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Abstract
The rising prevalence of obesity in Singapore is a harbinger for a corresponding increase in obesity-related complications such as type 2 diabetes mellitus (T2DM) and coronary heart disease. Obesity is a complex disease driven by multiple factors, and hence, treatment cannot follow a 'one-size-fits-all' approach. Lifestyle modifications involving dietary interventions, physical activity and behavioural changes remain the cornerstone of obesity management. However, similar to other chronic diseases such as T2DM and hypertension, lifestyle modifications are often insufficient on their own, hence the importance of other treatment modalities including pharmacotherapy, endoscopic bariatric therapy and metabolic-bariatric surgery. Weight loss medications currently approved in Singapore include phentermine, orlistat, liraglutide and naltrexone-bupropion. In recent years, endoscopic bariatric therapies have evolved as an effective, minimally invasive and durable therapeutic option for obesity. Metabolic-bariatric surgery remains the most effective and durable treatment for patients with severe obesity, with an average weight loss of 25%-30% after one year.
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Affiliation(s)
- Phong Ching Lee
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Chin Hong Lim
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore
| | - Ravishankar Asokkumar
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
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Lai Y, Dhingra R, Zhang Z, Ball LM, Zylka MJ, Lu K. Toward Elucidating the Human Gut Microbiota-Brain Axis: Molecules, Biochemistry, and Implications for Health and Diseases. Biochemistry 2022; 61:2806-2821. [PMID: 34910469 PMCID: PMC10857864 DOI: 10.1021/acs.biochem.1c00656] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In recent years, a substantial amount of data have supported an active role of gut microbiota in mediating mammalian brain function and health. Mining gut microbiota and their metabolites for neuroprotection is enticing but requires that the fundamental biochemical details underlying such microbiota-brain crosstalk be deciphered. While a neuronal gut-brain axis (through the vagus nerve) is not disputable, accumulating studies also point to a humoral route (via blood/lymphatic circulation) by which innumerable microbial molecular cues translocate from local gut epithelia to circulation with potentials to further cross the blood-brain barrier and reach the brain. In this Perspective, we review a realm of gut microbial molecules to evaluate their fate, function, and neuroactivities in vivo as mediated by microbiota. We turn to seminal studies of neurophysiology and neurologic disease models for the elucidation of biochemical pathways that link microbiota to gut-brain signaling. In addition, we discuss opportunities and challenges for advancing the microbiota-brain axis field while calling for high-throughput discovery of microbial molecules and studies for resolving the interspecies, interorgan, and interclass interaction among these neuroactive microbial molecules.
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Affiliation(s)
- Yunjia Lai
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Campus Box 7431, Chapel Hill, North Carolina 27599, United States
| | - Radhika Dhingra
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Campus Box 7431, Chapel Hill, North Carolina 27599, United States
- Institute of Environmental Health Solutions, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Zhenfa Zhang
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Campus Box 7431, Chapel Hill, North Carolina 27599, United States
| | - Louise M Ball
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Campus Box 7431, Chapel Hill, North Carolina 27599, United States
| | - Mark J Zylka
- UNC Neuroscience Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
- Carolina Institute for Developmental Disabilities, The University of North Carolina at Chapel Hill, Carrboro, North Carolina 27510, United States
- Department of Cell and Molecular Physiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Kun Lu
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Campus Box 7431, Chapel Hill, North Carolina 27599, United States
- Curriculum in Toxicology and Environmental Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
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Yu Y, Ma Q, Hollenbach S, Zhu Y, Groth S. Pregnant Women Following Bariatric Surgery: a Focus on Maternal Mental Health and Its Impact on Birth Outcomes. Obes Surg 2022; 32:3696-3704. [PMID: 36136169 DOI: 10.1007/s11695-022-06283-7] [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: 07/13/2022] [Revised: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Bariatric surgery is associated with elevated risks for adverse birth outcomes, such as small-for-gestational-age infants (SGA). Maternal mental health is a critical regulator of fetal growth, but it is largely overlooked in pregnant women post-surgery. This study aimed to examine the associations between maternal mental health and birth outcomes in pregnant women post-bariatric surgery. MATERIALS AND METHODS This was a retrospective analysis of medical records of women who had a singleton delivery following Roux-en-Y gastric bypass or sleeve gastrectomy. Mental health measures included depression/anxiety and substance use (cigarettes, alcohol, opioids, and marijuana). Birth outcomes were fetal growth restriction, SGA, low birthweight, and preterm birth. Logistic regressions were used to assess the associations between maternal mental health and each of the birth outcomes. A post hoc logistic regression was conducted to assess factors that influenced maternal marijuana use. RESULTS Participants (N = 179) were mostly white (64.6%), non-Hispanic (84.5%), with a mean age of 32.7 ± 4.6 years, and mean body mass index of 37.2 ± 8.4 kg/m2 at conception. Maternal marijuana use significantly increased the odds for fetal growth restriction, SGA, low birthweight, and preterm birth. Cigarette use increased the risk for low birthweight. Conversely, alcohol use was protective of low birthweight and preterm birth. A post hoc analysis revealed that married women were less likely to use marijuana than those who were single, divorced, or widowed. CONCLUSION This analysis identified marijuana and cigarette use as risk factors for adverse birth outcomes post-bariatric surgery. Future studies with larger sample sizes are needed to confirm study findings.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Qianheng Ma
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Rd, Stanford, CA, 94305, USA
| | - Stefanie Hollenbach
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Yuansheng Zhu
- Golisano College of Computing and Information Sciences, Rochester Institute of Technology, 20 Lomb Memorial Dr, Rochester, NY, 14623, USA
| | - Susan Groth
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA
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Ming X, Yang M, Chen X. Metabolic bariatric surgery as a treatment for obstructive sleep apnea hypopnea syndrome: review of the literature and potential mechanisms. Surg Obes Relat Dis 2020; 17:215-220. [PMID: 33371935 DOI: 10.1016/j.soard.2020.09.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 11/18/2022]
Abstract
Obstructive sleep apnea hypopnea syndrome (OSAHS) is closely related to obesity and can cause multiple organs and systems damage. Metabolic bariatric surgery (MBS) is presently the only long-term effective treatment and an important strategy for severely obese population, which also provides a novel therapeutic for obese patients with OSAHS, especially in patients with poor continuous positive air pressure (CPAP) adherence. To date, the resolution mechanism of OSAHS in obese patients after MBS has not been fully clarified. In addition, there is no specific metabolic bariatric surgical treatment of OSAHS guidelines. Therefore, this review provides an update on the relationship between OSAHS and MBS for highlighting the importance of weight loss strategies for obese patients with OSAHS.
