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Yokote K, Ota R, Wada S, Matsuda H, Filomeno R. Clinical Efficacy and Safety of Anti-Obesity Medications Among Adult East Asian People with Obesity: A Systematic Literature Review and Indirect Treatment Comparison. Adv Ther 2024:10.1007/s12325-024-02941-7. [PMID: 39039386 DOI: 10.1007/s12325-024-02941-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/28/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION The prevalence of obesity has increased worldwide over the past decades. Regional variations exist in the relationship between body mass index (BMI), body fat, and health risks: Asians typically have a lower BMI than people of European descent, but a higher risk of obesity-related comorbidities. However, there is a paucity of evidence for anti-obesity medications (AOMs) in East Asian populations. In this study, we aimed to systematically review evidence regarding the safety and efficacy of AOMs among adults with obesity disease in East Asia, and to assess the feasibility of conducting an indirect treatment comparison (ITC) between the semaglutide and mazindol trials. METHODS The Embase, MEDLINE, and ICHUSHI databases were searched via the Ovid SP platform for randomized controlled trials, in English or Japanese, reporting data on semaglutide or mazindol therapy with placebo or diet and exercise as comparators. The potential risks of bias in conducting a population-adjusted ITC were determined based on the heterogeneity of potential effect modifiers and variations in study design. RESULTS Of 21 publications, 2 were included in this study based on the eligibility criteria. The STEP 6 study established the clinical efficacy of subcutaneous semaglutide compared with placebo in the reduction of body weight and cardiometabolic risk factors [glycated hemoglobin (HbA1c), total cholesterol, and systolic blood pressure] among Japanese and South Korean people with obesity disease. Mazindol also proved beneficial in reducing body weight and total cholesterol compared with placebo in Japan. Both semaglutide and mazindol were associated with higher rates of adverse events and treatment discontinuation than placebo. An ITC between the two studies was not deemed feasible based on the potential risks of bias. CONCLUSIONS Semaglutide and mazindol are associated with significant body weight reduction among people with obesity in East Asia. Further research based on label indications and up-to-date real-world data among East Asian people with obesity would help determine additional clinical benefits.
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Affiliation(s)
- Koutaro Yokote
- Chiba University Hospital, Chiba, Japan
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Riku Ota
- Novo Nordisk Pharma Ltd., Tokyo, Japan.
- Novo Nordisk A/S, Søborg, Denmark.
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Umemura A, Sasaki A, Takamura T, Takayama H, Takeshita Y, Toya Y, Kakisaka K, Hasegawa Y, Ishigaki Y. Relationship between the changes in hepatokine levels and metabolic effects after laparoscopic sleeve gastrectomy in severely obese patients. Surg Today 2024; 54:581-590. [PMID: 37957316 PMCID: PMC11102872 DOI: 10.1007/s00595-023-02767-w] [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: 06/28/2023] [Accepted: 09/25/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE To clarify the relationships between the changes in hepatokines and weight loss, and between these changes and the metabolic effects, and the roles played by these changes, after laparoscopic sleeve gastrectomy (LSG). METHODS We recruited 25 Japanese patients with severe obesity, who underwent LSG. We measured two hepatokines: selenoprotein P (SeP) and leukocyte cell-derived chemotaxin 2 (LECT2), at the baseline, and then 6 months and 1 year after LSG. Finally, we compared the changes in the hepatokines with the parameters of type 2 diabetes (T2D) and non-alcoholic steatohepatitis (NASH). RESULTS Changes in LECT2 were correlated with the percentage of total weight loss (ρ = - 0.499, P = 0.024) and the decrease in total fat area (ρ = 0.559, P = 0.003). The changes in SeP were correlated with those in hemoglobin A1c (ρ = 0.526, P = 0.043) and the insulinogenic index (ρ = 0.638, P = 0.010) in T2D patients. In patients with NASH, the LECT2 levels were correlated with liver steatosis (ρ = 0.601). CONCLUSIONS SeP levels decrease in association with HbA1c reduction, whereas LECT2 levels are associated with reductions in fat mass and NASH scores after LSG. Hepatokines may be involved in the pathology of obesity and its complications.
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Affiliation(s)
- Akira Umemura
- Department of Surgery, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Iwate, 028-3695, Japan.
