (weighted mean difference (WMD): 5.867, 95% CI: 4.481, 7.252, p < 0.001; I2: 96.70). Iteratively removing each item in the meta-analysis did not result in a significant alteration in the pooled estimate of effect size. There was an improvement in FMD for up to 6 months following bariatric surgery in a meta-analysis from 7 trials that included 356 subjects (WMD: 5.248, 95% CI: 2.361, 8.135, p < 0.001; I2: 98.18). The meta-analysis from 9 trials (n = 414 subjects) showed an improvement in FMD 6 to 12 months after bariatric surgery (WMD: 5.451, 95% CI: 3.316, 7.587, p < 0.001; I2: 94.18). The meta-analysis from 10 trials (n = 414 subjects) demonstrated an improvement in FMD 12 months after bariatric surgery (WMD: 2.401, 95% CI: 0.944, 3.859, p = 0.001; I2: 88.35). Random-effects meta-regression did not show any association between the alteration in FMD and percent body mass index (BMI) change (slope: 0.0258; 95% CI: −0.323, 0.375; p = 0.884), or changes in blood pressure; however, there was an association between the changes in FMD and the duration of follow-up (slope: −0.106; 95% CI: −0.205, −0.008; p = 0.033) with greater changes in FMD after 12 months. Conclusions. Bariatric surgery significantly improved FMD that increased with time, and the resultant improvement in endothelial function was independent of weight loss or a reduction in blood pressure.
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Affiliation(s)
- Tannaz Jamialahmadi
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran;
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran;
| | - Mona Alidadi
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran;
| | - Stephen L. Atkin
- School of Postgraduate Studies and Research, RCSI Medical University of Bahrain, Busaiteen 15503, Bahrain;
| | - Matthew Kroh
- Digestive Disease and Surgery Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, OH 44195, USA;
| | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi P.O. Box 124140, United Arab Emirates;
| | - Seyed Adel Moallem
- Department of Pharmacology and Toxicology, College of Pharmacy, Al-Zahraa University for Women, Karbala, Iraq;
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Khalid Al-Rasadi
- Medical Research Centre, Sultan Qaboos University, Muscat P.O. Box 373, Oman;
| | - John H. Rodriguez
- Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi P.O. Box 112412, United Arab Emirates;
| | - Raul D. Santos
- Lipid Clinic Heart Institute (Incor), University of São Paulo, Medical School Hospital, São Paulo 01000, Brazil;
| | - Massimiliano Ruscica
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, 20100 Milan, Italy;
| | - Amirhossein Sahebkar
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
- Department of Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
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Impact of Bariatric Surgery on Carotid Intima-Media Thickness in Patients with Morbid Obesity: a Prospective Study and Review of the Literature. Obes Surg 2022; 32:1563-1569. [PMID: 35237906 DOI: 10.1007/s11695-022-05976-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/08/2022] [Accepted: 02/17/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM One of the main causes of mortality among obese patients is cardiovascular disease (CVD). Carotid intima-media thickness (CIMT) is an independent predictor for atherosclerosis and risk of CVD, and has been demonstrated to be related with obesity. This study aimed to evaluate the effect of substantial weight loss after bariatric surgery on CIMT. METHODS This prospective study was performed on patients with morbid obesity and standard indications for bariatric surgery in a tertiary referral center in Iran. The mean CIMT values were assessed using B-mode ultrasonography before and 6 months after bariatric surgery. RESULTS A total of 32 patients (25 females, 7 males) with a mean age of 38.18 ± 1.18 years were enrolled. Body mass index (BMI) was significantly reduced from 43.66 ± 6.44 to 29.01 ± 2.56 kg/m2 during 6 months following surgery (p: 0.001). The mean CIMT values at 6 months after surgery were significantly lower than the baseline (0.53 ± 0.06 vs. 0.50 ± 0.08; p: 0.001). Along with a significant hypertension and metabolic syndrome remission, we observed considerable reduction in FBS (p: 0.019), cholesterol (p: 0.061), triglycerides (p: 0.001), and insulin levels (p: 0.001). Besides, liver stiffness was significantly decreased after surgery (6.15 ± 0.82 vs. 5.26 ± 0.83; p: 0.001). There was no statistically significant correlation between changes in quantitative variables and changes in CIMT. CONCLUSION Bariatric surgery results in significant reduction in CIMT, metabolic syndrome factors, and liver stiffness in patients with morbid obesity.
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Gualano B, Kirwan JP, Roschel H. Exercise Is Key to Sustaining Metabolic Gains After Bariatric Surgery. Exerc Sport Sci Rev 2021; 49:197-204. [PMID: 34112745 PMCID: PMC8588125 DOI: 10.1249/jes.0000000000000253] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The extent to which the benefits of bariatric surgery may be maintained by lifestyle changes after surgery is unclear. Our hypothesis is that exercise may sustain some metabolic benefits and counteract some of the adverse effects of surgery. In this review, we present findings supporting the proposition that exercise is key to improving overall health in patients after bariatric surgery.
