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Qanaq D, O'Keeffe M, Cremona S, Bernardo WM, McIntyre RD, Papada E, Benkalkar S, Rubino F. The Role of Dietary Intake in the Weight Loss Outcomes of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: A Systematic Review and Meta-analysis. Obes Surg 2024:10.1007/s11695-024-07183-8. [PMID: 38907132 DOI: 10.1007/s11695-024-07183-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 06/23/2024]
Abstract
The relationship between postoperative dietary intake and weight loss after bariatric surgery remains unclear. We performed a systematic review and meta-analysis of studies published between January 2000 and May 2023, reporting weight loss outcomes, and dietary intake before and after Roux-en-Y gastric bypass and sleeve gastrectomy. A total of 42 studies were included. There was no detectable difference in dietary intake between the two procedures. Roux-en-Y gastric bypass induced an average decrease in energy intake of 886 kcal/day at 12-month post-surgery; however, there was no correlation between daily energy intake and weight loss. These findings show a substantial reduction of energy intake in the first year after bariatric surgery but do not support a link between lower energy intake and greater weight loss.
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Affiliation(s)
- Dalal Qanaq
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9RJ, UK
- College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, 11481, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Centre, 11481, Riyadh, Kingdom of Saudi Arabia
- Department of Nutritional Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| | - Majella O'Keeffe
- Department of Nutritional Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
- School of Food and Nutritional Sciences, University College Cork, College Road, Cork, Ireland
| | - Simone Cremona
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9RJ, UK
- General and Digestive Surgery Department of Hospital Del Mar de, 08003, Barcelona, Spain
| | | | - Robert D McIntyre
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9RJ, UK
- School of Sport, Exercise and Applied Science, St Mary's University, Twickenham, London, TW1 4SX, UK
| | - Efstathia Papada
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9RJ, UK
- Division of Medicine, University College London, London, WC1E 6JF, UK
| | - Saumit Benkalkar
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9RJ, UK
| | - Francesco Rubino
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9RJ, UK.
- Bariatric and Metabolic Surgery, King's College Hospital, London, SE5 9RS, UK.
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Voros C, Bananis K, Papapanagiotou A, Pouliakis A, Mavriki K, Gkaniatsos I, Daskalaki MA, Prokopakis I, Tsimpoukelis C, Koulakmanidis AM, Darlas M, Anysiadou S, Daskalakis G, Domali E. Application of Biomarkers in Obese Infertile Women: A Genetic Tool for a Personalized Treatment. J Clin Med 2024; 13:2261. [PMID: 38673534 PMCID: PMC11051271 DOI: 10.3390/jcm13082261] [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: 03/15/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
This study investigates links between CART and leptin gene expression, FSH receptor Asn680Ser polymorphism, and reproductive hormones in morbidly obese patients under 40 years old, facing infertility, and undergoing bariatric surgery. A total of 29 women were included in this study. A hormonal profile along with detection of CART and leptin gene expression was evaluated before and after bariatric surgery. Additionally, the presence or absence of Asn680Ser of the FSHR gene was studied. Following bariatric surgery, a mean reduction in BMI (16.03 kg/m2) was observed in all women. FSH levels preoperatively varied significantly among genotypes, with medians of 8.1, 9.5, and 10.3 for individuals without polymorphism, heterozygotes, and homozygotes, respectively (p = 0.0408). Post surgery, marginal differences in FSH levels were observed (5.8, 7.1, and 8.2, respectively) (p = 0.0356). E2 and LH levels exhibited no significant genotype-based differences pre and post surgery. Presurgical E2 levels were 29.6, 29.8, and 29.6, respectively (p = 0.91634), while postsurgical levels were 51.2, 47.8, and 47 (p = 0.7720). LH levels followed similar patterns. Our findings highlight bariatric surgery's positive impact on BMI reduction and its potential connection to genetic markers, hormones, and infertility. This suggests personalized treatments and offers a valuable genetic tool for better fertility outcomes in obese individuals.
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Affiliation(s)
- Charalampos Voros
- 1st Department of Obstetrics and Gynecology, ‘Alexandra’ General Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528 Athens, Greece; (K.M.); (I.G.); (I.P.); (C.T.); (A.-M.K.); (M.D.); (S.A.); (G.D.); (E.D.)
| | - Kyriakos Bananis
- Ealing Hospital, London North West University Healthcare NHS Trust, 601 Uxbridge Road, Southall UB1 3HW, UK;
| | - Angeliki Papapanagiotou
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Abraham Pouliakis
- 3rd Department of Obstetrics and Gynecology, Attikon Hospital, National and Kapodistrian University of Athens, Rimini 1, 12462 Chaidari, Greece;
| | - Konstantina Mavriki
- 1st Department of Obstetrics and Gynecology, ‘Alexandra’ General Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528 Athens, Greece; (K.M.); (I.G.); (I.P.); (C.T.); (A.-M.K.); (M.D.); (S.A.); (G.D.); (E.D.)
| | - Ioannis Gkaniatsos
- 1st Department of Obstetrics and Gynecology, ‘Alexandra’ General Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528 Athens, Greece; (K.M.); (I.G.); (I.P.); (C.T.); (A.-M.K.); (M.D.); (S.A.); (G.D.); (E.D.)
| | | | - Ioannis Prokopakis
- 1st Department of Obstetrics and Gynecology, ‘Alexandra’ General Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528 Athens, Greece; (K.M.); (I.G.); (I.P.); (C.T.); (A.-M.K.); (M.D.); (S.A.); (G.D.); (E.D.)
| | - Charalampos Tsimpoukelis
- 1st Department of Obstetrics and Gynecology, ‘Alexandra’ General Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528 Athens, Greece; (K.M.); (I.G.); (I.P.); (C.T.); (A.-M.K.); (M.D.); (S.A.); (G.D.); (E.D.)
| | - Aristotelis-Marios Koulakmanidis
- 1st Department of Obstetrics and Gynecology, ‘Alexandra’ General Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528 Athens, Greece; (K.M.); (I.G.); (I.P.); (C.T.); (A.-M.K.); (M.D.); (S.A.); (G.D.); (E.D.)
| | - Menelaos Darlas
- 1st Department of Obstetrics and Gynecology, ‘Alexandra’ General Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528 Athens, Greece; (K.M.); (I.G.); (I.P.); (C.T.); (A.-M.K.); (M.D.); (S.A.); (G.D.); (E.D.)
| | - Sofia Anysiadou
- 1st Department of Obstetrics and Gynecology, ‘Alexandra’ General Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528 Athens, Greece; (K.M.); (I.G.); (I.P.); (C.T.); (A.-M.K.); (M.D.); (S.A.); (G.D.); (E.D.)
| | - Georgios Daskalakis
- 1st Department of Obstetrics and Gynecology, ‘Alexandra’ General Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528 Athens, Greece; (K.M.); (I.G.); (I.P.); (C.T.); (A.-M.K.); (M.D.); (S.A.); (G.D.); (E.D.)
| | - Ekaterini Domali
- 1st Department of Obstetrics and Gynecology, ‘Alexandra’ General Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528 Athens, Greece; (K.M.); (I.G.); (I.P.); (C.T.); (A.-M.K.); (M.D.); (S.A.); (G.D.); (E.D.)
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Granero-Molina J, Jiménez-Lasserrotte MDM, Arias Hoyos C, Sánchez MJT, Fernández-Sola C, Ruiz-Fernández MD. Sexuality and self-concept of morbidly obese women who are sexually attracted to men after bariatric surgery: a phenomenological study. BMC Womens Health 2024; 24:174. [PMID: 38481251 PMCID: PMC10936016 DOI: 10.1186/s12905-024-03014-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/06/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Morbid Obesity (MO) is a public health problem that affects a person's physical, psychological and sexual well-being. Women with MO are affected by their body image and self-concept, and obesity stigma may affect women in social and sexual relationships. OBJECTIVE To describe and understand the experiences of morbidly obese heterosexual women (who are sexually attracted to men) in relation to their body image and sexuality after bariatric surgery. METHODOLOGY Qualitative study using Merleau-Ponty's hermeneutic phenomenology as a philosophical framework. Data collection took place between 2020 and 2021 in a southern Spanish province. A total of 22 in-depth interviews were conducted using open-ended questions until data saturation was reached. RESULTS Two main themes were identified: (1) "Escaping from a cruel environment": weight loss to increase self-esteem; with the sub-themes: 'I love myself now', and 'Body image and social relationships; a vicious circle; (2) "Now, I am truly me": accepting my body to reclaim my sexuality, with the sub-themes: 'The body as the focal point of sexuality', and 'When regaining your sex drive reignites your sex life and relationship'. CONCLUSION Weight loss and body acceptance radically change morbidly obese women's sex lives after bariatric surgery. They rediscover their bodies, have increased self-esteem, and see improvements in their social relationships and sexuality. These women feel seen, loved and desired, and now value their body image and femininity. As they go through continuous improvements following bariatric surgery, they gradually regain self-esteem, acceptance of their bodies and control over their sex life. Even though the women's partners benefit from these improvements, they seem to be afraid of being left.
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Affiliation(s)
- José Granero-Molina
- Physiotheraphy and Medicine Department, University of Almería, Almería, Spain
- Faculty of Health Sciences, Universidad Autónoma de Chile, Chile, Santiago, 7500000, Spain
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Eymard F, Aron-Wisnewsky J. Osteoarthritis in patients with obesity: The bariatric surgery impacts on its evolution. Joint Bone Spine 2024; 91:105639. [PMID: 37734439 DOI: 10.1016/j.jbspin.2023.105639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/28/2023] [Accepted: 09/03/2023] [Indexed: 09/23/2023]
Abstract
Obesity is one of the main modifiable risk factors for osteoarthritis (OA). Moreover, obesity is associated with greater pain intensity and functional limitation, but also with a significantly lower responder rate to intra-articular treatments. Consequently, an arthroplasty is indicated earlier and more frequently in patients with obesity. However, pain and functional symptoms improve slightly less after arthroplasty in patients with obesity, who display higher incidence of early and late complications following prosthetic surgery. Bariatric surgery (BS) has increased worldwide and is efficient to induce major and sustainable weight-loss. Importantly, BS significantly reduces pain and functional limitation in patients with symptomatic knee OA. Biomarkers analysis also revealed a decrease in catabolic factors and an increase in anabolic one after BS suggesting a structural protective effect in knee OA. Nevertheless, the impact of BS prior to arthroplasty remains unclear. BS seems to decrease short- and mid-term complications such as infections or thrombosis. However, BS does not appear to modify long-term complications rate, and may even increase it, especially revisions and infections. Although few studies have compared the symptomatic and functional outcomes of joint replacement with or without BS, these are not significantly improved by prior BS. Despite these heterogeneous results, medico-economic studies found that BS prior to arthroplasty was cost-effective. To conclude, BS could significantly reduce the symptoms of OA and potentially slow its progression, but appears more disappointing in preventing long-term complications of arthroplasties and improving their functional results.
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Affiliation(s)
- Florent Eymard
- Department of Rheumatology, Henri-Mondor University Hospital, Assistance publique-Hôpitaux de Paris, AP-HP, 1, rue Gustave-Eiffel, 94000 Créteil, France.
| | - Judith Aron-Wisnewsky
- Department of Nutrition, Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, AP-HP, 75013 Paris, France; Sorbonne université, Inserm, Nutrition and Obesity: Systemic Approaches, NutriOmics, 75013 Paris, France
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Phan A, Hage M, Zaharia R, Vigan M, Coursault S, Wilson S, Gabali E, Foussier L, Vychnevskaia K, Raffin-Sanson ML, Bretault M. Nutritional Status of Vegetarian Patients Before and After Bariatric Surgery: a Monocentric Retrospective Observational Case-Control Study. Obes Surg 2023; 33:1356-1365. [PMID: 36991254 DOI: 10.1007/s11695-023-06538-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 03/31/2023]
Abstract
The obesity pandemic is associated with an increasing number of bariatric surgeries which allow improvement in obesity-related comorbidities and life expectancy but potentially induce nutritional deficiencies. Vegetarianism becomes more and more popular and exposes as well to vitamin and micronutrient deficiencies. Only one study has explored the impact of vegetarianism on the preoperative nutritional status of eligible patients for bariatric surgery, but none in postoperative care. MATERIALS AND METHODS We conducted a retrospective case-control study in our cohort of bariatric patients, matching 5 omnivores for each vegetarian. We compared their biological profile regarding vitamin and micronutrient blood levels before and 3, 6, 12, and 30 months after surgery. RESULTS We included 7 vegetarians including 4 lacto-ovo-vegetarians (57%), 2 lacto-vegetarians (29%), and one lacto-ovo-pesco-vegetarian (14%). Three years after surgery with equivalent daily standard vitamin supplementation, the two groups showed a similar biological profile including blood levels of ferritin (p = 0.6), vitamin B1 (p = 0.1), and B12 (p = 0.7), while the total median weight loss at 3 years was comparable (39.1% [27.0-46.6] in vegetarians vs 35.7% [10.5-46.5] in omnivores, p = 0.8). We observed no significant difference between vegetarians and omnivores before surgery regarding comorbidities and nutritional status. CONCLUSION It seems that, after bariatric surgery, vegetarian patients taking a standard vitamin supplementation do not show an increased risk of nutritional deficiencies compared to omnivores. However, a larger study with a longer follow-up is needed to confirm these data, including an evaluation of different types of vegetarianism such as veganism.