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Affiliation(s)
- Xiaoping Ming
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China; Sleep Medicine Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Minlan Yang
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China; Sleep Medicine Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiong Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China; Sleep Medicine Center, Zhongnan Hospital of Wuhan University, Wuhan, China.
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5
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Abstract
PURPOSE OF REVIEW This review aims to evaluate the latest evidence on the treatment options for perceived poor responders to bariatric surgery and provide practitioners with a guide on when to consider revisional surgery and when to consider alternatives. RECENT FINDINGS The use of adjuvant pharmacotherapy has been increasingly described in the literature as an adjunct to primary bariatric surgery, in order to attain more weight loss or better control of obesity-related complications. The newer anti-obesity and anti-diabetes drugs also have cardiorenal benefits, which are shown in recent cardiovascular outcome trials. Revisional bariatric surgery has emerged as a distinctive entity and can be broadly organized into three categories: corrective, conversion, and reversal surgeries. Careful patient selection and preoperative optimization are needed to ensure long-term favorable outcomes. Newer treatment modalities involving the use of anti-obesity medications and endoscopic bariatric interventions provide patients and healthcare providers with more options, when faced with the challenge of poor response after bariatric surgery.
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Affiliation(s)
- Phong Ching Lee
- Department of Endocrinology, Singapore General Hospital, 20 College Rd, 169856, Singapore, Singapore.
| | - John B Dixon
- Clinical Obesity Research, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Pei Yin Sim
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, 20 College Rd, 169856, Singapore, Singapore
| | - Chin Hong Lim
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, 20 College Rd, 169856, Singapore, Singapore
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Goonawardena J, Ratnayake C, Cheung KT, Fox A. Should bariatric surgery be offered for hepatocellular adenomas in obese patients? Surg Obes Relat Dis 2020; 16:2117-2124. [PMID: 32771427 DOI: 10.1016/j.soard.2020.06.043] [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: 04/13/2020] [Revised: 06/04/2020] [Accepted: 06/23/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Obesity and metabolic syndrome are increasingly recognized as risk factors for development of hepatocellular adenoma (HCA). The implications of weight loss on HCA regression has not been previously reviewed. OBJECTIVES To analyze the effects of surgical and nonsurgical weight loss on HCA. SETTING University Tertiary Hospital. METHODS Literature review of full-text articles from PubMed and Scopus on patients with HCA who underwent surgical or nonsurgical weight loss was performed. Only English language articles were included and editorial comments were excluded. Wilcoxon signed rank test was used for paired data analysis. Spearman correlation was used for correlation between percent excess weight loss (%EWL) and number and size of HCA lesions. RESULTS Out of 4 studies, 7 patients were included in this review, all of whom were female. The median preintervention body mass index was 41 kg/m2 compared with the postintervention body mass index of 28 kg/m2 (P = .002). The %EWL following intervention positively correlated to reduction in number of HCA lesions (%) postintervention, with a Spearman correlation of .78 (P = .04). Similarly, %EWL postintervention was positively correlated, though not statistically significant, to reduction in lesion size (%), with a Spearman correlation of .46 (P = .29). All patients who were candidates for liver resection preintervention based on lesion size > 5 cm avoided liver resection postintervention following surgical and nonsurgical weight loss. CONCLUSIONS Effective long-term weight loss by surgical and nonsurgical methods result in regression of HCAs. Weight loss could avoid major liver resections or decrease the morbidity associated with liver surgery. Bariatric surgery should be considered as an option for management of surgically challenging HCAs in carefully selected obese patients. Multicenter long-term trials, while adjusting for cofounding factors, are required to determine the effects of surgical compared with nonsurgical weight loss on maintenance of HCA regression.
