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Green WD, Alwarawrah Y, Al-Shaer AE, Shi Q, Armstrong M, Manke J, Reisdorph N, Farrell TM, Hursting SD, MacIver NJ, Beck MA, Shaikh SR. Inflammation and Metabolism of Influenza-Stimulated Peripheral Blood Mononuclear Cells From Adults With Obesity Following Bariatric Surgery. J Infect Dis 2022; 227:92-102. [PMID: 35975968 PMCID: PMC10205606 DOI: 10.1093/infdis/jiac345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/09/2022] [Accepted: 08/15/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Obesity dysregulates immunity to influenza infection. Therefore, there is a critical need to investigate how obesity impairs immunity and to establish therapeutic approaches that mitigate the impact of increased adiposity. One mechanism by which obesity may alter immune responses is through changes in cellular metabolism. METHODS We studied inflammation and cellular metabolism of peripheral blood mononuclear cells (PBMCs) isolated from individuals with obesity relative to lean controls. We also investigated if impairments to PBMC metabolism were reversible upon short-term weight loss following bariatric surgery. RESULTS Obesity was associated with systemic inflammation and poor inflammation resolution. Unstimulated PBMCs from participants with obesity had lower oxidative metabolism and adenosine triphosphate (ATP) production compared to PBMCs from lean controls. PBMC secretome analyses showed that ex vivo stimulation with A/Cal/7/2009 H1N1 influenza led to a notable increase in IL-6 with obesity. Short-term weight loss via bariatric surgery improved biomarkers of systemic metabolism but did not improve markers of inflammation resolution, PBMC metabolism, or the PBMC secretome. CONCLUSIONS These results show that obesity drives a signature of impaired PBMC metabolism, which may be due to persistent inflammation. PBMC metabolism was not reversed after short-term weight loss despite improvements in measures of systemic metabolism.
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Affiliation(s)
- William D Green
- Department of Microbiology and Immunology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Yazan Alwarawrah
- Division of Pediatric Endocrinology and Diabetes, School of Medicine, University of North Carolina at Chapel Hill, North Carolina USA
| | - Abrar E Al-Shaer
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina USA
| | - Qing Shi
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina USA
| | - Michael Armstrong
- Department of Pharmaceutical Sciences, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jonathan Manke
- Department of Pharmaceutical Sciences, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nichole Reisdorph
- Department of Pharmaceutical Sciences, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
| | - Timothy M Farrell
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Steven D Hursting
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina USA
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, North Carolina, USA
| | - Nancie J MacIver
- Division of Pediatric Endocrinology and Diabetes, School of Medicine, University of North Carolina at Chapel Hill, North Carolina USA
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina USA
| | - Melinda A Beck
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina USA
| | - Saame Raza Shaikh
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina USA
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Kassel LE, Berei JJ, Pitlick JM, Rand JE. Insulin Dose Adjustment Following Bariatric Surgery, a Review of Available Literature. J Diabetes Sci Technol 2022; 16:1560-1566. [PMID: 34210197 PMCID: PMC9631544 DOI: 10.1177/19322968211028886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Bariatric surgery is a known and effective treatment for type 2 diabetes mellitus. Patients with type 1 diabetes mellitus and exogenous insulin-requiring type 2 diabetes mellitus require adjusted insulin dosing after surgery to avoid hypoglycemia. This review describes insulin dose adjustments following a variety of bariatric procedures. After searching the available literature and assessing for eligibility, 8 articles were included. The Johns Hopkins Research Evidence Appraisal Tool for literature appraisal was used. The results of this review reveal insulin dose adjustment varies based upon surgical procedure type and time of follow-up from the procedure.
