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Vanegas SM, Curado S, Gujral A, Valverde G, Parraga S, Aleman JO, Reid M, Elbel B, Schmidt AM, Heffron SP, Segal E, Li H, Abrams C, Sevick MA, Popp C, Armijos E, Merriwether EN, Ivezaj V, Ren-Fielding C, Parikh M, Jay M. Cohort profile: study design and baseline characteristics of an observational longitudinal weight loss cohort and biorepository of patients undergoing sleeve gastrectomy in the USA. BMJ Open 2024; 14:e081201. [PMID: 39181563 PMCID: PMC11344502 DOI: 10.1136/bmjopen-2023-081201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 07/19/2024] [Indexed: 08/27/2024] Open
Abstract
PURPOSE We developed a comprehensive sleeve gastrectomy (SG) weight loss study cohort and biorepository to uncover mechanisms, biomarkers and predictive factors of weight loss, weight maintenance and amelioration of obesity-related comorbidities. For this purpose, we collected psychosocial, anthropometric, clinical data and a variety of samples pre-surgery, intraoperatively and 1.5, 3, 12 and 24 months post-surgery. For longer-term assessment, the collection of psychosocial and anthropometric data was extended to 10 years. Here, we present in-depth characterisation of the cohort and detailed overview of study procedures as a foundation for future analyses. PARTICIPANTS We consented 647 participants between June 2017 and March 2020 from two bariatric surgery clinics in New York City-one major urban hospital and one private hospital. Of 355 participants who provided baseline data, 300 underwent SG. Of these, 79% are females with an average age of 38 years, 68% are Hispanic, 20% are non-Hispanic Black and 11% are non-Hispanic White. FINDINGS TO DATE We collected intraoperative adipose and stomach tissues from 282 patients and biosamples (blood, urine, saliva, stool) from 245 patients at 1.5 months, 238 at 3 month, 218 at 12 months and 180 at 24 months post-surgery. We are currently collecting anthropometric and psychosocial data annually until 10 years post-surgery. Data analysis is currently underway. FUTURE PLANS Our future research will explore the variability in weight loss outcomes observed in our cohort, particularly among Black and Hispanic patients in comparison to their White counterparts. We will identify social determinants of health, metabolic factors and other variables that may predict weight loss success, weight maintenance and remission of obesity-related comorbidities. Additionally, we plan to leverage our biorepository for collaborative research studies. We will complete long-term follow-up data by December 2031. We plan to apply for funding to expand biosample collection through year 10 to provide insights into the mechanisms of long-term weight maintenance.
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Affiliation(s)
- Sally M Vanegas
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Silvia Curado
- Department of Pathology, New York University Grossman School of Medicine, New York, New York, USA
- Department of Cell Biology, New York University Grossman School of Medicine, New York, New York, USA
| | - Akash Gujral
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Gabriela Valverde
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Susan Parraga
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Jose O Aleman
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Laboratory of Translational Obesity Research, New York University Grossman School of Medicine, New York, New York, USA
| | - Migdalia Reid
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Laboratory of Translational Obesity Research, New York University Grossman School of Medicine, New York, New York, USA
| | - Brian Elbel
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
- Wagner Graduate School of Public Service, New York University, New York, New York, USA
| | - Ann Marie Schmidt
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Sean P Heffron
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Eran Segal
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
| | - Huilin Li
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Courtney Abrams
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Mary A Sevick
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Collin Popp
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Evelyn Armijos
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Ericka N Merriwether
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Department of Physical Therapy Education, and Human Development, New York University, New York, New York, USA
| | - Valentina Ivezaj
- Department of Medicine, Yale University, New Haven, Connecticut, USA
| | - Christine Ren-Fielding
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Manish Parikh
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Melanie Jay
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
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Cai Z, Zhong Q, Feng Y, Wang Q, Zhang Z, Wei C, Yin Z, Liang C, Liew CW, Kazak L, Cypess AM, Liu Z, Cai K. Non-invasive mapping of brown adipose tissue activity with magnetic resonance imaging. Nat Metab 2024; 6:1367-1379. [PMID: 39054361 PMCID: PMC11272596 DOI: 10.1038/s42255-024-01082-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 06/14/2024] [Indexed: 07/27/2024]
Abstract
Thermogenic brown adipose tissue (BAT) has a positive impact on whole-body metabolism. However, in vivo mapping of BAT activity typically relies on techniques involving ionizing radiation, such as [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) and computed tomography (CT). Here we report a noninvasive metabolic magnetic resonance imaging (MRI) approach based on creatine chemical exchange saturation transfer (Cr-CEST) contrast to assess in vivo BAT activity in rodents and humans. In male rats, a single dose of the β3-adrenoceptor agonist (CL 316,243) or norepinephrine, as well as cold exposure, triggered a robust elevation of the Cr-CEST MRI signal, which was consistent with the [18F]FDG PET and CT data and 1H nuclear magnetic resonance measurements of creatine concentration in BAT. We further show that Cr-CEST MRI detects cold-stimulated BAT activation in humans (both males and females) using a 3T clinical scanner, with data-matching results from [18F]FDG PET and CT measurements. This study establishes Cr-CEST MRI as a promising noninvasive and radiation-free approach for in vivo mapping of BAT activity.
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Affiliation(s)
- Zimeng Cai
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China
| | - Qiaoling Zhong
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yanqiu Feng
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Medical Image Processing & Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence & Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Qian Wang
- The Biomedical Translational Research Institute, Faculty of Medical Science, Jinan University, Guangzhou, China
| | - Zuoman Zhang
- Department of Neonatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Cailv Wei
- School of Medicine, Shenzhen Campus, Sun Yat-sen University, Shenzhen, China
| | - Zhinan Yin
- The Biomedical Translational Research Institute, Faculty of Medical Science, Jinan University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine, Zhuhai People's Hospital Affiliated with Jinan University, Jinan University, Zhuhai, China
| | - Changhong Liang
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China
| | - Chong Wee Liew
- Physiology and Biophysics Department, University of Illinois at Chicago, Chicago, IL, USA
| | - Lawrence Kazak
- Rosalind & Morris Goodman Cancer Institute, McGill University, Montreal, Quebec, Canada
- Department of Biochemistry, McGill University, Montreal, Quebec, Canada
| | - Aaron M Cypess
- Diabetes, Endocrinology, and Obesity Branch, Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, USA
| | - Zaiyi Liu
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China.
| | - Kejia Cai
- Department of Radiology, University of Illinois at Chicago, Chicago, IL, USA
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA
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Menon R, Lockie P. Roux-en-Y gastric bypass in a transgender patient: a case report. J Surg Case Rep 2024; 2024:rjae168. [PMID: 38505332 PMCID: PMC10948746 DOI: 10.1093/jscr/rjae168] [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: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/21/2024] Open
Abstract
The frequency of transgender individuals seeking gender affirming care is increasing over the last decade. Transgender patients suffer from obesity and psychiatric illness at elevated levels compared with the general population. A 54-year-old male-to-female transition patient presented with morbid obesity, hyperlipidaemia, and weight gain 2 years after their gender-transition and hormonal therapy. She received a Roux-en-Y gastric bypass (RYGB). At 7 months postoperatively, the patient has experienced 49% excess body weight loss, her body dissatisfaction had resolved and has completed further plastic surgery. The RYGB is an effective method for weight loss as well as benefits from cardiovascular disease, cancer, metabolic related conditions, and psychosocial wellbeing. Holistic treatment in conjunction with dietetic and psychology services can help maintain long-term weight management. Bariatric surgery combined with a multidisciplinary care team addressing medical and psychiatric concerns is integral to achieving and maintaining weight loss and gender identity.
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Affiliation(s)
- Rahul Menon
- General Surgery Department, Ipswich Hospital, Ipswich QLD 4305, Australia
| | - Phil Lockie
- General Surgery Department, Ipswich Hospital, Ipswich QLD 4305, Australia
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Carr P, Keighley T, Petocz P, Blumfield M, Rich GG, Cohen F, Soni A, Maimone IR, Fayet-Moore F, Isenring E, Marshall S. Efficacy and safety of endoscopic sleeve gastroplasty and laparoscopic sleeve gastrectomy with 12+ months of adjuvant multidisciplinary support. BMC PRIMARY CARE 2022; 23:26. [PMID: 35123409 PMCID: PMC8817771 DOI: 10.1186/s12875-022-01629-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/19/2022] [Indexed: 02/07/2023]
Abstract
Background The laparoscopic sleeve gastrectomy (LSG) and the incisionless endoscopic sleeve gastroplasty (ESG) weight loss procedures require further investigation of their efficacy, safety and patient-centered outcomes in the Australian setting. Methods The aim was to examine the 6- and 12-month weight loss efficacy, safety, and weight-related quality of life (QoL) of adults with obesity who received the ESG or LSG bariatric procedure with 12+ months of adjuvant multidisciplinary pre- and postprocedural support. Data were from a two-arm prospective cohort study that followed patients from baseline to 12-months postprocedure from a medical center in Queensland. Percent excess weight loss (%EWL) was the primary outcome. Secondary outcomes were body composition (fat mass, fat-free mass, android:gynoid ratio, bone mineral content) via dual energy X-ray absorptiometry, weight-related QoL, lipid, glycemic, and hepatic biochemistry, and adverse events. Results 16 ESG (19% attrition; 81.2% female; aged:41.4 (SD: 10.4) years; BMI: 35.5 (SD: 5.2) kg/m2) and 45 LSG (9% attrition; 84.4% female; aged:40.4 (SD: 9.0) years; BMI: 40.7 (SD: 5.6) kg/m2) participants were recruited. At 12-months postprocedure, ESG %EWL was 57% (SD: 32%; p < 0.01) and LSG %EWL was 79% (SD: 24%; p < 0.001). ESG and LSG cohorts improved QoL (19.8% in ESG [p > 0.05]; 48.1% in LSG [p < 0.05]), liver function (AST: − 4.4 U/L in ESG [p < 0.05]; − 2.7 U/L in LSG [p < 0.05]), HbA1c (− 0.5% in ESG [p < 0.05]; − 0.1% in LSG [p < 0.05]) and triglycerides (− 0.6 mmol/L in ESG [p > 0.05]; − 0.4 mmol/L in LSG [P < 0.05]) at 12-months. Both cohorts reduced fat mass (p < 0.05). The ESG maintained but LSG decreased fat-free mass at 6-months (p < 0.05); and both cohorts lost fat-free mass at 12-months (p < 0.05). There were no adverse events directly related to the procedure. The ESG reported 25% mild-moderate adverse events possibly related to the procedure, and the LSG reported 27% mild-severe adverse events possibly related to the procedure. Conclusions In this setting, the ESG and LSG were safe and effective weight loss treatments for obese adults alongside multidisciplinary support. Patients who elected the ESG maintained fat-free mass at 6-months but both cohorts lost fat-free mass at 12-months postprocedure. Patients who elected the LSG had large and significant improvements to weight-related quality of life. Further well-powered studies are required to confirm these findings. Trial registration This study was registered prospectively at the Australia New Zealand Clinical Trials Registry on 06/03/2018, Registration Number ACTRN12618000337279. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01629-7.