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Affiliation(s)
| | - Chathri Ratnayake
- Department of Internal Medicine, Eastern Health, Box Hill, Victoria, Australia
| | - King Tung Cheung
- Department of Internal Medicine, Eastern Health, Box Hill, Victoria, Australia
| | - Adrian Fox
- Hepatobiliary Unit, Department of General Surgery, Eastern Health, Box Hill, Victoria, Australia; Monash University Eastern Health Clinical School, Box Hill, Victoria, Australia
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Cheroutre C, Guerrien A, Rousseau A. Contributing of Cognitive-Behavioral Therapy in the Context of Bariatric Surgery: a Review of the Literature. Obes Surg 2020; 30:3154-3166. [DOI: 10.1007/s11695-020-04627-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Cornejo-Pareja I, Clemente-Postigo M, Tinahones FJ. Metabolic and Endocrine Consequences of Bariatric Surgery. Front Endocrinol (Lausanne) 2019; 10:626. [PMID: 31608009 PMCID: PMC6761298 DOI: 10.3389/fendo.2019.00626] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 08/29/2019] [Indexed: 12/17/2022] Open
Abstract
Obesity is one of the most serious worldwide epidemics of the twenty-first century according to the World Health Organization. Frequently associated with a number of comorbidities, obesity threatens and compromises individual health and quality of life. Bariatric surgery (BS) has been demonstrated to be an effective treatment to achieve not only sustained weight loss but also significant metabolic improvement that goes beyond mere weight loss. The beneficial effects of BS on metabolic traits are so widely recognized that some authors have proposed BS as metabolic surgery that could be prescribed even for moderate obesity. However, most of the BS procedures imply malabsorption and/or gastric acid reduction which lead to nutrient deficiency and, consequently, further complications could be developed in the long term. In fact, BS not only affects metabolic homeostasis but also has pronounced effects on endocrine systems other than those exclusively involved in metabolic function. The somatotropic, corticotropic, and gonadal axes as well as bone health have also been shown to be affected by the various BS procedures. Accordingly, further consequences and complications of BS in the long term in systems other than metabolic system need to be addressed in large cohorts, taking into account each bariatric procedure before making generalized recommendations for BS. In this review, current data regarding these issues are summarized, paying special attention to the somatotropic, corticotropic, gonadal axes, and bone post-operative health.
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Affiliation(s)
- Isabel Cornejo-Pareja
- Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga—IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain
| | - Mercedes Clemente-Postigo
- Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga—IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain
- *Correspondence: Mercedes Clemente-Postigo
| | - Francisco J. Tinahones
- Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga—IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain
- Francisco J. Tinahones
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Ulker İ, Yildiran H. The effects of bariatric surgery on gut microbiota in patients with obesity: a review of the literature. BIOSCIENCE OF MICROBIOTA FOOD AND HEALTH 2018; 38:3-9. [PMID: 30705797 PMCID: PMC6343052 DOI: 10.12938/bmfh.18-018] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/13/2018] [Indexed: 12/19/2022]
Abstract
Obesity is a disease with a rapidly increasing prevalence all over the world in recent years. Genetic and environmental factors are involved in the etiology of obesity, and the effect of
microbiota on obesity is becoming increasingly clear. Obesity treatment has various treatment modalities such as behavior modification, medical nutrition therapy, physical activity
enhancement, and surgical intervention. When other treatment methods are not successful, bariatric surgery is usually resorted to as the treatment method. Some changes such as food choices,
the level of hormones and enzymes due to anatomical changes, pH of the stomach, and microbiota are observed after bariatric surgery. Alteration in the microbiota composition after bariatric
surgery has also been reported to be important in achieving body weight loss and preserving body weight loss.
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Affiliation(s)
- İzzet Ulker
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Besevler, Ankara, Turkey
| | - Hilal Yildiran
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Besevler, Ankara, Turkey
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10
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Bliss ES, Whiteside E. The Gut-Brain Axis, the Human Gut Microbiota and Their Integration in the Development of Obesity. Front Physiol 2018; 9:900. [PMID: 30050464 PMCID: PMC6052131 DOI: 10.3389/fphys.2018.00900] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/21/2018] [Indexed: 12/17/2022] Open
Abstract
Obesity is a global epidemic, placing socioeconomic strain on public healthcare systems, especially within the so-called Western countries, such as Australia, United States, United Kingdom, and Canada. Obesity results from an imbalance between energy intake and energy expenditure, where energy intake exceeds expenditure. Current non-invasive treatments lack efficacy in combating obesity, suggesting that obesity is a multi-faceted and more complex disease than previously thought. This has led to an increase in research exploring energy homeostasis and the discovery of a complex bidirectional communication axis referred to as the gut-brain axis. The gut-brain axis is comprised of various neurohumoral components that allow the gut and brain to communicate with each other. Communication occurs within the axis via local, paracrine and/or endocrine mechanisms involving a variety of gut-derived peptides produced from enteroendocrine cells (EECs), including glucagon-like peptide 1 (GLP1), cholecystokinin (CCK), peptide YY3-36 (PYY), pancreatic polypeptide (PP), and oxyntomodulin. Neural networks, such as the enteric nervous system (ENS) and vagus nerve also convey information within the gut-brain axis. Emerging evidence suggests the human gut microbiota, a complex ecosystem residing in the gastrointestinal tract (GIT), may influence weight-gain through several inter-dependent pathways including energy harvesting, short-chain fatty-acids (SCFA) signalling, behaviour modifications, controlling satiety and modulating inflammatory responses within the host. Hence, the gut-brain axis, the microbiota and the link between these elements and the role each plays in either promoting or regulating energy and thereby contributing to obesity will be explored in this review.