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Affiliation(s)
- Aurélie Phan
- Department of Nutrition, European Georges Pompidou Hospital, APHP, Paris, France
| | - Mirella Hage
- Department of Endocrinology-Nutrition, Ambroise Paré Hospital, AP-HP, EA4340 Research Unit, Université de Versailles Saint-Quentin-en-Yvelines, University Paris-Saclay, 92100, Boulogne-Billancourt, France
| | - Ramona Zaharia
- Department of Endocrinology-Nutrition, Ambroise Paré Hospital, AP-HP, EA4340 Research Unit, Université de Versailles Saint-Quentin-en-Yvelines, University Paris-Saclay, 92100, Boulogne-Billancourt, France
| | - Marie Vigan
- Clinical Research Unit, AP-HP, Paris-Saclay, Hôpital Ambroise Pare, Boulogne-Billancourt, France
| | - Séverine Coursault
- Department of Endocrinology-Nutrition, Ambroise Paré Hospital, AP-HP, EA4340 Research Unit, Université de Versailles Saint-Quentin-en-Yvelines, University Paris-Saclay, 92100, Boulogne-Billancourt, France
| | - Sandy Wilson
- Department of Endocrinology-Nutrition, Ambroise Paré Hospital, AP-HP, EA4340 Research Unit, Université de Versailles Saint-Quentin-en-Yvelines, University Paris-Saclay, 92100, Boulogne-Billancourt, France
| | - Elodie Gabali
- Department of Endocrinology-Nutrition, Ambroise Paré Hospital, AP-HP, EA4340 Research Unit, Université de Versailles Saint-Quentin-en-Yvelines, University Paris-Saclay, 92100, Boulogne-Billancourt, France
| | - Loic Foussier
- Department of Endocrinology-Nutrition, Ambroise Paré Hospital, AP-HP, EA4340 Research Unit, Université de Versailles Saint-Quentin-en-Yvelines, University Paris-Saclay, 92100, Boulogne-Billancourt, France
| | - Karina Vychnevskaia
- Department of Surgery and Oncology, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, France
| | - Marie-Laure Raffin-Sanson
- Department of Endocrinology-Nutrition, Ambroise Paré Hospital, AP-HP, EA4340 Research Unit, Université de Versailles Saint-Quentin-en-Yvelines, University Paris-Saclay, 92100, Boulogne-Billancourt, France
| | - Marion Bretault
- Department of Endocrinology-Nutrition, Ambroise Paré Hospital, AP-HP, EA4340 Research Unit, Université de Versailles Saint-Quentin-en-Yvelines, University Paris-Saclay, 92100, Boulogne-Billancourt, France.
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Martinelli V, Singh S, Politi P, Caccialanza R, Peri A, Pietrabissa A, Chiappedi M. Ethics of Bariatric Surgery in Adolescence and Its Implications for Clinical Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1232. [PMID: 36673981 PMCID: PMC9859476 DOI: 10.3390/ijerph20021232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
Obesity is increasingly prevalent among adolescents. Clinical and research data support the use of bariatric surgery (BS) as a treatment option for severely obese adolescents, with good results in terms of weight loss, improvement or resolution of comorbidities, and compliance to follow up. Nevertheless, concerns still remain, with significant disparities among countries and ethical concerns mainly raised by performing an irreversible and invasive procedure in adolescence, with potential life-long alterations. In this context, the purpose of this narrative review was to discuss the main current ethical challenges in performing BS in adolescence and to inform appropriate clinical management in the field. The core ethical principles of autonomy, beneficence, nonmaleficence, and justice were revised in terms of patient-centered healthcare through the lens of psychosocial implications. The review concludes with a discussion regarding the potential directives for future research for effective, patient-centered, and ethical management of obesity in the adolescent population.
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Affiliation(s)
- Valentina Martinelli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Simran Singh
- Medway Hospital, Windmill Rd, Gillingham ME7 5NY, UK
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
| | - Andrea Peri
- Department of Surgery, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
| | - Andrea Pietrabissa
- Department of Surgery, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
- Department of Surgery, University of Pavia, 27100 Pavia, Italy
| | - Matteo Chiappedi
- Vigevano Child Neurology and Psychiatry Unit, ASST Pavia, 27100 Pavia, Italy
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7
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Grilo CM, Ivezaj V, Duffy AJ, Gueorguieva R. 24-Month follow-up of randomized controlled trial of guided-self-help for loss-of-control eating after bariatric surgery. Int J Eat Disord 2022; 55:1521-1531. [PMID: 36054766 DOI: 10.1002/eat.23804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/10/2022] [Accepted: 08/10/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Loss-of-control (LOC)-eating postoperatively predicts suboptimal longer-term outcomes following bariatric surgery. This study examined longer-term effects through 24-month follow-ups after completing treatments in a randomized controlled trial testing guided-self-help treatments (cognitive-behavioral therapy [gshCBT] and behavioral weight-loss [gshBWL]) and control (CON) delivered postoperatively for LOC-eating. METHODS 140 patients with LOC-eating 6 months after bariatric surgery were randomized (5:5:2 ratio) to 3-months of gshCBT (n = 56), gshBWL (n = 60), or CON (n = 24) delivered by trained allied-health clinicians. Independent assessments were performed throughout/after treatments and at 6-, 12-, 18-, and 24-month follow-ups; 83% of patients were assessed at 24-month follow-up. RESULTS Intention-to-treat analyses comparing the three groups (gshCBT vs. gshBWL vs. CON) in LOC-eating abstinence at posttreatment (30%, 27%, 38%), 12-month follow-up (34%, 32%, 42%), and 24-month follow-up (45%, 32%, 38%) revealed no significant differences. Mixed-models revealed significantly reduced LOC-eating frequency through posttreatment, no significant changes in LOC-eating frequency during follow-up, and no differences between the three groups. Weight reduced significantly, albeit modestly, through posttreatment but increased significantly and substantially during follow-ups, with no differences between groups. CONCLUSIONS Overall, the 12-week scalable guided-self-help treatments did not differ from each other or control, were associated with significantly reduced frequency of LOC-eating and modest weight loss at posttreatment but were followed by significant weight gain during the 24-month follow-up. Weight gain was substantial and nearly universal whereas the frequency of LOC-eating did not change over time (i.e., LOC-eating reductions and abstinence rates were well maintained through 24-moth follow-ups). Patients with postoperative LOC-eating require more intensive adjunctive treatments. PUBLIC SIGNIFICANCE Loss-of-control (LOC) eating postoperatively predicts poorer bariatric surgery outcomes and the longer-term effects of postoperative adjunctive postoperative interventions for LOC eating are unknown. In this 24-month follow-up of a controlled study of scalable guided-self-help treatments and a control condition, improvements in LOC-eating frequency, eating-disorder psychopathology, and depression during treatment were maintained well, with no differences between the three groups. Proportion of patients achieving abstinence from LOC-eating at the 24-month follow-up ranged from 38% to 45% across the three groups. In contrast, weight increased significantly during the 24-month follow-ups, with no differences between the three groups. Findings suggest LOC-eating following bariatric surgery might represent a "marker" for a subgroup of patients that are at risk for substantial weight gains over time. LOC eating following bariatric surgery is challenging to treat with low-intensity scalable treatments and may require more intensive specialist treatments.
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Valentina Ivezaj
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Andrew J Duffy
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ralitza Gueorguieva
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
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Mele C, Caputo M, Ferrero A, Daffara T, Cavigiolo B, Spadaccini D, Nardone A, Prodam F, Aimaretti G, Marzullo P. Bone Response to Weight Loss Following Bariatric Surgery. Front Endocrinol (Lausanne) 2022; 13:921353. [PMID: 35873004 PMCID: PMC9301317 DOI: 10.3389/fendo.2022.921353] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 04/15/2022] [Accepted: 05/23/2022] [Indexed: 11/28/2022] Open
Abstract
Obesity is a global health challenge that warrants effective treatments to avoid its multiple comorbidities. Bariatric surgery, a cornerstone treatment to control bodyweight excess and relieve the health-related burdens of obesity, can promote accelerated bone loss and affect skeletal strength, particularly after malabsorptive and mixed surgical procedures, and probably after restrictive surgeries. The increase in bone resorption markers occurs early and persist for up to 12 months or longer after bariatric surgery, while bone formation markers increase but to a lesser extent, suggesting a potential uncoupling process between resorption and formation. The skeletal response to bariatric surgery, as investigated by dual-energy X-ray absorptiometry (DXA), has shown significant loss in bone mineral density (BMD) at the hip with less consistent results for the lumbar spine. Supporting DXA studies, analyses by high-resolution peripheral quantitative computed tomography (HR-pQCT) showed lower cortical density and thickness, higher cortical porosity, and lower trabecular density and number for up to 5 years after bariatric surgery. These alterations translate into an increased risk of fall injury, which contributes to increase the fracture risk in patients who have been subjected to bariatric surgery procedures. As bone deterioration continues for years following bariatric surgery, the fracture risk does not seem to be dependent on acute weight loss but, rather, is a chronic condition with an increasing impact over time. Among the post-bariatric surgery mechanisms that have been claimed to act globally on bone health, there is evidence that micro- and macro-nutrient malabsorptive factors, mechanical unloading and changes in molecules partaking in the crosstalk between adipose tissue, bone and muscle may play a determining role. Given these circumstances, it is conceivable that bone health should be adequately investigated in candidates to bariatric surgery through bone-specific work-up and dedicated postsurgical follow-up. Specific protocols of nutrients supplementation, motor activity, structured rehabilitative programs and, when needed, targeted therapeutic strategies should be deemed as an integral part of post-bariatric surgery clinical support.
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Affiliation(s)
- Chiara Mele
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- *Correspondence: Chiara Mele,
| | - Marina Caputo
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
- Division of Endocrinology, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Alice Ferrero
- Division of Endocrinology, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Tommaso Daffara
- Division of Endocrinology, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Beatrice Cavigiolo
- Division of Endocrinology, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Daniele Spadaccini
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Antonio Nardone
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation and Spinal Unit of Pavia Institute, Pavia, and Neurorehabilitation of Montescano Institute, Montescano, PV, Italy
| | - Flavia Prodam
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
- Division of Endocrinology, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Gianluca Aimaretti
- Division of Endocrinology, University Hospital “Maggiore della Carità”, Novara, Italy
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Paolo Marzullo
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- Istituto Auxologico Italiano, IRCCS, Laboratory of Metabolic Research, S. Giuseppe Hospital, Piancavallo, Italy
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9
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Demerdash HM. Weight regain after bariatric surgery: Promoters and potential predictors. World J Meta-Anal 2021; 9:438-454. [DOI: 10.13105/wjma.v9.i5.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/07/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
Obesity is globally viewed as chronic relapsing disease. Bariatric surgery offers the most efficient and durable weight loss approach. However, weight regain after surgery is a distressing issue as obesity can revert. Surgical procedures were originally designed to reduce food intake and catalyze weight loss, provided that its role is marginalized in long-term weight maintenance. Consequently, it is essential to establish a scientifically standardized applicable definitions for weight regain, which necessitates enhanced comprehension of the clinical situation, as well as have realistic expectations concerning weight loss. Moreover, several factors are proposed to influence weight regain as psychological, behavioral factors, hormonal, metabolic, anatomical lapses, as well as genetic predisposition. Recently, there is a growing evidence of utilization of scoring system to anticipate excess body weight loss, along with characterizing certain biomarkers that identify subjects at risk of suboptimal weight loss after surgery. Furthermore, personalized counseling is warranted to help select bariatric procedure, reinforce self-monitoring skills, motivate patient, encourage mindful eating practices, to avoid recidivism.
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Affiliation(s)
- Hala Mourad Demerdash
- Department of Clinical Pathology, Alexandria University Hospitals, Alexandria 21311, Egypt
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10
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Gasmi A, Bjørklund G, Mujawdiya PK, Semenova Y, Peana M, Dosa A, Piscopo S, Gasmi Benahmed A, Costea DO. Micronutrients deficiences in patients after bariatric surgery. Eur J Nutr 2021; 61:55-67. [PMID: 34302218 DOI: 10.1007/s00394-021-02619-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/09/2021] [Indexed: 12/14/2022]
Abstract
Bariatric surgery is an effective option for managing obesity and has gained general acceptance among patients in recent years. Generally, despite the high caloric intake, a bad nutritional habit of obese people results in the deficiency of several vitamins, minerals, and trace elements essential for body metabolism and normal physiological processes. Additionally, the current bariatric surgical approaches such as sleeve gastrectomy (SG), Roux-en-Y-gastric bypass (RYGB), laparoscopic adjustable gastric banding (LAGB), and jejunoileal bypass (JIB) can cause or exacerbate these deficiencies. Based on several reports, it appears that the various bariatric surgical procedures affect nutrient absorption differently. Being purely restrictive, LAGB and SG affect the absorption of iron, selenium, and vitamin B12, while RYGB, JIB, and biliopancreatic diversion have a more profound impact on the absorption of essential vitamins, minerals, and trace elements. Nutritional deficiencies in vitamins, minerals, and trace elements may follow bariatric surgery and are associated with clinical manifestations and diseases, including anemia, ataxia, hair loss, and Wernicke encephalopathy. The present review summarizes some of the major vitamin and micronutrient deficiencies associated with bariatric surgery, particularly those presented post-surgically. To avoid any adverse consequences of vitamin and trace element deficiency, proper monitoring and tests are recommended at any stage, from pre- to post-surgery (periodical check-up), followed by specific and individual nutritional supplementation treatments and a proper healthy diet.