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Iwate, 028-3695, Japan
| | - Toshinari Takamura
- Department of Endocrinology and Metabolism, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, 920-8640, Japan
| | - Hiroaki Takayama
- Department of Endocrinology and Metabolism, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, 920-8640, Japan
| | - Yumie Takeshita
- Department of Endocrinology and Metabolism, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, 920-8640, Japan
| | - Yosuke Toya
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Iwate, 028-3695, Japan
| | - Keisuke Kakisaka
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Iwate, 028-3695, Japan
| | - Yutaka Hasegawa
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Iwate, 028-3695, Japan
| | - Yasushi Ishigaki
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Iwate, 028-3695, Japan
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Shangguan Q, Liu Q, Yang R, Zhang S, Sheng G, Kuang M, Zou Y. Predictive value of insulin resistance surrogates for the development of diabetes in individuals with baseline normoglycemia: findings from two independent cohort studies in China and Japan. Diabetol Metab Syndr 2024; 16:68. [PMID: 38491516 PMCID: PMC10943817 DOI: 10.1186/s13098-024-01307-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 03/05/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Insulin resistance (IR) plays a crucial role in the occurrence and progression of diabetes. This study aimed to evaluate and compare the predictive value of four IR surrogates, including the triglycerides glucose (TyG) index, TyG and body mass index (TyG-BMI), triglycerides/high-density lipoprotein cholesterol (TG/HDL-C) ratio, and the metabolic score for IR (MetS-IR) for diabetes in two large cohorts. METHODS A total of 116,661 adult participants from the China Rich Healthcare Group and 15,464 adult participants from the Japanese NAGALA cohort were included in the study. Multivariable Cox proportional hazards models were used to assess the standardized hazard ratio (HR) of the TyG index, TyG-BMI, TG/HDL-C ratio, and MetS-IR directly associated with diabetes. Receiver operating characteristic (ROC) curve and time-dependent ROC curve analysis were performed to evaluate and compare the predictive value of the four IR surrogates for diabetes. RESULTS In the two independent cohorts, the average follow-up time was 3.1 years in the China cohort, with 2681(2.30%) incident cases of diabetes recorded, and 6.13 years in the Japan cohort, with 373 incident cases (2.41%) of diabetes recorded. After adjusting for potential confounding factors, we found that among the four IR surrogates, TyG-BMI and MetS-IR showed stronger associations with diabetes. The stronger associations persisted even after further stratification by age, sex, hypertension, and obese subgroups. In terms of diabetes prediction, based on ROC analysis, TyG-BMI demonstrated the highest predictive accuracy for diabetes in the Chinese population, while both TyG-BMI and MetS-IR showed the highest predictive accuracy in the Japanese population. The results of further subgroup ROC analysis confirmed the robustness of these findings. Furthermore, the time-dependent ROC results indicated that among the four IR surrogates, MetS-IR exhibited the highest accuracy in predicting future diabetes at various time intervals in the Japanese population. CONCLUSION Our findings suggest that evaluating TyG-BMI and MetS-IR as IR surrogates may be the most useful for predicting diabetes events and assessing the risk of developing diabetes in East Asian populations.
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Affiliation(s)
- Qing Shangguan
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
| | - Qiuling Liu
- Cardiovascular Research Institute of Jiangxi Province, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
| | - Ruijuan Yang
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
- Department of Endocrinology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
| | - Shuhua Zhang
- Cardiovascular Research Institute of Jiangxi Province, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
| | - Guotai Sheng
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
| | - Maobin Kuang
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China.
- Cardiovascular Research Institute of Jiangxi Province, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China.
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China.
| | - Yang Zou
- Cardiovascular Research Institute of Jiangxi Province, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China.