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Affiliation(s)
- Edward S. Bliss
- School of Health and Wellbeing, University of Southern Queensland, Toowoomba, QLD, Australia
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Farias G, Netto BDM, Boritza KC, Bettini SC, Dâmaso AR, de Freitas ACT. Mechanisms of sustained long-term weight loss after RYGB: α-MSH is a key factor. Neuropeptides 2018; 69:60-65. [PMID: 29685637 DOI: 10.1016/j.npep.2018.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/09/2018] [Accepted: 04/12/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Gisele Farias
- Surgical Clinic Post Graduate Program, Department of Surgery, Hospital de Clínicas - Universidade Federal do Paraná, UFPR, Surgical Clinic Post Graduate Program, Curitiba, PR, Brazil.
| | - Bárbara Dal Molin Netto
- Nutrition Post Graduate Program, Universidade Federal de São Paulo, Escola Paulista de Medicina, UNIFESP-EPM, Nutrition Post Graduate Program, São Paulo, SP, Brazil.
| | - Katia Cristina Boritza
- Biochemistry Section, Hospital de Clínicas, Universidade Federal do Paraná, UFPR, Curitiba, PR, Brazil
| | - Solange Cravo Bettini
- Gastrointestinal Surgery Service of Hospital de Clínicas, Universidade Federal do Paraná, UFPR, Curitiba, PR, Brazil
| | - Ana Raimunda Dâmaso
- Nutrition Post Graduate Program, Universidade Federal de São Paulo, Escola Paulista de Medicina, UNIFESP-EPM, Nutrition Post Graduate Program, São Paulo, SP, Brazil
| | - Alexandre Coutinho Teixeira de Freitas
- Surgical Clinic Post Graduate Program, Department of Surgery, Hospital de Clínicas - Universidade Federal do Paraná, UFPR, Surgical Clinic Post Graduate Program, Curitiba, PR, Brazil
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Abstract
Language is powerful. Our words convey our impressions, attitudes, and worldview. Language not only reflects, but also shapes, the way that we think. In the field of bariatric-metabolic surgery, it is critical for clinicians to choose our language thoughtfully. In this paper, we demonstrate the importance of language choices in our clinical work and our professional communications; explore the potential pitfalls of words and phrases commonly used in the field of obesity; and encourage the use of more productive language choices in our communications with patients and professional colleagues, both within and outside of our field.
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Affiliation(s)
- Stephanie Sogg
- Massachusetts General Hospital Weight Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | | | - John B Dixon
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Iverson Health Innovation Research Institute, Swinburne University, Melbourne, Victoria, Australia; Primary Care Research Unit, Monash University, Melbourne, Victoria, Australia
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Cheng J, Gao J, Shuai X, Wang G, Tao K. The comprehensive summary of surgical versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomized controlled trials. Oncotarget 2018; 7:39216-39230. [PMID: 27233078 PMCID: PMC5129927 DOI: 10.18632/oncotarget.9581] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 05/20/2016] [Indexed: 12/18/2022] Open
Abstract
Background Bariatric surgery has emerged as a competitive strategy for obese patients. However, its comparative efficacy against non-surgical treatments remains ill-defined, especially among nonseverely obese crowds. Therefore, we implemented a systematic review and meta-analysis in order for an academic addition to current literatures. Methods Literatures were retrieved from databases of PubMed, Web of Science, EMBASE and Cochrane Library. Randomized trials comparing surgical with non-surgical therapies for obesity were included. A Revised Jadad's Scale and Risk of Bias Summary were employed for methodological assessment. Subgroups analysis, sensitivity analysis and publication bias assessment were respectively performed in order to find out the source of heterogeneity, detect the outcome stability and potential publication bias. Results 25 randomized trials were eligibly included, totally comprising of 1194 participants. Both groups displayed well comparability concerning baseline parameters (P > 0.05). The pooled results of primary endpoints (weight loss and diabetic remission) revealed a significant advantage among surgical patients rather than those receiving non-surgical treatments (P < 0.05). Furthermore, except for certain cardiovascular indicators, bariatric surgery was superior to conventional arms in terms of metabolic secondary parameters (P < 0.05). Additionally, the pooled outcomes were confirmed to be stable by sensitivity analysis. Although Egger's test (P < 0.01) and Begg's test (P<0.05) had reported the presence of publication bias among included studies, “Trim-and-Fill” method verified that the pooled outcomes remained stable. Conclusion Bariatric surgery is a better therapeutic option for weight loss, irrespective of follow-up duration, surgical techniques and obesity levels.
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Affiliation(s)
- Ji Cheng
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jinbo Gao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaoming Shuai
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Guobin Wang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Kaixiong Tao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Abstract
PURPOSE OF REVIEW This review examines the food addiction model and the role of food hedonic pathways in the pathogenesis and treatment of obesity. RECENT FINDINGS The hedonic pathway interacts with the obesogenic environment to override homeostatic mechanisms to cause increase in body weight. Weight gain sustained over time leads to "upward setting" of defended level of body-fat mass. There are neurobiological and phenotypic similarities and differences between hedonic pathways triggered by food compared with other addictive substances, and the entity of food addiction remains controversial. Treatment for obesity including pharmacotherapy and bariatric surgery impacts on neural pathways governing appetite and hedonic control of food intake. The food addiction model may also have significant impact on public health policy, regulation of certain foods, and weight stigma and bias. Recent rapid progress in delineation of food hedonic pathways advances our understanding of obesity and facilitates development of effective treatment measures against the disease.
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Affiliation(s)
- Phong Ching Lee
- Obesity and Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Bukit Merah, Singapore
| | - John B Dixon
- Clinical Obesity Research, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria, 3004, Australia.
- Iverson Health Innovation Research Institute, Swinburne University, Melbourne, Australia.
- Primary Care Research Unit, Monash University, Melbourne, Australia.