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Affiliation(s)
- Amin Gasmi
- Société Francophone de Nutrithérapie et de Nutrigénétique Appliquée, Villeurbanne, France
| | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine (CONEM), Toften 24, 8610, Mo i Rana, Norway.
| | | | - Yuliya Semenova
- Semey Medical University, Semey, Kazakhstan
- CONEM Kazakhstan Environmental Health and Safety Research Group, Semey Medical University, Semey, Kazakhstan
| | - Massimiliano Peana
- Department of Chemistry and Pharmacy, University of Sassari, Sassari, Italy
| | - Alexandru Dosa
- Faculty of Medicine, Ovidius University of Constanta, Constanta, Romania
| | - Salva Piscopo
- Société Francophone de Nutrithérapie et de Nutrigénétique Appliquée, Villeurbanne, France
- Department of Nutritional Research and Development, Nutri-Logics SA, Weiswampach, Luxembourg
| | - Asma Gasmi Benahmed
- Académie Internationale de Médecine Dentaire Intégrative, Paris, France
- Université Claude Bernard, Lyon 1, Villeurbanne, France
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11
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Granero-Molina J, Torrente-Sánchez MJ, Ferrer-Márquez M, Hernández-Padilla JM, Sánchez-Navarro M, Ruiz-Muelle A, Ruiz-Fernández MD, Fernández-Sola C. Sexuality amongst heterosexual women with morbid obesity in a bariatric surgery programme: A qualitative study. J Adv Nurs 2021; 77:4537-4548. [PMID: 34252209 DOI: 10.1111/jan.14972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/20/2021] [Accepted: 06/27/2021] [Indexed: 11/29/2022]
Abstract
AIMS The objective of this study is to describe and understand the experiences of sexuality amongst heterosexual women with morbid obesity (MO) who are in a bariatric surgery program. BACKGROUND Morbid obesity is a chronic, metabolic disease that affects women's physical, psychological and sexual health. MO is associated with anxiety, depression and body image disorders. Bariatric surgery is a reliable method for weight loss in people with MO. DESIGN A qualitative descriptive study research design was adopted. METHODS Twenty-one heterosexual women with MO in a bariatric surgery program were recruited through purposive sampling. Data collection included individual semi-structured interviews conducted between November 2018 and May 2019. Interviews were audio recorded, transcribed verbatim and analysed using a computer-assisted qualitative data. FINDINGS Three main themes emerged from the analysis: (1) trapped in a body that limits my sexuality; (2) between neglect and hope and (3) the partner as a source of support for sexuality in women with MO. CONCLUSION Women hide a body that they do not accept and ignore their own sexuality, focusing on that of their partner. Although the women have doubts about their partners' desire for them, they share the decision-making process with them whilst waiting for bariatric surgery, on which they place all of their hopes for improved sexuality and quality of life. IMPACT The findings highlight the importance of exploring the experiences and sexual issues faced by heterosexual women with MO in a bariatric surgery program. Bariatric nurses have a privileged position to assess these women's sexuality, recommend alternatives to sexual intercourse or refer them to sexologists. As part of the multidisciplinary team, nurses can contribute to managing the expectations of women with MO and their partners in relation to the improvement of their sex lives following bariatric surgery.
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Affiliation(s)
- José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Santiago, Chile
| | | | - Manuel Ferrer-Márquez
- Bariatric Surgery Unit, Hospital HLA Mediterráneo, Almería, Spain.,Bariatric Surgery Unit, Hospital Universitario Torrecárdenas, Almería, Spain
| | - José Manuel Hernández-Padilla
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain.,Adult, Child and Midwifery Department, School of Health and Education, Middlesex University, London, UK
| | | | - Alicia Ruiz-Muelle
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain
| | | | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Santiago, Chile
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12
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Social Support for People with Morbid Obesity in a Bariatric Surgery Programme: A Qualitative Descriptive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126530. [PMID: 34204427 PMCID: PMC8297395 DOI: 10.3390/ijerph18126530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/18/2022]
Abstract
Background—Morbid obesity (MO) is a chronic metabolic disease affecting physical, psychological and social wellbeing. Bariatric surgery is a reliable method for losing weight in the long term, improving the quality of life, body image and social life of people with MO. Current literature recognises the importance of social support in controlling weight and coping with MO. The objective of this study was to describe and understand experiences related to social support for patients with MO included in a bariatric surgery programme. Methods—A qualitative descriptive study, where data collection included thirty-one interviews with people diagnosed with MO involved in a bariatric surgery programme. Results—Three main themes emerged from the analysis: (1) accepting the problem in order to ask for help, (2) the need for close support and (3) professional support: opposing feelings. Conclusions—A partner, family and friends are the key pillars of social support for those with MO included in a bariatric surgery programme. Healthcare professionals gave formal support; the bariatric surgery team provided information, trust and assurance. Nurses provided healthcare 24 h a day, making them the main formal support for people in the bariatric surgery programme.
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13
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Sherf-Dagan S, Sinai T, Goldenshluger A, Globus I, Kessler Y, Schweiger C, Ben-Porat T. Nutritional Assessment and Preparation for Adult Bariatric Surgery Candidates: Clinical Practice. Adv Nutr 2021; 12:1020-1031. [PMID: 33040143 PMCID: PMC8262552 DOI: 10.1093/advances/nmaa121] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/25/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022] Open
Abstract
Bariatric surgery (BS) has proven to be highly efficacious in the treatment of obesity and its comorbidities. However, careful patient selection is critical for its success. Thus, patients should undergo medical, behavioral, and nutritional assessment by a multidisciplinary team. From the nutritional point of view, BS candidates should undergo nutritional assessment, preparation, and education by a registered dietitian in the preoperative period. Currently, detailed specified and comprehensive information on these topics is lacking. The present narrative review aimed to summarize the available literature concerning both the preoperative nutritional assessment components and the preoperative nutritional preparation and education components of patients planning to undergo BS. Current literature indicates that proper management before BS should include a comprehensive nutritional assessment, in which it is advisable to perform a clinical interview to assess patients' medical background, weight management history, eating patterns and pathologies, oral health, physical activity habits, nutritional status, supplementation usage, BS knowledge, surgery expectations and anthropometric measurements. Nutritional preparation and educational strategies should include an individualized preoperative weight-loss nutrition program, improvement of glycemic control, micronutrients deficiencies correction, eating and lifestyle habits adaptation, physical activity initiation, and strengthening knowledge on obesity and BS. At this stage, more well-designed intervention and long-term cohort studies are needed in order to formulate uniform evidence-based nutritional guidelines for patients who plan to undergo BS, including populations at higher nutritional risk. Moreover, postoperative outcomes of presurgical nutritional intervention programs should be studied.
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Affiliation(s)
- Shiri Sherf-Dagan
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel
- Department of Nutrition, Assuta Medical Center, Tel Aviv, Israel
| | - Tali Sinai
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
- School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Ariela Goldenshluger
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, and Sylvan Adams Sports Institute, Tel-Aviv University, Tel Aviv, Israel
| | | | - Yafit Kessler
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel
- Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
| | - Chaya Schweiger
- Nutrition Service, Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel
| | - Tair Ben-Porat
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Ein-Kerem Campus, Jerusalem, Israel
- Department of Human Metabolism and Nutrition, Braun School of Public Health, Hebrew University, Jerusalem, Israel
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14
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Piché ME, Clavel MA, Auclair A, Rodríguez-Flores M, O'Connor K, Garceau P, Rakowski H, Poirier P. Early benefits of bariatric surgery on subclinical cardiac function: Contribution of visceral fat mobilization. Metabolism 2021; 119:154773. [PMID: 33838144 DOI: 10.1016/j.metabol.2021.154773] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/10/2021] [Accepted: 04/01/2021] [Indexed: 01/01/2023]
Abstract
AIMS We explored the early effects of bariatric surgery on subclinical myocardial function in individuals with severe obesity and preserved left ventricular (LV) ejection fraction. METHODS Thirty-eight patients with severe obesity [body mass index (BMI) ≥35 kg/m2] and preserved LV ejection fraction (≥50%) who underwent bariatric surgery (biliopancreatic diversion with duodenal switch [BPD-DS]) (Surgery group), 19 patients with severe obesity managed with usual care (Medical group), and 18 age and sex-matched non-obese controls (non-obese group) were included. Left ventricular global longitudinal strain (LV GLS) was evaluated with echocardiography speckle tracking imaging. Abnormal myocardial function was defined as LV GLS <18%. RESULTS Age of the participants was 42 ± 11 years with a BMI of 48 ± 8 kg/m2 (mean ± standard deviation); 82% were female. The percentage of total weight loss at 6 months after bariatric surgery was 26.3 ± 5.2%. Proportions of hypertension (61 vs. 30%, P = 0.0005), dyslipidemia (42 vs. 5%, P = 0.0001) and type 2 diabetes (40 vs. 13%, P = 0.002) were reduced postoperatively. Before surgery, patients with obesity displayed abnormal subclinical myocardial function vs. non-obese controls (LV GLS, 16.3 ± 2.5 vs. 19.6 ± 1.7%, P < 0.001). Six months after bariatric surgery, the subclinical myocardial function was comparable to non-obese (LV GLS, 18.2 ± 1.9 vs. 19.6 ± 1.7%, surgery vs. non-obese, P = NS). On the contrary, half of individuals with obesity managed medically worsened their myocardial function during the follow-up (P = 0.002). Improvement in subclinical myocardial function following bariatric surgery was associated with changes in abdominal visceral fat (r = 0.43, P < 0.05) and inflammatory markers (r = 0.45, P < 0.01), whereas no significant association was found with weight loss or change in insulin sensitivity (HOMA-IR) (P > 0.05). In a multivariate model, losing visceral fat mass was independently associated with improved subclinical myocardial function. CONCLUSIONS Bariatric surgery was associated with significant improvement in the metabolic profile and in subclinical myocardial function. Early improvement in subclinical myocardial function following bariatric surgery was related to a greater mobilization of visceral fat depot, linked to global fat dysfunction and cardiometabolic morbidity.
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Affiliation(s)
- Marie-Eve Piché
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada; Faculty of Medicine, Laval University, Québec, Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada; Faculty of Medicine, Laval University, Québec, Canada
| | - Audrey Auclair
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | - Marcela Rodríguez-Flores
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico
| | - Kim O'Connor
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada; Faculty of Medicine, Laval University, Québec, Canada
| | - Patrick Garceau
- Faculty of Medicine, Montreal University, Montréal, Canada; Institut de Cardiologie de Montréal, Montréal, Canada
| | | | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada; Faculty of Pharmacy, Laval University, Québec, Canada.
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15
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Kindel TL, Ganga RR, Baker JW, Noria SF, Jones DB, Omotosho P, Volckmann ET, Williams NN, Telem DA, Petrick AT, Gould JC. American Society for Metabolic and Bariatric Surgery: Preoperative Care Pathway for Laparoscopic Roux-en-Y Gastric Bypass. Surg Obes Relat Dis 2021; 17:1529-1540. [PMID: 34148848 DOI: 10.1016/j.soard.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Tammy L Kindel
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Rama Rao Ganga
- Department of Surgery, University of Missouri, Columbia, Missouri
| | - John Wilder Baker
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Sabrena F Noria
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Daniel B Jones
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Philip Omotosho
- Department of Surgery, Rush Medical College, Chicago, Illinois
| | - Erick T Volckmann
- Department of Surgery, University of Utah and Affiliated Hospitals, Salt Lake City, Utah
| | - Noel N Williams
- Department of Surgery; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dana A Telem
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Anthony T Petrick
- Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Jon C Gould
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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16
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Arboleda S, Pianeta R, Vargas M, Lafaurie GI, Aldana-Parra F, Chaux CF. Impact of bariatric surgery on periodontal status in an obese cohort at one year of follow-up. MEDICINE INTERNATIONAL 2021; 1:4. [PMID: 36699146 PMCID: PMC9855275 DOI: 10.3892/mi.2021.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/10/2021] [Indexed: 01/28/2023]
Abstract
The effect of weight loss on the periodontal condition remains unclear. The present prospective study thus aimed to evaluate the effect of weight loss on the periodontal status of 57 obese patients (BMI ≥30 kg/m2) with ages ranging from 18 to 60 years, at 12 months following bariatric surgery. Demographic, biological and behavioral variables were analyzed. All participants underwent a periodontal examination, including plaque index (PI), bleeding on probing (BOP), pocket depth (PD) and clinical attachment level (CAL). Anthropometric measurements, such as weight, height and body mass index (BMI) were calculated. Fisher's exact test, ANOVA, Bonferroni, Spearman's rank correlation and Wilcoxon signed-rank tests were used for the statistical analysis (P<0.05). Prior to surgery, 49% of patients were classified as having obesity class I, 33% as obesity class II and 18% as obesity class III. Variables, such as BMI and PD exhibited statistically significant differences among the obesity class I, II and III groups (P<0.05). As regards periodontal diagnosis, 37% of patients were classified as having gingivitis, 46% as having periodontitis stages I-II, and 17% as having periodontitis stages III-IV. BMI, PI, BOP and PD exhibited statistically significant differences following bariatric surgery (P<0.0001). No statistically significant differences were observed in the CAL (P>0.05). Thus, the findings of the present study suggest that weight loss was associated with decreased periodontal inflammation and an improved plaque control following bariatric surgery. CAL remained unaltered during the study period.