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Kanai R, Kinoshita S, Kanbe I, Sameda M, Yamaoka S, Horikawa O, Watanabe Y, Tatsuno I, Shirai K, Oshiro T, Saiki A. Once-weekly semaglutide administered after laparoscopic sleeve gastrectomy: Effects on body weight, glycemic control, and measured nutritional metrics in Japanese patients having both obesity and type 2 diabetes. OBESITY PILLARS (ONLINE) 2024; 9:100098. [PMID: 38230266 PMCID: PMC10789635 DOI: 10.1016/j.obpill.2023.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/31/2023] [Accepted: 12/31/2023] [Indexed: 01/18/2024]
Abstract
Background Glucagon-like peptide (GLP)-1 analogue may be useful for controlling weight recurrence and diabetes relapse after bariatric surgery, but may also adversely affect the measured nutritional metrics. This study aimed to investigate the effect of treatment with once-weekly semaglutide after laparoscopic sleeve gastrectomy (LSG) in patients with type 2 diabetes (T2D). We also examined the effects of combined use with a low-energy, high-protein formula diet (FD). Methods This study was a single-center retrospective database analysis. We enrolled 29 Japanese patients with T2D who underwent LSG, and more than 12 months later received semaglutide. The patients were divided retrospectively into a FD group (=6) and a conventional diet (CD) group (n = 23). Results BMI and HbA1c decreased significantly by 10.7 kg/m2 and 1.1 %, respectively, 12 months after LSG, and decreased by an additional 1.6 kg/m2 and 0.6 % after 12-months of treatment with semaglutide. Decreases in serum albumin, vitamin B12 and zinc were observed only after semaglutide administration. A ratio of energy from protein, fat and carbohydrates changed from 13:31:56 before to 19:30:50 after LSG, and from 17:32:51 before to 15:29:56 after semaglutide. Skeletal muscle ratio, which is the ratio of skeletal muscle mass to body weight, increased after LSG, but did not change after semaglutide. FD group showed a significant increase in skeletal muscle mass per 1 % body weight compared to CD group during semaglutide treatment. Conclusion Semaglutide after LSG in patients with obesity and T2D resulted in additional weight reduction and improved glycemic control, but worsened measured nutritional metrics. Administration of a low-energy, high protein formula diet may ameliorate adverse nutritional effects of semaglutide in patients with T2D after LSG. (Ethics Committee of Toho University Sakura Medical Center approval number S18061).
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Affiliation(s)
- Rieko Kanai
- Department of Medical Nutrition, Toho University Sakura Medical Center, Sakura, Japan
| | - Sachiho Kinoshita
- Department of Medical Nutrition, Toho University Sakura Medical Center, Sakura, Japan
| | - Izumi Kanbe
- Department of Medical Nutrition, Toho University Sakura Medical Center, Sakura, Japan
| | - Mariko Sameda
- Department of Medical Nutrition, Toho University Sakura Medical Center, Sakura, Japan
| | - Shuhei Yamaoka
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Osamu Horikawa
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Yasuhiro Watanabe
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Ichiro Tatsuno
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
- Chiba Prefectural University of Health Sciences, Chiba, Japan
| | - Kohji Shirai
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
- Department of Internal Medicine, Mihama Hospital, Chiba, Japan
| | - Takashi Oshiro
- Department of Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Atsuhito Saiki
- Department of Medical Nutrition, Toho University Sakura Medical Center, Sakura, Japan
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
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Ohta M, Endo Y, Shiroshita H, Kawasaki T, Masuda T, Hirashita T, Fukuda K, Ogawa R, Mizukami K, Masaki T, Murakami K, Inomata M. Clinical significance of colonoscopy before laparoscopic bariatric/metabolic surgery in Japanese patients. Surg Today 2024; 54:80-85. [PMID: 37286812 DOI: 10.1007/s00595-023-02706-9] [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: 01/30/2023] [Accepted: 04/30/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE Obesity is known to be associated with colorectal adenoma (CRA) and colorectal cancer (CRC); yet colonoscopy is not considered an essential preoperative evaluation before bariatric/metabolic surgery. The aim of this study was to clarify the clinical significance of preoperative colonoscopy for obese Japanese patients. METHODS The subjects of this retrospective study were 114 patients who underwent screening colonoscopy before bariatric/metabolic surgery. Multivariate analyses were performed to evaluate the independent predictors of CRA/CRC among the characteristics identified as significant or nearly significant by univariate analyses. RESULTS Colonoscopy revealed abnormal findings indicating the need for biopsy or polypectomy in 20 of the 114 patients (17.5%), and CRA was diagnosed in 13 patients (11.4%). Three patients (2.6%), who were all ≥ 56 years old, had a CRA ≥ 10 mm in diameter. The multivariate analysis showed that older age and male sex were significant predictors of CRA/CRC, which was identified in 46.2% of the male patients aged ≥ 46 years. CONCLUSION Our findings suggest that older age and male sex may be risk factors for CRA/CRC in obese Japanese candidates for bariatric/metabolic surgery; thus, preoperative colonoscopy should be considered for these high-risk patients.