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Affiliation(s)
- Bruno Gualano
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport; Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, BR, University of Sao Paulo, SP, BR
| | - John P. Kirwan
- Integrated Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport; Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, BR, University of Sao Paulo, SP, BR
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Almabadi ES, Seymour GJ, Akhter R, Bauman A, Cullinan MP, Eberhard J. Reduction of hsCRP levels following an Oral Health Education Program combined with routine dental treatment. J Dent 2021; 110:103686. [PMID: 33957190 DOI: 10.1016/j.jdent.2021.103686] [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: 10/26/2020] [Revised: 04/20/2021] [Accepted: 05/01/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The present study aimed to determine the effect of a personalised oral health education program, in combination with routine dental treatment, on serum biomarkers of systemic disease compared to dental treatment alone in a population from a low-socioeconomic community with poor oral health. METHODS This secondary analysis of a randomised clinical trial involved 295 participants (mean age, 45.4 ± 11 years) assigned to two groups. One group received dental treatment combined with the Oral Health Education Program (OHEPDT), while the second group (DT) received dental care without the Education Program. Serum levels of high-sensitivity C-reactive protein (hsCRP), lipid profile (total cholesterol, triglycerides, and high- and low-density lipoprotein cholesterol), and HbA1c levels were analysed at baseline and after 12 months. Changes in diet, smoking and alcohol consumption were also determined. RESULTS No intergroup differences were observed for the lipid profile and HbA1c levels. A reduction in the hsCRP levels at the 12-month follow-up was observed in the OHEPDT group, which was significantly different from the DT group (p = 0.01). Multivariate modelling indicated that baseline hsCRP levels (p = 0.000), baseline body mass index (p = 0.000), and higher consumption of vegetables (p = 0.021) predicted a reduction in hsCRP levels. CONCLUSIONS This study demonstrated that personalised oral health education combined with routine dental treatment was associated with a significant reduction in hsCRP levels subsequent to dietary behavioural changes. These findings suggest that personalised oral health education in combined with routine dental treatment may have beneficial effects on general health. CLINICAL SIGNIFICANCE The strategy for developing an oral health program that involves education of the modifiable common risk factors for general health has beneficial effects and should be one of the priority components of these programs to improve oral and general health, particularly for at-risk communities.
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Affiliation(s)
- Eman S Almabadi
- The University of Sydney, The Charles Perkins Centre and the School of Dentistry, Faculty of Medicine and Health, Camperdown, Sydney, New South Wales, Australia; Pediatric Dentistry and Orthodontics Department, College Dentistry, Taibah University, Medina, Saudi Arabia.
| | - Gregory J Seymour
- The University of Queensland, School of Dentistry, Herston, Queensland, Australia
| | - Rahena Akhter
- The University of Sydney School of Dentistry, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Adrian Bauman
- The University of Sydney, School of Public Health, Sydney, New South Wales, Australia
| | - Mary P Cullinan
- The University of Queensland, School of Dentistry, Herston, Queensland, Australia
| | - Joerg Eberhard
- The University of Sydney, The Charles Perkins Centre and the School of Dentistry, Faculty of Medicine and Health, Camperdown, Sydney, New South Wales, Australia.
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Kaul A, Kumar A, Baksi A, Singla V, Aggarwal S, Gulati G, Narang R, Kashyap L. Impact of bariatric surgery on carotid intima-medial thickness and cardiovascular risk: results of a prospective study. Surg Endosc 2020; 35:6006-6012. [PMID: 33048234 DOI: 10.1007/s00464-020-08088-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 10/03/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The impact of bariatric surgery on atherosclerosis is a relatively less studied subject. Obesity has been identified as an independent risk factor for cardiovascular disease (CVD). Carotid intima-media thickness (CIMT), a surrogate marker for atherosclerosis and risk of CVD, has been found to be associated with obesity. Recent literature has shown that there is significant reduction in CIMT following bariatric surgery. The aim of this study was to evaluate the impact of bariatric surgery on CIMT and risk of CVD in an Indian population. METHODS This is a prospective study conducted in a tertiary referral centre in India. Patients undergoing bariatric surgery from December 2017 to September 2019 were included. CIMT measurements and American College of Cardiology/American Heart Association (ACC/AHA)-pooled cohort CVD risk scores were done before and at 6 months and 12 months after surgery. RESULTS Fifty-four patients were enrolled, of which 70% were females. Mean age was 40.8 ± 10.7 years. Mean pre-operative weight and mean BMI were 115.2 ± 21.9 kg and 45.9 ± 6.5 kg/m2, respectively. Patients who completed 12-month follow-up were considered for analysis of outcomes. There was significant reduction in BMI to 33.1 ± 5.7 kg/m2 at 12 months after surgery (p < 0.0001). Mean CIMT reduced significantly from 0.58 ± 0.08 mm at baseline to 0.52 ± 0.10 mm at 12 months. Lipid profile, fasting blood sugar and HbA1C also improved, which resulted in reduction of lifetime and 10-year CVD risk from 42.3 to 26% and 4 to 1.5%, respectively, at 12 months after surgery. CONCLUSIONS Bariatric surgery results in significant reduction in CIMT and CVD risk in patients with morbid obesity.
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Affiliation(s)
- Aashir Kaul
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Arun Kumar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Aditya Baksi
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Vitish Singla
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sandeep Aggarwal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Gurpreet Gulati
- Department of Cardiac Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajiv Narang
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Lokesh Kashyap
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
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Iqbal Z, Adam S, Ho JH, Syed AA, Ammori BJ, Malik RA, Soran H. Metabolic and cardiovascular outcomes of bariatric surgery. Curr Opin Lipidol 2020; 31:246-256. [PMID: 32618731 DOI: 10.1097/mol.0000000000000696] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW Bariatric surgery is an effective therapy for morbid obesity that also improves weight-related metabolic parameters and reduces morbidity and mortality. The purpose of this review is to consolidate our current understanding of metabolic, macrovascular and microvascular benefits of bariatric surgery and to provide an update. RECENT FINDINGS Early resolution of insulin resistance and type 2 diabetes mellitus (T2DM) varies by type of bariatric surgery and appears to be mediated by changes in secretion of gut hormones, metabolism of bile acids, expression of glucose transporters and the gut microbiome. Dyslipidaemia, atherosclerosis, microvascular complications of obesity and diabetes, systemic and tissue-level inflammation show evidence of regression and hypertension improves significantly after bariatric surgery. SUMMARY Bariatric surgery leads to improvements in obesity-related metabolic comorbidities such as dyslipidaemia, HDL functionality, hypertension, T2DM, insulin resistance and inflammation. It slows the atherosclerotic process and reduces cardiovascular and all-cause mortality. Recent data have demonstrated regression of the microvascular complications of obesity and diabetes including the regeneration of small nerve fibres. The magnitude of change in short-term metabolic effects depends on the surgical procedure whilst longer term effects are related to the amount of sustained excess weight loss.