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Affiliation(s)
- Silie Arboleda
- School of Dentistry, Unit of Clinical Oral Epidemiology Investigations-UNIECLO, El Bosque University, Bogotá 110121, Colombia
| | - Roquelina Pianeta
- School of Dentistry, Rafael Núñez University Corporation, Cartagena 130001, Colombia
| | - Miguel Vargas
- School of Dentistry, Unit of Clinical Oral Epidemiology Investigations-UNIECLO, El Bosque University, Bogotá 110121, Colombia
| | - Gloria Inés Lafaurie
- School of Dentistry, Unit of Basic Oral Investigation-UIBO, El Bosque University, Bogotá 110121, Colombia
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17
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Toman D, Vavra P, Jelinek P, Ostruszka P, Ihnat P, Foltys A, Pelikan A, Roman J. Effect of bariatric surgery on fatty liver disease in obese patients: A prospective one year follow-up study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 166:195-203. [PMID: 33885048 DOI: 10.5507/bp.2021.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/07/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD), often associated with obesity and metabolic syndrome, manifests itself as steatosis, hepatic fibrosis, cirrhosis, or even end-stage liver disease. NAFLD causes inflammation, insulin resistance and cardiovascular complications. The current study aimed to evaluate the beneficial effects of bariatric surgery on biochemical parameters of hepatic functions in obese patients by comparing them before and one-year after the surgery. METHODS A total of 72 morbidly obese patients underwent bariatric surgery between 2016 and 2018. The incidence of diabetes mellitus in this group was 29%, median body weight was 124.5 kg (109.0-140.0) and mean body mass index (BMI) was 44.38 ± 6.770 kg/m2. The used surgical procedures included gastric bypass, sleeve gastrectomy, laparoscopic gastric plication, and single anastomosis duodeno-ileal bypass-sleeve gastrectomy. Biochemical parameters including ALT/AST ratio (AAR), NAFLD fibrosis score (NFS), hepatic fibrosis index (FIB-4) and Fatty Liver Index (FLI) were evaluated in all patients at the time of surgery and one year after the intervention. RESULTS Significant improvement after the intervention was observed in 64 patients. A significant reduction in body weight (P<0.0001), waist circumference (P<0.0001), and body mass index (P<0.0001) were observed. NAFLD liver fibrosis index changed significantly (P<0.0001), suggesting a trend of improvement from advanced fibrosis towards stages 0-2. The FIB-4 fibrosis index indicated significant improvement (P=0.0136). Besides, a significant decline in hepatic steatosis (P<0.0001) was observed after bariatric surgery as compared to the pre-surgery fatty liver conditions. CONCLUSION Among the strategies to overcome NAFLD-associated impediments, bariatric surgery can be considered effective in reducing obesity and metabolic co-morbidities. TRIAL REGISTRATION ClinicalTrials.gov (NCT04569396).
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Affiliation(s)
- Daniel Toman
- Department of Surgery, Faculty of Medicine, Ostrava University, Czech Republic.,Department of Surgery, University Hospital Ostrava, Czech Republic
| | - Petr Vavra
- Department of Surgery, Faculty of Medicine, Ostrava University, Czech Republic.,Department of Surgery, University Hospital Ostrava, Czech Republic
| | - Petr Jelinek
- Department of Surgery, Faculty of Medicine, Ostrava University, Czech Republic.,Department of Surgery, University Hospital Ostrava, Czech Republic
| | - Petr Ostruszka
- Department of Surgery, Faculty of Medicine, Ostrava University, Czech Republic.,Department of Surgery, University Hospital Ostrava, Czech Republic
| | - Peter Ihnat
- Department of Surgery, Faculty of Medicine, Ostrava University, Czech Republic.,Department of Surgery, University Hospital Ostrava, Czech Republic
| | - Ales Foltys
- Department of Surgery, Faculty of Medicine, Ostrava University, Czech Republic.,Department of Surgery, University Hospital Ostrava, Czech Republic
| | - Anton Pelikan
- Department of Surgery, Faculty of Medicine, Ostrava University, Czech Republic.,Department of Surgery, University Hospital Ostrava, Czech Republic.,Department of Surgery, St. Mary's Hospital, Newport, Isle of Wight, United Kingdom.,Department of Health Care Sciences, Faculty of Humanities, Tomas Bata University Zlin, Czech Republic
| | - Jan Roman
- Department of Surgery, Faculty of Medicine, Ostrava University, Czech Republic.,Department of Surgery, University Hospital Ostrava, Czech Republic
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18
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Grilo CM, Ivezaj V, Duffy AJ, Gueorguieva R. Randomized Controlled Trial of Treatments for Loss-of-Control Eating Following Bariatric Surgery. Obesity (Silver Spring) 2021; 29:689-697. [PMID: 33694287 PMCID: PMC7995173 DOI: 10.1002/oby.23124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/15/2020] [Accepted: 12/23/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Loss-of-control (LOC) eating postoperatively is a consistent predictor of suboptimal longer-term bariatric surgery outcomes. This randomized controlled trial examined the effectiveness of two guided self-help treatments (cognitive behavioral therapy [gshCBT] and behavioral weight loss [gshBWL]) compared with a control (CON) for reducing LOC eating and weight. METHODS A total of 140 patients with recurrent LOC eating approximately 6 months after bariatric surgery were randomly assigned (5:5:2 ratio) to one of three conditions: gshCBT (n = 56), gshBWL (n = 60), or CON (n = 24). Three-month treatments were delivered by trained allied health clinicians to increase generalizability to bariatric surgery settings. Independent assessments were performed by doctoral research-clinicians using established interviews/measures; posttreatment outcomes were obtained for 89% of patients. RESULTS Mixed models revealed significant improvements for LOC eating frequency and weight loss but no significant differences between treatments; race neither predicted (main effect) nor moderated (interaction effect) treatment outcomes. Intent-to-treat categorical analyses of abstinence from LOC eating (30% for gshCBT, 27% for gshBWL, 38% for CON) and proportion attaining 5% weight loss (20%, 22%, 17%) revealed no significant differences between treatments; non-White participants had a higher proportion achieving LOC eating abstinence but a lower proportion attaining 5% weight loss compared with White participants. CONCLUSIONS In this 12-week randomized controlled trial following bariatric surgery, significant LOC eating reductions and weight loss did not differ significantly between treatments. Race was associated with posttreatment categorical outcomes.
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Affiliation(s)
- Carlos M. Grilo
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
- Yale University, Department of Psychology, New Haven, CT, USA
| | - Valentina Ivezaj
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Andrew J Duffy
- Yale School of Medicine, Department of Surgery, New Haven, CT, USA
| | - Ralitza Gueorguieva
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
- Yale School Public Health, Department of Biostatistics, New Haven, CT, USA
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19
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Alimoğulları M, Buluş H. Effectiveness of ursodeoxycholic acid treatment in the prevention of gallstone formation after laparoscopic sleeve gastrectomy. Acta Chir Belg 2021; 121:109-114. [PMID: 33252027 DOI: 10.1080/00015458.2020.1857569] [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] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bariatric surgery is a critical risk factor for cholelithiasis. This study aimed to investigate the role of treatment with ursodeoxycholic acid (UDCA) in the prevention of gallstone formation after laparoscopic sleeve gastrectomy (SG) in morbidly obese patients. METHODS Patients who underwent SG for morbid obesity from January 2016 to September 2016 were evaluated. Patients without hepatobiliary disorders were included. Patients were divided into two groups based on whether they did (Group I) or did not receive treatment with UDCA (Group II). Indication for UDCA treatment was symptomatic alkaline reflux. Demographic characteristics, comorbid diseases, preoperative blood parameters, early and late period weight loss rates, and gallstone development were monitored and compared between the groups. RESULTS Ninety-six of 155 patients met the inclusion criteria. Group I and II included 49 and 47 patients, respectively. The mean age was 39.1 ± 10.8 (range 18-69) years and the mean follow-up period was 20.75 ± 6.6 (range 12-34) months. Gallstone formation was significantly lower in Group I compared to Group II [5 patients (10.2%) vs. 21 patients (44.6%), p<.001]. Moreover, the absence of UDCA treatment was independently and significantly associated with gallstone formation (hazard ratio: 3.08; 95% confidence interval: 1.73-5.50; p<.001) in multivariate analyses. There was no difference in weight loss rates between the two groups at the early or late periods. CONCLUSIONS Treatment with UDCA seems to be effective in the prevention of gallstone formation after sleeve gastrectomy. Furthermore, early and late period weight loss rates were not found to have significant effects on the risk of cholelithiasis.
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Affiliation(s)
- Mustafa Alimoğulları
- Department of General Surgery, University of Medical Sciences Keçiören Training and Research Hospital, Ankara, Turkey
| | - Hakan Buluş
- Department of General Surgery, University of Medical Sciences Keçiören Training and Research Hospital, Ankara, Turkey
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Dalboh A, Al-Shehri DM, Abd El Maksoud WM, Abbas KS, Alqahtani AJ, Al-Malki AQ, Al-Shahrani KA. Impact of Laparoscopic Sleeve Gastrectomy on Gastroesophageal Reflux Disease and Risk Factors Associated with Its Occurrence Based Upon Quality of Life. Obes Surg 2021; 31:3065-3074. [PMID: 33779876 DOI: 10.1007/s11695-021-05347-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/06/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND To assess the impact of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) symptoms and to determine factors associated with the occurrence of post-LSG GERD symptoms. MATERIAL AND METHODS This is a retrospective study that included all obese patients who underwent LSG in Aseer Central Hospital, during the period from August 2017 to August 2019. GERD-Health-Related Quality of Life questionnaire was used to assess the patients' pre- and postoperative GERD symptoms and their satisfaction toward their general health. RESULTS The study included 326 patients (195 males and 131 females) with a mean age of 39.43 ± 11.17 years. Postoperatively, GERD symptoms newly developed in 105 patients (32.2%), while 25 patients out of 127 with preoperative GERD symptoms (19.69%) showed resolution of symptoms. There were significant associations (p < 0.001) between the old age, smoking and existence of comorbidities, and the occurrence of postoperative heartburn and regurgitation symptoms. Postoperatively, excess weight loss (EWL) was significantly associated with postoperative regurgitation (p = 0.045) and patients showed significant improvement in their satisfaction toward their health condition even those who developed GERD symptoms. CONCLUSIONS After LSG, GERD symptoms developed in about one-third of the patients while symptoms improved in only one-fifth of patients. Older patients, smokers, patients with comorbidities, and patients with more EWL had significantly worse GERD symptoms postoperatively. Weight loss rather than GERD symptoms significantly influenced patients' satisfaction toward their general health. Further prospective studies are needed to determine the relationship between weight loss and other factors associated with post-LSG reflux and overall quality of life.
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Affiliation(s)
- Abdullah Dalboh
- Surgery Department, Faculty of Medicine, King Khalid University, P.O.: 641, Abha, 61421, Saudi Arabia
| | - Dafer M Al-Shehri
- General Surgery Department, Aseer Central Hospital, Abha, Saudi Arabia
| | - Walid M Abd El Maksoud
- Surgery Department, Faculty of Medicine, King Khalid University, P.O.: 641, Abha, 61421, Saudi Arabia.
| | - Khaled S Abbas
- Surgery Department, Faculty of Medicine, King Khalid University, P.O.: 641, Abha, 61421, Saudi Arabia
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8. Obesity Management for the Treatment of Type 2 Diabetes: Standards of Medical Care in Diabetes-2021. Diabetes Care 2021; 44:S100-S110. [PMID: 33298419 DOI: 10.2337/dc21-s008] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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[Effect of eating speed modification techniques and strategies on food or energy intake: a systematic review and meta-analysis]. NUTR HOSP 2021; 38:631-644. [PMID: 33840198 DOI: 10.20960/nh.03467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Scientific evidence indicates that eating slowly reduces food and energy intake. However, few investigations have studied the effect of techniques and strategies that modify eating speed on intake. The objective of this study is to analyze the relationship between these techniques and food and/or energy intake. Therefore, a systematic review of 15 human studies and a meta-analysis of 7 studies with 11 experimental and 1 observational manipulations were carried out. Only the results of two conditions were included, "slow" vs. "fast" of eating speed and ingestion. The estimation of the effect was expressed in OR with a 95 % CI under a random effects model, and heterogeneity was assessed with I2. Publication bias was also assessed with a funnel plot and Egger's linear regression test. The results indicate that eating slowly is a protective factor (OR = 0.73) from excessive intake. Additionally, eating small bites with a small spoon (OR = 0.315), serving food preparations on separate plates (OR = 0.860 and OR = 0.831), using a vibrotactile feedback fork (OR = 0.847), and eating hard-textured foods (OR = 0.831) are the techniques and strategies that modify eating speed and decrease food or energy intake. The present study confirms the premise that eating slowly can reduce excessive food and energy intake.
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Complications nutritionnelles de la chirurgie de l’obésité : prévalence, prévention, traitement. Revue systématique de littérature. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Assakran BS, Widyan AM, Alhumaidan NA, Alharbi FA, Alhnaya MA, Aljabali AA, Aleid MA. Dietary assessment and patient-perspective reasons for poor adherence to diet and exercise post bariatric surgery. BMC Res Notes 2020; 13:526. [PMID: 33176857 PMCID: PMC7659172 DOI: 10.1186/s13104-020-05373-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/31/2020] [Indexed: 12/03/2022] Open
Abstract
Objective Obesity prevalence is increasing, and as an outcome, bariatric procedures are on the rise. Previous articles about bariatric surgery disclosed tremendous results. This study aims to assess eating patterns and identify the reasons behind poor adherence to diet and exercise in postbariatric patients. Results According to the questionnaire used, the majority (85.5%) of our patients scored “good”, 12% scored “fair”, and only 2% scored “excellent”. None scored “needs improvement”. Fruits had a mean consumption of 1.51 ± 0.79 and vegetables 1.78 ± 0.76. The main reasons for patient nonadherence to healthy eating were low self-discipline (48%), lack of motivation (28%), and availability of healthy food and being too busy to prepare healthy meals, both at 25%. Additionally, 55.9% of the study subjects engaged in physical activity. Lack of time (47%), low self-discipline (38%), and weather (32%) were the primary reasons for not exercising regularly.