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Affiliation(s)
- Masayuki Ohta
- Research Center for GLOBAL and LOCAL Infectious Diseases, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan.
| | - Yuichi Endo
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Hidefumi Shiroshita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Takahide Kawasaki
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Takashi Masuda
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Teijiro Hirashita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Kensuke Fukuda
- Department of Gastroenterology, Oita University Faculty of Medicine, Oita, Japan
| | - Ryo Ogawa
- Department of Gastroenterology, Oita University Faculty of Medicine, Oita, Japan
| | - Kazuhiro Mizukami
- Department of Gastroenterology, Oita University Faculty of Medicine, Oita, Japan
| | - Takayuki Masaki
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Oita University Faculty of Medicine, Oita, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Oita University Faculty of Medicine, Oita, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
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Oshiro T, Wakamatsu K, Nabekura T, Moriyama Y, Kitahara N, Kadoya K, Sato A, Kitahara T, Urita T, Sato Y, Nagashima M, Tsuchiya M, Okazumi S. Treatments for Staple Line Leakage after Laparoscopic Sleeve Gastrectomy. J Clin Med 2023; 12:jcm12103495. [PMID: 37240601 DOI: 10.3390/jcm12103495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/29/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
The number of laparoscopic sleeve gastrectomies (LSGs) performed in patients with obesity who are eligible for bariatric and metabolic surgery is currently much lower in Japan than in other countries. Considering the large number of potential patients with obesity and type 2 diabetes and the unique Japanese national health insurance system that guarantees fair healthcare delivery, there is room to increase the number of LSGs in Japan in the near future. However, strict health insurance regulations may limit access to mandatory devices needed to treat postoperative complications, such as staple line leakage, which can cause severe morbidity and even mortality. Therefore, understanding the pathogenesis and treatment options for this complication is crucial. This article examined the current situation in Japan and its impact on staple line leakage management, including the role of endoscopic treatment in reducing reoperation. The authors suggest increasing education and collaboration between healthcare professionals to optimize management and improve patient outcomes.
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Affiliation(s)
- Takashi Oshiro
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Kotaro Wakamatsu
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Taiki Nabekura
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Yuki Moriyama
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Natsumi Kitahara
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Kengo Kadoya
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Ayami Sato
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Tomoaki Kitahara
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Tasuku Urita
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Yu Sato
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Makoto Nagashima
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Masaru Tsuchiya
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
| | - Shinichi Okazumi
- Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Japan
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Wakamatsu K, Oshiro T, Kitahara N, Moriyama Y, Nabekura T, Hashi K, Hayashi K, Saiki A, Okazumi S. Feasibility of Laparoscopic Sleeve Gastrectomy for Patients with Obesity and Disorders of Intellectual Development: a Single Institutional Experience. Obes Surg 2023; 33:1327-1332. [PMID: 36943609 PMCID: PMC10156847 DOI: 10.1007/s11695-023-06543-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Owing to their difficulty following clinical advice for procedural safety and ideal surgical outcomes, bariatric and metabolic surgery (BMS) for patients with disorders of intellectual development (DID) is concerning. Studies reporting the feasibility of BMS for this population remain scarce. This study aims to clarify the feasibility of laparoscopic sleeve gastrectomy (LSG) for patients with clinically severe obesity and DID. METHODS A retrospective analysis of a single institutional prospective database collected from 2010 to 2022 was performed. The Wechsler Adult Intelligence Scale (WAIS) was used to measure intellectual ability before LSG. A multidisciplinary team approach was implemented to give special support and care to patients with DID. Patients were categorized into groups according to their WAIS scores. LSG outcomes were statistically compared between the DID and average intellectual ability groups. RESULTS Using the WAIS to measure intellectual ability among patients who underwent LSG, we identified 14 patients with DID (IQ score: < 69, mean IQ: 63.4) and 71 with average intellectual ability (IQ score: 90-109, mean IQ: 98.9). Operative outcomes were comparable between the groups as follows: operation time (DID: 163 ± 41 min, average intelligence: 162 ± 30 min), hospital stay (DID: 4 [4-5] days, average intelligence: 5 [4-6] days), and total comorbidities (DID: 7.1%, average intelligence: 8.4%). No reoperations were performed, and no mortalities were observed. CONCLUSIONS With medical and social support and care, performing LSG on patients with clinically severe obesity and DID is safe, with good short-term results.
