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Salmón-Gómez L, Catalán V, Frühbeck G, Gómez-Ambrosi J. Relevance of body composition in phenotyping the obesities. Rev Endocr Metab Disord 2023; 24:809-823. [PMID: 36928809 PMCID: PMC10492885 DOI: 10.1007/s11154-023-09796-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 03/18/2023]
Abstract
Obesity is the most extended metabolic alteration worldwide increasing the risk for the development of cardiometabolic alterations such as type 2 diabetes, hypertension, and dyslipidemia. Body mass index (BMI) remains the most frequently used tool for classifying patients with obesity, but it does not accurately reflect body adiposity. In this document we review classical and new classification systems for phenotyping the obesities. Greater accuracy of and accessibility to body composition techniques at the same time as increased knowledge and use of cardiometabolic risk factors is leading to a more refined phenotyping of patients with obesity. It is time to incorporate these advances into routine clinical practice to better diagnose overweight and obesity, and to optimize the treatment of patients living with obesity.
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Affiliation(s)
- Laura Salmón-Gómez
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Irunlarrea 1, Pamplona, 31008, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain
| | - Victoria Catalán
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Irunlarrea 1, Pamplona, 31008, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA) Pamplona, Pamplona, Spain
| | - Gema Frühbeck
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Irunlarrea 1, Pamplona, 31008, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA) Pamplona, Pamplona, Spain
- Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - Javier Gómez-Ambrosi
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Irunlarrea 1, Pamplona, 31008, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain.
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA) Pamplona, Pamplona, Spain.
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Tabesh MR, Abolhasani M, Zali MR, Bagheri R, Alipour M, Cheraghloo N, Asadzadeh-Aghdaei H, Wong A, Zahedi H, Hobaby S, Shadnoush M, Cheraghpour M. The impact of bariatric surgery procedures on the modulation of cardiometabolic risk factors in patients with severe obesity: a 12-month follow-up. J Int Med Res 2022; 50:3000605221119657. [PMID: 36314880 PMCID: PMC9629577 DOI: 10.1177/03000605221119657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Objective To evaluate the effects of one anastomosis gastric bypass (OAGB), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) on cardiometabolic risk factors (CMRFs) in patients with severe obesity. Methods This retrospective cohort study included patients with severe obesity who had undergone OAGB, RYGB, or SG between 2015 and 2017 and follow-up assessments over 12-months. Results Among 485 included patients, anthropometric measurements, body composition, fasting blood glucose (FBG), lipid profile, and comorbidities were significantly improved for all three procedures throughout the follow-up period. Weight, % total weight loss (%TWL), body mass index, fat mass and fat mass to fat-free mass ratio improvements were higher with RYGB and OAGB than SG. There were no significant differences between procedures in all other variables. A significant trend toward remission rate of dyslipidemia and type 2 diabetes mellitus was observed with all three procedures, with no significant difference between the three groups. %TWL statistically correlated with fat mass, FBG, and triglycerides. Conclusions OAGB, RYGB, and SG had a beneficial impact on CMRFs and comorbidities during 12 months of follow-up. Of note, RYGB and OAGB may result in better outcomes, particularly anthropometric and body composition indices. Further large-sample, long-term follow-up studies are required to expand on the present findings.