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Affiliation(s)
- Prudence Carr
- Department of Science, Nutrition Research Australia, Level 10, 20 Martin Place, Sydney, New South, Wales
| | - Tim Keighley
- Department of Science, Nutrition Research Australia, Level 10, 20 Martin Place, Sydney, New South, Wales
| | - Peter Petocz
- Department of Science, Nutrition Research Australia, Level 10, 20 Martin Place, Sydney, New South, Wales
| | - Michelle Blumfield
- Department of Science, Nutrition Research Australia, Level 10, 20 Martin Place, Sydney, New South, Wales
| | - Graeme G Rich
- Bariatric Gastroenterologist & Director, Bariatrics Australia, Sydney Adventist Hospital, Wahroonga, Australia
| | - Felicity Cohen
- Weightloss Solutions Australia, Varsity Lakes, Queensland, Australia
| | - Asha Soni
- Weightloss Solutions Australia, Varsity Lakes, Queensland, Australia
| | | | - Flavia Fayet-Moore
- Nutrition Research Australia, Level 10, 20 Martin Place, Sydney, New South, Wales
| | - Elizabeth Isenring
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Skye Marshall
- Department of Science, Nutrition Research Australia, Level 10, 20 Martin Place, Sydney, New South, Wales. .,Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia.
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Le Moli R, Vella V, Tumino D, Piticchio T, Naselli A, Belfiore A, Frasca F. Inflammasome activation as a link between obesity and thyroid disorders: Implications for an integrated clinical management. Front Endocrinol (Lausanne) 2022; 13:959276. [PMID: 36060941 PMCID: PMC9437482 DOI: 10.3389/fendo.2022.959276] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/03/2022] [Indexed: 11/25/2022] Open
Abstract
Obesity is strongly associated with chronic low-grade inflammation. Obese patients have an increased risk to develop thyroid autoimmunity and to became hypothyroid, suggesting a pathogenetic link between obesity, inflammation and autoimmunity. Moreover, type 2 diabetes and dyslipidemia, also characterized by low-grade inflammation, were recently associated with more aggressive forms of Graves' ophthalmopathy. The association between obesity and autoimmune thyroid disorders may also go in the opposite direction, as treating autoimmune hyper and hypothyroidism can lead to weight gain. In addition, restoration of euthyroidism by L-T4 replacement therapy is more challenging in obese athyreotic patients, as it is difficult to maintain thyrotropin stimulation hormone (TSH) values within the normal range. Intriguingly, pro-inflammatory cytokines decrease in obese patients after bariatric surgery along with TSH levels. Moreover, the risk of thyroid cancer is increased in patients with thyroid autoimmune disorders, and is also related to the degree of obesity and inflammation. Molecular studies have shown a relationship between the low-grade inflammation of obesity and the activity of intracellular multiprotein complexes typical of immune cells (inflammasomes). We will now highlight some clinical implications of inflammasome activation in the relationship between obesity and thyroid disease.
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Food Tolerance, Nutritional Status and Health-Related Quality of Life of Patients with Morbid Obesity After Bariatric Surgery. Clin Nutr ESPEN 2022; 48:321-328. [DOI: 10.1016/j.clnesp.2022.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 11/21/2022]
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Story NM, Lumby J, Fethney J, Waters D. A comparative study of eating behaviours within and between conventional metabolic (bariatric) surgery procedures. J Clin Nurs 2021; 30:3342-3354. [PMID: 34002891 DOI: 10.1111/jocn.15847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/28/2021] [Accepted: 04/22/2021] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To compare eating behaviours within and between gastric bypass, sleeve gastrectomy and gastric band procedures and to investigate associations between eating behaviours and body weight. BACKGROUND Eating behaviours are subjective constructs representing physiological need and the hedonic need to eat. After metabolic surgery, eating behaviours have been observed to change. Little is known about whether eating behaviour change differs according to the metabolic procedure performed. DESIGN Adults (n = 204) with severe obesity from three countries were followed 1 year after metabolic surgical procedures (n = 121). METHODS We measured eating behaviours using the Three-Factor Eating Questionnaire and used linear mixed models to compare eating behaviours within and between three procedure groups. We complied with the STROBE checklist for reporting observational studies. RESULTS Within groups, there were statistically significant increases in restraint and decreases in disinhibition and hunger. Between groups, we observed differences in disinhibition associated with the band procedure. There were no significant differences between any group for body weight or body mass index a year post-surgery. Disinhibition was the only eating behaviour associated with body weight, body mass index and the per cent of weight loss. CONCLUSIONS Eating behaviours in adults with severe obesity who underwent any of the three metabolic procedures were associated with eating behaviour change 1 year post-surgery. Disinhibition was the only eating behaviour that was associated with body weight. RELEVANCE TO CLINICAL PRACTICE Irrespective of the procedure, we found participants had a statistically significant increase in restraint and decreases in disinhibition and hunger 1 year post-surgery. Despite the significant reduction in disinhibition within the band group, this behaviour was more pronounced post-surgery compared with other groups. Although the reduction in hunger showed the greatest change, it was not associated with weight outcomes. This is relevant clinical knowledge for nurses who support bariatric surgical patients.
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Affiliation(s)
- Narelle Margaret Story
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
| | - Judith Lumby
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
| | - Judith Fethney
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
| | - Donna Waters
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
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8
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Oliver A, Hooper S, Lau R, Hutchinson A. Effect of a multidisciplinary rehabilitation program for patients receiving weight management interventions on eating behaviours and health-related quality of life. Obes Res Clin Pract 2021; 15:268-274. [PMID: 33736958 DOI: 10.1016/j.orcp.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 03/03/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
The rapid rise in obesity prevalence is life-style related and tackling this problem requires a pro-active multi-faceted approach to management. A private health care provider in Melbourne, Australia, developed a multidisciplinary rehabilitation program for patients who had undergone bariatric surgery or receiving pharmacological weight loss treatments. The study aim was to assess the programs' effect on patients' quality of life, mental well-being, and eating behaviours. METHODS A prospective, observational, before and after study design was used. A total of 54 patients, 27 who had bariatric surgery and 27 receiving pharmacotherapy participated. Outcome measures were: change in weight and BMI, intuitive eating scale, impact of weight on quality of life scale and the depression, anxiety and stress scale. RESULTS Both medical and surgical patients reported improvements in their health-related quality of life and eating behaviours. Despite this, at program completion 71.4% of patients who had bariatric surgery reported severe anxiety and 52.4% severe stress levels. CONCLUSION Participation in a rehabilitation program that provided patients with peer support and access to expert advice supported patients to make healthy eating choices and improved their quality of life. The high prevalence of stress and anxiety related symptoms highlights the need to provide individuals who have undergone bariatric surgery with ongoing mental health support.
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Affiliation(s)
- Abigail Oliver
- Prevention and Chronic Illness Care, Merri Health, Melbourne, Australia; Epworth Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia.
| | - Suzie Hooper
- Epworth Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia.
| | - Rosalind Lau
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research Epworth/Deakin Partnership, Faculty of Health, Deakin University, Geelong, Australia.
| | - Ana Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research Epworth/Deakin Partnership, Faculty of Health, Deakin University, Geelong, Australia.
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Mansoor S, Jain P, Hassan N, Farooq U, Mirza MA, Pandith AA, Iqbal Z. Role of Genetic and Dietary Implications in the Pathogenesis of Global Obesity. FOOD REVIEWS INTERNATIONAL 2021. [DOI: 10.1080/87559129.2021.1874409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Sheikh Mansoor
- Division of Biochemistry, Faculty of Basic Sciences, SKUAST, Jammu, India
| | - Pooja Jain
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Nazia Hassan
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Uzma Farooq
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Mohd. Aamir Mirza
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Arshad A Pandith
- Advanced Centre for Human Genetics, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, J&K, India
| | - Zeenat Iqbal
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
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Abstract
PURPOSE OF REVIEW This review outlines the recent findings regarding the impact of bariatric surgery on bone. It explores potential mechanisms for skeletal changes following bariatric surgery and strategies for management. RECENT FINDINGS Bone loss following bariatric surgery is multifactorial. Probable mechanisms include skeletal unloading, abnormalities in calciotropic hormones, and changes in gut hormones. Skeletal changes that occur after bariatric surgery are specific to procedure type and persist for several years post-operatively. Studies suggest that while bone loss begins early, fracture risk may be increased later in the post-operative course, particularly after Roux-en-Y gastric bypass (RYGB). Further research is needed to assess the extent to which skeletal changes following bariatric surgery result in fragility. Current management should be geared toward prevention of bone loss, correction of nutritional deficiencies, and incorporation of weight bearing exercise. Pharmacologic treatment should be considered for high-risk patients.
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Affiliation(s)
- Alexandra N Krez
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery New York, New York, USA
| | - Emily M Stein
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery New York, New York, USA.
- Weill Cornell Medical College, 535 East 70th Street, New York, NY, 10021, USA.
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11
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Lambert GW, Schlaich MP, Eikelis N, Lambert EA. Sympathetic activity in obesity: a brief review of methods and supportive data. Ann N Y Acad Sci 2019; 1454:56-67. [PMID: 31268175 DOI: 10.1111/nyas.14140] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/11/2019] [Accepted: 05/23/2019] [Indexed: 12/12/2022]
Abstract
The increase in the prevalence of obesity and the concomitant rise in obesity-related illness have led to substantial pressure on health care systems throughout the world. While the combination of reduced exercise, increased sedentary time, poor diet, and genetic predisposition is undoubtedly pivotal in generating obesity and increasing disease risk, a large body of work indicates that the sympathetic nervous system (SNS) contributes to obesity-related disease development and progression. In obesity, sympathetic nervous activity is regionalized, with activity in some outflows being particularly sensitive to the obese state, whereas other outflows, or responses to stimuli, may be blunted, thereby making the assessment of sympathetic nervous activation in the clinical setting difficult. Isotope dilution methods and direct nerve recording techniques have been developed and utilized in clinical research, demonstrating that in obesity there is preferential activation of the muscle vasoconstrictor and renal sympathetic outflows. With weight loss, sympathetic activity is reduced. Importantly, sympathetic nervous activity is associated with end-organ dysfunction and changes in sympathetic activation that accompany weight loss are often reflected in an improvement of end-organ function. Whether targeting the SNS directly improves obesity-related illness remains unknown, but merits further attention.