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Affiliation(s)
- Lynn E. Kassel
- Drake University College of Pharmacy
& Health Sciences, Des Moines, IA, USA
- MercyOne West Des Moines Medical
Center, West Des Moines, IA, USA
| | - Jessica J. Berei
- PGY-2 Ambulatory Care Pharmacy
Resident, VA Nebraska Western-Iowa Health Care System, Omaha, NE, USA
| | - Jamie M. Pitlick
- Drake University College of Pharmacy
& Health Sciences, Des Moines, IA, USA
- Iowa Diabetes, West Des Moines, IA,
USA
- Jamie M. Pitlick, PhD, BCPS, BC-ADM, Drake
University College of Pharmacy & Health Sciences, 2507 University Avenue,
Cline Atrium 008, Des Moines, IA 50311, USA. Clinical Pharmacist, Iowa Diabetes,
West Des Moines, IA 50324, USA.
| | - Joel E. Rand
- MercyOne Bariatric Surgery, MercyOne
West Des Moines Medical Center, West Des Moines, IA, USA
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Hedfi I, Mahjoub F, Amor NB, Berriche O, Gamoudi A, Karmous I, Jerraya H, Nouira R, Kamoun HJ. Impact of sleeve gastrectomy on abnormalities in carbohydrate tolerance in obese adult. LA TUNISIE MEDICALE 2021; 99:669-675. [PMID: 35244920 PMCID: PMC8795997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Facing the repeated failures of the medical management of obesity, bariatric surgery offers a promising therapeutic option in terms of achieving weight loss and metabolic benefits. AIM To evaluate the impact of sleeve gastrectomy on the carbohydrate profile of a group of obese subjects. METHODS It is a prospective study including 40 obese patients (7 Men and 33 Women) who underwent sleeve gastrectomy between 2016 and 2018. Clinical and biological parameters were collected before the intervention, at six months and one year after. Insulin resistance was defined by a HOMA-IR index ≥2.4. Remission of diabetes was determined using the American Society for Metabolic and Bariatric Surgery's (ASMBS) criteria. RESULTS The mean patients' age was 34.65 ± 8.17 years. The mean body mass index (BMI) was 50.23 ± 8.3 kg/m². One year after sleeve gastrectomy, the frequency of insulin resistance, decreased from 89% to 4% (p<0.05). The evolution of carbohydrate tolerance abnormalities was marked by the diabetes and prediabetes remission in 75% and 100% of cases, respectively. The mean excess weight loss was 55.8% at 12 months. CONCLUSION These results have expanded our knowledge of the short-term sleeve gastrectomy's effectiveness on the carbohydrate profile of obese subjects. However, it would be interesting to check the durability of this metabolic benefit in the medium and long term.
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Affiliation(s)
- Imene Hedfi
- 1- Service A des maladies de la Nutrition, Institut National Zouhair Kallel de Nutrition et de Technologie Alimentaire, Tunis. / Université de Tunis El Manar, Faculté de Médecine de Tunis
| | - Faten Mahjoub
- 2- Unité d'obésité UR18ES01, Université de Tunis El Manar, Faculté de Médecine de Tunis. / Université de Tunis El Manar, Faculté de Médecine de Tunis
| | - Nadia Ben Amor
- 2- Unité d'obésité UR18ES01, Université de Tunis El Manar, Faculté de Médecine de Tunis. / Université de Tunis El Manar, Faculté de Médecine de Tunis
| | - Olfa Berriche
- 1- Service A des maladies de la Nutrition, Institut National Zouhair Kallel de Nutrition et de Technologie Alimentaire, Tunis. / Université de Tunis El Manar, Faculté de Médecine de Tunis
| | - Amel Gamoudi
- 2- Unité d'obésité UR18ES01, Université de Tunis El Manar, Faculté de Médecine de Tunis. / Université de Tunis El Manar, Faculté de Médecine de Tunis
| | - Inchirah Karmous
- 2- Unité d'obésité UR18ES01, Université de Tunis El Manar, Faculté de Médecine de Tunis. / Université de Tunis El Manar, Faculté de Médecine de Tunis
| | - Hichem Jerraya
- 3- Service de chirurgie générale B23, Hôpital Charles Nicolle, Tunis. / Université de Tunis El Manar, Faculté de Médecine de Tunis
| | - Ramzi Nouira
- 3- Service de chirurgie générale B23, Hôpital Charles Nicolle, Tunis. / Université de Tunis El Manar, Faculté de Médecine de Tunis
| | - Henda Jamoussi Kamoun
- 1- Service A des maladies de la Nutrition, Institut National Zouhair Kallel de Nutrition et de Technologie Alimentaire, Tunis. / Université de Tunis El Manar, Faculté de Médecine de Tunis