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Affiliation(s)
- Kotaro Wakamatsu
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan
| | - Takashi Oshiro
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan.
| | - Natsumi Kitahara
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan
| | - Yuuki Moriyama
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan
| | - Taiki Nabekura
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan
| | - Kozue Hashi
- Department of Neuropsychiatry, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan
| | - Karin Hayashi
- Department of Psychiatry, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan
| | - Atsuhito Saiki
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan
| | - Shinichi Okazumi
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan
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Kimura Y, Fujishima Y, Nishizawa H, Saito T, Miyazaki Y, Shirahase K, Tokuzawa C, Nagai N, Fukuda S, Maeda K, Maeda N, Doki Y, Shimomura I. Changes in Eating Behaviors and Their Associations with Weight Loss in Japanese Patients Who Underwent Laparoscopic Sleeve Gastrectomy. Nutrients 2023; 15:nu15020353. [PMID: 36678222 PMCID: PMC9866351 DOI: 10.3390/nu15020353] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) has been established to provide long-term weight loss in severe obesity. In this study, we investigated the factors that affect post-operative weight loss, with a particular focus on changes in eating behaviors. METHODS Time-course changes in body weight and eating behaviors were examined in 49 Japanese patients who underwent laparoscopic sleeve gastrectomy from the first visit to 12 months after surgery. Each eating behavior was evaluated via the questionnaire of the Japan Society for the Study of Obesity. RESULTS Pre-operative weight reduction mediated by dietary and lifestyle interventions showed significant positive correlations with weight loss outcomes at 12 months after surgery. We observed significant decreases in scores for most of the eating behaviors 12 months after surgery. However, "emotional eating behavior" scores declined temporarily in the early post-operative period of one month but thereafter returned to the pre-operative level at 12 months. Furthermore, increases in the scores for "emotional eating behavior" and "sense of hunger" from 1 to 12 months post-operatively were significantly associated with poor weight loss. CONCLUSIONS Our results demonstrate the beneficial effects of MBS on obesity-related eating behaviors, as well as highlighting "emotional eating behavior" as requiring particular attention.
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Affiliation(s)
- Yu Kimura
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Yuya Fujishima
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Hitoshi Nishizawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
- Correspondence: ; Tel.: +81-(66)-8793732; Fax: +81-(66)-8793739
| | - Takuro Saito
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Yasuhiro Miyazaki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
- Department of Surgery, Osaka General Medical Center, Osaka 558-8558, Japan
| | - Keiko Shirahase
- Division of Nutrition Management, Osaka University Hospital, Osaka 565-0871, Japan
| | - Chie Tokuzawa
- Division of Nutrition Management, Osaka University Hospital, Osaka 565-0871, Japan
| | - Naoko Nagai
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
- Division of Nutrition Management, Osaka University Hospital, Osaka 565-0871, Japan
| | - Shiro Fukuda
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Kazuhisa Maeda
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Norikazu Maeda
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
- Department of Metabolism and Atherosclerosis, Graduate School of Medicine Osaka University, Osaka 565-0871, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
- Division of Nutrition Management, Osaka University Hospital, Osaka 565-0871, Japan