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Affiliation(s)
- Gavin W Lambert
- The Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia.,The School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia
| | - Nina Eikelis
- The Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia.,The School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Elisabeth A Lambert
- The Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia.,The School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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12
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Ceccarini G, Pelosini C, Ferrari F, Magno S, Vitti J, Salvetti G, Moretto C, Marioni A, Buccianti P, Piaggi P, Maffei M, Santini F. Serum IGF-binding protein 2 (IGFBP-2) concentrations change early after gastric bypass bariatric surgery revealing a possible marker of leptin sensitivity in obese subjects. Endocrine 2019; 65:86-93. [PMID: 30945111 DOI: 10.1007/s12020-019-01915-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 03/25/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Expression of IGFBP-2 in mice is regulated by leptin. Over-expression of IGFBP-2 is associated with reduced caloric intake and resistance to weight gain. Hormonal variations contributing to weight loss occur very early after bariatric surgery but have not been fully elucidated. We evaluated IGFBP-2 serum changes after bariatric surgery and their relationship with leptin variations to test the hypothesis that an increase of leptin sensitivity may explain some of the effects of gastric bypass. METHODS This is a historical prospective study. Fifty-one obese patients (41 women e 10 men), 9 non-obese surgical controls and 41 lean matched controls were studied. Serum IGFBP-2 and leptin were measured after bariatric bypass surgery at various time points up to 18 months, after non-bariatric laparoscopic surgery in a control group, and in lean matched controls. RESULTS Compared to lean controls, serum IGFBP-2 levels were lower in obese patients. After gastric bypass, IGFBP-2 significantly increased at 3 days and became normal before the occurrence of relevant changes in body weight, remaining stable up to 18 months after surgery. IGFBP-2/leptin ratio increased early after surgery and became normal after one year. CONCLUSIONS After gastric bypass, serum IGFBP-2 increases in a window of time when variations of hormones mediating the effects of bariatric surgery occur. Our results suggest that IGFBP-2, a leptin-regulated protein, may be an in-vivo marker of leptin action. If this is the case, an early improvement of leptin sensitivity might contribute to the anorectic effect of gastric bypass.
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Affiliation(s)
- Giovanni Ceccarini
- Obesity Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy.
| | - Caterina Pelosini
- Obesity Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
| | - Federica Ferrari
- Obesity Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
| | - Silvia Magno
- Obesity Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
| | - Jacopo Vitti
- Obesity Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
| | - Guido Salvetti
- Obesity Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
| | - Carlo Moretto
- Unit of Bariatric Surgery, University Hospital of Pisa, Pisa, Italy
| | | | | | - Paolo Piaggi
- Obesity Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, United States
| | - Margherita Maffei
- Obesity Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
- Institute of Clinical Physiology, Italian National Research Council, Pisa, Italy
| | - Ferruccio Santini
- Obesity Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
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Lambert EA, Esler MD, Schlaich MP, Dixon J, Eikelis N, Lambert GW. Obesity-Associated Organ Damage and Sympathetic Nervous Activity. Hypertension 2019; 73:1150-1159. [DOI: 10.1161/hypertensionaha.118.11676] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Elisabeth A. Lambert
- From the Iverson Health Innovation Research Institute and School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia (E.A.L., N.E., G.W.L.)
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (E.A.L., M.D.E., N.E., G.W.L.)
| | - Murray D. Esler
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (E.A.L., M.D.E., N.E., G.W.L.)
| | - Markus P. Schlaich
- Dobney Hypertension Centre, School of Medicine–Royal Perth Hospital Unit, University of Western Australia (M.P.S.)
| | - John Dixon
- Clinical Obesity Research Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.D.)
| | - Nina Eikelis
- From the Iverson Health Innovation Research Institute and School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia (E.A.L., N.E., G.W.L.)
| | - Gavin W. Lambert
- From the Iverson Health Innovation Research Institute and School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia (E.A.L., N.E., G.W.L.)
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (E.A.L., M.D.E., N.E., G.W.L.)
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Debédat J, Amouyal C, Aron-Wisnewsky J, Clément K. Impact of bariatric surgery on type 2 diabetes: contribution of inflammation and gut microbiome? Semin Immunopathol 2019; 41:461-475. [DOI: 10.1007/s00281-019-00738-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/15/2019] [Indexed: 02/06/2023]
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Zhang Q, Chen Y, Li J, Chen D, Cheng Z, Xu S, Huang Y, Wang Q. A meta-analysis of the effects of bariatric surgery on fracture risk. Obes Rev 2018; 19:728-736. [PMID: 29334691 DOI: 10.1111/obr.12665] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 02/05/2023]
Abstract
Bariatric surgery effectively treats morbid obesity. However, the negative effect of this surgery on the bone is concerning. The aim of this meta-analysis was to investigate the fracture risk associated with bariatric surgery in morbidly obese subjects. Relevant studies published from database inception to September 2017 were identified in PubMed, Embase and the Cochrane Library. The Newcastle-Ottawa Scale was used to evaluate the quality of the observational studies, and the Jadad score evaluated randomized controlled trials. Among the 1003 studies initially identified, five observational trials and one randomized controlled trial were eligible for inclusion. All studies included in the meta-analysis were considered high quality. Risk for any type of fracture was higher in the surgical group than in the non-surgical group (risk ratio [RR] 1.29, 95% confidence interval [CI] 1.18-1.42). After surgery, the fracture risk in non-vertebral sites was significantly increased, especially in the upper limbs (RR 1.42, 95% CI 1.08-1.87; and RR 1.68, 95% CI 1.15-2.45). Compared with those with restrictive procedures, subjects who underwent mixed restrictive and malabsorptive procedures tended to have an increased fracture risk (RR 1.54, 95% CI 0.96-2.46). To conclude, bariatric surgery is associated with an increased risk of total and non-vertebral fractures, especially in the upper limbs.
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Affiliation(s)
- Q Zhang
- Department of Endocrinology and Metabolism, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Y Chen
- Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - J Li
- Department of Endocrinology and Metabolism, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - D Chen
- Department of Endocrinology and Metabolism, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Z Cheng
- Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - S Xu
- Department of Endocrinology and Metabolism, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Y Huang
- Department of Endocrinology and Metabolism, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Q Wang
- Department of Endocrinology and Metabolism, Sichuan University West China Hospital, Chengdu, Sichuan, China
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Fischer IP, Irmler M, Meyer CW, Sachs SJ, Neff F, Hrabě de Angelis M, Beckers J, Tschöp MH, Hofmann SM, Ussar S. A history of obesity leaves an inflammatory fingerprint in liver and adipose tissue. Int J Obes (Lond) 2018; 42:507-517. [PMID: 28901330 PMCID: PMC5880583 DOI: 10.1038/ijo.2017.224] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/28/2017] [Accepted: 09/04/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND/OBJECTIVES Dieting is a popular yet often ineffective way to lower body weight, as the majority of people regain most of their pre-dieting weights in a relatively short time. The underlying molecular mechanisms driving weight regain and the increased risk for metabolic disease are still incompletely understood. Here we investigate the molecular alterations inherited from a history of obesity. METHODS In our model, male high-fat diet (HFD)-fed obese C57BL/6J mice were switched to a low caloric chow diet, resulting in a decline of body weight to that of lean mice. We measured body composition, as well as metrics of glucose, insulin and lipid homeostasis. This was accompanied by histological and gene expression analysis of adipose tissue and liver to assess adipose tissue inflammation and hepatosteatosis. Moreover, acute hypothalamic response to (re-) exposure to HFD was assessed by qPCR. RESULTS & CONCLUSIONS Within 7 weeks after diet switch, most obesity-associated phenotypes, such as body mass, glucose intolerance and blood metabolite levels were reversed. However, hepatic inflammation, hepatic steatosis as well as hypertrophy and inflammation of perigonadal, but not subcutaneous, adipocytes persisted in formerly obese mice. Transcriptional profiling of liver and perigonadal fat revealed an upregulation of pathways associated with immune function and cellularity. Thus, we show that weight reduction leaves signs of inflammation in liver and perigonadal fat, indicating that persisting proinflammatory signals in liver and adipose tissue could contribute to an increased risk of formerly obese subjects to develop the metabolic syndrome upon recurring weight gain.
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Affiliation(s)
- I P Fischer
- JRG Adipocytes and Metabolism, Institute for Diabetes and Obesity, Helmholtz Diabetes Center at Helmholtz Center Munich, Garching, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Division of Metabolic Diseases, Department of Medicine, Technische Universität München, Munich, Germany
| | - M Irmler
- Institute for Experimental Genetics, Helmholtz Zentrum München, München-Neuherberg, Germany
| | - C W Meyer
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Division of Metabolic Diseases, Department of Medicine, Technische Universität München, Munich, Germany
| | - S J Sachs
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Medizinische Klinik und Poliklinik IV der LMU, Munich, Germany
- Institute for Diabetes and Regeneration, Helmholtz Diabetes Center at Helmholtz Zentrum München, Garching, Germany
| | - F Neff
- Institute for Pathology, Helmholtz Zentrum München, München-Neuherberg, Germany
| | - M Hrabě de Angelis
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Experimental Genetics, Helmholtz Zentrum München, München-Neuherberg, Germany
- Technische Universität München, Lehrstuhl für Experimentelle Genetik, Freising, Germany
| | - J Beckers
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Experimental Genetics, Helmholtz Zentrum München, München-Neuherberg, Germany
- Technische Universität München, Lehrstuhl für Experimentelle Genetik, Freising, Germany
| | - M H Tschöp
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Division of Metabolic Diseases, Department of Medicine, Technische Universität München, Munich, Germany
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center at Helmholtz Zentrum München, Garching, Germany
| | - S M Hofmann
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Medizinische Klinik und Poliklinik IV der LMU, Munich, Germany
- Institute for Diabetes and Regeneration, Helmholtz Diabetes Center at Helmholtz Zentrum München, Garching, Germany
| | - S Ussar
- JRG Adipocytes and Metabolism, Institute for Diabetes and Obesity, Helmholtz Diabetes Center at Helmholtz Center Munich, Garching, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
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17
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Dixon JB, Eaton LL, Curry T, Lee PC. Health Outcomes and Explant Rates After Laparoscopic Adjustable Gastric Banding: A Phase 4, Multicenter Study over 5 Years. Obesity (Silver Spring) 2018; 26:45-52. [PMID: 29265773 DOI: 10.1002/oby.22050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/26/2017] [Accepted: 09/19/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study aimed to evaluate the real-world safety and effectiveness of the LAP-BAND (Apollo Endosurgery Inc., Austin, Texas) adjustable gastric banding system (LBS) for 5 years following implantation. METHODS This prospective, longitudinal, phase 4, multicenter study involved 652 patients who had implantation of the LBS system. The primary outcome was the percentage of subjects who had LBS explant over 5 years. The secondary outcomes included the rate of reoperations, clinical and biochemical measures, and patient-reported outcome measures over 5 years. RESULTS The study cohort consisted of 79.3% females with a mean age of 44 years and a mean BMI of 45.4 kg/m2 . The primary end point was met with an explant rate of 8.74% (95% CI: 6.6%-10.9%) at 5 years. The rates for completer-only analysis and imputed missing data analysis were 12.81% (95% CI: 9.7%-15.9%) and 12.85% (95% CI: 10.2%-15.5%), respectively. All were significantly lower than the historic rate of 39.4% (P < 0.001). There were 43 patients who required reoperations or revisions excluding explants (6.6%). A mean weight loss of 18.7% was maximally achieved by 2 years, and weight loss was maintained through to 5 years. All patient-reported outcomes showed improvement following LBS treatment throughout 5 years. CONCLUSIONS This study validates the long-term safety and effectiveness of LBS for the treatment of patients with obesity and its related conditions.