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Affiliation(s)
- Zohaib Iqbal
- Faculty of Biology, Medicine and Health, University of Manchester
- Cardiovascular Trials Unit, Manchester University NHS Foundation Trust
| | - Safwaan Adam
- Faculty of Biology, Medicine and Health, University of Manchester
- The Christie Hospital NHS Foundation Trust, Manchester
| | - Jan H Ho
- Faculty of Biology, Medicine and Health, University of Manchester
- Cardiovascular Trials Unit, Manchester University NHS Foundation Trust
| | - Akheel A Syed
- Faculty of Biology, Medicine and Health, University of Manchester
- Department of Diabetes, Endocrinology and Obesity Medicine
| | - Basil J Ammori
- Faculty of Biology, Medicine and Health, University of Manchester
- Department of Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Rayaz A Malik
- Faculty of Biology, Medicine and Health, University of Manchester
- Weill-Cornell Medicine-Qatar, Doha, Qatar
| | - Handrean Soran
- Faculty of Biology, Medicine and Health, University of Manchester
- The Christie Hospital NHS Foundation Trust, Manchester
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Sanches E, Topal B, Proczko M, Stepaniak PS, Severin R, Phillips SA, Sabbahi A, Pujol Rafols J, Pouwels S. Endothelial function in obesity and effects of bariatric and metabolic surgery. Expert Rev Cardiovasc Ther 2020; 18:343-353. [DOI: 10.1080/14779072.2020.1767594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Elijah Sanches
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Besir Topal
- Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Monika Proczko
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Gdansk University, Gdansk, Poland
| | - Pieter S. Stepaniak
- Department of Operating Rooms, Catharina Hospital, Eindhoven, The Netherlands
| | - Rich Severin
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
- Doctor of Physical Therapy Program, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
| | - Shane A. Phillips
- Department of Physical Therapy, Integrative Physiologic Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Ahmad Sabbahi
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
- Department of Physical Therapy, Integrative Physiologic Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
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Effect of Bariatric Surgery on Serum Inflammatory Factors of Obese Patients: a Systematic Review and Meta-Analysis. Obes Surg 2020; 29:2631-2647. [PMID: 31093862 DOI: 10.1007/s11695-019-03926-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Obesity is one of the main causes of inflammation. Previous studies have reported inconclusive results regarding the effect of bariatric surgery on inflammatory markers. This systematic review and meta-analysis is aimed at describing the effect of bariatric surgery on C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α). PubMed/Medline and Scopus were systematically searched for all eligible studies from inception to June 2018. Results are expressed as weighted mean difference (MD) with 95% confidence intervals (CI) using a random effects model. Overall, 116 studies which evaluated serum CRP, IL-6, and TNF-α after bariatric surgery were included. Pooled effect size showed significant reduction in serum CRP (- 5.30 mg/l, 95% CI - 5.46, - 5.15, P < 0.001), IL-6 (- 0.58 pg/ml, 95% CI - 0.64, - 0.53, P < 0.001), and TNF-α (- 0.20 pg/ml, 95% CI - 0.39, - 0.02, P = 0.031) with significant heterogeneity across studies (> 95% for all factors). Bariatric surgery significantly lowered inflammatory factors; however, baseline BMI, follow-up duration and type of surgery could impact the extent of observed effects.
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15
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Cobeta P, Osorio A, Cuadrado-Ayuso M, García-Moreno F, Pestaña D, Galindo J, Botella-Carretero JI. Sleeve Gastrectomy and Gastric Bypass Decrease the Carotid Intima-Media Thickness in Obese Men: Association with Weight Loss, Cardiovascular Risk Factors, and Circulating Testosterone. Obes Surg 2020; 30:851-859. [DOI: 10.1007/s11695-020-04405-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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16
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Sultan S, Patel AG, El-Hassani S, Whitelaw B, Leca BM, Vincent RP, le Roux CW, Rubino F, Aywlin SJB, Dimitriadis GK. Male Obesity Associated Gonadal Dysfunction and the Role of Bariatric Surgery. Front Endocrinol (Lausanne) 2020; 11:408. [PMID: 32636807 PMCID: PMC7318874 DOI: 10.3389/fendo.2020.00408] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/20/2020] [Indexed: 01/01/2023] Open
Abstract
Obesity is an ever growing pandemic and a prevalent problem among men of reproductive age that can both cause and exacerbate male-factor infertility by means of endocrine abnormalities, associated comorbidities, and direct effects on the precision and throughput of spermatogenesis. Robust epidemiologic, clinical, genetic, epigenetic, and preclinical data support these findings. Clinical studies on the impact of medically induced weight loss on serum testosterone concentrations and spermatogenesis is promising but may show differential and unsustainable results. In contrast, literature has demonstrated that weight loss after bariatric surgery is correlated with an increase in serum testosterone concentrations that is superior than that obtained with only lifestyle modifications, supporting a further metabolic benefit from surgery that may be specific to the male reproductive system. The data on sperm and semen parameters is controversial to date. Emerging evidence in the burgeoning field of genetics and epigenetics has demonstrated that paternal obesity can affect offspring metabolic and reproductive phenotypes by means of epigenetic reprogramming of spermatogonial stem cells. Understanding the impact of this reprogramming is critical to a comprehensive view of the impact of obesity on subsequent generations. Furthermore, conveying the potential impact of these lifestyle changes on future progeny can serve as a powerful tool for obese men to modify their behavior. Healthcare professionals treating male infertility and obesity need to adapt their practice to assimilate these new findings to better counsel men about the importance of paternal preconception health and the impact of novel non-medical therapeutic interventions. Herein, we summarize the pathophysiology of obesity on the male reproductive system and emerging evidence regarding the potential role of bariatric surgery as treatment of male obesity-associated gonadal dysfunction.