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15
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Farias G, Netto BDM, Bettini SC, Dâmaso AR, de Freitas ACT. Neuroendocrine regulation of energy balance: Implications on the development and surgical treatment of obesity. Nutr Health 2017; 23:131-146. [PMID: 28838280 DOI: 10.1177/0260106017719369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Obesity, a serious public health problem, occurs mainly when food consumption exceeds energy expenditure. Therefore, energy balance depends on the regulation of the hunger-satiety mechanism, which involves interconnection of the central nervous system and peripheral signals from the adipose tissue, pancreas and gastrointestinal tract, generating responses in short-term food intake and long-term energy balance. Increased body fat alters the gut- and adipose-tissue-derived hormone signaling, which promotes modifications in appetite-regulating hormones, decreasing satiety and increasing hunger senses. With the failure of conventional weight loss interventions (dietary treatment, exercise, drugs and lifestyle modifications), bariatric surgeries are well-accepted tools for the treatment of severe obesity, with long-term and sustained weight loss. Bariatric surgeries may cause weight loss due to restriction/malabsorption of nutrients from the anatomical alteration of the gastrointestinal tract that decreases energy intake, but also by other physiological factors associated with better results of the surgical procedure. OBJECTIVE This review discusses the neuroendocrine regulation of energy balance, with description of the predominant hormones and peptides involved in the control of energy balance in obesity and all currently available bariatric surgeries. CONCLUSIONS According to the findings of our review, bariatric surgeries promote effective and sustained weight loss not only by reducing calorie intake, but also by precipitating changes in appetite control, satiation and satiety, and physiological changes in gut-, neuro- and adipose-tissue-derived hormone signaling.
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Affiliation(s)
- Gisele Farias
- 1 Department of Surgery, Universidade Federal do Paraná, UFPR, Curitiba-Pr, Brazil
| | | | - Solange Cravo Bettini
- 3 Federal University of Paraná (UFPR), Gastrointestinal Surgery Service of Hospital de Clínicas, Curitiba-PR, Brazil
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16
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Abstract
Obesity is a major public health concern that leads to numerous metabolic, mechanical and psychological complications. Although lifestyle interventions are the cornerstone of obesity management, subsequent physiological neurohormonal adaptations limit weight loss, strongly favour weight regain and counteract sustained weight loss. A range of effective therapies are therefore needed to manage this chronic relapsing disease. Bariatric surgery delivers substantial, durable weight loss but limited access to care, perceived high risks and costs restrict uptake. Medical devices are uniquely positioned to bridge the gap between more conservative lifestyle intervention and weight-loss pharmacotherapy and more disruptive bariatric surgery. In this Review, we examine the range of gastrointestinal medical devices that are available in clinical practice to treat obesity, as well as those that are in advanced stages of development. We focus on the mechanisms of action as well as the efficacy and safety profiles of these devices. Many of these devices are placed endoscopically, which provides gastroenterologists with exciting opportunities for treatment.
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Carlsson LMS, Sjöholm K, Carlsson B, Peltonen M. Bariatric surgery, glycaemic status, and microvascular complications - Authors' reply. Lancet Diabetes Endocrinol 2017; 5:416-417. [PMID: 28549504 DOI: 10.1016/s2213-8587(17)30145-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 04/12/2017] [Indexed: 11/21/2022]
Affiliation(s)
- Lena M S Carlsson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg 405 30, Sweden.
| | - Kajsa Sjöholm
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg 405 30, Sweden
| | - Björn Carlsson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg 405 30, Sweden; AstraZeneca Gothenburg, Mölndal, Sweden
| | - Markku Peltonen
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
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Genser L, Robert M, Barrat C, Caiazzo R, Siksik JM. [The place of bariatric surgery in the management of obesity]. SOINS; LA REVUE DE RÉFÉRENCE INFIRMIÈRE 2016; 61:42-46. [PMID: 27978975 DOI: 10.1016/j.soin.2016.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Surgical treatment of obesity, also called "bariatric surgery", is the reference treatment for severe and morbid forms of obesity after proper multidisciplinary medical treatment has failed. However, it is only one step in the pathway of the obese patient and should only be envisaged in the framework of lifelong nutritional care.
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Affiliation(s)
- Laurent Genser
- Service de chirurgie digestive hépato-bilio-pancréatique et transplantation hépatique, Groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Institut de cardiométabolisme et nutrition (Ican), Groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - Maud Robert
- Centre intégré de l'obésité, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France
| | - Christophe Barrat
- Service de chirurgie digestive et métabolique, hôpital Avicenne, AP-HP, Centre intégré nord-francilien de l'obésité, 125, rue de Stalingrad, 93000 Bobigny, France
| | - Robert Caiazzo
- Service de chirurgie générale et endocrinienne, centre hospitalier régional universitaire, 2, avenue Oscar-Lambret 59000 Lille, France
| | - Jean-Michel Siksik
- Service de chirurgie digestive hépato-bilio-pancréatique et transplantation hépatique, Groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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Faucher P, Poitou C. [Physiopathology, causes and complications of obesity]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2016; 61:20-25. [PMID: 27978968 DOI: 10.1016/j.soin.2016.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Obesity is a chronic disease associated with respiratory, mechanical, cardiovascular, metabolic as well as psychological and social comorbidities. It has become increasingly prevalent over the last thirty years. The causes are multiple and interwoven, related to diet, sedentary lifestyles, psychological factors, genetics, the socio-economic context and biological factors. Management strategies must be adapted to the clinical situations and treatment must be individualised.