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Affiliation(s)
- Bandar Saad Assakran
- Bariatric Division, General Surgery Department, King Fahd Specialist Hospital, Alnaziyah, P.O. Box 2290, Buraidah, Qassim, 52366, Saudi Arabia.
| | - Adel Mefleh Widyan
- Mathematics Department, College of Science, Qassim University, Buraidah, Qassim, Saudi Arabia
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El Ansari W, El-Ansari K. Missing something? A scoping review of venous thromboembolic events and their associations with bariatric surgery. Refining the evidence base. Ann Med Surg (Lond) 2020; 59:264-273. [PMID: 33133579 PMCID: PMC7588328 DOI: 10.1016/j.amsu.2020.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/09/2020] [Accepted: 08/09/2020] [Indexed: 11/01/2022] Open
Abstract
Background Venous thromboembolic events (VTE) post-bariatric surgery (BS) lead to morbidity and mortality. Methods This scoping review assessed whether reported VTE post-BS could be under/over-estimated; suggested a possible number of VTE post-BS; appraised whether VTE are likely to decrease/increase; examined BS as risk/protective factor for VTE; and mapped the gaps, proposing potential solutions. Results VTE appears under-estimated due to: identification/coding of BS and VTE; reporting of exposure (BS); and reporting of outcomes (VTE). The review proposes a hypothetical calculation of VTE post-BS. VTE are unlikely to decrease soon. BS represents risk and protection for VTE. Better appreciation of VTE-BS relationships requires longer-term strategies. Conclusion VTE are underestimated. Actions are required for understanding the VTE-BS relationships to in order to crease VTE by better-informed prevention strategy/ies.
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Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad General Hospital, 3050, Doha, Qatar.,College of Medicine, Qatar University, Doha, Qatar.,Schools of Health and Education, University of Skovde, Skövde, Sweden
| | - Kareem El-Ansari
- Volunteer, Hamad General Hospital, Hamad Medical Corporation, 3050, Doha, Qatar
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Moore JM, Glover JJ, Jackson BM, Coughlin CR, Kelsey MM, Inge TH, Boles RE. Development and application of an ethical framework for pediatric metabolic and bariatric surgery evaluation. Surg Obes Relat Dis 2020; 17:425-433. [PMID: 33191162 DOI: 10.1016/j.soard.2020.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/16/2020] [Accepted: 09/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND As severe obesity continues to rise among youth, metabolic and bariatric surgery (MBS) will increasingly be used as a treatment of choice for durable weight loss and improvement of obesity-related complications. MBS for youth with intellectual and developmental disabilities (IDD) and for preadolescents has raised ethical questions. OBJECTIVES The purpose of this article is to present the creation and application of an ethical framework that supports why MBS should be considered in pediatrics based on the principle of justice without automatic exclusions. This framework also provides a guide for how to conduct a robust, ethically grounded evaluation of pediatric patients presenting for MBS in general, and among subpopulations including youth with IDD and preadolescents. SETTING Academic medical center, United States. METHODS An ethical framework was developed and applied through a collaboration between an MBS center at a children's hospital and the institution's ethics consult service. RESULTS Application of the ethical framework to address 4 core ethical questions is illustrated using 2 hypothetical cases: 1 that highlights an adolescent with IDD and 1 that highlights a preadolescent. CONCLUSIONS We have demonstrated the application of a novel, overarching framework to conduct the ethical evaluation of youth presenting for MBS. This framework resulted from a collaboration between MBS and ethics consult teams and has the potential to be used as a prototype for other youth-focused MBS programs. Next steps include prospective data collection to test the framework and determine its validity in the target population.
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Affiliation(s)
- Jaime M Moore
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado.
| | - Jacqueline J Glover
- Department of Pediatrics, Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora, Colorado
| | - Brian M Jackson
- Department of Pediatrics, Section of Pediatric Critical Care, Center for Bioethics and Humanities, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Curtis R Coughlin
- Department of Pediatrics, Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora, Colorado
| | - Megan M Kelsey
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Thomas H Inge
- Department of Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Richard E Boles
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
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The Metabolic Effects of Pre-probiotic Supplementation After Roux-en-Y Gastric Bypass (RYGB) Surgery: a Prospective, Randomized Controlled Study. Obes Surg 2020; 31:215-223. [PMID: 32803709 DOI: 10.1007/s11695-020-04894-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/25/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Following Roux-en-Y gastric bypass (RYGB), positive alterations are observed in gut microbiota and intestinal peptides. Previous studies demonstrated similar alterations observed in cases when pre-probiotics are used without surgery. The aim of this trial was to evaluate the effectiveness of early use of pre-probiotics after RYGB. MATERIAL AND METHODS The operation and follow-up of the patients were performed at Istanbul University Medical Faculty. Thirty-two patients who had undergone RYGB were randomized to pre-probiotic group (PreProBG, n = 16; 200 g/day yogurt plus 10 g/day inulin+oligofructose) and probiotic group (ProBG, n = 16; 200 g/day yogurt only) for 6 months. Blood samples (glucose, insulin, A1c, GLP-1, PYY), anthropometric measurements, and appetite ratings have been evaluated at baseline and 3 (m3) and 6 (m6) months after RYGB. RESULTS Initial anthropometric measurements and appetite ratings decreased significantly after surgery and there were no significant differences between the groups. The decrease of area under the curve(insulin) was less and has a positive correlation with the changes in anthropometric measurements in PreProBG. GLP-1 and PYY which increased dramatically after surgery in all patients were higher in PreProBG. But this increase had a negative correlation with the changes in anthropometric measurements during the study. CONCLUSION Increased insulin, GLP-1, and PYY secretion was more enhanced by pre-probiotic use in early postoperative period. But this increase not only in anthropometric measurements but also in appetite ratings affects negatively, contrary to expectations. In summary, it should be investigated with new studies that use of pre-probiotics in the late postoperative period may be more effective in patients with weak insulin and incretin response and therefore insufficient weight loss. Trial Registration clinicaltrials.gov Identifier: NCT03517345.
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Raatz SK, Johnson LK, Caliquary A, King WC, Kalarchian MA, Devlin MJ, Marcus MD, Mitchell JE. Reported nutrient intake over 7 years after Roux-en-Y gastric bypass in the Longitudinal Assessment of Bariatric Surgery-3 (LABS-3) psychosocial study. Surg Obes Relat Dis 2020; 16:1022-1029. [PMID: 32418771 PMCID: PMC7423730 DOI: 10.1016/j.soard.2020.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/19/2020] [Accepted: 04/08/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bariatric surgery is the most effective therapy for severe obesity. It reduces gastric capacity and may modify regulation of appetite, satiety, insulin, and other physiologic processes, resulting in weight loss. OBJECTIVE Long-term data on postsurgical nutrient intake are lacking. SETTING The Longitudinal Assessment of Bariatric Surgery-3 psychosocial study. METHODS Reported dietary intake was assessed in a subset of participants (n = 72) of the Longitudinal Assessment of Bariatric Surgery-3 psychosocial study who underwent Roux-en-Y gastric bypass surgery. Two 24-hour diet recalls at presurgery and annual assessments over 7 years were obtained. Reported diets were evaluated for energy, macro- and micronutrient intake, and assessed for adequacy by comparison to the dietary reference intakes. RESULTS After surgery, reported intake of total energy, and all macronutrients were significantly reduced. At least a quarter of participants reported protein intake below the recommended dietary allowance. Over half of participants reported intake of several vitamins (C, D, A, E, thiamin, folate) and minerals (zinc, calcium) below recommended levels over 7 years. Compared with presurgery, reported energy intake was reduced over 7 years. This study was registered at ClinicalTrials.gov as NCT02495142. CONCLUSIONS The reduction in energy resulted in intakes below the dietary reference intakes for many micronutrients among the majority of participants and below the recommended dietary allowance for protein in a substantial subgroup. These data support continued long-term nutrition education, monitoring, and supplementation.
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Affiliation(s)
- Susan K Raatz
- Department of Food Science and Nutrition, University of Minnesota, Saint Paul, Minnesota.
| | - LuAnn K Johnson
- Division of Research and Economic Development, University of North Dakota, Grand Forks, North Dakota
| | | | - Wendy C King
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | | | - Michael J Devlin
- Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York
| | - Marsha D Marcus
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Tabesh MR, Maleklou F, Ejtehadi F, Alizadeh Z. Nutrition, Physical Activity, and Prescription of Supplements in Pre- and Post-bariatric Surgery Patients: a Practical Guideline. Obes Surg 2020; 29:3385-3400. [PMID: 31367987 DOI: 10.1007/s11695-019-04112-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
According to ASMBS, the rate of bariatric surgery increased from 158,000 in 2011 to 196,000 in 2015. Nevertheless, this growth in invasive techniques does not eliminate unhealthy habits, so lifestyle modification such as healthy nutrition and correct physical activity programs may improve surgical results. The objective of the present narrative review was to categorize the guidelines related to nutrition, physical activity, and supplement prescription before and after bariatric surgery. The main key words including nutrition, diet, physical activity, exercise, supplements, macronutrients, micronutrients, weight reduction, bariatric surgery, Roux-en-Y gastric bypass, sleeve gastrostomy, laparoscopic adjustable gastric banding, and biliopancreatic diversion with duodenal switch were searched in databases including PubMed/Medline, Cochrane, and some other sources such as Google scholar. The recommendations are classified based on the type of surgery. The indications for surgery and the type of bariatric surgery are not included in this review. This review helps medical teams, including bariatric surgeons, nutritionists, and sports medicine specialists, with proper management before and after bariatric surgery.
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Affiliation(s)
| | - Faezeh Maleklou
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ejtehadi
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Alizadeh
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, No. 7, Ale-ahmad Highway, Opposite of the Shariati Hospital, Tehran, 14395-578, Iran.
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Freire CC, Zanella MT, Arasaki CH, Segal A, Carneiro G. Binge eating disorder is not predictive of alcohol abuse disorders in long-term follow-up period after Roux-en-Y gastric bypass surgery. Eat Weight Disord 2020; 25:637-642. [PMID: 30859463 DOI: 10.1007/s40519-019-00663-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 02/26/2019] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Some studies have shown an increase in alcohol use disorders (AUD) after Roux-en-Y gastric bypass surgery (RYGB), but its relationship with binge eating disorder (BED) has not been fully explored. The purpose of this study was to determine the prevalence of AUD and BED after RYGB and also to evaluate if BED is predictive of late postoperative occurrence of AUD or BED. METHODS Patients (n = 46) submitted to RYGB, in a tertiary outpatient weight management service at a Federal University of Sao Paulo, Brazil, were tested for BED and AUD using the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) and AUDIT, respectively. BED was tested before surgery, while both disorders were evaluated with a follow-up period of 12 ± 1.6 years after RYGB. RESULTS No patients reported AUD before RYBP. After a mean period of 12 years from surgery, ten patients (21.7%) were diagnosed with AUD. Before surgery, BED was present in 24 patients (52.2%) and it was detected in seven out of these 24 patients (29.2%) after RYGB. Thirteen new cases of BED (28.2%) were detected after surgery; total of 20 patients (43.5%) with BED. No association was found between pre- and postsurgery BED (p = 0.148). After RYGB, four out of 24 patients (16.6%) with presurgery BED developed AUD, and no association was found between presurgery BED and postsurgery AUD (p = 0.384). Seven out of ten patients (70%) with AUD after RYGB also developed BED, but no statistical significance was found between these two disorders (p = 0.061). CONCLUSION The presence of BED before RYGB did not predict AUD and BED after RYGB. Nevertheless, factors involved in a possible association between BED and AUD after surgery remain to be determined. LEVEL OF EVIDENCE Level III, cohort study.
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Affiliation(s)
- Cristina Cardoso Freire
- Department of Medicine, Division of Endocrinology and metalolism, Universidade Federal de São Paulo, End: Street Leandro Duprat, 365, São Paulo, 04025-010, Brazil.
| | - Maria Teresa Zanella
- Department of Medicine, Division of Endocrinology and metalolism, Universidade Federal de São Paulo, End: Street Leandro Duprat, 365, São Paulo, 04025-010, Brazil
| | - Carlos Haruo Arasaki
- Department of Surgery, Division of Surgical Gastroenterology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Adriano Segal
- Adriano Segal, Department of Medicine, Obesity and metabolic syndrome outpatient service, Universidade de São Paulo, São Paulo, Brazil
| | - Gláucia Carneiro
- Department of Medicine, Division of Endocrinology and metalolism, Universidade Federal de São Paulo, End: Street Leandro Duprat, 365, São Paulo, 04025-010, Brazil
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Alwasaidi TA, Alahmadi DK, Alrufayi BM, Alaofi RK, Almutairi SR. Determining the prevalence and causes of anaemia in patients after bariatric surgery in a Saudi hospital. J Taibah Univ Med Sci 2020; 15:129-135. [PMID: 32368209 PMCID: PMC7184217 DOI: 10.1016/j.jtumed.2020.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 11/02/2022] Open
Abstract
Objectives Obesity is a chronic disease with high prevalence in Saudi population. Bariatric surgery is an effective method for significant weight reduction. However, various types of nutritional deficiencies occur after weight loss surgery which increase the risk of anaemia. In this study, we aimed to determine the incidence of anaemia after bariatric surgery. Method A retrospective descriptive study was conducted with 70 patients of both genders aged over 16 years. These patients underwent bariatric surgery between February 2016 and March 2018 and had completed 6 months or more of post-surgery follow-up. Anthropometric and laboratory data were obtained before and after surgery at standard time intervals. All patients were on postoperative vitamin supplements. Results Of the total study patients, 41 were women (58.57%) and 29 were men (41.42%) with a median age of 38.5 years (range, 16-65). The median follow-up time was 8 months (6-24 months). Postoperatively, 16 patients (22.9%) developed anaemia, and interestingly, all of them were women (39%). Fifteen of these sixteen patients (93.8%) had microcytic anaemia. Two of those sixteen patients (12.5%) had Roux-en-Y gastric bypass, while fourteen (87.5%) had sleeve gastrectomy. Conclusion Anaemia and its related nutritional deficiencies are a common complication after bariatric surgery which exerts a major impact on health, particularly in women. Hence, a strict post-operative follow-up and appropriate supplementation are recommended to combat anaemia and its related nutritional deficiencies.