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Affiliation(s)
- Sana Sultan
- Department of Endocrinology and Metabolic Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ameet G. Patel
- Department of Minimal Access Surgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Shamsi El-Hassani
- Minimal Access and Bariatric Unit, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, Orpington, United Kingdom
| | - Benjamin Whitelaw
- Department of Endocrinology and Metabolic Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Bianca M. Leca
- Department of Endocrinology and Metabolic Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Royce P. Vincent
- Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Carel W. le Roux
- Diabetes Complication Research Centre, School of Medicine and Medical Science, UCD Conway Institute, University College Dublin, Belfield, Ireland
| | - Francesco Rubino
- Department of Minimal Access Surgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Simon J. B. Aywlin
- Department of Endocrinology and Metabolic Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Georgios K. Dimitriadis
- Department of Endocrinology and Metabolic Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
- *Correspondence: Georgios K. Dimitriadis
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Borzì AM, Buscemi C, Corleo D, Randazzo C, Rosafio G, Pantuso G, Buscemi S. Endothelial Function in Obese Patients Treated with Bariatric Surgery. Diabetes Metab Syndr Obes 2020; 13:247-256. [PMID: 32099431 PMCID: PMC7007802 DOI: 10.2147/dmso.s230684] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/23/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Bariatric surgery (BS) is becoming an increasingly frequent treatment option especially in people with morbid obesity, demonstrating that it is able to reduce total mortality and cardiovascular (CV) risk. Despite endothelial dysfunction is an essential requisite contributing to atherosclerosis and predicting CV events, only some studies have investigated the effects of BS on endothelial function with controversial results. In this study, the effects of weight loss on endothelial function were investigated in obese patients after BS and compared with patients after medical nutrition treatment (MNT). PATIENTS AND METHODS Seventeen obese patients who underwent BS procedures (9 adjustable gastric bands, 3 gastric by-passes and 5 biliopancreatic diversions) were included in the study and compared with 18 obese individuals who underwent MNT. Endothelial function was investigated by flow-mediated dilation (FMD) of the brachial artery. Also, carotid intima-media thickness (c-IMT) was measured as a marker of subclinical atherosclerosis. RESULTS At the end of follow-up, the mean weight loss was 18.8% in the BS group and 7.0% in the MNT group. After treatment, FMD significantly decreased in the BS group (mean ± SD before: 9.0 ± 4.7; after: 6.1 ± 2.9%; P= 0.04); however, no significant change was observed in the MNT group (before: 9.4 ± 5.8; after: 8.3 ± 5.3; P= 0.41). The modification of endothelial function was negatively correlated with c-IMT change in the BS group (r= -0.63; P <0.007). CONCLUSION A significant endothelial dysfunction occurred following BS but not after MNT. Furthermore, the decline of endothelial function observed in the BS group might have contributed to atherosclerosis.
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Affiliation(s)
- Antonio Maria Borzì
- Department of Clinical and Experimental Medicine, Specialization School in Geriatrics, University of Catania, Catania, Italy
- Specialization School in Geriatrics, Catania, Italy
| | - Carola Buscemi
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palerno, Italy
- Unit of Malattie Endocrine, del Ricambio e della Nutrizione, Policlinico University Hospital, Palermo, Italy
| | - Davide Corleo
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palerno, Italy
- Unit of Malattie Endocrine, del Ricambio e della Nutrizione, Policlinico University Hospital, Palermo, Italy
| | - Cristiana Randazzo
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palerno, Italy
- Unit of Malattie Endocrine, del Ricambio e della Nutrizione, Policlinico University Hospital, Palermo, Italy
| | - Giuseppe Rosafio
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palerno, Italy
- Unit of Malattie Endocrine, del Ricambio e della Nutrizione, Policlinico University Hospital, Palermo, Italy
| | - Gianni Pantuso
- Dipartimento di Discipline Chirurgiche e Odontostomatologiche (DICHIRONS), Unit of Chirurgia Oncologica, Policlinico University Hospital, Palermo, Italy
| | - Silvio Buscemi
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palerno, Italy
- Unit of Malattie Endocrine, del Ricambio e della Nutrizione, Policlinico University Hospital, Palermo, Italy
- Correspondence: Silvio Buscemi Unit of Malattie Endocrine, del Ricambio e della Nutrizione, Policlinico University Hospital, Piazza delle cliniche 2, Palermo90127, Italy Email
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Blaum C, Brunner FJ, Kröger F, Braetz J, Lorenz T, Goßling A, Ojeda F, Koester L, Karakas M, Zeller T, Westermann D, Schnabel R, Blankenberg S, Seiffert M, Waldeyer C. Modifiable lifestyle risk factors and C-reactive protein in patients with coronary artery disease: Implications for an anti-inflammatory treatment target population. Eur J Prev Cardiol 2019; 28:152–158. [PMID: 33838040 DOI: 10.1177/2047487319885458] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/09/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Modifiable lifestyle risk factors (modRF) of coronary artery disease (CAD) are associated with increased inflammation represented by elevated C-reactive protein (CRP) levels. Lifestyle changes may influence the inflammatory burden in patients with CAD, relevantly modifying the target population for emerging anti-inflammatory compounds. AIMS The aims of this study were to analyse the association of modRF and CRP levels in CAD patients, and to define a potential target population for anti-inflammatory treatment with and without the optimisation of modRF. METHODS We included all patients with angiographically documented CAD from the observational cohort study INTERCATH. Patients with recent myocardial infarction, malignancy, infectious disease, and pre-existing immunosuppressive medication including a history of solid organ transplantation were excluded. Overweight (body mass index (BMI) ≥ 25 kg/m2), smoking, lack of physical activity (PA; <1.5 h/week), and poor diet (≤12 points of an established Mediterranean diet score (MDS), range 0-28 points) were considered as modRF. CRP was measured by a high-sensitivity assay (hsCRP) at baseline. We performed multivariable linear regressions with log-transformed hsCRP as the dependent variable. Based on these associations, we calculated potential hsCRP levels for each patient, assuming optimisation of the individual modRF. RESULTS Of 1014 patients, 737 (73%) were male, the mean age was 69 years, and 483 (48%) had an hsCRP ≥ 2 mg/l. ModRF were significantly overrepresented in patients with hsCRP ≥ 2 mg/l compared to patients with an hsCRP < 2 mg/l (BMI ≥ 25 kg/m2: 76% vs 61%; PA < 1.5 h/week: 69% vs 57%; MDS ≤ 12: 46% vs 37%; smoking: 61% vs 54%; p < 0.05 for all). hsCRP increased with the incremental number of modRF present (median hsCRP values for N = 0, 1, 2, 3, and 4 modRF: 1.1, 1.0, 1.6, 2.4, 2.8 mg/l, p < 0.001). Multivariable linear regression adjusting for age, sex, intake of lipid-lowering medication, and diabetes mellitus revealed independent associations between log-transformed hsCRP and all modRF (BMI ≥ 25 kg/m2: exp(ß) = 1.55, p < 0.001; PA < 1.5 h/week: exp(ß) = 1.33, p < 0.001; MDS ≤ 12: exp(ß) = 1.18, p = 0.018; smoking: exp(ß) = 1.18, p = 0.019). Individual recalculation of hsCRP levels assuming optimisation of modRF identified 183 out of 483 (38%) patients with hsCRP ≥ 2 mg/l who could achieve an hsCRP < 2 mg/l via lifestyle changes. CONCLUSION modRF are strongly and independently associated with CRP levels in patients with CAD. A relevant portion of CAD patients with high inflammatory burden could achieve an hsCRP < 2 mg/l by lifestyle changes alone. This should be considered both in view of the cost and side-effects of pharmacological anti-inflammatory treatment and for the design of future clinical trials in this field.