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Affiliation(s)
- John B Dixon
- Clinical Obesity Research, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Trace Curry
- JourneyLite Surgery Centre, Cincinnati, Ohio, USA
| | - Phong Ching Lee
- Obesity and Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore
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18
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Harper C, Pattinson AL, Fernando HA, Zibellini J, Seimon RV, Sainsbury A. Effects of obesity treatments on bone mineral density, bone turnover and fracture risk in adults with overweight or obesity. Horm Mol Biol Clin Investig 2017; 28:133-149. [PMID: 27665425 DOI: 10.1515/hmbci-2016-0025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 08/04/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND New evidence suggests that obesity is deleterious for bone health, and obesity treatments could potentially exacerbate this. MATERIALS AND METHODS This narrative review, largely based on recent systematic reviews and meta-analyses, synthesizes the effects on bone of bariatric surgery, weight loss pharmaceuticals and dietary restriction. RESULTS AND CONCLUSIONS All three obesity treatments result in statistically significant reductions in hip bone mineral density (BMD) and increases in bone turnover relative to pre-treatment values, with the reductions in hip BMD being strongest for bariatric surgery, notably Roux-en Y gastric bypass (RYGB, 8%-11% of pre-surgical values) and weakest for dietary restriction (1%-1.5% of pre-treatment values). Weight loss pharmaceuticals (orlistat or the glucagon-like peptide-1 receptor agonist, liraglutide) induced no greater changes from pre-treatment values than control, despite greater weight loss. There is suggestive evidence that liraglutide may increase bone mineral content (BMC) - but not BMD - and reduce fracture risk, but more research is required to clarify this. All three obesity treatments have variable effects on spine BMD, probably due to greater measurement error at this site in obesity, suggesting that future research in this field could focus on hip rather than spine BMD. Various mechanisms have been proposed for BMD loss with obesity treatments, notably reduced nutritional intake/absorption and insufficient exercise, and these are potential avenues for protection against bone loss. However, a pressing outstanding question is whether this BMD reduction contributes to increased fracture risk, as has been observed after RYGB, and whether any such increase in fracture risk outweighs the risks of staying obese (unlikely).
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Lindqvist A, Ekelund M, Garcia-Vaz E, Ståhlman M, Pierzynowski S, Gomez MF, Rehfeld JF, Groop L, Hedenbro J, Wierup N, Spégel P. The impact of Roux-en-Y gastric bypass surgery on normal metabolism in a porcine model. PLoS One 2017; 12:e0173137. [PMID: 28257455 PMCID: PMC5336237 DOI: 10.1371/journal.pone.0173137] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 02/15/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND A growing body of literature on Roux-en-Y gastric bypass surgery (RYGB) has generated inconclusive results on the mechanism underlying the beneficial effects on weight loss and glycaemia, partially due to the problems of designing clinical studies with the appropriate controls. Moreover, RYGB is only performed in obese individuals, in whom metabolism is perturbed and not completely understood. METHODS In an attempt to isolate the effects of RYGB and its effects on normal metabolism, we investigated the effect of RYGB in lean pigs, using sham-operated pair-fed pigs as controls. Two weeks post-surgery, pigs were subjected to an intravenous glucose tolerance test (IVGTT) and circulating metabolites, hormones and lipids measured. Bile acid composition was profiled after extraction from blood, faeces and the gallbladder. RESULTS A similar weight development in both groups of pigs validated our experimental model. Despite similar changes in fasting insulin, RYGB-pigs had lower fasting glucose levels. During an IVGTT RYGB-pigs had higher insulin and lower glucose levels. VLDL and IDL were lower in RYGB- than in sham-pigs. RYGB-pigs had increased levels of most amino acids, including branched-chain amino acids, but these were more efficiently suppressed by glucose. Levels of bile acids in the gallbladder were higher, whereas plasma and faecal bile acid levels were lower in RYGB- than in sham-pigs. CONCLUSION In a lean model RYGB caused lower plasma lipid and bile acid levels, which were compensated for by increased plasma amino acids, suggesting a switch from lipid to protein metabolism during fasting in the immediate postoperative period.
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Affiliation(s)
- Andreas Lindqvist
- Neuroendocrine Cell Biology, Department of Clinical Sciences Malmö, Lund University Diabetes Centre, Malmö, Sweden
| | - Mikael Ekelund
- Department of Surgery, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Eliana Garcia-Vaz
- Vascular ET-coupling, Department of Clinical Sciences Malmö, Lund University Diabetes Centre, Malmö, Sweden
| | - Marcus Ståhlman
- Sahlgrenska Academy, Institute of Medicine, Department of Molecular and Clinical Medicine and Wallenberg Laboratory, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Pierzynowski
- Department of Cell and Organism Biology, Lund University, Lund, Sweden
- Innovation Center STB, Tczew, Poland
| | - Maria F. Gomez
- Vascular ET-coupling, Department of Clinical Sciences Malmö, Lund University Diabetes Centre, Malmö, Sweden
| | - Jens F. Rehfeld
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Leif Groop
- Diabetes and Endocrinology, Department of Clinical Sciences Malmö, Lund University Diabetes Centre, Malmö, Sweden
| | - Jan Hedenbro
- Neuroendocrine Cell Biology, Department of Clinical Sciences Malmö, Lund University Diabetes Centre, Malmö, Sweden
- Surgery, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Nils Wierup
- Neuroendocrine Cell Biology, Department of Clinical Sciences Malmö, Lund University Diabetes Centre, Malmö, Sweden
| | - Peter Spégel
- Molecular Metabolism, Department of Clinical Sciences Malmö, Lund University Diabetes Centre, Malmö, Sweden
- Centre for Analysis and Synthesis, Department of Chemistry, Lund University, Lund, Sweden
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Lespessailles E, Toumi H. Vitamin D alteration associated with obesity and bariatric surgery. Exp Biol Med (Maywood) 2017; 242:1086-1094. [PMID: 28103699 DOI: 10.1177/1535370216688567] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Obesity and severe obesity constitute growing serious health problems reaching epidemic proportion in most countries. Interactions and relationships between obesity and bone tissue and its metabolism are complex but are more and more studied and recognized. Obesity is associated with an altered hormonal profile including particularly bone-regulating hormones like vitamin D. Bariatric surgery procedures, thanks to their effectiveness to achieve therapeutic endpoints for comorbidities associated with obesity, have had an increasing success. However, these surgeries by producing mechanical restriction and or malabsorption syndrome lead to nutritional deficiencies including vitamin D. In this review, we aim to (1) discuss the nutritional deficiency of vitamin D in the obese, (2) to summarize the different surgical options in bariatric surgery and to present the evidence concerning these procedures and their associated profile in vitamin D post-operative insufficiency, (3) to present the different recommendations in clinical practice to prevent or treat vitamin D deficiencies or insufficiencies in patients treated by bariatric surgery and finally to introduce emerging assumptions on the relationship between vitamin D, microbiota composition and circulating bile acids. Impact statement Obesity and severe obesity constitute growing serious health problems reaching epidemic proportion in most countries with a prevalence increasing from 6.4 in 1975 to 14.9% in 2014. This present review summarizes currently available data on vitamin D deficiencies in the obese population before and after bariatric surgery. The important evidence emerging from our evaluation confirms that obese patients are at risk of multiple nutritional deficiencies, especially vitamin D deficiency, before bariatric surgery. Our survey confirms that the precise role of the gut microbiome and its associated changes on the vitamin D metabolism after the different bariatric surgery procedures has not yet been studied. Furthermore, whether differences in the microbiota may alter the therapeutic responses to vitamin D is not known.
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Affiliation(s)
- Eric Lespessailles
- 1 Univ. Orleans, I3MTO Laboratory EA 4708, Orleans 45067, France.,2 Rheumatology Department, Hospital Orleans, Orleans 45067, France
| | - Hechmi Toumi
- 1 Univ. Orleans, I3MTO Laboratory EA 4708, Orleans 45067, France.,2 Rheumatology Department, Hospital Orleans, Orleans 45067, France
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Štimac D, Klobučar Majanović S, Ličina M. Recent Trends in Endoscopic Management of Obesity. Surg Innov 2016; 23:525-537. [DOI: 10.1177/1553350616643615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Obesity remains a tremendous public health, clinical, and scientific challenge globally. Conventional approaches in the management of obesity offer limited potential for sustained weight loss. Bariatric surgery, although it represents the most effective weight loss treatment, has its own risks and is associated with substantial costs and limited patient applicability. Endoscopic weight loss procedures are considered as the major breakthrough in the management of obesity. Endoluminal interventions performed entirely through the gastrointestinal tract have evolved as a result of an attempt to replicate some of the anatomical features and the physiological effects of the traditional weight loss surgery while being reversible, less invasive, and more cost-effective. Restrictive procedures act to decrease gastric volume by space-occupying devices and/or by suturing or stapling techniques that alter gastric anatomy, whereas malabsorptive procedures tend to create malabsorption by preventing food contact with the duodenum and proximal jejunum. Other procedures act by influencing gastric function (gastric botulinum injections, gastric pacing, and vagal nerve blocking) or by gastric aspiration. It is important to underline that the majority of endoscopic weight loss procedures are still being evaluated and are not yet available routinely. Even though some of the techniques and devices that have recently emerged have demonstrated promising short-term results, evidence on their safety and long-term efficacy from well-designed and well-conducted research should be given before they can become an inherent part of everyday clinical practice. Given the rapid development of endoscopic weight loss procedures, this review considers the current state and recent trends in endoscopic management of obesity.
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Bradley D, Hsueh W. Type 2 Diabetes in the Elderly: Challenges in a Unique Patient Population. JOURNAL OF GERIATRIC MEDICINE AND GERONTOLOGY 2016; 2:14. [PMID: 31692858 PMCID: PMC6831098 DOI: 10.23937/2469-5858/1510014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In the older patient population, rates of Type 2 Diabetes (T2D) and obesity are reaching epidemic proportions. In fact, older patients will soon constitute the majority of patients with T2D in most developed countries. The higher prevalence of T2D in older individuals is seen in both men and women and across racial and ethnic groups. However, certain ethnic groups are disproportionately affected and successful strategies must account for these fundamental differences. T2D in old age is associated with traditional diabetes-associated complications including micro- and macro vascular disease, but is also closely related to numerous other comorbidities including cognitive impairment, urinary incontinence, sarcopenia, and increased fall risk. An overall state of chronic inflammation and dysregulated immune system may underlie these increased risks; yet our understanding of immunometabolism during the aging process remains incomplete. In addition, optimal recognition and treatment of diabetes in the elderly is hampered by a lack of relevant, high-quality studies, as the majority of clinical trial data establishing risk profiles, glycemic targets, and therapeutic interventions for T2D are not applicable for large segments of the older patient population. Simply acknowledging this gap is inadequate. We need strong evidence-based data upon which to successfully identify diabetic patients and then intervene in ways that are targeted to specific individuals within a heterogeneous group of elderly patients with T2D.