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Affiliation(s)
- Turki A Alwasaidi
- Medicine Department, College of Medicine, Taibah University, Almadinah Almunawwarah, KSA
| | - Duha K Alahmadi
- College of Medicine, Taibah University, Almadinah Almunawwarah, KSA
| | | | - Rawan K Alaofi
- College of Medicine, Taibah University, Almadinah Almunawwarah, KSA
| | - Saad R Almutairi
- Hematology Division, Medicine Department, Prince Mohammed Bin Abdulaziz Hospital, Ministry National Guard - Health Affairs, Almadinah Almunawwarah, KSA
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Hewitt S, Kristinsson J, Aasheim ET, Blom-Høgestøl IK, Aaseth E, Jahnsen J, Eriksen EF, Mala T. Relationships Between Vitamin D Status and PTH over 5 Years After Roux-en-Y Gastric Bypass: a Longitudinal Cohort Study. Obes Surg 2020; 30:3426-3434. [PMID: 32306297 PMCID: PMC7378105 DOI: 10.1007/s11695-020-04582-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Purpose Secondary hyperparathyroidism (SHPT) after obesity surgery may affect bone health. Optimal vitamin D levels have not been established to prevent SHPT postoperatively. We investigated whether SHPT differed across threshold levels of serum 25-hydroxyvitamin D (S-25(OH)D) from 6 months up to 5 years after Roux-en-Y gastric bypass (RYGB). Materials and Methods We included 554 patients at follow-up 5 years postoperatively. Blood samples were analysed for S-25(OH)D, ionized calcium (iCa) and parathyroid hormone (PTH) during follow-up. Results PTH and prevalence of SHPT increased from 6 months to 5 years postoperatively, while S-25(OH)D and iCa decreased (all P < 0.001). PTH and SHPT development are related with S-25(OH)D, and PTH differed between all subgroups of S-25(OH)D. SHPT occurred less frequently across all subgroups of S-25(OH)D ≥ 50 nmol/l during follow-up: odds ratio (OR) 0.44 (95% CI 0.36–0.54) in patients with S-25(OH)D ≥ 50 nmol/l, OR 0.38 (0.30–0.49) with S-25(OH)D ≥ 75 nmol/l and OR 0.19 (0.12–0.31) with S-25(OH) D ≥ 100 nmol/l, all compared with S-25(OH)D < 50 nmol/l. At 5 years, 208/554 patients (38%) had SHPT; SHPT was found in 94/188 patients (50%) with S-25(OH)D < 50 nmol/l, in 69/222 (31%) with S-25(OH)D 50–74 nmol/l, in 40/117 (34%) with S-25(OH)D 75–99 nmol/l and in 5/27 (19%) with S-25(OH)D ≥ 100 nmol/l. An interaction existed between S-25(OH)D and iCa. Bone alkaline phosphatase remained increased with SHPT. Conclusions A significant relationship existed between S-25(OH)D and development of PTH and SHPT. The prevalence of SHPT was lower with threshold levels 25(OH)D ≥ 50 nmol/l and ≥ 75 nmol/l over the 5 years, and lowest with S-25(OH)D ≥ 100 nmol/l. Electronic supplementary material The online version of this article (10.1007/s11695-020-04582-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephen Hewitt
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital HF, Aker, P.O. Box 4950 Nydalen, 0424, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, 0450, Oslo, Norway.
| | - Jon Kristinsson
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital HF, Aker, P.O. Box 4950 Nydalen, 0424, Oslo, Norway.,Department of Gastrointestinal Surgery, Oslo University Hospital, P.O. Box 4950, Nydalen, 0407, Oslo, Norway
| | - Erlend Tuseth Aasheim
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital HF, Aker, P.O. Box 4950 Nydalen, 0424, Oslo, Norway.,Department of Global Health and Documentation, Norwegian Directorate of Health, P.O. Box 220, Skøyen, 0213, Oslo, Norway
| | - Ingvild Kristine Blom-Høgestøl
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital HF, Aker, P.O. Box 4950 Nydalen, 0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, 0450, Oslo, Norway
| | - Eirik Aaseth
- Department of Medicine, Innlandet Hospital Trust, Elverum, Norway
| | - Jørgen Jahnsen
- Institute of Clinical Medicine, University of Oslo, 0450, Oslo, Norway.,Department of Gastroenterology, Akershus University Hospital, 1474, Lørenskog, Norway
| | - Erik Fink Eriksen
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital HF, Aker, P.O. Box 4950 Nydalen, 0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, 0450, Oslo, Norway
| | - Tom Mala
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital HF, Aker, P.O. Box 4950 Nydalen, 0424, Oslo, Norway.,Department of Gastrointestinal Surgery, Oslo University Hospital, P.O. Box 4950, Nydalen, 0407, Oslo, Norway
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Association Between Self-Reported Eating Rate, Energy Intake, and Cardiovascular Risk Factors in a Multi-Ethnic Asian Population. Nutrients 2020; 12:nu12041080. [PMID: 32295057 PMCID: PMC7230501 DOI: 10.3390/nu12041080] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 12/26/2022] Open
Abstract
Eating faster is associated with greater body mass index (BMI), but less is known about the relationships between eating rate, energy intake, body composition, and cardio-metabolic risk factors in different Asian ethnic groups. Using data from the Singapore Multi-Ethnic Cohort (n = 7011; 21-75 y), we investigated associations between self-reported eating rate (SRER), with energy intake, body composition, blood pressure, and blood lipids. SRER and lifestyle was assessed using interviewer-administered questionnaires. Multivariable models were used to examine the associations of SRER with energy intake, body composition, blood pressure, and blood lipids after adjusting for covariates. General and abdominal overweight were defined as BMI ≥ 23 kg/m2 and waist circumference > 90cm (men) and > 80cm (women), respectively. On average, faster eaters (vs. slower eaters) consumed 105kcal/day more (p = 0.034), had ~5kg higher body weight (p < 0.001), 1.3 kg/m2 higher BMI (p < 0.001), and 3.1cm larger waist-circumference (p < 0.001). Faster eaters had significantly higher blood pressure, circulating triglycerides, and total-to-high-density lipoprotein cholesterol ratio than slower eaters. Faster eaters were twice as likely to develop general (multivariable-OR: 2.2;95%CI,1.8-2.6; p < 0.001), and abdominal (OR:1.8;95%CI, 1.5-2.2; p < 0.001) overweight than slower eaters. This association was observed across all subgroups by age, sex, and ethnicity. Findings suggest that SRER is a robust behavioral marker for increased risk of higher energy intake, obesity, and poor cardio-metabolic health, and a modifiable behavioral risk-factor for obesity prevention.
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Preoperative Endoscopic and Radiologic Evaluation of Bariatric Patients: What Do They Add? J Gastrointest Surg 2020; 24:764-771. [PMID: 31073799 DOI: 10.1007/s11605-019-04219-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 03/27/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Preoperative esophagogastroduodenoscopy (EGD) and barium swallow (BS) are commonly performed for evaluation in bariatric surgery patients. The routine use of these modalities has been controversial. METHODS A retrospective review of a prospectively maintained database was performed to include primary bariatric surgery patients between March 2013 and August 2016. RESULTS Two hundred nine patients were included. All the patients underwent preoperative EGD and BS. The mean age was 43.12 years and BMI 46.4 kg/m2. Reflux symptoms were present in 58.5% of patients. Preoperative EGD revealed abnormalities in 87.5% of patients: esophagitis (54.5%), Barrett's esophagus (5.3%), dysplasia (1%), and gastritis (51%). Endoscopic evidence of HH was documented in 52.2% of patients while only 34% of patients had evidence of HH in their BS. Of the asymptomatic patients, 80.2% had abnormal EGD. Helicobacter pylori on biopsy was found in 17.2% patients, out of which 47.2% were asymptomatic. Based on EGD findings, the choice of surgical procedure was changed in 3.34% of patients. Repair of HH was performed in 107 patients, with 68.2% (n = 73) symptomatic patients and 31.8% (n = 34) asymptomatic patients. On ROC analysis, EGD was better predictive of the presence of HH (AUC = 0.802, OR 5.20, p = < 0.0001) and symptoms were a poor indicator for GERD. CONCLUSIONS Preoperative EGD is abnormal in the majority of patients regardless of their symptoms. EGD is the only modality that can provide tissue sample, which can potentially determine the type of bariatric surgery. Given the low diagnostic accuracy of BS, its routine use can be eliminated.
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Janmohammadi P, Sajadi F, Alizadeh S, Daneshzad E. Comparison of Energy and Food Intake Between Gastric Bypass and Sleeve Gastrectomy: a Meta-analysis and Systematic Review. Obes Surg 2020; 29:1040-1048. [PMID: 30610675 DOI: 10.1007/s11695-018-03663-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AbstractObesity is a developed nutritional problem, and today, surgery is one of the approaches to cure it. A good understanding of the variations in food intake will be beneficial for sustaining long-term weight loss post-surgery and for improving nutrition care strategies. The purpose of this review was the comparison of the impact of two methods of gastric bypass (GBP) and sleeve gastrectomy (SG) on dietary intake. Databases of PubMed, Embase, Scopus, Google Scholar, and Web of science were used for the literature search up to June 2018. We concluded the studies that measured mean daily energy intake and the percent of macronutrients from total calorie intake of before and after GBP and SG. A total of 18 studies were finally included in the meta-analysis for the effect of bariatric surgery on food intake. Bariatric surgery significantly decreased energy intake by 1050.04 kcal/day (p < 0.001) compared with the baseline values of energy intake. The pooled effect of bariatric surgery on protein intake was 0.82 g/day (p = 0.004) compared with the baseline values. The pooled analysis found no significant impact of bariatric surgery on carbohydrate intake (WMD = 0.56 g/day; p = 0.40) compared with the baseline values. The pooled estimate of effect for bariatric surgery on fat intake was - 1.34 g/day (p = 0.006). This study demonstrates that bariatric surgery might be effective on energy and fat intake; however, there was no effect on carbohydrate intake.
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Affiliation(s)
- Parisa Janmohammadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Forough Sajadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Shahab Alizadeh
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Elnaz Daneshzad
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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Imperatori C, Bianciardi E, Niolu C, Fabbricatore M, Gentileschi P, Di Lorenzo G, Siracusano A, Innamorati M. The Symptom-Checklist-K-9 (SCL-K-9) Discriminates between Overweight/Obese Patients with and without Significant Binge Eating Pathology: Psychometric Properties of an Italian Version. Nutrients 2020; 12:nu12030674. [PMID: 32121618 PMCID: PMC7146623 DOI: 10.3390/nu12030674] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/23/2020] [Accepted: 02/28/2020] [Indexed: 02/06/2023] Open
Abstract
A general personality and psychopathology evaluation is considered to be crucial part of the multidisciplinary assessment for weight-related problems. The Symptom Checklist-90-Revised (SCL-90-R) is commonly used to assess general psychopathology in both overweight and obese patients seeking weight-loss treatment. The main purpose of the present research was to investigate the psychometric properties of the brief form of the SCL-90-R (i.e., the SCL-K-9) in a clinical sample (N = 397) of patients seeking weight-loss treatment (i.e., bariatric surgery and a nutritional weight-loss program). The results of the confirmatory factor analysis supported a one-factor solution of the SCL-K-9, with all nine items loading significantly on the common latent factor (lambdas ≥ 0.587). The ordinal α (= 0.91), the inter-item mean indices of correlation (rii = 0.53), and the convergent validity were also satisfactory. A receiver operating characteristic curves procedure showed that both SCL-90-R and SCL-K-9 were able to classify patients with and without significant binge eating pathology according to the Binge Eating Scale (BES) total score. Overall, our results suggest that the SCL-K-9 has adequate psychometric properties and can be applied as a short screening tool to assess general psychopathology in overweight/obese individuals seeking weight-loss treatment and at follow-up interviews when time restraints preclude the use of the full-length form.
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Affiliation(s)
- Claudio Imperatori
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Via degli Aldobrandeschi 190, 00163 Roma, Italy; (M.F.); (M.I.)
- Correspondence: ; Tel.: +06-66-54-38-73
| | - Emanuela Bianciardi
- Psychiatric Chair, Department of Systems Medicine, University of Rome “Tor Vergata”, Via Cracovia, 50, 00133 Roma, Italy; (E.B.); (C.N.); (G.D.L.); (A.S.)
| | - Cinzia Niolu
- Psychiatric Chair, Department of Systems Medicine, University of Rome “Tor Vergata”, Via Cracovia, 50, 00133 Roma, Italy; (E.B.); (C.N.); (G.D.L.); (A.S.)
| | - Mariantonietta Fabbricatore
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Via degli Aldobrandeschi 190, 00163 Roma, Italy; (M.F.); (M.I.)
| | - Paolo Gentileschi
- Bariatric Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome “Tor Vergata”, Via Cracovia, 50, 00133 Roma, Italy;
| | - Giorgio Di Lorenzo
- Psychiatric Chair, Department of Systems Medicine, University of Rome “Tor Vergata”, Via Cracovia, 50, 00133 Roma, Italy; (E.B.); (C.N.); (G.D.L.); (A.S.)