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Affiliation(s)
- Christopher Blaum
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Fabian J Brunner
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Friederike Kröger
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Julian Braetz
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Thiess Lorenz
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Alina Goßling
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Francisco Ojeda
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Lukas Koester
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg/Kiel/Lübeck, Germany
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg/Kiel/Lübeck, Germany
| | - Dirk Westermann
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg/Kiel/Lübeck, Germany
| | - Renate Schnabel
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg/Kiel/Lübeck, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg/Kiel/Lübeck, Germany
| | - Moritz Seiffert
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg/Kiel/Lübeck, Germany
| | - Christoph Waldeyer
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
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The impact of periodontal treatment on inflammatory markers and cellular parameters associated with atherosclerosis in patients after myocardial infarction. Cent Eur J Immunol 2019; 43:442-452. [PMID: 30799993 PMCID: PMC6384430 DOI: 10.5114/ceji.2018.81356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 04/23/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction The aim of this study was to analyze whether periodontal treatment affects the cardiovascular risk profile of patients after myocardial infarction (MI). Material and methods The study included 30 patients with chronic periodontitis (ChP). Sociodemographic and medical variables were collected. Patients were provided with scaling and root planing (SRP) 3 months after MI (1st visit). Periodontal examination and blood tests were performed immediately before SRP, then 1 month and 6 months after treatment (2nd and 3rd visit, respectively). Results A statistically significant decrease in blood hsCRP concentration and a decrease in the number of white blood cells (WBC) and neutrophils between the first and the second visit were observed. At 6 months after SRP, the mean platelet volume (MPV) had increased with respect to the value at 1 month after treatment. Multivariate analysis showed that the associations between: 1) change in LDL-C concentration and change in approximal plaque index value (b = –0.546, p = 0.005); 2) change in the number of monocytes and change in the plaque index value (b = 0.616, p = 0.01); 3) change in MPV and change in probing pocket depth (b = 0.567, p = 0.018) are all independent of the classic cardiovascular risk factors. Conclusions The obtained results indicate the existence of a relationship between the state of periodontal tissues on one hand and mediators of atherosclerosis and the number of immunologically competent cells on the other hand.
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de Oliveira PA, Kovacs C, Moreira P, Magnoni D, Saleh MH, Faintuch J. Unsaturated Fatty Acids Improve Atherosclerosis Markers in Obese and Overweight Non-diabetic Elderly Patients. Obes Surg 2018; 27:2663-2671. [PMID: 28470492 DOI: 10.1007/s11695-017-2704-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Several studies have demonstrated the benefits of replacing trans and saturated fats with unsaturated fatty acids on cardiovascular diseases. We aimed to demonstrate the effect of polyunsaturated and monounsaturated fat supplementation on the biochemical and endothelial markers of atherosclerotic disease in obese or overweight non-diabetic elderly patients. METHOD Seventy-nine patients were randomly divided into three groups: flaxseed oil, olive oil, and sunflower oil; patients in each group received 30 mL of oil for 90 days. Patients were subjected to anthropometric and bioimpedance assessments; biochemical and endothelial evaluations were performed through ultrasonography of the brachial artery and carotid artery for endothelium-dependent dilation and intima-media thickness assessment, respectively, before and after the intervention. The participants' usual diet remained unchanged. RESULTS The flaxseed oil group had improved ultra-sensitive C-reactive protein levels (p = 0.074) and reduced carotid intima-media thickness (CIMT) (p = 0.028); the olive oil group exhibited an improved apolipoprotein (Apo)B/ApoA ratio (p = 0.021), reduced CIMT (p = 0.028), and improved flow-mediated vasodilation (FMV) (p = 0.054); and similarly, the sunflower oil group showed an improved ApoB/ApoA ratio (p = 0.024), reduced CIMT (p = 0.048), and improved FMV (p = 0.001). CONCLUSION Unsaturated fatty acid supplementation using the three vegetable oils attenuated pro-inflammatory properties and improved prothrombotic conditions. Therefore, introducing or replacing saturated and trans fat with unsaturated fatty acids is beneficial for cardiovascular risk reduction in obese or overweight non-diabetic elderly people. Further studies are needed to determine which unsaturated fat best prevents cardiovascular disease in elderly patients.