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Affiliation(s)
- David Bradley
- Department of Internal Medicine, Wexner Medical Center, The Ohio State University, USA
| | - Willa Hsueh
- Department of Internal Medicine, Wexner Medical Center, The Ohio State University, USA
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23
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Aron-Wisnewsky J, Verger EO, Bounaix C, Dao MC, Oppert JM, Bouillot JL, Chevallier JM, Clément K. Nutritional and Protein Deficiencies in the Short Term following Both Gastric Bypass and Gastric Banding. PLoS One 2016; 11:e0149588. [PMID: 26891123 PMCID: PMC4758752 DOI: 10.1371/journal.pone.0149588] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/01/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The number of morbidly obese patients undergoing bariatric surgery (BS) has increased dramatically in recent years. Therefore, monitoring food intake and its consequences in terms of nutritional status is necessary to prevent nutritional deficiencies. The aim of this study was to analyze the effect of food restriction on nutritional parameters in the short-term (≤3 months) period after BS in morbid obesity. METHOD In a prospective study, we followed 22 obese women who underwent Roux-en-Y gastric bypass (GBP) or adjustable gastric banding (AGB) at baseline (T0) and 1 (T1) and 3 (T3) months after surgery. We evaluated food intake, nutrient adequacy and serum concentrations of vitamins and minerals known to be at risk for deficiency following BS. RESULTS Before surgery, we observed suboptimal food intakes, leading to a risk of micronutrient deficiencies. Serum analysis confirmed nutritional deficiencies for iron and thiamine for 27 and 23% of the patients, respectively. The drastic energy and food reduction seen in the short term led to very low probabilities of adequacy for nutrients equivalent across both surgeries. Serum analysis demonstrated a continuous decrease in prealbumin during the follow-up, indicating mild protein depletion in 21 and 57% of GBP patients and 50 and 63% of AGB patients, respectively, at T1 and T3. Regarding vitamins and minerals, systematic supplementation after GBP prevented most nutritional deficiencies. By contrast, AGB patients, for whom there is no systematic supplementation, developed such deficiencies. CONCLUSIONS Our results suggest that cautious monitoring of protein intake after BS is mandatory. Furthermore, AGB patients might also benefit from systematic multivitamin and mineral supplementation at least in the short term.
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Affiliation(s)
- Judith Aron-Wisnewsky
- Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière hospital, Nutrition department, F-75013, Paris, France
- Sorbonne Universités, UPMC University Paris 06, UMR_S 1166 I, ICAN, Nutriomics team, F-75005, Paris, France
- INSERM, UMR_S U1166, NutriOmics team, F-75013, Paris, France
| | - Eric O Verger
- Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière hospital, Nutrition department, F-75013, Paris, France
- INSERM, UMR_S U1166, NutriOmics team, F-75013, Paris, France
| | - Carine Bounaix
- Sorbonne Universités, UPMC University Paris 06, UMR_S 1166 I, ICAN, Nutriomics team, F-75005, Paris, France
- INSERM, UMR_S U1166, NutriOmics team, F-75013, Paris, France
| | - Maria Carlota Dao
- Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière hospital, Nutrition department, F-75013, Paris, France
- INSERM, UMR_S U1166, NutriOmics team, F-75013, Paris, France
| | - Jean-Michel Oppert
- Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière hospital, Nutrition department, F-75013, Paris, France
| | - Jean-Luc Bouillot
- Assistance Publique-Hôpitaux de Paris, Visceral surgery Department, Ambroise Paré Hospital, 92100 Boulogne-Billancourt, France
| | - Jean-Marc Chevallier
- Assistance Publique-Hôpitaux de Paris, Visceral surgery Department, Hopital Europeen Georges Pompidou, F-75015, Paris, France
| | - Karine Clément
- Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière hospital, Nutrition department, F-75013, Paris, France
- Sorbonne Universités, UPMC University Paris 06, UMR_S 1166 I, ICAN, Nutriomics team, F-75005, Paris, France
- INSERM, UMR_S U1166, NutriOmics team, F-75013, Paris, France
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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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Dixon JB, Lambert EA, Lambert GW. Neuroendocrine adaptations to bariatric surgery. Mol Cell Endocrinol 2015; 418 Pt 2:143-52. [PMID: 26044866 DOI: 10.1016/j.mce.2015.05.033] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 04/16/2015] [Accepted: 05/04/2015] [Indexed: 02/07/2023]
Abstract
The global epidemic of obesity and its related disease in combination with robust physiological defence of intentional weight loss generates a pressing need for effective weight loss therapies. Bariatric surgery, which works very effectively at delivering substantial sustained weight loss, has been an enigma with respect to mechanism of action. Naive concepts of restriction and malabsorption do not explain the efficacy of the most commonly used bariatric procedures. This century has seen increased interest in unravelling the mystery of the mechanisms underlying surgery associated weight loss with a focus on integrative gastrointestinal (GI) physiology, gut-brain signalling, and beyond weight loss effects on metabolism. GI interventions, some very minor, can alter GI wall stretch and pressure receptors; a range of GI hormones affecting hunger and satiety; bile acid metabolism and signalling; the characteristics of GI microbiome; portal vein nutrient sensing; and circulating concentrations of amino acids. Understanding the mechanisms involved should present targets for less invasive effective therapies.
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Affiliation(s)
- J B Dixon
- Baker IDI Heart & Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.
| | - E A Lambert
- Baker IDI Heart & Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - G W Lambert
- Baker IDI Heart & Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
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LAP-BAND for BMI 30-40: 5-year health outcomes from the multicenter pivotal study. Int J Obes (Lond) 2015; 40:291-8. [PMID: 26283140 DOI: 10.1038/ijo.2015.156] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 06/28/2015] [Accepted: 06/28/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND We performed a 5-year multicenter study to evaluate the safety and effectiveness of the LAP-BAND System surgery (LBS) in patients with obesity with a body mass index (BMI) of 30-39.9 kg m(-)(2). This pivotal study was designed to support LBS application to the US Food and Drug Administration for broadening the indications for surgery and the lower BMI indication was approved with 1-year data in 2011, with the intention to complete the 5-year evaluation. OBJECTIVES To present broad health outcome data including weight change, patient reported outcomes, comorbidity change and complications during the 5-year study. SETTING The study was conducted at seven US private practice clinical trial sites. METHODS We enrolled 149 BMI 30-39.9 subjects into a 5-year, multicenter, longitudinal, prospective post-approval study. Data for those completing each time point are presented. RESULTS The predefined target of at least 30% excess weight loss was achieved by more than 76% of subjects by 1-year and at every year thereafter during the 5-year study. Mean percentage weight loss at 5 years was 15.9±12.4%. Sustained weight loss was accompanied by sustained improvement in generic and weight-specific quality of life, symptoms of depression and the prevalence of binge-eating disorder. The number of subjects with normal fasting triglyceride, high-density lipoprotein cholesterol, plasma glucose and HbA1c increased significantly between baseline and 5 years. Fifty-four months after LBS implantation, the rate of device explants without replacement was 5.4%; however, the rate of explants increased to 12.1% by month 60 owing to no cost-elective band removals offered to subjects at study exit. No deaths or unanticipated adverse device effects were reported. CONCLUSIONS The LBS is safe and effective for people with BMI 30-39.9 with demonstrated improvements in weight loss, comorbidities and quality of life, and with a low explant rate through 5 years following treatment.
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Palikhe G, Gupta R, Behera BN, Sachdeva N, Gangadhar P, Bhansali A. Efficacy of laparoscopic sleeve gastrectomy and intensive medical management in obese patients with type 2 diabetes mellitus. Obes Surg 2015; 24:529-35. [PMID: 24272885 DOI: 10.1007/s11695-013-1114-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND There are a dearth of studies comparing laparoscopic sleeve gastrectomy (LSG) and intensive medical treatment (IMT) in obese type 2 diabetes mellitus (T2DM) patients. This study compares these modalities in terms of weight loss, metabolic parameters and quality of life (QOL) score. METHODS We evaluated the efficacy of LSG (n = 14) vs. IMT (n = 17) comprising of low calorie diet, exenatide, metformin and if required insulin detemir in 31 obese T2DM patients with BMI of 37.9 ± 5.3kg/m(2) and target HbA1c < 7 %. The mean (±SD) age of the patients was 49.6 ± 11.9 years and 74 % were women. The mean duration of diabetes was 8.5 ± 6.1 years and mean HbA1c was 8.6 ± 1.3 %. Primary end point was excess body weight loss (EBWL) at the final follow-up. RESULTS The mean duration of follow-up was 12.5 ± 5.0 (median 12) months. EBWL was 61.2 ± 17.6 % and 27.4 ± 23.6 % in LSG and IMT group respectively (p < 0.001). Glycemic outcomes improved in both with mean HbA1c of 6.6 ± 1.5 % in LSG and 7.1 ± 1.2 % in IMT group. In LSG group, there was resolution of diabetes and hypertension in 36 and 29 % of patients respectively while none in the IMT group. HOMA-IR, hsCRP, ghrelin and leptin decreased while adiponectin increased significantly in LSG compared to IMT group. QOL score improved in LSG as compared to IMT. CONCLUSIONS In obese T2DM patients, LSG is superior to IMT in terms of weight loss, resolution of comorbidities and QOL score.
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Affiliation(s)
- Gaurav Palikhe
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India,
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The effects of gastrointestinal surgery on gut microbiota: potential contribution to improved insulin sensitivity. Curr Atheroscler Rep 2015; 16:454. [PMID: 25214424 DOI: 10.1007/s11883-014-0454-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bariatric surgery induces weight loss and major improvement in insulin-resistance through many mechanisms some of which are weight independent. It is now well acknowledged that gut microbiota is involved in the development of obesity and its related metabolic diseases, at least in mice. However, its causal role in human obesity progression remains to be demonstrated. Few studies now pointed at changes in microbiota composition after bariatric surgery, suggesting links between gut microbiota switch and metabolic improvement observed after surgery. As such new potential mechanisms of actions have been proposed. The aim of this review is to describe microbiota modifications observed after bariatric surgery and its potential relationships with improved insulin resistance. We here list some hypotheses, which will need further demonstration.
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Verbeek J, Lannoo M, Pirinen E, Ryu D, Spincemaille P, Vander Elst I, Windmolders P, Thevissen K, Cammue BPA, van Pelt J, Fransis S, Van Eyken P, Ceuterick-De Groote C, Van Veldhoven PP, Bedossa P, Nevens F, Auwerx J, Cassiman D. Roux-en-y gastric bypass attenuates hepatic mitochondrial dysfunction in mice with non-alcoholic steatohepatitis. Gut 2015; 64:673-83. [PMID: 24917551 DOI: 10.1136/gutjnl-2014-306748] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE No therapy for non-alcoholic steatohepatitis (NASH) has been approved so far. Roux-en-y gastric bypass (RYGB) is emerging as a therapeutic option, although its effect on NASH and related hepatic molecular pathways is unclear from human studies. We studied the effect of RYGB on pre-existent NASH and hepatic mitochondrial dysfunction-a key player in NASH pathogenesis-in a novel diet-induced mouse model nicely mimicking human disease. DESIGN C57BL/6J mice were fed a high-fat high-sucrose diet (HF-HSD). RESULTS HF-HSD led to early obesity, insulin resistance and hypercholesterolaemia. HF-HSD consistently induced NASH (steatosis, hepatocyte ballooning and inflammation) with fibrosis already after 12-week feeding. NASH was accompanied by hepatic mitochondrial dysfunction, characterised by decreased mitochondrial respiratory chain (MRC) complex I and IV activity, ATP depletion, ultrastructural abnormalities, together with higher 4-hydroxynonenal (HNE) levels, increased uncoupling protein 2 (UCP2) and tumour necrosis factor-α (TNF-α) mRNA and free cholesterol accumulation. In our model of NASH and acquired mitochondrial dysfunction, RYGB induced sustained weight loss, improved insulin resistance and inhibited progression of NASH, with a marked reversal of fibrosis. In parallel, RYGB preserved hepatic MRC complex I activity, restored ATP levels, limited HNE production and decreased TNF-α mRNA. CONCLUSIONS Progression of NASH and NASH-related hepatic mitochondrial dysfunction can be prevented by RYGB. RYGB preserves respiratory chain complex activity, thereby restoring energy output, probably by limiting the amount of oxidative stress and TNF-α. These data suggest that modulation of hepatic mitochondrial function contributes to the favourable effect of RYBG on established NASH.