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Affiliation(s)
- Pauline Faucher
- Service de nutrition,; Institut de cardiométabolisme et nutrition (Ican),.
| | - Christine Poitou
- Service de nutrition,; Institut de cardiométabolisme et nutrition (Ican),; Sorbonne Universités, université Pierre-et-Marie-Curie, UMR S 1166, Nutriomics
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Zhang X, Yu B, Yang D, Qiao Z, Cao T, Zhang P. Gastric volume reduction is essential for the remission of type 2 diabetes mellitus after bariatric surgery in nonobese rats. Surg Obes Relat Dis 2016; 12:1569-1576. [DOI: 10.1016/j.soard.2016.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/18/2016] [Indexed: 01/19/2023]
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Wang JL, Xu XH, Zhang XJ, Li WH. The role of obestatin in roux-en-Y gastric bypass-induced remission of type 2 diabetes mellitus. Diabetes Metab Res Rev 2016; 32:470-7. [PMID: 26445403 DOI: 10.1002/dmrr.2735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/31/2015] [Accepted: 10/04/2015] [Indexed: 12/21/2022]
Abstract
Type 2 diabetes mellitus (T2DM) is a complex and multifactorial disease that is generally characterized by insulin resistance and loss of β-cell function that develops in adulthood. To date, more than 6% of the world's population is affected by T2DM. The main treatments of T2DM are dietary and lifestyle changes. However, only dependent on behaviour modification and oral hypoglycemics, many patients are unable to maintain glycemic control. Emerging evidence indicates that up to 80% of patients with T2DM undergoing Roux-en-Y gastric bypass (RYGB) experience complete remission of their T2DM and the majority of remissions occur almost immediately following the operation. Obestatin is a 23-amino-acid peptide, which is not only thought to suppress food intake and decrease gastric emptying but also found to exert survival effects in pancreatic β cells, increase glucose-stimulated insulin secretion, and reduce insulin resistance and inflammation. In addition, some researchers demonstrated that obestatin is a nutritional marker reflecting body adiposity and insulin resistance. Although results from previous studies were conflicting, the peripheral blood concentrations of obestatin were changed after RYGB. Therefore, regulation of obestatin level may be another mechanism for RYGB-induced remission of T2DM. In this article, we review briefly the effect of RYGB on T2DM in humans and offer an overview of the published data on the effects of RYGB on obestatin level in patients with T2DM. Furthermore, the possible roles of obestatin in the remission of T2DM following RYGB are also reviewed. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jian-Li Wang
- Qingdao University, Qingdao, China
- Department of General Surgery 1, The Affiliated Hospital of Chengde Medical College, Chengde City, China
| | - Xian-Hui Xu
- Department of General Surgery, No. 401 Hospital of People's Liberation Army, Qingdao, China
| | - Xue-Jun Zhang
- Department of General Surgery 1, The Affiliated Hospital of Chengde Medical College, Chengde City, China
| | - Wei-Hua Li
- Department of General Surgery, No. 401 Hospital of People's Liberation Army, Qingdao, China
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Makaronidis JM, Batterham RL. Potential Mechanisms Mediating Sustained Weight Loss Following Roux-en-Y Gastric Bypass and Sleeve Gastrectomy. Endocrinol Metab Clin North Am 2016; 45:539-52. [PMID: 27519129 DOI: 10.1016/j.ecl.2016.04.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bariatric surgery is the only effective treatment for severe obesity. Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), the most commonly performed procedures, lead to sustained weight loss, improvements in obesity-related comorbidities and reduced mortality. In humans, the main driver for weight loss following RYGB and SG is reduced energy intake. Reduced appetite, changes in subjective taste and food preference, and altered neural response to food cues are thought to drive altered eating behavior. The biological mediators underlying these changes remain incompletely understood but changes in gut-derived signals, as a consequence of altered nutrient and/or biliary flow, are key candidates.
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Affiliation(s)
- Janine M Makaronidis
- Department of Medicine, Centre for Obesity Research, Rayne Institute, University College London, Rayne Building, 5 University Street, London WC1E 6JF, UK; University College London Hospitals (UCLH) Bariatric Centre for Weight Loss, Metabolic and Endocrine Surgery, UCLH, Ground Floor West Wing, 250 Euston Road, London NW1 2PG, UK; National Institute of Health Research University College London Hospitals Biomedical Research Centre, 149 Tottenham Court Road, Kings Cross, London W1T 7DN, UK
| | - Rachel L Batterham
- Department of Medicine, Centre for Obesity Research, Rayne Institute, University College London, Rayne Building, 5 University Street, London WC1E 6JF, UK; University College London Hospitals (UCLH) Bariatric Centre for Weight Loss, Metabolic and Endocrine Surgery, UCLH, Ground Floor West Wing, 250 Euston Road, London NW1 2PG, UK; National Institute of Health Research University College London Hospitals Biomedical Research Centre, 149 Tottenham Court Road, Kings Cross, London W1T 7DN, UK.