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Roma, Italy
| | - Alberto Siracusano
- Psychiatric Chair, Department of Systems Medicine, University of Rome “Tor Vergata”, Via Cracovia, 50, 00133 Roma, Italy; (E.B.); (C.N.); (G.D.L.); (A.S.)
| | - Marco Innamorati
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Via degli Aldobrandeschi 190, 00163 Roma, Italy; (M.F.); (M.I.)
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Rudolph A, Hilbert A. Cognitive-Behavioral Therapy for Postbariatric Surgery Patients With Mental Disorders: A Pilot Study. Front Psychiatry 2020; 11:14. [PMID: 32116836 PMCID: PMC7028699 DOI: 10.3389/fpsyt.2020.00014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/07/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Binge-eating disorder (BED) and major depressive disorder (MDD) following bariatric surgery are significant predictors for less post-operative weight loss and/or weight regain, however, cognitive-behavioral therapy (CBT) addressing these disorders following surgery has not been investigated so far. OBJECTIVE This study examined feasibility of a short-term CBT based on evidence-based manuals for BED and MDD that were adapted to patients following bariatric surgery, and investigated its effectiveness in improving weight loss outcome, psychopathology, and psychosocial functioning. MATERIALS AND METHODS In an uncontrolled proof-of-concept study, the CBT manual was piloted in N = 7 patients who had undergone roux-en-Y gastric bypass surgery at least 6 months before. Weight loss, eating disorder psychopathology, depressive symptoms, and self-esteem were assessed using clinical interviews and self-report questionnaires at pre-treatment, post-treatment, and in a 3-month follow-up. RESULTS A significant reduction of body weight was found as well as medium to large effects in the improvement of eating disorder psychopathology, depressive symptoms, and self-esteem from pre-treatment to post-treatment were found. Most of those changes remained stable during the 3-month follow-up period. Study retention was 71.4%. CONCLUSIONS Feasibility and effectiveness of CBT were documented for patients with BED or MDD following bariatric surgery. Adaptations of the study procedure for proof-of-efficacy in randomized-controlled studies are discussed.
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Affiliation(s)
- Almut Rudolph
- Clinical Psychology and Psychotherapy, Department of Psychology, Faculty of Life Sciences, University of Leipzig, Leipzig, Germany
| | - Anja Hilbert
- Integrated Research and Treatment Center Adiposity Diseases, Departments of Medical Psychology and Medical Sociology and Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
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Saiki A, Kanai R, Nakamura S, Tanaka S, Oka R, Watanabe Y, Yamaguchi T, Ohira M, Oshiro T, Hayashi K, Tatsuno I. Impact of Mental Health Background and Nutrition Intake on Medium-Term Weight Loss in Japanese Patients Undergoing Laparoscopic Sleeve Gastrectomy. Obes Facts 2020; 13:371-383. [PMID: 32810852 PMCID: PMC7590761 DOI: 10.1159/000509342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/10/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Bariatric surgery is the most effective weight loss therapy, and recently laparoscopic sleeve gastrectomy (LSG) is gaining popularity worldwide. On the other hand, patients undergoing bariatric surgery have a high prevalence of mental disorders. A Japanese nationwide survey reported high prevalence of mental disorders in patients with low percent total weight loss (%TWL) and also in those with high %TWL. The aim of this study was to investigate the relationship of 1-year %TWL with background mental health status, 3-year outcomes, and nutrition intake in Japanese patients after LSG. METHODS This study was a single-center retrospective database analysis. A total of 89 Japanese patients who underwent LSG and were followed for 3 years were enrolled (mean age 41.9 years, baseline body mass index 44.9, baseline glycosylated hemoglobin, HbA1c, 7.0%). The patients were divided into 3 groups according to 1-year %TWL as follows: ≤19.9% (insufficient group), 20.0-34.9% (average group) and ≥35.0% (excessive group). Psychosocial and nutritional status as well as physical data were collected from all patients. RESULTS The prevalence of mental disorders was 51.7%, and 1-year %TWL was 28.1% in all patients. No significant differences were observed in the changes in body weight and HbA1c between patients with and those without mental disorders. The prevalence of mental disorders was particularly high in the insufficient and excessive groups. In the insufficient group, mood disorders and mental retardation/developmental disorders were frequent, and snacking and eating out habits were often observed. In the excessive group, the frequencies of mood disorders and binge eating were high, and a decrease in skeletal muscle mass due to low protein intake was observed. Furthermore, weight regain was shown 12 months after LSG in both groups. In the average group, there were fewer problems in weight loss outcomes, mental health, nutrition intake and body composition. CONCLUSIONS Psychosocial and nutritional problems were often found not only in patients with insufficient weight loss, but also in those with seemingly "excellent" weight reduction. To improve long-term weight loss outcome and future health, a multidisciplinary approach focusing on mental health and nutrition is essential for patients undergoing bariatric surgery.
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Affiliation(s)
- Atsuhito Saiki
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan,
| | - Rieko Kanai
- Department of Medical Nutrition, Toho University Sakura Medical Center, Sakura, Japan
| | - Shoko Nakamura
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Sho Tanaka
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Rena Oka
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Yasuhiro Watanabe
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Takashi Yamaguchi
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Masahiro Ohira
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Takashi Oshiro
- Department of Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Karin Hayashi
- Department of Neuropsychiatry, Toho University Sakura Medical Center, Sakura, Japan
| | - Ichiro Tatsuno
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Haidar Ahmad H, Saliba C, Nicolas G, Ghandour MA, Zeaiter NM, Alzein H, Kassem A, Houmani A, Abtar HK, Karake M, Akil MH, Ballout H. Unexpected Gastric Ectopic Pancreas During Sleeve Gastrectomy: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1966-1968. [PMID: 31885033 PMCID: PMC6956835 DOI: 10.12659/ajcr.916366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Patient: Female, 30-year-old Final Diagnosis: Gastric ectopic pancreas Symptoms: — Medication: — Clinical Procedure: Laparscopic sleeve gastrectomy Specialty: Surgery
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Affiliation(s)
| | | | | | | | | | - Hassan Alzein
- Division of Surgery, Saint George Hospital, Hadath, Lebanon
| | - Ali Kassem
- Division of Surgery, Saint George Hospital, Hadath, Lebanon
| | - Ali Houmani
- Department of Radiology, Saint George Hospital, Hadath, Lebanon
| | | | - Mohamad Karake
- Division of Surgery, Saint George Hospital, Hadath, Lebanon
| | | | - Hajar Ballout
- Division of Endocrinology, Saint George Hospital, Hadath, Lebanon
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Saiki A, Yamaguchi T, Tanaka S, Sasaki A, Naitoh T, Seto Y, Matsubara H, Yokote K, Okazumi S, Ugi S, Yamamoto H, Ohta M, Ishigaki Y, Kasama K, Seki Y, Irie J, Kusakabe T, Tsujino M, Shimizu H, Shirai K, Onozaki A, Kitahara A, Hayashi K, Miyazaki Y, Masaki T, Nagayama D, Yamamura S, Tatsuno I. Background characteristics and postoperative outcomes of insufficient weight loss after laparoscopic sleeve gastrectomy in Japanese patients. Ann Gastroenterol Surg 2019; 3:638-647. [PMID: 31788652 PMCID: PMC6875950 DOI: 10.1002/ags3.12285] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 12/22/2022] Open
Abstract
AIM Laparoscopic sleeve gastrectomy (LSG) is becoming popular in Japan, but insufficient weight loss is often observed in patients after LSG. We investigated the effect of LSG on obesity-related comorbidities and identified the background characteristics of Japanese patients with insufficient weight loss after LSG. METHODS In this multi-institutional retrospective study at 10 certified bariatric institutions, 322 Japanese patients who underwent LSG with a follow-up period of more than 2 years were analyzed. Anthropometry, obesity-related comorbidities and psychosocial background data were collected. Weight loss was expressed as 2-year percent total weight loss (%TWL). RESULTS Mean age, body weight, body mass index (BMI) and glycated hemoglobin were 46.9 years, 119.2 kg, 43.7 kg/m2 and 7.1%, respectively. Prevalence of mental disorders was 26.3%. Mean BMI declined to 30.3 kg/m2 at 2 years and %TWL was 29.9%. Improvements in the markers and prevalence of obesity-related comorbidities were observed. Remission rates of diabetes, dyslipidemia and hypertension were 75.6%, 59.7% and 41.8%, respectively. %TWL at the respective cut-off level of diabetes remission was 20.8%. Lower remission rates of diabetes in patients with %TWL <20%, and less calorie restriction and higher prevalence of mental disorders (46.9%) in patients with %TWL <15% were observed. Frequencies of %TWL <15% and <20% were 6.5% and 18.5%, respectively. CONCLUSION %TWL 20% was a candidate cut-off point of insufficient weight loss for diabetes remission after LSG, and mental disorders might be relevant to intractable obesity in Japanese patients.
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Affiliation(s)
- Atsuhito Saiki
- Center of Diabetes, Endocrine and MetabolismToho University Sakura Medical CenterChibaJapan
| | - Takashi Yamaguchi
- Center of Diabetes, Endocrine and MetabolismToho University Sakura Medical CenterChibaJapan
| | - Sho Tanaka
- Center of Diabetes, Endocrine and MetabolismToho University Sakura Medical CenterChibaJapan
| | - Akira Sasaki
- Department of SurgeryIwate Medical University School of MedicineIwateJapan
| | - Takeshi Naitoh
- Department of SurgeryTohoku University Graduate School of MedicineMiyagiJapan
| | - Yasuyuki Seto
- Department of Gastrointestinal SurgeryUniversity of TokyoTokyoJapan
| | - Hisahiro Matsubara
- Department of Frontier SurgeryGraduate School of MedicineChiba UniversityChibaJapan
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and GerontologyChiba University Graduate School of MedicineChibaJapan
| | - Shinichi Okazumi
- Department of SurgeryToho University Sakura Medical CenterChibaJapan
| | - Satoshi Ugi
- Department of MedicineShiga University of Medical ScienceShigaJapan
| | - Hiroshi Yamamoto
- Department of Gastrointestinal SurgeryKusatsu General HospitalShigaJapan
| | - Masayuki Ohta
- Department of Gastroenterological and Pediatric SurgeryFaculty of MedicineOita UniversityOitaJapan
| | - Yasushi Ishigaki
- Division of Diabetes and MetabolismDepartment of Internal MedicineIwate Medical UniversityIwateJapan
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery CenterYotsuya Medical CubeTokyoJapan
| | - Yosuke Seki
- Weight Loss and Metabolic Surgery CenterYotsuya Medical CubeTokyoJapan
| | - Junichiro Irie
- Department of Internal MedicineSchool of MedicineKeio UniversityTokyoJapan
| | - Toru Kusakabe
- Department of Endocrinology, Metabolism, and HypertensionClinical Research InstituteNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Motoyoshi Tsujino
- Department of EndocrinologyTokyo Metropolitan Tama Medical CenterTokyoJapan
| | - Hideharu Shimizu
- Department of SurgeryTokyo Metropolitan Tama Medical CenterTokyoJapan
| | - Kohji Shirai
- Department of Internal MedicineMihama HospitalChibaJapan
| | | | - Aya Kitahara
- Department of MedicineDivision of Diabetes, Metabolism and EndocrinologyChiba University HospitalChibaJapan
| | - Karin Hayashi
- Department of NeuropsychiatryToho University Sakura Medical CenterChibaJapan
| | - Yasuhiro Miyazaki
- Division of Gastroenterological SurgeryDepartment of SurgeryGraduate School of Medicine, Osaka UniversityOsakaJapan
| | - Takayuki Masaki
- Department of Endocrinology, Metabolism, Rheumatology and NephrologyFaculty of MedicineOita UniversityOitaJapan
| | | | - Shigeo Yamamura
- Faculty of Pharmaceutical SciencesJosai International UniversityChibaJapan
| | - Ichiro Tatsuno
- Center of Diabetes, Endocrine and MetabolismToho University Sakura Medical CenterChibaJapan
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Proulx É, Auclair A, Piché ME, Harvey J, Pettigrew M, Biertho L, Marceau S, Poirier P. Safety of Blood Glucose Response Following Exercise Training After Bariatric Surgery. Obes Surg 2019; 28:3976-3983. [PMID: 30097897 DOI: 10.1007/s11695-018-3449-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Safety of exercise training in relationship with the risk of hypoglycemia post-bariatric surgery is unknown. OBJECTIVE To evaluate the safety and magnitude of changes in blood glucose levels during exercise training following bariatric surgery. MATERIAL AND METHODS Twenty-nine severely obese patients undergoing either sleeve gastrectomy (SG) (n = 16) or biliopancreatic diversion with duodenal switch (BPD-DS) (n = 13) were prospectively enrolled. Three months after surgery, patients participated in a 12-week supervised exercise training program, (35-min aerobic training with a 25-min resistance exercises) three times a week. Capillary blood glucose (CBG) levels were measured immediately before and after each exercise session. RESULTS Seven patients (24%) had type 2 diabetes before surgery (mean duration: 10 years); four patients still have type 2 diabetes 3 months post-bariatric surgery. A total of 577 exercise training sessions with CBG monitoring were recorded. Only seven sessions (1.2%) were associated with an episode of asymptomatic hypoglycemia (CBG ≤ 3.9 mmol/L). Patients with type 2 diabetes at baseline showed a larger decrease in CBG with pre-exercise CBG being between 6.1 and 8.0 mmol/L (- 1.6 ± 1.2 vs. - 1.1 ± 0.9 mmol/L, p = 0.02). BPD-DS patients with CBG ≥ 6.1 mmol/L showed higher reduction in CBG following exercise vs. SG patients (- 1.7 ± 1.0 vs. - 1.1 ± 1.1 mmol/L; p < 0.001 and - 4.3 ± 1.0 vs. - 2.2 ± 1.4 mmol/L, p < 0.001, respectively). CONCLUSION Three months after bariatric surgery, exercise training program in patients without and with type 2 diabetes is safe, and is associated with a desirable glycemic profile, with few episodes of asymptomatic hypoglycemia.