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Affiliation(s)
- Jef Verbeek
- Department of Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Matthias Lannoo
- Department of Abdominal Surgery, University Hospitals KU Leuven, Leuven, Belgium
| | - Eija Pirinen
- Laboratory for Integrative and Systems Physiology, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland Departments of Biotechnology and Molecular Medicine, A.I. Virtanen Institute for Molecular Sciences, Biocenter Kuopio, University of Eastern Finland, Kuopio, Finland
| | - Dongryeol Ryu
- Laboratory for Integrative and Systems Physiology, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | | | - Ingrid Vander Elst
- Department of Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Petra Windmolders
- Department of Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Karin Thevissen
- Centre of Microbial and Plant Genetics (CMPG), KU Leuven, Leuven, Belgium
| | - Bruno P A Cammue
- Centre of Microbial and Plant Genetics (CMPG), KU Leuven, Leuven, Belgium Department of Plant Systems Biology, Vlaams Instituut voor Biotechnologie (VIB), Ghent, Belgium
| | - Jos van Pelt
- Department of Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Sabine Fransis
- Department of Pathology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Peter Van Eyken
- Department of Pathology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Chantal Ceuterick-De Groote
- Laboratory of Ultrastructural Neuropathology, Institute Born-Bunge (IBB), University of Antwerp, Antwerp, Belgium
| | - Paul P Van Veldhoven
- Laboratory of Lipid Biochemistry and Protein Interactions, KU Leuven, Leuven, Belgium
| | - Pierre Bedossa
- Department of Pathology, Hopital Beaujon, Clichy, France
| | - Frederik Nevens
- Department of Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Johan Auwerx
- Laboratory for Integrative and Systems Physiology, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - David Cassiman
- Department of Hepatology, University Hospitals KU Leuven, Leuven, Belgium Metabolic Center, University Hospitals KU Leuven, Leuven, Belgium
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Haemostatic and fibrinolytic changes in obese subjects undergoing bariatric surgery: the effect of different surgical procedures. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2014; 13:442-7. [PMID: 25545872 DOI: 10.2450/2014.0183-14] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 11/18/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Little is known about effects of different bariatric surgery procedures on haemostatic and fibrinolytic parameters. MATERIAL AND METHODS Consecutive obese subjects undergoing gastric bypass (GBP) or sleeve gastrectomy (SG) were enrolled. In all patients, levels of haemostatic factors (FII, FVII, FVIII, FIX, FX, vWF, fibrinogen), fibrinolytic variables (PAI-1, t-PA and D-dimer) and natural anticoagulants (AT, protein C and protein S) were evaluated before and 2 months after surgery. RESULTS A total of 77 GBP and 79 SG subjects completed the study. At baseline no difference in coagulation parameters was found between the two groups. After both GBP and SG, subjects showed significant changes in haemostatic and fibrinolytic variables and in natural anticoagulant levels. The Δ% changes in FVII, FVIII, FIX, vWF, fibrinogen, D-dimer, protein C and protein S levels were significantly higher in subjects who underwent GBP than in those who underwent SG. Multivariate analysis confirmed that GBP was a predictor of higher Δ% changes in FVII (β=0.268, p=0.010), protein C (β=0.274, p=0.003) and protein S (β=0.297, p<0.001), but not in all the other variables. Following coagulation factor reduction, 31 subjects (25.9% of GBP and 13.9% of SG; p=0.044) showed overt FVII deficiency; protein C deficiency was reported by 34 subjects (32.5% of GBP vs 11.4% of SG, p=0.033) and protein S deficiency by 39 (37.6% of GBP vs 12.6% of SG, p=0.009). Multivariate analyses showed that GBP was associated with an increased risk of deficiency of FVII (OR: 3.64; 95% CI: 1.73-7.64, p=0.001), protein C (OR: 4.319; 95% CI: 1.33-13.9, p=0.015) and protein S (OR: 5.50; 95% CI: 1.71-17.7, p=0.004). DISCUSSION GBP is associated with an increased risk of post-operative deficiency in some vitamin K-dependent coagulation factors. Whereas such deficiency is too weak to cause bleeding, it is significant enough to increase the risk of thrombosis.
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Abstract
Rather than investigating the extent to which training can improve performance under experimental conditions ('what could be'), we ask about the origins of expertise as it exists in the world ('what is'). We used the twin method to investigate the genetic and environmental origins of exceptional performance in reading, a skill that is a major focus of educational training in the early school years. Selecting reading experts as the top 5% from a sample of 10,000 12-year-olds twins assessed on a battery of reading tests, three findings stand out. First, we found that genetic factors account for more than half of the difference in performance between expert and normal readers. Second, our results suggest that reading expertise is the quantitative extreme of the same genetic and environmental factors that affect reading performance for normal readers. Third, growing up in the same family and attending the same schools account for less than a fifth of the difference between expert and normal readers. We discuss implications and interpretations ('what is inherited is DNA sequence variation'; 'the abnormal is normal'). Finally, although there is no necessary relationship between 'what is' and 'what could be', the most far-reaching issues about the acquisition of expertise lie at the interface between them ('the nature of nurture: from a passive model of imposed environments to an active model of shaped experience').
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Affiliation(s)
- Robert Plomin
- King's College London, MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, London, SE5 8AF, United Kingdom
| | - Nicholas G Shakeshaft
- King's College London, MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, London, SE5 8AF, United Kingdom
| | - Andrew McMillan
- King's College London, MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, London, SE5 8AF, United Kingdom
| | - Maciej Trzaskowski
- King's College London, MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, London, SE5 8AF, United Kingdom
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Medication Cost is Significantly Reduced After Roux-en-Y Gastric Bypass in Obese Patients. Obes Surg 2014; 24:1896-903. [DOI: 10.1007/s11695-014-1325-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Still CD, Wood GC, Chu X, Manney C, Strodel W, Petrick A, Gabrielsen J, Mirshahi T, Argyropoulos G, Seiler J, Yung M, Benotti P, Gerhard GS. Clinical factors associated with weight loss outcomes after Roux-en-Y gastric bypass surgery. Obesity (Silver Spring) 2014; 22:888-94. [PMID: 23804287 PMCID: PMC3819407 DOI: 10.1002/oby.20529] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 05/28/2013] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Gastric bypass surgery is an effective therapy for extreme obesity. However, substantial variability in weight loss outcomes exists that remains largely unexplained. Our objective was to determine whether any commonly collected preoperative clinical variables were associated with weight loss following Roux-en-Y gastric bypass (RYGB) surgery. METHODS The analysis was based on a prospectively recruited observational cohort of 2,365 patients who underwent Roux-en-Y gastric bypass surgery from 2004 to 2009. Weight loss was stratified into three major phases, early (0-6 months), nadir, and long-term (>36 months). Multivariate regression models were constructed using a database of over 350 variables. RESULTS A total of 12-14 preoperative variables were independently associated (P < 0.05) with each of the temporal weight loss phases. Preoperative variables associated with poorer nadir and long-term weight loss included higher baseline BMI, higher preoperative weight loss, iron deficiency, use of any diabetes medication, nonuse of bupropion medication, no history of smoking, age >50 years, and the presence of fibrosis on liver biopsy. CONCLUSIONS Several variables previously associated with poorer weight loss after RYGB surgery including age, baseline BMI, and type 2 diabetes were replicated. Several others suggest possible clinical interventions for postoperative management of RYGB patients to improve weight loss outcomes.
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Affiliation(s)
| | - G. Craig Wood
- Geisinger Obesity Research Institute, Geisinger Clinic, Danville, PA 17822
- Center for Health Research, Danville, PA 17822
| | - Xin Chu
- Weis Center for Research, Geisinger Clinic, Danville, PA 17822
| | - Christina Manney
- Geisinger Obesity Research Institute, Geisinger Clinic, Danville, PA 17822
| | - William Strodel
- Dept of Surgery, Geisinger Medical Center, Danville, PA 17822
| | - Anthony Petrick
- Geisinger Obesity Research Institute, Geisinger Clinic, Danville, PA 17822
- Dept of Surgery, Geisinger Medical Center, Danville, PA 17822
| | - Jon Gabrielsen
- Dept of Surgery, Geisinger Medical Center, Danville, PA 17822
| | - Tooraj Mirshahi
- Geisinger Obesity Research Institute, Geisinger Clinic, Danville, PA 17822
- Weis Center for Research, Geisinger Clinic, Danville, PA 17822
| | - George Argyropoulos
- Geisinger Obesity Research Institute, Geisinger Clinic, Danville, PA 17822
- Weis Center for Research, Geisinger Clinic, Danville, PA 17822
| | - Jamie Seiler
- Geisinger Obesity Research Institute, Geisinger Clinic, Danville, PA 17822
| | - Marco Yung
- Dept of Surgery, St. Francis Medical Center, Trenton, NJ
| | - Peter Benotti
- Dept of Surgery, St. Francis Medical Center, Trenton, NJ
| | - Glenn S. Gerhard
- Geisinger Obesity Research Institute, Geisinger Clinic, Danville, PA 17822
- Weis Center for Research, Geisinger Clinic, Danville, PA 17822
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Long-term outcomes of laparoscopic adjustable silicone gastric banding (LAGB) in moderately obese patients with and without co-morbidities. Obes Surg 2014; 23:897-902. [PMID: 23529850 DOI: 10.1007/s11695-013-0877-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Overweight and obesity independently increase cardiovascular risk, while even modest weight loss can result in clinically significant improvements in cardiovascular risk and reduce long-term mortality. Lowering the body mass index (BMI) threshold for bariatric surgery to those with moderate obesity might be one way to lower the burden of this disease. The aim of this study was to evaluate the efficacy and safety of laparoscopic adjustable silicone gastric banding (LAGB) in moderately obese subjects with or without obesity-related co-morbidities. METHODS Thirty-four patients with BMI between 30 and 35 kg/m(2) (5 males/29 females, mean age 36 ± 10 years, mean preoperative weight 87.9 ± 7.1 kg, mean BMI 32.6 ± 1.6 kg/m(2) and mean percentage excess weight 48.7 ± 9 %) who underwent LAGB via pars flaccida between June 1, 2002 and August 31, 2010 were included. Good response was defined as BMI <30 kg/m(2) or percentage estimated weight loss (%EWL) >50. Poor response was defined as BMI >30 kg/m(2) or %EWL less than 50 after a minimum of 1 year. RESULTS Mean weight, BMI and %EWL were recorded at 1, 3, 5 and 7 years and were 77.4 ± 7.6, 69.9 ± 10.8, 70.9 ± 9.3 and 73.3 ± 12.0 kg; 28.8 ± 2.9, 26.4 ± 3.2, 26.5 ± 3.4 and 27.4 ± 5.0 kg/m(2); and 36 ± 23, 46.1 ± 33.8, 58.6 ± 31.5 and 45 ± 57, respectively (p < 0.01). Co-morbidities were diagnosed in 17/34 (50 %) patients at baseline and underwent remission or improvement in all cases after 1 year. CONCLUSIONS LAGB in a safe and effective procedure in patients with a BMI <35 kg/m(2).