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Affiliation(s)
- Mastaneh Rajabian Tabesh
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Abolhasani
- Cardiac Primary Prevention Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Bagheri
- Department of Exercise Physiology, University of Isfahan, Isfahan, Iran
| | - Meysam Alipour
- Department of Nutrition, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran
| | - Neda Cheraghloo
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Asadzadeh-Aghdaei
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alexei Wong
- Department of Health and Human Performance, Marymount University, Arlington, VA, USA
| | - Hoda Zahedi
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Hobaby
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Shadnoush
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Makan Cheraghpour
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Valentí V, Cienfuegos JA, Becerril Mañas S, Frühbeck G. Mechanism of bariatric and metabolic surgery: beyond surgeons, gastroenterologists and endocrinologists. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 112:229-233. [PMID: 32081018 DOI: 10.17235/reed.2020.6925/2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Bariatric-metabolic surgery is the safest, most effective and long-lasting treatment for obesity and its associated co-morbidities, whether they be metabolic (type 2 diabetes, hyperlipidemia non-alcoholic fatty liver disease) or cardiovascular (myocardial infarction, stroke). Due to the obesity pandemic, bariatric-metabolic surgery is the second most frequent intra-abdominal procedure and the gastroenterologist and the surgeon must be aware of the physiologic changes caused by the anatomic reconfiguration following surgery. Among the mechanisms of action, independent of the loss of weight and fat tissue, surgery leads to the release of gut hormones related to carbohydrate metabolism (the rapid and continuous release of insulin), appetite and degree of satiety (glucagon-like peptide 1, peptide Y-Y, grhelin). As a result, indications for surgery have been extended to earlier disease stages. Apart from the neurohormonal effects, changes in the metabolism of biliary acids and the microbiota have also been reported. The aim of this review is to describe the physiologic changes caused by bariatric-metabolic surgery.
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Affiliation(s)
| | | | | | - Gema Frühbeck
- Endocrinología, Clínica Universidad de Navarra, España
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Type 2 Diabetes Mellitus and Simple Glucose Metabolism Parameters may Reliably Predict Nonalcoholic Fatty Liver Disease Features. Obes Surg 2017; 28:187-194. [DOI: 10.1007/s11695-017-2829-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Gómez-Ambrosi J, Andrada P, Valentí V, Rotellar F, Silva C, Catalán V, Rodríguez A, Ramírez B, Moncada R, Escalada J, Salvador J, Frühbeck G. Dissociation of body mass index, excess weight loss and body fat percentage trajectories after 3 years of gastric bypass: relationship with metabolic outcomes. Int J Obes (Lond) 2017; 41:1379-1387. [DOI: 10.1038/ijo.2017.134] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/15/2017] [Accepted: 05/25/2017] [Indexed: 12/18/2022]
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Abstract
PURPOSE OF REVIEW In the context of the worldwide obesity epidemic, bariatric surgery is the only therapy associated with a sustainable weight loss and to midterm prevention of obesity-related complications. However, nutritional and behavioral multidisciplinary medical preparation, as well as long-term postoperative nutritional follow-up, is strongly advised to avoid postoperative surgical, nutritional, or psychiatric complications. RECENT FINDINGS Due to a long history of restrictive diets and large body weight fluctuations, preoperative nutritional assessment and correction of vitamin and trace elements deficiencies are mandatory. A rapid and massive weight loss induces the loss of muscle mass and fat-free mass that could lead to malnutrition and osteoporosis. Dietetic counseling is advised to prevent postoperative food intolerance syndrome, malnutrition, and weight regain. Protein intake should be at least 60 g/day. Planned and structured physical exercise should be systematically promoted to maintain muscle mass and bone health. SUMMARY Bariatric surgery is mostly successful if patients are well prepared and monitored. The perfect patients' selection remains difficult in the absence of well defined predictive criteria of success. Future research is needed to define optimal perioperative nutritional management and its influence on long-term outcome, including quality of life and healthcare-related costs.