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Umemura A, Sasaki A, Nitta H, Katagiri H, Kanno S, Takeda D, Ando T, Amano S, Nishiya M, Uesugi N, Sugai T. A novel second-stage surgical strategy for severely obese patient with pancreatic neuroendocrine tumor: a case report. Surg Case Rep 2022; 8:125. [PMID: 35754064 PMCID: PMC9234015 DOI: 10.1186/s40792-022-01484-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 06/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Severely obese patients can have other diseases requiring surgical treatment. In such patients, bariatric surgeries are considered a precursor to operations targeting the original disease for the purpose of reducing severe perioperative complications. Pancreatic ectopic fat deposition increases pancreas volume (PV) and thickness, which can worsen insulin resistance and islet β cell function. To address this problem, we present a novel two-stage surgical strategy performed on a severely obese patient with pancreatic neuroendocrine tumor (PNET) consisting of laparoscopic sleeve gastrectomy (LSG) as a metabolic surgery followed by laparoscopic spleen-preserving distal pancreatectomy (LSPDP). Case presentation A 56-year-old man was referred to our hospital for further investigation of a pancreatic tumor. His initial body weight and body mass index (BMI) were 94.0 kg and 37.2 kg/m2, respectively. Contrast computed tomography revealed an enhanced tumor measuring 15 mm on the pancreatic body. The pancreas thickness and PV were 32 mm and 148 mL, respectively. An endoscopic ultrasonographic fine needle aspiration identified the tumor as PNET-G1. We first performed LSG, the patient’s body weight and BMI had decreased dramatically to 64.0 kg and 25.3 kg/m2 at 6 months after LSG. The pancreas thickness and PV had also decreased to 17 mm and 99 mL, respectively, with no tumor growth. Since LSG has been shown to reduce the perioperative risk factors of LSPDP, and to improve insulin resistance and recovery of islet β cell function, we performed LSPDP for PNET-G1 as a second-stage surgery. The postoperative course was unremarkable, and the patient was discharged on postoperative day 14 without symptomatic postoperative pancreatic fistula (POPF). He was followed without recurrence or type 2 diabetes (T2D) onset for 6 months after LSPDP. Conclusions We present a novel two-stage surgical strategy for a severely obese patient with PNET, consisting of LSG as a metabolic surgery for severe obesity, followed by LSPDP after confirmation of good weight loss and metabolic effects. LSG before pancreatectomy may have a potential to reduce pancreas thickness and recovery of islet β cell function in severely obese patients, thereby reducing the risk of clinically relevant POPF and post-pancreatectomy T2D onset.
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Takahashi N, Sasaki A, Umemura A, Sugai T, Kakisaka K, Ishigaki Y. Identification of a Fatty Acid for Diagnosing Non-Alcoholic Steatohepatitis in Patients with Severe Obesity Undergoing Metabolic Surgery. Biomedicines 2022; 10:biomedicines10112920. [PMID: 36428489 PMCID: PMC9687903 DOI: 10.3390/biomedicines10112920] [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: 10/27/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
The prevalence of nonalcoholic steatohepatitis (NASH) in severely obese Japanese patients is extremely high. However, there are currently no methods other than liver biopsy to assess hepatic steatosis and fibrosis. The purpose of this study was to comprehensively analyze changes in fatty acid (FA) and serum-free fatty acid (FFA) metabolism in severely obese Japanese patients to determine whether these could be surrogate markers. In this study, we enrolled 20 Japanese patients who underwent laparoscopic sleeve gastrectomy (LSG) for severe obesity and intraoperative liver biopsy. Serum FFAs were analyzed with liquid chromatography-mass spectrometry, and FAs in liver tissue were assessed using matrix-assisted laser desorption/ionization-imaging mass spectrometry to determine FAs that may be indicative of a positive NASH diagnosis. All patients showed significant weight loss and metabolic improvement following LSG. Regarding weight loss and metabolic improvement indices, 23 FFAs showed significant correlations with the baseline data. Narrowing down the phospholipids to commonly detected FAs detected in liver tissue, PC(18:1e_20:4) was significantly changed in the NASH group, suggesting that it could be used as a surrogate marker for NASH diagnosis. The results suggest that specific postoperative changes in blood phospholipids could be used as surrogate markers for NASH treatment.