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Cobourn C, Chapman MA, Ali A, Amrhein J. Five-year weight loss experience of outpatients receiving laparoscopic adjustable gastric band surgery. Obes Surg 2014; 23:903-10. [PMID: 23446665 PMCID: PMC3671103 DOI: 10.1007/s11695-013-0881-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study evaluated the efficacy and safety of laparoscopic adjustable gastric banding (LAGB) in a large cohort of morbidly obese patients followed for up to 5 years. METHODS Morbidly obese patients, ≥ 16 years of age, who underwent LAGB surgery at the Surgical Weight Loss Clinic in Ontario, Canada, between May 2005 and January 2011 were eligible for this retrospective chart review. Electronic files were searched to identify all patients who met the inclusion/exclusion criteria. Demographics, weights at baseline and follow-up visits (up to 60 months following surgery), and post-operative complications were documented. As follow-up visits occurred at unevenly spaced intervals within and across patients, modeling methods were used to more accurately assess mean % weight loss (WL) and % excess weight loss (EWL) over time. RESULTS This study included 2,815 patients (82 % female, mean age 43 years, mean baseline BMI 44.6 kg/m(2)) followed for a mean of 21.8 ± 15.4 months. Complications developed in 238 patients (8.5 %), the most frequent being prolapse/slippage (4.2 %), tubing/access port problems (1.2 %), and explantation (1.2 %). Mean %WL and %EWL progressed continuously over the first 2.5 years post-LAGB, plateauing at 20 and 49 %, respectively, for up to 5 years of follow up. Factors associated with increased weight loss were time since surgery, greater baseline weight (excess weight), older age at time of surgery, and male gender. CONCLUSIONS Weight loss was maintained for up to 5 years in our population of patients who underwent LAGB for the treatment of morbid obesity.
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Affiliation(s)
- Chris Cobourn
- Surgical Weight Loss Centre, 1413 Hurontario St., Mississauga, Ontario, L5G 3H5, Canada.
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Abstract
Bariatric surgery is an effective and increasingly common treatment for severe obesity and its many comorbidities. The side-effects of bariatric surgery can include detrimental effects on bone and mineral metabolism. Bone disease in patients who have had bariatric surgery is affected by preoperative abnormalities in bone and mineral metabolism related to severe obesity. Changes that arise after bariatric surgery are specific to procedure type: the most pronounced abnormalities in calciotropic hormones and bone loss are noted after procedures that result in the most malabsorption. The most consistent site for bone loss after all bariatric procedures is at the hip. There are limitations of dual-energy x-ray absorptiometry technology in this population, including artefact introduced by adipose tissue itself. Bone loss after bariatric surgery is probably multifactorial. Proposed mechanisms include skeletal unloading, abnormalities in calciotropic hormones, and changes in gut hormones. Few data for fracture risk in the bariatric population are available, and this is a crucial area for additional research. Treatment should be geared toward correction of nutritional deficiencies and study of bone mineral density in high-risk patients. We explore the skeletal response to bariatric surgery, potential mechanisms for changes, and strategies for management.
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Affiliation(s)
- Emily M Stein
- Columbia University College of Physicians and Surgeons, Columbia University, New York 10032, USA.
| | - Shonni J Silverberg
- Columbia University College of Physicians and Surgeons, Columbia University, New York 10032, USA
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Dixon JB. Surgical management of obesity in patients with morbid obesity and nonalcoholic fatty liver disease. Clin Liver Dis 2014; 18:129-46. [PMID: 24274869 DOI: 10.1016/j.cld.2013.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Most patients with severe complex obesity presenting for bariatric-metabolic surgery have nonalcoholic fatty liver disease (NAFLD). NAFLD is associated with central obesity, insulin resistance, type 2 diabetes, hypertension, and obesity-related dyslipidemia. Weight loss should be a primary therapy for NAFLD. However, evidence supporting intentional weight loss as a therapy for NAFLD is limited. Bariatric-metabolic surgery provides the most reliable method of achieving substantial sustained weight loss and the most commonly used procedures are associated with reduced steatosis and lobular inflammatory changes, but there are mixed reports regarding fibrosis. Surgery should complement treatment of obesity-related comorbidity, but not replace established therapy.
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Affiliation(s)
- John B Dixon
- Clinical Obesity Research, Baker IDI Heart & Diabetes Institute, PO Box 6492, St Kilda Road Central, Melbourne, Victoria 8008, Australia; Primary Care Research Unit, Monash University, Melbourne, Australia.
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Sucher R, Resch T, Mohr E, Perathoner A, Biebl M, Pratschke J, Mittermair R. Single-incision laparoscopic sleeve gastrectomy versus multiport laparoscopic sleeve gastrectomy: analysis of 80 cases in a single center. J Laparoendosc Adv Surg Tech A 2014; 24:83-8. [PMID: 24432970 DOI: 10.1089/lap.2013.0250] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Through efficacy and improved safety, multiport laparoscopic sleeve gastrectomy (LAPS-G) has emerged as an important and broadly available treatment option for people with severe and complex obesity. Because a single-incision laparoscopic sleeve gastrectomy (SILS-G) would be less invasive, we applied this novel surgical technique for a selected number of patients enrolled into our minimally invasive bariatric program. SUBJECTS AND METHODS A retrospective review of prospectively collected data from 80 morbidly obese patients who qualified for SILS-G or LAPS-G was performed from January 2011 to May 2012. RESULTS SILS-G and LAPS-G were performed in 40 patients, respectively. All patients were female. Mean age was 41 (range, 19-73) years (SILS-G, 37 [19-62] years; LAPS-G, 43 [24-73] years; P=not significant). Preoperative body mass index was 40.8 (35.1-45.0) kg/m(2) in the SILS-G group and 43.8 (35.0-47.8) kg/m(2) in the LAPS-G group (P=not significant). Total operative time was significantly lower in the SILS-G group (85±21 minutes) compared with the LAPS-G group (97±26 minutes) (P<.05). Median percentage excess weight loss was comparable in both groups (SILS-G, 57.2%; LAPS-G, 53.7%) at 6.6 months after surgery. Mean hospital stay was 5 days (SILS-G, 5 [4-24] days; LAPS-G, 6 [4-14] days; P=not significant). Complication rates were low in both groups: leakage, 2.5% in SILS-G and 0% in LAPS-G; bleeding, 2.5% in SILS-G and 2.5% in LAPS-G; and trocar-site hernia, 0% in both groups. Patients operated on with single-incision laparoscopy had a significantly better cosmetic outcome as assessed by a scar satisfaction assessment questionnaire (P<.01). CONCLUSIONS SILS-G is a feasible and safe operative procedure that leads to a significant reduction of total operative time compared with a multiport access procedure. Further potential benefits associated with single-incision laparoscopic surgery remain to be investigated objectively.
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Affiliation(s)
- Robert Sucher
- Department of Visceral, Transplant, and Thoracic Surgery, Innsbruck Medical University , Innsbruck, Austria
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Grilo CM, Henderson KE, Bell RL, Crosby RD. Eating disorder examination-questionnaire factor structure and construct validity in bariatric surgery candidates. Obes Surg 2013; 23:657-62. [PMID: 23229951 DOI: 10.1007/s11695-012-0840-8] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The Eating Disorder Examination-Questionnaire (EDE-Q) is increasingly used in studies with bariatric surgery patients although little is known about psychometric properties of this self-report measure in this clinical group. The current study evaluated the factor structure and construct validity of the EDE-Q in bariatric surgery candidates. METHODS Participants were a consecutive series of 174 obese bariatric surgery candidates who completed the EDE-Q and a battery of behavioral and psychological measures. RESULTS Confirmatory factor analysis (CFA) revealed an inadequate fit for the original EDE-Q structure but revealed a good fit for an alternative structure suggested by recent research with obese samples. CFA supported a seven-item, three-factor structure; the three factors were interpreted as dietary restraint, shape/weight overvaluation, and body dissatisfaction. The three factors converged with other relevant collateral measures. CONCLUSIONS These factor analytic findings, which replicate recent findings from studies with diverse obese samples, demonstrated convergent validity. Implications of these findings for clinical assessment and research with bariatric surgery patients are discussed.
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine, 301 Cedar Street, New Haven, CT 06519, USA.
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40
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Däster S, Droeser RA, Delko T, Oertli D. Two similar cases of internal hernia after laparoscopic Roux-en-Y gastric bypass surgery. BMJ Case Rep 2013; 2013:bcr-2013-010189. [PMID: 24072825 DOI: 10.1136/bcr-2013-010189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Internal hernia after laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery can lead to acute small bowel obstruction or chronic recurrent abdominal pain. We present two cases of internal hernias after antecolic antegastric LRYGB. Both patients presented to the emergency room with acute diffuse abdominal pain. Other than that, a physical examination and routine laboratory workup did not reveal any pathological finding. An abdominal CT was performed in both cases. It showed mesenteric torsion as a sign of internal hernia in one case, but remained inconclusive in the other patient. Immediate diagnostic laparoscopy was performed in both cases. Intraoperatively, both patients revealed an internal hernia, where the common channel herniated through the mesojejunal space. The conversion to upper median minilaparotomy was necessary for hernia reduction in both cases. No bowel resection was required and both patients recovered fully.
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Affiliation(s)
- Silvio Däster
- Department of General Surgery, University Hospital Basel, Basel, Switzerland
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41
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Grima M, Middleton S, Dixon J. Bariatric surgery for the treatment of severe complex obesity: An update. Nutr Diet 2013. [DOI: 10.1111/1747-0080.12068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Mariee Grima
- Clinical Obesity Research; Melbourne Victoria Australia
| | - Sonia Middleton
- Weight Assessment & Management Clinic; Melbourne Victoria Australia
| | - John Dixon
- Baker IDI Heart and Diabetes Institute; Melbourne Victoria Australia
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De Rosa A, Monaco ML, Capasso M, Forestieri P, Pilone V, Nardelli C, Buono P, Daniele A. Adiponectin oligomers as potential indicators of adipose tissue improvement in obese subjects. Eur J Endocrinol 2013; 169:37-43. [PMID: 23612446 DOI: 10.1530/eje-12-1039] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Adiponectin is an adipocytokine that exerts beneficial effects on obesity and related disorders by two receptors (ADIPORs). Adiponectin is produced as a monomer that circulates in serum as different oligomers. The oligomerization state and the tissue expression of adiponectin and ADIPORs are linked to its biological activities. In this study, the levels of total adiponectin and its oligomers were evaluated in relation to obesity and surgical weight loss. The expression of adiponectin and ADIPORs was analyzed in visceral and subcutaneous adipose tissues of obese patients. DESIGN AND METHODS In 25 obese patients and 44 age- and sex-matched controls, the serum levels of adiponectin and its oligomers were measured and compared by ELISA, western blotting, and gel filtration. The expression of adiponectin and ADIPORs in both adipose tissues was evaluated by real-time quantitative PCR and western blotting. RESULTS The amount of each adiponectin oligomer, including the monomer, increases after weight loss. The reduced circulating levels of adiponectin and its oligomers are not associated with the adipose tissue depot-specific expression of adiponectin and ADIPORs. CONCLUSIONS Our results suggest that in patients, adiposity is associated with the serum concentrations of adiponectin and its oligomers but not with adipose tissue depot-specific expression of adiponectin and ADIPORs. In particular, the increase in adiponectin monomer levels could probably be related to the improvement of the whole-body energy metabolism then being involved in the improvement of adipose tissue function after weight loss. This work indicates the importance of assessing the whole adiponectin oligomeric profile as further potential indicators of adipose tissue functions in obesity.