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Affiliation(s)
- Ronan Thibault
- aNutrition unit, Department of Endocrinology, Diabetology and Nutrition, Home Parenteral Nutrition Centre, CHU Rennes, Université de Rennes 1, INSERM U991, NuMeCan, Rennes, France bNutrition Unit, Geneva University Hospital, rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland
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Whitty JA, Ratcliffe J, Kendall E, Burton P, Wilson A, Littlejohns P, Harris P, Krinks R, Scuffham PA. Prioritising patients for bariatric surgery: building public preferences from a discrete choice experiment into public policy. BMJ Open 2015; 5:e008919. [PMID: 26474940 PMCID: PMC4611181 DOI: 10.1136/bmjopen-2015-008919] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To derive priority weights for access to bariatric surgery for obese adults, from the perspective of the public. SETTING Australian public hospital system. PARTICIPANTS Adults (N=1994), reflecting the age and gender distribution of Queensland and South Australia. PRIMARY AND SECONDARY OUTCOME MEASURES A discrete choice experiment in which respondents indicated which of two individuals with different characteristics should be prioritised for surgery in repeated hypothetical choices. Potential surgery recipients were described by seven key characteristics or attributes: body mass index (BMI), presence of comorbid conditions, age, family history, commitment to lifestyle change, time on the surgical wait list and chance of maintaining weight loss following surgery. A multinomial logit model was used to evaluate preferences and derive priority weights (primary analysis), with a latent class model used to explore respondent characteristics that were associated with variation in preference across the sample (see online supplementary analysis). RESULTS A preference was observed to prioritise individuals who demonstrated a strong commitment to maintaining a healthy lifestyle as well as individuals categorised with very severe (BMI≥50 kg/m2) or (to a lesser extent) severe (BMI≥40 kg/m2) obesity, those who already have obesity-related comorbidity, with a family history of obesity, with a greater chance of maintaining weight loss or who had spent a longer time on the wait list. Lifestyle commitment was considered to be more than twice as important as any other criterion. There was little tendency to prioritise according to the age of the recipient. Respondent preferences were dependent on their BMI, previous experience with weight management surgery, current health state and education level. CONCLUSIONS This study extends our understanding of the publics' preferences for priority setting to the context of bariatric surgery, and derives priority weights that could be used to assist bodies responsible for commissioning bariatric services.
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Affiliation(s)
- Jennifer A Whitty
- Faculty of Health and Behavioural Sciences, School of Pharmacy, The University of Queensland, St Lucia, Queensland, Australia
| | - Julie Ratcliffe
- Flinders Health Economics Group, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Elizabeth Kendall
- Centre of National Research on Disability and Rehabilitation, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
| | - Paul Burton
- Urban Research Program, Griffith School of Environment, Griffith University, Southport, Queensland, Australia
| | - Andrew Wilson
- Menzies Centre for Health Policy, University of Sydney, New South Wales, Australia
| | - Peter Littlejohns
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Paul Harris
- School of Human Services and Social Work, Menzies Health Institute Queensland, Griffith University,Meadowbrook, Queensland, Australia
| | - Rachael Krinks
- Centre of National Research on Disability and Rehabilitation, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
| | - Paul A Scuffham
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
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Abstract
The obesity epidemic, combined with the lack of available and effective treatments for morbid obesity, is a scientific and public health priority. Worldwide, bariatric and metabolic surgeries are increasingly being performed to effectively aid weight loss in patients with severe obesity, as well as because of the favourable metabolic effects of the procedures. The positive effects of bariatric surgery, especially with respect to improvements in type 2 diabetes mellitus, have expanded the eligibility criteria for metabolic surgery to patients with diabetes mellitus and a BMI of 30-35 kg/m(2). However, the limitations of BMI, both in the diagnosis and follow-up of patients, need to be considered, particularly for determining the actual adiposity and fat distribution of the patients following weight loss. Understanding the characteristics shared by bariatric and metabolic surgeries, as well as their differential aspects and outcomes, is required to enhance patient benefits and operative achievements. For a holistic approach that focuses on the multifactorial effects of bariatric and metabolic surgery to be possible, a paradigm shift that goes beyond the pure semantics is needed. Such a shift could lead to profound clinical implications for eligibility criteria and the definition of success of the surgical approach.
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Affiliation(s)
- Gema Frühbeck
- Department of Endocrinology &Nutrition, CIBEROBN, Clínica Universidad de Navarra, University of Navarra, IdiSNA, Avda. Pío XII 36, 31008 Pamplona, Spain
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