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Affiliation(s)
- Patrícia Amante de Oliveira
- Department of Gastroenterology, Hospital das Clínicas, São Paulo, 05403-900, Brazil. .,, Rua Abílio Soares, 250 - 3° andar - Paraíso, São Paulo, CEP: 04005-909, Brazil. .,Dante Pazzanese Institute of Cardiology, São Paulo, 04012-909, Brazil.
| | - Cristiane Kovacs
- Dante Pazzanese Institute of Cardiology, São Paulo, 04012-909, Brazil
| | - Priscila Moreira
- Dante Pazzanese Institute of Cardiology, São Paulo, 04012-909, Brazil
| | - Daniel Magnoni
- Dante Pazzanese Institute of Cardiology, São Paulo, 04012-909, Brazil
| | | | - Joel Faintuch
- Department of Gastroenterology, Hospital das Clínicas, São Paulo, 05403-900, Brazil
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Wolfe BM, Kvach E, Eckel RH. Treatment of Obesity: Weight Loss and Bariatric Surgery. Circ Res 2017; 118:1844-55. [PMID: 27230645 DOI: 10.1161/circresaha.116.307591] [Citation(s) in RCA: 379] [Impact Index Per Article: 54.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/29/2016] [Indexed: 12/11/2022]
Abstract
This review focuses on the mechanisms underlying, and indications for, bariatric surgery in the reduction of cardiovascular disease (CVD), as well as other expected benefits of this intervention. The fundamental basis for bariatric surgery for the purpose of accomplishing weight loss is the determination that severe obesity is a disease associated with multiple adverse effects on health, which can be reversed or improved by successful weight loss in patients who have been unable to sustain weight loss by nonsurgical means. An explanation of possible indications for weight loss surgery as well as specific bariatric surgical procedures is presented, along with review of the safety literature of such procedures. Procedures that are less invasive or those that involve less gastrointestinal rearrangement accomplish considerably less weight loss but have substantially lower perioperative and longer-term risk. The ultimate benefit of weight reduction relates to the reduction of the comorbidities, quality of life, and all-cause mortality. With weight loss being the underlying justification for bariatric surgery in ameliorating CVD risk, current evidence-based research is discussed concerning body fat distribution, dyslipidemia, hypertension, diabetes mellitus, inflammation, obstructive sleep apnea, and others. The rationale for bariatric surgery reducing CVD events is discussed and juxtaposed with impacts on all-cause mortalities. Given the improvement of established obesity-related CVD risk factors after weight loss, it is reasonable to expect a reduction of CVD events and related mortality after weight loss in populations with obesity. The quality of the current evidence is reviewed, and future research opportunities and summaries are stated.
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Affiliation(s)
- Bruce M Wolfe
- From the Department of Surgery, Oregon Health and Science University, Portland (B.M.W., E.K.); and Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora (R.H.E.).
| | - Elizaveta Kvach
- From the Department of Surgery, Oregon Health and Science University, Portland (B.M.W., E.K.); and Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora (R.H.E.)
| | - Robert H Eckel
- From the Department of Surgery, Oregon Health and Science University, Portland (B.M.W., E.K.); and Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora (R.H.E.)
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Improvement in cardiovascular risk in women after bariatric surgery as measured by carotid intima-media thickness: comparison of sleeve gastrectomy versus gastric bypass. Surg Obes Relat Dis 2017; 13:848-854. [PMID: 28411021 DOI: 10.1016/j.soard.2017.01.040] [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] [Received: 10/27/2016] [Revised: 12/12/2016] [Accepted: 01/27/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bariatric surgery may diminish cardiovascular risk (CVR) and its associated mortality. However, studies that compare these effects with different techniques are scarce. OBJECTIVE To evaluate the changes in CVR as estimated by carotid intima-media thickness (IMT) after obesity surgery in women with high CVR as defined by the presence of metabolic syndrome. SETTING Academic hospital. METHODS We studied 40 severely obese women, of whom 20 received laparoscopic Roux en Y gastric bypass (RYGB) and 20 received sleeve gastrectomy (SG). Twenty control women matched for age and cardiovascular risk were also included. Patients and controls were evaluated at baseline and 1 year after surgery or conventional treatment with diet and exercise, respectively. Only 18 of the 20 women in the control group were available for analysis after 1 year. None of the women who had bariatric surgery was lost to follow-up. RESULTS Mean carotid IMT decreased 1 year after surgery irrespective of the surgical technique used, whereas no changes were observed in the control women who had conventional therapy (Wilks´ λ = .802, P = .002 for the interaction, P = .011 for RYGB versus controls, P = .002 for SG versus controls, P = .349 for RYGB versus SG). CONCLUSION Both RYGB and SG decrease CVR as measured by carotid IMT in obese women.
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De Luca M, Angrisani L, Himpens J, Busetto L, Scopinaro N, Weiner R, Sartori A, Stier C, Lakdawala M, Bhasker AG, Buchwald H, Dixon J, Chiappetta S, Kolberg HC, Frühbeck G, Sarwer DB, Suter M, Soricelli E, Blüher M, Vilallonga R, Sharma A, Shikora S. Indications for Surgery for Obesity and Weight-Related Diseases: Position Statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg 2016; 26:1659-96. [PMID: 27412673 PMCID: PMC6037181 DOI: 10.1007/s11695-016-2271-4] [Citation(s) in RCA: 182] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Maurizio De Luca
- Director Department of Surgery, Montebelluna Treviso Hospital, Montebelluna, Treviso, Italy.