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Affiliation(s)
- Anna De Rosa
- CEINGE Biotecnologie Avanzate Scarl, Via Gaetano Salvatore 486, 80145 Naples, Italy
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Abstract
Obesity has become a major public health problem as a consequence of its prevalence, negative impact on morbidity, mortality and quality of life and its associated direct and indirect healthcare costs. The etiology of obesity is multifactorial and reflects complex interactions of genetic, neurohumoral, environmental, behavioral and possibly, microbial factors. Available treatments for obesity include diet and exercise, behavioral modification, medications and surgery. Gastroenterologists are becoming increasingly involved in the care of obese patients. Although much of this care has historically centered on the preoperative and postoperative care of the bariatric patient, gastroenterologists are also evaluating and managing a variety of gastrointestinal symptoms and disorders that occur more commonly among obese individuals and are increasingly involved in the primary treatment of obesity. In this review, the gastrointestinal symptoms and disorders that are associated with obesity will be reviewed, the gastrointestinal contribution to the pathogenesis of obesity will be described and the current treatment options of obesity and where the gastroenterologist typically plays a role in the management will be discussed.
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Affiliation(s)
- John K Dibaise
- Division of Gastroenterology, Mayo Clinic in Arizona, Scottsdale, AZ, USA.
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Kohli R, Bradley D, Setchell KD, Eagon JC, Abumrad N, Klein S. Weight loss induced by Roux-en-Y gastric bypass but not laparoscopic adjustable gastric banding increases circulating bile acids. J Clin Endocrinol Metab 2013; 98:E708-12. [PMID: 23457410 PMCID: PMC3615197 DOI: 10.1210/jc.2012-3736] [Citation(s) in RCA: 213] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CONTEXT It has been hypothesized that increased plasma bile acids (BAs) contribute to metabolic improvements after Roux-en-Y gastric bypass (RYGB) surgery by the G protein-coupled receptor TGR5-mediated effects on glucagon-like peptide-1 secretion and thyroid hormones. OBJECTIVE The objective of this study was to evaluate the importance of bariatric surgery-induced alterations in BA physiology on factors that regulate glucose homeostasis (insulin secretion and sensitivity) and energy metabolism (resting energy expenditure and thyroid hormone axis). DESIGN, PARTICIPANTS, INTERVENTION, AND MAIN OUTCOME MEASURE: Eighteen extremely obese subjects were studied before and after 20% weight loss, induced by either laparoscopic adjustable gastric banding (LAGB) (n = 10) or RYGB surgery (n = 8). RESULTS Plasma BAs more than doubled after RYGB [fasting: 1.08 (0.26-1.42) to 2.28 (1.59-3.28) μmol/L, P = .03; postprandial: 2.46 ± 1.59 to 6.00 ± 2.75 μmol/L, P = .01] but were either lower or did not change after LAGB [fasting: 1.80 (1.49-2.19) to 0.92 (0.73-1.15) μmol/L, P = .02; postprandial: 3.71 ± 2.61 to 2.82 ± 1.75 μmol/L, P = .14]. Skeletal muscle expression of TGR5 targets, Kir6.2 and cyclooxygenase IV, increased after RYGB but not LAGB. Surgery-induced changes in BAs were associated with increased peak postprandial plasma glucagon-like peptide-1 (r(2) = 0.509, P = .001) and decreased serum TSH (r(2) = 0.562, P < .001) but did not correlate with the change in insulin response to a meal (r(2) = 0.013, P = .658), insulin sensitivity (assessed as insulin stimulated glucose disposal during a hyperinsulinemic-euglycemic clamp procedure) (r(2) = 0.001, P = .995), or resting energy expenditure (r(2) = 0.004, P = .807). CONCLUSIONS Compared with LAGB, RYGB increases circulating BAs and TGR5 signaling, but this increase in BAs is not a significant predictor of changes in glucose homeostasis or energy metabolism.
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Affiliation(s)
- Rohit Kohli
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
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Abstract
Laparoscopic sleeve gastrectomy has gained popularity and acceptance among bariatric surgeons, mainly as a result of its low morbidity and mortality. Single-incision laparoscopic surgery (SILS), the most recent development in minimally invasive surgery, allows operations to be carried out through only a single incision using special ports. To further minimize the trauma of access incisions, we applied the SIL sleeve gastrectomy on a selected number of patients enrolled into our minimally invasive bariatric program. Between June 2010 and May 2012, 40 consecutive female patients underwent SIL sleeve gastrectomy. All data (demographic, morphologic, operative, and follow-up data) were prospectively collected in a computerized data bank. All patients were female. Mean age was 37 years (range, 19 to 62 years), preoperative body mass index was 40.8 kg/m2 (range, 35.1 to 45.0 kg/m2), and excess weight loss was 57.2 per cent at 6.6 months after surgery. Total operative time was 85 ± 21 minutes and mean hospital stay was 5 days (range, 4 to 24 days). Of the patients, two (5%) sustained postoperative complications such as leakage from the suture line and hemorrhage one in each case. There was no trocar site hernia. SIL sleeve gastrectomy seems to be an effective surgical option for the treatment of morbid obesity. During the first 6 months after the operation, weight loss was excellent. These results are at present comparable to those of multiport sleeve gastrectomy. SIL sleeve gastrectomy is safe and feasible and can be performed without changing the existing principles of this procedure.
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Affiliation(s)
- Reinhard Mittermair
- From the Department of Visceral-, Transplant-, and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Johann Pratschke
- From the Department of Visceral-, Transplant-, and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Robert Sucher
- From the Department of Visceral-, Transplant-, and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
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Jones LV, Jones KM, Hensman C, Bertuch R, McGee TL, Dixon JB. Solid Versus Liquid—Satiety Study in Well-Adjusted Lap-Band Patients. Obes Surg 2013; 23:1266-72. [DOI: 10.1007/s11695-013-0897-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abdel-Salam WN, Bekheit M, Katri K, Ezzat T, El Kayal ES. Efficacy of intragastric balloon in obese Egyptian patients and the value of extended liquid diet period in mounting the weight loss. J Laparoendosc Adv Surg Tech A 2013; 23:220-4. [PMID: 23234333 DOI: 10.1089/lap.2012.0382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
UNLABELLED Abstract Background: The surgical management of morbid obesity is faced by several challenges. Alternative therapeutic strategies could have an important role in the perioperative risk reduction. The BioEnterics(®) intragastric balloon (BIB) (Inamed Health, Santa Barbara, CA) has been described as being effective in weight reduction and is used as a bridge before bariatric surgery. This study examined the efficacy of BIB in obese Egyptian patients and the value of the extended low caloric liquid diet program in weight loss. SUBJECTS AND METHODS A retrospective review of a prospectively maintained bariatric database was conducted. Weight changes and complications data were analyzed. Indications for BIB placement were discussed. RESULTS Records of 55 patients (11 males and 44 females) were retrieved. The mean initial body mass index (BMI) was 45.3±11 kg/m(2). The mean of excess body weight percentage was 111.96±53.2%. Nausea was reported in 30 patients (54.5%). Epigastric discomfort was reported in 23 patients (41.8 %), and vomiting was reported in 27 patients (49.1%). Six patients (10.9%) had an early removal of the balloon, whereas 4 (7.2%) had delayed removal (more than 6 months). The mean excess weight loss percentage (EWL%) was 17.2%. There was significant reduction in patients' BMI from 45.3 to 38.3 kg/m(2) (P<.001). There was no significant correlation between the EWL% and the gender, age, or initial BMI. Two patients had second balloon insertions without complications. There was no significant difference in the EWL% between the 1-week liquid diet group and the extended (4-week) low caloric diet group. CONCLUSIONS The BIB is effective and safe in weight reduction in obese Egyptian patients. The impact of extended liquid dieting period is not significant.
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Affiliation(s)
- Wael Nabil Abdel-Salam
- Department of Surgery, Alexandria Main University Hospital, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Kee K, Naughton MT. Obstructive sleep apnea: should weight loss be prescribed? Expert Rev Respir Med 2013; 7:1-3. [DOI: 10.1586/ers.12.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Brzozowska MM, Sainsbury A, Eisman JA, Baldock PA, Center JR. Bariatric surgery, bone loss, obesity and possible mechanisms. Obes Rev 2013; 14:52-67. [PMID: 23094966 DOI: 10.1111/j.1467-789x.2012.01050.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 09/15/2012] [Accepted: 09/17/2012] [Indexed: 12/14/2022]
Abstract
Bariatric surgery remains the most effective treatment for severely obese patients. However, the potential long-term effects of bariatric surgical procedures on health, including bone health, are only partially understood. The goal of this review was to present data on the impact of bariatric surgery on bone metabolism and to analyse possible reasons for the loss of bone mass that frequently occurs after bariatric surgery. Such factors include nutritional deficiencies, rapid weight loss per se, effects of fat-derived adipokines and gut-derived appetite-regulatory hormones. However, the relative roles of these factors in skeletal regulation and the mechanisms by which they work are not yet fully defined. Our review was focussed on the complex relationship between body weight, fat mass and bone mass, as well as peripheral and central mediators potentially involved in the dual regulation of both energy and bone homeostasis. We also review the data on the inverse relationship between central obesity, bone marrow fat and osteoporosis. As the number of bariatric operations increases, it is imperative to recognize mechanisms responsible for bariatric surgery-induced bone loss, with careful monitoring of bone health including long-term fracture incidence in patients undergoing these procedures.
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Affiliation(s)
- M M Brzozowska
- Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia
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Ritz E. Bariatric surgery and the kidney-much benefit, but also potential harm. Clin Kidney J 2012; 6:368-72. [PMID: 27293562 PMCID: PMC4898330 DOI: 10.1093/ckj/sfs161] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 10/19/2012] [Indexed: 12/14/2022] Open
Abstract
Bariatric surgery is increasingly performed on overweight individuals. A significant benefit with respect to cardiovascular (CV) events and survival has been documented. After weight loss, reduction of albuminuria/proteinuria is almost consistently seen; small studies documented retardation of the glomerular filtration rate (GFR) loss after bariatric surgery; reduction of blood pressure (BP) is less consistent. It has been known for a long time that the frequency of oxalate stones is increased after bariatric surgery. The main renal threat of hyperoxaluria is renal oxalosis, often irreversible, causing persisting renal failure. The causes are reduced oxalate binding by calcium due to saponification of calcium causing fat malabsorption, increased permeability for oxalate because of increased permeability of colon mucosa triggered by increased bile salts and reduced colonization of the colon by oxalobacter formigenes. These mechanisms are susceptible to treatment.
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Affiliation(s)
- Eberhard Ritz
- Nierenzentrum , University of Heidelberg , Heidelberg , Germany
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