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Ferri FA, Frieder JS, Blanco DG, Funes DR, Gomez CO, Lo Menzo E, Szomstein S, Rosenthal RJ. Short-term multiorgan metabolic benefits of rapid weight loss after sleeve gastrectomy in severely obese patients. Surg Obes Relat Dis 2020; 17:284-291. [PMID: 33191164 DOI: 10.1016/j.soard.2020.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Sleeve gastrectomy (SG) has become the most prevalent bariatric-metabolic surgical approach in the United States. Its popularity among surgeons and patients is mainly due to a better safety profile and less overall morbidity, with broad benefits from a systemic and metabolic perspective. OBJECTIVE Comprehensively describe the short-term multiorgan metabolic effects of rapid weight loss after SG. SETTING Academic hospital, United States. METHODS We retrospectively reviewed the charts of patients that underwent SG at our institution between 2012 and 2016. We analyzed the required variables to calculate multiple risk scores, such as cardiovascular, hypertension, and diabetes risk scores. Furthermore, the renal and hepatic functions and the metabolic and hematologic profiles were assessed at 12 months of follow-up. RESULTS A total of 1002 patients were included in the analysis. The percentage of excess body mass index loss was, on average, 65% at 12 months of follow-up. We observed a positive cardio-renal-hepatic improvement, demonstrated by a substantial reduction of the 10-year cardiovascular risk. We noticed an improvement of renal function, which was more significant in chronic kidney disease (stage ≥2), and a significant improvement on liver function tests (measured by decreased aspartate aminotransferase and alanine transaminase) at 12 months of follow-up. Our data also show a positive impact on decreasing the risk of developing hypertension and type 2 diabetes. There was a positive impact on the lipid profile, with the exception of low-density lipoprotein. CONCLUSION There are significant short-term benefits on multiorgan metabolic parameters after rapid weight loss in severely obese patients undergoing sleeve gastrectomy.
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Affiliation(s)
- Francisco A Ferri
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Joel S Frieder
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - David Gutierrez Blanco
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - David Romero Funes
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Camila Ortiz Gomez
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Emanuele Lo Menzo
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Samuel Szomstein
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Raul J Rosenthal
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida.
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Boyle M, Carruthers N, Mahawar KK. Five-Year Outcomes with Stand-alone Primary Sleeve Gastrectomy. Obes Surg 2020; 29:1607-1613. [PMID: 30719651 DOI: 10.1007/s11695-019-03756-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Sleeve gastrectomy is now the commonest bariatric procedure worldwide, making it important to determine 5-year weight loss and micronutrient deficiency outcomes following primary, stand-alone sleeve gastrectomy (SG) with adequate follow-up. The purpose of this study was to evaluate weight loss, co-morbidity resolution, and haematological outcomes at 5 years with primary, stand-alone SG in our unit. MATERIALS AND METHODS Baseline data were obtained from our prospectively maintained database and patients were invited for a 5-year follow-up. For those who could not attend, further information was obtained by telephoning them and contacting their general practitioners. RESULTS A total of 92 patients (66 females) underwent primary SG at our centre in 2011. The median age was 46.0 years. The median weight and the body mass index (BMI) were 133.0 kg and 47.0 kg/m2 respectively. After 5 years, 7 (7.6%) patients had died due to unrelated causes and 11 (12.0%) had been converted to Roux-en-Y gastric bypass (RYGB). Of the remaining 74, we were able to obtain follow-up data on 64 (86.5%). Despite all efforts, 10 (13.5%) patients were lost to follow-up. The median total weight loss was 21.9% and median excess weight loss (EWL) was 48.0%. Patients developed a range of micronutrient deficiencies over the follow-up period. CONCLUSION This study shows acceptable results with SG at 5 years in our unit, but a large number of patients experienced GORD and some patients needed additional micronutrient supplementation over and above our unit recommendation of a single multivitamin/mineral A-Z tablet daily.