| | | | - Jacques Himpens
- The European School of Laparoscopic Surgery, Brussels, Belgium
| | | | | | | | - Alberto Sartori
- Director Department of Surgery, Montebelluna Treviso Hospital, Montebelluna, Treviso, Italy
| | | | | | | | | | - John Dixon
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | | | | | | | - Michel Suter
- University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Mattias Blüher
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | | | - Arya Sharma
- Obesity Research Management, University of Alberta, Edmonton, Canada
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Lipids and bariatric procedures Part 2 of 2: scientific statement from the American Society for Metabolic and Bariatric Surgery (ASMBS), the National Lipid Association (NLA), and Obesity Medicine Association (OMA) 1. Surg Obes Relat Dis 2016; 12:468-495. [DOI: 10.1016/j.soard.2016.01.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 01/08/2016] [Indexed: 12/17/2022]
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Lupoli R, Di Minno MND, Guidone C, Cefalo C, Capaldo B, Riccardi G, Mingrone G. Effects of bariatric surgery on markers of subclinical atherosclerosis and endothelial function: a meta-analysis of literature studies. Int J Obes (Lond) 2015; 40:395-402. [PMID: 26388348 DOI: 10.1038/ijo.2015.187] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/21/2015] [Accepted: 08/13/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND/OBJECTIVES Several studies confirmed a significantly increased carotid intima-media thickness (IMT) and impaired flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD) in obese subjects, but few data are available on the effects of bariatric surgery on these markers of cardiovascular (CV) risk. We performed a meta-analysis of studies evaluating changes in IMT, FMD and NMD in obese patients after bariatric surgery. METHODS A systematic search was performed in the PubMed, Web of Science, Scopus and EMBASE databases without any language or publication year restriction. The last search was performed in January 2015. In addition, the reference lists of all retrieved articles were manually reviewed. Prospective studies evaluating the impact of bariatric surgery on the markers of CV risk were included. Changes in IMT, FMD and NMD after bariatric surgery were expressed as mean differences (MD) with pertinent 95% confidence intervals (95% CIs). IMT has been expressed in millimeters (mm); FMD and NMD as percentage (%). Impact of clinical and demographic features on effect size was assessed by meta-regression. RESULTS Ten articles (314 obese patients) were included in the analysis. Six studies contained data on IMT (7 data sets; 206 patients), 8 studies on FMD (9 data sets; 269 patients) and 4 on NMD (4 data sets; 149 patients). After bariatric surgery, there was a significant reduction of IMT (MD: -0.17 mm; 95% CI: -0.290, -0.049; P=0.006) and a significant improvement in FMD (MD: 5.65%; 95% CI: 2.87, 8.03; P<0.001), whereas NMD did not change (MD: 2.173%; 95% CI: -0.796, 5.142; P=0.151). Interestingly, percentage of changes in the body mass index were associated with changes in IMT (Z=11.52, P<0.001), FMD (Z=-4.26, P<0.001) and NMD (Z=-3.81, P<0.001). CONCLUSIONS Despite heterogeneity among studies, bariatric surgery is associated with improvement of subclinical atherosclerosis and endothelial function. These effects may significantly contribute to the reduction of the CV risk after bariatric surgery.
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Affiliation(s)
- R Lupoli
- Department of Clinical Medicine and Surgery, Università Degli Studi Federico II, Naples, Italy
| | - M N D Di Minno
- Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - C Guidone
- Department of Internal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Cefalo
- Department of Internal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - B Capaldo
- Department of Clinical Medicine and Surgery, Università Degli Studi Federico II, Naples, Italy
| | - G Riccardi
- Department of Clinical Medicine and Surgery, Università Degli Studi Federico II, Naples, Italy
| | - G Mingrone
- Department of Internal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
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Joint scientific statement of the European Association for the Study of Obesity and the European Society of Hypertension. J Hypertens 2015; 33:425-34. [DOI: 10.1097/hjh.0000000000000473] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Joris PJ, Zeegers MP, Mensink RP. Weight loss improves fasting flow-mediated vasodilation in adults: a meta-analysis of intervention studies. Atherosclerosis 2014; 239:21-30. [PMID: 25568949 DOI: 10.1016/j.atherosclerosis.2014.12.056] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/07/2014] [Accepted: 12/09/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Obesity is associated with vascular endothelial dysfunction. Effects of weight loss on endothelial function are however not clear. Therefore, we performed a meta-analysis to quantify effects of weight loss on flow-mediated vasodilation (FMD) of the brachial artery, a measurement of endothelial function. METHODS Studies with experimental (RCTs) and quasi-experimental designs published before June 2014 were identified by a systematic search. Changes in FMD were defined as the difference between measurements before and after the study. For RCTs, changes were corrected for those in the no-weight loss control group. Summary estimates of weighted mean differences (WMDs) in FMD and 95% confidence intervals (CIs) were calculated using random-effect meta-analyses. The impact of subject characteristics, type of weight-loss treatment, and dietary composition on changes in FMD was also investigated. RESULTS Four RCTs involving 265 subjects were included. Weight loss increased FMD vs. control by 3.29% (95% CI: 0.98-5.59%; P = 0.005; mean weight loss: 8.6 kg). A total of 1517 subjects participated in 33 studies with 49 relevant study arms. It was estimated that each 10 kg decrease in body weight increased fasting FMD by 1.11% (95% CI: 0.47-1.76%; P = 0.001). Effects were more pronounced when participants had coexisting obesity-related morbidities. Also, effects may be larger when subjects received low-fat diets or weight-reduction regimens including exercise therapy or weight-loss medication. CONCLUSION Weight loss significantly improves fasting FMD in adults, which is a risk marker for cardiovascular disease. Effects may depend on subject characteristics, type of weight-loss treatment, and dietary composition.
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Affiliation(s)
- Peter J Joris
- Department of Human Biology, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands; Top Institute of Food and Nutrition (TIFN), Wageningen, The Netherlands.
| | - Maurice P Zeegers
- Department of Complex Genetics, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Ronald P Mensink
- Department of Human Biology, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands; Top Institute of Food and Nutrition (TIFN), Wageningen, The Netherlands.
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C-reactive protein level in morbidly obese patients before and after bariatric surgery. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2014; 79:90-5. [PMID: 24878218 DOI: 10.1016/j.rgmx.2013.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 11/11/2013] [Accepted: 11/25/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Human obesity is associated with a proinflammatory state and an elevated level of mediators, such as C-reactive protein (CRP). OBJECTIVES To establish CRP levels as baseline preoperative values and then at 6 months after bariatric surgery, as well as to determine the changes in weight, body mass index (BMI), leukocytes, and glycemia. MATERIALS AND METHODS An observational, analytical, retrospective, longitudinal, and open study was conducted. Serum CRP values were measured in 36 adults presenting with morbid obesity, and their baseline relation to weight, BMI, leukocytes, and glycemia was determined; the relation to the same parameters was established again, 6 months after bariatric surgery. RESULTS The mean and standard deviation of preoperative and postoperative CRP (mg/L) was 1.15±0.86 and 0.34±0.28, respectively with p<0.0001; weight (kg) 112.10±22.91 and 84.82±17.11, p=0.0443; BMI (kg/m(2)) 42.48±5.97 and 32.2±4.79, p=0.0988; glucose (mg/dL) 100.58±17.82 and 87.11±8.49, p<0.0001, and leukocytes (× 10(3)/mm(3)) 8.62±1.69 and 6.99±1.56, p=0.3192. Baseline CRP only correlated with weight and BMI (p=0.047 and p=0.027 respectively) and there was no correlation between postoperative CRP and the evaluated parameters. CONCLUSIONS Preoperative CRP had a significant lineal relation to weight and body mass index. Patients who underwent bariatric surgery had a significant decrease in CRP, weight, and fasting glucose at 6 months after surgery.