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Affiliation(s)
- Naoto Takahashi
- Department of Surgery, Iwate Medical University School of Medicine, Morioka 028-3695, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University School of Medicine, Morioka 028-3695, Japan
- Correspondence: ; Tel.: +81-19-6137111
| | - Akira Umemura
- Department of Surgery, Iwate Medical University School of Medicine, Morioka 028-3695, Japan
| | - Tamotsu Sugai
- Division of Molecular Diagnostic Pathology, Department of Pathology, Iwate Medical University School of Medicine, Morioka 028-3695, Japan
| | - Keisuke Kakisaka
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka 028-3695, Japan
| | - Yasushi Ishigaki
- Division of Diabetes and Metabolism, Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka 028-3695, Japan
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Umemura A, Sasaki A, Nikai H, Yanari S, Ishioka H, Takahashi N, Katagiri H, Kanno S, Takeda D, Morishita T, Eizuka M, Oizumi T, Nitta H. Improvements of lung volumes and respiratory symptoms after weight loss through laparoscopic sleeve gastrectomy. Langenbecks Arch Surg 2022; 407:2747-2754. [PMID: 35588327 DOI: 10.1007/s00423-022-02549-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This study evaluated the improvement of respiratory function and airway volumes using spirometry and computed tomography (CT) in severely obese Japanese patients undergoing laparoscopic sleeve gastrectomy (LSG). We also evaluated the quality of life (QOL) of enrolled patients using questionnaires. METHODS A total of 71 patients who underwent LSG at Iwate Medical University Hospital between October 2013 and September 2020 were enrolled. The changes and relationships between respiratory parameters including CT volumetry and weight-loss effects were evaluated. Improvements to QOL and bronchial asthma (BA) were also assessed before LSG and 1 year after LSG. RESULTS The mean excess weight loss percentage (%EWL) and total weight loss percentage (%TWL) were measured at 55.1% and 26.1%, respectively. The attack frequency of BA significantly decreased (6.1/month vs. 1.5/month; P < 0.001), and the disease severity decreased according to severity classification (P = 0.032). Almost spirometric parameters, lung volume (LV) (4905.0 mL vs. 5490.3 mL; P < 0.001), and airway volume (AV) (108.6 mL vs. 119.3 mL; P = 0.022) significantly improved. The change of functional residual capacity (FRC) was correlated with both %EWL (ρ = 0.69, P < 0.001) and %TWL (ρ = 0.62, P < 0.001). The increase of LV (ρ = 0.79, P < 0.001) and AV (ρ = 0.69, P < 0.001) were correlated with the increase of FRC. Scores of QOL questionnaires dramatically became better owing to improvements in dyspnea. CONCLUSION Weight loss effects and the reduction of body fat mass correlated significantly with increase in LV and AV. Improvements of respiratory functions after LSG contributes to QOL and BA symptoms.
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Affiliation(s)
- Akira Umemura
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan.
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Haruka Nikai
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Shingo Yanari
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Hideki Ishioka
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Naoto Takahashi
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Hirokatsu Katagiri
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Shoji Kanno
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Daiki Takeda
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Toshifumi Morishita
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Makoto Eizuka
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Tomofumi Oizumi
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
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Oh TJ, Lee H, Cho YM. East Asian perspectives in metabolic and bariatric surgery. J Diabetes Investig 2022; 13:756-761. [PMID: 35029061 PMCID: PMC9077716 DOI: 10.1111/jdi.13748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 11/28/2022] Open
Abstract
The prevalence of diabetes and obesity continues to rise in East Asia. As the risk of diabetes increases at a lower body mass index (BMI) in East Asians than in Europeans, the threshold of BMI values for metabolic and bariatric surgery (MBS) is lower in East Asians. MBS is considered upon reaching a BMI of 27.5 kg/m2 and is recommended at a BMI of ≥ 32.5 kg/m2 , depending on the status of glucose homeostasis. The most commonly performed MBS in East Asia is sleeve gastrectomy, followed by Roux-en-Y gastric bypass (RYGB). Because the incidence of gastric cancer is higher in East Asia than in other regions, concerns regarding surveillance for gastric cancer might be related to a preference for sleeve gastrectomy over RYGB in this region. Even though there is a paucity of data on direct comparisons of the efficacy of MBS among different ethnic groups, the degree of weight reduction in East Asians is not inferior to other ethnic groups. Moreover, studies suggest that the diabetes remission rate in East Asians seemed to be higher than in other ethnic groups. Future studies involving multiethnic groups are necessary to identify possible ethnic differences in diabetes remission and to determine the appropriate BMI threshold for MBS according to ethnicity.