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Affiliation(s)
- Maureen Boyle
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
| | | | - Kamal K Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK. .,University of Sunderland, Sunderland, UK.
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Mid-long-term Revisional Surgery After Sleeve Gastrectomy: a Systematic Review and Meta-analysis. Obes Surg 2019; 29:1965-1975. [PMID: 30903425 DOI: 10.1007/s11695-019-03842-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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7
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Capoccia D, Coccia F, Guarisco G, Testa M, Rendina R, Abbatini F, Silecchia G, Leonetti F. Long-term Metabolic Effects of Laparoscopic Sleeve Gastrectomy. Obes Surg 2018; 28:2289-2296. [PMID: 29497961 DOI: 10.1007/s11695-018-3153-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Obesity is one of the major health challenges throughout the world. The association between obesity and diabetes is well established because 90% of patients with type 2 diabetes mellitus (T2DM) show excess body weight. The aim of the study was to evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on morbid obesity and type 2 diabetes (T2DM) in the long-term follow-up. METHODS One hundred ninety-five obese patients, 78 with T2DM, were evaluated before and after LSG up to 10 years, to identify complete diabetes remission (FPG < 100 mg/dl, A1c < 6.0%), partial remission (FPG 100-125 mg/dl, A1c < 6.5%), or relapse. RESULTS Before surgery, body weight and BMI were 123 ± 21 kg and 44.6 ± 6.8 kg/m2 respectively; at a mean follow-up of 7 years (range 4-10), body weight was 104.9 ± 18 kg and BMI 37 ± 6 kg/m2. Minimum weight was reached after 2 years. T2DM remission was observed in 66, 57, and 52% at short (< 2 years), medium (2-5 years), and long-term (> 5 years) follow-up respectively. Furthermore, 45.2% maintained complete remission for at least 5 years and about 36% showed a persistent but improved diabetes. None of the patients cured from diabetes had a duration disease greater than 8 years and a glycemic control requiring insulin. The prevalence of hypertension and dyslipidemia significantly decreased from 49 to 35% and from 51 to 40% respectively. CONCLUSIONS LSG significantly improves body weight, diabetes, hypertension, and dyslipidemia in long-term follow-up.
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Affiliation(s)
- Danila Capoccia
- Department of Experimental Medicine, Division of Diabetes and Metabolic Diseases, Sapienza University, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Federica Coccia
- Department of Experimental Medicine, Division of Diabetes and Metabolic Diseases, Sapienza University, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Gloria Guarisco
- Department of Experimental Medicine, Division of Diabetes and Metabolic Diseases, Sapienza University, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Moira Testa
- Department of Experimental Medicine, Division of Diabetes and Metabolic Diseases, Sapienza University, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Roberta Rendina
- Department of Experimental Medicine, Division of Diabetes and Metabolic Diseases, Sapienza University, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Francesca Abbatini
- Department of Medical Surgical Sciences and Biotechnology, Division of General Surgery, ICOT, Sapienza University, Via Franco Faggiana, 1668, 04100, Latina, Italy
| | - Gianfranco Silecchia
- Department of Medical Surgical Sciences and Biotechnology, Division of General Surgery, ICOT, Sapienza University, Via Franco Faggiana, 1668, 04100, Latina, Italy
| | - Frida Leonetti
- Department of Experimental Medicine, Division of Diabetes and Metabolic Diseases, Sapienza University, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
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