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Genser L, Casella Mariolo JR, Castagneto-Gissey L, Panagiotopoulos S, Rubino F. Obesity, Type 2 Diabetes, and the Metabolic Syndrome. Surg Clin North Am 2016; 96:681-701. [DOI: 10.1016/j.suc.2016.03.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Affiliation(s)
- Francesco Rubino
- King's College London and consultant surgeon at King's College Hospital, London, UK. He is an organizer of the Diabetes Surgery Summit
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Calcaterra V, Cena H, Fonte ML, De Amici M, Vandoni M, Albanesi M, Pelizzo G. Long-term Outcome after Robotic-assisted Gastroplication in Adolescents: Hunger Hormone and Food Preference Changes Two Case Reports. J Clin Res Pediatr Endocrinol 2016; 8:250-6. [PMID: 26757831 PMCID: PMC5096486 DOI: 10.4274/jcrpe.2283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Weight loss surgery (WLS) is efficacious for long-term weight reduction and decreases overall mortality in severely obese patients. The mechanisms implicated in long-term weight loss are not fully understood. Proposed mechanisms include changes in gut hormones and brain regulation of appetite and satiety. We aimed to investigate the long-term ghrelin and leptin profiles and changes in food preference and eating behavior after WLS in adolescent patients. Two obese females aged 15 years and 14 4/12 years, who did not respond to lifestyle changes, including dietary intervention and physical exercise in combination with medical therapy, underwent robotic-assisted gastroplication. Anthropometric measurements, food habits and eating behavior, as well as metabolic and hormonal changes during long-term post-surgical follow-up were monitored. Long-term weight reduction was obtained in both patients, with a significant decrease in waist circumference. Resting energy expenditure showed a decrease over time, with a respiratory quotient that increased showing a shift from oxidation of a high-fat diet before surgery to oxidation of a mixed diet two and three years later. Both subjects improved their eating habits and lifestyle. Co-morbidity resolution was also noted. Increased pre-prandial ghrelin levels as well as higher post-prandial ghrelin and a leptin drop compared with pre-surgery values were observed in both patients. Persistent weight loss after gastroplication is associated with a favorable change in gut hormones and food preferences. The role of hormonal and sensory components in long-term results seems crucial. Particularly in adolescent patients, a multidisciplinary approach and continuous nutritional care is mandatory for weight maintenance and consolidation of changes.
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Affiliation(s)
- Valeria Calcaterra
- Fondazione IRCCS Policlinico San Matteo, University of Pavia and Department of Maternal and Children’s Health, Department of Internal Medicine, Pediatric Unit, Pavia, Italy
,
Equal contribution
| | - Hellas Cena
- University of Pavia, Department of Public Health, Neurosciences, Experimental and Forensic Medicine, Section of Human Nutrition, Pavia, Italy
,
Equal contribution
| | - Maria Luisa Fonte
- University of Pavia, Department of Public Health, Neurosciences, Experimental and Forensic Medicine, Section of Human Nutrition, Pavia, Italy
| | - Mara De Amici
- Fondazione IRCCS Policlinico San Matteo, Immuno-Allergy Laboratory, Clinic of Pediatric, Pavia, Italy
| | - Matteo Vandoni
- University of Pavia, Department of Public Health and Neuroscience, Pavia, Italy
| | - Michela Albanesi
- Fondazione IRCCS Policlinico San Matteo, University of Pavia and Department of Maternal and Children’s Health, Department of Internal Medicine, Pediatric Unit, Pavia, Italy
| | - Gloria Pelizzo
- Fondazione IRCCS Policlinico San Matteo and University of Pavia, Department of Maternal and Children's Health, Pediatric Surgery Unit, Pavia, Italy, Phone: +39 038 250 29 30 E-mail:
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Dixon JB. Self-harm and suicide after bariatric surgery: time for action. Lancet Diabetes Endocrinol 2016; 4:199-200. [PMID: 26781231 DOI: 10.1016/s2213-8587(16)00013-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 12/21/2015] [Accepted: 01/05/2016] [Indexed: 12/17/2022]
Affiliation(s)
- John B Dixon
- Clinical Obesity Research, Baker IDI Heart and Diabetes Institute, Melbourne, VIC 3004, Australia.
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Dixon JB, Bhasker AG, Lambert GW, Lakdawala M. Leg to leg bioelectrical impedance analysis of percentage fat mass in obese patients-Can it tell us more than we already know? Surg Obes Relat Dis 2016; 12:1397-1402. [PMID: 27134197 DOI: 10.1016/j.soard.2016.01.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/25/2016] [Accepted: 01/25/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bioelectrical impedance analysis (BIA) is well tolerated, inexpensive, and readily available, but can it be used to detect with clinical precision aberrant changes in the proportion of fat mass to fat-free mass during weight loss? OBJECTIVES To assess the variance in percentage body fat mass explained by the readily available inputs and assess residual variance provided by leg-to-leg BIA scales. METHODS Using cross-sectional data from a cohort of 665 patients of Indian ethnicity presenting for bariatric surgery, we examine the determinants of percentage body fat as provided by leg-to-leg output from Tanita SC-330 BIA scales. RESULTS Four input factors-sex, weight, height, and age-contributed to provide 92% and 95% explanation in output variance for percentage fat mass (%FM) and actual fat mass, respectively, in 665 patients. Body mass index alone explained 89% and 81% of variance in %FM output for women and men, respectively. Neither weight distribution, as indicated by waist and hip circumference or waist to hip ratio, nor plasma lipids or markers of glucose metabolism contributed additional variance in %FM when controlled for the 4 key inputs. CONCLUSIONS Simple, known input variables dominate the leg-to-leg BIA output of %FM, and this may compromise the detection of aberrant changes in %FM and fat-free mass with substantial weight loss. For clinical research, validated methods not largely dependent on known inputs should be used for evaluating changes in body composition after substantial weight loss.