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Affiliation(s)
- Tae Jung Oh
- Department of Internal MedicineSeoul National University College of Medicine and Seoul National University Bundang HospitalSeongnamKorea
| | - Hyuk‐Joon Lee
- Department of SurgerySeoul National University HospitalSeoulKorea
| | - Young Min Cho
- Department of Internal MedicineSeoul National University College of Medicine and Seoul National University HospitalSeoulKorea
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Sasaki A, Umemura A, Ishida K, Takahashi N, Nikai H, Nitta H, Takikawa Y, Kakisaka K, Abe T, Nishiya M, Sugai T. The Concept of Indeterminable NASH Inducted by Preoperative Diet and Metabolic Surgery: Analyses of Histopathological and Clinical Features. Biomedicines 2022; 10:biomedicines10020453. [PMID: 35203662 PMCID: PMC8962337 DOI: 10.3390/biomedicines10020453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/20/2022] [Accepted: 02/09/2022] [Indexed: 11/25/2022] Open
Abstract
Practitioners routinely perform intraoperative liver biopsies during laparoscopic sleeve gastrectomy (LSG) to evaluate nonalcoholic fatty liver disease (NAFLD). In some patients, hepatocyte ballooning, inflammation, and fibrosis without steatosis are observed, even in the absence of other etiologies. We call this finding indeterminable nonalcoholic steatohepatitis (Ind-NASH). In this study, we clarified the prevalence, as well as histopathological and clinical features, of Ind-NASH through intraoperative liver biopsy in Japanese patients presenting with severe obesity. We enrolled 63 patients who had undergone LSG and intraoperative liver biopsy. In patients diagnosed with histopathological NASH, we performed protocol liver biopsies at 6 and 12 months after LSG. We statistically analyzed these histopathological findings and clinical parameters and found the prevalence rate of Ind-NASH discovered through intraoperative biopsy to be 15.9%. Protocol liver biopsy also revealed that Ind-NASH was an intermediate condition between NASH and normal liver. The clinical features of patients with Ind-NASH are a higher body weight compared to NASH (134.9 kg vs. 114.7 kg; p = 0.0245), stronger insulin resistance compared to nonalcoholic fatty liver (homeostasis model assessment–insulin resistance: 7.1 vs. 4.9; p = 0.0188), and mild liver dysfunction compared to NASH. Patients with Ind-NASH observed positive weight-loss effects from a preoperative diet compared to the postoperative course (percentage total weight loss: 32.0% vs. 26.7%; p < 0.0001). Patients with Ind-NASH may also be good candidates for metabolic surgery owing to their good treatment response; therefore, efforts should be made by specialists in the near future to deeply discuss and define Ind-NASH.
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Affiliation(s)
- Akira Sasaki
- Department of Surgery, Iwate Medical University, Iwate 028-3695, Japan; (A.U.); (N.T.); (H.N.); (H.N.)
- Correspondence: ; Tel.: +81-19-6137111
| | - Akira Umemura
- Department of Surgery, Iwate Medical University, Iwate 028-3695, Japan; (A.U.); (N.T.); (H.N.); (H.N.)
| | - Kazuyuki Ishida
- Department of Diagnostic Pathology, Dokkyo Medical University, Tochigi 321-0293, Japan;
| | - Naoto Takahashi
- Department of Surgery, Iwate Medical University, Iwate 028-3695, Japan; (A.U.); (N.T.); (H.N.); (H.N.)
| | - Haruka Nikai
- Department of Surgery, Iwate Medical University, Iwate 028-3695, Japan; (A.U.); (N.T.); (H.N.); (H.N.)
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University, Iwate 028-3695, Japan; (A.U.); (N.T.); (H.N.); (H.N.)
| | - Yasuhiro Takikawa
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate 028-3695, Japan; (Y.T.); (K.K.); (T.A.)
| | - Keisuke Kakisaka
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate 028-3695, Japan; (Y.T.); (K.K.); (T.A.)
| | - Tamami Abe
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate 028-3695, Japan; (Y.T.); (K.K.); (T.A.)
| | - Masao Nishiya
- Department of Pathology, Iwate Medical University, Iwate 028-3695, Japan; (M.N.); (T.S.)
| | - Tamotsu Sugai
- Department of Pathology, Iwate Medical University, Iwate 028-3695, Japan; (M.N.); (T.S.)
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