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C-Reactive protein level in morbidly obese patients before and after bariatric surgery. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2014. [DOI: 10.1016/j.rgmxen.2013.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Teeuw WJ, Slot DE, Susanto H, Gerdes VEA, Abbas F, D'Aiuto F, Kastelein JJP, Loos BG. Treatment of periodontitis improves the atherosclerotic profile: a systematic review and meta-analysis. J Clin Periodontol 2013; 41:70-9. [PMID: 24111886 DOI: 10.1111/jcpe.12171] [Citation(s) in RCA: 206] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2013] [Indexed: 12/16/2022]
Abstract
AIM Systematic review and meta-analyses to study the robustness of observations that treatment of periodontitis improves the atherosclerotic profile. MATERIAL AND METHODS Literature was searched in Medline-PubMed, Cochrane CENTRAL and EMBASE, based on controlled periodontal intervention trials, including also a non-intervention group. Data were extracted and meta-analyses were performed. RESULTS From 3928 screened studies, 25 trials met the eligibility criteria. These trials enrolled 1748 periodontitis patients. Seven trials enrolled periodontitis patients that were otherwise healthy, 18 trials recruited periodontal patients with various co-morbidities, such as CVD or diabetes. None of the trials used hard clinical endpoints of CVD. However, improvement of endothelial function has been consistently reported. Meta-analyses demonstrated significant weighted mean difference (WMD) for hsCRP (-0.50 mg/l, 95% CI:-0.78; -0.22), IL-6 (-0.48 ng/l, 95% CI: -0.90; -0.06), TNF-α (-0.75 pg/ml, 95% CI: -1.34; -0.17), fibrinogen (-0.47 g/l, 95% CI: -0.76; -0.17), total cholesterol (-0.11 mmol/l, 95% CI: -0.21; -0.01) and HDL-C (0.04 mmol/l, 95% CI: 0.03; 0.06) favouring periodontal intervention. Importantly, periodontitis patients with co-morbidity benefitted most from periodontal therapy; significant WMD were observed for levels of hsCRP (-0.71 mg/l, 95% CI: -1.05; -0.36), IL-6 (-0.87 ng/l, 95% CI: -0.97; -0.78), triglycerides (-0.24 mmol/l, 95% CI: -0.26; -0.22), total cholesterol (-0.15 mmol/l, 95% CI: -0.29; -0.01), HDL-C (0.05 mmol/l, 95% CI: 0.03; 0.06) and HbA1c (-0.43%, 95% CI: -0.60; -0.25). CONCLUSIONS This systematic review and meta-analyses demonstrate that periodontal treatment improves endothelial function and reduces biomarkers of atherosclerotic disease, especially in those already suffering from CVD and/or diabetes.
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Affiliation(s)
- Wijnand J Teeuw
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
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Bigornia SJ, Farb MG, Tiwari S, Karki S, Hamburg NM, Vita JA, Hess DT, Lavalley MP, Apovian CM, Gokce N. Insulin status and vascular responses to weight loss in obesity. J Am Coll Cardiol 2013; 62:2297-305. [PMID: 23978693 DOI: 10.1016/j.jacc.2013.07.078] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 07/18/2013] [Accepted: 07/22/2013] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The aim of this study was to determine whether the effects of weight loss on arterial function are differentially modified by insulin status. BACKGROUND Clinical studies suggest that plasma insulin levels may predict the extent of cardiovascular benefit achieved with weight loss in obese individuals, but mechanisms are currently unknown. METHODS We prospectively followed 208 overweight or obese patients (body mass index [BMI] ≥25 kg/m(2)) receiving medical/dietary (48%) or bariatric surgical (52%) weight-loss treatment during a median period of 11.7 months (interquartile range: 4.6 to 13 months). We measured plasma metabolic parameters and vascular endothelial function using ultrasound at baseline and following weight-loss intervention and stratified analyses by median plasma insulin levels. RESULTS Patients age 45 ± 1 years, with BMI 45 ± 9 kg/m(2), experienced 14 ± 14% weight loss during the study period. In individuals with higher baseline plasma insulin levels (above median >12 μIU/ml; n = 99), ≥10% weight loss (compared with <10%) significantly improved brachial artery macrovascular flow-mediated vasodilation and microvascular reactive hyperemia (p < 0.05 for all). By contrast, vascular function did not change significantly in the lower insulin group (≤12 μIU/ml; n = 109) despite a similar degree of weight loss. In analyses using a 5% weight loss cut point, only microvascular responses improved in the higher insulin group (p = 0.02). CONCLUSIONS Insulin status is an important determinant of the positive effect of weight reduction on vascular function with hyperinsulinemic patients deriving the greatest benefit. Integrated improvement in both microvascular and macrovascular function was associated with ≥10% weight loss. Reversal of insulin resistance and endothelial dysfunction may represent key therapeutic targets for cardiovascular risk reduction in obesity.
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Affiliation(s)
- Sherman J Bigornia
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Melissa G Farb
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Stephanie Tiwari
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Shakun Karki
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Naomi M Hamburg
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Joseph A Vita
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Donald T Hess
- Department of General Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Michael P Lavalley
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Caroline M Apovian
- Department of Medicine, Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, Massachusetts
| | - Noyan Gokce
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts.
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