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Affiliation(s)
- John B Dixon
- Clinical Obesity Research, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
| | - Aparna G Bhasker
- Centre for Obesity and Digestive Surgery, Gamdevi, Mumbai, India; Institute of Minimally Invasive Surgical Sciences and Research Centre, Saifee Hospital, Mumbai, India
| | - Gavin W Lambert
- Human Neurotransmitter Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Muffazal Lakdawala
- Centre for Obesity and Digestive Surgery, Gamdevi, Mumbai, India; Institute of Minimally Invasive Surgical Sciences and Research Centre, Saifee Hospital, Mumbai, India
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Cardeal MDA, Faria SL, Faria OP, Facundes M, Ito MK. Diet-induced thermogenesis in postoperatve Roux-en-Y gastric bypass patients with weight regain. Surg Obes Relat Dis 2016; 12:1098-1107. [PMID: 27178617 DOI: 10.1016/j.soard.2016.01.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 01/12/2016] [Accepted: 01/19/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Bariatric surgery has been shown to be an effective treatment for obesity. Changes in energy expenditure, especially through diet-induced thermogenesis (DIT), have been identified as one of the mechanisms to explain this success. However, not all patients are able to maintain healthy postoperative weight loss. Therefore, a question arises: In the weight regain after bariatric surgery, are these changes in energy metabolism still active? OBJECTIVE To investigate if weight regain after Roux-en-Y gastric bypass (RYGB) surgery is associated with a lower diet-induced thermogenesis in the late postoperative period. SETTING A cross-sectional study with the participants chosen from among the patients from a private practice. METHODS This was a cross-sectional study where 3 groups of female patients were evaluated: (1) 20 patients with a RYGB postoperative time period of at least 2 years, who kept a healthy weight after surgery (loss of at least 50% of excess weight; Healthy group); (2) 19 patients with clinically severe obesity (BMI>40 kg/m(2), without co-morbidities and>35 kg/m(2), with co-morbidities; Pre group); (3) 18 patients who experienced weight regain after RYGB (Regain group). The 3 groups were submitted to indirect calorimetry to measure resting metabolic rate (RMR), respiratory quotient (RQ), and DIT. Immediately after the RMR measurement, a mixed meal of regular consistency was offered. Ten minutes after the food intake began, energy expenditure measurements were initiated continuing throughout the following 3 postprandial hours. Body composition was evaluated using multifrequency bioelectrical impedance. In subgroups of the studied population, glucose and insulin levels were measured at baseline and at 30, 60, 90, 120, and 180 minutes after feeding. The mean area under the curve (AUC) between the 3 groups and measurements at baseline were compared using the analysis of variance (ANOVA). RESULTS The Healthy group had the highest weight adjusted RMR value compared with both the Pre and Regain group (23.03±3.02 kcal/kg; 16.18±2.94 kcal/kg; 17.11±3.28 kcal/kg, respectively; P<.0001). The Regain and Pre groups showed no difference for this variable. The weight-adjusted DIT (AUC 0-180 min) was about 42% and 34% higher in the Healthy group compared with the Pre and Regain groups, respectively (P<.0001). Lean body mass (kg) showed a positive correlation with the AUC of weight-adjusted DIT in the 3 groups. Multiple regression revealed that lean body mass was the only variable related to weight adjusted DIT, independent of group and other selected variables. CONCLUSION Weight-adjusted DIT in the Regain group was smaller compared with the Healthy group, and with no difference compared with the Pre group. The lean body mass seems to have a positive association with diet-induced thermogenesis.
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Affiliation(s)
| | - Silvia Leite Faria
- University of Brasília, Brasilia, Brazil; Gastrocirurgia Clinic, private practice, Brasilia, Brazil.
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Cătoi AF, Pârvu A, Mureşan A, Busetto L. Metabolic Mechanisms in Obesity and Type 2 Diabetes: Insights from Bariatric/Metabolic Surgery. Obes Facts 2015; 8:350-63. [PMID: 26584027 PMCID: PMC5644813 DOI: 10.1159/000441259] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/17/2015] [Indexed: 12/11/2022] Open
Abstract
Obesity and the related diabetes epidemics represent a real concern worldwide. Bariatric/metabolic surgery emerged in last years as a valuable therapeutic option for obesity and related diseases, including type 2 diabetes mellitus (T2DM). The complicated network of mechanisms involved in obesity and T2DM have not completely defined yet. There is still a debate on which would be the first metabolic defect leading to metabolic deterioration: insulin resistance or hyperinsulinemia? Insight into the metabolic effects of bariatric/metabolic surgery has revealed that, beyond weight loss and food restriction, other mechanisms can be activated by the rearrangements of the gastrointestinal tract, such as the incretinic/anti-incretinic system, changes in bile acid composition and flow, and modifications of gut microbiota; all of them possibly involved in the remission of T2DM. The complete elucidation of these mechanisms will lead to a better understanding of the pathogenesis of this disease. Our aim was to review some of the metabolic mechanisms involved in the development of T2DM in obese patients as well as in the remission of this condition in patients submitted to bariatric/metabolic surgery.
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Affiliation(s)
- Adriana Florinela Cătoi
- Department of Functional Biosciences, Faculty of Medicine, ‘Iuliu Haţieganu’ University of Medicine and Pharmacy, Cluj-Napoca, Romania, Italy
| | - Alina Pârvu
- Department of Functional Biosciences, Faculty of Medicine, ‘Iuliu Haţieganu’ University of Medicine and Pharmacy, Cluj-Napoca, Romania, Italy
| | - Adriana Mureşan
- Department of Functional Biosciences, Faculty of Medicine, ‘Iuliu Haţieganu’ University of Medicine and Pharmacy, Cluj-Napoca, Romania, Italy
| | - Luca Busetto
- Department of Medicine, University of Padova, Padova, Italy
- *Dr. Luca Busetto, Clinica Medica 3, Policlinico Universitario, Via Giustiniani 2, 30100 Padova, Italy
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