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Affiliation(s)
| | - Audrey Auclair
- Laval University, Québec, Canada
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec City, QC, G1V 4G5, Canada
| | - Marie-Eve Piché
- Laval University, Québec, Canada
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec City, QC, G1V 4G5, Canada
| | - Jany Harvey
- Laval University, Québec, Canada
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec City, QC, G1V 4G5, Canada
| | - Myriam Pettigrew
- Laval University, Québec, Canada
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec City, QC, G1V 4G5, Canada
| | - Laurent Biertho
- Laval University, Québec, Canada
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec City, QC, G1V 4G5, Canada
| | - Simon Marceau
- Laval University, Québec, Canada
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec City, QC, G1V 4G5, Canada
| | - Paul Poirier
- Laval University, Québec, Canada.
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec City, QC, G1V 4G5, Canada.
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Mirhashemi S, Malekpour Alamdari N, Jaberi N, Shahrbaf MA. Prevalence of Anastomotic Leaks and Diagnostic Methods in Sleeve Gastrectomy. Bariatr Surg Pract Patient Care 2019. [DOI: 10.1089/bari.2018.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Seyedhadi Mirhashemi
- Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasser Malekpour Alamdari
- Department of General Surgery, Modarres, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Najmeh Jaberi
- Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Wen X, Zhu B, Zhang Y, Mei F, Cheng X, Qian C, Yang P, Lu L, Zhou D, Gao J, Bu L, Qu S. Alterations in Fat Mass and Bone Mineral Density Are Associated with Decreased Lipocalin-2 After Laparoscopic Sleeve Gastrectomy in Obese Chinese Women. Obes Surg 2019; 29:2862-2868. [PMID: 31147821 DOI: 10.1007/s11695-019-03914-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Lipocalin-2 (LCN2) plays an important role in the regulation of the obesity and obesity-related dysmetabolic state. This study aimed to analyze serum LCN2 level in Chinese women with obesity before and after laparoscopic sleeve gastrectomy (LSG) and determine the association between alteration in fat mass and bone mineral density (BMD) and LCN2 level. METHODS Fifty-two women (38 patients with obesity and 14 with normal body mass index (BMI)) were enrolled in this study. All patients with obesity underwent LSG. BMDs of the arm, leg, thoracic and lumbar spine, and pelvis were measured by dual-energy X-ray absorptiometry. Body fat mass and distribution were measured by dual-energy X-ray absorptiometry, and routine anthropometric/laboratory biochemical parameters at baseline and 3 and 12 months after LSG were recorded. Serum LCN2 levels were measured using an enzyme-linked immunosorbent assay. RESULTS Serum LCN2 level was significantly higher in women with obesity than in the controls with normal BMI (102.70 ± 27.19 vs. 80.66 ± 19.55 ng/mL, P = 0.009). LCN2 level was decreased at 3 and 12 months after LSG (86.73 ± 26.79 ng/mL, P = 0.171, and 64.79 ± 28.39 ng/mL, P < 0.001, respectively). LSG led to marked body fat mass and slight BMD decrease. Decreased LCN2 level was significantly correlated with alterations in left and right leg BMDs and trunk fat mass at 12 months after LSG. CONCLUSIONS Obesity was associated with up-regulated serum LCN2 level. Decreased LCN2 level was positively correlated with changes in BMD and fat mass at 12 months after LSG in Chinese women.
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Affiliation(s)
- Xin Wen
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China.,National Metabolic Management Center, Shanghai, 200072, China.,Thyroid Research Center of Shanghai, Shanghai, 200072, China
| | - Bing Zhu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China.,National Metabolic Management Center, Shanghai, 200072, China.,Thyroid Research Center of Shanghai, Shanghai, 200072, China
| | - Yi Zhang
- Laboratory of Endocrinology and Metabolism, Department of Endocrinology and Metabolism, National key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Fangyun Mei
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China.,National Metabolic Management Center, Shanghai, 200072, China.,Thyroid Research Center of Shanghai, Shanghai, 200072, China
| | - Xiaoyun Cheng
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China.,National Metabolic Management Center, Shanghai, 200072, China.,Thyroid Research Center of Shanghai, Shanghai, 200072, China
| | - Chunhua Qian
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China.,National Metabolic Management Center, Shanghai, 200072, China.,Thyroid Research Center of Shanghai, Shanghai, 200072, China
| | - Peng Yang
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China.,National Metabolic Management Center, Shanghai, 200072, China.,Thyroid Research Center of Shanghai, Shanghai, 200072, China
| | - Liesheng Lu
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Donglei Zhou
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Jingyang Gao
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China.,National Metabolic Management Center, Shanghai, 200072, China.,Thyroid Research Center of Shanghai, Shanghai, 200072, China
| | - Le Bu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China. .,National Metabolic Management Center, Shanghai, 200072, China. .,Thyroid Research Center of Shanghai, Shanghai, 200072, China.
| | - Shen Qu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China.,National Metabolic Management Center, Shanghai, 200072, China.,Thyroid Research Center of Shanghai, Shanghai, 200072, China
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Özdaş S, Bozkurt H. Factors Affecting the Development of Gallstones Following Laparoscopic Sleeve Gastrectomy. Obes Surg 2019; 29:3174-3178. [PMID: 31129884 DOI: 10.1007/s11695-019-03946-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Sleeve gastrectomy (SG) is a widely accepted procedure that has gained popularity among both bariatric surgeons and patients. There is still limited data in the literature on the formation of gallstones following laparoscopic sleeve gastrectomy, and so the present study determines the incidence of and potential risk factors related to the development of gallstones following laparoscopic sleeve gastrectomy. The data of patients who underwent laparoscopic sleeve gastrectomy at a single center due to morbid obesity between January 2014 and December 2017 was retrospectively reviewed and analyzed. The patients were divided into two groups, as those with gallstones detected on ultrasound at 12 months and those without gallstones. Data of the two groups was compared. BMI did not differ significantly between patients with positive (+) and negative (-) ultrasound findings (p > 0.05). Aside from age, hypertension, and coronary artery disease, other preoperative parameters showed no significant association with the development of gallstones in USG (-) and USG (+) patients. The present study identified no significant relationship between a decrease in BMI following LSG and the postoperative development of gallstones. Preoperative hypertension and coronary artery disease were found to be significantly related to the development of gallstones after surgery. The authors suggest that patients with preexisting CAD and hypertension in the preoperative period must be followed-up with ultrasound more meticulously.
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Affiliation(s)
- Sabri Özdaş
- Department of General Surgery, Faculty of Medicine, Adiyaman University, Adıyaman, Turkey
| | - Hilmi Bozkurt
- Gastrointestinal Surgery, Kosuyolu Research and Education Hospital, University of Health Sciences, Istanbul, Turkey.
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Wee MSM, Goh AT, Stieger M, Forde CG. Correlation of instrumental texture properties from textural profile analysis (TPA) with eating behaviours and macronutrient composition for a wide range of solid foods. Food Funct 2019; 9:5301-5312. [PMID: 30256358 DOI: 10.1039/c8fo00791h] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Faster eating rates have previously been associated with higher ad libitum energy intakes, and several studies have manipulated eating rates and intake by changing food textures. Food texture based changes to slow eating rates can produce reductions in energy intake without affecting post-meal satisfaction or re-bound hunger. However, an understanding of how specific food textures and instrumental texture properties influence oral processing behaviour remains limited. The current study sought to establish relationships between objective measures of oral processing behaviour (i.e. number of bites, average bite size, total chews, chews per bite, oro-sensory exposure time and eating rate) and instrumental measures of a food texture including hardness, adhesiveness, springiness, cohesiveness, chewiness, resilience and modulus. Across two studies, behavioural coding analysis was completed on video-recordings of participants consuming fixed portions of a wide range of different solid foods (n = 59) to derive objective measures of oral processing behaviours. These measures were correlated with instrumental Textural Profile Analysis (TPA) for the same set of foods. Significant correlations (p < 0.05) were found between oral processing parameters and texture properties (i.e. springiness, cohesiveness, chewiness and resilience). No significant correlations were found between hardness and modulus and oral processing parameters. Protein content of the food was associated with springiness and chewiness, which may help to further reduce eating rates. In terms of the 'breakdown path model', hardness and modulus might represent degree of initial food structure while springiness, cohesiveness, chewiness and resilience seem to determine how fast the degree of structure is reduced to the swallowing plane. Water content and adhesiveness were associated with level of lubrication that is required before reaching the swallowing plane. The current study highlights opportunities to understand eating rate (g min-1) through the breakdown path model and the potential for specific features of a foods texture to influence rate and extent of energy intake. The correlation between instrumental texture properties and oral processing patterns provides guidance on the parameters that are likely to produce 'faster' and 'slower' versions of foods, and suggests how texture modifications could be applied to moderate eating rate and energy intake within meals.
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Affiliation(s)
- May Sui Mei Wee
- Clinical Nutrition Research Centre (CNRC), Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore.
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Secondary Hyperparathyroidism in Patients with Biliopancreatic Diversion After 10 Years of Follow-up, and Relationship with Vitamin D and Serum Calcium. Obes Surg 2018; 29:999-1006. [DOI: 10.1007/s11695-018-03624-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Davies MJ, D'Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G, Rossing P, Tsapas A, Wexler DJ, Buse JB. Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2018; 61:2461-2498. [PMID: 30288571 DOI: 10.1007/s00125-018-4729-5] [Citation(s) in RCA: 748] [Impact Index Per Article: 124.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The American Diabetes Association and the European Association for the Study of Diabetes convened a panel to update the prior position statements, published in 2012 and 2015, on the management of type 2 diabetes in adults. A systematic evaluation of the literature since 2014 informed new recommendations. These include additional focus on lifestyle management and diabetes self-management education and support. For those with obesity, efforts targeting weight loss, including lifestyle, medication and surgical interventions, are recommended. With regards to medication management, for patients with clinical cardiovascular disease, a sodium-glucose cotransporter-2 (SGLT2) inhibitor or a glucagon-like peptide-1 (GLP-1) receptor agonist with proven cardiovascular benefit is recommended. For patients with chronic kidney disease or clinical heart failure and atherosclerotic cardiovascular disease, an SGLT2 inhibitor with proven benefit is recommended. GLP-1 receptor agonists are generally recommended as the first injectable medication.
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Affiliation(s)
- Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK.
- Leicester Diabetes Centre, Leicester General Hospital, Leicester,, LE5 4PW, UK.
| | - David A D'Alessio
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Judith Fradkin
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Walter N Kernan
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Chantal Mathieu
- Clinical and Experimental Endocrinology, UZ Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Geltrude Mingrone
- Department of Internal Medicine, Catholic University, Rome, Italy
- Diabetes and Nutritional Sciences, King's College London, London, UK
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | - Apostolos Tsapas
- Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Deborah J Wexler
- Department of Medicine and Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - John B Buse
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Comparison of Oral Iron Supplement Formulations for Normalization of Iron Status Following Roux-EN-y Gastric Bypass Surgery: a Randomized Trial. Obes Surg 2018; 28:369-377. [PMID: 28779269 DOI: 10.1007/s11695-017-2858-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The evidence behind recommendations for treatment of iron deficiency (ID) following roux-en-y gastric bypass surgery (RYGB) lacks high quality studies. SETTING Academic, United States OBJECTIVE: The objective of the study is to compare the effectiveness of oral iron supplementation using non-heme versus heme iron for treatment of iron deficiency in RYGB patients. METHODS In a randomized, single-blind study, women post-RYGB and iron deficient received non-heme iron (FeSO4, 195 mg/day) or heme iron (heme-iron-polypeptide, HIP, 31.5 to 94.5 mg/day) for 8 weeks. Measures of iron status, including blood concentrations of ferritin, soluble transferrin receptor (sTfR), and hemoglobin, were assessed. RESULTS At baseline, the mean ± standard deviation for age, BMI, and years since surgery of the sample was 41.5 ± 6.8 years, 34.4 ± 5.9 kg/m2, and 6.9 ± 3.1 years, respectively; and there were no differences between FeSO4 (N = 6) or HIP (N = 8) groups. Compliance was greater than 94%. The study was stopped early due to statistical and clinical differences between groups. Values before and after FeSO4 supplementation, expressed as least square means (95% CI) were hemoglobin, 10.8 (9.8, 11.9) to 13.0 (11.9, 14.0) g/dL; sTfR, 2111 (1556, 2864) to 1270 (934, 1737) μg/L; ferritin, 4.9 (3.4, 7.2) to 15.5 (10.6, 22.6) μg/L; and sTfR:ferritin ratio, 542 (273, 1086) to 103 (51, 204); all p < 0.0001. With HIP supplementation, no change was observed in any of the iron status biomarkers (all p > 0.05). CONCLUSIONS In accordance with recommendations, oral supplementation using FeSO4, but not HIP, was efficacious for treatment of iron deficiency after RYGB.
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